The 800-pound Gorilla, or Why I’m Mean to Acupuncturists, Part 2

Alert — and irritated — readers noted this recent entry by Bob Flaws on the Blue Poppy blog. When I first read it, I thought that I would be irritated as well. Instead, however, I was full of gratitude. I’m not being sarcastic, I was. The blog, the Facebook conversation it’s based on, and the first reader comment on the Blue Poppy site, if you consider them as a unit, are a thing of beauty, an encapsulation and illumination of an entire set of acupuncturist attitudes that I am constantly trying, and failing, to describe. And now here they are, all in one place. Right before I have to teach a workshop. 

What makes it even better is that I agree wholeheartedly with Bob that acupuncture theory doesn’t matter that much. No matter what points you choose, no matter what method of pulse diagnosis you use, no matter how you needle, the results are pretty comparable.  And I *also* think that there is an 800-pound gorilla in the room.

Different gorilla, though.

So this is what I want to do. Let’s pretend this is a workshop, and we’re going to discuss and dissect this blog post together. Looking at the blog, the FB conversation, and the first reader comment, I counted 10 separate glaring examples of either classism or acupuncturist-centric thinking. Any one of them, all by itself, will doom a community acupuncture clinic to failure — heck, they probably contribute to the failure rate for acupuncturists in general. I want you to list them. Everybody who identifies one of the 10 gets a gold star! If you identify one that I missed, you get 2 gold stars! Go!

Edit: I don’t seem to be able to count gold stars…I’ve been giving one star for each noted example of classist or practitioner-centric thinking, whether I missed it or not. Sorry about that, comrades. Please multiply accordingly.

Also, once the commenting has run its course, I’ll make a comprehensive list.

lisafer
Author: lisafer

Related Articles

Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.

Responses

  1. the one that really caught my eye

    is from the comment on the blog:

    “What was more interesting was that my colleague felt relieved to be rid
    of the community clinic sessions, preferring the one-on-one sessions
    himself. He felt like he could relax, do better work, interact with the
    patient etc. While he had done the math and discovered that a community
    model could actually be much more lucrative financially (I have run a
    number of spreadsheets/business models on this myself and, while
    counter-intuitive, the “community” model will actually make you more
    money) his job satisfaction was so much better that he just didn’t care.”

    HE preferred the one-on-one session because HE felt he could relax and so HE DID NOT CARE. pretty much leaves the whole patient access out of the picture. scary.

    c’mon teach, i want my gold star now 😉

    -tatyana

  2. Bob writes:

    “Acupuncture is a multi-factorial exchange between two human beings within a particular environment, only part of which involves sticking needles into the body. Other factors include…everything else about the physical…environment in which this exchange takes place. To categorically list all these factors is simply impossible. Nevertheless, they certainly include everything the patient experiences from the moment they decide to make contact with a particular practitioner, for instance, how the initial phone (or other) contact is handled/answered, the location of the clinic, its name, its decor, colors, lighting, reputation within the community, the way the practitioner is dressed and groomed, etc., etc., etc.”

    You bet your ass those factors matter! 

    I want to look at the physical issues: location, decor, colors, lighting, and the practitioner’s dress/grooming.

    Let’s pretend you’re an auto mechanic who just finished work.  You’re hungry.  You’re wearing your shop clothes, stained with sweat and grease.  There are two restaurants in town for you to choose from: the five star diner and the greasy spoon. 

    The 5-star diner is located across town from where you work.  When you walk in, you notice the  maître d’ grab a sport jacket and hold it out to you (b/c you’re not dressed appropriately), inquiring if you’d like to eat there.  The lighting is soft, music is elegant, and staff are dressed to the hilt.

    You drive back across town to the the greasy spoon which is right across the street from your auto-shop.  You notice truckers, young families, high school sweethearts, and an aging couple spread throughout the joint.  The lighting is a little dingy, the booths are scuffed-up, there is laughter in the air, and the wait staff are wearing clean but unremarkable clothes.

    Where would you feel most comfortable?

    Assuming that everyone wants the elegant, five-star-experience ignores the preferences of all those who are more comfortable in a greasy spoon.  It makes them invisible.

    That’s one aspect of classism.

    (Can I have a chocolate star, please?)

