Medicare and TCM Treatments for Menopause

[Guest guest]

> Group,

>

> The following news was picked up by Michael McGuffin

> (President of the

> American Herbal Products Assn) and sent out to

> encourage other potential

> supporters. Please note in the 5th paragraph below

> wherein licensed health

> care practitioners (even acupuncturists) would be

> given certain prescribing

> powers within the Medicare system. This is a

> monumental crack in the wall

> that those who are politically inclined shouldn't

> ignore.

> Stephen

>

>

> AHPA Update

> August 15, 2002

> New Legislation Pushes to Make Alternative

> Treatments for Menopausal

> Symptoms Covered by Insurance

> It has come to our attention that on July 24, 2002

> Congresswoman Barbara Lee

> (D-CA) introduced the “Hormone Replacement Therapy

> Alternative Treatment

> Fairness Act” (H.R. 5204) in the U.S. House of

> Representatives.

>

> The legislation would mandate coverage for “hormone

> replacement therapy and

> alternative treatments for hormone replacement

> therapy under the Medicare

> and Medicaid programs, group health plans and

> individual health insurance

> coverage and other Federal health insurance

> programs.”

>

> Congresswoman Lee’s bill states that most insurance

> plans, whether federal

> or private, do not cover non-prescription

> alternative HRT treatments yet,

> “33 percent of women in the United States who are

> undergoing menopause

> routinely use alternative treatments for menopausal

> symptoms, such as Soy,

> Black Cohosh, Chasteberry, Pro-Gest, Hops, Red

> Clover, Dong Quai, Evening

> Primrose Oil, Vitamin E, Flax Seed Oil, Ginseng and

> natural DHEA.”

>

> The Bill, which currently has no cosponsors, would

> amend the Social Security

> Act, the Public Health Service Act, the Internal

> Revenue Code and other

> laws. The amendments would require Medicare and

> Medicaid to cover both

> conventional and alternative therapy for treatment

> of menopausal symptoms

> and would prohibit group or individual health plans

> that provide benefits

> for outpatient prescription drugs from excluding

> either conventional or

> alternative therapy for such treatment.

>

> The Bill would limit all such coverage for

> alternative choices to those

> therapies that are “recommended by a health care

> provider who is licensed,

> accredited, or certified under State law” and that

> have been “proven safe

> and effective in peer-reviewed scientific studies.”

>

> A full copy of the bill can be found on the

> Congressional website in PDF

> format:

>

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=107_cong_bills & doc

> id=f:h5204ih.txt.pdf

>

> AHPA will keep its members posted on the status of

> the bill as it moves

> through Congress. If you have further questions,

> please contact Robin

> Gellman, Director of Communications of the American

> Herbal Products

> Association.

>

>

> Stephen Morrissey OMD

> Botanica BioScience Corp

> P.O. Box 1477

> Ojai, CA 93024

> Ph: 805-646-6062

> Fx: 805-646-3026

> email: stephen

>

>

>

> 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.

>

>

>

>

[Guest guest]

, Mr <

.geo> wrote:

 

Please note in the 5th paragraph below

> > wherein licensed health

> > care practitioners (even acupuncturists) would be

> > given certain prescribing

> > powers within the Medicare system. This is a

> > monumental crack in the wall

> > that those who are politically inclined shouldn't

> > ignore.

> > Stephen

 

Stephen

 

the first time I read this, I missed the next line which said only

those treatments which have been proven safe and effective. by

medicare standards, there are no TCM treatments that meet this

criteria. so the only thing exciting thing about this article is the

incentive to do research and hopefully 5-10 years from now, we

will actually get some reimbursement when everyone is

satisfied with our " proof " . this further underscores the damage

being done to our field by the large number of practitioners who

remain equivocal or even hostile to the importance of clinical

research. Because this news clip may ultimately only document

a missed opportunity, not a great milestone. The fact is that

when you look at the current NIH grants for CAM, most of the

studies are clearly designed to fund people's pet projects, rather

than advance the field as a whole. We are already so jaded that

the NIH is just a cash cow to us, not an opportunity to prove TCM

works. The current OCOM grant is a welcome exception to this

trend.

