source of income

[Guest guest]

, " " <@i...>

wrote:

> , " "

> > <zrosenbe@s...> wrote:

> >

> > The

> > > closer I hew to more classical acupuncture theory and technique,

the

> > > better my results. Several of my colleagues report the same

thing.

>

> Which is really not that meaningful in that many of my colleagues

have

> reported the opposite. Most of my career has been spent in settings

where I

> can actually observe and assess the results of a wide variety of

techniques -

> school clinics. You cannot have this experience in private

practice. In addition,

> I could really care less what style of acupuncture works best. So I

feel

> somewhat objective and detached in saying that while any given

practitioner

> may do better at one style or another, there is no difference in

overall

> longterm results when looking at entire groups. In other words, the

japanese

> acupuncturists may think they do a better job, but if you follow

their charts,

> their success rates are no better or worse than the TCM crowd or the

> orthopedists or even the NAET folks.

>

> Just because one gets better results with a certain style or

methodology says

> nothing about the style and everything about the practitioner. The

fact that

> different practitioners all claim their style is the best and has

adherents and

> patients to prove it tells me something. that all styles work. I

think people

> get better results with styles they resonate with because they

resonate with

> these styles. This is indeed the placebo effect in action. If you

like and

> believe what you do, you will do it focused and with all your heart.

And thus

> pulse balancers show equal intent and success as motor point

needlers do.

> Until a controlled study is done, all claims to this effect are

opinion and

> anecdote, including mine. However, I will add that the vast

majority of

> modern research showing the effectiveness of acupuncture is

allopathic,

> reductionist and physiological. So despite the lack of controlled

studies, I think

> the existing evidence lends much more weight to my position than the

other. I

> will yield to the evidence if it contradicts my belief, but I will

not just follow

> tradition.

>

 

 

Amen to that, bro.

 

Bob

[Guest guest]

, " "

<zrosenbe@s...> wrote:

> Bob Flaws in his previous post says I am known to have a 'classical

> bias'. I agree and make no apologies about it.

 

Nor was I busitng your chops for this. I was merely pointing this out

so that we all could determine what might be affecting what in which

way.

 

At the same time,

this

> does not mean I am not open to other perspectives, just because some

of

> them do not interest me. I practice what I think I do best in the

> vast landscape of medicine. If I have an 'agenda', it is to help

> insure that a classical perspective (seen through a modern

Westerner's

> eyes) survives.

 

Great! And good for you. That's your choice and I'm glad you're free

to make that choice.

 

> I also have some experience in large clinics where I can observe a

wide

> variety of approaches in medicine, some which work, some which

don't.

 

But the issue is, do styles of acupuncture work because of

something inherent in the style itself or because of other factors

that are not intrinsic to the style, such as personal confidence,

bedside manner, etc.

 

> I haven't just been sitting in my private clinic the entire time

these

> last twenty-plus years. And while I think Japanese approaches by

and

> large are 'superior', in terms of focus, subtlety, and delivery,

I've

> seen cases where a more aggressive style works better. I think

medical

> practice has to be a combination of focus and flexibility. After

all,

> the Nei Jing used quite a bit of blood letting, minor surgery

(draining

> pus) and aggressive methods such as fire needling.

 

Blood-letting, cautery, cupping, and guasha should not all be lumped

into acupuncture or thought of as different styles of acupuncture.

Each of these adjunctive therapies has different effects on the human

organism and should be thought of separately from the effects of the

hao zhen or fine needle. Otherwise, we are comparing apples to

oranges. I suggest we only compare hao zhen to hao zhen tx.

 

Bob

[Guest guest]

> I am a little uncomfortable with your continued use of the term

> 'anecdote'. Since anecdotal information is considered to be

> 'second-hand', it would throw away much of the accumulated

experience

> recorded in the Chinese medical literature, making for an unfair

bias

> in drawing one's conclusions. Add to that the biases implicit in

most

> modern studies of acupuncture (and many other clinical phenomena as

> well), and I really don't see where most modern studies of

acupuncture

> are truly authoritative or replace the experience of previous

> generations. There are too many questions about study design,

> especially when 'double-blind' or sham acupuncture points are used.

 

> Rather, these studies should be seen, in my opinion, as

complimentary

> to the traditional literature.

>

> I am also not sure what your belief is, in terms of following

> 'tradition' or using more modern methods. Especially when you make

a

> case for NAET results here, after expressing your problems with it

in

> previous postings.

>

> There may be several other approaches to treatment with the

modality

> of acupuncture, but at a certain point, they are no longer in the

realm

> of Chinese or Eastern medicine. This is where we must make some

kind

> of distinction.

