Guest guest Posted September 11, 2007 Report Share Posted September 11, 2007 Hugo, Sorry, I quoted you twice. rushed editing job. DK Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2007 Report Share Posted September 12, 2007 Hi David, I really believe that you are reading into my posts, but not reading them. That can really be a problem to communication. I hope that we can do better in future postings. David Karchmer <acuprof First of all, IVF is expensive to administer in part because it takes very expensive technology to perform. A proper IVF facility can expect a start up cost of between $1-2 million. Expensive is not synonymous with deceitful or dishonest. Clearly IVF is an expensive treatment. Add ICSI to the mix and it is more costly. But, as for who should or should not choose the more expensive treatment, that is a matter of medical necessity and personal choice. Why should we rule out ART on the basis that it is costly? You said, " I have a particular concern with reproductive technologies (which are a part of the overall medical organisation, to be clear). The ethical question I brought up with the mechanic analogy is the following: if you can do something cheaply, why do it expensively? " Am I reading you correctly? Are you suggesting that there is something underhanded, or malevolant about ART? You also said, " Further, if there is no evidence to support the use of an expensive, invasive procedure over the use of a cheaper, non- invasive procedure, then what should one do? Further, what is the long-term evidence supporting the use of reproductive technologies? Where are the studies describing the misuse of reproductive technologies? " Just what do you mean by the " evidence supporting ART " or the " Misuse of ART? " IVF began as a way to help couples where the female partner had no functional falopian tubes. It is a way to achieve conception and carry a baby to term by bypassing missing or damaged tubes. Furthermore, if the male has no sperm in the ejaculate, sperm can be obtained by aspirating it through the epididymous or obtained from testicular tissue via testicular biopsy. At this point, the sperm obtained can be used to fertilize the egg by way of ICSI. Are you suggesting that a cheaper method (such as TCM) could be used instead of IVF in cases of absent oviducts or azoospermia? ? Really Hugo, I don't think I understand what point you are trying to make. It just sounds like some kind of Alternative Medicine conspiracy theory. Can you clarify? David Karchmer Traditional_ Chinese_Medicine , Hugo Ramiro <subincor@.. .> wrote: > > Well David, tit for tat again I suppose. It's a little boring. I make a comment about mechanics and technological fixes and you think I shouldn't do that, and are offended(?), and yet you feel free to hit back with charges of intellectual dishonesty and irresponsibility (those are pretty serious, ya know). Have your cake and eat it too? I don't think so, at least not with me. > So anyway, if we're done with the alpha-male thing, let's move on. > > We have seen and documented, over and over, the human activities of corruption, power-mongering, etc etc. As a profession, we have seen supposed " scientists " dismiss reasoning, data, and evidence a priori, repeatedly. Some wiring is on the fritz there. I insist that intellectual bias as well as financial motivation are a huge factor in any organisation, and need to be dealt with ethically, as much as is possible. I have no particular concerns with ABORM over other organisations. ?I have a particular concern with reproductive technologies (which are a part of the overall medical organisation, to be clear). The ethical question I brought up with the mechanic analogy is the following: if you can do something cheaply, why do it expensively? Further, if there is no evidence to support the use of an expensive, invasive procedure over the use of a cheaper, non- invasive procedure, then what should one do? Further, what is the long-term evidence supporting the > use of reproductive technologies? Where are the studies describing the misuse of reproductive technologies > Is that clear enough for you? As a side-note, these are not jabs at you, these are simply restatements of what every single post of mine has been about. I'd also like to ask, where is the evidence that supports your point of view that we need certification? That specialist certification improves patient care and outcome? I am concerned that the CM profession is simply apeing western medical procedures and curricula. Don't even get me started on book learning as currently taught in many medical schools. > In any case, there is a great deal of controversy on whether to move forward or study more regarding reproductive technologies, but it might be interesting to look at ICSI (I don't care if nobody knows what that means, honestly) and how reproductive scientists feel about it: > > " No hard evidence presented at the moment can prove or disapprove ICSI's implications in epigenetic control. Nevertheless, we take the view that more comprehensive, long-term, and properly designed studies are imperative to be applied on a large-scale basis. We urge cautiousness, since the welfare of our progeny is what is at stake. " > > This is the ethical problem I've posed several times: " Our progeny are at stake " . > > Hugo > > ps - the writers are Greek, forgive their English spelling and grammar. Can be found at: > http://tinyurl. com/ypc66c > <!-- #ygrp-mkp{ border:1px solid #d8d8d8;font-family:Arial;margin:14px 0px;padding:0px 14px;} #ygrp-mkp hr{ border:1px solid #d8d8d8;} #ygrp-mkp #hd{ color:#628c2a;font-size:85%;font-weight:bold;line-height:122%;margin:10px 0px;} #ygrp-mkp #ads{ margin-bottom:10px;} #ygrp-mkp .ad{ padding:0 0;} #ygrp-mkp .ad a{ color:#0000ff;text-decoration:none;} --> <!-- #ygrp-sponsor #ygrp-lc{ font-family:Arial;} #ygrp-sponsor #ygrp-lc #hd{ margin:10px 0px;font-weight:bold;font-size:78%;line-height:122%;} #ygrp-sponsor #ygrp-lc .ad{ margin-bottom:10px;padding:0 0;} --> <!-- #ygrp-mlmsg {font-size:13px;font-family:arial, helvetica, clean, sans-serif;} #ygrp-mlmsg table {font-size:inherit;font:100%;} #ygrp-mlmsg select, input, textarea {font:99% arial, helvetica, clean, sans-serif;} #ygrp-mlmsg pre, code {font:115% monospace;} #ygrp-mlmsg * {line-height:1.22em;} #ygrp-text{ font-family:Georgia; } #ygrp-text p{ margin:0 0 1em 0;} #ygrp-tpmsgs{ font-family:Arial; clear:both;} #ygrp-vitnav{ padding-top:10px;font-family:Verdana;font-size:77%;margin:0;} #ygrp-vitnav a{ padding:0 1px;} #ygrp-actbar{ clear:both;margin:25px 0;white-space:nowrap;color:#666;text-align:right;} #ygrp-actbar .left{ float:left;white-space:nowrap;} ..bld{font-weight:bold;} #ygrp-grft{ font-family:Verdana;font-size:77%;padding:15px 0;} #ygrp-ft{ font-family:verdana;font-size:77%;border-top:1px solid #666; padding:5px 0; } #ygrp-mlmsg #logo{ padding-bottom:10px;} #ygrp-vital{ background-color:#e0ecee;margin-bottom:20px;padding:2px 0 8px 8px;} #ygrp-vital #vithd{ font-size:77%;font-family:Verdana;font-weight:bold;color:#333;text-transform:upp\ ercase;} #ygrp-vital ul{ padding:0;margin:2px 0;} #ygrp-vital ul li{ list-style-type:none;clear:both;border:1px solid #e0ecee; } #ygrp-vital ul li .ct{ font-weight:bold;color:#ff7900;float:right;width:2em;text-align:right;padding-ri\ ght:.5em;} #ygrp-vital ul li .cat{ font-weight:bold;} #ygrp-vital a{ text-decoration:none;} #ygrp-vital a:hover{ text-decoration:underline;} #ygrp-sponsor #hd{ color:#999;font-size:77%;} #ygrp-sponsor #ov{ padding:6px 13px;background-color:#e0ecee;margin-bottom:20px;} #ygrp-sponsor #ov ul{ padding:0 0 0 8px;margin:0;} #ygrp-sponsor #ov li{ list-style-type:square;padding:6px 0;font-size:77%;} #ygrp-sponsor #ov li a{ text-decoration:none;font-size:130%;} #ygrp-sponsor #nc{ background-color:#eee;margin-bottom:20px;padding:0 8px;} #ygrp-sponsor .ad{ padding:8px 0;} #ygrp-sponsor .ad #hd1{ font-family:Arial;font-weight:bold;color:#628c2a;font-size:100%;line-height:122%\ ;} #ygrp-sponsor .ad a{ text-decoration:none;} #ygrp-sponsor .ad a:hover{ text-decoration:underline;} #ygrp-sponsor .ad p{ margin:0;} o{font-size:0;} ..MsoNormal{ margin:0 0 0 0;} #ygrp-text tt{ font-size:120%;} blockquote{margin:0 0 0 4px;} ..replbq{margin:4;} --> _________ Want ideas for reducing your carbon footprint? Visit For Good http://uk.promotions./forgood/environment.html Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2007 Report Share Posted September 12, 2007 Me again. Here are some quick comments: " First of all, IVF is expensive to administer in part because it takes very expensive technology to perform. A proper IVF facility can expect a start up cost of between $1-2 million. " Yes, David. Obviously. I did not state that expensive = deceitful. I stated that expensive + no evidence to prefer over less expensive = something unethical. I hope that is clearer, I don't know if I could change that into numbers. " Why should we rule out ART on the basis that it is costly? " Again, that would be on the same grounds that we would prefer a non-invasive procedure to an invasive procedure if the results are similar. Where are the studies that compare and contrast CM vs ART? I don't claim that CM is better, I really don't care about that, I am claiming that you have no evidence to back up your assertion that ART is the primary choice in cases of infertility. I'm just looking for the evidence. It's expected of , so I am *fairly* expecting it of this particular western modality. This very point was made by an enlightened presenter at the Grand Rounds at which I was present last week. " Am I reading you correctly? Are you suggesting that there is something underhanded, or malevolant about ART? " No, you are not reading correctly. I am surprised that you are not aware of the protocols necessary to evaluate safety and efficacy. " Just what do you mean by the " evidence supporting ART " or the " Misuse of ART? " " Just what it says. The medical standard, apparently, is to find evidence of safety and efficacy. I really don't know what you're confused about. " Misuse " means " improper, unlawful or incorrect use " . ? Understand now? " It just sounds like some kind of Alternative Medicine conspiracy theory. " You certainly are imaginative. Hugo _________ Want ideas for reducing your carbon footprint? Visit For Good http://uk.promotions./forgood/environment.html Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2007 Report Share Posted September 12, 2007 Hugo, I am trying to understand you. I find your writing style to be a bit cryptic, so it's sometimes challenging to decipher what you are trying to communicate. Even though I am really making an effort, and checking in by asking such things as, " am I reading you correctly? " you seem kind of annoyed, and accuse me of " reading into your posts, but not reading them. " You write in a lot of metaphors, so there is a need to try to interpret what you are ttempting to communicate. I apologize if I am not interpreting correctly, but I am trying. Where IVF is concerned, it seems like you are saying that it is unethical when there are less expensive alternatives that are every bit as effective. You say that it would be preferable to use " a non- invasive procedure [instead of] an invasive procedure if the results are similar. " You said " I am claiming that you have no evidence to back up your assertion that ART is the primary choice in cases of infertility. I'm just looking for the evidence. " *************************************************************** I gave you two clinical scenarios in my last post, neither of which you have addressed here, and both of which are highly unlikely to respond to TCM. To quote my last post: " IVF began as a way to help couples where the female partner had no functional fallopian tubes. It is a way to achieve conception and carry a baby to term by bypassing the missing or damaged tubes. Furthermore, if the male has no sperm in the ejaculate, sperm can be obtained by aspirating it through the epididymous or obtained from testicular tissue via testicular biopsy. At this point, the sperm obtained can be used to fertilize the egg by way of ICSI. " So, I'll ask you again: Are you suggesting that a cheaper method (such as TCM) could be used instead of IVF in cases of absent oviducts or azoospermia? In your reply to this post, why didn't you address these very real and very common clinical situations? I cases of obstructed, scarred or absent fallopian tubes, do you think that a less expensive therapy (like TCM) would be as effective as IVF? In the case of azoospermia, or severely compromised sperm morphology, do you think that a less expensive therapy (like TCM) would be as effective as IVF? Next Hugo, you went on to say " I am surprised that you are not aware of the protocols necessary to evaluate safety and efficacy. " This is not an answer to my question. I asked, " Just what do you mean by the " evidence supporting ART " or the " Misuse of ART? " First of all, to say that you are " surprised " that I don't already know what the heck you are talking about is not an answer at all. And secondly, I am asking " what do YOU mean, " because as I already said, I am trying to check in with you to make sure that we are communicating. Instead of clarifying your statements, you just ducked the question entirely by saying, " Just what it says. The medical standard, apparently, is to find evidence of safety and efficacy. I really don't know what you're confused about. " Misuse " means " improper, unlawful or incorrect use " . Understand now? " No Hugo. No, I don't. Are you saying that IVF is improper, unlawful or performed incorrectly? Are you saying that this procedure is unsafe? And if so, are you suggesting that we should refuse to help people who have chosen to do IVF, or that we should try to persuade them not to do it? When I said, " It just sounds like some kind of Alternative Medicine conspiracy theory, " you answered: " You certainly are imaginative. " But that is just what this sounds like to me. It seems like a witch hunt to discredit the lawfulness, propriety, or correct usage of IVF. I'm sorry, but I just do not understand upon what basis you are making such claims. Furthermore, when I provided specific instances in which IVF may be absolutely necessary in order to bear biological children, you declined to comment. You asked for specifics, I gave you specific. So why no comment? This is a vitally important conversation to me because I am an advocate for Reproductive Oriental Medicine as a recognized sub- specialty, and an advocate for a credentialing process like the one proposed by the ABORM. And honest to goodness, I am trying to understand your meaning Hugo, but if you are saying the kinds of things that I think you are, this is a perfect example of why the public needs a clear distinction made between those Acupuncturists who understand the science and procedures involved in reproductive medicine and general practitioners who dabble in infertility treatment. If I have misinterpreted your statements, please set the record straight. And as a request, I would like more data, and fewer metaphors and inflammatory comments so that we can try, as you suggested to improve communication between us. David Karchmer ******************************************************************* Me again. > Here are some quick comments: > > " First of all, IVF is expensive to administer in part because it > takes very expensive technology to perform. A proper IVF facility > can expect a start up cost of between $1-2 million. " > > Yes, David. Obviously. > I did not state that expensive = deceitful. I stated that expensive + no evidence to prefer over less expensive = something unethical. I hope that is clearer, I don't know if I could change that into numbers. > > " Why should we rule out ART on the basis that it is costly? " > > Again, that would be on the same grounds that we would prefer a non-invasive procedure to an invasive procedure if the results are similar. Where are the studies that compare and contrast CM vs ART? I don't claim that CM is better, I really don't care about that, I am claiming that you have no evidence to back up your assertion that ART is the primary choice in cases of infertility. I'm just looking for the evidence. It's expected of , so I am *fairly* expecting it of this particular western modality. This very point was made by an enlightened presenter at the Grand Rounds at which I was present last week. > > " Am I reading you correctly? Are you suggesting that there is > something underhanded, or malevolant about ART? " > > No, you are not reading correctly. > > I am surprised that you are not aware of the protocols necessary to evaluate safety and efficacy. > > " Just what do you mean by the " evidence supporting ART " or > the " Misuse of ART? " " > > Just what it says. The medical standard, apparently, is to find evidence of safety and efficacy. I really don't know what you're confused about. " Misuse " means " improper, unlawful or incorrect use " . ? Understand now? > > " It just sounds like some kind of Alternative Medicine > conspiracy theory. " > > You certainly are imaginative. > > Hugo > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2007 Report Share Posted September 12, 2007 David, After reading many of these posts, it seems to me that the concern is whether we are treating a patient or a pregnancy. It does almost seem to be a blind interest to get people pregnant although I am sure that is not the only reason for treatment. Creating a niche simply because people want it is not always a good thing. We need a healthier society and need to get more involved with environmental issues as it will do more to guarantee a future then getting a few people pregnant. That is one of many reasons why I do not support a singular focus organizational certification. I can only hope that one of the DAOM's includes a focus upon fertility as it makes a lot more sense to go the formal education route. Mike W. Bowser, L Ac : acuprof: Wed, 12 Sep 2007 04:23:41 +0000Re: A case in point Hugo,I am trying to understand you. I find your writing style to be a bit cryptic, so it's sometimes challenging to decipher what you are trying to communicate. Even though I am really making an effort, and checking in by asking such things as, " am I reading you correctly? " you seem kind of annoyed, and accuse me of " reading into your posts, but not reading them. " You write in a lot of metaphors, so there is a need to try to interpret what you are ttempting to communicate. I apologize if I am not interpreting correctly, but I am trying.Where IVF is concerned, it seems like you are saying that it is unethical when there are less expensive alternatives that are every bit as effective. You say that it would be preferable to use " a non-invasive procedure [instead of] an invasive procedure if the results are similar. " You said " I am claiming that you have no evidence to back up your assertion that ART is the primary choice in cases of infertility. I'm just looking for the evidence. " ***************************************************************I gave you two clinical scenarios in my last post, neither of which you have addressed here, and both of which are highly unlikely to respond to TCM.To quote my last post: " IVF began as a way to help couples where the female partner had no functional fallopian tubes. It is a way to achieve conception and carry a baby to term by bypassing the missing or damaged tubes.Furthermore, if the male has no sperm in the ejaculate, sperm can be obtained by aspirating it through the epididymous or obtained from testicular tissue via testicular biopsy. At this point, the sperm obtained can be used to fertilize the egg by way of ICSI. " So, I'll ask you again: Are you suggesting that a cheaper method (such as TCM) could be used instead of IVF in cases of absent oviducts or azoospermia?In your reply to this post, why didn't you address these very real and very common clinical situations?I cases of obstructed, scarred or absent fallopian tubes, do you think that a less expensive therapy (like TCM) would be as effective as IVF?In the case of azoospermia, or severely compromised sperm morphology, do you think that a less expensive therapy (like TCM) would be as effective as IVF?Next Hugo, you went on to say " I am surprised that you are not aware of the protocols necessary to evaluate safety and efficacy. " This is not an answer to my question. I asked, " Just what do you mean by the " evidence supporting ART " or the " Misuse of ART? " First of all, to say that you are " surprised " that I don't already know what the heck you are talking about is not an answer at all. And secondly, I am asking " what do YOU mean, " because as I already said, I am trying to check in with you to make sure that we are communicating.Instead of clarifying your statements, you just ducked the question entirely by saying, " Just what it says. The medical standard, apparently, is to find evidence of safety and efficacy. I really don't know what you're confused about. " Misuse " means " improper, unlawful or incorrect use " . Understand now? " No Hugo. No, I don't. Are you saying that IVF is improper, unlawful or performed incorrectly?Are you saying that this procedure is unsafe? And if so, are you suggesting that we should refuse to help people who have chosen to do IVF, or that we should try to persuade them not to do it?When I said, " It just sounds like some kind of Alternative Medicine conspiracy theory, " you answered: " You certainly are imaginative. " But that is just what this sounds like to me. It seems like a witch hunt to discredit the lawfulness, propriety, or correct usage of IVF. I'm sorry, but I just do not understand upon what basis you are making such claims. Furthermore, when I provided specific instances in which IVF may be absolutely necessary in order to bear biological children, you declined to comment. You asked for specifics, I gave you specific. So why no comment? This is a vitally important conversation to me because I am an advocate for Reproductive Oriental Medicine as a recognized sub-specialty, and an advocate for a credentialing process like the one proposed by the ABORM. And honest to goodness, I am trying to understand your meaning Hugo, but if you are saying the kinds of things that I think you are, this is a perfect example of why the public needs a clear distinction made between those Acupuncturists who understand the science and procedures involved in reproductive medicine and general practitioners who dabble in infertility treatment. If I have misinterpreted your statements, please set the record straight. And as a request, I would like more data, and fewer metaphors and inflammatory comments so that we can try, as you suggested to improve communication between us. David Karchmer *******************************************************************Me again.> Here are some quick comments:> > " First of all, IVF is expensive to administer in part because it> takes very expensive technology to perform. A proper IVF facility> can expect a start up cost of between $1-2 million. " > > Yes, David. Obviously.> I did not state that expensive = deceitful. I stated that expensive + no evidence to prefer over less expensive = something unethical. I hope that is clearer, I don't know if I could change that into numbers.> > " Why should we rule out ART on the basis that it is costly? " > > Again, that would be on the same grounds that we would prefer a non-invasive procedure to an invasive procedure if the results are similar. Where are the studies that compare and contrast CM vs ART? I don't claim that CM is better, I really don't care about that, I am claiming that you have no evidence to back up your assertion that ART is the primary choice in cases of infertility. I'm just looking for the evidence. It's expected of , so I am *fairly* expecting it of this particular western modality. This very point was made by an enlightened presenter at the Grand Rounds at which I was present last week.> > " Am I reading you correctly? Are you suggesting that there is> something underhanded, or malevolant about ART? " > > No, you are not reading correctly.> > I am surprised that you are not aware of the protocols necessary to evaluate safety and efficacy.> > " Just what do you mean by the " evidence supporting ART " or> the " Misuse of ART? " " > > Just what it says. The medical standard, apparently, is to find evidence of safety and efficacy. I really don't know what you're confused about. " Misuse " means " improper, unlawful or incorrect use " . ? Understand now?> > " It just sounds like some kind of Alternative Medicine> conspiracy theory. " > > You certainly are imaginative. > > Hugo> > > > _______________ More photos; more messages; more whatever – Get MORE with Windows Live™ Hotmail®. NOW with 5GB storage. http://imagine-windowslive.com/hotmail/?locale=en-us & ocid=TXT_TAGHM_migration_HM\ _mini_5G_0907 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2007 Report Share Posted September 12, 2007 Mike, As far as the DAOM route is concerned, I believe Yosan University in LA is starting a doctoral program with a singular focus in Reproductive OM. In terms of creating a healthier society, while I agree that a healthier society would great, and I recognize that it is a noble thing to strive toward, this seems to me to be more of a philosophical issue than a medical one. I know Z'ev already took me to task for promoting the idea of Chinese " medicine " that is devoid of Taoist philosophy. I do not advocate that everybody should share my position on this point, but to try to institute a total transformation of society by application of TCM is not my personal mission. Furthermore, even if we were to accept that as our premise that it is our duty as doctors of TCM to improve society, I could argue with just as much validity that trying to help older, better educated, wealthy people to reproduce would be hugely advantageous to society. The infertility market is largely characterized by intelligent, affluent, educated people who are eager to have children, and therefore would likely be predsiposed to provide their offspring with an advantaged, loving and nurturing environment. If our goal is to improve society, wouldn't it be helpful to try to ensure that this segment of society is able to reproduce? And furthermore, wouldn't it be helpful to try to limit or prevent reproduction among poor, uneducated, single parents? You raised a concern about environmental issues: wouldn't the offspring of affluent, educated (but infertile) parents be more likely to contribute to the solution than would the offspring of poor, uneducated, single parents? I know that this prospect probably sounds absurd and even facist, and that such an idea poses and ethical nightmare. But, this is the territory we enter when we start speculating about the ethics of reproductive medicine. Who should decide who does and does not get to reproduce? And what are the broader social implications? I am not a medical ethicist. I am mostly concerned with the health and the health goals of my patients. And if I am in possession of some knowledge and some tools to help them to get what they want out of life, I just try to help them. I know some OB/GYN's who refuse to administer an IUI to a woman who is not married. If she is gay or single they refuse to perform the procedure. Personally, I feel like this is discriminatory and that it is not the role of the doctor to determine who should and should not receive medical care based on the doctor's personal religious or moral orientation. In the Bush Administration's FDA there are some advocates who want to give pharmacists the right to refuse to fill prescriptions based on the pharmacist's moral judgements. If such legislation wer to be enacted s/he could legally refuse to fill a prescription for Birth Control, for example, if the pharmacist were a Catholic. In both of these cases, there is absolutely no medical or health basis for the decision to refuse such patients service, only social or moral reasons. This is my point, Mike. I do not feel that it is my place to try to use to impose my personal philosophy. Rather it is my goal to use the medicine that I know to try to help people and to improve their lives. David Karchmer Chinese Medicine , mike Bowser <naturaldoc1 wrote: > > David, > After reading many of these posts, it seems to me that the concern is whether we > are treating a patient or a pregnancy. It does almost seem to be a blind interest > to get people pregnant although I am sure that is not the only reason for treatment. > > Creating a niche simply because people want it is not always a good thing. We > need a healthier society and need to get more involved with environmental issues > as it will do more to guarantee a future then getting a few people pregnant. > > That is one of many reasons why I do not support a singular focus organizational > certification. I can only hope that one of the DAOM's includes a focus upon fertility > as it makes a lot more sense to go the formal education route. Mike W. Bowser, L Ac > > > : acuprof: Wed, 12 Sep 2007 04:23:41 +0000Re: A case in point > > > > > Hugo,I am trying to understand you. I find your writing style to be a bit cryptic, so it's sometimes challenging to decipher what you are trying to communicate. Even though I am really making an effort, and checking in by asking such things as, " am I reading you correctly? " you seem kind of annoyed, and accuse me of " reading into your posts, but not reading them. " You write in a lot of metaphors, so there is a need to try to interpret what you are ttempting to communicate. I apologize if I am not interpreting correctly, but I am trying.Where IVF is concerned, it seems like you are saying that it is unethical when there are less expensive alternatives that are every bit as effective. You say that it would be preferable to use " a non-invasive procedure [instead of] an invasive procedure if the results are similar. " You said " I am claiming that you have no evidence to back up your assertion that ART is the primary choice in cases of infertility. I'm just looking for the evidence. " *********************************************************** ****I gave you two clinical scenarios in my last post, neither of which you have addressed here, and both of which are highly unlikely to respond to TCM.To quote my last post: " IVF began as a way to help couples where the female partner had no functional fallopian tubes. It is a way to achieve conception and carry a baby to term by bypassing the missing or damaged tubes.Furthermore, if the male has no sperm in the ejaculate, sperm can be obtained by aspirating it through the epididymous or obtained from testicular tissue via testicular biopsy. At this point, the sperm obtained can be used to fertilize the egg by way of ICSI. " So, I'll ask you again: Are you suggesting that a cheaper method (such as TCM) could be used instead of IVF in cases of absent oviducts or azoospermia?In your reply to this post, why didn't you address these very real and very common clinical situations?I cases of obstructed, scarred or absent fallopian tubes, do you think that a less expensive therapy (like TCM) would be as effective as IVF?In the case of azoospermia, or severely compromised sperm morphology, do you think that a less expensive therapy (like TCM) would be as effective as IVF?Next Hugo, you went on to say " I am surprised that you are not aware of the protocols necessary to evaluate safety and efficacy. " This is not an answer to my question. I asked, " Just what do you mean by the " evidence supporting ART " or the " Misuse of ART? " First of all, to say that you are " surprised " that I don't already know what the heck you are talking about is not an answer at all. And secondly, I am asking " what do YOU mean, " because as I already said, I am trying to check in with you to make sure that we are communicating.Instead of clarifying your statements, you just ducked the question entirely by saying, " Just what it says. The medical standard, apparently, is to find evidence of safety and efficacy. I really don't know what you're confused about. " Misuse " means " improper, unlawful or incorrect use " . Understand now? " No Hugo. No, I don't. Are you saying that IVF is improper, unlawful or performed incorrectly?Are you saying that this procedure is unsafe? And if so, are you suggesting that we should refuse to help people who have chosen to do IVF, or that we should try to persuade them not to do it?When I said, " It just sounds like some kind of Alternative Medicine conspiracy theory, " you answered: " You certainly are imaginative. " But that is just what this sounds like to me. It seems like a witch hunt to discredit the lawfulness, propriety, or correct usage of IVF. I'm sorry, but I just do not understand upon what basis you are making such claims. Furthermore, when I provided specific instances in which IVF may be absolutely necessary in order to bear biological children, you declined to comment. You asked for specifics, I gave you specific. So why no comment? This is a vitally important conversation to me because I am an advocate for Reproductive Oriental Medicine as a recognized sub-specialty, and an advocate for a credentialing process like the one proposed by the ABORM. And honest to goodness, I am trying to understand your meaning Hugo, but if you are saying the kinds of things that I think you are, this is a perfect example of why the public needs a clear distinction made between those Acupuncturists who understand the science and procedures involved in reproductive medicine and general practitioners who dabble in infertility treatment. If I have misinterpreted your statements, please set the record straight. And as a request, I would like more data, and fewer metaphors and inflammatory comments so that we can try, as you suggested to improve communication between us. David Karchmer *******************************************************************Me again.> Here are some quick comments:> > " First of all, IVF is expensive to administer in part because it> takes very expensive technology to perform. A proper IVF facility> can expect a start up cost of between $1-2 million. " > > Yes, David. Obviously.> I did not state that expensive = deceitful. I stated that expensive + no evidence to prefer over less expensive = something unethical. I hope that is clearer, I don't know if I could change that into numbers.> > " Why should we rule out ART on the basis that it is costly? " > > Again, that would be on the same grounds that we would prefer a non- invasive procedure to an invasive procedure if the results are similar. Where are the studies that compare and contrast CM vs ART? I don't claim that CM is better, I really don't care about that, I am claiming that you have no evidence to back up your assertion that ART is the primary choice in cases of infertility. I'm just looking for the evidence. It's expected of , so I am *fairly* expecting it of this particular western modality. This very point was made by an enlightened presenter at the Grand Rounds at which I was present last week.> > " Am I reading you correctly? Are you suggesting that there is> something underhanded, or malevolant about ART? " > > No, you are not reading correctly.> > I am surprised that you are not aware of the protocols necessary to evaluate safety and efficacy.> > " Just what do you mean by the " evidence supporting ART " or> the " Misuse of ART? " " > > Just what it says. The medical standard, apparently, is to find evidence of safety and efficacy. I really don't know what you're confused about. " Misuse " means " improper, unlawful or incorrect use " . ? Understand now?> > " It just sounds like some kind of Alternative Medicine> conspiracy theory. " > > You certainly are imaginative. > > Hugo> > > > _______________ > More photos; more messages; more whatever – Get MORE with Windows Live™ Hotmail®. NOW with 5GB storage. > http://imagine-windowslive.com/hotmail/?locale=en- us & ocid=TXT_TAGHM_migration_HM_mini_5G_0907 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2007 Report Share Posted September 12, 2007 I heard it on NPR. " In Some Circles, Four Kids Is the New Standard " by by Tovia Smith Weekend Edition Sunday, August 5, 2007 · The newest status symbol for the nation's most affluent families is fast becoming a big brood of kids. Historically, the country-club set has had the smallest number of kids. But in the past 10 years, the number of high-end earners who are having three or more kids has shot up nearly 30 percent. Some say the trend is driven by a generation of over-achieving career women who have quit work and transferred all of their competitive energy to baby making. They call it " competitive birthing. " http://www.npr.org/templates/story/story.php?storyId=12513004 Karen Chinese Medicine , " David Karchmer " <acuprof wrote: > > The infertility market is largely characterized by intelligent, > affluent, educated people who are eager to have children, and > therefore would likely be predsiposed to provide their offspring > with an advantaged, loving and nurturing environment. > > If our goal is to improve society, wouldn't it be helpful to try to > ensure that this segment of society is able to reproduce? And > furthermore, wouldn't it be helpful to try to limit or prevent > reproduction among poor, uneducated, single parents? > > You raised a concern about environmental issues: wouldn't the > offspring of affluent, educated (but infertile) parents be more > likely to contribute to the solution than would the offspring of > poor, uneducated, single parents? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2007 Report Share Posted September 12, 2007 Thaks for sharing, Karen. VERY interesting social trend. David K. --- In Chinese Medicine , " Karen Tang " <ohkaren wrote: > > I heard it on NPR. > > " In Some Circles, Four Kids Is the New Standard " by by Tovia Smith > > Weekend Edition Sunday, August 5, 2007 · The newest status symbol > for the nation's most affluent families is fast becoming a big brood > of kids. > > Historically, the country-club set has had the smallest number of > kids. But in the past 10 years, the number of high-end earners who > are having three or more kids has shot up nearly 30 percent. > > Some say the trend is driven by a generation of over-achieving > career women who have quit work and transferred all of their > competitive energy to baby making. > > They call it " competitive birthing. " > > http://www.npr.org/templates/story/story.php?storyId=12513004 > > > Karen > > Chinese Medicine , " David > Karchmer " <acuprof@> wrote: > > > > > The infertility market is largely characterized by intelligent, > > affluent, educated people who are eager to have children, and > > therefore would likely be predsiposed to provide their offspring > > with an advantaged, loving and nurturing environment. > > > > If our goal is to improve society, wouldn't it be helpful to try > to > > ensure that this segment of society is able to reproduce? And > > furthermore, wouldn't it be helpful to try to limit or prevent > > reproduction among poor, uneducated, single parents? > > > > You raised a concern about environmental issues: wouldn't the > > offspring of affluent, educated (but infertile) parents be more > > likely to contribute to the solution than would the offspring of > > poor, uneducated, single parents? > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 David, Nice to know about the possible DAOM at Yosan. Are you planning to enroll? You mentioned, " wouldn't the offspring of affluent, educated (but infertile) parents be more likely to contribute to the solution than would the offspring of poor, uneducated, single parents? " Actually my response to this is that affluence and industrialization are major contributors to much of our pollution and health problems. Be careful with who you choose to endorse. The rich tend to be overly willing to indulge in excesses and those who are poor deficiency, at least that is how it appears to be. Lastly, I guess I am a bit surprised that you claim not to have a philosophy about our medicine and its place in our culture. As ethics is guided by philosophy, I am deeply concerned about this attitude and what I am hearing. Mike W. Bowser, L Ac _______________ Kick back and relax with hot games and cool activities at the Messenger Café. http://www.cafemessenger.com?ocid=TXT_TAGLM_SeptWLtagline Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 Hi David, I lost my reply to an earlier post of yours, so I'll get to that again when I have time. Some comments on your interesting and revealing post below: " In terms of creating a healthier society, while I agree that a healthier society would great, and I recognize that it is a noble thing to strive toward, this seems to me to be more of a philosophical issue than a medical one. " This is the technician talking, and it is the western medical physician talking. Unfortunately for you, the newest and most vital trend in medicine is exactly the opposite of what you are saying. I would also ask your opinion on whether philosophical positions are important or not. " I know Z'ev already took me to task for promoting the idea of Chinese " medicine " that is devoid of Taoist philosophy. I do not advocate that everybody should share my position on this point, but to try to institute a total transformation of society by application of TCM is not my personal mission. " It is not the " application of TCM " , which is a sly way of decreasing the importance of the concept. It is the application of knowledge and technology in a human-centred fashion. In other words, it is the application of knowledge and technology in a healthy and sustainable manner. It is NOT " following the data " - i.e. " because it is there, then I will look " . There are choices to be made and unfortunately they are moral, ethical choices. The hardest kind. That is medicine, whether you think so or not. Medicine without the moral choices is a technician's trade, and really, does not exist. When do you pull the plug? Resuscitate or not? Morphine in terminal cancer cases? The baby or the mother? Moral / ethical cannot be avoided, but they can be glossed over, as you are doing. " I am not a medical ethicist. I am mostly concerned with the health and the health goals of my patients. And if I am in possession of some knowledge and some tools to help them to get what they want out of life, I just try to help them. " This is one of your most interesting points. Not being a medical ethicist is not an excuse for you to do whatever you feel is appropriate. Not being a medical ethicist means you educate yourself on and follow what a specialist in medical ethics says, just as you would follow a specialist's recommendation in any other field. In other words, if you do not concern yourself with that aspect of medicine, you remove your own ability to meaningfully participate in these types of dialogues. You'll notice that 21st century hospitals in north america have a much heavier medical ethics presence than they did even ten years ago. It's another one of those trends that is forcing medicine to go beyond mere technical work. " In both of these cases, there is absolutely no medical or health basis for the decision to refuse such patients service, only social or moral reasons. " Once again, David, these are only your assertions, and they are far from being factual. Perhaps we can talk more about this. I would like to take one blinker off of you anyway, and that is to say that when you provide service to people regardless of whether they " should " or not, you are making a moral judgement. Do you believe, David, that you provide service because these people's health depends on them getting pregnant? " This is my point, Mike. I do not feel that it is my place to try to use to impose my personal philosophy. Rather it is my goal to use the medicine that I know to try to help people and to improve their lives. " I hope you can see by now that in fact you _do_ impose your personal philosophy on your patients, as each of us does. You even state your philosophy there in your last sentence, above. Your position is untenable. By the way, I'm still waiting for you to get back to me on the pubmed citation that I sent you and the list. Hugo _________ Answers - Got a question? Someone out there knows the answer. Try it now. http://uk.answers./ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 Mike, I pointed these things out (wouldn't the offspring of affluent, educated parents be more likely to contribute to the solution...) somewhat mockingly. My point is that we are not capable of making such a judgement. I think it would be a horrible violation of ethics to look at every infertile couple that approaches us for medical help, and to try to make some kind of assessment or prediction about what contributions their offspring might make (or not make) to the social problems that grip our world. First of all, we have no way to make such predictions. And secondly - even if we did, is it up to us as acupuncturists to use that " information " as a guage of whether we will or will not treat such patients? This is a very slippery slope. Once these kinds of assessments are mingled into our choice of which patients to accept and which one's we reject, where does it end? Should we cease to treat Jews who struggle with infertility because of the likelyhood that their offspring will further contribute to the global menace of Jewiness? Should we refuse care to the rich because their offspring are predisposed to make worse the problems of Richiness? My point is that these are not our judgements to make. I help people. If people want to have children and there is no discernable medical reason why they should not, I try to help them get what they most want. If there is a medical risk, I try to learn as much as I can so that I can best educate them about what potential risks are involved. David Karchmer Chinese Medicine , mike Bowser <naturaldoc1 wrote: > > David, > Nice to know about the possible DAOM at Yosan. Are you planning to enroll? > > You mentioned, " wouldn't the offspring of affluent, educated (but infertile) parents be more likely to contribute to the solution than would the offspring of poor, uneducated, single parents? " > > Actually my response to this is that affluence and industrialization are major > contributors to much of our pollution and health problems. Be careful > with who you choose to endorse. The rich tend to be overly willing > to indulge in excesses and those who are poor deficiency, at least > that is how it appears to be. > > Lastly, I guess I am a bit surprised that you claim not to have a > philosophy about our medicine and its place in our culture. As > ethics is guided by philosophy, I am deeply concerned about this > attitude and what I am hearing. Mike W. Bowser, L Ac > _______________ > Kick back and relax with hot games and cool activities at the Messenger Café. > http://www.cafemessenger.com?ocid=TXT_TAGLM_SeptWLtagline > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 Hi David. I don't see that you responded to Mike's concerns. Mike wrote: " As ethics is guided by philosophy, I am deeply concerned about this attitude and what I am hearing. " Hugo David Karchmer <acuprof Chinese Medicine Wednesday, 12 September, 2007 7:19:24 PM Re: A case in point Mike, I pointed these things out (wouldn't the offspring of affluent, educated parents be more likely to contribute to the solution...) somewhat mockingly. My point is that we are not capable of making such a judgement. I think it would be a horrible violation of ethics to look at every infertile couple that approaches us for medical help, and to try to make some kind of assessment or prediction about what contributions their offspring might make (or not make) to the social problems that grip our world. First of all, we have no way to make such predictions. And secondly - even if we did, is it up to us as acupuncturists to use that " information " as a guage of whether we will or will not treat such patients? This is a very slippery slope. Once these kinds of assessments are mingled into our choice of which patients to accept and which one's we reject, where does it end? Should we cease to treat Jews who struggle with infertility because of the likelyhood that their offspring will further contribute to the global menace of Jewiness? Should we refuse care to the rich because their offspring are predisposed to make worse the problems of Richiness? My point is that these are not our judgements to make. I help people. If people want to have children and there is no discernable medical reason why they should not, I try to help them get what they most want. If there is a medical risk, I try to learn as much as I can so that I can best educate them about what potential risks are involved. David Karchmer Traditional_ Chinese_Medicine , mike Bowser <naturaldoc1@ ...