Paradigms of evidence

[Guest guest]

, " Alon Marcus " <

alonmarcus@w...> wrote:

Much of what we do in the so-called medical approaches to acupuncture are

highly influenced by osteopathic research on somatovisceral, facilitated

segments etc.

> Alon

 

Its a good point and also brings up the issue of training. could an osteopath

or

chiropractor learn to practice TCM in 200 hours. definitely not. Assuming

they already do trigger point work, etc., could they learn how to safely use one

of the various modern orthopedic approaches to acupuncture in 200 hours? I

think the answer might be yes. I wonder what will happen if we fight tooth

and nail to keep such px from doing acupuncture while at the same time there

may be a body of research developing to support their approach. In fact, one

could probably muster up more peer-reviewed information at this point to

support using a physiological and/or orthopedic approach to acupuncture than

a classical or traditional one.

 

On the other hand, lets hypothetically assume that such other practitioners

(DO,MD,DC) should not be allowed to call what they are doing as TCM, CM,

meridian therapy, acupuncture, etc. If they want to call it needle therapy or

some such thing, fine. But perhaps we should focus on making the case that

terms such as acupuncture and TCM relate to a body of theory and knowledge.

If one does not use that body of knowledge, one is not practicing acupuncture.

Perhaps we should fight the idea that merely sticking needles in the body

constitutes acupuncture and take control of the term. However we may have

to resign ourselves to the fact that the clinical evidence will prove so-called

medical acupuncture is safe and effective for a wide range of conditions.

fighting the battle on the point that such practitioners are not safe or

effective

will probably ultimately be a losing one. so the question is how to effectively

make the case that is misleading to the public to allow such osteopathic

needlers to call what they do CM or acupuncture.

 

Now let me play my own devil's advocate. Its interesting when one begins to

pursue a political case based upon a supposedly logical argument and then

finds that the logic comes back to bite one's own hindquarters. The position

stated above certainly begs the question about those within our own

profession who also do not actually practice anything resembling the classical

tradition (such as NAET). To be clear, I have no trouble with people doing

muscle testing. Though I firmly believe it has been proven experimentally to

NOT work, I say caveat emptor. If some people believe it helps them, who am

I to complain.

 

But I also think that the buyer cannot really properly beware if he is misled.

so to portray something as rooted in our 2000 year old tradition, when it is

nothing of the sort (whether NAET or orthopedic style acupuncture) is really

deceptive. To be honest, I have no idea how NAET is portrayed to patients. If

it focuses solely on the questionable idea of energetic allergy elimination with

no mention of chinese medicine, then perhaps its not so bad. However since

those practicng it are mostly L.Ac., there is an implicit assumption that it is

part of the tradition. Should all such px make it clear to their patients that

they are using needles to effect a different purpose than the chinese ever

conceived of. that the procedure is based on modern ideas, but there is as of

yet no research to confirm it. lacking either tradition or modern confirmation,

it essentially constitues an experiment and should require precise informed

consent. Right?

 

[Guest guest]

At 3:57 PM +0000 8/8/03, wrote:

But perhaps we should focus on making

the case that

terms such as acupuncture and TCM relate to a body of theory and

knowledge.

If one does not use that body of knowledge, one is not practicing

acupuncture.

Perhaps we should fight the idea that merely sticking needles in the

body

constitutes acupuncture and take

control of the term...

 

Now let me play my own devil's

advocate. Its interesting when one begins to

pursue a political case based upon a supposedly logical argument and

then

finds that the logic comes back to bite one's own hindquarters.

The position

stated above certainly begs the

question about those within our own

profession who also do not actually

practice anything resembling the classical

tradition (such as

NAET).

--

Surely there's a difference between the case of the LAc/NAET

practitioner, and the untrained practitioner using acupuncture.

 

A licensed acupuncturist is trained and tested on a certain body

of knowledge deemed necessary to the practice of acupuncture, but is

not restricted to that body of knowledge when performing acupuncture

therapy. Likewise, a chiropractor, for example, is trained and tested

on a certain body of knowledge to perform chiropractic therapy. The

training and testing justifies the use of the therapy by the

practitioner. Neither is justified in using the therapy of the

other, because they aren't trained to do so.

