An Open Letter To Mark Seem

This letter is posted here in response to a post on the AAAOM FPD forum by the president of Tri-State College of Acupuncture, Mark Seem.

So, let’s be clear Mark.  You’re suggesting that poor minority students, especially Blacks and Hispanics, are disinterested in an AOM education, not because of the $50,000-$100,000 price tag involved, but because they lack the entrepreneurial drive of white middle-class students and prefer the security of mainstream medical settings.  Really?  Where is your evidence?  Please share you “informal market analysis” with the rest of us and I would ask if any other AOM college president or upper administration would care to make the same claim.  It is insulting to minority people to suggest this and you would do well to back your statement up with evidence.  Suggesting that the Community Acupuncture Network (CAN) opposition to the first professional doctorate has the backdoor effect of keeping minority students at arms length from AOM education simply has no merit.  

As a matter of fact, according to the just released Babson College and Baruch College Global Entrepreneurship Monitor (GEM) 2006-2007 National Entrepreneurial Assessment for the United States of America, “minorities demonstrated higher rates of entrepreneurship than did Whites, and they showed the same demographic and motivation as White entrepreneurs in terms of business types, growth expectation and education.”  Are minority students more drawn to group practice, or are they too smart to invest in a degree that has no payoff?  That jobs exist for other medical and allied healthcare professionals before they choose their path seems to be lost in your reasoning.  There is some irony in the emphasis you would place on critical thinking in AOM education and the lack of it required to invest in said education.  

Why would any under, working or lower-middle class person, regardless of race, commit the amount of money that you expect for a product that has little to no representation in the western healthcare industry, is only just beginning the process of collecting income statistics for practitioners of its field, and is widely rumored to have a failure rate greatly in excess of 50% for students 5 years post graduation?  On what merits do you propose that western healthcare facilities will begin hiring acupuncturists that have the appropriate competencies? According to the Summary of Results of the Complementary and Alternative Medicine Survey of Hospitals from the American Hospital Association/Health Forum, CAM in western medical settings is on the decline.  The money isn’t there.  The statistics in this study do not bode well for any proponent of the FPD claiming that said education will be warranted by jobs in western medical settings.

The CAN board understands quite well that the FPD is not being discussed as an entry-level degree at this stage in the game.  We are aware of your position and understand the process.  You presume too much in your post.  Have you had a single conversation with any member of the board or its founders?  No, you have not.  Your gross misrepresentation of our views speaks to that fact.

There is nothing “ostensible” about our support of NADA practitioners.  Michael Smith is a revolutionary figure, as well as a visionary.  He has taken much grief from the AOM establishment, a fact that we find truly indicative of the turf-war mentality that beleaguers the AOM profession.  We would have NADA technicians in our clinics as assistants treating any condition, not just detoxification.  The utility of the 5NP contains the very essence of AOM: simple, cheap to administer and effective.  That you would claim that CAN is “critical of providing AOM care free to anyone (and thus leave out the working poor and totally poor citizens who have no health insurance and no way of getting access to such care).” is outrageous.  On what do you base this claim?  Back up and source this statement.  

Neither is CAN critical of, nor does it begrudge the “treatment of middle class and wealthy patients who can afford to pay top dollar (thus undervaluing the right of those citizens to get AOM care)” We would, however, challenge your definition of the middle-class, assert that acupuncture only becomes truly accessible and thus effective at the upper end of the middle-class and question what defines “top dollar” when value is subjective and based intimately, though not exclusively, on income.  That you fail to understand this and use the phrase “top dollar” is an inappropriate point of view for a healthcare practitioner, much less a leading educator and speaks to the morass the profession is currently in.  If you had truly read The Remedy beyond skimming, a claim that I doubt, you would find no mention of the idea that acupuncture should be practiced at the expense of all economic classes save the working class.  Where did you get this idea? Again, back up and source this statement.

