treatment of cancer patients.

[Guest guest]

Bob,

 

I was responding to Alon's comments. However, the source of the post

is not important. What's important to me is evidence to the contrary

of what Prfessor Cheng said regarding metal touching cancer cells. I

find it interesting that you consider Professor Cheng's comments not

longer deemed professionally adequate. What do you mean by that? I

know that you and other members of this list are very proficient in

the literature of old. Would you please guide me to case studies of

real-life patients by Li Dong Yuan, Fu Qing-zhu or Zhu Dan-xi? What

parts of Professor Cheng's manner of discourse are not adequate?

Thanks,

 

Fernando

 

, " pemachophel2001 "

<pemachophel2001> wrote:

> Fernando,

>

> What I think Todd was getting at was that Prof. Cheng's method of

> writing supplied no evidence for his position, at least not the kind

> of evidence modern professional health care providers typically

> require. He gave no case histories of real-life patients nor did he

> report any evidence based on retrospective clinical audits or

> prospective clinical trials. While Prof. Cheng's style of writing

(at

> least when it comes to making clinical assertions) may have been

> acceptable among Chinese medical practitioners of an earlier

> generation, they are no longer deemed professionally adequate.

Again,

> I don't think Tood or I are talking about Prof. Cheng's theory and

> praxis but rather his manner of discourse.

>

> Bob

>

> , " fbernall " <fbernall@a...> wrote:

> > , " ALON MARCUS " <alonmarcus@w...>

> > wrote:

> > > more words. no evidence.

> >

> > Point well taken. However, do you have any evidence to the

contrary?

> >

> > Fernando

[Guest guest]

, " fbernall " <fbernall@a...> wrote:

> , " ALON MARCUS " <alonmarcus@w...>

> wrote:

> > more words. no evidence.

>

> Point well taken. However, do you have any evidence to the contrary?

>

> Fernando

 

I feel the burden is upon those with claims for cure to prove it. It

is not for me to prove they don't work. I assume any unproven idea

does not work and I believe it is incumbent upon me to not test

unproven ideas upon my patients with life threatening diseases. I

favor conservative surgery most of the time. Massive chemo or

radiation is not as acceptable to me with regard to its impact on life

quality. However,in some cases like hodgkins and certain leukemias,it

is quite effective. The latest research in treating cancer with

vaccines and other nontoxic immune system manipulations (and things

like inducing programmed cell death in the tumor) are very promising

for many cancers and will replce the harsher therapies in our

lifetimes. If a patient has no other recourse to a safe therapy with a

high success rate, then any other approach is worth investigating.

 

[Guest guest]

, " fbernall " <fbernall@a...> wrote:

What

> parts of Professor Cheng's manner of discourse are not adequate?

 

 

Fernando

 

I think it is merely that he posits a theory but does not provide

evidence from either classical texts, modern research, documented case

hisotries to support his contention. On the other hand, a number of

studies from China have shown increased survival rates from integrative

therapy. Dharmananda at itmonline.org has written quite a bit on this

subject. You and Jim should contact him at 503-233-4907 to have him

point you towards the evidence. And Bob is correct, I have no problem

with the theory or the man. I am just a pragmatist and am admittedly

quite narrowmindedly evidence based in my thinking about medicine,

eastern and western. I think there is a place to try these things when

there are no other safe effective recourses, but as a hard and fast

rule to never use the knife or even chemo (as in hodgkins), I am quite

uncomfortable. While this is somewhat a personal judgment call,

hashing this out in public is quite valuable, because courts decide

things like this based upon a consideration of community ethical

standards. We do not have a consensus among ourselves on this issue

yet. I have made my own position clear, but I hold the possibility

(and perhaps even secret hope) that I am someday proven wrong. but

until then, I err on what I consider the side of caution.

 

[Guest guest]

I have made my own position clear, but I hold the possibility

> (and perhaps even secret hope) that I am someday proven wrong. but

> until then, I err on what I consider the side of caution.

>

 

 

And I think the best course of action till that time regarding this

discussion on this list is respect the right of anyone to share their

position, keeping in mind that some may disagree vehemently (but

hopefully with civility). However, one way to avoid too strong a

response is to be clear about what one is suggesting with a post. Are

we just floating an idea for discussion or actually advocating the use

of a methodology? If we are actively advocating a methodology for a

life threatening illness like cancer, then I think it is useful to know

how successful this approach has been in real life and what the

evidence is. If there is no evidence, then we need to know that so as

to make an informed decision about how to make use of said information.

