Laura Chadwick
NuHerbs Scholarship Application Essay
April 7, 2008
The term “traditional” was ironically attached to “Chinese medicine” to describe the newly codified and scientized version of ancient Chinese healing therapies that emerged in the 20th Century. Mao Tsedong agreed that Chinese medicine constituted a “national treasure,” authorizing the formation of professional associations and funding for training colleges. It wasn’t until the social scientism campaign of the 1980’s that state-funded training college campuses were rebuilt, decaying infrastructure rehabilitated, nationalentrance and exit exams were instituted and the project of “scientizing” Chinese medicine took root. Furthermore, young, newly trained doctors found themselves competing internationally for funding, causing them to eagerly adopt “certain empiricist apologetics,” (Farquhar 1994:19). In this way, China absorbed “Western” cultural practices.
In the aftermath of Globalism’s furious expansion of the 1980’s and 1990’s, social theorists question whether biomedicine can be called “Western” anymore. The medical anthropologist, Arthur Kleinman notes that biomedicine is rapidly being incorporated into geographically and culturally diverse settings and adapted to suit local cultural protocols. Likewise, China’s booming economy is a signal not only of heavy international investment in the Chinese economy, but that Chinese cultural practices are also being exported. TCM is one of those practices. In the United States, TCM is categorized as an “alternative” medical system. Complementary and Alternative Medicine (CAM) is one of the fastest-growing fields of medical research. According to the National Center for Complementary and Alternative Medicine (NCCAM), there were 10,000 nationally certified acupuncturists in 1995. Only five years later, that number doubled to about 20,000 (NCCAM 2004). Federal funding for CAM research has increased from $2 million in 1992 to $68.7 million in 2000 (Goldstein 2002:46). Funding for the National Center for Complimentary and Alternative Medicine (NCCAM), which operates under the auspices of the National Institute for Health (NIH) has increased in recent years while federal funding for the rest of the NIH has remained more or less static (Goldstein 2002:58).
A handful of Medical Anthropologists have begun inquiring into the reasons non-Chinese Americans choose TCM and how the practice of TCM is being adapted to U.S. society. For example, the medical anthropologist, Martha Hare writes that in New York City, Americans’ choice of Chinese Medicine stemmed directly out of individual, personal experiences with illness rather than scientific research into medical literature. Many of Hare’s informants came to Chinese Medicine after disappointment with biomedical care and doctor-patient interactions. She theorizes that biomedicine fragments the patient’s experience of illness, losing site of the totality of the individual’s state of health. Patients in this ethnography speak highly of the attention they felt they received from their Chinese Medicine doctor.
This ethnography highlights biomedicine’s catch-22: biomedicine’s strength and efficacy stems from its epistemological orientation towards the infinitely divisible and observable nature of the human body and illness events, but it is precisely this orientation that prevents biomedicine from adequately acknowledging the complex social origins of disease and the complex social and moral experience of illness. Arthur Kleinman writes that, “Because it eschews teleology[1], the very idea of a moral purpose to the illness experience is a biomedical impossibility,” (Kleinman 1995:32).
The primary emphasis in Chinese medical practice is not book-learning or theory, but shijian, experience. The site of experience is the doctor in the clinical setting. The doctor must use his/her own judgment to mediate between textbook knowledge and the patient’s illness. As the patient’s illness shifts and changes day by day, so too must the doctor’s assessment, interpretation and prescription. Therefore, the clinical encounter, as “humble” as it may appear (Farquhar 1994:228) to Western readers, represents a model of continually functioning agency.
Of the few anthropologists that have done research into Chinese Medicine in the U.S., all of them agree that its acceptance, adaptation and exponential expansion in America began as a grass-roots movement, emanating from the “ground up”. Here lies TCM’s strength and potential for growth.
Not only does TCM seem to provide the patient with a more holistic experience, with the doctor inquiring into the social contributions of the patient’s illness, considering the patient’s quality of life, TCM’s “efficacy” is beginning to accumulate documentation in American clinical research. Additionally, stirrings of TCM’s greater cost-effectiveness, especially for treating chronic problems, have attracted interest from both private and state-run health insurance companies.
Although little is still known about TCM’s cost-effectiveness, three major European studies have indicated financial benefit to alternative medical treatment. One study from Spain published in the journal Acupuncture in Medicine in June 2007 showed that acupuncture treatments reduced patient expenditure on pain-killing anti-inflammatory drugs (and therefore overall expenditure on pain management). Two other studies published in the United Kingdom pointed to cost-effectiveness in treating migraines and low-back pain (MacPherson 2006:838). Unfortunately, there is not enough published data to say with certainty that TCM could alleviate overall health care expenditures for a major government health care programs like Medicare.
