Clipping Board » Medical Affairs and Administration ─ Medical system, pharmaceuticals, and medical community-related reports
2009.05.01 AM 10:13
An Open Letter to Director-General Yeh Chin-chuan
By Huang Da-fu, President
In the 21st century, where health authorities worldwide strongly advocate "evidence-based medicine," medicine is only divided into scientific and non-scientific categories, not into Chinese or Western distinctions. Research indicates that approximately one-third of U.S. healthcare expenditures are wasted on ineffective treatments. Therefore, President Obama specifically allocated $1.1 billion from the $800 billion economic stimulus budget for "Comparative Effectiveness Research" to determine which treatments are more effective. Future healthcare payments will be based on these research findings to fundamentally reduce waste. It is shocking to see Taiwan’s National Health Insurance (NHI) moving backward by spending even more money on entirely unproven and unscientific treatments.
According to a report in the New Life Daily on April 6, Shen Mao-ting, a manager at the NHI Bureau, confirmed the implementation of the "Pilot Program for Traditional Chinese Medicine Consultation in Western Medicine Hospitalization for Stroke and Cancer Patients." Last year’s budget was NT$85 million, and this year it will exceed NT$100 million. I would like to know what scientific evidence the NHI Bureau relied on to formulate this policy and what decision-making process was followed.
The U.S. National Center for Complementary and Alternative Medicine (NCCAM) was established in 1992 and has since spent over $1 billion researching alternative therapies widely used by the public. After 17 years of numerous clinical studies, no favorable results have been found for herbal medicine. Instead, side effects such as ginseng, garlic, and ginkgo causing bleeding during surgery have been confirmed. Chinese herbal medicines containing heavy metals can lead to kidney failure, Jin Bu Huan causes severe liver damage, and aristolochic acid can trigger kidney cancer...
Consequently, some in the U.S. medical community question whether it is worth continuing to spend money on alternative therapies when so little has been proven effective over 17 years. Should NCCAM be shut down? In September of last year, Dr. Josephine Briggs, the current director of NCCAM, told The New York Times, "There are still too many alternative therapies claiming significant efficacy that have not undergone rigorous scientific testing. Now, with more precise and sensitive measurement methods available to evaluate different treatments, the center’s existence remains valuable in the long run if it can distinguish effective from ineffective therapies."
Especially in Taiwan, where the NHI is heavily indebted and financially strained, the healthcare it provides is already struggling under cost-cutting measures. Clearly, Taiwan has even less leeway to spend money on the wrong things. Moreover, any policy implementation will have serious crowding-out effects, so NHI funds should be used even more cautiously. It is astonishing that the NHI Bureau would waste precious resources on unproven and potentially harmful alternative therapies. Combining Chinese and Western medicine for cancer treatment is inadvisable. Often, interactions between Chinese herbs and chemical drugs reduce the efficacy of the latter. The claim that Chinese medicine can mitigate the side effects of chemotherapy is dangerous precisely because it counteracts the drugs’ effectiveness. However, incomplete chemotherapy leading to cancer recurrence often occurs years later, making it difficult for patients to recognize the cause-and-effect relationship.
Wasting NHI funds is regrettable, but neglecting lives is unforgivable. I must hereby lodge a solemn protest against the NHI Bureau’s reckless decision-making process.Source: http:/ / www. kfsyscc. org/ index……menu_id=4046& article_id=4558
Although my letter last week was addressed to Director-General Yeh Chin-chuan, since Dr. Lin Yung-nung, Chairman of the National Union of Chinese Medical Doctors' Associations, has mentioned me by name today, I might as well respond to avoid confusion.
First, because the issue of "fee allocation" is entirely unrelated to the topic of my letter, I did not mention the "problem of fee allocation between Chinese medicine and health insurance" at all in my previous letter. I have no bias against Chinese medicine; I only care about scientific evidence. I have always believed that health insurance should cover any medical treatment that benefits patients, regardless of whether it is Western or Chinese medicine. I also believe that, no matter whose money is being spent, it should be used wisely. Spending even a single penny on something not worthwhile is a waste, and recklessly spending health insurance funds (the hard-earned money of the people) is unforgivable.
