Including Traditional Chinese Medicine Diagnoses in ICD-11 May Not Advance the Evaluation of Traditional Chinese Medicin
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COMMENTARY
Including Traditional Chinese Medicine Diagnoses in ICD‑11 May Not Advance the Evaluation of Traditional Chinese Medicine Therapies Stewart Geary1
© Springer Nature Switzerland AG 2019
1 Introduction The inclusion of a traditional medicine chapter based on Traditional Chinese Medicine (TCM) in the 11th Revision of the International Classification of Diseases (ICD-11) has elicited a range of reactions, from condemnation that the World Health Organization (WHO) is embracing the “integration of quackery with real medicine” [1] to expressions of hopeful envy from practitioners of Ayurvedic medicine [2]. As a specialist in pharmaceutical medicine, I do not consider myself a neutral party in any debate about the role of TCM within medical care or drug development, but living in Tokyo, where my home is a few blocks from a popular TCM pharmacy, I appreciate that there is a substantial use of these therapies especially in Asia. I would like to suggest that the addition of Chapter 26 on TCM in ICD-11 is unlikely to have the effects described by either its advocates or opponents.
2 The Traditional Chinese Medicine (TCM) Codes in the International Classification of Diseases 11th Revision (ICD‑11) Will Not be Used for Reporting Mortality The original purpose of the ICD was to create a common set of terms with agreed definitions for reporting and comparing mortality and morbidity statistics internationally. Because TCM and Western medicine will look at the same condition and define it differently, the ICD would lose its first purpose if it began to be used optionally to report mortality either
based on TCM or the more familiar diagnostic codes. Perhaps for that reason, the introduction to Chapter 26 states it should not be used to report mortality, but this caveat somewhat undermines the stated purpose of having an alternative system of diagnoses in what originated as a common international diagnostic manual. The WHO says of ICD that, “It is the international standard for defining and reporting diseases and health conditions” [3]. How can the “international standard” maintain its usefulness if it is in fact two alternative standards?
3 Chapter 26 in ICD‑11 is Not a List of Therapies But of Diagnoses Some of the advocacy for the addition of TCM in ICD-11 is to encourage greater use of TCM as “complementary” to Western medicine. For instance, using acupuncture to lessen nausea and vomiting in patients with cancer [4] who may have those symptoms as side effects of their chemotherapy. However, that type of usage does not require creating new diagnostic terms. It is difficult to imagine an oncologist being more likely to prescribe acupuncture as symptomatic relief if they were required to find a diagnostic code somewhere in Chapter 26 of ICD-11. The problem is compounded because of the language of TCM diagnoses, for instance, “Triple energizer meridian pattern,” with its inclusions “Triple burner meridian pattern” and “Triple warmer meridian pattern,” is so foreign to a practitioner of ‘Western’ medicine.
This co
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