By Mal Vickers

I went along to Open Day at RMIT Bundoora.  Oh boy, where do I start?

As a skeptic, I’m interested in the courses offered that seem further along the woo scale than most. To be fair, I should point out that RMIT is a big university, the overwhelming majority of courses on offer are high quality, science or humanities based. However, this is a skeptical blog, RMIT’s Chiropractic and Chinese Medicine disciplines are of interest to me.

In 2011 I took a close look at Chiropractic, I asked some questions about the practice and wrote two blog posts (here and here). A year later my questions about Chiropractic, still remain unanswered.

This year, I thought I’d take a closer look at Chinese Medicine.

RMIT offers a range of courses in both Chinese herbal medicine and acupuncture, up to and including a degree in Chinese Medicine.

Before I get into the details, here’s a little disclaimer.

Discussing Chinese Medicine can be tricky, due to cultural sensitivities, so let me state what I’m trying to do up front. I question the ‘medicine’ part of the description ‘Chinese Medicine’. Saying something is a ‘medicine’ implies that it’s effective for, at least, some health conditions. The associated cultural grouping is irrelevant. I could be investigating ‘Collingwood Supporter’s Medicine’ or ‘Morris Dancer’s Medicine’ – it’s the ‘medicine’ part that interests me. I also wish to question the teaching of Chinese Medicine by RMIT whilst the effectiveness of the practice isn’t well established, i.e. why set up a course to produce practitioners of Chinese Medicine whilst the science suggests that a great deal of it might not be effective?

I’ll address the question of which parts of Chinese Medicine are effective later in the post.

In this post, I don’t wish to stop research into Chinese Medicine, nor do I wish to denigrate any individual person or cultural group.

Is it too much to ask? Is it possible to untangle the cultural aspect from the ‘Medicine’ part?  I’d like to think so.

It’s not that I’m biased toward western medicine; I don’t mind what you call any medicine on offer. If it can be rigorously and scientifically demonstrated that it’s effective, then I’m in favour of it.

Open Day

RMIT opens its doors to the public every year in August for Open Day.  It’s a chance for Year 11 and 12 students and their parents, to look into possible options for further education. However, anyone from the community is welcome to ask questions and look at the facilities at one of Australia’s largest Universities.

The Traditional Chinese Medicine (TCM) department is located in Building 202 at the Bundoora campus of RMIT in the outer Northern suburbs of Melbourne.

The correct name of the department is in fact, the ‘World Health Organization Collaborating Centre for Traditional Medicine’. Why the department is named as such is explained by RMIT on their web site, here.

Indeed, it looks as though, from my research, the Chinese Medicine department at RMIT has the blessing of the World Health Organisation.

I found this statement by the WHO about Chinese Medicine practices:

WHO does not currently recommend these practices [TCM], but is working with countries to promote an evidence-based approach to addressing safety, efficacy and quality issues.

To me, this is a muddled policy, on the one hand, they don’t recommend TCM, perhaps they might if it becomes evidence-based. Yet, they are lending their good name to an institution that teaches people the practices they don’t recommend; well….. I find it odd.

I can understand WHO supporting various traditional medicines in countries where they can afford little else; however this is Australia.

What did I find at RMIT?

I saw a demonstration of acupuncture, of cupping and how to make up a Chinese Medicine face cream that, they claimed, can successfully treat eczema. I had a look in the TCM dispensary, which contained row upon row of all kinds of herbs, dried fungi etc, all neatly arranged and labelled.

I attended a talk/demonstration aimed at prospective students in the ‘acupuncture laboratory’. I’d actually never seen cupping done before.  Cupping was demonstrated as follows: the practitioner, using long tweezers, gripped a piece of cotton wool and dipped it in what I think was the flammable liquid ethanol. The cotton wool is then set alight and held for a few seconds inside an upturned bulbous glass cup. The opening of the cup, with the hot air inside, was then quickly applied to the skin of the patient – the stomach area of a volunteer student in this case. As the heated air cooled in the cup it contracted. The skin and perhaps a little subcutaneous fat are drawn up into the glass by the vacuum created by the contracting, cooling air. When the skin reaches a height of about 10mm or so, a quick twist of the cup will release the skin-cup seal.

