research and pattern dx

January 21, 2002

I believe that there is at least one or two comparison studies quoted

in Chinese Medical Psychiatry between Chinese meds prescribed on

the basis of disease diagnosis and those prescribed on the basis of

pattern discrimination. If not in there, I am sure there are several

in my, Lynn Kuchinski, and Dr. Casanas's upcoming The Treatment of

Diabetes with . In the articles I remember, treatment

based on individual pattern discrimination was more successful than on

disease diagnosis alone.

While studies comparing one Chinese medical treatment to another

Chinese medical treatment (for instance bian bing to bian zhen) are

not all that common in the Chinese journal literature, what I can say

I see happening is that less and less studies are based on giving one

formula or one treatment to everyone (unless the authors have

described their cohort group as all manifesting a single pattern).

Most studies I read use a basic formula or protocol which is then

modified for specific presenting patterns. Further, almost always the

basic protocol is based on the assumption that most patients manifest

combinations of patterns. Differences between protocols then consist

of the authors' varying opinions on which combinations of patterns

they believe they see most often or think most root-like or which

specific meds they like for a particular treatment principle in a

particular disease.

I haven't read the whole thread on this topic; so I'm not sure these

responses are at all germane. I'm very busy these days with Blue

Poppy. Therefore, my participation on this list is going to have to be

scaled back. But, in closing, one of the very interesting types of CM

journal article is the " Progress on... " or " A Summary of Advances

in... " These articles consist of a literature search of all published

articles on a particular disease. These articles, a particular genre

of article within CM journals, compare outcomes from different

protocols. Commonly, they include subsections on single protocol

formulas and their outcomes and protocols based on pattern

discrimination and their outcomes. Interestingly, these outcomes are

not typically compared between protocol types. However, the reader can

easily compare these outcomes if they wish. These articles also

usually include sections on acupuncture-moxibustion.

Bob

, wrote:

> Bob Flaws (and, of course, anyone else who might have a thought on

> this),

>

> You might know this since you read a lot of research reports on

chinese

> outcome studies. Would you say it is a consistent theme in the

> literature to see evidence that pattern diagnosis yields better

results

> than giving the same formula to the entire group, regardless of

their

> TCM pattern? How much research is done this way? I ask because

Alon

> abstracted the Bensouusan irritable bowel study on another list. It

> makes the point of saying the the study showed no added benefit from

TCM

> pattern differentiation. Apparently, in the whole article, it is

stated

> that in some cases of those on individualized formulas, improvements

> lasted up to 14 weeks after stopping the herbs, though. This was

not

> true for any on the standard one size fits all rx. There was just

no

> greater symptom relief during the experimental period with pattern

based

> tx.

>

> I think the long lasting relief in the pattern based group is of

great

> significance, perhaps suggesting that root and branch were both

treated

> effectively. I do wonder how accurate the pattern based formulas

were.

> If one accepts that complex diagnoses like IBS often involve several

> mutually engendering pathomechanisms (and I know not everyone agrees

> with this), it may be folly to do research that breaks disease down

by

> textbook patterns and then fits patients into whatever group is the

> closest match. For instance, don't the vast majority of IBS

patients

> have some combination of spleen vacuity, liver qi depression,

> damp-heat. I also frequently see yang xu with this. What good

would it

> do to put people in one or the other group? Now if each test group

had

> some version of a formula that actually treated a complex

> multi-patterned diagnosis, perhaps the test group would have fared

> better. Perhaps one reason the standard formula did so well is

because

> it did address a more complex diagnosis.

>

> --

> Chinese Herbs

>

> FAX:

January 21, 2002

Bob,

I realize that you're preoccupied with

other matters, but when you have a moment

I'd appreciate hearing your thoughts on

what seems to me to be a fundamental

conundrum related to the design as

well as the reporting of clinical

trials. In short, how to reconcile the apparent

conflict between the traditional Chinese model,

based on criteria that suggest treatment

be made suitable for individuals and

their particular circumstances in

time and space, and the conventional

scientific model of the randomized

double-blind placebo controlled trial,

that requires statistically reproducible

results.

I'm waiting to get a complete copy of

the Bensoussan article that included some

mention of this topic. But I need to

understand this and I'm hoping that you

can help.

Ken

, " pemachophel2001 "

<pemachophel2001> wrote:

>

> I believe that there is at least one or two comparison studies

quoted

> in Chinese Medical Psychiatry between Chinese meds prescribed on

> the basis of disease diagnosis and those prescribed on the basis of

> pattern discrimination. If not in there, I am sure there are

several

> in my, Lynn Kuchinski, and Dr. Casanas's upcoming The Treatment of

> Diabetes with . In the articles I remember,

treatment

> based on individual pattern discrimination was more successful than

on

> disease diagnosis alone.

>

> While studies comparing one Chinese medical treatment to another

> Chinese medical treatment (for instance bian bing to bian zhen) are

> not all that common in the Chinese journal literature, what I can

say

> I see happening is that less and less studies are based on giving

one

> formula or one treatment to everyone (unless the authors have

> described their cohort group as all manifesting a single pattern).

> Most studies I read use a basic formula or protocol which is then

> modified for specific presenting patterns. Further, almost always

the

> basic protocol is based on the assumption that most patients

manifest

> combinations of patterns. Differences between protocols then

consist

> of the authors' varying opinions on which combinations of patterns

> they believe they see most often or think most root-like or which

> specific meds they like for a particular treatment principle in a

> particular disease.

>

> I haven't read the whole thread on this topic; so I'm not sure

these

> responses are at all germane. I'm very busy these days with Blue

> Poppy. Therefore, my participation on this list is going to have to

be

> scaled back. But, in closing, one of the very interesting types of

CM

> journal article is the " Progress on... " or " A Summary of Advances

> in... " These articles consist of a literature search of all

published

> articles on a particular disease. These articles, a particular

genre

> of article within CM journals, compare outcomes from different

> protocols. Commonly, they include subsections on single protocol

> formulas and their outcomes and protocols based on pattern

> discrimination and their outcomes. Interestingly, these outcomes

are

> not typically compared between protocol types. However, the reader

can

> easily compare these outcomes if they wish. These articles also

> usually include sections on acupuncture-moxibustion.

>

> Bob

>

> , wrote:

> > Bob Flaws (and, of course, anyone else who might have a thought on

> > this),

> >

> > You might know this since you read a lot of research reports on

> chinese

> > outcome studies. Would you say it is a consistent theme in the

> > literature to see evidence that pattern diagnosis yields better

> results

> > than giving the same formula to the entire group, regardless of

> their

> > TCM pattern? How much research is done this way? I ask because

> Alon

> > abstracted the Bensouusan irritable bowel study on another list.

It

> > makes the point of saying the the study showed no added benefit

from

> TCM

> > pattern differentiation. Apparently, in the whole article, it is

> stated

> > that in some cases of those on individualized formulas,

improvements

> > lasted up to 14 weeks after stopping the herbs, though. This was

> not

> > true for any on the standard one size fits all rx. There was

just

> no

> > greater symptom relief during the experimental period with

pattern

> based

> > tx.

> >

> > I think the long lasting relief in the pattern based group is of

> great

> > significance, perhaps suggesting that root and branch were both

> treated

> > effectively. I do wonder how accurate the pattern based formulas

> were.

> > If one accepts that complex diagnoses like IBS often involve

several

> > mutually engendering pathomechanisms (and I know not everyone

agrees

> > with this), it may be folly to do research that breaks disease

down

> by

> > textbook patterns and then fits patients into whatever group is

the

> > closest match. For instance, don't the vast majority of IBS

> patients

> > have some combination of spleen vacuity, liver qi depression,

> > damp-heat. I also frequently see yang xu with this. What good

> would it

> > do to put people in one or the other group? Now if each test

group

> had

> > some version of a formula that actually treated a complex

> > multi-patterned diagnosis, perhaps the test group would have fared

> > better. Perhaps one reason the standard formula did so well is

> because

> > it did address a more complex diagnosis.

> >

> > --

> > Chinese Herbs

> >

> > FAX:

January 21, 2002

realize that you're preoccupied withother matters, but when you have a momentI'd appreciate hearing your thoughts onwhat seems to me to be a fundamentalconundrum related to the design aswell as the reporting of clinicaltrials. In short, how to reconcile the apparentconflict between the traditional Chinese model,based on criteria that suggest treatmentbe made suitable for individuals andtheir particular circumstances intime and space, and the conventionalscientific model of the randomizeddouble-blind placebo controlled trial,that requires statistically reproducibleresults.>>>>>There is no problem and you can see this in Bensoussan article. All that needs to be done is create a blind step. Perhaps the pharmacist. The auditor must be other then the treating Drs. There is no problem is studding systems or individualized treatments as long and the patients are randomized to other control groups.

Alon

-

dragon90405

Monday, January 21, 2002 8:54 AM

Re: research and pattern dx

Bob,I realize that you're preoccupied withother matters, but when you have a momentI'd appreciate hearing your thoughts onwhat seems to me to be a fundamentalconundrum related to the design aswell as the reporting of clinicaltrials. In short, how to reconcile the apparentconflict between the traditional Chinese model,based on criteria that suggest treatmentbe made suitable for individuals andtheir particular circumstances intime and space, and the conventionalscientific model of the randomizeddouble-blind placebo controlled trial,that requires statistically reproducibleresults.I'm waiting to get a complete copy ofthe Bensoussan article that included somemention of this topic. But I need tounderstand this and I'm hoping that youcan help.Ken, "pemachophel2001" <pemachophel2001> wrote:> > > I believe that there is at least one or two comparison studies quoted > in Chinese Medical Psychiatry between Chinese meds prescribed on > the basis of disease diagnosis and those prescribed on the basis of > pattern discrimination. If not in there, I am sure there are several > in my, Lynn Kuchinski, and Dr. Casanas's upcoming The Treatment of > Diabetes with . In the articles I remember, treatment > based on individual pattern discrimination was more successful than on > disease diagnosis alone.> > While studies comparing one Chinese medical treatment to another > Chinese medical treatment (for instance bian bing to bian zhen) are > not all that common in the Chinese journal literature, what I can say > I see happening is that less and less studies are based on giving one > formula or one treatment to everyone (unless the authors have > described their cohort group as all manifesting a single pattern). > Most studies I read use a basic formula or protocol which is then > modified for specific presenting patterns. Further, almost always the > basic protocol is based on the assumption that most patients manifest > combinations of patterns. Differences between protocols then consist > of the authors' varying opinions on which combinations of patterns > they believe they see most often or think most root-like or which > specific meds they like for a particular treatment principle in a > particular disease.> > I haven't read the whole thread on this topic; so I'm not sure these > responses are at all germane. I'm very busy these days with Blue > Poppy. Therefore, my participation on this list is going to have to be > scaled back. But, in closing, one of the very interesting types of CM > journal article is the "Progress on..." or "A Summary of Advances > in..." These articles consist of a literature search of all published > articles on a particular disease. These articles, a particular genre > of article within CM journals, compare outcomes from different > protocols. Commonly, they include subsections on single protocol > formulas and their outcomes and protocols based on pattern > discrimination and their outcomes. Interestingly, these outcomes are > not typically compared between protocol types. However, the reader can > easily compare these outcomes if they wish. These articles also > usually include sections on acupuncture-moxibustion.> > Bob> > , wrote:> > Bob Flaws (and, of course, anyone else who might have a thought on> > this),> > > > You might know this since you read a lot of research reports on > chinese> > outcome studies. Would you say it is a consistent theme in the> > literature to see evidence that pattern diagnosis yields better > results> > than giving the same formula to the entire group, regardless of > their> > TCM pattern? How much research is done this way? I ask because > Alon> > abstracted the Bensouusan irritable bowel study on another list. It> > makes the point of saying the the study showed no added benefit from > TCM> > pattern differentiation. Apparently, in the whole article, it is > stated> > that in some cases of those on individualized formulas, improvements> > lasted up to 14 weeks after stopping the herbs, though. This was > not> > true for any on the standard one size fits all rx. There was just > no> > greater symptom relief during the experimental period with pattern > based> > tx.> > > > I think the long lasting relief in the pattern based group is of > great> > significance, perhaps suggesting that root and branch were both > treated> > effectively. I do wonder how accurate the pattern based formulas > were.> > If one accepts that complex diagnoses like IBS often involve several> > mutually engendering pathomechanisms (and I know not everyone agrees> > with this), it may be folly to do research that breaks disease down > by> > textbook patterns and then fits patients into whatever group is the> > closest match. For instance, don't the vast majority of IBS > patients> > have some combination of spleen vacuity, liver qi depression,> > damp-heat. I also frequently see yang xu with this. What good > would it> > do to put people in one or the other group? Now if each test group > had> > some version of a formula that actually treated a complex> > multi-patterned diagnosis, perhaps the test group would have fared> > better. Perhaps one reason the standard formula did so well is > because> > it did address a more complex diagnosis.> > > > -- > > Chinese Herbs> > http://www..org> > FAX: Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

January 21, 2002

Ken,

First, I think the Chinese research is valid, " outcomes-based "

research. (That's as long as you don't think it is all a lie or has

been fudged. But we've been over that ground before.) The so-called

gold standard of Western medical research of the prospective,

randomly assigned, double-blind, placebo-controlled study is currently

under attack from anumber of different angles, especially from the

social scientists. So I think we need to be careful not to embrace a

research model that may be on its way out, not on its way up. I've

argued before that the Chinese style research may just well be the

wave of the future in medical research as we become more and more

aware of the limitations and distortions of Western-centric, " gold

standard " research.

