Let’s imagine that you, a rational person, are a high muckety-muck in some prestigious scientific institution — like, say, the Royal Society of New Zealand — and you’re asked whether some fringe subject — like, say, Traditional Chinese Medicine — should receive the endorsement of your society. How would you determine your answer?
If you’re anything like me, you’d go to experts and ask, “Is there good evidence that this really works? Is it a subject we should pursue in greater depth?”
Not the Royal Society of New Zealand, though. No, forget all that business of whether TCM actually works, or even does harm: instead, they hired a consultant psychologist who interviewed 30 people and asked them whether they’d used TCM. Their conclusion:
The Society recommends that TCM should become a registered profession and that registered practitioners should be clinically well qualified.
It apparently doesn’t matter whether it works or not, and the fact that it can cause harm was actually used to support endorsing it in a fine piece of topsy-turvy logic.
There is the potential of harm from the practice of TCM. Apart from the risks already outlined in the proposal document, clients consulting TCM practitioners are at risk of delayed diagnosis and treatment of their conditions, which can carry significant consequences. It is possible that an occult fracture is missed in a client consulting a TCM practitioner for foot pain, or early meningococcal disease overlooked in a client with fevers and general malaise.
Regulation of TCM will ensure that all TCM practitioners are aware of the limitation of their service, and to know when to refer clients to another health service if necessary. Improper practice of TCM, such as tuina (massage therapy) and tei-da (practice of bone-setting), has been shown to induce physical damage (e.g. joint dislocation, spindle damage, deep tissue/muscle damage) to the patients and some herbal medicine may also not be suitable for pregnant women. It will therefore be important to ensure that registered TCM practitioners are responsible and clinically well qualified.
I have decided that chewing broken glass is a cure for cancer. It is irrelevant whether it actually does so; it does cause severe bleeding and oral and throat damage, though, so I’m moving to New Zealand, where that will be cause to officially recognize and register my practice, so that the state can better protect my patients from harm.
(Also on Sb)
This seems more like a harm reduction measure than legitimization of Traditional Chinese Medicine. The report says that TCM, as practiced now, has serious risks, and a licensing scheme could mitigate some of the risk.
It’d be nice if no one visited TCM practitioners, but so long as people, such a scheme will help prevent injuries.
Does this mean they will realise their quackery is useless and do some normal doctoring?
Crap, the last sentence should read:
It’d be nice if no one visited TCM practitioners, but so long as people do, such a scheme will help prevent injuries.
It looks like their reasoning is: a lot of people engage in this crap, and if we don’t recognize and regulate it, these people could get hurt.
This isn’t entirely ridiculous reasoning, if your institution is in charge of public welfare and health (ex. the government, medical associations, etc.). On the other hand, if your institution is a science institution, your reaction to “a lot of people engage in this crap” should be “then let’s educate these people and inform them why its crap, so they don’t do it anymore.”
…in other words, how to recognise when the
markpatient hasbeen milked for maximum pay-outreceived the greatest possible benefit of the alternative therapy.Well, I can see their line of reasoning.
Things are never easy when dealing with humans and they’re trying to go for the lesser evil.
They seem to figure that they can’t fight the quacks with logic and reason, so they’re trying to protect people, stupid, foolish people, from harm.
Woo is highly incorporated into the German health-care system and into real medicine.
This has advantages and disadvantages. Our family GP is high on woo. Ozone therapy, accupuncture, homeopathy, you name it, she’s got it.
Still, she doesn’t use them when things really matter (Scarlet fever? Here’s your family-size pack of penicilin!) and she’s a great doctor who really, really cares for her patients.
I just wished she’d drop the woo.
On the other hand, people who are high on woo, too, don’t stop seeing a real doctor.
Namely, “our service doesn’t work.” So basically they’re saying that by regulating TCM, they can ensure that its practitioners in New Zealand are not merely misguided, but out and out frauds? Who know that when they stick pins in you and rub your feet, they’re doing nothing for you? But still brazenly let you pay them for doing nothing? What an improvement!
The cynic in me (which is pretty much all of me) suspects this just illustrates that the Royal Society of New Zealand is not primarily a scientific organization at all, but rather a political organization, and this recommendation is driven by someone-or-other’s desire to expand his empire by acquiring the power to license acupuncturists.
