Dear Ms. Alderman,
Thank you for your article about paying for acupuncture. You put a lot of basic truths about acupuncture in to print, the ones that those of us who are absorbed in the field often have trouble conveying to people outside it: why people seek it out; that there a few solid studies showing that it helps with certain conditions; that insurance rarely covers it and when it does, the coverage is often minimal and frustrating; and most importantly, what it usually costs. Your article is a major contribution, and a big event, in the acupuncture world.
And it’s an even bigger event in the world of community acupuncture, in the community acupuncture movement. If anyone had any doubt that it is in fact a movement, the flood of comments about community acupuncture on the Well Blog should clear that up. To summarize the movement’s reaction to your article –and this letter that I am writing to you – it was, Wow! Wait, what? Ouch. And finally, please, please retract and rewrite.
Please bear with me while I explain.
Acupuncture is steadily receding out of reach for people of ordinary incomes. The goal of the Community Acupuncture Network, or CAN, is to reverse that tide, that tide which of course is inseparable from the widening chasm of inequality in America in general. In 2005, the New York Times did a beautiful series of articles, “Class Matters”; one of my favorites in that series was the one that compared the care that three people of different classes received when they each suffered a very similar heart attack (“Life at the Top in America Isn’t Just Better, It’s Longer”, Janny Scott, May 16, 2005). Obviously, acupuncture isn’t cardiology, but many of us who either practice acupuncture, or value being able to receive it, care deeply about equality of access. Those of us in the community acupuncture movement believe that healthcare is a right, not a privilege, and we have put all of our resources into making that a reality in the part of the world that we can affect: the practice of acupuncture in our communities.
The title of your article, “Acupuncture Is Popular, but You’ll Need to Pay” makes it clear immediately that this article is written for upper middle class people, people of means who might prefer not to shell out cash for acupuncture but who will if they have to. You’re not talking to lower middle class and working class people who could not possibly pay $65 to $120 per treatment. You’re talking to people who could, if they had to, find $40 for a series of “discounted” treatments at an acupuncture school. You’re talking to people whom you can assume have health insurance. The community acupuncture movement was not founded for those people.
I know this because I founded it. In 2002 I was part of a pilot program for hospice patients, using acupuncture to treat anxiety. I had one patient with metastatic lung cancer who had an extraordinary response to acupuncture; not only did it help his anxiety, but he stopped coughing up blood, stopped getting pneumonia, and his energy soared. When his allotted treatments ran out, he immediately got worse again. He had worked all his life, but after years of cancer, he had very little money.(Skeptics will no doubt cite the placebo effect here, but skeptics, I have to ask you, if you were treating someone who sincerely believed that what you were doing was keeping him alive, if nothing else could help him and he was trying to maximize what time he had with his family, would it matter? Would a lack of scientific evidence for what you were doing change your responsibility in that situation to keep doing it? Right.) I turned the business model for acupuncture inside out and discovered it worked better that way, for me and for other working class people. My patient got kicked out of hospice and lived five more active, happy years. When I started making acupuncture available for $15, I met dozens more patients who felt it helped them: bipolar moms at the end of their rope, construction workers who had to get over their injuries fast if they wanted to feed their families, people with chronic diseases that nothing would cure, just looking for a slightly better quality of life. All of them struggling to make ends meet, all of them suffering. I got thoroughly radicalized by my patients, though they didn’t know it, and I started radicalizing other acupuncturists, for the sole purpose of making acupuncture available to people with serious problems and little money.
Your article casually reframes community acupuncture as a last-ditch option for people of means, who could pay conventional rates if they had to, but if their problems aren’t serious, maybe they’d just rather not –and this is why so many of us are so upset. That paragraph completely erases the needs and the pain and the reality of the people who make up the community acupuncture movement. It doesn’t matter that the erasing is clearly unintentional, because that’s how classism works most effectively anyway. You don’t have to out and out explain that we are dirty and ignorant and don’t deserve healthcare; you just have to dismiss us offhandedly, and proceed as if we don’t exist. Casually redefining community acupuncture as “a chair massage” also erases our initiative and our creativity. We don’t mind if upper middle class people use community acupuncture because it’s easier, cheaper, and more convenient, we really don’t; but we didn’t create community acupuncture as a convenience for you, we created it as a necessity for us, and it looks the way it does because that’s how it can fit into our communities. We have limited options because we have limited resources, but that doesn’t mean that we have not put our entire hearts into what we have created.
I’m not blaming you, you got your information from acupuncturists, and acupuncturists in general don’t believe that people with limited means are smart enough to be interested in acupuncture, so why would an article be directed towards them anyway? In related news, pain and suffering in people of limited means is notoriously uninteresting to acupuncturists. Some “leading” acupuncturists charge $300 per treatment – what exactly are they leading in, sheer greed? And some acupuncturists are economically desperate enough to want to see community acupuncture misrepresented, even though the patients we treat would not be seeing anyone else anyway. So there are three main points about the information that you got from other acupuncturists that I want to make.