> wrote: > > David, > Nice to know about the possible DAOM at Yosan. Are you planning to enroll? > > You mentioned, " wouldn't the offspring of affluent, educated (but infertile) parents be more likely to contribute to the solution than would the offspring of poor, uneducated, single parents? " > > Actually my response to this is that affluence and industrialization are major > contributors to much of our pollution and health problems. Be careful > with who you choose to endorse. The rich tend to be overly willing > to indulge in excesses and those who are poor deficiency, at least > that is how it appears to be. > > Lastly, I guess I am a bit surprised that you claim not to have a > philosophy about our medicine and its place in our culture. As > ethics is guided by philosophy, I am deeply concerned about this > attitude and what I am hearing. Mike W. Bowser, L Ac > ____________ _________ _________ _________ _________ _________ _ > Kick back and relax with hot games and cool activities at the Messenger Café. > http://www.cafemess enger.com? ocid=TXT_ TAGLM_SeptWLtagl ine > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 Chinese Medicine , Hugo Ramiro <subincor wrote: > > Hi David. I don't see that you responded to Mike's concerns. > Mike wrote: > " As ethics is guided by philosophy, I am deeply concerned about this attitude and what I am hearing. " > > Hugo > > > David Karchmer <acuprof > Chinese Medicine > Wednesday, 12 September, 2007 7:19:24 PM > Re: A case in point > > > > > > > Mike, > > > > I pointed these things out (wouldn't the offspring of affluent, > > educated parents be more likely to contribute to the solution...) > > somewhat mockingly. My point is that we are not capable of making > > such a judgement. > > > > I think it would be a horrible violation of ethics to look at every > > infertile couple that approaches us for medical help, and to try to > > make some kind of assessment or prediction about what contributions > > their offspring might make (or not make) to the social problems that > > grip our world. First of all, we have no way to make such > > predictions. And secondly - even if we did, is it up to us as > > acupuncturists to use that " information " as a guage of whether we > > will or will not treat such patients? > > > > This is a very slippery slope. Once these kinds of assessments are > > mingled into our choice of which patients to accept and which one's > > we reject, where does it end? Should we cease to treat Jews who > > struggle with infertility because of the likelyhood that their > > offspring will further contribute to the global menace of Jewiness? > > Should we refuse care to the rich because their offspring are > > predisposed to make worse the problems of Richiness? > > > > My point is that these are not our judgements to make. I help > > people. If people want to have children and there is no discernable > > medical reason why they should not, I try to help them get what they > > most want. If there is a medical risk, I try to learn as much as I > > can so that I can best educate them about what potential risks are > > involved. > > > > David Karchmer > > > > Traditional_ Chinese_Medicine , mike Bowser > > <naturaldoc1@ ...> wrote: > > > > > > David, > > > Nice to know about the possible DAOM at Yosan. Are you planning > > to enroll? > > > > > > You mentioned, " wouldn't the offspring of affluent, educated (but > > infertile) parents be more likely to contribute to the solution than > > would the offspring of poor, uneducated, single parents? " > > > > > > Actually my response to this is that affluence and > > industrialization are major > > > contributors to much of our pollution and health problems. Be > > careful > > > with who you choose to endorse. The rich tend to be overly willing > > > to indulge in excesses and those who are poor deficiency, at least > > > that is how it appears to be. > > > > > > Lastly, I guess I am a bit surprised that you claim not to have a > > > philosophy about our medicine and its place in our culture. As > > > ethics is guided by philosophy, I am deeply concerned about this > > > attitude and what I am hearing. Mike W. Bowser, L Ac > > > ____________ _________ _________ _________ _________ _________ _ > > > Kick back and relax with hot games and cool activities at the > > Messenger Café. > > > http://www.cafemess enger.com? ocid=TXT_ TAGLM_SeptWLtagl ine > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 Hugo, Two things to say. 1) I think I laid out my philosophy pretty succinctly in my response to Mike. If people want to have children and there is no discernable medical reason why they should not, I try to help them get what they most want. If there is a medical risk, I try to learn as much as I can so that I can best educate them about what potential risks are involved. I use the principles of to help my patients to become as healthy as possible so that their chances of natural conception increase (if they choose to try to conceive naturally), and their chances of having a successful outcome with ART improve (if they choose to use ART procedures). The goal of my clinic is healthy full term pregnancies resulting in live births. This is achieved through the application of TCM in order to optimize health, thereby maximizing outcomes. Period. 2) I am not a Taoist priest, a philosopher or a shaman. I am not an ethicist, a clergyman or a sage. To quote DeForest Kelley, " Dammit Jim, I'm just a country doctor! " My purpose is to help people to optimize physiological function so that they are able to conceive, maintain a healthy pregnancy, carry their baby(s) to term, have a healthy post-partum recovery, and have the family for which they have longed. Although I am not sure why it is integral or particularly relevant to the conversations at hand, that is my philosophy. I hope that helps, somehow. David K Chinese Medicine , Hugo Ramiro <subincor wrote: > > Hi David. I don't see that you responded to Mike's concerns. > Mike wrote: > " As ethics is guided by philosophy, I am deeply concerned about this attitude and what I am hearing. " > > Hugo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 Hi David, the point was simply that you asserted that " personal philosophies " had no place in a " medical " or " health " setting for you, when in fact, they do have a central place for you. If you like I can copy and paste the relevant passages from your messages. I think we all agree that we bring our philosophies to practice. Hugo David Karchmer <acuprof Chinese Medicine Wednesday, 12 September, 2007 8:16:26 PM Re: A case in point Hugo, Two things to say. 1) I think I laid out my philosophy pretty succinctly in my response to Mike. If people want to have children and there is no discernable medical reason why they should not, I try to help them get what they most want. If there is a medical risk, I try to learn as much as I can so that I can best educate them about what potential risks are involved. I use the principles of to help my patients to become as healthy as possible so that their chances of natural conception increase (if they choose to try to conceive naturally), and their chances of having a successful outcome with ART improve (if they choose to use ART procedures). The goal of my clinic is healthy full term pregnancies resulting in live births. This is achieved through the application of TCM in order to optimize health, thereby maximizing outcomes. Period. 2) I am not a Taoist priest, a philosopher or a shaman. I am not an ethicist, a clergyman or a sage. To quote DeForest Kelley, " Dammit Jim, I'm just a country doctor! " My purpose is to help people to optimize physiological function so that they are able to conceive, maintain a healthy pregnancy, carry their baby(s) to term, have a healthy post-partum recovery, and have the family for which they have longed. Although I am not sure why it is integral or particularly relevant to the conversations at hand, that is my philosophy. I hope that helps, somehow. David K Traditional_ Chinese_Medicine , Hugo Ramiro <subincor@.. .> wrote: > > Hi David. I don't see that you responded to Mike's concerns. > Mike wrote: > " As ethics is guided by philosophy, I am deeply concerned about this attitude and what I am hearing. " > > Hugo <!-- #ygrp-mkp{ border:1px solid #d8d8d8;font-family:Arial;margin:14px 0px;padding:0px 14px;} #ygrp-mkp hr{ border:1px solid #d8d8d8;} #ygrp-mkp #hd{ color:#628c2a;font-size:85%;font-weight:bold;line-height:122%;margin:10px 0px;} #ygrp-mkp #ads{ margin-bottom:10px;} #ygrp-mkp .ad{ padding:0 0;} #ygrp-mkp .ad a{ color:#0000ff;text-decoration:none;} --> <!-- #ygrp-sponsor #ygrp-lc{ font-family:Arial;} #ygrp-sponsor #ygrp-lc #hd{ margin:10px 0px;font-weight:bold;font-size:78%;line-height:122%;} #ygrp-sponsor #ygrp-lc .ad{ margin-bottom:10px;padding:0 0;} --> <!-- #ygrp-mlmsg {font-size:13px;font-family:arial, helvetica, clean, sans-serif;} #ygrp-mlmsg table {font-size:inherit;font:100%;} #ygrp-mlmsg select, input, textarea {font:99% arial, helvetica, clean, sans-serif;} #ygrp-mlmsg pre, code {font:115% monospace;} #ygrp-mlmsg * {line-height:1.22em;} #ygrp-text{ font-family:Georgia; } #ygrp-text p{ margin:0 0 1em 0;} #ygrp-tpmsgs{ font-family:Arial; clear:both;} #ygrp-vitnav{ padding-top:10px;font-family:Verdana;font-size:77%;margin:0;} #ygrp-vitnav a{ padding:0 1px;} #ygrp-actbar{ clear:both;margin:25px 0;white-space:nowrap;color:#666;text-align:right;} #ygrp-actbar .left{ float:left;white-space:nowrap;} ..bld{font-weight:bold;} #ygrp-grft{ font-family:Verdana;font-size:77%;padding:15px 0;} #ygrp-ft{ font-family:verdana;font-size:77%;border-top:1px solid #666; padding:5px 0; } #ygrp-mlmsg #logo{ padding-bottom:10px;} #ygrp-vital{ background-color:#e0ecee;margin-bottom:20px;padding:2px 0 8px 8px;} #ygrp-vital #vithd{ font-size:77%;font-family:Verdana;font-weight:bold;color:#333;text-transform:upp\ ercase;} #ygrp-vital ul{ padding:0;margin:2px 0;} #ygrp-vital ul li{ list-style-type:none;clear:both;border:1px solid #e0ecee; } #ygrp-vital ul li .ct{ font-weight:bold;color:#ff7900;float:right;width:2em;text-align:right;padding-ri\ ght:.5em;} #ygrp-vital ul li .cat{ font-weight:bold;} #ygrp-vital a{ text-decoration:none;} #ygrp-vital a:hover{ text-decoration:underline;} #ygrp-sponsor #hd{ color:#999;font-size:77%;} #ygrp-sponsor #ov{ padding:6px 13px;background-color:#e0ecee;margin-bottom:20px;} #ygrp-sponsor #ov ul{ padding:0 0 0 8px;margin:0;} #ygrp-sponsor #ov li{ list-style-type:square;padding:6px 0;font-size:77%;} #ygrp-sponsor #ov li a{ text-decoration:none;font-size:130%;} #ygrp-sponsor #nc{ background-color:#eee;margin-bottom:20px;padding:0 8px;} #ygrp-sponsor .ad{ padding:8px 0;} #ygrp-sponsor .ad #hd1{ font-family:Arial;font-weight:bold;color:#628c2a;font-size:100%;line-height:122%\ ;} #ygrp-sponsor .ad a{ text-decoration:none;} #ygrp-sponsor .ad a:hover{ text-decoration:underline;} #ygrp-sponsor .ad p{ margin:0;} o{font-size:0;} ..MsoNormal{ margin:0 0 0 0;} #ygrp-text tt{ font-size:120%;} blockquote{margin:0 0 0 4px;} ..replbq{margin:4;} --> _________ Want ideas for reducing your carbon footprint? Visit For Good http://uk.promotions./forgood/environment.html Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 David, I appreciate your opinion but find it odd that your philosophy seems to be out of step with the profession. I do, however, agree with trying to help every patient just not your goal of reproduction (this is not a sign of health and unhealthy people can and do get pregnant also). " I use the principles of to help my patients to become as healthy as possible... " Mike W. Bowser, L Ac _______________ Gear up for Halo® 3 with free downloads and an exclusive offer. It’s our way of saying thanks for using Windows Live™. http://gethalo3gear.com?ocid=SeptemberWLHalo3_WLHMTxt_2 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 Mike, My practice is about 95% fertility related cases. Our goals for treatment are closely tied to reproductive outcomes. As a practitioner of CM, I find that the factors that inhibit conception or full term pregnancy are the results of meridian/organ imbalances. In such cases, the treatment plan is focused on correcting the imbalances so that normal/optimal function returns. Once normal function is restored, the probability of a favorable reproductive outcome is increased. If you substitute " favorable Reproductive Outcomes " for Weight loss, smoking cessation, eradication of headaches or pain, then I don't see how that is out of step with our profession. David K. Chinese Medicine , mike Bowser <naturaldoc1 wrote: > > David, > I appreciate your opinion but find it odd that your philosophy > seems to be out of step with the profession. I do, however, > agree with trying to help every patient just not your goal of > reproduction (this is not a sign of health and unhealthy people > can and do get pregnant also). > > " I use the principles of to help my patients to become as healthy as possible... " Mike W. Bowser, L Ac > _______________ > Gear up for Halo® 3 with free downloads and an exclusive offer. It's our way of saying thanks for using Windows Live™. > http://gethalo3gear.com?ocid=SeptemberWLHalo3_WLHMTxt_2 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 David, I am not for screening people (unethical) that was your suggestion. I am for improving one's health and helping society be its best, which most healthcare professions also follow, including ours. The goal of ABORM appears not as much for this but for the goal of pregnancy. I see this as of secondary importance and a philosophy that can run against our main goal at times. A patient's wants are not the same as their needs. I think being educated to deal with this is good just not for unregulated certification/specializations as these do seem to be divisive. What do you tell the many Asian trained practitioners in women's health, who know much more then many of us, about their educational focus or the need for board creation? I can guess that many will not follow another western attempt at legitimacy and will opt out. Our profession seems at many times out of touch with these practitioners, a great case in point, was the DAOM. It was reported that over 600 Asian practitioners attended an ACAOM DAOM meeting and voted overwhelmingly for even an entry level doctorate degree when the rest of us were half and half. That meeting really decided a lot and told us that many professionals were not consulted and when this happens you have division. Why not follow one of the ABORM board member's (Ray Rubio) example of getting a DAOM (maybe in women's health?)