doctors and patients

[Guest guest]

, " "

<zrosenbe@s...> wrote:

 

We must be

> > cautious of using translational opinion to drive legislative and

> > regulatory agency agenda. That is occurring with the new accreditation

> > commission; they are using Deke's model as the basis for a scientific

> > approach to OM.

 

Is that really what is happening? I believe these new accreditors have

adopted Deke as their patron saint because his scholarship can give them

cover for their goals, which center around a fast track doctorate. I do

not think Deke's writings spurred this movement in any way. So his

translational opinion is not really the driving force for change. It is

being used by other forces towards an end, which appears to be actually

about status, power, title and of course, money. There are others with

essentially the same motivations who are working towards similar ends,

just utilizing different means. BTW, as least this new group is not

intending to do automatic grandfathering, but instead will require CEUs

and examination to become a DOM.

 

I don't like any of it personally. Is this patient centered medicine?

The one thing that sticks out about all the posturing on these things is

the absence of the patient from the discussion. I have tried to raise the

economic issue of entry level docs from the point of society and patients

on several occasions. Consider again one of the great scourges on

healthcare today. The cost of drugs. One such factor is the dispensing

of drugs, which has become much more expensive for society and patients

due to unnecessary overeducation of pharmacists. A tiered system would

have protected public safety, allowed some pharmacists to become doctors,

as necessary and kept down the cost of medicine overall. This is the

opinion of many in the field and was conveyed to me by my father, whose

career included owning a drugstore in the sixties, running NJ medicaid's

pharmaceutical services for over a decade and then another decade as a VP

at Merck. Of course, his position is biased by his lifelong commitment to

making social justice a central part of our capitalist system.

 

George Soros, the billionaire philanthropist, writes on this issue. Soros,

for those who don't know the name, is best known for being practically

singlehandedly responsible for the legalization of medical marijuana

throughout the western united states. Soros, in his writings on the open

society, makes a very strong case that unrestrained market influences do

not lead to a stable society. That social issues need to be actively

figured into the equation of any economic policy because it is a complete

utter fallacy that insuring the welfare of those delivering the products

or services will automatically translate into benefits for those receiving

them. By the way, that fallacy is called supply side economics and was

the hallmark of Reagan administration, whose policies actually led Soros

to fight back..

 

So the question is how does having an entry level DAOM benefit patients

and society more than a tiered system? If care is safe and effective and

cheap for most complaints commonly seen in an acupuncturist's office, why

should entry level be any more than the 1800 hours most people got back in

the eighties. Just limit and enforce scope. I mean people aren't

suggesting that the majority of acupuncturists in the country do not have

adequate training to safely practice at this time, are they? So how do

students benefit from spending huge sums for school, many of whom will be

in debt for decades? How do patients benefit by paying more for services?

How does society benefit as healthcare eats up more and more of people's

budgets?

Fact is according to Eisenberg at Harvard, most people do not use less WM

because they also use CM, so insurers will tell you that including our

services has not yet saved them a dime. Not till research proves we can

do certain things will people choose us as sole provider for the

complaints we prove we can treat. Currently most patients who see us are

also under physician care (96%). While arguably we could save society

huge sums of money by helping patients avoid surgery and expensive end of

life care, I am not sure how all of us being DAOMs would speed this goal.

In fact, it is not CM therapeutics that would be a major money saver in

this area anyway. We may help some people avoid back surgery or GYN

surgery, but diet and exercise discipline are absolutely necessary to cut

the extreme expense and high incidence of cardiovascular procedures. As

long as people are unwilling or unable to address such issues,the high

cost of unnecessary surgery will only be minimized slightly by our field.

And as many of you know, obesity is far higher now than it was 25 years

ago at the dawn of the modern field of TCM in america.

 

It is somewhat of a catch-22 this issue embodies. In order to justify to

legislatures that entry level must be a doctorate, one is effectively

arguing that current practitioners are unqualified to practice. Yet at

the same time, the same organizations are arguing to insurance companies

that acupuncture is safe as currently practiced. And then further

suggesting that only those who are entering the field actually need to

demonstrate doctoral level competency while those already in the field,

many with only 2400 hours of training should just be trusted to have

learned doctoral level medicine through isolated praxis.

 

 

 

Chinese Herbs

 

 

" Great spirits have always found violent opposition from mediocre

minds " -- Albert Einstein

[Guest guest]

I have just two small points to make in regard to your very well

thought-out and written argument for a multi-tiered educational system.

 

1) I think the main benefit of the doctorate is simply the change of

perception by the public and medical profession that they are clearly

dealing with primary health care professionals, rather than therapists.