My own experience with students is that explanation and rationalization

of ideas is essential to learning. Otherwise statements may either be

given too much or not enough weight.

 

[Guest guest]

, " 1 " <@i...> wrote:

>However, one way to avoid too strong a response is to be clear about

>what one is suggesting with a post.

 

>Are we just floating an idea for discussion or actually advocating

>the use of a methodology? If we are actively advocating a

>methodology for a life threatening illness like cancer, then I think

>it is useful to know how successful this approach has been in real

>life and what the evidence is. If there is no evidence, then we

>need to know that so as to make an informed decision about how to

>make use of said information.

 

 

 

Good point. In presenting my post on Professor Cheng's thoughts on

cancer treatment, my intentions were not to advocate a methodology but

only to share his thoughts and get feedback. I have my own thoughts on

the subject which, by enlarge, I keep to myself.

 

However, in retrospect, I find that what disturbs my thinking is on

the use of the term " professional " . What is the standard or criteria

whereby one's style of writing is not longer deemed professionally

adequate. Maybe I misunderstand the word. But to me, any thing,

action, or words that brings reproach to a profession, is what I would

consider to not be professional. Perhaps Professor's style of writing,

or the manner in which his words were translated, may not be

" technically correct " by today's standars.

 

You have no idea of the agonizing process that I go through when

writing to this list. Choosing the " right " word, spelling, etc. Why?

Because, I wish to not bring reproach, a)to our profession, b)to this

list, and c)to myself. I have the feeling that I'm not alone.

 

However, I've decided that if I'm to learn from the seniors in this

list, that there must be honesty among thieves. I can't worry about

the little boy screaming to his mom " look! that Colombian has no

clothes " ;-)

 

-Fernando

[Guest guest]

Fernando,

 

First of all, please know that I very much do appreciate the

vulnerability of speaking in public. However, part of being

professional in my experience is debating differences. As Ken has said

many times before on this list, this is how we all learn and grow. It

is only by taking the risk of putting an idea out in public that we

can test that idea and receive feedback from others thinking and

working in the same field. I also understand that the word

" professional " is an extremely loaded one, and it is all too easy to

say that something is unprofessional simply if one doesn't like or

agree with it. Nevertheless, we are trying to grow this profession

here in the West, and we cannot allow ourselves to retreat from a

debate over what is or is not unprofessional due to oversensitivity to

political correctness. It seems to me that professionalism has to be

one of the topics on the table for debate.

 

When I use the term " professional " vis a vis communication among

health care practitioners, I am thinking of the standards of discourse

common among other contemporary health care professions. Having worked

at Denver General Hospital as well as in the offices of both MDs and

DCs, having written a study for the NIH which required my discussion

with a large number of MDs and Ph.D.s of various disciplines, being a

contributing editor for the Townsend Letter for Doctors, regularly

teaching MDs and DOs in the U.S. and Europe, and having collaborated

with numerous MDs on a variety of different projects, it is my

experience that there are certain standards of discourse in modern

medicine. Further, in my experience of reading the contemporary

Chinese medical literature or having worked in various Chinese

hospitals and clinics, these are basically the same standards of

discourse in contemporary professional Chinese medicine in China.

 

In modern professional medicine, East or West, if one makes a

statement, then one is expected to back that statement up by some kind

of proof. That proof could be 1) a citation from some source deemed to

be authoritative (for instance your citation of Prof. Cheng), 2) a

case study, 3) a retrospective clinical audit, 4) a prospective

clinical trial, or 5) the results of laboratory, anthropological,

sociological, or epidemiological research. When one asserts such a

proof, then one has to be ready for others to question the vailidity

of that proof. That is how we test and assess the validity of our

ideas and assertions. In Western medical school, that questioning is

commonly extremely aggressive. It is called " pimping. " I have,

likewise, been pimped by some (agreed, not all) of my Asian teachers.

(In Asia, because of concerns over " face, " pimping is not always

acceptable.)

 

In my opinion, if this medicine is going to survive in the modern

world, then we as practitioners must learn to discourse at the same

level of sophistication, intelligence, and education as members of

other health care professions. In the early 70s, I would have been

very impressed with Prof. Cheng's opinion. Hell, I probably would of

included it in one of my books as if it were gospel. Today, I am not

so impressed since it was unsupported by any kind of real evidence,

Western or Chinese.