By this logic, beating a person over the head with a large club could become a treatment for quackery.
It’s not a completely crazy line of reasoning — they seem to be taking a tack of “harm reduction”, which in general is something I support. As long as people are going to engage in quackery, making sure they do so in a way that is “only” wasteful (and not actively harmful) is arguably a good thing. Of course, if you end up lending credibility to it that’s obviously a bad thing… so it’s a tough call. I don’t think it’s as cut-and-dry as you make it sound.
I think alt-med should be treated with the respect accorded to real-med: it should be regulated, its practitioners should be liable for malpractice, their products should pass clinical trials to show effectiveness before being brought to market, and interventions with side-effects should require a prescription from a physician.
And that would be that.
In the UK and Ireland it is not uncommon to see Chinese medicine stores set up in shopping centres with all kinds of bogus claims and cures plastered on front of their windows. You’d think the lot would be shut down or at least tightly regulated. But apparently not.
The first comment is spot on. It seems more like an attempt to regulate an at best kooky, at worst harmful practice. There is a similar debate going on in the US with regards to direct entry midwives. Some would like to see much stronger licensing regulations for home midwifery while others see licensing as legitimizing an inherently risky practice that provides little real benefit.
Fascinating. I’m almost eager to see this thing blossom.
Yes, quackery is dangerous, but you know what? There aren’t enough high-profile lawsuits against woo-woo practitioners. If they are government regulated health organizations who must comply with the law, doesn’t that make them liable if they injure someone, or of causing no positive change despite telling their client that there is one (ie, malpractice)? This is opening the door to all sorts of lawsuits, because every single one of these quacks can’t do shit about shit. Every single client is a guaranteed failure!
I don’t want anyone waving their hands and calling themselves a licensed-by-the-state physician, but sometimes you have to break a few eggs before the dominoes bring down the house of cards. Checkmate.
Seems a good move – make sure that practitioners are clinically trained and operate as such.
Would appear to me that once you’re trained to the correct standard that actually practicing TCM would be grounds for having the license revoked.
I like the system, it is very Heller.
Exactly. Though it is kind of funny to contemplate:
“Where you goin’ Timmy?”
“Oh, down to the alternative safe injection site the government set up.”
“I didn’t know you were a junkie.”
“Oh, I’m not. I said the alternative safe injection site. I’ve got a qi blockage in my kidney meridian and I need an acupuncturist.”
At least if there is a proper scheme in place for regulating traditional Chinese medicine, you won’t get any old Tom, Dick or Harry claiming taxpayers’ money for peddling treatments that don’t actually work.
Speaking as a New Zealander, I can categorically say that New Zealanders aren’t at all rational. Can’t I?
From what I’ve read, TCM is actually a notch above Homeopothy and the like as far as gettting positive results is certain situations. You can’t really control for needles vs. not needles, but as placibos go, it’s a pretty good one (needling seems to get some results, although it doesn’t seem to matter much where you stick them), and for some people, a good placibo may be a decent course of treatment.
Or at least this is the rationalization I’ve come up with, as my wife is a TCM practitioner, and I need to be at peace with this some how. People often come to her to help deal with side effects of standard medical treatments, and generaly respond well to the time and attention she spends with them, which is not to be discounted.)
So if people are going to do it, I say go on with the harm reduction. With good regulation and monitoring, maybe we can limit the scope of treatments to conditions that respond to a little tcm tlc.
If I was running the show I wouldn’t be regulating TCM, I’d be starting an advertising campaign making it clear that TCM practioners are prone to misdiagnose complaints and the general public should steer well clear of them – but that’s just me.
Even if the point is harm reduction, why wasn’t a study done to find out what harm is now being caused, and what registering practitioners might actually do to legitimizing the practice as well as in reducing harm?
Interviewing people regarding TCM is a poor way of coming up with recommendations that it should be registered. It might have some benefit along with other studies, but by itself it doesn’t tell us much.
Wouldn’t public education be a likely way to get people to at least see a real doctor if they’re going for TCM? I just don’t see how registering it is likely to be the best response.
Glen Davidson
The trouble is that such advertising campaigns tend to miss minority populations, and small minority groups are often mistrustful of these sorts of campaigns that look like an assault on elements of their home culture.
A kind of harm reduction-based licensing scheme is an effective way to reduce damage while not alienating the people who would otherwise be hurt the most.
