1085: Traditional Chinese Medicine | Skeptical Sunday

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1:56Today, traditional Chinese medicine might have started in China, but these days it seems to be everywhere. Acupuncture is practiced worldwide. The ancient practice of cupping is growing in popularity. And herbal medicine is in pretty much every pharmacy. Everybody knows somebody who swears by one or maybe even all of these practices. But is traditional Chinese medicine effective medicine passed on for millennia or ancient superstition here in the modern world? Today, skeptic and comedian Michael Regilio is here to express the Tao, or is it Tao, I would say Tao, of how traditional Chinese medicine works, or doesn't work.

2:33How's it going, Michael? Hey, Jordan. How are you feeling today? I'm feeling peachy, man. Peachy. Interesting. Did you eat peaches to become peachy? Because in traditional Chinese medicine, maybe. I don't know. I didn't come across that. I thought you were just making a really terrible dad joke. But I know that when you eat certain things, like cold or hot foods, something, something, your energy. You know what I was really getting at is, are you feeling balanced? Well, I'm not falling out of my chair. So I'm physically balanced. I have a balanced diet, a balance between work and leisure. So I'm not exactly sure what you're asking.

3:06What do you mean? Am I feeling balanced? I simply meant your yin and your yang. Of course. How could I forget? No, I'm not so sure about that. I don't really know. I don't know what my yang is up to today. Well, that's interesting because that is the crux of traditional Chinese medicine. A traditional Chinese healer is trying to restore balance between these two complementary forces that flow through not just your body, but throughout the entire universe. According to traditional Chinese medicine, a person is healthy when harmony exists between these two forces, and sickness occurs when there's more yin than yang or more yang than yin.

3:44Okay, seems like the obvious next question is, what the heck are yin and yang? We've all seen the graphic representation on posters in teenagers' rooms and on the walls of suburban dojos. For lack of a better example, it looks like a white sperm and a black sperm positioned head to tail in a circle. Sixty-nining? Oh, God. Okay. You couldn't have thought for like one second longer and come up with a less crass description? Tadpole would have worked. You could have added the word whale. A sperm whale looks close enough, like a beluga thing. All right, that's totally different, but whatever. And you could have left out the other bit.

4:23Fine. Okay. But even then, these cliched posters I'm talking about, they're just graphic representations of something actually unseen, an invisible life force. Yin is considered the female of these two forces. For an ancient, highly patriarchal culture, I'm actually kind of impressed they chose to represent females. The female force, Yin, is considered cold, dark, and passive. Just once, I'd like to be surprised by an ancient patriarchal culture, but not this time, apparently. Yin's opposite won't surprise you either, then, because yang represents masculinity. Light and warmth actually sound more female than male.

5:03Yeah, ironically, they got yin and yang mostly backwards. Although the female yin does also represent earth, softness, and rain. So those are nice. As well as blackness, evil, smallness, and even numbers. Okay, even numbers. So ancient Chinese also had an opinion on even numbers? Yeah, as we'll see, much of traditional Chinese medicine isn't that far removed from numerology, astrology, and stuff like that. Yang represents heaven, sunshine, hardness, goodness, the color white, largeness, and of course, odd numbers. According to ancient texts, the interplay between these forces make up qi, which is the life force that flows around and through our bodies.

5:53So yin and yang represent two opposite polarities within the force of qi, like the positive and negative polarities in electricity? Yeah, actually that's really good. You might have a little side hustle in traditional Chinese medicine in your future, Joe. I like poking holes in people. Okay, let's leave that there. But what is chi, like scientifically speaking, this thing that they thought was chi? Okay, look, after a lot of research, I can only say with some generosity that chi is a metaphor, an attempt by ancient peoples to explain complex systems like nature and the human body. If I wanted to be really generous, I'd say it's kind of like the force in Star Wars, which that's pretty cool.

