What the Opioid Epidemic Really Means

America is in the midst of an epidemic.  Americans are hurting and turning to painkillers to ease their pain.  Unfortunately, opiates pave a road to addiction and death.  In 1999, 4,000 people died from overdoses.  The total number of deaths attributable to opiates skyrocketed to 62,000 in 2015, making the opioid epidemic a greater cause of death in our country than car accidents.  Put another way, prescription drugs end 78 American lives each day.

The feds have responded by declaring a war on prescription drugs and sending their agents out to investigate, prosecute, and penalize.  Cracking down on healthcare providers, government efforts have had the unintended effect of pushing sufferers to turn to heroin to ease their chronic pain.  Of course, the switch from legal to illegal pain management does nothing to reduce the chance of falling victim to an overdose, and many hooked on heroin have ended up on the slab.

Our government is missing the point.  The opioid epidemic is not a drug epidemic but a failure of our current system of healthcare to effectively treat our chronic pain.  With the number of annual prescriptions for pain meds climbing to a staggering pinnacle of 289 million prescriptions in 2016, one thing is clear:  too many patients are left with no better option than to numb their bodies and sedate their minds in order to be able to function.  Revoking the licenses of pharmacists and doctors who demonstrate injudicious or criminal behavior may be a critical stopgap measure, but we ultimately need more innovation and flexibility in our management of chronic pain to get to the root of this problem.

Others have pointed out the absurdity of government policy that is punitive without offering any solutions to the complex dilemma of pain management.  We must always use opiates responsibly to control our aches and pains but we also need to be able to perform simple daily tasks without paralyzing discomfort.  One wonders if, between massive cuts in the healthcare budget and the war on prescription drugs, American patients dealing with chronic pain will be left with no good options beyond biting the bullet and getting through life as best they can despite the agony.

To be clear, this is not a partisan issue or, even, a political issue.  The pain epidemic and the opioid epidemic that follows in its wake is an American healthcare crisis.  Although we need our government to recognize that the American people need its support, not just law enforcement, it is even more important for our healthcare providers to respond to the crisis with new ideas and therapies.

Some good options for pain management do not need discovery but only await formal recognition.  Few alternatives to palliative care with risky opioids are as promising as traditional acupuncture.  As a treatment option, Chinese acupuncture care is methodical, well researched, low cost, and safe.  It can often be used by those who are not be good candidates for surgery and have exhausted other conventional treatments, patients who desperately require relief from chronic pain syndromes, offering them quality of life without the risk of addiction.

Those of us who use acupuncture have been successfully treating chronic pain for decades, but we need a shift on the part of lawmakers who develop policies to incorporate acupuncture care more completely into the mainstream.  Other CAM methods must be explored as well.  Only by first recognizing that Western medicine is failing these patients and then seeking out practical answers for chronic pain conditions will we be able to stem the rising tide of dependence on prescription opiates.  This is the only public health strategy that promises a permanent fix and sets American patients on a course that is safer, healthier, and happier.

Why I Translate

Recently, I decided to get back into the task of translating Chinese medical journal articles into English.  While working through the first selection, I reflected on the process of translation and decided that I wanted to share something with you about my motivation to translate.

Generally speaking, translating Chinese medical material into English is considered an esoteric pursuit.  Even among those in the field of Chinese medicine, most assume that it is extremely difficult, and I have been told by those who have never attempted it that it would simply be impossible for them.  For those of us with experience in this area, we realize that translating Chinese medical writings into English is a technical skill that, in fact, demands only a limited amount of working knowledge.  Blood, sweat, and tears, not a special gift or superior intellect, are the key credentials needed for successful translation.

Having the capability to translate Chinese medical material is a motivation, but there are two far more important reasons why I translate.  First, with the vast ocean of untranslated Chinese medical material that exists, it is up to those of us in the field who cherish this medicine to get to work on building a larger body of high quality resources.  Chinese medicine is still a recent immigrant to the West and, if we want to learn all it has to offer us, we need to hear more from the architects of this system, the doctors in China themselves.  The more we translate from the Chinese the more likely we are to accurately perceive the essence of Chinese medicine before it becomes irrevocably altered in its adoptive home.

