In this blog post, we explore the nature and issues surrounding the regulatory debate over the use of medical devices such as CT-MRI X-rays in Korean oriental medicine clinics.
On December 29, 2014, the Korean government’s regulatory improvement task was released, reigniting a debate that has been going on for 20 years. It included a push to remove restrictions on the use of medical devices by doctors. The idea was to improve the convenience of patients by introducing medical devices into oriental medicine clinics from the dualized system where imaging data was read by the radiology department and used for oriental medicine treatment. We are referring to medical devices such as CT, MRI, and X-ray. In this article, we’ll discuss why medical devices are not allowed in Korean clinics, at least not yet.
In the 20 years since this issue was proposed in Korea, there has been a lot of discussion, but the medical and TCM sides have barely come to an agreement. In my opinion, the reason why the issue is still not resolved is because people don’t know what the most important points in this debate are. Even the two sides of the debate, the TCM and medical communities, continue to argue over side issues such as finances. Both the TCM and medical associations continue to refute the other’s data and argue over financial issues. The problem is that the so-called research published by both sides has been nothing more than hype, even to the layman. It doesn’t really matter what the economic impact of this policy will be. Even if the policy were beneficial to the economy, there are good reasons to oppose it. Nevertheless, I sighed at the passive and insincere rebuttal of the TCM community’s arguments. The public can’t help but think that this is just a battle between two groups, and that a compromise should be found.
But what is really important in this matter? Let’s think about what doctors and TCM practitioners exist for: income, which is something that all professions have in common. They make money by treating patients to make a living. We don’t want to criticize that, of course, but what should always take precedence over this goal is protecting the lives of patients. If not in other professions, at least in medicine, that should be the primary goal. I believe this is the same in TCM, which means that financial concerns come second, and identifying policies that benefit the patient’s health comes first.
In modern medicine, it is mandatory for radiologists to read imaging data. This is to reduce the chances of misdiagnosis, as doctors who have to study extensively for at least 12 years to become certified in their field can’t read an X-ray correctly. It would be very convenient if a specialist could take and read the images themselves, but in practice, this is not possible. It would be very convenient for a specialist to read and interpret the images by themselves, but it’s not really feasible. In any industry, the probability of a defective product is lowered at a cost, and the trade-off is made at the point where the most profit can be made. In medicine, however, the trade-off is much more in the direction of reducing errors than in other industries.
A doctor of medicine, with far less training in imaging modalities and anatomy, and far less exposure to imaging, is naturally not going to be as good a reader as a specialist in the same field, and should therefore be left to the radiologist. It’s very simple logic. It may be a hassle for the patient to have to go to another hospital for imaging, but it may reveal a serious illness that might otherwise have gone undetected.
The suggestion of requiring oriental medicine practitioners to complete training on imaging devices and then allowing them to use them after they meet the criteria is also not feasible for the same reason. If this level of training is sufficient, there is no reason why a thoracic surgeon could not read a CT scan of his patient’s lungs.
The counterargument to this argument is that TCM needs time to become more scientific. The argument is that if enough research is done and TCM and medicine can be integrated, medical science can make great strides. It’s a valid point. A common method used by pharmaceutical companies to develop new drugs is to analyze the ingredients used in folk remedies to see if they actually work. If they do, the ingredients can be isolated and used as medicines. If we can scientifically prove the effectiveness of the ingredients used in TCM, it can be very helpful to medicine. In response to the criticism that TCM is unscientific, TCM practitioners argue that how can it be scientific if they are not allowed to use imaging devices?
Many TCM practitioners argue that the reason they want to use imaging is to treat simple sprains, dislocations, and fractures, not serious illnesses. When a patient comes to an oriental medicine clinic with a sore leg, it is much easier to treat it if they know whether it is a bone problem or a ligament problem. He also presents data showing that Koreans often visit oriental medicine clinics for simple ailments such as the above. You may think that it is unnecessary to visit multiple hospitals for such a simple condition.
There is no doubt that the scientificization of TCM would be beneficial to modern medicine. However, this does not justify the use of imaging modalities by TCM practitioners. There are plenty of opportunities for research in the current situation where imaging is done in radiology departments. Having an imaging device in the clinic may make research more convenient, but using it to treat a patient without a radiologist’s opinion is the same as experimenting on a patient. Of course, when imaging devices were first invented, they were quickly adopted into clinical practice, and the advancement of imaging devices went hand in hand with the advancement of treatments using them. Some may argue that it is unfair to prevent TCM from being able to combine treatment and research in the same way. However, it was because imaging devices were introduced at that time to treat patients who could not be treated before. It’s one thing to have a radiologist read an image, but it’s quite another to leave it up to the judgment of a medical doctor to decide which patients can be treated safely. Again, it’s important to remember that our goal is to save patients’ lives, not to achieve a fair distribution of profits between medicine and TCM. Even if the TCM side loses a little, there are more important values to protect.
A study focusing on patients who were diagnosed by both a medical doctor and an imaging specialist might shed light on how imaging devices can help the development of TCM. Only when research shows that imaging technology can help TCM can it be introduced into clinical practice. We don“t yet know if it”s possible to scientize TCM. At the very least, this is the first step before we can ask for medical devices to be used in TCM clinics.
The second argument is also clearly refutable. What may seem like a simple illness can actually be serious. For example, I once suffered from a pneumothorax, but I didn’t think I had a diseased lung at the time and simply thought I had a stiff back. In fact, at the time, the radiologist didn’t even realize I had a pneumothorax. The radiologist didn’t realize I had a pneumothorax because he took an X-ray of a different part of my body, not my lungs. Of course, professionals make mistakes like this, but at least they do so much less frequently than non-professionals.
TCM practitioners claim that they will use ultrasounds and X-rays, which are more basic than CT or MRI, and that they will only use them for simple conditions. However, this is a very dangerous argument. Often, seemingly simple conditions are actually very serious and can be life-threatening. For example, cancerous tissue in the lungs behind the heart cannot be detected by an X-ray. It’s very rare, and a CT scan is the only way to know for sure. However, a clinic may take an X-ray of a patient who comes in with lung pain, conclude that there is nothing wrong, and prescribe herbal medicine to restore vitality. In this case, we may lose a life that could have been saved under the current system.
