ideology and debate

February 4, 2004

I forgot that Rory asked me a long time ago to point if I was just

writing something for the sake of argument. Well, fact is that I do

not learn anything without debate. so all my posts are pretty much for

the sake of making a case to see if its logic stands. So that should

be an a priori assumption with everything I write. Whether I believe

everything I write is really not the point. And it shouldn't matter to

any of you. If the initial premises are correct and the logic is

valid, then the case is made. Lawyers frequently advocate positions

they do not believe. While I have said I will not be swayed by mere

rhetoric on this list, I have in fact been enlightened by the

revelation of new evidence on this list on many occasions.

Interestingly many of those who get so riled up about my continual

devil's advocacy have never budged one iota from any stated position

they have ever made on this list. But that is not surprising. Because

when you accept the tenets of chinese medicine without skepticism, you

are accepting them on faith. No one likes to have their faith

challenged. And believers are usually quite dogmatic. In other words,

if its in the scriptures, it must be true. How could one ever back

down from a faith based assumption without sacrificing one's entire

identity.

BTW, if anyone on this list finds the questioning of faith based belief

offensive, I apologize, but I will not back down. I think faith based

action is the scourge of history and I have fought all my life to

prevent it from playing any role in the public domain. I certainly

don't want my career to appear to be a cult to outsiders, as it was

characterized to me like my student's mother-in-law at the PCOM

graduation I mentioned earlier. People are free to believe as they

please and post what you want, but I have no interest in debating

arguments where the sole recourse of the opposition is to refer to

chinese classics or " personal experience " . I like to know what's in

the classics and what people's experiences are. But not to accept them

blindly, rather to form a basis for testing them if they do not sync

with my preconceptions. I am also quite clear that CM developed by

reference to and expansion of what are essentially scriptures of

medicine and those who operate on what I call faith are actually

following tradition while I am admittedly not. But that is because I

do not see evidence that all the developments are of equal medical

value. Some may have only played a cultural role in whatever era of

china they arose in (as Unschuld makes the case). Maybe my personal

study of logic and philosophy as well as my rejection of religion at

age 11 has warped my mind. C'est la vie. I am sure other CM lists are

more metaphysically oriented.

I also believe this debate evidences an irreconcilable rift in our

profession, similar to that going on in the macrocosm of american

society. Those who would justify action through faith rather than

rational thought. I also think it signals a battle for the heart of

the profession and the future of medicine in america. If we are not

willing to test every assumption of CM under the light of science, I do

predict we will be marginalized and ultimately history will pass us by.

a great opportunity lost. I know others believe the exact opposite

and thus the forces are engaged.

I caution people to follow my lead in what comes next. I never direct

posts such as this to any one person, nor do I ever call an individual

person a derogatory name. Z'ev is also to be lauded for not

personalizing these matters online. If you cannot generalize your

arguments in passionate posts, please hold them for a day and see if

you really want to send the mail to the group. No attacks will be

tolerated.

Chinese Herbs

FAX:

February 4, 2004

I forgot that Rory asked me a long time ago to point if I was just

writing something for the sake of argument. Well, fact is that I do

not learn anything without debate. so all my posts are pretty much for

the sake of making a case to see if its logic stands. So that should

be an a priori assumption with everything I write. Whether I believe

everything I write is really not the point. And it shouldn't matter to

any of you.

>>>Dido

Alon

February 4, 2004

At 10:27 AM -0800 2/4/04, wrote:

>Because when you accept the tenets of chinese medicine without skepticism, you

>are accepting them on faith. No one likes to have their faith

>challenged. And believers are usually quite dogmatic. In other words,

>if its in the scriptures, it must be true. How could one ever back

>down from a faith based assumption without sacrificing one's entire

>identity.

>

>BTW, if anyone on this list finds the questioning of faith based belief

>offensive, I apologize, but I will not back down.

--

I must be forgetting, so could you give us a typical instance of

someone on this list taking the literature of CM on unquestioning

faith. Has anyone in this conference suggested that the classics of

Chinese medicine should be read, or their content accepted,

uncritically? Unless you can come up with an example of a common

pattern, I'll have to conclude that this is a straw man.

I'm a pretty skeptical person, not just with the CM literature, but

with any notion that I may have helped my own patients when they get

better under my care. Nevertheless, I see this claim of your's and

Alon's being used as a bludgeon to deride the positions of those who

don't agree with you.

And could you explain the correlation you are making between

acceptance of a body of medical knowledge which has demonstrated

utility, and religious belief. It seems to me these are quite

different things.

