Tao of Integrationessential knowledge in the age of healthcare reform

Outliers – M. Gladwell

Being in the right place at the right time . . . And knowing you are there.

Cultural cognition is no phantom.

The Situation

What are the challenges to practicing TCM in North America? ‘alien medicine’ Culturally-bound concepts Concepts which don’t ‘translate’ Inherently different epistemology Lack of acceptance Our patients and fellow medical colleagues

‘don’t know what they don’t know’

The Challenge

How can a single TCM practitioner make a difference? Know the strengths of TCM Communication skills (lay patients as

well as MD’s) Deliver in clinic and play according to

the ‘rules’ of professionals

Knowledge and Skills

What are the essential knowledge and skill-set that allow for high-quality practice and integration? Clear understanding of the historical

moment and the cultural epistemology of TCM vis a vis conventional medicine

Razor sharp clinical skills – a demo is worth a thousand explanations

Knowledge of the Historical Moment

Too much confusion exists surrounding the practice of Holism in North America? Confusion may be expected from

conventional professionals The majority is coming form holistic

practitioners themselves who have not yet clarified what they do

What makes the situation in the North America unique? Conventional medicine does not address

chronic disease very well. Why?▪ 50 million without healthcare▪ WHO report in 2005 (WHO Press, 2005)▪ ICIC findings (Wielawski, Irene M.) “An

estimated total of 133 million people in the United States – nearly half of all Americans – have at least one chronic condition

“Healthcare in the U.S. and the current practice of medicine must change . . . The projection is $3.4 trillion ($10,500/capita) by about 2011 or 18% of GDP . . . Our care delivery is about 95% treatment and 5% prevention. The U.S. cannot sustain the present system for much longer.” (DeHaven, 2005)

“A critical experience for most medical students (is) where they see physiological responses to various chemicals introduced into a living animal . . . (which) serves as the architecture for developing medical knowledge . . . (this) quickly becomes the only reasonable way to think . . . physiology elaborates this world in the language of mechanism and function.” (Good and Good, 1993)

What is Reductionism?

“Science, assisted by mathematics, was able to describe the universe in quantitative terms that had impressive predictive power. Using the scientific approach, any phenomenon could be isolated and analyzed under repeatable conditions until even the most complex of processes were reduced to a collection of known elementary units acting predictably as a result of the forces between them.” (Peat, 1987)

“Learning a foreign language is a central metaphor for medical education . . . and competence in medicine depends on learning to speak and read the language . . . the language learned and the world revealed to the medical gaze are closely linked . . . Several aspects of the medical world and the experiences associated with discovering this world may be identified. First, it is wonderfully reductionistic.” (Good and Good, 1993)

“We lack a precise vocabulary with which to deal with mind-body-society interactions and so we are left suspended in hyphens, testifying to the disconnectedness of our thoughts.” (Scheper-Hughes and Locke, 1987)

What is real? Paradox is real! “a singular premise guiding Western

(conventional) science and clinical medicine (and one, we hasten to add, that is responsible for its awesome efficacy) is commitment to a fundamental opposition between spirit and matter, mind and body, and (underlying this) real and unreal.” (Scheper-Hughes and Locke, 1987)

Hidden Implications

"Measurement!  It is the very foundation of the modern scientific method, the means by which the material world is admitted into existence.  Unless we can measure something, science won't concede it exists, which is why science refuses to deal with such "non-things" as the emotions, the mind, the soul or the spirit.“ (Pert p.21)

“If and when we think reductionistically about the mind-body, it is because it is ‘good for us to think’ in this way. To do otherwise, using a radically different metaphysics would imply the ‘unmaking’ of our own assumptive reality. To admit the ‘as-ifness’ of our ethnoepistemology is to court the Cartesian anxiety – the fear that in the absence of a sure objective foundation for knowledge we would fall into the void, into the chaos of absolute relativism and subjectivity.” (Scheper-Hughes and Locke, 1987)

It is not only that reductionism is itself a uniquely discernable ontology, it is also the case that a feature of reductionism is to deny comparable status to any alternative ontological world-view save one which reflects reductionism.

