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[Guest guest]

> " The ax that I am grinding is that people should come into the

> profession understanding enough about Chinese medicine as a human

> intellectual art, and as a history of human enterprise, to make

> reasoned judgments about the ideas, products and leaders they are

> offered. Critiquing and discussing the ideas that motivate opinion

> about the profession is an important aspect of professional

> development. "

 

This is a good idea. But I think it should be seen in the larger

context of exploration of issues and territory pointed at by Scheid,

Unschuld, etc., and in the narrower Western side of things, Kuhn etc.

 

If we don't undertake this larger project, I think there's a notable

threat that our profession will not resist pressure from the

biomedical field.

 

By the way, in response to Bob Flaw's points about the standard of

students doing normal Masters Degree level and medical school

courses, the problematic issues we face practising CM are, in my

opinion, much more complex than those dealt with in normal university

courses, which in Kuhn's terminology, pretty much involve

straightforwardly pursuing 'normal science', or its equivalent in

non-science courses. That sort of stuff is easy, really.

 

Will we rise to the challenges that face us? Quite honestly, I have

grave doubts about this, partly because I don't see that leaders in

our field, including educators, are taking these issues seriously

enough, and there is always a great temptation to gain acceptance and

prestige by making compromises with people who approach these matters

with biomedical/scientific assumptions.

 

Wainwright

[Guest guest]

At 3:13 AM +0000 10/30/03, kenrose2008 wrote:

>then I'd

>tend to see the situation not as a failing

>of students but as a failing of the

>institutions that 1) accept them as

>students; and 2) fail them further by

>not ensuring that they measure up or

>get out.

--

Ken,

 

I think this is exactly right.

 

Entry into ACAOM accredited schools requires only 60 units community

college with a 2.0 gpa. Schools I know of allow these requirements to

be filled in massage school, not even community college. Obviously,

this is a totally inadequate preparation for a masters level program.

 

This situation is driven by the fact that there are too many OM

colleges in competition with each other for new students. The schools

I'm aware are generally interested in packing as many students as

possible into their program, regardless of suitability or

preparedness. If a better school dismisses a student, he will usually

find another with lower standards willing to take him.

 

ACAOM should develop higher standards of entry prerequisites in terms

of subject matter and performance. However, the relationship of the

schools with ACAOM makes this unlikely, and seems to be pretty much a

closed circuit. ACAOM relies for it's income on schools paying

accreditation process fees. In these circumstances professional

practitioner views on standards are unlikely to prevail over the

financial interests of school owners.

 

Rory

--

 

 

 

[Guest guest]

Hi Ken

 

From my Dutch view on these matters:

 

> So I ask you...and everyone else,

> where does this attitude come from?

> From what body of experience, thought,

> writing or other source does the notion

> emerge that one need not be well prepared

> to study Chinese medicine?

 

This attitude comes from the view in our western society that,

Acupuncture and TCM being part of the " alternative scene " , it is not

a serious subject and is studied by housewives who have to much time

at their hands. Just as you can study massage without specific

prerequisites, so you can acupuncture, tcm, feng shui, Bach Flowers,

etc.

 

This view comes from an attitude that things that we westerners did

not discover, can't be as good as the things we did discover

ourselves and that medical treatments that aren't supported by the

regular channels of medical science can't be as good as regular

western medicine. There is a holy reverence for people wearing white

coats. Only last week I spoke a psychologist who thought that

acupuncture was " something spiritual " .

 

This comes from a gross ignorance among the general public about the

history and the efficacy of TCM. A lot of publicity about the

successes of TCM in the popular media, is one of the approaches that

should change public opinion. Targeting the general public instead of

science would be much more effective in my opinion. Politicians are

only " normal " people.

 

 

Alwin

[Guest guest]

A few points -

 

Competition - this is indeed a big issue in terms of admitting students.

