EBM and WC - ACOEM

[Guest guest]

Todd -

 

The worker's comp (WC) system is facing problems besides societies need for

evidence based medicine (EBM)...and let there be no mistake, we are facing an

emerging tyranny of EBM.

 

We as profession must face the fact that there are practitioners who

overbill. (One recent WC bill was for over $110,000 - is this fair to the

patient our

profession or society? No.)

 

Understanding this we must come forward with contrition and acknowledge the

problem. As a profession we need to develop standards and communicate them to

the community, the legislators, lawyers, patients and any other stakeholders.

We must adhere to ethical billing and practice standards as a community of

professionals if we want the responsibility that professionals maintain within a

society. Otherwise....

 

Will

 

 

> " Our profession must develop evidence-based standards of care and

> treatment guidelines to supplement existing occupational medicine

> treatment guidelines, and get them adopted for workers' compensation

> guidelines. "

>

>

> For those who do insurance care, it will soon all be EBM; anything that

> is proven will be valid, so its not about inflexible standards, just

> evidence.

>

> As has also been pointed out is that if those who now depend on WC and

> other types of third party payment lose that access they will begin to

> compete for the cash patients. So this affects even those who wish to

> remain outside the constraints of the insurance system (as I do)

>

> Most people will have to receive their acupuncture under some form of

> insurance coverage as they cannot afford to pay out of pocket. this

> will remain the case as long as the current economic era prevails. so

> unless we want TCM to be confined only to an elite clientele, we must

> all either support EBM or prove to legislators and insurers that it is

> the wrong path.

>

 

 

Will Morris, L.Ac., OMD, MSEd

Dean of Educational Advancement

Emperor's College

Secretary AAOM

 

 

This message is a PRIVATE communication. This e-mail and any attachments may

be confidential and/or legally privileged. If you are not the intended

recipient, please do not read, copy, or use it, and do not disclose it to

others.

Please notify the sender of the delivery error by replying to this message with

the word delete in the subject column, and then delete it and any attachments

from your system. Thank you.

 

 

 

 

 

 

[Guest guest]

offlist--thanks for writing that post in rebuttal to Todd. I hardly dare to

write any more because he has 'censored' my posts in the past, refusing to

post them to the group because they were 'too personal' while continuing to post

his own opinions which included blasting me. Seems like that is his trend.....

-roseanne s.

[Guest guest]

, WMorris116@A... wrote:

 

> Understanding this we must come forward with contrition and acknowledge the

> problem. As a profession we need to develop standards and communicate them to

> the community, the legislators, lawyers, patients and any other stakeholders.

> We must adhere to ethical billing and practice standards as a community of

> professionals if we want the responsibility that professionals maintain within

a

> society. Otherwise....

>

> Will

 

 

I agree with everything you said except that EBM is an emerging tyranny. I

think people

should be able to do as they please with their own money, but if the government

or HMOs

are going to spend MY money to take care of OTHER people, then I either want

evidence or

my money back. I do not support that government of insurers paying for anything

our

colleagues feel like doing. that is recipe for a economic disaster. If you

can't prove that

what you do works or at least ground it in the written historical tradition, it

needs to be

done as a private transaction between the parties (no govt or HMO involved). I

would be

outraged if the government spent my money to reimburse for therapies with no

proven

history or science behind them. and sorry to say that would include ALL secret

or personal

traditions. If we argue for the right to just do as we please with no

constraints of

evidence, I predict we will be perceived as careless and dangerous and

ultimately see

decreased scopes forced on us, not increased ones. In fact, if we are not

careful with our

claims, we be relegated solely to treating musculoskel dz.

 

While chiropractic has a long history of treating a wide range of internal

disorders (which

is just as sensible to me as such being treated with acupuncture), no insurer

will ever

cover chiropractic for such things due to the speciousness of the claims. The

claims for

acupuncture as just as specious at this point, yet we insist that we are

qualified to use

needles for any disease. And at the same time, you see jabs at our DC

colleagues in AT

saying they are desperately trying to revive chiropractic as a form of internal

medicine

despite no evidence to support this. That really sounds like the pot calling

the kettle

black. Without properly done EBM, acupuncture is dead in the water, IMO.