Rory

--

February 4, 2004

Nevertheless, I see this claim of your's and

Alon's being used as a bludgeon to deride the positions of those who

don't agree with you.

>>>What claims, have i been making claims? i have been asking questions.

Alon

February 4, 2004

At 1:53 PM -0800 2/4/04, ALON MARCUS wrote:

> >>>What claims, have i been making claims? i have been asking questions.

--

How about these:

At 6:24 PM -0600 2/1/04, Alon Marcus wrote:

> >>>>>That is not what i am saying. There is a diffrence between

>developing ideas and having to justify them as having merit based on

>defecto classics or bibles. New developments in CM have all got

>their justification from such fixed bibles of old wisdom.

&

At 12:32 PM -0600 2/1/04, Alon Marcus wrote:

>This is the basic tone running throughout the history of CM and this

>discussion, i.e., we do not know enough, we need to understand more,

>we need to be more religious.

&

At 5:37 PM -0800 2/2/04, ALON MARCUS wrote:

>I do not agree and just want to bring up the question of do we treat

>CM as a science, that is challenging and trying to both prove and

>disprove our beliefs. Or as a religion in which we have faith and

>only need to be more devout.

--

There are several more along the same lines. These are not questions.

They are rhetorical statements.

You are presenting a false dichotomy: ie the alternative to proving

or disproving a belief in Chinese medicine is not a religious belief.

Rory

--

February 4, 2004

You are presenting a false dichotomy: ie the alternative to proving

or disproving a belief in Chinese medicine is not a religious belief.

>>>>>What i am saying that the difference between science and religion is

assumed faith or belief. If one takes the position that the classics are correct

at face value to me that is religion. If one study them and tests the ideas in a

laboratory or clinical setting that is science.

Its just a difference in the way one views something at the get go. Therefore,

my main points is do we question what is at this point dogma or choose another

word if you want. Do we view it all as needing proof or not?

Alon

February 4, 2004

I for one always question. Throughout my undergraduate studies I found

the belief without question of anything written in a " classic " poor

science/medicine. This questioning (perhaps serious doubt) only got

more intense when the theories taught for clinical application and

practice were often in direct conflict with these " classics " .

I have no doubt that the " classics " hold deep wisdom. But, since the

time these ideas were put to paper (you know what I mean;-)) our

tradition has learnt more and has not stagnated with the belief that

there is no more to learn. We can just look at the number of " lesser

Classics " with titles containing " Corrections of..... " to see this.

Perhaps it is a shame that when these classics are taught, they are

done so in a manner that suggests these are unquestionable " truths "

rather than in the context of the beginnings and milestones in the

development of our tradition.

My chinese teachers always has a greater acceptance of contradiction in

these texts than I. Perhaps due to the Chinese education system, the

chinese have greater tendency to accept without question. I certainly

found this whenever I looked for a clear and comprehensive explanation

of certain passages in texts such as the Nei Jing. Often the answer

came down to " If you think you know better than the ancients.... "

Debate about what constitutes the " truth " in TCM has never stopped. We

now have new tools and technology to move at a far greater speed in

this pursuit. We also have a much greater opportunity for debate and

share of these discoveries than ever before (such as this list).

Personally, I have felt from early on in my studies that much of the

principles and theories need to be " cleaned-up " and made more

consistent at the undergraduate level. This process is certainly in

progress in china. Perhaps the west currently has the greater

inclination to hold onto " niche " theories and practices than china

itself.

I am not suggesting we dispense with these inconsistencies altogether.

I just query the benefit of their introduction at an early stage in

undergraduate education. I know I found it rather hard to wrap my

logical, 1+1 = 2, mind much of the basic theory. I have since come to

better terms with contradiction, but wasted much time attempting to

unify everything before I was ready.

It seems to me that as in all facets of life and all cultures; there

are those who find comfort in the acceptance of ancient " truths " and

" dogma " and those who won't believe until they see it for themselves. I

think this is a beneficial and healthy thing. They are a Yin and Yang

pair that keep chinese medicine a living and growing entity with a

" memory " .

Best Wishes,

Steve

On 05/02/2004, at 12:04 PM, ALON MARCUS wrote:

> You are presenting a false dichotomy: ie the alternative to proving

> or disproving a belief in Chinese medicine is not a religious belief.

>

>>>>>> What i am saying that the difference between science and religion

>>>>>> is assumed faith or belief. If one takes the position that the

>>>>>> classics are correct at face value to me that is religion. If one

>>>>>> study them and tests the ideas in a laboratory or clinical

>>>>>> setting that is science.

> Its just a difference in the way one views something at the get go.

