Tooth Fairy science about traditional Chinese medicine, promoted in the Wall Street Journal

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They are winning.

I’ve spent nearly ten years on this blog and nearly seven years at my not-so-super secret other blog (where I will likely crosspost this over the weekend) discussing the infiltration of quackery into medicine, both in academic medical centers and, increasingly, even in community medical centers. There’s a term that I wish I had coined but do frequently use to describe this infiltration: Quackademic medicine. Over the last 30 years or so, what was once quackery, rightly dismissed in a famous 1983 editorial in the New England Journal of Medicine as a “pabulum of common sense and nonsense offered by cranks and quacks and failed pedants who share an attachment to magic and an animosity toward reason” has become mainstream, evolving from quackery to “alternative medicine” to “complementary and alternative medicine” (CAM) and finally to “integrative medicine.”

At each stage, the idea was to rebrand medicine based on pseudoscientific, mystical, and/or prescientific beliefs as somehow being co-equal with “Western” or “scientific” medicine through the clever use of language, whose latest term, “integrative” medicine is a near perfect Orwellian twisting of language meant to imply that what is happening is the “integration” of what advocates of integrative medicine like to call the “best of both worlds.” Of course, as I and others have pointed out time and time again, when you “integrate” quackery with science-based medicine, as is becoming so common in quackademic medical centers, you don’t instantiate the quackery, nor do you make medicine better. Let’s just put it this way. When you “integrate” modalities like “energy healing,” of which reiki, for example, is nothing more than faith healing and intercessory prayer (distant healing), substituting Eastern mystical beliefs for Christianity as its basis, can it honestly be said that medicine is improved? Does mixing magical thinking with science help patients?

If you want to see just how successful quackademic medicine has been at not only infiltrating itself into what should be bastions of science-based medicine but at changing the very terms and language under which it is considered, just look at this article that appeared in the Wall Street Journal yesterday by Shirley S. Wang entitled A Push to Back Traditional Chinese Medicine With More Data: Researchers Marry Modern Analytical Techniques to Centuries-Old Theories on What Makes People Sick:

Traditional Chinese medicine teaches that some people have hot constitutions, making them prone to fever and inflammation in parts of the body, while others tend to have cold body parts and get chills.

Such Eastern-rooted ideas have been developed over thousands of years of experience with patients. But they aren’t backed up by much scientific data.

Now researchers in some the most highly respected universities in China, and increasingly in Europe and the U.S., are wedding Western techniques for analyzing complex biological systems to the Chinese notion of seeing the body as a networked whole. The idea is to study how genes or proteins interact throughout the body as a disease develops, rather than to examine single genes or molecules.

“Traditional Chinese medicine views disease as complete a pattern as possible,” says Jennifer Wan, a professor in the school of biological sciences at the University of Hong Kong who studies traditional Chinese medicine, or TCM. “Western medicine tends to view events or individuals as discrete particles.” But one gene or biological marker alone typically doesn’t yield comprehensive understanding of disease, she says.

As if to drive home the “integrative medicine” narrative that TCM is equivalent to “Western” medicine, there’s even a truly infuriating illustration of a stylized human body, half of which is TCM and half is “Western medicine,” with “Western medicine” ascribing the cause of the example, rheumatoid arthritis, to autoimmune disease, with treatments listed as being nonsteroidal antiinflammatory drugs, steroids, disease-modifying antirheumatic drugs to slow disease progression. On the other side, TCM postulates as the cause of rheumatoid arthritis the “blockage in flow of qi and blood in the energy pathways of the body; wind, cold, and damp penetrate the body and get into muscles, joints; there are different forms of arthritis depending on if wind, cold, damp, or heat predominate.” I kid you not. And the treatment? Acupuncture, tai chi, and herb thunder god vine. I’m saving this poster for use in future talks to illustrate just what I’m talking about, so emblematic is it of the false equivalence “integrative medicine” lends to prescientific, unscientific, and pseudoscientific ideas. The overall idea communicated by the illustration? That TCM’s magic-based description of the pathophysiology and treatment of rheumatoid arthritis is worthy of being considered along with the science-based knowledge, gathered over decades, of what causes rheumatoid arthritis and how to treat it.

