Primum non nocere
My receptionist couldn't come in one Saturday, so I stuck my boys at the front desk (first time). I divided the duties between them. The 11-year-old was on telephone and computer re/scheduling. The 9-year-old was on greeting, sign-in, and new patient paperwork. The 9-year-old said to me: “But Mom, when do we get to stick needles in them?” I responded: “You don’t have enough education to stick needles in patients.” 9-year-old rolled his eyes at me: “Any idiot can do what you do.”
Which makes me wonder:
- What exactly do we do?
- Can any idiot do it?
What exactly do we do?
My esteemed colleague Whitsitt wrote: “What the hell is going on with needling people? Would someone please figure out whether we’re pulling qi to an area, or pushing qi away, or what? And does it really matter whether you twist the pins one way or the other? And why on earth would sticking pins in someone’s leg make their shoulder better? Seriously. WTF, people?”
WTF is right.
Recently, there was a discussion on a 5-Element list serve, and the gist went something like this: If you don’t treat to balance the Law of the Husband-Wife, the patient can die. Now, the only practitioners who ever treat the proverbial-husband-wife imbalance are 5-Elementers, and clearly the rest of civilization is not dropping like flies from untreated H/W. Does this mean that perhaps we acupuncturists might not know exactly what it is that we are doing?
I like Skip’s thoughts here: “something does happen when we needle people or when we get needled. We do know that. There's something very powerful there; we just don't know what it is exactly. Maybe in the future we or our descendants will figure it out; right now we don't know. We don't even know what works best or why. Our medicine is so full of rationalizations that it's quite easy to lose yourself in them. The bottom line is that with all the ancient and recent theories, the field is a mess and it will be our and our descendants' jobs to untangle that mess. “
Let’s concede for a humbling moment that we don’t know what the hell we are doing. We know: a) how to stick a needle in a person, and b) that the patient will feel better afterwards. But we’re not exactly sure what is happening between a and b, or for that matter why or even how it happens.
So what about the second question: “Can any idiot do it?”
The AAAOM and NCCAOM addressed this issue in their 10/22/10 press release, stating: “not a single death has been reported to result from acupuncture in the US.” (I wish that I could attach the release here but I can't for technical reasons, and I haven't found an online copy to hyperlink with either. If you're really interested in seeing it, let me know and I can email you the PDF.)
Notice that the AAAOM/NCCAOM release didn’t state that acupuncture deaths are more prevalent in lesser-trained professionals. It didn’t state that individuals with doctorates have a lower incidence of acupuncture-related-death. The educational requirements of acupuncturists range from 300 to 4,000 hour programs, but the press release didn’t make any distinction between the safety of acupuncture in the hands of RN’s, PT’s, LAc’s, MD’s, DC’s, DOM’s or any other alphabet concoction. It didn’t even matter if a practitioner was NCCAOM-certified or not. The press release very clearly and unequivocally stated that there has never been a single reported death from acupuncture in the US. Ever.
Therefore, I infer: Yes, any idiot can do it. Any PT, MD, or DC can do acupuncture. Any weekend intensive will suffice. A NADA certificate is just as safe as a Doctoral program.
We don’t know WTF the needles do; we just need to get them safely in the patient, and it seems that just about any idiot can do so. Until Community Acupuncture clinics are as common as dirt, I welcome the fact that a wide range of professionals can stick needles, because there are too many neighborhoods underserved by acupuncturists. Look at the numbers:
- 76 million Americans live with pain every day.
- There are 310,592,000 Americans.
- 99% of Americans aren’t getting acupuncture.
- That leaves 307,492,000 Americans who have never tried acupuncture.
- Generously assuming that we have 30,000 licensed acupuncturists,
- Each currently licensed acupuncturist would have to treat 10,250 NEW patients just to give every American one single treatment.
- WCA as a clinic hasn’t even served that many new patients with all of their punks poking over the past 8 years.
WE NEED MORE NEEDLERS POKING PEOPLE.
Acupuncture is the least expensive, broadest spectrum, safest medicine in our society. I don’t care what initials are behind your name. If you can legally stick a 2-cent-needle in somebody to reduce their suffering, you have a social obligation to do so.
