Diagnostic Authority

June 20, 2000

The biomedical use of latin, is no more a `choice' than is the use highly

metaphorical language in Chinese medicine. Both were determined by historic

and cultural circumstances. The primary difference is not the terms but the

epistemology, the rationale for `truth.'

Scientifically, Chinese patterns are no more or less justifiable than biomedical

disease labels. If the pattern names are unique, that is, if we eliminate the

collapsing of distinction presently evident in the English language literature,

there would be no qualitative distinction between these two labelling systems.

If

we can show that similarly trained clinicians examining a similar patient

population agree on the pattern labels more frequently than is likely by chance,

(what is known technically as `inter-rater reliability'), and that the

therapeutic

outcomes are as reliable as the now-standard therapies, the diagnostic authority

of Chinese medicine would be at no practical disadvantage to many biomedical

therapies, of which fewer than people imagine are actually R.C.T. established.

Insurance companies would probably pay voluntarily because of the implicit

savings but, regardless, could not sustain refusal to pay for outcome justified

treatments in court. Only those whose training was known to produce inter-

rater reliable diagnoses could legally or morally justify practising Chinese

medicine - regardless of whatever other license they may hold.

bob Paradigm Publications

www.paradigm-pubs.com 44 Linden Street

Robert L. Felt Brookline MA 02445

617-738-4664

June 20, 2000

In a message dated 6/20/00 8:55:23 PM Pacific Daylight Time,

yulong writes:

<<

But in the existing scene in Chinese medical education in the U.S.,

the only organizing principles that exist relate to the content of licensing

exams that are themselves highly questionable when it comes to reflecting

meaningful standards of the subject itself.

>>

Ken, how many Chinese medical educational institutions in the US are you

familiar with? What makes you think -- specifically, what knowledge do you

have that this might be true -- that there are " no organizing principles

other than those that relate to the content of licensing exams " ?

<< Students metriculating into various " master's " programs are not even

required to be in possession of any prerequisite sense of what knowledge

is. This means, and we can see it in the various issues that come before

us for discussion, that the whole field lacks a root.

>>

Where is your spell checker? -- why is " master's " in quotes? Do you think

we do not actually have master's programs? Why do you think students are not

required to be in possession of " any prerequisite sense of what knowledge

is " ? How would you judge whether a student had such a prerequisite sense?

Ken, you are sounding rather arbitrarily negative on the schools here. Why?

(I say " arbitrary " because I am not sure you have a lot of first hand

knowledge of very many US schools -- I could be wrong -- if so, correct me.)

Julie

June 20, 2000

> The biomedical use of latin, is no more a `choice' than is the use highly

> metaphorical language in Chinese medicine. Both were determined by

historic

> and cultural circumstances. The primary difference is not the terms but

the

> epistemology, the rationale for `truth.'

As so often in the past, Bob Felt has yet again hit the nail on the head.

The issue of

epistemology, i.e. the methods employed for the development of knowledge,

is a critical and all too often overlooked one in the field of Chinese

medical

study and practice in the West. Epistemology means: " the study or a theory

of

the nature and grounds of knowledge especially with reference to its limits

and validity. "

Thomas Kuhn, the preeminent historian of sciene, wrote in The Structure

of Scientific Revolutions that " Scientific knowledge, like language, is

intrinsically the common property of a group or else it is nothing at all.

To understand it we need to know the special characteristics of the group

that creates and applies it. "

One of the great advantages of medical doctors is the existence of a shared

epistemology, a common set of tools and standards that they employ to

develop their understandings and techniques. Of course, people can and do

become the slaves of this sort of shared paradigm; and Kuhn notes that

it is this sort of intellectual slavery that helps set the stage for the

advent

of scientific revolutions.

Yet we need to face the fact that there is virtually no common epistemology

in

place in the field of Chinese medicine in the West. All you need to do to

understand what I mean by this remark is to review the archives of this

list for the past two months. Even a relatively small group of individuals

can find precious little to agree about with respect to what Chinese

medicine is or ought to be.