Secondly, we need to remember that the healing encounter is

multifactorial. But I don't need to tell you that. We're both on the

same page with that. If one does " gold standard " research, I think one

needs to keep in mind what this research does and doesn't tell you.

However, that being said, I don't see any conceptual difficulty with

doing " gold standard " research on the clinical use of Chinese

medicinals. The Bensoussan model is, I think, an ok model:

prospective, randomly assigned, a basic protocol with individual

modifications based on pattern discrimination, outcomes criteria, and

statistically analyzed and reported outcomes. As long as all patients

went through the same prescriptive process, one could also do

double-blind. Also, there needs to be standard written criteria for

pattern discrimination (such as in most modern Chinese research) and a

written list of individual modifications (also such as in most modern

Chinese research). In other words, the list of possible modifications

cannot be open-ended. While this does limit the practitioner somewhat,

we all have to accpet some limitations in everything we do. As for

placebo-controlled, that can also be done, especially if one uses

encapsulated extracts meds. If the actual physical form of the placebo

differs from the treatment group meds, then one has to assure that

there is no mixing, no communication between the two groups. That

would be a problem.

Even better, is a three-winged study, 1) " real " treatment, 2) placebo,

and 3) comparison. The comparison could be done by enrolling more

patients in the study or it can be drawn from other, already published

studies (given that there is no significant statistical difference

between the cohorts in the two studies). There is a lot of research

already published on Western meds and vartious conditions. You don't

need to invent the wheel each time one does a study. It is legitimate

to compare the outcomes of one study with another as long as the

statisticians say this is ok.

Personally, I'm not convinced that we need to be doing " gold standard "

research. I think that type of research is a dinosaur and is behind

the historical curve. I'd rather forge common cause with the critics

of the " gold standard " and promote the vailidity and clinical utility

of the outcomes-based research which already exists.

Bob

, " dragon90405 " <yulong@m...> wrote:

> Bob,

>

> I realize that you're preoccupied with

> other matters, but when you have a moment

> I'd appreciate hearing your thoughts on

> what seems to me to be a fundamental

> conundrum related to the design as

> well as the reporting of clinical

> trials. In short, how to reconcile the apparent

> conflict between the traditional Chinese model,

> based on criteria that suggest treatment

> be made suitable for individuals and

> their particular circumstances in

> time and space, and the conventional

> scientific model of the randomized

> double-blind placebo controlled trial,

> that requires statistically reproducible

> results.

>

> I'm waiting to get a complete copy of

> the Bensoussan article that included some

> mention of this topic. But I need to

> understand this and I'm hoping that you

> can help.

>

> Ken

>

> , " pemachophel2001 "

> <pemachophel2001> wrote:

> >

> > I believe that there is at least one or two comparison studies

> quoted

> > in Chinese Medical Psychiatry between Chinese meds prescribed on

> > the basis of disease diagnosis and those prescribed on the basis

of

> > pattern discrimination. If not in there, I am sure there are

> several

> > in my, Lynn Kuchinski, and Dr. Casanas's upcoming The Treatment of

> > Diabetes with . In the articles I remember,

> treatment

> > based on individual pattern discrimination was more successful

than

> on

> > disease diagnosis alone.

> >

> > While studies comparing one Chinese medical treatment to another

> > Chinese medical treatment (for instance bian bing to bian zhen)

are

> > not all that common in the Chinese journal literature, what I can

> say

> > I see happening is that less and less studies are based on giving

> one

> > formula or one treatment to everyone (unless the authors have

> > described their cohort group as all manifesting a single pattern).

> > Most studies I read use a basic formula or protocol which is then

> > modified for specific presenting patterns. Further, almost always

> the

> > basic protocol is based on the assumption that most patients

> manifest

> > combinations of patterns. Differences between protocols then

> consist

> > of the authors' varying opinions on which combinations of patterns

> > they believe they see most often or think most root-like or which

> > specific meds they like for a particular treatment principle in a

> > particular disease.

> >

> > I haven't read the whole thread on this topic; so I'm not sure

> these

> > responses are at all germane. I'm very busy these days with Blue

> > Poppy. Therefore, my participation on this list is going to have

to

> be

> > scaled back. But, in closing, one of the very interesting types of

> CM

> > journal article is the " Progress on... " or " A Summary of Advances

> > in... " These articles consist of a literature search of all

> published

> > articles on a particular disease. These articles, a particular

> genre

> > of article within CM journals, compare outcomes from different

> > protocols. Commonly, they include subsections on single protocol

> > formulas and their outcomes and protocols based on pattern

> > discrimination and their outcomes. Interestingly, these outcomes

> are

> > not typically compared between protocol types. However, the reader

> can

> > easily compare these outcomes if they wish. These articles also

> > usually include sections on acupuncture-moxibustion.

> >

> > Bob

> >

> > , wrote:

> > > Bob Flaws (and, of course, anyone else who might have a thought

on

> > > this),

> > >

> > > You might know this since you read a lot of research reports on

> > chinese

> > > outcome studies. Would you say it is a consistent theme in the

> > > literature to see evidence that pattern diagnosis yields better

> > results

> > > than giving the same formula to the entire group, regardless of

> > their

> > > TCM pattern? How much research is done this way? I ask because

> > Alon

> > > abstracted the Bensouusan irritable bowel study on another list.

> It

> > > makes the point of saying the the study showed no added benefit

> from

> > TCM

> > > pattern differentiation. Apparently, in the whole article, it

is

> > stated

> > > that in some cases of those on individualized formulas,

> improvements

> > > lasted up to 14 weeks after stopping the herbs, though. This

was

> > not

> > > true for any on the standard one size fits all rx. There was

> just

> > no

> > > greater symptom relief during the experimental period with

> pattern

> > based

> > > tx.

> > >

> > > I think the long lasting relief in the pattern based group is of

> > great

> > > significance, perhaps suggesting that root and branch were both

> > treated

> > > effectively. I do wonder how accurate the pattern based

formulas

> > were.

> > > If one accepts that complex diagnoses like IBS often involve

> several

> > > mutually engendering pathomechanisms (and I know not everyone

> agrees

> > > with this), it may be folly to do research that breaks disease

> down

> > by

> > > textbook patterns and then fits patients into whatever group is

> the

> > > closest match. For instance, don't the vast majority of IBS

> > patients

> > > have some combination of spleen vacuity, liver qi depression,

> > > damp-heat. I also frequently see yang xu with this. What good

> > would it

> > > do to put people in one or the other group? Now if each test

> group

> > had

> > > some version of a formula that actually treated a complex

> > > multi-patterned diagnosis, perhaps the test group would have

fared

> > > better. Perhaps one reason the standard formula did so well is

> > because

> > > it did address a more complex diagnosis.

> > >

> > > --

> > > Chinese Herbs

> > >

> > > FAX:

January 21, 2002

In other words, the list of possible modifications cannot be open-ended.

>>>Why not?

Alon

-

pemachophel2001

Monday, January 21, 2002 12:51 PM

Re: research and pattern dx

Ken,First, I think the Chinese research is valid, "outcomes-based" research. (That's as long as you don't think it is all a lie or has been fudged. But we've been over that ground before.) The so-called gold standard of Western medical research of the prospective, randomly assigned, double-blind, placebo-controlled study is currently under attack from anumber of different angles, especially from the social scientists. So I think we need to be careful not to embrace a research model that may be on its way out, not on its way up. I've argued before that the Chinese style research may just well be the wave of the future in medical research as we become more and more aware of the limitations and distortions of Western-centric, "gold standard" research.Secondly, we need to remember that the healing encounter is multifactorial. But I don't need to tell you that. We're both on the same page with that. If one does "gold standard" research, I think one needs to keep in mind what this research does and doesn't tell you.However, that being said, I don't see any conceptual difficulty with doing "gold standard" research on the clinical use of Chinese medicinals. The Bensoussan model is, I think, an ok model: prospective, randomly assigned, a basic protocol with individual modifications based on pattern discrimination, outcomes criteria, and statistically analyzed and reported outcomes. As long as all patients went through the same prescriptive process, one could also do double-blind. Also, there needs to be standard written criteria for pattern discrimination (such as in most modern Chinese research) and a written list of individual modifications (also such as in most modern Chinese research). In other words, the list of possible modifications cannot be open-ended. While this does limit the practitioner somewhat, we all have to accpet some limitations in everything we do. As for placebo-controlled, that can also be done, especially if one uses encapsulated extracts meds. If the actual physical form of the placebo differs from the treatment group meds, then one has to assure that there is no mixing, no communication between the two groups. That would be a problem. Even better, is a three-winged study, 1) "real" treatment, 2) placebo, and 3) comparison. The comparison could be done by enrolling more patients in the study or it can be drawn from other, already published studies (given that there is no significant statistical difference between the cohorts in the two studies). There is a lot of research already published on Western meds and vartious conditions. You don't need to invent the wheel each time one does a study. It is legitimate to compare the outcomes of one study with another as long as the statisticians say this is ok. Personally, I'm not convinced that we need to be doing "gold standard" research. I think that type of research is a dinosaur and is behind the historical curve. I'd rather forge common cause with the critics of the "gold standard" and promote the vailidity and clinical utility of the outcomes-based research which already exists.Bob, "dragon90405" <yulong@m...> wrote:> Bob,> > I realize that you're preoccupied with> other matters, but when you have a moment> I'd appreciate hearing your thoughts on> what seems to me to be a fundamental> conundrum related to the design as> well as the reporting of clinical> trials. In short, how to reconcile the apparent> conflict between the traditional Chinese model,> based on criteria that suggest treatment> be made suitable for individuals and> their particular circumstances in> time and space, and the conventional> scientific model of the randomized> double-blind placebo controlled trial,> that requires statistically reproducible> results.> > I'm waiting to get a complete copy of> the Bensoussan article that included some> mention of this topic. But I need to> understand this and I'm hoping that you> can help.> > Ken> > , "pemachophel2001" > <pemachophel2001> wrote:> > > > > > I believe that there is at least one or two comparison studies > quoted > > in Chinese Medical Psychiatry between Chinese meds prescribed on > > the basis of disease diagnosis and those prescribed on the basis of > > pattern discrimination. If not in there, I am sure there are > several > > in my, Lynn Kuchinski, and Dr. Casanas's upcoming The Treatment of > > Diabetes with . In the articles I remember, > treatment > > based on individual pattern discrimination was more successful than > on > > disease diagnosis alone.> > > > While studies comparing one Chinese medical treatment to another > > Chinese medical treatment (for instance bian bing to bian zhen) are > > not all that common in the Chinese journal literature, what I can > say > > I see happening is that less and less studies are based on giving > one > > formula or one treatment to everyone (unless the authors have > > described their cohort group as all manifesting a single pattern). > > Most studies I read use a basic formula or protocol which is then > > modified for specific presenting patterns. Further, almost always > the > > basic protocol is based on the assumption that most patients > manifest > > combinations of patterns. Differences between protocols then > consist > > of the authors' varying opinions on which combinations of patterns > > they believe they see most often or think most root-like or which > > specific meds they like for a particular treatment principle in a > > particular disease.> > > > I haven't read the whole thread on this topic; so I'm not sure > these > > responses are at all germane. I'm very busy these days with Blue > > Poppy. Therefore, my participation on this list is going to have to > be > > scaled back. But, in closing, one of the very interesting types of > CM > > journal article is the "Progress on..." or "A Summary of Advances > > in..." These articles consist of a literature search of all > published > > articles on a particular disease. These articles, a particular > genre > > of article within CM journals, compare outcomes from different > > protocols. Commonly, they include subsections on single protocol > > formulas and their outcomes and protocols based on pattern > > discrimination and their outcomes. Interestingly, these outcomes > are > > not typically compared between protocol types. However, the reader > can > > easily compare these outcomes if they wish. These articles also > > usually include sections on acupuncture-moxibustion.> > > > Bob> > > > , wrote:> > > Bob Flaws (and, of course, anyone else who might have a thought on> > > this),> > > > > > You might know this since you read a lot of research reports on > > chinese> > > outcome studies. Would you say it is a consistent theme in the> > > literature to see evidence that pattern diagnosis yields better > > results> > > than giving the same formula to the entire group, regardless of > > their> > > TCM pattern? How much research is done this way? I ask because > > Alon> > > abstracted the Bensouusan irritable bowel study on another list. > It> > > makes the point of saying the the study showed no added benefit > from > > TCM> > > pattern differentiation. Apparently, in the whole article, it is > > stated> > > that in some cases of those on individualized formulas, > improvements> > > lasted up to 14 weeks after stopping the herbs, though. This was > > not> > > true for any on the standard one size fits all rx. There was > just > > no> > > greater symptom relief during the experimental period with > pattern > > based> > > tx.> > > > > > I think the long lasting relief in the pattern based group is of > > great> > > significance, perhaps suggesting that root and branch were both > > treated> > > effectively. I do wonder how accurate the pattern based formulas > > were.> > > If one accepts that complex diagnoses like IBS often involve > several> > > mutually engendering pathomechanisms (and I know not everyone > agrees> > > with this), it may be folly to do research that breaks disease > down > > by> > > textbook patterns and then fits patients into whatever group is > the> > > closest match. For instance, don't the vast majority of IBS > > patients> > > have some combination of spleen vacuity, liver qi depression,> > > damp-heat. I also frequently see yang xu with this. What good > > would it> > > do to put people in one or the other group? Now if each test > group > > had> > > some version of a formula that actually treated a complex> > > multi-patterned diagnosis, perhaps the test group would have fared> > > better. Perhaps one reason the standard formula did so well is > > because> > > it did address a more complex diagnosis.> > > > > > -- > > > Chinese Herbs> > > http://www..org> > > FAX: Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

January 21, 2002

Bob,

Many thanks for the thoughtful reply.

