Focus on Alternative and Complementary Therapies
www.pharmpress.com/fact
Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2004; 9: 3–4
About 130 years ago, Japan abandoned its traditional medicine, which was based on Chinese medicine. Instead it chose Western medicine, especially German medicine, as its orthodox medicine. Since then Japanese traditional medicine, such as acupuncture and Kampo (Chinese herbal medicine), has been considered ‘unorthodox medicine’ or ‘fringe medicine’. Medical schools have taught only the concept, knowledge and techniques of Western medicine. Even today elderly Japanese doctors write medical records in German. In recent years, Japanese people seem to be following the West again, subscribing to the trend towards CAM.
In 2001 our research group conducted a nationwide telephone survey on the use of CAM among Japanese people.1 Seventy-six per cent of respondents were found to have used at least one CAM therapy in the past 12 months, and the percentages of use for each CAM therapy were as follows: nutritional and tonic drinks 43.1%, dietary supplements 43.1%, health-related appliances 21.5%, herbs or OTC Kampo products 17.2%, massage or acupressure 14.8%, ethical Kampo (i.e. Kampo prescribed by medical doctors) 10.0%, aromatherapy 9.3%, chiropractic or osteopathy 7.1%, acupuncture and moxibustion 6.7%, homoeopathy 0.3% and other therapies 6.5%. Dietary supplements, aromatherapy and reflexology have shown remarkable growth. Sales of dietary supplements (or health foods) have risen from ¥ 416 billion in 1995 to ¥ 542 billion in 2000.2 Aromatherapy (including purchases of related products) and reflexology (probably included in the above option ‘massage or acupressure’) were largely unknown to the Japanese people just 10 years ago, but these therapies are now winning popularity, especially among young urban women. The practice of claiming an ‘authentic British style’ by many reflexology and aromatherapy therapist groups entices many Japanese people to try these therapies. Similarly, many dietary supplements and health-related appliances are claimed to be ‘very popular in the USA’. Homoeopathy has lagged behind in popularity so far, but it might come into vogue if drugstore chains begin marketing it with a catchphrase such as ‘in the German tradition’.
There are national licensing examinations for therapists of acupuncture, moxibustion, Anma (Japanese style massage), massage and Shiatsu (acupressure). It takes three years to become a therapist in these fields, learning the basic principles of Western as well as Oriental medicine. Nevertheless, these therapists have to put up a hard battle against self-proclaimed reflexologists, aromatherapists and chiropractors who have no statutory licence in Japan.
Why are the Western CAM therapies becoming so popular in Japan? Perhaps because many Japanese people look at the West with combined feelings of exoticism and an inferiority complex. They like to imitate Western culture as well as its medical technologies. If a young person favours acupuncture, moxibustion or Japanese herbal decoctions, friends may make fun of him/her for being old-fashioned. On the other hand, when it comes to reflexology, aromatherapy, dietary supplements or British herbal tea, the same friends would consider these chic, sophisticated and luxurious.
Although Japan has followed the West, especially the USA, for the past few decades, the Japanese government does not seem to be very interested in supporting research on CAM even after the establishment of the National Center for Complementary & Alternative Medicine in the NIH. There is no national institute or government office established for CAM. Given this situation, one of the most problematic issues seems to be a conflict of interest in CAM research. Many CAM-related research activities are supported by companies with commercial interests, and many CAM papers are published in the journals of CAM-related societies. Obviously these companies and societies do not like negative papers to be published. Under such circumstances, it is doubtful that Japanese CAM researchers can publish negative results. Vickers,3 in his systematic review of papers published between 1966 and 1995, pointed out that Japan and some other East Asian countries produce unusually high proportions of positive results in controlled trials. CAM journals, as well as other medical journals, should therefore require authors to declare a conflict of interest regarding their research. More importantly, however, unbiased CAM researchers should be able to conduct unbiased CAM research with unbiased research funding. This is why Japan needs a national CAM research institute.
In the meantime, publication bias seems to be improving, at least regarding acupuncture papers written in Japanese. Between 1996 and 2003, more than 20 papers or abstracts on RCTs of acupuncture were published in the Journal of the Japan Society of Acupuncture and Moxibustion. About 30% of these report negative results, although in some cases the quality of the research is low. A similar trend is not yet apparent in other fields of Japanese CAM research. Considering that most of the acupuncture researchers rely on practising or teaching acupuncture for their income, I applaud the research spirit of the Japanese researchers of acupuncture and the unbiased editorial policies of the Japan Society of Acupuncture and Moxibustion (JSAM). (Here I should declare a conflict of interest: I am an acupuncturist and belong to the JSAM.)
Many of the original Japanese CAM studies remain hidden from an international audience because the papers are written in Japanese. Some clinical trials were carried out many years ago. For example, an RCT comparing deep and shallow acupuncture for sciatica was conducted in 1971.4 The Japanese medical database Igaku Chuo Zasshi (Japana Centra Revuo Medicina) contains approximately 13 000 articles on acupuncture published in Japan between 1983 and 2003. In Japan CAM researchers are missing the opportunity of contributing to the international research scene of CAM by publishing non-English original papers in domestic journals.
As a Japanese acupuncturist who usually uses local tender points as well as traditional acupoints, I sometimes feel strange referring to acupuncture treatment procedures in published RCTs in the West. Many of these exclusively use formularised acupoint prescriptions. This kind of RCT has less impact for Japanese acupuncturists and consumers because the treatment style is too different from the actual Japanese acupuncture practice. This situation might also hold true for other CAM therapies.
To facilitate more efficient CAM research, I propose the following. First, non-English-speaking CAM researchers should have their papers translated into English if they believe their results are valid. Second, international CAM journals should encourage and welcome English-written systematic reviews of CAM trials from non-English-speaking countries. Third, CAM researchers should consult a clinician or researcher who is familiar with the actual practice of the CAM therapy being tested. In this age of electronic mail we should communicate more intensely so that our work becomes globally available, to the benefit of everyone.