> Therefore, my main points is do we question what is at this point

> dogma or choose another word if you want. Do we view it all as needing

> proof or not?

> Alon

>

February 4, 2004

It seems to me that as in all facets of life and all cultures; there

are those who find comfort in the acceptance of ancient " truths " and

" dogma " and those who won't believe until they see it for themselves. I

think this is a beneficial and healthy thing. They are a Yin and Yang

pair that keep chinese medicine a living and growing entity with a

" memory " .

>>>>How true

Alon

February 4, 2004

Yet I can imagine that your chinese teachers have greater acceptance of the

contradictions of the clinic vs. " truths " of the ancient teachings. And at some

point

this contradicition no longer is a contradiction but an expression of the art of

the

medicine. At least that's my experience.

doug

>

> My chinese teachers always has a greater acceptance of contradiction in

> these texts than I. Perhaps due to the Chinese education system, the

> chinese have greater tendency to accept without question. I certainly

> found this whenever I looked for a clear and comprehensive explanation

> of certain passages in texts such as the Nei Jing. Often the answer

> came down to " If you think you know better than the ancients.... "

>

> Steve

>

February 5, 2004

At 5:04 PM -0800 2/4/04, ALON MARCUS wrote:

>If one takes the position that the classics are correct at face

>value to me that is religion.

--

You can call it a religion, but you are using a false definition of

religion. In so doing you deride the point of view of others. Again I

ask:

Please give us a typical instance of someone on this list taking the

literature of CM on unquestioning faith.

Is there anyone on this list whose position is that the classics of

Chinese medicine should be read, or their content accepted,

uncritically?

Rory

--

February 5, 2004

Several months ago, Newsweek ran an article about either A) the existence of

evil in the world, or B) the issue of faith. Ity may even

have been an article linking the two. Sorry, I don't clearly remember. What I do

remember is the statement that maintaining

consistency is one of human being's main priorities in life. That people are

made more nervous about appearing/being inconsistent

than public speaking. I believe it was Mark Twain who said something to the

effect that, if a person believes something for a half hour,

they'll continue believing that same thing for the rest of their life. As I have

said before (I believe on this list), it is my experience that

every argument eventually comes down to some basic sets of irrational beliefs

held by the two parties (most definitely myself

included), and all the " evidence " presented in the argument is merely the

attempt to rationalize and remain consistent to those beliefs.

If that appears jaundiced, perhaps I've spent too much time studying

communication and marketing theory.

In any case, I very much agree with your observation that there is a rift in

this profession between those who approach this medicine

as part of their spiritual belief system and those who approach it as the

secular practice of clinical medicine in a heterodox society. It

is my perception that this rift is growing wider and wider day by day to the

point that one group has little influence on the other. It is

also my perception that a number of the smartest, most educated, and most

intellectually mature members of the profession simply

have given up dialoguing with the rank and file.

If you'd like some " hard evidence " of the anti-intellectual tendencies among the

North American rank and file, here are some statistics

to ponder. Yesterday, Blue Poppy's General Manager made the decision that The

Heart Transmission of Medicine and The Divinely

Responding Classic are both going out of print because they sell less than 50

copies per year, while The Medical I Ching sells several

hundred copies per year. The Divinely Responding Classic is the treatment

formulary section of the Zhen Jiu Da Cheng (Great

Compendium of Acupuncture-Moxibustion), the most famous pre-modern text on the

clinical practice of acupuncture, and the Heart

Transmission is a famous 19th century text on the use of a few classical

formulas and combining herbs in real-life practice. This book

is still required reading of licensed acupuncturists in certain provinces of

China. While people say they want the " real " Chinese

medicine (meaning the pre-TCM stuff), they are not actually interested in buying

and reading books on the real pre-TCM stuff. My

guess is that these are but the first two of the Great Masters series which will

be going out of print over the next couple-few years.

Bob

February 5, 2004

Please give us a typical instance of someone on this list taking the

literature of CM on unquestioning faith.

>>>>>There is constant underlying view that we have " no excess to the

literature " and therefore do not really know what TCM can do and what it can

not. I have always said that having two eyes and good evaluation skills (or more

so the will to evaluate truthfully) can be done by spending time in clinics in

china etc. What i hear back is well you cant even read Chinese what do you know.

