Paper to the 24th IVAS Congress, Chitou, Taichung, Taiwan, August 1998
Part 1
Summary
The Law of Change is fundamental in traditional Chinese medicine (TCM) and acupuncture (AP). Few technical changes are occurring faster than those in areas of modern communications and information technology (IT) and in areas of professional interest (review articles, clinical papers, new research findings, etc). We all need continuing professional development (CPD) to keep abreast of very rapid change in our areas of professional expertise. If it is relevant to the professional's needs, and if it produces effective results, this ongoing study programme can be formal, informal, or both.
Distance learning (computer-aided learning) is possible in ways unimaginable before now. Intelligent use of modern IT gives the best prospects for rapid communication between professionals interested in all aspects of AP/TCM. It is also the best way to influence sceptical and uncommitted professionals in the scientific and academic fields to take our clinical and research findings seriously.
This paper discusses practical uses of modern IT as an aid to research, study and clinical practice in TCM and AP. Five areas of IT are discussed:
Introduction
I thank colleagues in PA-L (Professional Acupuncture List) for many stimulating ideas throughout the year, and especially Art Ortenburger, David Jaggar, Helen Berschneider, Narda Robinson, Simon Strauss and Susan Wynn for commenting on the manuscript, or questions raised in it, during the drafting stage.
Bob Felt (1997, http://www.paradigm-pubs.com/html/forum.html) has an excellent overview of information technology (IT) in Chinese Medicine, and the difficulties to be solved before this can be realised. See also Appendix 2 for the JAMA Editorial (1996) by Chi-Lum et al: "Physicians Accessing the Internet, the PAI Project: An Educational Initiative".
The Law of Change is fundamental in traditional Chinese medicine (TCM) and acupuncture (AP). Few technical changes are occurring faster than those in areas of modern communications and IT and in areas of professional interest (review articles, clinical papers, new research findings, etc).
Life-Science publications cover many disciplines and areas of expertise. These include genetics, environment, physiology, nutrition, endocrinology, psychology, behaviour, addictive states and psychiatry, epidemiology, medicine (human or animal), diagnosis, prognosis, therapy, surgery, pharmacology, chemotherapy, etc.
The list of life-science journals is extensive and growing. The annual output of publications is mind-boggling. Several thousand new articles, reviews, textbooks, reports, etc are published in these areas each year. Many of the journals are available online (i.e. on the Internet). The text of all these data would run to several tens of thousands of pages annually.
Parallel with developments in allopathic medicine, research and clinical publications on holistic medical areas are becoming more numerous. These complementary or alternative medical areas include physiotherapy, homeopathy, biofeedback, meditation techniques, hypnosis, etc. They also include AP, moxibustion and allied methods. The latter include trigger-point therapy, transcutaneous electrical nerve stimulation (TENS), low level laser therapy (LLLT), phytotherapy and TCM.
To remain technically competent, skilled professionals in medical and paramedical areas need to keep up to date with current knowledge in our areas of expertise. We live in an age of Information Overload. No one person could hope to master all these areas. Keeping up-to-date, even in narrow areas, is very difficult. If one were to do nothing else but speed-read from morning to night, no one person, no matter how talented, could hope to read a fraction of the annual output in the total medical area.
As in the song made famous by French actor, Maurice Chevalier, ("Ah Yes!, I remember it well ."), the major problem of human memory is accurate recall of stored information at a later date, and making appropriate linkages between different "packages of memory-stored data". If we are not actively involved in meat-inspection, poultry diseases, or research on the Krebs Cycle, how many of us can recall accurately our undergraduate notes on those topics? Most of us knew those details in college! Though they are stored somewhere in our memory banks, their recall may be as low as 5-15%, rather than 100%. Most people have poor to only partial recall of data.
