harmonizing the paradigms

[Guest guest]

May 6,2003

May 7,2003

Dear Zev, Emmanuel, Bob,

 

" integration is the proposal that better health care can be delivered to more people if these practices are in some way mutually availailable... " Bob .

 

In my last postings I have clarified the meaning of 'integration' or jie he in the context of the historical situation in China after l950's. It actually refers to how the Communist Party in China 'fused' the two systems of medicine , supposedly. And now, in the wake of the SARS epidemic, the cracks in this 'integrated edifice' seems to be showing with TCM practitioners in the mainland starting it's critic of the system and arguing for an independent and separate identity instead of a frankensteinian one.

 

The evolution of the policy of integrating CM with WM was not impelled by a desire for a rationale dispensation of health care services to the whole population . The policy is in response to the continuing history of unresolved conflicts (political, cultural, scientific, economic etc.) between the two systems of medicine which ensued when Western scientific medicine came to China during the 19th century.

 

Regards,

 

Rey Tiquia

[Guest guest]

 

The evolution of the policy of integrating CM with WM was not impelled by a desire for a rationale dispensation of health care services to the whole population . The policy is in response to the continuing history of unresolved conflicts (political, cultural, scientific, economic etc.) between the two systems of medicine which ensued when Western scientific medicine came to China during the 19th century. Regards,Rey Tiquia

 

Rey,

I agree that most or nearly all decisions made by government bureaucracies are political and not scientific. The bureaucracies themselves like the USDA and FDA are creations of the political arms of economic interests.

I have little interest in TCM as an example of the integrated practice of CM and WM. I can see it for the political compromise that it is. It not hard to see and realize that real integration is when CM stands for itself with all of its own authority. It will clash and harmonize with WM on its own merits. I am intrigued only to see how it has clashed in China in order to wonder how it will clash here.

From what I have been gathering not only from you and Ken but also from classically trained CM practitioner friends, it seems that CM itself may be in short supply in both China and in the U.S. There are, however, even more rare disciplines here in the West that I can think of. It would not stop me from training in those fields if I chose to. Or accessing them if I chose to.

I have access to enough CM and WM where I live to feel satisfied that I have the best of both worlds. My closest friends are excellent MDs and excellent Chinese practitioners. In this manner I'm lucky. I've integrated CM and WM for myself. Many of you on list share my good fortune. Do I hope that others may also benefit in a similar manner? Yes. Though I'm not so sure that it must be (or even could be) mandated in the form of public institutions.

Hard to keep up with so many excellent posts.

In Gratitude,

Emmanuel Segmen

[Guest guest]

That is why I enjoy Dr. Wang's article so much. It is not afraid to

show what CM has to offer, and challenges WM to look at other tools in

handling the treatment of epidemic qi. no me-too-ism or 'SARS

formulas " .

 

 

On Wednesday, May 7, 2003, at 02:33 AM, Emmanuel Segmen wrote:

 

>     I have little interest in TCM as an example of the integrated

> practice of CM and WM.  I can see it for the political compromise that

> it is.  It not hard to see and realize that real integration is when

> CM stands for itself with all of its own authority.  It will clash and

> harmonize with WM on its own merits.  I am intrigued only to see how

> it has clashed in China in order to wonder how it will clash here.

[Guest guest]

I am interested in more details on the evolution of integrative policy

in China, as it seems to be largely accepted in the West as a possible

course of development of the profession in the future. As I quoted

from Harris Coulter in one of my recent posts, the question is 'who

will be doing the fusing and who will be fused'.

 

 

On Tuesday, May 6, 2003, at 05:16 PM, rey tiquia wrote:

 

> May 6,2003

> May 7,2003

> Dear Zev, Emmanuel, Bob,

>

> " integration is the proposal that better health care can be delivered

> to more people if these practices are in some way mutually

> availailable... "  Bob .

