The Middle Way
September 22, 2008 at 4:47 pm | In Chinese Medicine | Leave a CommentZhong-Yi. “Middle-Medicine”. This is the doctrine of Balance: Moderation in all things – even moderation.
Zhong-Yi, “Middle-Medicine”, also known as Chinese Medicine, is based on this founding principle of balance. How to maintain it, and how to regain it.
It was decided, as a profession, ages ago, that extreme conditions were inherently unstable and unsafe, and that, for these reasons, these situations should be avoided whenever possible. This meant a focus on preventative care – the maintenance and potentiation of health.
It was understood that, for balance to be maintained, there was a price to be paid, on a daily basis. A price, fee, or tax, that – over the years – amounted to a healthy balanced body. Or a weakened and diseased one.
The old Tai Chi (and Chinese Medical) axiom “four ounces to move a thousand pounds” captures the essence of this process. A small force, applied consistently at the correct point, can shift huge masses in our favour – or against us.
Like anything else in life, all of this is a skill that must be learned, practiced and perfected.
* The most recent Blog posts will always begin below this first introduction *
Top killers in U.S.
January 14, 2009 at 9:57 pm | In BioMedicine, Modern Research, Science, Social Medicine | 3 CommentsTags: Iatrogenic Disease
Tope three killers in the u.s. as reported in JAMA: 1 700000 2. 553000 3. 250000
(* Note: I made two errors when making my beautiful piechart – I cited 250,000 as the number of iatrogenic deaths, when the actual number is 280,000. I also mistakenly switched two sources for the deaths, ADRs and total injuries. Source below.)
Over a million patients are injured in U.S. hospitals each year, and approximately 280,000 die annually as a result of these injuries. Therefore, the iatrogenic death rate dwarfs the annual automobile accident mortality rate of 45,000 and accounts for more deaths than all other accidents combined.
Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel G, Sweitzer BJ, SheaBF, Hallisey R, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995 Jul 5;274(1):29-34.
When these numbers came out in 1995, Reuters didn’t pick them up. Why? These are shocking numbers.
It’s not the only piece of research that paints this shocking picture either: Gary Null paints a picture far more gruesome – total deaths due to conventional medical interventions and problems picked up in hospitals (such as infections) is 783,936 per year. Then, depending on the numbers for the other two top killers, Heart Disease and Cancer, Conventional medicine takes either the top or second spot.
Let’s look at another pie graph:
Top three killers in the u.s. as reported by G Null
The modern healthcare system is not supposed to do this. This is out of bounds. What now?
References:
Lazarou J, Pomeranz BH, Corey PN, Incidence of Adverse Drug Reactions in Hospitalized Patients, Journal of the American Medical Association (JAMA), Vol. 279. April 15, 1998, pp. 1200-05.
Bates, DW., Drugs and Adverse Drug Reactions: How Worried Should We Be? JAMA, Vol. 279. April 15, 1998, pp. 1216-17.
Leape L, Error in medicine, JAMA 1994;272:1851-7.
Schuster M, McGlynn E, Brook R. How good is the quality of health care in the United States? Milbank Q. 1998;76:517-563.
Starfield B. Evaluating the State Children’s Health Insurance Program: critical considerations. Annu Rev Public Health.
Phillips D, Christenfeld N, Glynn L. Increase in US medication-error deaths between 1983 and 1993. Lancet. 1998;351:643-644.
Leape L. Unnecessary surgery. Annu Rev Public Health. 1992;13:363-383.
Weingart SN, Wilson RM, Gibberd RW, Harrison B. Epidemiology and medical error. BMJ. 2000;320:774-777.
Guyer B, Hoyert D, Martin J, Ventura S, MacDorman M, Strobino D. Annual summary of vital statistics 1998. Pediatrics. 1999;104:1229-1246.
