What constitutes a thriving profession : Chinese medicine’s future

I’m positively buried in a ton of unbelievably exciting business work, all of which will be coming out in a series of posts sometime in the not-too-distant future. When I’m not working on that stuff, I’m hiding from the brutal heatwave that is currently crouching over my fair city, Portland. However, I’ve found some time to engage in a rather lively conversation in the comments on my recent post about a post on another blog concerning the Lingshu and the superior physician. This discussion, and a conversation I’ve been in with a close friend for the last year, has me thinking about the future of Chinese medicine.

It should be noted that, as an American, I’m almost certainly talking about the American profession of Chinese medicine – as different places have their own eccentricities to reckon with. But, some of what I think about may have relevance – particularly in other Westernized countries.

I’m new to this profession. Very new! Folks like Bob Flaws, Heiner Fruehauf, Dan Bensky, Leon Hammer and other long-time practitioners surely have a more seasoned perspective on the whole matter. I’m sure they have seen trends come and go, have seen government become more and less interested, seen the tide of popularity spike and settle down. I crave that perspective. Unfortunately, I’m stuck with my own for now.

Below, find my Chinese medicine profession wish list. These are the things I would like to see grow and thrive in our profession in the next 10 years. You’ll notice that much of it evades ever being “done” at all, being more process oriented than outcome oriented. But, I’d like to see significant progress made on these fronts in the next decade.

  1. More intelligent, intentional dialogue : There are already good conversations going on here at Deepest Health, as well as at blogs, conferences, schools and other places all over the country (and the world). However, I would like to see even more overt, intentional, respectful conversation going on between people who respect one another’s opinions and are open-minded enough to have their opinions changed. This can happen electronically, in person, on the phone, by Skype, on blogs, through Twitter, in journals and magazines – any method is fine, so long as ideas are being exchanged and the general level of understanding is being elevated.
  2. More publications : Here, I’m thinking specifically about magazines and journals. I would love to see more topical, peer-reviewed Chinese medicine journals. While research briefs are interesting, if you’re into that, I’d like to see a wider range of articles being published. I think the Lantern is a good example of something I’d like to see done more often. I would also love to see more blogs, more magazine-style websites and even zines or other DIY publications done by students, practitioners, patients and groups who are passionate about Chinese medicine.
  3. More residencies : Why don’t I just say, “Any residencies.” Some folks want post-graduate education in a residency style. While people are capable of forging their own post-graduate relationships and creating residency-like positions, I really think a more organized, institutionally supported program would be helpful for students. In showing new students that we are serious about fostering their clinical success, we will improve the quality of applicants and build the profession for the future.
  4. More research into the Classics : I would love to see little institutes springing up all over the country that pay visiting scholars to give talks and do research into Classical topics. I might start one of my own someday. ;)
  5. More business and personal cultivation taught in the schools : I’m surprised how many graduates leave Chinese medicine school not knowing how to care for themselves, personally or professionally. It’s not just us, many graduates of many types of programs feel the same way. Why is it so hard to teach practical skills? Who is doing this better than us, and how can we emulate them?
  6. Board exams that make sense : I mean, seriously.
  7. More easily available information on herbal quality and availability : Many people have no idea where they can get good quality Chinese herbs. I was just informed of a company I have never heard of that seems to have incredible product – and I’ve been doing research for almost two years! What of those who don’t know how to get started on such a research project? They may just end up using whatever the school clinic uses, for better or worse. This isn’t good for our profession and certainly isn’t good for smaller herb companies without the funding to advertise in Acupuncture Today or similar publications. It would be a great boon if the schools would teach a class about evaluating herbal quality. I suppose that might not be popular with all the herb companies…
  8. More control over our destiny, particularly regarding herbal access : For me, this may actually be #1. I shouldn’t have to hunt so long and so hard to find Xi Xin and Ma Huang. These herbs are not dangerous in the hands of trained and licensed Chinese herbalists. I’m not going to go on and on about this point right now, but I think this should be the number one priority of the AAAOM. I know they are working on it, I’d like to see their efforts triple. Of course, that’s going to mean tripling my donation. :)

What would be on your Chinese medicine profession wish list? Let us know in the comments. I would love to hear everyone’s thoughts – whether experienced and informed or brash and absurd. All kinds are welcome here at Deepest Health. :)



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About Eric Grey

Hi - I'm the founder of Deepest Health. When I'm not writing here, you can find me reaching out to the Chinese Medicine community across the web and in my own backyard. I currently teach Chinese herbs at my alma mater, the National College of Natural Medicine. Additionally, I'm the founder of Watershed Community Wellness, a thriving local clinic in Southeast Portland in Oregon. No matter where I'm working, you'll find my focus on the Classical approach to Chinese medicine laced throughout everything I do.

