Conversations with Dilip Babu M.D., Part Two
on capitalism in healthcare and developing as an acupuncturist
Part One is here.
Dilip: As I was saying, working at WCA is a lot like waiting tables in a diner. And in terms of my prior experience training as an oncologist in a cancer center, that was like working at a Michelin-starred restaurant. It’s like the TV show “The Bear,” where he had to put up with all this trauma to be in that high-end setting.
Me: I’m seriously considering assigning “The Bear” as homework for POCA Tech students. It’s the best description of small business I’ve ever seen on TV.
Dilip: A diner isn’t better or worse than a Michelin-starred restaurant, it’s just really different. Even when it’s busy, I don’t feel stressed out or anxious when I’m working at WCA. If you’re in a Michelin-starred restaurant and someone paid $500, there’s the expectation that the experience will be transformative. WCA doesn’t burden patients or practitioners with those expectations.
To be fair, when you’re working at a cancer center the stakes can literally be life and death, so there’s a certain intensity level there. But there’s also a lot of mythology about cancer centers, which is very much encouraged by all the fantastical, sci-fi marketing they use.
Me: I remember a few years ago, there was a billboard facing I-84 and all it said was Gamma Knife. Trademarked of course, with a link to a local cancer center. I was like, what IS this? It sounds like the title of an action movie.
Dilip: All the emotional manipulation around cancer centers feels like capitalism at its worst. Which to me brings up ethical questions about marketing to desperate, vulnerable people.
Me: Those people also come to WCA, so that gets us back to trauma informed care: no pressure, no surprises.
Dilip: Which is a good thing about the diner: you know exactly what you’re getting.
I think all kinds of healthcare providers have a role. Oncologists have training to treat cancers, which obviously can do a lot of good and can even be life-saving sometimes. On the other hand, I’ve seen situations where acupuncture works remarkably well for the problem the patient comes in with – for example chemotherapy-induced neuropathy or nausea. There are even some non-cancer conditions that acupuncture can manage, for which biomedical treatments are frustratingly ineffective. I’m thinking of fibromyalgia or chronic low back pain.
Unfortunately, as much good as it can potentially do, the medical-industrial complex1 needs a massive amount of resources to do what it does. It has a huge carbon footprint2, and sometimes I wonder if the resources it consumes are disproportionate. Capitalism isn’t set up to align resources with needs. If we had a rational system we could have these different kinds of medicine and they could work together.
To be clear, I’m not saying cancer centers shouldn’t exist. Once they’re owned by private equity, though, they become predatory.3
Me: It’s just the way the system works. The neat thing about acupuncture, and also the frustration and the challenge of it — is the lack of money. So far there’s no way to monetize it the way other parts of healthcare have been monetized. Did I ever tell you what happened when somebody tried? (Quick conversational detour into Modern Acupuncture’s attempt to wring a profit out of the community acupuncture model.)
Dilip: That’s a very funny story.
Me: Right? But let’s go back to where we started, with figuring out how you were going to become an acupuncturist given that you had another job and you didn’t need a license. We basically started you at the end of the first year of the program so you could start learning clinical approaches — we didn’t try to get you to memorize all the points ahead of time, you learned the points basically as you went along, as part of the approaches. Which to me makes more sense. And then we got you into student clinic as fast as humanly possible. We decided you didn’t have to have all the didactic material ahead of time, you could pick things up as you went along.
Dilip: I was very open to that approach because I know from my prior experience that you have to just get in there and do it, you’ll never feel as ready as you want to feel. But you don’t learn without doing it. When I was in my Palliative Care fellowship I had an attending physician who liked to say, the patients are the teachers; the textbooks and lectures just help me understand what patients are telling me.
Me: Yeah, exactly.
Dilip: I actually really love Miriam Lee 10. About half of my treatments now are Miriam Lee 10 plus a few extra points — that’s my default. And I know how to do three or four other things.
It’s like when artists talk about constraints feeding creativity — I don’t find it limiting. I’ve learned so much more about ML 10 by practicing it. Having done hundreds of treatments at this point, ML 10 has become more interesting to me now than it was before. It’s like a whole world.