Second, the establishment of the National Center for Complementary and Alternative Medicine (NCCAM) by the U.S. National Institutes of Health was precisely because too many people today are using various traditional and alternative therapies from around the world. Therefore, the U.S. government, standing on the side of patient protection, needs to scientifically verify the efficacy of these alternative therapies to address public concerns. Therapies proven effective through scientific research are then integrated into conventional medicine. In my previous article, I specifically quoted the current director of NCCAM, Dr. Josephine Briggs, who said that there are currently too many alternative therapies claiming significant efficacy that have not yet undergone rigorous scientific testing, so she still has much work to do.
Clearly, I am not among those who advocate shutting down NCCAM but stand on Dr. Briggs' side. Therefore, I am very pleased to see Taiwan also beginning scientific research on traditional medicine.
What I question is the decision-making process of the "Pilot Program for Chinese Medicine Consultation in Western Medicine Hospitalization for Stroke and Cancer." I believe that before research confirms its efficacy and it is accepted as conventional medicine, this so-called pilot program should be a research project. Thus, I hope to see this program designed to meet the standards of rigorous clinical trials and medical research ethics. This includes the issues raised by Chairman Lin, such as "how to properly use medications, their scope of application, dosage, indications, and how to avoid toxic side effects..." Only then can we find answers. The funding for such a research project should come from the National Science Council or the Department of Health, not from health insurance funds.
Over the past twenty years, I have continuously advocated for patient-centered, evidence-based medicine in Taiwan. To provide patients with the most beneficial treatments, I spend at least ten hours every week studying the latest medical science, including reports from NCCAM, continuously monitoring patient safety in the hospital, and prospectively measuring the effectiveness of different treatments. What I pursue is scientific evidence. If Chairman Lin believes my arguments are "hearsay and parroting," I welcome you to present evidence to the contrary; otherwise, it may be considered a personal attack.
Source: http:/ / www. kfsyscc. org/ index……menu_id=4046& article_id=4558
April 21, 2009, Apple Daily
In an open letter to Minister Yeh Chin-chuan, Dr. Huang Ta-ta, President of Koo Foundation Sun Yat-Sen Cancer Center, extensively addressed the allocation of resources for traditional Chinese medicine (TCM) and National Health Insurance (NHI) expenses. As a member of the TCM community, I would like to offer a few thoughts for Dr. Huang’s consideration.
1. Dr. Huang mentioned in his letter that countries worldwide strongly advocate "evidence-based medicine," asserting that medicine is not divided into Eastern or Western but rather into scientific and unscientific. While we deeply agree with this perspective, Dr. Huang may have overlooked the fact that countries worldwide also place significant emphasis on traditional medicine.
**Global Recognition of Traditional Medicine**
While promoting "evidence-based medicine," the World Health Organization (WHO) of the United Nations also completed its "Global Strategy on Traditional Medicine and Alternative Medicine for 2002–2005" in 2002. Recognizing the value of traditional medical experience, the U.S. FDA (Food and Drug Administration) has relaxed the threshold for clinical trials of Chinese herbal medicine, allowing direct human trials with toxicological tests to be supplemented afterward. The global medical discourse embraces both modern and traditional approaches, gradually determining which treatments are more effective—rather than hastily dismissing certain therapies as "unscientific," as Dr. Huang suggested.
2. Dr. Huang questioned the scientific basis for the NHI Bureau’s implementation of the "Pilot Program for TCM-Assisted Treatment in Stroke and Cancer Patients Hospitalized in Western Medicine." This reminds us of the 2002 report revealing that combining NSAIDs with gastric medications actually increased the risk of gastric ulcers. Yet, for decades prior, what scientific evidence did Taiwan’s medical community rely on to prescribe this combination? Similarly, most chemotherapy regimens involve multiple drugs—were these protocols scientifically validated before clinical use, or were retrospective studies conducted later to justify their continued application? If every drug combination required "scientific evidence," with clinical trials taking years and costing billions, how could the public receive timely healthcare?
3. Dr. Huang claimed that the U.S. National Center for Complementary and Alternative Medicine (NCCAM), after 17 years and over $1 billion in funding, has yet to find any herbal remedy with favorable therapeutic outcomes. We wonder whether this assertion is hearsay or if Dr. Huang has rigorously reviewed all literature on complementary and alternative medicine over the past decade with the spirit of "evidence-based medicine."
