Response to “Acupuncture Is Popular, but You’ll Need to Pay”

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.

Sincerely,

Lisa Rohleder, L.Ac.

Working Class Acupuncture

www.workingclassacupuncture.org

lisafer
Author: lisafer

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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.

Responses

  1. Thank you

    For this lucid and important response to the framing of community acupuncture. For founding Working Class Acupuncture and CAN. For creating a world in which acupuncturists can make a living while providing access to health care for people not affluent enough to afford private treatments.

    My passion in life after my family is the community acupuncture clinic I had the good fortune to launch in my own neighborhood. This entire movement will continue to swell and the news stories will look quite different in the not-too-distant future. With gratitude and love from San Diego.

  2. You

    You are a ROCK STAR.

     

    bless you, Sister, for your wise and articulate ways.

     

    with so much love and gratitude (and more than just a wee bit of awe…)

    Julia in Berkeley

  3. powerful followup

    Thanks Lisa for leading by example….speaking the truth with eloquence and respect. I like how you simultaneously rip apart the falsehoods of the NYT article while very deliberately and genuinely respecting its author. 

    What’s with the stuck-on-87-comments situation though? Are we to believe that the NYT doesn’t have the $ to pay someone to work on the weekends to quickly read through some comments and determine they aren’t libelous or spam…what would that take….about 10 – 20 seconds on average per comment?

    Or maybe, they weren’t expecting this kind of organized response and instead of acknowledging the inaccuracies of the article and being transparent, they are exercising their corporate power and squashing the discussion by not moderating the hundreds of comments which are surely waiting in moderation. It’s Monday in New York now. The Friday story is old news now. 

    Then again, I must remember patience….the truth always wins out…pen mighter than sword…one candle eliminates the darkness. Rock on CAN!

  4. Really?

    “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.”

    Hey.  I love you CAN and I love you Lisa, but I don’t love the quoted section above.  I think it is sort of like saying Community Acupuncture is for simple problems.  A one-off comment that doesn’t truly address the complexity of the community.  Do I think many acupuncturists are oblivious to the needs of those with limited means — yes.  Do I think many don’t even know how to begin to address the needs of that population.  Yes.  I don’t actually know of any acupuncturists that think those with limited means aren’t smart enough to want acupuncture but I’m sure you’ve met those who do feel that way.  Still, I bristle.  I’m trying to find ways to make my practice more accessible.  I’m also aware that my private room practice has enabled me to help some folks that I wouldn’t be able to help in a CA setting — and some of those folks are people of limited means — and I struggle with how to continue to be able to do that while also making myself more available to more people of more classes.  It isn’t easy.  I’m super glad CAN is there, doing what it does.  And I wish there wasn’t the understandable, given the history, yet still hurtful (emotionally and for the greater good) tendency to dismiss the non-CAN-ers as a uniform group of clueless, greedy, self-serving, snobbish, classist dimwits.

  5. Thank you, Lisa! A great

    Thank you, Lisa! A great response that is clear and to the point.   You move me every time.  

     

    Erica Leaton

    Central Coast Community Acupuncture

    Newport, OR 

  6. Generalizing Acupuncturists

    Thank you for speaking your mind about the controversial issues that have come up in response to the NYTimes article. Your response was for the most part very thoughtful, comprehensive, and passionate. It is clear that you really believe in what you do and that you are making a difference in your community as well as within the community of acupuncture and the practice of acupuncture in America.

    I really appreciate the distinctions you make in the following quote about the different ways in which acupuncture can be practiced in terms of diagnostic methods and treatments and I find it very elucidating in terms of community acupuncture vs. private practice.

    ” 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. ”

    I believe it is important for this kind of discussion to continue to develop among the acupuncture and non-acupuncture community in order to find a more universal language that describes the practice of acupuncture as it becomes continuously influenced by modern science and western culture.

    I think it is really important that as acupuncturists we never denounce other acupuncturists or put them into a ‘general’ category such as with this comment ‘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’. I find this comment a little offensive. We are practicing in a country where we are challenged by the scientific community on a regular basis to provide evidence using testing systems that are not necessarily compatible with the Chinese Medical system and therefore don’t always provide results that will satisfy insurance companies or those with the current authority to dictate how much government funded support acupuncture will receive and based on this lack of acknowledgment, acupuncture faces a lack of respect from within the health-care community; because of this we need to support each other and the different ways in which we practice.

    I also don’t believe that acupuncture will ‘never get adequate health insurance coverage’ and I don’t see the point in making negative statements like that. Chinese medicine works because it is based in a philosophy which is not shrouded in judgment; on the contrary, it is all inclusive and strives to find balance and harmony in ways which are non-invasive and respect life and nature; furthermore, it honors the spirit and in doing so gives us access to forces that are greater than our own. We are only as limited as we choose to be and we have to start with ourselves, so it’s important to be aware of how we are framing our thoughts and ideas when conveying important ideas about acupuncture.

  7. Yes, really.

    How did it happen that the cost of acupuncture has made it completely inaccessible to most people in America? Acupuncturists set those fees of $65 to $120 a treatment. I’m pretty sure nobody held a gun to their heads. That’s some massive institutional classism — or you could call it massive institutional cluelessness, greed, selfishness and snobbery too if you wanted to, I guess. Acupuncturists set up this structure, and they are responsible for it.

    And I am also pretty sure that nobody has challenged that structure within the context of private practice acupuncture (leaving NADA and public health out of this argument, because that’s different), nobody has challenged the acupuncture profession on its classism, other than me, or somebody that I invited/encouraged/gave a platform to/radicalized. Nobody else said, wait, this is wrong, look at how many people we are excluding. If I’m mistaken about that, and there are other acupuncturists who have been leading on this issue, challenging the profession in public, and otherwise taking the heat, please send me their names and I’ll apologize to them personally — also, I probably want to hang out with them. But if I am correct on this point, that apparently the business of quietly and steadily making acupuncture inaccessible to everyone except wealthy people was just fine with everybody, until I started organizing around the astounding possibility that maybe it wasn’t — I won’t be apologizing for that statement. And if it wasn’t fine, why didn’t anybody else stand up and say so? You want me to give individual acupuncturists the benefit of the doubt for some reason. Elaine, I love you too, but you are asking too fucking much, given the context. 