This is not, by the way, because no such epistemology exists. The Chinese

have had a fairly standard approach to answering questions such as

what is Chinese medicine? what is qi? what is yin and yang? and so on

for centuries. Nor has it resulted in a homogenization of the subject.

To the contrary, this common understanding of the fundamental definitions

has given rise to enormous variety in both theory and practice.

But in the existing scene in Chinese medical education in the U.S.,

the only organizing principles that exist relate to the content of licensing

exams that are themselves highly questionable when it comes to reflecting

meaningful standards of the subject itself.

Students metriculating into various " master's " programs are not even

required to be in possession of any prerequisite sense of what knowledge

is. This means, and we can see it in the various issues that come before

us for discussion, that the whole field lacks a root.

To address this situation, we have to deal with the roots. How do we

go about studying and verifying the validity of data in Chinese medicine?

Long before we can deal with complex issues such as clinical efficacy

and the proof thereof, we are going to have to roll up our sleeves and

construct a valid epistemology for the subject that is based upon its

actual roots.

There is, in fact, a choice that every individual has to make.

As it was put in the Sixties, " you're either part of the problem

or part of the solution. "

Ken Rose

June 21, 2000

1) Unfortunately, the schools and licensing boards have often co-evolved,

each responding to developments in licensing standards and educational

requirements, each again based on available English language literature,

which was often sparse and quite imprecise.

>

><<

> But in the existing scene in Chinese medical education in the U.S.,

> the only organizing principles that exist relate to the content of licensing

> exams that are themselves highly questionable when it comes to reflecting

> meaningful standards of the subject itself.

> >>

2) I think Ken is referring to the traditional sense of immersion in Yi

Jing and Confucian classics that were considered to be prerequisites for

studying medicine. . . .in other words, some familiarity with classical

Chinese thought and philosophy. How many of our students have that? By

the way, we recently had a discussion about this at PCOM. . . .my

experience and that of other instructors is that those students with

backgrounds in the martial arts, Chinese language, Yi jing, qi gong, or an

'eastern' spiritual practice were more in tune with the Chinese medical

program than those who came in 'cold'.

>Ken, how many Chinese medical educational institutions in the US are you

>familiar with? What makes you think -- specifically, what knowledge do you

>have that this might be true -- that there are " no organizing principles

>other than those that relate to the content of licensing exams " ?

>

><< Students metriculating into various " master's " programs are not even

> required to be in possession of any prerequisite sense of what knowledge

> is. This means, and we can see it in the various issues that come before

> us for discussion, that the whole field lacks a root.

> >>

>

June 21, 2000

Dear Ken,

This is not, by the way, because no such epistemology exists. The Chinesehave had a fairly standard approach to answering questions such as what is Chinese medicine To the contrary, this common understanding of the fundamental definitionshas given rise to enormous variety in both theory and practice.

Will you elaborate please?Long before we can deal with complex issues such as clinical efficacy and the proof thereof, we are going to have to roll up our sleeves and construct a valid epistemology for the subject that is based upon its actual roots.

Can we construct more than one?

Joseph Balensi

June 21, 2000

Julie,

> Ken, how many Chinese medical educational institutions in the US are you

> familiar with?

You raise a good point. How have I come to my conclusions?

I do indeed have a limited personal experience with American

schools of Chinese medicine, with any and all schools of

Chinese medicine for that matter. I have personal experience

with the schools in LA and have been to PCOM in San Diego

to lecture. I've visited at a few other schools in California,

and I have gotten to know many students from America and

other Western countries both here and in China. I have formed

a general sense of the strengths and weaknesses of various schools

and of the entire zone based upon impressions gathered from these

kinds of contacts as well as from listening to others with experience

far more extensive than my own. Fortunately, we're not dependent

only upon that which we can experience in the flesh as valid

sources of information.