And here is exactly where our critique of the FPD has foundation, has strong bearing on the issue and comes from a wider point of view then you demonstrate here.   First, we believe that the priority placed on renewing and reviewing ACAOM doctoral standards and allowing schools to implement pilot programs represents a dramatic misunderstanding of the economic reality that inhibits working and lower-middle class people of any race from studying AOM and results in the disenfranchisement of these classes from AOM care.  We too are not surprised that a very large percentage of TSCA students (76%) and well more than half of the graduates that responded to your survey are open to coming back or staying on an extra year for doctorate training, though we would hardly consider 53% of graduates a number to boast about.  If these students and graduates can already entertain the hours and money at the masters degree level, we argue that they are not working or lower-middle class people and that the AOM educational model which you yourself had a heavy hand in molding is designed in such a way that AOM education is an afterthought for these populations.  It is not as simple as denying students and graduate’s the right to such an education as you accuse, when the masters level degree as already established excludes working and lower-middle class people from study. That you don’t identify current expenses related to AOM education as being exclusionary, especially considering a graduates prospects post-graduation are telling. Tuition will rise.  It has to.  Expenses will rise.  They have to.  And now you will ask all future students to subsidize the notion, the idea, that a first professional doctorate is in the publics best interest and represents a movement forward for the field.  

We believe that your product, AOM education, is a failure.  It is failure not only to those that take up the task of studying it, but also to the vast majority of people that could benefit from its use.  This is not because it is missing Institute Of Medicine core competencies resulting in a lack of preparedness for graduates to enter multidisciplinary settings.   The Institute Of Medicine report that you are citing mentions the terms acupuncture, Oriental medicine, CAM and any specific CAM modality exactly zero times in the entire length of the paper, while making numerous examples of various medical and allied health care professionals repeatedly.  While we would agree that any acupuncturist working within a western-based multidisciplinary setting should be able to communicate effectively with western medical providers of any stripe, we simply assert that this step is not in the best interest of our communities of interest, the people that sit in our chairs, and until it is demonstrated clearly that jobs await AOM students in western medical settings en masse, you will not have our support.  That we have founded and promoted a practice model entirely contrary to what you have taught us makes us of the mindset that many others like us could learn to practice and positively affect their own communities the way that we have.  You and other AOM educational leaders have created the boundaries that exist to access and now plan to create even more and it is something we will not abide silently.  If we weren’t so successful at what we were doing, demonstrating daily the excessive and wasteful nature of AOM education as you and others like you have structured it, we wouldn’t be in the position to argue with you that we find ourselves in now.

So while your Lincoln Detox Acupuncture experience left you “delighted to be part of a community acupuncture setting serving patients even poorer than my own background, and felt very positive about the work, and the fact that lower class citizens were gaining access to this medicine, from the very beginning.” you largely misunderstand what community acupuncture as taught by CAN is about and how FPD standards threaten it.  Community acupuncture (CA) was not born of ideas and theories of “accessible healthcare” and “affordability”.  It was born from real relationships between real people, some of whom knew how to stick needles into people.  It was the assimilation of acupuncture into those relationships that gave birth to CA, not some liberal notions of do-good behavior.  At $50,000-$100,000+ most any chance for Black, Hispanic, White, Red, Yellow or Green working and lower-middle class (and increasingly middle class) people to assimilate acupuncture into their already established social networks is non-existent.  CA is not dependent on disasters, natural or man-made to be a viable practice model.  But the slim chances that these working and lower-middle class people will commit to the price tag attached to AOM education right now, today, at the masters-level, is only exacerbated by the first professional doctorate, optional or not.  And this, more than anything, is why we will resist the FPD.  Our critique may be radical.  It is also clear headed and honest.  We refuse to consent to any further changes in the profession that attract and further churn out people that have little to no emotionally involved social relationships with our communities of interest, namely the working, lower-middle and middle class.  We reject the idea that AOM education made more costly in time and money will attract minority students.  In fact, the notion is ludicrous.    

Everyday middle, upper-middle and truly upper-class people sit in our chairs.  However, we are committed to the idea that acupuncture treatment must both be affordable to those people making minimum wage, while providing ourselves with a living wage.  We fully support the idea that people of all classes should have access to care, not favoring the status of any particular class and your cynical attempt to differentiate us from the middle class is both ill informed and divisive.  Our critique as stakeholders can and will influence the development of FPD standards, contrary to your dissent.  Further, what you believe the response rate necessary in any survey in support of the development of FPD standards needs to be is of no real value.  That rate will be decided by the Department of Education, which already uses the term “widely accepted” when defining what would justify any change in scope of practice.  That means more than “evenly divided”.  Declaring a mandate based on your own preference of a split is beyond childish.  

You espouse a fanciful picture of what AOM could look like, how “the term ‘community acupuncture’ would take on even greater significance” when the FPD standards “are adopted”.  There is little influx of practitioners beating the walls demanding that change and we are convinced that if you and the rest of the AOM educational leadership re-prioritized in the best interest of patients, AOM would be in a much more powerful position than an FPD could ever promise.  Our reality is thousands upon thousands of patients that get acupuncture every week and believe passionately in what we do and why we are doing it.  In the end, whose vision do you think is going to prevail?  Theirs, or yours?   