View all posts by Eric Grey - Website: http://deepesthealth.com

Bonnie says:
07/30/2009

I’d love to see more places for acupuncturists to be employed rather than having to be in their own small business. While there are some fantastic business people out there not everyone wants to run a business, nor is everyone suited to it.

I’d also like to see programs like Bastyr’s doctoral program is described as being crop up… that is the idea that acupuncturists would be working alongside Western Medical practitioners in a truly integrated setting. Unfortunately I hear from those in the program it’s not exactly like that. At the same time, I think their ideals are in the right place and I’d like to see something like that come to fruition

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Evan says:
07/31/2009

People will never learn to care for themselves whilever the cognitive is regarded as the dominant aspect of persons. (To put it another way – whilever the healing professions buy into the academic.)

I’m in favour of much more discussion but peer review is just talking behind someone’s back (at best impolite).

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Evan says:
07/31/2009

I just thought of a model. Some kinds of training in psychotherapy where the training involves the trainees dealing with their own issues. An excellent model for any healing modality.

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Delli says:
07/31/2009

I think #1 on my wish list would be an Iphone app that can confirm the diagnosis for me. (using classical diagnostic methods, of course)
Now that would be awesome!

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Yan says:
08/01/2009

Hi, Eric, i love your ideas, and totally support from #1 to #8. special the one about classics. I am original from China, so i can read all the books in Chinese,one of my dreams is translating some classic books in better and deeper way, but they are so hard. it still will take me many many years to study. really like to join all kind of discuss, dialogues, and conversations. exchange the ideas. really admire your effort and faith to Chinese medicine. not feeling alone on the way to the deepest medicine.

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Eric says:
08/01/2009

Bonnie,

I’ve heard similar things about Bastyr’s program, and other programs like it. Do you think there could be something inherent to the very nature of the two medicines that makes such an outcome inevitable? What do you think needs to be done to make this type of a program more viable?

Eric

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Eric says:
08/01/2009

Evan,

I’m interested in your idea of peer review as “talking behind someone’s back,” given the connotations that this phrase implies. I don’t think of peer review that way at all. I’m interested in hearing more about your perspective.

Eric

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Eric says:
08/01/2009

Yan,

Thank you! It’s great to hear from a new reader. I’ll be very interested to hear your comments as the blog continues. Please keep reading and commenting!

Eric

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Evan says:
08/01/2009

Hi Eric,

In the peer review practice, as usually done, the person who submits doesn’t know who is doing the reviewing. This makes it (at least) very difficult for the person submitting to challenge the review. (I value equality in relationships).

I think a reviewer should be willing to state their reasons face to face. If the reviews opinions can’t withstand being challenged they can’t be worth much.

Basically I think someone should be willing to stand up for the opinions and judgements (which is after all what the review is about).

One way to alleviate the pernicious effects of the secrecy of the process would be to have a site where the rejected papers were published (the equivalent of the “salon refusee” – spelling? – that some art prizes have). It would be interesting to see which gained more readers and which contributed more to the practice of the medicine.

Trust this makes sense.

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Eric says:
08/01/2009

Evan,

Ok, I can see the merit in what you’re saying, but will have to think on it some more. Having been involved in discussions and planning for a couple of journals (in CM and not) I think has given me a particular perspective that is more pragmatic than anything – but – again, I will have to think on it.

I want to ask one question, however. When you say “Trust this makes sense,” what do you mean? I’ve seen you write it before. I have to admit it’s a bit off-putting. Coming from a spiritual teacher or someone that I have put my trust into already about some matter, it would be acceptable. In this case, I’m not sure why I would “trust” that someone’s opinion about a particular professional or intellectual issue “make sense,” without my having evaluated it to actually make sense. Does that make sense? Perhaps I misunderstand the content, or intent. Please enlighten me.

That being said, and reading over your comment again, I do think that one thing for sure “makes sense” although I’m not sure how we can make it make “cents,” or at least have it pay for itself — the idea of having a “salon refusee” website or other cheap publication for those who have been passed over has definite merit and would be quite fun! I wonder what it would do to the volume and quality of submissions…

Eric

Eric

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Bonnie says:
08/01/2009

Eric, I think that they manage to integrate the two medicines in China–but I can not speak from experience, only what I’ve heard.

At any rate, I think our schools have more difficulty integrating than the practitioners do. There is so much fear around the potential lawsuit that that makes it hard to allow anyone to do or say anything. In a school setting, teaching acupuncturists to be “doctors of Oriental Medicine” alongside those who already have a medical doctor degree doesn’t allow the acupuncturist to have the same footing. While the MD might not be teaching the acupuncturist anything, they still have to be aware they are working with someone who is “a student” which creates an unequal relationship.

