Chapter V

Discussion and Conclusion

Discussion

     This study focused upon a specific practice, Qigong, within the larger and growing phenomena of  alternative and complementary health care in the United States.  Qigong and the "field" of alternative and complementary medicine are increasingly becoming powerful influences on the belief systems of the contemporary health care consumer and to a lesser extent Western scientific health care providers.  The research of Qigong has expanded from China to the U.S. and now includes the NIH's Office of Complementary and Alternative Medicine and a growing number of various national and international organizations and individuals all across the world.
     Alternative and complementary health care has much to offer in examining the past development of the United States' health care system, the current restructuring of the health care system, and the future direction of the system.  The focus is moving from treatment to preventive health care and health education.  This changing focus is created by the changing structure of the healthcare system from the traditional fee for service to several other reimbursement options, including the capitated health maintenance organizations (HMO's) and preferred provider organizations (PPO's).  This change is resulting in changes in health behavior; and health care consumer's behavior, as a driving economic force, can offer much insight into the successes and failures of such restructuring.
     Modern American scientific medicine began in response to the Flexner Report written in the early 20th century (1910 Flexner).  From this report the standardized curriculum taught in medical schools was established and remains today largely unchanged.  This educational model, a dualistic, organ system approach has left much to be desired as "[t]he current process is lengthy, costly, and has produced an overabundance of specialists and too few primary care physicians" (1995 Kovner 63).  Modification of this situation is a difficult problem as all states require licensed physicians to be graduates of approved schools.  The accredation process is regulated by the Liaison Committee on Medical Education, which is jointly controlled by the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC)  (87).  Thus, as physicians are the leaders of the health care field and responsible for the educational development of the schools, change is slow to occur.
     Health care provider behavior can be instrumental in insuring a high quality of health care.  The way and form in which care is provided can have extreme implications for the difference between life and death.  The care provider should have a working knowledge of the culture of those they are caring for in order to properly communicate vital information.  As well, education about culturally different forms of health care and care providers should become a part of the framework of overall care.  Alternative forms of health care, such as chiropractic and the traditional health systems of India and China, have demonstrated remarkable health benefits that should not be ignored because they originated outside of the traditional Western bioscientific approach.
Many physicians believe the only medicine worth writing about is
the highly scientific medicine sometimes practiced in university
hospitals, but such medicine is in fact the exception rather than the rule.  Most of our encounters with the doctor are about everyday
problems such as fatigue, panic attacks, high blood pressure, vaginal
infections, and birth control that don't always have "scientific solutions." (1988 Payer 19)
Many practices called "alternative" are mainstream treatments in other Western medical traditions such as in Germany and France.  As well, many "mainstream" practices in America are not "...the result of scientific progress but rather outgrowths of American cultural biases that in some cases harmed more than helped our health and well-being" (1988 Payer 16).  The behavioral practices of healthcare providers have a direct and often measurable effect on health, as can be seen in the many malpractice suits brought in our society.
     At present one of the prime movers of the healthcare system is the drive to control cost.  Among the many reasons are "[t]he combined effects of prospective payment (PPS), managed care and capitation (HMOs) and limits to Medicare reimbursements (DRGs) began to squeeze income and cut into paid patient days" (1997 Press 2).  The result being that our health care system is attempting to do more with less.  The solution that appears to be developing is that health and prevention rather than treatment is being emphasized.  "As more hospitals and physicians participate in capitated health plans, it will be in their best financial interests to keep patients healthier and away from formal providers and institutionalized care" (1997 Press 3).  This trend has resulted in many insurance companies and other health management organizations to increasingly provide coverage for such "alternative" treatments as chiropractic and acupuncture.  On the downside of this movement are examples of "...nitpicking 'utilization reviews' of doctors' bills by insurance-company bureaucrats; patients hustled out of a hospital within hours, even after surgery as traumatic as breast removal; gag orders forbidding doctors to tell a patient about an expensive treatment" and being billed for an expensive emergency room visit for a perceived emergency that turns out to be a false alarm and the HMO will not cover it (1997 Church 32).  On the upside many detection and preventive health practices are now being covered that were previously disallowed.
     For the future, patient behavior is one of the most likely sources to have an extreme impact on individual health and the health care system.  Certain behavioral and cultural practices can be harmful to the human organism.  Culturally defined definitions of disease and pain can have great impact on both prevention and treatment of disorders.   Behavioral practices and non-practices are important for health outcomes.  Eating and exercise habits are prime movers in the maintenance or non-maintenance of health.  Most of the major health problems in our society today are a direct result of patient behavior or lifestyle choices.  Examining consumer behavior and culture can be a useful tool to find ways to modify human behavior to a healthier and better quality of life.
     Another factor which will greatly impact the future of health care is technology.  Technology brings both great benefits and numerous problems as it constantly and ever more quickly improves.  Two of the greatest problems brought on by technology are its cost and the ethicacy of its use.  For example:  "early studies assumed that more services were synonymous with better quality care; however, recognition has grown that many technologies are used extensively in situations where they may not be appropriate" (1995 Kovner 403-404).
     We have a duty to the future to study other cultures as well as our own.  From this examination, we have and will discover many valuable practices and lifestyles, including the uses of various flora and fauna.  Some of the less technologically advanced peoples of the world have provided us with some very valuable health information in the past.  Many of our most important medicines have come from the pharmacopeia of primitive peoples and the search continues among them today as evidenced by The University of Mississippi's Natural Products Center.   Applied social sciences, such as medical anthropology, can do much to examine the current health care systems of the world and lead us on to a healthier future.

