LHC and physical exam

[Guest guest]

Actually I was wrong about the LHC report not mentioning physical

exam. In the midst of a long discussion on education, LHC blasts the

passage of AB 1943 last year for a number of reasons. AB 1943 was a

CA bill passed last year mandating programs of no less than 3000

hours, up from the old 2350, I believe. LHC pointed out that each

increase in educational requirements has been ostensibly to fulfill

the scope of practice. However, LHC maintains that the Acupuncture

board incorrectly interpreted scope of practice for many years in

order to elevate the status of the profession. LHC singles out the

requirement of AB1943 that would add 240 hours of " clinical medicine,

patient assessment and diagnosis " to the curriculum as an example of

increasing " requirements in areas of practice where the legal

authority to provide that service is unclear " . This would include

physical exam used in WM but not in OM. While this statement is

diplomatically vague, their final recommendation is not. It says OM

coursework " should only be for subject matter needed to competently

and safely practice the legal scope... " .

 

Now I don't disagree with Doug about the usefulness of being able to

order lab tests. I have been a loud trumpeter of the cause of

integrative med for a long time. However arguing that we needed to do

it all was really a matter of necessity more than common sense. I

never felt OM training was adequate to ground one in this area. I got

an undergrad degree in physiology and also studied western physical

and laboratory exam quite extensively at naturopathic school. For

those who are unaware, the accredited naturopathic schools actually

teach as much if not more physical and lab exam than regular med

schools. But acupuncture schools do not and cannot without shorting

the study of OM itself. And our law apparently does not grant us this

right anyway. The argument of necessity or convenience is a slippery

slope. That is the same argument that could be used for any

overextension of anyone's scope. That a chiro should be able to do

acupuncture because they can do a form of it safely and it is

convenient for their patients. Where is the line drawn? There is one

line in the report even questioning clinical counseling as outside our

scope.

 

Now an increase to 4000 hour entry level doc might make a place for

such studies (but probably at the expense of chinese language and

classics), but I think LHC has made it clear that WM is not the domain

of our profession. Not at the masters level or at the doctoral level.

That if one wants to be an integrative practitioner, one must pursue

a dual degree; they says this a number of times, it is a key theme in

the report. An option now in CA is the ND degree which does allow

western dx and exam and lab tests. For those who want it all,

pursuing an ND or collaborating with one is the way to go. In fact,

my private practice in OR forced me to collaborate as all WM dx is

illegal there for LAc. So my experience prior to CA was of the nature

now recommended by LHC. My focus in the last few years on an

independent integrative practice has been due to 3 artificial pressures.

 

1. my erroneous belief that CA law allowed us to basically practice

naturopathy by allowing western dx, lab tests and prescribing of

supplements other than chinese herbs (yes, in all likelihood,

clarifications of our scope will eliminate our rights to prescribe non

TCM supplements as is the case in OR - since we are not trained in

their use, they are not part of OM and any use is thus predicated on

either other folk traditions or modern science, they are outside our

scope).

 

2. the absence of any other licensed healthcare professional in the

state with formal medical training. Thus necessity dictated that I

sometimes ordered lab tests I would rather have referred to an ND for.

 

While the LHC report is a mixed bag, there is no doubt the intent of

the authors is to limit us to OM. They also recommend some kind of

mandatory WM examination of patients undergoing acupuncture for

chronic undiagnosed complaints. One silver lining is that it does get

us back to brass tacks. The focus of learning to treat pain should be

the classical works on bi syndrome plus the tui na techniques of old,

not Travell's trigger point therapy. Practices like NAET and AK are

definitely called into question. If western med is not the area in

which the profession will expand, then it will be in the realm of OM

itself. LHC recommends getting rid of unnecessary WM inthe current

master's curriculum. What will replace it in order to keep the 3000

hours in place. The schools like that goldmine, so they will look for

other subjects to fill the void.

 

Is now the time I never thought would come, when there may actually be

a place in the master's curriculum for chinese language and classics

and even a mandate from the government to pursue that route?

Certainly there is a logic to it all. We are the supposed experts in

OM, but as a profession we are unwilling to pursue the deeper study of

our own medicine, which is only possible if a large number of us learn

to read chinese and do profuse translation. So we look to our

existing strengths (like science in my case) to shore ourselves up.