Alternative ontologies in American medicine are “denied by an ideology or epistemology which regards its creations as really lying ‘out-there’ – solid, substantial things-in-themselves . . . this illusion is ubiquitous in our culture.” (Taussig, 2003)

“Darwin’s alienation of the outside from the inside was an absolutely essential step in the development of modern biology. Without it, we would still be wallowing in the mire of an obscurantist holism that merged the organic and the inorganic into an un-analyzable whole. But the conditions that are necessary for progress at one stage in history become bars to further progress at another. (Lewontin: 2000)

“The time has come when further progress in our understanding of nature requires that we reconsider the relationship between the outside and the inside, between organism and environment.” (Lewontin: 2000)

“Crisis . . . ‘a crucial or decisive point or situation: a turning point . . . In physics, biology, chemistry . . . experts concur on the fact that the traditionally western dependence upon reductionism, linear thinking . . . has reached its limits.” (Pritzker, 2002)

What is holism?

The primary tenet of the holistic cognitive archetype is an axiomatic assumption that the inner and outer aspects of any given phenomena relate – i.e. they are not separate, but one, seamless and paradoxically indivisible whole. Reductionism divides these inner and outer realities for convenience and ease of therapeutic manipulation. But in the end, the micro and macro-cosms influence one another in a bi-directional relationship. The significance of this one single assumption is enough to make a logical case for why the holistic approach is the clear champion for the management of chronic disease.

Inherently suited to the treatment of chronic disease

Because chronic disease inevitably involves myriad factors, it is of supreme importance that patients glimpse their role in driving their illness/recovery.

What is/are the danger(s) of holistic practice?

“Most of us on hearing that the most probable initial event in OA (osteoarthritis) is the mitosis of the chondrocyte with increased synthesis of proteoglycans and type II collagen, won’t have the foggiest notion of what this means on an everyday level and what we ourselves can do about this.

“Traditional Chinese Medicine (holism) . . . is based on a vision of the human body as a microcosmic miniature of the natural world. Therefore, the language of Chinese medicine is the language we use everyday to describe events in the world around us. More importantly, using this language, we are empowered to take charge of our own lives and well-being so that whether we experience pain and discomfort becomes a function of how we live our life.” (Flaws and Frank, 2006)

The research pyramid which places the randomized control trial at the top in terms of validity and reliable knowledge is being continued. There is much debate in the research world about the need for research that can comprehend and embrace higher levels of complexity than the RCT. The knowledge pyramid might be inverted in another culture and another time. In any regard, the problem of controls has yet to be solved in acupuncture, and this article - as well as the meta-analyses that it cites - does not acknowledge the problem with achieving a decent control in acupuncture research.

Will Morris, Letter to NCCAM

The issue of research methodologies is that reductionism inherently requires different parameters than holism. Of course subjective aspects of health and illness are primary in chronic disease since these lead to patient empowerment. The research methodology that allows for subjectivity is the preferred methodology of holism – i.e. n-of-1.

Randomized Controlled Trials: An opportunity for Complementary and Alternative Medicine Evaluation.

What is the essential, practical aspect of quantum?

“Implicit in such a . . . vision (i.e. the vision of conventional medicine) . . . is the image of a scientist who stands outside the system as impartial observer, able to predict events according to deterministic laws, without disturbing events in any way . . . the term “spectator must be struck from the record and the new word “participator” must replace it. By virtue of the quantum theory . . . physics and physicist are no longer separable but are one indivisible whole.” (Peat, 1987)

The quantum omission that observer and observed are linked is the very foundation of (practical) holism

Hospital Acupuncturists: are we ready for the new trend? J. Painovich. American Acupuncturist, Spring 2008, vol. 43

Forging New Ground: Gaining Clinical Privileges to Practice Acupuncture in a Conventional Clinical Setting. American Acupuncturist, Fall 2008. vol. 45

The importance of communication skills

The More You Meet and Greet, the More You Will Get to Treat. M. Allen, Acupuncture Today

Explaining Chinese Medicine to Laypeople. Blue Poppy Blog, Bob Flaws, April 28th, 2009

All are required to teach

Issues in communication How to talk about qi – vitalist vs.

biomedical language Unambiguous understanding of holism –

to wit, pattern discrimination, disease mechanisms

Survey of Physicians

90% of MD’s and Administrators indicated that ‘Communicating AOM concepts in a Language which works with conventional practitioners is top priority (4 or 5 on the Lickert scale). (Weeks, et al, 2007)

Because there is an inherent focus on inner reality (or at least an acknowledgement) the temptation is to operate in a backlash against material science Flaws, Myths of Chinese medicine, Spirit

in Chinese medicine (pod-casts)

“Again and again, both Westerners and non-Westernsers alike point to individualism as the central distinguishing mark of the West.” (Huntington, 1999)

The cultural focus on individualism is (paradoxically) the strength of Western culture and the obstacle to good holism.

The first thing young practitioners will do, to show how committed and spiritual they are is to “sever their relationship with money.” (C. Myss, 2005)

“in order to receive something (healing) it is important for patients to give something up.” (K. Cohen, 2006)

Clinical skills Patterns related to pain, stress, anxiety and

depression, Disease mechanisms

Teaching skills How to talk to MD´s about qi, etc.

Kinesthetic skills How to palpate and really feel what you are

doing Good holistic thinking

Understanding epistemology – East - West

Understanding liver-spleen disharmony and its possible implications / variations Unblocking the Pivot, Sharon Weizebaum,

Oriental Medicine Journal, Summer 2008 Managing Patients with Multiple Complaints,

Jake, Fratkin, Acupuncture Today, July 2008 Flaws, Bob. numerous articles and lectures

Pritzker, Sonya. From the Simple to the Complex: what is complexity theory and how does it relate to Chinese medicine? Clinical Acupuncture and Oriental Medicine. Elsevier Science Ltd. Vol. 3. 2002. p. 99-104

Flaws, Bob and Douglas Frank. Curing Arthritis Naturally with Chinese Medicine. Blue Poppy Press. Boulder, Colorado, 2006.

Astin, John A. Why Patients Use Alternative Medicine: results of a national study. JAMA. 1998: 279; 1348-1353

Good, Byron J. and Mary-Jo DelVecchio Good. Learning Medicine: the constructing of medical knowledge at Harvard Medical school. From Knowledge, Power and Practice; the anthropology of medicine and everyday life. University of California Press, Berkeley, 1993.

Johnston, Bradley C and Mills, Edward. N-of-1 Randomized Controlled Trials: An opportunity for Complementary and Alternative Medicine Evaluation. Journal of Alternative and Complementary Medicine, volume 10, number 6, 2004, pp. 979-984

Peat, F. David. Synchronicity: the bridge between mind and matter. Bantam Book, New York, 1987

Scheper-Hughes, Nancy and Margaret Locke. The Mindful Body. Medical Anthropology Quarterly. Volume 1, number 1. March, 1987

Taussig, Michael. The Nervous System. “Reification and the Consciousness of the Patient.” Routledge. New York, London. 2003.

DeHaven, Mark. Personal interview with author: July 2005

Good, Byron J. and Mary-Jo DelVecchio Good. Learning Medicine: the constructing of medical knowledge at Harvard Medical school. From Knowledge, Power and Practice; the anthropology of medicine and everyday life. University of California Press, Berkeley, 1993.

Pert, Candace. Molecules of Emotion – why you feel the way you do. Touchstone Press, New York, NY. 1999

Lewontin, Richard. The Triple Helix: gene organism and environment. Harvard University Press, Cambridge Massachusetts, 2000

Huntinigton, Samuel. The Clash of Civilizations and the remaking of world-order. Touchstone Press, New York, NY. 1996

Myss, Carolyn. From and audio recording; Advanced Energy Anatomy, Sounds True recordings, 2001

Cohen, Keneth. Honoring the Medicine - the essential guide to Native American healing. Balantine Books, New York, NY. 2006

World Health Organization. Preventing chronic diseases: a vital investment. WHO press, Geneva Suisse. 2005

Wielawski, Irene M. Improving Chronic Illness Care. To Improve Health and Healthcare, Volume X. p. 53

Weeks, John. (et al). Survey of MD’s/Administrators of Integrative Clinics to Gather Information on Competencies of Licensed Acupuncturists for Practice in Hospitals, Integrated Centers and Other Conventional Healthcare Settings. National Education Dialogue to Advance Integrated Health Care academic Consortium for Complimentary and Alternative Health Care. Project Director: John Weeks. December 2007.