6:37Yeah, that's definitely pretty cool, but it's also definitely made up. But I'm guessing we're going to get to that shortly. Yes. And traditional Chinese healers try to correct the imbalances of qi and yin and yang through the practices of herbal medicine, acupuncture, and cupping. These practices originated as far back as 22 centuries ago. Wow. So people have continually researched qi and yin and yang for 2 ,200 years or so. Well, frankly, that's incredible and impressive. And one would normally think speaks to some effectiveness in some way. No, because right off the bat, there's a misconception there.

7:18Traditional Chinese medicine. So can we just call it TCM? TCM, but people might confuse that with Turner Classic movies. I think it'll be all right. Okay, fine. So back as far as the 1600s, TCM had been written off as superstition in China. And by the 1800s, TCM had pretty much been completely abandoned. The Chinese were adopting Western medicine and leaving TCM to the fringe view. So even 400 years ago, people had walked away from TCM and moved towards Western medicine, which, by the way, at that point, Western medicine was probably something like, oh, she's got the vapors. I'll go get the leeches.

7:58So that's surprising. It's so strange to me they were ditching this stuff way back then because it's so huge these days. So what happened? Was there an event or something along those lines? Let's put it this way. As my weird social studies teacher at high school used to say, communism doesn't work. And that's what happened. Okay. What do you mean by that? Chairman Mao and the Chinese Communist Party found themselves in a bit of a pickle in the early 1960s. They had promised healthcare to everyone, but didn't have the doctors, facilities, or medicines to make good on that promise. TCM offered a solution.

8:36Practitioners didn't require the same extent of training as Western doctors. The doctor shortage of China was particularly pronounced in rural China, and rather cynically, the Communist Party kind of assumed these, for lack of a better term, hicks wouldn't know the difference anyway. So this gave rise to what they called the, quote, barefoot doctors, which were basically just farmers who had taken a crash course in TCM. Chairman Mao was happy as he was able to fulfill his promises. And in general, people were happy as they had medical care. And after a several centuries long break, TCM came roaring back.

9:13I guess everybody was happy with that, right? So Mao, he looks good. The people who are getting and treated look good and feel good. Well, except for the people who actually needed medical treatment, this was a clever solution. Yeah, in fact, Mao himself was an avowed believer in Western medicine. His personal physician quotes him as saying, quote, even though I believe we should promote Chinese medicine, I personally do not believe in it. I do not take Chinese medicine. So he really could not be any clearer on that. That's funny, it's so blunt. But how did so many people in America then come to believe in TCM?

9:53How did it make its way here and then suddenly become like ancient Chinese technology that they don't want you to know? Some of the credit goes to, and I'm sure you've probably already guessed this, Richard Nixon. Yeah, I was absolutely not going to guess Richard Nixon. What does he have to do with any of this? In 1972, Richard Nixon famously visited China. And as always, a press pool followed. In that press pool was James Reston of the New York Times, a political reporter. While there in China, Reston fell ill and needed an emergency appendectomy. Oof, ouch. Getting sick in a foreign country is scary.

10:28Getting surgery in a foreign country would be really scary, especially if it's China in 1972. So I had a root canal in the former East Germany, which was very developed by the time I got there in the 90s. It was no longer East Germany, of course. and the dentist, he had been trained in the Soviet Union and just happened to be out of anesthetic or didn't use it. He only had that banana flavored spray. This spray is what they use when they're like, oh, I'm gonna scrape something under your gum. They don't need to inject you. That's all he had, but then I got a root canal with that and it hurt really bad.

11:02They had to hold me down, not the dentist, obviously he was working. His assistants held me down in the chair. It was hopefully as close to being tortured as I will ever get. And meanwhile, there was an entire room full of anesthetics in the next room over, and it was just this stereotypical evil East German dentist. No, we have no anesthetic. Yeah. All right. He really just didn't like me at all, I think, is what it came to. Okay. American, huh? No anesthetic. Sorry, we're out. All right. Chinese doctors gave James Reston, who we were originally talking about, almost entirely Western medicine when they performed surgery on him.