HarHolland E, Degruy F. Drug-Induced Disorders – November 1, 1997 – American Family Physicianrold LR, Field TS,
Gurwitz JH. Knowledge, patterns of care, and outcomes of care for generalists and specialists. J Gen Intern Med. 1999;14:499-511.
World Health Report 2000. Available at: http://www.who.int/whr/2000/en/report.htm. 2000;21:569-585.
Sugar Proven Addiction
December 31, 2008 at 6:33 pm | In BioMedicine, Modern Research | Leave a CommentTags: perception, Sugar, Diabetes, Bias
From: http://tinyurl.com/a3bbja
It would be so nice to read a headline on a study like this that goes, “Scientists confirm what we all knew”. It would lead to such a different perception of the process.
As it stands, it seems to me that we give up our self-awareness to studies like this, simply by accepting that this kind of research “needs” to be done.
In all honesty, anyone with a smidgen of self-awareness knows that a human being can become addicted to anything.
Sugar? Well, absolutely.
So what’s the research for?
To find what particular pathways are affected.
To what end?
To help people come off their addiction. Ok, stop. Is sugar addiction really that strong? Are we so weak that we can no longer fight against pasta, bread, glucose-supplemented fruit juices and chocolate? There seems to be a slippery slope here somewhere… I am sure that someone, somewhere, has commented on the medicalisation of the human condition – “Why you’ve been hopelessly afflicted with the Human Condition? Egads, good thing we have a drug for that. Several actually…take a seat – they’re still experimental… but you’ll be helping us clear the path… good man”.
Maybe the benefits are in the spin-off research – if we study the pathways of sugar addiction we’ll find the cure to alzheimers. Or an anti-diabetes drug (or the solution for global warming!). All well and good when we put it that way…but isn’t a major issue for most diabetics “managing” sugar effectively? See my diabetes post for a discussion on this topic.
In any case, the idea is regarding the usefulness of research – something that is greatly critiqued in the bioethics community:
This is [...] to note that much of the scientific literature – perhaps especially the biomedical literature – is as much about waving arms as it is about communicating results. This is a vulgar glut that pollutes the scientific corpus. (Goodman 2003)
I hope that the next time we see a research article that seems to proclaim a re-invention of the wheel, we will stop and realise that in science, like in any other profession, there are factors at play which are very human in nature. See if the article says something really useful, and otherwise maintain a healthy skepticism – which, by the way, does not take a particular stance, other than to question until clarity occurs.
Bubonic Plague
December 20, 2008 at 12:46 am | In History Lesson | Leave a CommentTags: History
During the last years of the Qing Dynasty (around 1900), the bubonic plague swept through Hong Kong, then a British colony. British administrators divided patients into two groups, one of which was treated by Chinese medicine and the other by Western medicine, and evaluated the efficacy of each treatment. The first evaluation indicated that Chinese medicine was 50% more effective than Western medicine. Western doctors in Hong Kong challenged this evaluation and demanded a second evaluation with re-designed parameters. However, the second evaluation also showed that Chinese medicine was effective in 60% of the cases while Western medicine was effective in only 30% of the cases. As a result of this experiment the practice of Chinese medicine was officially allowed in Hong Kong. This historical case is recorded in a well known Chinese medicine book, Yi Xue Zhong Zhong Can Xi Lu (Modifying Chinese and Introducing Western Medicine, Zhang Xi-chun, 1935, reprint 1985, China).
Wow, that’s a lot of needles.
December 11, 2008 at 6:53 pm | In Acupuncture | Leave a CommentTags: Acupuncture
Lots of Needles
“The skilled physician uses 1 to 3 needles”
- Chinese Proverb
Season influences Asthma
December 11, 2008 at 3:07 pm | In Uncategorized | Leave a CommentIn Chinese Medicine, the Lungs are most vulnerable during the Autumn season, and breathing disorders, such as those described by the western medical term “Asthma”, are commonly seen during that time.
