Dr. Fan Nien-tsung of VGH also presented a report describing his experiences following his training in TCM at the VGH Traditional Medicine Research Center, from his use of traditional Chinese pulse reading to diagnose AIDS cases to his being commissioned by the government of Thailand to establish an AIDS treatment program employing Chinese meditation and breathing techniques and the cultivation of chi.A lack of persuasive research
But some are not so positive. "Although these medical professionals are open-minded and pro-active, and their research both creative and impressive, when you examine it carefully, you find that it lacks sufficient scientific evidence, especially in the clinical trials," says Chou Pi-she, a professor at Yang-Ming Medical College.
Chou, whose primary area of research is clinical statistics, states that most of this research is limited to extractions and animal research in the Chinese medical laboratory, or consists of individual case reports. It focuses on the search for individual problems and is not widely applicable general research.
"Only a very few projects can really be said to have been designed as clinical trials. And even in these cases, the design is still rough. It isn't rigorous enough and so lacks persuasiveness," says Chou, who was the concluding speaker at the conference. According to him, the scientific procedure is: One must first have experimental evidence. Then, in conducting the first stage of clinical observations it is important to have a large, randomly chosen sample group if one wishes the results to be generally accepted.
"Taiwan is obviously very weak in the area of clinical research," agrees Lai Gi-ming. He feels that this can be attributed to too few demands and too little training in the early years of medical education in Taiwan, as well as a lack of support in the larger environment. "On the one hand, in the early days people generally studied medicine to become a doctor and make money. Very few were willing to immerse themselves in conducting basic research. The nation was also in the habit of importing techniques and medications from abroad. We didn't have the ambition or the confidence to carry out our own research and development, meaning we never built up this kind of system."
"In the past, most of Taiwan's medical research was funded by the National Science Council. It supported research at all the medical schools, research centers and medical treatment facilities. But they were limited in terms of equipment and manpower, and thus unable to carry out large-scale clinical research," says Lai. He says that the National Health Research Institutes (NHRI) were established in 1994 to promote clinical research. "Their aim is to draw doctors into clinical research and to push following up experiments with clinical research." Lai says that the money, equipment and manpower required for large-scale clinical trials are all considerable. Support is a necessity. In his own case, it was only after he entered the NHRI that he had the opportunity to carry out his research on urine extracts in depth. He is already planning to work with National Taiwan University to carry out animal experiments to test whether combining his extract with vitamin A increases its effectiveness. He plans the final stage of his research to be clinical trials on humans.
Lai Chi-ming must be considered fortunate. Other researchers don't necessarily have the same kind of opportunities or support. For example, although Sun An-ti works at NTUH, the island's number one medical center, his research often encounters resistance from a system that is focused on Western medicine. His research is not thought to be a part of his duties. And Julia Tsuei, a former professor at the Yang-Ming College of Medicine, often encounters funding difficulties. This is in spite of the fact that her research into diagnostic similarities in Western and Chinese medicine, a large-scale clinical research project of a sort rarely seen in Taiwan, has the support of the private Foundation for East-West Medicine.One-tenth the resources
"In fact, if only policies were a little more liberal and the distribution of resources a little more even, it would greatly improve the environment for research into Chinese medicine," says Sun An-ti. For this reason, in addition to his clinical duties and research pursuits, the vigorous Sun also actively involves himself in government and community work. He hopes to improve the situation by changing government policy. A former member of the Kuomintang (KMT) Central Committee, Sun travels all over the island speaking and strongly pushing for the inclusion of a provision promoting research into Chinese medicine in the KMT's party charter and in the constitution of the ROC. "When mainland China drew up a constitution in the 1970s, it clearly stated that the nation's medical mainstream would be a combination of TCM and Western medicine. For this reason, it has received long-term support and promotion, and has attained its current level of achievement. In contrast, of the 14 medical centers in Taiwan, only the China Medical College and CGMH have established departments of Chinese medicine with a status equal to that of their departments of Western medicine. The unequal distribution of resources is plain to see."
