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My patients really don’t care how faithful I am to Traditional Chinese Medicine theory, they want treatments that are safe and effective.  Most of them don’t care if an herbal medicine is from China or the USA (though when asked, most would prefer USA).  They want herbs which are safe and effective.  Acupuncture patients are always curious about “how it works” and seem more receptive to talk of endorphins and trigger points than telling them the most Qi is in the Liver meridian between 1 and 3 AM.  But, really, most of them just want it to work.  They want their pain to go away.  They want to avoid rotator cuff surgery.  They want to avoid taking Cholesterol medication or other prescriptions like antidepressants or antibiotics.  Some of them want to have more energy, some want to overcome emotional and creative blocks.

Chinese medicine supply companies mainly want my business (well, they want to avoid liability, too).  They each promote several product lines, often competing to have the most alluring literature.  This includes marketing materials about using their herbs to treat serious diseases, pamphlets about seminars in things like “Acutonics astrological tuning fork therapy” and muscle testing, great claims about their founders’ magic acupuncture point system or important role in restoring the true Classical Chinese traditions.  Most of these things make claims which are easily testable, but apparently it’s taboo to ask for proof.

My college wanted to sell me a degree.  They wanted me to pass the exams, show up to classes, meet their accreditation standards, be a satisfied customer, but mostly, to pay tuition.

I want to understand nature.  I want to know the Truth.  I want to help others with that knowledge and understanding.  Years ago, I dedicated myself to learn and practice the Taoist healing arts and sciences.  Why Taoist?  Because of the importance philosophical Taoism places on observing the cycles of nature, and the way that grew into a system of medicine that should therefore be based on optimal health through harmony with accurate observation of nature.

But Taoism, which has many sects and schools, is part philosophy and part religion.  Some sects use talismans and tricksters, others believe in powerful protective magic spells (to which menstrual blood is like Kryptonite!).  One Japanese acupuncturist decided it was the spiritual thing to do to release Sarin nerve gas in the subway system.  If you want to study far out belief systems, Asian spiritual/medical systems are a productive area to investigate.

The Chinese herbal medicine world is still working out the ramifications of herbs containing Aristolochic Acid, a highly carcinogenic toxin that caused an unsuspecting Oregon woman to experience kidney failure while under the care of one of my teachers.  I was in school with him at the time.  I learned about it years later in a book by a journalist.  I contemplate this looking for answers, but mostly it generates questions.  I want to discover the best questions to ask.  The ones which can change the world for the better.  The ones that let me help the most people.

What is safe and effective?  Where am I on the search for Truth?

I’ve been devouring books on science, skepticism, and criticism of Complementary and Alternative Medicine (CAM is a term I never liked, I prefer “natural medicine” as cheesy as that may sound to some).  Some of the best are by people trained in alternative medicine, who got into research of alternative medicine.  Edzard Ernst’s Trick or Treatment, R. Barker Bausell’s Snake Oil Science, Rose Shapiro’s Suckers, Dan Hurley’s Natural Causes.  These clearly written, well-referenced books are far outweighed by my many books on acupuncture, Chinese herbs, Chinese medical theory, martial arts, and various nutritional therapies.  One of my first skeptical books was Mystical Diets:  Paranormal, Spiritual, and Occult Nutrition Practices.  I bought it on sale at Powell’s Bookstore in Portland when I was a TCM student at the Oregon College of Oriental Medicine.  I wanted it to be a “pro” book, but the “con” aspect was fascinating–more detailed than most of the “pro” books about the history and thinking behind these systems.

One of the biggest message of these books is that the placebo effect is very powerful, and unless you compare an alternative therapy against a placebo in a big enough, well-designed study, you will never know the truth.  ”Systematic reviews” of many studies, when weighted for the quality of the research, already show a picture that not many proponents of homeopathy, chiropractic, herbal medicine, and acupuncture like.  Good news for acupuncturists is that there’s more supporting evidence for acupuncture than for homeopathy and chiropractic.  But it’s still pretty slim, and far more limited than acupuncture texts and teachers proclaim..  There is still time for proponents to produce good quality proof of their claims, but time is growing short…

I’m fascinated by cults, brainwashing, occultism, paganism, conspiracies…  But so much of it gets tiresome.  At first, it is exciting to read about a yoga sex scandal or someone who tries to escape Scientology and has cat blood smeared on her walls.  But after a decade or two of seeing this pattern, it doesn’t have the same excitement.  ”Another person fell for this scam, why didn’t they see through it earlier?”  Why didn’t I?