    Speaking of the context — we are talking about a situation in which acupuncturists gave information to a major news source that may very well result in the people who need acupuncture most not getting it, like my patient with Parkinsons. And what you are focusing on is that I am being unfair to acupuncturists. That I said something unkind about acupuncturists. That I am not taking the time to address the complexity of the community of acupuncturists.  WTF?

  8. Sarah, please see my response : yes, really

    to Elaine, below. Also, I have been an acupuncturist for 16 years, and for that entire time, acupuncturists have been announcing that insurance coverage for acupuncture is just around the corner. It’s time to deal with the fact that it’s just not going to happen.

  9. it is a choice

    since most of us are self-employed, pricing our services is pretty much always our choice, and it is not a neutral one, EVER, because the higher acupuncture is priced, the more peole are excluded from access. it is basic math and basic economics. before WCA and CAN came along and shook things up, this profession just acted like it is normal to charge high fees for acupuncture and no one questioned it publicly, while thousands of acupuncture students were going deep into debt becoming thousands of acupuncturists who are struggling to make money and attract patients, while milions of potential patients who could benefit from acupuncture would not even consider it as an option beacuse of how it is priced.

     

  10. barking up the wrong tree , again

     

    “don’t always provide results that will satisfy insurance companies or
    those with the current authority to dictate how much government funded
    support acupuncture will receive and based on this lack of
    acknowledgment, acupuncture faces a lack of respect from within the
    health-care community”

    i think this just gets at one of the fundamantal differences between community acupuncturists and the traditional acu establishment. we’ve seen that this effort to “convince” govt and for profit insurance companies hasn’t worked for more than 20 years! community acupuncturists have seen that these wasted resources are better spent getting more people more acupuncture.  we’re not really interested in “satisfying insurance companies” because that doesn’t seem to have worked much at all in getting medicine to those that need it.

    i think that one of the main reasons acupuncture lacks respect in the health-care community and the community at large is that only 1% of Americans have tried it. we can stay complacent and spend our precious resources “respecting all ways of practicing” or we can ask the difficult questions about why very few people are and have been getting acupuncture.

    two of the main reasons have got to be that the acu establishment does nothing to promote acupuncture DIRECTLY to the public instead of courting insurance industry reps and paying lobbyists in Washington; and another is that acupuncture at market rates is too expensive for the majority of people to take a chance on it. so by extension, most acupunturists over the past 20 years haven’t done enough to promote acupuncture directly to the public either–by  making it less expensive and more accessible.

    “it is all inclusive and strives to find balance and harmony in ways which are non-invasive and respect life and nature”

    i agree that this statement is true, which is why i think we need to apply it to patients as much as we do to acupuncturists. if we are really to respect life and nature and strive for balance and inclusiveness, then how can we justify allowing the prevailing ethos in our profession to be to charge so much that most people can’t access the power that is this medicine?
    when i hear Lisa’s comment about those “with limited means being smart enough to be interested in acupuncture” what i hear is the willingness to ask the uncomfortable question that if we do think they are interested then why haven’t we have been marketing and making our practices available to them all along?

    certainly many acupuncturists have been and are still doing what they can to provide acupuncture and doing some great work.  it’s just that mostly this has still left 99% of the population out. do you see how this makes it hard to respect ourselves as a profession that took an oath to provide medicine? or ask for that respect from others? the community acupuncture movement is willing to acknowledge that the acupuncture establishment and lots of us acupuncturists have mostly been willing to “make invisible” anyone who isn’t willing to pay the exhorbitant rates that are being charged. and while we all want to respect what everyone is doing, this gets difficult when we see lots and lots of people suffering that don’t need to be.

    i just don’t think we’ll ever have enough double-blind yada yada studies to get “the respect we
    deserve” and in the meantime many, many thousands of people who could
    be relieved of suffering are caught in the middle of this battle.

    and get respect from whom? western docs who, even if they do think acupuncture is great, already have to struggle to keep their own practices running? insurance companies that are looking to cut more corners every day? gov’t programs that are constantly unreliable because they will always be caught in the winds of political change? are these really the folks we need to earn respect from or is earning it from thousands and thousands of new acupuncture patients getting results going to be what real matters?

     

     

    Melissa

    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.

  11. Poor information/context

    1)  Articles about acupuncture almost always contain some really bogus statements.  It took a lot of years of a lot of people speaking up before every acupuncture-related article didn’t end with something along the lines of, and if you want to get acupuncture, be sure to see a Medical Doctor.  I’m a fairly well read and involved practitioner and I knew nothing about CAN until about 6 months ago.  I was ignorant.  Not willfully ignorant, I just didn’t know what I didn’t know.  Bad me.  It is unfortunate that the writer didn’t get info. from acupuncturists who knew more, and it is fortunate that CAN has its act together and was able to do such a good job in responding to the errors in the article.

    2)  I don’t care about the unfairness to acupuncturists merely because it is better or nicer to be fair.  I care, because it seems that CAN really would like more acupuncturists to get what you are about and would like more practitioners to become CAN practitioners.  You care deeply about the communities you are serving and you want more practitioners to serve those communities.  Looking through the best of CAN blogs, reading a Tale of Two Missions, I find a recurring pattern.  Practitioner is exploring CAN, considering how it might work for them, sharing some of their concerns/questions.  Generally in fairly short order most of them ask or say something that results in the “You just DON’T GET IT” conclusion, and CAN doesn’t care to/isn’t able to help you get it and practitioner decides, okay, this CAN thing ain’t for me.  CAN-ers then express their upset and disgust that no one gets it.  Repeat.  It wouldn’t matter so much if it didn’t mean that some folks who might get it, give up, and that means that the communities they aren’t serving have to keep waiting.