  3. I followed the Facebook

    I followed the Facebook thread a little. Bob said
    the question of price, for him, is moot because he hasn’t practiced in
    so many years. Then he said he only treats buddhists nuns and llamas
    for free. So while it seems that pricing is moot, the bigger question
    of who one choses to treat is alive and well for old Bob. Only the
    purest of the spiritually pure for him.

    If acupuncture tequniques all work as well as the next, then the only reason to suggest that community acupuncture treatments are less effective is because of WHO IS RECEIVING THEM or WHO IS GIVING THEM. As in, this medicine is inherently wasted on the working class, another way to say this isn’t for you or your scruffy practitioners.

    AND, does he really think CANners don’t put thought into “bedside manner”, relationships, overall clinical experience? It will require a paradigm shift to see that we deliberately choose to improve the clinical experience outside of actual treatment in such different ways because we want to treat (and spend all day with) such different people. Totally missing the classist and alienating messages we’ve been taught by the profession to broadcast and the work it takes to recognize and remove them….SO PEOPLE CAN GET BETTER. Different people.

    Kelly

  4. The spin

    Almost everything Bob says can actually be pro Community Acupuncture Practitioners (CAP) and against Standard Acupuncture Practitioners (SAP). Just needs a slightly different spin.

    Needling only accounts for a small portion of the effect: well yeah, that’s why we aim to create a comfortable and friendly environment. I let my clients create their own, ugh “healing space” themselves, not force them to accept my own. The good old NADA group Qi effect plays a huge role in the healing, probably even more than the needles, since seeds seem to work nearly as well.

    It certainly looks like our role, both as an organisation and as individual practitioners is still on education. Educating our patients is pretty easy, either they like us or they don’t – I’ve had patients who didn’t return because they didn’t like it so much as a SAP, a CAP and even still with my NADA practice. If people don’t come back, I can blame them for not seeing how this is better, I can blame myself for not reaching out hard enough, or I can let it slide and do my best for the folk who show up.

    Educating other practitioners is the much harder job especially if we spend a lot of time and energy mocking them. I’m hoping to get my practice large enough that I could get them all working for me one day, and I don’t want to piss of my future employees!

    Also, 800 pounds sounds like a pretty big gorilla, I thought they usually weighed under 200 kilos. Still pretty big tho.

  5. Oooo, Oooo, pick me ….

    The assumption is that the patient -has- a choice, that the only question is what they prefer given many available options.

    Not classism, but still worth pointing out — 1/3 the benefit at 1/4 the price still makes good economic sense.

  6. Two Gold Stars for Kelly!

    1 for point #1 on my list: that the post is based on the assumption that community acupuncture is just sticking needles in to people — as opposed to recognizing that yes, all the other physical and environmental factors are just as important in community acupuncture as they are in conventional acupuncture. They’re not ABSENT, they’re DIFFERENT. Assuming they’re absent is some monumental classism.

    And 1 for catching the spiritual purity aspect of the FB conversation, I missed that one.

  7. Yes, a gold star for Tatyana! With bonus points!

    Gold star for noting the part where the world revolves around what the practitioner wants to do — and bonus points for highlighting “he did not care”. There’s so, so much this dude does not care about.

  8. Two things

    First, Bob gives this guy a platform to spew his ill-formed math equation, 3 CA txs = 1 BA tx. 

    But that’s nothing as Bob then, wait for it! TAKES THIS JERK SERIOUSLY by saying, and I quote,

    “However, if it is, indeed, true, then sticking needles in acupoints accounts for only 1/3 of the effects of acupuncture. ”

    Words are failing me about how pompous Bob is, thinking that he actually has a say in how Acupuncture is developing in this country and how much he has lost touch with the medicine. His lazy New-Age speak once again shows how little compassion he actually has, matched exactly by his outsized ego. 

  9. Gold star for Keith!

    I missed the “so-called community acupuncture” and the derisive implications. You also get a kiss, for the mad passionate love.

  10. You know, even if I weren’t

    You know, even if I weren’t in acupuncture school, even if I weren’t connected to this community, if I had just read that blog entry by Mr. Flaws I would still be offended by the dripping condecension of his tone.  The problem with his argument (aside from the tone) is that it’s all about self-fulfilling prophecy –  seeing what one wants to see,  I believe my way is better so that is all I see.  That kind of myopia is the basis for the debunking of Freud’s entire body of “work”.  I don’t understand how this isn’t perfectly obvious to someone of Mr. Flaws’, ahem, stature.