If you have too few patients to even afford an office (go to the street view ~ hi MJ!); if you find yourself professionally obfuscating; if you blather-on about how the Republicans or Medicare or branding will save the acu-industry…then you are wasting your education and doing a disservice to the millions of Americans who need your help now.
We don’t need to understand how-the-fuck acupuncture works in order for it to work, and acupuncture is so safe that we can reasonably train any idiot to do it…therefore, the rest of you punks better take-up the call to treat your neighbors, or I will personally find a way to get those needles in the hands of some kids who want to do the work that you should be but are not doing.
Author: Jessica Feltz, L.Ac.
<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...
Jessica you are clear in what you mean by social obligation.
I am clear on what you mean by social obligation. That much is clear, now let’s get to some poking.
Thanks Jess for the
Thanks Jess for the perspective, these numbers have been in the back of my mind for some time. With all the recent topdown talk of lobbying, alphabet org membership/participation, medicare/insurance inclusion, bringing acupuncture education into the 21st century world medical model with an FPD, and turf wars, it’s good to step back and understand where the real change happens – it’s with the people.
It comes down to that nagging question?
Whom do you serve? The patients, yourself, your employer? What’s your mission? your passion?
While the orgs and schools will do what they think best from their perspective, most acupuncturists need to keep on doing what we do best, continuing the grassroots effort locally to treat as many people as possible with affordable, simple, effective treatments. Get the word out, promote promote promote. This is the local public education campaign that is shifting the acupuncture landscape everywhere everyday across our country, regardless of how long it takes for the alphabet orgs and schools to organize anything nationally resembling a public education campaign, besides a random press release once a year for world AOM day. Seriously, how many schools market and promote acupuncture via their clinics to patients on a regular basis ?
On another note, there are around 850,000-900,000 MDs in the U.S. today, and in 2005 the HRSA put the number of primary care physicians at 264,000, or about 90 physicians per 100,000 people or 1 PCP per 1100 people, and this can vary widely based on location across the country.
30,000 is a generous estimate of active acupuncture licenses across the country. My sense is less than 2/3 of those have anything resembling a practice (or around 20,000 ). So by my math the average number is closer to one “practicing” acupuncturist per 15,000-20,000 people, with regional density variations. (by state and by urban, suburban, rural)
Here are the state by state by state density variations:
Population 2009
L.Ac.s 2009
ratio, 1 LAc per thousands people
.Alabama
4,708,708
50
94174
.Alaska
698,473
93
7510
.Arizona
6,595,778
482
13684
.Arkansas
2,889,450
33
87559
.California
36,961,664
9402
3931
.Colorado
5,024,748
1035
4855
.Connecticut
3,518,288
350
10052
.Delaware
885,122
40
(2010 est)
22128
.District of Columbia
599,657
146
4107
.Florida
18,537,969
1900
9757
.Georgia
9,829,211
175
56167
.Hawaii
1,295,178
624
2076
.Idaho
1,545,801
160
9661
.Illinois
12,910,409
631
20460
.Indiana
6,423,113
85
75566
.Iowa
3,007,856
60
50131
.Kansas
2,818,747
100
28187
.Kentucky
4,314,113
44
98048
.Louisiana
4,492,076
18
249560
.Maine
1,318,301
120
10986
.Maryland
5,699,478
800
7124
.Massachusetts
6,593,587
961
6861
.Michigan
9,969,727
100
99697
.Minnesota
5,266,214
358
14710
.Mississippi
2,951,996
3
983999
.Missouri
5,987,580
82
73019
.Montana
974,989
147
6633
.Nebraska
1,796,619
10
179662
.Nevada
2,643,085
45
58735
.New Hampshire
1,324,575
110
12042
.New Jersey
8,707,739
700
12440
.New Mexico
2,009,671
700
2871
.New York
19,541,453
3312
5900
.North Carolina
9,380,884
392
23931
.North Dakota
646,844
25
25874
.Ohio
11,542,645
147
78521
.Oklahoma
3,687,050
125
29496
.Oregon
3,825,657
947
4040
.Pennsylvania
12,604,767
468
26933
.Rhode Island
1,053,209
150
7021
.South Carolina
4,561,242
89
51250
.South Dakota
812,383
25
32495
.Tennessee
6,296,254
108
58299
.Texas
24,782,302
842
29433
.Utah
2,784,572
103
27035
.Vermont
621,760
152
4091
.Virginia
7,882,590
406
19415
.Washington
6,664,195
1142
5836
.West Virginia
1,819,777
35
51994
.Wisconsin
5,654,774
401
14102
.Wyoming
544,270
20
27214
and here is the same list sorted, with the most densely packed states at the top:
Surprise #1 – Hawaii !