The following is from the New York Times (read the article here):
How, when and where a child is born may all play a role in lifetime asthma risk, new studies suggest.
Asthma occurs when airways in the lungs spasm and swell, restricting the supply of oxygen. The incidence of asthma in the United States has risen steadily for more than two decades, and about 6 percent of children now have asthma, up from less than 4 percent in 1980, according to the Centers for Disease Control and Prevention.
The reasons for the increase are not entirely clear. Genetics probably plays a role in the risk for asthma, but an array of environmental factors — pollen, dust, animal dander, mold, cockroach feces, cigarettes, air pollution, viruses and cold air — have all been implicated in its development.
This month, The American Journal of Respiratory and Critical Care Medicine is reporting that children born in the fall have a 30 percent higher risk for asthma than those born in other seasons. The finding is based on a review of birth and medical records of over 95,000 children in Tennessee.
There is a Rhyme and a Reason
December 8, 2008 at 12:54 am | In Chinese Medicine, Herbal Medicine, Modern Research, Science | Leave a CommentTags: Chinese Medicine, Herbal Medicine, jargon, Skepticism, Theory
While I don’t like to go on about reductionism and its assumed evils and so forth, there are grains of truth in these criticisms.
There is a difference between a complex, open (interconnected) system and a small, (relatively) closed system – the former is like the weather, and the latter is like a motor vehicle. I believe we are all familiar with the viscissitudes of weather forecasting, and yet, on the other hand, how generally reliable and unperplexing our vehicles are.
In essence, the first system cannot be reduced without losing its essential complexity and interrelatedness, while the second one can (for a deeper discussion on the relative aspects of this idea, click here). This means that in order to understand a complex, open system, it must be met in its arena of effect. Reducing the arena changes the game and damages the data irretrievably.
In a previous post (Herb Comparable to Prednisone), I wrote about how the oversimplification of Chinese Medical principles tended to damage the effectiveness of the intervention, sometimes completely, and how it was important to understand that in Chinese Medicine we do things for a reason.
More careful research can illuminate some of these reasons, and I would like to provide you with a brief glimpse into one of these investigations:
Chinese Medicine almost always uses herbal combinations rather than single herbs, not only because a single herb has a weak effect, but because herbs can act in synergistic or antagonistic ways to each other (amongst other effects). Thus a properly constructed formula with the individual patient in mind provides a superior effect than the administration of a single herb, or of a non-individualised formula.
The following graph from the Biological and Pharmaceutical Bulletin (2003;26(7):911-919) dramatically illustrates this phenomenon:
The blood concentration of wagonoside from HuangQinTang was twice as high as that of HuangQin alone.
HuangQin Tang is a Chinese Herbal Combination, Huang Qin is merely the lead herb.
HuangQin Tang contains: huáng qín, huáng lián, gé gēn, and zhì gān cǎo.
This type of investigation makes two points:
1. There is a reason that herbal combinations are the standard of care in CM.
2. Deconstructing an open, complex system is fraught with dangers if the aim is to illuminate the true mechanisms or energetic dynamics of said system.
In the western world, and even the eastern world, too much effort has been spent on “identifying” the one herb in a formula which provides the effect, and then further “isolating” “active ingredients” in order to provide the end-user with a “real” medicinal in a “more potent” form for, ostensibly, superior clinical effect.
It’s as if a scientist wanted to provide us with a better vehicle, and decided the active ingredient was the piston, made us a big giant piston to use and acted all proud.
It is my hope that our understanding of the ancient and wise medical systems of this world becomes much more mature in the next short little while.
Incidentally, HuangQin Tang is primarily used for something called “Damp-Heat in the Lower Burner”, one manifestation of which is dysentery. Years ago, a chemical called “berberine” was isolated from another herb in this formula, huáng lián, and used in cases of dysentery. And yes, you guessed it, it doesn’t work as well as HuangQin Tang for the indicated condition.
Oh well.