>

>      In my last postings I have clarified the meaning of 'integration'

> or  jie he  in the context of the  historical situation  in China

> after l950's. It actually refers to how the Communist Party in China

> 'fused' the two systems of medicine , supposedly. And now, in the wake

> of the SARS epidemic, the cracks in this 'integrated edifice' seems to

> be showing with TCM practitioners in the mainland starting it's critic

>  of the system  and arguing for  an independent   and separate

> identity instead of a  frankensteinian one.

>

>     The evolution of the policy  of integrating CM with WM was not

> impelled by a desire for a  rationale dispensation of  health care

>  services  to the whole population . The policy is in response to  the

>  continuing  history of unresolved conflicts (political, cultural,

> scientific, economic etc.)  between the two systems of medicine  which

> ensued when Western scientific medicine came to China during the 19th

> century.

>

> Regards,

>

> Rey Tiquia

<image.tiff>

>

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

>

>

>

[Guest guest]

, " " wrote:

> As I quoted from Harris Coulter in one of my recent posts, the

question is 'who will be doing the fusing and who will be fused'.>>>

 

 

Z'ev:

 

Being a cynic, I would think " follow the money. "

 

 

Jim Ramholz

[Guest guest]

Jim,

>

> Being a cynic, I would think " follow the money. "

>

>

> Jim Ramholz

 

Just curious, but why equate cynicism

and money?

 

Ken

[Guest guest]

, " dragon90405 " wrote:

> Just curious, but why equate cynicism and money? >>>

 

 

 

Ken:

 

While they don't have to be equated, it is 'a philosophy of my own,

all made up of private notations and cynicisms,' to paraphrase Henry

James. My fear is that politics and money will shape the integration

of CM and WM here in this country more than ideology.

 

 

Jim Ramholz

[Guest guest]

Jim,

 

> Ken:

>

> While they don't have to be equated, it is 'a philosophy of my

own,

> all made up of private notations and cynicisms,' to paraphrase

Henry

> James. My fear is that politics and money will shape the

integration

> of CM and WM here in this country more than ideology.

>

>

> Jim Ramholz

 

If you're devoted to clinical results, then money

is probably a more accurate measure of

effecicacy than ideology. Every interaction

in the marketplace is a vote of confidence.

 

If we paid closer attention to the flow

of money, I think we'd have a much clearer

understanding of the actual efficacy of

the ideas and practices we talk about here.

 

And I don't think there's anything the least

bit cynical about that. It may be painful,

but cynicism is a response to pain and not

the pain itself.

 

Ken

[Guest guest]

, " dragon90405 " wrote:

> If you're devoted to clinical results, then money

> is probably a more accurate measure of

> effecicacy than ideology. Every interaction

> in the marketplace is a vote of confidence. >>>

 

 

Ken:

 

While I was thinking more of lobbying and political influence, I can

understand and agree with your point. As I wrote earlier, I think

this 'marketplace vote of confidence' is the greatest strength of CM

in the US and the reason why it has become fairly mainstream. When I

started studying CM 30 years ago in the 70s, I never anticipated

this kind of mainstreaming.

 

 

Jim Ramholz

[Guest guest]

Jim,

 

I never anticipated

> this kind of mainstreaming.

>

>

> Jim Ramholz

 

Scary, ain't it?

 

Ken

[Guest guest]

Ken,

 

I very much agree. Money is just another form of qi. (Please, please,

please don't ask me to define that term.) It is simply a way of

quantifying how much something is worth to another person.

 

I was at the National Alliance convention this last weekend where the

Visioning Commission had a " Town Meeting " to hear in-put from the rank

and file. It's interesting that so many people think things happen in

the world because of logic and rationality on the one hand and

righteousness and altruism on the other. In my experience, the bottom

line question is, " What's in it for me? " I believe that monetary value

and the flow of commerce is a main way of answering that question. I

believe commerce shapes history as much (if not more) than any other

factor. If an idea, product, or practice cannot/does not sell, then it

does not matter how seemingly good or beneficial that idea, practice,

or practice is. What matters is whether others perceive that idea,

practice, or product has value to them.