The National Health Insurance (NHI) system's payments schedule is another frequent point of dispute. Most people feel that the scope of NHI's payments for traditional Chinese medical procedures is too limited. For example, payments for traditional medical services currently account for less than 10% of NHI's expenditures for medical services. And last year, while NHI's total expenditures totaled NT$173 billion, expenditures for traditional medical procedures were a mere NT$10.8 billion, or only about 6%.
"Things like the higher payments that are made for hospital stays have not been fully liberalized for hospitals of Chinese medicine. In fact, it is only being tried at a few such as CMCH, Kaohsiung Municipal Hospital for Chinese Medicine and Taipei Municipal Hospital of Chinese Medicine," says CGMH's Lin I-hsin.
Therefore, the hospital stay fees associated with Chang Gung's in-patient Chinese medicine treatment for spondylitis must be covered by patients themselves. "The lack of a system which pays for hospital stays affects the source of our cases for clinical research. We have no way of making long-term observations of the effectiveness of clinical treatment. This is a major obstacle to conducting research on the use of TCM to treat chronic illnesses."
Within the government, the Department of Health's Committee on Chinese Medicine and Pharmacy, established only in 1995, is the highest governing body solely responsible for overseeing Chinese medicine on the island. Chang Chung-Gwo, who just took over the leadership of the committee early this year, says with some exasperation, "That's just the way it is. We got started much too late." Chang says that the medical system also maintains a very conservative attitude towards the development of Chinese medicine. For example, when Vice President Lien Chan, in opening remarks at the recent National Convention of Chinese Medicine, stated that the government would push the opening of departments of TCM at all 14 of the island's medical centers, there was much grumbling. "Many people are afraid that this will create stiff competition [for resources], and access to fewer resources than they currently enjoy."Is integrated treatment illegal?
The law has also failed to keep up. "Based on the law governing doctors, the integration of Chinese and Western medicine is still illegal. Unless they have licenses to practice both forms of medicine, doctors of Western medicine cannot practice Chinese medicine, and doctors of Chinese medicine are not allowed to practice Western. The law governing pharmaceuticals also stipulates that Chinese herbal medicines and Western pharmaceuticals cannot be administered together," says Chinese Medicine Committee chairman Chang, who is also a former head of Kaohsiung Municipal Hospital for Chinese Medicine. He says that in the past, everyone was worried about problems resulting from insufficient medical skills. "But if there were research reports firmly supporting a treatment's efficacy and if a strict assessment of the treatment were carried out, why shouldn't each type of medicine be allowed to complement the other?" Chang, who in his own clinical practice has dedicated himself to the integration of Chinese and Western medicine, overcame the legal problems by becoming a licensed doctor of both forms of medicine. Thus he could have his patients take their Western prescriptions before meals and their Chinese prescriptions after meals. Though this method did not fall within the system's rules, its effectiveness was obvious, and Chang had the full confidence of his patients.
Chang has laid out a series of working points to promote the development of Chinese medicine. It includes everything from reform of the educational system and the examination structure, oversight of the quality of Chinese medications and fostering the development of Chinese medical research to making the Chinese medical classics available online and evaluating the effectiveness of clinical treatments. "We've got too much to do. It's exhausting! Why on earth did I take this job? Why didn't I just continue earning money from my practice?" Although Chang often makes such remarks, he is at work in his office at seven every morning. And when visitors come, he himself pulls out the transparencies and explains the committee's work and future direction. "It used to be that not many people understood TCM, and that was an obstacle its development. If we want to overcome this obstacle, we have to do our utmost to promote TCM."
Chang Yung-hsien, who often receives invitations from medical centers and academic associations abroad to teach acupuncture, is, in class, fond of mentioning an observation made by the scholar of Chinese technology and culture, Joseph Needham. Needham believed that the originally separate streams of Chinese and Western culture would come together and blend into one great stream at the end of the 20th century. "This is the trend of the era. It's just that, early on, most of these trends are led by the West. Now Taiwan must pick up its own pace in order to speed the integration of Chinese and Western medicine."
