Herding Cats

Organizing acupuncturists is like trying to herd cats.”

“Most of us know that a spider is a creature with eight legs coming out of a central body. With a magnifying glass, we can see that a spider also has a tiny head and eight eyes…If you chop off the spider’s head, it dies. It could maybe survive without a leg or two, and could possibly even stand to lose a couple of eyes, but it certainly couldn’t survive without its head…At first glance, a starfish is similar to a spider in appearance. Like a spider, the starfish appears to have a bunch of legs coming out of a central body. But that’s where the similarities end…With a spider, a body’s a body, a head’s a head, and a leg’s a leg. But starfish are very different. The starfish doesn’t have a head. Its central body isn’t even in charge. In fact, the major organs are replicated throughout each and every arm. If you cut the starfish in half, you’ll be in for a surprise: the animal won’t die, and pretty soon you’ll have two starfish to deal with…They can achieve this magical regeneration because in reality, a starfish is a neural network – basically a network of cells. Instead of having a head, like a spider, the starfish functions as a decentralized network. Get this: for the starfish to move, one of the arms must convince the other arms that it’s a good idea to do so.” Excerpted from The Starfish and the Spider, by Ori Brafman and Rod Beckstrom.

Why the frack am I prattling on about starfish, spiders, and cats? I am contemplating how it is that CAN, the youngest acu-org in the nation, has grown the loudest voice in an industry of apathetic naysayers. In recent weeks, we ruffled feathers among the Presidents of various acupuncture colleges with almost 200 comments to the USDE about Title IV funding. This spring, we submitted hundreds of responses to the New York Times within 48 hours of their article mentioning Community Acupuncture.  And last winter, we procured thousands of letters to the ACAOM during their FPD public comment period.

How is it that we’ve organized a notoriously apolitical group of professionals into the lively, passionate conglomerate that is CAN?

Steven Stumpf has referred to CAN as a “decentralized organization.”  And that, I believe, is the key to our anomaly. I recently read Brafman and Beckstrom’s above-referenced book, subtitled The Unstoppable Power of Leaderless Organizations, and it floored me. The authors open their book by revealing that in response to over-centralized industries (like the inbreeding of the AAAOM, CCAOM, ACAOM, NCCAOM), participants rebel and create open starfish systems (like CAN). Every single page of The Starfish and the Spider spoke to the spirit of CAN, and it reminded me of what I love most about this organization: the punks who pour their hearts and souls into it. The advent of the Internet has helped unleash countless decentralized organizations, such as CAN. Society is being rearranged very fundamentally, at a faster rate than many people realize, because of the speed at which information is shared.

The acupuncture industry is no exception.

Let’s look at one of the best-known starfish of them all: Alcoholics Anonymous (AA). At AA, no one’s in charge. And yet, everyone’s in charge. It is an open system in action. AA is constantly changing form as new members come in and others leave. The one thing that remains constant is the recovery principle – the famous Twelve Steps. Brafman and Beckstrom note that in decentralized organizations—such as AA—members can help each other without asking permission or getting approval from anyone. Empowering members in such a way enables open systems to quickly adapt and respond to changing needs.

Sound familiar? If you’re a CAN member, you’ve likely explored the rich forums inside this website where members talk to one another daily: seeking advice, swapping stories, asking for support…”helping each other without asking permission or getting approval from anyone.”

Like AA’s famous Twelve Steps, CAN clinics adhere to core principles as defined in our mission statement on top of the home page: acupuncture is offered in a group setting for $15 – $40, no less than three days per week. Will we kick you out of CAN if you don’t meet the guidelines? Naaaah. Just like in AA, you’re welcome to stick around and learn as much as you can for as long as you’d like, whether or not you adhere to all of our principles. (Just don’t ask us to modify them to meet your needs.  In the same way that AA’s alcoholics don’t get to modify the Twelve Steps to make their work easier, our core principles are not up for discussion…but you are welcome to start your own separate organization, if you feel so inclined.)

In The Starfish and The Spider, the authors identified seven major principles of decentralization:

1.  When attacked, a decentralized organization tends to become even more open and decentralized.

Look at what happened when somebody dissed a fellow clinic’s grand opening.  According to Brafman and Beckstrom, “For the starfish to move, one of the arms must convince the other arms that it’s a good idea to (act).” Our members quickly launched into action by commenting on the original article, and they commented again on the subsequent CAN blog. We saw this same behavior with the NYT article: over 100 pro-CAN comments on the Well Blog in less than 24 hours, before the article had even been printed, and dozens more comments on Lisa’s blog in the days after. In fact, we see it over and over when any of our comrades are “attacked” on these blogs: individual CAN members come out of the woodwork to defend and discuss what is happening. While some of these commentators are members of the CAN-Board or Executive Committee, the vast majority are not. It is apparent that our members feel empowered to speak their truths without having to first run their commentary through a chain-of-command filter.

