Now that we’re sliding into the cold and flu season, a quick post on medicine seems entirely warranted. I’ll start off with a personal anecdote. The other morning, I woke up with a headache. The heat has been on for only a few weeks, so my rapidly-aging body is still adjusting to the suddenly desiccated environment. One result is that a morning headache is fairly normal this time of year.
As are nose bleeds. Dry air and all, you understand. My problem the other day was that the headache prompted me to pop a couple aspirin, a drug that is (I forgot) a blood thinner. When I got to the office and the nose bleed began, it was quickly apparent that the flood gates had been thrown open, along with strategically placed chocks to prevent them from accidentally closing. Metaphorically speaking, of course – I didn’t actually have any foreign objects up my nose until much later in the morning.
Becoming concerned, I finally ended up at a “health clinic,” something I almost never do. Turned out to be no problem, but the doc gave me some Traditional Chinese Medicine, which I ended up tossing in the nearest trash receptacle.
Yes, it’s going to be one of those posts.
Here’s the problem. Why should I ingest a chemical for a specific efficacious purpose when that chemical might very well not have been subject to rigorous scientific testing? Why should anyone?
There are two issues when it comes to drug testing: safety and efficacy. The first thing we want to know is whether the drug is going to hurt us. This is, by the way, the justification behind a great deal of product regulation.
What about efficacy? Does this stuff actually do anything beneficial? How do we know?
Call me crazy, but the usual answer of “It’s been used for 4,000 years, so of course it’s efficacious!” is not very persuasive. That being said, at least it’s a better justification than we often time get in the West. I grew up in LA amid the New Age revival, and during that period, it was amazing how many crystals, potions and gizmos were sold merely on the basis that a famous Hollywood actor endorsed it. “Hi, I’m Troy McClure, star of blockbuster action movies like ‘The Fungus that Ate Scranton’ and tearjerkers like ‘Chardonnay and Handkerchiefs.’ I recently started rubbing extract of Wildebeest penis onto my unmentionables, and wow, is my wife pleased with the results!”
With all due respect to the folks in the TCM industry, if the medicine works, then there should be no disagreement with testing. If the results show that the drug is indeed efficacious, then I’ll withdraw my objections. Simple as that. Keep in mind, however, that such testing must be rigorous and conducted according to the scientific method, essentially the same kind of drug trial regimen that is mandated for all other medications. Testing done by the World TCM Hobbyist Society or the South China Institute for TCM Research or whatever doesn’t count. As to critics who say that the scientific method is biased, I would respond that people can be biased, yes. Rationality itself, not so much.
There are a lot of conspiracy theorists out there who bristle at any contention that TCM is a hodgepodge of unproven remedies, believing that the entire discussion is a ploy by Big Pharma to protect market share. This might be persuasive if there was any evidence to back it up, and of course the inconvenient fact that many of the largest food supplement and herbal remedy companies in the world are now owned by Big Pharma.
Another problem I have with TCM, and other traditional remedies around the world, is that some avenues of treatment are based on pseudoscience. Consider Wu Xing theory, the balance of Qi, or yin and yang. Wonderful stories associated with these theories, along with books, institutes, laboratories, probably even mini-series and graphic novels. Admittedly, these sorts of treatments can be effective once in a while (or appear to); however, that doesn’t mean that the underlying theory is at all based in reality. Kind of hard to test these drugs when there is no way, for example, to even prove that Qi exists.
Concerned Friend: Oi, Carstairs, how ya feelin’? Heard you came down with some sort of brain fungus last week.
Patient: No worries Ian, I’m right as rain now. Doc said sumptin about vacuity of me qi.
CF: Gave you a bit of a fright, did it?
P: Yeah, said I was breathin’ bad air or some such. But then he mixed me up a tonic, and I’m good as new.
CF: Well, I’ve never seen your qi look better.
Unfortunately, we seem to be predisposed to believe in this sort of thing. No, I won’t go into another screed about religion or other forms of superstition and irrationality. Just keep in mind that every society has its own “folk remedies,” some of which are complete bullshit and some others that have found their way into the modern pharmacopeia (after their efficacy has been proven).
So exactly what provoked this latest TCM outburst? Well, as I was reflecting on my trip to the health clinic, I realized that I had a doctor who was giving me a treatment that had not been proven to be efficacious. Now, if this was a doctor I had gone to for years, someone that I implicitly trusted, that would be one thing. But I don’t have a regular physician and must rely on professional licensing requirements, facility licensing, and other regulatory regimens; in other words, government oversight of doctors, hospitals and drugs. And if the government condones, and even encourages, the practice of prescribing drugs whose efficacy has not been tested, well, that’s a problem.
But, I hear you say, don’t we have just as many problems with food safety in China? Why single out TCM? Because, we now have laws on the books that mandate food safety, and the remaining problems are mostly to do with enforcement. We all agree, for example, that Clostridium botulinum is not a proper food supplement. In the realm of TCM (or in other countries, herbal remedies and food supplements), there is no legal mechanism for protecting the public against quackery.
Yes, some governments may have a licensing regime that protects the public against unsafe products, but pretty much everywhere, that doesn’t mean that hucksters cannot slip Essence of Rhino Prostate onto the market, calling it a food supplement (to avoid drug and advertising laws) while everyone knows it is a common folk remedy for a dislocated crotch. And even if the rhino prostate won’t kill you, you might forego a bona fide efficacious treatment and be saddled with a dislocated crotch for a protracted period of time, which is no doubt extremely uncomfortable.
I’ve danced around this topic for years, but to be blunt, I fail to see why any of this “alternative medicine” should be allowed on the market. If there is no clear scientific evidence, let’s stop letting the quacks and hucksters foist these treatments onto us. “My Granny swore by this stuff,” is simply not a good enough justification anymore.