  11. A Gold Star for Elaine!

    For getting #7 on my list, the laughable idea that patients can indeed “vote with their dollar”, when one of the options to vote for requires more dollars than they actually have. And yes, that IS classism, most definitely.

  12. Just some thoughts

    Boulder, as a city, is a beautiful geographic location, but it’s not a realistic snapshot of today’s society. There are few working class people who actually live in the city limits. Community clinics in the surrounding areas would make sense since that’s where the working class people actually live. Underlying factors of ‘who’ makes up the population can drastically change the message being presented. Similar to being in school vs. being in practice.

  13. Gold Star for KimDC! With bonus points!

    I missed the self-fulfilling prophecy aspect. Bonus points for “dripping condescension”! This is how classism plays out in a lot of hybrids; practitioners think that the one on one sessions are better, patients pick up on it, and later, the practitioners claim that the patients “voted with their dollar”.

  14. Two Scruffy and Delicious Chocolate Stars for Jessica!

    1 for point #1 (as noted to Kelly below): that the post is based on the assumption that
    community acupuncture is just sticking needles in to people — as
    opposed to recognizing that yes, all the other physical and
    environmental factors are just as important in community acupuncture as
    they are in conventional acupuncture. They’re not ABSENT, they’re
    DIFFERENT. Assuming they’re absent is some monumental classism.

    Bonus points for spelling out what they might look like in working class context.

    1 for point #9 on my list. Granted, Bob wrote that it isn’t possible to categorize all the physical and environmental factors that contribute to good clinical results. But he made a list of factors anyway, and somehow all of them referred to the clinic’s image and the impression it makes, and none of them had anything to do with accessibility. Lighting and grooming make the list, but hours don’t? Fees don’t? 

  15. maybe, just maybe,

    Flaws meant that that practitioner is only practicing “so-called” community acupuncture because he’s doing the hybrid dance?  Maybe?

  16. Oh yeah,

    I knew that not realizing that some people don’t have options is classist.  It was my line that, even with options, the less expensive option might be the best value that I thought was sensible economics rather than a classism issue….

  17. Woo! Gold stars!

    Can’t resist the temptation of gold stars. 😉

    “This could be seen as a commentary on the Boulder demographic, where acupuncture has been commonplace for decades – however, Malia and I found this to be true for us as well when we were living in the Midwest and were the only game in town.”

    Wait wait….he’s drawing a gross generalization from this one acupuncturist who run a “community style” on the side that they’re really not into. You know your patients can tell if you’re really not into them.

    And I am living in the Midwest and the only game in town, and if he can generalize from places where there’s lots of acupuncture to his only game in town in the Midwest with all the CAN clinics succeeding we can generalize to the whole universe!

    (Patient) coming back to post more later…

    acupuncturewinona.com

  18. 800 pound misunderstandings

    Hi Lisa and Everyone else at CAN,

    Whoa nellie…what a tempest. I would, in defense of my husband and business partner, just like to say that it is possible to read Bob’s blog without reading into it anything elitist, sexist, classist, or having any political implication or denigration of anyone or anyone’s style AT ALL.
    Please remember that Bob is a man who, several years ago, in the earliest stages of the CA movement, came out greatly in favor of CA, in public and in print! And more than once! In this blog, he was commenting on another practitioner’s remarks as a way to open a discussion about the complexity of the clinical exchange, the mystery of it if you will, and about what we think we are doing when we do acupuncture, about how placebo affect has an impact on what we ALL do, whatever type of style or practice we have. Bob is not trying to doom anyone or denigrate ANY style of practice. Everyone needs to soften around the edges here a little bit.

    I am amazed and astounded. And PLEASE, before you begin to attack me for supporting him, remember that I, too, have come out in favor and support of the CA in public, in print, and regularly. I teach about it and suggest it as a viable and useful practice model for my students all the time, year after year. I will not list my personal middle class or working class bona fides, which are just fine with me and just fine with my middle class, hard-working husband.