CPD is mandatory in some disciplines and in some countries. In spite of nominal compliance with CPD requirements, many practitioners and researchers fall behind in their knowledge, i.e. become more and more out-of-date. A harsher assessment of our knowledge and technical service could classify us as obsolete. Last June, my eldest daughter qualified as a veterinarian. I had qualified from the same college 34 years earlier, but when I read the questions asked in her Final Examination, I was very humbled: I would have failed to pass the examination in which she obtained an honours grade. I had forgotten many details that I once knew, and she had learned many new details, which I had not learned. That is a reality of our time. Only those with photographic memories can recall (and link) most of what they have read.
In contrast, computer-memories seldom "forget", unless there is a "head-crash", disk-failure, or power-failure. Data stored on computer-type media (memories), either on hard disk, or on other media (CD ROMS, floppy disks, zip disks, etc) usually are retrievable. Modern computer technology offers fast, easy and total retrieval of stored data. In contrast to human memory, if the data are coded correctly, and if correct search terms are used, every reference to a particular data-string can be recalled.
In the age of "information overload", we need a quick and easy way to filter out the data of most value to us. For example, Nigel Wiseman and Feng Ye have recently published their monumental work " A Practical Dictionary of Chinese Medicine" (Paradigm Publications, Brookline, Mass, 1998). That text has 945 pages of dense text on all aspects of TCM terminology, classical TCM Syndromes, AP points, herbal formulas etc. Assuming a rapid reading rate of 25 pages/h, and a study time of 2h/d, it would take >18 days to "skim" the book once. To absorb its contents would take dozens of readings. Having absorbed them, what would our recall of specific details be 12 or 18 months later? On the other hand, suppose that a CD ROM, with a proper index/thesaurus, contained the total detail of this work. If one had access to that via a fast computer, one could query any term at any time and locate every bit of detail about that term in minutes.
In this paper, we will consider applications of modern information technology (IT) for those interested in any aspect of acupuncture (AP) or TCM under five main headings:
The GIGO Law: Before going into detail on any of those topics, note that, in computer jargon, GIGO means "garbage in, garbage out!". Paper does not refuse ink, and keyboards do not refuse keystrokes. If incorrect, misleading or false data are accepted for publication, whether it be in a peer-refereed journal, a textbook, a database, an Internet Web Page, or an Email Discussion List, the reader is exposed to (and may be misled by) those incorrect data.
A. Distance-Learning
Many years ago, the British Broadcasting Corporation (BBC) scandalised conservative academics when it launched the Open University (OU) on TV. How could ordinary people take a university course from home, merely by watching TV and reading recommended course-notes and texts? Years later, the OU continues to fulfil its function, to give university education to those who, otherwise, would never be able to have that privilege. The experiment established that the concept of Distance Learning could be applied in very diverse areas of education in the languages, arts and sciences.
Other countries also are use distance learning. For example, radio and TV have been used for years to educate children in the Australian outback, who otherwise could not easily get a good education. In most countries, audio- and video- tapes are available on a very wide range of educational topics.
The TCM International Correspondence Program runs Distance-Learning courses in AP and TCM for Professionals. The Training Centre of National Medical and Pharmaceutical Administration Bureau, the China Continuing Education United Institute, and the Beijing Herbal Medicine Acupuncture Institute jointly sponsor the course. These seem to be bona fide groups, under the auspices of the Chinese State. See http://www.unitedmedicine.com/tcm/chinatcm.htm for details.
Internet Sites and Databases
Modern IT, especially the Internet, offers the most revolutionary development in education since the discovery of writing. Modern multimedia technology includes audio and video media, together with access to ever increasing amounts of technical data on databases, diskettes, or compact disk read-only-memory (CD ROM) media. Most parents who have bought a PC for their children will know that a powerful encyclopaedia (for example, the Microsoft Encarta or the Grolier Multimedia) usually comes with the package.
Expanding on the concept of the OU, via the Internet and complementary multimedia technology, very high calibre staff in a well equipped University in one country have the possibility today to educate thousands of people all over the world. This form of education is suitable only for the theoretical bases of the courses. Practical hands-on, or manipulative, skills still need to be demonstrated and practised under expert supervision within a suitable centre. However, the potential of these media for postgraduate education, including specialist areas in medicine and paramedicine, is enormous and remains to be exploited fully.