    Having spent time working with groups, trying to educate others, I also understand that some CAN-ers are likely burned out on this conversation.  Been there, done that, I can either use my energy to do this work or use my energy to teach people, but not both.  And that’s fine.  And perhaps it would serve CAN to find a few people who are still willing to have that conversation.  Code Blue, we have someone trying to get it, please call in the emergency responders.  Find a way to help that person get it, or at least understand that it isn’t for them based on a true understanding of CAN, and it seems that would help CAN.

    I imagine the confused student at the front of the math class.  They went to crappy schools until now and are woefully behind.  They want to get it, there is a glimmer of understanding.  They ask a question and the teacher responds, “YOU JUST DON’T GET IT.  YOU DON’T CARE.”  Or, teacher responds — I’m not able to help you now, there are 25 students who do get it who need my attention, but I’ll meet you during study hall.  Or, I’m not able to explain this in a way that you understand, let me find a classmate of yours who can help.  Or, I’m burned out, but here is a great tutorial you can take on line that might help.

    For the teacher to not be willing to find some way to help the student get it and then to state that student doesn’t care, doesn’t want to care, is too selfish or stupid, or whatever, well, it just isn’t true.  And it’s a waste of energy, and it isn’t helpful to the poor student and in the case of CAN, it isn’t helpful to the working class that can’t afford acupuncture and are waiting for a clinic to open.  That’s how I see it and that is why I cared enough to post.  Not because you hurt my feelings.

  12. Even if insurance coverage DID happen, would you really want it?

    I hope Lisa is right and insurance isn’t on the way. Dealing with insurance is NOT fun, and some doctors offices have full time people dealing with it. Other doctors outsource it. There’s even a movement for cash-based practices.

    Why?

    Because insurance is a pain to deal with. They have money. They don’t want to pay you with it.

    Besides, with community acupuncture payment scales, insurance becomes moot – since the payment is about the same a deductible, who cares if it’s covered?

  13. I understand what you are getting at

    But I’m having some trouble with what the real world application would look like. Let’s take an immediate example. The only acupuncturist so far to respond on the NYT comment page to the CANners says he wants to understand community acupuncture. Is he the confused math student at the front of the class? If he’s not, how do we figure out the difference between him and the confused student at the front of the class, who sincerely wants to get it and needs a little help? Here is his comment:

    “I’m a practicing acupuncturist as well, and I want to ask the
    acupuncturist who are promoting community-style acupuncture:

    1. How much was your education? (I know what I paid to graduate
    from a 4.5 year acupuncture school in NYC).

    2. What are you making a year doing community-style acupuncture? If
    you have taken out student loans, have you paid them back in full yet?

    3. What do other medical professionals (alternative or allopathic)
    who put in the same number of years of school make in comparison?

    I applaud offering people sliding scale fees, because someone has to
    do it, but in essence, you’re driving down our rates with community
    acupuncture.

    A. When insurance companies, and later Medicaid research our general
    fees to figure out how much the govt especially will cover later, they
    will notice that community acupuncture fees are $15-30. Essentially,
    community acupuncturists are shooting the acupuncture community in the
    foot. (but helping others in the process). MDs who take 200 hour
    certification courses would not be caught dead reducing their rates
    offering acupuncture, but they are off on vacation– paid by the people
    who respect their work and pay full price.

    B. Many acupuncturists who are self-employed don’t even have health
    insurance themselves.

    C. There are not enough business classes in acupuncture school (a
    semester right before graduation) for acupuncturists to really get a
    sense of how to profit from their work. Many go back to their old jobs
    after graduating from school; some never practice at all.

    D. Many “healer types” struggle with guilt regarding making money
    from their work. IT’S OKAY TO MAKE A HEALTHY LIVING FROM DOING THE WORK
    YOU LOVE.

    I’ve worked at NADA (ear acupuncture) clinics as a volunteer. And
    I’ve also charged in the upper echelon of acupuncture clinics. Right
    now I’ve settled comfortably in the middle bracket.

    My main point is this: It’s ridiculous to have a Master’s degree and
    be making below or the same as someone without advanced college
    training. It’s a poor investment and unwise thinking!”

    Code Blue, anyone? Anyone want to patiently explain why taking care of our neighbors is not actually a poor investment?

    The absolute worst part for me about the people who say they want to get what we’re doing is comments like “I applaud you offering sliding scale rates because someone has to do it…BUT DID YOU NOTICE THAT YOU ARE DEVALUING THE PROFESSION???”

    So many people have applauded me while asking questions about what I do that somehow included underhanded digs at my self esteem and/or my patients’ values, that now when someone applauds me, I have a reflexive desire to smack them. There are also the many acupuncturists who are fascinated with our business model (speaking from experience here), who will take up hours and days of CANners’ time if we let them while we patiently explain every aspect of what we do and why it works, only to say at the end,  that’s nice, but I just think I deserve more than $15 for a treatment.

    So for the guy above, who feels that we are shooting the acupuncture community in the foot, the best response still seems to me to be what Skip said when he read this, and what Larry G. wrote on the blog: hmm, I guess we need to aim higher.

     

  14. Hey Elaine

    You say you would like to see more of this: “Or, teacher responds — I’m not able to help you now, there are 25
    students who do get it who need my attention, but I’ll meet you during
    study hall.  Or, I’m not able to explain this in a way that you
    understand, let me find a classmate of yours who can help.  Or, I’m
    burned out, but here is a great tutorial you can take on line that might
    help”–

    But the thing is, there *is* an online tutorial: it’s this website, and the forums on it, which are chock-full of years of discussion on this stuff, plus helpful tips and shared experience besides.  There ARE classmates you can talk to: they are your colleagues, 1000 or so of whom are CAN members; not to mention your patients and the members of your community.  There is a study hall: it’s called “The Remedy” and “Acupuncture is Like Noodles.”  There are jillions of books and websites and blogs and articles that talk about classism and other stuff, many of which are linked to in the forums.  I know people have different learning styles, but in the end folks still have to do their own homework–right?  Knowledge doesn’t come pre-digested.

    I know that I could be a little more patient in my dealings with colleagues at times.  But I also kind of feel like prefigurative politics is a two-way street.  