The idea is great, but I’ve yet to see it in practice. I know many acupuncturists (and I count myself among them) who have had wonderful relationships with naturopathic physicians within the same office. I do know of an acupuncturist who works in a medical doctor’s office. I think these areas are setting the stage for the two medicines to work together, but we are not yet as integrated as the two medicines could be.

There is a lot of fear and misunderstanding on both sides. While I hear a lot of negatives about acupuncture from doctors who “don’t believe”, I also hear a lot of negatives about western medicine from acupuncturists who don’t think doctors can do anything right. Attitudes like that tend to prevent us from really talking and making the full contribution to the health of another.

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Evan says:
08/01/2009

Hi Eric, I am told that I tend to write too densely and I think I make intuitive leaps. This has lead to people telling me that what I say has lost them or doesn’t make sense. My saying that “I hope this makes sense” is my way of taking responsibility for my style of writing and acknowledging that it may lose some people. It is not intended to be a claim that what I say matches another’s experience, only to say that I hope I have expressed myself clearly.

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08/02/2009

Hi All,
I just wanted to throw my two cents in about the idea that in China/Hong Kong/Taiwan, the medicines are integrated. I do not find this to be the case. What is different is here, CM has it’s own wing in most hospitals. Patients that go to that wing if the want CM, or they go to another part of the hospital if they want WM. They do not really work together- a patient chooses one wing or another. The same is said for outside clinics-they are either 中醫 or 西醫. The other difference I see here in Taiwan is that (because they have government insurance) both are equally covered. People here don’t pay for medicine, and they have complete choice over what type of practitioner they see. Herbs are covered too! (but if you want the good stuff, best to pay out of pocket) As a foreigner living here, I even get to participate. Cost is about $20/per month :)

I really don’t like the word integration, which means blending two things together into a whole. I find the idea of combining two completely different paradigms together impossible, though many who practice “medical acupuncture” are doing so. If our goal is integrating, that is likely what we are to end up with. Cooperation? That sounds nice. Acceptance by medical insurance and government funding? Even better.

I think the idea of a cooperative relationship between the two medicines is nice, but as there is no model for this anywhere, I’m not surprised that such programs do not succeed.

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Evan says:
08/02/2009

For integration to be possible we need a theory that is adequate to explain both.

I think we start working at the basis of this now – using western technology to find out what pins in different points actually do to the person. It is a long way to go but I think we do have the possibility of building the foundation: in 20 years I think we could have made great strides.

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08/02/2009

Hi Evan,
I am quite happy with the theories we have to explain Chinese medicine. I’m personally not interested in coming up with a different approach just to satisfy those who operate under another paradigm. I’m sure there are others who are interested in satisfying the W. med community, and I wish them luck.

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Evan says:
08/02/2009

Hi Richard,
My interest isn’t in the Western medical community, my interest is in healing more people more effectively. My guess is that if we can watch what the pins do that this will advance our understanding and therapeutic effectiveness.

There are lots of issues involved here I think. I don’t think that Chinese medicine is justified by the Western approach, I think that both of them are justified by healing people (in this regard I think for the everyday stuff for most problems the Chinese approach is clearly superior). The gift of the West I think lies not so much in the medicine as in Public Health and infrastructure – sewerage and soap and so on.

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Yan says:
08/02/2009

to all
in China, the integration of Chinese medicine and western medicine has been going on for at least 30 years. but it is not successful, not only that, also make Chinese Medicine lost the direction under the modern science philosophy, “which is we only accept things we can see, and deny the exist of the rest” it is not the simple integration of two kind of Medicine, it must happen when modern civilization is humble enough to go back study other ancient ones. go with modern science, maybe one day, when the meridians can be detected, then we can talk. not now. besides, when we spend too much time thinking of convincing Western Medicine, we lose the time to study classic, that has been happening all over the China.

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Bonnie says:
08/02/2009

What I would like to see is a place where each medicine has it’s role and that the Western docs do their thing and the acupuncturists do their thing with mutual respect. I think such a thing is possible but it probably isn’t easy.

As for there being two medicines, as a student of Dr. Tran Viet Dzung, I disagree. Tran always tells us there is one medicine. Any seminar with him begins with the Western perspective of the problem and then he does the classical acupuncture perspective. Throughout the latter he always reminds us how although we use a different language, we are essentially describing the same processes through the body. We differ on where to offer assistance and how to do so.

There are clinics where acupuncturists work in the same office as an MD. These do work well. I am talking about in Vancouver, Washington where I live. How well it works depends upon the mutual respect the two parties have for the type of medicine the other practices.

