Monthly Archives: February 2013

Sacred Cows

Posted on by

The First in a Recurring Feature —

As I was leaving an Acupuncture Advisory Board meeting I had a brief discussion with a Medical Acupuncturist (an MD who does acupuncture) who had attended the meeting as an observer.  It left me pondering one of the “truths” trotted out whenever acupuncturists talk about non-LAcs using acupuncture (and even sometimes when folks from one acupuncture lineage talk about a different tradition) – that treatment from “one of those” practitioners might reduce pain and symptoms and the patient might feel better, but, because the underlying imbalance wouldn’t be treated, the patient would be harmed.

I’ve heard it said about PT’s doing dry needling, and in the past I’ve said it myself about Medical Acupuncturists.  In the conversation I was having, the Medical Acupuncturist said he had concerns with patients going to LAc’s if they hadn’t first been seen by an MD.  After all, he said, in what I’m sure he thought was a respectful and honoring way, you guys are SO GOOD at treating pain, you could mask an underlying serious condition.

I set aside my immediate desire to respond, hey, that’s what we say about you because your acupuncture training is so pathetic (yes, old habits die hard).  I tucked away for future action my shame that after all these years we LAcs haven’t done a better job educating and connecting with the MD’s who respect and use our medicine.  (No doubt they have much to teach us about things like participating in Medicare and could be allies in some of our political work.)  And I have continued to ponder this idea that acupuncture, done by anyone, could really treat symptoms well while leaving a festering problem untouched. Can this happen?  Does it?  I mean sure, maybe for a week or two, but isn’t one of the underlying teachings of our paradigm that if we don’t treat the underlying imbalance the problem will continue to reveal itself?

I’ve begun to think that this belief is nothing more than a Sacred Cow.  What do you think? I don’t need to hear about MD’s missing medical diagnoses, or about the harm done by western treatments.  I’m looking for the specifics in which acupuncture treatments relieved symptoms but did not address the underlying imbalance, thereby doing harm.

An article of interest?

Posted on by

An article about the experience of acupuncture school grads could read a lot like this article in today’s New York Times’ Business section.  Many acupuncture students (and student wannabees) are ignorant (or even worse, misinformed) about the business realities they’ll face upon graduation, and the schools, ACAOM, and the AAAOM have not made changing that a priority.  I suppose they have no incentive to give an accurate picture of professional opportunities or the lack thereof because they depend on a constant stream of students to pay the bills.

I took special notice of the section on the under-served areas of the country, since this is something we find in acupuncture too.  The reference to the loan forgiveness programs was also informative.  I know some of the leaders in our field have pointed to inclusion in these programs as a potential cure for some of our problems, but I see there is still quite a bit to learn about them.

The article does not consider whether the increase in health insurance for pets is contributing to the declining salaries.  A topic for further consideration, perhaps.

The article reminds me of the topic of unintended consequences.  I remember when eligiblility for federal student loans was celebrated as a great step forward for the profession.  Now, I can’t help but think the main consequence has been to enable the schools to charge more, and students to unthinkingly take on more debt.  I’m excited for the arrival of POCA tech — a school with a goal of making acupuncture education affordable.  Not only does the school promise to be a great addition to the profession’s education options, but we can hope that competition for student dollars exerts some downward pressure on the other acupuncture schools’ tuition bills.

 

A House Built on Shifting Sand

Posted on by

About eighteen years ago, as we were advocating for a practice act in Virginia, a big upset was that MD’s, DC’s, and DO’s (and podiatrists within their scope) could practice acupuncture with only 200 hours of training.  Time and again, acupuncturists complained (and continue to complain) about this — after all they say (and we said to the legislators and staff at the Department of Health Professions) acupuncture is far more than sticking a needle in the body.  Acupuncture is a complete system of healing, a theory, a philosophy, a paradigm, a system of diagnosis.  A doctor may be able to safely stick a needle in a point (though these are, after all, very special needles, nothing like a crude hypodermic), but they aren’t doing “acupuncture.”  Mention MD’s and DC’s “with limited training” doing acupuncture to most LAcs today and you’ll get anger and complaints.