I tell myself (and my readers) that I willingly suspended disbelief to be a good student.  But from the start I thought, “Hey, if you prescribe herbs and do acupuncture to each new patient at the first session, how will you know which is having the effect?”  I kept my mouth shut and filled the formula in the herb pharmacy.  I figured out that the ozone generator that made my mentor’s house smell like a thunderstorm probably was contributing to his family’s asthma and coughs.  I printed out a ream of info from the American Lung Association, trying to convince him to turn it off.  I guess the ALA was too mainstream.  Coughs were unsuccessfully treated with homeopathics.  In the world of magical thinking, it becomes more useful to say, “Hey, the problem is you wrote ‘Cough’ on the bottle, and it’s working as intended!  Shouldn’t you write ‘Healthy Breathing’ on there instead?”  That criticism was more well-received than pages of well-explained research.

I numbed myself for a long time.  I got so comfortable with assumptions that I forgot they were there.  I assumed the herb company founders were smart, highly ethical, and very careful to sell only safe, effective formulas.  I was impressed by books, still am to some degree.  If it’s big and hardback, like a textbook, then it has an air of authority around it.  I got so used to applying my filters, ignoring the recommendations to use mercury and arsenic while thinking the parts on bupleurum and asarum were certainly sensible.  The books and their authors seemed reasonable and admirable.

Beri-beri is a nutritional deficiency disease, largely caused by eating too much white rice instead of brown rice.  There’s a simple, natural cure for it called Thiamine.  However, many acupuncture texts have multiple points with “beri-beri” as an indication.  I just ignored the acupuncture points claimed to treat beri-beri, but I still use Spleen 6 (above the inner ankle) to drain dampness and Heart 7 (on the outer wrist) to calm the spirit for anxiety and insomnia.  How do I decide what is meaningless and what is useful?

Often I don’t tell my patients what the points are intended to do, as I want the points to work on their own.  Now I realize that the treatments would work better if I confidently proclaimed the intended point functions.  This is true whether or not the points actually have those functions.  Patients often have bigger things to talk about, however.  Big issues of life, career, relationship.  ”I’ll be your counsellor, but you’ll have to let me put a bunch of needles in while you tell me your problems.”  I really want to know the roles and limits of acupuncture, hypnosis, placebo, and kind communication.

Medical experimentation on humans without informed consent is a crime made famous by the Nazis.  It has been banned in international law, the Nuremburg Code of medical ethics.  In the US, pharmaceuticals need to be shown to be safe and effective in a progressive series of tests where the first humans to take it are fully informed and carefully monitored.  Still, drug companies have been found guilty of going to Africa and testing unapproved new drugs on poor black kids.  It’s a terrible crime, and goes against any concept of medical ethics or human rights.