 

Two years ago, I had the opportunity to coauthor a book with an

extremely intelligent and well educated man, Dr. James Lake, a

graduate of Stanford Medical School and board ceritified psychiatrist

who came to the practice of Western medicine in his 40s after having

been a psychotherapist, linguist, and, if I remember correctly, some

kind of computer scientist. The book we worked on was Chinese Medical

Psychiatry. Coauthoring this book with Dr. Lake made me come up to a

whole new level of medical and general intellectual professionalism. I

suggest you give that book a look-see. You may or may not care for the

Chinese medicine in the book, but it has been hailed by members of

various health care professions across North America and Europe for

its medically professional style of writing.

 

You might also want to check out the Blue Poppy On-line Chinese

Medical Journal. It contains numerous Chinese clinical studies

translated from Chinese medical journals. It's free and it'd give you

some idea of how contemporary professional Chinese doctors present

their findings to their colleagues.

 

Bob

 

, " fbernall " <fbernall@a...> wrote:

> , " 1 " <@i...> wrote:

> >However, one way to avoid too strong a response is to be clear

about

> >what one is suggesting with a post.

>

> >Are we just floating an idea for discussion or actually advocating

> >the use of a methodology? If we are actively advocating a

> >methodology for a life threatening illness like cancer, then I

think

> >it is useful to know how successful this approach has been in real

> >life and what the evidence is. If there is no evidence, then we

> >need to know that so as to make an informed decision about how to

> >make use of said information.

>

>

>

> Good point. In presenting my post on Professor Cheng's thoughts on

> cancer treatment, my intentions were not to advocate a methodology

but

> only to share his thoughts and get feedback. I have my own thoughts

on

> the subject which, by enlarge, I keep to myself.

>

> However, in retrospect, I find that what disturbs my thinking is on

> the use of the term " professional " . What is the standard or criteria

> whereby one's style of writing is not longer deemed professionally

> adequate. Maybe I misunderstand the word. But to me, any thing,

> action, or words that brings reproach to a profession, is what I

would

> consider to not be professional. Perhaps Professor's style of

writing,

> or the manner in which his words were translated, may not be

> " technically correct " by today's standars.

>

> You have no idea of the agonizing process that I go through when

> writing to this list. Choosing the " right " word, spelling, etc. Why?

> Because, I wish to not bring reproach, a)to our profession, b)to

this

> list, and c)to myself. I have the feeling that I'm not alone.

>

> However, I've decided that if I'm to learn from the seniors in this

> list, that there must be honesty among thieves. I can't worry about

> the little boy screaming to his mom " look! that Colombian has no

> clothes " ;-)

>

> -Fernando

[Guest guest]

Bob,

 

Thanks for taking time to address the topic. I do appreciate it!

 

Fernando

 

, " pemachophel2001 "

<pemachophel2001> wrote:

> Fernando,

>

> First of all, please know that I very much do appreciate the

> vulnerability of speaking in public. However, part of being

> professional in my experience is debating differences. As Ken has

said

> many times before on this list, this is how we all learn and grow.

It

> is only by taking the risk of putting an idea out in public that we

> can test that idea and receive feedback from others thinking and

> working in the same field. I also understand that the word

> " professional " is an extremely loaded one, and it is all too easy to

> say that something is unprofessional simply if one doesn't like or

> agree with it. Nevertheless, we are trying to grow this profession

> here in the West, and we cannot allow ourselves to retreat from a

> debate over what is or is not unprofessional due to oversensitivity

to

> political correctness. It seems to me that professionalism has to be

> one of the topics on the table for debate.

>

> When I use the term " professional " vis a vis communication among

> health care practitioners, I am thinking of the standards of

discourse

> common among other contemporary health care professions. Having

worked

> at Denver General Hospital as well as in the offices of both MDs and

> DCs, having written a study for the NIH which required my discussion

> with a large number of MDs and Ph.D.s of various disciplines, being

a

> contributing editor for the Townsend Letter for Doctors, regularly

> teaching MDs and DOs in the U.S. and Europe, and having collaborated

> with numerous MDs on a variety of different projects, it is my

> experience that there are certain standards of discourse in modern

> medicine. Further, in my experience of reading the contemporary

> Chinese medical literature or having worked in various Chinese

> hospitals and clinics, these are basically the same standards of

> discourse in contemporary professional Chinese medicine in China.