One of the major problems in gathering reliable data in a format that is culturally relevant to Americans and Europeans and acceptable to policy-making institutions is how to design clinical trials. Very few guidelines are in place anywhere in Europe or the U.S. to determine whether a CAM study proposal is sound. Although the NCCAM developed general suggestions for gathering evidence of the efficacy of TCM and other “whole medical systems” about two years ago, the NCCAM has not developed specific guidelines for study designs. The Medical Research Council in the U.K. and the Norwegian National Research Center in Complementary and Alternative Medicine (abbreviated NAFKAM) have also sponsored conferences devoted to defining whole systems research, but like NCCAM, have not yet issued formal standards for research design. This leaves funding institutions with little to work with in trying to determine which proposal presents the strongest potential for gathering reliable results. (Boon 2007). As things stand today, many “randomized controlled trials” (RCTs) exclude any input from TCM practitioners. Therefore, clinical trials on TCM efficacy must make an effort to recruit TCM doctors to their research teams. Students of TCM in China and the United States must be offered training in clinical medical research methods as well, so they can be prepared to act as cultural brokers between the two systems.
In the mean time, the cost of providing conventional biomedicine continues to increase each year (Moon 2006:393). U.S. society continues to age, falling subject to chronic health problems like obesity, diabetes and osteoarthritis, all of which biomedicine have trouble coping with. Even infectious diseases are becoming drug resistant and re-emerging. The rising costs of health care present a serious economic and ethical challenge to U.S. society. For example, Congress’s only solution to funding health care for the elderly is to encourage privatization. Privatization itself poses ethical problems in that it tends to shut out the very sick and poor from health insurance options (Moon 2006:390-91).
Now is the time to invest effort and money in researching TCM, a modality that offers attention to quality of life using simple, inexpensive treatment methods. The exchanges between biomedicine and TCM have blurred the lines between the two and Chinese Medicine is in a prime position to become a useful tool in American society to cope with chronic illness and re-emergent diseases. TCM is a strong candidate for future research and investment on the part of “Western” governments. The more deeply integrated TCM becomes in the American medical system, and the more clinical research is forced to modify its research techniques to accommodate TCM’s unique synergistic use of acupuncture and herbs, the more the term “Chinese” will only refer to it’s place and culture of origin, rather than its location of primary application.
References
Boon, Heather, Hugh MacPherson, Sue Fleishman, Sameline Grimsgaard, Mary Koithan,
Arne Johan Norheim, Herald Walach. 2007. “Evaluating Complex Healthcare
Systems: A Critique of Four Approaches”. eCAM. 4(3) 279-285.
Chiang, Poney. 2007. “Evidence-Based Oriental Medicine and the Future of Integrative
Medicine”. Oriental Medicine News. Pacific College of Oriental Medicine.
Spring.
Farquhar, Judith. 1994. Knowing Practice: The Clinical Encounter in Chinese Medicine.
Westview Press. Oxford & Boulder.
Goldstein, Michael. 2002. “The Emerging Socioeconomic and Political Support for
Alternative Medicine in the United States”. Annals of the American Academy of
Political and Social Science. Vol. 583. Global Perspectives on Complementary
and Alernative Medicine. September 2002. pp. 44-63
Kleinman, Aurthur. 1995. “What is Specific to Biomedicine?”. Writing at the Margin:
Discourse Between Anthropology and Medicine. Berkley: University of California
Press.
MacPherson, Hugh. 2006. “Acupuncture Research: Time to Shift from Theoretical to
Practical Questions”. The Journal of Alternative and Complementary Medicine.
Vol. 12, No. 9, pp. 837-839
Moon, Marilyn. 2006. Organization and financing of health care. In Robert H. Binstock
and Linda K. George (eds.), Handbook on Aging and the Social Sciences, Sixth
Edition, 380-396.
“NCCAM Information and Resource Package”. 2004. National Center for
Complementary and Alternative Medicine of the National Institute of Health
(NIH). NCCAM Clearinghouse.
1
[1]“The doctrine that phenomena are guided not only by mechanical forces but that they also move toward certain goals of self-realization.”teleology. (n.d.). Dictionary.com Unabridged (v 1.1). Retrieved April 07, 2008, from Dictionary.com website: