Statistics

[Guest guest]

Z'ev and

 

I agree there is no need to " fight tooth and nail " . We're stating the places

where we live. Of course, where we each live is a hot bed of fighting. That

doesn't mean we need to jump into a crowded fistfight. Hopefully we can shine

the light here on CHA. No one is in danger of losing vital signs based on

anything said here, right? I personally like the exchange with people I even

deeply disagree with. And, you're in the " moderate " realms. ;-)

 

Emmanuel Segmen

 

-

Thursday, November 13, 2003 9:04 AM

Re: statistics

 

 

I am a little puzzled, by your response, because I, for one,

don't consider myself 'opposed' to 'science', to research, or to your

point of view. I refuse to be demonized or categorized just because I

find inspiration in the classical literature or in Paul Unschuld's

lectures. I don't want to see two artificial 'camps' develop over what

I see to be a lively debate. Obviously, I am more cautious about

science as an institutional structure in our society, with its

socio-political-economic connections to either capitalism or communism,

which will often dilute the central principle of impartiality that is

inherent to science. The same methods you think we need to confirm CM

in order to establish it in the west are those I am concerned about its

potential to dismember it. I don't think our disagreement goes any

further than that. I am actually quite a science fan, and count among

my 'heroes' such figures as Einstein, Da Vinci, and Feynman, but worry

about 'scientism' as a new secular religion. Just as science examines

phenomena, the edifice of science itself also needs to be examined for

bias. Why should this be taboo?

 

Anthropology is also a science, a valuable one at that. It allows us

to have perspectives on knowledge bases with a long history, such as

Chinese medicine. It also allows socio-economic and political

perspectives which are absent from many research models, such as a view

on how society as a whole enforces its perspective on the raw data that

is gained. There is a lot of material written on this subject. I

don't think one perspective damns another.

 

On Nov 13, 2003, at 8:42 AM, wrote:

 

> me, too. since in the end, science always prevails. you folks less

> " moderate "

> than me can quote your prophets till the cows come home. we'll see

> what we

> shall see. In the meantime, I will fight you tooth and nail on this

> matter. I

> think your position is not only misguided but actually dangerous.

 

 

[Guest guest]

, " "

<@h...> wrote:

 

 

> Not at all, it is just an estimate… Wouldn't you like to know that

> with scenario X there was only a 10% cure rate, and with scenario Y

> there was an 80% cure rate….Wow such valuable information. I think

> it takes a mature and confident profession to look at such stats… If

> something doesn't work I don't want to try it `that way' when a

> patient comes in… With this information I might consider a different

> approach. But if I know that 80% of the time this avg. joe formula

> works, I would most likely start with that. Does that mean give the

> exact formula, maybe or maybe not.. this is where personal style

> comes in .. personally I tweak everything.. I am just a tweaker..

>

 

Sure, if something is demonstrated not to be effective, then I would

not use that method. However, the question was HOW statistics would

be used in CM, not WHAT are statistics in CM. If you tweak a tested

method, then your tweak no longer falls into the statistical rhelm

from which you found it useful. Unless the tweak is then tested in a

clinical trial (a GOOD clinical trial), then it is just guesswork from

a Western Scientific viewpoint.

 

So, by using non-tested tweaks based on hopefully good statistics is

not good scientific use of statistics. In the Western scientific

model that includes the use of statistics, all assumptions must be

tested, or they are not included.

 

I do have an answer, though, about HOW statistics can be usedin CM.

We need only to start keeping records of the clinical successes /

failures and degrees inbetween for various ailments, not of specific

treatments, but of in general. Then, these numbers

can be compared to the numbers produced by Western Medicine.

 

Within the profession, it will much harder. For instance, if a

clinical study showed that a certain TCM point protocol was more

effective for elbow pain from repetitive use than, say, Richard Tan's

method, then based on that study, it would be considered unethical to

use Richard Tan's method to treat that condition. However, studies

have flaws, and another study may show Richard Tan's method to be the

better method. This is what happens in Western Medicine / Science.

The point of view changes all of the time. One only need to look at

Western dietary recommendations over the last 20 years. Do we want to

flip / flop with our views or do we want to be right and provide

effect treatment. Because of the nature of clinical trials, the

nature of those who volunteer to be in trials, and difficultly in

generalizing results of clinical trails to the whole population,

results will be limitless, varying, and even contradictory. Where

will this get us?

Do I need to prove that my point combination or herbal combination is

better than someone elses? How could this even apply from one

individual in one moment of time to another individual in another

moment of time?

 

To sum this up, we can use statistics to show what kind of success CM

as a whole can get for various illness. This and letting the public,

insurance companies, and other interested parties knowing about it

seems to be all we need to secure our place as a profession.

 

Brian C. Allen

[Guest guest]

, " bcataiji " <bca@o...>

wrote:

 

If you tweak a tested

> method, then your tweak no longer falls into the statistical rhelm

> from which you found it useful. Unless the tweak is then tested in

a

> clinical trial (a GOOD clinical trial), then it is just guesswork

from

> a Western Scientific viewpoint.

 

Who said western scientific viewpoint??? Everyone must find there

comfort level, and I personally am comfotable with tweaking what has

been done previously because I understand treatment principles and

how herbs influence various factors... I am comfortable with these

general stats and find them extremely valuable in the clinic. I find

it has little to do with guesswork and all about understanding of

medicine and realtionships.

 

 

-

[Guest guest]

, " "

<@h...> wrote:

> , " bcataiji " <bca@o...>

> wrote:

>

> If you tweak a tested

> > method, then your tweak no longer falls into the statistical rhelm

> > from which you found it useful. Unless the tweak is then tested in

> a

> > clinical trial (a GOOD clinical trial), then it is just guesswork

> from

> > a Western Scientific viewpoint.

>

> Who said western scientific viewpoint??? Everyone must find there

> comfort level, and I personally am comfotable with tweaking what has

> been done previously because I understand treatment principles and

> how herbs influence various factors... I am comfortable with these

> general stats and find them extremely valuable in the clinic. I find

> it has little to do with guesswork and all about understanding of

> medicine and realtionships.

>

>

> -

 

I could have guessed your reply almost word for word, Jason. I agree

that " tweaking " is the way to practice . I also am

not questioning your understanding of CM. So, we are both on the same

page here. However, " tweaking " is not HOW to use statistics - period

- and that was the issue. It does not matter if you are comfortable

tweaking a statistic or not, it is not HOW statistic are properly used.

 

That said, knowing that tweaking is necessary for appropriate

treatment, and knowing that guiding formulas already exist for every

common pattern of every common CM disease, and taking into account

proper use of statistics, which is very narrow and limited, I see no

use for statistics in the manner which you suggested their use.

 

Brian C. Allen

 

 

BCA

[Guest guest]

> I think it would be fair to say that acceptance of

alternative medicine has been proportional to the perception of

valid research being done on the subject. >>>

 

The original acceptance and interest in CM was due to its

effectiveness and exotic nature. I think you're right that it's

continuing acceptence and integration into Western culture will

depend, in part, on research to validate its effectiveness. People

who wouldn't have originally tried CM would do so if there were

studies supporting it and they didn't like what WM was doing with

their condition.

 

But if we don't design and conduct our own type of research, we will

be at the mercy of those who do their own.

 

 

 

>>> Emmanuel: I actually worry that CM will be " relegated " to

standard American healthcare. Truly the nightmare of some would be

the sweet dreams of others. >>>

 

In part, it is already happening. The canary in the coal mine has

died; the paradigm is shifting. Medical acupuncture is doing a great

deal of research in biomedical terms and integrating CM into WM---

even the ER. No one is asking us or needs us to do anything.

 

And, if you look at the trend in schools and accreditation agencies,

CM is becoming increasingly biomedical in character; it is fast

becoming a subset of WM, using Chinese techniques.

 

But . . . if we don't want our version(s) of CM to become

marginalized here, we should do something persuasive. Like conduct

our own studies at CM colleges that demonstrate its effectiveness

for diseases and how it can compliment WM. What better advertising

could there be for CM than hearing on TV that " a study at a famous

acupuncture university released the results of a study showing CM's

effectiveness " . Instead of " ephredra has been outlawed. "

 

We are way past the time that students learning Chinese language

will help save CM by translating unreliable or suspect Chinese

research. Our new motto should be " CM made here in the USA. "

 

 

Jim Ramholz

[Guest guest]

, " bcataiji " <bca@o...>

wrote:

> However, " tweaking " is not HOW to use statistics - period

> - and that was the issue. It does not matter if you are comfortable

> tweaking a statistic or not, it is not HOW statistic are properly

used.

>

> That said, knowing that tweaking is necessary for appropriate

> treatment, and knowing that guiding formulas already exist for every

> common pattern of every common CM disease, and taking into account

> proper use of statistics, which is very narrow and limited, I see no

> use for statistics in the manner which you suggested their use.

>

> Brian C. Allen

 

Brian I cannot disagree more, I am sure you expected that

1)Where is the rule on how we use stats? Proper??? You may use them

one way I use them another, there is no right way! I use them as

guidelines you may use them as laws... There is no universal 'stat'

truth ¡V Period ƒº

2) Yes guiding Rx's exist for most patterns & diseases... And yes

there are more than one formula ( sometimes 20+ ) for a specific

pattern within a disease. But some patterns are just that easily

treated and some are not.. Some Rx's work well and some are

questionable, this is what needs to be sussed out... Just b/c it is

in your book does not mean that it is law and going to work. That is

why there is still research and new additions and trials for various

patterns. A Rx might work, but another might work better. I would

like to know this. If it were so easy we would be done... I.e. give

me a Rx with high success rate for tinnitus due to kidney vacuity. I

personally think this is hard to treat, if we knew that statistically

the main Rxs recommended did not due well we could venture out and

start trying new things. Because that is an obvious example, I have,

already¡K

 

You can say you don¡¦t like stats, fine that is your decision. I will

use them and make decisions in the clinic based on them, as well

texts old and new, and my experience¡K Chinese journals use stats,

therefore must think they are valuable, so I am not alone¡K

 

-

[Guest guest]

It would seem that every practitioner throughout history has used some sort

of simple statistics such as basing initial treatment on an assessment of

numbers helped against numbers worsened. In other factors

are added in such as the individual characteristics of the patient as well

as intuitive factors.

 

However the scientific use of statistics would call for the use of

statistically validated formulations in the treatment. Here is where you

lose your ability to tweak. Is what you have done statistically valid?

Where are the studies to support what you have done? What is your liability

for prescribing outside the bounds of statistically validated formulas?

Once you open this can of worms you lose control of your profession to those

who conduct the research and compile the statistics. Once this avenue is

opened there will be many outside your profession eager to profit from doing

the research and crunching the numbers.

 

I constantly hear people state that the reason they seek treatment outside

the mainstream WM profession is because they are tired to being treated as

if they were numbers and not individuals.

 

Barry Thorne

 

> However, " tweaking " is not HOW to use statistics - period

>- and that was the issue. It does not matter if you are comfortable

>tweaking a statistic or not, it is not HOW statistic are properly used.

>

>That said, knowing that tweaking is necessary for appropriate

>treatment, and knowing that guiding formulas already exist for every

>common pattern of every common CM disease, and taking into *******

>proper use of statistics, which is very narrow and limited, I see no

>use for statistics in the manner which you suggested their use.

>

>Brian C. Allen

>

>

>BCA

>

>

>

>

>Chinese Herbal Medicine, a voluntary organization of licensed healthcare

>practitioners, matriculated students and postgraduate academics

>specializing in Chinese Herbal Medicine, provides a variety of professional

>services, including board approved online continuing education.

>

>

>

>

[Guest guest]

Please expand on your statement below. Please explain whose acceptance you

are referring to. Do you mean by the established medical profession or by

the population at large or both. I have been questioning people who utilise

acupuncture to try to understand how they justify the expenditure and trust

they extend to that practice. None of them cite research. Most cite

personal positive effects as well as word of mouth positive effects cited by

others. THey also talk about being treated as an individual. In fact, most

persons whom I have questioned state that they are not at all interested in

the research as they have no faith in it.

 

Barry Thorne

 

 

I think it would be fair to say that acceptance of

>alternative medicine has been proportional to the perception of valid

>research

>being done on the subject. Any halt to this process which has barely begun

>would be the doom of any future but a marginal one. And I suppose that is

>what we have to decide. Do we want to make CM as much of a force in

>healthcare as possible or do we want to stick to some philosophical

>position

>that relegates us to obscurity. You may be right, but I do not agree and

>am not

>willing to take the chance.

>

>Todd

>

>

>

>Chinese Herbal Medicine, a voluntary organization of licensed healthcare

>practitioners, matriculated students and postgraduate academics

>specializing in Chinese Herbal Medicine, provides a variety of professional

>services, including board approved online continuing education.

>

>

>

>

[Guest guest]

, " wainwright " wrote:

> My take on this issue is that there is not anything necessarily

wrong with statistics, and I don't think that this is what Unschuld

meant to imply, although I was not there. >>>

 

 

Wainwright:

 

Good point. I agree. Nor was I there; I was teaching in Seattle.

 

Without Unschuld's original words and their context on a topic of

this importance the " standard " descriptions of what they say

Unschuld said sounds confused to me.

 

Didn't anyone take detailed notes that they can post to the Files

section?

 

When are the PCOM conference tapes available?

 

 

 

Jim Ramholz

[Guest guest]

, " Pat Ethridge " wrote:

> it may be possible to further refine biomedical prescribing by

analysing pharmaceutical drugs according to Chinese methods of

differentiation, and tailoring drug selection to the individual.

This would be a form of integrated medicine in reverse to the way

it's often conceived. - Wainwright

>

> Now this would be really useful and interesting. I have often

wondered about this myself. >>>

 

 

Pat:

 

We can " fit " drugs into CM if we use 5-Phases and pulses, or even

just look at signs and symptoms against side effects. Some of my

articles show how WM ideas can be integrated into pulse diagnosis.

 

As I've been saying all along, and Ken recently reiterated,

complexity theory is a place where WM and CM can meet on a more even

footing---if it becomes more broadly accepted. Unfortunately, it is

not well enough developed for that right now. But in 10-20 years,

who knows?

 

 

 

Jim Ramholz

 

 

 

 

 

Jim Ramholz

[Guest guest]

Jim,

 

I took detailed notes on Pauls remark about

statistics. I've stated it and them two or

three times now. So if you want to know

what Paul said, just reread my earlier

posts on this topic.

 

Ken

[Guest guest]

, " BARRY THORNE " <naturec@m...>

wrote:

> Please expand on your statement below. Please explain whose acceptance

you

> are referring to. Do you mean by the established medical profession or by

> the population at large or both. I have been questioning people who utilise

> acupuncture to try to understand how they justify the expenditure and trust

> they extend to that practice. None of them cite research.

 

I was talking about acceptance by researchers, insurers and mainstream

physicians. While the patients we see definitely DO NOT come because of stats,

we see only a minute fraction of the population. some of you may have heard

the stats that 40% of americans use alternative medicine, but did everyone

know that most of these visits are to weight loss clinics like Jenny Craig,

which

was included in the survey and acupuncture use is in the low single digits. I

believe acupuncture use will always remain in the low single digits until more

research is done because it is an expensive elitist service that most folks

literally cannot afford. Most people are in debt with negative savings, so ANY

additional expenditures just increases debt. This also why I think the whole

professionalism thing is misguided as well. Healthcare absolutely cannot be

delivered efficiently by professionals serving only the wealthy. Only research

will get insurers to cover and MD's to refer.

 

I am still an elitist because reimbursement is usually too low to actually cover

my expenses for treating the patient (ASHP offers $30 per tx after the 5th

visit). However reimbursement is low because the service is not really

regarded as effective by insurers - they include the acupuncture at signficant

expense to their insurees as a marketing perk. If there was widespread

acceptance of acupuncture's effectiveness, then it would be standard in all

policies because it would be shown to lower overall payouts. Until statistical

research is done, this will not change. Or let me say that even if the

anti-stat

crowd is right about their futurist projections, I can't wait 50 years while

people suffer in the meantime. It doesn't suit my temperment and I think the

attitude is wrong anyway. So if we want to reach out to the broader cross

section of the population, we must set up a system that recognizes our

effectiveness and delivers care to everyone who wants it.

 

That means research on one hand and perhaps insurers or government setting

the fees on the other. So you may not see insurers going for 150 a pop, but I

think we could get as much as others docs, like 65-75, which is fine. And if

you want to have an elitist service and maintain your professionalism, for

whatever that's worth, nothing's stopping you. And if you think our hands

would be tied by researched protocols, they would not. MD's prescribe offlabel

everyday and so can we. None of this binds anyone to anything, but it paves

the way for truly changing the healthcare system. This emphasis on

professionalism and eschewing of statistics will be what I think means the end

of CM in our time. We will be marginalized into obscurity at the same time as

WM will be developing newer, safer therapies that actually cure disease (Did

everyone hear about the heart disease stem cell study with amazing results so

far).

 

I think CM can contribute to the further development of healthcare in this

century by direct engagement with the mainstream, not by hiding behind the

veil of professionalism. And my prediction is that the future of medicine will

be a holistic systems oriented medicine that will be influenced by CM, but that

CM as a distinct practice from healthcare in general will probably cease to

exist

in a few generations regardless of what tactic we use. As soon as WM has

something safe, effective and easy, our patients will go away. It is only

current dissatisfaction with WM that has given us a blip on the radar anyway.

If one studies the hx of alternative med in the US, one can see this trend ebb

and flow a number of times. While it was the flexner report that closed most

of the alternative med schools around WWI, it was the advent of modern

phamaceuticals that really ended the show. Now we can expect similar things

to happen with stem cells and the genetically tailored drugs. So we can learn

our craft, help sick people during the transition to whatever comes next and

hopefully see the process accelerated by the experience and ideas of CM we

bring to the table.

 

[Guest guest]

Thanks for your information on the history of HRT. I went back and reviewed

the history of HRT and found it very interesting. In 1900 Knauer and Halban

established that the ovary exerts its influence on growth and maintenance of

the genital organs by secreting a hormone. So the search was on to identify

and isolate that hormone. In 1923 Alloen and Doisy developed a

quantitiative bioassay method based on changes in pap smears of rats. This

lead to the isolation of the hormone from urine and blood and the chemical

structure was elucidated. Soon scientists were proclaiming that estrogen

was the answer to the discomforts of menopause. Scientists theorized that

the hormone was somewhat involved in the aging process and that the use of

estrogen at menopause could prevent thinning of the bones, loss of skin

elasticity, and sclerosis of blood vessels (all age related). Scientists

urged doctors to freely use HRT for prolonged periods based on the

classification of the hormone as having a physiological and not a

pharmacological action in the body.

 

This history is interesting because it is illustrative of a tendency to use

limited scientific information to hypothesize about mechanisms of actions

for substances. Because of the high costs of research and the difficulties

with design of experiement many products are advanced with merely a valid

hypothesis to support them.

 

This confirms the old saying that a little knowledge is more dangerous than

none at all. Chinese medicine has a long history of use in humans. Its

effects are well understood and its methods are very safe when applied

correctly. Western medical science is very young and a review of the

conflicting reports in the literature reveal that its understanding of the

complexity of biological processes is questionable.

 

your point in regard to HRT is well made. Recent clinical studies

have established that risks outweigh benefits for most people. However, it

seems to me that most holistic practitioners already understood this without

scientific research to validate it. Recent HRT studies demonstate the

ability of science to correct misconceptions. The very fact that these

misconceptions arise and the enormous amount of conflicting scientific data

would suggest that extreme caution should be taken when using scientific

research. Doctors are having an encreasingly difficult time making sense of

it (especially with time constraints imposed by insurance companies).

 

From my observations, people are increasingly aware of the confusion and

frustrations of the MD community. THey are also becoming more sceptical of

the research.

 

Barry Thorne

 

 

 

 

>actually it was based upon speculation that since pre-menopausal women

>have less heart disease and osteoporosis, the hormones must be protective.

>there was never any evidence that this was correct and certainly no

>evidence

>that they were safe.

>

>Todd

>

>

>

>Chinese Herbal Medicine, a voluntary organization of licensed healthcare

>practitioners, matriculated students and postgraduate academics

>specializing in Chinese Herbal Medicine, provides a variety of professional

>services, including board approved online continuing education.

>

>

>

>

[Guest guest]

I was discussing this with a group of acupuncturists in this area

(Asheville). They all have practices that are see a maximum and are very

happy with the current situation. They agreed that many of their patients

cannot afford insurance and have no problem with the out of pocket expense.

We all observe that the profession is growing along the the number of

practitioners. Some of them have chosen not to take insurance and thereby

save the expense of hiring someone just to process the claims and file the

paperwork. Ultimately they felt that they have more time for their patients

and are rewarded with a loyal clientele. This area is certainly not a

wealthy area and everyone agreed that their patients could not be classed as

the wealthy.

 

Perhaps the profession can continue to grow with increasing numbers of

practitioners educating and providing sound treatments.

 

 

 

>I was talking about acceptance by researchers, insurers and mainstream

>physicians. While the patients we see definitely DO NOT come because of

>stats,

>we see only a minute fraction of the population. some of you may have

>heard

>the stats that 40% of americans use alternative medicine, but did everyone

>know that most of these visits are to weight loss clinics like Jenny Craig,

>which

>was included in the survey and acupuncture use is in the low single digits.

> I

>believe acupuncture use will always remain in the low single digits until

>more

>research is done because it is an expensive elitist service that most folks

>literally cannot afford. Most people are in debt with negative savings, so

>ANY

>additional expenditures just increases debt. This also why I think the

>whole

>professionalism thing is misguided as well. Healthcare absolutely cannot

>be

>delivered efficiently by professionals serving only the wealthy. Only

>research

>will get insurers to cover and MD's to refer.

>

 

 

 

 

>I am still an elitist because reimbursement is usually too low to actually

>cover

>my expenses for treating the patient (ASHP offers $30 per tx after the 5th

>visit). However reimbursement is low because the service is not really

>regarded as effective by insurers - they include the acupuncture at

>signficant

>expense to their insurees as a marketing perk. If there was widespread

>acceptance of acupuncture's effectiveness, then it would be standard in all

>policies because it would be shown to lower overall payouts. Until

>statistical

>research is done, this will not change. Or let me say that even if the

>anti-stat

>crowd is right about their futurist projections, I can't wait 50 years

>while

>people suffer in the meantime. It doesn't suit my temperment and I think

>the

>attitude is wrong anyway. So if we want to reach out to the broader cross

>section of the population, we must set up a system that recognizes our

>effectiveness and delivers care to everyone who wants it.

 

I have observed that many doctors are eliminating third party payments as

well. They are sick of fighting with the insurance company over what

treatment is most effective and cost efficient for their patients. Many

that I know state that they have no time to review the literature because

they have to see so many patients to make their living. They are tired to

waiting for long periods before getting reimbursed and the staff expense.

THey are frustrated because their patients are not getting the best care.

Many cannot afford to attend to their own professional development. On top

of that, malpractice insurance rates continue to rise with the frustration

perhaps the higher coverage will only lead to a greater probability of being

sued for a high amount. They are expressing the desire to set their own

fees and determine their own treatments.

 

 

 

 

>

>That means research on one hand and perhaps insurers or government setting

>the fees on the other. So you may not see insurers going for 150 a pop,

>but I

>think we could get as much as others docs, like 65-75, which is fine. And

>if

>you want to have an elitist service and maintain your professionalism, for

>whatever that's worth, nothing's stopping you. And if you think our hands

>would be tied by researched protocols, they would not. MD's prescribe

>offlabel

>everyday and so can we. None of this binds anyone to anything, but it

>paves

>the way for truly changing the healthcare system. This emphasis on

>professionalism and eschewing of statistics will be what I think means the

>end

>of CM in our time. We will be marginalized into obscurity at the same time

>as

>WM will be developing newer, safer therapies that actually cure disease

>(Did

>everyone hear about the heart disease stem cell study with amazing results

>so

>far).

>

 

If science does develop ways to actually cure disease, where will

acupuncture fit into this system anyway. The promise of cure has been just

around the corner for many years and the promise great.

 

 

>I think CM can contribute to the further development of healthcare in this

>century by direct engagement with the mainstream, not by hiding behind the

>veil of professionalism. And my prediction is that the future of medicine

>will

>be a holistic systems oriented medicine that will be influenced by CM, but

>that

>CM as a distinct practice from healthcare in general will probably cease to

>exist

>in a few generations regardless of what tactic we use. As soon as WM has

>something safe, effective and easy, our patients will go away. It is only

>current dissatisfaction with WM that has given us a blip on the radar

>anyway.

>If one studies the hx of alternative med in the US, one can see this trend

>ebb

>and flow a number of times. While it was the flexner report that closed

>most

>of the alternative med schools around WWI, it was the advent of modern

>phamaceuticals that really ended the show. Now we can expect similar

>things

>to happen with stem cells and the genetically tailored drugs. So we can

>learn

>our craft, help sick people during the transition to whatever comes next

>and

>hopefully see the process accelerated by the experience and ideas of CM we

>bring to the table.

>

>Todd

>

Of perhaps it was the headlong rush and almost religious acceptance of

science as the last frontier that so captured the imagination. Chinese

medicine is about balance and harmony. American history is about growth and

expansion, struggle and victory. America was young when science first

carried the day. Perhaps we have matured and grown wiser.

 

Barry Thorne

 

 

 

 

 

 

>

>

>Chinese Herbal Medicine, a voluntary organization of licensed healthcare

>practitioners, matriculated students and postgraduate academics

>specializing in Chinese Herbal Medicine, provides a variety of professional

>services, including board approved online continuing education.

>

>

>

>

[Guest guest]

All power to you, Emmanuel. Keep up the great work.

 

 

On Nov 14, 2003, at 7:34 PM, Emmanuel Segmen wrote:

 

> One area I think we ignore to our peril is public education.

> There have been few if any decent books or courses for laypeople on

> Chinese medicine, we are still a largely word-of-mouth field. We need

> our Andrew Weils to make the case, present the field in an honest and

> accurate light in bookstores and conferences.

>

>

>

> Hi Z'ev,

>

> In my classroom where most people are going on to nursing, optometry,

> medicine or some allied health profession, everyone has heard me speak

> about CM. I mention to them that CM is one of the few written, and

> often oral, traditions that seems capable of viewing life. It

> actually supports the manner in which I teach physiology and anatomy.

> I'm nearing the 2,000 mark for the number of students that I've had in

> one classroom or another and for whom I've written a final grade in

> anatomy, physiology, virology, nutrition and human dissection

> laboratory. So far I've had many lively discussions over the last 17

> or 18 years and only a couple of people did not seem to " get it "

> regarding CM. Also there are a half dozen or so practitioners that

> appear to have benefited since people have been asking me for

> referrals for these many years.

>

> I guess your point about public education hit a tender spot in me. I

> do indeed hope that CM's public presence grows exponentially. Growth

> in this America is indeed an enterprise of economics and politics,

> that is, social policies. When aspects of CM show up in K-12

> textbooks along with the " eating right pyramid " , I'll feel this

> culture has turned a corner. For now, I can only be sure that my own

> classroom contains this particular reference because I'm teaching

> " basic science " which is supposed to include a broad spectrum of

> reality ... even philosophy of science.