There are several thousand WWW Sites for AP and TCM. Many are commercial sites, advertising books, equipment, software, or training etc. Others are Homepages for private clinics, which offer diagnostic or therapeutic services. Commercial sites and other homepages that advertise for business may have little to offer the serious researcher or clinician in AP and TCM.
In contrast to strictly commercial sites, there are several hundred good sites with vast amounts of useful data. Appendix 1 lists some of these sites under the following headings:
SavvySearch Beta, from Colorado University, is an Engine of awesome power. It reads up to 9 of the main engines on the Web and integrates their outputs. It is one of the best engines for general Web searches. MedHunt and MedSurf are two powerful engines for general searches on medical topics.
PubMed MEDLINE is the most powerful database of conventional medicine on the WWW. It is also the best online source for free abstracts on AP and TCM. It is a free service, courtesy of the US Government, via the National Library of Medicine.
PubMed MEDLINE is invaluable for clinicians and researchers who want access to the abstracts of medical and veterinary papers. The next table shows the number of "hits" (titles or abstracts) that contained key words commonly used in alternative- or complementary- medicine.
(June 18 1998) |
Hits |
| "osteopathy OR chiropractic" | 191065 |
| "acupuncture OR moxibustion" | 6712 |
| "traditional Chinese medicine" | 3997 |
| "herbology OR herbal-medicine" | 1137 |
| "homoeopathy OR homeopathy" | 1121 |
| "laser AND (low-level OR cold OR low-power)" | 892 |
| "transcutaneous AND electrical AND nerve AND stimulation" | 765 |
| "trigger-point" | 130 |
Martindale's Health Science Guide 1998 is probably one of the best reference sources in Life Sciences on the web. It has extensive links in Medicine, Veterinary Medicine and biology.
The Chinese State underwrites IMICAMS (China Centre for TCM Literature Retrieval and Library of the China Academy of TCM). This is a most valuable research site AP and TCM. One page of IMICAMS (http://www.imicams.ac.cn/cminet/cminet_e.html) "Introduction to the Chinese Medical Information Network", states that China will link up her main Medical Universities and Institutes to pool their information resources on TCM. If those databases and multimedia can be translated, and made available in English and other languages, it would be a great step forward in spreading the art and science of TCM to the west.
Libweb (Berkeley University) has a list of all Libraries on the WWW. There are many specialist libraries on AP and TCM. AcuBase (Montpellier, France) has useful AP titles (but no abstracts) online. Medical AP Web Page, Veterinary AP Page and Acupuncture.com are three very useful research sites on AP. The Qi Journal and the Web Journal of AP are two online journals. HealthWorld Online, MedWeb Alternative Med and Rheuma Med have much free data on AP and TCM. IBIS (Interactive Body-Mind Information System) has useful AP links, but much of its data are accessible only on payment of an annual fee and on CD ROM. Appendix 1.2 also lists many bibliographies on AP and other useful research sites.
Appendix 1.3 lists many useful WWW sites with study material on the theory and practice of AP and TCM. These include: Acupuncture.com; AP in Practice (Campbell 1997); AP Lectures (Rogers); Healthworld and Rheuma Med. The Qi Journal Site and the TCM Org UK Site have very useful data on the location of the AP points. The TCM Org Site also has useful data on herbal remedies.
Appendix 1.4 lists many WWW sites that link to AP or TCM Colleges, Schools and Organisations.
Examples are: AP Course at UTS (University of Technology, Sydney); IVAS Homepage (International Vet AP Society); PA-L (Professional AP List); various Foundations and Institutes of AP and TCM; various National AP Associations (American, Australian, British, Danish, Dutch, Spanish, etc).
Most WWW sites on HM and CHM are commercial; they have little accessible data on the details of HM. A few sites, however, have useful data. These include TCM Org UK, AP & Herbs (RMHI Herbal), Acupuncture.com Herbology Index and Classic Works on Herbal Medicine. The IMICAMS databases, (b) above, have >600,000 articles on TCM, mainly on Herbal Medicine. What a resource to holistic medicine if the IMICAMS data were to be made available in western languages!