Population 2009
Lacs ’09
ratio 1 LAc per thousands people
.Hawaii
1,295,178
624
2076
.New Mexico
2,009,671
700
2871
.California
36,961,664
9402
3931
.Oregon
3,825,657
947
4040
.Vermont
621,760
152
4091
.District of Columbia
599,657
146
4107
.Colorado
5,024,748
1035
4855
.Washington
6,664,195
1142
5836
.New York
19,541,453
3312
5900
.Montana
974,989
147
6633
.Massachusetts
6,593,587
961
6861
.Rhode Island
1,053,209
150
7021
.Maryland
5,699,478
800
7124
.Alaska
698,473
93
7510
.Idaho
1,545,801
160
9661
.Florida
18,537,969
1900
9757
.Connecticut
3,518,288
350
10052
.Maine
1,318,301
120
10986
.New Hampshire
1,324,575
110
12042
.New Jersey
8,707,739
700
12440
.Arizona
6,595,778
482
13684
.Wisconsin
5,654,774
401
14102
.Minnesota
5,266,214
358
14710
.Virginia
7,882,590
406
19415
.Illinois
12,910,409
631
20460
.Delaware
885,122
40
(2010 est)
22128
.North Carolina
9,380,884
392
23931
.North Dakota
646,844
25
25874
.Pennsylvania
12,604,767
468
26933
.Utah
2,784,572
103
27035
.Wyoming
544,270
20
27214
.Kansas
2,818,747
100
28187
.Texas
24,782,302
842
29433
.Oklahoma
3,687,050
125
29496
.South Dakota
812,383
25
32495
.Iowa
3,007,856
60
50131
.South Carolina
4,561,242
89
51250
.West Virginia
1,819,777
35
51994
.Georgia
9,829,211
175
56167
.Tennessee
6,296,254
108
58299
.Nevada
2,643,085
45
58735
.Missouri
5,987,580
82
73019
.Indiana
6,423,113
85
75566
.Ohio
11,542,645
147
78521
.Arkansas
2,889,450
33
87559
.Alabama
4,708,708
50
94174
.Kentucky
4,314,113
44
98048
.Michigan
9,969,727
100
99697
.Nebraska
1,796,619
10
179662
.Louisiana
4,492,076
18
249560
.Mississippi
2,951,996
3
983999
Mississippi Goddamn
My Puncture the South campaign continues…and the Midwest…and the Plains…
Awesome blog, Jess.
.
great blog jessica. but now i feel like im just a monkey with a handful of sharp shiney objects. guess i’ll have to start sprinkling magic pixie dust with my treatments if i want to feel special. not aanyone can do that!
sort of off subject, but in reference to nora’s response. “mississippi goddamn” has become one of my favorite expressions as of late! so satiisfying on so many levels to say.high five.
Timely article
It discusses if dental therapists should be allowed to perform simple dental procedures in remote areas where there isn’t easy access to a dentist.
Apparently, the ADA thinks it’s better for people to suffer in pain!
Mississippi indeed
I feel so cool – I know two of the three licensed acupuncturists in Mississippi! Yes, we need to puncture the South! Seriously people, move to here. Patients are waiting for you.
Another brilliant blog, Jess.
How does acupuncture work?
It doesn’t. Our bodies work just fine. Just like the sun rises in the east… everyday. When that doesn’t happen, acupuncture will no longer work.