11:40He had normal anesthesia, antibiotics, et cetera. But as a little showcase for TCM, his post-surgery routine included acupuncture. Reston, who, as I said, was just a political reporter, he had no medical training or expertise to judge this, but he went back to America and he wrote a now-famous op-ed in the New York Times, completely touting this amazing ancient procedure, acupuncture. Even though Reston was clear in the op-ed about the fact that the acupuncture was just a post-procedure addition to his medical care, the rumor mill did what the rumor mill always does. And it churned out these fantastical stories here in the US about how only acupuncture was used and no Western medicine.

12:27And as a result, TCM in America became all the rage, which it remains. With roughly 38 ,000 licensed acupuncturists in the US, it's safe to say they are everywhere. In fact, it's so easy to find one that just out of curiosity, I asked my phone where the nearest one was. Can you do the same? I'd be curious. Where's your nearest acupuncturist? Sure. I don't even necessarily need to use my phone. My wife's parents know plenty of these folks, and I've had it done for pain, and I've done an entire Skeptical Sunday episode on acupuncture alone. It's everywhere. I live in the Bay Area here in California.

13:05There are literally hundreds of places to get it around here, but I last had it next door to my house because this friend of my wife's parents just happened to roll through, and I was like, sure, I'll do it. Wow. Okay, so you're like 15 yards away. Mine says 0.3 miles away is the closest acupuncturist, but then it tells me 0.4 miles away, there are three and a half mile away, there's even more acupuncturists. And when I hit the button for directions, the phone defaults to walking directions. That's how close my nearest acupuncturist is. Okay, but in truth, you're in LA, and I'm guessing that's not the national norm to have acupuncture within walking distance of your house.

13:44Yes, I anticipated that you might to say that. So I had a friend in Iowa do the same. And he said there are four in his zip code. The nearest one is under a mile from his house. Wow. Point taken, I guess there's a lot of acupuncturists in America. Sheesh. Yeah, that was a good one. Compare the 38 ,000 acupuncturists we have here to the measly 18 ,000 podiatrists in the US. It's really wild how many acupuncturists there are in the US. Could you imagine if you went to China and there was a Navajo medicine man on every corner in China? Right. Hey, like nearest Navajo medicine man. I need some burning herbs blown in my face.

14:23Oh, you just walked down the road that way. And if you go up to the third floor, that guy's a little bit better, in my opinion. Wow. So it sounds like it's big business giving people little pokes. Absolutely. Acupuncture brought in$27 billion in 2021. So when looking at the reasons these treatments are perpetuated, you really can't overlook the money. And that's not to say that there aren't other reasons. It seems like a good time to ask, since many people won't have recently heard our episode on acupuncture, which was a zillion years ago in podcast timing. What exactly is acupuncture, besides stabbing your way to the balance of yin and yang and whatnot?

14:59Okay, acupuncture, like all things TCM, has to do with qi, which, for the record, is spelt Q-I if you're looking to Google any of the stuff we're talking about later. And chi, which again is an invisible energy, it flows through invisible meridians in the body. Meridians are like channels through which the chi flows. According to TCM, there are 12 major meridians that connect to organs, tissue, veins, nerves, cell, atoms, and mother-freaking consciousness itself. And so then the needles are inserted into the meridians to readjust the flow of the chi in order to readjust the balance between the yin and the yang.

15:42Okay, so is any of it real? Are the meridians, did they turn out to be nerve pathways that everybody has? Does the human body have 12 of those? Can scientists see those on a cadaver or measure or detect any of this stuff? Short answer, no. Okay, that's a really short answer. Fine. Longer answer. Hell no. Am I being snarky? Hell yes. Is there more to it? Yes. The big question is if the acupuncture is doing anything or is the relief people receive, is it all in the brain? You know what will leave you feeling balanced? The fine products and services that support this show. We'll be right back. If you're wondering how I managed to book all these great authors, thinkers, and creators every week, it is because of my network, the circle of people I know, like, and trust.