There are several hundred Web Sites on Holistic, Alternative or Complementary Medicine and Health, especially as regards human problems. These include sites on homeopathy, osteopathy, chiropractic, massage, reiki, reflexology, dietary and nutritional therapies and supplements, yoga, meditation etc. Most of these sites are commercial; they merely advertise services offered by individual training-centres, clinics, health-food stores or gymnasia etc.
Appendix 1.6 lists some of the better sites. SciMedNet (Scientific & Medical Network) is a very useful contact-point for professionals interested in energetic medicine and in the interaction between mind, spirit and material body. AltVetMed has useful links to many sites in holistic veterinary medicine.
Amazon.com is one of the largest bookstores online. It can locate most titles in most areas of general interest. Specialist bookshops in the area of AP / TCM include Mayfair Medical Supplies, Paradigm Publications and Redwing Book Company Online.
Mayfair Medical Supplies is an excellent source for equipment and supplies used in AP / TCM. It operates an international email- or fax- order service from Kowloon, Hongkong. Its prices are competitive, and its response to queries is usually fast, courteous and trouble-free.
AP and TCM software comes in two main forms: Online (on the Internet) and Offline (on CD ROMs or diskettes). Online Resources are not yet as well developed as they might be, but many groups are addressing this problem. See Sections (b) to (e) inclusive, above. Offline Resources on AP and TCM are becoming available at affordable prices. See Appendix 1.7, below. See also the following Section (Section B).
There are major obstacles to the knowledge and use of AP and TCM in an integrated western medicine (Lin et al 1998). These include: lack of access to experimental and clinical trial data to satisfy western regulatory authorities; genuine concern as to the safety and efficacy of TCM; concerns about the sources and quality control of raw ingredients; and antipathy from vested interests (authority-challenged academics, pharmaceutical industries). However, the difficulty in accessing expert technical information on AP and TCM has been a major obstacle to those interested in TCM but unable, or unwilling, to spend many more years of full-time study to learn these details. As in other highly technical areas, modern IT has been used to make the technicalities of AP and TCM more accessible.
The Introduction gave an example of the scope for CD ROMs to store and give easy access to multi megabites of technical information that otherwise would be inaccessible to most western professionals. The example was " A Practical Dictionary of Chinese Medicine" by Wiseman & Ye (1998). As there are several hundred Chinese texts on AP and TCM, that example could be multiplied several hundred fold.
Ideally, the Chinese Medical and Veterinary Authorities, with the main Chinese research, clinical and educational authorities, and with international assistance, should prepare definitive texts on the entire technical base of AP and TCM. The Chinese Editorial Authority should ensure that their expert subcommittees are agreed on the content of these texts. The texts should contain the definitions, synonyms, theory, diagnostics, therapeutics etc of AP and TCM. IMICAMS is already working towards an All-China database of herbal medicine. The data in that database could be a major part of the theoretical and therapeutic aspect of the national TCM texts
Once the national TCM texts are published, they could be translated, further processed (to standardise terms and spellings), edited by IT experts, and transferred to CD ROMs for query by user-friendly interactive menus.
B. Expert Software Databases, CD ROMs and Diskettes
Existing software is varied in its TCM and / or Western content of AP [Dr Colin Lewis, BMAS Page [http://www.medical-acupuncture.co.uk/] or email: Drcalewis@aol.com]. However, most software gives users fast access to information that otherwise would be slow and tedious to locate.
Pending the development of AP and TCM Databases agreed officially by expert Chinese Medical and Veterinary Committees, many useful software packages give professionals access to some expert data. These include: AcuHerb Software, Acupuncture Energetics, ADA (Acupuncture Data Assistant) and Chinese Herbal Medicine: Green Medicine (Daniel Weber 1992).
