Read Medical Literature Widely, Trust Cautiously, Dare to Question, and Constantly Verify

Except for God, everyone else can only win our trust through data.

—Dr. Bernie Fisher

Modern medical textbooks are updated very quickly, with a new edition appearing every few years, and each edition differs considerably from the previous one. As times develop and more epidemiological and clinical studies appear, some earlier conclusions are overturned. Among the latest medical papers, not many are still regarded as correct ten years later. The same situation exists in the field of biology, where many conclusions also cannot stand the test of time.

For example, in the early 20th century, William Halsted, an experienced surgeon in Baltimore, USA, advocated extended resection for breast cancer patients, which he called radical mastectomy. William Halsted believed that extended resection could cure breast cancer. Because Dr. Halsted enjoyed a high reputation in the field, these propositions became fixed as surgical dogma. In 1980, 80 years after he performed his first radical resection, Dr. Bernie Fisher conducted a randomized trial comparing radical mastectomy with relatively conservative surgery. Dr. Bernie Fisher found that the recurrence rate among patients receiving radical mastectomy was essentially the same as among those receiving conservative surgery, but the numerous complications brought by radical resection caused breast cancer patients great suffering.

Likewise, for a long time the medical community generally believed that most breast cancer patients consumed more fat than women with healthy breasts, and related epidemiological investigations "confirmed" this. However, the latest epidemiological surveys show that breast cancer patients do not consume more fat than healthy women. The earlier conclusion that breast cancer patients consume more fat may have been related to the subjects' self-"psychological suggestion": the breast cancer patients surveyed had already "convinced themselves" that they had consumed too much fat.

Another common prejudice held that breast cancer was related to women's emotions, believing that women who were emotionally depressed had a greater probability of developing breast cancer than cheerful women. An epidemiological study lasting decades at the Mayo Clinic overturned this conclusion. That breast cancer patients are more depressed may be a manifestation after their diagnosis; their depression is the "effect" caused by breast cancer, not the "cause" of it.

There are countless conclusions overturned by new research like these. Epidemiological research is very difficult because many variable factors must be considered. I have seen certain overseas scholars argue that China's high liver cancer incidence is related to Chinese people's fondness for taking certain herbal medicines or eating certain plants, and I cannot agree with the epidemiological studies they conducted. In my practice, most liver cancers I have seen still develop from hepatitis B; hepatitis B is caused by the hepatitis B virus, and China is a country with a large hepatitis B burden. If studies on liver cancer in China do not take these factors into account and merely draw conclusions based on personal impression, they clearly violate the basic rules of statistics. The value of such medical research is not high, because the process by which such research reaches conclusions is not rigorous enough.

In my own practice, I often find that the viewpoints in authoritative medical literature do not hold up. For example, I read in a book by a certain authority in traditional Chinese medicine that arsenic compounds (realgar and arsenic trioxide) can be used to treat leukemia patients with a high white blood cell count, but should not be used to treat leukemia patients with a low white blood cell count. For a while I was also influenced by this and did not dare to use Chinese patent medicines containing realgar for patients with low white blood cell counts.

However, a leukemia patient I treated recently had a very low white blood cell count. I had previously prescribed Chinese patent medicines containing realgar for her, but when I saw that her white blood cells were low, I wavered and dared not give her such medicines. Nevertheless, the patient and her family insisted on continuing to use them, because they felt it would be a pity to abandon these anticancer drugs. As it turned out, under the condition of low white blood cells, realgar was not only not contraindicated in this leukemia patient, but after taking realgar the patient's white blood cells returned to normal. Had the patient and her family not firmly believed in my earlier medication advice, this patient would not have achieved such a good outcome.

Similarly, in the Chinese Materia Medica (Zhonghua Bencao) and the Dictionary of Chinese Traditional Medicine (Zhongyao Da Cidian), compiled under the organization of the National Administration of Traditional Chinese Medicine, I saw that ephedra (Mahuang) has the effect of raising blood pressure, warning that hypertensive patients should use it cautiously. Yet when I treated two patients with cervical spondylosis using ephedra, I not only cured their cervical spondylosis but also cured their hypertension. Surprisingly, after taking herbal formulas containing ephedra, their hypertension achieved a radical cure; they have not taken antihypertensive medication since, and their blood pressure has never again exceeded the normal range.

I use Agrimony (Xianhecao) to raise platelets, use Male Fern (Fengweicao) to stop pain and bleeding, and use Bletilla (Baiji) to stop bleeding—none of these uses come from orthodox medical literature. They are usages and dosages I figured out on my own, and the results I get this way are much better than the usages and dosages recorded in medical literature.

Therefore, if we rigidly adhere to medical literature, we can easily be misled by it. Many medical conclusions were reached by predecessors without sufficient rigor; the research they did and the experiments they designed may have had some unscientific aspects. If we readily believe these conclusions and are misled by them, we cannot solve patients' problems. I am often driven to desperation by patients, because neither I nor the other doctors treating them can solve their problems. At such times, I keep poring over all kinds of literature and independently making various attempts; sometimes unconventional attempts solve the patients' problems.

So nowadays, when I read medical literature, I try my best to trace certain conclusions back to their original sources, carefully examine the research done by the physicians and scientists who reached those conclusions, and see whether their research methods are impeccable. Designing clinical trials and drawing conclusions from statistical data are not easy tasks; scientific research is hard, and researchers have drawn far too many wrong conclusions. Therefore, when studying this medical literature, if we believe blindly and follow obediently, we can easily miss the correct conclusions.