Paradigms of evidence

[Guest guest]

Subject was formerly "source of income". My apologies for provocative comment at the end. ES

 

Z'ev wrote: I find it hard to believe that all the original studies were semi-anecdotal, and that all the recent studies were randomized and blind. If this is the case, why the sudden switch in format?Alon wrote: >>>>It took this long to do a true randomized study because just like in CM in WM belief systems often prevail for a long time. Women felt better and simple population studies showed all these benefits. Except that the benefits where only due to the fact that women that took these horse hormones also took better care of themselves. They did a lot of retrospective studies but no real time large randomized study until the famous one. Evidence is not very easy to come by. Randomized and blinded teddy designs are done for just these reasons

 

Z'ev wrote: why the sudden switch in format?Along wrote: >>>>>Because many treatments in WM are now being studied for evidence.

 

Dear Zev, Alon, and all Esteemed Colleagues,

 

I believe Alon exquisitely nailed a larger reality in the above posts with good questioning from Z'ev. The one sterling contribution from HMOs (whose existence I otherwise regret) is that they are in the same businesses as Las Vegas casinos. They are dispassionately and objectively assessing numerical risk for the sole purpose of making money. They are not prejudiced either by professional ethics nor by professional pride. The work of insurance companies is to assess and distribute risk. When WM is tested by Western science, you end up with a reasonable degree of integrity.

 

Now I hope you will forgive me. I want to add one somewhat provocative comment that I'm not really sufficiently credentialed to follow up on except as a Western scientist and philosopher. It is my assumption that CM must hew to the same principle as stated above for WM. That is, to maintain its integrity, Chinese medicine must adhere to Chinese (or taoist) principles of science and not to any particular ethos, professional pride or any other paradigm of science such as Western science or Western medicine. Thus, I would reject double blind studies with CM treatment principles regarding WM disease states since CM is not working with molecular mechanisms in the patient nor in the treatment model. To use Western scientific principles (or identify WM disease states) you need to identify molecular mechanisms that are normal, those that are abnormal and the molecular treatment that brings the pathology closer to the normal homeostasis. These are not constituents or variables that fit into the CM paradigm. Also, you can not assume that infection in a group of human hosts by a single pathogen represents a single disease state in CM. The logic that any group of specifically imbalanced humans beings are similar and that we can hold all variables steady except for one is not applicable at this time to CM .... except through an ordering of its own principles if it should chose to do this. If WM or Western science chose to sufficiently investigate CM to make it some subset of Western science and then apply Western scientific principles, then you would still be testing a subset of Western science, and you would not be testing Chinese medicine. No conclusions, good or bad, about CM could be drawn from such work.

 

I hate to throw this curve at you, but I have to state the facts. Maybe in a century or in a millennium things will be different. I was brought to this realization myself by three years of daily debate with Dr. Charles Chiang, owner of Min Tong Herbs. He holds a Ph.D. in pharmacology from the University of Tokyo, and his research was on CM digestive formulas in human and animal studies. I had the naive impression back in the late 1980s that Western science might get a grip on CM in a several decades of rigorous work. If you look very honestly and clearly at both paradigms, you'll see that creating a field of thought that could honestly encompass both Western and Chinese linguistic and scientific developments is a long way away from year 2003 ... or 2103 for that matter.

 

In gratitude for your patient reading,

Emmanuel Segmen

 

[Guest guest]

Right on, Emmanuel. You put your thoughts into words elegantly, and I

emphatically agree. If we are going to do studies on CM, we must use

the criteria of CM to design them, i.e. patterns and pathomechanisms

not molecular science.

 

 

 

On Thursday, July 24, 2003, at 03:20 PM, Emmanuel Segmen wrote:

 

> That is, to maintain its integrity, Chinese medicine must adhere to

> Chinese (or taoist) principles of science and not to any particular

> ethos, professional pride or any other paradigm of science such as

> Western science or Western medicine.  Thus, I would reject double

> blind studies with CM treatment principles regarding WM disease

> states since CM is not working with molecular mechanisms in the

> patient nor in the treatment model.  To use Western scientific

> principles (or identify WM disease states) you need to identify

> molecular mechanisms that are normal, those that are abnormal and the

> molecular treatment that brings the pathology closer to the normal

> homeostasis.  These are not constituents or variables that fit into

> the CM paradigm. 

[Guest guest]

design them, i.e. patterns and pathomechanisms not molecular science.>>>>There must however be a blind as well as objective criteria incorporated into the design of any study.