  15. You’re right

    And, some people don’t even know where to begin.  I’m trying to save my time and energy to actually reply to “an acupuncturist” over there at the NYT.  And most of what I’m going to say I learned from you.  And you folks have said it all before.  Perhaps you need a “bedbug letter” if you know the old joke, carefully edited and ready to send out when things like this come up.  But CAN was not a glimmer in my eye until — 1)  I read some of Lisa’s writings on a crazy google group of folks arguing about the FPD, 2)  was lucky enough to be a person who tends not to get defensive or turned away by people’s anger, 3)  decided to join CAN ,4)  Was lucky enough to have a WCA workshop happening at a time I could actually attend, 5) Bought Noodles.  I’m guessing, though I could be completely wrong, that “an acupuncturist” hasn’t gone through these steps.  I was unaware of any colleagues who were members of CAN, and my patients are the patients I’ve cultivated over 15 years of BA practice.  I didn’t know it was BA practice, it is what I thought acupuncture looked  like.  Yes, sometimes I was torn when trying to figure out how I could see people who couldn’t pay me and yet still pay the bills.

    I’ve been out here practicing for 15 years, been involved with state level acupuncture politics, and still would be ignorant of CAN if I hadn’t been fired up about the FPD and had a former classmate tell me about the group on which I read Lisa’s stuff.  Now that I know about you, and given that I don’t scare easy, I can access all the resources you mention.  6 months ago — total ignorance.  I personally didn’t need the material pre-digested, though some folks do, but I needed to know there was something there to eat.

  16. Number 235?

    I’m awaiting moderation, but if it goes through it will be 235 and you can see how I did.

    Yes, I’d get sick of having to go through the whole thing over and over.  A one page write-up that addressed the questions that come up every time would be useful.  Finding people who are willing to take their turn educating the heathen would be helpful.  Or, at the least, admitting that the ignorance of some is an indication of a lack of patient teachers at this moment, and isn’t always an indication of greed, selfishness, or other negative character traits.

  17. in the works

    Hello Ewolfk

    Members of the CAN board of directors are currently working on such a project.  We are aware that many of the same questions are raised over and over (e.g. “does CA devalue the profession”) and, yes, we do get tired of answering those questions multiple times.  So, those questions and ansers are being compiled into a FAQ document that can be referred to. 

    I’m not sure of the projected timeline, but it should be available before too long.

     

    David
    The Hammer from SF

  18. Buy the Noodles Book

    I think the Noodles Book is what’s needed to even “begin” understanding and then CAN 101. Because people are right CAN can’t address EVERYTHING in a blog post or forum post.

    I don’t think I even started to “get it” until I read the Noodles book. And it takes a while, I am still learning about the model everything as I practice it.

    Something that is valuable and deep takes a while to “get” because words don’t do a great job of conveying the amazing everyday practice of a CA clinic.

    acupuncturewinona.com

  19. yes!

    nora, that’s exactly what i thought – there is so much information available now than before. when i went to the first WCA workshop in 2006, there was no CAN, no Noodles or The Remedy. yet many of the 40+ folks who were there managed to “get it”, start community clinics that are runnign till this day and doing well. the board is working on making stuff easier to find on the forums – just about every question, doubt, issue with this practice model that we generally see brought up by newbies has already been discussed here several times over – if someone really wants to “get it”, CAN has the information they would need, the rest is up to them.

    -tatyana

  20. Getting to CAN.

    Yes, once people get to CAN, if they are brave enough to dive in, everything is there.  My initial comments were in response to Lisa’s letter to the NYT writer, which was posted on the Well Blog.  One of the things that stirred up CAN was that, by saying CA was for simple conditions, the article may have discouraged people who would be well-served by CA wouldn’t give it a try.  That was upsetting.

    The paragraph that I took issue with in Lisa’s response seems likely to do the same thing for practitioners — keep some who might be well-served by CAN from checking it out.  It is like trying to address a legitimate issue with your partner by starting out — You never or You always — then the fight becomes about whether always or never is accurate, rather than about the real issue — in this case, the way the mainstream acupuncture community has overlooked the financial reality of the vast majority of potential clients.

  21. A time and a place for everything —

    Yeah, a certain amount of courage is needed to really get it.  People have got to be willing to stretch a bit and get shaken up.  Still, it seems it would be worthwhile to give people a chance to get interested before we test their cojones.  As I wrote in response to Tatyana – a letter to the NYT blog that might be a practitioners first intro to CAN might be a place for MLK — righteous indignation — without a molotov cocktail thrown in.

    In general, I try to treat people the way I would like to be treated.  I’m happy to be challenged and made to think.  But I haven’t found I’ve been in a good place to listen if I’ve been labeled a selfish money-grubbing classist before I’ve even had a chance to hear what you have to say.

  22. That’s great —

    I’m very happy to hear that is something you are working on.  It may be presumptuous of me, but I’d be happy to give you my 2 cents on it before it goes public.

    There is one thing I think it would be great for CAN to think about and talk about — does the CAN community believe that there are honorable reasons for a practitioner to run a BA practice rather than a CA clinic?  Because the mixed messages run deep throughout the blogs.  A crapload of time has gone into this back and forth on forums and blogs.

    A month ago I mentioned CAN in a conversation with a colleague.  She mentioned that she didn’t like the group because they thought everybody should have a CA practice and that it was bad for anyone to do any other type of practice.  At the time, I argued that that wasn’t the case at all.  I knew I had read posts in which CAN-ers talked about referring to BA practices, and mentioned that some clients might need a different setting and that some practitioners might not have the skills to run a CA clinic.  Yet, as I’ve read more in the past months I’ve begun to see what my colleague was referring to.  More often than not, practitioners who do not chose the CA model are described in overwhelmingly negative terms.

    I don’t expect you folks to be a monolith, I know sometimes frustration gets the better of us, I know you are only giving as good as you get.  Still, I can think of many ways the public is served by having a variety of treatment models.  I can see how having a one evening a week CA clinic might be a good way for a practitioner who excels at time intensive medical qi gong to also give something to her community — and yet that will be dismissed or bashed as a joke.

    Sounds trite — but I do say it because I care.