Extremely little to be done about that. The people you’re describing, if TCM were completely banned, would go to back-alley acupuncturists and unblock their qi with coat-hangers. If someone is that determined to kill himself with quackery (or booze or heroin, but that’s a separate topic) you might as well let them. You can’t stop them, and if you could they’d hate you for it anyway.
Which is why these kinds of harm reduction measures are important. PZ should be supporting them and encouraging more.
While I understand the desire to mitigate harm, defenses of the licensing-for-quacks recommendation sound much like variations of the familiar “Little People” Argument we hear far too often from critics of the gnu atheism: yes, yes, we can handle and deal with the truth — but the Little People cannot. Those simple children of the earth need to believe in God/woo — plus, they can’t understand hard things like reason and science. Thus we need to be realistic and stop expecting the Little People to be as intelligent and strong as we are: it’s really kinder that way, poor things. Lower expectations are more likely to be met.
As Dawkins has pointed out, there is something arrogant and preening about this rationale. It wouldn’t take much for such condescension to morph into racism — especially if the Little People who use TCM just happen to be C.
No, it’s not the Little People.
People who run to woo-practitioners are often educated middle-class. They couldn’t afford the reiki-accupunture-homeopathy (I’m a big fan of homeopathic accupuncture, I keep an open box of pins around)else.
Hell, my own dad goes for accupuncture. He’s an intelligent person who believes in science an the scientific method, yet when I told him about the placebo studies, he told me “but it helps me”. Sure, they put him into a nice room with nice music for an hour, very relaxing.
My husband works in a lab. His and his colleagues’ job is to find trace amounts of substances. Given the formulas they’re fully aware that there’s nothing in a homeopathic remedy, yet one of his colleagues claims it works wonders with her guinea pigs.
Fact is that a lot of people simply ignore the truth and the facts and buy into this “that’s your truth and this is mine BS.
That doesn’t mean we should just let those people (and their children) be harmed and then tell them “I told you so”.
Again, PZ getting schooled by his readers. Why don’t you give these things a little more thought before you post them?
@26
You’re not reading the comments for comprehension, if you think PZ is getting ‘schooled’.
If they played by the same rules as real doctors — requiring evidence that their procedures are actually safe and effective — the entire field of TCM would not exist. The whole thing is about as absurd as regulating psychics. It’s not that some of them are frauds — ALL of them are frauds.
So to practice you must be registered – and to be registered you have to meet conditions. The actual conditions then become crucial to how things turn out.
So they have to be “well qualified”. OK, so a proper MD at least, right? That seems like a pretty good condition. Even though we have seen a number of pretty wooey MDs around the place.
They later quite explicitly call out the harm that can be done by woo-ists in delaying real treatment, something that normally goes right over the head of a lot of people who claim that “oh it doesn’t do any harm” and so on.
Reiterating “*clinically* well qualified”.
This could of course all be smoke and mirrors that lets wootanists get away with their idiocy but it could work the right way and restrict them to a very limited niche that they are both trained and required to pop patients out of when appropriate. And yes of course ‘when appropriate’ might be a dangerous phrase here.
All in all it could be a very sneaky way to drown them in kindness, which clearly goes against all that is good and right with Pharyngula, but drowned is drowned. Doesn’t matter much whether it is in hydrofluoric acid or malmsy.
In Canada chiropractors are “registered practitioners” and “clinically well qualified”.
Is that so in New Zealand?
I couldn’t disagree with the comments more and as a Kiwi, I’m disappointed.
The Royal Society is not the one making the policy, it’s been asked to give a recommendation. In this role I would assume that a robust, well researched, science based appraisal should have been in order.
It is the self proclaimed “only organization in New Zealand which focuses on the criterion of excellence in research in science, technology and the humanities.”
I’m sure the health ministry will be asking others for their recommendations, including the TCM industry, plus others. The Royal society has not had the courage to look at the evidence and just looked over the fence to see what others are doing and gone with that. It’s definitely not “promoting excellence in science, technology and the humanities.”
If a strategy is in place to recommend that TCM should be regulated, then some stringent conditions and caveats should be recommended as well and this strategy should be clearly outlined.
In my opinion, strategy or not, the Royal Society has failed in its advisory role.