But then we have the herbal medicine world.  It’s not only tolerated but economically encouraged for someone with a theory to make up a new herbal pill, claim it can treat a multitude of diseases, and start selling it to acupuncturists, naturopaths, or chiropractors to resell to their patients with claims fully attached.  In fact, it’s over a billion dollar industry.  Peppermint for upset tummy or chamomile before bed on stressful day are likely safe and effective.  But competition has made the stakes higher.  Seven Forests Eupolyphaga Tablets for Cancer and AIDS (Eupoloyphaga is a Chinese Wingless Cockroach, conveniently left off the label and out of marketing materials) and Heiner Fruehauf’s Classical Ocean Pearls are clearly marketed by their creators for cancers and sexually transmitted diseases.  Perhaps there is some Chinese research on some ingredients, but these exact formulas haven’t been tested in any controlled way.  They are being tested on the patients who are prescribed them, and useful data is not even being collected.  I used to trust herb companies like this.  After Aristolochic Acid, everyone’s suspicions should be raised.  The marketing materials clearly are illegal–they blatantly ignore the laws about making drug claims.  What other things are being ignored?  Cleanliness?  Species identification?  Current research?  Do we cut them slack on proving these types of formulas are safe and effective because they are small companies?  Seven Forests reportedly made $1.4 million a year back in the 1990s.  Boiron, a multinational homeopathic corporation, makes $20 million annually off their duck remedy, the best research suggests “high potency” homeopathics are no better than placebo.  At what point do we insist on basic research?  Or because they are “natural” (or supernatural?) is it fine to skip that, even when patients with AIDS and serious cancers are making important decisions which might dramatically affect their lifespan?  At what point is it unethical human experimentation?

In trying to discuss these issues with other acupuncturists, I have met a few who share my perspective, favoring science and standard medical ethics.  But others instantly attack me.  ”Western medicine is more toxic than Chinese Medicine, so shut up.”  ”You should just treat patients and stop writing.”  ”You are a hypocrite, as you have a Cold Sore cream on your website.”  That last one is an actual example from someone who had no better response to my criticism about marketing of a remedy for ovarian cancer and gonorrhea.  I took off the Cold Sore cream to demonstrate my willingness to walk my talk.  I’ve taken off Aconite, traditional patent remedies with tiny amounts of Aconite, and long ago discontinued products for hair loss when I learned about the laws regarding topical drug products.

The other business models continue to grow.  Customers hear a convincing sales pitch and think, “What have I got to lose?  It’s just $20, I’ll give it a try.”  Multiply that by one million.  Ten million.  One hundred million.  You have a big industry.  I’d like a piece of that pie.  Make it a big slice, I’m hungry.  ”What have I got to lose?” asked Beverly Hames.  She lost her kidneys after faithfully following the advice of my teacher Mitch Stargrove, taking herbs from Subhuti Dharmananda’s Seven Forests line and other Chinese herb companies.  Clearly that doesn’t sit well with me.  What can I trust in my training and my industry?  What theories and practices are actually safe and effective?  It will take me a long time to answer these questions, but I will not abandon my quest.

I bonded tightly with an acupuncture classmate at OCOM.  I’ll call him Nathan, it’s not his real name.  He was pretty far out.  I was pretty far out, trying to get even farther.  He had no car.  I drove him all over the place.  We went to extreme yoga classes.  The teacher said, “I know how to attain physical immortality.  I’m just busy doing more important things, like running my clinic.”  I hurt my neck standing on my head too much.  It didn’t improve the blood flow enough to improve my critical thinking skills.  We went to Hare Krishna free dinners (perhaps the same group Steve Jobs went to when he was in Portland!).  ”You can climb the mountain of enlightenment via many paths.  But we have an elevator.  Maybe it’s more like a helicopter.  Yeah, that’s it, a helicopter to the top!”

Nathan and I shivered in his unheated shack of a house eating millet and drinking tea, “If you were really sick, who would you go see?”  I chose Mitch Stargrove as my top choice, should I have a severe injury or life-threatening illness.  There were some other naturopaths and acupuncturists we idolized, too.  Generally, the more extreme their claims and firm their confidence, the more we would trust them with our lives.

I’ve been thinking a lot about Beverly Hames lately.  I suspect that really is her name.  I found PO Box for a Beverly Hames in the online Portland white pages.  I’m writing a letter in my head.  Yesterday, I realized that Beverly Hames could have very easily been my mother.  Or even more likely, me.  I don’t cry very easily.  I’m crying right now.

If my mom had fallen off a ladder like Beverly did, or been in a car accident like Beverly was later, and finally told me, to my great satisfaction, that she wanted to use acupuncture and herbs in her recovery, I would have confidently referred her to Mitch.  ”Take whatever he tells you, even if you don’t understand it.  He’s really smart and nice.  He’s my professor of Medical History East/West at OCOM, and he’s also a naturopathic doctor.”  And of Seven Forests, “Subhuti is a genius in the field, highly respected.  It’s an Oregon company, he pays close attention to quality.”