When Harvard medical school started requiring that students med students be

in school for 3 years and not simply repeat the studies of the 1st year in

the 2nd year, they nearly folded - but were able to maintain because of the

backing of the institution. It takes a brave school to try to make these

changes. ACTCM used to require a bachelor's degree for entry. I don't

know if they still do - but, I have to say that given the state of higher

education in this country, I'm not really sure that it makes any

difference. I have seen some pretty amazingly poorly educated college

graduates - and some extremely bright, excellent scholars with only 2 years

of undergrad. So, perhaps the issue is not simply raising the requirements

for undergrad training, but finding some other solutions.

 

One solution that has been discussed is to admit students to the academic

program but (the first year) but require that they apply to the clinical

program and that the application be reviewed by all of the faculty of the

first year - this gives the faculty an opportunity to evaluate the student

both academically and in terms of their interpersonal skills - also

important to the practice. This requires a different amount of faculty

involvement - it also requires somewhat smaller programs - I think it is

hard to do this kind of a process when you are evaluating 25 - 100 students

every 3-4 months.

 

The other reallyimportant thing is to start helping prospective students to

get a clear idea of what they should be studying as undergrad

students. Most pre-med college students know exactly what they need to do

to get in to med school and that they probably won't get in if they

don't. I of course think that students should study Chinese, Chinese

history/philosophy, certain of the biosciences (biology, chemistry, etc.)

and also have a few classes where they are required to do critical reading

and writing - anthropology, english, something. I hope that as we move

toward having more schools that are integrated into mainstream, regionally

accredited colleges that some of this will be a natural evolution.

Remember, that just 20 years ago it was possible to study CM with only a

high school degree. We have moved forward, quite rapidly in fact, and we

continue to do.

 

IF a few schools are able to start raising their standards, and in fact,

refusing admission to students they feel are unqualified, in time, other

schools will have to work to reach these same standards Perhaps I am being

naive - but the changes that I have seen in education over the last 13

years are pretty marked - not yet where we can be, but definitely moving

forward.

 

I agree that most Master's level programs are not really that - but also

remember that many Master's degrees are completed in 2 years (not 4) and

are, in many ways, much less rigorous than our programs. This is to say,

that the first 2 years (60 credits) of our programs are actually classified

as undergraduate and the remained as graduate. If a student is not

qualified for entry after those first 60 credits, perhaps that is a good

time to ask them to leave - with a Bachelor's degree but not a master's

thus, excluding them from practice. Those schools that have 1st year

comprehensive exams do weed out many students after the first year. More

such weeding is needed, but let's not throw out the baby with the bath water.

 

More to come later - I have to go.

 

Marnae

At 08:57 AM 10/30/2003 -0500, you wrote:

>At 3:13 AM +0000 10/30/03, kenrose2008 wrote:

> >then I'd

> >tend to see the situation not as a failing

> >of students but as a failing of the

> >institutions that 1) accept them as

> >students; and 2) fail them further by

> >not ensuring that they measure up or

> >get out.

>--

>Ken,

>

>I think this is exactly right.

>

>Entry into ACAOM accredited schools requires only 60 units community

>college with a 2.0 gpa. Schools I know of allow these requirements to

>be filled in massage school, not even community college. Obviously,

>this is a totally inadequate preparation for a masters level program.

>

>This situation is driven by the fact that there are too many OM

>colleges in competition with each other for new students. The schools

>I'm aware are generally interested in packing as many students as

>possible into their program, regardless of suitability or

>preparedness. If a better school dismisses a student, he will usually

>find another with lower standards willing to take him.

>

>ACAOM should develop higher standards of entry prerequisites in terms

>of subject matter and performance. However, the relationship of the

>schools with ACAOM makes this unlikely, and seems to be pretty much a

>closed circuit. ACAOM relies for it's income on schools paying

>accreditation process fees. In these circumstances professional

>practitioner views on standards are unlikely to prevail over the

>financial interests of school owners.

>

>Rory

>--

>

>

>

[Guest guest]

Will we rise to the challenges that face us? Quite honestly, I have

grave doubts about this, partly because I don't see that leaders in

our field, including educators, are taking these issues seriously

enough, and there is always a great temptation to gain acceptance and

prestige by making compromises with people who approach these matters

with biomedical/scientific assumptions.