>

> Finally, I don't see where studies are necessarily less biased than

> so-called anecdotal case histories. The recent debacle of the years

of

> the conclusions drawn from clinical trials on hormone replacement

> therapy should be enough to dispel that myth. What myth? That it is

> possible to eliminate human bias and perspectives from these

studies.

> The observer never disappears, or fails to influence clinical

results

> in any format.

>

>

 

Z'ev,

 

In medicine, there are different kinds of proof, and its important not

to use the wrong kind of proof to justify a position. The only way we

can ever determine if style or theory affects outcomes in any way

objectively, is through an RCT. You've got to factor out placebo to

answer this question. No amount of traditional case studies can ever

do this. Case studies can tell you something works, but not why it

works. Here we are discussing the why of acupuncture, not the if. So I

believe that Todd is correct in stating that only through RCT could we

ever come close to answering this question.

 

Bob

[Guest guest]

Ken et al.

 

> One of the truly fascinating things about

> science is that it is the tendency of science

> to disprove virtually everything.

>

> If you can hold your breath long enough,

> you'll discover that everything you know

> is wrong.

 

Madyamika Buddhism 101: Everything is no-thing-ness, even the concept

of no-thing-ness.

 

I'm reading Unschuld's new book now. Can't digest more than a few

pages at a time. Mind-blowing in the above sense.

 

Bob

[Guest guest]

And

contrary to

> Mr. Flaws, I consider the Visioning Search Task Force an Essential

> communication mode for peaceful alternatives to active undermining

of either schools or

> the profession.

 

My point was that, no matter how much we within the profession discuss

and map out where we would like to go, where we wind up will largely

be determined by economic forces (both within our profession and

within the larger matrix as a whole) which are largely beyond our

control.

 

Bob

[Guest guest]

Will,

I said I was able to support the professional (both practitioner and

educational) organizations on issues that I think deserve and need my

support. I also said that these same organizations have made many

mistakes in the past. That is all I am going to say on the matter,

because I don't want to be labeled or 'demonized' by association or by

mentioning specific incidents. Let's just say I've seen others accused

of things, including schools, of doing things that never happened by

specific groups, and I've seen positions taken on both sides of the

fence (practitioners vs. colleges) that were mutually destructive.

 

Otherwise I support your efforts, including visioning task forces and

the like. As you say, aim for the higher ground.

 

 

 

On Thursday, July 24, 2003, at 12:15 AM, WMorris116 wrote:

 

> In a message dated 7/23/2003 10:24:58 AM Pacific Daylight Time,

> zrosenbe writes:

>

>

>

> Cirriculum development

>

> Licensure issues

>

> Scope of practice

>

> the Doctorate

>

>

>

> Z'ev - I too am a practitioner involved in academia. I don't quite

> understand your mistrust of professional organizations on these

> matters. And contrary to Mr. Flaws, I consider the Visioning Search

> Task Force an Essential communication mode for peaceful alternatives

> to active undermining of either schools or the profession. I believe

> we must hold for the high ground and the potential of our profession

> in this culture. Nonetheless, the Little Hoover Commission will weigh

> in on scope, education and entry level criteria from a detached

> perspective. They will make calls in that process that will define

> this field for the whole country.

>

> Will

<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.

>

>

>

>

[Guest guest]

I did a weekend seminar with him back in 1987. He was very

charismatic, but also had excellent technique. Dr. Manaka and his

assistant, Dr. Itaya, designed some interesting studies they presented

at that time.

 

 

On Thursday, July 24, 2003, at 09:51 AM, Bob Flaws wrote:

 

> Frankly, I feel much the same way about Manaka. I believe his success

> was mostly based on his personality and charisma as well as on his

> personal enthusiasm.

>

> Bob

[Guest guest]

He was very

> charismatic, but also had excellent technique.

 

Z'ev,

 

Excellent is a value judgement. It has nothing to do with the present

discussion.

 

Bob

[Guest guest]

, " Bob Flaws "

<pemachophel2001> wrote:

>

> Frankly, I feel much the same way about Manaka. I believe his

success

> was mostly based on his personality and charisma as well as on his

> personal enthusiasm.

>

> Bob

 

Ogawa Takayoshi said in his 1996 seminar in Seattle that the opinion of

many in Japan was that ~50% of Manaka's clinical success was due to

what he called " Manaka magic " , ie what Bob just said. This didn't sit

too well with the students at the seminar, BTW.

