East and West are about to Meet – Traditional Chinese Medicine as a BC University Discipline

Submitted by Joseph Ranallo, BA (Hon), MA, R. Ac.

It is not surprising that, on the eve of what could be one of the BC Liberal government’s most recent and enlightened health care decision, that the Doctors of BC Association, formally the BC Medical Association, should object to the province’s January 24, 2014, announcement that, as early as 2015, Kwantlen Polytechnic University may host the first Traditional Chinese Medicine (TCM) public funded diploma program in British Columbia.

The current Doctor’s Association and its predecessor have complained before. In 1996, the BC Medical Association objected to the BC government’s creation of the CTCMA, the body that licenses and regulates BC TCM practice. In the late 90’s, the same Association opposed the BC government’s initiative to provide TCM patients with the MSP coverage. Last year, following the Liberal government’s 2013 pre election throne speech, in which the government announced its intention to make TCM a university discipline, the Doctor’s objected again.

This time, in Carlito Pablo’s February 5, 2014 Georgia Straight article, “Traditional Chinese Medicine is still a divisive issue in BC,” Doctors of BC Association’s chair of the counsel on health promotion, Dr. Lloyd Oppel, argued, in a phone interview, that, because the government has failed to considered the “perspective of the scientific medical community” in its current decision, it may be putting the public at a health risk. Let’s consider the evidence that Oppel presents to support his case.

Oppel contents that some Chinese herbal ingredients may be toxic. To support his contention, he alludes obliquely to the unfortunate misuse of a member of the Aristolochia plant genus by a practitioner from Europe who, at the time, may not have been following TCM protocols. Because of this highly publicized case, in 2001, Health Canada removed this plant genus from the market.

This plant, which according to a Wikipedia entry (http://en.wikipedia.org/wiki/Aristolochia) consists of over 100 species worldwide, has not only been a part of TCM, but has also been a component in the medicine systems of the ancient Egyptians, Greeks, and Romans. More recently, it was included in the allopathic medical practices of Germany, the Netherlands, Belgium, and other western countries. For centuries, products from this plant genus have been included in what, today, we consider to be Western Medicine and its fore runners. Is Oppel suggesting that, because, until recently, it too has had a long history of using ingredients from the Aristolochia genus, Western Medicine should be eliminated from the university curriculum? Is he, in fact, suggesting that his own credentials should be questioned? If he is not, his argument about keeping TCM from a university curriculum because it has used this herb, in the past, does not hold water. According to the old cliché, what is good for the goose has to be good for the gander.

Today, TCM practitioners work closely with Health Canada to insure that ingredients from the Aristolochia genus are so highly controlled that they are almost impossible to purchase through legal channels. We have to wonder why Oppel would even consider referring to this incident that was dealt with well over a dozen years ago. Surely, a true scientist would be much more current in his research.

Moreover, Western Medicine presents a long history of recalling substances that have been found to be harmful after passing the Phase 3 clinical trials. The Wikipedia article, ‘Lists of withdrawn drugs,’(http://wikipedia.org/wiki/List_of_withdrawn_drugs) cites well over 150 pharmaceuticals that fall into this category. From the 1960’s to the present, these drugs have been recalled from the Western Medicine practiced in Europe, the Americas, Australia, Asia, and Africa. This list includes the infamous Thalidomide (1961) that some of us, who are old enough still remember its horrendous and devastating consequences after it was prescribed for nausea and morning sickness during pregnancies. Although the drug has been recalled, it was reinstated later for some serious cases of cancers and leprosy.

Is Oppel insinuating that, any medical system that has prescribed medicinals that, before their recall have harmed patients, is too dangerous to receive university status? If he is, where does that leave Western Medicine?

Oppel further states that if “ … the courses being offered are not based on good evidence or if there is good evidence that the treatments being offered are ineffective or harmful, then, you know, offering things that are not really safe in a university context… then there is a risk the public may be harmed.” The Wikipedia entry on ‘Iatrogenesis’ (http://en.wikipedia.org/ wiki/Iatrogenesis), estimates that the following Iatrogenesis deaths occur yearly in the United States alone:

!2,000 from unnecessary surgeries;

7,000 from hospital medication errors;

20,000 from hospital errors;

80,000 from nosocomial;

106,000 from negative effects of drugs. (p.4)

Although the article explains that these deaths are not always deliberately and knowingly caused by incompetent physicians and/or inadequate health care facilities, they, nonetheless, do occur. According to Oppel’s so called scientific reasoning, universities, who should be fully aware that these things have happened, should not be putting patients at risk by offering Western Medical training.

