Retcon (shortened form of RETroactive CONtinuity; first made popular in the comic book world):

  1. (original meaning) Adding information to the back story of a fictional character or world, without invalidating that which had gone before.
  2. (more common usage) Adding or altering information regarding the back story of a fictional character or world, regardless of whether the change contradicts what was said before.

Introduction: In which I confess my (relevant) geekiness

For many years, I was a comic book geek. At the height of my geekdom, I generally purchased anywhere from eight to twenty titles a month and read them all voraciously. This went on from around the time I was 12 or so until around six or seven years ago, when, for reasons that I still don’t quite understand, my interest waned. I bought fewer and fewer titles. These days there remain only one or two to which I subscribe, and all that remains of those three decades are around 10 long boxes full of comics dating back to the mid-1970s and even earlier.

If there’s one thing any long-time comics geek knows, it’s the concept of retconning, and retconning is what this post is about. To understand how, please indulge me a moment while I discuss something unrelated to medicine, namely comic books. “Retcon” is short for “RETroactive CONtinuity.” It’s something that happens in virtually all comics at one time or another in which something about the back story of character is changed, sometimes in major ways, to serve the current story (or, not infrequently, because some editor thinks it would be cool). There are several general forms of retconning. Sometimes retcon changes add to the back story and lead the reader to see the fictional character or world in a new and interesting way (retcon definition #1, above); more commonly, they obliterate or significantly alter previous events in ways that have the potential to ruin current enjoyment of the story (retcon definition #2, above). Sometimes they’re just “meh” and do neither (this can happen in retcons following either definition #1 or #2).

In comics, TV, and literature, retconning is not inherently good or bad. It’s to be expected when any serial story lasts decades—ofttimes even necessary. (After all, if my favorite superhero team of all time, the Fantastic Four, hadn’t been retconned, they’d all have to be around 90 or older, given that Reed Richards and Ben Grimm both fought in World War II.) Admittedly, retconning does have a bad reputation because most of the time retcons tend to range from bad to insulting. For example, if you want to see examples of how ridiculous retconning can get, there are articles like “The 15 Dumbest Superhero Retcons Of All Time“, which require no knowledge of the comics discussed to appreciate the sheer stupidity of the retcons mocked, such as the one that changed Spider-Man’s origin so that he was new the avatar of a spider god or the one where Iron Man/Tony Stark was revealed to be a sleeper agent for the villain Kang The Conqueror. The latter was a storyline so bad that it had to be immediately retconned again back to the Iron Man we all know and love. Come to think of it, one of those retcons, the “One More Day/Brand New Day” retcon of The Amazing Spider-Man, was probably the bit of sheer stupidity that finally made me give up Marvel comics, much the way arguably the most infamously lazy retcon of all time, in which Bobby Ewing’s death and everything that happened after it was revealed to be just a dream, led some Dallas fans to drop the show.

Finally, some retcons are useful and necessary. For instance, the retconning of how Susan Storm (a.k.a. the Invisible Woman of the Fantastic Four) first met and fell in love with her future husband Reed Richards (a.k.a. Mister Fantastic) when he was a college freshman rooming at her aunt’s boarding house to change her from being a 12-year-old girl at the time, who then waited to be old enough for Reed to notice her romantically, isn’t a bad thing. That version, which itself was a retcon of Stan Lee and Jack Kirby’s original origin story in which Susan was the “girl next door” that Reed left behind when he went to serve in the OSS during World War II, comes across as profoundly creepy to 2014 sensibilities and was therefore best retconned away.

Brand New Day, part 1: The story of TCM and why Oceania has always been at war with Eastasia

Now that you (hopefully) understand the basic concept of retconning, you’ll soon see what I’m getting at. It’s not just fictional stories that can be subject to retconning. The narrative of history can also be retconned. Of course, the difference between retconning fiction and historical narrative is that historical narrative has facts and evidence to support it. Still, as all historians know, history is often incomplete, and there are often errors that need to be corrected, and that doesn’t even take into account different interpretations of the past. This is often referred to as historical revisionism, but you can see the similarity to the concept of retconning. Similar to retconning, revisionism is not in and of itself inherently good or bad. It is, in fact, an accepted part of historical scholarship, given that new documents about various historical events often need to be put into context with the old, altering the historical narrative. However, like retconning, revisionism also has a very dark side. One dark version of revisionism, the study of which served as my “gateway drug,” so to speak, into skepticism, is Holocaust revisionism, which is in reality Holocaust denial, whose main purposes are to minimize the suffering Jews endured, to deny or minimize the genocide of the Holocaust, and to rehabilitate fascist beliefs that led to the Holocaust.