 

A critical factor in doing intelligent research in TCM is having

access to chinese source materials. Quite a bit of past research

and many current projects are being done by groups of

americans who do not read chinese. Some notable failed

studies in the past should never have been done because

ample evidence already existed in the chinese literature to

discount the researchers hypothesis. So in order to do the

proper literature review prior to developing a study, someone

must be able to search the chinese. So in order to do the volume

of research necessary in the next decade, we need a lot of

americans who can read chinese. As those who are familiar

with the principles of professional translation know, we must

have translators whose native language is the target language

(english). It has never been considered sufficient to have all

translation done by those whose native language is the source

tongue.

 

With regard to language study in the DAOM program, PCOM was

recently notified that they would not be able to offer a three track

program (integrative, classical and research). they must offer a

single program for all students. I don't understand the details,

really. But the program is now going to have a heavy research

emphasis. this necessitates a strong integrative track. what is

getting short shrift will no doubt be classical studies. It was the

classic and to a lesser extent, the integrative tracks, that had a

strong language emphasis. the research track had no language

requirement.

 

I am sure that language is still included in the new PCOM DAOM

proposal, but the pressure from ACAOM has really put PCOM in

a position where language cannot be a central emphasis. Since

students will have no choice but to devote substantial time to

research subjects like design and statistics. Even under the old

plan, there was concern that the students studying language in

the other tracks would not develop sufficient skills to support the

researchers in their literature reviews. Now this is even more

likely to be a problem. The only solution to this problem is to

require language study from day one in the master's program. If

you have to toss the qi gong, tai ji and massage classes to do

that, so be it. Don't get me wrong, I think these other things are

very valuable and I would rather do any of them than study

chinese, but if we have to choose, I think it is our misplaced

priorities that have elevated self-cultivation and bodywork above

rigorous academics. We say study chinese on your own. Well, I

say say, study tai ji on your own.

 

It is all part of this anti-intellectual mentality that Wiseman talks

about in his recent articles uploaded to CHA. the idea that

touching bodies and developing our spiritual powers through qi

gong is ALL one needs to practice TCM. That is the taoist way,

the true TCM, not this bastardized communist revisionism, that,

horror of horrors suggests we buckle down and study. Now, I

don't think we all need to know chinese to practice well, but the

time has come in our field when we have no choice but to

require it of our current students or we will have lost a great

opportunity. Because you can damn well be sure that when

mainstream academia goes for a slice of this pie, they will draw

on the full resouces of their asian studies departments and we

will never see a dime of NIH dollars ever again. time to get our

heads out of the sand.

 

There is a corrollary to this. if students will be required to learn

chinese at the Master's level, then so must professors. All

schools will have to require ALL TCM professors to take

language classes and provide the classes for free and pay the

professors for their time spent in class. California law requires

that on the job training be compensated and without cost to the

employee. Despite my resistance to study chinese, I would do it

under these circumstances and no doubt, be better for it.

Sometimes we need a sword over our heads to do something,

even if it is good for us. sometimes we just need to get paid for

our time because of financial concerns. Let's face it, at the egoic

level of consciousness, we need incentives to do things we don't

like. Let's get off our horses and figure out what those incentives

are. Currently, the ROI on learning chinese is neglible for either

professors or practitioners. That's what we need to change

somehow.

 

[Guest guest]

, " 1 " <@i...> wrote:

> the first time I read this, I missed the next line which said only

> those treatments which have been proven safe and effective. by

> medicare standards, there are no TCM treatments that meet this

> criteria. so the only thing exciting thing about this article is

the

> incentive to do research and hopefully 5-10 years from now, we

> will actually get some reimbursement when everyone is

> satisfied with our " proof " . this further underscores the damage

> being done to our field by the large number of practitioners who

> remain equivocal or even hostile to the importance of clinical

> research.

 

:

 

Do you think acupuncture colleges would be interested in setting up

research studies, the way western colleges do? Not many of the

Chinese studies are accepted by the West, and many results are

suspect and probably unverifiable in any case. To prove the

effectiveness of TCM, we will probably be on our own.

 

Jim Ramholz

[Guest guest]

, " jramholz " <jramholz>

wrote:

 

>

> Do you think acupuncture colleges would be interested in

setting up

> research studies, the way western colleges do?

 

yes, but they are easily victim to the pet project syndrome due to

the serious cash needs of most schools just to run their existing

programs.