I look at aspects of the scene, such as the enormous attrition rates

of graduated and certified practitioners, the overall lack of knowledge

and responsibility on the part of schools of and for their graduates,

to name a copule of critical ones; and I work to synthesize a critical

analysis of what underlies such failings.

>What makes you think -- specifically, what knowledge do you

> have that this might be true -- that there are " no organizing principles

> other than those that relate to the content of licensing exams " ?

Is it coincidence that the bulk of the curricula of the extant acupuncture

schools coincides with the content of licensing exams? If you look at the

wide range of schools of thought and approaches to Chinese (or Oriental)

medicine, can it be explained any other way that so many schools

organize their curricula primarily in order to prepare students to pass the

exams?

What else are the schools in the business of doing if it isn't preparation

to pass the exams? This is not really an indictment of the schools. It is an

observation

about the nature of the existing scene. In a sense, it was put together

backwards. First a law was passed, and then a subject was designed to

meet the various criteria of the law. The subject is senior in importance

to the policies that regulate it. But the policy infrastructure in which the

schools and the exams currently exist has served as the organizing

principle of Chinese medicine in the States. No?

> Where is your spell checker? -- why is " master's " in quotes? Do you

think

> we do not actually have master's programs?

My use of quotations was meant to set the word off and suggest that its

usage requires closer examination. I'm grateful that you picked up on it.

My personal view is that there is an odd confluence of meanings related

to this word, particularly with respect to Chinese medicine and other

traditional arts. The word " master " is used to translate the Chinese term

" sifu " , which means literally, " teacher, " but which has a profound meaning

in the traditional Chinese context. Likewise the English word has a set of

meanings that can confound. I think that the sense of " mastering " a subject

and of being a " master " of a subject is altogether different than what is

meant by " master's degree, " for example. Almost all of the good, long

term practitioners I know would concur with the idea that in their

master's degree education they mastered nothing but became qualified

as students. The common idea that you don't really learn the subject

in school but once you get out is, I believe, an accurate reflection of

the state of the art of Chinese medical education in this country.

When you add the complicating factor of the Chinese sense of

" master, " I think we wind up with a fairly confusing term, one which

requires closer scrutiny, hence the quote marks.

>Why do you think students are not

> required to be in possession of " any prerequisite sense of what knowledge

> is " ?

I think this as a result of long term (since 1970) involvement with the

Chinese medical scene in Southern California. Up until the late 80's,

students could get

into a masters programs here with only a high school diploma. As an

aside, I want to make it clear that I personally do not tend to equate

knowledge with

certificates. And I realize that prerequisites to the study of medicine in

contemporary schools have stiffened a bit. When I look at the prerequisites

to the study of medicine suggested by past masters of Chinese medicine,

however, I observe that our modern standards fall quite short. I don't

believe this is necessary or desirable. I think we should prove ourselves

worthy of at least those standards and seek to advance them.

But the point I was making was with respect to the subject

of epistemology. I meant to point out that whereas students

entering top flight medical schools to study Western medicine

can be expected to be in possession of certain rudimentary

skill and data sets, the same can not be said with any comparable

intent with respect to those entering medical schools in this

country that purvey education in Chinese medicine, as a general

rule. Correct me if I'm wrong.

>How would you judge whether a student had such a prerequisite sense?

On an individual basis, I would do it the way that my teachers

do it with me. They get to know me. They observe me. They

test me. They talk with me. They establish a mutual sense of

committment to the task of study.

Again, with respect to the issue of epistemology, which was my

original intent and target, were I to assess a student's preparedness

to study Chinese medicine, I would look for their capacty to acquire

knowledge from without their existing frames of reference. I would

also inquire as to their character with an eye towards determining

whether or not they possess a compassionate spirit and were capable

of developing the art of benevolence.

I would make it difficult for students to enter or survive in a program

who were intent upon proving their own pre-conceptions and satisfying

their own prejudices.

And I would make cheating on exams the basis for

mandatory and immediate expulsion.