To be fair, the revision of history to serve a current political narrative is not a new idea. What was the Ministry of Truth in the fictional nation of Oceania, for which the proponent Winston Smith worked in George Orwell’s Nineteen Eighty-Four, but an entire ministry devoted to revising historical narratives? In that famous novel, Smith’s ministry was responsible for continuously updating—dare I say, retconning?—news and history to be in agreement with Oceania’s ever-changing official version of the past. The original documents were thrown down the “memory hole,” where they were destroyed, and people became “unpersons,” not just killed but every memory of them erased, every document and photo indicating that they had ever existed eliminated. This very concept of erasing “inconvenient” history led to one of the most famous lines from the novel. When the fictional totalitarian nation of Oceania in which Smith lives suddenly shifts alliances in its never-ending war, making peace with Eurasia and going to war with Eastasia, its people are informed that “Oceania has always been at war with Eastasia” and expected to believe it.

Unfortunately, false historical revisionism is a very common practice. Perhaps the key difference between retconning fiction and retconning history (i.e., historical revisionism) is that for fiction the reasons for changing or ignoring past narratives are often convenience, lazy plotting, and/or a genuine desire to flesh out a character. For history, the motivation tends to be ideological. Such is the case with TCM, beginning with one of the greatest retconners/revisionists of all, Chairman Mao Zedong. After all, totalitarian regimes, as Orwell so astutely noticed, rely on controlling history in order to control present-day narratives. Given that TCM is, by and large, prescientific, pseudoscientific, and religion-based quackery grounded in vitalistic beliefs, to make it palatable to doctors who are ostensibly advocates of evidence-based medicine requires the retconning of its history on a massive scale. Of course, retconning/revisionism can only work if the original narrative that is replaced is not well known.

Particularly galling about the ascendency of TCM in the US is the myth that is swallowed whole by its advocates and promoted as truth. That myth is the very history of TCM, whose true origins are unknown by all but a very few. Contrary to popular belief (particularly about acupuncture), TCM does not go back thousands of years into antiquity, when the ancient healing wisdom of the Chinese was supposedly first discovered and codified and acupuncture discovered. In actuality, very few people are aware that the single person most responsible for the current popularity of TCM was not an ancient Chinese healer but rather Chairman Mao Zedong, as described in an excellent summary by Alan Levinovitz in last year, “Chairman Mao Invented Traditional Chinese Medicine“:

…Mao was under no illusion that Chinese medicine—a key component of naturopathic education—actually worked. In The Private Life of Chairman Mao, Li Zhisui, one of Mao’s personal physicians, recounts a conversation they had on the subject. Trained as an M.D. in Western medicine, Li admitted to being baffled by ancient Chinese medical books, especially their theories relating to the five elements. It turns out his employer also found them implausible.

“Even though I believe we should promote Chinese medicine,” Mao told him, “I personally do not believe in it. I don’t take Chinese medicine.”

Much of the reason for the popularity of TCM in China and its spread to the US and beyond was actually because Chairman Mao promoted it. The reason, as has been explained by our very own Kimball Atwood, Steve Novella, Harriet Hall, and Ben Kavoussi, is because there simply weren’t enough doctors in China trained in scientific medicine, as admitted by Mao (quoted by Levinovitz):

Our nation’s health work teams are large. They have to concern themselves with over 500 million people [including the] young, old, and ill. … At present, doctors of Western medicine are few, and thus the broad masses of the people, and in particular the peasants, rely on Chinese medicine to treat illness. Therefore, we must strive for the complete unification of Chinese medicine. (Translations from Kim Taylor’s Chinese Medicine in Early Communist China, 1945-1963: A Medicine of Revolution.)

Who knew? (Well, I did.) I also knew, as Levinovitz relates, that this was the very first “integrative” medicine, “integrating quackery with science-based medicine more than five decades before the term “integrative medicine” caught on in the US. A particularly pertinent quote sums this idea up:

“This One Medicine,” exulted the president of the Chinese Medical Association in 1952, “will possess a basis in modern natural sciences, will have absorbed the ancient and the new, the Chinese and the foreign, all medical achievements—and will be China’s New Medicine!”