 

From your many years in marketing, you well know that one of the keys

to sucessful marketing is to emphasize benefits, not features. For

those who may not recognize these terms vis a vis

marketing/advertising, saying our medicine is 2,000 years old,

holistic, natural, Daoist, good, great, or wonderful are all features

that may matter to us, but not to the end consumer. Saying that our

medicine is free from side effects, relatively cost effective, is

clinically effective, doesn't hurt, or that our clinic is centrally

located and has convenient parking are benefits. Benefits are what

most people are interested in. Again, WIIFM, what's in it for me?

 

To me, that's not cynicism. It's pragmatism.

 

Bob

 

If you're devoted to clinical results, then money

> is probably a more accurate measure of

> effecicacy than ideology. Every interaction

> in the marketplace is a vote of confidence.

>

> If we paid closer attention to the flow

> of money, I think we'd have a much clearer

> understanding of the actual efficacy of

> the ideas and practices we talk about here.

>

> And I don't think there's anything the least

> bit cynical about that. It may be painful,

> but cynicism is a response to pain and not

> the pain itself.

>

> Ken

[Guest guest]

ob,

 

, " Bob Flaws "

<pemachophel2001> wrote:

> Ken,

>

> I very much agree. Money is just another form of qi. (Please,

please,

> please don't ask me to define that term.) It is simply a way of

> quantifying how much something is worth to another person.

>

It's also a way of symbolizing one's confidence

in the future, i.e., in one's ability to deal

with the future. People put their trust into

their money, which is in fact all that gives it

and maintains its value.

 

Money is a kind of prophecy. It's a statement

that such and such a present effort can be

stored up for use in the future by means

of exchanging and converting today's activity

into this highly abstract symbol of power

that we call money. Such prophecy always

includes the supposition of the maintenance

of the status quo.

 

As such it is very much a form of qi (Gee,

can you define that term? Just kidding.).

The qi of the society.

 

Money is probably one of the last surviving

mystic truths in the United States of America.

And it's hard to find a single soul who doesn't

believe in it more or less absolutely.

 

But that condition is transient, as are

all conditions. You referred to my past life

in marketing, and I did indeed used to do

PR for a bunch of folks who dealt in

ideas about money. And one of the things

I learned in those days was that all money

comes to an end, and generally by more

or less the same route. It's a little too

complicated to go into here, but the end

point of this route to the death of

currency is the point at which the people

who've been using it to store up value

(qi) for the future lose their confidence

in it. And when the symbol loses its

meaning, well, its use becomes futile.

 

On the back of US dollars issued before

1932 there was a sentence that read:

 

This note represents that there has been

placed on deposit in the Treasury of the

United States one dollar in gold coin

payable to the bearer on demand.

 

In the same space on current one dollar

notes we now find a different sentence:

 

In God we trust.

 

Now that's what I call a mystic truth!

 

This SARS thing is fascinating when viewed

from the angle of money, since as much or

more than the cost of human lives the epidemic

is now being calculated in dollar denominated

terms. The SARS virus, whatever that is,

seems to replicate in the currency and

exhaust it. A socio-political-economic

virus that is evidently transmitted through

the media.

 

Dr. Fan in his article touches on and in

his conversations with me emphasized the

importance of taking such societal conditions

into consideration when diagnosing SARS...

or any disease.

 

It dawns on me that the true practice of

traditional Chinese medicine always includes

harmonizing its paradigms with those of

the place and time in which it is to

be studied and practiced.

 

Ken

[Guest guest]

, " Bob Flaws " wrote:

I believe that monetary value and the flow of commerce is a main way

of answering that question. I believe commerce shapes history as

much (if not more) than any other factor. If an idea, product, or

practice cannot/does not sell, then it does not matter how seemingly

good or beneficial that idea, practice, or practice is. What matters

is whether others perceive that idea, practice, or product has value

to them. >>>

 

 

Bob:

 

My initial comment about cynicism and money was aimed at the larger

political agenda. Like you, I have no aversion to making a good

living.