Alon

[Guest guest]

Thus, I would reject double blind studies with CM treatment principles regarding WM disease states since CM is not working with molecular mechanisms in the patient nor in the treatment model

 

>>>Why then we see treatment of western diseases with Chinese medicine all over the literature? I totally reject your statement above. What we need is to have studies that allow CM all the freedom it needs within it own paradigm but at the same time, if it can not change the course of biomedical defined disease than CM will have no future. If I cant see blood glucose drop I do not care how you frame the treatment of diabetes in CM

Alon

 

[Guest guest]

Bian bing or disease differentiation is part and parcel of Chinese

medicine from the premodern era. However, each disease is

differentiated according to pattern, individualizing treatment to some

degree. So the same disease will be dependent on the differing

terrains of different patients, and the treatment will vary

accordingly. It may be that indirectly the blood glucose will drop,

but will any researcher be able to find one herb or one acupuncture

point, or even one combination of herbs and points that will treat

every case of diabetes? Any studies to that effect (lowering glucose

levels in diabetics) will have to include pattern differentiation to do

so.

 

I think this is what Emmanuel is talking about. We are not going to

find repeatable treatments with the same substance or points in

regulated dosage to replace insulin.

 

Finally, in many cases, we won't be able to reduce glucose levels.

However, CM can treat peripheral neurapthies, impotence, blood

circulation problems, blurry vision and other aspects of diabetes

effectively.

 

 

On Thursday, July 24, 2003, at 06:38 PM, Alon Marcus wrote:

 

> >>>Why then we see treatment of western diseases with Chinese medicine

> all over the literature?  I totally reject your statement above. What

> we need is to have studies that allow CM all the freedom it needs

> within it own paradigm but at the same time, if it can not change the

> course of biomedical defined disease than CM will have no future. If I

> cant see blood glucose drop I do not care how you frame the treatment

> of diabetes in CM

> Alon

[Guest guest]

, " "

<zrosenbe@s...> wrote:

> Right on, Emmanuel. You put your thoughts into words elegantly,

and I

> emphatically agree. If we are going to do studies on CM, we must

use

> the criteria of CM to design them, i.e. patterns and

pathomechanisms

> not molecular science.

>

>

>

>

Z,

 

Do you not think that you can do both at once? I.e. if one does a

study on AIDS patients with patterns and pathomechanism... this

incorporates to ideas, a specific pathogen (virus) and then the CM

pattern. This seems to one of the trends in china. I think

forgetting about the western disease in many cases would lead to

serious detriment...

Sometimes it is nice to have the patient feel better, (as this is

extremely important, but not that hard with acupuncture), but to

create serious organic change seems to be paramount in many modern

diseases, cancer, hep, aids, etc... noting the biological markers for

these diseases, most of the time can determine the stage the patient

is in... Is this not valuable? For health? For acceptance in our

western medical society, that we all are involved in?

 

-JAson

[Guest guest]

, " "

<zrosenbe@s...> wrote:

> Bian bing or disease differentiation is part and parcel of Chinese

> medicine from the premodern era. However, each disease is

> differentiated according to pattern, individualizing treatment to

some

> degree. So the same disease will be dependent on the differing

> terrains of different patients, and the treatment will vary

> accordingly. It may be that indirectly the blood glucose will

drop,

> but will any researcher be able to find one herb or one acupuncture

> point, or even one combination of herbs and points that will treat

> every case of diabetes? Any studies to that effect (lowering

glucose

> levels in diabetics) will have to include pattern differentiation

to do

> so.

>

 

I think this is understood. But I would like to hear how we go about

this in an non-western way that gives us what we need. What is the

resistnec to the western research method. The chinese use it... What

is better. Finally we can use pattern diff and still have a western

research design model. a western model doesn't mean we are purely

looking at some biological marker with some single herb therapy.

 

-Jason

[Guest guest]

>

> Finally, in many cases, we won't be able to reduce glucose levels.

> However, CM can treat peripheral neurapthies, impotence, blood

> circulation problems, blurry vision and other aspects of diabetes

> effectively.

>

>

> On Thursday, July 24, 2003, at 06:38 PM, Alon Marcus wrote:

>

 

>I think this is a good point, in certain situations we can't treat/

(cure) the 'disease' , but can just treat the symptoms, and this is a

huge strength we have... but if we did that for every disease than we

are second rate, clean-up docs... maybe this is our destiny. But I

know in china this is not their goal. Last weekend, I spent time

with a CM doc from china, and we were looking at all his published

materials. ANd the research and treatments were relevant here, b/c

for the most part they were all 'treating' real (western) diseases.

and maybe it is not always about a complete cure, but let's say we

could show that with pattern differentiation we can keep viral loads

down longer than the current western medical approach. Well, then we

have something, and then the insurance companies will want us, then

the schools will have more enrollment, then the schools will have

more money, and the teachers might get paid what they deserve... just

my little fantasy... but even with let's say peripheral

neuropathies. If we can say, hey, this symptom of DM can be

alleviated more efficiently than WM's approach, with less side-

effects, then this is just as powerful. It is one thing to have

proof, and another so just say we treat something… We can say we

treat anything right? And have you ever met am CM doc that doesn't

have great success? This is why formal studies are needed…

 

-JAson

[Guest guest]

, " "

<zrosenbe@s...> wrote:

 

>

> There is no doubt that this is all valuable and important. And, in

> many cases, I think WM does a good job at it, although sometimes

not

> with therapeutic interventions. I don't have a problem with that,

I

> have a problem with CM trying to do something that WM does more

> efficiently, and ending up being second-rate at it. CM will

target

> the patient in a different way, and this is truly 'complimentary'.