Indeed, what’s interesting about Levinovitz’s article is his description of how the exportation of TCM to the world was quite deliberate, as part of a strategy to popularize it among the Chinese. There was a problem, however. As Levinovitz noted, there was no such thing as “traditional Chinese medicine.” Rather, there were traditional Chinese medicines. For many centuries, healing practices in China had been highly variable. Attempts at institutionalizing medical education were mostly unsuccessful and “most practitioners drew at will on a mixture of demonology, astrology, yin-yang five phases theory, classic texts, folk wisdom, and personal experience.” Mao realized that TCM would be unappealing to foreigners, as even many Chinese, particularly those with an education, understood that TCM was mostly quackery. For instance, in 1923, Lu Xun realized that “Chinese doctors are no more than a type of swindler, either intentional or unintentional, and I sympathize with deceived sick people and their families.” Such sentiments were common among the upper classes and the educated. Indeed, as we have seen, Mao himself didn’t use TCM practitioners. He wanted scientific “Western” medicine. The same was true of educated Chinese. It still is.

Mao’s strategy to deal with these criticisms was quite deliberate—and clever. It consisted of two strategies, both designed to mythologize TCM as being a scientifically sound and harmonious “whole medical system” and to provide “evidence” in the form of testimonials that it worked, as Levinovitz relates:

His solution was a two-pronged approach. First, inconsistent texts and idiosyncratic practices had to be standardized. Textbooks were written that portrayed Chinese medicine as a theoretical and practical whole, and they were taught in newly founded academies of so-called “traditional Chinese medicine,” a term that first appeared in English, not Chinese. Needless to say, the academies were anything but traditional, striving valiantly to “scientify” the teachings of classics that often contradicted one another and themselves. Terms such as “holism” (zhengtiguan) and “preventative care” (yufangxing) were used to provide the new system with appealing foundational principles, principles that are now standard fare in arguments about the benefits of alternative medicine.

This effort to “scientify” TCM, or, as I like to call it now, to retcon the science, is very much a part of the promotion of TCM and continues this very day, as you will see in the concluding section of this post.

The second part of Mao’s strategy was the dissemination of spectacular anecdotes to “prove” the efficacy of TCM. The most famous of these was the case of James Reston, a New York Times editor who underwent an emergency appendectomy while visiting China in 1971. Even though the surgeons there used a fairly standard anesthesia technique, described by our SBM colleague Kimball Atwood as sounding like a “standard regional technique, most likely an epidural,” acupuncture was used to treat cramping on second evening after the surgery, which I interpreted as being the evening of postoperative day one. The story is familiar to any general surgeon; about a day and a half after surgery Reston had some cramping, likely due to postoperative ileus that kept the gas from moving through his bowels the way it normally does. It passed after an hour or so. Around that time, the staff at the hospital used acupuncture to treat his discomfort, and the logical fallacy known as post hoc ergo propter hoc fallacy (and a bunch of credulous Westerners, eager to believe that some magical mystical “Eastern” wisdom” could do what “Western medicine” could not) did the rest. Most likely what happened is that Reston finally passed gas spontaneously (which is how postoperative ileus nearly always resolves), letting the built-up gas move through and relieving the cramps and bloating. About a day or two after an uncomplicated appendectomy is about right for that.

Over time, reports of “acupuncture anesthesia” trickled out of China to a welcoming, credulous “Western” press. When examined closely by doctors who know about anesthesia (such as an anesthesiologist), these stories universally have big holes in them. Just a few examples were catalogued by our very own anesthesiologist, again Kimball Atwood. In fact, you can view Levinovitz’s article as the CliffsNotes version of the campaign by Mao to convince the West that acupuncture (and, by extension, TCM) worked as well or better than any “Western medicine.” Read Kimball Atwood’s epic “Acupuncture Anesthesia”: A Proclamation from Chairman Mao (Part I, Part II, Part III, Part IV, and Part V) for the detailed version. Of particular interest to students of “integrative medicine” is Part III, in which Dr. Atwood has an entire section entitled “From ‘Co-operation’ to ‘Integration,'” in which he lists the five main party slogans about TCM:

  • 1945-50 ‘The Co-operation of Chinese and Western Medicines’
  • 1950-8 ‘The Unification of Chinese and Western Medicines’
  • 1950-53 ‘Chinese Medicine studies Western Medicine’
  • 1954-8 ‘Western Medicine studies Chinese Medicine’
  • 1958- ‘The Integration of Chinese and Western Medicines’

