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Acupuncture Victory in the White House!

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http://www.healthcmi.com/index.php/acupuncturist-news-online/694-whitehousevictoryacupuncture

The acupuncture profession will officially get a response from the Obama administration on the inclusion of acupuncture in the Medicare system. A formal petition to the White House passed today. This mandates a response by the White House. Auspiciously, this is also the first day of the Chinese New Year.

President Obama

We ring in the Chinese Year of the Snake with over 26,000 signatures on the acupuncture petition. The petition went over the top by passing the 25,000 signature threshold required to mandate a formal response by the White House. The petition notes that many professions are recognized in the Social Security Act and are therefore included in the Medicare system. Dieticians, nurse practitioners, physician assistants, nurse midwives and clinical social workers are already included in the system. Absent is the federal recognition of licensed acupuncturists despite their formal, legal and well-regulated inclusion in almost every state. As a result, Medicare reimbursement is not possible for acupuncture therapy.

Many people look forward to becoming eligible for Medicare benefits. Unfortunately, a majority of health insurance plans that cover acupuncture for those without Medicare benefits drop acupuncture as a benefit once the insured party becomes eligible for Medicare. These plans abruptly slash acupuncture health insurance coverage citing that if the service is not reimbursable under Medicare, then the secondary insurance will not cover it either. Inclusion of acupuncture in the Medicare system will close this loophole and allow the insured to continue receipt of acupuncture benefits.

Recently, California and Maryland went so far as to mandate acupuncture coverage in all health insurance plans for individuals and small groups. The regulations made by these states were required by Obama’s new healthcare legislation requiring state guidelines for the implementation of preventative medicine and pain management. The California and Maryland legislatures both chose to include acupuncture as part of a comprehensive healthcare plan.

The federal government is far behind the states in recognizing and regulating licensed acupuncturists. For example, the California Acupuncture Board, a division of California’s Department of Consumer Affairs, has long regulated the licensing and oversight of licensed acupuncturists. In a similar fashion, the Maryland Board of Acupuncture is responsible for oversight of licensed acupuncturists. The same is true of most states. Each has a licensing board that carefully outlines educational standards and training requirements in addition to licensing and professional oversight.

Taking a step beyond state by state legislation formalizing acupuncturists as licensed professionals is the NCCAOM, the National Certification Commission for Acupuncture and Oriental Medicine. This non-profit organization validates entry level competency for acupuncture and Oriental medicine through a rigorous professional certification program. Most states require this certification prior to licensing acupuncturists. The NCCAOM ran an effective email campaign to draw awareness to the White House petition. As a result of their proactive outreach, the petition has passed.

The petition notes that acupuncture research demonstrates that patients utilizing acupuncture therapy recover more quickly than those without acupuncture care. In addition, the petition notes that patients require less medication when acupuncture is part of a treatment program. The petition requests that acupuncturists become recognized healthcare providers under the Social Security Act thereby making reimbursement for acupuncture therapy possible under the Medicare system. With more than the required 25,000 signatures within a one month period, the White House will respond to the petition with a formal statement.

 

The Point of Acupuncture: local acupuncturist starts-up free community style clinics

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http://www.press-citizen.com/article/20130204/NEWS01/302040024?source=nletter-top5&nclick_check=1

Stacy Kluck uses the scent a cigarette to decrease Ron Oge's urge to smoke during an acupuncture clinic Thursday at the Shelter House.

Stacy Kluck uses the scent a cigarette to decrease Ron Oge’s urge to smoke during an acupuncture clinic Thursday at the Shelter House. / David Scrivner / Iowa City Press-Citizen
Written by
Alesha L. Crews
Iowa City Press-Citizen

It can be a bit difficult for people to get their head around exactly how acupuncture works.

The theory behind the traditional Chinese practice, which involves thin, flexible needles inserted into a person’s skin at key points to correct imbalances in the flow of qi, is abstract, to say the least.

While the science behind it is difficult to pinpoint, acupuncturist Laura Christensen said more than 3,000 years of practice illustrate its effectiveness.

Furthermore, in her more than 20 years practicing acupuncture in the Iowa City area, Christensen said she has successfully used the method to treat a slew of ailments, from pain and headaches to infertility and asthma. In addition, she said acupuncture helps patients sleep, have higher energy levels, reduce stress and improve overall wellness.

Christensen, who opened Acupuncture of Iowa in 1991, said the popularity and acceptance of acupuncture has grown. There are now several clinics in the area and she and acupuncturist Stacy Kluck treat an average of 60 patients each week at the Acupuncture of Iowa clinic.

“At this point in history, it is quite popular in the United States,” Christensen said. “There are 50 schools that train acupuncturists and there are something like 30,000 acupuncturists practicing in the United States.”

But while acupuncturists work as primary health care providers and are licensed by the Board of Medical Examiners, Christensen said the practice still isn’t completely accepted as medical treatment by insurance companies. The majority of her clients, she said, pay for services out of pocket.

To introduce acupuncture to the broader community, Kluck started a free community-style acupuncture clinic at Iowa City’s Shelter House to aid underserved populations. She worked at similar community clinics in Chicago, and said she was excited to offer similar experiences to Iowa City residents.

For the past 10 weeks, Shelter House residents have been invited to a free, two-hour clinic to receive acupuncture treatments. Each week the clinic attracts between six and 15 people, Kluck said.

At the clinics, Kluck uses auricular acupuncture — acupuncture of the ear — with a stress-relieving protocol from the National Acupuncture Detoxification Association.