     

  23. see my last comment at the end of this thread

    https://www.communityacupuncturenetwork.org/blog/response-acupuncture-popular-youll-need-pay#comment-26450

    i think that fits pretty well as my response to the above comment. and my guessis that we are really not that interested in discussing the merits of running a BA practice or a BA practice that decides to offer low-cost treatments once per week,etc.

    should everybody have a CA practice? i can’t speak for everybody, but i think we are after having as many CA practices as possible and we don’t much care about the BA ones – they do not need us and we have nothing much to offer them.

    -tatyana

  24. My question –

    is whether current BA practitioners who are potential CA practitioners are scared off by BA bashing, and whether that serves any useful purpose.

    If there were acknowledgment within CAN (and no, I don’t know what that would look like — more like keeping that in mind when these dialogues happen) that some BA folks are good, hard-working, compassionate, etc., and that they are running BA practices for reasons other than selfish, clueless disregard for the working class, I think there might be more CA practices.  Does the mean-spiritedness that often comes through help your cause?  Help you get your message out?  It may feel good, but if it closes someone down to the message before they can really think about it, does it do more harm than good?

  25. Answer to Elaine about “honorable value.”

    Elaine asked: does the CAN community believe that there are honorable reasons for a practitioner to run a BA practice rather than a CA clinic?  Let’s look at your question from Lisa’s “Acupuncture is like Noodles” analogy.

    Imagine that there is a chef in your city who excels at preparing a particular type of elegant, exotic noodle-dish with a price tag of $200. The waiting list for this exclusive restaurant is many months’ long.
    In this city, there are also several dozen low-cost restaurants where folks can belly-up to a plate of comfort foods: macaroni & cheese, spaghetti & meatballs, pad thai, and more. You can make a reservation if you want, or you can often walk in and be seated within the hour.
    Finally, this city has a soup kitchen which receives its funding from a state grant and offers free cups of chicken noodle soup to those in need. The line for soup often stretches out of the building’s front door.

    Is there value in having all of these restaurants in the same city? Since they all have customers, one could say the market has answered “yes”. Each serves a specific demographic and need. Each is justifying its existence by satisfying its own clientele.

    Are there honorable reasons for having the fancy-schmancy chef in town?

    Because of the fancy-schmancy-chef, the low-cost restaurants do not have to cater to the city’s socialites who may have special, time-consuming requests like this. Part of the low-cost restaurant’s ability to keep their prices affordable stems from the fact that their customers order from a standard menu and don’t expect a lot of time or attention from the wait staff. That is the value of having a fancy-schmancy chef in town: keeping the attention-seeking, system-clogging, needy-patrons out of a busy restaurant which is focused on helping as many people as it can, while keeping its prices as affordable as possible.

    Now imagine a second city with only a fancy-schmancy chef and a soup kitchen; imagine that there are no cheap places for food.  The average, working people there are starving because they can’t make their own food, they can’t afford the expensive restaurant, and they are too proud to ask for the free hand-out. Even if the fancy restaurant still has a long waiting list, is there honor in running an exotic business when people all around you are starving? 

    Oh! This chef is so good at making his fancy-schmancy-egg-noodles!” you might cry. “He has spent his entire life perfecting this dish, and it is so amazing, and people are willing to pay for it and wait for it, and how can you just deny them that privilege?!”

    Look around: people are starving. In my eye, there is no value in this restaurant’s service. I find it deplorable that he has the skills to prepare food, prevent suffering, and serve where there is a need…but instead he chooses to indulge his passion and creativity with artful food presentations. 

    Let’s imagine just one more town. In this town, there is no fancy-schmancy chef, and there is no soup kitchen. There are only low-cost restaurants. The socialites have been forced to eat in the same establishments as the postal workers, the teachers, and the janitors; they have walked past those who are starving on the city’s streets. What if their eyes opened to the suffering of those around them, because they were no longer segregated from different classes? What if they started helping the less fortunate? What if they chose to spread the wealth?

    That’s what I call Revolution.

    And this is what so many of us get pissed about. I think that Boutique Acupuncture currently has limited value, only in that it helps us Community punks focus on treating our community members efficiently. I think Boutique Acupuncture has zero value when offered in a community with no affordable acupuncture services. And I think Boutique Acupuncture ultimately serves as a barrier to creating real, effective social change by further promoting classism in our society.

  26. Elaine, I answered this question

    (does the CAN community believe that there are honorable reasons for a practitioner to run a BA practice rather than a CA clinic?) on the next page because reading these skinny comment boxes make my eyes wonky.

  27. Elaine,

    I totally get your question because I asked it here almost two years ago.  I think a lot of us have been in your shoes, asking the same questions.  It can take a long time to “get it.”  I like Skip and Lisa’s answers.  I can’t say it any better than they did.

  28. Oy —

    I’m getting tired of this, and I’ve only read conversations like this about 10 times in my 6 months of CAN, so you folks who have been around and participating in them for years must be way sick of it.

    My question (I think, now I am on the post screen and can’t double-check) wasn’t whether CAN-ers thought that BA itself had value, but whether you thought there were honorable reasons for someone not to open a BA clinic.  Staying with the chef analogy, perhaps chef has a repetitive motion injury and can only do a limited amount of cooking.  She really should retire, but has kept her high-end establishment so that she can do some of what she loves while making enough to survive. Or, she poured her heart and soul into her establishment and just doesn’t have the qi to start over at this point in her life — her location is not suited to serve the masses, the real estate market has crashed, and she can’t unload her place.  Or she has a terrible history of working with others and knows that she can only be succesful in a small establishment where she can control every detail.  Or, she was brutally attacked 10 years ago and doesn’t feel safe in groups.  Or, she serves a clientele with severe allergies that need special food to thrive.  Or, her establishment has become a haven for others who have had traumatic life experiences — they talk and talk and she thinks it helps that she can sit with them for long stretches.