My first thought is, can you write an

article for CAOM that develops and presents

these ideas more fully?

I think your critique of the current gold

standard is quite accurate, but I'd add

that although it may be on its way out

it still survives. The mechanisms that

keep it in place have an interia that is

not all that easily overcome. Here again

we should bear in mind what Max Planck

pointed out about the shifting of scientific

ideologies.

I am not arguing in its favor here or

suggesting that it be adopted by researchers

or the designers of studies. I'm simply

interested in the potential for conflicting

points of view.

I'm going to read through your post a

couple more times before responding further.

But thanks, again. I hope you have the

time and inclination to prepare a piece

for the journal.

Ken

, " pemachophel2001 "

<pemachophel2001> wrote:

> Ken,

>

> First, I think the Chinese research is valid, " outcomes-based "

> research. (That's as long as you don't think it is all a lie or has

> been fudged. But we've been over that ground before.) The so-called

> gold standard of Western medical research of the prospective,

> randomly assigned, double-blind, placebo-controlled study is

currently

> under attack from anumber of different angles, especially from the

> social scientists. So I think we need to be careful not to embrace

a

> research model that may be on its way out, not on its way up. I've

> argued before that the Chinese style research may just well be the

> wave of the future in medical research as we become more and more

> aware of the limitations and distortions of Western-centric, " gold

> standard " research.

>

> Secondly, we need to remember that the healing encounter is

> multifactorial. But I don't need to tell you that. We're both on

the

> same page with that. If one does " gold standard " research, I think

one

> needs to keep in mind what this research does and doesn't tell you.

>

> However, that being said, I don't see any conceptual difficulty

with

> doing " gold standard " research on the clinical use of Chinese

> medicinals. The Bensoussan model is, I think, an ok model:

> prospective, randomly assigned, a basic protocol with individual

> modifications based on pattern discrimination, outcomes criteria,

and

> statistically analyzed and reported outcomes. As long as all

patients

> went through the same prescriptive process, one could also do

> double-blind. Also, there needs to be standard written criteria for

> pattern discrimination (such as in most modern Chinese research)

and a

> written list of individual modifications (also such as in most

modern

> Chinese research). In other words, the list of possible

modifications

> cannot be open-ended. While this does limit the practitioner

somewhat,

> we all have to accpet some limitations in everything we do. As for

> placebo-controlled, that can also be done, especially if one uses

> encapsulated extracts meds. If the actual physical form of the

placebo

> differs from the treatment group meds, then one has to assure that

> there is no mixing, no communication between the two groups. That

> would be a problem.

>

> Even better, is a three-winged study, 1) " real " treatment, 2)

placebo,

> and 3) comparison. The comparison could be done by enrolling more

> patients in the study or it can be drawn from other, already

published

> studies (given that there is no significant statistical difference

> between the cohorts in the two studies). There is a lot of research

> already published on Western meds and vartious conditions. You

don't

> need to invent the wheel each time one does a study. It is

legitimate

> to compare the outcomes of one study with another as long as the

> statisticians say this is ok.

>

> Personally, I'm not convinced that we need to be doing " gold

standard "

> research. I think that type of research is a dinosaur and is behind

> the historical curve. I'd rather forge common cause with the

critics

> of the " gold standard " and promote the vailidity and clinical

utility

> of the outcomes-based research which already exists.

>

> Bob

>

> , " dragon90405 " <yulong@m...> wrote:

> > Bob,

> >

> > I realize that you're preoccupied with

> > other matters, but when you have a moment

> > I'd appreciate hearing your thoughts on

> > what seems to me to be a fundamental

> > conundrum related to the design as

> > well as the reporting of clinical

> > trials. In short, how to reconcile the apparent

> > conflict between the traditional Chinese model,

> > based on criteria that suggest treatment

> > be made suitable for individuals and

> > their particular circumstances in

> > time and space, and the conventional

> > scientific model of the randomized

> > double-blind placebo controlled trial,

> > that requires statistically reproducible

> > results.

> >

> > I'm waiting to get a complete copy of

> > the Bensoussan article that included some

> > mention of this topic. But I need to

> > understand this and I'm hoping that you

> > can help.

> >

> > Ken

> >

> > , " pemachophel2001 "

> > <pemachophel2001> wrote:

> > >

> > > I believe that there is at least one or two comparison studies

> > quoted

> > > in Chinese Medical Psychiatry between Chinese meds prescribed

on

> > > the basis of disease diagnosis and those prescribed on the

basis

> of

> > > pattern discrimination. If not in there, I am sure there are

> > several

> > > in my, Lynn Kuchinski, and Dr. Casanas's upcoming The Treatment

of

> > > Diabetes with . In the articles I remember,

> > treatment

> > > based on individual pattern discrimination was more successful

> than

> > on

> > > disease diagnosis alone.

> > >

> > > While studies comparing one Chinese medical treatment to

another

> > > Chinese medical treatment (for instance bian bing to bian zhen)

> are

> > > not all that common in the Chinese journal literature, what I

can

> > say

> > > I see happening is that less and less studies are based on

giving

> > one

> > > formula or one treatment to everyone (unless the authors have

> > > described their cohort group as all manifesting a single

pattern).

> > > Most studies I read use a basic formula or protocol which is

then

> > > modified for specific presenting patterns. Further, almost

always

> > the

> > > basic protocol is based on the assumption that most patients

> > manifest

> > > combinations of patterns. Differences between protocols then

> > consist

> > > of the authors' varying opinions on which combinations of

patterns

> > > they believe they see most often or think most root-like or

which

> > > specific meds they like for a particular treatment principle in

a

> > > particular disease.

> > >

> > > I haven't read the whole thread on this topic; so I'm not sure

> > these

> > > responses are at all germane. I'm very busy these days with

Blue

> > > Poppy. Therefore, my participation on this list is going to

have

> to

> > be

> > > scaled back. But, in closing, one of the very interesting types

of

> > CM

> > > journal article is the " Progress on... " or " A Summary of

Advances

> > > in... " These articles consist of a literature search of all

> > published

> > > articles on a particular disease. These articles, a particular

> > genre

> > > of article within CM journals, compare outcomes from different

> > > protocols. Commonly, they include subsections on single

protocol

> > > formulas and their outcomes and protocols based on pattern

> > > discrimination and their outcomes. Interestingly, these

outcomes

> > are

> > > not typically compared between protocol types. However, the

reader

> > can

> > > easily compare these outcomes if they wish. These articles also

> > > usually include sections on acupuncture-moxibustion.

> > >

> > > Bob

> > >

> > > , wrote:

> > > > Bob Flaws (and, of course, anyone else who might have a

thought

> on

> > > > this),

> > > >

> > > > You might know this since you read a lot of research reports

on

> > > chinese

> > > > outcome studies. Would you say it is a consistent theme in

the

> > > > literature to see evidence that pattern diagnosis yields

better

> > > results

> > > > than giving the same formula to the entire group, regardless

of

> > > their

> > > > TCM pattern? How much research is done this way? I ask

because

> > > Alon

> > > > abstracted the Bensouusan irritable bowel study on another

list.

>

> > It

> > > > makes the point of saying the the study showed no added

benefit

> > from

> > > TCM

> > > > pattern differentiation. Apparently, in the whole article,

it

> is

> > > stated

> > > > that in some cases of those on individualized formulas,

> > improvements

> > > > lasted up to 14 weeks after stopping the herbs, though. This

> was

> > > not

> > > > true for any on the standard one size fits all rx. There was

> > just

> > > no

> > > > greater symptom relief during the experimental period with

> > pattern

> > > based

> > > > tx.

> > > >

> > > > I think the long lasting relief in the pattern based group is

of

> > > great

> > > > significance, perhaps suggesting that root and branch were

both

> > > treated

> > > > effectively. I do wonder how accurate the pattern based

> formulas

> > > were.

> > > > If one accepts that complex diagnoses like IBS often involve

> > several

> > > > mutually engendering pathomechanisms (and I know not everyone

> > agrees

> > > > with this), it may be folly to do research that breaks

disease

> > down

> > > by

> > > > textbook patterns and then fits patients into whatever group

is

> > the

> > > > closest match. For instance, don't the vast majority of IBS

> > > patients

> > > > have some combination of spleen vacuity, liver qi depression,

> > > > damp-heat. I also frequently see yang xu with this. What

good

> > > would it

> > > > do to put people in one or the other group? Now if each test

> > group

> > > had

> > > > some version of a formula that actually treated a complex

> > > > multi-patterned diagnosis, perhaps the test group would have

> fared

> > > > better. Perhaps one reason the standard formula did so well

is

> > > because

> > > > it did address a more complex diagnosis.

> > > >

> > > > --

> > > > Chinese Herbs

> > > >

> > > > FAX:

January 21, 2002

Bob,

(see below)

>

> pemachophel2001 [pemachophel2001]

> Monday, January 21, 2002 12:52 PM

>

> Re: research and pattern dx

>

> Ken,

>

> First, I think the Chinese research is valid, " outcomes-based "

> research. (That's as long as you don't think it is all a lie or has

> been fudged. But we've been over that ground before.) The so-called

> gold standard of Western medical research of the prospective,

> randomly assigned, double-blind, placebo-controlled study is currently

> under attack from anumber of different angles, especially from the

> social scientists. So I think we need to be careful not to embrace a

> research model that may be on its way out, not on its way up. I've

> argued before that the Chinese style research may just well be the

> wave of the future in medical research as we become more and more

> aware of the limitations and distortions of Western-centric, " gold

> standard " research.

>

> Secondly, we need to remember that the healing encounter is

> multifactorial. But I don't need to tell you that. We're both on the

> same page with that. If one does " gold standard " research, I think one

> needs to keep in mind what this research does and doesn't tell you.

>

> However, that being said, I don't see any conceptual difficulty with

> doing " gold standard " research on the clinical use of Chinese

> medicinals. The Bensoussan model is, I think, an ok model:

> prospective, randomly assigned, a basic protocol with individual

> modifications based on pattern discrimination, outcomes criteria, and

> statistically analyzed and reported outcomes. As long as all patients

> went through the same prescriptive process, one could also do

> double-blind. Also, there needs to be standard written criteria for

> pattern discrimination (such as in most modern Chinese research) and a

> written list of individual modifications (also such as in most modern

> Chinese research). In other words, the list of possible modifications

> cannot be open-ended. While this does limit the practitioner somewhat,

> we all have to accpet some limitations in everything we do. As for

> placebo-controlled, that can also be done, especially if one uses

> encapsulated extracts meds. If the actual physical form of the placebo

> differs from the treatment group meds, then one has to assure that

> there is no mixing, no communication between the two groups. That

> would be a problem.

>

> Even better, is a three-winged study, 1) " real " treatment, 2) placebo,

> and 3) comparison. The comparison could be done by enrolling more

> patients in the study or it can be drawn from other, already published

> studies (given that there is no significant statistical difference

> between the cohorts in the two studies). There is a lot of research

> already published on Western meds and vartious conditions. You don't

> need to invent the wheel each time one does a study. It is legitimate

> to compare the outcomes of one study with another as long as the

> statisticians say this is ok.

>

> Personally, I'm not convinced that we need to be doing " gold standard "

> research. I think that type of research is a dinosaur and is behind

> the historical curve. I'd rather forge common cause with the critics

> of the " gold standard " and promote the vailidity and clinical utility

> of the outcomes-based research which already exists.

>

> Bob

Bob,

Maybe I Missed some earlier post, but is there some literature

giving a detailed outline to this anti-gold-standard approach, and do

you have a Chinese research design that demonstrates this.