 

But to enlarge on your comment, I don't think real integration of WM

and CM can happen until acupuncturists and herbalists are getting

paid out of the same sources, and roughly equivalently, by insurance

providers, Medicare, etc. If students coming out of school do not

have hospital priviledges and cannot make near what MDs and Chiros

make, then the future of the profession will, in your qi and money

metaphor, suffer from vacuity. They won't be able to pay off their

student loans, and schools will have a difficult time expanding the

program to include things like learning Chinese because of the poor

ROI.

 

 

Jim Ramholz

[Guest guest]

Jim,

 

I don't think real integration of WM

> and CM can happen until acupuncturists and herbalists are getting

> paid out of the same sources, and roughly equivalently, by

insurance

> providers, Medicare, etc.

 

This may indeed be the point at which " real "

integration occurs. But let's at least pause

long enough in the headlong rush to mainstream

integration to bear witness to what is lost...

as well as what is gained...through such...

harmonization...I use the word advisedly.

 

Accepting money from third party payers

entails accepting other aspects of the

qi of these parties. It's a multi-edged

sword...and it spins quickly and cuts

very thoroughly. How do you think the

heart of Western medicine was removed?

 

Through just such an operation conducted

by third party interests...business people

not medical people...or worse...government

employees who view in the economic

activity generated surrounding disease the

enormous potential for profit margins, even

when it means marginalizing the medicine itself.

 

Do you really want to construct an entire

profession of Chinese medicine that is denominated

in the coded language of insurance forms?

 

Ken

[Guest guest]

difficult it is

one word

no meaning

or?

 

analysis

between word

and meaning...

 

yet

money

makes

US forget

the real thing

 

heal

no between

 

Qi

is not money

money may be Qi

 

lets not forget...

 

 

 

Marco Bergh

[Guest guest]

, " dragon90405 " wrote:

> This may indeed be the point at which " real "

> integration occurs. But let's at least pause

> long enough in the headlong rush to mainstream

> integration to bear witness to what is lost...

> as well as what is gained...through such...

> harmonization...I use the word advisedly.

>

> Accepting money from third party payers

> entails accepting other aspects of the

> qi of these parties. It's a multi-edged

> sword...and it spins quickly and cuts

> very thoroughly. How do you think the

> heart of Western medicine was removed?

>

> Through just such an operation conducted

> by third party interests...business people

> not medical people...or worse...government

> employees who view in the economic

> activity generated surrounding disease the

> enormous potential for profit margins, even

> when it means marginalizing the medicine itself.

>

> Do you really want to construct an entire

> profession of Chinese medicine that is denominated

> in the coded language of insurance forms? >>>

 

 

 

Ken:

 

You present a rather negative and fatalistic picture. Who and what,

then, is involved in the integration process---if not money and

hospital priviledges?

 

 

Jim Ramholz

[Guest guest]

I don't see it as a fatalistic picture. I see it as realistic. Many

of my M.D. colleagues constantly complain about their loss of

decision-making in medical treatment at the hands of insurance

companies and HMO's. A few of the more enlightened ones have moved

towards cash practice. I think for true independence, the higher the

cash percentage, the more freedom to practice.

 

There is an interview in the NY Times on Tuesday 5/6 with a

neurobiologist/physician (Dr. Floyd Bloom) who complains about the loss

of autonomy of physicians as being the major crisis in the profession.

His wife, also a physician, complains that " she spends most of the time

alloted for contact with patients trying to get their insurance

providers to allow the treatments she knows are most needed and

completing endless paperwork to keep benefits coming " .

 

There is also a great interview with Stephen Brown in the March 2003

issue of North American Journal of Oriental Medicine, largely devoted

to Japanese acupuncture. The article ( " Why I Don't Work With

Insurance " ) makes one of the most inspiring cases for a cash practice.

As he says, " working with insurance companies forces a practitioner to

compromise the doctor-patient relationship unique to Oriental medicine. "

 

I am aware that the relationship with HMO " s and insurance companies is

a very personal decision. I understand the pressures to make a good

living in one's chosen profession. But I think Ken Rose and Stephen

Brown are right. If we play for the same insurance dollar, we need to

ask if our profession is going to be transformed into something we will

regret in the long run. If indeed this does happen, I hope some of us

'old fossils' will survive somehow, perhaps in Joni Mitchell's 'Tree

Museum' ( " they paved paradise, put in a parking lot " - Big Yellow Taxi).

