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Tradicionalna kitajska medicina je uradno ‘prava medicina’

Updated: Dec 26, 2019


Svetovna zdravstvena organizacija (WHO) v svojo vplivno knjigo vključuje poglavje o tradicionalni kitajski medicini, kjer razvršča na tisoče bolezni. Mednarodna klasifikacija bolezni (ICD) in ICD kode so alfanumerične kode, ki se uporabljajo za klasifikacijo diagnoze. Zdaj bodo prvič v zgodovini ICD kode vsebovale tudi TKM terminologijo kot je npr. primanjkljaj vraničnega Qi ali stagnacija jetrnega Qi.

Globalni doseg navedbe virov je neprimerljiv. Dokument kategorizira tisoče bolezni in diagnoz in določa zdravstveni program v več kot 100 državah. Vpliva tudi na to, kako zdravniki postavljajo diagnozo, kako zavarovalnice določajo zdravstveno zavarovanje, kako epidemiologi osnujejo svoje raziskave in kako zdravstveni uradniki razlagajo statistike o smrtnosti.

Skrbi konvencionalnih zdravnikov

Vendar so številni zahodnjaško izobraženi zdravniki in biomedicinski znanstveniki globoko zaskrbljeni. Kritiki gledajo na izvedbe TKM kot neznanstvene, nepodprte s kliničnimi raziskavami in včasih celo nevarne: kitajski nadzorniki zdravil letno dobijo več kot 230 000 poročil o škodljivih učinkih TKM.

Kritiki se prerekajo, da ne obstajajo niti fiziološki dokazi o obstoju Qi ali meridianov niti skromni dokazi, da TKM res deluje. Bila je le peščica primerov randomiziranih kontroliranih kliničnih poskusov, ki so pokazali, da so zdravljenja s kitajskim zeliščarstvom učinkovita. Opazna in pomembna učinkovina, ki izvira iz TKM, je artemizinin. Prvič ga je izolirala Youyou Tu na Kitajski akademiji tradicionalne kitajske medicine v Pekingu, zdaj pa je ta molekula močno zdravilo za malarijo, ki je Youyou Tu priborila Nobelovo nagrado v fiziologiji oz. medicini l. 2015.

Vendar so znanstveniki porabili milijone dolarjev za randomizirane poskuse z drugimi TKM zdravili in terapijami z malo uspeha. V eni izmed obširnejših ocen so si raziskovalci na Univerzi Maryland na šoli medicine v Baltimoru ogledali 70 sistematičnih ocen, ki so merile učinkovitost tradicionalne medicine, vključujoč akupunkturo. Nobena izmed teh študij ni mogla doseči trdnega zaključka, saj so bili dokazi ali pomanjkljivi ali slabe kakovosti [1]. NIH-jev Center za komplementarno in integracijsko zdravje v Bethesdi, Marylandu je zaključil, da za večino stanj ni dovolj doslednih znanstvenih dokazov, ki bi pričevali, da TKM metode res delujejo za zdravstvena stanja, za katera se uporabljajo.

Drugačen pristop konvencionalne in tradicionalne medicine

TKM temelji na teorijah o Qi, vitalni energiji, za katero je rečeno, da kroži po kanalih, imenovanih meridiani, in pomaga telesu pri vzdrževanju zdravja. Pri akupunkturi iglice prebadajo kožo, da se dotaknejo katere koli izmed na stotine točk na meridianih, kamor je tok Qi lahko preusmerjen, da povrne telesu zdravje. Zdravljenja z bodisi akupunkturo bodisi zeliščnimi zdravili so prav tako prepoznana, da delujejo na sile uravnoteženja, ki so poznane kot jin in jang.

Izvajalci TKM in zahodno izobraženi zdravniki so se pogosto sumničavo opazovali. Zahodna konvencija je usmerjena, da išče dobro utemeljene, dobro preizkušene razloge za pojasnitev stanja bolezni. Tipično zahteva randomizirane, nadzorovane klinične poskuse, ki zagotavljajo statistične dokaze, da zdravilo deluje.

Z vidika TKM je to pretirano poenostavljeno. Dejavniki, ki določajo zdravjo, so specifični glede na posameznika. Prihajanje do zaključka na podlagi velike skupine je težko, če že ne celo nemogoče. Poleg tega so zdravila pogosto mešanica ducata ali celo večih sestavin z mehanizmi, ki ne morejo biti, tako pravijo, reducirani do enega samega dejavnika.

Kako ICD-11 vpliva na običajne ljudi? Denar je pomemben.

Ne glede na skrbi glede odločitve WHO o vključitvi TKM so tudi kritiki mnenja, da bi lahko 26. poglavje služilo za konstruktivne namene. Za vse tiste, ki so prežeti z zahodno medicino, je nadaljnje širjenje tradicionalnega zdravljenja zaskrbljujoče. Izvajalci TKM vse več govorijo o zamenjavi dokazane zahodne medicine s tradicionalnimi zamenjavami, kjer je cena prednost. Na podlagi informacije ICD je 70 % denarja, globalno porabljenega za zdravstveno oskrbo, povrnjenega ali nakazanega izvajalcem. Od zdaj naprej bo tudi TKM del tega sistema.

