May 30, 2007
The Chinese Medicine Minefield
By RUTH DORIS
THE doctor checks my pulse with his fingertips and asks me to stick out my tongue. He speaks rapidly to his assistant - a young Chinese man dressed in a suit - who acts as a translator.It is Dr Liao's opinion that the severe headaches, nausea, dizziness and vomiting I've been suffering from for the last three weeks are the result of not having 'enough blood' in my head. 'The blood is going up to here,' the translator says, indicating at the top of his throat, 'and not all of it going all the way up'.
Sitting on a stool in a cramped consulting room on Grafton Street, I take a few seconds to think about this diagnosis.
'So is it a circulation problem?' I ask. I'm told it could be a problem with my neck and this is stopping the blood reaching my head. What kind of neck problem isn't explained, but I'm assured that I can be cured with a combination of acupuncture, acupressure and cupping.
'And some herbs, all natural' the young translator adds, almost as an afterthought. ' Definitely no side effects,' he says. What's more, the treatment will banish this problem for 'maybe twenty years'.
Which is just as well because the costs of curing my 'blood in the head' problem are mounting up.
A session of acupuncture costs e40, acupressure is e30 and cupping is e20.
The specially prepared herbs cost e8 per bag - for the recommended five days that's e40.
So to start with my treatment I will have to fork out e130 for one session consisting of the three therapies and five days of herbs. And I'm told I will probably need more than one session.
I leave the clinic telling them I'll call to make an appointment later. But in reality I don't have a headache and I'm in no need of treatment, medical or otherwise.
Instead, I'm investigating the growing number of Traditional Chinese Medicine (TCM) clinics, like this one, that have been springing up in cities and towns all around Ireland.
One of the oldest system of medicine, Traditional Chinese Medicine has existed for up to 5,000 years.
China currently devotes around 25 per cent of its annual health budget to supporting TCM therapies, used in conjunction with Western medicine, to treat a range of conditions from asthma to fertility problems.
It is based on the Chinese belief in the existence of Qi, pronounced 'chee'.
Qi is the body's own life energy and illness is caused when this energy is out of balance.
BUT scientific studies have also shown acupuncture to be an effective treatment of chronic pain and pain clinics at some of the country's main hospitals include acupunture as part of their treatment programmes.
The belief is that it works by causing the release of 'feel- good' endorphins in the body and also by providing a stimulus that interrupts the pain messages to the brain.
Last month the internationally respected Cochrane Collaboration, a charity that specialises in reviewing scientific data, announced that Chinese herbal medicine may safely reduce the adverse side effects of chemotherapy drugs and antipsychotic medication.
And in November, the drugs giant Merck said it was seeking help from Chinese medicine to find a cure for cancer.
In Ireland, its popularity is growing, with private insurers now covering TCM and 500 practitioners registered around the country.
But alongside its growth in popularity, concerns are being raised that there is not enough regulation to safeguard patients.
While independent regulatory bodies such as the Acupuncture Council of Ireland, the Irish Register of Chinese Herbal Medicine and the Association of Chinese Herbalists in Ireland provide a strict code of practice for their members, they are only voluntary organisations.
The reality is that anyone can call themselves a practitioner of Chinese Medicine. As a result, industry insiders worry that the industry has become littered with poorly-trained or unscrupulous doctors, cashing in on the popularity of TCM and offering unnecessary treatments. They are also unable to recognise and diagnose serious medical conditions.
Some are prescribing herbs without checking patients' full medical history and some clinics offer consultations with doctors who may be adequately qualified but who rely on a translator to communicate with the patient.
'This is something that we're very concerned about,' says Celine Leonard, chairwoman of the Irish Register of Chinese Herbal Medicine.
'If you have a centre with a retail compulsion behind it, the impulse is to sell something and not necessarily to advise them to go back to their doctor.
'It is an issue for the Irish Medicines Board and the Department of Health.
We are pressing for regulation of the industry to protect the public and to protect ourselves.' As part of my investigation I visited six clinics presenting myself with the same symptoms each time: severe headaches for three weeks on the left side of my head, accompanied by nausea, dizziness and vomiting - typical symptoms of migraine.
I said I had been taking painkillers but they didn't give me any relief.
The consultations lasted between five and 20 minutes. Three of the clinics ad a Chinese doctor who didn't speak English and the consultation done with a translator, shop assistant or receptionist.
Only two of the six told me that my headache was a migraine. The various diagnoses I received were that I didn't have 'enough blood in the head', that d a 'neck problem' or I had a nerve problem'.
During my investigation, I was constantly told the herbs were comely 'safe' with 'no side effects'.
Professor Thomas Shanahan of the Irish Register of Chinese Herbal Mede says: 'That is absolutely blaly wrong. Some of the deadliest substances in the world are herbal.'
At some clinics, there seemed to be a one treatment fits all'
approach despite different diagnoses, the same al preparations were herb presented e in three clinics.
At two clinics, Medic Herb on Henry Street and Tai-ji on Grafton Street, they didn't take a history of my allergies or ask whether I was taking any prescribed medications. They didn't ask any more than my symptoms and I didn't even see a Chinese medical doctor. It was the receptionist or assistant who produced the same herbal preparation in red packaging (Zheng Tian Wan).
