Guest guest Posted May 6, 2003 Report Share Posted May 6, 2003 May 6,2003 May 7,2003 Dear Zev, Emmanuel, Bob, " integration is the proposal that better health care can be delivered to more people if these practices are in some way mutually availailable... " Bob . In my last postings I have clarified the meaning of 'integration' or jie he in the context of the historical situation in China after l950's. It actually refers to how the Communist Party in China 'fused' the two systems of medicine , supposedly. And now, in the wake of the SARS epidemic, the cracks in this 'integrated edifice' seems to be showing with TCM practitioners in the mainland starting it's critic of the system and arguing for an independent and separate identity instead of a frankensteinian one. The evolution of the policy of integrating CM with WM was not impelled by a desire for a rationale dispensation of health care services to the whole population . The policy is in response to the continuing history of unresolved conflicts (political, cultural, scientific, economic etc.) between the two systems of medicine which ensued when Western scientific medicine came to China during the 19th century. Regards, Rey Tiquia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2003 Report Share Posted May 7, 2003 The evolution of the policy of integrating CM with WM was not impelled by a desire for a rationale dispensation of health care services to the whole population . The policy is in response to the continuing history of unresolved conflicts (political, cultural, scientific, economic etc.) between the two systems of medicine which ensued when Western scientific medicine came to China during the 19th century. Regards,Rey Tiquia Rey, I agree that most or nearly all decisions made by government bureaucracies are political and not scientific. The bureaucracies themselves like the USDA and FDA are creations of the political arms of economic interests. I have little interest in TCM as an example of the integrated practice of CM and WM. I can see it for the political compromise that it is. It not hard to see and realize that real integration is when CM stands for itself with all of its own authority. It will clash and harmonize with WM on its own merits. I am intrigued only to see how it has clashed in China in order to wonder how it will clash here. From what I have been gathering not only from you and Ken but also from classically trained CM practitioner friends, it seems that CM itself may be in short supply in both China and in the U.S. There are, however, even more rare disciplines here in the West that I can think of. It would not stop me from training in those fields if I chose to. Or accessing them if I chose to. I have access to enough CM and WM where I live to feel satisfied that I have the best of both worlds. My closest friends are excellent MDs and excellent Chinese practitioners. In this manner I'm lucky. I've integrated CM and WM for myself. Many of you on list share my good fortune. Do I hope that others may also benefit in a similar manner? Yes. Though I'm not so sure that it must be (or even could be) mandated in the form of public institutions. Hard to keep up with so many excellent posts. In Gratitude, Emmanuel Segmen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2003 Report Share Posted May 7, 2003 That is why I enjoy Dr. Wang's article so much. It is not afraid to show what CM has to offer, and challenges WM to look at other tools in handling the treatment of epidemic qi. no me-too-ism or 'SARS formulas " . On Wednesday, May 7, 2003, at 02:33 AM, Emmanuel Segmen wrote: > I have little interest in TCM as an example of the integrated > practice of CM and WM. I can see it for the political compromise that > it is. It not hard to see and realize that real integration is when > CM stands for itself with all of its own authority. It will clash and > harmonize with WM on its own merits. I am intrigued only to see how > it has clashed in China in order to wonder how it will clash here. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2003 Report Share Posted May 7, 2003 I am interested in more details on the evolution of integrative policy in China, as it seems to be largely accepted in the West as a possible course of development of the profession in the future. As I quoted from Harris Coulter in one of my recent posts, the question is 'who will be doing the fusing and who will be fused'. On Tuesday, May 6, 2003, at 05:16 PM, rey tiquia wrote: > May 6,2003 > May 7,2003 > Dear Zev, Emmanuel, Bob, > > " integration is the proposal that better health care can be delivered > to more people if these practices are in some way mutually > availailable... " Bob . > > In my last postings I have clarified the meaning of 'integration' > or jie he in the context of the historical situation in China > after l950's. It actually refers to how the Communist Party in China > 'fused' the two systems of medicine , supposedly. And now, in the wake > of the SARS epidemic, the cracks in this 'integrated edifice' seems to > be showing with TCM practitioners in the mainland starting it's critic > of the system and arguing for an independent and separate > identity instead of a frankensteinian one. > > The evolution of the policy of integrating CM with WM was not > impelled by a desire for a rationale dispensation of health care > services to the whole population . The policy is in response to the > continuing history of unresolved conflicts (political, cultural, > scientific, economic etc.) between the two systems of medicine which > ensued when Western scientific medicine came to China during the 19th > century. > > Regards, > > Rey Tiquia <image.tiff> > > > 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 May 7, 2003 Report Share Posted May 7, 2003 , " " wrote: > As I quoted from Harris Coulter in one of my recent posts, the question is 'who will be doing the fusing and who will be fused'.