That to me comes from a stance that there must be and there is more secrets or

again what ever you want to call it, instead of taking a position that yes we

need to constantly learn more but we also need to look at what is infront f our

eyes and discuss it openly. You say nobody is taking anything in faith. I am

sorry but all (or almost all) i hear is how great TCM is and what great results

everybody is getting. I do not hear anything about the failures and short

comings. I see articles and books claiming for example that TCM can cure

schizophrenia and neither the writers (translators) or the community is saying

anything inspire the clear evidence, and if you do not believe me go to

hospitals in china, on the contrarily

So to tell you the truth, i feel i need to play a role, even though often its

more to just make points and try to get these issues to become a part of

mainstream discussion, then my personal beliefs.

Rory critical thinking would demand seeing for example a good study on pulse

taking for which we have entire industries, the study i just talked about, were

are the voices speaking about what we need to do and what does it mean for us

and for TCM education, how do we design studies to account for such problems, if

so-called pattern diagnosis at the end as less in choosing a treatment ( ie

formula) than the disease (RA) then were should we put our emphasis in education

and research, etc etc.

There is much discussion on philosophy, on world views, on cultural

perspectives, on anecdotal clinical experiences, but on this list we do not hear

discussions and action on what is needed from the other side, ie, expectable

clinical

evidence

When we talk about what is needed in education we hear more about learning

Chinese than we hear about learning critical thinking, understanding of

statistics, understanding of pathology, natural course of diseases, and so on.

We hear about CM view is different so lets not forget it. Well may be true but

at the same time we need to understand the current state of the art in human

disease and health so that we can put in perspective what we see from a CM

perspective. This profession at this point can not.

When see more of this level of discussion i would probably start talking about

the need to study more Chinese and be more devote

Thanks for letting me rave'

Alon

February 5, 2004

If you'd like some " hard evidence " of the anti-intellectual tendencies among the

North American rank and file, here are some statistics

to ponder. Yesterday, Blue Poppy's General Manager made the decision that The

Heart Transmission of Medicine and The Divinely

>>>>Bob where are the intellectual elite in discussing clinical medicine and

evidence?

Alon

February 5, 2004

Alon,

I'm not sure what you're asking.

I, for one, have offered to underwrite clinical research via the donation of

medicinals for clinical trials. I have repeatedly made this offer

to both schools and individuals and no one has taken me up on it. You probably

also know that I was a co-author of an NIH-funded

RCT 10 or more years ago that got published in JAMA.

Bob

February 5, 2004

I, for one, have offered to underwrite clinical research via the donation of

medicinals for clinical trials. I have repeatedly made this offer

to both schools and individuals and no one has taken me up on it. You probably

also know that I was a co-author of an NIH-funded

RCT 10 or more years ago that got published in JAMA.

>>>>>I am actually talking about open discussion of translated materials with

critical evaluation. We see so many articles that clearly do not pan out

clinically, however this is not discussed enough. I just think there is still a

kind of immature attitude towards our medicine, as soon as there is any

criticism people jump into defensive mode. Bob i have always appreciated your

choice of materials you translate, focusing on clinically relevant materials and

articles. However, i think you need to begin adding some critic beyond saying

that in your experience this would help clinicians in the west because so and

so. Now i know this is very difficult to do especially when basically

translating others work. But you are extremely intelligent and i am sure you

have seen enough during the last 20 plus years that needs to be spoken on more

in the open. It may not be best for business but necessary for us to grow as a

profession

By the way the people i am close to at Kaiser research dep have left and so far

nobody has taking me on (with your offer) to do any studies.

Alon

February 5, 2004

At 4:25 PM +0000 2/5/04, Bob Flaws wrote:

>In any case, I very much agree with your observation that there is a

>rift in this profession between those who approach this medicine as

>part of their spiritual belief system and those who approach it as

>the secular practice of clinical medicine in a heterodox society. It

>is my perception that this rift is growing wider and wider day by

>day to the point that one group has little influence on the other.

--

Bob, I hope you are not suggesting that those who approach the

medicine as part of their spiritual belief system are less rational

or less skeptical or less discriminating than others. Or that they

view the classics of Chinese medicine as objects of unquestioning

worship.

" I maintain that the cosmic religious feeling is the strongest and

noblest motive for scientific research "

-- Albert Einstein, Reigion and Science

Rory

--

February 6, 2004

Alon,

I don't know if you've read the several articles I've published where I have

criticized the Chinese authors for some perceived failing. I

don't know how many of these I've done, but there's a number. Either I have

criticized the protocol as being poorly designed, the study

as being poorly designed, the theory as being poorly thought out, or the

outcomes as being suspect. I agree that more could be done

along these lines. Mostly, I try to concentrate on translating articles that I

think contain protocols that I think are or should be effective

based on my own clinical experience. I am quite clear that the Chinese outcomes

are not going to be reproducable here in the West

for a variety of reasons. (I'm not going to rehash all that.) Mostly what I'm

attempting to do with these translations is present a body of

literature of how Chinese are actually treating as opposed to the textbook

literature. Until or unless we have sufficient examples of the

entire body of Chinese medical literature, most of us have very truncated and

limited views of contemporary Chinese practice.

