HI ERIC--

Thank you for bringing this article to our attention. Unfortunately, these are issues that never seem to go away, and there is always the potential for enough bad press to lead to more draconian governmental regulations on CM medications. On the bright side, many of the older, problematic ready-made CM formulations seem to have been weeded out of the marketplace. At the same time, however, more needs to be done to insure that CM medicine continues to grow in popularity and credibility. As a profession, we need to make the best choices going forward and make our voice heard in order to preserve the ability to practice safe and effective Chinese medicine. It is my opinion that we can also do more as individual practitioners to promote a positive image of Chinese herbal medications and prevent problems that might ultimately put both our patients and our profession at risk.

When prescribing Chinese medicines, we should all always strive for a high level of professionalism. I have seen many instances where licensed practitioners fail to follow a professional, rigorous model for prescribing Chinese herbs. For examples, there are practitioners, often in contexts such as Chinatown clinics and pharmacies, who hand patients brown ‘grab bags’ of Chinese herbs and offer no additional written documentation regarding the specific contents or instructions for appropriate use. In the event of a rare allergic reaction or other adverse effect, the patient would then be unable to provide any useful information to an ER doc about the formulas constituents, frustrating efforts to address the negative reaction and successfully treat the patient—perhaps even putting someone’s life at risk. More frequently in my community I see practitioners who write prescriptions but leave them incomplete. It is not unusual for prescriptions to be handwritten on a plain piece of paper or scrap paper, often without details regarding dosage. Some of the prescriptions do not even include the name of the patient. These inadequate documents are not only the product of student practitioners, but are also submitted by respected professionals. It is difficult to understand how a supervisor at a school could preside over the writing of a prescription that lacks some of the most basic requisite data, setting a precedent that sadly carries over into professional Chinese medical practice.

It is also crucial that we as a community are scrupulous and knowledgeable about the quality and safety of the products we prescribe for our clients. We had a client in the school clinic about a year ago who had been taking a ready-made for nasal congestion prescribed by a Chinese practitioner in China for a number of years. I had the awkward task of informing him that the tablets that he had become some dependent upon were fundamentally contraindicated for hypertension and that the specific brand he used was well-known to be adulterated with at least three different Western drugs. He had no idea of the dangers posed by the Chinese supplement and was shocked to find that the efficacy hinged on potentially dangerous pharmaceuticals, exactly what he wished to avoid when he first explored Chinese medicine.

In my practice, I depend heavily on GMP-certified products. Like any certification, there are pros and cons to relying on the GMP label. Nevertheless, not unlike organic certification, GMP credentials are a tool to identify professional products from reputable companies. Explaining to patients that you use GMP products helps to dispel some of their concerns about news stories like the one in question and demonstrates that you truly care about their health and well-being.

Ultimately, choosing herbal products for your patients involves the issue of clarity, a concept that I strongly emphasize as an instructor. I never find the argument ‘well, it worked’ compelling as a teacher, and I do not think it is sufficient for licensed professionals, either. At the educational level, when we downplay the critical importance writing up good cases where the methodology is clear and logical and focus our attention almost exclusively on clinical outcomes, we promulgate an approach to Chinese medicine that is result-based and lacks the deep consideration and understanding that is characteristic of the superior physician. This general attitude towards practice, begun in student acupuncture clinics, frequently extends into herbal practice. All too often, the ‘it works’ argument is used to defend minute doses of herbs, the use of supplements from non-TCM disciplines that the practitioner may not have adequate training to use, and the prescription of questionable ready-made CM products. In such cases, a reality check is warranted, reminded ourselves that at least 40% of any treatment can be ascribed to the placebo effect (whatever that might be!). If we hold ourselves to a higher standard, where clarity and a deeper understanding of our patients and treatments is given priority, I think we can avoid many of the issues that can lead to our reputation being dragged through the mud in the popular press.

David.