-Jason

January 21, 2002

I think your critique of the current goldstandard is quite accurate, but I'd addthat although it may be on its way outit still survives. The mechanisms thatkeep it in place have an interia that isnot all that easily overcome. Here againwe should bear in mind what Max Planckpointed out about the shifting of scientificideologies.>>>>The era of evidence based medicine is stronger now than ever

Alon

-

dragon90405

Monday, January 21, 2002 4:24 PM

Re: research and pattern dx

Bob,Many thanks for the thoughtful reply.My first thought is, can you write anarticle for CAOM that develops and presentsthese ideas more fully? I think your critique of the current goldstandard is quite accurate, but I'd addthat although it may be on its way outit still survives. The mechanisms thatkeep it in place have an interia that isnot all that easily overcome. Here againwe should bear in mind what Max Planckpointed out about the shifting of scientificideologies.I am not arguing in its favor here orsuggesting that it be adopted by researchersor the designers of studies. I'm simplyinterested in the potential for conflictingpoints of view.I'm going to read through your post acouple more times before responding further.But thanks, again. I hope you have thetime and inclination to prepare a piecefor the journal.Ken, "pemachophel2001" <pemachophel2001> wrote:> Ken,> > First, I think the Chinese research is valid, "outcomes-based" > research. (That's as long as you don't think it is all a lie or has > been fudged. But we've been over that ground before.) The so-called > gold standard of Western medical research of the prospective, > randomly assigned, double-blind, placebo-controlled study is currently > under attack from anumber of different angles, especially from the > social scientists. So I think we need to be careful not to embrace a > research model that may be on its way out, not on its way up. I've > argued before that the Chinese style research may just well be the > wave of the future in medical research as we become more and more > aware of the limitations and distortions of Western-centric, "gold > standard" research.> > Secondly, we need to remember that the healing encounter is > multifactorial. But I don't need to tell you that. We're both on the > same page with that. If one does "gold standard" research, I think one > needs to keep in mind what this research does and doesn't tell you.> > However, that being said, I don't see any conceptual difficulty with > doing "gold standard" research on the clinical use of Chinese > medicinals. The Bensoussan model is, I think, an ok model: > prospective, randomly assigned, a basic protocol with individual > modifications based on pattern discrimination, outcomes criteria, and > statistically analyzed and reported outcomes. As long as all patients > went through the same prescriptive process, one could also do > double-blind. Also, there needs to be standard written criteria for > pattern discrimination (such as in most modern Chinese research) and a > written list of individual modifications (also such as in most modern > Chinese research). In other words, the list of possible modifications > cannot be open-ended. While this does limit the practitioner somewhat, > we all have to accpet some limitations in everything we do. As for > placebo-controlled, that can also be done, especially if one uses > encapsulated extracts meds. If the actual physical form of the placebo > differs from the treatment group meds, then one has to assure that > there is no mixing, no communication between the two groups. That > would be a problem. > > Even better, is a three-winged study, 1) "real" treatment, 2) placebo, > and 3) comparison. The comparison could be done by enrolling more > patients in the study or it can be drawn from other, already published > studies (given that there is no significant statistical difference > between the cohorts in the two studies). There is a lot of research > already published on Western meds and vartious conditions. You don't > need to invent the wheel each time one does a study. It is legitimate > to compare the outcomes of one study with another as long as the > statisticians say this is ok. > > Personally, I'm not convinced that we need to be doing "gold standard" > research. I think that type of research is a dinosaur and is behind > the historical curve. I'd rather forge common cause with the critics > of the "gold standard" and promote the vailidity and clinical utility > of the outcomes-based research which already exists.> > Bob> > , "dragon90405" <yulong@m...> wrote:> > Bob,> > > > I realize that you're preoccupied with> > other matters, but when you have a moment> > I'd appreciate hearing your thoughts on> > what seems to me to be a fundamental> > conundrum related to the design as> > well as the reporting of clinical> > trials. In short, how to reconcile the apparent> > conflict between the traditional Chinese model,> > based on criteria that suggest treatment> > be made suitable for individuals and> > their particular circumstances in> > time and space, and the conventional> > scientific model of the randomized> > double-blind placebo controlled trial,> > that requires statistically reproducible> > results.> > > > I'm waiting to get a complete copy of> > the Bensoussan article that included some> > mention of this topic. But I need to> > understand this and I'm hoping that you> > can help.> > > > Ken> > > > , "pemachophel2001" > > <pemachophel2001> wrote:> > > > > > > > > I believe that there is at least one or two comparison studies > > quoted > > > in Chinese Medical Psychiatry between Chinese meds prescribed on > > > the basis of disease diagnosis and those prescribed on the basis > of > > > pattern discrimination. If not in there, I am sure there are > > several > > > in my, Lynn Kuchinski, and Dr. Casanas's upcoming The Treatment of > > > Diabetes with . In the articles I remember, > > treatment > > > based on individual pattern discrimination was more successful > than > > on > > > disease diagnosis alone.> > > > > > While studies comparing one Chinese medical treatment to another > > > Chinese medical treatment (for instance bian bing to bian zhen) > are > > > not all that common in the Chinese journal literature, what I can > > say > > > I see happening is that less and less studies are based on giving > > one > > > formula or one treatment to everyone (unless the authors have > > > described their cohort group as all manifesting a single pattern). > > > Most studies I read use a basic formula or protocol which is then > > > modified for specific presenting patterns. Further, almost always > > the > > > basic protocol is based on the assumption that most patients > > manifest > > > combinations of patterns. Differences between protocols then > > consist > > > of the authors' varying opinions on which combinations of patterns > > > they believe they see most often or think most root-like or which > > > specific meds they like for a particular treatment principle in a > > > particular disease.> > > > > > I haven't read the whole thread on this topic; so I'm not sure > > these > > > responses are at all germane. I'm very busy these days with Blue > > > Poppy. Therefore, my participation on this list is going to have > to > > be > > > scaled back. But, in closing, one of the very interesting types of > > CM > > > journal article is the "Progress on..." or "A Summary of Advances > > > in..." These articles consist of a literature search of all > > published > > > articles on a particular disease. These articles, a particular > > genre > > > of article within CM journals, compare outcomes from different > > > protocols. Commonly, they include subsections on single protocol > > > formulas and their outcomes and protocols based on pattern > > > discrimination and their outcomes. Interestingly, these outcomes > > are > > > not typically compared between protocol types. However, the reader > > can > > > easily compare these outcomes if they wish. These articles also > > > usually include sections on acupuncture-moxibustion.> > > > > > Bob> > > > > > , wrote:> > > > Bob Flaws (and, of course, anyone else who might have a thought > on> > > > this),> > > > > > > > You might know this since you read a lot of research reports on > > > chinese> > > > outcome studies. Would you say it is a consistent theme in the> > > > literature to see evidence that pattern diagnosis yields better > > > results> > > > than giving the same formula to the entire group, regardless of > > > their> > > > TCM pattern? How much research is done this way? I ask because > > > Alon> > > > abstracted the Bensouusan irritable bowel study on another list. > > > It> > > > makes the point of saying the the study showed no added benefit > > from > > > TCM> > > > pattern differentiation. Apparently, in the whole article, it > is > > > stated> > > > that in some cases of those on individualized formulas, > > improvements> > > > lasted up to 14 weeks after stopping the herbs, though. This > was > > > not> > > > true for any on the standard one size fits all rx. There was > > just > > > no> > > > greater symptom relief during the experimental period with > > pattern > > > based> > > > tx.> > > > > > > > I think the long lasting relief in the pattern based group is of > > > great> > > > significance, perhaps suggesting that root and branch were both > > > treated> > > > effectively. I do wonder how accurate the pattern based > formulas > > > were.> > > > If one accepts that complex diagnoses like IBS often involve > > several> > > > mutually engendering pathomechanisms (and I know not everyone > > agrees> > > > with this), it may be folly to do research that breaks disease > > down > > > by> > > > textbook patterns and then fits patients into whatever group is > > the> > > > closest match. For instance, don't the vast majority of IBS > > > patients> > > > have some combination of spleen vacuity, liver qi depression,> > > > damp-heat. I also frequently see yang xu with this. What good > > > would it> > > > do to put people in one or the other group? Now if each test > > group > > > had> > > > some version of a formula that actually treated a complex> > > > multi-patterned diagnosis, perhaps the test group would have > fared> > > > better. Perhaps one reason the standard formula did so well is > > > because> > > > it did address a more complex diagnosis.> > > > > > > > -- > > > > Chinese Herbs> > > > http://www..org> > > > FAX: Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

January 21, 2002

Maybe I Missed some earlier post, but is there some literaturegiving a detailed outline to this anti-gold-standard approach, and doyou have a Chinese research design that demonstrates this

>>>>Remember the so stated gold standard applies only to single drugs. Even in biomedicine there are plenty of good and excepted research that does not follow this to the T

Alon

-

Monday, January 21, 2002 7:07 PM

RE: Re: research and pattern dx

Bob,(see below)> > pemachophel2001 [pemachophel2001]> Monday, January 21, 2002 12:52 PM> > Re: research and pattern dx> > Ken,> > First, I think the Chinese research is valid, "outcomes-based"> research. (That's as long as you don't think it is all a lie or has> been fudged. But we've been over that ground before.) The so-called> gold standard of Western medical research of the prospective,> randomly assigned, double-blind, placebo-controlled study is currently> under attack from anumber of different angles, especially from the> social scientists. So I think we need to be careful not to embrace a> research model that may be on its way out, not on its way up. I've> argued before that the Chinese style research may just well be the> wave of the future in medical research as we become more and more> aware of the limitations and distortions of Western-centric, "gold> standard" research.> > Secondly, we need to remember that the healing encounter is> multifactorial. But I don't need to tell you that. We're both on the> same page with that. If one does "gold standard" research, I think one> needs to keep in mind what this research does and doesn't tell you.> > However, that being said, I don't see any conceptual difficulty with> doing "gold standard" research on the clinical use of Chinese> medicinals. The Bensoussan model is, I think, an ok model:> prospective, randomly assigned, a basic protocol with individual> modifications based on pattern discrimination, outcomes criteria, and> statistically analyzed and reported outcomes. As long as all patients> went through the same prescriptive process, one could also do> double-blind. Also, there needs to be standard written criteria for> pattern discrimination (such as in most modern Chinese research) and a> written list of individual modifications (also such as in most modern> Chinese research). In other words, the list of possible modifications> cannot be open-ended. While this does limit the practitioner somewhat,> we all have to accpet some limitations in everything we do. As for> placebo-controlled, that can also be done, especially if one uses> encapsulated extracts meds. If the actual physical form of the placebo> differs from the treatment group meds, then one has to assure that> there is no mixing, no communication between the two groups. That> would be a problem.> > Even better, is a three-winged study, 1) "real" treatment, 2) placebo,> and 3) comparison. The comparison could be done by enrolling more> patients in the study or it can be drawn from other, already published> studies (given that there is no significant statistical difference> between the cohorts in the two studies). There is a lot of research> already published on Western meds and vartious conditions. You don't> need to invent the wheel each time one does a study. It is legitimate> to compare the outcomes of one study with another as long as the> statisticians say this is ok.> > Personally, I'm not convinced that we need to be doing "gold standard"> research. I think that type of research is a dinosaur and is behind> the historical curve. I'd rather forge common cause with the critics> of the "gold standard" and promote the vailidity and clinical utility> of the outcomes-based research which already exists.> > Bob Bob, Maybe I Missed some earlier post, but is there some literaturegiving a detailed outline to this anti-gold-standard approach, and doyou have a Chinese research design that demonstrates this.-JasonChinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

January 22, 2002

Ken,

I've been thinking about this further while walking my dogs this AM.

You were in marketing in a previous incarnation, weren't you? I

seem to remember your once telling me this. So, forgive me if I'm

preaching to the choir, but I've been taking a crash course lately in

1980s-early 90s " positioning " marketing theory. (One of the reasons

I don't have more than 15 minutes per day for this list.) So here are

some thoughts based on the works of Ries & Trout et al.

According to some marketers, all markets tend to wind up as mainly a

two " product " race in terms of market share, with the product with the

second place share earning half as much as the first place product

(and similarly down the rungs of the market share ladder). According

to Ries & Trout, in such a situation, to imitate the position of the

#1 only reinforces #1's dominance in that market. This point is also

made by Spolestra in Marketing Outrageously (pub. 2001). Therefore, #2

needs to find the creneau, crevass, or chink in #1's marketing

message. This chink will be an opposite message, based on the idea

that every positive idea, when taken to it logical conclusion, has

within it its own weakness. E.g., bigger may be better, but

bigger may also be slower, more cumbersome, less responsive,

etc. Viz. Hertz v. Avis.

Further, the #1 product, service, politician, etc. in a market is

typically the first one chronologically to capture that position in

the minds of the customers of that market, and, once that #1 position

is attained, it is very difficult to dislodge that position since

" people do not change their minds. " As an extension of this, Ries &

Trout advise not taking aim at #1, but taking aim at the #2 position.

The point that I'm getting at is that it seems to me that interest in

research by members of our profession is driven mainly by marketing

concerns, not purely scientific concerns. We tend to see it as a way

of capturing market share. However, if the above marketing/positioning

premises are true (and lots of CEOs, politicians, etc. still think

they are), then I would argue that A) acupuncture/CM should aim at

becoming the #2 health care delivery system in the U.S. (this is

doable; our target would then be DCs, a much softer, more vulnerable

target), and B) it should do that not by playing #1's game but by

exploiting a different marketing message which resonates with a

consumer niche we actually have an opportunity to capture and which

exploits #1's weakness(es).

One way of doing that is to actually criticize/publicize the faults of

" golden standard " research: ethnocentric, cultural imperialism,

typically " male " arrogant, divorced from everyday reality, divorced

from every clincial needs, a " military-industrical complex " designed

to stifle competition, unfair restriction of trade, an " old boys

club, " culturally insensitive in a multi-cultural world, out of step

with 2/3 of the planet, behind the curve, the old paradigm,, a

dinosaur, etc., etc.

Other ways of doing this (besides criticizing the meta-issues behind

" GS " research) would be to exploit/position our age, our tradition,

our Eastern cachet, our holism, our caring, our freedom from adverse

reactions, our cost effectiveness, our ren

(humanity/compassion/benevolence), our patient-centered approach

(another buzzword in evolving medicine). Wow! There's a lot of

positive positioning messages we could be hammering home on without

being sucked into #1's game.

I'm not saying that we ignore the 800 pound gorilla in the room, but

that we don't try to take on that gorilla on its own terms. You're a

tai ji player. I know you are pickled in this idea of using an

opponents strengths to defeat that opponent by taking those strengths

to their logical negative conclusion. I agree that WM is the dominant

product in the U.S. health care market, and I'm not saying that we

ignore that product. What I'm suggesting is that we make a strength

out of our #2 position the same way Avis did against Hertz: " We're #2,

so we try harder. " Other examples of successful use of this approach:

7-Up, the unCola; Pepsi, the drink of a new generation; Tylenol, the

nonaspirin pain-reliever, etc., etc.