What gets LAcs (or OMDs or CAcs) even more incensed today — Physical Therapists (or DC’s) sticking a needle in a point and saying it isn’t acupuncture.  After all, we say to the regulatory boards (and even more loudly to each other), they’re sticking an acupuncture needle in a point.  We don’t care whether the PT is thinking only that a trigger point causing pain could be released by this needle.  Or that they know nothing of the theory of Chinese medicine.  All we know is that if they are sticking a needle in a point they are doing acupuncture, they darn well better not call it anything else, and they ought not be allowed to do it.

I’ll save the in-depth conversations about TPDN, scope of practice (it doesn’t mean what you think it means), and coalition building for other days.  For today, I just want to ask that our profession show some consistency.  Consider the implications of insisting that acupuncture is defined as a needle in a point, or the implications of insisting it is far more than that, and especially consider the implications of changing the definition to suit a short term need.  Consider the implications on what you do in your treatment room, as well as the impact on our battles with other professions, our interactions with regulators, our involvement with third-party payer systems, and perhaps most importantly, on how we build our brand.  Above all, remember that like a house built on shifting sands, a profession built on shifting definitions is unlikely to stand the test of time.

A Mature Profession? Part Three

Posted on by

I’ve heard it said that, while “The White House Petition” in and of itself can accomplish nothing, it is still a positive development for the profession — that it stirs things in the right direction.  I disagree —

1)       Many people signing it, which includes practitioners and patients, don’t realize that it is meaningless. It increases hopes which are bound to be dashed, contributing to the destructive and already prevalent feeling that we’ve been wronged.

2)      The petition reveals a profession which does not understand how the system works.  It makes us look ignorant (because we are, mostly).

3)      The profession should have other priorities.  We still have six states without licensure.  If we want to have a national week of action on something, why not that?  (I’d say that’s a necessary precursor to being included in Medicare, for one thing.)

4)      We are completely unprepared to do anything with the attention this creates.  If the president called the AAAOM tomorrow and said, wow, we think this acupuncture thing is really interesting, how many practitioners are interested in becoming Medicare Providers, what answer would they get?  If they asked what sort of support we had for our last bill, do you think saying we had 37 Representatives sign on would be impressive?

A petition might be a reasonable piece of a well-thought out plan to change something that had widespread support in the profession, and for which we were on the verge of success, but as an independent statement it is a distraction, a waste of energy, and misleads rather than informs.  A triple threat!

A Mature Profession, Part Two.

Posted on by

(An intercepted letter)

Dear K,

Thanks so much for the time you’ve given to our dialogue and for the work you’ve done for the profession thus far.  You are incredible.  Forgive my response in a numbered list.  There are so many issues and it is often a battle between my natural wordiness and my hope for clarity (and that people will stay tuned in).  Also, I’m quoting you because you bring up good points shared by many; I’m not intending to pull things apart word by word as though your quick email was meant to be read like a scholarly article.

1)       You wrote ” I don’t really think anyone in our profession understands how the federal level works – our profession is still so young that it is really completely state regulated, and differently in every state.”  I agree that our profession has a shortage of individuals with a good understanding of how things work at the federal level.  However, our youth alone is not an excuse.  In fact, if we’d educated ourselves about how things work on a federal level even two years ago, the last time a petition like this went around, we’d be in much better shape today.  Our ignorance is due to the fact that no national organization has made it a priority (or, been able to act effectively if it was a priority) to do the important work of hiring some teachers and consultants to inform us about “how it works,” or even just to provide a safe forum for exploration.  The longer we stumble around in blindness the more lost we get.  The CSA and state orgs are great, but we need national leadership to help us see how state issues impact the whole, and an understanding of federal issues is critical.