? That type of situation makes more sense for our profession and moving forward otherwise this is more of the same from the past. Create your own company, teach, test and certify all w/o any oversight. I know the ABORM is not doing all of these but many of these do apply and will not make us any more acceptable to others. If we are seeing more and more environmental toxins (CDC study) finding its way into our body and interfering with our hormones, then would it not make more sense to deal with this issue as opposed to just the person? I think that the concept of harmony has been violated and our civilization has lost its natural interconnectedness. You do not help patients find it just by getting them pregnant but by teaching them about living with harmony. A physician is first a teacher. Mike W. Bowser, L Ac : acuprof: Thu, 13 Sep 2007 03:02:35 +0000Re: A case in point Chinese Medicine , Hugo Ramiro <subincor wrote:>> Hi David. I don't see that you responded to Mike's concerns.> Mike wrote:> " As ethics is guided by philosophy, I am deeply concerned about this attitude and what I am hearing. " > > Hugo> > > David Karchmer <acuprof> Chinese Medicine > Wednesday, 12 September, 2007 7:19:24 PM> Re: A case in point> > > > > > > > > > > > > > Mike,> > > > I pointed these things out (wouldn't the offspring of affluent, > > educated parents be more likely to contribute to the solution...) > > somewhat mockingly. My point is that we are not capable of making > > such a judgement. > > > > I think it would be a horrible violation of ethics to look at every > > infertile couple that approaches us for medical help, and to try to > > make some kind of assessment or prediction about what contributions > > their offspring might make (or not make) to the social problems that > > grip our world. First of all, we have no way to make such > > predictions. And secondly - even if we did, is it up to us as > > acupuncturists to use that " information " as a guage of whether we > > will or will not treat such patients?> > > > This is a very slippery slope. Once these kinds of assessments are > > mingled into our choice of which patients to accept and which one's > > we reject, where does it end? Should we cease to treat Jews who > > struggle with infertility because of the likelyhood that their > > offspring will further contribute to the global menace of Jewiness?> > Should we refuse care to the rich because their offspring are > > predisposed to make worse the problems of Richiness?> > > > My point is that these are not our judgements to make. I help > > people. If people want to have children and there is no discernable > > medical reason why they should not, I try to help them get what they > > most want. If there is a medical risk, I try to learn as much as I > > can so that I can best educate them about what potential risks are > > involved. > > > > David Karchmer> > > > Traditional_ Chinese_Medicine , mike Bowser > > <naturaldoc1@ ...> wrote:> > >> > > David,> > > Nice to know about the possible DAOM at Yosan. Are you planning > > to enroll?> > > > > > You mentioned, " wouldn't the offspring of affluent, educated (but > > infertile) parents be more likely to contribute to the solution than > > would the offspring of poor, uneducated, single parents? " > > > > > > Actually my response to this is that affluence and > > industrialization are major> > > contributors to much of our pollution and health problems. Be > > careful> > > with who you choose to endorse. The rich tend to be overly willing> > > to indulge in excesses and those who are poor deficiency, at least > > > that is how it appears to be. > > > > > > Lastly, I guess I am a bit surprised that you claim not to have a> > > philosophy about our medicine and its place in our culture. As > > > ethics is guided by philosophy, I am deeply concerned about this> > > attitude and what I am hearing. Mike W. Bowser, L Ac> > > ____________ _________ _________ _________ _________ _________ _> > > Kick back and relax with hot games and cool activities at the > > Messenger Café.> > > http://www.cafemess enger.com? ocid=TXT_ TAGLM_SeptWLtagl ine> > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 Hugo, Are you familiar with the internet term, Troll? I can post the definition if you like. David K Chinese Medicine , Hugo Ramiro <subincor wrote: > > Hi David, the point was simply that you asserted that " personal philosophies " had no place in a " medical " or " health " setting for you, when in fact, they do have a central place for you. If you like I can copy and paste the relevant passages from your messages. > I think we all agree that we bring our philosophies to practice. > > Hugo > > > David Karchmer <acuprof > Chinese Medicine > Wednesday, 12 September, 2007 8:16:26 PM > Re: A case in point > > > > > > > Hugo, > > > > Two things to say. > > > > 1) I think I laid out my philosophy pretty succinctly in my response > > to Mike. > > > > If people want to have children and there is no discernable medical > > reason why they should not, I try to help them get what they most > > want. If there is a medical risk, I try to learn as much as I can so > > that I can best educate them about what potential risks are involved. > > > > I use the principles of to help my patients to > > become as healthy as possible so that their chances of natural > > conception increase (if they choose to try to conceive naturally), > > and their chances of having a successful outcome with ART improve > > (if they choose to use ART procedures). > > > > The goal of my clinic is healthy full term pregnancies resulting in > > live births. This is achieved through the application of TCM in > > order to optimize health, thereby maximizing outcomes. > > > > Period. > > > > 2) I am not a Taoist priest, a philosopher or a shaman. I am not an > > ethicist, a clergyman or a sage. To quote DeForest Kelley, " Dammit > > Jim, I'm just a country doctor! " > > > > My purpose is to help people to optimize physiological function so > > that they are able to conceive, maintain a healthy pregnancy, carry > > their baby(s) to term, have a healthy post-partum recovery, and have > > the family for which they have longed. > > > > Although I am not sure why it is integral or particularly relevant > > to the conversations at hand, that is my philosophy. I hope that > > helps, somehow. > > > > David K > > > > Traditional_ Chinese_Medicine , Hugo Ramiro > > <subincor@ .> wrote: > > > > > > Hi David. I don't see that you responded to Mike's concerns. > > > Mike wrote: > > > " As ethics is guided by philosophy, I am deeply concerned about > > this attitude and what I am hearing. " > > > > > > Hugo > > > > > > > > <!-- > > #ygrp-mkp{ > border:1px solid #d8d8d8;font-family:Arial;margin:14px 0px;padding:0px 14px;} > #ygrp-mkp hr{ > border:1px solid #d8d8d8;} > #ygrp-mkp #hd{ > color:#628c2a;font-size:85%;font-weight:bold;line- height:122%;margin:10px 0px;} > #ygrp-mkp #ads{ > margin-bottom:10px;} > #ygrp-mkp .ad{ > padding:0 0;} > #ygrp-mkp .ad a{ > color:#0000ff;text-decoration:none;} > --> > > > > <!-- > > #ygrp-sponsor #ygrp-lc{ > font-family:Arial;} > #ygrp-sponsor #ygrp-lc #hd{ > margin:10px 0px;font-weight:bold;font-size:78%;line-height:122%;} > #ygrp-sponsor #ygrp-lc .ad{ > margin-bottom:10px;padding:0 0;} > --> > > > > <!-- > > #ygrp-mlmsg {font-size:13px;font-family:arial, helvetica, clean, sans-serif;} > #ygrp-mlmsg table {font-size:inherit;font:100%;} > #ygrp-mlmsg select, input, textarea {font:99% arial, helvetica, clean, sans-serif;} > #ygrp-mlmsg pre, code {font:115% monospace;} > #ygrp-mlmsg * {line-height:1.22em;} > #ygrp-text{ > font-family:Georgia; > } > #ygrp-text p{ > margin:0 0 1em 0;} > #ygrp-tpmsgs{ > font-family:Arial; > clear:both;} > #ygrp-vitnav{ > padding-top:10px;font-family:Verdana;font-size:77%;margin:0;} > #ygrp-vitnav a{ > padding:0 1px;} > #ygrp-actbar{ > clear:both;margin:25px 0;white-space:nowrap;color:#666;text- align:right;} > #ygrp-actbar .left{ > float:left;white-space:nowrap;} > .bld{font-weight:bold;} > #ygrp-grft{ > font-family:Verdana;font-size:77%;padding:15px 0;} > #ygrp-ft{ > font-family:verdana;font-size:77%;border-top:1px solid #666; > padding:5px 0; > } > #ygrp-mlmsg #logo{ > padding-bottom:10px;} > > #ygrp-vital{ > background-color:#e0ecee;margin-bottom:20px;padding:2px 0 8px 8px;} > #ygrp-vital #vithd{ > font-size:77%;font-family:Verdana;font-weight:bold;color:#333;text- transform:uppercase;} > #ygrp-vital ul{ > padding:0;margin:2px 0;} > #ygrp-vital ul li{ > list-style-type:none;clear:both;border:1px solid #e0ecee; > } > #ygrp-vital ul li .ct{ > font-weight:bold;color:#ff7900;float:right;width:2em;text- align:right;padding-right:.5em;} > #ygrp-vital ul li .cat{ > font-weight:bold;} > #ygrp-vital a{ > text-decoration:none;} > > #ygrp-vital a:hover{ > text-decoration:underline;} > > #ygrp-sponsor #hd{ > color:#999;font-size:77%;} > #ygrp-sponsor #ov{ > padding:6px 13px;background-color:#e0ecee;margin-bottom:20px;} > #ygrp-sponsor #ov ul{ > padding:0 0 0 8px;margin:0;} > #ygrp-sponsor #ov li{ > list-style-type:square;padding:6px 0;font-size:77%;} > #ygrp-sponsor #ov li a{ > text-decoration:none;font-size:130%;} > #ygrp-sponsor #nc{ > background-color:#eee;margin-bottom:20px;padding:0 8px;} > #ygrp-sponsor .ad{ > padding:8px 0;} > #ygrp-sponsor .ad #hd1{ > font-family:Arial;font-weight:bold;color:#628c2a;font- size:100%;line-height:122%;} > #ygrp-sponsor .ad a{ > text-decoration:none;} > #ygrp-sponsor .ad a:hover{ > text-decoration:underline;} > #ygrp-sponsor .ad p{ > margin:0;} > o{font-size:0;} > .MsoNormal{ > margin:0 0 0 0;} > #ygrp-text tt{ > font-size:120%;} > blockquote{margin:0 0 0 4px;} > .replbq{margin:4;} > --> > > _________ > Want ideas for reducing your carbon footprint? Visit For Good http://uk.promotions./forgood/environment.html > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 David, " I pointed these things out (wouldn't the offspring of affluent, educated parents be more likely to contribute to the solution...) somewhat mockingly. My point is that we are not capable of making such a judgement. " What judgement? Many of the so-called rich own the very companies that seek to destroy our environment, which leads us down the reproductive path and no more children. We need to become more involved with being more green and getting this message out there. You do understand that global warming is real, don't you?Mike W. Bowser, L Ac : acuprof: Thu, 13 Sep 2007 02:19:24 +0000Re: A case in point Mike,I pointed these things out (wouldn't the offspring of affluent, educated parents be more likely to contribute to the solution...) somewhat mockingly. My point is that we are not capable of making such a judgement. I think it would be a horrible violation of ethics to look at every infertile couple that approaches us for medical help, and to try to make some kind of assessment or prediction about what contributions their offspring might make (or not make) to the social problems that grip our world. First of all, we have no way to make such predictions. And secondly - even if we did, is it up to us as acupuncturists to use that " information " as a guage of whether we will or will not treat such patients?This is a very slippery slope. Once these kinds of assessments are mingled into our choice of which patients to accept and which one's we reject, where does it end? Should we cease to treat Jews who struggle with infertility because of the likelyhood that their offspring will further contribute to the global menace of Jewiness?Should we refuse care to the rich because their offspring are predisposed to make worse the problems of Richiness?My point is that these are not our judgements to make. I help people. If people want to have children and there is no discernable medical reason why they should not, I try to help them get what they most want. If there is a medical risk, I try to learn as much as I can so that I can best educate them about what potential risks are involved. David KarchmerChinese Medicine , mike Bowser <naturaldoc1 wrote:>> David,> Nice to know about the possible DAOM at Yosan. Are you planning to enroll?