This narrative has become so depressingly common that it ought to have a name. “They thought it was quackery but now it’s science”? Too long, but that’s the false message of every one of these stories, which is that they thought us mad, mad, I tell you! But now we’re showing those nasty, close-minded, reductionistic “Western” doctors! Except that they aren’t, and this story inadvertently shows why they aren’t. Still, a punchier name for the trope would be useful. “They thought us quacks,” maybe? The “we’re really, really science, maaaan” trope, perhaps? Perhaps you can help me out. I’ll leave thinking of a pithy, punchy name for this trope as an exercise for the reader in the comments.

In the meantime, let’s take a closer look at the article. It’s based entirely on the very hubris behind “integrative medicine,” namely that medicine based on prescientific and religious beliefs, like traditional Chinese medicine, is at least nearly co-equal with medicine based on science and rigorous clinical trials. Or, at least, it would be equal to scientific medicine if there were actually some evidence for it, which these brave maverick doctors and scientists are furiously searching for, no matter how much they have to torture modern systems biology and molecular biology techniques to shoehorn TCM’s fantasy-based “networks” into networks of gene activity being increasingly understood by modern molecular biology. Look at the passage above. Wan claims that TCM views disease as “complete a pattern as possible.” Really? Would she say the same thing about ancient “Western” medicine? After all, ancient “Western” medicine believed that imbalances in the four humors (phlegm, blood, yellow bile, and black bile) caused disease. TCM postulates that ascribes illness to six pernicious influences, which include wind, cold, heat, dampness, dryness and summer heat, which are, like totally not like the four humors. (There are, after all, six pernicious influences.) TCM also has the “five elements” (fire, wood, earth, water, and metal), which are associated with different organs. So maybe TCM is on to something because its prescientific beliefs were more complicated than Western prescientific beliefs. That means they must be better, right?

I know, I know. Regular readers are wondering why I’m using the term “Western” medicine given that I find the whole “East-West” dichotomy favored by advocates of TCM and “integrative medicine” to be borderline, if not outright, racist. After all, the unspoken assumption behind this dichotomy, whether those using it realize it or not, is that the “West” is cold, reductionistic, and scientific while the “East” is “wholistic” and connected to the human. It’s all pernicious nonsense, of course, insulting to Chinese and other Asian scientists. Science is science, and those in the “East” can do science as well as we “Western” scientists can. What counts are evidence, experiments, and reason, none of which knows “East,” “West,” “North,” or “South.”

Another trope is plain in the passage above. Where “Western” medicine is presented as “reductionistic.” Note the bit about viewing events or individuals as “discrete particles” and how “one gene or biological marker alone typically doesn’t yield comprehensive understanding of disease. We hear this time and time and time again, but no one can tell me how viewing organs as related to “five elements” (which are not actually elements, of course) and disease as being caused by six pernicious influences is in any way “wholistic” or more “wholistic” than viewing disease as being due to imbalances in four humors. Moreover, although in metabolism science has always looked at whole networks (e.g., glycolysis, the Krebs cycle, oxidative phosporylation, and all the metabolic networks that feed into these pathways), part of the reason why science focused on single genes for so long is because it was limited by the technology. It wasn’t until about 15 years ago that the tools were developed to start looking at, yes, “wholistic” changes in gene expression using whole genome expression profiling, which allows the detection of changes in the expression of every known gene in the genome. Since then, we’ve only become better at this. Using next generation sequencing techniques, it’s possible to examine changes in expression of every transcript in the genome, coding and noncoding, simultaneously, and the technology has gotten to the point where it is now becoming possible to examine the changes in gene expression of the whole genome of single cells.

Much of the second half of the article deals with what TCM refers to as “hot” or “cold” syndrome. I swear, when I saw this next passage I couldn’t believe an otherwise intelligent journalist could write something so ridiculous with a straight face:

One promising area of TCM research several independent groups of scientists are investigating is the notion of hot and cold syndromes. The work is still in its early stages. But it could result in a new direction for TCM research by using the systems biology approach and integrating it with experience gleaned from TCM patient care, says Yale’s Dr. Cheng, who also serves as chairman of the Consortium for the Globalization of Chinese Medicine.

In a series of studies, Tsinghua’s Dr. Li and his colleagues examined people with hot and cold syndromes and whether they exhibited different signs of illness, including gastritis, a common digestive disorder in which the lining of the stomach becomes inflamed or irritated.

To gauge whether gastritis patients had cold or hot syndromes, researchers asked questions like whether individuals had chilly body parts or exhibited a preference for hot beverages or a susceptibility to catching colds. Doctors dug into their subjects’ emotional states, asking whether they experienced so-called cold feelings like apathy. The scientists also measured proteins linked to gastritis and took measurements of the bacteria in the gut and imaged the bacteria in the tongue’s coating.

