Your Comments: BI's LAc Fellowship, Wikipedia & that Quack Paracelsus, NCCAM Not Seeking the Cause
Written by John Weeks
Your Comments: 3 on BI's LAc Fellowship, Wikipedia on that Quack Paracelsus, NCCAM's Agenda and Seeking the Cause
Summary: Tom Ballard, ND shares a fascinating
encounter with Wikipedia over whether Paracelsus was the original
medical quack ... Acupuncturist Gary Wagman, LAc calls Beth Israel's fellowship for licensed acupuncturists a shame ... Bethany Leddy, LAc and consultant Linda Rapuano offer correction that the original inpatient fellowship for LAcs was not at Beth Israel but at St. Vincent ... Consumer Perry Chapdelaine, Sr. urges that NCCAM examine those integrative practices that seek to work with patients to find and treat the causes of disease.
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Gary Wagman, LAc, MTOM
1. Gary Wagman, LAc, MTOM: Shame
on Beth Israel for making LAcs pay to work
"This
program is an extreme insult to the Oriental Medical profession.
"Shame
on Beth Israel for making acupuncturists pay to work!!
"I am
sure that a hospital as prestigious as Beth Isreal could establish even
a
low-ball salary for these services."
Gary
Wagman, L.Ac., MTOM
Comment: My first response on reading
Wagman's comments was my own shame/discomfort that I had celebrated the program with these inequities.
One wants to radically reject an operation in which a group of practitioners is working for nothing when fellows of other stripes get paid for what they do. (See "Stamford Hospital begins integrative medicine fellowship" in the May 2010 Round-up.) For better and for worse, my adoptive belief in evolutionary, stepwise
strategies for change quickly rolling over my feeling and allows me to
comfortably restate, here and now, my view that the founders of the BI
program, the 2nd in the country (not the 1st - see below), deserve credit for forging it. Yet one can appreciate the urge to just say no to such a scheme. Maybe the LAcs, or the MDs who set up the program, should be demanding more respect, in the form of payment. Unlike
Wagman's labor of dedication at Outside In, for instance, the paid
services in Beth Israel's inpatient services are feeding hundreds of fat wallets of cardiologists, anesthesiologists, oncologists, radiologists, ophthalmologists, other specialists and upper level administrative staff.
Note #1: It has come to my attention that some readers
thought that an earlier version of my comment field was referencing the staff
family medicine personnel and acupuncturist when I spoke of "fat
wallets." My sincere apologies for any confusion there. I was referring to
those specialists and administrators who are earning $200,000-$1,000,000+ per year whose patients are
benefiting from the acupuncture and from whom a few alms could provide payment
for the services of the acupuncture fellows.
Note #2: To be utterly clear, I have honored and continue to honor the pioneering leaders of this program and the LAcs who are delivering services throughout the BI system. They are creating change which will open road to better inpatient care for untold tens of thousands as inpatient programs begin to expand into other systems across the country. I also know that both Arya Nielsen, PhD, LAc, and Ben Kligler, MD, MPH, the fellowship directors, are doing what they can to find a way to create some payment for the fellows. What angers me is the economic injustice in which these professionals are only able to provide their services, at this point in time, by working for free while an anesthesiologist, to name just one specialty group, averages $350,000+ a year. Why not $338,000 and spin $12,000 a year off to feed the LAcs? There is plenty of fat in the system to pay the fellows. Living with the compromises of "integration" is sometimes awfully distasteful.
"In your recent integrated medicine and health care round up
April 2010 you stated that the Acupuncture fellowship program at Beth
Israel was the nation's first inpatient fellowship for licensed
acupuncturist.
"This statement is inaccurate. The nation's
first inpatient fellowship program for licensed acupuncturist was at St.
Vincent's Hospital in Manhattan. The program began in 2005 by Dr. Ning
Ma, LAc, and Linda Rapuano of St Vincent's. The program ran for
three
years and then became a paid outpatient clinic in the
outpatient rehabilitation department of St. Vincent's.
"I was the
Chief Fellow of the March 2006-2007 program. The program was fully
integrated inpatient and outpatient program with didactic instruction.
The
Acupuncture fellows received referral orders from the physicians for
both
inpatient and outpatient patients, the fellows also attended Doctor,
and Nurse
team meetings for each department they were involved with. The program
was run by the Acupuncture Research and Development corporation started
by Dr.
Ning Ma. I hope you will post this information on your blog so that
the
inaccuracy can be corrected.
"I am glad to see that Beth Israel has begun a program as
well. Patients will benefit greatly from the integration of
Acupuncture
and Western Medicine."
Bethany Leddy, L. Ac. www.bethanyleddy.com
Linda Rapuano
2B. Consultant Linda Rapuano: The St. Vincent program was "an incredible feat"
I received a note from Linda Rapuano, who consulted for years with the
St. Vincent's system, when I first posted the piece, briefly correcting
me. I subsequently read in April that a St. Vincent's Hospital,
known also for its support of midwifery and lower-than-average
c-section rate, was closing. (See Integrator
piece here.) I asked Rapuano if this was her hospital. This is
her response.
"That's the one; ten years of my
life trying to build a model of integrative care there. Just last year I
did a very large 'consumer-focused facility design' project around the
new
hospital they were planning to build. All the components supporting
integrative
care would have begun with that facility design including re-engineered
administrative processes and technology interface. I am glad the
laughing
Buddha is entertained. The hospital itself will close in 30-40 days
time. There are some services like the HIV and Behavioral Health which
I
believe may still be under discussion with unnamable entities.
The Acupuncture Fellowship at BI was
conceived and
modeled
after the Acupuncture Fellowship at St. Vincent's
two years
prior to BI's.
"By the way, as long as we've
touched on the topic (of my work gone to dust), here's the correction
on your
BI piece: the Acupuncture Fellowship Program at BI was conceived and
modeled
after the Acupuncture Fellowship Program I launched at St. Vincent's
two years
prior to BI's. I spent 18 months in overdrive developing that program
with Dr. Ning Ma, the then clinical director of Pacific College of
Oriental Medicine, doing everything from
recruitment of candidates, staffing, internal credentialing, patient
charts,
developing western medicine diagnostic categories, distinct acupuncture
protocols that matched the diagnostics, physician and staff in-service
and
training, patient education, delivery logistics and yes, we even began
research at the level we were able to since we began only 1 day a week.
The
plans for further development were very exciting but St.
Vincent's internal problems made things virtually
impossible. The program launched in Rehab in 2006 and we moved it into
Internal Medicine in 2007. It was an incredible feat because there were
even
more challenges than the usual ones. By the way, if you look in your
archives, you will find the blurb you wrote up.
"Oh well, enough of
that. I went to see [Tim] Burton's Alice
with my 12 year old
niece and was reminded of the necessity for coming up with 6 impossible
things
every morning. Easy in this field."
All best,
Linda Rapuano
Comment: Rapuano reminded me
that I had indeed written up her work and noted the fellowship in this
December 2006 article. (It is sometimes useful to have chemo brain as an
excuse.) Meantime, I find great pathos in Rapuano's telling. Perhaps it is the months "in overdrive" with so much passion leading to "an incredible feat" trhat, none-the-less, leads to the end that was the shuttering of St. Vincents. One reflects of taking hills, in stories of ground troops, only to lose them again. Having helped start a couple of initiatives myself that have not lasted, I can appreciate the sentiments. One learns to count value in the way things reach into other lives, how they jump from being to being, rather than how they raise edifices. Good for Rapuano, Leddy and Ning Ma that their work lives on in the program at Beth Israel.
Tom Ballard, RN, ND
3. Tom Ballard, ND: On Wikipedia's biases, quicksilver and the origins of the complimentary term "quack"
"Pertinent to your recent posting of Peter D'Adamo's
challenges to Wikipedia.com, I happened to come across another example
of how
this site distorts truth to support the medical-industrial complex. "An editor reading over my new book manuscript questioned
my explanation of the word 'quack.' I had long ago learned that 'quack'derives from quecksilber (quick silver), a German word
for mercury. The term originally referred to a doctor who prescribes
mercury. In
looking up 'quack' in Wikipedia I was surprised to read their claim that
it is
derived from "quacksalver", a Dutch word meaning 'boaster who applies
salve.'
Had I been wrong all these years?
"I investigated further and found that the first person
labeled as a quack was Paracelsus (1493-1521), a famous Swiss physician,
because he was the first doctor to use salves containing mercury to
treat
syphilitic ulcers. Was Paracelsus known as a boaster? No. Was he the
first to
prescribe salves? Not by a long shot. The only connection between
Paracelsus
and the word quack is his use of mercury.
The first
person
labeled as a quack was Paracelsus. Originally the the term was considered a
compliment.
"Originally the term quack was considered a compliment.