Mao’s idea was nothing less than the complete unification of TCM and “Western” medicine, as quoted by Kimball Atwood further from The Private Life of Chairman Mao:

Mao laughed. ‘The theory of yin and yang and the five elements really is very difficult,’ he said. ‘The theory is used by doctors of Chinese medicine to explain the physiological and pathological conditions of the human body. What I believe is that Chinese and Western medicine should be integrated. Well-trained doctors of Western medicine should learn Chinese medicine; senior doctors of Chinese medicine should learn anatomy, physiology, bacteriology, pathology, and so on. They should learn how to use modern science to explain the principles of Chinese medicine. They should translate some classical Chinese medicine books into modern language, with proper annotations and explanations. Then a new medical science, based on the integration of Chinese and Western medicine, can emerge. That would be a great contribution to the world.’

Moreover, acupuncture is probably not nearly as ancient as its advocates portray it. Common portrayals of acupuncture paint it as being 3,000 years old, as implausible as that is. Why implausible? For one thing, the technology to make such incredibly thin needles didn’t exist 3,000 years ago. For another thing, as Harriet Hall points out, the earliest Chinese medical texts from the 3rd century BC don’t mention acupuncture, and the earliest reference to “needling” is from 90 BC referring to bloodletting and lancing abscesses. Indeed, even by the 13th century the earliest accounts of Chinese medicine reaching the West didn’t mention acupuncture, and the first account of acupuncture by a Westerner in the 1600s described large golden needles inserted into the skull and left in place for 30 respirations. It has also been argued that acupuncture evolved from bloodletting based on astrology. In any case, as Harriet Hall described, as recently as less than 100 years ago, acupuncture involved the insertion of needles that were frequently red-hot and sometimes left in the body for days, as described by Scottish surgeon Dugald Christie, who served as a missionary doctor in northeastern China from 1883 to 1913:

Chinese doctors own that they know nothing at all of surgery. They cannot tie an artery, amputate a finger or perform the simplest operation. The only mode of treatment in vogue which might be called surgical is acupuncture, practised for all kinds of ailments. The needles are of nine forms, and are frequently used red-hot, and occasionally left in the body for days. Having no practical knowledge of anatomy, the practitioners often pass needles into large blood vessels and important organs, and immediate death has sometimes resulted. A little child was carried to the dispensary presenting a pitiable spectacle. The doctor had told the parents that there was an excess of fire in its body, to let out which he must use cold needles, so he had pierced the abdomen deeply in several places. The poor little sufferer died shortly afterwards. For cholera the needling is in the arms. For some children’s diseases, especially convulsions, the needles are inserted under the nails. For eye diseases they are often driven into the back between the shoulders to a depth of several inches. Patients have come to us with large surfaces on their backs sloughing by reason of excessive treatment of this kind with instruments none too clean.

Compare this to the prevailing narrative today of the history of acupuncture and TCM as “ancient wisdom” that has existed for millennia. Retconning, revisionism, or whatever you want to call it, the history that we are told does not match the real history, which has largely disappeared down the memory hole.

Brand New Day, Part 2: Retconning the science of TCM

Over the last 30 years or so, what was once quackery, rightly dismissed in a famous 1983 editorial in the New England Journal of Medicine as a “pabulum of common sense and nonsense offered by cranks and quacks and failed pedants who share an attachment to magic and an animosity toward reason” has become mainstream, evolving from quackery to “alternative medicine” to “complementary and alternative medicine” (CAM) and finally to “integrative medicine.” For no form of quackery has this been more true than for traditional Chinese medicine, which is now considered downright respectable in many places, practiced and studied, as it is, in some of the most prestigious medical schools and academic medical centers in the US. Mao, I suspect, is laughing in his grave.

At each stage of this “evolution,” the idea was to retcon the history and science of TCM in order to represent various ancient folk medicines from China based on pseudoscientific, mystical, and/or prescientific beliefs as somehow being co-equal with “Western” or “scientific” medicine through the clever use of language. If you want to see just how successful TCM has been at not only infiltrating itself into what should be bastions of science-based medicine but at changing the very terms and language under which it is evaluated, just look at this article by Shirley S. Wang that appeared in The Wall Street Journal last Monday entitled “A Push to Back Traditional Chinese Medicine With More Data: Researchers Marry Modern Analytical Techniques to Centuries-Old Theories on What Makes People Sick“:

Traditional Chinese medicine teaches that some people have hot constitutions, making them prone to fever and inflammation in parts of the body, while others tend to have cold body parts and get chills.