What do we do?
We move Qi. Acupuncturist = Qi Technician.
Can anyone do it?
No. Not everyone can. Not everyone can fix cars. Not everyone can help the body heal. Just read about the five failings of physicians in the Neijing. How it all works is right there. Most of us are just handicapped. We do not read and write our medicine’s language.
Do we need to find more Qi Technicians. Absolutely.
all good medicine,
Ben
The People’s Acupuncture Clinic
“health for the people… by the people.”
http://www.thepeoplesacupunctureclinic.com
“We don’t know WTF the
“We don’t know WTF the needles do; we just need to get them safely in the
patient, and it seems that just about any idiot can do so. Until
Community Acupuncture clinics are as common as dirt, I welcome the fact
that a wide range of professionals can stick needles, because there are
too many neighborhoods underserved by acupuncturists.”
It does matter who does the sticking; and we do need more pokers. If anyone can do the poking, just watch, it will be M.D.s at $80 a whack. So much for community acupuncture.
Tess Bois (formerly McGinn)
One World Community Acupuncture
Fitchburg, MA
Or acupuncturists doing the
Or acupuncturists doing the poking at $80 a wack, like it is in so many places now.
As I understand it, MDs can
As I understand it, MDs can get trained very quickly. I’ve never known one that does it (just one DO connected with my school, and she went through a master’s program, not the several-months’ course for doctors).
in my area there are lots
lots and more everyday. In principle I don’t think it’s a bad idea, it’s just that there should be some minimal qualifications to trained in it. Just like minimum qualifications to be a nurse practitioner or an RN.
Tess Bois (formerly McGinn)
One World Community Acupuncture
Fitchburg, MA
This applies to us!
I am a L.Ac and when we decided to open a community clinic, I “allowed” my husband who is a DC to get his Acu license. I say allow because for years I shot down his interest in Acupuncture because I was hung up on the “I went to school for 3 years to do this, its not fair for him to do it in a couple hundred hours.” I think this also stems from my school’s elitist ideas that Acupuncturists need to have a Masters/Doc to perform the job. While practicing in my solo clinic I often thought to myself “Why am I even taking pulse/tongue, why am I asking tons of constitution questions when the patient is only here for their shoulder?” Attending the CAN seminar really opened my eyes up and I knew having a CA clinic I didn’t want to practice alone. We attend Acu seminars together and I find myself saying “what should I do for this?” because he has learned Tung and other techniques more than I have.
A few other LA.c’s (outside of CAN) have expressed their dislike for MD/DC’s practicing, and I always say “The more people getting acupuncture the better.” Sure I think there are issues with safety/technique training, but I have also had patients who have had negative experiences with LAc’s (ie: continuning to ‘stimulate’ a needle that is burning, and leaving with continued site pain.)
Great blog! Another example of CAN’s core beliefs, alot people need Acupuncture and it should be accessible! Now if I could just ‘get over’ my ridiculous school loan bill!!!
Christina
Alpine Community Acupuncture, Flagstaff, AZ
I’m not sure you get my reasoning.
M.D.s don’t make bad acuncturists but they do by and large make expensive ones. So do D.C.s. But an acu tech license should have some minimum qualifications.
Tess Bois (formerly McGinn)
One World Community Acupuncture
Fitchburg, MA
Any idiot???
I speak here as an MD who has a little traditional training in acupuncture (I apprenticed for a while years ago, and have no formalized training and thus do not use it anywhere outside myself and family). I was directed to your blog by a dear friend whom I have great respect for who is training in DC. I enjoyed your post very much and it is quite a conversation starter. I would like to make two comments.
First, the comment about any idiot can do it. What your article shows is safety, not efficacy. It shows that “any idiot” can try to do acupuncture and not kill someone. I find this reassuring personally, but this does not address whether any idiot can facilitate healing using this modality. So, can any idiot do this? I can’t tell from what you presented (and from experience I don’t think so, but that is just opinion).
