Traditional East Asian Medicine (TEAM) Case Reports & their potential impact on the community

Customising, individualising and characteristic (non-treatment) effects  

 

One of the solid arguments for CHM (and acupuncture) is the customisation and individualisation of our treatments. We might start with one herbal formula that we adjust according to how the patient’s presentation changes. It happens all the time. Some symptoms and signs disappear, while others come to the forefront. This situation of customisation and modification requires an accommodating research format, and case reports offer the opportunity to capture these details. Don’t we believe that our advice to the patient on lifestyle, diet, and adjunct treatment components such as moxibustion should play an essential role in achieving the desired treatment outcome? Langevin and colleagues call them characteristic non-needling (non-herbal) components (Langevin et al., 2011). They are called “characteristic” because their theory is grounded in the TEAM frameworks. A case report offers a possibility to note the advice that we have given to our patients. Once we can analyse case report data, we could “measure” the impact of those characteristic non-needling (non-herbal) effects.

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Case reporting is widespread in medicine, too.

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Since the prestigious medical journal, The Lancet introduced a dedicated section for case reports in 1995, case reports have gained popularity. It might be essential to note that GP practices and psychology started to focus on qualitative research and the study of the individual patient during this time, which might have been a reason for the increased recognition. Historically, in biomedicine, case reports have illumined new knowledge of existing diseases (Propranolol for infantile haemangioma) and are a source of discovery for novel conditions or treatments such as in the case of the Human Immunodeficiency Virus (HIV) which was first captured in a case report. Even though case reports are less cited than other types of medical research, it has inspired many medical journals to invest in publications for case reports. Over 160 journals (primarily open access) focus on case reports (Rison et al., 2017), and many medical researchers praise case reports as a complement to evidence-based medicine. Case reports are at the bottom of the research pyramid because there is no control group; they have a limited sample size (one to a few) and are not blinded. These missing factors are considered limitations to the interpretation of findings. However, N-of-1 or single-subject clinical trials (one individual patient) to investigate efficacy or side-effect profiles of different treatments (Lillie et al., 2011) are an exciting development as they acknowledge that each patient is unique.  

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What is next

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First, learning how to compile structured case reports for CHM is an excellent contribution to our profession, as our patients will benefit long-term. How can our patients gain from us compiling and publishing case reports? If we can produce case reports reflecting our encounters with patients in our everyday clinics, we contribute to the body of knowledge. We are “indulging” in the clinician-researcher role because case reports are considered (research) evidence. If we compile these case reports systematically, we can utilise them for data mining, synthesis, and trend analysis. Case reports suiting our primary modalities – acupuncture and CHM well. The patient takes centre stage, the individualisation of our treatments can be acknowledged, and the different styles we practice (if we disclose them) can be accommodated.

Convergent Points is an established platform where we can publish our (peer-reviewed) case reports. If that sounds too good to be true, then think again. This is an excellent opportunity to show that we can be evidence-based practitioners. The only barrier I can see is that we might have to spend some time and effort familiarising ourselves with writing case reports. I will endeavour to help with this critical task as it is an excellent opportunity for our profession to excel.