The ‘acupuncture laboratory’ is an interesting room. It didn’t have anything like the clutter of equipment and benches that one expects to see in a University research ‘laboratory’. There were at least eight acupuncture trolleys (or gurneys) for patients undergoing acupuncture or cupping whilst prone. Some of the walls were decorated with acupuncture charts that most readers would be familiar with, showing the supposed meridian lines on the human body and the location of the many acupuncture points. Against other walls were enclosed glass shelving displaying containers of various Chinese medicines.  Also in the room there was an electro-acupuncture machine and a laser acupuncture machine.

I’m describing the room rather than showing you a photo because my request to take a photograph was declined by the staff of RMIT Chinese Medicine.

During the acupuncture demonstration, whilst inserting a needle the lecturer said

… when you feel the qi, you stop… and ….what you do is you put it (the acupuncture needle) on the acupuncture point and you feel for the qi…. ah now I got it.

(Note that ‘qi’ is pronounced chee. It’s also sometimes written in English as ‘chi’ or ‘ch’i’).

It was at this point in the demonstration that I had a moment of self-reflection. What was I doing here? Going to unusual places and doing a little skeptical investigation can give you that creepy ‘fish-out-of-water’ feeling from time to time. I had to check for certain – yes, I was listening to an introductory talk for a degree course, in a tax-payer funded Australian University.

On reflection, either:

(a) what I was seeing and hearing was worthy of a Nobel Prize, or

(b) I had just witnessed someone saying the equivalent of having seen a fairy at the bottom of the garden.

Am I the only person who finds talk of this mythical life force ‘qi’ in this situation extraordinary? My understanding is that the concept of ‘qi’ isn’t established in science.

The current Wikipedia entry for qi agrees with me.

The discovery of qi would surely be worthy of a Nobel Prize or two, I think. The as-yet-undiscovered life force was spoken about as if it was a straight forward, no big deal, reality.

Pellet

After the acupuncture and cupping demonstration people were invited forward to have an acupuncture pellet applied. I had one applied to my ear (see photo). It’s basically a small, clear sticker with a tiny round metal ball in the centre. These pellets are also applied to the postulated meridian lines with the same claimed benefits as the needles. Apparently these are fast becoming popular with practitioners and patients of acupuncture. As these stickers don’t penetrate the skin, they don’t have the same ‘ick’ factor as a needle and they can remain on the skin for a few days.

I was told that the pellet being applied to my ear would help me to be ‘calm’. So if there is any backlash to this post suggesting that I’m some kind of angry person, all I can say is, that’s impossible. I had the pellet on my ear whilst I wrote it 🙂

TCM Herbal

In the session on Chinese Herbal Medicine the demonstrator mixed up a facial cream from various herbal powders. She said that she’d given the mixture to a number of patients suffering from eczema and she claimed that they had all experienced significant improvement. The demonstrator also spoke of some of the details of improving period pain with various herbal preparations.

Later, I took the trouble of searching for eczema and Chinese medicine in Cochrane Reviews of the scientific literature. Apparently there have been some small trials of a product called ‘Zemaphyte’. The reviews found some benefit in the use of Zemaphyte, although the trials were small and of poor quality. Actually Zemaphyte is no longer manufactured.

There was no mention that a Zemaphyte-like cream was being made

at the demonstration. It worries me that the speaker at RMIT wasn’t showing the appropriate level of caution in relation to our current knowledge of the efficacy of TCM regarding eczema and period pain.

Here is part of a poster on display at RMIT which suggests TCM can be used for other human health conditions.

How much does it cost to study TCM?

Whilst still at RMIT during Open Day, I heard a student of Chinese medicine mention the costs associated with the course. It seems that after five years in the Chinese Herbal Medicine degree course, it’s not unusual to run up a HECS debt of $60,000. Individual courses (or subjects) can cost up to $1200 each.

In the final year of the Chinese herbal medicine degree course, students get to travel to China and work for six months under instruction at the Nanjing University Hospital.

Part of the TCM course at RMIT is about teaching students how to set up their own consulting room TCM business in Australia. There is instruction in managing your own business and it was suggested that the best way to get started was to find room at an existing doctors or physio clinic rather than work from home.