 

robert hayden

[Guest guest]

Dear Ken,

 

Seems to me that we've both responded to this thread with identical ideas ... differing only with respect to our different training. For this reason it would be an act of utter hubris and egotism if I were to compliment you on your post. I will merely reflect upon the fact that I enjoyed it and learned from it. ;-)

 

Emmanuel Segmen

 

Alon, Z'ev, Bob Flaws, and others,Evidence is not very easy to come by. I think this remark more or less sums upa critical point that should be stronglyemphasized in this discussion. One of thegreat lessons I've learned from Paul Unschuld'swork is that we (meaning us human beings)do what we do with respect to medical carebased largely on, for lack a better term,the status quo. We do what we do becausethat's what we do.It's an expression of who we perceive ourselvesto be.I remember some time back that Bob Felt posedthe question here as to who do we think weare. And I suggest that we need to revisitsuch questions from time to time.Bob Flaws called it perceived need.But an even more basic way of statingthe proposition is simply: Perception.One of the truly fascinating things aboutscience is that it is the tendency of scienceto disprove virtually everything. Thinkback to what people believed on the basisof science as little as 100 years ago oreven 50 years ago. No doubt science ofthe future will continue to manifest thisevidently inevitable tendency.If you can hold your breath long enough,you'll discover that everything you knowis wrong.And one of the truly fascinating thingsabout Chinese medicine is that it haslasted so long in what is an albeitchaotic state, which nonetheless includescertain critical elements of theoryand practice that continue to demonstratetheir applicability in successive agesand in far flung parts of the world.So are we talking about the source ofincome? Or are we talking about thesource of ideas?Why are the schools set up the way they are?Why do the early texts omit comprehensivepresentations and discussions of the nomenclature?How have the vested interested become vested?And who are we?KenChinese 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]

I will yield to the evidence if it contradicts my belief, but I will not just follow tradition.Bob Flaws wrote: Amen to that, bro.

 

Dear Todd and Bob,

 

While your post from which this was extracted is a clear and taut argument, your main point of disagreement with Z'ev was in your final sentence above. I refer you to a thread I started today on Paradigms of Evidence wherein I not only agree with Alon Marcus, I say that his comments "nailed a larger reality." You must use the context of a paradigm to prove that paradigm. You can not use one paradigm to prove another one. I refer you to Thomas Kuhn's The Structure of Scientific Revolutions.

 

In a post of some months ago I suggested that if people on this list interested in Western science should only read the first 2 or 3 chapters of this thin paperback. This is the classic in philosophy of science and absolutely required reading at Harvard, MIT and the University of Chicago in this area of thought. It's available at this moment at Amazon.com for $9.60. It would be an embarrassment on the parts of some people on this list not to personally own this very basic piece of information. Oh ... and it's in English. ;-)

 

So, if you want to "yield to evidence", I'm afraid you will have to look for it precisely in the "tradition" of the paradigm in which you are working. If it comes from anywhere else it will be tautologically, epistemologically and scientifically not "evidence".

 

Emmanuel Segmen

[Guest guest]

It seems we can all agree with Ken on this. I would post one further comment aside from my view that WM and CM will not prove anything about each other for at least another century. As they interface with each other in this 21st Century, I believe they will each push each other through new thresholds as they consider one another.

 

Emmanuel Segmen

 

-

Bob Flaws

Thursday, July 24, 2003 10:19 AM

Re: source of income

Ken et al.> One of the truly fascinating things about> science is that it is the tendency of science> to disprove virtually everything. > > If you can hold your breath long enough,> you'll discover that everything you know> is wrong.Madyamika Buddhism 101: Everything is no-thing-ness, even the concept of no-thing-ness.I'm reading Unschuld's new book now. Can't digest more than a few pages at a time. Mind-blowing in the above sense.BobChinese 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]

of Manaka's clinical success was due to what he called "Manaka magic", ie what Bob just said. This didn't sit too well with the students at the seminar

>>>The bigger problem is how do you know what the other 50% is?

Alon

[Guest guest]

Emmanuel,

 

> It seems we can all agree with Ken on this. ...

 

Gosh, there's a scary thought.

 

Reminds me of that gem from Grouch Marx:

 

I refuse to join any group that would

have me as a member.

 

I was thinking about Todd's original

post on this, and it struck me that

what he was trying to elicit was a

discussion about the ways in which

vested interests shape our thinking.

 

And I realized that my original response

was evasive. I do indeed have vested

interests to do definitely shape my

thinking and my actions. I'm not

sure I can actually describe them

accurately. But I'll give it a go,

as I think Todd's intent was an

important one.

 

I think people should know where

we're coming from as well as where

we fancy ourselves heading.