The TCM Iatrogenesis are far less spectacular and infrequent. Last year, a Toronto based Massage Therapist who had learned what little he knew about Acupuncture through private studies and a course delivered on several weekends, caused an Olympic class athlete to suffer a pneumothorax that brought his competitive career to a sudden end. This unfortunate incident, caused by a practitioner that our own CTCMA would not have licensed to practice because his training was inadequate, was so rare and unusual that it attracted the attention of the national press. If this negligence had been perpetrated by a western doctor, the press would likely not even have noticed it.

Oppel can be forgiven for presenting these questionable positions. After all, he is the chair of his Association’s committee charged with promoting his own profession. But for the same reason, we must take his words with the traditional grain of salt. What he has done in these cases is nothing less than irresponsible, but understandable posturing and turf protection.

But what he has to say about Acupuncture, is totally un absolvable. He describes this most ancient, most complex, and most precise healing modality as “a random poke in the skin.” Whereas his previous comments reveal his bias, this definition reflects either his ignorance or maliciousness or both.

If Oppel really understood the complexities of Acupuncture, he could not possibly have arrived at this limiting definition. To select a specific acupoint, a fully trained, competent, acupuncturist must, among many other details, consider the interaction among the five Elements (Wood, Fire, Earth, Metal, and Water), must be familiar with  the organs associated with each element, must know the emotions associated with each organ imbalance, must be able to trace  the pathways of the Meridians that transport the Qi among the organs and elements, and must know precisely where the individual acupoints exit the skin. The Acupuncturist must be able to determine all of this by palpating the human wrist pulse, examining the patient’s tongue, and asking the right questions to arrive at an accurate diagnosis. To pass their licensing examinations, Acupuncture students must demonstrate their ability to locate acupoints within a three mm. margin. If they are unable to do this, they are simply not licensed to practice in BC. This requirement demonstrates that their point location skills are anything but random.

Victoria based Doctor of Chinese Medicine, Dr. Xiaochuan Pan, the recent author of Classical Chinese Medicine Made Visible, states that the earliest Chinese practitioners claimed that a Classical doctor had to know “the heaven above, the earth below, and the human in the middle” (p. 3). This is quite an undertaking, certainly more than what Oppel’s insulting definition would imply. We have to assume that, if Dr. Oppel really knew all this and was entirely honest and ethical, he would not have arrived at such an inflammatory definition. If he knows even some of this and can still defend his word choice, then his motives have to be questioned.

Oppel identifies himself as a member of the elite “scientific medical community.” Science, as we know it, is a fairly recent phenomenon. It offers one of many forms of logic. Although some naïve people would force us to believe otherwise, it certainly is not the only system of reasoning and learning. Traditional Chinese Medicine predates science by approximately six thousand years. As Pan passionately maintains in his new text, it  is unreasonable to subject TCM to a system that is so far removed from its origin. (p. 63). We do not subject the Great Wall of China or the pyramids built worldwide to today’s building codes. Yet these structures have stood the test of time. The civilizations that built them must have had access to other knowledge systems that pre date modern science. The same can be said about TCM.

The scientific method of reasoning does not answer all questions satisfactorily. Nor does it always work in favor of Western Medicine. Let me illustrate. We all like to believe that the medical doctor’s work save lives. If our premise is correct, then, when the doctors stop working, human mortality should increase. With this premise in mind, let us examine, for a moment, what has happened when doctors have participated in lengthily and major service interruptions such as strikes.

There have been several major doctors’ strikes in the last sixty years. Some of the longest ones took place in the 1960’s and 1970’s in various parts of the world: Saskatchewan (1962), Israel (1973), Columbia (1973), and Los Angeles (1976). During each of these strikes, the mortality rate actually dropped by 18 to 5o %. (Ranallo, Vancouver Sun, Letters to the Editor, February 22, 2013) Scientific reasoning would lead us to conclude that the doctors’ work may actually pose a life threat to their patients. This simple example should help us see that scientific reasoning has its limits.