 

When a acupuncturist uses a different or new diagnostic technique

to justify their acupuncture treatment, they are doing so using their

(don't laugh) informed judgement, based on their training, which they

can always fall back on. A chiropractor, or other untrained

practitioner, has nothing to fall back on except luck. So the LAc/NAET

practitioner is in a different situation to the non-acupuncturist when

it comes to using acupuncture needles. The fact that the LAc in this

case may have squeaked through training and licensing, and is now

relying on NAET because of unwillingness or incompetence to apply

their training is regrettable, but there are such people in all fields

of medicine, and this doesn't negate the general principle.

 

I think the LAc/NAET practitioners place themselves at risk as

individuals, rather than the profession as a whole, as they are

clearly not within the standard of practice.

 

Rory

--

[Guest guest]

At 3:57 PM +0000 8/8/03, wrote:

However we may have to resign

ourselves to the fact that the clinical evidence will prove so-called

medical acupuncture is safe and effective for a wide range of

conditions. fighting the battle on the point that such

practitioners are not safe or effective will probably ultimately be a

losing one.

--

 

I agree, but it would be interesting to see them try to justify

it as effective. In a discussion with a research member of AAMA

a couple of years ago, he told me that, in his opinion, only one

protocol for one medical condition has been shown in the literature

with reasonable certainty to be effective: Pc 6 etc for morning

sickness.

 

Rory

--

[Guest guest]

 

 

I strongly suggest that you publish these thoughts in AT so that more

practitioners would be exposed to them. Perhaps an expanded version. I

think it'd rattle a few cages. Should be fun.

 

Bob

 

, " " <@i...>

wrote:

> , " Alon Marcus " <

> alonmarcus@w...> wrote:

> Much of what we do in the so-called medical approaches to

acupuncture are

> highly influenced by osteopathic research on somatovisceral,

facilitated

> segments etc.

> > Alon

>

> Its a good point and also brings up the issue of training. could an

osteopath or

> chiropractor learn to practice TCM in 200 hours. definitely not.

Assuming

> they already do trigger point work, etc., could they learn how to

safely use one

> of the various modern orthopedic approaches to acupuncture in 200

hours? I

> think the answer might be yes. I wonder what will happen if we

fight tooth

> and nail to keep such px from doing acupuncture while at the same

time there

> may be a body of research developing to support their approach. In

fact, one

> could probably muster up more peer-reviewed information at this

point to

> support using a physiological and/or orthopedic approach to

acupuncture than

> a classical or traditional one.

>

> On the other hand, lets hypothetically assume that such other

practitioners

> (DO,MD,DC) should not be allowed to call what they are doing as TCM,

CM,

> meridian therapy, acupuncture, etc. If they want to call it needle

therapy or

> some such thing, fine. But perhaps we should focus on making the

case that

> terms such as acupuncture and TCM relate to a body of theory and

knowledge.

> If one does not use that body of knowledge, one is not practicing

acupuncture.

> Perhaps we should fight the idea that merely sticking needles in the

body

> constitutes acupuncture and take control of the term. However we

may have

> to resign ourselves to the fact that the clinical evidence will

prove so-called

> medical acupuncture is safe and effective for a wide range of

conditions.

> fighting the battle on the point that such practitioners are not

safe or effective

> will probably ultimately be a losing one. so the question is how to

effectively

> make the case that is misleading to the public to allow such

osteopathic

> needlers to call what they do CM or acupuncture.

>

> Now let me play my own devil's advocate. Its interesting when one

begins to

> pursue a political case based upon a supposedly logical argument and

then

> finds that the logic comes back to bite one's own hindquarters. The

position

> stated above certainly begs the question about those within our own

> profession who also do not actually practice anything resembling the

classical

> tradition (such as NAET). To be clear, I have no trouble with

people doing

> muscle testing. Though I firmly believe it has been proven

experimentally to

> NOT work, I say caveat emptor. If some people believe it helps

them, who am

> I to complain.

>

> But I also think that the buyer cannot really properly beware if he

is misled.

