Our Worst Enemy

How do you feel about a regulatory situation that increases the odds that patients will receive acupuncture from minimally trained, non-LAcs while making it difficult for extensively trained LAcs to practice?  Is it better or worse if it is a state’s very own LAcs who are creating this situation?

The Delaware Acupuncture Council recently refused to grant a license to one of the most excellent practitioners I know.  This Virginia LAc,  a NCCAOM AC Diplomate and a Nurse, has had a very successful practice for over 13 years.  She is a former president of the Acupuncture Society of Virginia and has studied Medical Qi Gong extensively for the past three years.  The three LAcs on the DE Council present for the June meeting refused to grant her a license because she does not have NCCAOM OM Diplomate status.  Although the Council was reminded that they could grant an exception, they refused to do so.

It appears that only one of the four LAcs on the Council has the full NCCAOM OM status and one has NCCAOM AC status.  A third LAc has no formal acupuncture education or NCCAOM status, holding a degree in ayurvedic medicine granted for overseas study. I could not discover any information about the fourth LAc on the Council.

Delaware passed legislation related to the practice of Acupuncture in 2008, which you can read about here.  The legislation required full NCCAOM OM certification, including herbs but included three caveats, as noted in the AT article:  1) acupuncturists practicing in the state at the time the legislation was passed, regardless of education and credentials, were grandfathered in;   2) the legislation did not interfere with the activities of other professionals who were allowed to perform acupuncture; 3) the Acupuncture Council was expressly allowed to waive the requirements as appropriate.

Remember – herbs are not regulated by the FDA, and products containing Chinese herbs are available in the grocery store (see Airborne), or on-line, and are available to the public without prescription or the involvement of any health care professional.

Delaware currently has about 35 LAcs serving a population of about 1 million people. According to my research, there are 9 NCCAOM AC Diplomates in DE, and another 6 OM Diplomates.  The decision of the Council only increases the odds that the people of Delaware will receive treatment from non-LAcs.

The way I see it, it isn’t the lack respect from the western world, competition from other professions, or inequities in insurance reimbursement that are the biggest problems facing the profession.  It is a system in which small groups of LAcs in various states have determined that more credentials and education are necessary, even for those who are already extensively trained in Acupuncture and Oriental Medicine. They work for laws and regulations that increase the cost and time necessary to obtain an acupuncture degree and limit practice opportunities for LAcs.  This increases the odds that the public will receive treatment from providers who are not LAcs.

With friends like this….

To Wit, Hypocrites with Double Standards?

This will be it (I hope) regarding dry needling for a while.  Just these last few points which are pertinent to other discussions.

Will Morris concluded his AT article with this  — “To wit: let us pursue a collaborative process of developing inter-professional competencies. Remove biomedicine and herbal medicine courses from the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) standards. Then, take what is left over in acupuncture programs as the starting place for a dialogue for portable competencies….To avoid conflicts of interest, no individual who stands to profit from seminars should determine competencies and educational standards, nor should they testify in legislature on behalf of the common good.”

My comments  –

1)    Collaborative processes don’t start with a one-sided statement of the starting point.

2)      Why stop with removing only biomedicine and herbal medicine from the ACAOM standards?  An incomplete list of things I was taught in my ACAOM accredited program that seem unnecessary for the education of a licensed PT who wants to use an acupuncture needle to stimulate a trigger point: tai chi, qi gong, pulse diagnosis, tongue diagnosis, point location, point indications, the officials, the five elements, business development, TCM principles, and the Classics. I have yet to find a colleague who could come up with more than 40 hours of content – Day 1: contraindications, risk factors, areas in the vicinity of forbidden points, reasons to refer.  Day 2: Clean needle technique, Day 3-5: Needle technique, practice and a review of reasons to refer. Seems like anything more and we are encouraging these practitioners to move beyond trigger point release.

4)      As a member of a regulatory board, I believe it is important to hear from educators when exploring issues of scope, or really, any issue. On the other hand, when NCCAOM sent two representatives to a Virginia board meeting to explain why requiring licensees to maintain current NCCAOM Diplomate status was critical to protect the public I did feel it was self-serving. So, to those making this argument, will you agree to it across the board? If there is any exploration about licensure requirements for LAcs will the schools, NCCAOM, ACAOM, and any other organization that “stands to profit” keep silent on behalf of the common good?  Some may say this violates the First Amendment, but as long as everyone agrees to abide by this limitation, I’m willing to give it a try.

Who is a Word-Trickster?

Will Morris, in Acupuncture Today, writes — ” ‘Word-tricksters’ – as I like to call them – change language in order to gain personal advantage.”

I haven’t received much input on my questions about nomenclature, but in my conversations with practitioners around the country I haven’t found any agreement or clarity about where acupuncture begins or ends.

I do have a question for Dr. Morris and the others who have been so insistent that the other professions should use “acupuncture” rather than “dry needling” or any other term. Would folks be happy with an outcome in which all professions agreed to use the term acupuncture for anything that used a filiform needle, but in which the LAc community still had no say in the regulations, education requirements, and scope for those professions?

The acupuncture community would not see that as a win. I believe that the people arguing for the global use of the term acupuncture are doing so because they think it will give them control over the procedure — that is, to gain personal advantage.  Doesn’t that make us the Word Tricksters?

In the meantime, based on youtube videos and discussions on various list serves, my colleagues are very interested in being able to draw distinctions between how they use needles and how the PT’s and others use needles.  Wouldn’t insisting on the use of the term “Dry Needling” help?