Friday, 17 May, 2013

 

I have had 14 years to accumulate a full picture of the relationships my patients (and the patients of my colleagues) have with their physicians about acupuncture.  What has clearly emerged are three distinct categories of relationship.  At one end are the few doctors who enthusiastically endorse acupuncture (the enthusiasts).  At the other end are the few doctors who vigorously reject acupuncture (the rejectionists).  And in the middle are the majority of doctors who take what I would call a passive-supportive position regarding acupuncture (the passive supporters).

My main concern here is to help you, as a patient, navigate your choices in healthcare with a perspective you might not realise is available to you.  Practically speaking, what are the implications of this distinction for you as a patient seeking care?  It is always good to know who you are talking to.  What perspective do they bring to the conversation?  Where does it come from?  How does it fit into the full range of perspectives?  In this case, don’t assume all medical doctors represent the same perspective.  They don’t.

Is your doctor an ‘enthusiast’, a ‘rejectionist’ or a ‘passive supporter’?   For one thing, when you go to your doctor with a symptom or complaint, while it is possible, it is not a given that your doctor will present you with all of your medical options.  Acupuncture is, in many more cases than you likely realise, one of your medical options.

 

The Enthusiasts

It is only a small minority of doctors who are actually going to consistently take the proactive initiative to suggest acupuncture as a therapeutic option for you.   These are the group I call the enthusiasts.  And even within this group, it is most likely, at least where I live, they are only going to make that suggestion for musculoskeletal pain conditions and not for the much broader range of health concerns for which acupuncture is very appropriate and effective.  Let’s call them the ‘limited enthusiasts’ because their proactive support is limited.  There are also what I would call, ‘fully embracing enthusiasts’.  These are the much rarer medical doctors who truly understand and appreciate the full breadth and depth of acupuncture.  Some of them even study, practice and teach acupuncture.

Examples of doctors in this category include Ed Neal MD and Leon Hammer MD.  Dr. Neal is trained as a medical doctor of Internal Medicine.  He first studied acupuncture with another ‘doctor enthusiast’, Italian physician, Anita Cignolini MD.  Dr. Neal now practices and teaches acupuncture and is busy translating the original 2000 year old acupuncture text, the Nei Jing into English. Dr. Hammer is a psychiatrist who studied with the legendary Chinese pulse master, John HF Shen.  He has  developed an innovative model of contemporary pulse diagnosis and founded his own school of Chinese Medicine.

 

The Passive-Supporters

The majority of doctors, the ones in the passive-support position will not suggest acupuncture to you up front.  However, in my experience, if you suggest to them you would like to try acupuncture, they will then promptly come on board with at least some degree of support for you trying that option.  Even within this category, there are some subtle differences worth recognising.  Some will at least with some enthusiasm declare that they think acupuncture is a “good idea” if you suggest it.  Others, in a barely minimal step over the line from being rejectionist, will declare something like, “well, it can’t hurt”.  Depending on their tone and gesture, this may actually be a passive aggressive version of the rejection posture (I’ve certainly encountered that myself).

 

The Rejectionists

And then there are the rejectionists.  They see acupuncture as nothing but quackery practiced by fraudulent charlatans (which is not to say versions of that don’t exist in the world of acupuncture or alternative medicine!  They do.  And they also exist in the world of mainstream medicine).  Should you let a doctor holding the rejectionist posture know you are thinking about receiving acupuncture or are already receiving it, you will likely meet some form of demonstrable rejection about your choice.  It may be in the form of a mild or sarcastic rebuke or it may even get quite bitter, hostile and strident.  This category of physicians often represent themselves as ‘Skeptics’ and may even be bold enough to congregate under the banner of ‘Science-Based Medicine’ (a bold assertion that I would argue represents a fundamental confusion about precisely what science is).  Harriet Hall MD at sciencebasedmedicine.org  is a good example of a medical doctor in this category.  She is very strident, gives talks on the subject and writes prolifically on the subject.