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16:55And many of the guests on the show subscribe and contribute to the course. So come on and join us. you'll be in smart company where you belong. You can find the course at sixminutenetworking.com. Now, back to Skeptical Sunday. First of all, if I'm not mistaken, my health insurance when I lived in L.A. covered acupuncture. And I know that there have been studies showing some merit. And of course, there's all the people I know who swear by it. We did the episode on acupuncture. A lot of people emailed in and were like, okay, okay, but you're wrong about a few things. And I use it for my pets or whatever.

17:28I did it for pain in my shoulder. and I am open to the idea that it's just placebo. But first of all, the placebo effect is certainly real and measurable and well-studied. It certainly sounds like there's a there there because I will say my shoulder pain was remarkably degraded and I assumed it was placebo, but I'll take it. Fine, sign me up. Absolutely, I get that. I understand that. But you mentioned the studies and I wanna talk about them. Let's start with those studies because you're right. There have been studies and studies do show acupuncture to be effective, but there's a problem, and it's a big problem.

18:00Most of the studies that prove a benefit were conducted in China. And these Chinese studies stand in contrast to most studies done outside of China. And scientifically speaking, when you have, that's a big red flag. And I don't just mean the one with little yellow stars on it. So it sounds like you're saying the Chinese cherry-picked or maybe even fabricated the data or the results. I don't have to say it. China's food and drug regulators unearth widespread data fabrication in these studies. Chinese regulators carried out a one-year review of clinical trials and concluded that more than 80 % of clinical data is fabricated.

18:39And this doesn't just go for acupuncture, by the way. These studies included all the Chinese pharmaceuticals. Buyers of Chinese medication online, myself included, 10 years ago. Beware. Yeah, I believe that would be called caveat di emperor. Sometimes I know a joke is clever, which makes it even more annoying somehow. So Chinese studies can't be trusted when it comes to this stuff, I'm guessing. I mean, that's what it sounds like. Here's the thing. Actually, most studies of acupuncture can't really be trusted because of the impossibility of performing a true double blind study. That is to say, a study in which both the researcher and participant don't know which is the placebo and which is the actual treatment.

19:24I see. I would imagine that would be difficult because how could the person administering acupuncture not know that they're administering acupuncture? It's not like they're giving somebody a pill and they don't know if the pill is placebo or real. They have to stick needles in meridians or whatever. Right. Yeah. Yeah, and obviously the flip side of that is how could the person receiving the acupuncture not know they're receiving acupuncture? Right. So what does an acupuncture placebo even look like? I mean, a needle's a needle, and I guess that's where we get stuck. No pun intended again. Sorry.

19:55Placebo, you could, I don't know, try poking people with insults. Look, to do a proper scientific study, you need a control group, and that's just not possible with acupuncture. So in studies, the control group receives the placebo, right? Yes, exactly. So what some studies have done is to test acupuncture against what they call sham acupuncture. Basically, one group, they use the real meridians, by which I mean the imaginary meridians. And in the other group, they just randomly put the needles in non-meridian spots. And I'm guessing the problem with that should seem relatively obvious. right because why would it matter if needles were placed on imaginary meridians or imaginary non-meridians it all it sounds all the same i mean if you just put a needle anywhere and it'll maybe do something you're right because if it's not real and that's what you're testing for then you can't really check where the meridian is because you can't see it and it's not detectable anywhere unless you put the needle in it it does something oh yeah we're sort of caught in this weird loop.

21:03Yeah. And look, that's pretty much what the study showed. And these were large clinical trials conducted in Germany and the US. Yeah, not China then. Right, which is worth noting. And these non-Chinese trials consistently showed traditional acupuncture and sham acupuncture are pretty much the same decreasing pain levels for migraines, lower back pain, and knee pain. I'm steel manning this. It sounds like what you're saying is, hey, there is relief from acupuncture because migraines are tough to treat and lower back pain sucks and so does knee pain. So sign me up for acupuncture. Absolutely. And you'd be right.