I volunteered a lot of time to Mitch.  I moderated the early e-mail list for the Alchemical Medicine Research and Teaching Association (AMRTA, a pun on Amrita, the Hindu nectar of immortality).  This was back in the day with my 14.4k modem and Macintosh IIsi.  For a long time, Mitch’s e-mail tag line was a Voltaire quote:  ”The art of medicine is to entertain the patient while nature cures the disease.”  It seemed funny at the time, somewhat sarcastic but also hopeful that the disease would still be cured.  It doesn’t seem so funny anymore.  Beverly Hames would have certainly preferred something more entertaining than Aristolochic Acid while nature cured her back pain.  Back pain generally does self-resolve, as do many complaints people seek natural medicine therapies for.  This, of course, complicates conclusions based on “clinical experience.”

I’d like to assume that Aristolochic Acid was the only mystery carcinogen in traditional Chinese herbs.  But I assumed those herbs were safe before Aristolochic Acid caused multiple deaths.  As did Mitch and Subhuti and every other Traditional Chinese Medicine teacher, practitioner, and pharmacy.  It took “Western Medicine” doctors and researchers to put the puzzle together.  I’ve read the Natural Causes chapter about half a dozen times now, verified parts of it with other Portland acupuncturists.  This part echoes:

Following publication of the study, a distributor of Chinese herbs in Portland wrote a paper for the American Botanical Council titled “Stephania and Magnolia Bark:  Targets of a Misdirected Investigation.”  The distributor, Subhuti Dharmananda, PhD, was director of the Institute for Traditional Medicine.  Casting the Lancet study in terms of a turf battle between Eastern- and Western-style practitioners, he asserted that Dr. Vanherweghem was simply seeking to “enter the fray about herb regulation in Europe.”  Dharmananda saw only “flimsy circumstantial evidence” to support the claim that herbs had anything to do with the patients’ kidney failure.  In fact, he wrote, “No safety problems have been noted in the U.S. where stephania and magnolia bark (sometimes used together) have been utilized since at least 1976 and continue to be used extensively.”

Subhuti has a great reputation in the Chinese Medicine world.  I’ve looked up to him, myself, printing and treasuring his essays.  I’m sure Subhuti felt terrible when he learned that Beverly Hames had kidney failure largely due to herbal products his company had made.  No sane person would sell such toxic herbs intentionally.

But now I find myself wondering about his response.

At that point, Dharmananda, whose company annually grossed some $1.4 million selling herbs, did nothing more to check on the safety of the 500 to 900 bottles of stephania tablets that he sold each year, even though he did not actually know where Taising obtained its stephania.

Last night I searched for “aristolochic acid recall” and found many records from around the year 2000.  No mention of Seven Forests Stephania Tablets.  Mayway, my favorite company, still has a detailed page up about it.  They recalled some bulk herbs of the Temple of Heaven brand they had distributed.  The FDA has a list of Chinese herb formulas they tested and found Aristolochic Acid in.  Lotus Herbs, Qualiherbs, East Earth Herbs (Jade Pharmacy) are on there, but no Seven Forests.

Does this mean that after Subhuti learned that his Stephania Tablets had significantly contributed to Beverly Hames’ kidney failure, he quietly settled out of court with her and kept it as secret as possible?  Certainly he had records of all of the acupuncturists he had shipped that batch to.  Were they all contacted?  Did the acupuncturists who sold those batches contact their patients and warn them about the signs of kidney failure and bladder cancer?  Did those patients at least get kidney function tests?  Or was it all just kept quiet, in the hope that no one else would have Beverly Hames’ bad luck?  Was his strategy to hope nobody else would connect their kidney failure or bladder cancer to the herbs they took?  Searching Subhuti’s site only produces academically written articles which still make it sound like Aristolochic Acid damage from Chinese herbs is theoretical, rare, and somewhere far away.