Instead of spending millions on research, maybe we should be spending

the same amount of a good PR/ad agency.

Bob

, " dragon90405 " <yulong@m...> wrote:

> Bob,

>

> Many thanks for the thoughtful reply.

> My first thought is, can you write an

> article for CAOM that develops and presents

> these ideas more fully?

>

> I think your critique of the current gold

> standard is quite accurate, but I'd add

> that although it may be on its way out

> it still survives. The mechanisms that

> keep it in place have an interia that is

> not all that easily overcome. Here again

> we should bear in mind what Max Planck

> pointed out about the shifting of scientific

> ideologies.

>

> I am not arguing in its favor here or

> suggesting that it be adopted by researchers

> or the designers of studies. I'm simply

> interested in the potential for conflicting

> points of view.

>

> I'm going to read through your post a

> couple more times before responding further.

>

> But thanks, again. I hope you have the

> time and inclination to prepare a piece

> for the journal.

>

> Ken

> , " pemachophel2001 "

> <pemachophel2001> wrote:

> > Ken,

> >

> > First, I think the Chinese research is valid, " outcomes-based "

> > research. (That's as long as you don't think it is all a lie or

has

> > been fudged. But we've been over that ground before.) The

so-called

> > gold standard of Western medical research of the prospective,

> > randomly assigned, double-blind, placebo-controlled study is

> currently

> > under attack from anumber of different angles, especially from the

> > social scientists. So I think we need to be careful not to embrace

> a

> > research model that may be on its way out, not on its way up. I've

> > argued before that the Chinese style research may just well be the

> > wave of the future in medical research as we become more and more

> > aware of the limitations and distortions of Western-centric, " gold

> > standard " research.

> >

> > Secondly, we need to remember that the healing encounter is

> > multifactorial. But I don't need to tell you that. We're both on

> the

> > same page with that. If one does " gold standard " research, I think

> one

> > needs to keep in mind what this research does and doesn't tell

you.

> >

> > However, that being said, I don't see any conceptual difficulty

> with

> > doing " gold standard " research on the clinical use of Chinese

> > medicinals. The Bensoussan model is, I think, an ok model:

> > prospective, randomly assigned, a basic protocol with individual

> > modifications based on pattern discrimination, outcomes criteria,

> and

> > statistically analyzed and reported outcomes. As long as all

> patients

> > went through the same prescriptive process, one could also do

> > double-blind. Also, there needs to be standard written criteria

for

> > pattern discrimination (such as in most modern Chinese research)

> and a

> > written list of individual modifications (also such as in most

> modern

> > Chinese research). In other words, the list of possible

> modifications

> > cannot be open-ended. While this does limit the practitioner

> somewhat,

> > we all have to accpet some limitations in everything we do. As for

> > placebo-controlled, that can also be done, especially if one uses

> > encapsulated extracts meds. If the actual physical form of the

> placebo

> > differs from the treatment group meds, then one has to assure that

> > there is no mixing, no communication between the two groups. That

> > would be a problem.

> >

> > Even better, is a three-winged study, 1) " real " treatment, 2)

> placebo,

> > and 3) comparison. The comparison could be done by enrolling more

> > patients in the study or it can be drawn from other, already

> published

> > studies (given that there is no significant statistical difference

> > between the cohorts in the two studies). There is a lot of

research

> > already published on Western meds and vartious conditions. You

> don't

> > need to invent the wheel each time one does a study. It is

> legitimate

> > to compare the outcomes of one study with another as long as the

> > statisticians say this is ok.

> >

> > Personally, I'm not convinced that we need to be doing " gold

> standard "

> > research. I think that type of research is a dinosaur and is

behind

> > the historical curve. I'd rather forge common cause with the

> critics

> > of the " gold standard " and promote the vailidity and clinical

> utility

> > of the outcomes-based research which already exists.

> >

> > Bob

> >

> > , " dragon90405 " <yulong@m...> wrote:

> > > Bob,

> > >

> > > I realize that you're preoccupied with

> > > other matters, but when you have a moment

> > > I'd appreciate hearing your thoughts on

> > > what seems to me to be a fundamental

> > > conundrum related to the design as

> > > well as the reporting of clinical

> > > trials. In short, how to reconcile the apparent

> > > conflict between the traditional Chinese model,

> > > based on criteria that suggest treatment

> > > be made suitable for individuals and

> > > their particular circumstances in

> > > time and space, and the conventional

> > > scientific model of the randomized

> > > double-blind placebo controlled trial,

> > > that requires statistically reproducible

> > > results.

> > >

> > > I'm waiting to get a complete copy of

> > > the Bensoussan article that included some

> > > mention of this topic. But I need to

> > > understand this and I'm hoping that you

> > > can help.

> > >

> > > Ken

> > >

> > > , " pemachophel2001 "

> > > <pemachophel2001> wrote:

> > > >

> > > > I believe that there is at least one or two comparison studies

> > > quoted

> > > > in Chinese Medical Psychiatry between Chinese meds prescribed

> on

> > > > the basis of disease diagnosis and those prescribed on the

> basis

> > of

> > > > pattern discrimination. If not in there, I am sure there are

> > > several

> > > > in my, Lynn Kuchinski, and Dr. Casanas's upcoming The

Treatment

> of

> > > > Diabetes with . In the articles I remember,

> > > treatment

> > > > based on individual pattern discrimination was more successful

> > than

> > > on

> > > > disease diagnosis alone.

> > > >

> > > > While studies comparing one Chinese medical treatment to

> another

> > > > Chinese medical treatment (for instance bian bing to bian

zhen)

> > are

> > > > not all that common in the Chinese journal literature, what I

> can

> > > say

> > > > I see happening is that less and less studies are based on

> giving

> > > one

> > > > formula or one treatment to everyone (unless the authors have

> > > > described their cohort group as all manifesting a single

> pattern).

> > > > Most studies I read use a basic formula or protocol which is

> then

> > > > modified for specific presenting patterns. Further, almost

> always

> > > the

> > > > basic protocol is based on the assumption that most patients

> > > manifest

> > > > combinations of patterns. Differences between protocols then

> > > consist

> > > > of the authors' varying opinions on which combinations of

> patterns

> > > > they believe they see most often or think most root-like or

> which

> > > > specific meds they like for a particular treatment principle

in

> a

> > > > particular disease.

> > > >

> > > > I haven't read the whole thread on this topic; so I'm not sure

> > > these

> > > > responses are at all germane. I'm very busy these days with

> Blue

> > > > Poppy. Therefore, my participation on this list is going to

> have

> > to

> > > be

> > > > scaled back. But, in closing, one of the very interesting

types

> of

> > > CM

> > > > journal article is the " Progress on... " or " A Summary of

> Advances

> > > > in... " These articles consist of a literature search of all

> > > published

> > > > articles on a particular disease. These articles, a particular

> > > genre

> > > > of article within CM journals, compare outcomes from different

> > > > protocols. Commonly, they include subsections on single

> protocol

> > > > formulas and their outcomes and protocols based on pattern

> > > > discrimination and their outcomes. Interestingly, these

> outcomes

> > > are

> > > > not typically compared between protocol types. However, the

> reader

> > > can

> > > > easily compare these outcomes if they wish. These articles

also

> > > > usually include sections on acupuncture-moxibustion.

> > > >

> > > > Bob

> > > >

> > > > , wrote:

> > > > > Bob Flaws (and, of course, anyone else who might have a

> thought

> > on

> > > > > this),

> > > > >

> > > > > You might know this since you read a lot of research reports

> on

> > > > chinese

> > > > > outcome studies. Would you say it is a consistent theme in

> the

> > > > > literature to see evidence that pattern diagnosis yields

> better

> > > > results

> > > > > than giving the same formula to the entire group, regardless

> of

> > > > their

> > > > > TCM pattern? How much research is done this way? I ask

> because

> > > > Alon

> > > > > abstracted the Bensouusan irritable bowel study on another

> list.

> >

> > > It

> > > > > makes the point of saying the the study showed no added

> benefit

> > > from

> > > > TCM

> > > > > pattern differentiation. Apparently, in the whole article,

> it

> > is

> > > > stated

> > > > > that in some cases of those on individualized formulas,

> > > improvements

> > > > > lasted up to 14 weeks after stopping the herbs, though.

This

> > was

> > > > not

> > > > > true for any on the standard one size fits all rx. There

was

> > > just

> > > > no

> > > > > greater symptom relief during the experimental period with

> > > pattern

> > > > based

> > > > > tx.

> > > > >

> > > > > I think the long lasting relief in the pattern based group

is

> of

> > > > great

> > > > > significance, perhaps suggesting that root and branch were

> both

> > > > treated

> > > > > effectively. I do wonder how accurate the pattern based

> > formulas

> > > > were.

> > > > > If one accepts that complex diagnoses like IBS often involve

> > > several

> > > > > mutually engendering pathomechanisms (and I know not

everyone

> > > agrees

> > > > > with this), it may be folly to do research that breaks

> disease

> > > down

> > > > by

> > > > > textbook patterns and then fits patients into whatever group

> is

> > > the

> > > > > closest match. For instance, don't the vast majority of IBS

> > > > patients

> > > > > have some combination of spleen vacuity, liver qi

depression,

> > > > > damp-heat. I also frequently see yang xu with this. What

> good

> > > > would it

> > > > > do to put people in one or the other group? Now if each

test

> > > group

> > > > had

> > > > > some version of a formula that actually treated a complex

> > > > > multi-patterned diagnosis, perhaps the test group would have

> > fared

> > > > > better. Perhaps one reason the standard formula did so well

> is

> > > > because

> > > > > it did address a more complex diagnosis.

> > > > >

> > > > > --

> > > > > Chinese Herbs

> > > > >

> > > > > FAX:

January 22, 2002

Bob,

> I've been thinking about this further while walking my dogs this

AM.

> You were in marketing in a previous incarnation, weren't you?

I've worked in the field of communications

for my whole life. It's not really a previous

incarnation, as I'm still very much concerned

with issues that relate to the effective

communication of ideas, messages, etc.

It's just that now I tend to concentrate on

the transmission of ancient Chinese ideas

to contemporary Western minds.

I

> seem to remember your once telling me this. So, forgive me if I'm

> preaching to the choir, but I've been taking a crash course lately

in

> 1980s-early 90s " positioning " marketing theory. (One of the reasons

> I don't have more than 15 minutes per day for this list.) So here

are

> some thoughts based on the works of Ries & Trout et al.

I know their work well and even worked on

a number of projects on which they consulted

in the 80s. I found Positioning: The Battle

for Your Mind to be an enlightening and

instructive book.

>

> According to some marketers, all markets tend to wind up as mainly

a

> two " product " race in terms of market share, with the product with

the

> second place share earning half as much as the first place product

> (and similarly down the rungs of the market share ladder).

According

> to Ries & Trout, in such a situation, to imitate the position of

the

> #1 only reinforces #1's dominance in that market. This point is

also

> made by Spolestra in Marketing Outrageously (pub. 2001).

This is one of the most obvious pitfalls and challenges of

smaller competitors, i.e. how to take advantage

of both their competition's size and strength

and their own relative lack thereof.

Therefore, #2

> needs to find the creneau, crevass, or chink in #1's marketing

> message. This chink will be an opposite message, based on the idea

> that every positive idea, when taken to it logical conclusion, has

> within it its own weakness. E.g., bigger may be better, but

> bigger may also be slower, more cumbersome, less responsive,

> etc. Viz. Hertz v. Avis.

Avis is one of the clearest examples of the

successful attempts of a smaller competitor

to co-opt the advantages of the larger

competition. Anyone who was alive in

America in the 60's when the Avis campaign

was run remembers, " We're #2. We try harder. "

>

> Further, the #1 product, service, politician, etc. in a market is

> typically the first one chronologically to capture that position in

> the minds of the customers of that market, and, once that #1

position

> is attained, it is very difficult to dislodge that position since

> " people do not change their minds. " As an extension of this, Ries &

> Trout advise not taking aim at #1, but taking aim at the #2

position.

I think these basics remain sound, but like

everything else in the current economic

conditions, is subject to profound and

rapid change. Enron, for example, went

in the course of less than one calendar

year, from being the 7th largest company

in the country to being its largest

bankruptcy ever. And it's collapse

now threatens one of the cornerstones

of the accounting profession and a number

of other individual and organizations.

Point being that one of the things called

for today in implementing communications

strategies based on these principles is

a correspondingly high degree of flexibility

in both thought and action. Rather like

the dexterity of a well trained doctor

of Chinese medicine in the skill and capacity

to respond actively to the changing

conditions of the situation.

>

> The point that I'm getting at is that it seems to me that interest

in

> research by members of our profession is driven mainly by marketing

> concerns, not purely scientific concerns. We tend to see it as a

way

> of capturing market share.

A manifestation of the way in which the

profession has developed until the present.

What we now call Western medicine was once

a bunch of market savy entrepreuneurs as

well who managed to drive the competition

into the hinterland, where it continued to

develop and up until today, flourish.

However, if the above marketing/positioning

> premises are true (and lots of CEOs, politicians, etc. still think

> they are), then I would argue that A) acupuncture/CM should aim at

> becoming the #2 health care delivery system in the U.S. (this is

> doable; our target would then be DCs, a much softer, more

vulnerable

> target), and B) it should do that not by playing #1's game but by

> exploiting a different marketing message which resonates with a

> consumer niche we actually have an opportunity to capture and which

> exploits #1's weakness(es).

