NCCAOM’s Ethics, Structural Violence, and Our Petition

When I first heard that the NCCAOM had put out a call for public comment on their code of ethics, I thought, I should write something. I tried but almost immediately gave up. I thought, where do I even start??? But it kept nagging at me. And so I brought it to the POCA Tech Board of Directors and we did this:

https://www.change.org/p/national-certification-commission-for-acupuncture-and-om-nccaom-make-the-acupuncture-profession-more-ethical

It's only been a few hours and it's already been interesting to see the response. A number of POCA comrades have been spreading the petition around the internet (thank you!). I noticed that on one acupuncture group, someone had posted: How will signing this help my crushing debt burden? Is the NCCAOM or OCOM going to refund me?

I think that's actually a really good question. What's the point of this petition?

It would be ideal if all the people who feel that they were deceived by the acupuncture profession about their prospects could get refunds.  That would be like a miracle of justice. Those sorts of things rarely fall out of the sky, though; there are usually some intermediate steps involved. Here are a couple I think we should consider.

1) We have to talk about structural violence.

As Paul Farmer and his friends said, “Structural violence is often embedded in longstanding “ubiquitous social structures, normalized by stable institutions and regular experience” [59]. Because they seem so ordinary in our ways of understanding the world, they appear almost invisible.”

In fact structural violence is supported and reinforced by invisibility. How can you fight something, how can you change something, when it seems not be something at all, but just “the way things are”? How can you focus on something that is camouflaged by everything else? The first step in confronting structural violence is to make it visible, to name it as a thing. Not part of everything. Just a thing, and not necessarily a permanent one.

And the next step is to make it not just visible, but seen. Something that operates in the background, something that nobody wants to look at, has much more power than something that is being scrutinized in public.  Being scrutinized can equal being vulnerable.

The acupuncture profession as a whole has agreed, without ever announcing it, that this is just how things are: current students and new graduates underwrite the costs of our institutions, so that they enter their careers deeply in debt.

The assumption is that we have ALL agreed to that. That it’s OK with us. 

Speaking as the Director of POCA Tech, it is totally NOT OK with me.

This is an opportunity for all of us to publicly say, No, actually, I don’t agree to that arrangement. I see what is happening here and I don’t support it.

Also, it’s POCA Tech’s job to do this. Some 1100 people viewed the petition in the first few hours after I posted it. From POCA Tech’s perspective as an educational institution, a thousand or so people were probably introduced for the first time to the concept of structural violence as it applies to the acupuncture profession.  Part of POCA Tech’s mission is to develop Liberation Acupuncture as a school of thought, and it looks like school’s in session!

2) We have to talk about the role of the NCCAOM.

To quote the Integrator Blog: NCCAOM Steps Up to Fill National Leadership Gap for the Acupuncture Profession : as the American Association of Acupuncture and Oriental Medicine continues to struggle with issues of funding, membership and credibility, the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is increasingly filling a professional organization role.

So the NCCAOM is the defacto leadership of the acupuncture profession. They’re not elected by us; they’ve just stepped into a vacuum. With this petition, we’re taking advantage of one of the few opportunities we have to give them feedback about anything — because they asked.

And even if they hadn’t, it’s really past time to get a public conversation going about the dominant role that our credentialing body is playing in our profession. See above: did we actually agree to this? If we didn’t, it’s time to say something.

And if they are our leaders, they need to take some responsibility. It’s remarkable to me that the terrible, horrible, no good, very bad numbers of the Job Task Analysis have not caused anybody to say, “We need to do something about this situation.” Why not?

3) If things were to change radically with respect to the economics of the acupuncture profession, a public discussion like this is most likely how it would start. It wouldn’t start with automatic refunds to everybody who discovered they couldn’t pay back their acupuncture school loans by working as an acupuncturist. Too bad, but we have to start somewhere.

4) But why address the NCCAOM at all? They can't control what the schools charge.

This is where the above points about structural violence and the leadership role of the NCCAOM come together. To quote noted smart person Robert Hayden:

“I would submit that, as an educator, my view is that NCCAOM is as responsible for the bloated curriculum in acupuncture school as anyone else. In fact, I believe they are more responsible than most. This is something that students and most of the profession do not fully grasp, I think.

The more test items and subject areas that end up on the boards, the more pressure there is to include everything on the curriculum. Either shove it all into three years or expand the program, and with it, the cost. Bottom line for every student in acu-school is “what information do I need to pass the boards”. The pressure mounts as the tuition costs go up. NCCAOM is notoriously tight-lipped about test content, so curriculum needs to include massive amounts of information, which is never truly learned (you should see my inbox from graduates emailing me) just regurgitated. Every few years, the JTA is done, which then includes whatever is the AOM trend du jour in the possible subjects to be tested. Which means we need to find space in the curriculum for it. Speaking as someone with 15 years of teaching acu school, it has gotten to be insane. There is no evidence that a leaner curriculum jeopardizes public safety – otherwise there would be no practitioners with 20+ years of experience, we'd all have lost our licenses. So why, for an entry-level curriculum, do we need all of this content? NCCAOM can surely do something about that.”

20 years ago there was one NCCAOM exam. Today there are four. Is the public safer as a result? Can we prove that? If not, why can't we go back to having just one exam?

The NCCAOM is taking public comments about their Code of Ethics until Sept. 12; if you’d prefer to talk to them directly, you can do so here: https://www.nccaom.org/call-for-public-comments

Anyway, given the factors involved, I think this is one situation where a signature on a petition could actually make a difference. The more signatures, the more obvious it is that the economic violence embedded in the acupuncture profession is not invisible anymore. So please, if you can, sign the petition.

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