A case in point

September 11, 2007

Hugo,

Sorry, I quoted you twice. rushed editing job.

DK

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

>

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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

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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

>

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> > > >

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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

>

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?

>

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?

> >

>

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

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./

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

>

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

>

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

>

> >

>

> >

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

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

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_________

Want ideas for reducing your carbon footprint? Visit For Good

http://uk.promotions./forgood/environment.html

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

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

>

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> > > > > >

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

>

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>

_________

> Want ideas for reducing your carbon footprint? Visit For

Good http://uk.promotions./forgood/environment.html

>

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

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> >

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

>

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> >

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

>

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 manâ€™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 â€ " 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 â€œpotentialâ€ 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 â€ " 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 â€œtingedâ€ 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. â€œTingedâ€ 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 â€˜potentialâ€™ 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 â€œSuccess Storiesâ€

and â€œTestimonialsâ€ on our websites, but we seem to steer away from

web pages called, â€œThe stupidest shit I have ever done.â€

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 REâ€™s and OB/GYNâ€™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) â€ " As practiced in China and

illuminated in books like â€œThe Infertility Cureâ€ and â€œThe Treatment

of Infertility with ,â€ 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 (donâ€™t) see â€ " As acupuncturists, we are always

looking for subtle changes â€ " 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 â€œThin PCOS.â€

PCOS is usually a phlegmatic condition and is frequently accompanied

by hirsutism, insulin resistance, anovulatory amenorrhea , and

obesity. There is also a diagnosis called â€˜atypical PCOSâ€™ 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 â€œthin PCOSâ€™ 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

>

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