    I am truly sorry that anything on the Blue Poppy blog has made anyone so unhappy and upset, but I agree with Bob that it is not a bad thing to look deeply at what we do and try to understand how to help our patients get better, with needles and by every other means possible, which was, in fact, the point of his blog.

    All good things to everyone,
    Honora Lee Wolfe

  19. then read the post with the eye of someone

    who is paying attention to what is being said Honora.  Because as someone posted earlier, it is indeed “dripping with condescension.”

  20. more about Boulder

    I do.  I used to be one of those working class folks living in Boulder.  There is a whole service economy that drives in, past the lovely open space, to make sandwiches and pull lattes for the folks that live in Boulder.  They live in the “L” suburbs (Lafayette, Louisville, Longmont), or way up in the canyons.  The environmentally conscious people of Boulder hate that people drive, but the structure of the town (limits on building height to preserve views of the mountains, a growth boundary of open space around the town) have kept housing costs high, to the benefit of the owning class.

    There’s this old story about the KKK staging a rally on the Pearl Street Mall in downtown Boulder that Ward Churchill told me.  All the supposedly liberal Boulder types showed up to protest, of course.  The KKK speaker says to them that he doesn’t know why they’re protesting him, that they’ve already created what looks like the promised land to him.

    Boulder is a town of upper class values, obsessed with appearance and the politics of aesthetics.  It’s a lovely place to play if you can afford to live there.

  21. trying for a star now…

    Ok… notice how he qualifies the CA sessions with “short, repetitive,” but not the BA sessions?  Is that because people can afford to repeat a CA session?

    Also, he considers diet and lifestyle counseling to be “more,” while those seem to be kinda detrimental for a lot of folks who just want acupuncture.  Especially if you only have an hour to cram everything in.

    Which leads me to point out that a CA session is “short” (which it is, if seen from the acupuncturist’s perspective) while a BA treatment is an hour, but if you actually clock needle time between the two, this is backwards.

    “A practitioner may be effective because they are famous” So if theory doesn’t make a difference (something we’ve noted here before), then what makes a difference is obviously everything to do with the practictioner.  Not how often a patient can get in, not the fact that healing can happen with friends, family, and local strangers, not group qi… but just the simple fact that a practitioner has some fame can just automagically get that star-struck patient to heal!

     

  22. Honora, I hear what you’re saying,

    and I read Bob’s subsequent blog post about ruffled feathers, but — and I’m not attacking you or Bob — what you wrote just doesn’t make sense in the context of the original post.

    After describing the testimony of the other practitioner, Bob writes, “… it has to be taken with a grain of salt. However, if it is,
    indeed, true, then sticking needles in acupoints accounts for only 1/3
    of the effects of acupuncture…In fact, I have been saying this for years.” That’s where I get what you’re saying about the placebo effect, right?

    But here is the thing: to arrive at that figure of 1/3, which Bob says he believes, the only way to do the calculation is if you take what the other practitioner wrote, that there’s a three-to-one effectiveness ratio between one-on-one acupuncture and community acupuncture. Otherwise, why include the testimony of the other practitioner in the first place? And, if you are using that ratio to talk about placebo, as Bob is doing, he has calculated that all the placebo is happening in the one-on-one setting. Far from being a discussion of how placebo matters everywhere, as you claim, the original post uses what we do in community acupuncture to represent the control group, the one without placebo. The control group that is defined as “just sticking needles in”.  Bob reiterates the ratio later when he says, “If the practitioner who responded to Juliette’s Facebook
    question is correct, all these other things are twice as
    important as the simple act of choosing points and inserting and
    manipulating needles.”

    The post you are describing, about the mystery of the clinical exchange, sounds lovely, but that is not the post that Bob wrote. He wrote about a ratio, and he invited a frank discussion. We are all smart people here, and to suggest that we completely misread it and that you are amazed and astounded at how we are overreacting is kind of insulting. If the post really is about the healing encounter, and “everything else about the physical and emotional environment in
    which this exchange takes place.”,
    Bob is making his point after defining community acupuncture as lacking all the important aspects of the physical and emotional environment. Otherwise, the first two paragraphs wouldn’t be there at all.