Furthermore, Dr. Huang cited numerous toxic side effects of Chinese herbal medicine. Without debating the rigor and validity of these studies, we ask: If someone were to present evidence of chemotherapy drugs’ toxic side effects and advocate for their complete abolition, would Dr. Huang agree? A drug’s side effects are inherently linked to its therapeutic effects—the key lies in proper usage: scope, dosage, indications, and mitigating adverse effects. Does Dr. Huang agree with this fundamental pharmacological logic?
4. Dr. Huang noted that some in the U.S. medical community question the lack of proven alternative therapies despite 17 years of funding and quoted the current NCCAM director: "We now have more precise and sensitive measurement methods to evaluate the efficacy of different therapies..." We fully endorse using modern methodologies to verify TCM’s efficacy and believe this aligns with National Taiwan University Hospital’s recent establishment of a "Complementary and Alternative Medicine Clinic." "The more life-saving methods, the better"—Dr. Huang should not hastily condemn traditional Chinese medicine.
**TCM Accounts for Only 4% of NHI Expenditures**
5. Dr. Huang labeled TCM as a "waste of precious funding and NHI resources."Since the implementation of the global budget payment system under the National Health Insurance (NHI) in 2000, traditional Chinese medicine has received just over 4% of the annual NHI budget of more than NT$400 billion, while dentistry has received slightly over 8%. Over 85% of NHI resources are allocated to modern medicine, commonly referred to as Western medicine. If there is any misuse or misallocation of NHI resources, the data should reveal where the waste occurs.
Finally, we strongly agree that "while the waste of NHI funds is regrettable, the neglect of life is unforgivable." However, we further believe that if one, out of stubbornness and without rigorous observation and evidence, hastily and maliciously criticizes, leading to the deprivation of patients' right to choose medical treatment in their condition, it would bring even greater harm to the public.
The author is the Chairman of the National Union of Chinese Medical Doctors’ Associations, R.O.C.
Source: http:/ / tw. nextmedia. com/ appl……id/ 31563749/ IssueID/ 20090421
Say No to Mixing Chinese and Western Cancer Treatments!
An Open Letter to Director-General Yeh Chin-chuan
By Huang Da-fu, President
In the 21st century, where health authorities worldwide strongly advocate "evidence-based medicine," medicine is only divided into scientific and non-scientific categories, not into Chinese or Western distinctions. Research indicates that approximately one-third of U.S. healthcare expenditures are wasted on ineffective treatments. Therefore, President Obama specifically allocated $1.1 billion from the $800 billion economic stimulus budget for "Comparative Effectiveness Research" to determine which treatments are more effective. Future healthcare payments will be based on these research findings to fundamentally reduce waste. It is shocking to see Taiwan’s National Health Insurance (NHI) moving backward by spending even more money on entirely unproven and unscientific treatments.
According to a report in the New Life Daily on April 6, Shen Mao-ting, a manager at the NHI Bureau, confirmed the implementation of the "Pilot Program for Traditional Chinese Medicine Consultation in Western Medicine Hospitalization for Stroke and Cancer Patients." Last year’s budget was NT$85 million, and this year it will exceed NT$100 million. I would like to know what scientific evidence the NHI Bureau relied on to formulate this policy and what decision-making process was followed.
The U.S. National Center for Complementary and Alternative Medicine (NCCAM) was established in 1992 and has since spent over $1 billion researching alternative therapies widely used by the public. After 17 years of numerous clinical studies, no favorable results have been found for herbal medicine. Instead, side effects such as ginseng, garlic, and ginkgo causing bleeding during surgery have been confirmed. Chinese herbal medicines containing heavy metals can lead to kidney failure, Jin Bu Huan causes severe liver damage, and aristolochic acid can trigger kidney cancer...
Consequently, some in the U.S. medical community question whether it is worth continuing to spend money on alternative therapies when so little has been proven effective over 17 years. Should NCCAM be shut down? In September of last year, Dr. Josephine Briggs, the current director of NCCAM, told The New York Times, "There are still too many alternative therapies claiming significant efficacy that have not undergone rigorous scientific testing. Now, with more precise and sensitive measurement methods available to evaluate different treatments, the center’s existence remains valuable in the long run if it can distinguish effective from ineffective therapies."