What works and what is questionable?

Despite possibly thousands of years of existence, there’s not much rigorous supporting science for Chinese Medicine. Its use is justified as ‘traditional’.

TCM Herbs

The greatest scientifically verifiable successes with Chinese Medicine have been with the use of herbs. Although it could be argued that in any large sample of plant species you’re bound to come across some useful compounds. Our modern pharmacies, contain many medicines, the active ingredient of which is a compound derived from plants found in nature.

Artemisinin is a compound isolated from the plant ‘Artemisia annua’. Artemisinin when used as a drug, is verifiably successful at removing malaria parasites from the body. The initial scientific work on Artemisinin was done by the Chinese Army in 1960 and the efficacy of the drug has since been replicated by others.

Artemisinin, in combination with other compounds, is now the recommended choice for the treatment of malaria. The reason that Artemisinin is not used alone; it’s known that use of a single compound would allow the malaria parasite to more easily develop resistance.

I didn’t hear any of this information at RMIT open day. I’m pointing this out, to be fair to Chinese Medicine. When properly and rigorously tested, some traditional Chinese Medicines have been shown to work. However, the great majority have no rigorous science behind them. If you visit a Chinese Medicine practitioner and get some kind of herbal preparation, it’s not regulated by Australia’s Therapeutics Goods Administration as would be the case if you purchase from your local pharmacy.

Acupuncture

There have been many studies into the efficacy of acupuncture. Typically the studies are small and lack rigorous controls such as a good placebo control. A very good placebo for acupuncture does exist however. The placebo is a superbly designed needle that, with a little resistance, slides back into the handle. The placebo acupuncture needle feels exactly the same to the patient and the practitioner as a real acupuncture needle. Thus those involved in this sham form of acupuncture using the placebo needle don’t know if the skin is being penetrated or not. These placebo acupuncture needles were developed in 1999; however I didn’t see any evidence of their use at RMIT.

Contemporary Australian researchers appear to ignore them. The author of this study argues against the use of a placebo control in a recent acupuncture trial.

The ideas underpinning acupuncture, that there is this a life force known as ‘qi’ (or Chi) that runs along specific ‘meridian’ lines under the skin, has no support at all in modern science or physiology.

I don’t know of any suitable placebo for cupping; giving someone a ‘hickey’ perhaps?

Questions for RMIT

After my visit to RMIT’s Chinese Medicine department on Open Day, I sent the following questions for clarification to RMIT University’s communications office.

1. I saw an instructor named [name removed], perform a demonstration of acupuncture. During the demonstration he said that he could feel the ‘qi’ (or ‘chi’) life force through an acupuncture needle inserted in a volunteer patient.

My question is:

Would [name removed] be willing to show that ‘qi’ exists by taking part in a double blinded test to help establish the existence of ‘qi’? 

I may be able to help arrange such a test. If the existence of ‘qi’ could be established, it would be very exciting news, and RMIT would be part of that and truly considered a world leader in the field. In my opinion, proving the existence on ‘qi’ would qualify as a paranormal power.  [name removed] would be eligible for a $100,000 prize from the Australian Skeptics for proving the existence of a paranormal power. He could then possibly go further and try for the one million dollar prize available in the USA. The test would be done fairly and in consultation with [name removed] and subject to all appropriate scientific protocols.

I couldn’t say for sure how such a fair test would be done, that is yet to be worked through. However this is a rough sketch based on what I observed at RMIT Open Day. A number of identical screens cover people or synthetic rubber blocks. Only one acupuncture needle would protrude through a small hole in the screen. It would be the job of the acupuncture expert to touch the needle and declare if he could or could not feel the life force known as ‘qi’ from the needle. The synthetic rubber block, having never lived should have no life force.

2. In relation to other claims made at Open Day, my question is:

What rigorous scientific evidence do you have that Chinese herbal medicine is effective for the treatment of period pain and eczema?

I heard claims at RMIT that Chinese Medicine preparations could be used for the treatment of period pain and eczema. I’m concerned that prospective students might be misled into starting a long and expensive course to become practitioners, based on dubious claims.