Do Breast Tumours Go Away On Their Own?
November 25, 2008 at 7:26 pm | In BioMedicine, Modern Health-Care, Modern Research | Leave a CommentTags: Anomalous Data Point, Fear, RCT
The Archives of Internal Medicine published an article this week which challenges the conventional wisdom regarding the early detection of breast cancer.
This bit of research is an excellent example of what RCTs are good for: examination of apparently homogeneous populations to find indications of non-homogeneity.
Two groups were studied – women with frequent screening (and their cancer rates), and women with infrequent screening (and their cancer rates). The researchers were astounded to discover that, in these two large groups of people (approx 100,000 each), there was a twenty two percent greater incidence of cancer in the women who were screened frequently[1].
There are many explanations for this phenomena – the one that the authors advance is that a certain proportion of tumors go away “on their own” (although this author is certain it is not quite that random or mysterious).
If we read the USA Today article, we can find an interesting statement by the cancer society’s Robert Smith: “It’s important that people not wonder if women lost their breasts for no reason. That’s a reprehensible conjecture.”
Mr. Smith, medicine is not about feel-good. It’s about finding the correct way to maintain health and the correct way to resolve disease. Avoiding a conjecture because of a bad feeling is bad medicine. Conjectures should be based on the best available data and followed accordingly.
And, yes, unfortunately, human life does seem to have quite a bit of uncertainty and ignorance built-in.
From the study:
Conclusions Because the cumulative incidence among controls never reached that of the screened group, it appears that some breast cancers detected by repeated mammographic screening would not persist to be detectable by a single mammogram at the end of 6 years. This raises the possibility that the natural course of some screen-detected invasive breast cancers is to spontaneously regress.
Why the fear that cancer can be cured? Why not just write that the evidence indicates that the body is able to heal some cancers on its own some of the time?
The fear, in this case, doesn’t help us.
There is another possibility, which is the one that the spokesman for the cancer society immediately assailed: is it possible that the search and treatment for cancer causes more cancer?
It would seem that, if this is the case, the fear definitely doesn’t help us.
1.The natural history of invasive breast cancers detected by screening mammography. Arch Intern Med. 2008 Nov 24;168(21):2302-3.
The Influence of Qi
November 24, 2008 at 11:10 am | In Uncategorized | Leave a CommentTags: Qi
The Chinese word “Qi” (氣) is greatly misunderstood. Often translated as “energy”, its real meaning has many more facets than that. One sinologist insists that its best translation is “influence”.
I was walking through downtown Toronto yesterday evening, and as I finished crossing an intersection, eastbound, I stepped onto the sidewalk and almost ran into a man going southbound. I politely stopped myself and moved out of his way, and he continued on at his clip, as did I after he had passed. After a few meters I looked back and saw this gentleman, seemingly looking around for the first time, in the middle of an intersection which had only just turned green in his favour.
It happened that at that moment there was little traffic, but I thought to myself that had traffic been different, this man might have found himself part of an accident. As I walked along I considered some of the benefits of rudeness, and in particular of the lack of awareness that my politeness had allowed this man to continue to engage in.
At this point, some of you may be saying “karma” – I would agree.
Diagnosis
November 13, 2008 at 4:45 pm | In BioMedicine, Chinese Medicine | Leave a CommentTags: jargon, Terminology
Question: Does anyone know what Trichotillomania is? My daughter was diagnosed with this recently. Any help is appreciated.
Response: Oh gosh. Trichotillomania. How obscenely stupid. I wonder if this syndrome is further differentiated based on whether it is the left or right hand that’s doing the pulling, or if there is a naming convention that takes into account how many strands of hair are in each fistful, and how many, thereof, are dyed, split-ended or glossy?
There is one good thing about this obsessive compulsion to give long, stupid names to diseases, and that is that the name for fear of long names is Hippopotomonstrosesquippedaliophobia.