Especially in Taiwan, where the NHI is heavily indebted and financially strained, the healthcare it provides is already struggling under cost-cutting measures. Clearly, Taiwan has even less leeway to spend money on the wrong things. Moreover, any policy implementation will have serious crowding-out effects, so NHI funds should be used even more cautiously. It is astonishing that the NHI Bureau would waste precious resources on unproven and potentially harmful alternative therapies. Combining Chinese and Western medicine for cancer treatment is inadvisable. Often, interactions between Chinese herbs and chemical drugs reduce the efficacy of the latter. The claim that Chinese medicine can mitigate the side effects of chemotherapy is dangerous precisely because it counteracts the drugs’ effectiveness. However, incomplete chemotherapy leading to cancer recurrence often occurs years later, making it difficult for patients to recognize the cause-and-effect relationship.
Wasting NHI funds is regrettable, but neglecting lives is unforgivable. I must hereby lodge a solemn protest against the NHI Bureau’s reckless decision-making process.Source: http:/ / www. kfsyscc. org/ index……menu_id=4046& article_id=4558
Response - Truth Emerges through Debate∕Huang Dayou
First, because the issue of "fee allocation" is entirely unrelated to the topic of my letter, I did not mention the "problem of fee allocation between Chinese medicine and health insurance" at all in my previous letter. I have no bias against Chinese medicine; I only care about scientific evidence. I have always believed that health insurance should cover any medical treatment that benefits patients, regardless of whether it is Western or Chinese medicine. I also believe that, no matter whose money is being spent, it should be used wisely. Spending even a single penny on something not worthwhile is a waste, and recklessly spending health insurance funds (the hard-earned money of the people) is unforgivable.
Second, the establishment of the National Center for Complementary and Alternative Medicine (NCCAM) by the U.S. National Institutes of Health was precisely because too many people today are using various traditional and alternative therapies from around the world. Therefore, the U.S. government, standing on the side of patient protection, needs to scientifically verify the efficacy of these alternative therapies to address public concerns. Therapies proven effective through scientific research are then integrated into conventional medicine. In my previous article, I specifically quoted the current director of NCCAM, Dr. Josephine Briggs, who said that there are currently too many alternative therapies claiming significant efficacy that have not yet undergone rigorous scientific testing, so she still has much work to do.
Clearly, I am not among those who advocate shutting down NCCAM but stand on Dr. Briggs' side. Therefore, I am very pleased to see Taiwan also beginning scientific research on traditional medicine.
What I question is the decision-making process of the "Pilot Program for Chinese Medicine Consultation in Western Medicine Hospitalization for Stroke and Cancer." I believe that before research confirms its efficacy and it is accepted as conventional medicine, this so-called pilot program should be a research project. Thus, I hope to see this program designed to meet the standards of rigorous clinical trials and medical research ethics. This includes the issues raised by Chairman Lin, such as "how to properly use medications, their scope of application, dosage, indications, and how to avoid toxic side effects..." Only then can we find answers. The funding for such a research project should come from the National Science Council or the Department of Health, not from health insurance funds.
Over the past twenty years, I have continuously advocated for patient-centered, evidence-based medicine in Taiwan. To provide patients with the most beneficial treatments, I spend at least ten hours every week studying the latest medical science, including reports from NCCAM, continuously monitoring patient safety in the hospital, and prospectively measuring the effectiveness of different treatments. What I pursue is scientific evidence. If Chairman Lin believes my arguments are "hearsay and parroting," I welcome you to present evidence to the contrary; otherwise, it may be considered a personal attack.
Source: http:/ / www. kfsyscc. org/ index……menu_id=4046& article_id=4558
Open Letter to Dean Huang Dafu (Lin Yongnong)
In an open letter to Minister Yeh Chin-chuan, Dr. Huang Ta-ta, President of Koo Foundation Sun Yat-Sen Cancer Center, extensively addressed the allocation of resources for traditional Chinese medicine (TCM) and National Health Insurance (NHI) expenses. As a member of the TCM community, I would like to offer a few thoughts for Dr. Huang’s consideration.