They found some variations depending on whether patients were identified as hot or cold. They also found differences in the bacteria of patients’ tongues that corresponded with tongue coating color and whether patients had been diagnosed with hot or cold syndrome.

One might as well run systems biology experiments on patients subjected to magical incantations, because that’s basically what is happening here! As I’ve said before, if the treatments and diagnostic modalities being tested are prescientific or pseudoscientific, using all the flashy new science in the world won’t make the experiment science. If there’s one thing I see in common with experiments examining whether “hot” or “cold” diagnoses correlate with changes in biomarkers and other laboratory values is that they tend to be small studies, prone to false positives, and to be massive fishing expeditions, with large numbers of comparisons. In this they remind me of some homeopathy studies.

Consider what it is that TCM means by “hot” and “cold” diagnoses. The root of the “hot-cold” dichotomy is not based on any science. Rather, it’s based in Taoist religion, the “Yin Yang theory” of disease. As described here, TCM states:

The root of many of the ideas within Chinese medicine lies in the concept of Yin and Yang. Yin and Yang are emblems of the fundamental duality in the universe, a duality that is ultimately unified. Yin and Yang are complementary, and not contradictory. Nor is one regarded as ‘good’ and the other ‘bad’. People will often state that, “I am Yin”, or “I am Yang”, but this would be inaccurate; they may have a Yin-Yang imbalance or tendancies, but everyone has both qualities.

Harmony is sought between these Yin and Yang qualities and any imbalance avoided when approaching the body as a holistic union. Yin is matter like Blood, fluids and tissue in the body. Yang is the action potential, Qi, and heat in the body. Chinese medicine balances Yin and Yang and can also build these qualities in the body when they are deficient. No one person is completely Yin or Yang; rather, one would look for tendencies and patterns, and weigh them out; one organ system may have Yang excess while another organ system in the same body can have Yang Deficiency.

From the same source, we learn that “yang excess” or “yin deficient” signs include things like constipation, thirst, dark yellow urine, red tongue, dryness, heavy loud respiration, burning bowel movement, and strong body odor. (I suppose the last two probably go together.) We also learn that signs of “true heat” include blood in the nose, stool, or urine; yellow green mucus; fever; and sticky, thick excretions. These are the sorts of things that TCM practitioners look for and ask about. I suppose it’s possible that certain biomarkers might be different in people with true heat or yang excess or yin deficiency, but whether those have anything to do with a disease like rheumatoid arthritis due to anything other than coincidence is unlikely.

It’s all utter nonsense, of course. It’s as perfect example of what Harriet Hall likes to refer to as Tooth Fairy science as I’ve ever seen. Basically, Tooth Fairy science involves applying the scientific method to phenomena that don’t exist. As Harriet’s pointed out many times (and I’ve echoed), we can study the amount of money left by the Tooth Fairy in different settings, but since we havent’ determined that there really is a Tooth Fairy, any conclusions we reach will be falsely attributed to a magical being, rather than to the real cause. The prescientific beliefs behind TCM are are a lot like the Tooth Fairy. It’s not for nothing that a Chinese physician has issued a TCM challenge, not unlike James Randi’s million dollar challenge to TCM practitioners to prove their methods.

Lots and lots of research money is being wasted studying prescientific superstition such as qi, yin and yang, and “hot” and “cold” applied to human disease, and universities are embracing such twaddle with both arms. Just this year, for instance, the Cleveland Clinic opened an herbal medicine clinic run by a naturopath practicing largely TCM (mentioned in the article). Dozens of academic medical centers offer this sort of quackery to their patients, in the name of supposedly wanting to study it, but if they don’t know it works how can they offer it as anything other than experimental therapy? Instead, they offer it as though it were validated medicine. Meanwhile, TCM advocates try to sell this prescientific form of medicine as though it were somewhere on the same planet, evidence-wise, as scientific medicine when it is not. Let’s just put it this way. You can make up all the complex “networks” and “systems” that claim to describe human physiology and disease as you want, but if they aren’t grounded in reality and evidence they’re nothing more than fantasy. Indeed, fantasy is what is being “integrated” with scientific medicine, fantasy like TCM.

It should anger you. It should anger anyone who cares about science and medicine. Sadly, the reaction of the vast majority of physicians is a shrug.