Monday, March 14, 2011

on Evidence Based Medicine

Medicine or drug? Western? The ideal or your ideal body temperature? Diagnosis = guesses? Below are some of my quick comments on the above.

Technically, those man made "medicines" are not medicines (药), they are drugs (毒).

Instead of calling them western, a more appropriate term is evidence based medicine. However, in order to be evidence based, they need statistics. Yet not many people are good in statistics, and there are limitations in statistics. Thus, most of the time, they need to focus on only a few but typically one measurable quantity, and find evidence of effectiveness of some drugs on that quantity.

These drugs will surely be very effective on making that particular quantity up or down towards the so called ideal, but actually just some typical values, that is believed to be better.

Important notes:
1) These individual quantities (e.g. body temperature, blood pressure, etc.) don't adequately represent our complex biological machine.
2) The typical values may not be the best value, for each individual.

For me, I think our body has a very good design and self-healing ability to handle many known and expected intrusions/poisons/injuries. So, trust it more to heal itself, simply by giving it rest, water and good natural foods. Traditional [Chinese] medicine respects that while the evidence based medicine sees our body as a dumb organic anatomy and simply intervene with short sighted goals (e.g. getting rid of pain, fever, cough, running nose, etc.) while ignoring the cause. By the way, these pain, fever, cough, running nose and etc. are just part of our own self healing processes. Furthermore, most man made drugs have substances that aren't expected to be in our body and many times our body are not effective enough to deal with these drugs.

Recently, there is a discussion about using the term "TCM specialist." I think it might be contradictory in the term "TCM specialist" if by specialist it refers to a particular organ since TCM is about tuning the body as a whole to its balance/healthy state.

I think it should be the other way around, TCM should be a main field of medicine to maintain one's health while western medicine as complementary when it is already too late.

Just as we are encouraged to go for dental checkup every 6 months, or go for health screening regularly, we should also be encouraged to visit a "family" TCM doctor regularly to maintain our health. However, to do this we need to even out the bias in favor of evidence based medicine by the insurance industry. It is financially difficult to go for a non-insurance-covered TCM or natural therapy over a fully covered modern medicine therapy.

Western medicine has a relatively short history and seems mainly sprang off due to demands from large scale wars, where there were many unnatural injuries and short term remedies are priorities over long term health/well being (e.g. the use of marijuana). Thus, it should remain as a complementary mode for people who had failed to maintain their health or had unnatural injuries.

Lastly, all these regulations on western medicine were mainly due to the danger of its drugs developed from narrow "minded" evidence based methods, and its one drug for all application. If you compare the vast amount of regulations on a short history of western medicine to the little or almost nil regulations on a long history of TCM, it implies that the danger/risk levels of western medicine is very very very much higher than that of TCM.

Basically, all doctors diagnosis judgement are guesses. However, western medicine tries to guess the specifics, while TCM guess the general. Western drugs are very effective to the specifics, while TCM tune the body slightly in a general direction. Thus, western medicine doctors are more likely to make wrong guesses, and the more kiasi or inexperienced ones will asked for more tests, i.e. more costs, more time, more inconveniences, more potential harm.

Furthermore, a wrong guess by a western medicine doctor could be very destructive due to the high effectiveness of the drugs, while a wrong guess in TCM is relatively less harmful and patient can easily sense that diagnosis or prescription is not appropriate.

A true TCM doctor should be like what my wife described of an old sinseh she knew as a child who scolded the patient if he tries to describe his conditions to him.

No comments:

Related Posts with Thumbnails