By inserting about five needles at specific points in each of the patients’ ears, Kluck is able to help reduce stress and pain.

“The whole body is mapped onto the ear so I can press around and do a shoulder point or a hip point or just a general pain-relieving point,” she said.

She said she also has had success helping some people decrease and even quit smoking by stimulating the lung point on the ear while having the person smell a cigarette.

“I’ve had a number of people after the session go outside and try to smoke a cigarette and they can’t finish it,” she said. “And even if they smell someone else’s smoke, (they don’t like it). So it’s actually creating a physiological response.”

Shelter House resident Ron Oge said he began coming to the clinic to get help quitting smoking, which he has previously tried by using gum, patches and medication. He said he went from smoking three or four packs of cigarettes a day to smoking three or four cigarettes a week.

In addition to the help quitting smoking, he said he has received other benefits from the acupuncture sessions as well.

“It’s really relaxing,” he said.

Resident Charles Ruth said he has always wanted to try acupuncture to reduce his neck and shoulder pain, the result of a serious car accident 29 years ago. He attended the clinic for the first time last week and said he hopes to continue receiving treatment.

Christensen said the clinic is particularly useful in an environment such as Shelter House because it is portable, quick and relatively non-invasive. She said she is working to start two more similar clinics, one with MECCA Services and the other with the Iowa City Free Medical Clinic.

“I’m at a point in my professional development where I want to start doing service for the community,” she said.

In addition to getting help for specific ailments, people who receive acupuncture treatments also tend to experience general “healthifying,” she said.

“They sleep better, they don’t eat inappropriately as much, they deal with stress better, they don’t get sick as often. If they do get sick, they get better faster,” she said.

Kluck said she believes acupuncture is especially effective because instead of just targeting a person’s symptoms, it targets the cause of the ailment.

“Every treatment is custom made to the person, as they are presenting that moment in time,” Kluck said. “… It pays attention to patterns and changes and always meets the person where they are at.

“We never proclaim that we can cure everything or make everything better — no medicine can do that — be we can at least effect some sort of positive change.”

 

Penelope Cruz with Acupuncture Ear Beads

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http://abcnews.go.com/blogs/health/2013/01/24/penelope-cruz-sports-acupuncture-beads/

 

Cruz was spotted wearing auriculotherapy at the January 10 premiere of “Venuto Al Mondo.” (Image credit: Carlos Alvarez/Getty Images)

The swath of tiny studs in Penelope Cruz’s ear isn’t the latest piercing fashion – it’s auriculotherapy, a form of acupuncture used to fight stress, pain and infertility.

The gold beads were spotted Jan. 10 at the Madrid premiere of “Venuto Al Mondo,” sparking rumors about whether the 38-year-old actress and husband Javier Bardem were hoping to give their toddler son a sibling.

“Auriculotherapy can be used for fertility, but those are not fertility points on her ear,” said Jill Blakeway, director of the Manhattan-based YinOva Centerfor complementary medicine. “Hers is a very standard protocol for people with stressful, busy lives.”

CLICK HERE to read about other celebrity remedies.

Auriculotherapy uses relexology points on the ear to tap into distant parts of the body, according to Blakeway.

“It’s almost like there’s a little homunculus; a little representation of the body that comes during embryonic development,” she said, describing how points in Cruz’s ear help calm the heart, mind and spleen, and bring the body into balance. “Auriculotherapy is remarkably effective,” she said.

During a treatment session, auriculotherapy needles are inserted about a quarter inch into the outer ear. When the session is over, Blakeway said the needles are removed and replaced with tiny gold or silver beads affixed with a sticky bandage that “potentiates the treatment.”

“It’s quite popular for relaxation,” Blakeway said of auriculotherapy. “We also do a lot for hunger, for people on diets.”

Acupuncture is gaining popularity in the U.S. as patients — and doctors — embrace a more holistic approach to medicine.

“Western medicine is very good for some things and not very good for others,” said Dr. Tony Chon, a medical acupuncturist with the Mayo Clinic’s Complementary and Integrative Medicine Program. “Treatments like acupuncture and stress management therapy look at patients as more of a whole rather than their individual parts.”

But studies on acupuncture have yielded a “hodgepodge of results,” Chon said, because the gold standard placebo-controlled trial doesn’t always work. “It’s hard to study because people have pain and stress for different reasons,” he said.

Blakeway said acupuncture is “particularly good for treating chronic long-term imbalances like arthritis, irritable bowel, asthma, allergies and hormonal imbalances that cause infertility.” Her husband, YinOva Center co-director Noah Rubenstein, performed acupuncture on Kristen Davis during an episode of  ”Sex and the City.” Davis’ character, Charlotte, was undergoing in vitro fertilization.

“Some studies have shown that acupuncture increases IVF rates,” said Dr. William Hurd, division chief of reproductive endocrinology and infertility at University Hospitals Case Medical Center in Cleveland. “Based on the limited data, we don’t recommend it, but we do offer it.”

Acupuncture’s stress-relieving effects in some patients can also boost the odds of becoming pregnant, Hurd said.

“The stress of not getting pregnant makes it less likely to get pregnant, so we encourage everyone to try anything they find helpful for stress as we help them with the medical side of it,” said Hurd.

