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Walters Presents at Augsburg College

John Walters, L.Ac., recently presented an overview of traditional Chinese medicine and acupuncture to students and faculty of the physician’s assistant program at Augsburg College in St. Paul. The Augsburg physician’s assistant faculty were interested in their students having a more complete and rounded understanding of complementary health practices in the Twin Cities to which they might refer their patients.

In Healthcare, Is Anything Less Than Full Disclosure Acceptable?

A recent study found that 20 percent of more than 2,000 physicians surveyed admitted that they had not told patients the truth when they had committed an error. Moreover, the study found that more than 10 percent had not discussed financial conflicts of interest with patients and 15 percent said they gave a more favorable picture about prognosis, risk, and and benefit with respect to a disease.

Society expects physicians to always be truthful, but the survey apparently shows that there is a considerable amount of withholding of the truth or being less than forthright. So is this a problem and should physicians or any health care practitioner never lie?

There are definitely circumstances where anything less than full disclosure and truth-telling are wrong. For example, patients have every right to know about potential or actual conflicts of interest, financial or otherwise, and the practitioner should volunteer that information. At HealthPoint we have no such conflicts and that is true throughout most of traditional Chinese medicine. The financial stakes are much larger in western biomedicine, but the same rules should apply nonetheless. Inform the patient and then let them decide whether the facts preclude further treatment from that practitioner.

Despite the dictum of “first do no harm,” errors do occur. These can occur as a result of what the practitioner does or fails to do. Systems approaches and protocol check-lists help, but mistakes can happen and when they do it is not advisable and is inexcusable to cover-up or lie. It can be difficult to admit a mistake. Communication with the patient or their family can be more difficult when a patient is harmed, seriously or otherwise. But it is important that the practitioner address it forthrightly.

How to portray a difficult prognosis can be less clear. How the message is conveyed may require subtlety but the truth should be told. While we do not want to frighten a patient about a diagnosis, it is nonetheless important that they know the facts in order to make an informed choice regarding treatment. For example, if someone has a family history of Alzheimer’s or breast cancer, it is reasonable to point out the statistics to that patient and to inform them about currently understood preventive measures. This conversation needs to be forthright about potential illness without causing the patient undo worry about a result that no one knows for certain will occur.

What about a patient with a terminal illness who has a very short time to live and who asks their physician’s advice regarding a supplement with an apparently good but short track record regarding the disease but where the supplement has undergone no long-term randomized clinical trials involving humans? That is a gray area. Should the physician recommend that the patient take the supplement? Should the physician chart and/or report the recommendation? What might be the result to the physician should be patient’s life end more quickly than, say, his family expected and they bring legal action? Things can seem less than black-and-white. But generally, full disclosure and communication with all players is preferred. Fortunately, this level of complexity is rare in the practice of traditional Chinese medicine. I do not envy physicians who confront such scenarios with greater frequency.

Telling the truth is important, but so is conveying the message with sensitivity and in a humane manner so that the message is understood in a way that is not psychologically or emotionally harmful to the patient.

A Brief History of Diabetes Mellitus and TCM

Diabetes is first mentioned in the traditional Chinese medicine literature in the 1st century BCE during the early Han dynasty. In one of the books of the Huang Di Nei Jing Su Wen (Simple Questions), a condition referred to as xiao ke 消渴 was described as a disease state characterized by persistent thirst and hunger, copious urination, and weight loss (emaciation). The Su Wen made the simple observation that xiao ke is due to consuming too much fatty, sweet, or rich food and that the condition occurs among the wealthy. By standards of the day in ancient China, modern Americans would be considered wealthy. Xiao ke was long considered a disease of affluence. Today it can be quite expensive to eat organic, whole food in a market with a short local growing season. As a result, people's diets may be largely composed of highly manufactured and/or processed foods.

Xiao ke was differentiated into three subtypes involving the three jiao (burners) of the body, with one each of the "three poly's" (polydypsia, polyphagia, and polyuria (i.e., excessive thirst, hunger, and urination) being associated with the upper, middle, and lower burners, respectively. One of the great contributions of biomedical laboratory analysis is the ability to rather clearly identify disease states before a patient realizes that they have a disease. This is true of both diabetes and hypertension (high blood pressure) where urinalysis and blood-pressure cuff readings can identify the presence of disease before the patient may know that they are truly sick. An astute clinician (either a Chinese medicine practitioner/acupuncturist or a Western medicine clinician) may be able to identify such conditions based on directly observable signs and/or symptoms (a hallmark of TCM), but it is always nice to be able to validate clinical diagnoses with laboratory analysis.