Me: It sounds like you’re being very present with your treatments.
Dilip: Just a couple of months ago I got to the place where I really feel like I can needle Lung 7 finally. Needling that one point is different every time even when it’s on the same person who comes in every week. During my Oncology fellowship, I had an attending physician who could draw out teaching points from every case even though all the patients we were seeing in that particular clinic had breast cancer; some of even technically had the same diagnosis. Needling each point is like that. I’m interested in Liver 3 because it called to me during a treatment so I did it — it would be hard to come up with a justification. But now I want to explore that point in the same way as Lung 7.
And I feel like I have a lot of time to develop as an acupuncturist, there’s no rush.
I was listening to an interview with Brian Eno recently where he talked about how he composes and he said, "The most important question you can ask yourself is, 'What is it I really like?'"
Me: Yes! From my perspective, that’s exactly how people develop as acupuncturists: by asking themselves what they like and following it, wherever it leads. You were talking about allopathic medicine and the idea of disease entities that sort of exist in the ether, separate from individual humans — I think there’s a similar distinction here. Your practice isn’t this abstract thing floating in space, it’s embodied. It emerges from you as an individual human, being present with other individual humans in the clinic. It’s relational and grounded and extremely specific. What works for your hands is going to be different than what works for mine. You can trust that and let it guide you.
And that’s how I wish we could educate everybody: to start with an approach like Miriam Lee that’s simple and safe and then branch out from there along the lines of what people like. Let it be an exploration. As opposed to trying to download a ton of theoretical knowledge that people don’t have context for. I’d love to make the program simpler, less abstract, and more intuitive.
Dilip: In oncology, historically the way some of the treatment protocols get worked out is, you take a very potent, very toxic drug and ask, what’s the highest amount of this that you can give before humans can’t tolerate it anymore due to side effects? And then it’s like, okay we’ll use a bit less – as close to the maximum tolerated dose as possible. More must be better, right? Then once you’ve determined what dose humans can tolerate, you do more trials to see if the drug is effective or not.
But maybe the highest dose of whatever isn’t the most effective dose. Some of the most amazing acupuncture treatments I received were Korean 4 Point treatments in the student clinic. Literally 4 needles.
We don’t often think of the cancer journey from the perspective of the oncologist, but it can be pretty harrowing to prescribe chemo for someone. You know you’re likely to make them feel worse, but you justify it to them (and yourself) because you hope that the ultimate outcome will be better. Depending on the situation – for example if it’s a young, fit patient and you’re trying to cure their cancer – you might have to really hit them hard. Those treatments can be rough.
That’s why I’ve never been interested in using a lot of needles in my acupuncture practice.
No one actually wants to beat patients up, for lack of a better word, even if I may have done that sometimes in my day job. So as an acupuncturist, I’m never going to be the person pushing the limits to find out what a patient can take. The cowboy persona never fit me.
Me: That’s why you’re such a good fit for WCA, though.
Dilip: Working once a week at WCA is like a vacation from capitalism .
To be continued (after the next time we get coffee, which we try to do every other month.)
Shameless plug of the day, take two: Dilip kindly offered to teach a class to POCA Tech students, which we subsequently turned into a CEU: Oncology and Palliative Care for Acupuncturists. It’s great! Please check it out if you need CEUs!
Not a new phrase – this comes from an article published nearly 50 years ago in the New England Journal of Medicine by its editor at the time, Arnold Relman: Relman AS. The new medical-industrial complex. N Engl J Med. 1980 Oct 23;303(17):963-70.
For more on the climate impacts of the US healthcare sector, as well as efforts to reduce it, see: Dzau VJ, Levine R, Barrett G, Witty A. Decarbonizing the U.S. Health Sector - A Call to Action. N Engl J Med. 2021 Dec 2;385(23):2117-2119.
For more on the increasing role of private equity in US healthcare, see: Bruch JD, Roy V, Grogan CM. The Financialization of Health in the United States. N Engl J Med. 2024 Jan 11;390(2):178-182.