An Interview With Professor Chris Zaslawski: Standardization and its Role in Acupuncture Research

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Associate Professor Chris Zaslawski is currently the Director of the College of Traditional Chinese Medicine, within the Faculty of Science at the University of Technology, Sydney (UTS), Australia. UTS is one of three universities that teaches and researches Chinese and oriental medicine in Australia. Chris has been practicing acupuncture and herbal medicine for nearly 30 years and is an active acupuncture researcher. He has also been the English editor for three acupuncture texts, Therapeutics of Acupuncture and Moxibustion (1996), The Foun dation of Acupuncture and Moxibustion Acupuncture – Moxibustion (1997), and University Textbooks of Traditional Chinese Medicine for Overseas Advanced Students (1999) which were published in conjunction with Chinese medicine colleagues from the Guangzhou University of Traditional Medicine in China. Currently Chris is working in conjunction with a colleague on the translation of several books on the clinical work of a famous Beijing acupuncturist, Professor He Pu Ren. Chris is also the Deputy Editor for the Australian Journal of Acupuncture and Chinese Medicine, Australia's only Chinese medicine peer reviewed journal; he is also on the International Editorial Board for two other acupuncture journals, Acupuncture Research, and the Journal of Acupuncture and Tuina Science. More recently, he was the international reviewer for the Best Scientific Manuscript Competition sponsored by the Journal of Acupuncture and Meridian Studies.

Chris was a temporary consultant for the World Health Organization (WHO) on four occasions and contributed to the development of two WHO documents concerning acupuncture clinical research and traditional medicine education. He was also a reviewer for the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region, which was published in 2007. He attended several forums on the development of a standard for the single use acupuncture needle, an in itiative supported by the Korean Institute of Oriental Medicine. Most recently, he was the head of a delegation from Standards Australia to Beijing to establish a technical committee for the standards relating to Asian medicine.

His research has focused on experimental pain and acupuncture, reliability of Chinese medicine diagnosis including tongue diagnosis, and the impact of research ethics on the design of acupuncture and herbal medicine studies. He has also been involved in several acupuncture clinical studies involving the efficacy of acupuncture on male sub-fertility, hepatitis C and stress. He is currently in the recruitment phase of a clinical trial that evaluates the effect of acupuncture on lateral elbow pain and a Delphi study on a rating scale for assessing the adequacy of acupuncture in clinical trials.

He delivered a presentation at the Symposium on Acupuncture and Meridian Studies 2009, in Seoul, Korea, titled Standardization and its role in acupuncture research. During the conference we managed to obtain a brief interview with him.

Q: Standardization is a very hot topic in Oriental medicine at the moment. How did you become interested in the area?

A: During 2006, the Korean Institute of Oriental Medicine initiated a forum on the development of a standard for the single use acupuncture needle. I have now attended four forums and the group has developed a draft standard for the single use acupuncture needle and indwelling auricular needle. The forums led to the establishment of the International Network for Standardisation in Acupuncture (INSA), which had its first conference in 2009. More recently, the international standard organization (ISO) has just established a technical committee for traditional Chinese medicine, so along with Korea and Japan and China, Australia will play a significant role as a participating member in promoting standardization within Chinese or Oriental medicine. I see this a good opportunity for a truly international approach for developing the traditional medicines of Japan, Korea and China.

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Q: You are also interested in acupuncture research methodology?

A: Yes, that is another area I find interesting and challenging for our profession. The design of acupuncture research continues to become more complex and trying to ensure that the research designs align with clinical practice is important. Many of the scientific models that are frequently used in acupuncture research such as the randomized controlled trial, were primarily developed for pharmacological (drug) studies. I feel this type of research model is unsuitable for the clinical research of Oriental medicine. So, one of my particular goals in designing studies is to ensure that it is scientifically rigorous yet reflects the nuances of current clinical practice. It has been very informative to be able to listen to the many international researchers from China, Japan and Korea at SAMS 2009. I think the both acupuncture and herbal medicine has scope for modernization and development but we need to do this carefully to ensure we do not lose the essence of its practice.

Q: Can you tell us a little about the College of Traditional Chinese Medicine at the University of Technology, Sydney, where you work?

A: The College is situated within the Faculty of Science at my University. We are located right in the central business district of Sydney and are one of three universities in Australia that teach Oriental or traditional medicine. The College has been established within the higher education sector since 1994, but prior to that, it existed outside the University sector as a private teaching institution. In 1991, discussion began concerning the integration of the College (known then as Acupuncture Colleges Australia), into the University system. Initially there was only a 3.5 year acupuncture program being taught as acupuncture had been introduced earlier into in the West than herbal medicine, However, over the last fifteen years, we have also seen an increasing use of, and increasing interest in, herbal medicine. Now the curriculum includes both acupuncture and herbal medicine within the 4-year program. We have 6-week clinical placements for the final year UTS students both in China and more recently in South Korea. Interestingly, we have a large cohort of Korean students enrolled in the program, approximately 40% and we have had several visiting scholars from Korean universities coming to UTS for periods of time. Currently I teach both acupuncture and herbal medicine within the Bachelor of Health Science (Traditional Chinese medicine) at UTS, and I also have several postgraduate students doing research in both acupuncture and herbal medicine.

Q: Can you tell us a little about the current state of Chinese medicine in Australia?

A: Both acupuncture and herbal medicine are used extensively by the Australian public. Currently, the practice of Chinese medicine is not regulated in Australia, except for the state of Victoria, where it is regulated by the State government. As of 2012, however, national government regulation of the practice of Chinese medicine will occur, which I see as being a positive step forward in the recognition of Oriental medicine in Australia. This will establish national standards for the education and clinical practice of Oriental medicine and will be the first time a Western country has established national government regulation of its practices.

Q: Do you have any other research interests?

A: One other area I am interested in is the application of human research ethics, and its impact on research design. Issues such as informed consent, the ethical use of a placebo comparator and effective blinding have to be considered when designing a clinical study. I have published some papers that discuss these ethical concerns and will continue on with theoretical research in that area. I am also involved in a clinical trial for lateral elbow pain. Having a background as a physical therapist, I treat a lot of patients with musculoskeletal pain. The study has commenced and we are currently recruiting participants; we hope to enroll around twenty people in the pilot study. If we can demonstrate a significant decrease in pain and function, we will then apply for further funding for a much larger study. I think it is a very exciting time to be involved with Oriental medicine, and there is much opportunity for international discussion and collaboration.