 

 

On Thursday, May 8, 2003, at 08:51 PM, James Ramholz wrote:

 

> Ken:

>

> You present a rather negative and fatalistic picture. Who and what,

> then, is involved in the integration process---if not money and

> hospital priviledges?

>

>

> Jim Ramholz

[Guest guest]

Z'ev,

 

If indeed this does happen, I hope some of us

> 'old fossils' will survive somehow, perhaps in Joni

Mitchell's 'Tree

> Museum' ( " they paved paradise, put in a parking lot " - Big Yellow

Taxi).

 

Don't it always seem to go

but you don't know what you got

til it's gone.

 

By the way, in my last post, I wasn't really

trying to lobby for one position or the other.

I was raising the question of whether or not

we, as individuals and as a profession, want

to further institutionalize the same mechanisms

which have so thoroughly ravaged the practice

of contemporary medicine.

 

It seems to me that this " alternative " is

one of the things that patients...at least

some patients seek when the choose traditional

Chinese over conventional medicine.

 

And please everyone note at least in passing

that the crux of the issue is...

 

 

....definitions of terms.

 

Ken

[Guest guest]

, " " wrote:

> I am aware that the relationship with HMO's and insurance

companies is a very personal decision. I understand the pressures to

make a good living in one's chosen profession. But I think Ken Rose

and Stephen Brown are right. If we play for the same insurance

dollar, we need to ask if our profession is going to be transformed

into something we will regret in the long run. >>>

 

 

Z'ev:

 

I choose not to take insurance simply for the practical reasons of

the time and fuss---but I would still like the option to be

available. Without option for the choice or, worse, to preclude it

altogether simply makes no sense to me.

 

Who knows? Maybe the inclusion of our profession into the process

will help change things for the better. You can't know until it

happens. To expect " regret in the long run " is fatalistic.

 

So, again, who and what are being integrated?

 

 

Jim Ramholz

[Guest guest]

, " dragon90405 " wrote:

> It seems to me that this " alternative " is

> one of the things that patients...at least

> some patients seek when the choose traditional

> Chinese over conventional medicine. >>>

 

 

Ken:

 

Wouldn't more patients seek it even more often if payment was

covered and it was also available by highly trained professionals in

hospitals?

 

 

Jim Ramholz

[Guest guest]

Ken,

This is the best argument yet against integration that I've heard. It's actually why I pay out of pocket for both WM and CM. I have Blue Cross major medical for $160 every other month. All other personal medical or health needs are met out of pocket. This way I spend my dollars on exactly who and what I want. I would never have learned about various genetic markers unless I personally paid for lab work myself. In this manner I can look for them in my sons. Also I get to spend my health care dollars on my favorite CM practitioners. Nam Singh and I go see one of Andy Gaeddert's teachers who is now in his late 80s. We save (practically enshrine) his wonderfully insightful written prescriptions.

Actually the WM doctors who I like to see (and bring my family to) much prefer my out of pocket payments and are glad to cut the price of office visits and lab work on the rare occasions when I visit them with family members.

Staying out of the encrypted software mainstream sounds like a great idea to me.

Emmanuel Segmen

 

Ken Rose wrote:This may indeed be the point at which "real"integration occurs. But let's at least pauselong enough in the headlong rush to mainstreamintegration to bear witness to what is lost...as well as what is gained...through such...harmonization...I use the word advisedly.Accepting money from third party payersentails accepting other aspects of theqi of these parties. It's a multi-edgedsword...and it spins quickly and cutsvery thoroughly. How do you think theheart of Western medicine was removed?Through just such an operation conductedby third party interests...business peoplenot medical people...or worse...governmentemployees who view in the economicactivity generated surrounding disease theenormous potential for profit margins, evenwhen it means marginalizing the medicine itself.Do you really want to construct an entireprofession of Chinese medicine that is denominatedin the coded language of insurance forms?