Such Eastern-rooted ideas have been developed over thousands of years of experience with patients. But they aren’t backed up by much scientific data.

Now researchers in some the most highly respected universities in China, and increasingly in Europe and the U.S., are wedding Western techniques for analyzing complex biological systems to the Chinese notion of seeing the body as a networked whole. The idea is to study how genes or proteins interact throughout the body as a disease develops, rather than to examine single genes or molecules.

“Traditional Chinese medicine views disease as complete a pattern as possible,” says Jennifer Wan, a professor in the school of biological sciences at the University of Hong Kong who studies traditional Chinese medicine, or TCM. “Western medicine tends to view events or individuals as discrete particles.” But one gene or biological marker alone typically doesn’t yield comprehensive understanding of disease, she says.

At least she acknowledges that TCM isn’t “backed up by much scientific data.” Of course, that acknowledgment is the justification for studying TCM, the assumption being that, because it is ancient, there must be something to it. As if to drive home the “integrative medicine” narrative that TCM is equivalent to “Western” medicine, the article even includes a truly infuriating illustration of a stylized human body, half of which is filled with TCM-related illustrations such as herbs and words like “fire” and “metal,” and half is filled with illustrations covering “Western medicine” like the DNA double helix and a gel electrophoresis:


In the illustration, “Western medicine” ascribes the cause of the disease example used, rheumatoid arthritis, to autoimmune disease and lists treatments such as nonsteroidal antiinflammatory drugs, steroids, and disease-modifying antirheumatic drugs to slow disease progression. On the other side, TCM postulates as the cause of rheumatoid arthritis “blockage in flow of qi and blood in the energy pathways of the body; wind, cold, and damp penetrate the body and get into muscles, joints; there are different forms of arthritis depending on if wind, cold, damp, or heat predominate.” Truly, I kid you not. And the TCM treatment? Acupuncture, tai chi, and herb thunder god vine. This is such a great example that I’m saving this poster for use in future talks, so emblematic is it of the false equivalence “integrative medicine” lends to prescientific, unscientific, and pseudoscientific ideas. The overall idea communicated by the illustration? Clearly, the illustration is intended to imply strongly that TCM’s magic-based description of the pathophysiology and treatment of rheumatoid arthritis is worthy of being considered as an equal to science-based knowledge about the disease, gathered over decades, of what causes rheumatoid arthritis and how to treat it.

This narrative has become so depressingly common that it ought to have a name. “They thought it was quackery but now it’s science”? Too long, but that’s the false message of every one of these stories, which is that they thought us mad, mad, I tell you! But now we’re showing those nasty, close-minded, reductionistic “Western” doctors! Except that they aren’t, and this story inadvertently shows why they aren’t. Still, a punchier name for the trope would be useful. “They thought us quacks,” maybe? The “we’re really, really science, maaaan” trope, perhaps? Perhaps you can help me out. I’ll leave thinking of a pithy, punchy name for this trope as an exercise for the reader in the comments.

In the meantime, let’s take a closer look at the article. It’s based entirely on the very hubris behind “integrative medicine,” namely that medicine based on prescientific and religious beliefs, like traditional Chinese medicine, is at least nearly co-equal with medicine based on science and rigorous clinical trials. Or, at least, it would be equal to scientific medicine if there were actually some evidence for it, which these brave maverick doctors and scientists are furiously searching for, no matter how much they have to torture modern systems biology and molecular biology techniques to shoehorn TCM’s fantasy-based “networks” into the networks of gene activity being increasingly understood by modern molecular biology.

Here’s where the retconning comes in. Look at the passage above. Wan claims that TCM views disease as “complete a pattern as possible.” This is a narrative that we hear time and time and time again about TCM, that it considers the “whole patient,” that it is “wholistic,” that it considers the patient as a “system.” Of course, if that “system” isn’t based on science and evidence, then who cares? After all, what about ancient “Western” medicine, which stated that imbalances in the four humors (phlegm, blood, yellow bile, and black bile) caused disease? It’s pretty similar in many ways to TCM postulates, which ascribes illness to six pernicious influences. These include wind, cold, heat, dampness, dryness and summer heat, which are, like totally not like the four humors. (There are, after all, six pernicious influences. Can’t you count?) TCM also has the “five elements” (fire, wood, earth, water, and metal), which are associated with different organs. So maybe TCM is on to something because its prescientific belief is a bit more complicated than the prescientific belief system that undergirded “Western medicine” for many centuries before scientific medicine arose. That means TCM must be better, right? After all, there must be a reason why there’s all this scientific interest in studying diagnoses based on the five elements and six pernicious influences, but no love left over for studying diagnoses based on imbalances between the four humors, right?

