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The Integrator Blog. News, Reports and Networking for the Business, Education, Policy and Practice of Integrative Medicine, CAM and Integrated Health Care. - Your Comments: BI's LAc Fellowship, Wikipedia & that Quack Paracelsus, NCCAM Not Seeking the Cause
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Your Comments: BI's LAc Fellowship, Wikipedia & that Quack Paracelsus, NCCAM Not Seeking the Cause PDF Print E-mail
Written by John Weeks   

Your Comments: 3 on BI's LAc Fellowship, Wikipedia on that Quack Paracelsus, NCCAM's Agenda and Seeking the Cause

SummaryTom 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

Gary Wagman, LAc, MTOM is a clinician at Harmony Clinic outside Portland, Oregon who is also on the clinical faculty at Oregon College of Oriental Medicine. He writes in response to the Integrator article on an inpatient fellowship for licensed acupuncturists at New York Beth Israel in which the LAcs pay BI a stipend to participate in the fellowship, rather than being paid for their work. Wagman also serves the homeless as a clinician at Portland's Outside In
"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.   

Bethany Leddy, LAc
2A.  Bethany Leddy, LAc:
Beth Israel's inpatient fellowship for LAcs was not the first

I received two notices that I had wrongly declared that the inpatient fellowship for licensed acupuncturists at New York's Beth Israel hospital. The first is from Bethany Leddy, LAc, who practices near Union Square in New York City.
"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.

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"

Seattle naturopathic physician and writer Tom Ballard, ND, last seen here in the Integrator, offers a history lesson on the origins of the term quack, via a dialogue with the unseen editorial legions at Wikipedia. Ballard is the author of Nutrition-1-2-3: Three proven diet wisdoms for losing weight, gaining energy, and reversing chronic disease, and other books.
"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
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, or tolle 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.

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