Prof. Terje Alraek

Prof. Terje Alraek


University of Troms, Norway


Title: Designing Clinical Studies that Take into Account East Asian Medicine's Systems and Methods


Terje Alraek became acupuncturist (BAc) in 1982 after 3 years full time study at The International College of Oriental Medicine, England.

After a long periode in acupunture practice and as scholar-shipholder at the Institute of Commuity Medicine at the University of Bergen, he was confered his doctor's degree (PhD) in acupuncture in 2004. His dissertation was acupuncture in the prevention of recurrent uncomplicated lower urinary tract infection in adult women.

To day Terje Alraek runs the Acupuncture Clinic (Akupunktur-klinikken) in Bergen, and works as senior researcher at The National Research Center in Complementary and Alternative Medicine (NAFKAM), a unit of the Faculty of Medicine at the University of Troms. Alraek holds also a position as a Associate Professor at the University College of Health Sciences CK, Oslo.

The Norway-China Cooperation regarding Traditional Chinese Medicine (TCM) is coordinated by NAFKAM. Terje Alraek is the project manager.


http://www.alraek.no/english.html



Q1.

Clinical studies using pattern identification have made considerable improvement in standardization of traditional medicine; please tell us the implication of your presentation today.


The implication for my study I think it’s, in a way to me it’s helped me in a way to communicate some of the patterns identification working relation to western medicine. Because some of the western doctors, they don’t know anything about pattern identification. So instead of saying like in my studies, Spleen Qi Yang Xu or Liver Qi Stagnation or Kidney Yin no Kidney Yang Qi Xu, I can tell these doctors, that there are certain characteristics to these people. Like for instance, in the Kidney group, I can tell the group who… the best effect for my treatment was the women who said that they have to use extra pressure when they go to the toilet, they were little bit anxious, they feel a little bit more cold than other women. In this way I think standardization, P I can help us communicate with western doctors. Maybe here in Korea, it’s easier for you because you have, you can talk together. But in the west, it’s very seldom, if we say something like Spleen Qi Yang Xu, they say no, they don’t want to listen. So, I think, in the way of standardization, we use these words, we can also easier transform that into western medicine in a way.


Q2.

Okay, here is the second question. You have used pattern identification in your clinical studies. Adjusting East Asian Medicine system to clinical studies seems quite challenging. Could you tell us difficulty during this attempt?


Some of the studies that I have done was little bit early. I was the one who started to dig into this in the west… so that moment, we have the consensus between the two practitioners, if they can reach consensus in each patient. So, that was little bit difficult. But then, in the next study we did where we used pattern identification, we involved ten clinical experts in Norway. And then we compared the result of their agreement with ten international experts. We did this in what’s called a Delphi study? So, that was actually a very good one. And you can see actually quite a little difference. The agreement on patterns is quite large, but the agreement which points to use was very little, so in this study, there was only 28% overlap between the clinic experts in Norway and international experts.


Q3.

Did you have any difficulty in reflective with clinical situation when you apply P I to your clinical studies? Could P I fully reflect real world situation?


Yes, to me I think it’s good, because it’s based on symptoms and signs, I mean, we’re dealing with real patients, and they’re telling us which symptoms and signs they have. So, I think it’s a good way to pick up a real world situation. The problem is of course, where we should put the symptoms and signs, I mean, do these symptoms belong to Kidney Yang Xu, do these symptoms belong to Liver Qi Stagnation. That’s difficult. As a framework, I think it’s very good to ask different patient within the same diseases to describe the symptoms. And I think we could do qualitative studies, looking into patients, we have different diseases, we can ask about the symptoms and then we can have an agreement afterwards. The thinking behind using symptoms and signs as a framework when doing P Is, I think is good, but it’s difficult for us as researcher where to put them because we don’t agree on that.


Q4.

Then is there any attempt to make an agreement on the P I?


Oh Yes. As I tell you, the simple thing is among practitioners, that’s the simple one. The next one is the delta process, where you can… because in a delta process anonymously. So, you can have people from, I have people from US, UK, Germany, China and Norway and now I have Korea this night. But uhm… so that’s a good way because you can challenge each other, because you don’t know if you or the other one will answer them. So you trust yourself. So, I think it’s a good way. But of course, it raises a lot of issues. I mean, there are lots of difficulties with this, but that’s why we have this kind of meetings because the more collaboration we can have internationally among different countries, we can see if there are cultural changes, if one symptom is more described in one part of the world than the other world. Like for instance, we did a study in hot flashes, which seems to be major problem in Scandinavian countries, where I live. While women in Asian country seems to have more problem with musculoskeletal problems and not with these vasomotor symptoms. 


Q5.

Was there any literature or textbook that researchers could share and could think as standard?


Yeah. As you saw, every research starts always with a literature research or like we tend to start this. We asked the acupuncturist in Norway, “Have you treated this kind of problem? And what kind of P Is do you find? And how would you, with what kind of acupuncture points would you use?”, then the next step for us to do is do the literature research and go to textbooks.


Q6.

TCM textbook?


Yeah, TCM textbooks, of course. We do that. And then the next step would be to go to the literature and see if the research is using the same P Is as written in the textbooks. And then, also because with international collaboration now we can have access to Korean databases, Chinese databases as well. But of course, it’s very important to start with a literature. That’s the first, major thing to do.


Q7.

And here’s the last question. There would be some difference between standardized P I and Traditional P I. I mean, TCM was reconstructed in 1950’s, so that some people estimated that standardized P I was developed in a speculative manner? Some conceptual… so, it may have some limitation in make uh… divide the pattern. So, with this gap, how could we deal with this problem? If there would be clinical significance in traditional P I, how could we modify this point?


That’s a good question. But you’re right. In 1950’s there was a change, because… uhm, the people in China that worked with TCM, they wanted it to be more equal in terms with western science and western medical things. So, for instance like, I work with hot flashes in acupuncture study, we have a lot of this issue around Kidney Yin Xu, Kidney Yang Xu and all this. And Kidney Yin Xu is very comparable to western medical term of reduction in the estrogen production. So we think there’s lot of things that was made.


I think again as we get access to lot of historical documents both maybe from Korea as well, but mainly from China since I’m trained in TCM. I think that’s an important thing now. It’s also important to include literates, I mean people who read Chinese, who are not only TCM. And it’s also important to include other people who are interested in China, like anthropologists and different people who can look at these traditional papers in another way, and they can put it into context in terms of history. That’s very important, I think.


Because, yes we know, but the only thing I can say at the moment is that this is what we, or I, my generation, we learned at school, and that’s what we can do research on. There are lots of things which could have been better and there are something around the P I which is not correct maybe. But, anyway, that’s what we were taught in school and that’s what we can do research at the moment. So, maybe our next generation of researchers can build up on other things. I think it’s interesting because in this way we can also compare different schools of thought. We can say that school of thought in 1950 was this, and then maybe we can find another school of thought from 1600. And we can compare what thoughts and what thinking they did around hot flashes. And then you can make new studies where you compare different schools of thought.


Q8.

Okay, thank you.


Thank you.


Q9.

Thank you so much.



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