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The tyranny of the microscope

... and the allure of certainty

from the Editors

The Lantern: Volume I, Issue 2 - Article #1

Chinese and Western medicine complement each other so well because of the great difference in mindset, in approach. Chinese medicine is handicapped when there is a change at the cellular level that is not reflected in either bodily sensations or appearance of the patient (including tongue, facial colour, pulse and various bodily discharges). Western medicine can often pick this up early — for example, in a simple pap smear. Western medicine is handicapped when the patient feels something is wrong but none of the diagnostic tests show any changes. There is a tendency to downplay the patient’s sensations of illness, or suggest that it may be stress, depression or imagination.

This is not a consciously applied technique on the part of Western medicine, it is a natural outgrowth of the technology that focuses on chemicals, cells and molecules. In this world, the world of the microscopic, it is visible physical change at this level that is significant; vague subjective sensations give only a general hint about which tests to run. Once the tests come back, there is concrete evidence of the problem, a certainty to the diagnosis; there is a clear line: complaint—test—results—diagnosis. There is a firm foundation, someplace solid to stand. This concrete certainty is extremely alluring. You have proof for every move you make! You are Right, and you can prove it.

That is, if the tests come back with concrete evidence. Without clear positive results, there is no certainty, and for those reliant on certainty this would feel extremely precarious. Like sailors pre-Columbus: over there, beyond that horizon, is Chaos!

Infinitely variable life has a way of disrupting our certainties.

So what do you do? Improve the tests, by all means. Develop more sensitive scanning devices — perhaps the answer is at an even smaller level. One day surely we can control all the variables.

Or you learn to work with uncertainty. One might have methods of measurement that give you enough to go on, enough to be able to plot a course of action, without the comfort of absolute concrete evidence. One might navigate by the stars, instead of that solid dependable coastline.

This is the everyday world of Chinese medicine, our proper place, and one of our major contributions to the health care of our society: a different way of navigating. This is clinic, not the lab. We take the evidence of our own senses, together with the “vague subjective sensations” of the patient, and look for recognisable patterns. We have learned, over hundreds of generations of humans, what to look for, the patterns to seek, which could be confused with what, how to differentiate. There is no certainty, but from these pattern constellations we plot our course, the course for doctor and patient, back home to that fluid state called health.

Evidence-based medicine is very attractive if one is uncomfortable dealing with uncertainty. There is the proof: this treatment will work, for sure. Well, at least for a certain percentage of patients; the others are non-responders. Too bad for them. There is also the understandable tendency to try to fit the patient to the treatment instead of fitting the treatment to the patient: “Well, I know this works, it’s proven, and he is almost right for the category, so ..."

This type of approach also seems so undeniably right. Who can dispute that “we should use what works”? “There is proof for this treatment, it works, of course it should be used’ (unfortunately this all too easily slips into the false corollary, “There is no proof for this treatment, of course it should not be used.”) And again: works for who?

There are those who lament the advent of evidence-based medicine as the demise of the art of the clinic in Western medicine; the movement in this direction has been inexorable ever since Western doctors began looking more at their lab results than they do at their patients. This all may be so; it is really none of our business except perhaps to watch and learn.

It becomes our business when we are told that Chinese medicine should change its clinical approach to be more like Western medicine, when we are told we should have proof, and more certainty.

When certainty exists, by all means take advantage of it (before it moves!) — but when that coastline has disappeared behind you, and the waterfall at the edge of the world is before you, try Chinese medicine. It’s been there before.