 

My sense of obligation emerged more

or less in full bloom one afternoon in

1971 or 72 at Cal Arts in a push hands practice

with Martin Inn. He was talking about

a line from the taiji classics that

says, to enter the door and be shown

the way you must be orally taught.

 

He explained that the notion of " orally

taught " here includes being tactilely

taught. He pointed out that in taiji,

the gift that the teacher gives the

student comes in many forms and that

of paramount importance is the sensory

impression or, in other words, the

correct touch.

 

He didn't say much more than that,

and then we spent an hour or more

just doing push hands.

 

Later I was mulling over the day's

lesson, and it dawned on me that

one of the implications of what

Martin had been saying and doing

was that a lineage in taiji consists

of generations of teachers and students

who had all been in touch with each

other. This is the part that I'm not

sure I can adequately describe, because

it was a sensation more than anything

else. I simply felt the presence of

all this touching and it has served as

a more or less ever-present awareness

ever since of the debt I owe to the

transmission of certain ideas and

practices. And this obligation extends

both backwards and forwards in time,

as it also radiates in all directions.

 

Although it is not an economic obligation

(unless you understand " economy " in its

etymological sense as " keeping one's house

in order " ) this awareness does indeed

bind me to a certain perspective and

a point of view from which I tend to

see, understand, and operate in the

area of traditional Chinese thought,

which very much includes traditional

Chinese medicine.

 

I, too, would never blindly follow

tradition. But the fact of the matter

is that on this day thirty years ago

an important aspect of tradition was

illuminated for me and brought to life.

 

And I am definitely aware that I think

and act accordingly.

 

Maybe this was already apparent and

people can now feel more comfortable

branding me as a traditionalist or

whatever.

 

But I just wanted to expand upon my

earlier response to Todd's question.

 

I have gotten and continue to get a

vast amount of " income " from the traditions

that we are talking about, and I am

very dedicated to protecting this

investment.

 

Ken

[Guest guest]

, " Emmanuel Segmen "

<susegmen@i...> wrote:

> I will yield to the evidence if it contradicts my

belief, but I will not just follow tradition.

>

>

> Bob Flaws wrote: Amen to that, bro.

>

> Dear Todd and Bob,

>

> While your post from which this was extracted is a clear and taut

argument, your main point of disagreement with Z'ev was in your final

sentence above. I refer you to a thread I started today on Paradigms

of Evidence wherein I not only agree with Alon Marcus, I say that his

comments " nailed a larger reality. " You must use the context of a

paradigm to prove that paradigm. You can not use one paradigm to

prove another one. I refer you to Thomas Kuhn's The Structure of

Scientific Revolutions.

>

> In a post of some months ago I suggested that if people on this

list interested in Western science should only read the first 2 or 3

chapters of this thin paperback. This is the classic in philosophy

of science and absolutely required reading at Harvard, MIT and the

University of Chicago in this area of thought. It's available at

this moment at Amazon.com for $9.60. It would be an embarrassment on

the parts of some people on this list not to personally own this very

basic piece of information. Oh ... and it's in English. ;-)

>

> So, if you want to " yield to evidence " , I'm afraid you will

have to look for it precisely in the " tradition " of the paradigm in

which you are working. If it comes from anywhere else it will be

tautologically, epistemologically and scientifically

not " evidence " .

 

 

E & others,

 

I can't say I have an answer to this quagmire, but there are some

facts to reconcile with. a) CM is constantly evolving; it is not

stuck in some classical philosophical vacuum. b) CM is China, right

now, has integrated western style research, western style thinking,

western biological markers. Therefore the Chinese (as well as

Japanese Taiwanese etc.) seem to all agree with Todd's statement.

They do not just follow tradition; they are constantly testing and

improving on the past. And this improvement seems to have

incorporated western thinking. So the tradition IMO has changed...

Furthermore, stemming from this modern approach are the tools

needed to treat `real' modern diseases. We whine that we are not

more than second rate practitioners (not getting the respect that we

need), but I believe to be primary care physicians we must not only

read Chinese (or have access to the journals/ research), but embrace

the research and mentality that is going on in china. It comes down

to one thing, proof. Do we have the proof for the insurance

companies and American public to successfully `treat' these more

difficult diseases? I just don't buy that some classical acupuncture

and pattern differentiations are enough. And someone's charisma

might make him a champ, but will his system work for others… How do

we test that? TCM (from china) has discovered an immense amount of

information for the treatment for modern diseases.