Others overlay OM with spirituality or energy medicine, but none of it

is really OM. People (like me) pride themselves on their skill at

searching the medline or the internet, but sidestep the huge and

obvious gaps in such searches as most such data relevant to OM is

beyond the realm of the english language (perhaps more than 90%).

Perhaps the profession should focus deeply on the study of OM and

leave all the WM to someone else.

 

Recent research and publication scandals in WM leave me even more

disillusioned with much of the existing scientific research. Vested

interests at both NIH and prominent journals. But even more

disturbing is that drug companies may bury ten studies that show a

drug is dangerous until they get one that shows it to safe and

effective. I still think good research has been done in WM and can be

done in OM, but much of what we think we " know " could be wrong.

Consider the past few years and HRT, phen-fen, SSRIs, now vioxx.

There is no doubt in my mind that drug companies have buried numerous

studies showing increased suicidal ideation with SSRIs. We should

probably get our own house in order before we jump too quick into theirs.

 

BTW, I have been invited to speak at the Scripps natural supplements

conference in january in SD. My co-lecturer will be Pamela Richter,

DPharm, L.Ac. She will speak about a model she has been developing to

predict possible drug/herb interactions and safely avoid them. She

shows how in most cases, time of administration can eliminate all

risk. I will present the idea of collaborative drug/herb prescribing

for maximum therapeutic benefit. Using examples from the chinese

research literature about combining drugs and herbs to lower side

effects and maintain drug benefits. The emphasis will be the need to

work as a team to do this and monitor with lab tests as necessary.

 

[Guest guest]

While the LHC report is a mixed bag, there is no doubt the intent of

the authors is to limit us to OM.

>>>And when did the development of OM stop? What is included? should we take out

anything that has its roots in india or anywhere else? If not why not? and if we

leave it than why not add modern science? Can we treat a modern disease? if yes

than do we need a modernly trained supervisor? Can we conduct our own research?

if yes can it be modern research or do we need a modernly trained chaperone?

 

 

If we are not define our own profession then who should? Evry profession defines

its own limits, and if we leave this to this commission or anyone else we are

dead.DON'T FORGET THIS

Alon

 

 

[Guest guest]

, " Alon Marcus " <alonmarcus@w...>

wrote:

 

>

> If we are not define our own profession then who should? Evry profession

defines its

own limits, and if we leave this to this commission or anyone else we are

dead.DON'T

FORGET THIS

 

 

I hope you realize I am reporting this, not supporting it all. I have long

argued for

independent integration, but now see the need to play devil's advocate to flesh

out this

matter.

 

[Guest guest]

I hope you realize I am reporting this, not supporting it all. I have long

argued for

independent integration, but now see the need to play devil's advocate to flesh

out this

matter.

 

>>>>I hope people are paying attention when I started to state this 10 years ago

no-one was listening, these are very subtle ways that can kill us if we do not

take the bull by the horn

alon

 

 

[Guest guest]

, " Alon Marcus "

<alonmarcus@w...> wrote:

 

> >>>>I hope people are paying attention when I started to state this

10 years ago no-one was listening, these are very subtle ways that can

kill us if we do not take the bull by the horn

> alon

 

You keep saying things like " we're dead " and " kill us. " Who are you

talking about?

 

I will be satisfied with doing CM without WM diagnostics, exams, or tests.

 

I got into this field for 2 reasons.

1) because I really wanted to learn CM for my own educational sake

2) to help others

 

I figured that I would be able to make a modest living doing CM also,

so that just makes it a career, rather than a hobby.

 

Brian C. Allen

[Guest guest]

Who are you

talking about?

>>>>TCM as independent profession.

Alon

 

 

[Guest guest]

is this lecture open to the public (i.e. us)?

 

On Oct 17, 2004, at 8:56 AM, wrote:

 

> BTW, I have been invited to speak at the Scripps natural supplements

> conference in january in SD.

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

, Al Stone <alstone@b...> wrote:

> is this lecture open to the public (i.e. us)?

 

its for professionals and I think there is a fee. will post more later.