    I think I get why CAN wants there to be more CA practices, and why BA comes to represent an uncaring harsh world.  I just wish that that didn’t result in the blanket condemnation of those who, understanding their own limits and skills, decide they aren’t yet or won’t ever be able to move to CA.  Yes, some are thoughtless slime balls, but not all.  Yes, and CAN doesn’t exist for them, but if CAN had some respect for them (NOT the slime balls, the others),perhaps they could see the value of CAN and support it and explain it to others, and tell the NYT how great it was and be happy to tell clients that can’t afford their services about another wonderful thing they can try.  (Jessica, I sent a guy called Jamie your way….)

  29. No.

    Social change is complicated for everybody. 

    There were lots of people with lots of “reasons” who tried to explain why they couldn’t adapt to social change (equal rights) for women, for persons of color, for GLBT…

    Those reasons are not “honorable”; they are just excuses.

    Thank you for the referral; you should stop in sometime. 

  30. we’re not alarm clocks

    I don’t know… I was originally attracted to CA because Lisa’s writing was some of the first I came across in the acu-world that didn’t seem just plain insane.  People don’t need baby steps, or watered-down whatever.  Trying to turn someone who isn’t into the real deal of CAN into someone who is just seems disrespectful to me.  There’s plenty of room for everyone, just maybe not here.

    But then again, I was radicalized by life long before discovering acupuncture.

  31. Another question

    Why does it matter to the BA acupuncturist what CAN, as an organization, or individuals within CAN, think of their motivations for practicing the way they do?  Are they really that insecure?

    I mean, if they’ve got solid reasons for doing what they do, then I reckon they’re happy with what they’re doing, and what anyone else thinks won’t matter.

    Further, we don’t need their support.  We need the support of our patients.

  32. hi ewolfk

    I think your question about how to make CAN more accesible and welcoming to people checking it out as well as the, ‘what about ______ scenario’ questions really boils down to the same simple answer: If your primarily intention is to find a way to treat as many people as you possibly can, to make acupuncture both easily accesible and affordable to all, and to help to truly change the way in which health care is provided, you will find some of the most amazingly helpful and beautiful open hearts you have ever met here to help you in that direction. you will also find loads and loads of written material and guidance based on the experiences gathered from countless hours of practitioner sweat, given freely to you. you’ll find great conversation and community support like you have never felt in the acupuncture world before. and you’ll find many people open to helping you through whatever individual struggles you might have in getting you to that place where you can be treating as many people as possible, making acupuncture affordable and accesible, and changing the way health care is provided. you have to want that though. If you come in and your primary intention is to flame the community, prove to yourself or others that this model has its limitations, its members are impersonal, cheapen acupuncture, or that there is no way the model is financially sound, then you will not only find all of that to be as true as you wanted it be but you will probably find yourself alienated from the community. not because you werent wanted, but because you arent NEEDED for the community to continue to function, and you never wanted to be a part of it in the first place. i think we would agree that really its a very healthy and necessary boundary to set when begining any new relationship whether in community or any interpersonal relationship. if you truly are interested in CAN(i dont mean you personally), stick your hand out, people very quickly pick up on sincerity and will respond with the same. and most importantly do the work of putting your time in, read the forums/books/FAQS/etc. to learn what you can and give it some time to soak in. doing this shows that you are truly interested in being a part of a community and goes a really long way in that community opening its doors to you. basically, show up with an empty belly, a bottle of wine, and wear a shirt that you dont mind getting spaghetti stains on.

  33. Right back at ya

    This whole dialogue started around CAN being pissed because the acupuncturists the NYT reporter spoke to were ignorant about CA.  I began to look at possible explanations for why there was so much ignorance. 

     By your reasoning, if CAN practitioners are secure in what they do, who cares if others are misinformed.  You’ve got your solid gold reasons and the support of your patients, so any concern about the NYT article is a sign of insecurity?

  34. I was exploring

    how to bridge the initial gap.  It is far more likely that folks will come with defenses down, willing to learn and listen, if they aren’t labeled and judged before they even know who you are.

    If the first contact of potential CA practitioners with CAN is a public letter which states that they don’t believe the working class is smart enough to want acupuncture, it comes as no surprise to me that the hand they arrive with is more likely to have a raised middle finger than an open palm.

  35. R-evolution

    So, the patient who has found that medical qi gong does help them when acupuncture itself could not has been brainwashed by the elite?

    Revolutions do prefer black and white.  Far too time-consuming to consider on a case by case basis someone’s motives.  Medical qi gong = burgeois and into the tumbrels they go.  Should we burn the books, too, to avoid the pollution of the dangerous ideas within?

    I’ve tended think in terms of evolution — it can be slow (though not always — round-up resistant weeds, anyone) — but it generally avoids a fair bit of collateral damage.  Did the peasants who had no care at all appreciate the purge of the acupuncturists, killed or sent to re-education camps because what they were doing was woo woo?

  36. Values

    Chai writes: “If your primary intention is to find a way to treat as many people as you possibly can…” 

    The thing is, outside of CAN, I don’t see other acupuncturists who value helping as many people as possible.  It’s not how they define their success. 

    We (on CAN) talk freely about the number of folks we treat per week or month or year.  That is how we measure our level of success in our communities.

    I see this (thread on 5/9/10 at 6:31pm), where one acupuncturist brags to another that has a two week waiting list for new patients.  What-wait-what?!?  She defines her success by the inaccessibility of her clinic to patients who need care.  Or further down the thread, same acupuncturist encourages a new practitioner to raise her fees, writing “May I suggest you start your first visit fee at $120 that way you are closer to market.”  (She herself charges $250 for her initial visits and $120 for follow-up visits.) 

    Success here is defined in terms of the acupuncturist: how popular am I, how high can I push my rates.  There is no value placed on how many people she can help. 

    Then there’s this boutiquer who realizes that his fees are a problem for his patients, “but will not change (his) fees because (his) skill level hasn’t changed.” Again, the emphasis is placed on the practitioner…not the patients.  This is about his skill set needing to be valued…not about the people he is trained to serve.

    I think the crux of our professional disagreements arise because we have two very different value systems in this industry: there are those who value serving the people and want to help as many people as possible; and there are those who value themselves and/or the medicine, and seek to find ways to elevate their/its status. 

    We can’t have a conversation that makes any sense if we don’t share the same values.

