The Challenges of Integrating Eastern and Western Medicine

My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix. On the other hand, it gives some practical advice and examples on how to effectively integrate so one knows it is not unattainable. The very word integration requires partnership for the act to occur. How can we as alternative health care providers continue to provide partnership, despite the odds? The following is an excerpt from my thesis:

Pharmaceutical Industry

The Pharmaceutical industry is a powerful and profitable $400 billion per year beast of an industry. While it has brought ground-breaking advances, one cannot overlook the corruption and harm this industry has brought upon us both physically and financially. Medical errors account for 240,000 deaths in the U.S. annually, making it the third leading cause of death.

Prescription drug mistakes account for 140,000 deaths annually (American Medical Association), which by any account is a staggering number. Side effects from pharmaceutical drugs can sometimes cause symptoms worse than the primary concern that was initially presented. One might wonder how this happens in a field that is based on evidence and science-based medicine. Despite the advantages of profit driven innovation, the pharmaceutical industry monopolizes and suppresses the alternative medical industry, whether intentionally or by default by being such a giant. To further drive a wedge into a potential partnership between Eastern and Western medicine, the pharmaceutical industry legally steals herbal medicines, causing them to be banned altogether, breaching the path to integration.

Most consider evidence-based research and meta-analysis to be the "gold standard" of research, and Western medicine demands meta-analysis and evidence-based research for every product on the market. However, since researchers are not required to publish their findings, there are drugs on the market that may be ineffective - or worse – dangerous, yet drive sales and profit, and therefore continue to stay on the market. Companies typically only publish what is considered beneficial to the sales of their company, resulting in mostly positive research being published. As Ben Goldacre, MD, states in his book, Bad Pharma, "Medicine is broken." He goes on to say, "We like to imagine that medicine is based on evidence and the results of fair tests. In reality, those tests are often profoundly flawed." Additionally, many drugs that have been proven effective might not be placed on the market due to the fact that the pharmaceutical company might not make a large profit (usually due to prior trademarks or patents from individuals or labs).

As long as the pharmaceutical industry is driven by profit rather than stimulating the health of the world by providing the best products and thorough research, it will be linked to corruption (Orrin, 2006), disable alternative medical communities, and harm the health of the public. While Chinese medicine focuses on the root issue that caused the illness, leading to either acupuncture or an herbal formula for a short term, the pharmaceutical industry is collectively an enormous business - whose business it is to sell medications to as many consumers as possible and for as long a period of time as possible. The goal is selling medications and profit maximization, not health care. As Dr. Arnold Relman, former President of the New England Journal of Medicine wrote, "We should not allow the medical-industrial complex to distort our health care system to its own entrepreneurial ends."

Pharmaceutical companies focus on providing drugs that drive income and profit, regardless as to whether they are the best product available. We know this, as a return on investment and a promise for profit is the priority written in all the mission statements for stockholders, with a secondary promise to advance health care.

The conflicts of interest between public health and profit motivation are quite obvious, as we will see in the following paragraphs. If the industry were not-for-profit, health care around the world would be available to everyone and cost a fraction of what it does now. Doctors and pharmaceutical companies would work side by side with acupuncturists and Chinese herbalists. Additionally, research would hold a level of integrity that it does not currently hold. There would be no reason to hide research, since healthcare is the priority, rather than profit. Doctors and labs would fight for the best pharmaceutical product in order to win a Nobel Prize, rather than companies suppressing a product that might hinder sales of one of their products.

Instead, the pharmaceutical industry is vastly influential given the budget for lobbying, public marketing and direct payments to doctors. Drug companies have paid out hundreds of millions of dollars, and in some cases billions of dollars, to settle whistleblowing lawsuits for paying kickbacks to physicians for prescribing certain drugs to patients. It is estimated that in 2012 and 2013, there were $60 million of direct payouts to doctors in the U.K. per year (The Association of the British Pharmaceutical Industry).

