The Intersection Between Asian Traditional Medicine and Western Biomedicine

Frustrated by the limitations of biomedicine, many patients have turned to Asian medical systems, which have come under the scrutiny of Western evidence-based clinical research. According to Vincanne Adams et al. in Medical Anthropology Quarterly, efforts to conduct Western clinical research on a non-Western medical system require stringent “negotiations and translations across cultures” because varying medical systems may lack analogous concepts. Yet from current literature, negotiation and translation seemed to be lacking in both sides of the aisle.

For instance, in  “Acupuncture for Patients with Migraine: A Randomized Control Trial,” a German study published in the Journal of the American Medical Association investigating “the effectiveness of acupuncture compared with sham acupuncture and with non-acupuncture in patients with migraine.” The research revealed the connections between cross-cultural medical research and loss of cultural context, assumption of biomedical superiority, a need for a steady framework supporting cross-cultural translation, and political and social undercurrents. These factors underscore the difficulties in the proper cross-cultural evaluation of non-Western medical efficacy.

Throughout the study, the rich dynamics of acupuncture were stripped of their underlying theory—simplified to the physical points and the act of administration. While investigators consulted with experts in acupuncture, the study simplified the application of acupuncture to the semi-standard and traditionally defined “basic points” of insertions. As such, this study treats acupuncture as “technological intervention” and disregards its holistic views on the body, health, and disease, underscoring the loss of theoretic, cultural, and religious context of acupuncture within the study.

Second, the authority of Western evidence-based biomedical science was unquestioned throughout the study. All of the authors bore Western credentials, and their bias was evident in their initial assumptions regarding placebo and the effects of acupuncture. In a departure from typical study models, the investigators incorporated the wait-list group into the study because the investigators did not consider sham acupuncture—involving predefined distant non-acupuncture points—as a “physiologically inert placebo,” as it may trigger relief based on patient expectation, or have an unintended physiological effects. However, this discrimination against placebo, according to Adams, does not exist in certain Asian systems, as “what [Western medicine] call[s] placebo is [considered] a necessary part of good [non-Western] medical treatment.” As such, the distinction between effectiveness and placebo treatment is culturally particular.

This study revealed the need for a framework capable of contextual translation. When asked whether western research methods was suited to test the effectiveness/efficacy of Asian medicine, Dr. Linde replied over an e-mail interview, “In principle, I do not see a fundamental problem to use trial methodology for Asian medicine […] [but] the typical interpretations [of what] ‘acupuncture is or is not…’ are too broad.” Although Dr. Linde believes that the double-trial method is suited to test the efficacy of acupuncture, even he conceded that the question asked and the conclusions derived may be too broad. Within this particular study, acupuncture had a very limited control in defining the terms of its own inspection under biomedicine. As such, cross-cultural medical research needs a framework capable of bearing conceptual translation in order to effectively evaluate the effects of Asian medicine under negotiated conditions.

            The particulars of JAMA trial also hinted at political and societal undercurrents. The trial was sponsored by German social health insurance funds, such as Deutsche Angestellten-Krankenkasse, Barmer Ersatzkasse, Kaufammische Krankenkasse, Hamburg-Munchener Krankenkasse, to decide whether acupuncture should be included into routine reimbursement, thereby underscoring a highly probable economic incentive. Dr. Linde, in an email interview, confirmed this, stating,  “[to this day] acupuncture is not reimbursed for migraine and tension-type headache… [which is] somewhat [of a] political decision.” From 2001 to 2004, out of more than 2 million patients were treated with acupuncture, a third had migraines. As the public’s demand for alternative medicine grows, health care providers want to be assured of their efficacy before issuing reimbursements.

            Western biomedicine still lacks answers to many afflictions. Yet, despite its shortcomings, it is the international authority of medical knowledge against which other systems attempt to legitimize themselves for economic or political gains. Additional factors, such as investigator bias, a skewed power structure, and lack of a proper research framework, make it difficult to derive a truly objective understanding of Asian medicine within the context of Western biomedicine and underscores the necessity for of a cross-cultural framework to understand and test the effects and the efficacy of Asian medicine, and other types of medicine, in future experiments.