[Guest guest]

Jim,

>

>

> Ken:

>

> Wouldn't more patients seek it even more often if payment was

> covered and it was also available by highly trained professionals

in

> hospitals?

>

>

> Jim Ramholz

 

Well, I can't see the future any more clearly than

you. And I'm not really trying to make predictions.

I was just raising the question. Z'ev said he thought

I was right, but all I did was ask the question.

 

Is that what we want?

 

You say you choose not to use insurance but wish

you had the option. If you don't have the option

you're not making a choice. I bring this up because

sometimes all it takes to get us to want something

is to tell us we can't have it.

 

In Laozi it says you can keep your heart

from becoming confused by not looking at the

desirable...or something like that.

 

Do your current patients seek you out because

of the convenience of your payment plans?

 

The costs do not vanish when a third party

steps in and assumes them in exchange for

issuing payments. In fact, the third party's

presence increases the cost to all concerned.

 

Do the math.

 

Within the complexities of the contemporary

regulatory environment that governs the

insurance industry there is so much incredible

excess...naw, let's call it what it is...waste

that one wonders whether or not the whole

system hasn't gone septic.

 

Perhaps the emergence of new diseases is

symptomatic of a deeper condition and this

third party payer scheme may be closer to

the root than we have previously imagined.

 

Maybe if you interrupt the direct exchange

of valuables between doctor and patient

you diminish the efficacy of the medicine.

 

Of course people will stomp and scream for

the double blinded trials to prove it, as

they must. But perhaps humans really are

too complicated to adequately sum up in

such relatively simplistic models.

 

I'm just thinking out loud but did, as I

said earlier, want to slow down just a

minute or two and think about what is involved

in buying in to such schemes.

 

Ken

[Guest guest]

Excellent point. Keep the "clear vision".

 

Emmanuel Segmen

 

-

Marco

 

difficult it is

one word

no meaning

or?

 

analysis

between word

and meaning...

 

yet

money

makes

US forget

the real thing

 

heal

no between

 

Qi

is not money

money may be Qi

 

lets not forget...

 

 

 

Marco BerghChinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

Jim,

You've raised an interesting point with regard to "hospital privileges". One thing is that they don't really exist any more ... not since 1998. MDs have been paying for the "privilege" to see their patients in the HMOs.

After reading one of your recent posts, I envisioned the re-invention of hospitals. You know, except for county hospitals, hospitals in many ways have ceased to exist. I had this crazy vision of practitioners opening a clinic with treatment rooms and then recovery rooms. In some cases they would be the same room. My point is that one could have a patient remain in a treatment or recovery room for an extended period of time the way an old country doctor would do ... or my great grandmother herbalist would do. This would be a "hospital" in a sense.

Crazy what your imagination does when you wish for what's been lost.

Emmanuel Segmen

 

 

-

James Ramholz

Thursday, May 08, 2003 11:55 PM

Re: harmonizing the paradigms

, "" wrote:> I am aware that the relationship with HMO's and insurance companies is a very personal decision. I understand the pressures to make a good living in one's chosen profession. But I think Ken Rose and Stephen Brown are right. If we play for the same insurance dollar, we need to ask if our profession is going to be transformed into something we will regret in the long run. >>>Z'ev:I choose not to take insurance simply for the practical reasons of the time and fuss---but I would still like the option to be available. Without option for the choice or, worse, to preclude it altogether simply makes no sense to me.Who knows? Maybe the inclusion of our profession into the process will help change things for the better. You can't know until it happens. To expect "regret in the long run" is fatalistic.So, again, who and what are being integrated?Jim RamholzChinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

There is a saying:

Money

makes the world round

 

yet

complexities...

 

Rich and Poor

US and Guatemala

 

Books and no books

Knowledge

but knowing?

 

yes,

complex

it is

 

like

word and meaning

Classical

or

Frankenstein

 

yet

health

irrelevant

of money

 

Chinese medicine

and doing

 

 

 

Marco Bergh