> so to portray something as rooted in our 2000 year old tradition,

when it is

> nothing of the sort (whether NAET or orthopedic style acupuncture)

is really

> deceptive. To be honest, I have no idea how NAET is portrayed to

patients. If

> it focuses solely on the questionable idea of energetic allergy

elimination with

> no mention of chinese medicine, then perhaps its not so bad.

However since

> those practicng it are mostly L.Ac., there is an implicit assumption

that it is

> part of the tradition. Should all such px make it clear to their

patients that

> they are using needles to effect a different purpose than the

chinese ever

> conceived of. that the procedure is based on modern ideas, but

there is as of

> yet no research to confirm it. lacking either tradition or modern

confirmation,

> it essentially constitues an experiment and should require precise

informed

> consent. Right?

>

 

[Guest guest]

 

Its interesting when one

> begins to

> > pursue a political case based upon a supposedly logical argument

and

> then

> > finds that the logic comes back to bite one's own hindquarters.

The

> position

> > stated above certainly begs the question about those within our

own

> > profession who also do not actually practice anything resembling

the

> classical

> > tradition (such as NAET).

 

What would your response likely be to

an initiative coming from Chinese quarters,

for example, based on the argument that what

Americans do under the banner of traditional

Chinese medicine is not in conformity with the

knowledge base of the subject and should

therefore not be allowed to be known as

traditional Chinese medicine?

 

I'd say the collective hindquarters of

" the profession " are extremely exposed

to this kind of biting. After all, much

of the cohort of L.Ac's in the States

could not even pass a test on the

nomenclature of Chinese medicine.

 

What you are talking about is nothing

more and nothing less than the definition

of terms, in particular the basic terms

such as " acupuncture " and " Chinese medicine. "

 

A comprehensive initiative to put in

place a common set of terms in the

subject, far from being merely an

often heard argument from myself and

others, would be a major step forward

in confronting and dealing with the

situation that concerns everyone so

profoundly.

 

Ken

[Guest guest]

, " kenrose2008 " <

kenrose2008> wrote:

 

>

> What would your response likely be to

> an initiative coming from Chinese quarters,

> for example, based on the argument that what

> Americans do under the banner of traditional

> Chinese medicine is not in conformity with the

> knowledge base of the subject and should

> therefore not be allowed to be known as

> traditional Chinese medicine?

 

If anyone ever got the impression that I do not think that the native chinese

are the subject matter experts at TCM, they are gravely mistaken. My critique

of the role of SOME chinese in our TCM educational system has nothing at all to

do with content or knowledge and everything to do with style. I have long

allied myself with the chinese professors on the issue of content. It is the

issue of class structure upon which I differ with many I have met. To

reiterate, according to Karstens, once upon a time the modern chinese adopted

the early 20th century german university educational model. I reject this

model as obsolete just as all major med schools have done (including german

ones). It is not chinese anyway and they should have no allegiance to it,

either. I would welcome a chinese initiative on the bastardization of the

profession with regard to all the MSU. I think many chinese and many

americans feel similarly about this content issue.

 

[Guest guest]

Todd:

I agree with your post 100%. I like your term " bastardization of the

profession " because this is exactly what is happening. The schools

don't seem to care because they have no economic incentive to care.

 

Warren

 

> If anyone ever got the impression that I do not think that the

native chinese

> are the subject matter experts at TCM, they are gravely mistaken.

My critique

> of the role of SOME chinese in our TCM educational system has

nothing at all to

> do with content or knowledge and everything to do with style. I

have long

> allied myself with the chinese professors on the issue of content.

It is the

> issue of class structure upon which I differ with many I have met.

To

> reiterate, according to Karstens, once upon a time the modern

chinese adopted

> the early 20th century german university educational model. I

reject this

> model as obsolete just as all major med schools have done (including

german

> ones). It is not chinese anyway and they should have no allegiance

to it,

> either. I would welcome a chinese initiative on the bastardization

of the

> profession with regard to all the MSU. I think many chinese and

many

> americans feel similarly about this content issue.

>

 

[Guest guest]

At 3:07 PM +0000 8/9/03, wrote:

I would welcome a chinese initiative

on the bastardization of the

profession with regard to all the

MSU.

