Is Health Care Against Society?

I ran into an old friend at the grocery store a couple days ago. We greeted each other warmly, after not seeing each other for several years. Matt is a medical doctor, specifically a radiologist, who was one of few medical professionals in our small rural California town to accept my efforts practicing Chinese medicine fifteen years ago. At that time, we bonded over our deep concern for the well-being of patients and our scornful opinions concerning the practice of medicine.

Yet, Matt and I were going in different directions. He was pretty cynical about many of his local colleagues, and how they used (and mis-used!) the very expensive technology at the core of his specialty. I learned a lot from him about both the strengths and limitations of medical imaging as part of my specialized training in “acupuncture orthopedics,” and I was searching for an entirely different conceptual framework for practicing health care. We drifted apart as the stresses of our respective lives consumed our attention, even though our souls knew we were “brothers” in our quest to improve American health care.

The focus of Matt’s rapier wit has shifted from local to global. He now believes there are severe systemic flaws in American health care, and declares that only a complete transformation of financial incentives can repair the system. Matt shared his perception that:

The current fee-for-service health care system renders patients into fodder to generate fees (and hence INCOME) for providers

Matt strongly expressed his conviction that our health care system can only be repaired by adopting a national program like the one in Great Britain. His twenty-five years practicing medicine has convinced him that the health care system must be designed with patient welfare at its center! I heartily agree with that perception.

While I may identify different specifics and remedies, Matt and I agree on many aspects of our societal challenges with health. I concur that our health care system suffers because of some very warped incentives, and believe lasting effective remedies must address them. Twenty years ago the “money people” devised “managed care,” which was supposed to squeeze the inefficiencies out of our health care system. Yet, that industry now soaks up more than 17% of GNP, and our health outcomes are poor relative to other industrialized nations, especially when measuring health span. Maybe we can start with several principles:

  1. We must find ways to put patients back at the center of health care, especially identifying specific life changes they can cultivate to promote healing
  2. We must line up incentives throughout the entire economy to support health
  3. Modern (western) medicine doesn’t have a monopoly on wisdom about health — a free marketplace of ideas will optimize our solutions

We can find solutions for our health care crisis!

I told Matt about my blogging concerning health care policy; he shared his small website to spread his philosophy. I suppose he got disheartened or busy with other things, because he hasn’t continued writing new pieces for that site. Matt seemed inspired by the idea of blogging, and I hope he gets invigorated to share his experience and insights about our profound societal health care challenges. While our voices and messages are rather different, I believe that a mélange of caring and concerned health care practitioners will identify the important principles for resolving our health care challenges.

Sometimes, the darnedest things happen at the supermarket!


Are they Divergent Channels or Channel Divergences?

I say potāto and you say potäto… Does any of it really matter?

I talked with Andy Ellis a few days ago, who brought to me the question posed in the title of this posting. He mentioned that according to Chinese syntax and usage, the translated name should be “channel divergences,” rather than the commonly used “divergent channels.” Initially, I didn’t see the significance of that distinction, but within a few days decided to change the translation I use to reflect more closely the original Chinese syntax.

Does this change of syntax have any significance on how we understand and use these terms? I think it does, and understanding how leads into considering of the roles of the “primary” and “secondary” vessels of acupuncture. The primary channels regulate the moment-to-moment physiological process of the embodied spirit, and the “secondary” vessels (as they are sometimes called) work in various ways that support the primary channels in doing that. They are NOT LESS IMPORTANT than the “primary channels,” but “secondary” because they support the primary channels in maintaining life.

The channels distinctions and divergences facilitate the primary channels in two important and related ways:

As “distinctions,” they contain the individual’s learned interpretations and automatic patterns of activation and reaction that allow individuals to engage an increasing number and complexity of interactions. They project those interpretations and “pre-dispositions” onto all experience, which facilitates the person’s movement as an individual through life. The channel distinctions (along with the sanjiao mechanism) individuate the person’s implementations of the universal movements of the primary channels. They also make what Zen Buddhist practitioners call “beginner’s mind” so difficult to achieve!

As “divergences,” they absorb unresolved pathogenic factors, and provide the embodied spirit a place to suspend them in “dormancy.” This process allows individuals to “go on” to engage new experiences and opportunities in life, even when previous experiences have not been processed to resolution. However, these unresolved pathogenic factors accumulate and may fester; eventually, they exceed the embodied spirit’s capacity to contain them and they emerge as progressive or degenerative disease.

Indeed. some consider these “secondary” vessels MORE IMPORTANT than the primary channels . At the beginning of Book II of his Systematic Classic of Acupuncture and Moxibustion (Jiayijing), Huang Fumi (215-82) asserted:

The twelve channels are responsible for life in humans and the development of illness. They concern the origins and treatment of a person’s illness. They must be studied by the beginner and yet provide the skilled (practitioner) with limitations (they cannot exceed). The mediocre (practitioner) finds them easy, while the superior one finds them difficult.
The Yellow Emperor asked: What are the separations (bie — divergences and distinctions) and anastomoses, the exits and entrances (of the channels)?
Qi Bo responded: These (topics) are neglected by the mediocre, while the superior practitioner is familiar with them. Please allow me to inform you about them: [He then delineates the Six Confluences of the channel divergences and distinctions (jingbie)!]

Translation by Charles Chase and Yang Shouzhong (pg. 95-6)

The channels distinctions and divergences are centrally important in how they serve and support the primary channels. Their name in Chinese (jingbie) indicates that relationship; perhaps we should use a translation into English that conveys that meaning.