Insomnia? Try Acupuncture

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http://www.healthcmi.com/index.php/acupuncturist-news-online/669-discoverysleepst36acupuncture

Electrical engineers in a medical research team discovered how acupuncture benefits sleep. They did it by measuring brain activity with EEG (electroencephalography) before, during and after an acupuncture treatment. Results were conclusive, acupuncture significantly increases slow wave activity of the brain relative to fast wave activity in both the frontal and central lobes. This phenomena is known to benefit the quality and duration of sleep.

EEG

The acupuncture point used in this study increases the delta band power density, a known sleep related brain wave band. In addition, acupuncture at this point downregulates alpha and beta band activity relative to delta band activity. The decreases in these bands also enhances sleep quality.

The researchers applied manual acupuncture to humans at acupoint ST36. It was found that this acupoint significantly increases the power ratio index of slow waves to fast waves following an acupuncture treatment. Stainless steel 0.2 mm diameter acupuncture needles were applied to the subjects. The needles were applied and retained for an initial two minutes followed by manual rotation of the needles applied for another two minutes. Measurements were taken throughout the brain of the delta (0 – 4 Hz), theta (4 – 8 Hz), alpha (8 – 13 Hz) and beta (13 – 30 Hz) bands. Notably, there were increases in the delta band power in five major brain areas during and after acupuncture.

The researchers note that “acupuncture at ST36 can induce obvious changes in different EEG rhythms in healthy subjects.” They also note that acupuncture modulations of brain activity resulting from acupuncture point stimulation show “that the  brain plays a key role in acupuncture research.” They also suggest that “cortical electrical activities may be an important mechanism by which acupuncture exerts its complex multisystem effects.”

 

 

ST36 Acupuncture EEG

 

Reference:
Chin. Phys. B Vol. 22, No. 2 (2013) 028703. Modulation of electroencephalograph activities by manual acupuncture stimulation in healthy subjects: An
autoregressive spectral analysis. Yi Guo-Sheng, Wang Jiang, Deng Bin, Wei Xi-Le, and Han Chun-Xiao.
a)School of Electrical and Automation Engineering, Tianjin University, Tianjin, China
b)Tianjin Key Laboratory of Information Sensing & Intelligent Control

Acupuncture for Plantar Fasciitis

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New research concludes that acupuncture is effective for treating plantar fasciitis, a painful inflammatory foot condition. Plantar fasciitis typically presents with pain on the underside of the foot and heel. The pain is often most severe when first stepping out of bed onto the floor in the morning. Another telltale sign of plantar fasciitis is pain upon dorsiflexion, lifting the foot towards the shin.

In this controlled clinical investigation, the acupuncture group demonstrated a significant reduction in foot pain while the control group showed only minimal changes. The control group received five weeks of analgesic medications, stretching exercises and shoe modifications. The acupuncture group received the same therapies plus electro-acupuncture treatments. The researchers concluded that, “Electro-acupuncture coupled with conventional treatments provided a success rate of 80% in chronic planar fasciitis which was more effective than conventional treatments alone.”

Another recent study demonstrates that acupuncture is effective for the treatment of plantar heel pain. The researchers note that acupuncture has more significant improvements in both pain relief and the restoration of function than a standard regime of care that includes non-steroidal anti-inflammatory medications. Based on these findings, the researchers formally recommend acupuncture for the treatment of plantar heel pain.

In yet another study, investigators concluded that acupuncture at acupoint P7 (Daling, “Big Tomb”) relieves the pain of plantar fasciitis. P7 is located in the middle of the transverse crease of the wrist. P7 is a Shu-Stream point and Yuan (Primary) acupuncture point that is known for the treatment of Heart and Spirit related issues including myocarditis, palpitations, insomnia, mental illness, irritability, and cardiac pain. P7 is also used for Stomach related conditions, however, nearby point P6 is a more common point for the treatment of Stomach issues such as stomachache, nausea, and vomiting.
According to Chinese medicine and acupuncture theory, Shu-Stream points treat a heavy sensation of the of the body and painful joints. P7 is therefore a common point for the treatment of wrist pain because it is a Shu-Stream point located at the wrist . However, the researchers have chosen P7 for the wrist’s distal relationship to the ankle and heel region. At a six month follow-up examination, the P7 acupuncture group showed a significant improvement over the control group.
Plantar fasciitis affects approximately 2 million US citizens annually. These findings demonstrate that acupuncture is an important treatment modality for inflammation of the connective tissue on the bottom of the foot. Advantages to acupuncture treatment are that it is both safe, acupuncture is nontoxic and is nonsurgical, and effective.
References:
The American Journal of Chinese Medicine, An International Journal of Comparative Medicine East and West. Efficacy of Electro-Acupuncture in Chronic Plantar Fasciitis: A Randomized Controlled Trial. Wipoo Kumnerddee and Nitsara Pattapong. Volume 40, Issue 06, 2012.

Shi Ping Zhang, Tsui-Pik Yip, and Qiu-Shi Li.  Acupuncture Treatment for Plantar Fasciitis: A Randomized Controlled Trial with Six Months Follow-Up. Evidence-Based Complementary and Alternative, Medicine, Volume 2011 (2011), Article ID 154108.

Acupunct Med. doi:10.1136/acupmed-2012-010183. The effectiveness of acupuncture for plantar heel pain: a systematic review. Richard James Clark, Maria Tighe.

http://www.healthcmi.com/index.php/acupuncturist-news-online/661-acupunctureceusplantarfasciitisea

Acupuncture Reduces Knee Pain

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A new study concludes that acupuncture reduces knee pain and increases mobility for patients with osteoarthritis. This new randomized, controlled, double-blinded study also revealed some differences in acupuncture treatments. The researchers compared non-specific (sham) needling, modern acupuncture and classical acupuncture treatments.