‘’To, kar želijo oni, je, da bi TKM pridobila prizvok uradnega in bila prepoznana s strani zavarovalnih podjetij. Zaradi relativno nizkih stroškov jo bodo zavarovalnice sprejele,’’ pravi Grollman, raziskovalec na področju raka s Stony Brook University v New Yorku.

Številni drugi se strinjajo, da bo WHO-jeva odločitev pomagala pri širjenju TKM. Vključitev v ICD-11 je ‘’močno orodje za [zdravstveno oskrbo] dobavitelje, da lahko trdijo o TKM kot legitimni medicini vsem zavarovalničarjem,’’ pravi Ryan Abbott, doktor medicine, ki se je prav tako uril v TKM in je član University of California, Los Angeles, Centru za vzhodno-zahodno medicino. WHO-jeva dejanje, ki se tiče TKM, pravi, ‘’je večinske sprejetosti, ki bo imela pomemben vpliv povsod po svetu.’’

Vir: https://www.nature.com/articles/d41586-018-06782-7

prevod: Tanja Topić

Traditional Chinese medicine is officially "real medicine"

The World Health Organisation (WHO) is including a chapter on Traditional Chinese medicine in its influential book classifying thousands of diseases.International Classification of Diseases (ICD) and ICD codes are alphanumeric codes used to classify diagnoses. For the first time in history, ICD codes will include TCM terminology such as Spleen Qi Deficiency or Liver Qi Stagnation.

The global reach of the reference source is unparalleled. The document categorizes thousands of diseases and diagnoses and sets the medical agenda in more than 100 countries. It influences how physicians make diagnoses, how insurance companies determine coverage, how epidemiologists ground their research and how health officials interpret mortality statistics.

Concerns from conventional doctors

Many Western-trained physicians and biomedical scientists are deeply concerned, however. Critics view TCM practices as unscientific, unsupported by clinical trials, and sometimes dangerous: China’s drug regulator gets more than 230,000 reports of adverse effects from TCM each year.

Critics argue that there is no physiological evidence that qi or meridians exist, and scant evidence that TCM works. There have been just a handful of cases in which Chinese herbal treatments have proved effective in randomized controlled clinical trials. One notable product that has emerged from TCM is artemisinin. First isolated by Youyou Tu at the China Academy of Traditional Chinese Medicine in Beijing, the molecule is now a powerful treatment for malaria and won Tu the Nobel Prize in Physiology or Medicine in 2015.

But scientists have spent millions of dollars on randomized trials of other TCM medicines and therapies with little success. In one of the most comprehensive assessments, researchers at the University of Maryland school of medicine in Baltimore surveyed 70 systematic reviews measuring the effectiveness of traditional medicines, including acupuncture. None of those studies could reach a solid conclusion because the evidence was either too sparse or of poor quality1. The NIH’s National Center for Complementary and Integrative Health in Bethesda, Maryland, concludes that “for most conditions, there is not enough rigorous scientific evidence to know whether TCM methods work for the conditions for which they are used”.

Different approach from conventional and traditional medicine

TCM is based on theories about qi, a vital energy, which is said to flow along channels called meridians and help the body to maintain health. In acupuncture, needles puncture the skin to tap into any of the hundreds of points on the meridians where the flow of qi can be redirected to restore health. Treatments, whether acupuncture or herbal remedies, are also said to work by rebalancing forces known as yin and yang.

Practitioners of TCM and Western-trained physicians have often eyed each other suspiciously. The Western convention is to seek well-defined, well-tested causes to explain a disease state. And it typically requires randomized, controlled clinical trials that provide statistical evidence that a drug works.

From the TCM perspective, this is too simplistic. Factors that determine health are specific to individuals. Drawing conclusions from large groups is difficult, if not impossible. And the remedies are often a mix of a dozen or more ingredients with mechanisms that cannot, they say, be reduced to a single factor.

How does ICD-11 affect ordinary people? Money matters.

Despite the concern over the WHO’s decision to include TCM, even critics of the practices say that Chapter 26 could serve a constructive purpose.For those steeped in Western medicine, the continued spread of traditional treatments is worrisome. TCM practitioners increasingly talk of replacing proven Western medicines with traditional substitutes, where there is a cost advantage. Seventy per cent of money spent on health care globally is reimbursed or allocated on the basis of ICD information. Now TCM will be part of that system.

“The thing they want is to make it sound official and be recognized by the insurance companies. Because it’s relatively low cost, insurance companies will accept it,” says Grollman, a cancer researcher at Stony Brook University in New York.

Many others agree that the WHO’s decision will help the spread of TCM. Inclusion in ICD-11 is “a powerful tool for [health-care] providers to say this is legitimate medicine” to insurers, says Ryan Abbott, a medical doctor who has also trained in TCM and is a faculty member at the University of California, Los Angeles, Center for East–West Medicine. The WHO’s action regarding TCM, he says, “is a mainstream acceptance that will have significant impact around the world”.

Information source: https://www.nature.com/articles/d41586-018-06782-7


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