We do not dismiss either Science or Western Medicine. We recognize their place in our complex, modern world. What we resent is an officer from Western Medicine using the prestige of his position to present criticisms of TCM that apply just as readily, if not more so, to his own profession.

Science is neither good nor bad. It just is. It is what we do with it that colors it. And, as Philip Coppens concludes in the Lost Civilization Enigma, for some people, science has become the new Inquisition that attempts to maintain the status quo by burning, at the stake, those who challenge it. ( p. 59). It is most unlikely that Oppel’s intention is to actually burn those who support the inclusion of TCM into a university system. But through his questionable comments, he is unethically attempting to mislead people to doubt the credibility of TCM, an amazing, safe, time tried, and ancient health care modality. Instead, as the officer in charge of health promotion for his own Association, he should not publically malign TCM or any other health care systems that, for the benefit of the patients, Western Medicine should endorse as partners in healing.

In his article, Carlito Pablo has presented a reasonably balanced view of the issue—whether TCM should be offered as a university discipline. He has given a fair and considerable amount of print space to Poppy Sabhaney, who speaks for the BC community of TCM practitioners. Although Sabhaney does correct some of the misinformation Oppel presents, he retains a positive and objective tone. He states that TCM ”… is as valid as western medicine” and that they “… both have their place” in BC’s health care system. As such, he represents the voice of reason, something that we need to cultivate to provide BC with the best health care choices.

Pablo is also fair to the BC Ministry of Health. He provides Minister Amrik Virk with the opportunity to explain why the Liberal government is supporting this recent move. The government, Virk insinuates, has listened to the people and wants to give them the choice they seek. Virk states that he is comfortable with this choice. “If one association has a slightly different view,” he states in a phone interview, “I am not going to be alarmed by that.”

Virk also dispels the accusation that the 2013 government’s pre election throne speech announcement that, in its next term, it would explore ways of making TCM a BC university discipline, was merely a political gesture to secure votes. “It about promises made and promises kept,” Virk stated. If the throne speech announcement had been designed only to draw votes from BC’s Chinese community, Premier Christy Clark, could have dropped the issue following her government’s undisputed victory at the polls. Because she did not, we have to assume that she was sincere when she endorsed the content of the throne speech.

Recently, the government has made three critical moves that continue to suggest that its interest in TCM is genuine. On January 24, it announced that the inaugural program would be hosted by Kwantlen Polytechnic University. This is an optimistic choice because it is well known that this university has wanted to do this. Dr. Tru Freeman, Dean of Kwantlen’s Faculty of Community and Health Studies, has demonstrated both her university’s and her own personal  commitment to make TCM into a serious university discipline through her voluntary and repeated presence at several recent Greater Vancouver based TCM functions. She has demonstrated to the BC TCM community that it has the support of her university.

Also, in December 2013, Richard Lee, Burnaby North MLA, was appointed parliamentary secretary for Traditional Chinese Medicine in BC. Like Freeman, MLA Lee, has also attended many major TCM functions in the Lower Mainland. At these gatherings, he has gone out of his way to reach out to as many participants as he could. By so doing, he has revealed his long standing commitment to TCM. Because he has done this, he makes an excellent choice for this critical office. Both the TCM community and the province will benefit from his supportive leadership.

And lastly, Minister Virk hinted that the Kwantlen diploma program may be initiated as early as 2015. The close proximity of this date suggests that the government is seriously thinking about this bold and courageous move, a change that BC wants and needs.

So, if East and West have not yet met in British Columbia, they are about to do so at Kwantlen Polytechnic University in the next year. Let us hope that the Doctors of BC will join us to help us celebrate this auspicious occasion, an event that may change health care delivery in this province.  Already, some Eastern and Western practitioners are cooperating to offer the patients the best health care measures available. The general TCM support level has never been higher than  it is today. This historic event will help to intensify this necessary collaboration. The university setting will also provide a platform for BC Eastern and Western Medicine to communicate objectively in an open, highly scrutinized, and ethical academic climate.