Second I want to say that it is true that often we don’t know how something works, and in medicine (where we have very significant potential to harm) this often leads to bad things. An example might suffice. For about thirty years, doctors gave women hormone replacement therapy to prevent heart attack and strokes. The “thinking” was that women did not get these problems until menopause and thereafter their risk within a year or two sharply increases to match that of men with similar risk factors (matched for smoking, family history, etc.) Since we “knew” menopause was just caused by a fall in estrogen, and giving estrogen stopped the symptoms of menopause, estrogen was heart healthy. Sounds good right? We did this for 20 years. Then we did a huge study (around 7000 women if memory serves) and low and behold, there is a small but significant increase in heart attack and stroke in the women taking hormone replacement. Our theory of heart disease and our theory of menopause were both much too simplistic. My point – base treatment on results, studies and experience, not theory. You may be pushing, pulling, moving or fricasseeing Qi, or not. Nobody I have met knows for sure. Don’t treat based on theory unless you have nothing else to go on, and then at least in medicine where there is potential for harm, be up front about it.
Just my two cents as an unqualified MD (who refers to acupuncturists quite a lot).
Hi Unverified MD
Here’s a blog which addresses the efficacy of acupuncure: https://www.communityacupuncturenetwork.org/blog/statistics-and-acupuncture I didn’t talk about it in this post, because it’s already been discussed. Thanks for participating.
Tess wrote:
That there are “minimum qualifications to be a nurse practitioner or an RN.” I am thinking more along the lines of minimum qualifications for being an LPN or even CNA.
monkeys
if you put a bunch of needles in a room with a bunch of monkeys, will they eventually become acupuncturists?!
studies
the trouble with studies–as you also pointied out–is that so often they are constantly changing the party line, the standard of care, making it a moving target. take mamograms, for example; first it was get one done at age 35 and then anually (I think) thereafter. Later we heard about all the false-positive mamograms causing a lot of people a lot of stress about disease they didn’t have. not sure this was ever resolved.
Certain things we *know* are good for us, like getting enough exercise, eating enough veggies and fruit. I think acupuncture is in this category.
Makes “theory” a lot more attractive as a guideline for treatment plans.
Dig deep!
Dig deep!
They did at my school!
They did at my school!
who matters
Murray Hill Neighborhood Acupuncture and Chinese Medicine, LLC
Address: 1926 East Park Place Milwaukee, Wisconsin 53211
Open seven days a week by appointment. Phone 414 906 8881.
6 comfortable recycled lounge chair
It all depends on who matters. If it is the patient who really matters, then if the patient says they feel better, (for example, pain or other symptoms),then, that’s valid and the end of the story, regardless if it corresponds with scientific “fact,” or not. If the patient really matters, then the more people who do acupuncture the better, and it doesn’t matter which profession is doing it. If the patient matters, you do want some minimum standards to prevent harm and you want to keep the costs down. If the patient matters, then other practitioners’ experiences matter, because those come directly from patients in their clinic who tell them if they are helped or not and what techniques worked or not. When it is the patient who matters, all the arguments become clear and the right answers become compassionate and obvious.
menopause
Murray Hill Neighborhood Acupuncture and Chinese Medicine, LLC
Address: 1926 East Park Place Milwaukee, Wisconsin 53211
Open seven days a week by appointment. Phone 414 906 8881.
6 comfortable recycled lounge chair
And how about viewing the ageing process and a woman turning into a loving and wise grandma as a beautiful and natural treasure instead of a dysfunctional machine with body parts breaking down requiring horse urine for repair?
Citation of Data, so I can use it too, please 🙂
Can you please provide a reference or citation of the data chart of acupuncturists per state, so that I can use it in my business plan/marketing research? Thank you!
…
https://www.communityacupuncturenetwork.org/blog/survey-says-27965-licensed-acupuncturists-us-july-2009
As an acupuncturist who
As an acupuncturist who “gets it” I am horribly offended by this article and think this is the quickest way to get our sophisticated and complex medicine illegalized. In China acupuncturists have 6 years of schooling and are doctors, this is the direction that the US should be heading rather than assuming that you can simplify it to a technicians position or under a weekend trained MD who had no concept of the intricacies of TCM.