The ‘bottom-line’ is simple.  It’s your body.  You are the chooser.  The rest of us are here to help you achieve your goals (which should include opening your awareness to options you may not realise you have).  So be informed, be in the driver’s seat and be aware of the three distinct relationships (and the more subtle distinctions) your Doctor may have to acupuncture –

-Enthusiast
Fully Embracing Enthusiast
Limited Enthusiast

-Passive Supporter
Supportive Passive Supporter
Passive Aggressive Passive Supporter

-Rejectionist
Passive Aggressive Rejectionist
Strident Rejectionist

 

The Big Picture – Whats Going On?

You may wonder . . . how is it possible that medical doctors who have all been through more or less the same schooling in the modern scientific medical paradigm can present to the world on the one hand , Ed Neal’s fully embracing enthusiasm for acupuncture and on the other hand, Harriet Hall’s strident rejection of acupuncture – and every possible position between those two postures?  It really is a fascinating question.  And a discussion MUCH too big to have here.  Behind the distinctions I have made for you above, there is an emerging story about the present state of science – of which medical science is a part.

The present model of science on which modern medicine rests is truly in a state of crisis.  And crisis always involves friction.  People take all kinds of positions.  Some people tend towards holding on more and more tenaciously to what they already know.  And others get excited about the new unknowns that are being revealed with a willingness to explore them.  Interestingly, it is the very spirit of true science to be curious and inquisitive.  But when it gets a little too close to home, otherwise curious scientific minds can shut down.  What is emerging at this time is that the very way in which science currently investigates things is what is in need of investigation.  Science is in need of investigating itself!

This is abundantly evident in the particular case of acupuncture, as it faces the current orthodoxy of what is called ‘Evidence Based Medicine’ or EBM.  I see evidence every single day in my clinic – stunning evidence – that the channels of acupuncture exist, that many of the phenomena of Chinese Medicine are real and that what I do is effective far beyond mere placebo.  Yet, the frameworks for gathering evidence that modern science has created seem surprisingly blind to what I witness daily in my clinic.  There are two possible responses to that.  Either I and my patients are deluded.  Or, the way in which science gathers evidence has serious in-built blind spots that need to be investigated and remedied.  People like Harriet Hall MD would likely argue the former.  People like Ed Neal MD and Leon Hammer MD would likely argue the latter.

The bigger crisis in science that is beginning to emerge goes way beyond the world of acupuncture.  One recent episode demonstrates how touchy things get when orthodoxies and dogmas get challenged; the ‘Sheldrake TED Talk affair’.

TED Talks is a well known non-profit organisation devoted to “Ideas Worth Spreading”.  Rupert Sheldrake is a Cambridge and Harvard University trained scientist with impressive credentials.  He has dedicated decades of his professional life to challenging many of the dogmas and pillars on which modern science is built.  His recent book, Science Set Free  is a good read if you are interested.  His recent TED Talk  was taken down from the TED site when its science advisory board (which includes some strident Skeptics) insisted it be removed.  The folks at TED Talks caved.  This became a huge controversy and generated tremendous levels of discussion and Internet chatter about Science, Skepticism and the process of challenging dogma.

The irony here is that the TED organisation is allegedly devoted to the promotion of ‘new ideas’.  Sheldrake really is among those at the forefront of challenging science to critically examine it’s very core beliefs.  What ensued from Sheldrake’s talk was a clear demonstration of just how ossified even organisations working under the pretense of leading edge innovative thinking can be when truly provocative but credible challenges are issued.

At this time in history, it’s really not surprising at all that doctors span the full spectrum of relationship to acupuncture, from enthusiast to passive support to outright rejection.  This is simply a reflection of the dynamic and changing state of our culture and it’s relationship to science and medicine.  It’s an exciting time to be involved in all of it.  Where medicine, science and culture will be several decades from now is hard to predict.  There are many forces at play, some with strong interests and rigid dogmas to protect, others with an open and available interest in taking things constructively forward.  Also at play, of course, is a very complex and quite distorted distribution of money, power and influence.  As a patient, you are no less an important player in how things unfold and what emerges than anyone else.  The choices you make not only impact your health.  They also profoundly influence all those around you.  Educate yourself on all of your options and be fully awake to the perspective of everyone you talk to, including your doctor.