I don't fault your reasoning here,

but I think that we also have to bear

another factor in mind. With the denigration

of the language and literature of the subject

that has taken place in English-language based

education, we have developed a cohort of

individuals who have had to fashion their

self image out of bits and pieces of materials

from Chinese sources mixed liberally with

their own cultural icons ( " the doctor " )

as well as dreams and themes of social

disobedience. In my neck of the woods,

Chinese medicine in the early 70s was

definitely identified with a vaguely

formulated social agenda that positioned

itself outside of everything that could

be identified as " the establishment " .

The Chinese medicine movement, at least

in California, comes from the " counterculture "

or " alternative lifestyle " movement which

was the denouement of the 60's.

I mention this because in effective communication

you just can't ignore the truth.

So I'd say that the truth needs to be

considered. Who are we? What are we really

doing? What are our motivations? What

do we aim to accomplish, both for our

patients, our students, etc. and for

our civilization?

Quality, therefore standards of quality

do not come from any other sources than

individual human minds. The public, so

often ridiculed for its lack of intelligence

and discernment, can actually sniff out

intentions rather well and has become

rather savvy in the deduction of

intentions from results.

>

> One way of doing that is to actually criticize/publicize the faults

of

> " golden standard " research: ethnocentric, cultural imperialism,

> typically " male " arrogant, divorced from everyday reality, divorced

> from every clincial needs, a " military-industrical complex "

designed

> to stifle competition, unfair restriction of trade, an " old boys

> club, " culturally insensitive in a multi-cultural world, out of

step

> with 2/3 of the planet, behind the curve, the old paradigm,, a

> dinosaur, etc., etc.

Well, the methodology is, in fact questionable.

>

> Other ways of doing this (besides criticizing the meta-issues

behind

> " GS " research) would be to exploit/position our age, our tradition,

> our Eastern cachet, our holism, our caring, our freedom from

adverse

> reactions, our cost effectiveness, our ren

> (humanity/compassion/benevolence), our patient-centered approach

> (another buzzword in evolving medicine). Wow! There's a lot of

> positive positioning messages we could be hammering home on without

> being sucked into #1's game.

But we have to tell the truth. And

before we can tell the truth, we have

to know what the truth is. It's one

of the big problems with having an

incompletely defined and understood

nomenclature. You can never really

be sure what everyone is talking

about. Those who have flourished

in this environment may experience

the influx of knowledge as a threatening

flood. But I believe that if we want

to talk about an effective communications

campaign directed at the general public

then we have to build it upon a

strong foundation of knowing the

accepted ideas (i.e. the facts) about

the subject which includes both its

classical descriptions and its modern

scientific " explanations " .

>

> I'm not saying that we ignore the 800 pound gorilla in the room,

but

> that we don't try to take on that gorilla on its own terms.

When it comes to medicine, the gorilla is science.

Fortunately, this gorilla in the end will listen

to sense, again, bearing in mind what Planck pointed

out, i.e. that it takes the death of one generation

of scientists before a new generation of scientific

ideas can come to be accepted.

As the thread about Unschuld's remarks at PCOM

last year illustrate, you just can't escape

the political dimensions of human action. Nor

can you rely upon saying a thing once if you

care about being understood.

You're a

> tai ji player. I know you are pickled in this idea of using an

> opponents strengths to defeat that opponent by taking those

strengths

> to their logical negative conclusion.

Pickled, as charged. I'll just add that

I'm also a student of Chinese medicine

and understand that an end is always

followed by a new beginning and that

what seems negative one moment can

suddenly turn positive...and vice

versa.

I agree that WM is the dominant

> product in the U.S. health care market, and I'm not saying that we

> ignore that product. What I'm suggesting is that we make a strength

> out of our #2 position the same way Avis did against Hertz: " We're

#2,

> so we try harder. " Other examples of successful use of this

approach:

> 7-Up, the unCola; Pepsi, the drink of a new generation; Tylenol,

the

> nonaspirin pain-reliever, etc., etc.

>

> Instead of spending millions on research, maybe we should be

spending

> the same amount of a good PR/ad agency.

I think it's a sound idea. As I said at

the top, I'd just add that it's not an

" either-or " contest. And to do such a thing

we've got to nudge progress along two

main vectors: one is the development of

ever-more-authentic reflection of Chinese

medicine; two is the emergence of a language

that can be understood by both contemporary

scientists and those schooled in the

epistemology of Chinese medicine.

The latter, of course, goes beyond words

to the substance of efficacy. Does it work?

How does it work? Why does it work?

These questions may not, in fact, be

possible to answer in any complete way.

But they are questions that need to be

addressed in communication to the public

about medicine. I'm not saying that the

individual members of the general public

need to understand technical or scientific

explanations of the medicines they take.

But these explanations need to be available

in the system so that the chain of confidence

that results in someone putting something

inside their body can be established.

Such chains represent access to the

marketplace in which the mass of patients

and consumers of medical products transacts

their business.

Ken

January 22, 2002

The point that I'm getting at is that it seems to me that interest in research by members of our profession is driven mainly by marketing concerns, not purely scientific concerns

One way of doing that is to actually criticize/publicize the faults of "golden standard" research: ethnocentric, cultural imperialism, typically "male" arrogant, divorced from everyday reality, divorced from every clincial needs, a "military-industrical complex" designed to stifle competition, unfair restriction of trade, an "old boys club," culturally insensitive in a multi-cultural world, out of step with 2/3 of the planet, behind the curve, the old paradigm,, a dinosaur, etc., etc.

Instead of spending millions on research, maybe we should be spending the same amount of a good PR/ad agency

>>>>>And who cares about truth.

Alon

-

pemachophel2001

Tuesday, January 22, 2002 10:14 AM

Re: research and pattern dx

Ken,I've been thinking about this further while walking my dogs this AM. You were in marketing in a previous incarnation, weren't you? I seem to remember your once telling me this. So, forgive me if I'm preaching to the choir, but I've been taking a crash course lately in 1980s-early 90s "positioning" marketing theory. (One of the reasons I don't have more than 15 minutes per day for this list.) So here are some thoughts based on the works of Ries & Trout et al.According to some marketers, all markets tend to wind up as mainly a two "product" race in terms of market share, with the product with the second place share earning half as much as the first place product (and similarly down the rungs of the market share ladder). According to Ries & Trout, in such a situation, to imitate the position of the #1 only reinforces #1's dominance in that market. This point is also made by Spolestra in Marketing Outrageously (pub. 2001). Therefore, #2 needs to find the creneau, crevass, or chink in #1's marketing message. This chink will be an opposite message, based on the idea that every positive idea, when taken to it logical conclusion, has within it its own weakness. E.g., bigger may be better, but bigger may also be slower, more cumbersome, less responsive, etc. Viz. Hertz v. Avis. Further, the #1 product, service, politician, etc. in a market is typically the first one chronologically to capture that position in the minds of the customers of that market, and, once that #1 position is attained, it is very difficult to dislodge that position since "people do not change their minds." As an extension of this, Ries & Trout advise not taking aim at #1, but taking aim at the #2 position.The point that I'm getting at is that it seems to me that interest in research by members of our profession is driven mainly by marketing concerns, not purely scientific concerns. We tend to see it as a way of capturing market share. However, if the above marketing/positioning premises are true (and lots of CEOs, politicians, etc. still think they are), then I would argue that A) acupuncture/CM should aim at becoming the #2 health care delivery system in the U.S. (this is doable; our target would then be DCs, a much softer, more vulnerable target), and B) it should do that not by playing #1's game but by exploiting a different marketing message which resonates with a consumer niche we actually have an opportunity to capture and which exploits #1's weakness(es). One way of doing that is to actually criticize/publicize the faults of "golden standard" research: ethnocentric, cultural imperialism, typically "male" arrogant, divorced from everyday reality, divorced from every clincial needs, a "military-industrical complex" designed to stifle competition, unfair restriction of trade, an "old boys club," culturally insensitive in a multi-cultural world, out of step with 2/3 of the planet, behind the curve, the old paradigm,, a dinosaur, etc., etc. Other ways of doing this (besides criticizing the meta-issues behind "GS" research) would be to exploit/position our age, our tradition, our Eastern cachet, our holism, our caring, our freedom from adverse reactions, our cost effectiveness, our ren (humanity/compassion/benevolence), our patient-centered approach (another buzzword in evolving medicine). Wow! There's a lot of positive positioning messages we could be hammering home on without being sucked into #1's game.I'm not saying that we ignore the 800 pound gorilla in the room, but that we don't try to take on that gorilla on its own terms. You're a tai ji player. I know you are pickled in this idea of using an opponents strengths to defeat that opponent by taking those strengths to their logical negative conclusion. I agree that WM is the dominant product in the U.S. health care market, and I'm not saying that we ignore that product. What I'm suggesting is that we make a strength out of our #2 position the same way Avis did against Hertz: "We're #2, so we try harder." Other examples of successful use of this approach: 7-Up, the unCola; Pepsi, the drink of a new generation; Tylenol, the nonaspirin pain-reliever, etc., etc.Instead of spending millions on research, maybe we should be spending the same amount of a good PR/ad agency.Bob, "dragon90405" <yulong@m...> wrote:> Bob,> > Many thanks for the thoughtful reply.> My first thought is, can you write an> article for CAOM that develops and presents> these ideas more fully? > > I think your critique of the current gold> standard is quite accurate, but I'd add> that although it may be on its way out> it still survives. The mechanisms that> keep it in place have an interia that is> not all that easily overcome. Here again> we should bear in mind what Max Planck> pointed out about the shifting of scientific> ideologies.> > I am not arguing in its favor here or> suggesting that it be adopted by researchers> or the designers of studies. I'm simply> interested in the potential for conflicting> points of view.> > I'm going to read through your post a> couple more times before responding further.> > But thanks, again. I hope you have the> time and inclination to prepare a piece> for the journal.> > Ken> , "pemachophel2001" > <pemachophel2001> wrote:> > Ken,> > > > First, I think the Chinese research is valid, "outcomes-based" > > research. (That's as long as you don't think it is all a lie or has > > been fudged. But we've been over that ground before.) The so-called > > gold standard of Western medical research of the prospective, > > randomly assigned, double-blind, placebo-controlled study is > currently > > under attack from anumber of different angles, especially from the > > social scientists. So I think we need to be careful not to embrace > a > > research model that may be on its way out, not on its way up. I've > > argued before that the Chinese style research may just well be the > > wave of the future in medical research as we become more and more > > aware of the limitations and distortions of Western-centric, "gold > > standard" research.> > > > Secondly, we need to remember that the healing encounter is > > multifactorial. But I don't need to tell you that. We're both on > the > > same page with that. If one does "gold standard" research, I think > one > > needs to keep in mind what this research does and doesn't tell you.> > > > However, that being said, I don't see any conceptual difficulty > with > > doing "gold standard" research on the clinical use of Chinese > > medicinals. The Bensoussan model is, I think, an ok model: > > prospective, randomly assigned, a basic protocol with individual > > modifications based on pattern discrimination, outcomes criteria, > and > > statistically analyzed and reported outcomes. As long as all > patients > > went through the same prescriptive process, one could also do > > double-blind. Also, there needs to be standard written criteria for > > pattern discrimination (such as in most modern Chinese research) > and a > > written list of individual modifications (also such as in most > modern > > Chinese research). In other words, the list of possible > modifications > > cannot be open-ended. While this does limit the practitioner > somewhat, > > we all have to accpet some limitations in everything we do. As for > > placebo-controlled, that can also be done, especially if one uses > > encapsulated extracts meds. If the actual physical form of the > placebo > > differs from the treatment group meds, then one has to assure that > > there is no mixing, no communication between the two groups. That > > would be a problem. > > > > Even better, is a three-winged study, 1) "real" treatment, 2) > placebo, > > and 3) comparison. The comparison could be done by enrolling more > > patients in the study or it can be drawn from other, already > published > > studies (given that there is no significant statistical difference > > between the cohorts in the two studies). There is a lot of research > > already published on Western meds and vartious conditions. You > don't > > need to invent the wheel each time one does a study. It is > legitimate > > to compare the outcomes of one study with another as long as the > > statisticians say this is ok. > > > > Personally, I'm not convinced that we need to be doing "gold > standard" > > research. I think that type of research is a dinosaur and is behind > > the historical curve. I'd rather forge common cause with the > critics > > of the "gold standard" and promote the vailidity and clinical > utility > > of the outcomes-based research which already exists.> > > > Bob> > > > , "dragon90405" <yulong@m...> wrote:> > > Bob,> > > > > > I realize that you're preoccupied with> > > other matters, but when you have a moment> > > I'd appreciate hearing your thoughts on> > > what seems to me to be a fundamental> > > conundrum related to the design as> > > well as the reporting of clinical> > > trials. In short, how to reconcile the apparent> > > conflict between the traditional Chinese model,> > > based on criteria that suggest treatment> > > be made suitable for individuals and> > > their particular circumstances in> > > time and space, and the conventional> > > scientific model of the randomized> > > double-blind placebo controlled trial,> > > that requires statistically reproducible> > > results.> > > > > > I'm waiting to get a complete copy of> > > the Bensoussan article that included some> > > mention of this topic. But I need to> > > understand this and I'm hoping that you> > > can help.> > > > > > Ken> > > > > > , "pemachophel2001" > > > <pemachophel2001> wrote:> > > > > > > > > > > > I believe that there is at least one or two comparison studies > > > quoted > > > > in Chinese Medical Psychiatry between Chinese meds prescribed > on > > > > the basis of disease diagnosis and those prescribed on the > basis > > of > > > > pattern discrimination. If not in there, I am sure there are > > > several > > > > in my, Lynn Kuchinski, and Dr. Casanas's upcoming The Treatment > of > > > > Diabetes with . In the articles I remember, > > > treatment > > > > based on individual pattern discrimination was more successful > > than > > > on > > > > disease diagnosis alone.> > > > > > > > While studies comparing one Chinese medical treatment to > another > > > > Chinese medical treatment (for instance bian bing to bian zhen) > > are > > > > not all that common in the Chinese journal literature, what I > can > > > say > > > > I see happening is that less and less studies are based on > giving > > > one > > > > formula or one treatment to everyone (unless the authors have > > > > described their cohort group as all manifesting a single > pattern). > > > > Most studies I read use a basic formula or protocol which is > then > > > > modified for specific presenting patterns. Further, almost > always > > > the > > > > basic protocol is based on the assumption that most patients > > > manifest > > > > combinations of patterns. Differences between protocols then > > > consist > > > > of the authors' varying opinions on which combinations of > patterns > > > > they believe they see most often or think most root-like or > which > > > > specific meds they like for a particular treatment principle in > a > > > > particular disease.> > > > > > > > I haven't read the whole thread on this topic; so I'm not sure > > > these > > > > responses are at all germane. I'm very busy these days with > Blue > > > > Poppy. Therefore, my participation on this list is going to > have > > to > > > be > > > > scaled back. But, in closing, one of the very interesting types > of > > > CM > > > > journal article is the "Progress on..." or "A Summary of > Advances > > > > in..." These articles consist of a literature search of all > > > published > > > > articles on a particular disease. These articles, a particular > > > genre > > > > of article within CM journals, compare outcomes from different > > > > protocols. Commonly, they include subsections on single > protocol > > > > formulas and their outcomes and protocols based on pattern > > > > discrimination and their outcomes. Interestingly, these > outcomes > > > are > > > > not typically compared between protocol types. However, the > reader > > > can > > > > easily compare these outcomes if they wish. These articles also > > > > usually include sections on acupuncture-moxibustion.> > > > > > > > Bob> > > > > > > > , wrote:> > > > > Bob Flaws (and, of course, anyone else who might have a > thought > > on> > > > > this),> > > > > > > > > > You might know this since you read a lot of research reports > on > > > > chinese> > > > > outcome studies. Would you say it is a consistent theme in > the> > > > > literature to see evidence that pattern diagnosis yields > better > > > > results> > > > > than giving the same formula to the entire group, regardless > of > > > > their> > > > > TCM pattern? How much research is done this way? I ask > because > > > > Alon> > > > > abstracted the Bensouusan irritable bowel study on another > list. > > > > > It> > > > > makes the point of saying the the study showed no added > benefit > > > from > > > > TCM> > > > > pattern differentiation. Apparently, in the whole article, > it > > is > > > > stated> > > > > that in some cases of those on individualized formulas, > > > improvements> > > > > lasted up to 14 weeks after stopping the herbs, though. This > > was > > > > not> > > > > true for any on the standard one size fits all rx. There was > > > just > > > > no> > > > > greater symptom relief during the experimental period with > > > pattern > > > > based> > > > > tx.> > > > > > > > > > I think the long lasting relief in the pattern based group is > of > > > > great> > > > > significance, perhaps suggesting that root and branch were > both > > > > treated> > > > > effectively. I do wonder how accurate the pattern based > > formulas > > > > were.> > > > > If one accepts that complex diagnoses like IBS often involve > > > several> > > > > mutually engendering pathomechanisms (and I know not everyone > > > agrees> > > > > with this), it may be folly to do research that breaks > disease > > > down > > > > by> > > > > textbook patterns and then fits patients into whatever group > is > > > the> > > > > closest match. For instance, don't the vast majority of IBS > > > > patients> > > > > have some combination of spleen vacuity, liver qi depression,> > > > > damp-heat. I also frequently see yang xu with this. What > good > > > > would it> > > > > do to put people in one or the other group? Now if each test > > > group > > > > had> > > > > some version of a formula that actually treated a complex> > > > > multi-patterned diagnosis, perhaps the test group would have > > fared> > > > > better. Perhaps one reason the standard formula did so well > is > > > > because> > > > > it did address a more complex diagnosis.> > > > > > > > > > -- > > > > > Chinese Herbs> > > > > http://www..org> > > > > FAX: Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

