Sunday, February 16, 2014

Evidence Based Medicine and Chinese Traditional Medicine

Conventional medicine is ‘evidence based’.  That means that it uses a scientific paradigm of accountability.  A hundred people with a broken arm get better when we ‘set’ the fracture. Chinese Traditional Medicine doesn’t have a similar ‘accountability’ process.
Today the demands on the busy clinician are massive, time consuming and increasingly perfectionistic.  There are no similar demands on the ‘alternative health care givers’. Mostly they are ‘judged’ by their following.  This is naturally not an issue with conventional physicians because they have huge followings and extensive wait lists.
When alternative health providers have had public funding there have been extraordinary scandals with abuse of care and corruption and all manner of cost concerns. I’m not saying that this hasn’t happened with conventional medicine but there is a huge industry of oversight on the doctor whereas these ‘newcomers’ rarely appear to be subjected to the same demands or restrictions or monitoring.
I note that pharmacists who are increasingly taking on an ‘education’ role are not restricted by their obvious ‘conflicts of interest’.  I wouldn’t be concerned but for the desire to see a ‘level playing field’.
I see the new kids on the block only liking the field because they are not subjected to the same level of restriction, educational requirement, and scrutiny that physicians have.  To them it's easy money but nothing in my education or work has ever amounted to easy money.  It's been horrendously demanding, threatening, dangerous, long hours and in the end I'm happy if I get minimum wage given the hours of work I put in and the years I didn't get paid and the long time in the process of learning and developing clinical skills and training.  I look around and see others throwing up a shingle and focusing on the money, those with the least illness and greatest resources.
Indeed colleagues are moving out of conventional medicine into alternative areas because they are so lucrative and carry none of the heavy baggage of monitoring, litigation and pain.  In California this occurred when there were restrictions placed on ‘counselling’ and overnight the ‘channelling’ movement became notable.
The "worried well” are big business.  Historically general medicine was always a ‘group insurance plan’ with the hard cases and major burden of medicine being lightened by the easier cases. This no longer is the case with so many of the ‘worried well’ opting for less mainstream health care approaches.
Clearly, just as there is a ‘traditional chinese medicine’ model, there are ‘traditional ethnic medicine’ models from every group that has immigrated to Canada.  Can we expect the Chinese, presumably the principal consumers of this model, to continue to ‘pay into the collective plan’ or will they like the other alternative health care models simply take the ‘cream’ and leave the curds to the under paid over educated, overworked existing conventional medical practitioners, especially those who are themselves Chinese.  Will we soon see a Traditional Jamaican Medicine Model and a Traditional East Indian Medicine Model all of which appear wholly ignorant of the local 'traditional Canadian Medicine Model."
Increasingly conventional medicine is being subjected to the criticism of the Cochrane Collaboration, a controversial meta analysis approach, originally beneficial for the simplest of questions comparing drug x to drug y, now being used well beyond it’s original scope and expertise but still causing headaches for clinicians already straddled with local scientific demands.
Will Traditional Chinese Medicine be subjected to Cochrane Review analysis when already the majority of it’s offerings cannot compete with conventional medicine in any pragmatic way.  Traditional Chinese Medicine eventually set fractures the same way conventional medicine does. Conventional medicine is what works.
It’s of considerable issue for me as a psychiatrist especially one who works as a  "four dimensional psychiatrist’, i.e. one who works in the physical, emotional, intellectual and spiritual domains’ seeing mental illness as ‘mind’ illness rather than solely ‘brain disease’, the neurologists realm, really.  The psychiatrists approach to illness is similar to some of the Tradtional Chinese Medicine approaches but where as psychiatry has validity beyond ‘anecdote’ there is limited ‘science’ or ‘accountability’ or any of what the Cochrane Collaboration would conclude is worthy to it.  Indeed pharmacists have been advised to avoid addressing psychiatric medications due to their complexity and the complex ways psychiatrists use medications as one of many process interventions. Indeed family physicians are usually as respectful of the success of psychiatrists way of using medications we all have access to but like the dermatologists use of medications, the success family physicians or generalists get with the same 'toolbox' is never the same.  As a GP who later trained as a psychiatrist I learned that the medication was a wholly different 'thing' in different hands.  As a gp I saw medication unidimensionally whereas a psychiatrist sees medication multidimensionally and especially from a psychosomatic perspective. But monitors are reductionist policemen and as always the arrogant know everything so are unteachable.  The same will likely hold true for Traditional Chinese Medicine but how will Traditional Chinese Medicine practitioners find being assessed by general practioners of a conventional background or courts of a conventional reductionist bearing. To the court, everything is money,naturally.
If I were to provide Traditional Scottish Irish Canadian Medicine approaches would these be subjected to the same ‘standards’ as the Traditional  Chinese Medicine models or would I be expected to adhere to a Cochrane model even though Cochrane himself didn’t see any difference between the Irish, Scottish, and English models of medicine.
Fareed Zakaria writes that we're in a Post American World but we collectively or just a few of us.
It’s no surprise that Ireland separated from Britain and that Scotland is doing so or that Canada is a unique entity that government rulers and monitors would like to see as ‘american’ or ‘english’ given their tendency to uphold the works of these ruling countries even when our ‘local’ approaches are vastly superior as evidenced by the people here staying here and having their medical needs met here.
It’s just a thought.  And I don’t think anyone else is thinking about it.  I’m sure that a notice has been placed on some wall on another planet about it though.

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