>>> Z'ev: Being a cynic, I would think " follow the money. " Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2003 Report Share Posted May 7, 2003 Jim, > > Being a cynic, I would think " follow the money. " > > > Jim Ramholz Just curious, but why equate cynicism and money? Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2003 Report Share Posted May 7, 2003 , " dragon90405 " wrote: > Just curious, but why equate cynicism and money? >>> Ken: While they don't have to be equated, it is 'a philosophy of my own, all made up of private notations and cynicisms,' to paraphrase Henry James. My fear is that politics and money will shape the integration of CM and WM here in this country more than ideology. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2003 Report Share Posted May 7, 2003 Jim, > Ken: > > While they don't have to be equated, it is 'a philosophy of my own, > all made up of private notations and cynicisms,' to paraphrase Henry > James. My fear is that politics and money will shape the integration > of CM and WM here in this country more than ideology. > > > Jim Ramholz If you're devoted to clinical results, then money is probably a more accurate measure of effecicacy than ideology. Every interaction in the marketplace is a vote of confidence. If we paid closer attention to the flow of money, I think we'd have a much clearer understanding of the actual efficacy of the ideas and practices we talk about here. And I don't think there's anything the least bit cynical about that. It may be painful, but cynicism is a response to pain and not the pain itself. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 , " dragon90405 " wrote: > If you're devoted to clinical results, then money > is probably a more accurate measure of > effecicacy than ideology. Every interaction > in the marketplace is a vote of confidence. >>> Ken: While I was thinking more of lobbying and political influence, I can understand and agree with your point. As I wrote earlier, I think this 'marketplace vote of confidence' is the greatest strength of CM in the US and the reason why it has become fairly mainstream. When I started studying CM 30 years ago in the 70s, I never anticipated this kind of mainstreaming. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 Jim, I never anticipated > this kind of mainstreaming. > > > Jim Ramholz Scary, ain't it? Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 Ken, I very much agree. Money is just another form of qi. (Please, please, please don't ask me to define that term.) It is simply a way of quantifying how much something is worth to another person. I was at the National Alliance convention this last weekend where the Visioning Commission had a " Town Meeting " to hear in-put from the rank and file. It's interesting that so many people think things happen in the world because of logic and rationality on the one hand and righteousness and altruism on the other. In my experience, the bottom line question is, " What's in it for me? " I believe that monetary value and the flow of commerce is a main way of answering that question. I believe commerce shapes history as much (if not more) than any other factor. If an idea, product, or practice cannot/does not sell, then it does not matter how seemingly good or beneficial that idea, practice, or practice is. What matters is whether others perceive that idea, practice, or product has value to them. From your many years in marketing, you well know that one of the keys to sucessful marketing is to emphasize benefits, not features. For those who may not recognize these terms vis a vis marketing/advertising, saying our medicine is 2,000 years old, holistic, natural, Daoist, good, great, or wonderful are all features that may matter to us, but not to the end consumer. Saying that our medicine is free from side effects, relatively cost effective, is clinically effective, doesn't hurt, or that our clinic is centrally located and has convenient parking are benefits. Benefits are what most people are interested in. Again, WIIFM, what's in it for me? To me, that's not cynicism. It's pragmatism. Bob If you're devoted to clinical results, then money > is probably a more accurate measure of > effecicacy than ideology. Every interaction > in the marketplace is a vote of confidence. > > If we paid closer attention to the flow > of money, I think we'd have a much clearer > understanding of the actual efficacy of > the ideas and practices we talk about here. > > And I don't think there's anything the least > bit cynical about that. It may be painful, > but cynicism is a response to pain and not > the pain itself. > > Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 ob, , " Bob Flaws " <pemachophel2001> wrote: > Ken, > > I very much agree. Money is just another form of qi. (Please, please, > please don't ask me to define that term.) It is simply a way of > quantifying how much something is worth to another person. > It's also a way of symbolizing one's confidence in the future, i.e., in one's ability to deal with the future. People put their trust into their money, which is in fact all that gives it and maintains its value. Money is a kind of prophecy. It's a statement that such and such a present effort can be stored up for use in the future by means of exchanging and converting today's activity into this highly abstract symbol of power that we call money. Such prophecy always includes the supposition of the maintenance of the status quo. As such it is very much a form