by Eric Brand

A few weeks ago, my blog discussing examination texts raised the topic of “study guides,” which all-too-often seem to be more popular with students than actual primary source texts. While it is natural for people to use quick reference materials for fast lookups in the clinic, many of these study guides fail to maintain consistent quality in terms of their information. Regardless of whether one is using a study guide to prepare for exams or to jog one’s memory when treating a patient in clinic, it is essential that practitioners rely on high quality information.

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Medical study requires years of effort and careful vetting of sources. There is no quick guide that can replace reading real books, and our patients depend on us to use reliable sources when they come to our clinic for treatment. Few patients would want to see an MD that didn’t own a PDR and instead prescribed drugs based on the guidelines of a pocket manual compiled by a third year med student. However, reliance on inaccurate study guides is an endemic problem in Chinese medicine schools in the USA.

The main problem is that students don’t even know that there is a problem with relying on study guides. Many study guides are created by relatively inexperienced fellow students that got their information from wholesale plagiarism of source texts. Lack of expertise allows material of questionable accuracy to make it into the book, and wholesale plagiarism is one of the many factors that is hastening the demise of the TCM publishing industry in English (contrary to popular student opinion, it isn’t generally acceptable to copy and sell the core info from Bensky’s entire book simply because a footnote at the bottom says that it came from Bensky). In fact, several TCM publishers have already started to cut back on producing new Chinese medical texts, so we are already feeling the impact of piracy in our community.

Beyond the problem of plagiarism, there is a huge problem with accuracy. The internet has transformed the modern world, and there is more information available than ever before (though it requires more and more diligence to separate the wheat from the chaff). Students constantly have their laptops open, and a recent grad friend of mine reports that many students in his class were constantly surfing the digital study guides instead of listening to the lectures in class. The problem of students focusing too much attention on tests and grades at the expense of learning about the deeper medicine beyond the test is endemic. Even more troubling, the study guide materials that students rely on often have major mistakes and inaccuracies.

When I was teaching in California, I never got to see exactly what was on the laptops, but I saw no end of students that used a dubious little spiral bound notebook that was sold on the student underground. One student copied the textbooks, put it all together, and took it around the schools to sell it through student distributors (presumably because the bookstores can’t actually carry pirate titles). This little red book was basically a rip-off of Bensky and CAM, but it had all kinds of other info like orthopedic tests in it. It sold for the price of a real book, but it made me cringe every time I saw students using it when they were treating real-world human beings in the clinic. It is full of random mistakes (Yin Yang Huo tonifies yin, for example), and I always feared that the students would think about herbs based on this dubious little handbook instead of their real textbooks.

At the end of the day, most students own this little handbook but they don’t own real materia medica books like Jiao Shu-De’s Ten Lectures on Medicinals. A book like Jiao could truly enrich their knowledge about herbal medicine and can be purchased for the same price, but the focus on tests and the “cliff note guide to clinical practice” phenomenon seems to be hard to overcome. As a teacher, the fact that students chose to buy this book instead of a book like Jiao made me truly disappointed.

The thing that makes this all so unfortunate is that many people in our profession simply don’t pay attention to the importance of accuracy. There is a tremendous amount of reliable, published material that is already available, yet students still continue to make up their own junk instead of just approaching publishers with their project ideas. There are several publishers that have all the data that one could ever hope for, so any techie student with a bright idea could easily get permission to use good data in their application.

All it would take to turn this blog post around 180 degrees would be for a student to show up with a good study guide plan. Rather than ripping off Bensky and selling through the student underground, why not just write to the publisher and ask for permission to use their work? Give the original author some royalties instead of making shady deals in the student lounge and pocketing the money made from stealing Bensky’s hard work. Voila, instant quality data and a perfect study guide that helps the field rather than hurting the field. Sadly, this almost never happens.

In the past, I’ve been involved in many database projects. My teacher Nigel Wiseman was one of the original pioneers of Chinese medical translation, and he created amazing databases on terms (30,000+), formulas (4000+), medicinals (6000+), acupoints (2000 entries), and other key branches of medical knowledge. When I lived in Taiwan, I spent years working with Nigel and I managed to help bring all his databases from DOS (!) to Windows. At the time, Nigel was an advisor to the WHO traditional medicine terminology committee and I helped him to match his terms to all of the terms selected by the WHO (along with terms by China’s State Administration of TCM and Xie Zhu-Fan). A few years later, the AAAOM started working on a comparative term database, so I integrated John Chen, Dan Bensky, and Blue Poppy’s term databases into the system. I created a database with the full content of my book with Nigel, Concise Chinese Materia Medica, which become part of the CD package that came with the book. Last year, I helped create the basics of an herbal database that was funded by the NIH, and now I’m helping with all these iphone projects that will get these great databases into the pocket of the modern day clinician. So I understand the basics of databases and information management.

When it comes to making a database, there is a basic saying that I learned from Bob Felt, the head of Paradigm Publications and an early computer programming expert: “Garbage in, garbage out.” The value in a database is entirely dependent on the quality of information that goes into it. If there is no vetting for quality control before filling up a database, the database is nearly useless. However, some databases have fantastic information that goes into them, such as the iphone.mindbodycures.com website. This is a simple, free application that doesn’t need to be downloaded and works from a laptop, iphone, or android phone. Unlike many similar products, it was made with permission- the developer simply asked Bob Felt if he could use the information from Wiseman’s books, and the permission was granted with no strings attached. Consequently, the data within the application is very reliable, since Nigel Wiseman translated it all from Chinese source texts with a transparent and cohesive system.

Soon, a similar product will be available as a Pleco dictionary add-in for the iphone. It will contain Nigel’s entire Practical Dictionary of Chinese Medicine, and future iphone apps will come out to make the rest of Nigel’s work available for the first time. (You can download Nigel’s term list for free here) Amazingly, Nigel translated the actions of over 6000 substances and 4000 formulas from the Chinese literature over 20 years ago, but the book was never printed because it would be too thick and expensive. It has never been released before, but we are working on getting it out as an iphone and computer application now.

It is essential to have quick study guides and iphone applications for Chinese medicine. The simple reality is that we often cannot memorize all the key information in TCM, and we need to look up formula ingredients and such in a hurry when we are in clinic. Study guides have an important role. But this is medicine, we are treating human beings based on the actions and indications in the clinic handbook. The issue of accuracy is not something that is an ivory tower debate on subtle nuances; it is a simple question of giving the right herbs to a suffering human being. If the pocket manual says that Yin Yang Huo treats yin vacuity, it is time to get a new pocket manual.

Good study guides and clinic pocketbooks sell very well. Publishers would love to get in on that market and would love it if students approached them with a project rather than simply stealing the material. The quality of material would be much higher. Most of us enter medicine because we want to improve the health of the world; having reliable information improves the health of our patients and keeps the TCM publishing industry healthy. Buying books that plagiarize and fail to maintain consistent quality jeopardize the health of our patients and devastate the TCM book industry. This prevents future generations of students from having access to awesome titles like Jiao Shu-De’s books, which harms the patients even more in the long-term. Unfortunately, this is not a theoretical discussion- publishers are already throwing in the towel on making new titles like Jiao’s. Homemade flash cards with colorful animals and shoddy content sell like hotcakes, but awesome books by modern masters like Jiao Shu-De can’t even earn back the cost of the paper they are printed on. This is a real tragedy. There is no study guide that can enhance knowledge like those Jiao books can.