Don’t be so quick to throw the tea leaves out with the old water. A few facets of TCM, mostly pharmacological, DO work. Ear-fungi tend to reduce blood pressure, for example, and I can attest to the calming effects of h’sia-ku-t’sao (self-heaf flower spike) tea. Luohan-guo (arahant fruit) also makes a nice sweetener and is probably healthier than stevia and definitely better than HFCS.
The entire thing about the interlocking systems is of course bunkum; where exactly do the san-jiao (three burners) reside in the body? Nowhere. TCM’s best contribution to global medicine is the idea of balancing acid and alkaline and employing bioactive compounds to slow inflammation, IMO.
You misspelled “pointless.” A licensed quack is still a quack, and an idiot who trusts quacks is still an idiot who trusts quacks. If banning acupuncture won’t stop people seeking it out, then regulating it certainly won’t. But if someone goes to an acupuncturist he is by definition harmed: if there’s anything wrong with him, he just left it untreated; and if nothing’s wrong with him, he just got bilked. That’s equally true whether or not the quack had a license.
The only arguable benefit would be if acupuncturists were using dirty needles, but nowhere in their recommendation do they mention an epidemic of AIDS or hepatitis spread by dirty acupuncture needles.
Hazuki, what you’re talking about is medicine. I don’t think anyone on this site would doubt that there are plenty of herbs out there that have benefits, any maybe many traditions that need to be investigated and more widely acknowledged but why do we need a TCM practitioner to administer them?
While TCM has found many real remedies through hundreds of years of trial and error, they’ve gotten hung up on the spiritual side of things. I think that if you ask a TCM practitioner you’ll find that fungi help to expel heat from the body – science has added the, well science.
The trouble that I have with TCM is the secrecy that shrouds many herbal remedies and the refusal to recognize the actual mechanisms behind many of the beneficial effects or otherwise.
In addition there is the fact that encouraging TCM encourages the trade in animal parts but that needn’t be addressed here.
Giliell #25 wrote:
I know. But that doesn’t preclude them being “Little People” — even in their own minds. Appeals to personal experience and one’s special sensitivity to spiritual forces are often accompanied by a childish insistence that any criticism of a modality is criticism of the person who “follows” it: they have a RIGHT to believe whatever they want. Skeptics turn into bullies picking on the weak, rude intruders trying to take away the open sense of wonder and discovery with the demand that everyone conform to one way of doing things.
That’s just so unfair. There are lots of different sciences, so there are no wrong answers in science. The wee children of the earth want to keep their own ways of knowing.
Hazuki #33 wrote:
Hm. Not so sure about this — there’s a lot of acid/alkaline woo around, I think. I’d run that by Science-Based Medicine.
But, as John says in #35, if you can demonstrate it works then you can only do so through standard scientific methods — which doesn’t make it special to any traditional Chinese medical system. Pharmacognosy — pharmaceuticals-derived-from-natural-substances. Not alternative; just medicine.
I’m going to cut ‘n’ paste this comment next to one calling this place an echo chamber to see if I can power anything with the energy released in the resulting explosion.
No, no – because we’re upside down, things that don’t work else-ware work here ;)
In all seriousness, I wonder what will happen when the folk at sciblogs.co.nz find out…
Did you even read the article? This bit here, particularly:
The licensing is working directly to reduce harm inflicted by TCM practitioners.
Ditto.
Glen Davidson
I am ashamed for my country. That’s just ridiculous.
Chigau @31 Yes chiropractors are registered practitioners. Many people go to them. They aren’t even really considered alternative. A good half of the people I know visit chiropractors occasionally. When I was pregnant my midwife even reccomended moxi sticks, acupuncture & visiting a chiropractor to turn a breech baby.
There is harm reduction regulation covering TCM (acupuncture really) already, via local councils and the Ministry of Health that cover skin piercing, code of patients rights, consumer legislation and so on. There doesn’t need to be official legitimising of TCM over and above that. This is depressing as with Chiropractors, the abuse of the legitimacy of regulation is clear and they offer treatment way past any evidence base and still act like normal alternative practitioners and dish out bad advice and are generally anti-vaccination and so on. That being said, there were some critical submissions including that of NZ Skeptics so it’s not all bad, one thing in particular that was pointed out was the lack of evidence and the lack of attention to inherent risk. The discussion document they put out repeatedly said that it was poor training that caused much of the risks involved, but the reality is there is inherent risks in doing stuff like sticking needles in there and it just makes it worse when it can’t possibly do anything.