The other reason I translate Chinese medical works into English is a personal one:  going back to the source, reading about Chinese medicine in Chinese, allows me a better understanding of the basic logic inherent in the medicine.  As medical anthropologists have shown, every medical system is the product of the culture where it originated, its philosophies, beliefs, history, and its language.  The ways in which we make connections in Chinese medicine--and Chinese medicine is, at its core, all about networks--directly relate to how effectively we practice.  If there is one single thing I have learned in my many years in the clinic, it is that clinical outcomes are clearly the product of practicing Chinese medicine according to its own rules, on its own terms.

If you are a patient, share this with your practitioner in the hopes that he or she will join us in this important endeavor.  If you are a practitioner or a translator, I invite you to participate in our community effort to grow our corpus of professional medical literature and, in the process, dive more deeply into the soul of the medicine.  We will thank you, your patients will thank you, and, once the value of translation becomes obvious to you, you will be thankful to have the opportunity to connect with all of the illustrious Chinese mentors who have taken the time to share their invaluable experience with us.

New Acupuncture Research

Conventional medical sources regularly publish promising research on acupuncture.  In this blog, we will review some studies that have appeared in the last two months.

According to an article from March 14th, research done at Taipei Medical University in Taiwan demonstrated the effectiveness of acupuncture in treating tumor and cancer surgery related pain.  The sizable meta-analysis reviewed 36 randomized, controlled trials that involved a total of 2,213 patients.  Researchers found that acupuncture was effective in managing the pain due to cancer surgeries and cancerous neoplasms.  Although the meta-analysis failed to show that acupuncture improved pain due to chemotherapy, hormone therapy, or radiation treatment, the Medscape article included reports from several acupuncturists at large U.S. cancer care centers where most patients report pain reduction when acupuncture is used to treat the side effects of cancer treatments.  In fact, acupuncture has proven so effective in providing better quality of life to cancer patients that a subspecialty called oncology acupuncture is being created.

The big news in acupuncture last month was a much publicized article on acupuncture care for migraine sufferers.  Featured on Medscape on February 24th, research conducted at Chengdu University of TCM demonstrated a statistically significant reduction in migraine frequency and severity with true acupuncture compared to sham acupuncture.  Treatment consisted of daily acupuncture treatments for 5 days with a 2-day hiatus each week.  The complete course of care lasted 4 weeks for a total of 20 acupuncture sessions.   There were no serious adverse effects reported, and patients enjoyed benefits for twenty weeks after treatment.  Compare this to the use of regular Botox injections which can cost hundreds or, even, thousands of dollars and may result in a variety of minor to severe side effects.

According to a February 13th article, even the American College of Physicians has joined the growing body of acupuncture proponents.  Their new guidelines, published online in the Annals of Internal Medicine, recommend acupuncture for nonradicular lower back pain.  The authors selected therapies that were low risk and low cost, criteria that very much describe the nature of acupuncture care.  Other therapies featured in the guidelines include mindfulness-based stress reduction and tai ji (t'ai ch'i).  

Stay tuned for more mainstream research validating the effectiveness of Chinese medical care.  For those of us who are familiar with Chinese medical care, generations of empirical experience has more than confirmed the tremendous value of traditional Chinese medicine.  New research, however, adds to our understanding and opens doors for new ways to incorporate these ancient therapies into modern practice.

The Whole is Greater than the Sum of the Parts

Modern Western medicine largely ignores this gem of Aristotelian wisdom, embracing instead the assumption that the identification of all of the components in the body will ultimately result in the ability to understand and end disease.  Mapping the human genome was the final frontier, a staggering accomplishment of science that, 14 years later, has, disappointingly, not yet proven to be a real game changer.  With all of the cards on the table, there was an expectation that the cures for common ailments would naturally follow, but our newest drugs are, for the most part, just variations on a familiar theme.  No magic bullets thus far.

