Transcript Barefoot Medicine Training

Tao of Integration
essential knowledge in the age of healthcare reform

Being in the right place at the right time . . .
And knowing you are there.

Cultural cognition is no phantom.

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’

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

What are the essential knowledge and skillset 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

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)

“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)

"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 bidirectional 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

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 nonWesternsers 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.