The results showed that sham acupuncture only achieved a patient pain reduction rate in 48% of patients while modern acupuncture achieved a 64% rate and classical acupuncture achieved a 73% rate. Sham acupuncture did not improve knee mobility but modern and classical acupuncture made significant, measurable improvements in knee mobility. The researchers concluded that there is “a specific effect of acupuncture in knee mobility.” The researchers also note, “With respect to knee motility, individualised classical acupuncture achieved twice the effect of semistandardised modern acupuncture.”

Acupuncture for Knees

The sham acupuncture bodily points were those not specifically noted for the treatment of knee pain in Chinese medicine texts. The modern acupuncture points were those suggested based on the biomedical condition of knee osteoarthritis. The acupuncture points were: ST36, ST34, EX32, SP9, SP10, SP6, GB34, LI4. The classical acupuncture points chosen were based on a customized differential diagnosis based on tissue tenderness, tongue diagnosis, pulse diagnosis, syndrome differentiation and symptoms. Needles chose for the study in all cases were 0.22 X 40mm copper needles. Ear and hand points were excluded from the study. Needle stimulation was applied and needle retention was a total of 30 minutes per treatment.

The researchers note, “This suggests a considerable specific effect of acupuncture in objective knee flexibility, an effect that appears to be method-specific as well… we observed a rapid improvement of knee flexibility immediately after classical acupuncture, which was twice the effect observed after modern acupuncture and absent after non-specific needling.”

This is not the first study showing the effectiveness of acupuncture for the treatment of knee disorders. One recent study discovered that acupuncture is more effective than both sham acupuncture and biomedicine for the treatment of knee pain. A meta-analysis of 14 random controlled clinical trials involving 3,835 patients states, “Acupuncture provided significantly better relief from knee osteoarthritis pain and a larger improvement in function than sham acupuncture, standard care treatment, or waiting for further treatment.” The study notes that acupuncture for the treatment of knee osteoarthritis is “better at relieving pain and restoring function” than both standard biomedical care and sham acupuncture.
References:
Max Karner, Frank Brazkiewicz, Andrew Remppis, et al., “Objectifying Specific and Nonspecific Effects of Acupuncture: A Double-Blinded Randomised Trial in Osteoarthritis of the Knee,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 427265, 7 pages, 2013. doi:10.1155/2013/427265

Sau. Med J. 2012 May;33(5):526-32. Needle acupuncture for osteoarthritis of the knee. A systematic review and updated meta-analysis. Cao L, Zhang XL, Gao YS, Jiang Y. Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China.

http://www.healthcmi.com/index.php/acupuncturist-news-online/671-acupuncturereducekneeflexibility

Can Acupuncture Help Children?

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Acupuncture is a common alternative-medicine treatment for adults, but it has benefits for kids, too.

http://www.everydayhealth.com/pain-management/can-acupuncture-help-children-8847.aspx
By Jennifer Acosta Scott
Medically reviewed by Pat F. Bass III, MD, MPH

Say the words “alternative medicine,” and you’re likely to envision acupuncture, a treatment that involves stimulating strategic points on the body with small needles. According to statistics from the National Institutes of Health, millions of adults have used acupuncture to treat a variety of conditions, from migraine headaches to low-back pain. But what’s often not mentioned is that children can be acupuncture patients, too. Figures from a 2007 National Health Interview Survey, which collects data every five years on the use of complementary and alternative medicine, showed that 150,000 children in the United States used acupuncture.

Exactly how acupuncture works is unknown. Traditional Chinese medicine practitioners say that the treatment spurs healing by modulating the body’s chi or energy pathways. Western medicine experts believe that placing thin, metallic needles under the skin stimulates the release of certain chemicals in the brain that can calm down pain receptors in the body.

“Our belief is that a lot of chronic pain is not caused by anything other than a hyper-arousal of the nervous system,” says Michael Waterhouse, a licensed acupuncturist in Beverly Hills, Calif., who works with the pediatric pain program at the University of California, Los Angeles. “The kids have been in pain so long that the pain receptor sites in the brain are firing off all the time. Acupuncture can help stop that.”

The American Academy of Pediatrics (AAP) has no official stance on treating children with acupuncture, but a recent study published in its journal, Pediatrics, found that the practice is generally safe when performed by a skilled practitioner. In fact, fewer serious adverse effects are reported with acupuncture than with conventional pain treatments. Acupuncture can be used on even very young children, as long as the practitioner is trained to work with patients of that age. “I’ve treated 2-week-old infants with colic, for instance,” Waterhouse says.

Though the effectiveness of acupuncture for adults has been widely studied, less research on pediatric acupuncture exists. Waterhouse notes that large-scale trials in pediatrics have not happened yet. However, some studies have shown it to be an effective treatment for ailments like acute pain, anesthesia-induced vomiting, and headache. In the United States, acupuncture is mainly used in children to control nausea from surgery or chemotherapy treatments, as well as chronic pain, says Lawrence Rosen, MD, chairman of the AAP section on integrative medicine.

Most children tolerate acupuncture treatments quite well, says Waterhouse, whose pediatric patients are usually 8 to 18 years old. Patients who may not like the idea of having needles under their skin can still take advantage of acupuncture’s benefits with laser acupoint stimulation, which uses cold lasers to stimulate points on the body, or with acupressure, which involves pressing or massaging these areas.  “It’s very easy to do a lot of points without pain this way,” Waterhouse says.

