Monday, 5 August 2013

Statistics Quo

I loathe Chinese medicine, and I'm not entirely sure why. I wondered if it's simply because both my great-grandfather and my grandmother were both traditional Chinese medicinal herbalists (and acupuncturists to an extent) and I just like to antagonise my forebears. But then again, they were also both Christians and that's indelibly stuck with me?

I don't remember much of my great-grandfather, other than that he had this wooden reclining chair that I loved. He lived about a block away from me when I was a kid, and often I'd run over to his place and plonk myself atop his thin and fragile frame as children do, rollin' his tobacco as he gently rocked the chair. I guess that's probably why I like these types of chairs so much: there's something reassuringly crib-like about them.

They're both death now, but I vaguely recall that one of the last conversations that I had with my grandmother was about the day that my great-grandpa died. Apparently, when they gave me the news (*), I stood up in the cold fury of my then-boyish machismo and demanded that I wasn't going to let him die. I guess that ought to be the kind of story that I should tell if I ever become a doctor...well, a medical doctor, as opposed to a philosophical one (**).

And I know that rationally, given what I know, I probably shouldn't be hating Chinese medicine so much. I mean, it has the potential to actually be efficacious (both as placebo and drug). For example, the best antimalarial drug used world-wide has been employed by traditional Chinese medicinal practitioners to treat malaria for over 15 centuries (in fact, we're using it so much that malaria is beginning to acquire a tiny bit of resistance). Okay, that was somewhat of an extreme example. In particular because the history of how this drug came to be adopted is often paraded around as a prototypical demonstration of the disdain held by conventional scientists for all other paradigms of knowledge (***).

See, the thing about Chinese medicine is that its origins are probably statistically based...and now has evolved into a strange mish-mash of pseudo- and proto-science (****).

At the heart of much of Chinese medicine (at least historically) seems to be trial and error. Let's say that someone got sick in a village, and they hear from their neighbours that drinking the soup made from that tree near the town pond will help them get better. So, they willingly make this soup and two things happen: either they get better or they don't. Now, if the soup actually is an effective medicine, then the odds are that the person will probably get better and so this knowledge will probably be passed on. On the other hand, if it the soup isn't really effective, then it's a bit trickier because it's not just a case of the drug not working and this treatment being forgotten - because the drug could still function quite well as a placebo. Well, actually, the real story is even more complicated, some times the treatment could be useless but people just think that they've not boiled it properly or picked the wrong tree or something like that; and vice versa, you might think that you kinda just got lucky (especially if the soup tasted like and looked like water and you told your mum that she was crazy for thinking that your pernicious sickness could be cured by something so insubstantial).

But whatever the case, over a long period of time (and China has been practicing such herbal remedies for a fairly long period of time, and with a very large population) more than just a few truly effective drugs are bound to result from this. This is effectively a Darwinian method of doing pharmaceutical research.

Now, that all sounds nice and pragmatic, but unfortunately (or fortunately, depending on your beliefs), in the process of developing a scientific model for why and how these medicines function, the absence of an understanding of chemistry resulted in the current Chinese medicinal theory with its undeniable Taoist undertones.

Now I wish that, we can simply stand back in our scientific smugness and mock these prehistoric physicians. But I feel that I must concede that the underlying theory of Chinese medicine, given that it has been derived without the aid of any of the modern investigative tools of evidence-based medicine, is astonishingly functional and reasonable. I mean, the most basic idea is that all symptoms are classified as being either yin or yang in nature. Since yin is meant to be more moist in nature (it means shade), symptoms to do with a lack of yin include cold sweats, dry mouth...etc. And since yang is meant to be more heaty in nature (one of the characters for the Sun), a lack of yang is supposed to manifest in symptoms such as cold limbs (under room temperature), diarrhoea (*****) or having a pallid complexion (it's not quite as well defined as this, but it's just to give you an idea).

And the idea then is that when you get one of these symptoms you often have a lot of the others. For example: when I have the flu, I am likely to have a pallid complexion, I'm likely to feel "the chills" (hence cold limbs) and I might even have diarrhoea. Then, in treating for the chills (e.g.: chicken soup), I might be dealing with the root cause of the other symptoms too.

So, there is some merit to this classification. This yin/yang thing isn't a very well defined variable, but it's surprisingly difficult to disprove it without assuming some knowledge of human anatomy (even then, it's still difficult) - precisely because of this statistical grounding (and to give some perspective on how much human anatomy people understood back then, we didn't even figure out how our circulatory system worked until some time after the first millenia (okay, Galen came close, fair enough. But Galen was a Baus).

Now, you might think that modern evidence-based medicine would have weeded all of this out already, But not so! A lot of medical professionals in China (and out of China too) are being trained both in evidence-based (Western) medicine and traditional Chinese medicine. Now, a part of this is because many doctors are terrible statisticians, but I think that there's also some element of pragmatic dishonesty going on here. Some of the best Chinese medical practitioners are increasingly introducing new language to the theory of Chinese medicine, with concepts like heatiness-that-looks-like-coldness being used to account for (in my mind) the inadequacies of the yin/yang system. And there are definitely practical merits to doing this.
  1. Many (esp. older) Chinese people are very vary of Western-based medicines, considering conventional drugs too "hard" or potent, and "hence" having many side-effects. (But they mentally ignore the fact that many Chinese herbal supplements also have drastic side-effects...including: death) In particular, they often function as excellent placebos.
  2. There are a hella heap o' con-men who utilise Chinese medicine as their preferred method of robbery. So having an officially sanctioned form of Chinese medical practice helps to regulate this jazz.
  3. It works. As in, in curing people of stuff.
  4. It helps to preserve a significant aspect of the Chinese cultural heritage. And as the walls of Communism are slowly being eroded by the winds of economic growth, China is turning to things like nationalism to hope to maintain its political stability.

Well, well, well...this was unexpected. I think that I was originally just going to point out that stats is being used in medical research in a winnar way like:

Using stats yo'. Cancer treatment winnar. Chomp!

But I guess...yea...I really hate traditional Chinese medicine - especially because, I, of all people, am forced to occasionally defend it. Hm...and could it be that another reason that I dislike it is because it reminds me of religion? That is reminds me of the foolishness of what I preach and practice as a Christian?

Maybe that's a post for another day. =D

*: in no uncertain terms either. Hey man - we don't mince words in my family, and my parents have no qualms telling me that I was an accident =P.
**: strangely enough, the etymology of the word doctor comes from docere, which means teacher. Plus, a doctor used to be called a leech.
***: okay, so the mechanism by which Artemisinin works is really tricksy - it's kinda usually stable but becomes unstable upon contact with some part of the malaria parasite, which leads to it blowing up like a bomb. It was pretty surprising to all scientists that something like that could work. On the other hand, I do have to concede that most scientists are kind of closed minded (and with good historical reason, I guess?).
****: look, you don't need to lecture me on the irony of calling something so old a protoscience.
*****: stemming from the Chinese idea that cold/flus are caused by the wind getting into your stomach - of course, this is a surprisingly difficult hypothesis to disprove without modern medical equipment, since there is a big chance that you will catch a cold (during the right season) if you sleep in a poorly heated environment and your immune system isn't performing as well. Or to put it into statistician lingo: there's a high correlation between a drop in your core temperature (esp. during sleep) under "windy" conditions and the inefficacy of one's immunue response. SOOOO, the sensation of bloatedness often associated with diarrhoea conjures up the image of this wind rattling about one's stomach, hence the association with "coldness" - i.e.: the absence of yang.

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