>

>

> >

 

No doubt, this is the fine line.. Obviously we cannot replace insulin

shots, and shouldn't try. But before the p starts shooting, we might

be able to regulate glucose levels enough to stabilize them... this

we should be able to do much better than WM... and if we had research

that says we can, then bam... I don't know what this `bam' is about,

but it sounds like a good thing...

 

-

[Guest guest]

Emmanuel wrote: Thus, I would reject double blind studies with CM treatment principles regarding WM disease states since CM is not working with molecular mechanisms in the patient nor in the treatment model

 

Alon wrote: >>>Why then we see treatment of western diseases with Chinese medicine all over the literature? I totally reject your statement above. What we need is to have studies that allow CM all the freedom it needs within it own paradigm but at the same time, if it can not change the course of biomedical defined disease than CM will have no future. If I cant see blood glucose drop I do not care how you frame the treatment of diabetes in CM

 

Hi Alon. I kind of thought this would get your attention. ;-) I've really wanted to discuss this with you since we've been agreeing about stuff of late.

 

No, I would not want to limit your knowledge of WM or CM nor your practice of each nor your chance to integrate the two. In fact you and I have come to a number of agreements regarding this point. I like that you have some very clear knowledge about what's real in WM and Western science. You've made some profoundly insightful points in the past that caught my attention. I think I acknowledged that regarding you post today, right? It gave me a chance to segue into how paradigms communicate and how they don't communicate.

 

It's great that you have your knowledge and your practice. Beware of being true to your own statement from earlier today. Figure out what is "evidence" within a given paradigm. I most heartily agree with you that WM has an enormous amount of "bad science" because people want to practice clinically as they always have and were trained to do and refuse to accept epidemiological studies. You made an excellent point about that today.

 

However, if you prove with double blind studies that certain herbs formulated together cure or successfully treat a WM disease state, you've said nothing about CM and everything about WM. Hey, it works, right? Your technique for proof would be the Western scientific paradigm and your proof itself would be about a WM disease state. Thus, you would be practicing WM and introducing a CM herbal formula into it. That seems to be a fairly common practice among practitioners on list. They are not practicing CM. They are practicing WM using CM tools. No flies on you if you get the results that you are seeking. Think about which paradigm you are contributing to if you present your study. WM practitioners may nod their heads and agree, by golly he did it. I used to win many of my judo matches with standard college wrestling techniques. Hey, I won. Right? Did I advance with regard to judo? No. I just proved that people who practice judo at the student level are vulnerable to college wrestling techniques. My judo master still swept the floor with me as easily as before. I think it's clear to you that you are doing WM with CM tools. I don't think you mind as long as you are serving your patients. I don't think your patients mind as long as they are getting well. It's all good, right?

 

If, however, you want to advance one paradigm or the other, you need to find evidence based tests within the context of that paradigm. Read my post again. I definitely reject double blind studies with CM treatment principles regarding WM disease states as advancing anything in particular. Some pharmacologist or biochemist will come along and characterize the molecules that she or he can find in the herbal formula and make a WM drug. So statins are really CM based on Merck's research at UCLA, right? Wrong. It's WM research. Yes, it works. Yes, CM thought of it first ... way first ... like centuries first. But the whole nature of what Merck did was not CM, it was WM. So the results are WM.

 

Here's the real take home lesson, Alon, that I'm trying to comment on. When Merck did this research, did WM communicate with CM at all? The answer is no. Not at all. Can you, Alon, nevertheless use this information and get positive results in treating your patients? Yes. I just suggest to you to keep a wary eye that this sort of thing does not advance CM. Unless I'm mistaken, you are credentialed as an L.Ac. That is the correct credential in this country for practicing CM. You can embrace WM all you want, but I suspect your fortune lies with the advancement of CM. Are you following my drift here, Alon? This is actually more than just a philosophical issue. It's an issue of identity and credibility. Please read Thomas Kuhn's book. It's thin, it's in English, it costs $9.60, and you've got one of the quickest minds around. I also sense you are nobody's fool. Am I right? So figure out what is the dominant paradigm. Figure out the paradigm of your credential. Where is your future and your fortune? Is it time to become a PA or an MSN? Is it time to embrace CM and figure out how to do evidence based studies from the perspective of CM? Or if you don't do the research, is it time to figure out when research supports CM? How does this differ from research that takes the tools of CM to prove a point in WM? Hey, I'm a Western scientist. I'm just calling out in a friendly way across the Gulf of CM/Western science to say that I've got plenty of friends in Western science here in the U.S. of A. I'd really kind of like to see CM flourish as well. So I'm hoping since you've got some training in CM that you'll consider helping it flourish. I keep seeing CM people bow to paradigm proofs of Western science.