All of this points to something more, a ghost in the machine, if you will, that is critical to the workings of the human organism.  Like the dark matter that comprises the bulk of the mass of our universe, the fundamental nature of our human software is elusive.  The operating system - we like the moniker HS 1.0 or Homo Sapiens 1.0 - may come to be understood as a network of chemistry, electricity, some of both, or something completely different.  At any rate, it will likely take science decades to begin to unravel its complexities.

Nevertheless, it is there, the elephant in the room.  We often see evidence of the body's operating system in medical research.  Consider, for example, both fibromyalgia and IBS.  Patients who suffer from these conditions have real, debilitating pain, but decades of study have not yielded definitive diagnostic tests or discovered any abnormal changes in the affected tissues.  Instead we can only speculate about the pathology of these conditions and offer patients symptomatic relief with modest results.

The placebo effect offers additional evidence of the innate programs driving the hardware of the human anatomy.  Essential in the methodology of medical testing, researchers use the placebo effect to validate medical claims, but Western science is unable to offer a cogent explanation for how the placebo effect actually works.  Responsive to the expectations of test subjects and researchers alike, the placebo effect clearly demonstrates that there is more to the body than meets the eye, providing additional evidence of a network connecting all of the cells of the human organism, controlling balance and health.

While we wait for science to first recognize and then explore the HS 1.0 operating system, Chinese medicine offers a complex and fully realized system of theory and practice to ensure that our software is running smoothly.  Taken as a whole, the channels, network vessels, extraordinary vessels, and smaller tributaries of the human body comprise a matrix that might be likened to the motherboard of a computer.  The acupoints, not dissimilar to the keys on a keyboard, allow for user interface when the software becomes corrupted.  This comprises the system used by the acupuncturist to treat disease and restore balance throughout the body. 

The old saying "two heads are better than one" points out the value of having more than one perspective.  As proud as we may be of our accomplishments as a species over the last few centuries, it is becoming increasingly apparent that ancient knowledge, the product of a very different point-of-view, may be more relevant than ever to humanity today.  It is crucial that we recognize the value of all human knowledge, regardless of its age, so that we can work towards the best possible future for ourselves and our planet.

A Larger Perspective on American Healthcare

Both from the perspective of doctors and their patients, it may not be apparent why the United States needs to be on a different trajectory for healthcare.  For those of us who have lived or traveled abroad in the developing world, we have seen the inadequacy of healthcare services firsthand and feel fortunate to have state-of-the-art medical resources at home.  Not only is exceptional medical treatment available to American patients, it is also true that we boast some of the best medical schools and medical technology in the world.  For many healthcare workers outside of the U.S., it is often a dream to be able to study medicine and hone their skills on American soil.

Personal experience with socialized medicine and universal healthcare models may also make us feel lucky to have the system we do.  Excessive government control of medical services can lead both to fewer choices as well as lower quality of healthcare due to a lack of competition. Complacency and stagnation may threaten the quality of medical care we receive almost as much as insufficient resources and poverty.

As Americans, we realize that exceptional healthcare is available to us, but we also recognize that many people struggle to afford their insurance premiums.  In my practice, I have often heard the stories of patients who are unable to retire as they cannot afford health insurance without any employer subsidies.  For many, the cost of insurance seems to be the only real healthcare crisis, and we have all heard and read about Americans whose premiums went up, not down, with the Affordable Care Act.  For those individuals, Obamacare did exactly the opposite of what was promised, so, although the high cost of insurance is unequivocally a problem, the ACA legislation does not feel like the correct fix.

The issue, however, only becomes clear when we step back and look at the big picture, viewing American healthcare from a public health point-of-view.  Back in 1970, most developed nations, the U.S. included, spent between 5% and 7% of their national Gross Domestic Product on healthcare.  Talking about the percentage of GDP needed for healthcare is helpful as it not distorted by the effects of inflation.  Today, the total cost to provide healthcare to our European counterparts has risen to approximately 10% of GDP, but here in the U.S., depending on the source of your statistics, we spend a whopping 17.2% of our GDP for medical care.