Now, compare that with the reaction of the very centralized AAAOM members to this summer’s British Journal article about acupuncture safety. *crickets* It took some time for the AAAOM’s executives to analyze and approve their official response. Eventually, the heads of this spider club drafted a formal position and posted it on Acupuncture Today. According to Brafman and Beckstrom, centralized organizations are notoriously slow and creaky in their responsiveness to attack.

2. It is easy to mistake starfish for spiders.

Outsiders often mistake CAN for a spider and complain that we are “disorganized.” What they misunderstand is that we’re not trying to replicate anything else in our industry’s existence. We are not trying to be orderly or convenient to work with. But observers who mistakenly assume that CAN should be more centralized, and perceive our “chaos” as a shortcoming, wrongly classify us as an entity that we have no intention of becoming.

“In the digital world, decentralization will continue to change the face of industry and society…These forces can be harnessed for immense power…Decentralized organizations appear at first glance to be messy and chaotic. But when we begin to appreciate their full potential, what initially looked like entropy turns out to be one of the most powerful forces the world has seen.” — The Starfish and The Spider, p. 208

3. An open system doesn’t have central intelligence; intelligence is spread throughout the system. Information filters in at the edges, close to action.

CAN has no phone number. No central headquarters. We are a cyber-network of punks spread from coast-to-coast and around the world. We share what we hear in our communities: filtering in at the edges, close to action. Some of us even get our very own Deep Throats.*  This is a reversal of the command and control system of yore where most important decisions were made by senior folks at the top of the organization. The latter process was slow as the information travelled from the point of action uphill, to the point of decision, and then back down again.

4. Open systems can easily mutate.

150 clinics, at last count. Enough said.

5. The decentralized organization sneaks up on you.

Brafman & Beckstrom write: “Spider organizations weave their webs over long periods of time, slowly amassing resources and becoming more centralized. But the starfish can take over an entire industry in the blink of an eye.”

  • By the time AT realized CAN’s “dangerous potential to the profession” in 2006,  they had already given us our springboard for inception via the Social Entrepreneurship Talk Back forums (thanks!).
  • CAN unexpectedly and quite successfully stopped the forward movement of the FPD in 2008, and our ongoing efforts against the FPD were on the front page of June’s AT. 
  • Utne Reader’s one and only article on acupuncture was about Community Acupuncture.

CAN has redefined acupuncture: who gets it, how much it costs, what the treatment room looks like, which story the mainstream media should present. The ACAOM doctoral task force had been at work on the FPD for over ten years (weaving their webs over long periods of time); in the blink of an eye, we challenged the notion that more education makes for a better practitioner and brought their slow progress to a halt in 2008.

6. As industries become decentralized, overall profits decrease.

This is our peers’ biggest complaint about Community Acupuncture: we devalue the profession with our bargain-basement prices.

7. Put people into an open system, and they’ll automatically want to contribute.

Much like a gift economy, our members want to contribute. People on CAN help in the best way they each know how: by congratulating a new clinic’s opening, by sharing an experience, by blogging, or just by showing-up to check the forums and see if anyone on the site needs support. In four years’ time, we have amassed over 1,000 blogs; 5,000 informational threads; and 29,000 comments on this website. Our members like to contribute…a lot.

Contrast that with the AAAOM’s forums…wait, they appear to have discontinued their forums.  Perhaps due to non-use?  Last I checked, they had been inactive for over a year. 

In addition to the above seven principles, the authors also identified Five Building Blocks in the foundations of decentralized organizations:

1. Circles.

Membership consists of circles. Each of our CAN-clinics is an independent, autonomous circle within its own community: TCA in Tucson, MCA in Milwaukee, WCA in Portland, SCA in Sarasota, PCA in Philadelphia, etc. Furthermore, many of our clinics have banded together to form larger circles of regional nodes, which can then act independently to coordinate regional activities, media campaigns, or networking opportunities.

2. Ideology.

Ideology is the glue that holds decentralized organizations together. In CAN, it is the notion that acupuncture should not be expensive, but rather accessible to people of ordinary financial means.

3. Pre-existing Network.

Again: hat-tip to AT for giving us a platform from which to piggyback and launch this entity.