Conclusions

     Qigong with its emphasis as a prevention and health maintenance method first and a treatment method second has the potential to be an extremely effective and simple approach to improve health and quality of life.  TCM is based on thousands of years of observation while modern scientific medicine is less than one-hundred years old.  Qigong is the final component of this ancient health care system to receive attention and research in the West.  The other components of TCM, its plant and animal pharmacopeia  and acupuncture have been and continue to be researched and have provided us with many treatments and drugs that have shown effectiveness.  This should demonstrate that TCM, as a practical approach to observed phenomena, has validity; and qigong, as a part of that approach, deserves our research attention.  We can ill afford our past ethnocentric perspective about the perfection of Western medicine, which has largely come to mean scientific medicine as practiced in the United States, and must utilize the scientific method in an unbiased way while keeping an open mind with respect for the vast experience and possibilities offered by much older systems of health care.
     Much of the research in this study has indicated mechanisms at work which are not understood or completely validated at this time by science.  However, many of the mechanisms are probably as old as humanity itself and could be termed a human universal.  From the first shaman until today the mind and body have worked largely the same; and ways to influence the healing of it, as well, remain the same.
     The conclusions from this study leaves more questions than answers.  Much of the ethnographic experience in this study is difficult to explain in scientific terms other than placebo effect or power of suggestion, which are powerful healing methods with documented effectiveness, yet they do not seem to convey or explain exactly all of what I observed.  The survey demonstrated significant positive results in the areas of Perceived Health and Pain which are both very important for quality of life.  As well, the Pain score is interesting when considered in the context of a possible relation to the external qi healer's reported ability to reduce pain.
     The overall conclusion that I am able to draw from this study is that qigong has great potential as a health care modality that could easily and economically be implemented.  Qigong has many applications "some of the most promising for Western healthcare are for chronic problems such as hypertension, cardiovascular disease, aging, asthma, allergies, neuromuscular problems, and cancer.  These areas of public health deserve consideration by Western medical establishments." (1996 Sancier 45) As well, there is some basis for the possibility that the TCM view of qi (or bioenergy) could be a part of the mechanism at work in qigong.  As would be expected, from the few thousand year head start, the TCM view generally explains the functioning and outcomes of its applications, such as acupuncture, with far greater accuracy than scientific western medicine is yet able to accomplish.  From the interest generated by the study survey and from the ethnographic subjects there appears to be an increasing public perception and belief that qigong "works" as an acceptable, accessible, and increasingly available health care system.

Limitations

     This study was intended to be an initial examination of the health outcomes of qigong practice and to assist in directing future and more refined studies.  The utilization of the World Wide Web as a source for research subjects has its benefits and drawbacks from a sampling perspective.  The WWW was an invaluable tool for locating practitioners of such a relatively recent health care import into the United States.  As well, survey data collected via this medium are already inputed and ready to be utilized by computer analysis programs and virtually eliminates the phenomena of missing data.  The small sample size of the survey, the sample method utilized, and the great similarity between the groups could be reasons for there not being many differences between the experiment and control groups.  The Duke Health Profile might not adequately measure the health outcomes of qigong practice.  Qigong practice for personal health can be done in around thirty minutes a day, however, at advanced stages (for those wishing to be healers etc.) it is a very time consuming and lengthy, to the point of years, practice that might be better served by a measure longer than the single week used by the Duke.  Research into the effectiveness of qigong healers could be completed in a relatively short time.  Both short term and long term studies of qigong practitioners should be undertaken to examine the various health benefits attributed to qigong practice.

Future Research

     Specialized qigong surveys for each of the different "groups" of qigong practitioners and methodologies might demonstrate interesting differences among them.  With the growing popularity of this practice in the U.S. we should in time have a larger sample size of practitioners to work with.  Measures of qigong practitioners in their first and subsequent years of practice until they reach the "mastery" level could as well provide some interesting results.  A prospective study could be conducted to measure patients or new practitioners and then after exposure to the healing techniques of qigong another measure could be conducted to assess the actual health outcomes.  Qigong practice has great potential as a community based health approach which could be implemented at very low cost.  Individual ethnographic research with those who are considered qigong masters should as well be conducted to examine the often extraordinary claims surrounding them.

Works Cited