Tyranny will

only be the result if those who practice styles other than TCM decide to

stubbornly resist

the call for EBM and then cry foul from the sidelines. If what you do works, it

is simple to

prove it, no matter how weird or holistic or idiosyncratic. Tyranny only

results from

allowing oneself to be tyrannized. but then the disparity on this point is

perhaps just one

more example of the burgeoning (and likely irreconcilable) philosophical gap in

our field,

one that largely derives upon the forced fit of herbology and acupuncture into

the same

profession in america. while many will say this is unrealistic, we actually

need to either

separate the professions or create an herb organization to represent those who

are

primarily herbalists. The nature of acupuncture and many whom it appeals to

makes unity

on many matters inherently impossible.

 

[Guest guest]

On Jun 13, 2004, at 8:05 AM, WMorris116 wrote:

 

> and let there be no mistake, we are facing an

> emerging tyranny of EBM. 

>

>

 

This is not directed at Will, just a rant that was spurred by the word

tyranny.

 

 

If we have a tyranny of anything in our field, it is the same

relativistic, intellectually bankrupt, multi-culturalism that infects

our entire society. I completely agree with that article Roger sent

about the perennial wisdom. The founders of the US embraced the

rational enlightenment. Any references to god in their works were

clearly in this enlightened non-theistic sense (note I did not say

atheistic). The culture that had developed and the one that overthrew

the british was one that rejected the role of theisms in the state (not

a rejection of the notion of something transcendent, but clearly a

rejection of the role of religion). They laid a foundation for a

common culture that could transcend class and ethnic differences. The

postmodern idea that American culture itself is some form of tyranny is

the biggest lie of history.

 

The rise of postmodernist multiculturalism in the US has paralleled the

rise of tribal barbarism around the world. It has also ironically

paralleled the increasing polarization of america into basically two

black and white camps (meant philosophically and figuratively, not

racially). A far cry from the days in the 19th century when

deTocqueville could comment on the amazing egalitarianism and ease of

civil and productive communication between economic classes and

political affiliations that he witnessed in the US. Something unheard

of in europe at that time and long since forgotten today. And the

reason may in large part be due to the poisonous pill of postmodern

deconstructionism and its offspring, multiculturalism.

 

The beauty of the american culture that had evolved in the first 100

years (not been imposed as the deconstructionists would have it) was

that this cultural identity was one of shared civil and secular values,

not religious or ethnic identity. This postmodern regression into the

elevation of religious or ethnic identity above shared civil or secular

values of the founders is the death knell of america. It is hardly

surprising that the new age, multiculturalism and fundamentalism all

occurred at the same time in history as they are just different

manifestations of the same thing, the breakdown of American culture

into emotionally driven tribes who have abandoned all rationale for

some identity with a group and the temporary solace that brings.

 

Any trend in our field that mimics this trend towards relativism and

away from rationalism I cannot support. Whether it is an anything goes

attitude with taxpayer dollars spent on healthcare or the

indoctrination of TCM students in a quasi-religious environment. Do as

you please in your private contractual relationships, but if you

participate in a public sphere (like WC or HMOs), I want you to be

regulated to some sort of standards just like every other recipient of

my money. And I am hardly alone. The majority of americans regularly

vote to tie the hands of lawmakers to take their money (though the

idiots will gladly vote for the government to borrow money from someone

else - yea, Arnold!). They are also outraged at the excesses of the

healthcare industry that they must already bear, like exorbitant drug

profits. There is no widespread public sentiment to give a blank check

to anyone anymore.

 

For every patient who wants their provider to cover acupuncture, there

are probably 3 others who would rather forgo the coverage and not have

their premiums go up to cover others who choose differently. I am

actually one of the latter. I don't want my catastrophic coverage

rates to go up to provide more funding for those who would overuse

so-called preventive medical services. While regular healthcare is

probably desirable, I think there is some evidence that educated people

who exercise and eat right actually do better if they steer clear of

all healthcare unless absolutely necessary. So I could never support

the use of public or insurance dollars to pay for the type of patient

who comes for acupuncture every week for years despite having no real

problem and getting no real relief. I would say about 100 such monthly

patients are currently ongoing regulars at PCOM (that is about 20% of

the patient load). I believe that those who truly need healthcare

should have access. I do not believe that insurance should just pay

for any decision made by any patient and their provider. OTOH, I do

believe any private transaction in which no party is injured without

informed consent should be legal. Most health comes down to some

pretty some rules of living and these rules do not need to be

medicalized (another disturbing trend in our society is the

medicalization of fitness and developmental issues).