of qi (Gee, can you define that term? Just kidding.). The qi of the society. Money is probably one of the last surviving mystic truths in the United States of America. And it's hard to find a single soul who doesn't believe in it more or less absolutely. But that condition is transient, as are all conditions. You referred to my past life in marketing, and I did indeed used to do PR for a bunch of folks who dealt in ideas about money. And one of the things I learned in those days was that all money comes to an end, and generally by more or less the same route. It's a little too complicated to go into here, but the end point of this route to the death of currency is the point at which the people who've been using it to store up value (qi) for the future lose their confidence in it. And when the symbol loses its meaning, well, its use becomes futile. On the back of US dollars issued before 1932 there was a sentence that read: This note represents that there has been placed on deposit in the Treasury of the United States one dollar in gold coin payable to the bearer on demand. In the same space on current one dollar notes we now find a different sentence: In God we trust. Now that's what I call a mystic truth! This SARS thing is fascinating when viewed from the angle of money, since as much or more than the cost of human lives the epidemic is now being calculated in dollar denominated terms. The SARS virus, whatever that is, seems to replicate in the currency and exhaust it. A socio-political-economic virus that is evidently transmitted through the media. Dr. Fan in his article touches on and in his conversations with me emphasized the importance of taking such societal conditions into consideration when diagnosing SARS... or any disease. It dawns on me that the true practice of traditional Chinese medicine always includes harmonizing its paradigms with those of the place and time in which it is to be studied and practiced. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 , " Bob Flaws " wrote: I believe that monetary value and the flow of commerce is a main way of answering that question. I believe commerce shapes history as much (if not more) than any other factor. If an idea, product, or practice cannot/does not sell, then it does not matter how seemingly good or beneficial that idea, practice, or practice is. What matters is whether others perceive that idea, practice, or product has value to them. >>> Bob: My initial comment about cynicism and money was aimed at the larger political agenda. Like you, I have no aversion to making a good living. But to enlarge on your comment, I don't think real integration of WM and CM can happen until acupuncturists and herbalists are getting paid out of the same sources, and roughly equivalently, by insurance providers, Medicare, etc. If students coming out of school do not have hospital priviledges and cannot make near what MDs and Chiros make, then the future of the profession will, in your qi and money metaphor, suffer from vacuity. They won't be able to pay off their student loans, and schools will have a difficult time expanding the program to include things like learning Chinese because of the poor ROI. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 Jim, I don't think real integration of WM > and CM can happen until acupuncturists and herbalists are getting > paid out of the same sources, and roughly equivalently, by insurance > providers, Medicare, etc. This may indeed be the point at which " real " integration occurs. But let's at least pause long enough in the headlong rush to mainstream integration to bear witness to what is lost... as well as what is gained...through such... harmonization...I use the word advisedly. Accepting money from third party payers entails accepting other aspects of the qi of these parties. It's a multi-edged sword...and it spins quickly and cuts very thoroughly. How do you think the heart of Western medicine was removed? Through just such an operation conducted by third party interests...business people not medical people...or worse...government employees who view in the economic activity generated surrounding disease the enormous potential for profit margins, even when it means marginalizing the medicine itself. Do you really want to construct an entire profession of Chinese medicine that is denominated in the coded language of insurance forms? Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 difficult it is one word no meaning or? analysis between word and meaning... yet money makes US forget the real thing heal no between Qi is not money money may be Qi lets not forget... Marco Bergh Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 , " dragon90405 " wrote: > This may indeed be the point at which " real " > integration occurs. But let's at least pause > long enough in the headlong rush to mainstream > integration to bear witness to what is lost... > as well as what is gained...through such... > harmonization...I use the word advisedly. > > Accepting money from third party payers > entails accepting other aspects of the > qi of these parties. It's a multi-edged > sword...and it spins quickly and cuts > very thoroughly. How do you think the > heart of Western medicine was removed? > > Through just such an operation conducted > by third party interests...business people > not medical people...or worse...government > employees who view in the economic > activity generated surrounding disease the > enormous potential for profit margins, even > when it means marginalizing the medicine itself. > > Do you really want to construct an entire > profession of Chinese medicine that is denominated > in the coded language of insurance forms? >>> Ken: You present a rather negative and fatalistic picture. Who and what, then, is involved in the integration process---if not money and hospital priviledges? Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2003 Report Share Posted May 8, 2003 I don't see it as a fatalistic picture. I see it as realistic. Many of my M.D. colleagues constantly complain about their loss of decision-making in medical treatment at the hands of insurance companies and HMO's. A few of the more enlightened ones have moved towards cash practice. I think for true independence, the higher the cash percentage, the more freedom to practice. There is an interview in the NY Times on Tuesday 5/6 with a neurobiologist/physician (Dr. Floyd Bloom) who complains about the loss of autonomy of physicians as being the major crisis in the profession. His wife, also a physician, complains that " she spends most of the time alloted for contact with patients trying to get their insurance providers to allow the treatments she knows are most needed and completing endless paperwork to keep benefits coming " . There is also a great interview with Stephen Brown in the March 2003 issue of North American Journal of Oriental Medicine, largely devoted to Japanese acupuncture. The article ( " Why I Don't Work With Insurance " ) makes one of the most inspiring cases for a cash practice. As he says, " working with insurance companies forces a practitioner to compromise the doctor-patient relationship unique to Oriental medicine. " I am aware that the relationship with HMO " s and insurance companies is a very personal decision. I understand the pressures to make a good living in one's chosen profession. But I think Ken Rose and Stephen Brown are right. If we play for the same insurance dollar, we need to ask if our profession is going to be transformed into something we will regret in the long run. If indeed this does happen, I hope some of us 'old fossils' will survive somehow, perhaps in Joni Mitchell's 'Tree Museum' ( " they paved paradise, put in a parking lot " - Big Yellow Taxi). On Thursday, May 8, 2003, at 08:51 PM, James Ramholz wrote: > Ken: > > You present a rather negative and fatalistic picture. Who and what, > then, is involved in the integration process---if not money and > hospital priviledges? > > > Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2003 Report Share Posted May 9, 2003 Z'ev, If indeed this does happen, I hope some of us > 'old fossils' will survive somehow, perhaps in Joni Mitchell's 'Tree > Museum' ( " they paved paradise, put in a parking lot " - Big Yellow Taxi). Don't it always seem to go but you don't know what you got til it's gone. By the way, in my last post, I wasn't really trying to lobby for one position or the other. I was raising the question of whether or not we, as individuals and as a profession, want to further institutionalize the same mechanisms which have so thoroughly ravaged the practice of contemporary medicine. It seems to me that this " alternative " is one of the things that patients...at least some patients seek when the choose traditional Chinese over conventional medicine. And please everyone note at least in passing that the crux of the issue is... ....definitions of terms. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2003 Report Share Posted May 9, 2003 , " " wrote: > I am aware that the relationship with HMO's and insurance companies is a very personal decision. I understand the pressures to make a good living in one's chosen profession. But I think Ken Rose and Stephen Brown are right. If we play for the same insurance dollar, we need to ask if our profession is going to be transformed into something we will regret in the long run. >>> Z'ev: I choose not to take insurance simply for the practical reasons of the time and fuss---but I would still like the option to be available. Without option for the choice or, worse, to preclude it altogether simply makes no sense to me. Who knows? Maybe the inclusion of our profession into the process will help change things for the better. You can't know until it happens. To expect " regret in the long run " is fatalistic. So, again, who and what are being integrated? Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2003 Report Share Posted May 9, 2003 , " dragon90405 " wrote: > It seems to me that this " alternative " is > one of the things that patients...at least > some patients seek when the choose traditional > Chinese over conventional medicine. >>> Ken: Wouldn't more patients seek it even more often if payment was covered and it was also available by highly trained professionals in hospitals? Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2003 Report Share Posted May 9, 2003 Ken, This is the best argument yet against integration that I've heard. It's actually why I pay out of pocket for both WM and CM. I have Blue Cross major medical for $160 every other month. All other personal medical or health needs are met out of pocket. This way I spend my dollars on exactly who and what I want. I would never have learned about various genetic markers unless I personally paid for lab work myself. In this manner I can look for them in my sons. Also I get to spend my health care dollars on my favorite CM practitioners. Nam Singh and I go see one of Andy Gaeddert's teachers who is now in his late 80s. We save (practically enshrine) his wonderfully insightful written prescriptions. Actually the WM doctors who I like to see (and bring my family to) much prefer my out of pocket payments and are glad to cut the price of office visits and lab work on the rare occasions when I visit them with family members. Staying out of the encrypted software mainstream sounds like a great idea to me. Emmanuel