AcuHerb Software is available from the Internet. It is an experimental (gamma) package that integrates expert data on TCM Theory (AP Channels, characteristics of TCM Syndromes etc), AP (points, indications, point prescriptions for specific Chinese Syndromes) and Herbal Medicine (details of herbs and formulas, indications etc). It is especially useful to western users, in that it suggests therapeutic programmes, with AP points and / or herbal formulae for specified Syndromes. It allows for storage and easy retrieval of patient records.
Acupuncture Energetics is available from Joseph Helms & Kirsten Malmquist, Medical Acupuncture Publishers. This package integrates data on AP Theory (Channels, points, indications) with help on selection of point prescriptions for specific conditions. It allows for storage and easy retrieval of patient records.
ADA (Acupuncture Data Assistant): ADA allows the user to input any number of clinical signs or symptoms, assign a Clinical Importance Score to each one, and search the database for the best AP point combination for the selected combination of signs. ADA is a most useful tool for professionals who want to select effective points for combinations of clinical signs. However, its graphics and eye appeal are dated, and it does not allow for storage of patients' records. An update is planned to add many new features. Meanwhile the points' database in ADA is very solid, possibly the most comprehensive available.
Chinese Herbal Medicine: Green Medicine: Daniel Weber published this package in 1992. It is available from Redwing Books Online, and other supply houses, such as Paradigm Publications (see Appendix 1.8). This is a very useful package on herbal remedies, the functions and uses of individual herbs. It allows the user to search for specific Chinese Syndromes and output formulas to treat them. Like ADA, however, its eye appeal is dated. Another weakness is that the user needs to be reasonably familiar with Chinese Syndromes to get the best from the package.
The IBIS Website has more software in AP / TCM; it is constructing an expert online interactive site in these areas. Appendix 1.7 gives other examples of expert software in AP and TCM, and section (A.h), above has further details.
C. Professional email Discussion Groups (See Appendix 1.4)
An email discussion group, or List, is a group of people who communicate regularly by email on a specific topic of common interest (the ListTopic). Examples of ListNames (self-explanatory and aligned to the ListTopic), include:
AAVLD-L (American Association of Veterinary Laboratory Diagnosticians List)
Beef-L (Beef List)
BSE-L (Bovine Spongiform Encephalopathy List)
Dairy-L (Dairy List)
INDHN-L (International Nondenominational Distant Healers Network List)
PA-L (Professional Acupuncture List)
SciMedNet (Scientific & Medical Network)
Vet.ie-List (Irish Veterinary Association List)
For a List to work efficiently, it must have a central computer "hub", the ListServer, through which all communications are routed. At least one person, the ListMaster controls the ListServer.
ListTopics are as varied as special interest groups; they span topics from A to Z, from Alzheimer's Disease, to Biblical Studies, gardening, healing, nuclear physics, orthopaedic surgery, restoration of antique clocks, ruminant nutrition, etc.
ListMembers may live anywhere in the world, provided that they have regular access to a PC, an account with an Internet Service Provider (which may be the national Telecommunications organisation), and email software. It is not necessary for one member to know the addresses of the other members (although one can get the addresses from the ListServer if one wishes). Neither is it necessary to address mail of common interest to each individual. One can communicate with all members of the List simultaneously by sending an email to one specific email address, the ListAddress. That address is not the same as the ListServer Address, the address of the computer that controls automatic commands, such as Subscribe, Unsubscribe etc. Similarly, each mail sent to the ListAddress goes to each member automatically.
List-Archive: Most Lists maintain an Archive of previous mails. All members have access to the Archive, which they can search for any key words of interest to them.
Language difficulties on Lists?: Most Lists use English as the preferred language but this need not be so. Language need not be a major barrier to communication with Lists if all members can speak at least one European language. AltaVista, a common Internet Search Engine, allows free translation from English to French, German, Italian, Spanish or Portuguese (and from any one of those languages to English).