>

> Emmanuel Segmen

>

>

>

>

[Guest guest]

, " BARRY THORNE " <naturec@m...>

wrote:

> I was discussing this with a group of acupuncturists in this area

> (Asheville). They all have practices that are see a maximum and are very

> happy with the current situation. They agreed that many of their patients

> cannot afford insurance and have no problem with the out of pocket expense.

 

because they are seeing patients who have the cash. yes, there are plenty of

happy acupuncturists and happy patients and progressive MD's, but that is

really not my point. my point is that the vast majority of people DO NOT have

access to these services and never will if they have to pay out of pocket. I

think its simple economics, you either have the cash or you don't. So there

will be a cutoff point where there are not enough people who have the need,

the cash and the acceptance. 15 years ago I had a similar attitude to you and I

can say my predictions for the future at that time have not panned out. While

I may not be patient enough, I do not think society can wait 50 years for he

post-statisctics age and I also do think the position is just wrong based upon

everything I know about development of paradigms.

 

But of course, my analysis here is based upon statistics of income and

healthcare usage, etc. so I need statistics to prove the value of statistics,

which

is of course circular and invalid. So if one person rejects statistics and

another

insists on them, there is no logical argument that can really bridge the divide,

is there? We must first agree on an initial premise to have a logical argument.

We agree the sun is hot, then we debate why. I can't even have the debate

that rejects stats because it is an inital premise for me. but let me be clear

about one thing. I do not think research is necessary to develop new

therapies, but it is the only tool we have to explore the safety and efficacy of

those that already exist for whatever reason. I will remind the unschuldites

that PU also has said that he does NOT believe CM has been proven clinically

effective by its long tenure, only culturally effective. He also said to take

from

the history what makes sense for one's current culture and don't blindly follow

the PRC or the japanese or whatever. Well, using stats to research all this

makes sense to me. But this debate is somewhat moot as all the major colleges

and professional orgs and herb companies are already on the research

bandwagon to one degree or another and no amount of gum-flapping here will

change that. that is the momentum of history as far as I can tell and hopefully

we will live long enough to see what comes out the other side.

 

[Guest guest]

I see your point, and I think that helping our poor populations with

Chinese medicine is an important goal. One way around this problem

would be state or federal funding of low-cost alternative medicine

clinics to serve poor areas. However, the insurance game also excludes

large proportions of poor people, and the HMO-ization of the field will

not make high-quality Chinese medicine available to the general public,

it will cheapen it, just as it has done to biomedical practitioners.

There is a crisis in the health care system, and our treatments are

relatively low-cost, so even those patients who have health insurance

are willing to pay rather than up their monthly insurance payments

dramatically.

 

 

On Nov 16, 2003, at 11:40 AM, wrote:

 

> because they are seeing patients who have the cash. yes, there are

> plenty of

> happy acupuncturists and happy patients and progressive MD's, but that

> is

> really not my point. my point is that the vast majority of people DO

> NOT have

> access to these services and never will if they have to pay out of

> pocket. I

> think its simple economics, you either have the cash or you don't.

> So there

> will be a cutoff point where there are not enough people who have the

> need,

> the cash and the acceptance. 15 years ago I had a similar attitude to

> you and I

> can say my predictions for the future at that time have not panned

> out. While

> I may not be patient enough, I do not think society can wait 50 years

> for he

> post-statisctics age and I also do think the position is just wrong

> based upon

> everything I know about development of paradigms.

[Guest guest]

I think you are making an artificial division, here, Todd. I don't

think we need to place any one in any 'camp' called " Unschuldite " .

Despite our attempts at categorization, human beings remain complex,

contradictory and all too difficult to pin down. I, for one, may agree

with much of what Unschuld says, but I also have disagreements as well.

Every human being has their limitations.

 

What he said at his PS seminar is that having the greatest access to

the history of the Chinese medical tradition will help us find the best

expression in our own culture.

 

I also don't get the sense that anyone here is against research, just

concerned about the quality and nature of that research. Not that I

think it is going to 'save' our profession, or that it will be

adequately funded or supported in the short-term.

 

Enough us or them, stuff, please. I don't want to see artificial

divisions splitting up the CHA. Divisiveness has already lead to

multiple problems with practitioner's associations vs. the schools, and

now we have the Little Hoover Commission looking into deciding what we

can or cannot do with our profession, largely because of our lack of

agreement on anything.

 

 

 

 

On Nov 16, 2003, at 11:40 AM, wrote:

 

> I will remind the unschuldites

> that PU also has said that he does NOT believe CM has been proven

> clinically

> effective by its long tenure, only culturally effective. He also said

> to take from

> the history what makes sense for one's current culture and don't

> blindly follow

> the PRC or the japanese or whatever.

[Guest guest]

I know for a fact that many of the patients seeking acupuncture would not be

listed in the statistical category of having the cash. I am acquainted with

many who sacrifice and save in order to get acupuncture. many do not have

insurance so acupuncture is the most afordable avenue for them and besides

they have no desire to see a regular MD.

 

Your assumption that the vast majority of people cannot or will not pay for

acupuncture out of pocket is not correct. They will pay if they see the

benefit. They did not need research to prove effectiveness. Over the

years, I have noticed that people respond more to testimonial evidence than

to research evidence. So who is to say that as more people experience

positive healing from the acupuncture profession and they tell others then

the profession will continue to grow of its own.