IMO, I do not understand why the schools haven't incorporated

research into their curriculums. This seems essential, especially if

people want to do non-western style studies… which BTW, I would like

to seem a design for… otherwise, without these type of studies, what

can be said…

 

-Jason

[Guest guest]

Jason,

The introduction of WM into China and Japan was quite dramatic and

sudden, in the late 19th and early 20th century, if my historical

studies serve me well. Hardly evolutionary, but revolutionary.

Chinese medicine almost disappeared from the map in both countries. CM

was forced to adapt to a 'new reality', and this new reality continues

to inform the modern practice, for better or for worse. Something

lost, something gained. This doesn't mean, however, that we have to

let the more 'traditional' medicine disappear or be melded into WM

practice. I don't think it does justice to the 'treasure house of

Chinese medicine'.

 

Integrated Western-Chinese medicine, in my opinion, makes sense in

integrated environments, such as hospitals and group practices.

However, many patients want a different approach to medicine, one that

is more individualized, process-oriented, supportive, and nurturing.

One that involves lifestyle, living with the seasons and the

environment, dietary changes, and behavioral modification. In the

present HMO-Insurance-Big Medicine system, there isn't time to feel

pulses, talk to patients, treat them at a reasonable pace (for the most

part. . .there are always exceptions). It is also more difficult to

talk about pattern differentiation with both patients and physicians in

this setting.

 

I still think of integrated Western-Chinese medicine as an ongoing

experiment, one which is not yet complete. As you point out, a lot of

interesting and valuable and information has come forth, but for me it

lacks juice, it is dry and without much heart. I find a lot of good

data and information in the journal articles and books, but I don't

find inspiration, heart, or anything to uplift mind and spirit. Sorry,

that's my opinion.

 

I don't oppose those who want to make this connection, and I certainly

don't oppose studying biomedical science in any shape or form. I work

complimentarily with several Western physicians, and we seem to do just

fine. However, it has to be based on a mutual respect for the

strengths of each system, without one dominating the other. Until that

is truly possible, I think it makes sense to guard our autonomy and

respect the differences as well as the similarities.

 

 

On Thursday, July 24, 2003, at 07:18 PM, wrote:

 

> CM is constantly evolving; it is not

> stuck in some classical philosophical vacuum. b) CM is China, right

> now, has integrated western style research, western style thinking,

> western biological markers. Therefore the Chinese (as well as

> Japanese Taiwanese etc.) seem to all agree with Todd's statement.

> They do not just follow tradition; they are constantly testing and

> improving on the past. And this improvement seems to have

> incorporated western thinking. So the tradition IMO has changed...

> Furthermore, stemming from this modern approach are the tools

> needed to treat `real' modern diseases. We whine that we are not

> more than second rate practitioners (not getting the respect that we

> need), but I believe to be primary care physicians we must not only

> read Chinese (or have access to the journals/ research), but embrace

> the research and mentality that is going on in china. It comes down

> to one thing, proof. Do we have the proof for the insurance

> companies and American public to successfully `treat' these more

> difficult diseases? I just don't buy that some classical acupuncture

> and pattern differentiations are enough. And someone's charisma

> might make him a champ, but will his system work for others… How do

> we test that? TCM (from china) has discovered an immense amount of

> information for the treatment for modern diseases.

[Guest guest]

, " "

<zrosenbe@s...> wrote:

> Jason,

> The introduction of WM into China and Japan was quite dramatic and

> sudden, in the late 19th and early 20th century, if my historical

> studies serve me well. Hardly evolutionary, but revolutionary.

> Chinese medicine almost disappeared from the map in both

countries. CM

> was forced to adapt to a 'new reality', and this new reality

continues

> to inform the modern practice, for better or for worse. Something

> lost, something gained.

 

Yes I guess revolutionary or evolutionary is debatable...

 

This doesn't mean, however, that we have to

> let the more 'traditional' medicine disappear or be melded into WM

> practice. I don't think it does justice to the 'treasure house of

> Chinese medicine'.

 

Trust me, I think you know that I personally have great respect for

classical approaches

 

>

> Integrated Western-Chinese medicine, in my opinion, makes sense in

> integrated environments, such as hospitals and group practices.

> However, many patients want a different approach to medicine, one

that

> is more individualized, process-oriented, supportive, and

nurturing.

> One that involves lifestyle, living with the seasons and the

> environment, dietary changes, and behavioral modification.

 

Yes, this is true, but this is all in TCM. I was trained with all

these ideas and use them in my practice daily. I have worked with

Chinese docs trained under the `communistic party' and they have this

knowledge… I do not think this integration is turning its back on

any of this... well maybe some of the astrological stuff, but hey,

win some lose some... (but if it proved effective then I think it

would still be used, but I could be wrong)...