 

[Guest guest]

A critical factor in doing intelligent research in TCM is having access to Chinese source materials. Quite a bit of past research and many current projects are being done by groups of americans who do not read chinese. Some notable failed studies in the past should never have been done because ample evidence already existed in the chinese literature to discount the researchers hypothesis.

>>>You think there is a lack of "chinese studies" published or translated into English and that are "positive" and one can try to replicate

Alon

[Guest guest]

In a message dated 8/16/2002 4:50:34 PM Central Standard Time, alonmarcus writes:

 

 

and many current projects are being done by groups of

americans who do not read chinese. Some notable failed

studies in the past should never have been done because

ample evidence already existed in the chinese literature to

discount the researchers hypothesis.

 

Dear Alon:

 

I remain fascinated with the idea that one must read Chinese to understand fully Chinese herbology.

 

However, I am wondering if you would give an example or two (in brief synopsis) of the "failed studies" you referenced. It is my understanding that studies don't fail one way or another unless they are improperly designed.

 

When designed properly they either confirm or fail to confirm a null hypothesis in a statistically significant manner.

 

The idea that one must read Chinese in order to do these studies implies that one must be able to read English in order to do studies on pharmaceuticals and that German speaking researchers would thereby be at a disadvantage. I don't quite see why this would be the case.

 

Guy Porter

 

DrGRPorter

[Guest guest]

, drgrporter@a... wrote:

> In a message dated 8/16/2002 4:50:34 PM Central Standard

>

> Dear Alon:

>

> I remain fascinated with the idea that one must read Chinese

to understand

> fully Chinese herbology.

 

I think you missed my point. you must read chinese to find out

what studies have been done on a given subjct since most such

studies have not been translated. this has nothing to do with

comprehension. it is about data that is only in a foreign

language pure and simple. If I want to know what active

constituents are in an herb, I need to find a source that records

this. Hsu covers a 1000 herbs, but there are about another 5000

that there is no english data on.

 

>

> However, I am wondering if you would give an example or two

(in brief

> synopsis) of the " failed studies " you referenced.

 

 

dang gui was studied at kaiser permanente in oregon in the

early 90's for its purported estrogenic effects, even though this

" effect " had been disproven decades before in chinese

research. dharmananda reported on this at the time.

 

It is my understanding that

> studies don't fail one way or another unless they are

improperly designed.

 

they can fail to prove the hypothesis. while it is useful to know

that dang gui is NOT estrogenic, that was already well

established. thus this was a waste of time and money that

could have been avoided by a simple literature review of the

chinese language literature. Plus we need to have successful

application of our methods demonstrated, not unsuccessful,

regardless of the scientific value.

 

 

> one must be able to read English in order to do studies on

pharmaceuticals?

 

you would if there was no information available in any other

language. this just seems a given to me. it has nothing to do

with whether you would understand better in english or chinese.

we can argue this till the cows come home. it's just whether the

info is available at all. that doesn't really seem debatable unless

I am missing sonmething here.

 

[Guest guest]

Dear Dr. Porter

I agree with Alon. It is standard that before you make

any scientific research project you have to be

familiar with literature on the subject and with the

studies already done before. In TCM most of them are

done in China in Chinese. It means that you have to

know about them and their results, therefore you have

to be able to read Chinese somehow. Otherwise it is

not serious, it is just wasting time and money

Yuri

--- drgrporter wrote:

> In a message dated 8/16/2002 4:50:34 PM Central

> Standard Time,

> alonmarcus writes:

>

>

> > and many current projects are being done by groups

> of

> > americans who do not read chinese. Some notable

> failed

> > studies in the past should never have been done

> because

> > ample evidence already existed in the chinese

> literature to

> > discount the researchers hypothesis.

>

> Dear Alon:

>

> I remain fascinated with the idea that one must read

> Chinese to understand

> fully Chinese herbology.

>

> However, I am wondering if you would give an example

> or two (in brief

> synopsis) of the " failed studies " you referenced. It

> is my understanding that

> studies don't fail one way or another unless they

> are improperly designed.

>

> When designed properly they either confirm or fail

> to confirm a null

> hypothesis in a statistically significant manner.

>

> The idea that one must read Chinese in order to do

> these studies implies that

> one must be able to read English in order to do

> studies on pharmaceuticals

> and that German speaking researchers would thereby

> be at a disadvantage. I

> don't quite see why this would be the case.

