Happy New Year to everyone.
Roger and I hope the return to work has not been too stressful for all. Given the world failed to end as predicted we have a good set of posts planned for 2013 to further the cause of the understanding of scientific philosophy and rejection of pseudoscience and bad science.
This week I received a copy of McLean’s magazine through the mail. To those outside of Canada unfamiliar with this glossy periodical, it is basically a version of “Hello” for the “chattering classes” (to borrow Waugh’s term). I confess now, I am only receiving it now as I got a free three month subscription from my cellphone provider as I am rather a skinflint and couldn’t bring myself to actually pay for a copy.
Anyhow, apart from the usual doom and gloom stories predicting the collapse of the housing market in Canada and the imminent fall off of the Fiscal Cliff stateside, there was an article on Chinese medicine and diagnosis of illness by clinical examination of the tounge.
It described the use of using tongue examination as a standard diagnostic practice used by traditional Chinese medical (TCM) practitioners and Naturopaths. Apparently by examining your tongue you can diagnose anything from GI problems, allergies, asthma and some practitioners even claim cancer (OK, not of the tongue – as that would be a tad obvious). There is a website by the Miami TCM practitioner James Rohr explaining the use of this technique and a video of the same. He has even produced a very cool “Tongz” App for smartphones so people can self-diagnose. The argument given is that western invasive diagnostic tools (such as blood lab work or radiography) are expensive and inaccessible to many and that the same results can be obtained by clinical examination of the tongue.
Practitioners make the usual non-science claims for efficacy; i.e. has been used for thousands of years, appeal to the masses (of patients who believe in it), bad western “allopathic” medicine vs good Eastern holistic medicine etc., and explain the theory behind it being disorders of the flow of the bodies natural “chi” energy with disease processes causing abnormal presentations of the tongue. Quite remarkable really, but to be fair there is a grain of truth (as with many CAM therapies) in this. Unfortunately, there is also a lot of nonsense too.
Clinical examination of externally visible tissues and organs is very much a part of modern medicine. This is an art studied and practised by doctors and nurses, and assessed in their education and training particularly in the notoriously difficult Objective Structures Clinical Examinations or OSCE’s doctors and nurse practitioners have to pass. You can lean a lot by clinical examination. e.g. anaemia indicated by pallor, jaundice indicating liver disease or renal dysfunction, or barrel chest indicating chronic asthma. Indeed examination of the tongue and oral mucosa can give some useful diagnostic information (particularly about oral hygiene standards), but to suggest you can diagnose Asthma from a ridge in the tongue as one practitioner claims, or insomnia is clinical nonsense. There is no evidence base for this, and so far no rigorous scientific studies have been able to identify the presence of any chi energy flow in the body. Indeed, practitioners explain this as an energy flow that cannot be detected by modern scientific instruments, and so falls into the realms of magical explanation.
That is not to say that there isn’t some form of chi energy flowing through all of us, and that its disorder is associated with disease, and manipulation of it can improve health. Scientific inquiry may simply not have discovered it yet. However, if that were the case we would at least expect some clearly demonstrable results and consistent repeatable instances. What’s more it would seem there is a massive conspiracy by the scientific medical profession to ignore the evidence of thousands of years that we can diagnose a whole range of illnesses by simple examination of the tongue.
What is worrying is that people accept these explanations without questioning this. Naturopaths claim to be (and in many places are accepted as) scientific doctorly prepared practitioners, but then support this sort of mystical nonsense. If it works, why can’t we measure the results and devise a clear set of clinical guidelines for tongue diagnosis that are effective in scientific terms? This is really the same argument that traditional healers in some countries use when explaining how they diagnose illness by examining the entrails of slaughtered animals (i.e. resorting to magical explanations).
Unfortunately, it just doesn’t work, and if we look at most of the diagnoses made by tongue analysis, they are more easily explained by other more obvious signs. For example I can tell if someone is tired without looking at their tongue (wrinkled skin around the eyes, bloodshot eyes, rubbing of the eyes, yawning, and cognitive slowness) or constipated (by asking when they last had their bowels open) or eats a lot of sugar (by their dental status), or is anaemic (conjunctival and skin pallor) etc.
The diagnoses given through tongue examination are also generally very vague. Frankly, looking at the tounge and claiming “you are tired and eating too much sugar” is not an astounding diagnosis, but claiming it represents a diagnostic science does smack of quackery. That is not to say many TCM and other CAM practitioners are not bonafide genuine practitioners, who actually believe in this stuff, and I am sure many do. But, I must admit when I see CAM holistic practitioners championing natural traditional therapies, with cool websites, awesome tans, and enough cosmetic dental work for my local dentist to retire to the Bahamas, I do being to ask “what is the probability…”
Eckler, R. (2013) Tongues are Wagging, Maclean’s Magazine, January 14