If a member with Portuguese but no English, wishes to communicate with an English-language List (or vice-versa), he or she may write the message in Portuguese, process it to English through AltaVista Babelfish (at http://babelfish.altavista.digital.com/cgi-bin/translate?), and transmit the English version to the List. The translation may not be perfect, but it usually is adequate to give the List a basic understanding of the message content. On receipt of replies (in English), the member could process the replies from English to Portuguese via Babelfish. There are, however, no free translation packages from European to Oriental languages, and vice-versa. Thus, for example, communication between non-Chinese-speaking members with Chinese who can not speak or write in a European language would be impossible except through a third party who might act as a translator. Oriental-English-Oriental Translation software exists, but is expensive. Hopefully, some far-seeing organisation will provide such services online free in the future.
There are many classifications of email Lists. The more important are:
The following Lists may interest those working in areas related to AP, TCM and Holistic philosophy: Acupuncture Mailbase (UK), PA-L (Professional Acupuncture List) and SciMedNet.
Acupuncture Mailbase (UK): Though founded by professional physiotherapists with expertise in AP, this is an Open, Unmoderated List to discuss all aspects of AP and related TCM theories. One can join by sending an email to mailbase@mailbase.ac.uk and in the Message (Text) Field of the email, type JOIN ACUPUNCTURE Firstname Familyname (i.e. Joe Bloggs). Alternatively, email "Panos Barlas" <p.barlas@coventry.ac.uk>, or "Kam-Wah Mak" <K-W.Mak@tees.ac.uk>, the ListMasters.
PA-L (Professional Acupuncture List): PA-L is a Closed, Unmoderated List, hosted by the Medical Acupuncture Web Page, which has its base in the Medical School of Thessaloniki University, Greece. PA-L aims to foster informed discussion on all aspects of AP and related TCM theories. It also aims to be a clinical forum where members can discuss difficult cases, or ask for help on them from their peers. Membership is restricted to professional acupuncturists or students of AP. As of April 19th 1998, PA-L membership was 275 in 37 different countries. It has medics, physios, vets, LicAcs, OMDs, TCM-trained physicians and other qualified professionals.
We invite qualified professionals to apply for PA-L membership. Certification by IVAS, or by any bona fide National- or State- Vet AP Society, that the applicant is competent to practice Vet AP is accepted as adequate qualification to join PA-L. One may apply online to join PA-L [http://users.med.auth.gr/~karanik/english/pa-l/palapl.html]. Please send the online form direct to "Charisios Karanikiotes" <karanik@med.auth.gr>.
SciMedNet : The Scientific and Medical Network aims to promote open exploration in science and human experience and to deepen understanding in science, medicine and education by fostering both rational analysis and intuitive insights. It questions the assumptions of contemporary scientific and medical thinking, so often limited by exclusively materialistic reasoning. It a disparate group of >1800 Full Members and about 750 Associate- or Student- Members in more than 50 countries. Although mainly concentrated in the UK, it has >200 Members in the USA, 300 in Continental Europe, 70 in Australasia and 30 in India. It has a wide range of Interests and Professions: physicians, scientists, veterinarians, teachers, writers, artists and philosophers. It hosts a number of Lists which may interest colleagues whose work is at the interface of Science / Religion / Art / Intuition / Holistic Medicine. See the Web Site at: http://www.cis.plym.ac.uk/SciMedNet/home.htm
Other Lists discuss all aspects of Medicine, allopathic and holistic. For details, search the List of Lists [http://www.llnl.gov:80/llnl/lists/listsl.html]. Alternatively, search SavvySearch Beta [http://guaraldi.cs.colostate.edu:2000/form?beta] for the keywords which describe the List(s) of interest, for example, "discussion list holistic medicine", or "discussion list Chinese herbal medicine" etc. Alternatively, search Mailbase UK Lists [http://www.mailbase.ac.uk/lists.html] or Interlinks Email Discussion Groups [http://alabanza.com/kabacoff/Inter-Links/listserv.html] or Tile Net Lists [[http://tile.net/lists/], or Liszt, the mailing list directory [http://www.liszt.com/].