New laws require that the pharmaceutical companies reveal how much they spend to sponsor healthcare professionals to attend scientific conferences and meetings (Makary, 2012). While doctors might deny that taking money from drug companies influences their judgement about a medicine, it is hard to imagine how one can stay neutral, especially when research findings are only partially published and usually only published when they favour the sponsoring pharmaceutical company. Acupuncture is usually the last recommendation a medical doctor will make - after prescribing drugs or surgery – especially when prescribing drugs can be lucrative for the doctors. Surgeries use the most drugs in the shortest amount of time as one will need antibiotics prior to the surgery, anaesthesia during the surgery, and pain medication afterwards.

Chinese medicine is truly focused on individual and community health care, finding the source of the person's disease and healing it; when one party has ulterior motives or lacks integrity, the other party might disengage from wanting to partner with them, which will make progression impossible. There is not enough space to cover the entire corruption of the pharmaceutical industry. The problems in the industry are well known, and many books have been written about them. Since corruption is commonplace and somewhat accepted in the pharmaceutical industry, next wee will look at how this corruption specifically affects the Chinese herbal community.

Thievery of Chinese Medicine

One of the main complaints that Western medical practitioners have about Chinese herbal medicine is that it has not been fully tested with trials and meta-analysis. It would cost a fortune to test the efficacy of the herbs, as well as to test the safety with all commonly used pharmaceutical drugs. As exampled below, there are reasons that herbalists like to keep their medicines out of the hands of researchers and the pharmaceutical industry so as to protect the herbs from being exploited.

Chinese herbal medicine is firmly established and has not changed in the last 5,000 years. The same dosage, safety information and indications for diseases, as well as contraindications with other herbs that was taught then is still being taught today. However, pharmaceuticals are so new and potentially dangerous (remember above that medical errors are the third leading cause of death), that research is constantly being done, yet every three years pharmaceutical books expire and new ones need to be purchased. This adds further fuel to the fire leading the separation between Eastern and Western medicines.

One of the main critiques of the pharmaceutical industry is that it mostly changes around formulas and patents, yet rarely comes out with any new drugs (save Viagra, which was released in 1998). In its quest for the next big drug, researchers seek out what works in herbal medicine, sending researchers into different parts of the world, targeting medicines from China, the Amazon, the oceans and even the Australian outback, to find more molecules to reproduce, patent and manufacture into prescription drugs. This exploitation of nature and traditional medicine has been labelled "biopiracy" and is more common than one would think. When Big Pharma successfully patents a molecule inside of an herbal product, they are able to cause the herb itself to be banned from the mainstream market and certified herbalists, so that it can be sold exclusively via prescription drug. This is expected to happen for the profiteering purposes of the pharmaceutical industry, but in the long run it makes it hard for Chinese and Western herbalists to practice their trade and for citizens to receive alternative medical treatments at an affordable price.

When Big Pharma uses herbs in a partial manner of extracting key constituents and patenting the active element, they often lose much of the traditional medicine and balance, as well as cut into low cost, natural health practices. When the herb or key chemical works, no credit is given to the CAM community, but when it is abused and harm comes from utilizing it as a drug, Chinese medicine is given a bad reputation for it's dangerous products. What is worse is when traditional herbs are not used in their traditional context and are abused; the Food and Drug Administration (FDA) has to step in and ban the herb altogether, causing everyone to lose. Big Pharma not only successfully suppresses traditional Chinese herbal medicine, but it also steals from the cultural intellectual property without honouring the tradition. This antagonism further challenges the integration between East and West and creates huge resentment towards a potential health care partner. The most scandalous examples in recent history are herbal ephedra in its use as a statin.