> > You mentioned, " wouldn't the offspring of affluent, educated (but infertile) parents be more likely to contribute to the solution than would the offspring of poor, uneducated, single parents? " > > Actually my response to this is that affluence and industrialization are major> contributors to much of our pollution and health problems. Be careful> with who you choose to endorse. The rich tend to be overly willing> to indulge in excesses and those who are poor deficiency, at least > that is how it appears to be. > > Lastly, I guess I am a bit surprised that you claim not to have a> philosophy about our medicine and its place in our culture. As > ethics is guided by philosophy, I am deeply concerned about this> attitude and what I am hearing. Mike W. Bowser, L Ac> ________> Kick back and relax with hot games and cool activities at the Messenger Café.> http://www.cafemessenger.com?ocid=TXT_TAGLM_SeptWLtagline> > [Non-text portions of this message have been removed]> _______________ Can you find the hidden words? Take a break and play Seekadoo! http://club.live.com/seekadoo.aspx?icid=seek_wlmailtextlink Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 David, You can keep throwing gas on a fire to keep it going also. That does not mean it is the right thing to do. As your focus is mainly on getting women pregnant you may be blinded to what I am simply saying. Connecting birth to success does not equal patient health. Mike W. Bowser, L Ac : acuprof: Thu, 13 Sep 2007 14:52:17 +0000Re: A case in point Mike,My practice is about 95% fertility related cases. Our goals for treatment are closely tied to reproductive outcomes. As a practitioner of CM, I find that the factors that inhibit conception or full term pregnancy are the results of meridian/organ imbalances. In such cases, the treatment plan is focused on correcting the imbalances so that normal/optimal function returns. Once normal function is restored, the probability of a favorable reproductive outcome is increased.If you substitute " favorable Reproductive Outcomes " for Weight loss, smoking cessation, eradication of headaches or pain, then I don't see how that is out of step with our profession.David K.--- In Chinese Medicine , mike Bowser <naturaldoc1 wrote:>> David,> I appreciate your opinion but find it odd that your philosophy> seems to be out of step with the profession. I do, however,> agree with trying to help every patient just not your goal of> reproduction (this is not a sign of health and unhealthy people> can and do get pregnant also). > > " I use the principles of to help my patients to become as healthy as possible... " Mike W. Bowser, L Ac> ________> Gear up for Halo® 3 with free downloads and an exclusive offer. It's our way of saying thanks for using Windows Live™.> http://gethalo3gear.com?ocid=SeptemberWLHalo3_WLHMTxt_2> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 Mike, I don't think that we will come to an agreement on this one. I have stated repeatedly that my approach to helping people with reproductive health is to educate them about their options and risks, and to apply the principles of TCM to optimize health. Which part of that violates the " spirit " of our medicine or negatively impacts the environment or society? David K Chinese Medicine , mike Bowser <naturaldoc1 wrote: > > David, > > You can keep throwing gas on a fire to keep it going also. That does not > mean it is the right thing to do. As your focus is mainly on getting women > pregnant you may be blinded to what I am simply saying. Connecting > birth to success does not equal patient health. Mike W. Bowser, L Ac > > > : acuprof: Thu, 13 Sep 2007 14:52:17 +0000Re: A case in point > > > > > Mike,My practice is about 95% fertility related cases. Our goals for treatment are closely tied to reproductive outcomes. As a practitioner of CM, I find that the factors that inhibit conception or full term pregnancy are the results of meridian/organ imbalances. In such cases, the treatment plan is focused on correcting the imbalances so that normal/optimal function returns. Once normal function is restored, the probability of a favorable reproductive outcome is increased.If you substitute " favorable Reproductive Outcomes " for Weight loss, smoking cessation, eradication of headaches or pain, then I don't see how that is out of step with our profession.David K.--- In Chinese Medicine , mike Bowser <naturaldoc1@> wrote:>> David,> I appreciate your opinion but find it odd that your philosophy> seems to be out of step with the profession. I do, however,> agree with trying to help every patient just not your goal of> reproduction (this is not a sign of health and unhealthy people> can and do get pregnant also). > > " I use the principles of to help my patients to become as healthy as possible... " Mike W. Bowser, L Ac> ________> Gear up for Halo® 3 with free downloads and an exclusive offer. It's our way of saying thanks for using Windows Live™.> http://gethalo3gear.com? ocid=SeptemberWLHalo3_WLHMTxt_2> > [Non-text portions of this message have been removed]> _______________ > Capture your memories in an online journal! > http://www.reallivemoms.com?ocid=TXT_TAGHM & loc=us > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 Mike, I am not an environmentalist. I am sympathetic to the cause of environmentalism, and sensitive to the very real dangers that are posed by global warming, but I cannot see how that possibly bears any relationship to my professional purpose. I am not a lobbyist, a politician or an activist. Did I miss some part of the hypocratic oath? The part where it said that doctors have to be green? You said, " We need to become more involved with being more green and getting this message out there. You do understand that global warming is real, don't you? " While I can understand that this is a very compelling message and something that you personally feel strongly about, can you explain exactly why as an acupuncturist, I " need to become more involved? " David K Chinese Medicine , mike Bowser <naturaldoc1 wrote: > > David, > " I pointed these things out (wouldn't the offspring of affluent, educated parents be more likely to contribute to the solution...) somewhat mockingly. My point is that we are not capable of making such a judgement. " > > What judgement? Many of the so-called rich own the very companies > that seek to destroy our environment, which leads us down the reproductive > path and no more children. We need to become more involved with being > more green and getting this message out there. You do understand that > global warming is real, don't you?Mike W. Bowser, L Ac > > > : acuprof: Thu, 13 Sep 2007 02:19:24 +0000Re: A case in point > > > > > Mike,I pointed these things out (wouldn't the offspring of affluent, educated parents be more likely to contribute to the solution...) somewhat mockingly. My point is that we are not capable of making such a judgement. I think it would be a horrible violation of ethics to look at every infertile couple that approaches us for medical help, and to try to make some kind of assessment or prediction about what contributions their offspring might make (or not make) to the social problems that grip our world. First of all, we have no way to make such predictions. And secondly - even if we did, is it up to us as acupuncturists to use that " information " as a guage of whether we will or will not treat such patients?This is a very slippery slope. Once these kinds of assessments are mingled into our choice of which patients to accept and which one's we reject, where does it end? Should we cease to treat Jews who struggle with infertility because of the likelyhood that their offspring will further contribute to the global menace of Jewiness? Should we refuse care to the rich because their offspring are predisposed to make worse the problems of Richiness?My point is that these are not our judgements to make. I help people. If people want to have children and there is no discernable medical reason why they should not, I try to help them get what they most want. If there is a medical risk, I try to learn as much as I can so that I can best educate them about what potential risks are involved. David Karchmer- -- In Chinese Medicine , mike Bowser <naturaldoc1@> wrote:>> David,> Nice to know about the possible DAOM at Yosan. Are you planning to enroll?> > You mentioned, " wouldn't the offspring of affluent, educated (but infertile) parents be more likely to contribute to the solution than would the offspring of poor, uneducated, single parents? " > > Actually my response to this is that affluence and industrialization are major> contributors to much of our pollution and health problems. Be careful> with who you choose to endorse. The rich tend to be overly willing> to indulge in excesses and those who are poor deficiency, at least > that is how it appears to be. > > Lastly, I guess I am a bit surprised that you claim not to have a> philosophy about our medicine and its place in our culture. As > ethics is guided by philosophy, I am deeply concerned about this> attitude and what I am hearing. Mike W. Bowser, L Ac> ________> Kick back and relax with hot games and cool activities at the Messenger Café.> http://www.cafemessenger.com?ocid=TXT_TAGLM_SeptWLtagline> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 David, I can't commit to sharing that kind of thing every time I post, but if you have a more specific question, I'll do my best to answer it. David K --- In Chinese Medicine , " flyingstarsfengshui " <flyingstarsfengshui wrote: > > Hi David: > > Each time you discuss how you practice for fertility > it is the basics of our Medicine, can you share the Expert Knowledge > you have refered to, from a Chinese Medical View? > > thanks, > > david > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2007 Report Share Posted September 13, 2007 David T, In terms of being competent or qualified to treat non-fertility conditions, I did go to acupuncture college where I was trained in the basics (as all Reproductive Specialists are), and then I did have a general practice for 7-8 years before moving more toward specialization. So, yes. I probably am still able to handle that other 5% of cases, and as I have stated on this board in the past, we still accept these kinds of cases on a referral basis from our fertility patients. In some instances when people ask if we treat different types of complaints, we refer them out to other general practitioners in our area. There are just some things I do not enjoy treating. (Allergies, for example.) As far as " specialized training " goes, there are two principle issues as I see it. 1) Understanding western medicine well enough to be able to refer out appropriately, recognize potentially dangerous conditions, understand western assays, and understand western protocols and medications. 