2)      If you go to the NCCAOM site and click on the Job Task Analysis Fact Sheet you will see their write-up about the BLS process.  I don’t see a connection between the BLS process and Medicare in that document.

3)      You use the introduction of HR 646 as a clue to help you figure out potential connections (or lack thereof) between BLS and Medicare.  The existence of HR 646 shows only that Congressman Hinchey likes acupuncture and acupuncturists and, in every congress since 1993, has introduced a similar bill.   I’m not going to take time to compile a list of nutty bills, but I’m sure I could.  I’m not saying that 646 was nutty, but that having a bill introduced in Congress is not evidence of much.

4)      Regarding benefits and costs of Medicare Inclusion – I’ve read and written thousands of words on this topic in various acupuncture-related list serves and publications but I have yet to see a careful study and analysis by experts to help us explore this issue.  That is my main complaint here.  There is evidence from other professions on the impact of Medicare.  Let’s have a national exploration of the issue based on more than what you or me or my great Aunt Tilly thinks is a good or bad idea.  I’ve written a lot of checks to national acupuncture organizations over the years.  Is a well-done exploration of this issue too much to ask?  Is distribution (again) of an at best minimally useful petition the best they can do?  And let’s not forget, this isn’t just about the impact of Medicare inclusion on individual practitioners, but on how it could impact the medicine itself.   Issues such as best practices and standardization are sure to arise.

5)      Sorry for the confusion about my use of the word “covered.”  I was referring only to Medicare.  Acupuncturists are not listed as providers in Medicare AND acupuncture is specifically listed as a service that is NOT covered.  So, my thought/question was around whether additional action would be needed to remove acupuncture from the not covered list, even if acupuncturists were listed as providers.   There must be some expert somewhere who could tell me.  (And, yes, the piecemeal nature of state laws about things like titles for professionals who do acupuncture would no doubt complicate any action on a federal level.)

6)      Regarding the EHB effort.  I hear you.  I was on the AAAOM Board at that time and it was like something from a dystopian novel.  The people in power believed what they wanted to believe and anyone who didn’t accept their beliefs was shut down.  There is no way I can succinctly sum up the dysfunction I observed.   It just about broke me.

As for the rest of your email, it fits right in with my Barking up the Wrong Tree post.  We’ve got a bunch of “solutions” being promoted and we don’t even have a good understanding of the problems.   Not only that, it’s been a long, long time since we’ve had a forum or group that’s truly exploring the big picture, helping the profession really understand the problems and explore possible solutions.  That’s not to knock CSA and the hard work of many, many people, but it’s the national level that is missing.

 

With hope for the future,

EWK

A Mature Profession?

Posted on by

Not again.  That misleading petition, forwarded along by many colleagues and even by schools, the AAAOM, and the NCCAOM, is making the rounds again.  You know, the whitehouse.gov petition that we should all sign to have acupuncturists designated covered health care providers?  Well, just as it was last time around, it’s b.s.  It doesn’t matter how many signatures we get, the Executive Branch does not determine who is a covered provider under the Social Security Act.

It would be nice if I could tell you the process we’d have to go through to make acupuncture a covered service.  I can tell you that finding the information and understanding it isn’t easy, but that my efforts continue!  (Of course, I’ll share what I learn.)  But why should I be the one doing this work?  Surely, one of the national organizations has figured it out.   You’d think, wouldn’t you, that they’d be a resource, providing information so that we knew what we as a profession needed to do to effect change, that, as practitioners we understood what would happen after a “victory” in this battle, that they’d have some ideas about the implications of a win?

Well, I guess, if you’ve been around a while you wouldn’t think that.  And clearly you shouldn’t.  So far, at least to the eyes of an acupuncturist more involved than most, the total input of our national organizations has been to further distribute a misleading petition, encouraging more wasted qi, and doing nothing to educate or inform the profession.

If it is correct that part of this process is to be determined to be a “mature profession” by BLS, as another colleague reports, then this petition, and the response to it by our national organizations, works against us.