January 22, 2002

Ken,

Good points. Thanks.

Several years ago I wrote a piece suggesting that PR " success " could

be the deathnell of this profession in its current form, for which I

got roundly criticized. My point was, if we really got the exposure

and position in the marketplace we often say we want, would we be able

to handle it, to live up to the expectations that would create? My

opinion at the time was that we would not be able to live up to the

hype. While there are some small beginnings of good changes, I can't

say as that opinion is radically different today. Isn't there a saying

that one needs to be careful what they wish for, lest they get it? I

don't think many aspects of our profession as it currently exists

could stand much in the way of outside scrutiny.

So my marketing plan was actually ivory tower theorizing. I agree that

we need to be careful of what we put in motion. I guess I was looking

at what I take to be the meta-issue behind the discussion of " GS "

research. But I'm not at all sure I would actually recommend

initiating such a PR push at this time.

Bob

, " dragon90405 " <yulong@m...> wrote:

> Bob,

>

> > I've been thinking about this further while walking my dogs this

> AM.

> > You were in marketing in a previous incarnation, weren't you?

>

> I've worked in the field of communications

> for my whole life. It's not really a previous

> incarnation, as I'm still very much concerned

> with issues that relate to the effective

> communication of ideas, messages, etc.

> It's just that now I tend to concentrate on

> the transmission of ancient Chinese ideas

> to contemporary Western minds.

>

> I

> > seem to remember your once telling me this. So, forgive me if I'm

> > preaching to the choir, but I've been taking a crash course lately

> in

> > 1980s-early 90s " positioning " marketing theory. (One of the

reasons

> > I don't have more than 15 minutes per day for this list.) So here

> are

> > some thoughts based on the works of Ries & Trout et al.

>

> I know their work well and even worked on

> a number of projects on which they consulted

> in the 80s. I found Positioning: The Battle

> for Your Mind to be an enlightening and

> instructive book.

> >

> > According to some marketers, all markets tend to wind up as mainly

> a

> > two " product " race in terms of market share, with the product with

> the

> > second place share earning half as much as the first place product

> > (and similarly down the rungs of the market share ladder).

> According

> > to Ries & Trout, in such a situation, to imitate the position of

> the

> > #1 only reinforces #1's dominance in that market. This point is

> also

> > made by Spolestra in Marketing Outrageously (pub. 2001).

>

> This is one of the most obvious pitfalls and challenges of

> smaller competitors, i.e. how to take advantage

> of both their competition's size and strength

> and their own relative lack thereof.

>

> Therefore, #2

> > needs to find the creneau, crevass, or chink in #1's marketing

> > message. This chink will be an opposite message, based on the idea

> > that every positive idea, when taken to it logical conclusion, has

> > within it its own weakness. E.g., bigger may be better, but

> > bigger may also be slower, more cumbersome, less responsive,

> > etc. Viz. Hertz v. Avis.

>

> Avis is one of the clearest examples of the

> successful attempts of a smaller competitor

> to co-opt the advantages of the larger

> competition. Anyone who was alive in

> America in the 60's when the Avis campaign

> was run remembers, " We're #2. We try harder. "

>

> >

> > Further, the #1 product, service, politician, etc. in a market is

> > typically the first one chronologically to capture that position

in

> > the minds of the customers of that market, and, once that #1

> position

> > is attained, it is very difficult to dislodge that position since

> > " people do not change their minds. " As an extension of this, Ries

&

> > Trout advise not taking aim at #1, but taking aim at the #2

> position.

>

> I think these basics remain sound, but like

> everything else in the current economic

> conditions, is subject to profound and

> rapid change. Enron, for example, went

> in the course of less than one calendar

> year, from being the 7th largest company

> in the country to being its largest

> bankruptcy ever. And it's collapse

> now threatens one of the cornerstones

> of the accounting profession and a number

> of other individual and organizations.

>

> Point being that one of the things called

> for today in implementing communications

> strategies based on these principles is

> a correspondingly high degree of flexibility

> in both thought and action. Rather like

> the dexterity of a well trained doctor

> of Chinese medicine in the skill and capacity

> to respond actively to the changing

> conditions of the situation.

> >

> > The point that I'm getting at is that it seems to me that interest

> in

> > research by members of our profession is driven mainly by

marketing

> > concerns, not purely scientific concerns. We tend to see it as a

> way

> > of capturing market share.

>

> A manifestation of the way in which the

> profession has developed until the present.

> What we now call Western medicine was once

> a bunch of market savy entrepreuneurs as

> well who managed to drive the competition

> into the hinterland, where it continued to

> develop and up until today, flourish.

>

> However, if the above marketing/positioning

> > premises are true (and lots of CEOs, politicians, etc. still think

> > they are), then I would argue that A) acupuncture/CM should aim at

> > becoming the #2 health care delivery system in the U.S. (this is

> > doable; our target would then be DCs, a much softer, more

> vulnerable

> > target), and B) it should do that not by playing #1's game but by

> > exploiting a different marketing message which resonates with a

> > consumer niche we actually have an opportunity to capture and

which

> > exploits #1's weakness(es).

>

> I don't fault your reasoning here,

> but I think that we also have to bear

> another factor in mind. With the denigration

> of the language and literature of the subject

> that has taken place in English-language based

> education, we have developed a cohort of

> individuals who have had to fashion their

> self image out of bits and pieces of materials

> from Chinese sources mixed liberally with

> their own cultural icons ( " the doctor " )

> as well as dreams and themes of social

> disobedience. In my neck of the woods,

> Chinese medicine in the early 70s was

> definitely identified with a vaguely

> formulated social agenda that positioned

> itself outside of everything that could

> be identified as " the establishment " .

> The Chinese medicine movement, at least

> in California, comes from the " counterculture "

> or " alternative lifestyle " movement which

> was the denouement of the 60's.

>

> I mention this because in effective communication

> you just can't ignore the truth.

>

> So I'd say that the truth needs to be

> considered. Who are we? What are we really

> doing? What are our motivations? What

> do we aim to accomplish, both for our

> patients, our students, etc. and for

> our civilization?

>

> Quality, therefore standards of quality

> do not come from any other sources than

> individual human minds. The public, so

> often ridiculed for its lack of intelligence

> and discernment, can actually sniff out

> intentions rather well and has become

> rather savvy in the deduction of

> intentions from results.

> >

> > One way of doing that is to actually criticize/publicize the

faults

> of

> > " golden standard " research: ethnocentric, cultural imperialism,

> > typically " male " arrogant, divorced from everyday reality,

divorced

> > from every clincial needs, a " military-industrical complex "

> designed

> > to stifle competition, unfair restriction of trade, an " old boys

> > club, " culturally insensitive in a multi-cultural world, out of

> step

> > with 2/3 of the planet, behind the curve, the old paradigm,, a

> > dinosaur, etc., etc.

>

> Well, the methodology is, in fact questionable.

> >

> > Other ways of doing this (besides criticizing the meta-issues

> behind

> > " GS " research) would be to exploit/position our age, our

tradition,

> > our Eastern cachet, our holism, our caring, our freedom from

> adverse

> > reactions, our cost effectiveness, our ren

> > (humanity/compassion/benevolence), our patient-centered approach

> > (another buzzword in evolving medicine). Wow! There's a lot of

> > positive positioning messages we could be hammering home on

without

> > being sucked into #1's game.

>

> But we have to tell the truth. And

> before we can tell the truth, we have

> to know what the truth is. It's one

> of the big problems with having an

> incompletely defined and understood

> nomenclature. You can never really

> be sure what everyone is talking

> about. Those who have flourished

> in this environment may experience

> the influx of knowledge as a threatening

> flood. But I believe that if we want

> to talk about an effective communications

> campaign directed at the general public

> then we have to build it upon a

> strong foundation of knowing the

> accepted ideas (i.e. the facts) about

> the subject which includes both its

> classical descriptions and its modern

> scientific " explanations " .

> >

> > I'm not saying that we ignore the 800 pound gorilla in the room,

> but

> > that we don't try to take on that gorilla on its own terms.

>

> When it comes to medicine, the gorilla is science.

> Fortunately, this gorilla in the end will listen

> to sense, again, bearing in mind what Planck pointed

> out, i.e. that it takes the death of one generation

> of scientists before a new generation of scientific

> ideas can come to be accepted.

>

> As the thread about Unschuld's remarks at PCOM

> last year illustrate, you just can't escape

> the political dimensions of human action. Nor

> can you rely upon saying a thing once if you

> care about being understood.

>

> You're a

> > tai ji player. I know you are pickled in this idea of using an

> > opponents strengths to defeat that opponent by taking those

> strengths

> > to their logical negative conclusion.

>

> Pickled, as charged. I'll just add that

> I'm also a student of Chinese medicine

> and understand that an end is always

> followed by a new beginning and that

> what seems negative one moment can

> suddenly turn positive...and vice

> versa.

>

> I agree that WM is the dominant

> > product in the U.S. health care market, and I'm not saying that we

> > ignore that product. What I'm suggesting is that we make a

strength

> > out of our #2 position the same way Avis did against Hertz: " We're

> #2,

> > so we try harder. " Other examples of successful use of this

> approach:

> > 7-Up, the unCola; Pepsi, the drink of a new generation; Tylenol,

> the

> > nonaspirin pain-reliever, etc., etc.