 

In the

> present HMO-Insurance-Big Medicine system, there isn't time to feel

> pulses, talk to patients, treat them at a reasonable pace (for the

most

> part. . .there are always exceptions).

 

Well, I do think there are plenty of exceptions... I know multiple

people who do insurance billing, and I myself just signed up with a

few companies (HMOs...ooooooo).. but it sounds great to me, I get to

spend as long as I want with my patients... and the pay is fine… It

is just how greedy one wants to be… If you want to see 5 people and

hour, then yes you will not have time to do things that you mention

above.. I personally see 1 p per hour….

 

>

> I still think of integrated Western-Chinese medicine as an ongoing

> experiment, one which is not yet complete. As you point out, a lot

of

> interesting and valuable and information has come forth, but for me

it

> lacks juice, it is dry and without much heart. I find a lot of

good

> data and information in the journal articles and books, but I don't

> find inspiration, heart, or anything to uplift mind and spirit.

Sorry,

> that's my opinion.

 

That is fine, and yes it is data, not philosophical writings… and

this is valuable to me, and I can get the philosophy and more poetic

juice elsewhere… we need both, as I think you are saying.

 

>

> I don't oppose those who want to make this connection, and I

certainly

> don't oppose studying biomedical science in any shape or form. I

work

> complimentarily with several Western physicians, and we seem to do

just

> fine. However, it has to be based on a mutual respect for the

> strengths of each system, without one dominating the other. Until

that

> is truly possible, I think it makes sense to guard our autonomy and

> respect the differences as well as the similarities.

 

You are definitely right… We should know our boundaries, and let WM

do what it does best…. I just feel at our current place, we are

severely underestimated, and under-trained for the potential that CM

has to offer...

 

-Jason

[Guest guest]

Jason,

I was talking more about working in a hospital setting than a

private practice with insurance billing. However, each format

(including private cash practice, like I do) has its benefits and

challenges. I have no problem with folks like yourself billing HMO's

and insurance (I have a patient do-your-own filing policy), as long as

it doesn't become required that we belong to HMO's to practice Chinese

medicine. Practitioners should have a choice of models. Back in the

80's, I had a huge practice (or so it seemed) in Denver, up to 100

people per week, with a greater percentage of insurance, two paid

assistants, raw herb pharmacy and big overhead. I had a lot of

insurance ripoffs, by companies, patients, and docs who promised to

file and didn't. I ended up with serious burnout and financial

problems. I took a year sabbatical and moved. Based on good advice

from Donn Hayes, I decided to simplify, lower my overhead, and keep a

more reasonable (for me) patient load, one that did not exhaust my

personal resources. A cash practice may be a luxury for many, but in

certain settings, it can work out.

 

I know you are in a group practice, and probably have a dedicated

individual to deal with insurance and HMO's. You are also younger, and

have the fire for lots of new experiences and patients, and are in a

competitive market in Boulder. So what you are doing makes perfect

sense. I am glad we still have the relative freedom in this profession

to make such choices as you and I have made, and I hope in the future

we will have more, not fewer ones. Keep on growing, Jason, it sounds

like you are doing great.

 

 

On Thursday, July 24, 2003, at 08:09 PM, wrote:

 

> Well, I do think there are plenty of exceptions... I know multiple

> people who do insurance billing, and I myself just signed up with a

> few companies (HMOs...ooooooo).. but it sounds great to me, I get to

> spend as long as I want with my patients... and the pay is fine… It

> is just how greedy one wants to be… If you want to see 5 people and

> hour, then yes you will not have time to do things that you mention

> above.. I personally see 1 p per hour….

[Guest guest]

Jason,

 

I would disagree that the CM practitioners of merit in China and Taiwan embrace WM evidence models on behalf of CM. The practitioners of merit that I know have an ethos like Alon's. They want to see clearly in both paradigms and also practice in both paradigms. But they are the ones who've guided the views that I presented to you this day. It's for this reason that I hope you'll consider this issue. Dr. Chiang of Min Tong Herbs and Dr. Kang, former chief of Shanghai Hospital #1 are the ones who made me face this issue of growth and development. That's Taiwan and China. I believe that facing this issue is necessary for modern growth in CM. Paradigms tend to eat each other. Based on your post below, you may already believe that you are practicing a form of Western medicine but simply using CM tools. As I said to Alon, that's really okay for the time being if it gets you where you want to go. In the long run, what you practice is what you will become (maybe read this sentence twice.) You may currently have the wrong credential for what you are practicing and, therefore, becoming. I suspect you'll be needing a P.A. or an MSN before long ... possibly an MD.