 

Anyway, please read Thomas Kuhn and get back to me on this. I have a sense we might make some headway in our discussion of this point. It's not about your freedom to practice what you want today. It may be about your freedom to do so in 10 years. It's mainly about your future credibility and the credibility of CM as it grows up in the U.S.

 

Emmanuel Segmen

[Guest guest]

Dear Esteemed Colleagues,

 

I hope you'll take up this discussion where I left it with Alon. I kind of hope you all figure out what a research paradigm is, and what a dominant paradigm is. I hope you see that proving something in paradigm #1 about paradigm #2 makes paradigm #2 a lesser part of paradigm #1. If this is not quite getting across to you, take a moment review my post to Alon. If you're still not there, try reading Thomas Kuhn's Structures of Scientific Revolution. Consider that really winning any argument is proving the other guy right. If you can prove the other guy is right, then your reality contains his reality.

 

I'm not skittish at all of people ganging up on me regarding this point. I'll take the heat. But like a really good medical student or practitioner, please comment or ask a question after you've researched it a bit. Okie dokie? This is about the real future of CM. Michael McGuffin warned us at AHPA meetings that the FDA was going to come up with a standard practice model for CM. It's on their agenda and may take several years to put together. Check with him about it. If some academic or professional network puts together a written paradigm, the FDA may adopt it in part or in whole. If you make the CM paradigm based on Western science principles, my sons will not have what I have in 2003 regarding CM treatment in the U.S. Small actions taken over time have profoundly big consequences. Watch your back.

 

Emmanuel Segmen

[Guest guest]

Hi Emanuel,

 

I was just thinking: how, from a TCM perspective, can you do double blind

studies to compare the results, unless your are dealing with patients

that have the same tongue and pulse readings and the same differential

diagnosis? Otherwise, even if the patients had precisely the same

diagnosis, how could you possibly compare results because the treatment

protocols would be completely different. It would be like comparing

apples and oranges (even though both are fruit, and both are cool, sweet

and sour, they nonetheless are quite different).

 

I think that I remember Ted Kapchuk making the point that each system

is its own science with its own laws, but that the methods and

properties of one can't be applied to another.

 

Besides, can you ever imagine reading in JAMA an article entitled:

" Results of double-blind study of Liver-fire derived hypertension of 200

patients in the 30 to 40 age group, treated with acupuncture? " Maybe

someday, but far in the future.

 

Sincerely,

 

Yehuda

 

______________

The best thing to hit the internet in years - Juno SpeedBand!

Surf the web up to FIVE TIMES FASTER!

Only $14.95/ month - visit www.juno.com to sign up today!

[Guest guest]

, yehuda l frischman

<@j...> wrote:

> Hi Emanuel,

>

> I was just thinking: how, from a TCM perspective, can you do double

blind

> studies to compare the results, unless your are dealing with

patients

> that have the same tongue and pulse readings and the same

differential

> diagnosis? Otherwise, even if the patients had precisely the same

> diagnosis, how could you possibly compare results because the

treatment

> protocols would be completely different. It would be like

comparing , yehuda l

frischman <@j...> wrote:

> Hi Emanuel,

>

> I was just thinking: how, from a TCM perspective, can you do double

blind

> studies to compare the results, unless your are dealing with

patients

> that have the same tongue and pulse readings and the same

differential

> diagnosis? Otherwise, even if the patients had precisely the same

> diagnosis, how could you possibly compare results because the

treatment

> protocols would be completely different. It would be like

comparing

> apples and oranges (even though both are fruit, and both are cool,

sweet

> and sour, they nonetheless are quite different).

>

> I think that I remember Ted Kapchuk making the point that each

system

> is its own science with its own laws, but that the methods and

> properties of one can't be applied to another.

>

> Besides, can you ever imagine reading in JAMA an article entitled:

> " Results of double-blind study of Liver-fire derived hypertension

of 200

> patients in the 30 to 40 age group, treated with acupuncture? "

Maybe

> someday, but far in the future.

