Along the Silk Road of Traditional Chinese Medicine (TCM)
                                                                 by: Joel K. Fairbanks, Ph.D.

     This past spring I had the good fortune of traveling with a group of physicians and other health care professionals to
Guangzhou, China, P.R. to study at the Guangzhou University's Medical School of Traditional Chinese Medicine.  The goal of
the trip was to observe how the Chinese have integrated the model of "modern" western medicine into their system of traditional chinese medicine (TCM).  Do two distinctive systems of health care delivery exist in China, as in India with the strong
differentiation between Ayervedic and "British" medicine?   To my pleasant surprise, the Chinese offer the choice of care to the
public but the government provides both options within the same medical setting.  Guangzhou is a city of about 5 1/2 million
citizens and is situated on the Yellow river.  The city's history goes back well over 4000 years as the eastern end of the Silk
Road traveled for centuries by caravans from around the world.  As a result, Guangzhou has always maintained that it has been
more progressive and independent than most of China.  In a city of 5 1/2 million, there are only five hospitals which also
provide most of the outpatient service in addition to their inpatient care.  The clinic at the university's hospital treats about 5000
outpatients per day.  Patients choice between western medicine, acupuncture, physical therapy, or herbal treatment. Observing
in these doctors in the TCM clinics, the herbal doctors did not hesitate to appropriately prescribe a CT scan or other lab
procedures in addition to the list of herbs prescribed.  TCM doctors are initially trained in western medicine and then study
TCM as a western medical student would chose a residency for specialized training after medical school.  As a result, most
doctors we met had an equal respect for each of these two approaches to medical care.

     Most of the doctors we met with agreed that western medicine is still the most appropriate initial response for acute care
while TCM best addresses chronic illnesses and preventative care.  We observed acupuncture was used for chronic pain,
stroke victims, childhood nervous disorders, and even hair loss while herbs were used to treat sinus problems, digestive
disorders, and other typical outpatient complaints.  Herbs were also recommended for preventative health care.  In fact, the
chinese are very concerned with preventative health care.  In a country with over a billion people where the state provides
health care coverage for 80% of the population, the government of China has become concerned with controlling health care
expenses.  Mao's major focus was on mandating a health wellness program based on education and and preventive services. It
was interesting to learn that the major problem encountered by the chinese was the issue of public compliance.  Not unlike in
the west, in China, free annual check-ups are provided and encouraged yet less than 25% of the population takes advantage of
this service and most do not come to the doctor's until they are ill.  However, the difference is a real concern and interest in
providing health care for the population and the promotion and maintenance of wellness where as in the west our system of
health care really focuses on disease management.  We play great lip service to promoting wellness, but individual to burden the cost and responsibility for maintaining their health.  Health and wellness education is poorly implemented and inadequately
funded in our country.  Insurance companies will only reimburse for selling a physician when the patient has a diagnosable
disease, not for a "wellness consultation" (except maybe when it's part of a covered annual examination).  Most medications are reimbursed to treat an illness although vitamins and other "medications" may be effective in maintaining health and prevention of serious illness are not reimbursed.  Even though these preventative vitamins and "medications" are a fraction of the cost of what
prescribed medications cost insurance companies.

     The maxim of the best way to cure an illness is to prevent it from ever occurring is still the best and most humane approach
to "true" health care, although the cost savings of this approach to health care may not be realized for several years in an
individual case.  But most insurance companies are most concerned with the annual (or even quarterly) budgetary bottom line.
They know that next year they may not be providing coverage to the individual currently enrolled in their health care plan, so the insurance company has less interest in long range health care and cost savings past the current fiscal year.  Only in a state
funded program is there a vested interest in long-term health care and health maintenance, yet even our federally funded
programs fail to seriously address health care needs with a variety of funded preventative and wellness services.  Perhaps there
is much we can still learn from the east.  Regardless how one views current China, and regardless of the motives, China has
demonstrated a viable and intisive model of an integrated system of health care that actually attempts to focus on the
maintenance of health and wellness by providing state funded services to the public.  Just as Marco Polo returned from China,
along the silk road, with tales and wisdom form the orient, the west is free to use the information to question their current status
or pass it all off as the imaginative wonderings of a madman.