Guest guest Posted June 12, 2001 Report Share Posted June 12, 2001 Alon (and everyone), Perhaps an inter-rater reliability study could be designed as a series of simple-to-complex evaluations of pulses that could address the extent to which consensus can and does occur with respect to pulse diagnosis. For example, the first evaluation could simply be: normal or not normal. The participants in the study would be asked to feel the pulses of a group of patients and to simply state if they were normal or not. Subsequent evaluations could include more complex evaluations. And we might be able in the end to see how far inter-rater reliability can be established with respect to a range of aspects of the pulse. It would also be interesting to conduct identical studies among different groups of practitioners, perhaps in different geographical areas to address the question of whether or not different approaches to education and practice result in different degrees of consensus and reliability among practitioners. The design of any such study would be challenging as so many time-valued factors come to bear on a patient's pulse. And the pulses of patient X are bound to experience change between examinations by the many diagnosticians engaged in the study. In fact, I think that the design of such a study raises some fundamental questions about the nature and design of trials related to Chinese medical diagnostics and therapeutics. There's an article in the forthcoming issue of CAOM that addresses some of these fundamental issues that might be of use to those who are interested in pursuing the design and conduct of such a study. It's by a mathematician named Ron Bloom and discusses the history and philosophical basis of statistical inference. It raises the question, albeit indirectly, as to whether or not a method of scientific investigation designed to study the effects of fertilizers on crop production is really all that applicable or reliable for the design of studies aimed at increasing our understanding of human disease processes and the ways in which we assess and treat them. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2001 Report Share Posted June 12, 2001 At 4:54 AM -0400 6/12/01, yulong wrote: >It would also be interesting to conduct >identical studies among different groups >of practitioners, perhaps in different >geographical areas to address the question >of whether or not different approaches >to education and practice result in >different degrees of consensus and >reliability among practitioners. -- To do a study of inter-rater reliability amongst practitioners seems beside the point. I think it would be better to do such a study of clinic supervisors in the schools. That would focus attention on the source of the problem. I've been teaching CE workshops pulse diagnosis for several years, in San Francisco, Los Angeles, Boston, New York, Colorado, New Mexico, Holland and Israel. I can affirm, based on this experience, that inter-rater reliability in pulse diagnosis is consistent; it is consistently terrible. The primary reasons for this are obvious: - Students/practitioners do not memorize the basic features of each pulse quality. - There is little consistency amongst the school clinic supervisors. - Clinic supervisors won't devote the time to teach pulse in clinic. - Clinic supervisors, probably because of their own lack of competence with the pulse, frequently tell their students that the pulse is not important. - Students do not continue their study by following senior practitioners beyond their school experience. The individual exceptions to this sad litany are few and far between - I'd say that about 5% of participants in my seminars show real competence with the pulse going in. I imagine this is pretty representative of the profession at large. Of course there is a desire to learn, and many practitioners are only too aware of their shortcomings in this area. If it is to be addressed, this problem has to be addressed in the schools. Perhaps Emperor's College is doing this, now that it has a pulse zealot in residence (Hi Will!). Rory Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2001 Report Share Posted June 12, 2001 My experience as a teacher, both at an acupuncture college and at seminars, and as a past clinical supervisor is the same as Rory's. I agree with everything that is said below. We are way below par as a profession on pulse skills and reliability. This is perhaps our major weakness as practitioners. It is not helped by teachers with sub-par pulse skills telling students that pulse diagnosis is not important or subjective. Post-graduate experience with senior practitioners is essential, to gain constant practice and confirmation. We need to ideally aim for the level of expertise of the Tibetan physicians who were tested in American hospitals by diagnosing seriously ill patients by pulse alone. This kind of acid test would be failed by most of us, but its possibility raises the ante on what traditional diagnostic techniques can accomplish. On Tuesday, June 12, 2001, at 08:38 AM, Rory Kerr wrote: > At 4:54 AM -0400 6/12/01, yulong (AT) mindspring (DOT) com wrote: > >It would also be interesting to conduct > >identical studies among different groups > >of practitioners, perhaps in different > >geographical areas to address the question > >of whether or not different approaches > >to education and practice result in > >different degrees of consensus and > >reliability among practitioners. > -- > > To do a study of inter-rater reliability amongst practitioners seems > beside the point. I think it would be better to do such a study of > clinic supervisors in the schools. That would focus attention on the > source of the problem. > > I've been teaching CE workshops pulse diagnosis for several years, in > San Francisco, Los Angeles, Boston, New York, Colorado, New Mexico, > Holland and Israel. I can affirm, based on this experience, that > inter-rater reliability in pulse diagnosis is consistent; it is > consistently terrible. The primary reasons for this are obvious: > > - Students/practitioners do not memorize the basic features of each > pulse quality. > > - There is little consistency amongst the school clinic supervisors. > > - Clinic supervisors