At this point, I feel obligated to acknowledge that regular readers are probably wondering why I’m using the term “Western” medicine given that I find the whole “East-West” dichotomy favored by advocates of TCM and “integrative medicine” to be borderline, if not outright, racist. After all, the unspoken assumption behind this dichotomy, whether those using it realize it or not, is that the “West” is cold, reductionistic, and scientific while the “East” is “wholistic” and connected to the human. It’s all pernicious nonsense, of course, insulting to Chinese and other Asian scientists. Science is science, and those in the “East” can do science as well as we “Western” scientists can. What counts are evidence, experiments, and reason, none of which knows “East,” “West,” “North,” or “South”. However, it is the language assumed in Wong’s article; so I use it as I see fit in order to deconstruct it.

Another trope is plain in the passage above. “Western” medicine is disparagingly presented as “reductionistic.” Note the bit about viewing events or individuals as “discrete particles” and how “one gene or biological marker alone typically doesn’t yield comprehensive understanding of disease. We hear this time and time and time again, but it’s a straw man. Yes, “Western” science tends to break down processes to their smallest component parts but it also recognizes (and always has recognized) the complexity of the networks made up by those component parts. Oddly enough, no one seems able to tell me how viewing organs as related to “five elements” (which are not actually elements) and disease as being caused by “six pernicious influences” is in any way “wholistic” or more “wholistic” than viewing disease as being due to imbalances in four humors. Moreover, although in metabolism science has always looked at whole networks (e.g., glycolysis, the Krebs cycle, oxidative phosporylation, and all the metabolic networks that feed into these pathways), part of the reason why science focused on single genes for so long is because it was limited by the technology. It wasn’t until about 15 years ago that the tools were developed to start looking at, yes, “wholistic” changes in gene expression using whole genome expression profiling, which allows the detection of changes in the expression of every known gene in the genome. Since then, we’ve only become better at this. Using next generation sequencing techniques, it’s possible to examine changes in expression of every transcript in the genome, coding and noncoding, simultaneously, and the technology has gotten to the point where it is now becoming possible to examine the changes in gene expression of the whole genome of single cells.

Much of the second half of the article deals with what TCM refers to as “hot” or “cold” syndrome. What’s happening with this system of diagnoses is that credulous scientists are retconning the science, in essence shoehorning diagnoses based on prescientific vitalism into modern, systems biology and pretending that they were always harmonious and that systems biology supports TCM. Oceania has always been at war with Eastasia, and ancient TCM practitioners, in their wisdom, figured out things that science is only now coming to understand.

I swear, when I saw this next passage I couldn’t believe an otherwise intelligent journalist could write something so ridiculous with a straight face:

One promising area of TCM research several independent groups of scientists are investigating is the notion of hot and cold syndromes. The work is still in its early stages. But it could result in a new direction for TCM research by using the systems biology approach and integrating it with experience gleaned from TCM patient care, says Yale’s Dr. Cheng, who also serves as chairman of the Consortium for the Globalization of Chinese Medicine.

In a series of studies, Tsinghua’s Dr. Li and his colleagues examined people with hot and cold syndromes and whether they exhibited different signs of illness, including gastritis, a common digestive disorder in which the lining of the stomach becomes inflamed or irritated.

To gauge whether gastritis patients had cold or hot syndromes, researchers asked questions like whether individuals had chilly body parts or exhibited a preference for hot beverages or a susceptibility to catching colds. Doctors dug into their subjects’ emotional states, asking whether they experienced so-called cold feelings like apathy. The scientists also measured proteins linked to gastritis and took measurements of the bacteria in the gut and imaged the bacteria in the tongue’s coating.

They found some variations depending on whether patients were identified as hot or cold. They also found differences in the bacteria of patients’ tongues that corresponded with tongue coating color and whether patients had been diagnosed with hot or cold syndrome.