    I remember very well the earlier Blue Poppy post which was very supportive of community acupuncture. But please consider why I am writing this post at all. People come here because they want to learn about community acupuncture, and a lot of them intend to practice it. Certain unexamined attitudes within a practitioner will virtually ensure that their community acupuncture practice will fail. Unfortunately, lots of practitioners with these attitudes don’t just endorse or support community acupuncture, they like the idea so much that they are contemplating sinking thousands of dollars and years of their lives into it. Usually they don’t realize that they are thinking thoughts that will doom their practice, because the thoughts seem subtle until they are identified and worked through. Bob’s post is like a goldmine of these thoughts, and I pounced on a teachable moment, hoping to save some people some serious grief down the line. It’s even more teachable because Bob has supported community acupuncture in the past on the very same blog.

  23. not one but three gold stars for you, Whitsitt!

    You nabbed three of the things on my list:

    #2, the assumption that everyone wants diet and lifestyle counseling, and even more importantly, that any given acupuncturist is culturally competent to provide it. At WCA, we have patients who are vegan Hare Krishnas, Orthodox Jews, fundamentalist Christians, and a couple who I’m thinking must be Muslim because they come to acupuncture wearing full burqas. Automatic diet and lifestyle counseling? Bad, bad idea.

    #3, the complete erasing of whether or not the person can afford the treatment as the most important factor in the clinical efficacy;

    and #6, the framing of the acupuncture treatment itself completely from the practitioner’s point of view rather than the patient’s. I was thinking of the quote that assumes the practitioner “puts in train” the healing response by manipulating the needles (while the patient just lies there and thinks of England?), while you identified the backwards time calculation.

    Very nice. 

  24. Two Gold Stars to Clayton!

    1 for noting that, amazingly enough, the patients are actually capable of creating the “healing environment” themselves. (This is similar to #6 of my list, which no one has yet gotten.)

    And 2 for noting yet another forgotten 800 pound gorilla, which is the group qi effect. Anyone who doesn’t think it’s an 800 pound gorilla has never had it knock them on their ass, and let me tell you, you are missing something.

  25. Another comment for Bob’s blog, awaiting modding:

    I’m still waiting to hear from hybrid clinic folks for whom Community Acupuncture worked better; I’m not sure if I know any, though I do know many CANers that converted to CA and feel blessed to have done so (many of them are so busy they are now hiring).  
    For me, the take-home message here is: if Community Acupuncture is what you really want to do, do it full time with your whole heart.  And if you don’t REALLY want to do it, please don’t.  It will not work for you or your patients or your neighborhood.  
    If you are not sure, if you are still in school and this is the first you’ve heard of it, get a treatment at a CA clinic or three (one where Community Acupuncture is ALL they do), and see how you feel there, AS A PATIENT.  And if it feels great, jump in with both feet; there are lots of towns where we wish there were good CA clinics to refer people to, and there is lots of support to be had on CAN.  But please: don’t just dip your toes in, don’t use 2 hours a week “happy hour” “community acupuncture” as your loss leader for your “real” services, don’t think if you’re not doing rice grain moxa you’re cheating your patients (you can easily teach patients cupping, moxa & gua sha to do at home, btw).  If you’re hedging your bets, if you’re doing CA out of anything other than love, your patients will feel it.  You will probably get poor clinical results, and/or you will be tired after shifts and get burned out, and you will most likely fail. 

  26. By my unofficial count,

    By my unofficial count, we’ve seen #1, 2, 3, 6, 7, and 9 from your list, as well as a host of extras. When can we see the list, teach?

    This is definitely, for me, turning into that teaching moment you mentioned. I am going back and re-reading everything and my reactions after nearly every post.
    MM

  27. When people say CAN needs to

    When people say CAN needs to “soften” they are focusing on individual posts, and missing the point of what CAN is really about, and usually missing the point of what the angry post is about.  Anyone who reads these blogs, and the member forums as a whole will see that when someone asks a genuine question, or shows a real curiosity about what we do, CAN members will go out of their way to be helpful, they are often kind and extremely supportive.  Some posts are angry, that’s because there are things in the world to be angry about, CAN doesn’t shy away from those things, this group is filled with real people who are constantly questioning the status quo, anger is going to come up, but so is compassion.  I suggest to people who think CAN is too angry, keep reading, you might be surprised at what comes up.

  28. Yes I appreciate all that,

    Yes I appreciate all that, but I’m not asking generally, I’m specifically asking Honora (I replied directly to her response) since she was the one who told us this was necessary. 