won't devote the time to teach pulse in clinic. > > - Clinic supervisors, probably because of their own lack of > competence with the pulse, frequently tell their students that the > pulse is not important. > > - Students do not continue their study by following senior > practitioners beyond their school experience. > > The individual exceptions to this sad litany are few and far between > - I'd say that about 5% of participants in my seminars show real > competence with the pulse going in. I imagine this is pretty > representative of the profession at large. Of course there is a > desire to learn, and many practitioners are only too aware of their > shortcomings in this area. If it is to be addressed, this problem has > to be addressed in the schools. Perhaps Emperor's College is doing > this, now that it has a pulse zealot in residence (Hi Will!). > > Rory > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2001 Report Share Posted June 12, 2001 When we get the information from the pulse takers we can plug it into the computer and look at tons of stuff. All we have to do is keep changing the criteria of what we are looking for and get results of analysis. But we need to start getting the data, i.e. have pulse takers perform their stuff in controlled environment Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2001 Report Share Posted June 12, 2001 I'd say that about 5% of participants in my seminars show real competence with the pulse going in. >>>First we need to study if it is even possible to have agreement. We need to have the best of each system and see can they do it. For any clinical test one must show both consistency and relevancy. The best way to do this is to have more than one practioner of each system take the pulse in controlled environment and have data on the patients. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2001 Report Share Posted June 12, 2001 We need to ideally aim for the level of expertise of the Tibetan physicians who were tested in American hospitals by diagnosing seriously ill patients by pulse alone >>>Nobody really tested them. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2001 Report Share Posted June 12, 2001 Explain. I was there in person for one of the events here at UCSD. Z'ev On Tuesday, June 12, 2001, at 09:58 AM, <alonmarcus (AT) wans (DOT) net> wrote: > We need to ideally aim for the level of expertise of the Tibetan physicians who were tested in American hospitals by diagnosing seriously ill patients by pulse alone > >>>Nobody really tested them. > Alon > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2001 Report Share Posted June 12, 2001 Michael Broffman has a very interesting pulse measuring machine at his clinic. A gentleman named James McCormick has been doing some studies with it. They have been able to generate pictures of different pulses, such as wiry, floating, short, etc. This has been ongoing work for several years. Articles on this work were published in the California Journal of Oriental Medicine and the American Journal of Acupuncture. On Tuesday, June 12, 2001, at 09:51 AM, <alonmarcus (AT) wans (DOT) net> wrote: > When we get the information from the pulse takers we can plug it into the computer and look at tons of stuff. All we have to do is keep changing the criteria of what we are looking for and get results of analysis. But we need to start getting the data, i.e. have pulse takers perform their stuff in controlled environment > Alon > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2001 Report Share Posted June 12, 2001 Explain >>>We need a formal study Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2001 Report Share Posted June 12, 2001 Michael Broffman has a very interesting pulse measuring machine at his clinic. A gentleman named James McCormick has been doing some studies with it. They have been able to generate pictures of different pulses, such as wiry, floating, short, etc. This has been ongoing work for several years. Articles on this work were published in the California Journal of Oriental Medicine and the American Journal of Acupuncture.>>>I have seen it and had my as well as a couple of patients pulse taken Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2001 Report Share Posted June 13, 2001 Z'ev: How complex a pulse picture can the machine now recognize? Jim Ramholz , <zrosenbe@s...> wrote: > Michael Broffman has a very interesting pulse measuring machine at his > clinic. A gentleman named James McCormick has been doing some studies > with it. They have been able to generate pictures of different pulses, > such as wiry, floating, short, etc. This has been ongoing work for > several years. Articles on this work were published in the California > Journal of Oriental Medicine and the American Journal of Acupuncture. > > > On Tuesday, June 12, 2001, at 09:51 AM, <alonmarcus@w...> wrote: > > > When we get the information from the pulse takers we can plug it into > > the computer and look at tons of stuff. All we have to do is keep > > changing the criteria of what we are looking for and get results of > > analysis. But we need to start getting the data, i.e. have pulse takers > > perform their stuff in controlled environment > > Alon > > > <Attachment missing> > > > > > > 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. > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2001 Report Share Posted June 13, 2001 Not too complex. . . at least at my last inquiry 2 years ago. Nothing like dong han or hammer complexity. On Tuesday, June 12, 2001, at 11:17 PM, jramholz wrote: > Z'ev: > > How complex a pulse picture can the machine now recognize? > > Jim Ramholz > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2001 Report Share Posted June 13, 2001 It might make an interesting teaching aid. What does he plan to do with it? Jim Ramholz , <zrosenbe@s...> wrote: > Not too complex. . . at least at my last inquiry 2 years ago. Nothing like dong han or hammer complexity. > > > On Tuesday, June 12, 2001, at 11:17 PM, jramholz wrote: > > > Z'ev: > > > > How complex a pulse picture can the machine now recognize? > > > > Jim Ramholz > > > > > > Quote Link to comment Share on other sites More sharing options...
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