17.2% of GDP is a massive expenditure of resources just to stay well.  Imagine if a pioneer in the American West had to devote 17% of his or her resources towards managing illness:  it would be all but impossible to survive.  The amount of money necessary to sustain American health is a great personal burden, but, with government subsidizing well over half of the costs, it is also a devastating social strain.  If our healthcare costs can rise 50% faster than costs in countries like France and Germany in just 35 years, imagine what we will face in decades to come.

Of course, we would like to think that our investment in health--roughly three to four times per capita compared to other nations--pays off with better health and longer life.  In reality, the U.S. ranks poorly in many key indicators.  When it comes to arguably the most important statistic, life expectancy, Americans live shorter lives than people in about 30 other countries.  Perhaps even more shocking, there are many places with far lower rates of infant mortality. 

So there you have it:  Americans pay more than anyone in world for healthcare that, despite its potential for excellence, does not actually provide care comparable with most other developed nations.  In a nutshell, this is the core argument for healthcare reform.  Viewed from this angle, American healthcare has to change. 

The solutions are out there.  It is easy to see which countries today are the most successful at delivering the best possible medical care for the least amount of money.  Undeniably, the Spanish, the Israelis, and, perhaps most of all, the Japanese, top the charts as providing their citizens with the greatest wellness and longevity for the least amount of money.  If you were Japanese, you would be likely to live about 4 years longer than the average American and for about one-third of the cost.

The future of the Affordable Care Act is uncertain.  In its short history, it became obvious that the ACA suffered from deficiencies, and few Americans prefer government mandates if there are alternatives.  Nevertheless, Obamacare is inspired by the most successful healthcare models in the world, those which deliver medical services to as many people as possible without an untenable financial burden on individuals or society.  If the ACA is repealed, let us hope that lawmakers keep their eyes on the big picture and recognize that a future where 25% or more of our national resources are committed to keeping us healthy and alive is simply not sustainable.  Without a major overhaul of the healthcare system, Americans are headed either towards a future where healthcare becomes a luxury or keeping Americans alive bankrupts the nation.

 

Research on Sexual Function Validates TCM Approach

A study published in the Annals of Neurology on December 5th describes the discovery of a group of neurons in the spinal cord that relate to male ejaculation.  The researchers have coined the term SEG, spinal ejaculation generator, to describe this neurological mechanism.  Men with spinal cord injuries who suffer from anejaculation, an inability to discharge semen during intercourse, have been the focus of the studies.  The authors state "The hope is now we have identified this specialized area of the spinal cord, we can use other ways of stimulating these neurons - maybe with electrical, magnetic, or pharmacological methods - to enable ejaculation to occur."

Although it is unlikely that patients with spinal cord damage would be able to experience a sensory climax, treatment might allow for procreation.  Other benefits include an observed but poorly understood post-ejaculatory relaxation of the striated muscles of the limbs that provides relief to patients who suffer from spasticity.  According to the Medscape article by Sue Hughes published December 13th, care might not only aid those with spinal cord trauma but also might help patients without a history of injury who struggle with premature, delayed, or absent ejaculation for other reasons.

This is yet another example of how new research confirms and validates the Chinese medical perspective.  In Chinese medicine, semen is considered to be jing or essence.  The term essence describes more than just male semen, but semen is a visible manifestation of this resource.  Essence is stored in the kidney (we use the singular to differentiate from the Western anatomical concept of the organ).  The kidney resides in the lower back and, in Chinese medicine, is ascribed the function of governing the bone and the bone marrow.  Ergo, the fact that the discharge of semen is controlled by a neurological mechanism nestled in the lower back, specifically at the center of the spine, is no surprise to the traditional Chinese doctor.

