American Medical Association Studies Chinese Medicine

In what has been hailed as a milestone on the road to the creation of a single, integrated system of medicine, the American Medical Association devoted its Nov. 11 1999 issue of JAMA to research on alternative medicine. The issue featured three randomized controlled trials of Chinese medical treatments, making it the most heavily studied therapy in the journal.

The first study focused on the use of moxibustion for correction of breech presentation in pregnancy. (Moxibustion is the burning of a specific herbal preparation containing mugwort at an acupuncture point.) Treatment was given from the 33rd week of pregnancy through the 35th week. At the end of this period, ultrasound showed that 98 of 130 fetuses (75.4%) in the moxibustion group had turned to the normal head-down or cephalic position, while only 62 out of 130 (47.7%) turned in the group which didn’t have moxibustion. The authors concluded that moxibustion is a safe effective therapy for this condition, with additional advantage of being easy to administer at home, with minimal training.

Another study examined the treatment of Irritable Bowel Syndrome with Chinese herbal medicine. 116 patients were divided into three groups: the first group received a standardized Chinese herbal formula considered helpful in a broad range of IBS patterns; the second group received an individualized custom Chinese herbal formula; and the third group was given a placebo in capsule form visually identical to the two other preparations. The results showed that the two groups treated with Chinese herbs did significantly better than the placebo group, as measured both by the patients’ subjective reports and by their gastroenterologists’ evaluation. The authors of the study commented that, to their knowledge, “this is the first clinical trial in Chinese herbal medicine that fully adheres to the traditional Chinese diagnostic and treatment processes while using a strict and accepted methodological protocol.”

The third study—of treatments for pain due to HIV-related peripheral neuropathy—was more significant for the research issues it underlined than for its results. The study compared treatment with acupuncture against Amitriptyline (a conventional medical medication) and found that neither was effective. The authors of this study acknowledged that this result was very likely due to a problem with the study’s design.

Such design problems occur frequently when Chinese medicine is studied within a western research protocol, because the nature of Chinese medical treatment—based on individual characteristics—is not easily standardized, or generalizable over a broad range of cases as is required by western research methods. In addition, the creation of a meaningful placebo has also posed a hurdle for accurate research. Because while it is easy to put a neutral substance into a capsule, it is hard to give someone truly “neutral” acupuncture, or to fool them into thinking they haven’t had any acupuncture at all. Without a credible placebo, it is difficult for researchers to distinguish between the effects of “mind over matter” and the effects of the procedure itself.

In the context of these obstacles, this issue of JAMA is all the more significant because it takes conventional research past the point of rejecting alternative therapies on the basis of failure to show benefit in poorly designed studies. If research design challenges continue to be acknowledged by western researchers, they may ultimately spark better studies, with more accurate evaluation of this medical system that has already stood the test of time.