--

 

What sort of initiative have you in mind?

&

Can you give some examples of bastardization of the

profession...MSU?

 

Rory

--

[Guest guest]

, " " wrote:

>>> However we may have to resign ourselves to the fact that the

clinical evidence will prove so-called medical acupuncture is safe

and effective for a wide range of conditions. . . fighting the

battle on the point that such practitioners are not safe or

effective will probably ultimately be a losing one. >>>

 

We lost this battle a long time ago. They also have their own

research foundation that offer awards for important research. It

seems that in this country the most research is being done by

medical acupuncturists.

 

" MARF Research contest winners awarded

 

Winners of Medical Acupuncture Research Foundation's annual

Acupuncture Research Award, chaired by Michael Santoro, MD, were

announced at AAMA's 15th annual Symposium in Baltimore. Sponsored by

Seirin America and Oriental Medical Supplies, the MARF competition

awarded the following submissions:

 

First Place: Jay P. Shah, MD, of the National Institutes of Health

" The Use of a Novel, Microdialysis/Acupuncture Needle to Assess the

Neurochemical Milieu in Active and Latent Myofascial Trigger Points

in the Upper Trapezius Muscle at GB-21 "

First place won $3,000, Symposium registration, three nights hotel,

$750 towards expenses and presented his paper to the general

membership for an hour on Sunday morning.

Second Place: Teh-Ching Chu, PhD, LAc, other authors include: Robin

Socci, PhD, Lisa Zhong, MD, PhD, Jane Chu, BS and Craig Croson, PhD

" Mechanisms of Electroacupuncture-Induced Ocular Hypotension "

Second place won $2,000, Symposium registration, received

recognition before the general membership and $750 towards expenses.

Third Place: Sun Wei-Zen, MD

" Intensity-dependent, but not nociperception-dependent, analgesia

effect by electroacupuncture: behavioral correlates of c-fos

expression in rat spinal cord dorsal horn "

Third place won $1,000, Symposium registration, received recognition

before the general membership and $750 towards expenses. "

 

 

We need to stick with our strengthes: the scope of our education

system and getting people better. Although, MAs can argue that, with

seminars and conferences, our " extra " education is moot--they are

also into pulses, 5-Elements, scalp acupuncture, and herbs.

 

So we certainly need to promote ourselves better. We need to

establish equivalent degrees and social institutions. If we've

learned nothing else, we should realize that relentless self-

promotion will help the profession more than anything else.

 

 

Jim Ramholz

[Guest guest]

Will:

When I said the schools don't seem to care I was only talking about

the proliferation of MSU. PCOM is equally commited to curriculum

developement and I don't complain about teacher salaries because I

agree with your assessments. It's the bastardization of the medicine

that bothers me . And the schools seem to turn a blind eye to it.

Warren

 

 

, WMorris116@A... wrote:

>

> > The schools

> > don't seem to care because they have no economic incentive to

care.

> >

>

>

> Hi Warren et al -

>

> While I agree the schools have little economic incentive, I believe

they do

> care. A Masters Degree in OM is roughly $100-$120 per quarter unit

whereas the

> average national per quarter unit is $550...and that is often

subsidized. The

> ability of acupuncture schools to pay adequate salaries to faculty

is directly

> related to the cost of doing business vs. revenue stream.

>

> I took a cut in salary as a six figure a year practitioner in order

to give

> back to the field. It was also selfish, I wanted to get back into a

stream of

> senior influential practitioners from China, something we are

fortunate to have

> at Emperor's College. So here I sit as Academic Dean having given up

a

> portion if my retirement in order to contribute to program

development, faculty

> development and serve in professional organizations. And it feels

weird to be

> demonized along with the schools since I do administrate, teach and

practice in

> one.

>

> I offer this as an example not a complaint, because I feel truly

happy and

> aligned with my destiny, committed to the development of this

medicine.

>

> Best regards,

>

> Will

[Guest guest]

Will,

 

Your statement below got me thinking and

raised a few questions in my mind.

>

> While I agree the schools have little economic incentive, I

believe they do

> care.