In those with spinal trauma, there is, ipso facto, blood stasis and qi stagnation that affects the kidney organ and its related channels and network vessels.  In the short term, blockage of the conduits that allow the organ to interface with the rest of the body inhibits kidney function, while, over the course of time, the lack of nourishment results in the kidney essence being weakened and depleted.  The end result is the inability to ejaculate normally.

In contrast to conventional medicine and science, Chinese medicine also offers a cogent explanation for why ejaculation tends to relax the striated muscles in the limbs and alleviate spasticity.  Spasticity in Chinese medicine is considered a form of internal, bodily wind, and wind is directly linked to the liver.  Moreover, it is stated in Chinese medical classics that the "liver and kidney have the same source."  Trauma to the lower back primarily damages the kidney yin-essence, but liver yin-blood, which is transformed out of essence, is affected secondarily.  When ancient doctors proclaimed that "the liver is yin in form, but yang in function" they were referencing the fact that, although the liver is the main control mechanism for the movement of qi throughout the body, it ultimately depends on nourishment and moistening from the yin, blood, and essence to function well.  Physical trauma to channels and network vessels leads to blood stasis, and blood stasis, in turn, results in blood vacuity or deficiency.  This leaves the liver high and dry, so to speak, and causes it to fail in its main task of ensuring that qi and blood move smoothly and completely throughout the body.

When qi, like the electricity in a wire, cannot flow freely, it backs up and flares and expands outward, causing the limbs to jerk and twitch. Ejaculation is a sudden, strong discharge of qi.  This relaxes the liver and allows qi to naturally dissipate in the limbs, easing tension and resolving spasticity.  Of course, without sufficient lubrication by yin, blood, and essence, the liver will soon become bound again and will be unable to properly course qi in the body.

When the authors hypothesize that electrical, magnetic, or pharmacological stimulation of the SEG neurons might assist in restoring ejaculatory function, they are proposing what Chinese medicine has been doing for centuries.  The specific area where galaninergic neuron density is the greatest, between the L3 and L4 segments, is the location of Yao Yang Guan, the DU-3 point which is indicated for sexual dysfunction, while the Ming Men Du-4 point lies between L1 and L2.  The latter point is especially renowned in Chinese acupuncture for boosting the kidney and assisting with libido and reproduction. 

Seeing research like this study that so closely parallels the Chinese medical model leaves those of us steeped in the Chinese medical perspective feeling a quixotic combination of satisfaction and frustration.  On the one hand, validation of our analysis and methods from another medical model confirms what we already know and puts us in a position to say "I told you so".  On the other hand, it is vexing to watch as humanity reinvents the wheel over and over again.  Giving credit where credit is due, the authors findings have advanced human understanding of the anatomical specifics, but it is impossible to assume that any therapeutic value generated from their work will be an improvement.  It is not likely that the development of surgical implants, drugs with adverse effects, or expensive clinical procedures will be preferable over non-invasive acupuncture or complex herbal formulations that offer the advantages of low cost, centuries of empirical usage, and a low risk of side effects.

 

Cupping at the Olympics

Chinese medicine is in the news again with cupping of Michael Phelps and other Olympic athletes.  Judging from the online images, cupping is being performed by trainers with cups using a detachable pump.  The telltale marks suggest that the cupping is being done in the anatomical areas that are generally sore or stressed, unfortunately without specific regard to the course of acupuncture channels. 

While this is great publicity for us, this sort of use of Chinese medical treatments by individuals who are not trained in Chinese medicine, in concert with the musings of journalists, can mislead the public about our medicine.  In the NY Times article, the author offers several comments about the intended effects of cupping—not exactly congruent with the thinking in professional Chinese medicine—and offers up a few studies to explore the issue of whether or not cupping therapy is a placebo treatment. 