 

I understand that people will often choose allopathic medicine when out of

pocket expense is low. But this is changing rapidly for many people. The

costs of allopathic medicine are growing rapidly and more people are being

asked to pay out of pocket.

 

Research has its place in our economy, but I fail to understand how it will

save . It will drive the cost up. I hope we are wise

enough to control it so that the benefits outweigh the costs. I have my

doubts.

 

Barry

 

 

>

>because they are seeing patients who have the cash. yes, there are plenty

>of

>happy acupuncturists and happy patients and progressive MD's, but that is

>really not my point. my point is that the vast majority of people DO NOT

>have

>access to these services and never will if they have to pay out of pocket.

>I

>think its simple economics, you either have the cash or you don't. So

>there

>will be a cutoff point where there are not enough people who have the need,

>the cash and the acceptance. 15 years ago I had a similar attitude to you

>and I

>can say my predictions for the future at that time have not panned out.

>While

>I may not be patient enough, I do not think society can wait 50 years for

>he

>post-statisctics age and I also do think the position is just wrong based

>upon

>everything I know about development of paradigms.

>

>But of course, my analysis here is based upon statistics of income and

>healthcare usage, etc. so I need statistics to prove the value of

>statistics, which

>is of course circular and invalid. So if one person rejects statistics and

>another

>insists on them, there is no logical argument that can really bridge the

>divide,

>is there? We must first agree on an initial premise to have a logical

>argument.

>We agree the sun is hot, then we debate why. I can't even have the debate

>that rejects stats because it is an inital premise for me. but let me be

>clear

>about one thing. I do not think research is necessary to develop new

>therapies, but it is the only tool we have to explore the safety and

>efficacy of

>those that already exist for whatever reason. I will remind the

>unschuldites

>that PU also has said that he does NOT believe CM has been proven

>clinically

>effective by its long tenure, only culturally effective. He also said to

>take from

>the history what makes sense for one's current culture and don't blindly

>follow

>the PRC or the japanese or whatever. Well, using stats to research all

>this

>makes sense to me. But this debate is somewhat moot as all the major

>colleges

>and professional orgs and herb companies are already on the research

>bandwagon to one degree or another and no amount of gum-flapping here will

>change that. that is the momentum of history as far as I can tell and

>hopefully

>we will live long enough to see what comes out the other side.

>

>Todd

>

>

>

>Chinese Herbal Medicine, a voluntary organization of licensed healthcare

>practitioners, matriculated students and postgraduate academics

>specializing in Chinese Herbal Medicine, provides a variety of professional

>services, including board approved online continuing education.

>

>

>

>

[Guest guest]

Barry,

 

I would support your thesis. It's profoundly cheaper to pay out of pocket for

acupuncture than it is for even the cheapest health care insurance. If any one

feels otherwise, please, please direct me to the cheaper healthcare insurance.

Mine is absolutely minimal group insurance and is $384 every 2 months. It only

covers major medical and nothing else. I see a good MD buddy for blood work

when I want it and pay out of pocket.

 

The tens of millions of people who can not afford health insurance are the most

likely candidates for Chinese acupuncture. Actually most of my students fit

into this category, and I direct them as to where to find a local CM

practitioner so they don't need to suffer with the flu or other readily

treatable malady.

 

Emmanuel Segmen

 

-

BARRY THORNE

Sunday, November 16, 2003 3:20 PM

Re: statistics

 

 

I know for a fact that many of the patients seeking acupuncture would not be

listed in the statistical category of having the cash. I am acquainted with

many who sacrifice and save in order to get acupuncture. many do not have

insurance so acupuncture is the most afordable avenue for them and besides

they have no desire to see a regular MD.

 

Your assumption that the vast majority of people cannot or will not pay for

acupuncture out of pocket is not correct. They will pay if they see the

benefit. They did not need research to prove effectiveness. Over the

years, I have noticed that people respond more to testimonial evidence than

to research evidence. So who is to say that as more people experience

positive healing from the acupuncture profession and they tell others then

the profession will continue to grow of its own.

 

I understand that people will often choose allopathic medicine when out of

pocket expense is low. But this is changing rapidly for many people. The

costs of allopathic medicine are growing rapidly and more people are being

asked to pay out of pocket.

 

Research has its place in our economy, but I fail to understand how it will

save . It will drive the cost up. I hope we are wise

enough to control it so that the benefits outweigh the costs. I have my

doubts.

 

Barry

 

 

>

>because they are seeing patients who have the cash. yes, there are plenty

>of

>happy acupuncturists and happy patients and progressive MD's, but that is

>really not my point. my point is that the vast majority of people DO NOT

>have

>access to these services and never will if they have to pay out of pocket.

>I

>think its simple economics, you either have the cash or you don't. So

>there

>will be a cutoff point where there are not enough people who have the need,

>the cash and the acceptance. 15 years ago I had a similar attitude to you

>and I

>can say my predictions for the future at that time have not panned out.

>While

>I may not be patient enough, I do not think society can wait 50 years for

>he

>post-statisctics age and I also do think the position is just wrong based

>upon

>everything I know about development of paradigms.

>

>But of course, my analysis here is based upon statistics of income and

>healthcare usage, etc. so I need statistics to prove the value of

>statistics, which

>is of course circular and invalid. So if one person rejects statistics and

>another

>insists on them, there is no logical argument that can really bridge the

>divide,

>is there? We must first agree on an initial premise to have a logical

>argument.

