Somebody Had to Ask, Part 2

A POCA member made the very legitimate point that we could probably do a better job of addressing this issue than resorting to unadulterated snark. I was thinking about it and it seems to me that there are some larger issues that we have to consider, especially related to our organizational history. So here are some points I’d like to add to the discussion.

POCA on DN

We have to acknowledge that the exact same arguments currently leveled against Dry Needling were aimed at community acupuncture when it was new. In fact, some of us who were around during the bad old days have to admit that we were relieved when the acupuncture profession found a new target that wasn’t us. So POCA’s perspective on DN is inevitably informed by that experience. If you were lucky enough to miss that, here’s a blast from the past (CAN is the Community Acupuncture Network, POCA’s predecessor):

“C.A.N. IS NOT GOOD…
IT is a very dangerous revolution that will undermine and change all the
standards and medical social teaching that I have followed that were handed down from my teachers….
Out of respect for my teachers and the Chinese Medical Community
that I have been fortunate to grow up in…
I must publicly oppose C.A.N.'s attempts to lower educational and practice standards…
C.A.N. propaganda will undermine our branding and Marketability…  
I feel C.A.N. revolution will put the public,our practices,the profession,
and our ability for us to provide for our families at risk…  
Are you paying attention yet????”
–former AAOM “Acupuncturist of the Year”

1) Public safety — we were told that our practices could not possibly be safe because we were treating so many people in such short periods of time; also that we would fail to diagnose the many cases of low back pain that were actually cancer, because we didn’t do long intakes and orthopedic tests. More about all that in this post from 2013: https://pocacoop.com/prick-prod-provoke/post/all-the-things-that-didnt-happen-and-some-of-the-things-that-did

2) Debasing the traditions/devaluing the medicine — before Richard Tan’s balance method was introduced and adopted by many acupuncturists, community acupuncturists practicing meridian therapy were accused of debasing the tradition of acupuncture because we didn’t use TCM. (TCM, by the way, was designed for herbs, not acupuncture.) I remember a ludicrous argument with someone from the AAAOM about how much damage we were undoubtedly doing to our patients because we weren’t using Sp 6 correctly.

3) Impact on insurance — just like the PTs are ruining insurance reimbursement for L.Acs by billing for DN, community acupuncture was going to ruin reimbursement for conventional acupuncturists because our prices would be factored into the going rate. We still get accused of this periodically.

“Get in line and join the Revolution…
Give up your clinic in the medical arts building with all other health care providers…
Who needs referrals from mainstream medicine…?
CAN standards are so low…No one will refer any way….

Every homeless welfare public assisted drug addicted person can get treatment and be a part of this communist social network… For less then the price of a manicure….

No one needs to be without Acupuncture…
It is so low level low tech low cost that it will revolutionize the entire industry.
National reimbursement rates will fall…
This will drive everyone away from third party reimbursement because the rates are not enough for most to survive on…”

4) Unethical — we were told repeatedly that sliding scales were unethical and even fraudulent. We were told that our failure to consider the impact of our prices on the rest of the profession was unethical (and selfish). We still get accused of being unethical for calling ourselves “punks”.

5) Confusing the public about what “real acupuncture” is. “Be part of the movement that will lower Acupuncture and Chinese Medicine respectability in the minds of the media,health care community,patients ,practitioners and future generations in America forever….”

6) Inadequate training — this argument was revived in 2014 when we opened POCA Tech, even though POCA Tech’s program adheres to ACAOM standards. Robert Hayden addressed this at length here: https://www.facebook.com/notes/robert-hakim-hayden/misconceptions-regarding-poca-tech/10152286376417870

Speaking of that acupuncture school of ours:
we teach POCA Tech students to needle on the first day of school. Some of the arguments against DN are that people can’t possibly learn to needle safely without hundreds of hours of preparatory training. It’s interesting, on this anti-dry needling page there’s the claim “the national standard for supervised clinical training to perform acupuncture safely is 810 hours”. ACAOM’s program requirement for clinical training is 660 hours, and only 500 of those are supervised clinical internship, the rest are observation.