 

 

 

Chinese Herbs

 

 

FAX:

 

 

 

[Guest guest]

 

I am enjoying reading your comments. Can you elaborate on the statements below?

 

" ...but then the disparity on this point is perhaps just one

more example of the burgeoning (and likely irreconcilable) philosophical gap in

our field, one that largely derives upon the forced fit of herbology and

acupuncture into the same

profession in america. while many will say this is unrealistic,we actually need

to either separate the professions or create an herb organization to represent

those who are

primarily herbalists. The nature of acupuncture and many whom it appeals to

makes unity on many matters inherently impossible. " Why do the professions need

to be separated, and what is the difference between the people attracted to

each?

 

" The postmodern idea that American culture itself is some form of tyranny is the

biggest lie of history. " Whose idea is this?

 

" Whether it is an anything goes

attitude with taxpayer dollars spent on healthcare or the

indoctrination of TCM students in a quasi-religious environment. " Examples?

 

Thanks,

 

Jamie

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[Guest guest]

On Jun 13, 2004, at 8:05 AM, WMorris116 wrote:

 

> and let there be no mistake, we are facing an

> emerging tyranny of EBM. 

>

>

 

This is not directed at Will, just a rant that was spurred by the word

tyranny.

 

 

If we have a tyranny of anything in our field, it is the same

relativistic, intellectually bankrupt, multi-culturalism that infects

our entire society. I completely agree with that article Roger sent

about the perennial wisdom. The founders of the US embraced the

rational enlightenment. Any references to god in their works were

clearly in this enlightened non-theistic sense (note I did not say

atheistic). The culture that had developed and the one that overthrew

the british was one that rejected the role of theisms in the state (not

a rejection of the notion of something transcendent, but clearly a

rejection of the role of religion). They laid a foundation for a

common culture that could transcend class and ethnic differences. The

postmodern idea that American culture itself is some form of tyranny is

the biggest lie of history.

 

The rise of postmodernist multiculturalism in the US has paralleled the

rise of tribal barbarism around the world. It has also ironically

paralleled the increasing polarization of america into basically two

black and white camps (meant philosophically and figuratively, not

racially). A far cry from the days in the 19th century when

deTocqueville could comment on the amazing egalitarianism and ease of

civil and productive communication between economic classes and

political affiliations that he witnessed in the US. Something unheard

of in europe at that time and long since forgotten today. And the

reason may in large part be due to the poisonous pill of postmodern

deconstructionism and its offspring, multiculturalism.

 

The beauty of the american culture that had evolved in the first 100

years (not been imposed as the deconstructionists would have it) was

that this cultural identity was one of shared civil and secular values,

not religious or ethnic identity. This postmodern regression into the

elevation of religious or ethnic identity above shared civil or secular

values of the founders is the death knell of america. It is hardly

surprising that the new age, multiculturalism and fundamentalism all

occurred at the same time in history as they are just different

manifestations of the same thing, the breakdown of American culture

into emotionally driven tribes who have abandoned all rationale for

some identity with a group and the temporary solace that brings.

 

Any trend in our field that mimics this trend towards relativism and

away from rationalism I cannot support. Whether it is an anything goes

attitude with taxpayer dollars spent on healthcare or the

indoctrination of TCM students in a quasi-religious environment. Do as

you please in your private contractual relationships, but if you

participate in a public sphere (like WC or HMOs), I want you to be

regulated to some sort of standards just like every other recipient of

my money. And I am hardly alone. The majority of americans regularly

vote to tie the hands of lawmakers to take their money (though the

idiots will gladly vote for the government to borrow money from someone

else - yea, Arnold!). They are also outraged at the excesses of the

healthcare industry that they must already bear, like exorbitant drug

profits. There is no widespread public sentiment to give a blank check

to anyone anymore.

 

For every patient who wants their provider to cover acupuncture, there

are probably 3 others who would rather forgo the coverage and not have

their premiums go up to cover others who choose differently. I am

actually one of the latter. I don't want my catastrophic coverage

rates to go up to provide more funding for those who would overuse

so-called preventive medical services. While regular healthcare is

probably desirable, I think there is some evidence that educated people

who exercise and eat right actually do better if they steer clear of

all healthcare unless absolutely necessary. So I could never support

the use of public or insurance dollars to pay for the type of patient

who comes for acupuncture every week for years despite having no real

problem and getting no real relief. I would say about 100 such monthly

patients are currently ongoing regulars at PCOM (that is about 20% of

the patient load). I believe that those who truly need healthcare

should have access. I do not believe that insurance should just pay

for any decision made by any patient and their provider. OTOH, I do

believe any private transaction in which no party is injured without

informed consent should be legal. Most health comes down to some

pretty some rules of living and these rules do not need to be

medicalized (another disturbing trend in our society is the

medicalization of fitness and developmental issues).