This example is typical of how Chinese medicine is handled in the popular press.  It is understandable that journalists want to appeal to a broad audience, both the believers and the skeptics.  As a practitioner, it is, of course, frustrating to be reminded how biased the media is in regards to Chinese medicine.  Even indisputable evidence of the direct effects of acupuncture, with functional MRI demonstrating how acupuncture can modulate brain activity as one example, does not seem to be adequate to earn us the benefit of the doubt.  To be fair, there is some media coverage about the shortcomings of Western medicine, but even the biggest cautionary stories seem to be a flash in the pan.  A recent story, for example, described adverse events in hospitals as a leading cause of mortality in the United States.  No matter how alarming the news, once the clamor dies down, it is back to the business of showcasing the latest achievements in medicine and marveling at the bright future of cures, while Chinese medicine is presented with many caveats.

Coverage of Olympic cupping and the quality of the treatment aside, it is still good to have a Chinese medical treatment in the news.  As the old saying goes, there is no such thing as bad publicity, and the tempest in a teapot of Olympic cupping has at least piqued some interest.  People are talking about the use of cupping, and our patients have been asking questions and wanting to know more.  If more Americans realize that there are options available to them, our healthcare system can move forward to a more effective future.

We use cupping frequently here at White Pine.  Cupping is one of those modalities that seem to occur more frequently in clinics run by Chinese practitioners, but we pride ourselves on offering our patients the kind of care you would find in a good clinic in China.  For our patients, we primarily like to use cupping for back and hip pain and for treating stiffness of the neck and shoulders.  We favor the traditional technique of fire cup, where several balls of alcohol-soaked cotton are ignited and used to create a vacuum inside of a glass cup.  This method requires training and experience, so please do not try this at home!

In the coverage of the Olympic cupping, hematomas or bruises are attributed to the breaking of tiny capillaries.  While this may be true structurally, the Chinese understand that bruising is in direct proportion to the amount of blood stasis presenting in the area treated.  In other words, the more chronic, fixed, and severe the pain (all characteristic of blood stasis patterns), the darker the bruise after cupping.  Most of the time, bruising starts out heavy and grows lighter as the condition improves and the pain diminishes.  Of course, with traditional fire cupping, there is a limit to the amount of suction that can be achieved.  Having a ceiling on the force of the suction has an important benefit:  it is unlikely to cause damage to tissues.  The type of cupping featured in the story on the Olympic athletes, however, may involve a powerful suction that could even potentially even dislocate bones, such as spinal vertebra.  Traditional fire cupping is not only more entertaining to watch than pump cupping, it is also safer for the patient. For some of our patients, cupping is their favorite form of Chinese medical care.

Welcome to the White Pine Blog!

This is our first post to the blog on the new website.  We have been meaning to get a blog up and running for years, and the new website format has finally given us the incentive to make it happen.  We intend to post regularly on a variety of topics, both directly and rather indirectly related to Chinese medicine and the Chinese medicine lifestyle.

A new study demonstrates that the average American male has gotten even heavier—15 lbs. heavier than 20 years ago!  The obesity trend continues despite decades of public health education and the introduction of low-fat, “healthy” foods.  Over the last 40 years, Americans have shifted from beef to chicken, whole milk to low-fat, regular soda to diet soda, but we keep gaining weight.  It is time to recognize, once and for all, that the theories of modern nutrition fall short of keeping us thin and healthy.  If it is really all about the calories, then why do people get fatter drinking diet sodas?  When is the change from fatty beef to lean chicken going to pay off in a  thinner population less likely to die of heart disease?

Chinese medicine has good explanations for the areas where Western nutritional theory falls short.  For example, the sweet flavor, in traditional Chinese thinking, moistens and creates fluids that, in excess, congeal to form adipose tissue, fat, in the human body.  It does not matter whether or not the concentrated sweetener actually contains calories. So aspartame will make you fat despite the fact that it is not "a caloric food".  And, while red meat may often be high in fat, it is a neutral food--meaning neither warming nor cooling--that is less indicated for building blood and qi than chicken.  These surprises for Western nutritionists are just confirmation for the Chinese doctor that Chinese medical theory is as relevant today as it was thousands of years ago.  For those who are interested, we recommend Blue Poppy Publishing's The Tao of Healthy Eating available through Amazon or in our office.  Watch for our upcoming guide on eating right using Chinese medical theory!