 

They are businesses, right?

 

Businesses exist in order to pursue and exploit

economic benefits, right?

 

I can understand that the individuals within

a business might be motivated by " care " .

But it is harder for me to get the idea

of a business " caring " about, well, anything.

 

I can understand what a business cares about

by observing the conduct and overall behavior

of that business. Of course, this is true of

individuals as well.

 

So here are my questions:

 

What do you see that the schools care about

beyond their economic incentives?

 

In the case of your school, what actions has

it taken that demonstrate this care?

 

Ken

[Guest guest]

Will,

 

My questions weren't meant as a challenge.

They were meant to try and clarify and

concretize the discussion of economics

versus care. You said you agreed that

the schools had little economic incentive

to improve quality but that they cared

anyway. I didn't understand what that

meant and justwanted to know what you

were talking about. Thank you for taking

the time to reply.

 

I have another question.

 

Can you give a ballpark figure as to

how much money your school spends on the

various efforts and initiatives described

in your reply? I'm not asking for an

accounting. Just trying again to somehow

come to grips with the notion of

care about such issues and how it acutally

manifests in real world terms.

 

What percentage, for example, of the

gross income of your school is spent

on the various activities you describe?

 

Do you know how this compares to other

schools?

 

With the economy in poor condition and

with the resulting pressures on income,

are any of the programs and initiatives

you mention in jeopardy of losing their

funding? I guess what I'm trying to get

at here is a sense of priority of

committments on the part of the management.

 

Is there a general sense among the various

schools, either formally or informally,

of what constitutes caring about the

profession? And if so, can you summarize

it?

 

I'm asking because I truly do not know.

 

Sorry if the inquiry makes you feel

unduly challenged or put upon. But I

think that it comes with the territory.

 

No?

 

Ken

 

PS. I do not mean to single you or your

school out by asking along these lines.

I hope that others on the list from other

schools will also take time to reply

and help us all understand precisely

as possible what people mean when they

compare economic incentives and interest

with care.

[Guest guest]

Z'ev:

On more than one occasion within the last couple of months (and this

happens on a regular basis)I have become aware that entire three hour

points classes have been devoted to muscle testing. Now you can think

what you will about muscle testing but we teach in a school where the

students' hands on Chinese Medical diagnostic skills are woefully

lacking.And they are the first to admit it.How about a three hour

class in pulse diagnosis or abdominal palpation, etc? Also the entire

orthopedic acu class(42 hours)is based on motor point theory, not TCM

channel theory, which the students are never exposed to hands on. I

could go on and on. I think you get my point. I'm for teaching Chinese

medicine in a Chinese medicine school. If students want to do outside

workshops on whatever, that's on them. But they first need to learn

Chinese medicine, and with all the western medicine now getting thrown

at Pcom students I am seeing a generally more intelligent group of

students leaving school with minimal understanding of Chinese

medicine.

Warren

 

-- In , " "

<zrosenbe@s...> wrote:

> While I agree with you, Warren, I'd be interested in some specific

> examples of MSU in the classroom. You don't need to mention

specific

> teachers, just incidents that you are aware of.

>

>

> On Saturday, August 9, 2003, at 04:37 PM, wsheir wrote:

>

> > Will:

> > When I said the schools don't seem to care I was only talking

about

> > the proliferation of MSU. PCOM is equally commited to curriculum

> > developement and I don't complain about teacher salaries because I

> > agree with your assessments. It's the bastardization of the

medicine

> > that bothers me . And the schools seem to turn a blind eye to it.

> > Warren

[Guest guest]

Z'ev:

I don't think NAET, muscle testing, etc. have any place at all,not

even dessert,in pcom's classrooms.This is the bastardization of the

medicine that I refer to, and this doesn't even include the MSU of

some of the instructors who are clearly fudging their TCM knowledge.

Students are woefully deficient in practically all basic TCM skills:

needling, palpation, pulse taking, diagnosing, prescribing herbs, you

name it.Classroom time is precious.

Warren

 

In , " " <zrosenbe@s..