Larry Gatti
CAN Board  

Author: LarryG

CA punk for 12 years. AZ License #600

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Conference Keynote: Breaking the Ceiling

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  1. .

    wow. hell yes!


    still being fairly new to the whole world(and underworld)of acupuncture, i find most of the time i just need to sit back and listen to this all and try and take it in. But CAN has always sparked something within in me that is completely and undeniably drenched in truth. sometimes sloppy like a wet dog shaking off in the house and other times refined and as pointed as an arrow, but bigger than any individual involved the shen of this movement as a whole has always felt very truthful. it has also come at a time when it is needed most in this world. and much in the same way other revolutionary people/movements have sprung up at just the right moment and embody a conciousness that was looming in the air but hadnt fully manifested, here comes CAN. even the individuals involved throughout history, as great as they are, have only been conduits and messengers of the bigger picture; emma goldman, dorothy day and ammon hennacy, assata shakur, bob dylan…..punk rock.


    i too look forward to the future discussion of the FPD. i think it is very telling from mark’s response that between the lines he DOES understand the power of CAN, and as always happens to truly impactful and revolutionary groups, step one is to dissipate or in some way write off the opposition first as at best ill informed and at worst as marginal/radical/hurtful/etc etc. and that seems fairly clear in this case. trying to assimilate the CAN movement as a cute thing that we should all strive to donate a little charity time to at some point in our lives rather than as something completely outside of the control of the arbitrary institutions is again simply marginalize and assimilate. nothing is more threatening to insitutions than the idea that they arent necessary. its interesting to ask in any of these discussions, “what is the intention of the writer and who benefits from that perspective?”. i see the response as a victory for the CA movement.


    movements keep moving.

  2. Tell it, Larry.

    Thanks for posting the link to Seem’s letter; I hadn’t read it.  No pro-fpd post has convinced me that it’s not very heavy magical thinking that they’re engaged in.  Also, the term “competencies” is starting to give me serious malaise – what ever happened to skills?


  3. wow is right

    A post like this from one of the acupuncture establishment elites (Mr. Seem), is finally causing me to realize just how out of touch and misguided that the mainstream leaders of our profession have become. (Are they still the mainstream?)

    Lisa’s response to Mr. Seem (accessed through the link in the first sentence of Larry’s post) concisely (and humorously as usual) exposes the sly half truths, false truths, and classist/racist slander peppered throughout Mr. Seem’s dismissive and plausible (thanks for enlightening me on the meaning of this word Lisa) attack on community acupuncture.

    And as Larry states, it is unfortunate that these “leaders” choose not to redirect their energy to seek to meet the needs of patients instead of simply paying lipservice to that ideal, while first and foremost, stubbornly clinging to the failed business model they have created.

    Eventually they will come around, or else the hearty and healing weeds of Community acupuncture will rise up and take over their monoculture lawns which only survive with the heavy application of toxins.

    All true religions seek to gain access to that level of consciousness which is not ego-bound.&a

  4. Yep.

    Are minority students more drawn to group practice, or are they too smart to invest in a degree that has no payoff?

    I recently had a conversation with a working-class, minority woman who was was interested in acupuncture school but chose to become a nurse instead.  She didn’t want to go into so much debt without knowing there would be a demand for her skills upon graduation and jobs that would pay well enough for her to support her children and pay off her debt.  She ended up getting an “entry-level” nursing job that started at $48/hour.  I believe she’s making something like $55 right now.

    According to her, she didn’t have the luxury of becoming an acupuncturist.

  5. This is actually my story. 

    This is actually my story.  But after working as an RN for several years in a bad job market, being overworked and burned out, I went into non-profit work.  I only went back to my early dream of becoming an acupuncturist four years ago after being laid off.  Now I’ve got the acu achool debt blues.

    BTW, this notion of calling people of color “minorities” is always funny to me, given that – though we might be a numerical minority in parts of the west – we’re a majority around the world.


    “We are the ones we’ve been waiting for.” – June Jordan

  6. I second the motion

    I second the motion of posting this on AAAAAAAAAAOM forum.  Ha! ha!

    What I really want to know is what kind of jobs Seems is intending for his FPD army to have in these allied health settings.  I get  the feeling as if acupuncture will become extint since the FPD’s will be too busy doing blood work, running lab tests and taking x-rays to actually be treating patients. Especially since they will have “competency” for such things. The rest of us will slowly die off, and all of the physician assistants will loose their jobs to the FPD’s. 