>We agree the sun is hot, then we debate why. I can't even have the debate

>that rejects stats because it is an inital premise for me. but let me be

>clear

>about one thing. I do not think research is necessary to develop new

>therapies, but it is the only tool we have to explore the safety and

>efficacy of

>those that already exist for whatever reason. I will remind the

>unschuldites

>that PU also has said that he does NOT believe CM has been proven

>clinically

>effective by its long tenure, only culturally effective. He also said to

>take from

>the history what makes sense for one's current culture and don't blindly

>follow

>the PRC or the japanese or whatever. Well, using stats to research all

>this

>makes sense to me. But this debate is somewhat moot as all the major

>colleges

>and professional orgs and herb companies are already on the research

>bandwagon to one degree or another and no amount of gum-flapping here will

>change that. that is the momentum of history as far as I can tell and

>hopefully

>we will live long enough to see what comes out the other side.

>

>Todd

>

>

>

>Chinese Herbal Medicine, a voluntary organization of licensed healthcare

>practitioners, matriculated students and postgraduate academics

>specializing in Chinese Herbal Medicine, provides a variety of professional

>services, including board approved online continuing education.

>

>

>

>

[Guest guest]

I have been questioning people who utilise

acupuncture to try to understand how they justify the expenditure and trust

they extend to that practice. None of them cite research.

>>>>Again i will say see what happened to St Johns wort with just 2 negative

studies

alon

 

 

[Guest guest]

, " Kurt Kochek " <earthmed@m...>

wrote:

I don't see us isolated as a profession, but parallel to a whole movement that

is

gradually gaining momentum.

 

 

I wish I could agree but the rise of the SUV and the epidemic of obesity and

the war mongering have me really doubting that America is on the path of

redemption. I feel like we saw a blip of interest in alternative health peaking

a little while ago, which has now actually dipped (partly, I believe, because

the

research has lagged). Meat and tobacco consumption are both fashionable

again as an example of this trend. I think we either need to infiltrate the

mainstream healthcare system and lock in our gains, so to speak or we will be

marginalized. There will be a small group of the faithful in any era, but I see

no evidence that middle america is leaving the couch anytime soon.

 

[Guest guest]

As we know with one of the St. Johnswort studies, it was totally biased

and the intentions were malevolent. A German study was done by a

pharmaceutical company that bought out a company producing a St.

Johnswort product, measuring treatment of patients with major

depression by St. Johnswort. After the poor showing in the study, the

drug company apparently discontinued the product.

 

This brings up a number of problems. One is how we represent herbal

products as treatments for Western diseases, or more specifically,

labeling herbs as 'antidepressants', as if one herb could replace a

drug such as Prozac. Secondly, if we present herbs in this fashion, we

will eventually have to go 'mano a mano' with the drug companies and

compete. We will lose every time.

 

Research has to be designed from within, and within parameters

developed by the Chinese medical community, for realistic conditions

with realistic expectations. Otherwise, the pharmaceutical companies

will continue to savage products they cannot patent or control. They

don't want the competition from herbs, and have the advantage of

endless amounts of money. Also, the type of specificity of drugs in

terms of dosage and strength cannot be repeated in herbs, so using

single herbs as replacements for drugs is not a comparable method for

clinical treatment.

 

 

On Nov 17, 2003, at 12:47 AM, Alon Marcus wrote:

 

> I have been questioning people who utilise

> acupuncture to try to understand how they justify the expenditure and

> trust

> they extend to that practice. None of them cite research.

>>>>> Again i will say see what happened to St Johns wort with just 2

>>>>> negative studies

> alon

[Guest guest]

Interesting, Paul in his seminar addressed his personal concern that

after 9/11, interest in 'soft' medical technologies (including herbs

and acupuncture) would wane, and interest in 'hard' medical

technologies such as surgery and strong drugs would again increase.

This would be due to the influences of militarized world views, and

fears for security. We see increases of sometimes unnecessary surgeries

(the 'extreme makeover'), botox, Hummers and all the rest.

 

I used to see a version of the extreme makeover on " Twilight Zone " as a

kid, and Rod Serling was a prophet. What he saw has come to pass.

Surgically enhanced 'perfect' people.

 

However, the pendulum is always shifting. Politics in the modern era

shift rapidly. The fifties were quite a contrast to the sixties.

 

However, I think Todd is right. Interest in herbal medicine has peaked

recently in the marketplace, and some type of retrenchment may be

necessary for our profession.

 

 

On Nov 17, 2003, at 1:42 AM, wrote:

 

> , " Kurt Kochek "

> <earthmed@m...>

> wrote:

> I don't see us isolated as a profession, but parallel to a whole

> movement that is

> gradually gaining momentum.

>

>

> I wish I could agree but the rise of the SUV and the epidemic of

> obesity and

> the war mongering have me really doubting that America is on the path

> of

> redemption. I feel like we saw a blip of interest in alternative

> health peaking

> a little while ago, which has now actually dipped (partly, I believe,

> because the

> research has lagged). Meat and tobacco consumption are both

> fashionable

> again as an example of this trend. I think we either need to

> infiltrate the

> mainstream healthcare system and lock in our gains, so to speak or we

> will be

> marginalized. There will be a small group of the faithful in any era,

> but I see

> no evidence that middle america is leaving the couch anytime soon.

>

 

>

>

>

[Guest guest]

> However, the pendulum is always shifting. Politics in the modern

era

> shift rapidly. The fifties were quite a contrast to the sixties.

>

> However, I think Todd is right. Interest in herbal medicine has

peaked

> recently in the marketplace, and some type of retrenchment may be

> necessary for our profession.

>

>

 

 

Well, there's this concept called Yin and Yang...