While there can be no way of knowing for sure, I believe it makes much
more sense
that 'quack' refers to someone who prescribes mercury. "After Paracelsus, mercury continued to be used by medical
doctors for another 500 years, both externally in salves and internally
as a
tonic. Natural doctors did not recommend mercury. They believe in
nurturing,
not poisoning the body. "The word quack has now been appropriated by the
medical-industrial-complex to mean 'charlatan' or 'pretender to medical
skills." Paracelsus was not a pretender; he was a renowned medical
doctor. 'Quack' is commonly used against anyone who promotes nutrition, herbs,
exercise, or other lifestyle modifications to cure illness. Naturopathic
doctors and chiropractors are common targets, but anyone who disagrees
with the
authority of the dominant medical system is likewise smeared. I'm not
saying
there are not people with and without degrees, even MD degrees, who
overstep their education. And, there are outright frauds. However, the
word
quack is most commonly used to attack dissenters, those who challenge
medical
orthodoxy, such as the scientists that came forward to question the
safety of
Vioxx.
"The medical establishment claims they are 'scientific'
and dissenters are 'unscientific quacks' although few of their therapies
have
long-term, human, independent studies.
"Sadly, we see that Wikipedia and other supposedly 'independent' media are controlled by the same powers that control major
media
- large corporations - and their 'independent' hacks are perfectly
willing to
distort history to support the pharmaceutical orientation of medicine."
Tom Ballard, RN, ND www.PureWellnessCenters.com
Comment: Side note: In 1982, Ballard and D'Adamo were each part of the first class of graduates from what is now Bastyr University. I started working there in late 1983. That was in the dark age of utter medical segregation. Ballard's tone reminds me of these origins, and scars. Things are changing. Just today I referred to that era in speaking to an AOM professional and NIH-reviewer who is relative newcomer to the "CAM" world. My reference to a time "back when we were all quacks" (meaning considered as such) fell on deaf ears. This individual had no notable relationship to the term, or to an era in which such name-calling was common. Then again, perhaps her lack of challenges with cultural acceptance and esteem is because she knew, as Ballard suggests, that the term meant she was Paracelsus' kin.
Perry Chapdelaine, Sr.
4. Perry A. Chapdelaine, Sr: NCCAM should research practices that find and treat the causes of conditions
From time-to-time the Townsend Letter: The Examiner of Alternative Medicine re-prints an Integrator article. The following letter, from Perry A. Chapdelaine, Sr of the Arthritis Trust of America and the Philippine
Alternative Medicine Association, arrived in response to such a reprint.
"I'm currently located in the Philippines, and so I apologize
for commenting on your article 'Why Isn't NCCAM's 10th Year
Anniversary Symposium Focusing on Real-World Outcomes?' Townsend Letters was transshipped to me a wee bit
late! "I greatly appreciated your comments regarding the National
Center for Complementary and Alternative Medicine's 'signature event.'
You
certainly struck the proverbial nail on its big, fat head!
"I've not yet seen it clearly explained that CAM is the discovery of
causation and
removal of those damaging causes, not simply 'feel good programs' or
relief of
a cluster of symptoms."
"I would have been quite a bit stronger. There's a mind-set
in those who glibly talk and write about 'alternative/complementary'
medicine
that - at least to me - demonstrates a total ignorance of their subject.
As a
lay person, and CEO of The Arthritis Trust of America (a non-profit,
tax-exempt
charity) since 1982, I've been responsible for telling folks how our
doctors
handle the multi-factored sickness condition of rheumatoid disease and
related
health problems. It's long been clear to successful practitioners that
this
cluster of symptoms is, indeed, multi-factored, and no single therapy,
however
double-blinded, will help more than a small proportion of folks in their
search
for wellness.
"Even more important is the misconception that chasing after
symptom relief is any kind of measure of an effective wellness program.
Pharmaceutical companies are already expert at this futile chase.
"I've not yet seen it clearly explained, as I'd prefer it to
be, that 'alternative/complementary' medicine is the discovery of
causation and
removal of those damaging causes, not simply 'feel good programs' or
relief of
a cluster of symptoms.
"When a bureaucracy hires primarily those trained to 'heal' symptoms rather than to search out causations and remove them,
such a
bureaucracy is bound to spin its wheels, money, and influence seeking
prestige,
not truth."
Perry A. Chapdelaine, Sr.
Philippine Alternative Medicine Association
Comment: As repeatedly noted in these columns, it is indeed frustrating to not have our research focus on the multifaceted, real world protocols that characterize integrative practice. One potentially lucrative but essentially un-researched vein is the practitioner focus, as Chapdelaine references, on treating causes, ortolle causam as the naturopathic doctors put it. While I wouldn't place this approach in contradistinction with healing as Chapdelaine does, it appears true, for instance, that the emerging focus on effectiveness in treating pain is likely to be organized around individual therapies that alleviate or mask a cluster of symptoms. We see little focus yet on the gold ring of learning about a paradigm of treatment that seeks to help a patient work with causes toward being a more well person. Not focusing there, complex as it may be, may rightly be judged as causation for NCCAM to "spin its wheels" in our research agenda.