TCM does have effective treatments for diabetes (involving acupuncture and/or Chinese herbal formulas). At HealthPoint we are careful to insist that patients with seriously high blood glucose levels work carefully with their Western primary care physician or endocrinologist. Diabetes is, fundamentally, a vascular disease which, if not properly managed, can lead to serious consequences.

Contemporary TCM texts usually include diabetes within the disease diagnosis of xiao ke. In modern clinical practice, however, many patients diagnosed with diabetes or pre-diabetic conditions are overweight and thus do not display at least one of the characteristic symptoms of xiao ke (weight loss / emaciation). Moreover, the complications of diabetes are not necessarily present in xiao ke, and diseases other than diabetes mellitus can lead to symptoms of xiao ke such as diabetes insipidus, hyperaldosteronism and hyperparathyroidism.

The Truth About Big Pharma

 [IMAGE] Marcia Angell is a physician and the first woman to have served as the editor of the New England Journal of Medicine.

Her recent critique in the New York Review of Books regarding the pharmaceutical industry referenced the average price of the fifty drugs most used by senior citizens. But did you know that the average cost of a month’s supply of a traditional Chinese medicinal formula from HealthPoint is less than 12 percent of that same pharmaceutical industry average adjusted for inflation? Well, it’s true. And untoward side effects are extremely rare (and minor if they do occur). By any measure, a pretty good value.

If you are interested in reading Dr. Angell’s long, but insightful, article, click here. Dr. Angell has obvious credentials and her piece is well researched. Her article demonstrates the unintended consequences of overly helpful legislators who unwittingly created a new set of incentives to which academia, industry, and consumers have responded. She also briefly acknowledges some of the contributions of big pharma. But she highlights a number of concerns of many Americans with regard to the pharmaceutical industry. 
Click here to read the entire article.

Full-Spectrum Extracts vs. Standardized Extracts: Why This Is Important

HealthPoint has one of the largest and most varied traditional Chinese medicine (TCM) herbal pharmacies in the upper Midwest. Many visitors to our clinic are intrigued by the bulk-dispensed herbs in all their various colors, textures, smells, and listed functions. These are compounded into herbal formulas prescribed specifically for a particular patient and which the patient decocts in a water solution at home according to instructions from their licensed acupuncturist. (A TCM decoction is a liquid herbal extract formula made from water-soluble substances with the aid of boiling water; this differs from tea, which is steeped.) 


Our Granule Extract Pharmacy
But HealthPoint’s lower level boasts a similarly exhaustive full-spectrum granule extract pharmacy. In the context of TCM, full-spectrum extracts are those that include the natural constituents of an herbal medicinal substance that is obtained when the substance is decocted with the traditional water method. So “full-spectrum,” in the context of TCM refers to a water-based extract that does not focus on concentrating any one single constituent. Instead, extracts focus on concentrating all the water-soluble material in an herbal substance without affecting the natural ratio of these constituents. This best approximates the spectrum of constituents that Chinese medicine’s time-tested results are based upon. Note that this method differs from “standardized extracts” more commonly found in health-food stores or departments. Rather than leaving unchanged the broad-spectrum of chemical constituents found in a plant’s or other substance’s natural state, standardized extracts concentrate a single constituent or group of constituents.

Let’s look at an example. Renshen is a TCM herbal medicinal said to powerfully supplement the source qi, engender fluids, and boost the intelligence. It is commonly known as ginseng. A TCM full-spectrum extract producer would likely measure the ginsenoside content of both the raw material and the finished product of their renshen. Ginsenosides are a class of steroid glycosides, and triterpene saponins, found exclusively in the plant genus Panax (ginseng).  Let’s say that the TCM full-spectrum manufacturer’s standard for its renshen is 7 percent ginsenosides or more. If that company then made a full-spectrum 3:1 extract concentrate, they would require at least 21 percent ginsenosides, and they would test that this minimum level was achieved. Moreover, the final extract might be 22 to 25 percent ginsenosides (or even more), depending on the potency of the original raw herb. By contrast, a “standardized extract” of 21 percent ginsenosides would contain no more than that amount. Instead, the product could be made with whatever amount of whatever quality raw herb it took to achieve that level, including something less than the 7 percent ginsenosides of the raw herb used to achieve the higher quality full-spectrum extract.

Because science is a long way from identifying exactly which constituents or interactions between constituents are responsible for most of the effects observed with the use of Chinese herbal medicinals, it is best to use full-spectrum extracts as much as possible. And the best place to get these is from a trained and licensed acupuncturist.

We are happy to answer any questions that you may have about traditional Chinese herbal medicine. Just ask!

Thank You!

We are humbled by referrals from many of our patients; you are very kind. Referrals are the life-blood of any small business and we greatly appreciate your enthusiasm in sending those you know to us for service.

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