The role that acupuncture plays in a child’s treatment plan can vary. For children with cancer, it doesn’t replace conventional treatments, but it can be used to help control unwanted symptoms. For other conditions, acupuncture may be useful as a standalone therapy. “In acute or chronic pain cases, it may replace medication use in some patients,” Dr. Rosen says. In all instances, children who undergo acupuncture should be monitored by their pediatrician to make sure the treatments are helping.

Because the requirements for becoming an acupuncturist vary from state to state, it can be hard for parents to choose the right practitioner for their child. The most important step is checking with your state to make sure a practitioner you’re considering is licensed to practice acupuncture. A good place to start your search is on the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) website. Most states require that acupuncturists have completed the NCCAOM exam and/or certification process. You’ll need to check further with office that regulates acupuncture in your state (note that Kansas, Alabama, Oklahoma, South Dakota, North Dakota, and Wyoming do not regulate acupuncture).

If you visit the NCCAOM State Licensure Requirements page and click on Acupuncture Licensure Requirement, you’ll find a State Licensure Requirement table with contact information for your state. It’s also important to be sure that the acupuncturist you’re considering has experience in treating children.

“It’s just a question of personality after that,” Waterhouse says. “Make a few phone calls. Hopefully the acupuncturist will give you 5 minutes to talk on the phone and get a feel for what they’re like and if your personalities gel. You should always feel safe and that your child is in the hands of a competent practitioner.”

Ear Acupuncture for Addicted Pregnant Women

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http://7thspace.com/headlines/428916/auricular_acupuncture_for_chemically_dependent_pregnant_women_a_randomized_controlled_trial_of_the_nada_protocol.html

The prevalence of maternal drug use during pregnancy in North America has been estimated to be as high as 6-10%. The consequences for the newborn include increased risk for perinatal mortality and ongoing physical, neurobehavioral, and psychosocial problems.

Methadone is frequently used to wean women off street drugs but is implicated as a cause of adverse fetal/neonatal outcomes itself. The purpose of our study was to test the ability of maternal acupuncture treatment among mothers who use illicit drugs to reduce the frequency and severity of withdrawal symptoms among their newborns.

Methods: We randomly assigned chemically dependent pregnant women at BC Women’s Hospital in Vancouver, British Columbia to daily acupuncture treatments versus usual care.

By necessity, neither our participants nor acupuncturists were blinded as to treatment allocation. Our primary outcome was days of neonatal morphine treatment for symptoms of neonatal withdrawal.

Secondary neonatal outcomes included admission to a neonatal ICU and transfer to foster care.

Results: We randomized 50 women to acupuncture and 39 to standard care. When analyzed by randomized groups, we did not find benefit of acupuncture; the average length of treatment with morphine for newborns in the acupuncture group was 2.7 (6.3) compared to 2.8 (7.0) in the control group.

Among newborns of women who were compliant with the acupuncture regime, we observed a reduction of 2.1 and 1.5 days in length of treatment for neonatal abstinence syndrome compared to the non-compliant and control groups, respectively. These differences were not statistically significant.

Conclusions: Acupuncture may be a safe and feasible treatment to assist mothers to reduce their dosage of methadone.

Our results should encourage ongoing studies to test the ability of acupuncture to mitigate the severity of neonatal abstinence syndrome among their newborns.Clinical Trial Registrationhttp: www.clinicaltrials.gov registry: W05-0041

Author: Patricia JanssenLouise C DemorestAnne KellyPaul ThiessenRon Abrahams
Credits/Source: Substance Abuse Treatment, Prevention, and Policy 2012, 7:48

Acupuncture and Closure: Turf Wars

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An article about Acupuncture and its relationship to mainstream medicine and chiropractic

http://www.acupuncturetoday.com/mpacms/at/article.php?id=32682

By William Morris DAOM, PhD, LAc

Not a fan of turf battles, I support the notion of “portable competencies”, which are skills that may be applied by different professions. That ported competency, however, must be equitable, safe and effective.

As an example of equity, acupuncturists could perform chiropractic adjustment given a chiropractor who does acupuncture. The catch is quality. It is safe to assume poor quality services with low levels of education. The question: where are the bounds of safety, quality and efficacy given a ported competency?

It makes no difference if a legislator uses acupuncture. It is likely that someone important to them will during the course of their life. And – that beloved should be confident of the best possible care.

Safety and efficacy should be determined through co-operative inquiry in a large group process where important stakeholders participate to define the necessary educational, testing and certification processes.

Turf issues are often foisted upon policy makers as a concern for not confusing the public. Such arguments are often patronizing, and provide poor masks for the protection of monopolies.

Acupuncturists must now face the problem of other professions attempting to co-opt acupuncture by reframing acupuncture as dry needling, percutaneous electrical nerve stimulation (PENS) or trigger point therapies. As Shakespeare’s Juliet suggested, “What’s in a name? That which we call a rose by any other name would smell as sweet.” The insertion of a needle into the skin — no matter the purpose, cognitive framework upon which it is exacted, or best wishes of practitioners and policy makers — is acupuncture!

Economic impact of a work is at the heart of the matter. These efforts of turf battle are bound within a social power structure, which can be called “closure.” Here we explore Weber’s notion of Closure Theory, which describes a process of domination whereby one group monopolizes advantages in their own interest. This is accomplished by closing off opportunities to another group of outsiders beneath it, which it defines as inferior and ineligible.