    Did I ever tell you about the acupuncturist I met who works in an integrated hospital somewhere in California.  She works in the gift shop.  That is not a joke. 

    Thank you Lisa and Larry and the CAN Board for your amazing abilities to be so articulate and for your fighting spirits.


  7. uh-huh

    i totally understand where your friend is coming from.  i am an african-american woman and acupuncture student soon to graduate, and feeling really stupid for choosing this career path.  before starting acupuncture, i did a semester of nursing school only to decide that the western model of medicine was not for me. when i started acu school, i was a stay-at-home mom of 1 with the luxury to choose my dream career path while i had a husband to support me.  now i’m a divorced single mom and wondering how the hell i’m going to pay my mortgage, feed myself and my kid, and pay my student loan debt while trying to build a practice… it’s insane….  the only thing that keeps me hopeful is reading the CAN forums every day…  had i known 4 years ago that i’d be in this position, i would have stayed in nursing school, and maybe later would’ve done acupuncture school. 

  8. hi sarya

    We hope that CAN can give you the tools to move forward in spite of the obstacles you are facing.  Just know that we’re committed to assisting you with the CAN model in every way possible.

    Thanks for offering your experience.

  9. still not posted on the AAAOM forum…

    I guess the moderator is really busy.  I’m still kind of laughingly shocked that Seem dissed our “hand-me-down lounge chairs”…and here I thought that recycling was de rigeur among the middle and upper classes.  Maybe only if it’s not by necessity (“vintage” is chic, but “thrift” is still tacky, I guess).

    Off to go work on my t-shirt of Miriam Lee (in the style of Che Guevara)…


  10. I only just had the inspiration…

    I’ll try to make it actually happen.  Seems like there aren’t so many good pix of her…


  11. the dog’s meow

    Can we expect change from the current ACCOMfolks?

    They still think the gravy train is running AND they are the current only game in town

       Who are the allies of patients/students and practitioners in the wings?

    Can you teach a dog to meow………perhaps 

  12. I have volunteered in

    I have volunteered in non-profit clinics where we treat people for less money than what would qualify us as a “community acupuncture” clinic. In my own clinic, I see people of all income levels, for free if necessary. The people who have higher incomes pay the top going rate in my area. The people who are working class pay less or nothing. But I don’t trumpet my “goodwill” – it’s just doing what is best for the individual in front of me.
    It seems odd and telling to me that everyone in this “movement” can’t seem to bear the thought of a critique. Anytime someone critiques CA, they are marginalized immediately, accused of being “threatened”, or upper class, bourgeois, mainstream, etc etc etc. But the people I know who treat poor and homeless people every week, find CA insulting, reactive and childish. These aren’t people who have a reason to feel threatened by CA, and they have devoted their careers to helping the less fortunate. The CA clinics in the city where I live aren’t in the poor neighborhoods. THey are in the richest neighborhoods catering to people who can otherwise afford to pay top dollar. If CA folks were serious about helping the working class, they’d be where the poor people live. So I automatically find CA unauthentic.
    I think that if folks in this movement want to make a true impact on our profession and society, they should become less reactive and less self-righteous. This isn’t about you, folks. The focus is supposed to be on the patient and what the patient needs. Self-righteousness gets us nowhere fast. My impression, based upon many of the responses here and elsewhere, is that CA practitioners, while proclaiming that they are working for the good of their patients and society, are either just working out their own personal agendas, or looking for a way to succeed financially while being able to say, “look at what a good person I am”. The people I know who started CA clinics, or want to, did it first for financial reasons, second because they want to help people. It’s supposed to be the other way around.
    The treatments in CA clinics are ok for what they are, but in arm chairs, you can’t treat everything. I’m still waiting to see a CA clinic open where everyone gets whatever treatment they need, full body, full attention, and high quality. Until then, you are basically telling people that if they can’t afford a full treatment, they aren’t going to get one, even if that’s not the intention.
    I apologize for the venom, but it’s how I feel at the moment based upon what I have read in these posts.

  13. What its supposed to be about…

    The assertion that anyone should start a CA clinic primarily to help others and secondly to earn a living is naive and idealistic. How can any of us possibly afford to help another if we can’t meet our own basic needs and those of our families first? God helps those who help themselves…Those who are helped by God can then go on to help others.

    Don’t project…Introspect!