2) From the view of CM, understanding the subtleties of the menstrual cycle and using basal body temperature as a diagnostic tool. I think both are equally important and that neither are adequately covered in general training. This is why I maintain the position that favors the board certification process. You have asked in previous posts for two things: 1) Horror stories that would illustrate the need for a specialist / generalist distinction. 2) Specific CM diagnostic or treatment protocols that distinguish a reproductive specialist from a generalist I will do my best to address both questions. I ask that you (and anybody else reading) keeps in mind that this is just one man’s opinion, and that there are other reproductive acupuncturists out there who may have different views. So, please do not generalize my opinion to be representative of the profession. Secondly, I ask that you keep an open mind as you read these things and that you do not simply read them with a trolling eye looking for logical inconsistencies, or searching for a reason to discredit specialization, bolster your own arguments, or further any anti- ABORM sentiment that you may harbor. In other words, take a few minutes to let these ideas sink in, and see if they have any clinical merit. Horror Story # 1 †" A patient came in with a history of tubal damage and ectopic pregnancy. She also has PCOS. We have been treating this patient for about 9 months, and her cycles are both erratic and delayed (30-60 days). Last week she came in on cycle day 50 with light spotting and excruciating pain in the upper right quadrant. Suspecting a tubal pregnancy, we immediately referred her for an ultrasound and a pregnancy test. Now, bear in mind that this is a “potential†horror story, and no actual horror transpired. But, the potential for disaster rests in someone unversed in the fundamentals or reproductive medicine not realizing that the risks for tubal pregnancy are increased many fold in cases of previous ectopics or tubal damage. Further, a generalist who is not versed in the literature of reproductive medicine may not realize that the incidence of tubal pregnancies has risen exponentially in the last 20 years, and that women of color are at even greater risk. This is a very serious, and potentially life-threatening situation, and for the generalist managing reproductive cases, is a potential horror story waiting-to- happen. Horror Story #2 †" A patient has been under our care for about 3 months. She has an unconfirmed diagnosis of atypical PCOS, and experiences intermittent leukorrhea. Sometimes the discharge is clear, other times it is yellow with foul odor. This week she came in and reported that she had experienced a watery discharge that was “tinged†with pink. This discharge had been of a greater volume than previous episodes of leukorrhea, and occurred beginning around cycle day 10. Despite the fact that she has tested negative for both Chlamydia and gonorrhea, I suspected that there may be a hydrosalpinx because of her description of watery discharge. http://www.asrm.org/Patients/FactSheets/hydrosa.pdf Most of us who are trained in CM would think (watery discharge = KD Yang Xu. “Tinged†with pink = SP Qi Xu not holding blood.) This seems to be a very straightforward case of KD and SP Qi and Yang xu with watery discharge and light internal bleeding. But, with a western background of potential pathologies, we may have been able to discover another underlying explanation for her history of infertility. I recommended a Hysterosalpingogram (HSG) which is the preferred diagnostic test for tubal obstructions, including hydrosalpinx. Why is this important? Because if it turns out that there is a hydrosalpinx, her chances of conceiving with CM alone are close to nil. In this case, a CM practitioner may have treated her for months with no actual chance of success. This, I believe, would represent at best questionable ethics and at worst malpractice. Without knowing what tests to order (i.e. Western Reproductive Medicine) then it is possible and in many instances likely, that we will be applying acupuncture and herbs with no real chance of success. Furthermore, if there is a hydrosalpinx that goes undetected, and a pregnancy were to occur (either through IVF, or by way of ovulation through a healthy contralateral tube) there is a tremendous risk to the pregnancy, as a hydrosalpinx may leak toxic fluid into the uterine cavity and jeopardize the pregnancy. As I said, the above cases represent ‘potential’ and not actual horror stories. But, real horror stories are not easy to come by because most of us do not go around publishing the most egregious things that happen to our patients. We put “Success Stories†and “Testimonials†on our websites, but we seem to steer away from web pages called, “The stupidest shit I have ever done.†What I do get all the time are patients who come to me with a history of seeing another acupuncturist. And when I start to go through what I consider to be a very basic reproductive acupuncture intake, I come to rind out that their other acupuncturist never asked them questions about their ovulation, cervical mucous, BBT, or whether or not they have ever had an IVF, and HSG, Cycle Day 3 blood work, or a Clomid Challenge Test. The results of ALL of these tests can be very informative in terms of making a good TCM diagnosis and managing a case responsibly and ethically. Based on the number of times that this happens, I remain convinced that there is a fundamental difference between a reproductive acupuncturist, and an acupuncture generalist who dabbles in fertility. It also reinforces my conviction that there is a very real need to make available to the general public, to potential patients, and to referring RE’s and OB/GYN’s some kind of credential that can signal to all interested parties who does, and who does not possess a sound and fundamental understanding of reproductive medicine. This is not to say that anyone who is not ABORM certified is without understanding. I realize that there are probably a lot of folks who are quite talented and very knowledgeable in these areas, but who simply choose (for whatever reason) not to take the test. That is fine with me. I have no agenda for who does and does not get certified. But without such a credential, how will the public be able to gauge which of us a foundational understanding of reproductive medicine? In a landscape where anyone is free to represent themselves as a Reproductive Acupuncture Specialist with no testing of any kind, how will potential patients and referring docs make an intelligent choice? 2) What are the specific CM diagnostic or treatment protocols that distinguish a reproductive specialist from a generalist? I think that most of the differences here lie with diagnostic assessment, and less with treatment. Once you know the diagnosis, there is no real difference between a generalist and a reproductive specialist. However, where proper diagnostic procedures and case management is concerned, I think there are a few fundamental differences. 1) BBT (Basal Body Temperature) †" As practiced in China and illuminated in books like “The Infertility Cure†and “The Treatment of Infertility with ,†the BBT provides an valuable tool for identifying different kinds of hormonal changes throughout the five phases of the menstrual cycle (Bleeding, Follicular, Ovulatory, Luteal, and Pre-Menstrual). What I learned in school, and what I think is pretty standard in TCM education is that we want to build blood before ovulation, and move blood after ovulation. But accurate analysis of the BBT chart opens up an entirely new dimension into diagnosing and treating each specific phase of the cycle. This is something that is not covered in most acupuncture training, and therefore distinguishes a generalist from a specialist. 2) Treating what you (don’t) see †" As acupuncturists, we are always looking for subtle changes †" any deviation from normal that might provide insight about the syndrome or the causative factor(s). Usually we treat what we see in terms of supporting signs and symptoms. In the treatment of female infertility, this is often the case. But, there are quite a few instances where we must treat what we do not see. Much of the treatment principle will be derived from the stages of the cycle and the BBT, and not always from signs and symptoms. For example: There is a condition that we like to call “Thin PCOS.†PCOS is usually a phlegmatic condition and is frequently accompanied by hirsutism, insulin resistance, anovulatory amenorrhea , and obesity. There is also a diagnosis called ‘atypical PCOS’ where the ovaries will be filled with tiny pearl like cysts, but the patient will not have the accompanying hormonal markers that usually accompany the syndrome. Sometimes we see what we call the “thin PCOS’ patient. This is a patient with a PCOS diagnosis that has phlegmatic cysts obstructing the ovaries, and also has anovulatory amenorrhea, but is not overweight. In fact, they walk in like a classic Yin and Blood Xu patient with varying degrees of Xu Heat. Now, if you are not familiar with PCOS and how it is understood from the TCM perspective, a typical course of CM treatment might look to Build Yin and Blood during the Follicular Phase, and Move Blood and Clear Xu Heat after ovulation. This typical kind of TCM approach, however, will not be very likely to facilitate ovulation. Instead, by understanding both the CM and the western implications of PCOS, a practitioner might veer against conventional wisdom and treat for Phlegm Accumulation, even though the patient is thin and dry. Additionally, it might be helpful to initiate ovulation to strongly tonify KD Yang even though most of the signs point to Yin Xu with Heat. Because as acupuncturists, we understand Yin and Yang and follow the imperative that they must be balanced, our formulas will try to protect the Yin and Blood while also resolving Phlegm and Tonifying KD Yang. It is a balancing act in the truest sense of the term. However, without any specialized understanding of a pattern such as PCOS from both the Western and the CM points of view, a practitioner would be unlikely to try something as radical as promoting Yang and resolving Phlegm in a thin patient with Yin Xu Heat signs. And, in my view, without including these things in the treatment principle, natural ovulation will be unlikely to return. In conclusion, I think that (most) of this debate has been very interesting and hopefully will bring about a greater sense of responsibility and accountability to the institution of Specialty Boards. But as long as I keep getting infertility patients from other acupuncturists, who do not even cover those things considered basics in the world of Reproductive Acupuncture, I will remain steadfast in my view that specialty boards (like the ABORM) and the credentials that they seek to provide are both valuable and necessary. David Karchmer ------------------------------- --- In Chinese Medicine , " flyingstarsfengshui " <flyingstarsfengshui wrote: > > Hi David: > > From you: > > " My practice is about 95% fertility related cases. Our goals for > treatment are closely tied to reproductive outcomes. As a > practitioner of CM, I find that the factors that inhibit conception > or full term pregnancy are the results of meridian/organ imbalances. > In such cases, the treatment plan is focused on correcting the > imbalances so that normal/optimal function returns. Once normal > function is restored " > *********************************** > I agree with you and this is what every practioner learns, and with > experience they will get better and better at it. Every Licensed > practioner has the tool set to do this. > > Its seems much of what the certification is about is Western > Medicine, they want people to be well schooled in communicating with > the western community in their language, from a marketing > perspective its primarly about penetrating the western medical > community. But as you so clearly state above to practice Chinese > medicine for infertility we need to go to our chinese medical model > for diagnosis and treatment (of course if they have a medical > condition we need to know that, but this is true for everything). > Maybe they should create a certificate for understanding Infertilty > from a Western Medical view. > > Not to be too annoying, but if 95% of your practice is Reproductive > Medicine than you are not competent and qualified to treat other > conditions? > > regards, > > david > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.