The first is that there is another whole story here, hidden in plain sight, about how the cost of acupuncture and the classism of the acupuncture profession is also its economic undoing. Another way of saying that 3.1 million adults got acupuncture in 2007 is that, since the population of the US was about 300 million that year, 99% of Americans didn’t get acupuncture. Which would explain why a recent job analysis survey of the acupuncture profession shows that 91% of acupuncturists are self-employed (read: no jobs), and 70% of acupuncturists gross less than $60,000 per year. If you have ever been self-employed, you know the difference between gross income and net. Since even this job analysis is arguably full of positive spin, the take home message is that most acupuncturists can’t support themselves, because most Americans can’t afford their services. Those acupuncturists providing treatments at Beth Israel Medical Center not only aren’t getting paid, each of them is paying $3600 a year for the privilege of volunteering there.The accompanying photo of an acupuncture student treating another student in a school clinic is an accurate representation of what we have heard students report, all over the country — that they have to work on each other to accumulate enough treatments to graduate, since they can’t attract enough patients (with “serious” problems, or any other kind for that matter) from the surrounding community – a preview of what they can expect once they graduate. School clinics, if they have sliding scales, often also have humiliating income verification processes, in which patients have to prove that they are poor enough to deserve “discounted” acupuncture. The flip side of this sad story about economics is, of course, the one that could be titled: Acupuncture is Popular, and You Won’t Need to Pay Very Much, because There Are Hundreds of Community Acupuncturists Who Are Happily Learning How to Make a Modest Living By Treating People Like Themselves!
The second point is that the information you received is not objective. Acupuncture is ancient and elegant and part of its elegance is that there are many different ways to practice it, including many different ways to do diagnosis –unlike Western medicine. Some of those ways are lightning-fast, some are slow and time-intensive. In community acupuncture, we have sought out and practiced the methods of diagnosis and treatment that are quick and that emphasize what the patient does for herself, rather than what the practitioner does for the patient. We call this being efficient and empowering; our critics call it giving the equivalent of a chair massage. We maintain that if you are an acupuncturist and you want to treat people of ordinary incomes, for serious problems, for prices they can afford, you can do it without sacrificing clinical efficacy. Of course, if you are an acupuncturist, you can also justify why your art requires you to treat only wealthy people for $300 a session – acupuncture theory is like the Bible, it’s so old and so vast you can find justification for whatever you want.Many acupuncturists have great justifications for otherwise blatant classism.
The third and most important point about the information you got from other acupuncturists about community acupuncture is that it will have real-world consequences for our patients and potential patients, because it is now in print, in the New York Times. Here’s an example: one of my long term regular patients is a woman who is dealing with early-onset Parkinson’s disease. She is in her forties, she has kids at home, last year her husband lost his job. Nothing is going to cure her Parkinson’s, but she says acupuncture reduces her tremor, helps with her energy, and mitigates some of the side effects of the medications she takes. She told me that many people with Parkinson’s struggle with depression,and she did also, but now she doesn’t, as long as she gets regular acupuncture. What she values most about acupuncture is that it helps her cope. This is a big deal to her, given all that she is coping with. She has done a lot of research about her disease, and here’s the thing: if she had read your article before coming to our clinic, she would have thought that she couldn’t come to a community clinic, because obviously, her problem is both serious and complicated. However, she wouldn’t get acupuncture anywhere else either, because she couldn’t afford it, even at the school clinic, so the effect of your article would be that she just wouldn’t get acupuncture at all.There are legions of people like her. Even apart from the dismal economy, serious health problems have a way of severely limiting people’s finances. If they want acupuncture, where are they supposed to go? My clinic alone, for instance, provided about 24,000 treatments last year, the vast majority of those to people who have never had acupuncture outside of a community clinic and never will.
No matter what happens with healthcare reform, we don’t expect that insurance is ever going to adequately cover acupuncture for people with chronic illnesses. Since you can’t patent acupuncture, the research studies that would prove how much it helps are not ever going to be part of any corporation’s R&D budget, which means that most likely, those studies are not going to happen. The community acupuncture movement is not asking insurance companies to recognize us, or the government to subsidize us, or anyone to take care of us. We depend only on our relationships withour patients and on our own communities. But in this instance, we are asking you to correct what you wrote about us, because your article has pretty much demolished the foundation of what we do. And we can’t believe that you meant to do that, given that the point of your column is patient advocacy; and we don’t want to believe that the same newspaper that published “Class Matters” is effectively suggesting that acupuncture belongs only to upper middle class people.
Lisa Rohleder, L.Ac.
Working Class Acupuncture