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The Death of a Profession?
Will Traditional Chinese Medicine be lost as a result of the popularity of a procedure
called Acupuncture?
By Dr. Fujio McPherson, DAOM, MSN, ARNP, EAMP, LAc.,
With Curt Eschels, EAMP
One of the most distinguishing characteristics of Traditional Chinese Medicine (TCM*)
diagnosis and treatment is the ability to identify an imbalance or weakened condition
before it can manifest into a disease, preventing illness and strengthening the innate
ability of the body to self-heal. So I find it ironic that as a profession, there have been
so few practitioners of TCM who have spoken about the symptoms of imbalance within
the profession of acupuncture which may eventually result in the death of the profession
altogether.
Many would argue that the profession is the healthiest it has been since coming to the
United States in the 70’s. There are forty-nine Masters Degree programs in acupuncture in
the U.S and several are accredited for Doctoral degrees (1). Integrative models of health
care include acupuncture as part of their core structure. And more traditional systems of
care including the military are now incorporating Complementary and Alternative Medicine
(CAM) modalities including acupuncture to treat chronic conditions like pain and PTSD (2).
As the popularity of acupuncture becomes more public it has also translated into
significant gains in income potential and professional recognition. Web based health
career sites report acupuncture annual salaries between $45,000-$122,500 a year based on
years of experience, location and type of facility, and level of education (3). Currently 41
states recognize acupuncture and oriental medicine as a licensed profession. One estimate
is that the number of licensed acupuncturists has risen to 10,512, with an average of
9-12 million patient visits per year which has contributed to the growth in schools and
attention by other professional groups. With the growing use of acupuncture, a greater
percentage of physicians and insurance plans also include recommendations for/or
acceptance of acupuncture as a viable therapy. Of course all of this information looks
promising to the untrained eye because acceptance and income are usually the basis of
status and power.
However, in TCM the six internal evils have as much and sometimes more destructive
power than the external ones. When you study what is underneath the surface you begin
to see the slow progression of a disease that may eventually reduce the profession of
acupuncture into a non-entity within the health field, changing it from an ancient and
respected form of medicine to a simple procedure.
The first symptom lies within the training institutions themselves. As schools grow,
debates are focused on degrees (e.g. first professional doctorates) while the curriculums
remain the same, emphasizing TCM diagnosis, point location, needling techniques and
herbal therapy. And although no one would argue the importance of teaching these
subjects, the one unique aspect of TCM that may save the profession gets very little
focus. And that is how to practice TCM versus being clinical technicians trained to
perform a procedure called acupuncture. Thus, in addition to teaching only theory, school
curriculums should focus on training students in the application of a holistic approach to
care that places more emphasis on prevention than on a single or dual approach using just
acupuncture and herbs to treat a specific clinical complaint.
The second symptom of an internal imbalance within the profession lies with acupuncturist
and their failure to see beyond their individual styles of practice. Being an expert in
Five Element or Toyohari is a unique skill set which may or may not distinguish one
practitioner as being better than another. But, while acupuncturists are focusing on the
efficacy of a technique, and sometimes training non-acupuncturists to perform a specific
technique, they often fail to demonstrate the value of a holistic approach using the
principles and theories of TCM. And other non-acupuncturists (e.g. physical therapists,
medical doctors etc.) are following suit and drawing from these single skill sets with a
misperception that they can mimic the point selection and achieve the same results of
any Licensed Acupuncturist trained in TCM, as if the holistic principles of the profession
are irrelevant. Clearly, there are many acupuncturists who practice using a holistic
approach to care. And maybe the failure is our inability to bring the holistic nature of
our medicine into the public conscious and establish a clear definition of our medicine
that counters the attempts of others to reduce our medicine into a single skill set.
