Cross-posted from Huffington Post Canada
On April 1st 2013, Traditional Chinese Medicine (TCM) doctors and acupuncturists in Ontario will need a license to practice their unique brand of healing. This is the first of three vitalistic and unscientific healing practices to start accepting members in Ontario; the naturopaths will be next, followed by the homeopaths. This kind of “legislative alchemy” as described by Jann Bellamy from Science Based Medicine is spreading across jurisdictions all over North America in the under the auspices of protecting the public from substandard care.
Without a licence on April 1st 2013, you will not be able to diagnose heat stagnation by looking at the tongue. Without a licence on April 1st 2013 you will not be able to discern the state of the organs through the pulse in patient’s wrist. Without a licence on April 1st 2013, you will not be able to diagnose a fever caused by the wind, or needle the meridians of the body to unblock stagnant Qi, or, if all else fails, set alight a bundle of mugwort atop those same needles and let it burn until a small scar forms on the skin, to strengthen the blood. No foolin’.
I feel safer already.
The Ontario government is following in the footsteps of British Columbia, Alberta, Saskatchewan, Quebec and Newfoundland and Labrador, to license acupuncture and TCM. It doesn’t seem to matter that in the years since the original report on the college of TCM acupuncture has shown to be nothing more than an placebo. It does not matter where you insert the needles, or even if you insert the needles, all you get are “non-specific therapeutic effects”. In the absence of any efficacy beyond placebo, it is not ethical to expose the patient to the small but real risks of acupuncture, but soon you will have the overt permission of the province of Ontario to do so.
TCM relies on ideas of physiology and anatomy that were left behind by science over a hundred years ago. Qi or Chi is a magical energy field that has never been shown to exist, and “meridians” that are supposed to carry Qi do not correspond to any physical structures of the body, including the nerves or facia. There are plenty of studies on the herbal remedies offered by TCM doctors and herbalists, and this is probably the only promising part of the entire venture, although it is telling that most do not use the traditional TCM diagnosis, like a blockage of Qi, and instead use modern medical problems. However, in the light of the extreme detail we have about how the body works, the idea that discrete areas on the tongue correspond to the condition of the stomach, or the liver, or that the tongue is a continuation of the heart is about as absurd as the idea that the pulse can tell you anything other than the rate, rhythm and output of the heart. We have moved beyond these magical ideas.
We are faced with one striking dilemma, however: people are continuing to seek help from these professions, so what responsibility does the state have to its citizens when they seek help from non-traditional sources? After failing to win the scientific debate, professions like TCM, acupuncture, naturopathy and homeopathy in the past 10 years have turned to the government to gain legitimacy. This is the point that Ballamy makes above. The public see government regulation as a stamp of approval, when outsiders are brought into the mainstream, and professional associations know this. However, while acupuncture and TCM are used by many people, this argument from popularity does not make it true. The government should be focused on treatments known to work ; we have the tools to test their claims, and to ignore these tools in favour of ideology is to deliver the public into the hands of the charlatans.
That word has a lot of baggage, and I don’t use it offhandedly. I use it with the caveat that I don’t think that most TCM or acupuncture practitioners are willingly deceiving the public, but are instead deceiving themselves. Their earnest belief in a system that is much closer to religion than science also leaves us with no recourse when our pleadings for science go ignored or brushed off; you cannot reason someone out of something they did not first reason themselves into.
One note on the question of harm. Most jurisdictions in Canada that have a council that develop recommendations on which professions should be regulated take into account any possible harms offered by the trade. One harm that is continually ignored, to all our peril, is the harm of misdirected care. Turing to alternative medicine for a cure when mainstream medicine has an effective medicine already in place puts the public at risk. Many cry that mainstream medicine results in many deaths through its use, but they forget also to factor in the benefits. Both risk and benefit should always be included in this equation. Most mainstream medicines have risks, to be sure, but so does TCM and acupuncture. With no demonstrable benefit, any risk becomes too much, whether economic or physical: this cannot be forgotten when choosing who to turn to for help.
Come April 1st, choose wisely.