>

> In modern professional medicine, East or West, if one makes a

> statement, then one is expected to back that statement up by some

kind

> of proof. That proof could be 1) a citation from some source deemed

to

> be authoritative (for instance your citation of Prof. Cheng), 2) a

> case study, 3) a retrospective clinical audit, 4) a prospective

> clinical trial, or 5) the results of laboratory, anthropological,

> sociological, or epidemiological research. When one asserts such a

> proof, then one has to be ready for others to question the vailidity

> of that proof. That is how we test and assess the validity of our

> ideas and assertions. In Western medical school, that questioning is

> commonly extremely aggressive. It is called " pimping. " I have,

> likewise, been pimped by some (agreed, not all) of my Asian

teachers.

> (In Asia, because of concerns over " face, " pimping is not always

> acceptable.)

>

> In my opinion, if this medicine is going to survive in the modern

> world, then we as practitioners must learn to discourse at the same

> level of sophistication, intelligence, and education as members of

> other health care professions. In the early 70s, I would have been

> very impressed with Prof. Cheng's opinion. Hell, I probably would of

> included it in one of my books as if it were gospel. Today, I am not

> so impressed since it was unsupported by any kind of real evidence,

> Western or Chinese.

>

> Two years ago, I had the opportunity to coauthor a book with an

> extremely intelligent and well educated man, Dr. James Lake, a

> graduate of Stanford Medical School and board ceritified

psychiatrist

> who came to the practice of Western medicine in his 40s after having

> been a psychotherapist, linguist, and, if I remember correctly, some

> kind of computer scientist. The book we worked on was Chinese

Medical

> Psychiatry. Coauthoring this book with Dr. Lake made me come up to a

> whole new level of medical and general intellectual professionalism.

I

> suggest you give that book a look-see. You may or may not care for

the

> Chinese medicine in the book, but it has been hailed by members of

> various health care professions across North America and Europe for

> its medically professional style of writing.

>

> You might also want to check out the Blue Poppy On-line Chinese

> Medical Journal. It contains numerous Chinese clinical studies

> translated from Chinese medical journals. It's free and it'd give

you

> some idea of how contemporary professional Chinese doctors present

> their findings to their colleagues.

>

> Bob

>

> , " fbernall " <fbernall@a...> wrote:

> > , " 1 " <@i...> wrote:

> > >However, one way to avoid too strong a response is to be clear

> about

> > >what one is suggesting with a post.

> >

> > >Are we just floating an idea for discussion or actually

advocating

> > >the use of a methodology? If we are actively advocating a

> > >methodology for a life threatening illness like cancer, then I

> think

> > >it is useful to know how successful this approach has been in

real

> > >life and what the evidence is. If there is no evidence, then we

> > >need to know that so as to make an informed decision about how

to

> > >make use of said information.

> >

> >

> >

> > Good point. In presenting my post on Professor Cheng's thoughts on

> > cancer treatment, my intentions were not to advocate a methodology

> but

> > only to share his thoughts and get feedback. I have my own

thoughts

> on

> > the subject which, by enlarge, I keep to myself.

> >

> > However, in retrospect, I find that what disturbs my thinking is

on

> > the use of the term " professional " . What is the standard or

criteria

> > whereby one's style of writing is not longer deemed professionally

> > adequate. Maybe I misunderstand the word. But to me, any thing,

> > action, or words that brings reproach to a profession, is what I

> would

> > consider to not be professional. Perhaps Professor's style of

> writing,

> > or the manner in which his words were translated, may not be

> > " technically correct " by today's standars.

> >

> > You have no idea of the agonizing process that I go through when

> > writing to this list. Choosing the " right " word, spelling, etc.

Why?

> > Because, I wish to not bring reproach, a)to our profession, b)to

> this

> > list, and c)to myself. I have the feeling that I'm not alone.

> >

> > However, I've decided that if I'm to learn from the seniors in

this

> > list, that there must be honesty among thieves. I can't worry

about

> > the little boy screaming to his mom " look! that Colombian has no

> > clothes " ;-)

> >

> > -Fernando

[Guest guest]

I am just a pragmatist and am admittedly quite narrowmindedly evidence based in my thinking about medicine, eastern and western.