Segmen Ken Rose wrote:This may indeed be the point at which "real"integration occurs. But let's at least pauselong enough in the headlong rush to mainstreamintegration to bear witness to what is lost...as well as what is gained...through such...harmonization...I use the word advisedly.Accepting money from third party payersentails accepting other aspects of theqi of these parties. It's a multi-edgedsword...and it spins quickly and cutsvery thoroughly. How do you think theheart of Western medicine was removed?Through just such an operation conductedby third party interests...business peoplenot medical people...or worse...governmentemployees who view in the economicactivity generated surrounding disease theenormous potential for profit margins, evenwhen it means marginalizing the medicine itself.Do you really want to construct an entireprofession of Chinese medicine that is denominatedin the coded language of insurance forms? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2003 Report Share Posted May 9, 2003 Jim, > > > Ken: > > Wouldn't more patients seek it even more often if payment was > covered and it was also available by highly trained professionals in > hospitals? > > > Jim Ramholz Well, I can't see the future any more clearly than you. And I'm not really trying to make predictions. I was just raising the question. Z'ev said he thought I was right, but all I did was ask the question. Is that what we want? You say you choose not to use insurance but wish you had the option. If you don't have the option you're not making a choice. I bring this up because sometimes all it takes to get us to want something is to tell us we can't have it. In Laozi it says you can keep your heart from becoming confused by not looking at the desirable...or something like that. Do your current patients seek you out because of the convenience of your payment plans? The costs do not vanish when a third party steps in and assumes them in exchange for issuing payments. In fact, the third party's presence increases the cost to all concerned. Do the math. Within the complexities of the contemporary regulatory environment that governs the insurance industry there is so much incredible excess...naw, let's call it what it is...waste that one wonders whether or not the whole system hasn't gone septic. Perhaps the emergence of new diseases is symptomatic of a deeper condition and this third party payer scheme may be closer to the root than we have previously imagined. Maybe if you interrupt the direct exchange of valuables between doctor and patient you diminish the efficacy of the medicine. Of course people will stomp and scream for the double blinded trials to prove it, as they must. But perhaps humans really are too complicated to adequately sum up in such relatively simplistic models. I'm just thinking out loud but did, as I said earlier, want to slow down just a minute or two and think about what is involved in buying in to such schemes. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2003 Report Share Posted May 9, 2003 Excellent point. Keep the "clear vision". Emmanuel Segmen - Marco difficult it is one word no meaning or? analysis between word and meaning... yet money makes US forget the real thing heal no between Qi is not money money may be Qi lets not forget... Marco BerghChinese 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 May 9, 2003 Report Share Posted May 9, 2003 Jim, You've raised an interesting point with regard to "hospital privileges". One thing is that they don't really exist any more ... not since 1998. MDs have been paying for the "privilege" to see their patients in the HMOs. After reading one of your recent posts, I envisioned the re-invention of hospitals. You know, except for county hospitals, hospitals in many ways have ceased to exist. I had this crazy vision of practitioners opening a clinic with treatment rooms and then recovery rooms. In some cases they would be the same room. My point is that one could have a patient remain in a treatment or recovery room for an extended period of time the way an old country doctor would do ... or my great grandmother herbalist would do. This would be a "hospital" in a sense. Crazy what your imagination does when you wish for what's been lost. Emmanuel Segmen - James Ramholz Thursday, May 08, 2003 11:55 PM Re: harmonizing the paradigms , "" wrote:> I am aware that the relationship with HMO's and insurance companies is a very personal decision. I understand the pressures to make a good living in one's chosen profession. But I think Ken Rose and Stephen Brown are right. If we play for the same insurance dollar, we need to ask if our profession is going to be transformed into something we will regret in the long run. >>>Z'ev:I choose not to take insurance simply for the practical reasons of the time and fuss---but I would still like the option to be available. Without option for the choice or, worse, to preclude it altogether simply makes no sense to me.Who knows? Maybe the inclusion of our profession into the process will help change things for the better. You can't know until it happens. To expect "regret in the long run" is fatalistic.So, again, who and what are being integrated?Jim RamholzChinese 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 May 9, 2003 Report Share Posted May 9, 2003 There is a saying: Money makes the world round yet complexities... Rich and Poor US and Guatemala Books and no books Knowledge but knowing? yes, complex it is like word and meaning Classical or Frankenstein yet health irrelevant of money Chinese medicine and doing Marco Bergh Quote Link to comment Share on other sites More sharing options...
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