The third symptom of an imbalance is within the profession itself and the failure to
communicate. As national organizations representing professions like Physical Therapy
and Chiropractic medicine consolidate their efforts to increase their scope of practice
to include “dry needling” and establish their role in the health care system, a lot of
acupuncture organizations - state and national - are just struggling to sustain their
existence. The lack of membership, funding and most of all involvement from within the
profession results in many state organizations trying to tackle threats to the profession
alone with limited resources and success. Although organizations like NCCAOM and
AAAOM are making great efforts to provide a forum for acupuncturists to voice their
opinions and improve the profession, these efforts need to extend further than just
within the profession. As the popularity of acupuncture increases, our professional
organizations have an even greater responsibility to ensure that the perceptions and
theories of TCM are equally represented at the national and state level. But ultimately it
is the responsibility of every Licensed Acupuncturist to ensure that TCM, and not the
procedure of acupuncture, is properly represented during discussions about scope of
practice. We have a clear opportunity with our patients and our elected leaders to call
attention to how TCM benefits the national goal of improving health care because of its
ability to improve health outcomes and promote efforts in health promotion and disease
prevention.
If you think that acupuncture or Complementary and Alternative Medicine (CAM) is not at
risk then consider what has occurred in Great Britain. England has long supported CAM
therapies as part of its national health plan. CAM schools, certification programs, and
services have been funded by the government and third party payers equally with western
medical treatment options, far ahead of the U.S. system. But after decades of
acceptance, attitudes about CAM therapies have changed, primarily as a result of efforts
to discredit it or failure of these CAM practitioners to validate their effectiveness and
impact on the clinical outcomes through research and cost analysis. In a recent Integrative
Practitioner web posting, “the number of bachelor and master degrees in subjects such as
reflexology, aromatherapy, acupuncture and homeopathy in England have been reduced
by over a half since 2007 from 40 to 21. And starting this year, the study of homeopathy
at a degree level will no longer be available in a British university. A decade ago England
had 16 state-funded degree–awarding institutions offering 42 fully accredited BSc/BA
courses in 12 “non-evidence-based forms of medicine” (4). The only difference between
England and the U.S. is that most of the CAM education programs are privately funded,
however, a growing number of programs receive federal funding in terms of loan
assistance and there are continued efforts by western clinicians to absorb evidence based
CAM modalities like acupuncture into their own scope of practice.
What can we do? I think the answer, just like the medicine, is not limited to one solution.
It will take a holistic approach that can be directed by the larger organizations, both state
and national, as well as school boards to ensure the focus of TCM remains intact and is not
reduced down to a procedure. And it takes involvement from all of those who have been
trained in TCM to participate and practice according to the holistic principles and
theories of TCM and not reduce their therapies to just acupuncture and herbs. Each and
every one of us must communicate the benefits of TCM to our patients and decision
makers.
Of course this requires a new approach to practice and research to show a better
outcome than from a single or dual approach to care. For the past several years I have
been conducting a study to treat anxiety that I hoped would demonstrate the value of
following a holistic approach to care using the principles of TCM. The most promising
aspect of the study was that the most significant changes from the interventions were not
focused on a condition, although anxiety symptoms had statistically significant
improvements. Rather it was how the interventions changed patient perception and
behavior.
This aspect of health care; changing patient perception and behavior, has become one of
the most challenging aspects of western medicine. The national health care problem is
challenged with the question of why despite proper conventional medical care, chronic
conditions and disease prevention efforts fail or have limited effect. When TCM can
demonstrate through research and clinical practice its effectiveness at improving
outcomes, as well as changing behavior, it will be able to establish itself as a critical part
of the new medical model that is currently being developed. I only hope that we are not
too late.
References
- Acupuncture Schools (retrieved 28 December 2011)
- Niemtzow, RC. Gambel, J. Helms, J. Pock, A. Burns, SM. Baxter, J. 2006, Integrating ear and scalp acupuncture techniques into the care of blast-injured United States military service members with limb loss. J Altern Complement Med. Sep; 12(7):596-9.
- Healthcare Training Center (retrieved 3 January 2011)
- Integrative Practitioner (retrieved 12 January 2012)
* While we respect the authors, WEAMA prefers the term EAM (East Asian Medicine) to
TCM (Traditional Chinese Medicine), in order to include Japanese and Korean
practitioners.
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