>>>>

Evidence is just as good as the quality of the materiel. As I am with you on this, again i think the quality of evidence must be on the chopping block and openly discussed

Alon

[Guest guest]

However, in retrospect, I find that what disturbs my thinking is on the use of the term "professional".

>>>Personally i think professional is a code word for power and control. But that is definitely a different issue

Alon

[Guest guest]

I suggest you give that book a look-see. You may or may not care for the Chinese medicine in the book, but it has been hailed by members of various health care professions across North America and Europe for its medically professional style of writing. >>>>Bob why then there is no discussion on the so called quality of the outcomes in the book? Many of which, even though "published"are obviously suspect. I would be very surprised if Dr Lake as not questioned you on this as i know he is not a CM dr (somebody may want to forward this to Bob as he does not read my posts)

Alon

[Guest guest]

Although I do agree Chinese Medical Psychiatry in an excellent model for how clinical manuals should be written.

Alon

[Guest guest]

Bob, Fernando, and All,

 

> First of all, please know that I very much do appreciate the

> vulnerability of speaking in public. However, part of being

> professional in my experience is debating differences. As Ken has

said

> many times before on this list, this is how we all learn and grow.

 

And in situations where ideas and opinions

clash, I always like to refer to the proverb

the Wm. Blake brought back from his trip to

Hell, " Opposition is true friendship. "

 

As in push hands, there is nothing to compare

with the resistance of conflicting ideas. This

resistance and the pressures that build up

shine like beacons on those aspects of our

mutual understanding that require our attention.

 

Personally, I approach the whole affair as

an extension of my push hands practice and

focus on listening, sticking to the point,

and returning to those who will engage my

information and intent related to what they

put out. I pay careful attention to those

things that don't add up or fit in. And I

suggest, Fernando, that the difficulties

involved can be compared to the pain in

the thigh when sinking all the weight onto

one leg at a time. Without such practice

and pain, skill does not emerge.

 

 

 

It

> is only by taking the risk of putting an idea out in public that we

> can test that idea and receive feedback from others thinking and

> working in the same field.

 

Precisely. The concomitant joy that

accompanies the pain is the release

from the grip of wrong ideas or

needlessly difficult habits of thought

or expression. Bucky Fuller used to

point out that metaphysical wealth

only increases, for even when we discover

that all of our previous ideas were

incorrect, we still know more than

we did before. In the recognition of

what we got wrong, we open to the

possibility of getting it closer

to right. Again, I think the transformations

are what matter, and that the right-wrong a

xis exists primarily to serve as an attractor

to the forces that we exchange.

 

The process of learning is a dynamic

one indeed, and it has a direct impact

on clinical practice. For what you learn

in the morning might save a life in

the afternoon.

 

How I long for someone to demonstrate

to my satisfaction the error of my

thinking on the subject of Chinese

language and thought and the importance

of understanding them for those who

study and practice Chinese medicine.

I may still have several decades to live,

and if I could be disabused of this

conviction, I might spend the time

having some fun.

 

 

 

I also understand that the word

> " professional " is an extremely loaded one, and it is all too easy

to

> say that something is unprofessional simply if one doesn't like or

> agree with it. Nevertheless, we are trying to grow this profession

> here in the West, and we cannot allow ourselves to retreat from a

> debate over what is or is not unprofessional due to oversensitivity

to

> political correctness. It seems to me that professionalism has to

be

> one of the topics on the table for debate.

 

Agreed. And I think that the discussion

should include the implications of professionalism

and their impact on the clinical interaction.

 

By mimicing the beahvior patterns of

conventional medical doctors, do practitioners

of Chinese medicine enhance the delivery

of those modalities peculiar to the traditions

they purvey?

 

 

>

> When I use the term " professional " vis a vis communication among

> health care practitioners, I am thinking of the standards of

discourse

> common among other contemporary health care professions. Having

worked

> at Denver General Hospital as well as in the offices of both MDs

and

> DCs, having written a study for the NIH which required my

discussion

> with a large number of MDs and Ph.D.s of various disciplines, being

a

> contributing editor for the Townsend Letter for Doctors, regularly

> teaching MDs and DOs in the U.S. and Europe, and having

collaborated

> with numerous MDs on a variety of different projects, it is my

> experience that there are certain standards of discourse in modern

> medicine. Further, in my experience of reading the contemporary

> Chinese medical literature or having worked in various Chinese

> hospitals and clinics, these are basically the same standards of

> discourse in contemporary professional Chinese medicine in China.