Since we’re following ACAOM standards, we have to teach the history of acupuncture and Chinese medicine. If you actually do the reading, a lot of the arguments about what “real acupuncture” is start to fall apart.

“According to Paul Unschuld’s Medicine in China: a History of Ideas, “the origin of acupuncture in China is not clear.”([1] p.94) It is described for the first time in a document dated to 90 BC. Equally unclear is where the knowledge of acupuncture points originated. How those points were chosen and used undoubtedly changed over time; at some point “a system of cosmological correspondences” was apparently suddenly imposed over practices based on empirical use.([1] p.96). This system of correspondences was developed by unknown authors in the course of the last three centuries BC, and its theoretical principles closely tracked those of the socio-political order promoted by Confucian political ideology.([1] p.67)… The transfer of Confucian political ideology to an understanding of how healing functions and how acupuncture works must be seen within the context of a particular society at a particular time, rather than universally helpful in all situations, particularly those involving illness and inequality.” https://liberationacupuncture.org/node/32

The way people define and use acupuncture is constantly changing. There is no one right way — there never has been and there never will be. Insisting that there is makes us seem ignorant of our own history.  Aren’t we supposed to be the experts on this?

At POCA Tech, we’re trying to develop higher standards of safety, both physical and emotional, based on trauma-informed care. According to our standards, a lot of what happens in conventional acupuncture schools would be considered unsafe. There’s clearly a spectrum of safety and dry needling is on one end of it (along with other aggressive forms of deep needling — wait, wasn’t it Peter Deadman who said not so long ago that one of the things that was wrong with acupuncture in the West was that we shied away from causing “therapeutic trauma”?) while on the other end there’s shoni-shin and non-insertion techniques. The kind of acupuncture practiced in many POCA clinics  (gentle, shallow, very fine needles, trauma-informed) is less physically invasive than ear piercing. Does that mean we should be going after other practitioners? (Note: this might include each other. I have at least one POCA colleague who uses aggressive trigger point needling, because some of his patients like it. I’m not going to volunteer to have him do it on me, but does it then follow that he shouldn’t do it at all?)

As the quotes above indicate, POCA gathered itself together and started doing useful things in the context of a very hostile professional atmosphere. Ignoring what other people were saying about us was a necessary prerequisite for getting ANYTHING done, including establishing the co-op itself. We had to trust that the general public would get the most valuable information about acupuncture by being able to try it for themselves, and that our actions would speak louder than our words. IMHO we’ve been proven right,  and so it seems a little disingenuous to turn around now and start making public statements about DN.

I mean, I don’t know of any DN PTs who came charging into any community acupuncture clinics on their first day in business to yell at the stunned new owners, “you’re going to ruin it for everybody”. DN PTs didn’t leave nasty comments on articles written about new community acupuncture clinics.  No DN PT ever called all the POCA clinics in a region and demanded that we all start doing income verification with our patients, because otherwise he couldn’t make a living. No DN PT ever demanded to take over POCA’s leadership in order to teach us the error of our ways.  And no DN PT has ever sent me hate mail.

It was our fellow L.Acs who did all that. Somehow we managed to ignore it. OK, sometimes we mocked the hell out of it. And I will admit I’m a little cranky that NOW we’re expected to somehow defend the rest of the acupuncture profession in this particular way.

The acupuncture profession has a lot of problems besides DN. One is trying to define itself in a way that doesn’t fit the actual history of acupuncture. Yet another is ignoring the sky-high failure rate of new L.Acs. And maybe the most serious is the absurd cost of entry into the profession, relative to what L.Acs can earn. You can’t blame DN for these. POCA is genuinely trying to do something about all of them. Isn’t that more important than making statements about DN?

Author: Lisa Rohleder, L.Ac.