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Taylor says:
08/04/2009

I want to see more bridges being built between Chinese Herbalists, Western Herbalists, MDs, NDs, Chiropractors, etc. We are all in these professions to help people heal, and I think that the gaps that exist and the open disdain that is often present (when Western Herbalists talk of Allopaths, when MDs talk of Herbalists…we all do it) hurts us AND our clients/patients badly. That’s my #1.

Should we start a new version of ‘Bridging the Gap’? ;-)

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Paige says:
08/06/2009

I recently read Lisa Rohleder’s community acupuncture manifesto and it resonated deeply with me. I feel that as a profession (one which I am not yet qualified for;-) acupuncturists do themselves and Chinese medicine a disservice by trying to become integrated into the Western medicine system by emulating the white coats, snazzy clinic settings and cost issues that make CM a middle class medicine. I am awaiting delivery of the book by Lisa Rohleder called ‘Acupuncture is like Noodles’ to learn more about community acupuncture as practiced by an increasing number of acupuncturists. Does anyone have any experience or views of this practice?

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Eric says:
08/06/2009

Hey Paige,

Regarding community acupuncture – I like the idea of providing care for people at a lower price point. However, I’m not certain that the community acupuncture model as typically practiced is the only, or the most effective, way to do this. I have not been impressed with the community acupuncture I have experienced, and I’ve been to several different centers. Perhaps it works for some, but not for others. I find that the kind of medicine I do is well served by a more private session, and the kind of acu-moxa therapy I use typically takes longer than an average community acupuncture session would contain.

Other models to look into:

1. The Gift Economy model – practiced by Brandt Stickley at our clinic Watershed Community Wellness, you can see an article about him and his work there here : http://binalshah.wordpress.com/2009/06/18/karma-clinic-news/.

2. A model based on non-profit status, writing grants and soliciting donations the old fashioned way to enable lower price points for services.

I also encourage people interested in the community model to ask themselves why they are attracted to it, and to brainstorm as many ways as possible that they could fulfill their dreams – the current community acupuncture model certainly isn’t the only way.

Thanks for your comment!

Eric

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Bonnie says:
08/06/2009

Paige, I don’t understand why you think that integration would require emulating?

To me, emulating means that I have to change who I am or how I practice to become some other type of practitioner or fit in a box I don’t fit in.

Integration means that I use my skills as they are to the best of my ability and the others in my office setting use their skills to the best of their ability. We mutually refer back and forth to each other depending upon the needs of the individual patient. Emulation suggests a sort of competition or a take over one of the styles. Integration to me is about working along side each other as partners.

Yes I know there are so many people who think this can’t be done, but it’s done regularly with naturopaths and on a small scale with MDs. I would love to see that go to a larger scale.

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Eric says:
08/06/2009

Bonnie, Richard, et al

For my money, if integration means (truly) cooperation, then I’m all about it. There are times when I refer a person to a Western medicine practitioner (usually a Naturopath) to help them gain clarity on a specific problem. It’s just too bad that so often the integrative setting is cooperative only in words, not in actions. Chinese medicine is unfortunately seen as adjunct, suspect and likely to be replaced by Western understanding of what we’re doing. It’s depressing, and an issue I have no interest in working on myself, but I do hope that it changes. If only for the sake of patients who would like to see their various health care practitioners operating in harmony.

Eric

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Paige says:
08/06/2009

Thanks Eric, I am looking forward and trying to see where I want to go with my practice, so definitely must consider why the affordability option matters so much to me, but it is not hard to figure out when you live in a place with socialized medicine where most patients are not even used to a co-pay, let alone carrying the cost themselves. But as I am learning in my practice as a massage therapist, price is not really the main issue for most patients I see.

And I take your point Bonnie, I have seen more emulation than integration. I went to the Bastyr clinic in Seattle and felt that the practitioners I met seemed very much like doctors and the whole vibe was very much like any doctor’s office. I had acupuncture in Tokyo and it was a completely different experience, not much consultation, tatty curtains and a haze of moxa…. The UK is somewhere in between. But all are adjunct and thus sidelined as ‘alternative’ which is not integration or cooperation. It is competition and we are a small minority with vast numbers of our peers failing to make a living in the competitive marketplace after great expense on many levels.

NICE guidelines come out recently recommending acupuncture for all on the NHS, but those in charge are not going to give jobs to those outside their paradigm. So it is that acupuncture here is practiced (integrated) in the NHS by physios and doctors minimally trained in acupuncture with v. little CM at all. It is discouraging. If nothing else I adore the tagline of community acupuncture – the calmest revolution ever staged!

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