>>>This is because all the schools are commercial enterprises with the bottom

line being the number one issue. They cannot afford to have strict entrance and

maintenance criteria

Alon

 

 

[Guest guest]

Ken,

 

" I'd tend to see the situation not as a failing of students but as a

failing of the institutions that 1) accept them as students; and 2)

fail them further by not ensuring that they measure up or get out. "

 

I completely agree withn this, but I don't see it happening.

 

" I think this is an important point, but I don't think that it is best

portrayed as an indictment of the students themselves. After all, if a

student really does not belong in a program to train him or her to be

a doctor of Chinese medicine, then what is he or she doing there? "

 

Sorry, I didn't mean it to be an indictment of the students. I agree,

it's not their fault. What I meant was that I think Bob's (and my and

your) desires for the profession are far from reality and that,

without overhaul of our educational process we are not going to see

the level of professional discourse improve.

 

" I think that this list is representative of the level of discourse in

this profession. "

 

I wish it were. But I think this list is a self-selected group of more

than average practitioners and students. The fact that such a small

group regularly posts on this forum I think supports this belief. I

still believe the articles in AT are more representative of the wants,

abilities, and propensities of the rank and file.

 

" One thing one notices about traditional Chinese thinking is that it

is not based on the proposition that all men are created equal or that

we are endowed by our creator with certain inalienable

rights. "

 

For sure, the overwhelming majority of famous Chinese medical authors

were members of an intellectual elite in China. What I was getting at

is that perhaps Bob's, your, and my desires are ivory-towerist. I

guess I was/am still influecned by your call for self-disclosure.

You've said that you're skeptical about everything. I was just trying

to introduce some skepticism to Bob's call for a heightened

intellectual discourse.

 

" Once we agree that we're all elitists, then what? "

 

What do you mean by " all? " I don't accept the proposition that all

members of our profession are intellectually equal in terms of either

ability or achievement. Let me just talk about myself. Recognizing

that my aptitudes and achievements are relatively unique, is it fair

or reasonable to expect everyone else to operate at the same level? If

I do expect that, aren't I setting myself up for disappointment?

 

If we recognize that the world is made up of people with lower,

medium, and superior abilities (to use a traditional Chinese system of

ranking), isn't it more congruent with that reality to allow for

differences in the level of practice of Chinese medicine? In other

words, instead of expecting the profession as a whole to come up to

some higher level, what's wrong with letting the cream float to the

top? In fact, isn't that what we've done here at the CHA? Those of

like mind (not necessarily like opinion) continue to discourse

together. Others have taken themselves away. Is that bad or wrong? I

don't think so. Wasn't that also the case in Old China? Weren't there

many different levels of CM existing side-by-side? Caveat emptor.

 

When the premodern Chinese medical literature talks about inferior,

mediocre, and superior practitioners, it does so in terms of this

being a fact of life. Agreed, there is the implication in those

writings that employ this ranking system that one should aspire to the

highest level. However, I have never read anywhere in the Chinese

medical literature that everyone can reach such levels or that those

who do not should be disbarred from practice.

 

Thinking about all this, ultimately I would have to say, I'm not all

that concerned with the existence of various levels of thought and

practice within our profession. If Ye Tian-shi on his deathbed thought

his own sons were likely to do more harm than good through the

practice of Chinese medicine, superior practitioners have never been

that common. Does that mean that Bob, you, and I should not still keep

trying to lift the intellectual standards of our profession? No, I

don't think so. I think we should try. But I also think we should keep

perspective on how likely we are to succeed. And, perhaps, more

importantly, I think we should keep our own elitist tendencies in mind

when we attempt to do so. In my experience, these tendencies are a

double-edged sword for both ourselves and others.

 

Bob

[Guest guest]

So I ask you...and everyone else,

where does this attitude come from?

