208 HKMJ Vol 4 No 2 June 1998Tang et al - PDF document

208 HKMJ Vol 4 No 2 June 1998Tang et al COMMENTARY Traditional Chinese medicine (TCM) is gainingincreasing attention and popularity in Hong Kong. TheGovernment of the Hong Kong Special Administrativeand regulate the practice of TCM in the SAR. Localto train doctors in TCM. Approximately 50% to 60%of the population in Hong Kong have consulted TCM Our preliminary survey shows thatTCM in 1996 (unpublished data). Traditional Chinesecomponent of the SARÕs health care services.figure is growing rapidly. Americans spent an equiva- The UnitedStates Government has set up an Office of AlternativeTraditional Chinese medicine is gaining increasing attention and popularity in Hong Kong. There is nodoubt that traditional Chinese medicine as a system of medicine works; however, this does not imply thatevery therapy is efficacious. Prevention of the initiation and continuation of ineffective intervention isextremely important for the efficiency of any health care system. The evaluation of the clinical effectivenessof traditional Chinese medicine is thus a top priority. Efforts should be made to register all randomisedtrials in traditional Chinese medicine and to regularly review and disseminate the evidence from organisedresearch. These actions are essential for the promotion and practice of evidence-based decision makingKey words: Alternative medicine; Delivery of health care; Evidence-based medicine; Medicine, Chinese traditional;Randomized controlled trialsDepartment of Community and Family Medicine, The ChineseUniversity of Hong Kong, Lek Yuen Health Centre, Shatin, HongJL Tang, MB, BS, PhDTW Wong MB, BS, FHKAM (Community Medicine)Correspondence to: Dr JL TangTraditional Chinese medicine has a history ofÔalternativeÕ (as opposed to conventional) medicinethat are endorsed by the World Health Organization.There is, however, an urgent need to evaluate theclinical effectiveness of TCM. In acknowledgementof this need, the World Health Organization hasestablished an Office for the Evaluation of Traditional The primary driveefficiency of the health care system. The first step is toprevent the introduction of new but ineffectiveThere is no doubt that TCM works. It has developedits own coherent theories with regard to aetiology,conventional medicines. Artemisinin (Qinghaosu), for) and has been used by TCM HKMJ Vol 4 No 2 June 1998 209Effectiveness of traditional Chinese medicine Ephedrine, a widely used medicine,TCM. In addition, a TCM cure for eczema

has provedwhole, however, does not mean that its every inter-vention is efficacious. Many interventions that areshown by randomised controlled trials (RCTs) to beineffective or even harmful.11,12 Evidently, conventionmedicine; popularity, enthusiasm, or anecdotes shouldalso not be taken as evidence for clinical efficacy. Itis thus reasonable to believe that many TCM inter-ventions may not be clinically effective.evaluating the clinical effectiveness is the RCT. This(but worthwhile) effect. Many medical treatmentshave only moderate, rather than large, efinterventions whose effect is clearly evident, such aspenicillin and smallpox vaccine, are few and far between;most other interventions have only moderate effect.of its efficacy in clinical trials. Currently used inter-ventions are also being subjected to RCTs. ShouldTo demonstrate what works and what does not inTCM has other important implications. Firstly, it willof TCM theories. Secondly, treatments of proveneffectiveness will identify fruitful directions forbasic research in disciplines such as physiology, bio-chemistry, and pharmacology. Thirdly, a clinicallyresearch. Fourthly, diseases or syndromes that are onlyrecognised and curable in TCM may open up newFifthly, it will provide necessary information for theregulation of the practice of TCM. Finally, it will helpto dispel misconceptions about TCM, increase itsMuch research has been done in TCM; most, how-ever, is at the laboratory or biochemical level. Today,form of medicine. There is thus a need to study howbetterÕ. However, research progress may be restrictedby the available methodology and technology.Clinical effectiveness is what matters most in anyof action is secondary, and lack of this knowledgeshould not prevent the use of effective therapies.of action were understood. Therapies that lack ademonstration of clinical effectiveness, such as blood-letting and radical mastectomy, have been discarded,for which it claims to be effective. The misunder-standing and scepticism about TCM therapies willlikely continue until their clinical effectiveness iseffectiveness of TCM is thus an immediate and urgenttask for researchers of TCM.conducted in TCM. There are, however, a few methodo-of trials can be further improved. The first RCTs inthe past 15 years. A preliminary systematic review ofthe evidence for the effectiveness of TCM has identifiedture. The goal of the Cochrane Collaboration is to syste-matically review and summarise the evidence f

romdigestible manner. These efforts are essential formaking in TCM. It is a waste of human resources to 210 HKMJ Vol 4 No 2 June 1998Tang et alcontinue the use of clinically ineffective treatments.the use of clinically ineffective TCM therapies and topromote the use of effective ones. This can only beachieved through the systematic evaluation, review, andWe thank Prof J Dickinson for his valuable comments.artemether or quinine in Vietnamese adults with severe9.Sheehan MP, Rustin MH, Atherton DJ, et al. Efficacy of10.Latchman Y, Whittle B, Rustin M, Atherton DJ, Brostoff J.The efficacy of traditional Chinese herbal therapy in atopiceczema. Int Arch Allergy Immunol 1994;104:222-6.11.Office of Technology Assessment of the Congress of theUnited States. Assessing the efficacy and safety of medicaltechnology. Washington DC: US Government Printing Office,12.Chalmers I, Enkin M, Keirse MJ, editors. Effective care in13.Evidence-Based Medicine Working Group. Evidence-basedmedicine. A new approach to teaching the practice of medicine.JAMA 1992;268:2420-5.14.Collins R, Peto R, Gray R, et al. Large-scale randomizedevidence: trials and overviews. In: Weatherall DJ, LedinghamJG, Warrel DA, editors. Oxford Textbook of Medicine. 3rd ed.15.Saks M. Alternative medicine in Britain. Oxford: Clarendon16.Kleijnen J, ter Riet G, Knipschild P. Effectiviteit van alter-natieve geneeswijzen: Ein literatuuronderzoek. Limburg:17.Chalmers I. The Cochrane Collaboration: preparing, main-taining, and disseminating systematic reviews of the effects ofhealth care. Ann N Y Acad Sci 1993;703:156-63. has declared an ÔamnestyÕ 1997;315:622.References1.Chan M. Recent development of traditional Chinese medicinein Hong Kong [abstract]. In: Proceedings of the WorldBeijing: Chinese Association of the Integration of Traditionaland Western Medicine, 1997:82-3.2.Wong TW, Wong SL, Donnan SP. Prevalence and determinantsof the use of traditional Chinese medicine in Hong Kong. Asia3.Fisher P, Ward A. Complementary medicine in Europe. BMJ4.Eisenberg DM, Kessler RC, Foster C, et al. Unconventional5.Gavaghan H. Koop may set up new centre for alternative6.World Health Organization. Report from the Programme onTraditional Medicine: guidelines for the assessment of herbalmedicine. Geneva: World Health Organization, 1991.7.Gray JA. Evidence-based health care: how to make health careand management decisions. New York: Churchill Livingstone,8.Tran TH, Day NP, Nguyen HP, et al. A controlled trial o