> >

> > Instead of spending millions on research, maybe we should be

> spending

> > the same amount of a good PR/ad agency.

>

> I think it's a sound idea. As I said at

> the top, I'd just add that it's not an

> " either-or " contest. And to do such a thing

> we've got to nudge progress along two

> main vectors: one is the development of

> ever-more-authentic reflection of Chinese

> medicine; two is the emergence of a language

> that can be understood by both contemporary

> scientists and those schooled in the

> epistemology of Chinese medicine.

>

> The latter, of course, goes beyond words

> to the substance of efficacy. Does it work?

> How does it work? Why does it work?

>

> These questions may not, in fact, be

> possible to answer in any complete way.

> But they are questions that need to be

> addressed in communication to the public

> about medicine. I'm not saying that the

> individual members of the general public

> need to understand technical or scientific

> explanations of the medicines they take.

> But these explanations need to be available

> in the system so that the chain of confidence

> that results in someone putting something

> inside their body can be established.

>

> Such chains represent access to the

> marketplace in which the mass of patients

> and consumers of medical products transacts

> their business.

>

> Ken

January 22, 2002

I'd rather forge common cause with the critics

of the " gold standard " and promote the vailidity and clinical utility

of the outcomes-based research which already exists.

Bob et al,

Outcomes based research can and often has incorporated blinding, placebo

controls, and randomization, which are hallmarks of " gold standard " research

designs. Outcomes based research only distinguishes the way clinical end

points are measured and can be used in " gold standard " research designs as

well as other approaches to research. For example, a research study

designed to evaluate a treatment for environmental allergy could measure

histamine release as a physiological end point or evaluate outcomes using a

symptom score from a questionnaire assessing the subjective responses of

allergic subjects exposured to allergens. It is not uncommon to see an

improvement in outcomes when no improvement is reflected in the

physiological end point, especially in research on a theraperapeutic agent

such as an herbal formula for which the mechanism of action is not clearly

established. Therefore identifying the physiological response that reflects

the benefits offered by the treatment can be quite difficult when evaluating

herbal materials whose bioactive chemical components have not been

established, let alone when trying to predict physiological mechanisms

targeted by the chemical complexity of a formula. For that reason, I would

agree that Outcomes based research is a good way to go, although I prefer to

combine it with a physiological measurement just in case I get lucky. For

some reason, many people would rather take something that has shown to

reduce histamine response than another product that has shown to reduce

allergy without knowing the mechanism of action.

Stephen Morrissey OMD

Botanica BioScience Corp

Chinese Herbal Medicine, a voluntary organization of licensed healthcare

practitioners, matriculated students and postgraduate academics specializing

in Chinese Herbal Medicine, provides a variety of professional services,

including board approved online continuing education.

January 22, 2002

Bob,

>

> Several years ago I wrote a piece suggesting that PR " success "

could

> be the deathnell of this profession in its current form, for which

I

> got roundly criticized.

Well, I hope you'll consider doing a piece

on research and the dissemination of research

results that will help put all of this into

perspective for readers.

And, it goes without saying, expect to

be roundly criticized once again.

My point was, if we really got the exposure

> and position in the marketplace we often say we want, would we be

able

> to handle it, to live up to the expectations that would create?

The best, and I believe in the final analysis

the only PR that really matters is word of mouth,

i.e. what one friend tells another. " You've got

to go see my doctor. She is a miracle worker. "

That's about the best PR there is.

Of course, it's all based on results.

In the early 90s I worked at a multi-disciplinary

clinic and saw dozens of patients every day. This

was in LA. I routinely heard from patients who

had " oh yeah, tried acupuncture, but it didn't

really help. "

PR is an ongoing aspect of life. And the

sum total of all the results obtained

day in and day out constitute the foundations

of the PR of the field.

Conversely, whenever someone tries Chinese

medicine, whether it's herbs or acupuncture

and it " doesn't work " that lays the foundation

for a different kind of PR.

My

> opinion at the time was that we would not be able to live up to the

> hype. While there are some small beginnings of good changes, I

can't

> say as that opinion is radically different today. Isn't there a

saying

> that one needs to be careful what they wish for, lest they get it?

I

> don't think many aspects of our profession as it currently exists

> could stand much in the way of outside scrutiny.

The outside scrutiny is only just beginning.

>

> So my marketing plan was actually ivory tower theorizing. I agree

that

> we need to be careful of what we put in motion. I guess I was

looking

> at what I take to be the meta-issue behind the discussion of " GS "

> research. But I'm not at all sure I would actually recommend

> initiating such a PR push at this time.

From my perspective, we do not have the

luxury of deciding whether or not to

do it. All we can decide is how well

we do it.

Ken

January 22, 2002

The idea of 'major complaint', as espoused by many teachers in TCM

schools, seems rather nebulous to me. One has to be careful not to

leave out essential information. For example, 'headache' as major

complaint. If the patient has had migraines for ten years, they will

not alleviate by choosing a few simple points and giving an exterior

releasing prescription such as chuan xiong cha tiao san. One has to

look for all of the symptoms that the patient has to find a coherent

pattern, and treat that. Sometimes trying to treat a headache directly

will make it worse.

I am not aware of using needles to relieve symptoms and herbs to treat

the root as a standard treatment strategy in Chinese medicine. One

always tries to treat ben and biao, root and branch simultaneously.

On Sunday, January 20, 2002, at 02:20 PM, Wade De Loe wrote:

> Hey guys,

>

> New here, but I think i'm reading up on a very interesting topic. From

> my own understanding of treatment principles, I would say that the most

> effective way to treat a patient is to focus on the chief or major

> complaint / problem first. This is what I've been taught. My chinese

> professors, who all seem to disagree about diagnosis and treatment, at

> least teach that the most effective way to treat a patient is to use

> acupuncture mainly to elliviate symptoms of illness and herbs to get at

> the root problem in a conjunctive effort. The herbal therapies should

> focus on the most serious problem and hopefully correct that. When the

> patient returns his/her symptoms will have changed hopefully for the

> better, then you can concentrate on the secondary complaints of the

> patient. However, organ systems are all related. In the case of a

> liver heat excess, you're going to want to reduce the heat, benefit the

> liver yin and tonify spleen and probably benefit the heart as well.

> Liver problems often affect the heart and shen. Always in a liver

> disorder, the spleen should be benefitted first. That's my

> understanding.

> From what I understand of TCM every doctor uses his own creative

> abilities to aid the patient. Its a very artistic discipline. And in

> art, everyone has their own style and approach. Some people have a

> stronger gift for creativity than do others. As long as it works, the

> approach is good.

>

> Wade

>

> Send FREE video emails in Mail!

> http://promo./videomail/

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

January 22, 2002

For that reason, I wouldagree that Outcomes based research is a good way to go, although I prefer tocombine it with a physiological measurement just in case I get lucky. Forsome reason, many people would rather take something that has shown toreduce histamine response than another product that has shown to reduceallergy without knowing the mechanism of action.>>>You do not have to have a physiological end point although it is always nice. All you have to do is control the groups (and within a group can allow anything you want within parameters of study), randomize patients, and have a blinded evaluator and good statistics. That would be excepted by any good J. Just to look at so called clinical outcomes with out these other factors leads unreliable measurements.

Alon

-

stephen

Tuesday, January 22, 2002 2:51 PM

RE: Re: research and pattern dx

I'd rather forge common cause with the criticsof the "gold standard" and promote the vailidity and clinical utilityof the outcomes-based research which already exists.Bob et al,Outcomes based research can and often has incorporated blinding, placebocontrols, and randomization, which are hallmarks of "gold standard" researchdesigns. Outcomes based research only distinguishes the way clinical endpoints are measured and can be used in "gold standard" research designs aswell as other approaches to research. For example, a research studydesigned to evaluate a treatment for environmental allergy could measurehistamine release as a physiological end point or evaluate outcomes using asymptom score from a questionnaire assessing the subjective responses ofallergic subjects exposured to allergens. It is not uncommon to see animprovement in outcomes when no improvement is reflected in thephysiological end point, especially in research on a theraperapeutic agentsuch as an herbal formula for which the mechanism of action is not clearlyestablished. Therefore identifying the physiological response that reflectsthe benefits offered by the treatment can be quite difficult when evaluatingherbal materials whose bioactive chemical components have not beenestablished, let alone when trying to predict physiological mechanismstargeted by the chemical complexity of a formula. For that reason, I wouldagree that Outcomes based research is a good way to go, although I prefer tocombine it with a physiological measurement just in case I get lucky. Forsome reason, many people would rather take something that has shown toreduce histamine response than another product that has shown to reduceallergy without knowing the mechanism of action.Stephen Morrissey OMDBotanica BioScience CorpChinese Herbal Medicine, a voluntary organization of licensed healthcarepractitioners, matriculated students and postgraduate academics specializingin Chinese Herbal Medicine, provides a variety of professional services,including board approved online continuing education.

January 22, 2002

The best, and I believe in the final analysisthe only PR that really matters is word of mouth,i.e. what one friend tells another. "You've gotto go see my doctor. She is a miracle worker.">>>Except for legislation, hospital privileges, etc

Alon

-

dragon90405

Tuesday, January 22, 2002 2:57 PM

Re: research and pattern dx

Bob, > > Several years ago I wrote a piece suggesting that PR "success" could > be the deathnell of this profession in its current form, for which I > got roundly criticized.Well, I hope you'll consider doing a pieceon research and the dissemination of researchresults that will help put all of this intoperspective for readers.And, it goes without saying, expect tobe roundly criticized once again.My point was, if we really got the exposure > and position in the marketplace we often say we want, would we be able > to handle it, to live up to the expectations that would create?The best, and I believe in the final analysisthe only PR that really matters is word of mouth,i.e. what one friend tells another. "You've gotto go see my doctor. She is a miracle worker."That's about the best PR there is.Of course, it's all based on results.In the early 90s I worked at a multi-disciplinaryclinic and saw dozens of patients every day. Thiswas in LA. I routinely heard from patients whohad "oh yeah, tried acupuncture, but it didn'treally help."PR is an ongoing aspect of life. And thesum total of all the results obtainedday in and day out constitute the foundationsof the PR of the field.Conversely, whenever someone tries Chinesemedicine, whether it's herbs or acupunctureand it "doesn't work" that lays the foundationfor a different kind of PR.My > opinion at the time was that we would not be able to live up to the > hype. While there are some small beginnings of good changes, I can't > say as that opinion is radically different today. Isn't there a saying > that one needs to be careful what they wish for, lest they get it? I > don't think many aspects of our profession as it currently exists > could stand much in the way of outside scrutiny.The outside scrutiny is only just beginning.> > So my marketing plan was actually ivory tower theorizing. I agree that > we need to be careful of what we put in motion. I guess I was looking > at what I take to be the meta-issue behind the discussion of "GS" > research. But I'm not at all sure I would actually recommend > initiating such a PR push at this time.From my perspective, we do not have theluxury of deciding whether or not todo it. All we can decide is how wellwe do it.KenChinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

January 23, 2002

Ken,

Thanks for the invite, but this issue does not really grab me. I'm

very busy with several other projects, and, psychologically, I just

can't commit to anything else right now.

Bob

, " dragon90405 " <yulong@m...> wrote:

> Bob,

> >

> > Several years ago I wrote a piece suggesting that PR " success "

> could

> > be the deathnell of this profession in its current form, for which

> I

> > got roundly criticized.

>

> Well, I hope you'll consider doing a piece

> on research and the dissemination of research

> results that will help put all of this into

> perspective for readers.

>

> And, it goes without saying, expect to

> be roundly criticized once again.

>

> My point was, if we really got the exposure

> > and position in the marketplace we often say we want, would we be

> able

> > to handle it, to live up to the expectations that would create?

>

> The best, and I believe in the final analysis

> the only PR that really matters is word of mouth,

> i.e. what one friend tells another. " You've got

> to go see my doctor. She is a miracle worker. "

>

> That's about the best PR there is.

>

> Of course, it's all based on results.

>

> In the early 90s I worked at a multi-disciplinary

> clinic and saw dozens of patients every day. This

> was in LA. I routinely heard from patients who

> had " oh yeah, tried acupuncture, but it didn't

> really help. "

>

> PR is an ongoing aspect of life. And the

> sum total of all the results obtained

> day in and day out constitute the foundations

> of the PR of the field.

>

> Conversely, whenever someone tries Chinese

> medicine, whether it's herbs or acupuncture

> and it " doesn't work " that lays the foundation

> for a different kind of PR.

>

> My

> > opinion at the time was that we would not be able to live up to

the

> > hype. While there are some small beginnings of good changes, I

> can't

> > say as that opinion is radically different today. Isn't there a

> saying

> > that one needs to be careful what they wish for, lest they get it?

> I

> > don't think many aspects of our profession as it currently exists

> > could stand much in the way of outside scrutiny.

>

> The outside scrutiny is only just beginning.

> >

> > So my marketing plan was actually ivory tower theorizing. I agree

> that

> > we need to be careful of what we put in motion. I guess I was

> looking

> > at what I take to be the meta-issue behind the discussion of " GS "

> > research. But I'm not at all sure I would actually recommend

> > initiating such a PR push at this time.

>

> From my perspective, we do not have the

> luxury of deciding whether or not to

> do it. All we can decide is how well

> we do it.

>

> Ken

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