Closure can be accomplished when the state, through legislators, maintains economic interest in a profession. These interested and benefitted parties then play a role in a profession’s rise to dominance and power through the definition of licensing and educational requirements. Such goals are often achieved through ideas such as public safety – a necessary component of licensure – but, an idea, which is also used to sustain closure.

We have seen the effects of closure on natural products based care. In the post – Flexner era, schools of homeopathic and natural products bias were crushed, even though they were often safer and more effective than the surgical and chemical based forms of care at that time.1 We are finally seeing a return after some 83 years with Eisenberg’s report on use of CAM practices in 1993.2 Further, the impact of closure can affect the availability of Chinese medicine to patients and ultimately, whether we can lower ‘cost of care’ to the culture at large. Practitioners of acupuncture and Oriental medicine are often a last stop resort.

Weber identifies 4 types of closure. 1) Exclusion exercises hierarchical dominance of inferior social groups by closing off access to opportunities and resources. This occurs through the creation of specific skill sets and entry credentials that protect and secure a privileged access to the market. 2) Demarcation and interdisciplinary control occurs when members of a discipline monitor and regulate closely related occupations defining and controlling boundaries between them. 3) Exclusion suppresses vertically while demarcation does so horizontally. 4) Inclusion refers to subordinate’s attempts to access the advantages of higher-level groups. The privileged elite dismisses it as usurpation.3, 4

Closure contributes to a sociopolitical and economic environment that isolates and disconnects people. Thus, the issue of closure presents a larger concern than advantages for a given profession.5 Closure limits access to care and creates economic privilege. How is this to be balanced with quality, safety and the best possibilities for a social system? These are the questions we must solve.

Scope of practice refers to procedures. Any agency ruling upon scope, without clearly designated processes for establishing standards of education, operates in the interest of the guild and not the public.

Agencies are obligated to protect public safety. They should consider independent risk analyses that include available data on adverse events related to a given procedure. Risk is greater than individual physical harm caused by undertrained providers of acupuncture. There is risk of economic harm caused by poor results from undertrained providers. Lastly, there is potential harm caused at the level of public policy. Take for instance the lawmaker who may have a poor conception of the value of acupuncture based upon poor outcomes, personal experience and public perception of low levels of education.

To date, no state agency tasked with oversight of Chiropractic, Physical Therapy or Nursing has established guidelines for its approval of entry-level education and certification agencies for acupuncture. Those responsible for public safety should require an external qualifying agency for the procedures it authorizes. It should be an agency with a track record such as the National Commission for Certifying Agencies (NCCA). This would at least ensure that valid process for determining competencies and assessing them were achieved.

Further, no allied health care agency has performed appropriate risk analyses, published appropriate guidelines for qualifying certification agencies, nor have they demonstrated systems for oversight of physical therapists practicing acupuncture. The state acupuncture boards have. They are the only agencies identified in legal code with the authority, budget and capacity to ensure public safety in the practice of acupuncture.

The complexity of the problem is tied to the identity of a profession: AOM. We do acupuncture, but it is more than that. There is the entire fabric of being as a community and a profession.

Acupuncture, myofascial work, chiropractic manipulation and physical agents such as ultrasound and infrared therapies all have billable codes. In a world of equitable and truly portable competencies, there is a path for gaining rights and privileges commensurate with having gained the competency that allows for performing a procedure. Further, all procedures are placed upon the table and the requisite competencies are determined. Once this takes place, then the establishment of programs with corresponding assessments of outcomes is possible.

One option is an interdisciplinary process whereby the competencies that are to be shared between disciplines are defined and the criteria by which those competencies are accomplished are mutually agreed upon between the disciplines.

This should be inclusive of all procedures performed using physical agents, manual therapeutics and the full range of evaluation and management codes.

From: Acupuncture Today
January, 2013, Vol. 14, Issue 01

References

  1. Morris WR. Flexner to Eisenberg: The Turning of a Nation. Acupuncture Today. 2011;12(11).
  2. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional Medicine in the United States — Prevalence, Costs, and Patterns of Use. N Engl J Med. 1993;328(4):246-52.
  3. Parkin F. Strategies of social closure in class structure. London: Tavistock; 1974.
  4. Hollenberg D. Uncharted ground: Patterns of professional interaction among complementary/alternative and biomedical practitioners in integrative health care settings. Social Science & Medicine. 2006;62(3):731-44.
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Acupuncture in China, from Acupuncture Today magazine

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Acupuncture Today in China: Part I

By Brenda Duran, Senior Associate Editor

Editor’s Note: This is the first in a series exploring acupuncture care in China. For a week in October, I traveled to Tianjin and Beijing for a glimpse into where acupuncture is headed and what practitioners in the United States can learn from the latest innovative treatments abroad.

 http://www.acupuncturetoday.com/mpacms/at/article.php?id=32678

Tianjin, China – On the 12th floor of the First Teaching Hospital in Tianjin of TCM, 27-year-old stroke patient Ashley Boyes waited anxiously for her doctors to enter her room so she could greet them with a simple “hello.”

The road to recovery for Boyes has been long. Three years ago the Arizona resident lost her speech and mobility on the right side of her body.

She and her family struggled to find the proper care in the United States. Frustrated with the lack of improvement after undergoing surgery on the left side of her skull and extensive physical therapy Boyes came to Tianjin.