> Ken, you are sounding rather arbitrarily negative on the schools here.

Why?

I prefer to call it critical. As you know I am not of the opinion that all

criticism is negative or destructive. I believe, to the contrary, that

criticism and critical thinking are desperately needed within the halls of

Chinese

medical schools in this country. I think there is a crisis brewing and

I think we had better wake up to it quickly in order to prepare ourselves

to deal with it as it develops.

> (I say " arbitrary " because I am not sure you have a lot of first hand

> knowledge of very many US schools -- I could be wrong -- if so, correct

me.)

I'm sure I'm guilty of as much arbitrary thinking as anyone. And I have

already addressed your point about my personal experience with

schools. I long ago recognized that the world is far too vast a place

to rely on my personal experience as the sole basis for forging an

understanding of what is going on in it. That is what underlies my

fascination with literature in general, and with respect to the literature

of Chinese medicine we have to build up adequate literary resources

in order to overcome our innate lack of capacity to gather enough

personal experience to form reliable understanding of the subject.

It is this lack of a comprehensive literature of Chinese medicine

in English that emerges in my analysis as the pivotal factor

underlying the developing crisis in the subject here. A rapidly

growing edifice has been constructed without an adequate foundation.

As I have stated in the past, I not only criticize the educational

structure for its weaknesses, I look to it and its considerable

strengths as a source of solutions to these very real problems.

Ken

June 21, 2000

Joseph,

I'm short on time, as we're leaving for China tomorrow. But I wanted

to get you a brief reply.

This is not, by the way, because no such epistemology exists. The Chinesehave had a fairly standard approach to answering questions such as what is Chinese medicine To the contrary, this common understanding of the fundamental definitionshas given rise to enormous variety in both theory and practice.

Will you elaborate please?

If we take a look at the span of Chinese medical literature, we

find that over the centuries various theories have emerged as

organizing principles of the subject in different eras. One of

the accumlating benefits of those in later periods is access

to each of these sometimes competing points of view. After

more than 2,000 years of such accumulation, what has been

called the great treasure house of traditional Chinese medicine

is packed full of a wide variety of approaches to solving problems

related to human health, disease, and recovery.

When I say the Chinese have had a fairly standard way of dealing

with all of this, I don't mean that all Chinese view this panoply of

theory and method in the same or even similar ways. I mean that

there is a baseline of knowledge, an epistemology, that serves as

a ridgepole from which the entire structure of this vast treasure house

descends.

Beneath this ridgepole there is an even more fundamental cultural

foundation that supports all traditional arts and sciences. This

whole subject is the focus of our book, Who Can Ride the Dragon?

to which I refer you for a more detailed investigation.

Long before we can deal with complex issues such as clinical efficacy and the proof thereof, we are going to have to roll up our sleeves and construct a valid epistemology for the subject that is based upon its actual roots.

Can we construct more than one?

Can, have, and will continue to, no doubt. My point is that such

construction requires both firm rooting and adequate knowledge

of the tools of the trade.

Ken

June 21, 2000

I have to agree with Z'ev and Ken, being a current student. There is no

emphasis on grasping the essence of the medicine, through the understanding

of the culture, philosophy etc... This, I believe, is mandatory, as well as

learning Chinese language. And a " Master's " prg.??? This is definitely

debatable... we have to ask ourselves, what is better for our profession?

1) a massive amounts of acupuncture/herbalists that had no grounding in the

essence of the medicine and have relatively no idea what is going on. 2) or

maybe 20 % (number of graduates) that are good and have a clue. This too is

definitely debatable...

-

[zrosenberg]

Tuesday, June 20, 2000 11:21 PM

Re: Diagnostic Authority

1) Unfortunately, the schools and licensing boards have often co-evolved,

each responding to developments in licensing standards and educational

requirements, each again based on available English language literature,

which was often sparse and quite imprecise.

>

><<

> But in the existing scene in Chinese medical education in the U.S.,

> the only organizing principles that exist relate to the content of

licensing