>

>

 

Well this is somewhat going on now... there is a compromise, for

better or worse.. I.e. they find 500 people with hypertension, weed

out the ones that are NOT liver-fire. then they set up a criteria,

if they have liver fire with X syndrome add Y herb, if they have Z

syndrome add Y+YY herb.. etc.. Or they do the study with 3 patterns ,

liver fire, liv/kid yin xu, and sp qi xu. all with different base

formulas, and then modification based on symptoms... this is quite

reasonable IMO, and they still can (if they choose to) adhere to

normal western- research-rigor, to what degree is another question…

Emmanuel, are you against this? Of course in real practice as also

with WM, the whole human being is considered, fine… but if Chinese

herbs work for hypertension, we should be able to see it with such

studies… look at the IBS research…. Furthermore, most people in the

country aren't even writing individual Rx for each patient. They are

using patents, pills, extracts or whatever. SO such a study is

actually more detailed and more CM than most practitioners are even

practicing in this country…

 

-

 

> apples and oranges (even though both are fruit, and both are cool,

sweet

> and sour, they nonetheless are quite different).

>

> I think that I remember Ted Kapchuk making the point that each

system

> is its own science with its own laws, but that the methods and

> properties of one can't be applied to another.

>

> Besides, can you ever imagine reading in JAMA an article entitled:

> " Results of double-blind study of Liver-fire derived hypertension

of 200

> patients in the 30 to 40 age group, treated with acupuncture? "

Maybe

> someday, but far in the future.

>

>

 

Well this is somewhat goning on now... there is a comprimise, for

better or worse.. I.e. they find 500 people with hypertension, weed

out the ones that are NOT liver-fire. then they set up a criteria,

if they have liver fire with X syndrome add Y herb, if they have Z

syndrome add Y+YY herb.. etc.. Or they do the study with 3 patterns ,

liver fire, liv/kid yin xu, and sp qi xu. all with different base

formulas, and then modification based on symtpoms... this is quite

resonable in IMO....

 

-Jason

[Guest guest]

, " "

<zrosenbe@s...> wrote:

> But doesn't diabetes include peripheral neuropathies, impotence,

loss

> of eyesight, etc. as part of the disease? The glucose levels are

just

> the most dramatic and visible part of the disease.

 

But, if one has per neuropathy, impotence, loss of eyesite etc w/o a

glucose issue then is it diabetes..? I think the hallmark of WM Dx

is based on a definite lesion or pathogen oriented approach. There

are exceptions like fibromylagia... I consider the above s/s

secondary to the disease, but not necessary... this is where CM and

WM different correct? In CM s/s make the disease...

 

-

[Guest guest]

Mahayana Buddhism has posited an interesting solution to some of the

epistemological problems that, it seems to me, are driving the current

discussion on proof. Mahayana Buddhists posit two levels of truth

(don), relative and absolute. While I agree that there is no such

thing as objective truth and, therefore, objective proof, in terms of

absolute reality, within the everyday (presumably) consensual world,

there can be. In other words, within relative reality, we can critique

and judge the relative merits of different RCT designs and

implementation.

 

Having been involved in the design and implementation of a

single-blind acupuncture study for several years, I agree that

designing a blinded acupuncture study is fraught with all sorts of

practical difficulties which make it (currently, I believe) an

impossibility. However, that is different from agreeing with Todd that

the only way to really know if one style of acupuncture gets better

outcomes than another is to do a comparative study that eliminates all

extraneous factors. Whether or not this can actually be done is beside

the point.

 

What I see happening in this discussion is people throwing up all

sorts of peripheral objections to Todd's (and my) assertions about

acupuncture efficacy, but not being willing to accept that, until or

unless someone could do such a study, there is no logical way of

finding out for sure if style or theory of acupuncture plays any

significant non-pacebo role in its practice.

 

We're not going to agree on the issue about style or theory because

neither side can provide anything more than anecdotal evidence. But I

think we could agree on the how one theoretically could make these

determinations if one could carry out such a study. To know what is

causing what, you've got to eliminate as many extraneous factors as

possible. In relative reality, that can be done relatively.

 

Bob

 

, " kenrose2008 "

<kenrose2008> wrote:

> Alon,

>

> > >>>>There must however be a blind as well as objective criteria

> incorporated into the design of any study.

> > Alon

>

> And what about the discoveries of certain

> research in physics that suggest that

> blinding is not possible, i.e., that

> the act of perception itself is a

> causative factor in events?

>

> Perhaps this is what Yehuda was thinking

> of in evoking a " relativistic quantum "

> model of perception.

>

> So, to whose science shall we seek to

> conform?

>

> Today's, tomorrow's, yesterday's?

>

> Don't forget that the whole basis of

> RCT, i.e., statistical inference, is

> in and of itself a kind of archaic

> artifact of the 19th century that is

> deeply rooted in a highly culture-bound

> worldview that, truth be told, has no

> more claim on being " real " or " authentic "

> (and therefore credible and believable)

> than more or less any other.

>

> Pick a point. That's what Einstein said.

>

> And that's more or less what populations

> do. They pick a point, and that point serves

> as the focal point...until it doesn't

> and then they pick another point.

>

> They, of course, are us.

>

> That's what we're doing.