Herbal ephedra has been used for 5,000 years in Chinese medicine to treat conditions such as colds, fever, flu, headaches, asthma, wheezing, and nasal congestion. Traditionally, Chinese herbal doctors use 2 to 9 grams for most patients, but never more than 12 grams per serving, and typically prescribe it for up to two days, no longer. Traditionally, one makes the tea by brewing it first, and skimming off the foam on top, as the foam causes irritability (Bensky). Ephedra has been used safely and effectively in Chinese medicine but gained specific popularity in the mainstream market when Big Pharma discovered its use as a diaphoretic and speed or amphetamine-like compound and surmised that it might act as a weight loss supplement and athletic enhancer. Despite it being banned in the U.S. ,as well as many major sporting events, its abuse caused over a hundred deaths and left survivors with heart problems and other life-long issues (Harvard Medical School). With approximately 100 deaths reported due to ephedra abuse, it has become illegal, unless used by a Chinese herbalist, and even then, in such small quantities (.1 grams), it is not considered useful or effective. Interestingly, there are hundreds of thousands of deaths and side effects attributed to prescription drugs (especially non-steroidal anti-inflammatory drugs) each year and, of course, these very potent medicines (some available without a prescription) are still legal.

Another simple example of how Big Pharma uses Chinese herbal medicine for profiteering is red yeast rice. In the late 1970s, researchers began isolating lovastatin from aspergillus, a certain type of mold, which was later patented as a prescription statin drug, Mevacor, for Merck & Co. Lovastatin and other prescription "statin" drugs inhibit cholesterol synthesis by blocking action of the enzyme HMG-CoA reductase, which results in the circulating total cholesterol and LDL-cholesterol being lowered. In a meta-analysis of 91 randomized clinical trials of ≥12 weeks duration, totalling 68,485 participants, LDL-cholesterol was lowered by 24-49% depending on the statin (Edwards, 2003).

Chemical analysis of red yeast rice, a product used for healing purposes in Chinese herbal medicine, as well as a culinary ingredient show that the main chemical, monacolin K and the chemical lovastatin are identical. The article "The origin of statins" summarizes how the two isolations, documentations and patent applications were just months apart (Endo, 2004), so when Lovastatin became patented by Merck, red yeast rice become a contentious non-prescription dietary supplement, which Merck (for profiteering purposes) wanted banned, and claimed that it should be subject to regulation as a drug. In 1998, the FDA initiated action to ban a product (Cholestin) containing red yeast rice extract. At the same time, health food stores raced into action stocking their shelves with bottles of red yeast rice. Shortly thereafter, the FDA sent warning letters to companies selling red yeast rice, and the product disappeared from the market for five years until 2003.

By 2010, there were at least 30 brands of red yeast rice available. The labelling on these products often say nothing about cholesterol. In 2007, the FDA sent Warning Letters to two dietary supplement companies, since the FDA noted that both products contained monacolins. Both products were withdrawn. To further support Merck, the FDA also issued a warning press release (see Further Reading; FDA 2007). Of course, taking red yeast rice that contains monacolins alongside a pharmaceutical statin drug containing the same chemical could be considered overdosing and therefore toxic to one's health. Instead of saying this directly, and warning against "doubling up" on medications, the FDA's release stated that consumers should "...not buy or eat red yeast rice products...[as they] may contain an unauthorized drug that could be harmful to health," thus slowing down the sales of an herbal product by insinuating it is dangerous.

There are certain benefits to isolating the naturally occurring chemicals and selling them as pharmaceuticals. Over the counter herbs might render varying amounts of the targeting chemical, or provide inconsistent quality, quantity, potency or consistency. Many reputable Chinese herbal companies test their products for heavy metals and make the tests available to the public, yet many do not. Drug manufacturers test their products to make sure the precise amounts of chemicals are in each pill.

The point of this is simply to illuminate the power of the pharmaceutical industry to monopolize health care and suppress alternative medicine in their quest to protect the profits of corporations. The FDA partners with Big Pharma to take a natural product that has been safely used for thousands of years in Chinese medicine, and disallowed traditional practitioners from using it, rendering Chinese herbalists - as well as consumers - helpless.