4. Catalyst.

Leaders of starfish organizations are vastly different from traditional executives. A catalyst initiates a reaction and then fades away into the background. They generate ideas and then allow the circle to follow through. They get a decentralized organization going and then cede control to the members. Letting go of the leadership role (as ours did three years ago), the catalyst transfers ownership and responsibility to the group. The catalyst is an “inspirational” figure who spurs others to action. Circles don’t form on their own; a catalyst develops an idea, shares it with others, and leads by example. Sound like any inspiring punks you know?  Catalysts know that the way to mobilize people is to share inspirational stories. They go on the road, share the common ideology, and create new circles in their wake.

5. Champion.

Like catalysts, champions operate best in non-hierarchical environments. A champion is relentless in promoting a new idea. Catalysts are charismatic, but champions take it to the next level. Catalysts inspire and naturally connect people, but there’s nothing subtle about the champion. When intrigued with an idea, they grab on and won’t let go. Champions are inherently hyperactive. According to Brafman & Beckstrom, the Champion is “brazen and bold…(with)…passion and determination…willing to fight to the end” for the organization’s ideology.”

Back to my point…What I love about CAN are the punks who pour themselves into supporting new clinics, who share their stories (inspirational and otherwise), who help foster a supportive and collegial environment. I love that the life force of CAN is its members, a decentralized mass of technicians and social activists. I love that we’re messy and chaotic and unpredictable. I just mostly am writing to say that I love all of you. ~smooch~

*Oh, and here’s another Deep Throat message:“If you assume 79.2 visits per year per 1000 adult population (the NIH 2007 study), and assume 228,182,000 US adults (Wikipedia), and assume 26,000 acupuncturists (a VERY conservative number that does not take into account non-LAc’s like Chiropractors, Naturopaths, and NADA workers) and a 48-week work year you get about 14.5 visits per week per practitioner. That’s average, of course, so if any of you are doing 100 tx per week, 5 people aren’t doing any. A need to keep my day job is keeping me from posting this; I figured you might find use for it in your next blog. 8-/”

Jessica Feltz
Author: Jessica Feltz

<p> I learned about Community Acupuncture while studying at the Midwest College of Oriental Medicine (MCOM) in the Spring of 2006 when Lisa Rohleder's first article about her clinic appeared in Acupuncture Today. Coming from a middle-class background myself, I was the only student in my acupuncture class to have not experienced the healing benefits of this medicine prior to beginning studies at MCOM. I couldn't afford it. And my family couldn't understand what I was doing by investing in an education that they didn't perceive to be financially sustainable. </p> <p> The Community Acupuncture model is a perfect fit for me, balancing social justice and taoist simplicity with the patient's innate ability to heal him/herself (with a few gentle nudges from strategically placed needles). I am grateful every day to have found CAN and the love it brings into my life. I want to share that joy by spreading the message about how we can create a new health care experience in our communities through each of our very small efforts...and how those very small efforts can in turn change the world. </p> I enjoy my two sons, my 4 cats, and big stacks of books.  I own and operate...

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.


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  1. I was missing your writing, Jessica!

    Thanks for taking the time to write such a beautifully inspirational blog. I will never look at CAN, a spider or a starfish, the same way again! 


    *muchas smoochas*

    I love how it helps me think about things. For example, you could say that what community acupuncture does is to take a starfish approach not only to the political part of acupuncture but to the clinical part. We de-emphasize the role of the practitioner (spider) and emphasize the role of the patient community. Wow, hey, it works with the economic side too!  Our clinics are not webs that we build to attract patients, where the patients are passive and we are active; our clinics are networks that we participate in, networks based on mutuality and interdependence. This is something that is so hard to explain to anyone who has never treated in a community setting, that what you as the practitioner are doing is so much less important that what is just HAPPENING all around you, the thing that you are part of, the thing that you are not controlling. This analogy is so perfect for that. I think that when community clinics don’t succeed, it’s very often because the acupunk doesn’t know how to stop being a spider. 

    It makes so much sense. The traditional orgs, the spiders, are always looking for other spiders to validate them. (HR 646, anyone? Big Insurance?) This is such a great way to explain why we are not interested in all that. It’s just not what we do, not what we are. We don’t do what spiders do, we don’t need what they need. Our support comes from a thousand places, not from one or two central places.

    I am going to have a lot of fun thinking about the implications of this. Thank you, Jessica!

  3. and!

    there is also the part where, like a starfish, more and more often a community clinic spawned to create another when one of its practitioners went off to start a new clinic of their own.


  4. Microcosm

    I don’t know where you find the time to write wonderful pieces like this but Thank You! Thank You! Thank You!

    Recently I was sitting at a table full of people who were creating and critiquing my business card. They kept saying, “…and here’s where YOUR name goes…” and pointing to the center of the card. When I resisted putting my name on the card at all, it was hotly debated. But I cannot be the head of the spider. CCA has to be able to run on its own, has to be a starfish. The community of patients and the results they get and the word they spread can’t be all about me. It’s the clinic, the needles, the group energy, the demographic of people from all walks of life and most strata of society.