  29. On my computer the newest

    On my computer the newest posts just show up on top, her post is way down from yours.  I didn’t know you were replying directly to her or I wouldn’t have used “soften” it’s too late to edit, unfortunately.  My post was to no one in particular about the general anger complaint.

    Are the posts supposed to appear that way?  I have mac so some things tend to be different for me, it drives me crazy. 

  30. Wall o’ text time

    A couple of thoughts keep occuring to me as I read through all these wonderful threads about CAN anger and all the impolite questions we ask and the inconvenient observations we point out.

     

    First, when you are rationally and reasonably upset about things like inequality and privilege, it is a time-honored, old-as-the-hills silencing technique for someone with privilege to tell you to calm down, chill out, be-nice-and-maybe-then-I’ll-pay-attention-to-you.  Whether the person saying it consciously INTENDS to use it as a
    silencing technique or not doesn’t really matter, because at the end of
    the day that’s still what it is.  And that’s why it’s so infuriating–it feels like silencing and the intent is really immaterial to that.  More on that in a bit.

     

    The thing is, when we do back down and try to make nice, we get ignored, as Lisa and others have pointed out numerous times on these boards.  Partly because people saying “Calm down! Maybe if you weren’t so strident we might listen to you more!” have no intention of taking us seriously or treating us as equals, partly because they would rather we just shut up and quit threatening their unearned privilege. Ah, privilege.  It’s comfy, useful as hell, and makes a great insulator, but it comes at a cost.  To the extent one can pretend that it doesn’t and zie is just neutral and apolitical about all of this, that is the exent to which zie has privilege.  Or, as the inimitable Howard Zinn put it, you can’t be neutral on a moving train.

     

    Casting us as bitter, angry cranks is also a way for those in the acu establishment to cast themselves as the rational, reasonable side who is just trying magnanimously to have a productive conversation, and we ill-behaved CANners are the reason that can’t happen.   The thing is, we ARE the ones being rational here.  Yes we are angry, but you know what?  That is a perfectly reasonable response to the social and economic landscape in which we live, not to mention to the continued willful ignorance (or outright denial) of those protecting their interest in the status quo. 

     

    You see this in how the status quo deals with social justice movements all the time, and it is exactly backwards.  We can’t have the honest, productive conversation that needs to happen when those with privilege refuse to acknowledge or examine it.  And like Lisa says, it’s not a fun or easy process, that.  It is painful and often feels overwhelming, and it takes time to disabuse yourself of racist, classist, ableist, etc. ways of thinking (ask me how I know–I’ve been there, I’m there still, but I’m so much better than I used to be, and I wouldn’t go back for anything).  But that doesn’t make the process any less necessary.

     

    As for intent, maybe a person didn’t mean that classist remark in classist or condescending way, but THAT STILL DOESN’T MAKE IT NOT CLASSIST (or racist or whatever) even when all zie sincerely wants is for everyone to hold hands and sing We Are the World.  If that someone is you, when someone calls you on it, you deserve to be called on it–that is fair play, and it is a perfectly fine thing to then honestly consider that you may have in fact stepped in it, and just take responsibility for that already!   Simply being called out on your bias DOES NOT equal being attacked or insulted, nor does someone questioning the fuzzy, feel-good ideology underpinning BA-style acupuncture with more incisive observations or demands for clarity, and I really can’t emphasize that enough.  If it did, we really WOULD never get anywhere.

     

    Much love,

    Laura

  31. To add to what Nora wrote

    to those who think they want to practice CA, become a CAN member. Read CA 101 on this site (covers all the basics), then read the rest of the forums. Read the Noodles book by Lisa R. Then ask yourself why you want to practice CA. If it’s because you want to provide affordable, accessible acup. to as many people in your community as possible, then go ahead and do it. If that’s not the reason, then don’t practice CA.

  32. Oh Jeez, I figured it out,

    Oh Jeez, I figured it out, my computer was set to flat list instead of threaded, I always thought we just had a weird forum.  Eek, bad me, it really does read like I was trying to hijack your question.

     

  33. ahhh chocolate..

