Integrating modern medical knowledge into traditional medical practice (8) Chinese medicine

10 July, 2018

Thank you for bringing up traditional medicine again. I am not sure about African medicine but I am happy to share the situation of Chinese medicine (if you classify that as traditional medicine) in Hong Kong.

1. Coherent to Joseph Ana, I do not believe the issue of whether of mainstream should distract the topic. However, I would be very careful not to correlate the poor outcomes just to the utilisation of traditional medicine. Take Hong Kong and UK as an example, both places have similar economic status, health infrastructure and education level (somehow I still think UK is still doing better). However, Hong Kong has a longer life expectancy despite significantly longer working hours (which has proven to increase mortality) than UK. The obvious difference between the two places is the use of Chinese medicine. How would one interpret?

2. I think the benefit of traditional medicine, in my case, Chinese medicine, is less likely to be discovered, documented or disseminated. A simple example is that there are so many researches on acupuncture and very rich evidence in many disorders, especially on pain. (Have a look on British Acupuncture Council) Yet, when you ask a group of orthopaedic surgeons, how many have come across / tried to search for that? Overlooking the evidence on traditional medicine, in this case, acupuncture, may actually put more patients on the surgical table and led to unnecessary health expenditure and adverse outcomes.

We are conducting a series of pragmatic RCT on Chinese medicine and the preliminary result of one showed that a clinical protocol derived from Chinese medicine theory thousands of years ago actually retarded the progression of kidney disease by half. By rough estimation, denying the benefit of Chinese medicine (which has established for such a long period) may result in 30-50 % more diabetic kidney disease patients progressed to require renal replacement therapy. In this case, it is only Chinese medicine did not have enough recognition although the evidence was well documented but in an unfamiliar form to biomedicine.

3. Massimo Serventi is quite right that it is not practical to fit one paradigm of medicine to another as they have different epistemology - different theory of health, different classification of disease, different treatment and different outcome measurement.

We recently finished a series of focus group interviews with Chinese medicine clinicians and western medicine clinicians. As expected, they shared about their different paradigm of believes and practice. Probably the common ground is the patients' quality of life and life expectancy as the ultimate outcome.

We have also conducted a small pilot (n=300) to assess the correlation of different diagnosis paradigms with some pragmatic clinical outcomes. WM and CM explained similar degree of variability of only 30-40%. Only when they combine, integrative medicine explained the best. This somehow supported the idea that different streams of medicine have blind spots and biomedicine may not always be the best.

4. I think Charles Dhewa made a point on the actual implantation of health systems and behavioural change. We may like to implement an ideal and new paradigm of medicine to somewhere does not have it but if it is not done in an adaptive way to fit local context, it will fail or be very slow to succeed.

Best,

Chris

HIFA profile: Chris received training in biomedical science, clinical Chinese medicine and public health from Hong Kong Baptist University and London School of Hygiene & Tropical Medicine. He is currently a research clinician based in Hong Kong and has been actively engaged in clinical medicine, clinical trials, basic science research and qualitative research. He had served for Hospital Authority, World Health Organisation and hospitals on research consultancy, medical administration and clinical medicine in Hong Kong and mainland China before his academic engagement.