by Bob Flaws

Lately, as I read various Chinese medical journals published in China, I have been remarking on the seriousness of the diseases being discussed and treated. So many articles these days are dealing with chronic renal failure (CRF), diabetes, coronary artery disease (CAD), congestive heart failure, and stroke that often I can't find anything useful to translate. By this I mean material on conditions that I think practitioners within the Chinese medical profession here in North American are interested in and treat on a day-to-day basis. When I look at the diseases under discussion in these Chinese journals, I am struck by their seriousness. We're talking about real medicine here requiring a truly doctoral level of competence. I believe part of this trend is due to the aging of the generation currently making most use of Chinese medicine, even in China -- those people born before the mid-60s, those we call here in the U.S. Baby Boomers. As this generation ages (and we move inexorably towards death), systems start to fail. As I like to say, "The cheap miles are over."

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Based on this same trend in our own patient demographics, several years ago, Blue Poppy Press published a series of clinical manuals on cardiovascular disease, diabetes and its complications, and nephrology. As editor-in-chief of Blue Poppy at that time, I thought we practitioners needed to "come up to snuff" on these disorders. I figured that we'd be called on to treat more and more patients with conditions such as this and so needed more and better information on how to do this. Sorry to say, these three books sell very, very poorly. We can't even sell 500 copies of each of these per year to a profession which, by all accounts, now numbers over 20,000 in the U.S. Similarly, when I read Acupuncture Today, I am struck by the triviality of much of what members of our profession are talking about and treating compared to doctors in China. I'm sure cosmetic acupuncture is a boon to those who use it, but it's in a different league from cardiology or even endocrinology. Likewise, when I get questions from practitioners about difficult or perplexing cases, all too often they are on how to treat conditions such as trichotillomania. While trichotillomania (compulsive twisting and pulling of hair) may be emotionally painful to the patient who cannot stop playing with his or her hair, it is of a different order from a patient suffering from CAD. It's a neurosis, not a life-threatening degenerative disease. Like all too many of the conditions practitioners ask me about, there is no suggestion in the Chinese medical literature that Chinese medicine can or ever has been used to treat this condition.

Based on my reading of the Chinese literature and my own clinical experience, I know Chinese medicine has really great things to offer to patients with serious, potentially life-threatening diseases, and I wish more of my compatriots could/would use this medicine as part of their overall health care strategy. However, in most such cases, the best treatment for these kinds of serious diseases is a combination of Chinese medicine and Western medicine, with Chinese medicine allowing smaller doses of Western drugs with better therapeutic effects and less or no side effects. And this may be the reason why American practitioners are not increasingly serving this patient population. So far, we, as a profession, have not done a good job integrating what we do with the larger health care delivery system. We have been content to remain on the fringe, and part of that is treating patients with odd conditions such as trichotillomania and other non-somatically based disoders.

I see this as a kind of catch-22 or self-reinforcing loop. Because we are on the fringe, we tend to treat fringe conditions that other "real" doctors can't or don't want to treat. Sometimes, looking at the patients who come to us for care, I think our slogan should be "Wing-nuts Are Us." This makes it easy for those other professionals to dismiss what we do, thus keeping us on the fringe. Lately, there has been talk of a "first professional doctorate (FPD)." In other words, that a doctoral degree should be our entry-level credential. However, until or unless our education truly prepares us to treat this kind of serious disease, such an FPD degree is not going to be successful in moving us from the fringe into the mainstream of medicine on this continent. It seems to me that more members of our profession need to become interested in and knowledgeable and competent to treat conditions like CAD, diabetes, and CRF before society as a whole is going to see us as true doctors. Simply calling ourselves doctors is not going to put us in the same league as MDs or even our peers in China.

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