Especially undergraduates need to be aware that the textbooks are only one type

of written source material and that textbooks do not

and are not even meant to represent real-life clinical practice. In my

experience, it's necessary to balance the classics with the

contempoary textbooks with the teachings they have received from live teachers

with contemporary case histories with RCTs with

so-called medical essays, both premodern and contemporary, and then assess the

relevance of any or all of these with one's own

clinical experience. As John Shen was fond of saying, " Chinese medicine is easy

to study but hard to practice. "

Bob

February 6, 2004

> Bob, I hope you are not suggesting that those who approach the

> medicine as part of their spiritual belief system are less rational

> or less skeptical or less discriminating than others. Or that they

> view the classics of Chinese medicine as objects of unquestioning

> worship.

Rory,

Oh boy! I'm afraid that I am suggesting that, at least to some extent. While I

agree that one can be both spiritual and rational (at least

sequentially or when dealing with different aspects of things), I would also

have to say that it is my experience that, taken as a whole,

those who make Chinese medicine part of their spirituality are more prone to

mythologizing Chinese medicine than those who are not

or are less spiritually inclined. I think any number of discussions on this site

have shown that some people are only willing to question

their assumptions about Chinese medicine just so far before they begin to argue

illogically (what I have called red herrings in other

posts).

I may be totally wrong here, but this is the line of reasoning your question has

caused me to take: Spirituality is, ipso facto, irrational.

No one has succeeded in rationally proving the existance of G-d, although many

have tried and some have even claimed success,

e.g., I believe, St. Augustine. Therefore, spirituality always involves some

element of irrational faith. My experience is that people who

are willing to believe in one thing irrationally are often willing to take other

things on faith as well, especially if there is some

relationship between the two. As an example, take Tai Sophia, in my opinion, the

EST of American acupuncture.

I do think an agnostic, secular humanist, or materialist point of view does

allow for more skepticism in general and more of a

Missourian " show me " attitude. BTW, it is my personal experience that the

adoption of a RADICALLY agnostic attitude is the goal

and end-point of the spiritual journey. Here I am talking about the radical

unknowing of Teresa of Avila, the last card of the major

arcana of the Tarot, Jesus's lilies of the field, the Mahayana Heart Sutra's

no-thing-ness, the Zen saying, " If you meet the Buddha in

the road, kill him, " and the Sufi/Gudjieffian saying, " Better not to begin. Once

begun, better to finish. "

I hope I have not offended anyone with this response. Just trying to honestly

answer from my experience. At this point in my life,

similar it seems to I see religious belief as more of a problem than the

solution.

Bob

February 6, 2004

Bob,

I would not always conflate religion and spirituality. In the last

paragraph of your post, you seem imply the separation of the two in the

ultimately " evolved " person, but this is not explicitly stated. I have

known many people who were determinedly not " religious " and yet considered

themselves " spiritual. " As you say, much depends on the context and how

things are applied. Missouri-mind is not limited to Missouri.

Pat

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February 6, 2004

, " Pat Ethridge " <

pat.ethridge@c...> wrote:

I have

> known many people who were determinedly not " religious " and yet

considered

> themselves " spiritual. "

Pat

If we are talking solely about the issue of faith based belief, I am not sure I

see the difference. While being spiritual does not necessarily mean one

s to organized dogma, it does mean one has a worldview that does

not depend solely on rational explanation of phenomena. I have no trouble with

such a worldview for personal cultivation. But I find it anathema for politics

and medicine. It only causes trouble. That does not mean practitioners should

not be spiritual or encourage this in their patients. There is a lot of

evidence

that such beliefs are healthy. But that does not mean one should resort to

metaphysical explanations of how the medicine works or fall back on saying

smething like, " chinese medicne says .... " , like that proves anything at all.

These are two separate things, IMO. BTW, while one might think that the

proven value of religious beliefs somehow validates their fundamental

importance to the human psyche, I would offer that they merely provide

psychological comfort, an opiate to the masses. And like most other placebo

effects, if you believe, you benefit (I have seen the expereiments where

nonbelievers supposedly benefitted from the prayers of others, but I found

those studies highly flawed).

February 6, 2004

I appreciate your distinction between personal cultivation and

application to medicine. This is clear.