Monday, May 2, 2022

Acupuncture, TCM, or alternative medicine in general will be fully deciphered

M.D. Anderson (MDA) Cancer Center, the best cancer hospital in the US, posted a message to Facebook, "Pressing pressure points and energy channels that we can’t see may help with headaches, nausea and anxiety." Most readers cheer for or agree with the message. But one reader, a former MDA employee and also cancer survivor, criticized MDA for bringing alternative medicine into its toolbox when even the terminology used by alternative medicine is unscientific, thus tarnishing the image of MDA as a prestigious hospital. He says "What energy channels? What basis is there for the existence of these channels? I note that “Qi” is always placed in quotes. Why? If it’s something that can truly be manipulated, it ought to have an actual name and evidence of its existence. If not, then MD Anderson ought not be promoting something that has no basis in fact."

As usual, this type of questioning leads to a hot debate, and the original poster (MDA) decides to filter out all messages except this reader's initial message and MDA's direct response. My long response to the reader's message is among those filtered out as well. But I'd like to present it below.

The terms "qi", "energy channels" etc. indeed sound pre-scientific. But lack of understanding of the real mechanisms and temporarily using these terms should not blind us from tried-and-proved efficacy of acupuncture to improve certain symptoms, most notably pain. Your attitude is very understandable, and I'd like to compare that to Einstein's toward the probabilistic nature of small particles such as electrons; his "God does not throw dice" implies that he believes the true, non-probabilistic, definite time and place of any particle will eventually be revealed and the quantum phenomena are just one stage in the history of science. Well, we don't know if he'll eventually be proven right on that but we're quite sure many pre-scientific-sounding terms and the theories associated with them in alternative medicine are being rendered unnecessary. Just like we no longer say four humors of a human body, we're gradually substituting pharmacological findings for TCM's classification of herbs into hot-cold-mild-sweet-... The latter can still be retained for pedagogically convenient tools or mnemonics. As to acupuncture, for some reason, the study of the mechanism is far slower than pharmacology. (I recall reading an article about a Chinese Academy of Science biophysicist's research in 1980's.) But just because we don't know the true nature of it doesn't mean we should stop using it if it doesn't cause serious side effects and it works most of the time. (For instance, one pressure point, called 风池--I have to look up the English name--has remarkable reproducibility in temporarily relieving headache.)

The gold standard of double or single blind trials has its limitations, particularly when it comes to pain management (and I think one more field, psychiatry). It's almost impossible for the trial participant to not know if he's in control or intervention group. Instead of blindly blaming reported effects of acupuncture as placebo effect, other strategies such as N-of-1 trials may be adopted. For all its shortcomings, N-of-1 bypasses the said problem of blind trials and most importantly, tests a specific individual's response. When it comes to pain relief, psychiatric treatment, and probably more, it's a norm not exception for one intervention to be valid for John but not for Jack. Acupuncture falls into this category.

(By the way, I'm sorry to hear that you had cancer but I'm glad it was cured or is in remission. I think it's you that I worked with 16+ years ago on the leukemia project. Back then MDA probably did not have integrative medicine. But I think it's a welcome addition, because it helps relieve certain symptoms.)