2 separate things

[Guest guest]

I just want to make clear that there are 2 separate issues here with

regard to research. the future of chinese internal medicine and the

future of acupuncture orthopedics (BTW, I just got my new Marcus ortho

text and its quite good - review to come). Unless otherwise stated, I

am typically speaking to the future of CHIM (chinese herbal internal

medicine as we call it at PCOM) in my posts. while I have a stake in

the future acceptance of acupuncture orthopedics as about 60% of my

patients are such, I believe the research will easily show that

acupuncture improves the effectiveness of current therapies (though

traditional no more than so-called sham in some cases). Whatever the

mechanism, even if a reliable placebo in some cases, it will be

accepted. Same for the relief of symptoms such as nausea and some

other forms of pain and discomfort. It may be shown to be useful in

controlling certain problems like hypertension, though only the branch

and with a somewhat allopathic approach. It will not be shown to treat

chronic illness, except for noniatrogenic palliation. I encourage this

research for its benefit to society, but it is not my primary interest.

 

Traditional or Classical or even modern PRC CHIM, on the other hand,

will probably not be researched much at all in the US, I now believe.

At least not in the so-called gold standard trials for specific

conditions. While technically quite easy, there are just way too many

philosophical, ethical and legal obstacles to ever make such studies a

major undertaking. However we already have two decades worth of

patients who have been treated for a wide range of internal complaints.

How have these folks fared when compared to a similar group. A

longstanding school clinic could identify all their internal med

patients and then offer them some treatment for answering a

questionnaire. then one could find a matched group by age, sex, chief

complaint, health status at a local Kaiser who have not made CM part of

their primary healthcare. compare their current state of health and

you have some interesting data. Not about chinese herbology, per se,

but about how patients fare when getting comprehensive TCM healthcare

as a regular part of their regimen. by comparing a matched group, one

avoids the criticism that our patients are self-selected. This could

actually result in insurance coverage for regular ongoing TCM care and

sidestep the whole issue of diagnosis and insurance coding in the

process. If TCM care was found to insure better health as one ages,

then HMOs would save big bucks by encouraging it as most health costs

are for the diseases of aging. The whole issue of dx would be moot if

it was recognized that in general one would only benefit from TCM.

This could open the door to reasonable reimbursement for acupuncture

and even herbs when used for ANY complaint without ever having to code

for a specific complaint.

 

The idea would be that we improve health and relieve symptoms

noniatrogenically regardless of the western condition (which our

research would show with regard to decreased mortality and morbidity).

So it would always make sense to approve TCM treatment. Then we could

go merrily along our ways practicing CM without feeling some pressure

to be minidocs and do it all in order to have status (which really

translates into money and thus power). This may be an alternate way to

accomplish the goal of insuring our livelihoods and patients access to

affordable care. Then we could dispense with battling over issues like

titles and entry level and insurance reimbursement condition by

condition. Now again, I am talking here about CHIM. If the orthopods

among us want to be frontline care for injury rehab, they will probably

have to prove it condition by condition (but the hurdles to their

success are muc less than that for CHIM, IMO). But those who primary

interest is CHIM or at least comprehensive CM for IM conditions, the

general, rather than the specific, benefits of CM may be our best

focus. First, for some retrospective demographic and epidemiological

research to collect the proof and secondly, to make the case to

insurers and/or politicians (if medicare/aid still exist) that we

decrease costs and improve quality of life. A soundbite no one could

pass up.

 

 

 

Chinese Herbs

 

 

 

 

 

 

[Guest guest]

Not about chinese herbology, per se,

but about how patients fare when getting comprehensive TCM healthcare

as a regular part of their regimen. by comparing a matched group, one

avoids the criticism that our patients are self-selected

>>>Todd not true. This is what has been done for years with HRT. The problem is

that the patients are self-selected, ie, patients that choose to get TCM

treatments way be more likely to take care of their general health for example.

You then dont know if TCM has anything to do with their better health. That is

why a prospective study is needed. You need to control for as many variables as

possible.

I believe that if we as a profession would start doing the research we could do

it well (after a change in the way we teach at school takes place). This again

goes to the heart of what we vision as our profession. If we stay within the

current course i agree with you 100% and were we differ is that i believe this

will lead to the death of CM as an independent profession in the US. By not

owning the debate and research into our own practice we will loose the power to

control our destiny.