    I was going to say “I don’t want a case of if something happens to me the spider dies…” but of course last week something did and I was out of the clinic for almost a week. Regardless, the show rolled on. It was great. Some folks didn’t even notice that I wasn’t there. What a big change for me from being the almighty counselor/healer/angel to just the one who knows where the needles go (and sometimes I wing that too.)
    Thanks again, Jessica.

  5. Marketing

    Yes! I wasn’t even thinking of this book in terms of the microcosm–like you and Lisa and Taty did–but *yes*! I have a patient who is trying (relentlessly) to make me put-up a bio page about myself on the website, and I am completely resistant to that. It’s been impossible to explain why I don’t want a page about my “credentials” or my “experience”, why I’ve pulled my name from my printed marketing materials. The clinic isn’t about me at all; it’s about the people who support it, the people whom it supports, the networks it weaves within its walls and out into the wider community of Frederick. Maybe I’ll find a way to write a bio page about the clinic and our community instead…

  6. Really Lovely

    Beautifully done, Jessica.

    The ramifications of decentralization often open to me, both within our single clinic and CAN itself. It’s a hallmark of CA culture, clinically, administratively and of course within CAN an an organization. It’s never disappointed as a source of wonder and relief to me.

    I see CAN’s greatest challenge is its ability to continue harnessing the various and great talents of the membership and invested parties.

    Prime Movers will do as they do. Envisioning opportunities for the rest of us while effectively capitalizing on them is what will continue to move CA forward.

  7. Perfect, Jessica

    A shot in the arm for all of us. Whenever my strength wanes in the face of repeatedly hearing that we punks are traitors and assholes and just plain scurvy knaves, the actual experience of just going to work and being in the clinic while it’s full of people is what props me up and gives me the strength to keep pushing. You may have pegged what’s most important about the entire movement. If a starfish can be created here with all of us doing CA, in the face of everyone who says everything has to be a spider, then it can be created other places in the society, too. Your timing is kind of magical for me, because CA is taking hold here in Utah, and Monday night, we’re having the first annual Utah Acupunks BBQ. It’s a small group, but when I consider that 18 months ago, it wasn’t a group at all, and just 1 clinic soldiering bravely in the southern end of the state, it says something about how far things have come in a very short time. Now, it’s a small and growing community of friends representing 5 clinics and 1 hybrid who stay in touch online, support each other through the down times, and are feeling downright starfishy these days. When I look at our little group, and think that the same thing is going on in all sorts of different places around the country, the math for the future looks pretty inspiring. Thanks for the injection of enthusiasm and hope.  

  8. OMG!

    OMG Jess,  this is a beautiful crafted, thoughtful and inspiring blog.  I am going through a massive transition and there are so many things here that I can comment on in a future blog.

    All the best, Elizabeth

  9. Jessica the deep thinker…

    a great post!  I never considered CAN to be a starfish but the analogy is complete and beautifully described.

    We are lucky to have you in our ranks.

  10. Very nice blog, Jessica! I

    Very nice blog, Jessica! I heard about that book during an interview with the author on NPR, but hadn’t made the connection between decentralization and CAN. BTW, HOW DO YOU find time to write these things?

    Thanks again!


  11. Word.

    Yes!  I’ve always prefered the starfish model of political organizing.  This really clarifies that Neitzche quote “one must have chaos inside oneself to give birth to a dancing star”.


  12. Starfish begetting more starfish

    One thing I’ve found is that our model really gets people interested in creating other community-based businessesI recently met with a patient who wants to start a community kitchen/co-op; next week I’m meeting with a patient who wants to start a donation-based yoga studio.  People want to know how this Community Acupuncture thing works so they can apply the principles in other areas.  And so the world keeps getting starfishier…

     LOVE this blog, Jessica! 

    Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane. -Dr. Martin Luther King, Jr.

  13. mutual aid aint so scary

    nothing much more to add to what has already been said. but this is one of my favorite blogs in a LONG while. thanks jessica, for being awesome!


     funny side note:i was at a book store the same day this blog went up and was standing in line for the bathroom. the bookshelf i just happened to be standing next to was the business section and guess which book just happened to reach out at me and touch my shoulder! 

  14. I just love this metaphor

    and this: “…write a bio page about the clinic and our community instead…”  is also a lovely idea!  This whole post is so full of great ideas, and so impressively written!  Thanks for making all those connections, Jessica! 

  15. Wow now think POCA

    See you have no idea but the seed for POCA was right there with the spiders and starfish.

    I found this while trying to fgure out what to write as my bio.. not easy for us “defunt” punks-