..> wrote:

> Warren,

> I wasn't aware of this situation, and I am very disappointed to

hear

> it. I agree 100% we should be teaching core Chinese medical

cirriculum

> first, with the other stuff as dessert.

>

>

> On Saturday, August 9, 2003, at 11:54 PM, wsheir wrote:

>

> > Z'ev:

> > On more than one occasion within the last couple of months (and

this

> > happens on a regular basis)I have become aware that entire three

hour

> > points classes have been devoted to muscle testing. Now you can

think

> > what you will about muscle testing but we teach in a school where

the

> > students' hands on Chinese Medical diagnostic skills are woefully

> > lacking.And they are the first to admit it.How about a three hour

> > class in pulse diagnosis or abdominal palpation, etc? Also the

entire

> > orthopedic acu class(42 hours)is based on motor point theory, not

TCM

> > channel theory, which the students are never exposed to hands on.

I

> > could go on and on. I think you get my point. I'm for teaching

Chinese

> > medicine in a Chinese medicine school. If students want to do

outside

> > workshops on whatever, that's on them. But they first need to

learn

> > Chinese medicine, and with all the western medicine now getting

thrown

> > at Pcom students I am seeing a generally more intelligent group of

> > students leaving school with minimal understanding of Chinese

> > medicine.

> > Warren

> >

> > -- In , " "

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

> >> While I agree with you, Warren, I'd be interested in some

specific

> >> examples of MSU in the classroom. You don't need to mention

> > specific

> >> teachers, just incidents that you are aware of.

> >>

> >>

> >> On Saturday, August 9, 2003, at 04:37 PM, wsheir wrote:

> >>

> >>> Will:

> >>> When I said the schools don't seem to care I was only talking

> > about

> >>> the proliferation of MSU. PCOM is equally commited to curriculum

> >>> developement and I don't complain about teacher salaries because

I

> >>> agree with your assessments. It's the bastardization of the

> > medicine

> >>> that bothers me . And the schools seem to turn a blind eye to

it.

> >>> Warren

> >

> >

> >

[Guest guest]

I'll weigh in on this in a few sweeping generalizations. ;-)

The problem I see is that the schools have consumer students. Some of these

students do not do as well as they would like. They study their butts off to get

B's and

A's which they feel they deserve (because they are paying for it as well as

doing full

time jobs or raising a family etc..). Often the criteria upon which they are

tested is

ambiguous or based on memorization and a number of antiquated teaching methods.

Dissatisfied students complain loudly to the administration or to the

teacher,(who

may be unused to complaining students). The teacher makes their life easier by

making the classes and tests easier. The A students get bored by the 3rd

semester

and want more than is being offered. Since the TCM teachers can't get deeper

without

long and complicated discussions the students go outside of the curriculum to

find

the " real " medicine which they realize can't be the repetition of Zang-fu

patterns

semester after semester. A loop is created where some students breeze through

the

curriculum while trying to pick the esoteric elements provided by other willing

faculty.

Other students try to keep up with what is being taught and delve into other

methods

because they are more dynamically taught and stimulating.

 

doug

 

 

> As a recent graduate and tutor of fellow students,Unfortunately, most students

I've

met

> expect to be spoon-fed, and do not act as the

> discriminating consumers you describe.

>

>

> --- Julie Chambers <info@j...> wrote:

> > Hi Andrea,

 

> > > Students don't complain because they don't know

> > what

> > > they need to know, and what its superfluous to the

> > > practice of .> >

> >

> > Julie

[Guest guest]

I would like to chime in on the educational process that seems to be

a ongoing debate of this group. I am a third year student at MWCOM.

Our curriculum is somewhat different than PCOM. I feel that the

major failing of MWCOM is that there is not enough TCM study. We do

not study any Classics, treatment strategy is taught using one book,

technique of needling is dependant on the instructors viewpoint, and

herbal medicine is brute memorization.

 

I'm also aware of the lack of supervision of students in the clinic.

We have a very busy clinic and at times there can be no thought

process in learning the best treatment plan because of time

restrictions. In addition, I am sometimes amazed at how a previous

student has treated a patient.

 

And finally, as for the testing methods, most student feel that A is

the only grade they deserve.