“We have seen some dramatic results here,” said her mother, Esther House, who has been overseeing Boyes’ care at the highly regarded Chinese medical institution. “She went from not being able to make a sound to putting a few words together and having some movement.”

Now, after six weeks of treatment, the doctors filed in. Tracy’s eyes brightened.

“Hello.”

AT in ChinaSeeking Help in China

Boyes is one of the thousands of Americans who travel more than 7,000 miles every year to seek the specialized Traditional Chinese Medicine (TCM) care that the First Teaching Hospital in Tianjin has to offer. Like them, Boyes came here as a last resort: Acupuncture was her final attempt to get her life back.

Boyes’ mother said it was after seeing the documentary “9000 Needles,” which profiled a former body builder’s recovery efforts from a stroke at the Tianjin hospital, that she was motivated to seek care for her daughter in China.

Boyes’ mother and father were new to acupuncture and felt it was worth the trip after watching the film to try something that did not involve much invasive treatment and showed promising results in others.

“We are saddened that more people cannot take advantage of this level of care in the U.S.,” said House. “Based on what we have seen, we have high hopes Ashley will not need substantial treatment after being here.”

With more than 1,760 staff members, the hospital is well equipped to handle a steady stream of patients. In 2011, the number of outpatients reached 240,000 and the rate of sickbed utilization has remained at 100 percent for the past 17 years, according to hospital officials.

A typical day of care involves over five hours of treatment that include tuina massage, herbal baths, physical therapy and extensive electro acupuncture by numerous doctors and their student assistants.

Acupuncture Today in ChinaOne of the three main medical towers of the First Teaching Hospital in Tianjin, China.The Chinese government made efforts in 2010 to grow the hospital, which is the largest TCM medical center in the country, by approving an expansion that will be complete in 2014, 60 years after it was established.

The medical buildings now cover an area of more than 861,000 square feet. When the expansion is done the center will cover more than 1.7 million square feet with additional hospital towers and a research facility.

In the birthplace of acupuncture, TCM is more than a “complementary” treatment. For many Chinese it is recognized as primary care, and the Tianjin hospital is the first stop for most people in the area when it comes to their health.

Stellar Care A Priority

As dawn breaks, the entrance corridor of the First Teaching Hospital is crowded and bustling with patients.

They come seeking medical attention for an array of ailments, ranging from strokes to mild gastrointestinal maladies. With 103 special disease clinics, the hospital is run efficiently to accommodate the crowds in the morning with a fast triage system that includes a tongue and pulse assessment and quick blood work.

A long list of specialists’ names lines the wall at the entrance of the hospital, among them five experts conferred by the Tianjin municipal government, 12 internationally famous doctors, 161 doctors with high-grade professional titles, and 201 doctors with assistant professorship titles.

The hospital is also an education hub that attracts 24 doctoral candidate tutors and 169 master’s candidate tutors.

Traditional Chinese Medicine takes on a new meaning in Tianjin. In the United States, many TCM patients are known for seeking treatment after trying out Western medicine and not seeing any results, in China the process is reversed.

Patients seek TCM first and, if necessary, they will follow up with Western treatment if needed to complement their Eastern treatment.

The advantage of the Tianjin hospital is that it can offer both.

Often during the consultation, a TCM doctor surrounded by students and interns will make a “differentiation” or TCM diagnosis, and chart out a treatment strategy. They will then recommend both the number and the frequency of treatments that include Eastern and Western techniques.

The hospital has set itself apart for not simply treating illness, but also taking the whole person — body, mind and spirit — and finding solutions to their ailments combining a care program that is weaved in with Western medical techniques and tests.

“Patients get a lot more tools to manage their condition here,” said Alex Chen, L.A.c., DAOM, from San Francisco, Calif., who was doing a professional internship at the hospital this past fall. “What makes care unique here is that both Eastern and Western medicine is used to get the best treatment for patients.”

Although TCM is the primary source of care, the hospital is well equipped with Western technology, including 1,000 types of medical equipment, such as CAT scans, MRI machines and laboratories to aid physicians in treating their patients.

Making this type of high tech TCM care affordable and accessible to the masses is a high priority in Tianjin.

“For $2 you get seen by the doctor here, a medical file costs you no more than a few cents and your wait time is often no more than 15 minutes,” said Jing Liu, L.Ac, from the Scottsdale, Ariz.-based Eastern Medical Center who trains at the hospital annually. “Blood tests are done on the spot, you get the results the same day and you get a diagnosis right away so the problem can be fixed.”

As in many hospitals in China, access to acupuncture mimics what is known in the U.S. as “community acupuncture” – the acupuncture is made affordable and often treatment is done in-group settings for those with minor ailments.

However, care for serious health issues such as stroke or cancer is much more thorough, entailing laboratory work and frequent follow-ups.

Acupuncture Today in ChinaDr. Shi Xue Min being honored for 50 years of service at the first teaching hospital of Tianjin.Dr. Shi Xue Min, one of the hospital’s top officials and stroke rehabilitation expert said he feels the First Teaching Hospital of Tianjin is a good example of what the future could hold for acupuncture in the United States if treatment were more readily available and accessible to the masses.

“The insurance companies in China have very few restrictions on covering the acupuncture expense. So patients in China can receive sufficient treatment,” said Xue Min, via a translator. “But in America, most of the insurance companies more or less have difficulty covering acupuncture. From the financial perspective, many patients are concerned about the expense or the frequency of the treatment, so it’s difficult to achieve the acupuncture quantitative-effect relation.”