  37. My hope

    is that as we talk about these things, as we call people on the values their choices imply or reflect, at least some people will begin to rethink their priorities.  Far too many people live their lives on auto-pilot, never going deeper.  And some, no doubt, will only stand more firmly by their questionable choices.  I’m interested on how to connect with people so that they are more likely to explore their choices and see if they are indeed living with integrity.

  38. The difference is in the

    The difference is in the reach of the NY Times vs. the reach of CAN.  Whatever the NY Times prints tends to effect more folks than whatever anyone blogs about here.  When you add in the comment thread to their article, I reckon we did a good job of informing folks what we’re about.  And the article itself already said the same thing we’ve been saying: that BA acupuncture is too dang expensive for most folks.

    I don’t give a rat’s posterior what some BA acupuncturist thinks or says about CA.  Likewise, I just don’t think that we’re going to have any effect on their ability to make a living one way or another.

    Besides, the NY Times article did misrepresent CAN.  Anything that has been said about BA here is demonstrably true, regardless of the motivations of individual practitioners.

  39. Spreading information

    The original upset was a NYT article that got it wrong because it relied on BA folks who didn’t know what they were talking about.  And the CAN-ers did care.  The blog responses were fantastic, but aren’t automatically visible.  People have to look for them.  And as the article gets picked up by other sources, the comments don’t.  So, it seemed to me, that as CAN cared about the incorrect info. given by misinformed BA, it might be worthwhile to explore what might help or hinder more accurate communication.

    It is my sense that the language about the motivations of other practitioners contained in the posting on which I commented was far more likely to– close the ears of BA practitioners to the rest of the very compelling post, making it difficult for them to take an honest look at what they do and why they do it, piss off the BA practitioners, giving them justification for future badmouthing, and, piss off any clients who love and respect their current practitioner — though they may indeed be struggling to afford their services.  On the other hand, it was hard for me to imagine a helpful reason to include the attack, though I recognize it can be emotionally warding to launch an arrow at your attackers.

    That’s what I’ve been trying to look at — does the CAN tendency to lump all currently non-CAN practitioners into one big dishonorable lump that you say you don’t give a shit about actually help or hinder your goals.

  40. There are lots of voices on CAN.

    And while admittedly it may take an effort to hear them all, readers here know there are varieties of communication styles among active writers and commentators.

  41. I think it’s important to

    I think it’s important to consider what ewolfk is saying, and not dismiss it as “they just want us be nice”  More than once I have heard people simply dismiss CAN as a bunch of radicals who hate other acupuncturists, that perception can make it harder to get people to come here and explore what we are doing.  There are a lot of acupuncturists out there who aren’t maliciously greedy, they just don’t know any better, many are struggling and scared, they believe what they were told in school.  

    Many Canners have had a BA practice at one time, put yourself back there with no knowledge of CAN, imagine how you would feel about this group of people who told you that you were basically a useless, greedy, classist jerk who doesn’t care about your patients.  Would you really be interested in going to their website and learning more?

    When I joined CAN 3 years ago, many members had hybrids while they were transitioning, there were members who had BA practices and were there to learn more about possibly switching over.  These people weren’t attacked and told how horrible they were, there seemed to be more understanding of the process of learning about community acupuncture and the difficulty of changing your life to adopt this new way of practicing.

    Before the attacks on me start, I’m not saying we need to coddle and accept everyone no matter what they do, I’m not encouraging hybrids (I don’t like them) My only point is I think it’s a good idea to think about how we are viewed by acupuncturists and acupuncture students who don’t know anything about CAN.  We want people to want to come here and learn more.

  42. Hybrids

    Thanks Linda.

    There is lots of black and white in CAN that seems to serve the group very well.  I understand (to the best of my ability) why CAN doesn’t want to waste time on hybrids or why you have very clear boundaries on the LOC listings.  It makes good sense and I’m not going to be another voice trying to argue that you should bend here or bend there.  You’ve got your hands full.  It’s the us and them labels, and statements about why the thems are thems that I’m going on about.

  43. I know

    I never meant to imply you were talking about hybrids at all, they have nothing to do with this discussion, I only mentioned that to point out that there was less attacking of people in the beginning.  I was talking about the us and them too.

  44. I know

    it just reminded me that I wanted to clarify my own position as someone else had mentioned that they thought I was addressing all the other stuff.

  45. ewolfk, you’ll waste a lot of time

    and energy trying to convince people to practice the CA way. What convinced me was reading the guest articles written by Lisa Rohleder in Acup. Today (still available on the AT website, I think). After reading those and if someone still doesn’t get it, I don’t think any amount of arguing and trying to persuade will change someone’s mind. I think one’s energy and time are better spent on something more productive. As someone wrote here earlier, it’s really all about values. What is most important to a person? Is it the amount of $ one makes? Or is it helping as many people as possible in one’s community with this wonderful therapy which for so long has been out of reach for many because of the high cost.

  46. I’m not trying to convince anyone

    to practice CA.  I’m calling attention to the ways in which CAN might be contributing to the ignorance about CA and negative reception of CA among potential future CA practitioners.

    If the world would be served by having folks take a good look at their values, and considering whether they might be misplaced, then it would be worthwhile to maximize the liklihood they would do so.  Ad hominum attacks (as in, BA practitioners think those without financial resources are too dumb to want acupuncture) increases defensiveness while decreasing thoughful consideration.

  47. Doesn’t CAN make the point

    that most BA practitioners struggle to survive?  Don’t the early statistics show that average income of the established CA practitioner and established BA practitioner are comparable?  Isn’t it likely that in some areas a CA practitioner is far more likely to have a financially successful practice than a BA practitoner?  Isn’t a McDonald’s franchise far more likely to stay in business than the high-end Kobe’ burger and truffle establishment?

    I learned that here.

  48. In this particular case, I

    In this particular case, I think a better strategy is to make CAN more visible so that we aren’t relying on BA acupuncturists as gatekeepers to someone writing a story about us.