Anyway, on to something useful, I hope:
Apart from being all technically technicacious about our patients, we shouldn’t forget to be human. While we must be very careful to mind our manners, ethics, scope of practice and personal limitations, be not afraid to be human. If someone is pulling their hair out, ask yourself, what in god’s dreaming heaven would cause ME to pull out my mane. Start from there, and you may find a way to delicately tease out (part, just enough) of a painful story to inform your pattern diagnosis, and perhaps give the girl and her family a better result than something who blindly, meaninglessly tries to treat for liver qi, or phlegm misting the heart.
In a case like this, it might be most important to find out what started it. I just had a patient in the other week with bad chest pain who responded not at all to western medicine, a very competent naturopath or a very heartfelt osteopath, and yet responded in my clinic (with a 100% reduction in pain after 20 minutes), in my humble opinion, because I asked her what was going on when this started (thirty years ago when she was 17). And when she said “nothing”, I gently said, “something”. And eventually she “mentioned”, by the by, that her boyfriend, when she was 16, had tried to kill her. I gently, over the course of our conversation, explained about some possible connections, placed some needles in her, and she seemed to relax, cry, and begin a new stage in her life. Not my credit, I credit it to being human, and trying to keep the old sages in mind.
(excerpted from an online forum conversation)
CPR – Cardio Pulmonary Resuscitation
November 13, 2008 at 2:29 am | In Chinese Medicine, History Lesson, Modern Health-Care | Leave a CommentTags: CPR, History
I have something to say:
CPR saves lives. It is an excellent resuscitation technique:
Millions of people receive CPR training each year, and its use has been shown to increase the survival rate of people who are suffering from otherwise fatal conditions.
CPR is used in a variety of situations, including drug overdose, near drowning and electrical shock. It is also used when a person has entered cardiac arrest, or the heart has stopped beating (most often due to an abnormal heart rhythm called ventricular fibrillation). Patients may avoid sudden cardiac death if they receive CPR until emergency medical help arrives (who may use a defibrillator to restore a natural heart rhythm).
A Brief History of CPR
1891: The first external cardiac massage in the Western world was reported to be done successfully by Friedrich Maass.
1960: Kowenhoven and Knickerbocker reported their method in JAMA that chest compression was accepted as a method of resuscitation for cardiac arrest.
1966: The first guideline for CPR was published.
1970: Teaching the lay public to do CPR was started.
1974: American Heart Association (AHA) formally promoted the practice involving the combination of rescue breathing and external cardiac massage for cardiac arrest in a ratio of 2:15.
2005: Ewy in Arizona showed that hands-only CPR, at a rate of 100 per minute until the emergency crew armed with automated cardiac defibrillators arrive, was superior to the traditional method of CPR.
The AHA was hesitant to accept Ewy’s idea in their new guidelines for CPR in 2005, but as a compromise, recommended a ratio of 2 breaths to 30 chest compressions instead.
2007: In March The Lancet reported a Japanese study on a series of over 4000 cases in Tokyo, comparing traditional CPR to hands-only CPR by bystanders. The results showed that the latter was more successful in the resuscitation of cardiac arrest with preservation of neurological function.
2008: In April, the AHA finally gave its approval on hands-only CPR from bystanders.
Oh wait, I forgot something – Chinese Medicine has been practicing CPR since at least 403 BC:
A more complete History of CPR
403-221 BC: (Warring Kingdoms period) External cardiac massage was practised as a method of resuscitation for victims of suicide by hanging. Some credited this to Bian Que.
6 BC – 221 AD: (Eastern Han Dynasty) The first description of CPR for resuscitation of victims of hanging came from Zhang Zhongjing.