The low cost of acupuncture in China is what allows patients to be better served with more frequency.

To serve the large influx of patients who make their way to the hospital daily, acupuncture doctors have also reached high education levels and have committed to rigorous training not yet seen in the states, according to staff at the Tianjin hospital.

Most of the physicians study three years for their master’s degrees, three years for their PhD and have to complete medical training and three years of observations.

Only five percent of those who pass the final exam are allowed to needle a patient, according to the staff.

Doctors of TCM in China are also given the right to prescribe drugs when necessary – something that’s not allowed in the United States.

“Acupuncturists who come here are able to see the range of acupuncture in the role of disease management a lot better,” said Chen. “There are also a lot of techniques not available in the states that benefit patients dramatically, and that is the biggest difference.”

Making A Mark

Among some of those techniques are herbal injections, point injections and bloodletting. There is also the hospital’s most popular and sought-after treatment, Xing Nao Kai Qiao, or XNKQ, which is an acupuncture stroke treatment developed by Dr. Shi Xue Min.

Xing Nao Kai Qiao is translated as “activating the brain and opening the orifices.” The principle points of the XNKQ method include Du 26, P 6, Sp 6, Lu 5, Ht 1, and UB 40. Du 26 is a point that was highly regarded historically for emergency situations; it can directly excite and activate the restrained state of the brain cells. It has a special characteristic of increasing the circulation of the carotid artery, which helps the dynamics of blood circulation and improves cerebral circulation, according to Xue Min.

The hospital has received wide attention for this treatment in recent years, and the interest of U.S. acupuncturists in the technique has grown dramatically since Xue Min introduced it.

Last year marked 50 years of service by Xue Min at the hospital. To date, he is the most sought-after doctor there and is well known in TCM circles all over the country as the “godfather of acupuncture.”

His famed technique was highlighted in the film “9000 Needles” in 2010. In 2011, Xue Min also trademarked the treatment in the United States.

Min’s greatest contribution has been recognized as XNKQ, primarily for the success rate of the thousands of patients who come from all over the world to be treated at the Tianjin hospital.

According to the most recent statistics noted at the hospital, the clinical recovery rate with XNKQ for the acute and recovery phase is 88.5 percent; the total effective rate has reached 98.5 percent. The effective rate for the stroke sequel is 85.5 percent.

“The majority of the American patients who came to the first Teaching Hospital in Tianjin had been treated in America with Western medicine and they want their progress to go further,” said Xue Min via his translator. “After receiving three-month treatment in the First Teaching Hospital in Tianjin, the majority of them improve with different degrees. For those less severe stroke patients, they could take care of themselves and return back to their normal lives after treatment.”

Xue Min noted that what often prevents a stroke relapse for many of the patients treated with XNKQ in Tianjin is that the acupuncture is able to help reduce high blood pressure and increase low blood pressure for those who suffer a stroke due to the hypertension or hypotension.

Not having to worry about relapsing is the type of recovery most patients in the stroke rehabilitation section of the hospital hope to achieve.

Ohioan Looks to Recovery

Like American patient Boyes, Ken Kreuz, 75, of Sylvania, Ohio has high hope for a speedy recovery at the Tianjin hospital from the stroke he suffered in 2011.

Acupuncture Today in ChinaAshley Boyes of Arizona receiving her daily stroke rehabilitation treatment in Tianjin.This past fall, Kreuz was undergoing XNKQ treatment primarily for his mobility issues after he suffered a stroke the previous year. Kreuz said there was no indication he had previous health problems and suffered a stroke ironically while working out with his wife Sue.

Initially, Kreuz sought treatment at the University of Michigan; there he said doctors were trying to assess his recovery treatment for months.

“The therapist at the University of Michigan said ‘why are you here?’ Because I am an active senior soft ball player and a golfer,” said Kreuz while receiving a tuina massage at the Tianjin hospital in October. “They don’t know why this happened to me.”

Sue Kreuz said her and her husband decided to get educated about their options in alternative care. The couple read “Coming Out of Darkness” by Ruth Lycke, which chronicled her experience recovering from a stroke, and also watched Xue Min in 9000 Needles before making the trek to Tianjin.

“When we met with the staff at the University of Michigan they told us if this had happened to them they would come to this hospital,” said Sue Kreuz, who was overseeing her husband’s care at the Tianjin facility.

Ken Kreuz said he had been receiving care at the Tianjin hospital for two and a half months this past fall and was pleased with the results following XNKQ.

“I don’t think his arm would have the range that is has now,” said Sue Kreuz. “The attention he has been getting is unbelievable here.”

Ken Kreuz, like the other Americans at the hospital, normally receive a medical visa from the United States for a few months. In that time, patients like Kreuz and Boyes hope to gain more mobility and strength than they have lost.

“I’d like to be playing left field for the Detroit Tigers soon,” joked Kreuz. “But, in all honesty I am satisfied. I don’t know where I’d be if it weren’t for this place.”

The ideal treatment of XNKQ is recommended for patients such as Kreuz and Boyes to be twice a day at the Tianjin hospital.

Early Results

For Boyes, recovery results were seen soon after her third acupuncture treatment. Boyes’ mother said she was able to say the word “mango” initially and gained some movement in her arm following her acupuncture session, which included 3-inch, heavy gauge needles, typically used in China.

“It truly is shocking that back home the medical community doesn’t seem to accept this treatment – either they are skeptical or have no opinion,” said House, Boyes’ mother. “This treatment should be on the rise, this could be the future.”

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