 

Emmanuel Segmen

 

-

 

Thursday, July 24, 2003 7:18 PM

Re: source of income

, "Emmanuel Segmen" <susegmen@i...> wrote:> I will yield to the evidence if it contradicts my belief, but I will not just follow tradition.> > > Bob Flaws wrote: Amen to that, bro.> > Dear Todd and Bob,> > While your post from which this was extracted is a clear and taut argument, your main point of disagreement with Z'ev was in your final sentence above. I refer you to a thread I started today on Paradigms of Evidence wherein I not only agree with Alon Marcus, I say that his comments "nailed a larger reality." You must use the context of a paradigm to prove that paradigm. You can not use one paradigm to prove another one. I refer you to Thomas Kuhn's The Structure of Scientific Revolutions. > > In a post of some months ago I suggested that if people on this list interested in Western science should only read the first 2 or 3 chapters of this thin paperback. This is the classic in philosophy of science and absolutely required reading at Harvard, MIT and the University of Chicago in this area of thought. It's available at this moment at Amazon.com for $9.60. It would be an embarrassment on the parts of some people on this list not to personally own this very basic piece of information. Oh ... and it's in English. ;-)> > So, if you want to "yield to evidence", I'm afraid you will have to look for it precisely in the "tradition" of the paradigm in which you are working. If it comes from anywhere else it will be tautologically, epistemologically and scientifically not "evidence". E & others,I can't say I have an answer to this quagmire, but there are some facts to reconcile with. a) CM is constantly evolving; it is not stuck in some classical philosophical vacuum. b) CM is China, right now, has integrated western style research, western style thinking, western biological markers. Therefore the Chinese (as well as Japanese Taiwanese etc.) seem to all agree with Todd's statement. They do not just follow tradition; they are constantly testing and improving on the past. And this improvement seems to have incorporated western thinking. So the tradition IMO has changed... Furthermore, stemming from this modern approach are the tools needed to treat `real' modern diseases. We whine that we are not more than second rate practitioners (not getting the respect that we need), but I believe to be primary care physicians we must not only read Chinese (or have access to the journals/ research), but embrace the research and mentality that is going on in china. It comes down to one thing, proof. Do we have the proof for the insurance companies and American public to successfully `treat' these more difficult diseases? I just don't buy that some classical acupuncture and pattern differentiations are enough. And someone's charisma might make him a champ, but will his system work for others… How do we test that? TCM (from china) has discovered an immense amount of information for the treatment for modern diseases. IMO, I do not understand why the schools haven't incorporated research into their curriculums. This seems essential, especially if people want to do non-western style studies… which BTW, I would like to seem a design for… otherwise, without these type of studies, what can be said…-Jason

[Guest guest]

, " Emmanuel Segmen "

<susegmen@i...> wrote:

 

> In a post of some months ago I suggested that if people on this

list interested in Western science should only read the first 2 or 3

chapters of this thin paperback. This is the classic in philosophy

of science and absolutely required reading at Harvard, MIT and the

University of Chicago in this area of thought. It's available at

this moment at Amazon.com for $9.60. It would be an embarrassment on

the parts of some people on this list not to personally own this very

basic piece of information. Oh ... and it's in English. ;-)

 

But even more embarrassing to still accept it uncritically;

philosophy of science has moved on in the forty years since. There

are many books and articles refuting Kuhns' views, a bit of fun is "

Intellectual Impostures " by Sokal and Bricmont, also I wrote an

article which is posted in the files.

 

> So, if you want to " yield to evidence " , I'm afraid you will

have to look for it precisely in the " tradition " of the paradigm in

which you are working. If it comes from anywhere else it will be

tautologically, epistemologically and scientifically

not " evidence " .

>

 

If CM is going to get anywhere (albeit in a changed form)it has to

get past this hobbity backwater.

 

Simon

[Guest guest]

, emmanuel wrote:

 

> >

> > So, if you want to " yield to evidence " , I'm afraid you will

> have to look for it precisely in the " tradition " of the paradigm in

> which you are working. If it comes from anywhere else it will be

> tautologically, epistemologically and scientifically

> not " evidence " .

 

 

you must confuse me with someone else. I agree with you 100%. I have made

the same argument about paradigm shifts a dozen times on this list before you

ever joined. I do not believe anything I said in my last post contradicted

that

very solid position I have maintained for years..

 

 

[Guest guest]

Are you saying we all have hairy feet?

 

How will CM be changed, and who will do the changing? Don't expect it

will be us that does the changing. Is the only 'progress' to be a

subset of biomedicine?

 

Just asking.