21:39But is it the acupuncture or is it the placebo effect? There's actually a widely touted meta-analysis of acupuncture that shows a difference between real acupuncture and sham acupuncture. But in reading about this, there's a lot of critics of this meta-analysis. They point out that the differences are very minute between different people. Plus, there is like these huge criticisms of meta-analysis in general that I'm going to be honest with you, I don't understand. Yeah, a lot of that stuff is tough to understand because at first I was like, let me read this. And there's a lot of Greek symbols that are like, when you use lambda in the wrong way, then, and I'm like, oh, this looks like calculus.

22:19I am out. So I get it. This would be hard to understand anyway because it sounds as silly as doing a meta-analysis of like astrology or something. Where do you start? Yeah. Meridians and qi simply aren't proven, and balancing yin and yang isn't medically sound. And what are the odds that at the end, science ends up going, hey, look, turns out what ancient people believed with no understanding of biology, and they were totally right about all these invisible things they made up. Yeah, it's like saying, what if ancient people were right about sacrificing virgins to volcanoes? First of all, you and I both would have been in deep trouble back in high school.

22:59That was a private story I told you. Not anymore. Okay, look, we need to understand if the act of needles stabbing the skin does something real, like tangible and scientifically provable, or is it just all placebo? So I guess my little gripe with this is, it sounds like by saying placebo, you're almost saying, oh, this is worthless. And yes, I'm baiting you because we've done several episodes on the placebo effect, and I've got even more stuff about it in the pipeline. And it turns out that it's quite a legit way to treat pain. Yeah, it's awesome. In fact, in researching this episode, I came across several full-throated defenses of the placebo effect by some of the most reputable institutions in medicine.

23:41One article from Harvard Medical School was the one that really set me straight on placebos, particularly when it comes to pain management. Pain is in the brain. Ooh, that is dangerously close to a Cypress Hill lyric, I think. That it is. And I may be insane in the membrane, but the fact of the matter is the way our brain perceives the messages from pain receptors is pain. That's just what pain is. So if placebos convince our brains to release endorphins, which relieve pain, the pain relief is as real as if you'd taken a pharmaceutical drug without the risks of taking pharmaceutical drugs. Hey, placebos, like seriously, no disrespect.

24:24I get you. Yeah. I mean, you can't be allergic to your placebo. I don't even know. Maybe I spoke too soon. It seems like that could be one of the things that triggers is allergies, but whatever. So you asked if acupuncture might be doing something more, what would be the more if the idea is to treat the pain? Yeah. So actually, this is where it gets murky because serious professionals who I respect haven't ruled out that causing micro injuries might be triggering an immune response or sending anti-inflammatory proteins and other infection fighting and wound healing chemicals to these micro injured areas.

25:02Okay. I can get behind that, right? You're sticking a needle into something and maybe your body's like, hey, send more blood there. Because I'll tell you, the areas where I got poked by these little needles definitely turned red and some of them got a little sore and yada, yada. But also, on the other hand, the words might be in those sentences that you just previously spoke. It seems like they're doing a little bit of heavy lifting there. Yeah. Some also propose that these micro injuries might, and you said it, increase blood flow to the area or might activate nerve receptors. They're still hypothesizing about it, but there's not a lot of evidence.

25:40Gotcha. Yeah, and you're still using the word might quite a bit. Yeah. Look, in this case, might definitely doesn't make right. So what if they haven't ruled it out? They also haven't ruled it in. Reputable people do wonder if acupuncture is doing something more than the placebo effect. But the fact is, all the evidence suggests that on a neurological level, it's treating pain just like a placebo does. So for pain relief, it sounds like acupuncture gets a solid maybe. Yeah, I don't know. I'd go so far as to say a solid yes for pain treatment, as long as you believe. For skeptics, I couldn't help but wonder if the placebo effect is less or even no.