A well-trained and regulated quack is still a quack as said above. All that happens with regulation is there is official legitimising of the quackery and this misleads the public into thinking they are using worthwhile health care when it’s anything but.
Why do we need TCM when we have magic rocks?
You think that’s bad? The body that registers doctors, nurses, pharmacists and physios in Australia also registers chiropractors and osteopaths, thus giving them the same validity as science-based treatments.
Forgot link: http://www.ahpra.gov.au/
@MelissaF “my midwife even reccomended moxi sticks, acupuncture & visiting a chiropractor”
So a member of one branch of quackery recommended three others? Did she ever suggest you go and see a real doctor?
This is one of the problems with the NZ health system. Quackery in various forms is already regulated so people aren’t surprised to see one more. Pharmacies sell homoeopathic “medicines”. Midwives take over control of naive women’s pregnancies and do their best to stop them seeing doctors. When the inevitable happens and a preventable death happens to a baby the line is put out that the midwife wasn’t following standards, or was rogue or whatever ignoring the fact that it was just the time when her luck finally gave out.
If the regulation acts as harm minimisation then all well and good, but if it encourages them to make more outrageous claims then not-so-good.
What John (@32) said. This is embarrassing :-( It will be really interesting to see of the PM’s Chief Science Advisor has anything to say about it.
And yes, now the Sciblogs.co.nz folks do know about it cos I’ve sent my fellow bloggers the link to PZ’s post & will try to write something myself.
Bare faced, simplistic, logical take on the matter:
Premise 1: Some aspects of TCM are both safe and effective.
Premise 2: Other aspects of TCM are neither safe nor effective.
Premise 3: The lack of assured safety and efficacy makes TCM objectionable when modern medicine is available.
Premise 4: Strict regulation of TCM will ensure that only safe and effective elements of TCM are practised.
Discussion: From Premise 4 it follows that the objectionable aspects of TCM will not be practised. From Premise 3 it follows that those aspect of TCM which are practised under strict regulation will not be objectionable. Any remaining practices which are safe and effective will constitute a different discipline, let’s call it RCM (Regulated Chinese Medicine). RCM will not be objectionable.
Conclusion: Strict regulation of TCM is to be favoured.
You forgot 5:
Some (most) of TCM is safe but totally ineffective.
Um, here’s the actual submission from the RSNZ…
http://www.royalsociety.org.nz/publications/policy/2011/the-regulation-of-traditional-chinese-medicine/
Bruce @47 When I (politely but forcefully) declined those options, she went ahead with protocol thankfully & scheduled me an appt with a specialist to have an ECV, & then a c-section when the ECV didn’t work. What did worry me however was her encouraging me to try going ahead with a vaginal birth despite my daughter being in a bad breech position. An unnecessary risk imo.
tielserrath: if you have an illness and are given an ineffective treatment instead of an effective one, then you are not being well served by your practitioner. Most government health regulatory bodies, like the FDA in the US, require objective evidence of both safety and efficacy for regulated remedies. In that case, the snake oil should be thrown out too.
I’m all for regulating TCM. Ban it all until each remedy can be proven to be effective against the maladies for which efficacy is claimed and safe for the patient.
Some Chinese folk cures do work, but in my limited experience those working cures are applied by people without ever visiting the acupuncturist or the herbalist. When people don’t know of an effective folk cure then they waste money on the acupuncturists and herbalists. Some of the plant ingredients used can be fatal to humans, such as the ephedra root.
The TCM (and other voodoo) practitioners don’t really want regulation, they want blind approval. I say regulate ’em.
So is this regulation going to prevent the practice of draining bile from bears stuck in tiny cages and other bullshit like rhino horn harvesting and such that is so central to “TCM”?
Fuck TCM and no government should be giving it the pallor of legitimacy by regulating it unless the regulation is designed to kill it once and for all.
@Placibo#18: You don’t understand placebos. Except in the cases of hypochondriacs and incurable diseases, placebos literally do nothing. In the case of incurable diseases (and uncontrollable pain), the effect is merely psychological and not physiological (even though the patient may claim a reduction in some physical symptoms) – essentially it may calm the patient for a moment at best. This is why many decent clinical trials have a well planned placebo – it is essential for estimating the true efficacy of a drug vs. the patient’s enormous capacity for self-deception. (Placebos are not essential for all trials because there are cases where other tests can be used to make an objective assessment of the drug/therapy.)