    As for all this other stuff, I think it’s more effective to keep preaching to the choir than to try to change anyone’s mind about anything.  If someone resonates with CA, there’s a ton of supportive information for them.  If they don’t, there’s a fair bit of information to keep them out of the way.  I think spending time trying to change people’s minds, or convince acupuncturists that they should work this way, hinders our goals.  The right folks just want to do it and jump in.  It’s fairly self-evident for them.

  49. And yet, that is exactly the

    And yet, that is exactly the sort of thing we were taught to think in our practice management class at school.  “If people really value the medicine, they’ll figure out a way to pay for it,” etc…

  50. Folks have been taught

    some really stupid shit.  That’s why I’m so glad that there are people who figured out that it was stupid shit and that there is a better way.  Many practitioners (most of whom I think chose this work because they are caring people) who stop and think about it will see how ridiculous that statement is when applied to many populations.

     Also, I don’t think everyone was taught that.  Also, sometimes it is true.  I understand that we don’t know the details of everyone’s situation — I also know in the communities in which most of us thought to practice (the communities many of us come from), lots of people find the money to pay for expensive cocktails, fancy spa packages, pedicures, and freaking huge homes.  For that population it isn’t so ridiculous to think people’s willingness to open their wallet as an indication of what they value.

  51. genuinely wondering

    So, if I put aside all the explanations I have heard over the years from acupuncturists about why nobody has made a concerted effort to treat the people I treat — putting aside all the permutations of “they’re not smart enough” (not sophisticated enough/not educated enough/don’t value their health/spend all their $ on cigarettes) — what IS the reason that 80% of the population was left out of consideration in setting up fees and business structures, not marketed to, and generally ignored? 

  52. Voices

    There are lots of voices on CAN.On 5:28am May 14th, 2010 andy wegman said:”And while admittedly it may take an effort to hear them all, readers here know there are varieties of communication styles among active writers and commentators.”

    end of Andy’s quote. 

    We are many voices.  Lisa is an important voice on CAN, but we don’t have any one spokesperson, we are all encouraged to speak.  Members of CAN don’t have to agree 100% with what another member says, but the best approach when you disagree is to let your own voice be heard. We can all write our own letters and  blogs.  I’m not sure who is in charge of the blogs now, but it used to be that new writers were encouraged. Is that still the case?   This reply looks a little weird up here, it’s meant to address some of the earlier posts.  Elaine, it sounds like you have a lot to say and I think many of us would be interested in hearing your voice.

  53. I think it’s more complicated than that.

    There are actually lots of businesses that cater to working class people, from your local Coney Island diner to WalMart (don’t get me started on businesses whose market is poor folks, e.g. check cashing establishments).  And I think a lot of small businesses are started by working class people: neighborhood hardware stores, mechanic shops, daycare facilities, hair cutting and braiding…

    Also, if people “find the money” for a night at the bar, or a pedicure, or new rims, or whatever, maybe it’s because they *already know* they value that.  (Their cost-benefit analysis may not be perfect, but whose is?)  But if they’ve never had acupuncture, and no one they know has ever had acupuncture, how do they know what its value is? And how does it follow that if they don’t also “find the money” for acupuncture, they don’t value their health? 

  54. Interested bloggers

    can make their mark here. 

    CAN currently has a blog roll of more than 50 folks.   

    As vacancies in the blog roster arise, we take note of folks who have expressed an interest in blogging as well as those who seem a good match for CAN blogging, and we see what fits together.

  55. A huge blind spot

    Most of the practitioners I know grew up in white collar communities.  Many had professional jobs before they learned about acupuncture.  If they got treatment as an introduction to the medicine it was treatment in a BA setting.  The life of most American practitioners has been spent within the 20%, so that’s what they think about when they are imagining their future life as a practitioner.

    Interestingly, in my area, there is a type of CA in full swing — the Asian practitioners who trained in Asia.  They see 6 or so folks an hour, don’t ask about anything beyond the presenting symptoms, don’t offer a lot of privacy and charge about $15.00 – $30.00 per visit.  That’s what the acupuncture they grew up with looked like, so it’s what they think of when they imagine an acupuncture practice.

    So, I think it is often pure (and yes, mind boggling, but I’m guilty) ignorance and thoughtlessness that is the explanation — not negative assessments of the 80%.  The person opening the diner didn’t invent the idea — they were already familar with the concept.

  56. You’re right Nora, I

    You’re right Nora, I shouldn’t have said most people starting businesses, I didn’t finish the thought because I was in a hurry.  What I meant was most middle class and above people who start businesses don’t even put working class people into the equation unless they are making a conscious effort to get working class money or making a conscious effort to create an accessible business like Canners which is pretty rare.  I was actually thinking mostly about medical and other service practices.  

    I was trying to say I don’t think people are being malicious in not thinking of people who have less money than they have, they are just ignorant and need to be made aware that other people exist, the growth of CAN shows that.  I think there are some people who think the working class are too stupid to be interested, but I don’t think they are the majority. 

  57. Removed by moderator

    Guest – your comments were removed the first time as they are not germane to the original post. I’ve removed them again for the same reason.

    If you have something to add of substance to the conversation, do so. I’d also suggest you consider adding your name to your comments if you’d like to be taken seriously.

    Andy Wegman

  58. The AT articles did it for me, too.

    I actually grew up working class, but for some reason it never occurred to me that acupuncture could be affordable until I learned about CAN.  I’ve been reading this discussion and asking myself– if Lisa’s NYT response was the first exposure I had to community acupuncture, would I have been offended and written off the whole idea, or would I have stuck around to learn more?  And honestly, I don’t find it that hard-edged.  I even went back and skimmed through the last 3 months of CAN blogs, and I believe that the vast majority of information available to non-CAN members is helpful and uplifting.  Anyone coming to the site with an open mind will see that.That being said, I know that there are updates in the works for the CAN site, and I think it would be *fabulous* to change the site a bit so that prospective CAN members could access a bit of a community acupuncture primer (say, Lisa’s AT articles and the latest You Tube video) without getting distracted by whatever current events we are talking about on the blogs.  I know this information is in the links section but it could be better highlighted.  And if, after reading/watching this information they are offended… screw ’em! 😉