Letter to the Editor, Chicago Tribune
In Adam Minter’s article, Testing Traditional Chinese Medicine (Mon, Sept 21, 2015), he discusses the growing popularity of Traditional Chinese herbal medicine in China but fails to address the state of the practice and regulation in this country, only serving to spread fear and misinformation.
Chinese herbal medicines are currently regulated under the Dietary Supplement and Health Education Act of 1994 and the Food and Drug Administration has set standards for good manufacturing practices. Batch testing by independent labs includes screenings for pollutants such as pesticides and heavy metals and verifies the accuracy of the ingredients. Endangered species are prohibited in the United States and the FDA has banned several herbs that contain toxins. Chinese herbs in the US contain less pesticide residue than found in the produce department of a local grocery store since herbs containing any amount are generally refused entry.
Mr. Minter states that in the 70s acupuncture drew the attention of Westerners but he provides no follow up information to span the 45 years history since James Reston’s famous appendectomy. The US currently has 28,000 licensed acupuncturists with 757 residing in Illinois. The National Certification Commission for Acupuncture and Oriental Medicine, a non-profit board established in 1982, is the standard for licensure in 43 states (including Illinois), 98% of the states that regulate acupuncture. A graduate degree in Oriental medicine takes four years to complete and includes study in biomedical sciences, Chinese herbal medicine and acupuncture modalities including 1000 hours of supervised internship.
This growing profession is meeting a demand for safe, alternative options to pain management and chronic diseases that aren’t adequately addressed with Western medicine alone. Patient dependence and abuse of opiate medication has become so problematic that hospitals have created departments to regulate this risk. In January of 2015, the Joint Commission, which accredits hospitals in the US, revised its standards for pain management to include non-pharmacologic strategies including acupuncture, chiropractic therapy, osteopathic manipulative treatment, massage therapy, physical therapy, relaxation therapy, and cognitive behavioral therapy.
The expanding body of knowledge in the area of genomics has helped doctors to identify an individual’s likelihood for side effects to medications and proves that some of us just will not tolerate all drugs and need non-pharmacologic alternatives. Traditional Chinese medicine plays a great role in complementing our healthcare system in these areas, delivering low cost, effective and safe treatment. Integrative medicine programs associated with teaching hospitals in this country have embraced acupuncture and Chinese herbal medicine including Mayo and Northshore University Health System. Chinese herbal medicine still enjoys a safety record well beyond that of pharmaceuticals, which are responsible for 100,000 deaths per year in US hospitals due to adverse reactions from properly prescribed medication.
Since the 70s and in the last twenty years, research on acupuncture in the US has exploded. The National Institutes of health in a 1997 consensus statement recognized acupuncture’s efficacy for postoperative and chemotherapy nausea and vomiting and in postoperative dental pain and it’s usefulness as an adjunctive or alternative treatment for addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma. A recent landmark study in the Archives of Internal Medicine in 2012 showed that in 17,922 patients, acupuncture was effective for back and neck pain, osteoarthritis, chronic headache and shoulder pain.
Research on Traditional Chinese herbal medicine has not appeared as much in American peer reviewed journals as acupuncture. However, a notable trial in the Journal of the American Medical Association in 1998 by Bensoussan and Talley found Chinese herbal medicine significantly improved symptoms of irritable bowel syndrome as rated by both patients and their gastroenterologists without side effects. These are the kind of studies that we need more of—outcome studies that test the efficacy of the traditional system.
Mr. Minter recommends that for TCM to gain legitimacy scientists need to isolate compounds to make them more palatable to the US. While more research on Chinese herbal medicine is welcome, I caution against the reductionist mindset of rendering herbal medicine into isolated compounds. Whole plants (and yes, sometimes animal products are employed) offer a matrix of molecules and cofactors that often have synergistic and protective benefits. Stripping these away in favor of a single isolated compound may lead to adverse reactions and decrease efficacy. Researchers have discovered that an herb’s efficacy is not always easily reduced to a single molecule, as much as we might like to be wooed by the simplicity of this approach. Mr. Minter touts the research on artemisinin, a compound isolated from the Chinese herb qinghao in the 1960s for treating malaria. But now parasites are developing resistance to that compound. A recent study by the University of Massachusetts published in the Proceedings of the National Academy of Sciences found that the whole plant, qinghao, cured mice with artemisinin-resistant malaria. This study underscores the strength of traditional whole plant medicine, which ironically has much to offer the treatment-induced issues of our time.
Traditional Chinese medicine is a thriving, regulated and viable complement to Western medicine in this country and will continue to enjoy demand even while research catches up to its long history of safety and efficacy.
Nicole Hohmann, MSOM (Master of Science in Oriental Medicine), L.Ac. (Licensed acupuncturist