Hell, at this rate why don’t we just cut to the chase and ban any suggestion that people experience diseases differently? Clearly, subjective experience isn’t a convenient object of scientific study — therefore it’s meaningless, and any suggestion that a person might have a subjective experience of relief of suffering when they shove their fingers in their ears and hum “woo, woo, woo” must be prevented by a government-enforced no-fingers-in-the-ears policy!
Seriously — yeah, most of it’s bullshit by any evidence-based standard. And anyone who’s sick should see someone who applies evidence-based medical science. But if people want to seek out a particular elaborate placebo-effect ritual because it’s the one that best fits their psychology, internal metaphors of illness, etc., why should I get indignant about that? I’m perfectly happy just making sure that said woo-based placebo rituals don’t do any evidence-based harm. (I think my personal placebo ritual would mostly involve chasing my evidence-based meds with a great deal of chocolate ice cream. Rather more pleasant than needles or a few drops of water.)
Making TCM a registered profession is legitimizing it. Full stop. It is the exact wrong approach to deal with this woo.
I read a committee report on the Skeptical Inquirer website a while ago, regarding naturopaths who wanted to be licensed/registered in the state of Massachusetts. It was a scathing report, documenting the nonsense, lack of real education of “Drs.”, lack of submission of their techniques to the scientific method, lack of foundational chemistry/physics, and stating point blank that licensing/registering them would be legitimizing them and everything that stems from that. THAT was the right approach. NZ’s is the wrong approach.
NZ: Don’t do it!
TCM is complete garbage, is harmful, fleeces the ignorant of their money, and must be purged.
(As a side note, my wife recently went to see an acupuncturist…at a friend’s suggestion, and essentially for the hell of it. Wow. Talk about hocus-pocus. The “evaluation” had her holding a series of vials of materials, while the “Dr.” tested her straightened-arm strength, all to determine what she was alergic to. Streams of laughter…she said all she got from it was a sore shoulder! Yes, it really is that RIDICULOUS!!!)
for ‘registered practitioners’ read ‘fee paying members’….
in other words “we don’t care. Show us the money!!!”
aimee w: Thanks for the link, but not much more is provided there which was not discussed here. (I suppose that says something in and of itself.) It is barely longer than the quoted passages, and the link itself is in the article (unless it wasn’t at the time you had posted). Yet you probably helped prompt me to download the doc once I had finished reading the comments.
——
The Royal Society seems to think that MS Word documents are a valid medium of document exchange.
The Royal Society took a poll on how a handful of people felt about TCM being regulated as a method of gathering facts on which to base a recommendation.
Noted is that foreign practitioners generally graduate with a Bachelor of Woo degree from a college of woo. Thank heavens those folk are properly trained!
Licensing quackery just adds more bureaucracy, and regulations tend to benefit the regulated, not the public, eventually, if not right off the mark. Unless the regulation take the form of the U.S Marihuana Stamp Act, which was essentially a Catch 22 situation, it can’t really help improve the practice of TCM. Further, if regulation were even effective in the manner in which regulation actually works, it provides for (usually minimal) sanctions after damage has already been done. And what is to stop anyone “illegally” practicing out of their home, like so many do already, under the radar, and never to be reported by their true-believing clientele?
For the application of any possibly effective herbal remedies, these can usually be as effectively administered by the consumer, as by a practitioner. But I notice the complete lack of mention of the bizarre trade in animals and their parts, some from species on the verge of extinction, nor is there a mention of the use of insanely poisonous chemical compounds, some of which contain highly enjoyable elements of the metallic persuasion.
F @ #60:
I suggest you shop them to the appropriate authorities, as they are inmdirectly aiding and abetting software piracy.
I know OpenOffice.org can make a brave attempt to read .doc files, but many Windows users will end up using pirate copies of MS Office.
It would have been much better for them to post the document in the native .odt format used by OpenOffice.org. Then they could be absolutely sure they weren’t encouraging piracy (since it is by definition impossible to pirate an Open Source program).
And it isn’t just the patients who are harmed.