    I am a little out of the loop these days with everyone, but I did read Bob’s blog and have been pondering all the ridiculous things that were said…

    When he talks about lighting, decor, etc..that irritated me the most I think…yeah, someone with a migraine or back pain needs fancy decor to make them feel better…

    I just wanted to make one small analogy and then I will be on my way…if you stay in a fancy hotel and they turn down your comfy bed and put chocolate on your pillow, does that really make you sleep any better than being in a comfy bed at Quality Inn? 

     

  34. Bob Flaws’ follow-up post,

    in which he addresses none of the concerns detailed in this blog: https://www.bluepoppy.com/blog/blogs/blog1.php/2010/05/18/feathers-ruffled-by-yesterday-s-blog

    The problem is, when you think something is “all you are saying,” there’s always context, and subtext.  Too bad he didn’t want to talk about the concerns raised here.  Too bad people keep talking *about* CA without talking *with* people who practice CA, and then shut down when we get annoyed by that.  

  35. bravo, laura!

    edit

    Melissa

    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.

  36. Reading too much into it?

    I’m not sure about the comments on the BluePoppy blog or the FB conversation, but I think Bob deserves a break. For one thing, in his posts he never really said anything disparaging about CA, he only quoted a comment on FB and then started riffing about how big the placebo or non-needling effect of acupuncture.

    If you look at the BluePoppy blog, you’ll see that both Bob and Honora have expressed pretty full-on support for CA, and not as a “reasonable alternative” for “those with fewer means”, but as the best way to run an acu business.

    I’ve never met Bob, but from his writings he strikes me as someone who is above all practical in his approach to TCM, both in theory, practice and business. I don’t see why he deserves criticism, when he hasn’t said anything bad about CAN!

    But please, correct me if I’m wrong…

  37. the list and its purpose

    Here, as promised, is the list I made. The purpose of making this list is to give acupunks who are interested in community acupuncture (or think they are) a way to check their thinking for attitudes that will make it difficult, if not impossible, to have a successful practice. I think I’m going to have to do a separate post with all the additions everyone else came up with, and also, a bit of commentary. For now, here’s my original list of classist and/or acupuncturist-centric attitudes in the FB conversation, the post, and the first reader comment:

    1. The post is based on the assumption that community acupuncture is just
    sticking needles in to people — as opposed to recognizing that yes, all
    the other physical and environmental factors are just as important in
    community acupuncture as they are in conventional acupuncture. They’re
    not ABSENT, they’re DIFFERENT. Assuming they’re absent is some
    monumental classism. 

    2.  The conversation referred to in the first paragraph of the post assumes that everyone wants diet and lifestyle counseling, and
    even more importantly, that any given acupuncturist is culturally
    competent to provide it. To everyone.

    3. The post completely erases the question of whether or not the person can afford the
    treatment as the most important factor in the clinical efficacy. I’d like to see the ratio for that one.

    4. Similarly, the post ignores the importance of a course of treatment. Even if it were possible for one treatment with bells and whistles to be equivalent to three bare-bones treatments, one treatment is not going to provide much lasting benefit.

    5. The post doesn’t question the idea that it’s up to the practitioner to define how much his patients are getting out of a treatment.

    6. The post frames of the acupuncture treatment itself completely from the
    practitioner’s point of view rather than the patient’s — the idea that it’s the practitioner who is stimulating the qi, and “putting in train” the healing response. (Seriously, if you believe this one, what are you doing on this website?)

    7.  The belief referenced by the first comment, that patients can indeed “vote with their dollar”, when one of the
    options to vote for requires more dollars than they actually have. Classism or magical thinking? Hard to say.

    8.  Tatyana caught this one, but I forgot to number it: the unquestioned idea that it’s all about what the practitioner wants to do.

    9. The list of physical and environmental factors that contribute to good outcomes somehow included nothing related to access; however, the image of the clinic and the impression it made figured prominently. Lighting and practitioner grooming made the list, while clinic hours and fees didn’t.

    10. The idea that practitioners could somehow offer both community acupuncture and private treatments, and their attitudes would not affect what patients chose. Actually, this is pretty much what Kim said about self-fulfilling prophecies, so I should have numbered it. You could also call it the idea that practitioners don’t have any work to do around classism, and they don’t need to examine their assumptions  — because they’re acupuncturists and so authorities on the universe, objectively speaking.