One might as well run systems biology experiments on patients subjected to magical incantations, because that’s basically what is happening here! As I’ve said before, if the treatments and diagnostic modalities being tested are prescientific or pseudoscientific, using all the flashy new science in the world won’t make the experiment science. If there’s one thing I see in common with experiments examining whether “hot” or “cold” diagnoses correlate with changes in biomarkers and other laboratory values is that they tend to be small studies, prone to false positives, and to be massive fishing expeditions, with large numbers of comparisons. In this they remind me of some homeopathy studies.

Consider what it is that TCM means by “hot” and “cold” diagnoses. The root of the “hot-cold” dichotomy is not based on any science. Rather, it’s based in Taoist religion, the “Yin Yang theory” of disease. As described here, TCM states:

The root of many of the ideas within Chinese medicine lies in the concept of Yin and Yang. Yin and Yang are emblems of the fundamental duality in the universe, a duality that is ultimately unified. Yin and Yang are complementary, and not contradictory. Nor is one regarded as ‘good’ and the other ‘bad’. People will often state that, “I am Yin”, or “I am Yang”, but this would be inaccurate; they may have a Yin-Yang imbalance or tendancies [sic], but everyone has both qualities.

Harmony is sought between these Yin and Yang qualities and any imbalance avoided when approaching the body as a holistic union. Yin is matter like Blood, fluids and tissue in the body. Yang is the action potential, Qi, and heat in the body. Chinese medicine balances Yin and Yang and can also build these qualities in the body when they are deficient. No one person is completely Yin or Yang; rather, one would look for tendencies and patterns, and weigh them out; one organ system may have Yang excess while another organ system in the same body can have Yang Deficiency.

From the same source, we learn that “yang excess” or “yin deficient” signs include things like constipation, thirst, dark yellow urine, red tongue, dryness, heavy loud respiration, burning bowel movement, and strong body odor. (I suppose the last two probably go together.) We also learn that signs of “true heat” include blood in the nose, stool, or urine; yellow green mucus; fever; and sticky, thick excretions. These are the sorts of things that TCM practitioners look for and ask about. I suppose it’s possible that certain biomarkers might be different in people with true heat or yang excess or yin deficiency, but whether those have anything to do with a disease like rheumatoid arthritis due to anything other than coincidence is unlikely.

Oceania has always been at war with Eastasia

This whole endeavor is, of course, as perfect example of what Harriet Hall likes to refer to as Tooth Fairy science as I’ve ever seen. Basically, Tooth Fairy science involves applying the scientific method to phenomena that don’t exist. As Harriet’s pointed out many times (and I’ve echoed), we can study the amount of money left by the Tooth Fairy in different settings, but since we haven’t determined that there really is a Tooth Fairy, any conclusions we reach will be falsely attributed to a magical being, rather than to the real cause. The prescientific beliefs behind TCM are a lot like the Tooth Fairy. It’s not for nothing that a Chinese physician has issued a TCM challenge, not unlike James Randi’s million dollar challenge to TCM practitioners to prove their methods.

Lots and lots of research money is being wasted studying prescientific superstition such as qi, yin and yang, and “hot” and “cold” applied to human disease, and universities are embracing such twaddle with both arms. Just this year, for instance, the Cleveland Clinic opened an herbal medicine clinic run by a naturopath practicing largely TCM (mentioned in the article). Dozens of academic medical centers offer this sort of quackery to their patients, in the name of supposedly wanting to study it, but if they don’t know it works how can they offer it as anything other than experimental therapy? Instead, they offer it as though it were validated medicine. Meanwhile, TCM advocates try to sell this prescientific form of medicine as though it were somewhere on the same planet, evidence-wise, as scientific medicine when it is not. Let’s just put it this way. You can make up all the complex “networks” and “systems” that claim to describe human physiology and disease as you want, but if they aren’t grounded in reality and evidence they’re nothing more than fantasy. Indeed, fantasy is what is being “integrated” with scientific medicine, fantasy like TCM. To make it fit, the very history of TCM has been retconned beyond recognition, and believers are furiously retconning the narrative about the science of TCM. This retcon has been a smashing success for TCM.

Sadly, the reaction of the vast majority of physicians to the popularization of quackademic medicine is a shrug. It is more than a little depressing to think there are more than a few Very Serious Academic Doctors out there who have bought into this myth and have even widened Mao’s vision of “integration” beyond “integrating” SBM with TCM to include virtually every form of magical quackery in existence.



Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.