 

Agreed. It matters extensively how we

communicate with each other, with patients,

with colleagues in various professions.

Communication consists not only of having

a message but of taking into account all

those factors that impinge on the transmission

and reception of that message. Of course,

it also includes the capacity to receive

and understand what others in the communication

have to say.

>

> In modern professional medicine, East or West, if one makes a

> statement, then one is expected to back that statement up by some

kind

> of proof. That proof could be 1) a citation from some source deemed

to

> be authoritative (for instance your citation of Prof. Cheng), 2) a

> case study, 3) a retrospective clinical audit, 4) a prospective

> clinical trial, or 5) the results of laboratory, anthropological,

> sociological, or epidemiological research. When one asserts such a

> proof, then one has to be ready for others to question the

vailidity

> of that proof. That is how we test and assess the validity of our

> ideas and assertions. In Western medical school, that questioning

is

> commonly extremely aggressive. It is called " pimping. " I have,

> likewise, been pimped by some (agreed, not all) of my Asian

teachers.

> (In Asia, because of concerns over " face, " pimping is not always

> acceptable.)

 

Curious term. New to me. But

I certainly agree with the notion

that ideas should be subjected to

scrutiny and criticism. The traditions

of intellectual review and criticism

in China have fluctuated along with

the social standards and mores of

successive ages. But one of the

curious aspescts of Chinese medical

literature and lore is precisely the

way in which information has been

vetted by subtle and complex processes

over millennia. All such processes

proceed according to accepted values

and necessarily involve evaluation

of the material in question.

 

I think it is a matter of such values

that underlies the question of the

validity of Prof. Cheng's approach

to the treatment of cancer. I personally

place a high value on his comments

on virtually every subject that

he bothered to address. And, by the

way, I find the same difficulties and

challenges dealing with translations

of his work as with other Chinese sources.

He was a scholar in the classical tradition

and his written work is largely in the

style and language of the classical

literature. It is the work of a poet

who happened also to be a painter,

a doctor, and a master of tai4 ji2.

 

Such refinement is quite difficult to

comprehend for the rest of us, let

alone translate. And my understanding

of the Professor's tai4 ji2 teachings

leads me to believe that his own

application of the principles Fernando

cited would have been goverened by

a flexible mind that could adapt to

circumstances favorably.

>

> In my opinion, if this medicine is going to survive in the modern

> world, then we as practitioners must learn to discourse at the same

> level of sophistication, intelligence, and education as members of

> other health care professions. In the early 70s, I would have been

> very impressed with Prof. Cheng's opinion. Hell, I probably would

of

> included it in one of my books as if it were gospel. Today, I am

not

> so impressed since it was unsupported by any kind of real evidence,

> Western or Chinese.

 

Standards defining " real evidence " are,

like all other human artifacts, dynamic.

Prof. Cheng was a bridge between generations

and cultures. When we examine such peculiar

individuals, we should judge them not only

according to how well they conform to

accepted standards. We should pay attention

to what we can learn about the value systems

they represent, which might be of another

time or place or entirely of their own making.

I never met the old man, but from what I

understand from many who knew him for

years, he was such a character. And it

would be a loss, indeed, to discard his

teachings out of deference to a perceived

lack of " real evidence. "

>

Ken

[Guest guest]

Ken,

 

Thanks for your input and to the Push-hands reference. It's my

favorite aspect of Taiji training. It keeps my form honest.

 

Fernando

 

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

> Bob, Fernando, and All,

 

> As in push hands, there is nothing to compare

> with the resistance of conflicting ideas. This

> resistance and the pressures that build up

> shine like beacons on those aspects of our

> mutual understanding that require our attention.

>

> Personally, I approach the whole affair as

> an extension of my push hands practice and

> focus on listening, sticking to the point,

> and returning to those who will engage my

> information and intent related to what they

> put out. I pay careful attention to those

> things that don't add up or fit in. And I

> suggest, Fernando, that the difficulties

> involved can be compared to the pain in

> the thigh when sinking all the weight onto

> one leg at a time. Without such practice

> and pain, skill does not emerge.

>

>