>

> And the arguments about paradigms of

> science and the arguments about sources

> of income are, as Bob Flaws has eloquently

> suggested, pretty much the same thing.

>

> Ken

[Guest guest]

Yesterday I translated an article that compared the use of a standard

Chinese medicinal formula to glipizide (Glucotrol) for the treatment

of 60 some type 2 diabetics who presented a pattern of either qi & yin

dual vacuity or yin vacuity with heat exuberance. Not only did the

Chinese formula work equally well for lowering the FBG, PPBG, and IR

as the glipizide, the Chinese meds also lowered mean diastolic &

systolic blood pressure, TC, TG, blood viscosity, and red blood cell

agglutination. Seems to me that's a fine thing to know and

disseminate.

 

Bob

 

But before the p starts shooting, we

might

> be able to regulate glucose levels enough to stabilize them... this

> we should be able to do much better than WM... and if we had

research

> that says we can, then bam... I don't know what this `bam' is about,

> but it sounds like a good thing...

>

> -

[Guest guest]

, " Bob Flaws " <

pemachophel2001> wrote:

 

>

> Having been involved in the design and implementation of a

> single-blind acupuncture study for several years, I agree that

> designing a blinded acupuncture study is fraught with all sorts of

> practical difficulties which make it (currently, I believe) an

> impossibility. However, that is different from agreeing with Todd that

> the only way to really know if one style of acupuncture gets better

> outcomes than another is to do a comparative study that eliminates all

> extraneous factors. Whether or not this can actually be done is beside

> the point.

 

Actually I have no interest in a blinded study. I am interested in studying

outcomes. Get a thousand sinusitis patients. Randomize the groups and give

250 to a worsley style and 250 to TCM and 250 to japanese meridian therapy

and 250 to medical acupuncture (or some other 4 groups). Insure that the

treatments are done by qualified providers with 5 years experience and let

them do whatever they normally do. At the end of a year, analyze the results

and see if there are any differences. I don't want to test a protocol. No one

I

know claims cookbook protocols are effective. But lots of people claim their

methodology is superior. If the methodology is superior, than qualified

practitioners applying the methodology should get higher success rates which

could be easily measured.

 

This type of outcome study is the thing everyone wants to be able to do when

its CM versus WM. But to study the matter within CM is somehow anathema.

If all styles were proved largely equal (which is what I would predict) than

some of the sectarian rancor would end. Any fear that this would somehow

undermine CM is also unfounded. All the styles in question require extensive

training. If if turns out some styles are better than others for certain

conditions, this would support the eclectics who might use orthopedic style for

certain neuro conditions and worsley for psych, etc. If it turns out this is

not

the case, then so be it. Then everyone is qualified to treat everything (I

doubt

it; I'm not). Now it would be a serious problem if it turned out that children

or

monkeys could also perform effective acupuncture, but I hardly think that

would be the case. and besides, we won't study that anyway. I mean who

would approve such a study? :-)

 

Personally, I am not not a fan of either aggressive orthopedic techniques or

deep psychological probing, so I would love to discover that I serve all

patients

well with my style. If other styles were proven more effective for certain

complaints, it would be unethical for me not to refer the patient to someone

who had expertise in that area. What if TCM turned out to have a 30% success

rate in neuromuscular complaints and orthopedic styles such as taught by Matt

Callison turned out to have a reliable 80% success rate in thousands of

documented cases. At the very least, one would need to inform their patient

of this disparity, n'est-ce pas?

 

The other thing we need to remember since this is an herbal list is that the

TCM approach to chronic pain involves the use of large doses of herbs. so any

study that did not allow herbal prescribing as part of one's normal practice

would not yield a truly accurate picture of what might get accomplished. On

the other hand, it would be interesting to settle once and for all whether TCM

acupuncture practiced alone is the truly the weakling (or tour de force, as Bob

used to say) of our field.

 

As for paradigm shifts, I think proving TCM works for a wide range of

ailments within the prevailing version of normal science will be exactly the

thing that causes a paradigm shift (and this is based on my reading of Kuhn,

reiterated here many times). Because when it is proven that acupuncture and

herbs are more effective than WM for a wide range of complaints, the next

important questions will be how does it all work. and the subsequent

exploration of complex polypharmacy and mechanism of acupuncture will no

doubt push the boundaries of science, demanding the incorporation of

complexity theory and information science in order to arrive at a more

encompassing worldview that will sufficiently model observed phenomena.