We need to decide what our role is in the health care maze. Do we

want to just be therapists who work with limited complaints or under

M.D.'s, or do we want to be primary care providers on our own? For

example, I know that my own work is clearly primary care internal

medicine, and that I am not just practicing acupuncture, but herbal

medicine as well. This is not reflected in the title 'licensed

acupuncturist'.

 

2) While acupuncturists are presently practicing safely, how many can

we say are accurately practicing Chinese internal medicine, or true

Chinese diagnosis and pattern differentiation? I think the goal of

improving education has to be in producing practitioners who can truly

practice Chinese medicine beyond a cookbook or symptomatic level. This

should be the goal of doctorate, and truly any graduate level of

training.

 

 

On Wednesday, August 6, 2003, at 09:23 AM, wrote:

 

> So the question is how does having an entry level DAOM benefit

> patients and society more than a tiered system? If care is safe and

> effective and cheap for most complaints commonly seen in an

> acupuncturist's office, why should entry level be any more than the

> 1800 hours most people got back in the eighties. Just limit and

> enforce scope. I mean people aren't suggesting that the majority of

> acupuncturists in the country do not have adequate training to safely

> practice at this time, are they? So how do students benefit from

> spending huge sums for school, many of whom will be in debt for

> decades? How do patients benefit by paying more for services? How

> does society benefit as healthcare eats up more and more of people's

> budgets?

>

[Guest guest]

Todd -

 

I think you are misinterpreting my statement. I did not suggest that Deke's

academic " writings spurred this movement in any way. " Rather, I am referring to

the use of his materials to define political and legislative agenda when I state

" We must be cautious of using translational opinion to drive legislative and

regulatory agency agenda. That is occurring with the new accreditation

commission; they are using Deke's model as the basis for a scientific... " This

is an observation about specific commentary and behavior citing Deke's book as

the basis for curricular development by the new commission.

 

Will

 

In a message dated 8/6/2003 12:23:01 PM Eastern Daylight Time,

writes:

We must be > > cautious of using translational opinion to drive legislative and

> > regulatory agency agenda. That is occurring with the new accreditation > >

commission; they are using Deke's model as the basis for a scientific > >

approach to OM. Is that really what is happening? I believe these new

accreditors have adopted Deke as their patron saint because his scholarship can

give them cover for their goals, which center around a fast track doctorate. I

do not think Deke's writings spurred this movement in any way. So his

translational opinion is not really the driving force for change. It is being

used by other forces towards an end, which appears to be actually about status,

power, title and of course, money. There are others with essentially the same

motivations who are working towards similar ends, just utilizing different

means. "

[Guest guest]

, " "

<zrosenbe@s...> wrote:

> I have just two small points to make in regard to your very well

> thought-out and written argument for a multi-tiered educational

system.

>

> 1) I think the main benefit of the doctorate is simply the change

of

> perception by the public and medical profession that they are

clearly

> dealing with primary health care professionals, rather than

therapists.

> We need to decide what our role is in the health care maze. Do

we

> want to just be therapists who work with limited complaints or

under

> M.D.'s, or do we want to be primary care providers on our own? For

> example, I know that my own work is clearly primary care internal

> medicine, and that I am not just practicing acupuncture, but herbal

> medicine as well. This is not reflected in the title 'licensed

> acupuncturist'.

>

 

Agreed, But the schools need something that they don't have... A real

clinic/ hospital to actually see patients. And with that maybe some

clinical trials can show that we can preform on this level...

 

-

[Guest guest]

I have agreed and championed this idea for some time. Clearly we need

TCM hospitals in the West to move to another level of patient care.

Stuart Watts has also talked about this necessity for a long time, and

I believe Bob Flaws is presently attempting to develop this type of

project. Alas, funding is difficult to come by for such things.

 

 

On Thursday, August 7, 2003, at 07:21 AM, wrote:

 

> Agreed, But the schools need something that they don't have... A real

> clinic/ hospital to actually see patients. And with that maybe some

> clinical trials can show that we can preform on this level...

>

> -

[Guest guest]

:

> > Agreed, But the schools need something that they don't have... A

real

> > clinic/ hospital to actually see patients. And with that maybe

some

> > clinical trials can show that we can preform on this level...

 

Z'ev:

> I have agreed and championed this idea for some time. Clearly we

need

> TCM hospitals in the West to move to another level of patient

care.

 

Alwin:

Here in the Netherlands, though everything is on a small scale, my

Shenzhou Open University is connected to the Chinese Medical Centre

which is used for 'life patient treatment' as part of the education.

 

Another institute has agreements with several private practitioners

to provide for 'life patient treatment'.

 

How are those things arranged in the USA?

 

Alwin