From what body of experience, thought,

writing or other source does the notion

emerge that one need not be well prepared

to study Chinese medicine

>>>>It comes from the first generation of acup that have been controlling the

system for years. These were x counterculture types that did (and still do) not

want to see a professional level system. They have resisted every attempt for

change for the last 12 years in which i was aware of the process. They have had

a system that had everybody in the same bed making money and elevating new age

nonsense as a supreme value. Some on this list, that are now complain have

supported the old regime.

Alon

 

 

[Guest guest]

There is a holy reverence for people wearing white

coats. Only last week I spoke a psychologist who thought that

acupuncture was " something spiritual " .

>>>I would have to disagree, this comes from the west (culminated with worsly),

not western attitude in general

alon

 

 

[Guest guest]

Targeting the general public instead of

science would be much more effective in my opinion. Politicians are

only " normal " people.

 

>>>I do not know were you all practice but here in CA at least, we see

acupuncture gaining great acceptance within the medical profession. In Israel

some 15% or more by now of MD have had a 4 year training in acupuncture. The NIH

has gone quite far with its statements considering the state of research on

acupuncture. Hospitals, insurance companies and HMO in the US are paying for

acup. Some HMOs have LAc on their stuff. There is increasing monies given to

research. If we had a few serious schools we could see OM taken much more

seriously.

The problem is not the biomedical profession its the OM profession

Alon

 

 

[Guest guest]

Forgive me if you've heard this from me before. My thoughts on this have always

been

that the school situation is always dependant on the economics at the other end.

If

there were well paid jobs after a rigorous 4-6 year program there would be

schools

and students that would fill them. Perhaps this is more the case in Israel as

Alon

mentions. One imagines that these doctors are not being trained to be sent out

to

rent a storefront for their practice. As it is in " the West " there is usually

only a

potential, not a promise of a living wage at the end. So the schools have no

choice

but accomadate working students. A " top " student intellectually may still have

to earn

a living and can't devote all their time to studying.

 

Yo-San University, under Richard Hammershlag, (forgive me Julie telling this and

if I

get this wrong) tried institute a day-school only program for " serious "

non-working

students. Their enrollment went way down. Some students were attracted to the

rigor

(and the Taoist emphasis) but many after a few years left for other schools. The

students still needed the flexibility and Yo-San changed back to retain these

students.

 

The other issue is that, at least here in LA, there are few full-time academic

jobs and

those in schools are often for the most part administrative. China PRC has an

integrated system where a graduate can choose (or be assigned) teaching,

research or

administration or any other number of affiliated professions. (Although the

market

economy is changing things there also.) In the United States everything, save

for a

few school jobs in the big cities, is defined by the success of your clinical

practice.

And there as Bob Flaws points out comes the 3 levels of practice. And these are

not

only defined by academic excellence, as we know from the many less-than-top-

academically students who do very well financially in practice.

 

Once HMO's and hospitals start hiring en masse I can see that these jobs will

more

sooner than later be filled by the affiliate acupuncture graduates from Medical

Schools that will pump out the students to fill these jobs. Then you really will

have a

" non-spiritual " acupuncture. What percentage of those now actually employed in

hospitals are also RN's or PA's or other Western degreed?

 

this is how I see things in LA, perhaps Marnae has a different take from the

East Coast

where it seems the economic/political " integration " might be moving in a

different

manner.

 

doug

 

 

 

, Marnae Ergil <marnae@p...> wrote:

> A few points -

>

> Competition - this is indeed a big issue in terms of admitting students.

> When Harvard medical school started requiring that students med students be

> in school for 3 years and not simply repeat the studies of the 1st year in

> the 2nd year, they nearly folded - but were able to maintain because of the

> backing of the institution. It takes a brave school to try to make these

> changes. ACTCM used to require a bachelor's degree for entry. I don't

> know if they still do - but, I have to say that given the state of higher

> education in this country, I'm not really sure that it makes any

> difference. I have seen some pretty amazingly poorly educated college

> graduates - and some extremely bright, excellent scholars with only 2 years

> of undergrad. So, perhaps the issue is not simply raising the requirements

> for undergrad training, but finding some other solutions.