 

The change in worldview will be the paradigm shift. But no one will really

study any of this in sufficient depth to ever unravel this mystery unless they

are first convinced on a large scale that there is something worth studying in

the first place. Unfortunately, resources will not be expended just to

massively study cultural phenomena. But we claim this is efficacious medicine

and that bears study. so if we prove the medicine works in current scientific

terms, which is easily done, then we we stretch the paradigm proving how it

work. But I must add that I do not believe the resultant paradigm shift will

jettison us back to Han china. I believe modernist ideas will continue to

dominate the debate and medicine, the but the impact of studying TCM in this

way will open unthought of avenues in systems science, pharmacology and

neurobiology resulting in a truly holistic integrated high tech 21st century

medicine. and I have no idea what TCM will look like when the dust settles,

but I know the world be a better place for our contribution to this

development.

 

[Guest guest]

Emannuel,

 

I don't mean to foist this discussion off on Ken, Marne, Rey or

one of the many translators, but what is hypertension in the

paradigm of CM?

 

 

Let's put it into another frame of reference.

 

What is the aria of the Queen of the Night

in the second act of Die Zauberflote in

the paradigm of The Peony Pavillion?

 

I don't know if you or anyone will find this

even remotely responsive. But when I tried

to answer more directly, I ran into a

problem that I have been trying to get

well defined for more than a decade now.

 

This problem relates to the development

of a method for the transmission of

the gist of a set of ancient Chinese

ideas in terms that will be found not

only meaningful but alive by modern

non-Chinese readers and students.

 

And having failed to do so up until this

moment, of course, I could go no further.

 

So I had to use a manuver defined by

Richard Hofstadter as joots (jump out of

the system) in order to try and find a

frame of reference in which your question

and the answers...and further questions

that it develops might be most useful.

 

I know you're busy now, and in fact I

am about to disappear into a traveling

mode which could last for the next

few months. So I don't know that we'll

be able to beat this horse to death.

 

But if you compare the Queen of the Night's

arias from the first and second acts

of the Magic Flute, and if you ask yourself

how to translate that development into Beijing Opera

or the ecstacy of a whirling dervish

well then you'll be on the path of

discovering what hypertension is in

Chinese medicine...

 

....maybe.

 

Ken

[Guest guest]

Emannuel,

 

I don't mean to foist this discussion off on Ken, Marne, Rey or

one of the many translators, but what is hypertension in the

paradigm of CM?

 

 

Let's put it into another frame of reference.

 

What is the aria of the Queen of the Night

in the second act of Die Zauberflote in

the paradigm of The Peony Pavillion?

 

I don't know if you or anyone will find this

even remotely responsive. But when I tried

to answer more directly, I ran into a

problem that I have been trying to get

well defined for more than a decade now.

 

This problem relates to the development

of a method for the transmission of

the gist of a set of ancient Chinese

ideas in terms that will be found not

only meaningful but alive by modern

non-Chinese readers and students.

 

And having failed to do so up until this

moment, of course, I could go no further.

 

So I had to use a manuver defined by

Richard Hofstadter as joots (jump out of

the system) in order to try and find a

frame of reference in which your question

and the answers...and further questions

that it develops might be most useful.

 

I know you're busy now, and in fact I

am about to disappear into a traveling

mode which could last for the next

few months. So I don't know that we'll

be able to beat this horse to death.

 

But if you compare the Queen of the Night's

arias from the first and second acts

of the Magic Flute, and if you ask yourself

how to translate that development into Beijing Opera

or the ecstacy of a whirling dervish

well then you'll be on the path of

discovering what hypertension is in

Chinese medicine...

 

....maybe.

 

Ken

[Guest guest]

Emmanuel,

 

I am in your debt for your heroic flight of imagination.

>

Well, there you have it.

 

Actually there was no imagination involved

whatsoever. I was just sitting here listening

to The Magic Flute and trying to answer you.

So the two sets of melodies just flowed together.

 

One of the great things about boxing, of course,

is that typically, two enter and one leaves,

leaving no doubt as to who prevailed.

 

Medicine is far more subtle a form of combat

in which, ideally, we want everyone to

win. This removes the option of simply

beating the patient into submission.

 

Darn. That would make life so simple, eh?

 

Hypertension might also be a weird kind

of yin excess...just too much juice in

the pipes. Or, in the words of the ancient

sages of China:

 

" The superior man takes heed of the

alternation of increase and decrease,

fullness and emptiness; for it is

the course of heaven. "

 

Ken

[Guest guest]

, " Emmanuel Segmen " wrote:

I believe WM will respond badly to any success that CM has. I also

believe that CM will have success as more practitioners are trained

in CM and Americans spend their money on CM rather than on WM for

treatments that CM does well. >>>

 

 

Emmanuel:

 

Excellent point. In the end, Americans love success more than

anything else.

 

Unfortunately, it seems that the trend for CM in America is more

integration with WM on WM's terms. Even the NCCAOM's recent Dipl. OM

suggests that.

 

For better or worse, the premodern herbalist image that everyone

here seems to be championing is becoming less likely to become the

standard. It seems to me that only the politics of liability issues

and lack of Western testing for safety and effectiveness has

prevented herbs from being swept up in this culture along with

acupuncture.