 

 

On Thursday, July 24, 2003, at 11:01 PM, Simon King wrote:

 

> If CM is going to get anywhere (albeit in a changed form)it has to

> get past this hobbity backwater.

>

> Simon

[Guest guest]

, " "

<zrosenbe@s...> wrote:

> Are you saying we all have hairy feet?

>

> How will CM be changed, and who will do the changing? Don't expect

it

> will be us that does the changing. Is the only 'progress' to be a

> subset of biomedicine?

>

> Just asking.

>

>

> On Thursday, July 24, 2003, at 11:01 PM, Simon King wrote:

>

> > If CM is going to get anywhere (albeit in a changed form)it has to

> > get past this hobbity backwater.

> >

> > Simon

 

Mixing my subjects in that sentence, I meant the paradigm theorists

as the ones with hairy feet but if CM were to be too comforted by

that theory...

 

Simon

[Guest guest]

, " Emmanuel Segmen "

<susegmen@i...> wrote:

> Jason,

>

> I would disagree that the CM practitioners of merit in China and

Taiwan embrace WM evidence models on behalf of CM.

 

Maybe I am unclear what you are saying here, but I have met plenty of

amazing TCM practitioners that embraced WM... I have never said

abandon TCM for WM, I am just for integration…

 

> The practitioners of merit that I know have an ethos like Alon's.

They want to see clearly in both paradigms and also practice in both

paradigms.

 

this is precisely my point... they see in both paradigms.. this is

(in my mind) `embracing WM'....

 

 

> But they are the ones who've guided the views that I presented to

you this day. It's for this reason that I hope you'll consider this

issue. Dr. Chiang of Min Tong Herbs and Dr. Kang, former chief of

Shanghai Hospital #1 are the ones who made me face this issue of

growth and development. That's Taiwan and China. I believe that

facing this issue is necessary for modern growth in CM. Paradigms

tend to eat each other.

 

Can you elaborate I am unclear what you are getting at here...

 

> Based on your post below, you may already believe that you are

practicing a form of Western medicine but simply using CM tools.

 

This is so far from the truth... I actually practice a more

classically based CM. WM actually rarely enters my mind once I rule

out red flags, etc… But many herbs that I add will come from this

modern era (research).. I.e. – You have just finished writing a Rx

(of course based on the pattern) for a p with peripheral nerve

degeneration… You want to add 1 more blood tonic, which do you pick?

Well you might say hey he is a little on the warm side and has a

tendency for yang rising, and needs his liver softened I will pick

baishao… (but you might say, I know that heshouwu can regenerate

nerves, so I pick that, my root Rx should already cover the pattern.)

this is integration, and this is not practicing WM, IMO. And how

would we know this w/o research? – It might not be correct, but that

is a whole other question…

 

-

[Guest guest]

> > Dear Todd and Bob,

> >

> > While your post from which this was extracted is a clear and taut

> argument, your main point of disagreement with Z'ev was in your

final

> sentence above. I refer you to a thread I started today on

Paradigms

> of Evidence wherein I not only agree with Alon Marcus, I say that

his

> comments " nailed a larger reality. " You must use the context of a

> paradigm to prove that paradigm. You can not use one paradigm to

> prove another one. I refer you to Thomas Kuhn's The Structure of

> Scientific Revolutions.

> >

> > In a post of some months ago I suggested that if people on this

> list interested in Western science should only read the first 2 or 3

> chapters of this thin paperback. This is the classic in philosophy

> of science and absolutely required reading at Harvard, MIT and the

> University of Chicago in this area of thought. It's available at

> this moment at Amazon.com for $9.60. It would be an embarrassment

on

> the parts of some people on this list not to personally own this

very

> basic piece of information. Oh ... and it's in English. ;-)

> >

> > So, if you want to " yield to evidence " , I'm afraid you will

> have to look for it precisely in the " tradition " of the paradigm in

> which you are working. If it comes from anywhere else it will be

> tautologically, epistemologically and scientifically

> not " evidence " .

 

Jason,

 

While I've been aware of Kuhn's work for many years and agree with his

point of view in certain contexts vis a vis the relationship between

WM and CM, in the context of the present discussion, I believe Kuhn's

argument is simply beside the point. Absolute positions tend to be

wrong (or at least inappropriate) in a percentage of situations. If we

are looking to determine if different styles of acupuncture are more

effective than others, then it is only logic that one must first

identify and then screen out extraneous factors which might cloud the

outcome. It has nothing to do with paradigms and systems theory.

This is not a Western science vs. Chinese science issue. It's simple

logic and epistemology.

 

Bob

 

Bob