Please note, I’m asking about completed and replicated scientific studies in quality journals, not studies where the results are not yet known.

3. Nature News recently published the results of a DNA based investigation into Chinese Medicine preparations. The leader of the investigation team, Dr Mike Bunce said that “There’s absolutely no honesty in the labelling of these products. What they declare is completely at odds with what’s in there”.

I’m aware that the samples of Chinese Medicines were NOT taken from RMIT’s Chinese Medicine Clinic. My question is:

In light of these findings, I’d like to know if steps have been taken to ensure that patients at RMIT’s clinic are actually receiving the correct medicines that they’re prescribed?

I politely asked that the relevant personnel at RMIT to respond to my questions within a month.

On the 22^nd of August I received the following statement from RMIT in answer to my questions:

Statement from RMIT University

The key to safe practice in any health field is to have highly qualified and well-trained practitioners.

On the 1st of July this year, Chinese medicine came under national regulation through the registration and accreditation scheme supported by the Australian Health Practitioner Regulation Agency (AHPRA).

The purpose of health practitioner regulation is to protect the public by ensuring that only health practitioners who have the skills, qualifications and knowledge to provide safe care are registered.

The five-year double-Bachelor degree program in Chinese medicine at RMIT equips graduates with the skills and biomedical knowledge they need to be safe, ethical and professional practitioners.  

The program is subject to external accreditation and meets current professional standards.

As a responsible, public-funded institution, RMIT plays a key leadership role in providing quality education that incorporates the best available evidence, while promoting further clinical research.

I don’t know what you think dear reader; however I thought that none of my questions were seriously addressed. I again wrote to RMIT.

Thanks for the prompt reply.

To reiterate: I asked if [name withheld], a lecturer at RMIT, would be willing to scientifically confirm his ability detect ‘qi’ as he did in a simple and casual way at the talk I attended. It would be absolutely fantastic if he could, it’s something that has thus far eluded modern science.

I also asked for any evidence of the effectiveness of Chinese Medicine to treat period pain and eczema.  The claims for the benefits of TCM in the treatment of these conditions were made during the open day talks I attended. Please send me a link or reference to a scientific study which supports the claims.

In relation to the quality control of the herbal medicines dispensed at your public Traditional Chinese Medicine Clinic. In light of the research showing that many Chinese Medicines aren’t correctly labelled.  I think it’s reasonable to ask about improving quality control, is this happening?

I’ve received no further correspondence from RMIT.

In my humble opinion, RMIT’s responses were non-specific to my questions. They appear to use a logical fallacy commonly practiced by politicians known as ‘moving the goal posts’. I’ll explain. One of my questions was quite specific in asking; how effective is Chinese Herbal Medicine in the treatment of two health conditions? I asked RMIT about efficacy; they moved the goal posts and answered a question about safety.

Safety is actually only partly my concern. People wasting their money on something ineffective, or worse, being distracted by something useless when they should be getting an effective treatment is more of a concern.

The reality is, if you are generally healthy, sticking needles in your skin won’t harm you. It’s known that acupuncture does in fact give you a slight pain relief effect, although it doesn’t matter exactly where the needles are applied. The so called ‘meridian lines’ are irrelevant. You would naturally get the same numbing effect from sticking sewing needles in your skin.

Also, quaffing a mixture of exotic herbs probably won’t harm you. Most substances, including (so called) natural herbs, have a toxicity level to humans. As long as you consume the herb well below the toxicity level – you’ll probably be fine.

However, it is possible to come to some harm using TCM. The ‘What’s The Harm’ web site details examples of people who’ve been misdiagnosed, undergone useless treatments and in some cases died as a result of TCM. See the pages for acupuncture, cupping and herbal remedies.

Returning once again to my points about RMIT and Chinese Medicine:

It was very disappointing to see potential students encouraged to start a course to become a TCM practitioner in Australian – whist the supporting science for the practice isn’t very good. It was disappointing to hear a lecturer at an Australian University speaking of the mythical life force ‘qi’, so far unknown to science, as if it were real. Aren’t Australian Universities about striving for the highest standards in science? Aren’t they places for learning, research, scholarship and critical thinking?