1. Dr. Huang mentioned in his letter that countries worldwide strongly advocate "evidence-based medicine," asserting that medicine is not divided into Eastern or Western but rather into scientific and unscientific. While we deeply agree with this perspective, Dr. Huang may have overlooked the fact that countries worldwide also place significant emphasis on traditional medicine.
**Global Recognition of Traditional Medicine**
While promoting "evidence-based medicine," the World Health Organization (WHO) of the United Nations also completed its "Global Strategy on Traditional Medicine and Alternative Medicine for 2002–2005" in 2002. Recognizing the value of traditional medical experience, the U.S. FDA (Food and Drug Administration) has relaxed the threshold for clinical trials of Chinese herbal medicine, allowing direct human trials with toxicological tests to be supplemented afterward. The global medical discourse embraces both modern and traditional approaches, gradually determining which treatments are more effective—rather than hastily dismissing certain therapies as "unscientific," as Dr. Huang suggested.
2. Dr. Huang questioned the scientific basis for the NHI Bureau’s implementation of the "Pilot Program for TCM-Assisted Treatment in Stroke and Cancer Patients Hospitalized in Western Medicine." This reminds us of the 2002 report revealing that combining NSAIDs with gastric medications actually increased the risk of gastric ulcers. Yet, for decades prior, what scientific evidence did Taiwan’s medical community rely on to prescribe this combination? Similarly, most chemotherapy regimens involve multiple drugs—were these protocols scientifically validated before clinical use, or were retrospective studies conducted later to justify their continued application? If every drug combination required "scientific evidence," with clinical trials taking years and costing billions, how could the public receive timely healthcare?
3. Dr. Huang claimed that the U.S. National Center for Complementary and Alternative Medicine (NCCAM), after 17 years and over $1 billion in funding, has yet to find any herbal remedy with favorable therapeutic outcomes. We wonder whether this assertion is hearsay or if Dr. Huang has rigorously reviewed all literature on complementary and alternative medicine over the past decade with the spirit of "evidence-based medicine."
Furthermore, Dr. Huang cited numerous toxic side effects of Chinese herbal medicine. Without debating the rigor and validity of these studies, we ask: If someone were to present evidence of chemotherapy drugs’ toxic side effects and advocate for their complete abolition, would Dr. Huang agree? A drug’s side effects are inherently linked to its therapeutic effects—the key lies in proper usage: scope, dosage, indications, and mitigating adverse effects. Does Dr. Huang agree with this fundamental pharmacological logic?
4. Dr. Huang noted that some in the U.S. medical community question the lack of proven alternative therapies despite 17 years of funding and quoted the current NCCAM director: "We now have more precise and sensitive measurement methods to evaluate the efficacy of different therapies..." We fully endorse using modern methodologies to verify TCM’s efficacy and believe this aligns with National Taiwan University Hospital’s recent establishment of a "Complementary and Alternative Medicine Clinic." "The more life-saving methods, the better"—Dr. Huang should not hastily condemn traditional Chinese medicine.
**TCM Accounts for Only 4% of NHI Expenditures**
5. Dr. Huang labeled TCM as a "waste of precious funding and NHI resources."Since the implementation of the global budget payment system under the National Health Insurance (NHI) in 2000, traditional Chinese medicine has received just over 4% of the annual NHI budget of more than NT$400 billion, while dentistry has received slightly over 8%. Over 85% of NHI resources are allocated to modern medicine, commonly referred to as Western medicine. If there is any misuse or misallocation of NHI resources, the data should reveal where the waste occurs.
Finally, we strongly agree that "while the waste of NHI funds is regrettable, the neglect of life is unforgivable." However, we further believe that if one, out of stubbornness and without rigorous observation and evidence, hastily and maliciously criticizes, leading to the deprivation of patients' right to choose medical treatment in their condition, it would bring even greater harm to the public.
The author is the Chairman of the National Union of Chinese Medical Doctors’ Associations, R.O.C.
Source: http:/ / tw. nextmedia. com/ appl……id/ 31563749/ IssueID/ 20090421