>

> Guy Porter

>

> DrGRPorter

>

 

 

 

 

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[Guest guest]

Howe remain fascinated with the idea that one must read Chinese to understand fully Chinese herbology

>>>>Me too. I am still awaiting a single good example of a principal that can only be understood in Chinese

 

 

ver, I am wondering if you would give an example or two (in brief synopsis) of the "failed studies" you referenced. It is my understanding that studies don't fail one way or another unless they are improperly designed.

>>>>I think I wrote "positive"meaning with positive results that is successful clinical outcomes. I totally agree that a negative finding is just as important as a positive one. But for us as a profession, at this point, we need as many positive studies as possible. If we ever get Medicare (which I think at this point is a mistake) it would become the standard of care for CM in US. And they will probably only cover conditions that pass "evidence."At this point that would probably only be nausea vomiting

Alon

[Guest guest]

they can fail to prove the hypothesis. while it is useful to know that dang gui is NOT estrogenic, that was already well established. thus this was a waste of time and money that could have been avoided by a simple literature review of the chinese language literature. Plus we need to have successful application of our methods demonstrated, not unsuccessful, regardless of the scientific value.>>>>>

The study was done not because they thought dang gui is estrogenic but because it was a common herb used in healthfood stores and one that kaiser patient were saying they use often (with help). They considered doing several popular herbs and then chose dang gui. The next study was the one I was a part of and was on TCM diagnosis of menopausal women. We were going to use the findings to study formulas, but lost financing.

Alon

[Guest guest]

, " Alon Marcus " <

alonmarcus@w...> wrote:

 

>

> The study was done not because they thought dang gui is

estrogenic but because it was a common herb used in

healthfood stores and one that kaiser patient were saying they

use often (with help).

 

I was working at ITM at the time and Subhuti was contacted for

information. Yes, patients had reported that they used this herb

for menopausal symptoms. However, the researchers

speculated the mechanism was estrogenic. they asked about

both of these things. at the time, subhuti told the researchers

that dang gui would NOT relieve the sx of hot flash and

nightsweats in a controlled study and their hypothesis about

dang gui being estrogenic was wrong. they ignored him and

based their research on anecdotal reports from patients.

Subhuti was only aware of this because he was having research

reports from china translated for him on a regular basis at the

time. If only accessing english language literature, you would

have found nothing useful at the time.

 

[Guest guest]

they ignored him and based their research on anecdotal reports from patients.

 

>>>>>Todd the principal author of that study worked and organized the study I was involved with. I had a long conversation with him about the dang gue study. All the researchers were MDs and they did not try to study it from a TCM perspective, or to find out about Chinese literature, but only because it was, and still is, a popular herb for "hot flushes."They were quite aware of the predictions that it would fail, and that there were conflicting information as to having estrogenic effects.

It was not their hypothesis but was a question if dang gui is estrogenic (again because of conflicting data at the time). Ettinger is an open minded western Dr but with no training in TCM at all, although he did read several TCM books.

Alon

[Guest guest]

Leah and Porter, this is an interesting discussion, but I believe the

comments being ascribed to Alon were actually Todd's. Todd is the

person making the arguement for learning Chinese in order to review

studies done there. Alon does not usually argue for knowledge of

Chinese as an essential.

 

-- In , leah tynkova <leahhome> wrote:

> Dear Dr. Porter

> I agree with Alon. It is standard that before you make

> any scientific research project you have to be

> familiar with literature on the subject and with the

> studies already done before.

[Guest guest]

, " gabriellemathieu " <

gabriellemathieu> wrote:

Todd is the

> person making the arguement for learning Chinese in order to

review

> studies done there.

 

 

Yes, that is correct. Sorry that this comment accidentally got

ascribed to Alon. My mistake when replying.

 

[Guest guest]

Alon does not usually argue for knowledge of Chinese as an essential.>>>>>As essential to understand principals. It is certainly essential to read Chinese sources

Alon

[Guest guest]

, " Alon Marcus " <

alonmarcus@w...> wrote:

 

>

> >>>>>As essential to understand principals. It is certainly

essential to read Chinese sources

> Alon

 

I think we agree on this, but then what do we know since we

cannot read chinese.