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Specialties: A Not-So-Quiet Storm

I read with great interest and mounting passion Will Morris' article on specialization and the proximal ad by the American Board of Oriental Reproductive Medicine (ABORM) in the November 2007 issue of Acupuncture Today.

I agree with all of what Will said and much of what ABORM said. However, this is not the simple yin/yang issue that ABORM tried to make it. I take issue with the ABORM repeatedly referring to the previous month's ad as being from "the opposition." Just as ABORM is only one of several specialty boards, there may also be different sources of opposition to its agenda. Addressing all the various opponents of its agenda as a single monolith is inaccurate, manipulative and counter-productive to the necessary community dialogue.

I agree with many of ABORM's observations - for instance, I agree with its ad that we are in a similar place as was the American Medical Association, et al., in 1933. However, I don't agree with the assumptions and conclusions that ABORM bases on these observations. In response to the pressure exerted by "four pioneering specialty boards," the AMA and its associates embraced specialization in 1933 "to establish minimum standards of competency in [name your specialty]." However, one person's pioneer is another's profiteer. Seventy-five years after bowing to pressure, allopathic medicine is awash in plastic surgeons, dermatologists and fertility experts, while general practitioners are a dying breed. Is this really the example we want to follow?

I also take exception to ABORM's rhetorical devices. It wants to establish specialty boards "in order to prevent the establishment of enforced treatment protocols based upon Western research models?" Please. When has this been done to our profession? When are "enforced treatment protocols" ever likely to be imposed by an outside party? ABORM then goes on to state proudly that the two existing Oriental medicine specialty boards have "not resulted in centralized protocols." As if that's a triumph? With allies like these, who needs adversaries?

As for ABORM's disingenuous wondering if specialization will cause damage to the profession, I would say that its advertisement is proof of the damage that is occurring right now. The ad is all mind - no body (unless by "body" we mean "money") and no spirit whatsoever. I was taught that helping to bring another spirit into the world is a serious undertaking, fraught with karmic implications, not simply a matter of "three years of content development" and "the guidance of colleagues from the American College of Obstetricians and Gynecologists [ACOG]." Perhaps specialists with mind-first approaches should petition the AMA for inclusion in the ranks of their specialty boards as Acupuncture Technicians. There they can toil away at acupuncture that releases endorphins, stimulates prostaglandins and releases corticosteroids, while the rest of us monkey around with qi, blood and essence.

ABORM may be correct in the conclusion that our profession needs to take proactive steps to prevent being taken over by Western pirates, but there is no joy in that knowledge and little love in their agenda-driven insistence that this is one of the "conversations that we, the TCM community, must have." I certainly don't share their certainty that all our threats come from the outside.

Trey Casimir MS, LAc
Via e-mail