The Practice of Cooperation: Presentation by Dr. Andrew Zitcer

The Practice of Cooperation:
How Co-ops Can Transform Social and Economic Relations

Andrew Zitcer
Drexel University
POCA Tech 11-4-2016

Good afternoon. Thank you so much for having me here today.

I want to thank Lisa for inviting me, and I especially want to thank James Shelton for helping to organize this, and for doing the marketing.

It is a great pleasure to talk with you today about the practice of cooperation. I will be focusing on the research I have done with POCA over the last several years, but I also want to situate it as part of a bigger project I am doing on the importance of social and economic cooperation to our society. Today is the first day I am speaking to a group publicly about this idea, which is going to form the basis for a book (hopefully!). So I am deeply appreciative of your time and your feedback here today.

The plan is for me to talk for about half an hour or so, and then I am hoping we will have another half hour or so for discussion. