Response to Dan Benksy (long)

[Guest guest]

It is good to see a response from Dan Bensky, his

work has contributed in large part to education in,

and thus practice of, T.C.M. in the West.

Without Dan's own statement of his views

any debate or assessment is incomplete.

I also thank him for his kind words concerning

my colleagues' works.

 

There is much in Dan's post. Some is best responded

to by reference to published material. I will respond briefly

to some of the other issues but the key point of my response

will relate to the results ``on the ground.''

 

Dan notes that `naturalistic' and `clinical' are used as

perjoratives by scholars, and reminds us of the

`out-of-the-texts-themselves' argument that is one of

Nathan Sivin's significant themes. Both are

aspects of Nathan Sivin's critiques of Paul Unschuld's work.

Paul makes his own case in these regards and there is

enough in print for those who are interested.

The only thing I want to say is that Dr. Sivin translated

some very large bits of a basic text to discuss the

same issues Wiseman discusses, often with similar observations.

So, I don't think producing several hundred pages of rationale

and a dictionary that provides definitions drawn from the

literature most people are now studying can be fairly

said to ignore the texts.

 

Dan notes that I am arguing against a transparency of

language and I object to that description. I am arguing

for transparency of rationale and method. Again, there's

a couple of hundred pages people can read for free and

for themselves. I note that the set of words people continue

to identify as opaque remains small. Note too that there

are reasonably objective ways to look at this issue

because readability has been studied in the context of teaching.

For example, if you use the Practical Dictionary terms

to translate a Chinese passage translated in other writers'

books, then compare the two translations with objective

criteria for transparency, for example, readability software,

there is no decided advantage one way or another.

 

I have never argued against pluralism;. I have argued for

paying attention to what HMO managers think because they

determine who gets a check from their HMOs. Steve Birch

and I have a whole chapter in print, so I don't need to repeat

the detail. However, I have been following measures of the

T.C.M. economy for the nearly twenty years that the current

system has been in place. I see no evidence that everyone

who masters those materials (at least to the extent of getting

a license) is earning a living much less mastering practice.

If you want to say that my interest in inserting CM into

the Western medical delivery system, independent of, and

complementary to, biomedicine is not the deepest penetration

of the topic, that is OK by me. But, I don't think anyone

would refuse third party payment based on a T.C.M. diagnosis.

 

The subjects I feel I should address in Dan's post

concern the need for open access, in particular to an area

where I believe Dan has been academic, that is, abstracted from

the circumstances on the ground. Thus, I mainly want to discuss

the tendency I see to treat `standards' and `standardization' as

if they were the same.

 

I may be guilty of over-generalizing from Dan's post but generally the

argument is made that the holistic and naturalistic roots of CM mean

that the majority of its concepts are no more than conditionally fixed.

It is a claim that the size of the conceptual repetoir used in a fixed manner

within identifiable periods and genres in Chinese medicine is small

enough that the fixing of terms to English equivalents is of no value

and/or misleading. From this the argument follows that methodologically

pegging Chinese terms to English equivalents is inferior to the

situational judgment of an expert translator. Also implicit here

is the presumption, at least on the part of the audience, that clinical

translators' choices are based on clinical evidence and are thus

inherently superior to those rooted in generalist (`academic') approaches.

 

The creation of standards is a fact of human intellectual activity.

It is the process of arriving at shared processes, measures, and

principles that permit cooperation, interlinking or precise communications

within and among groups who agree on the advisability of cross

reference or some form of scholarly practice meant to make the

evidence for someone's claims open for inspection. It is by definition a tool

for achieving a group goal such as inter-process, inter- and intra-field

documentation, record-keeping, and so forth. It is by definition open,

shared and available for change in a structured way.

 

Standardization is a fact of human social, economic and political order.

It is the result of a mix of social, economic and political forces

that occur whether we like them, want them, or make them subject

to debate and change. It is distinguished from the process of

making standards by the fact of its enforcement by market or political

behaviors.

Standardization is the selection of a gate-keeping criteria

(which may or may not be a standard) that controls access to some

activity within a group, or even to the group itself. Standardization

is inescapable in organized human activities, there is only open

standardization and closed standardization, free access and restricted

access, open and closed social groups.

 

While there can be many standards, there is typically only

one controlling standard in any particular venue and much of

the critique levied against standards, such as rigidify, is

better aimed at the effects of political standardization. Biomedicine

is rigidly standardized, just ask an M.D. But, that standardization

is made rigid, not by science or evidence-based research, but by

the economic, political and social forces that control.

 

In commercial competition, for example, there can be as many

standards as there are economically viable markets. People

can choose the MacOS, Windows, LINUX, VMS or UNIX. All of which are

very formal and very complex published standards that have been

hammered-out in standard-setting groups (composed of

aggressive competitors) open to anyone who is willing to

put their engineering data and tests results on the table.

So long as there are enough users to support any one of those

competing standards, all can co-exist at little cost and great benefit to

the general user. For example, although you cannot

run a program for NT on LINUX because the ``hooks'' to the

file system are different in LINUX, the existence of published

standards means access to the NT market is open. All you need to

do is buy the manuals. In other words, there is unrestricted

access to any of the OS markets because of published standards.

 

What I have steadily argued is that as regards its acculturation,

and regardless of your view of its roots, or finest principles,

Chinese medicine is not different than the thousands of

other human activities that are a mix of commercial, political

and economic forces where open standards are common, useful and

better for all than personally controlled or closed criteria as

means of regulation.

 

Consider, for example, that to accept that I am guilty of a

straw anything concerning familiarity as a criterion you need to

know the standard. The fact many that Chinese

medical terms are everyday words is not germane

to using familiarity as a criterion until you know the list. Everydayness

is a quality that many have recognized. What is in question is not

the analysis but what response that analysis demand - not among

scholars all of whom can read the sources, but for students

who depend, not only on the translation, but on the value

assigned to that translation by their fields' social, political

and economic standardization.

 

The question is not really about everyday words, it is whether

these everyday terms are so automatically translated identically

by everyone and so fully cover the conceptual scope of

the traditional medical language that a formal standard is not required.

This is not obviously compelling. Again, as elsewhere stated

at length, there is enough variability and perceived confusion

to suggest that openly pegging terms to Chinese is practically

conducive not only to study and understanding but also to

attracting the type of publications investment the field requires.

 

In response to a rather absolute statement, I asserted that the size

of the term set Wiseman, et. al, has identified as methodologically

fixable to standard equivalents is large enough that `familiarity'

is a too poorly defined and impractical a criteria that will force

CM out of its epistemological context. Any argument, either pro

or con, concerning using word familiarity as the prime criteria

of term selection depends entirely on the size of the term set to be

preserved (at least in regard to the source Chinese) in translation.

You can argue that there are more familiar words available

but unless you show us what you propose the term set to be, you cannot

fairly dismiss my contention that Chinese medicine is a

superset that cannot be squeezed into the subset of familiar words.

Short of a term list that someone is willing to assert is the reasonable

limit to the concepts that can be fairly fixed in the literature

of T.C.M., I don't think there is a basis for Dan's complaint.

 

Next, without some idea of what it is about the translation of

those everyday words that is to supposed to guarantee accurate

transmission, that is, without a repeatable methodology for

selection, the debate has no where to go but ad hominum.

We can say what we prefer, who we like, or who we don't.

What we can't do is make an repeatable choice outside of our

own group. The fact that no translation is perfect does not logically

extend to the conclusion that the selection of term equivalents

needs no open method. The point of this is that even

in regard to preserving the subtle aspects of practice

Dan emphasizes, it makes sense for everyone to make

their underlying logic as open as possible.

 

For example, I advocate for the idea that T.C.M. concepts are

rooted in a qualitative and relational logic. I have argued that

this relational logical is consistently enough expressed in Chinese

that the Chinese itself can and should be used as a basis for the

design of a relational database. I have given everyone all they need

to examine this claim: statements of analysis, relation charts,

methodology, significant lists and examples anyone can use for or against

the position. If you prove some aspect of my design wrong because

the same Chinese in different contexts means something so different that a

relationship my design produces is not justified; if you show that

my design invents information by creating a relationship that

is accidental or false, I can fix the problem and move on. I may

not like that you caught me out but because the essentials of

assessment are on the table, my design will be better.

 

I want to be very careful here. Thus, I will state that I am not

blaming Dan Bensky for standardization; I do not doubt that

Dan and those who agree with him are sincere in their assertion

that their individual practice of Chinese medicine is

a guarantee of validity. I do not demean the value of clinical

experience in general or Dan's in particular. I have

watched too many fine clinicians answer their student's questions

to believe otherwise. Regardless, I have made too many formal analyses

of human activities as simple as entering name and address data

into software to believe people who swear up and down that

they all do things the same way when there is nothing on a piece

of paper. They don't. Humans don't. There needs to be some

way for people who do not have personal access to another

individual's experience to examine it, that is, to read their

clinical results in language.

 

The fact that individual clinical experience is (at least in my

view of apprenticeships) is one of the elements of Asian

intergenerational transmission, does not mean therefore

that it is the appropriate guarantee of validity for didactic texts.

This is particularly true in a context such as license education

where standardization is bound to occur and we are more

frequently discussing data (indications, etc.) than were are

investigating the obscure and subtle. First, it is impractical

to think one person will see enough patients to justify

a sizable literature or a field-wide conclusion. Second, it is a

closed system that is too easily subject to control.

Its value is highest in a small group environment where informal

technical vocabularies can evolve shared meanings by use,

not in public environments where meaning must be transmitted

in writing, or stored in written records. I can think

of no art in which such groups have automatically arrived at a

multi-group standard or cross-reference without the work of

analysts to provide the meta systems. I am not arguing against

hands-on study myself but it has never worked to create a

reliable literature.

 

Note too that using a fixed terminology pegged to the Chinese

in no way limits any author's ability to express individual understanding.

People have been commenting on the meaning of translated text

for generations. Thus, the absence of a published standard is

like using a nuclear bomb to stop a foe that can be chased away with a stick.

There is no question that scholars are various in their term choices.

They also publish their sources side by side, write for an audience

that has access to those sources, and can read them for themselves.

They use term lists to conform and index their books, they wrap their

translations in method papers and research monographs that are read

and argued by the readers of their translations. And, they award degrees

based on their student's ability to defend their own decisions, not

on their ability to repeat a standardized body of knowledge.

 

Thus, I believe it is a little impractical to think there

are not defacto standards and that this isn't something that should

be part of the field's public domain. That does not mean that

I believe that Dan Bensky's books are bad, should not be used in

schools, or that free translations and clinical approaches with

no basis in translation should all be taken out and burned.

In fact, I would be very surprised if Dan doesn't makes his books

with tools like dictionaries and term lists.

 

However, until Dan, or others, come forward with a list

that they explicitly label as the best current estimate of only those

terms that can be reasonably fixed within the modern T.C.M. literature,

we cannot reasonably argue some of these issues. Without an

apples to apples comparison reasonably available to the other experts who

have turned their attention to our field, that debate can go nowhere at all.

 

 

 

bob Paradigm Publications

www.paradigm-pubs.com 44 Linden Street

Robert L. Felt Brookline MA 02445

617-738-4664

 

You are old when your youth has been reduced to the themes of car commercials.

[Guest guest]

Biomedicine

is rigidly standardized, just ask an M.D. But, that standardization

is made rigid, not by science or evidence-based research, but by

the economic, political and social forces that control.

 

>>>that is true

 

You can argue that there are more familiar words available

but unless you show us what you propose the term set to be, you cannot

fairly dismiss my contention that Chinese medicine is a

superset that cannot be squeezed into the subset of familiar words.

Short of a term list that someone is willing to assert is the reasonable

limit to the concepts that can be fairly fixed in the literature

 

>>>definitions of terms is absolutely necessary, however, perhaps because

English is a second language for me, I really like to see words used that

are easily related to the terms they describe.

 

Regardless, I have made too many formal analyses

of human activities as simple as entering name and address data

into software to believe people who swear up and down that

they all do things the same way when there is nothing on a piece

of paper.

 

>>>I know they do not as our study at Kaiser showed.

Alon

 

of T.C.M.,

-

" Robert L. Felt " <bob

 

Tuesday, August 01, 2000 1:30 PM

Response to Dan Benksy (long)

 

 

> It is good to see a response from Dan Bensky, his

> work has contributed in large part to education in,

> and thus practice of, T.C.M. in the West.

> Without Dan's own statement of his views

> any debate or assessment is incomplete.

> I also thank him for his kind words concerning

> my colleagues' works.

>

> There is much in Dan's post. Some is best responded

> to by reference to published material. I will respond briefly

> to some of the other issues but the key point of my response

> will relate to the results ``on the ground.''

>

> Dan notes that `naturalistic' and `clinical' are used as

> perjoratives by scholars, and reminds us of the

> `out-of-the-texts-themselves' argument that is one of

> Nathan Sivin's significant themes. Both are

> aspects of Nathan Sivin's critiques of Paul Unschuld's work.

> Paul makes his own case in these regards and there is

> enough in print for those who are interested.

> The only thing I want to say is that Dr. Sivin translated

> some very large bits of a basic text to discuss the

> same issues Wiseman discusses, often with similar observations.

> So, I don't think producing several hundred pages of rationale

> and a dictionary that provides definitions drawn from the

> literature most people are now studying can be fairly

> said to ignore the texts.

>

> Dan notes that I am arguing against a transparency of

> language and I object to that description. I am arguing

> for transparency of rationale and method. Again, there's

> a couple of hundred pages people can read for free and

> for themselves. I note that the set of words people continue

> to identify as opaque remains small. Note too that there

> are reasonably objective ways to look at this issue

> because readability has been studied in the context of teaching.

> For example, if you use the Practical Dictionary terms

> to translate a Chinese passage translated in other writers'

> books, then compare the two translations with objective

> criteria for transparency, for example, readability software,

> there is no decided advantage one way or another.

>

> I have never argued against pluralism;. I have argued for

> paying attention to what HMO managers think because they

> determine who gets a check from their HMOs. Steve Birch

> and I have a whole chapter in print, so I don't need to repeat

> the detail. However, I have been following measures of the

> T.C.M. economy for the nearly twenty years that the current

> system has been in place. I see no evidence that everyone

> who masters those materials (at least to the extent of getting

> a license) is earning a living much less mastering practice.

> If you want to say that my interest in inserting CM into

> the Western medical delivery system, independent of, and

> complementary to, biomedicine is not the deepest penetration

> of the topic, that is OK by me. But, I don't think anyone

> would refuse third party payment based on a T.C.M. diagnosis.

>

> The subjects I feel I should address in Dan's post

> concern the need for open access, in particular to an area

> where I believe Dan has been academic, that is, abstracted from

> the circumstances on the ground. Thus, I mainly want to discuss

> the tendency I see to treat `standards' and `standardization' as

> if they were the same.

>

> I may be guilty of over-generalizing from Dan's post but generally the

> argument is made that the holistic and naturalistic roots of CM mean

> that the majority of its concepts are no more than conditionally fixed.

> It is a claim that the size of the conceptual repetoir used in a fixed

manner

> within identifiable periods and genres in Chinese medicine is small

> enough that the fixing of terms to English equivalents is of no value

> and/or misleading. From this the argument follows that methodologically

> pegging Chinese terms to English equivalents is inferior to the

> situational judgment of an expert translator. Also implicit here

> is the presumption, at least on the part of the audience, that clinical

> translators' choices are based on clinical evidence and are thus

> inherently superior to those rooted in generalist (`academic') approaches.

>

> The creation of standards is a fact of human intellectual activity.

> It is the process of arriving at shared processes, measures, and

> principles that permit cooperation, interlinking or precise communications

> within and among groups who agree on the advisability of cross

> reference or some form of scholarly practice meant to make the

> evidence for someone's claims open for inspection. It is by definition a

tool

> for achieving a group goal such as inter-process, inter- and intra-field

> documentation, record-keeping, and so forth. It is by definition open,

> shared and available for change in a structured way.

>

> Standardization is a fact of human social, economic and political order.

> It is the result of a mix of social, economic and political forces

> that occur whether we like them, want them, or make them subject

> to debate and change. It is distinguished from the process of

> making standards by the fact of its enforcement by market or political

behaviors.

> Standardization is the selection of a gate-keeping criteria

> (which may or may not be a standard) that controls access to some

> activity within a group, or even to the group itself. Standardization

> is inescapable in organized human activities, there is only open

> standardization and closed standardization, free access and restricted

> access, open and closed social groups.

>

> While there can be many standards, there is typically only

> one controlling standard in any particular venue and much of

> the critique levied against standards, such as rigidify, is

> better aimed at the effects of political standardization. Biomedicine

> is rigidly standardized, just ask an M.D. But, that standardization

> is made rigid, not by science or evidence-based research, but by

> the economic, political and social forces that control.

>

> In commercial competition, for example, there can be as many

> standards as there are economically viable markets. People

> can choose the MacOS, Windows, LINUX, VMS or UNIX. All of which are

> very formal and very complex published standards that have been

> hammered-out in standard-setting groups (composed of

> aggressive competitors) open to anyone who is willing to

> put their engineering data and tests results on the table.

> So long as there are enough users to support any one of those

> competing standards, all can co-exist at little cost and great benefit to

> the general user. For example, although you cannot

> run a program for NT on LINUX because the ``hooks'' to the

> file system are different in LINUX, the existence of published

> standards means access to the NT market is open. All you need to

> do is buy the manuals. In other words, there is unrestricted

> access to any of the OS markets because of published standards.

>

> What I have steadily argued is that as regards its acculturation,

> and regardless of your view of its roots, or finest principles,

> Chinese medicine is not different than the thousands of

> other human activities that are a mix of commercial, political

> and economic forces where open standards are common, useful and

> better for all than personally controlled or closed criteria as

> means of regulation.

>

> Consider, for example, that to accept that I am guilty of a

> straw anything concerning familiarity as a criterion you need to

> know the standard. The fact many that Chinese

> medical terms are everyday words is not germane

> to using familiarity as a criterion until you know the list. Everydayness

> is a quality that many have recognized. What is in question is not

> the analysis but what response that analysis demand - not among

> scholars all of whom can read the sources, but for students

> who depend, not only on the translation, but on the value

> assigned to that translation by their fields' social, political

> and economic standardization.

>

> The question is not really about everyday words, it is whether

> these everyday terms are so automatically translated identically

> by everyone and so fully cover the conceptual scope of

> the traditional medical language that a formal standard is not required.

> This is not obviously compelling. Again, as elsewhere stated

> at length, there is enough variability and perceived confusion

> to suggest that openly pegging terms to Chinese is practically

> conducive not only to study and understanding but also to

> attracting the type of publications investment the field requires.

>

> In response to a rather absolute statement, I asserted that the size

> of the term set Wiseman, et. al, has identified as methodologically

> fixable to standard equivalents is large enough that `familiarity'

> is a too poorly defined and impractical a criteria that will force

> CM out of its epistemological context. Any argument, either pro

> or con, concerning using word familiarity as the prime criteria

> of term selection depends entirely on the size of the term set to be

> preserved (at least in regard to the source Chinese) in translation.

> You can argue that there are more familiar words available

> but unless you show us what you propose the term set to be, you cannot

> fairly dismiss my contention that Chinese medicine is a

> superset that cannot be squeezed into the subset of familiar words.

> Short of a term list that someone is willing to assert is the reasonable

> limit to the concepts that can be fairly fixed in the literature

> of T.C.M., I don't think there is a basis for Dan's complaint.

>

> Next, without some idea of what it is about the translation of

> those everyday words that is to supposed to guarantee accurate

> transmission, that is, without a repeatable methodology for

> selection, the debate has no where to go but ad hominum.

> We can say what we prefer, who we like, or who we don't.

> What we can't do is make an repeatable choice outside of our

> own group. The fact that no translation is perfect does not logically

> extend to the conclusion that the selection of term equivalents

> needs no open method. The point of this is that even

> in regard to preserving the subtle aspects of practice

> Dan emphasizes, it makes sense for everyone to make

> their underlying logic as open as possible.

>

> For example, I advocate for the idea that T.C.M. concepts are

> rooted in a qualitative and relational logic. I have argued that

> this relational logical is consistently enough expressed in Chinese

> that the Chinese itself can and should be used as a basis for the

> design of a relational database. I have given everyone all they need

> to examine this claim: statements of analysis, relation charts,

> methodology, significant lists and examples anyone can use for or against

> the position. If you prove some aspect of my design wrong because

> the same Chinese in different contexts means something so different that a

> relationship my design produces is not justified; if you show that

> my design invents information by creating a relationship that

> is accidental or false, I can fix the problem and move on. I may

> not like that you caught me out but because the essentials of

> assessment are on the table, my design will be better.

>

> I want to be very careful here. Thus, I will state that I am not

> blaming Dan Bensky for standardization; I do not doubt that

> Dan and those who agree with him are sincere in their assertion

> that their individual practice of Chinese medicine is

> a guarantee of validity. I do not demean the value of clinical

> experience in general or Dan's in particular. I have

> watched too many fine clinicians answer their student's questions

> to believe otherwise. Regardless, I have made too many formal analyses

> of human activities as simple as entering name and address data

> into software to believe people who swear up and down that

> they all do things the same way when there is nothing on a piece

> of paper. They don't. Humans don't. There needs to be some

> way for people who do not have personal access to another

> individual's experience to examine it, that is, to read their

> clinical results in language.

>

> The fact that individual clinical experience is (at least in my

> view of apprenticeships) is one of the elements of Asian

> intergenerational transmission, does not mean therefore

> that it is the appropriate guarantee of validity for didactic texts.

> This is particularly true in a context such as license education

> where standardization is bound to occur and we are more

> frequently discussing data (indications, etc.) than were are

> investigating the obscure and subtle. First, it is impractical

> to think one person will see enough patients to justify

> a sizable literature or a field-wide conclusion. Second, it is a

> closed system that is too easily subject to control.

> Its value is highest in a small group environment where informal

> technical vocabularies can evolve shared meanings by use,

> not in public environments where meaning must be transmitted

> in writing, or stored in written records. I can think

> of no art in which such groups have automatically arrived at a

> multi-group standard or cross-reference without the work of

> analysts to provide the meta systems. I am not arguing against

> hands-on study myself but it has never worked to create a

> reliable literature.

>

> Note too that using a fixed terminology pegged to the Chinese

> in no way limits any author's ability to express individual understanding.

> People have been commenting on the meaning of translated text

> for generations. Thus, the absence of a published standard is

> like using a nuclear bomb to stop a foe that can be chased away with a

stick.

> There is no question that scholars are various in their term choices.

> They also publish their sources side by side, write for an audience

> that has access to those sources, and can read them for themselves.

> They use term lists to conform and index their books, they wrap their

> translations in method papers and research monographs that are read

> and argued by the readers of their translations. And, they award degrees

> based on their student's ability to defend their own decisions, not

> on their ability to repeat a standardized body of knowledge.

>

> Thus, I believe it is a little impractical to think there

> are not defacto standards and that this isn't something that should

> be part of the field's public domain. That does not mean that

> I believe that Dan Bensky's books are bad, should not be used in

> schools, or that free translations and clinical approaches with

> no basis in translation should all be taken out and burned.

> In fact, I would be very surprised if Dan doesn't makes his books

> with tools like dictionaries and term lists.

>

> However, until Dan, or others, come forward with a list

> that they explicitly label as the best current estimate of only those

> terms that can be reasonably fixed within the modern T.C.M. literature,

> we cannot reasonably argue some of these issues. Without an

> apples to apples comparison reasonably available to the other experts who

> have turned their attention to our field, that debate can go nowhere at

all.

>

>

>

> bob Paradigm Publications

> www.paradigm-pubs.com 44 Linden Street

> Robert L. Felt Brookline MA 02445

> 617-738-4664

>

> You are old when your youth has been reduced to the themes of car

commercials.

>

> Chinese Herbal Medicine, a voluntary organization of licensed healthcare

practitioners, matriculated students and postgraduate academics specializing

in Chinese Herbal Medicine, provides a variety of professional services,

including board approved online continuing education.

>

>

>