In his Essence of the Golden Chest, miscellaneous therapy #23, he described the method as follows: “Lower the victim gently, don’t just cut the rope, and lie him on the blankets. One person should put his feet against the shoulders of the victim and pull on his hair, rendering it taut (to open the airway). One person should put his hands on the victim’s chest and compress rhythmically (external cardiac massage). One person should flex and extend the victim’s limbs (to promote venous return). One person should press on the victim’s abdomen (to enhance intrathoracic pressure during external cardiac massage). ….This method is the best and usually successful.”
Zhang Zhongjing’s writings were handed down and read by Chinese physicians through the centuries.
1186-1249 AD: (Sung Dynasty) The above passage in Essence of the Golden Chest was cited by Sung Ci in his book on forensic medicine “Washing Away of Wrongs (Xi Yuan Ji Lu)”, which is recognized as the first book of forensic medicine in the world and has been translated into many languages both in Asia and Europe.
If you read the description of CM CPR carefully, you will see that there is no mention of rescue breathing.
CM has been teaching the better form of CPR for over 2400 years.
The above two histories are very slightly abridged and are courtesy of Am An Zhang, Child Psychiatrist and Author of “The Cockroach Catcher”, which is a very interesting book and available at online bookstores, including lulu.com.
Listeria Update
October 23, 2008 at 5:32 pm | In Uncategorized | Leave a Commentfrom: http://tinyurl.com/5bj5s9
and: http://tinyurl.com/6ffewr
As of October 22, 2008, the Listeria outbreak has claimed 20 lives across Canada.
Melamine has claimed 4 lives.
I wonder if we will hear more about Melamine or Listeria, in the end.
Herb-Drug Interactions Uncommon
October 23, 2008 at 5:22 pm | In Uncategorized | Leave a Commentfrom: http://www.medscape.com/viewarticle/533288
Herbal remedies are not just for health food stores anymore. The medications have gone mainstream, and as sales continue to rise, so do concerns about their interactions with prescription and more traditional over-the-counter drugs.
But new research suggests that potentially dangerous interactions may occur less often than are widely believed. Investigators reviewed the drugs taken by 7,652, mostly older Canadians, and found very few instances of such interactions.
Tongue Diagnosis
October 22, 2008 at 10:40 pm | In Chinese Medicine | Leave a CommentTags: Tongue Diagnosis
I am commonly asked why I look at a tongue and what it is I look for. The tongue, for some reason, shows a tremendous amount of variation which is consistently associated with the presenting signs and symptoms of a patient.
A tongue’s shape, coating, colour, salivary volume, inherent tissue moisture and movement will change according to the progression or remission of a state of illness.
Images from the Atlas of Lingual Coatings in Chinese Medicine
The above atlas features 300 different tongue presentations and states that “[i]t is axiomatic in Chinese Medicine that any part of the body may carry in it the traces of events occurring throughout the whole body”.
Doctors Wanted
October 14, 2008 at 3:50 pm | In Modern Health-Care, Social Medicine | Leave a CommentTags: Choice, perception
Doctors Wanted
According to Eisenberg et al, [1] total visits to alternative healthcare practitioners exceeded total visits to primary care physicians in the US back in the 1990s.
If we can leave our notions of healthcare aside and look at the available evidence, it would likely become apparent that there already exists a “shadow system” of healthcare – effective, safe, and able to provide some of the very medicine we need.
More and more professionals are calling for interprofessional collaboration, including “emerging” healthcare systems like Chinese Medicine. [2] In the 21st century it won’t be possible to maintain the rigid hierarchical structure as it exists today.
1. Trends in Alternative Medicine Use in the United States, 1990-1997
David M. Eisenberg, MD; Roger B. Davis, ScD; Susan L. Ettner, PhD; Scott Appel, MS; Sonja Wilkey; Maria Van Rompay; Ronald C. Kessler, PhD
JAMA. 1998;280:1569-1575.
2. The Case for Interprofessional Collaboration
Geoffrey Meads; John Ashcroft; Hugh Barr; Rosalind Scott; Andrea Wild
Blackwell Publishing. 2005
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