>

> ----------------->

> I agree that most Master's level programs are not really that - but also

> remember that many Master's degrees are completed in 2 years (not 4) and

> are, in many ways, much less rigorous than our programs. This is to say,

> that the first 2 years (60 credits) of our programs are actually classified

> as undergraduate and the remained as graduate. If a student is not

> qualified for entry after those first 60 credits, perhaps that is a good

> time to ask them to leave - with a Bachelor's degree but not a master's

> thus, excluding them from practice. Those schools that have 1st year

> comprehensive exams do weed out many students after the first year. More

> such weeding is needed, but let's not throw out the baby with the bath water.

>

> More to come later - I have to go.

>

> Marnae

[Guest guest]

Hi Alon

 

The situation among the medical profession in the Netherlands is

quite something different.

 

> >>>I do not know were you all practice but here in CA at least, we

see acupuncture gaining great acceptance within the medical

profession. In Israel some 15% or more by now of MD have had a 4 year

training in acupuncture.

<<<<<<<<<<<<<

 

In the Netherlands there are about 32.500 MD's and 7.500 dentists.

From these 40.000 doctors there are 363 (< 1%) trained in acupuncture

and member of the professional organisation of medical

acupuncturists. I don't believe the have done a 4 year study to

become an acupuncturist (in fact their 3 part training consists of

only 37 days theory and practice spread over 3 years).

 

>>>>>>>>

Hospitals, insurance companies and HMO in the US are paying for acup.

<<<<<<<<

 

In the Netherlands reimbursement is very limited. In most cases only

75% of the costs with a maximum for 7 - 10 consults pro year.

 

 

>>>>>>>>>>>>

> The problem is not the biomedical profession its the OM profession

> Alon

<<<<<<<<<<<<<<

 

Which problem are you precisely referring to?

In most cases both parties are to blame, but I think there are many

vested interests and over here the WM medics are feeling quite

superior to CAM-pracitioners. Beside this there isn't an equal amount

of publicity to CM and WM and the media have a bias to speak more

positive about WM than about CM/CAM.

The problem may indeed be how CAM is presenting itself, instead of

being 'suppressed' by WM. But I feel there isn't a level playing

field and CAM has to overcome a strong bias, and that is not caused

by CAM.

 

Alwin

[Guest guest]

Hi Alon

 

--- " Alon Marcus " wrote:

> There is a holy reverence for people wearing white

> coats. Only last week I spoke a psychologist who thought that

> acupuncture was " something spiritual " .

> >>>I would have to disagree, this comes from the west (culminated

with worsly), not western attitude in general

> alon

>>>>>>>>>>>>>>

 

She (the psychologist) didn't mean the Worseley approach to

acupuncture, but more in the sense that it isn't a proven medicine

and more a kind of a 'superstitious' phenomenon.

 

The holy reverence I was refering to is the general attitude of the

general public to the medical establishment. Many MD's keep a large

distance between themselves and the general public. Even the MD's

with the somewhat less glorious positions (company doctors, doctors

employed by insurance companies) feel quite superior, because they

studied medicine.

 

Alwin

[Guest guest]

Forgive me if you've heard this from me before. My thoughts on this have always

been

that the school situation is always dependant on the economics at the other end.

If

there were well paid jobs after a rigorous 4-6 year program there would be

schools

and students that would fill them. Perhaps this is more the case in Israel as

Alon

mentions. One imagines that these doctors are not being trained to be sent out

to

rent a storefront for their practice.

>>>>Doug in Israel all the acup education is privet. Most of these MDs are

looking for a way to make money outside the system and most never make it,

because there is way too many Acup practitioners in Israel.

Jobs etc. will only come with a better, socially recognized education. As long

as CM education stays outside mainstream (ie not regionally accredited) you can

not expect the society enlarge to see the CM profession as one on par with other

mainstream medical professions. We need to bight the bullet.

Alon