The writing was in Chinese except for the Latin names of the herbs listed on the side. When I asked the assistant in MedicHerb what the herbs were, she waved her hand at the rows of jars behind her, 'like those herbs,' she said.
According to the product's online blurb, the preparation 'moves the Qi upwards'. It is used for a 'variety of neural headache, vascular headache and migraine'.
When I researched the ingredients of this herbal treatment I found that it contained among others Angelica Sinensis, also known as Dong Quai, or 'women's ginseng'.
Dong Quai is commonly used for hormonal problems and should not be taken if you're pregnant. It can also interact with the contraceptive pill. I was not asked whether I was pregnant or taking the pill by these two clinics.
ANOTHER ingredient of the herbal package is Paeoniae Alba, which is also known as White Peony Root. It is a blood tonic but can cause low blood pressure, stomach upset and depression.
Again, I wasn't asked by either of these two clinics whether or not I suffered from blood pressure problems or stomach problems.
The Irish Medicines Board (IMB) advises patients of herbal medicine not to buy products which are not labelled in English and to tell your GP or pharmacist if you take any alternative treatments.
Last year the board issued a safety notice warning that a potentially harmful traditional Chinese medicinal product called Longdan Xiegan Wan was found on sale in Ireland.
This followed controversial findings of contaminated Chinese herbal remedies being sold in unregistered high street TCM clinics in Britain.
But what perhaps worried me most as stood in the clinics was that only one of the clinics asked me if I had seen my GP. This doctor, Dr Li from the Health Harmony clinic in Portobello, is, I later discover, registered with the TCMCI and the only one of the six on any of the Irish registers.
Last year the Department of Health issued a leaflet to complementary therapists. It recommended a full medical history be taken before prescribing any treatment and for therapists to ask if the patient has consulted their GP.
So how do you know who to trust?
Marese McElduff, from the Acupuncture Council of Ireland, says: 'It is very worrying that if someone had a bad experience it might put them off what is a wonderful therapeutic treatment.' She advises: 'Ask questions. People who are fully qualified are delighted to tell you about where they trained and where they're registered.' Professor Shanahan agrees. 'If you wanted medical treatment, would you go to a supermarket or would you go to a doctor's surgery?' he asks. 'Don't leave your common sense outside the door, your health is your most valuable commodity. People must be very sure that their practitioner - of any modality - is properly qualified, bound by a code of ethics and fully insured.'
For a list of qualified TCM practitioners, visit www.tcmci.ie; www.chinesemedicine.ie; or www.nationalregisterofherbalists
HEADACHE? IT'S THE BLOOD IN YOUR HEAD
RUTH DORIS visited six clinics complaining of increasingly severe headaches.
After the investigation, she approached them for their comment.
Dr Liao; HerbMedic, Grafton Street, Dublin 2.
FEE: Free consultation.
DIAGNOSIS: Not enough blood in the head.
RECOMMENDED TREATMENT: Herbs 40 for five days supply, course of acupuncture 40, acupressure 30 and cupping 20.
RESPONSE: The doctor is registered with an association in Britain and the clinic is part of a chain.
Dr Jane Li; Health Harmony, Portobello, Dublin 2.
RECOMMEND TREATMENT: A combination of 14 dried herbs taken twice a day over five days; 8.50 per bag; total of 42.50 plus a course of acupuncture costing 55 per session.
RESPONSE: There are a lot of these clinics from Britain opening up in shopping centres.
The doctors are not registered and this is a big problem in Ireland. An experienced and properly qualified doctor will ask you if you have seen your GP for your problem.
Herbmedic, Henry Street, Dublin 1; consultation with assistant FEE: Free DIAGNOSIS: Migraine headache.
RECOMMENDED TREATMENT: Two packets of herbs at 15 each for one week's supply, acupuncture 40, acupressure 30 and cupping 20.
RESPONSE: Maybe your problem was an easy problem.
For example, if you go to a health shop you will be given vitamins without asking about your medication. If you did take the herbs, you would then be asked to fill out a form giving your medical history.
Tai-Ji, Grafton Street, Dublin 2; consultation with assistant FEE: Usually 15.
RECOMMENDED TREATMENT: Herbs, 15, and acupuncture, 50 RESPONSE: Normally, we will ask and check with the doctor before offering any treatment.
The herbs are safe and don't have any side effects.
Dr Fan; Care Cure, Dun Laoghaire.
DIAGNOSIS: Neck problem.
RECOMMENDED TREATMENT: Acupuncture, 40, acupressure, 30, and cupping, free with the other two treatments. No herbs recommended.
RESPONSE: If you go to your GP, you will just get painkillers for this problem. Dr Fan is registered in Britain, you can ask for his certificate when you come to the clinic.
Dr Huan (visiting doctor); Dr China, Jervis Centre, Dublin 1.
DIAGNOSIS: Nerve problem
RECOMMENDED TREATMENT: Two packets of herbs at 12.50 each for one week's supply and acupuncture, 40.
RESPONSE: The doctor didn't need to check your pulse because when she asks questions she knows what condition you have. Our doctor has lots of experience. If you want the doctor to check your pulse you can ask.