 

 

 

Chinese Herbs

 

 

FAX:

 

 

 

[Guest guest]

 

 

You've placed a ban on topics relating to acupuncture. Yet, you

continue to use this forum to bash it. Is this fair? What is really

your problem with acupuncture? Do you forget that it is acupuncture

as a modality that has brought our profession thus far? Do you not

realize that acupuncture keeps most of us in practice? How many on

this list are making a living strictly with herbal medicine? Are you?

What would you do if you did not have your gig a PCOM? Just do herbs?

Could you make it without any other source of income?

 

Who's fault is it that about 20% of PCOM patients continue to come

for years? Maybe that's the reason why the have no 'real problems'.

If your conviction is genuine, then you or someone at your school

should put their foot down and tell this patients that enough is

enough. I'm sure their money is not the factor that keeps your

interns treating them.

 

There has been so much bashing on this list towards the new age

practitioner, but do you not realize that the new age patient has

kept many practices going? And that many of those new age patients

become tcm students?

 

On a previous post you stated that:

 

" While chiropractic has a long history of treating a wide range of

internal disorders (which is just as sensible to me as such being

treated with acupuncture), no insurer will ever cover chiropractic

for such things due to the speciousness of the claims. The claims for

acupuncture as just as specious at this point, yet we insist that we

are qualified to use needles for any disease. And at the same time,

you see jabs at our DC colleagues in AT saying they are desperately

trying to revive chiropractic as a form of internal medicine despite

no evidence to support this. That really sounds like the pot calling

the kettle black. Without properly done EBM, acupuncture is dead in

the water, "

 

What " long history " are you talking about? How old is the

chiropractic profession? How long has acupuncture been around? Ever

wonder why DC are so eager to practice acupuncture? If their modality

is so effective in treating such a " wide range of internal disorders "

why would they wish to use the needles? Is it the money?

 

Please, I know this is 'your' forum. But if you are going to

continue bashing acupuncture, then you should also give others the

opportunity to freely offer a different perspective.

 

Fernando Bernall

 

 

 

 

,

> For every patient who wants their provider to cover acupuncture,

there

> are probably 3 others who would rather forgo the coverage and not

have

> their premiums go up to cover others who choose differently. I am

> actually one of the latter. I don't want my catastrophic coverage

> rates to go up to provide more funding for those who would overuse

> so-called preventive medical services. While regular healthcare is

> probably desirable, I think there is some evidence that educated

people

> who exercise and eat right actually do better if they steer clear

of

> all healthcare unless absolutely necessary. So I could never

support

> the use of public or insurance dollars to pay for the type of

patient

> who comes for acupuncture every week for years despite having no

real

> problem and getting no real relief. I would say about 100 such

monthly

> patients are currently ongoing regulars at PCOM (that is about 20%

of

> the patient load). I believe that those who truly need healthcare

> should have access. I do not believe that insurance should just

pay

> for any decision made by any patient and their provider. OTOH, I

do

> believe any private transaction in which no party is injured

without

> informed consent should be legal. Most health comes down to some

> pretty some rules of living and these rules do not need to be

> medicalized (another disturbing trend in our society is the

> medicalization of fitness and developmental issues).

>

>

>

> Chinese Herbs

>

>

> FAX:

>

>

>

[Guest guest]

Fernando has a point, Todd.

 

While I appreciate your long and passionate posts, we should be careful

not to let CHA become a 'bully pulpit'. I propose that we do allow

some discussion of acupuncture on this list, but with clear guidelines

so we don't run into point prescription recipes and the like.

 

I appreciate Roger's point of view of practicing herbal medicine 'under

the radar', so to speak, but I oppose separating the acupuncture and

herbal professions outright. I think that people should be allowed to

focus on what they are best suited to do, but that arbitrarily

separating the professions would greatly weaken our stature as a

profession.

 

 

On Jun 13, 2004, at 2:03 PM, Fernando Bernall wrote:

 

> Please, I know this is 'your' forum. But if you are going to

> continue bashing acupuncture, then you should also give others the

> opportunity to freely offer a different perspective.