 

 

Jim Ramholz

[Guest guest]

, " Emmanuel Segmen " wrote:

I do not anticipate WM and CM integration in America unless Mao

reincarnates and invents the Microsoft of HMOs. I suppose this could

happen in America ... right, Jim? >>>

 

 

 

Emmanuel:

 

Actually, the Medical acupuncturists have been integrating CM into

Western institutions; including emergency rooms. They even have a

study on this subject. Their bottle neck is just waiting for

insurance companies to accept it more. So, no one is waiting for us

to lead the way because we have the longest training.

 

Understandably, classical herbalism probably won't be a regular part

of this picture of integration; while patent companies like Health

Concerns and Golden Flower may flourish in this new market.

 

On the other hand, those of us who are " real " acupuncturists and

herbalists can " integrate " into Western culture only to the extent

that we claim a percentage of the healthcare pie in private

practice, work in Western institutions, or work with WM specialists.

It seems unlikely that someone will invest in a CM outpatient center

or hospital here soon.

 

 

Jim Ramholz

[Guest guest]

While looking for Kuhn's book, Emmanuel, in the local library, I came

upon this instead. Enjoy

..

-Chad

 

"

God is twoing

God is threeing

God is multiplying

By dividing

The second law of thermodynamics—

Entropy—is also as we have learned

The law of increase of the Random Element

I.e., every system looses energy—but

Synergy means

Behavior of whole systems

Unpredicted by

The behavior of any separate part.

 

EN—ergy behaves entropically

SYN—ergy behaves syntropically.

God is entropy

And God is syntropy,

God is synergy.

God is energy.

And God is always

A verb—

The verbing of

Integrity.

"

 

-- Bucky Fuller

[Guest guest]

, " Emmanuel Segmen "

<susegmen@i...> wrote:

> Hey Chad,

>

> Thank you. You post is by far the best commentary on paradigms.

 

Paradigm theory is part of philosophy of science which is a rigourous

discipline. So, for instance, which of the twenty two ways in which

Kuhn uses " paradigm " ( Hacking, Representing and Intervening 1983)is

this the best commentary on? Or more generally, are you talking of

the relativist interpretation of Kuhn or the moderate historical

version?

 

The danger for CM of paradigm theory is that it can present a

feelgood philosophical quicksand whilst, I would suggest, that what

is needed is an underpinning of terminological ,philosophical and

scientific rigour.

 

Simon

 

> chadwick_m

>

> Saturday, July 26, 2003 8:54 PM

> Re: Paradigms of evidence

>

>

> While looking for Kuhn's book, Emmanuel, in the local library, I

came

> upon this instead. Enjoy

> .

> -Chad

>

> "

> God is twoing

> God is threeing

> God is multiplying

> By dividing

> The second law of thermodynamics-

> Entropy-is also as we have learned

> The law of increase of the Random Element

> I.e., every system looses energy-but

> Synergy means

> Behavior of whole systems

> Unpredicted by

> The behavior of any separate part.

[Guest guest]

, " Emmanuel Segmen "

<susegmen@i...> wrote:

>

> The danger for CM of paradigm theory is that it can present a

> feelgood philosophical quicksand whilst, I would suggest, that what

> is needed is an underpinning of terminological ,philosophical and

> scientific rigour.

>

> Simon

>

> Hi Simon,

>

> I like your post and thought I should first elaborate. My concern

with regard to much of the talk on this list is the notion that CM

and WM can be somehow seamlessly integrated or that they can inform

one another without regard to losses in translation.

 

The argumment against this, Emmanuel, accords with a moderate reading

of Kuhn and I think today few, in large part thanks to Kuhn, would

hold that this seamless integration is possible. The problem is with

the much more radical, relativist, reading; with it's implication

that in occupying different paradigms we are in a sense in different

worlds where, because our terminology and understanding is acultured

to those worlds, real translation is impossible, terms are

incommensurable and because there is no outside objective stand

point, anything goes.

 

It is very easy to slip between the two interpretations of Kuhn ( who

himself later disavowed the radical view)and the attractions of the

relativist position are obvious for CM as an easy philosophical

justification. However even if it were not a dubious philosophy, the

practical consequences are that scientific change is a power

struggle. In battle of the scientific worlds CM is a minnow. So a

good reason to be careful with talk of paradigms.

 

In fact I wrote the article on paradigms for the European Journal of

Oriental Medicine, a version of which is in the files, in response to

a report by the English House of Lords. CM theory was presented to it

as a paradigm existing independantly of WM and science. Their

response was basically, fine, then go off and exist independantly

(hence no funding ,research, integration into the health service etc)

and the status of the theory will be officially rated along side

crystal therapy. (Acupuncture did much better because no one talked

about theories let alone paradigms).

 

Simon