>

> Fernando Bernall

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

[Guest guest]

, " Fernando Bernall "

<fbernall> wrote:

>

>

> You've placed a ban on topics relating to acupuncture. Yet, you

> continue to use this forum to bash it. Is this fair? What is really

 

A more careful reading of what Todd writes will yield the conclusion

that his criticism are aimed mostly at certain types of practitioners

of acupuncture and the lack of evidence of the efficacy of acupuncture

for certain conditions, rather than acupuncture itself.

 

> There has been so much bashing on this list towards the new age

> practitioner, but do you not realize that the new age patient has

> kept many practices going? And that many of those new age patients

> become tcm students?

 

.... and thus the cycle continues...

 

> Please, I know this is 'your' forum. But if you are going to

> continue bashing acupuncture, then you should also give others the

> opportunity to freely offer a different perspective.

>

> Fernando Bernall

 

We all have the same opportunity to 'carefully' read what Todd wrote.

If we are going to respond to his views, the responses should at

least actually be based on his views, rather than be knee-jerk

reactions based on emotion.

 

Brian C. Allen

[Guest guest]

, ra6151@a... wrote:

> offlist--thanks for writing that post in rebuttal to Todd. I hardly

dare to

> write any more because he has 'censored' my posts in the past,

refusing to

> post them to the group because they were 'too personal' while

continuing to post

> his own opinions which included blasting me. Seems like that is his

trend.....

> -roseanne s.

 

I love the irony of this. It looks like you meant this to be offlist,

but here it is on the list.

 

Furthermore, even though you " hardly dare to write " because of

censorship, here is your message in all of its non-censored glory.

 

Brian C. Allen

[Guest guest]

Been off-line over the weekend (as usual) and seem to have jumped into

a lively little discussion. Can someone tell me, what do EBM and WC

stand for in this topic heading?

 

Also, I think we can and should talk about acupuncture's relationship

to Chinese herbal medicine historically, legally, economically, etc.

In the U.S., we cannot really talk about the one without reference (on

occasion) to the other. IMO, it's just the historical context on this

continent.

 

And finally, in the posts I've read this morning, I can't see where is " bashing " acupuncture. Bashing acupuncture would consist of

saying acupuncture is worthless, useless, harmful, quackery, totally

ineffective, a waste of time and money in any and every situation,

etc. I don't believe Todd has ever said any of the above. I agree with

Brian that those who are uncomfortable with Todd's views on

acupuncture need to read and think about what he is saying more

carefully. What Todd seems to be impassioned about is rationalism.

While my experience in life tells me that rationality is rare in

numan discourse and behavior, I do believe it is still a worthy goal

when arguing about seemingly intellectual matters.

 

Bob

[Guest guest]

EBM = evidence based medicine

 

WC = worker's compensation

 

 

 

[Guest guest]

, " Bob Flaws " <pemachophel2001>

wrote:

I agree with

> Brian that those who are uncomfortable with Todd's views on

> acupuncture need to read and think about what he is saying more

> carefully. What Todd seems to be impassioned about is rationalism.

 

 

Thanks for chiming in. I think I am a pretty clear writer, but you do have to

read all my

words. I am not sure what I can do about those who choose to comprehend my

words as

speaking to some other purpose than that for which they were intended. The

words are

not written for those who have already made up their minds anyway. The words

are out

there for those still willing to listen. they speak for themselves. I have

nothing to defend

myself for.

 

[Guest guest]

On Jun 13, 2004, at 12:05 PM, wrote:

 

> The nature of acupuncture and many whom it appeals to makes unity

> on many matters inherently impossible.

 

perhaps this is the line that got to some. so before someone sets up

another straw man, labels it Todd and knocks it down, let me clarify

what should have already been clear. I do not think acupuncture is

irrational. I think many who practice it are. I feel the same way

about psychotherapy. something about the nature of the topics attracts

magical thinkers. This does not mean I believe acupuncture is magical

in nature (nor psychotherapy, either). In fact, I think both are

actually quite sensible. But unless we get rational about it, very few

others will ever find out.

 

 

 

Chinese Herbs

 

 

FAX:

 

 

 

[Guest guest]

, " Bob Flaws " <pemachophel2001>

wrote:

Can someone tell me, what do EBM and WC

> stand for in this topic heading?

>

 

I believe WC means water closet and EBM is some kind of ballistic missile. Must

be

european terms or something. :-)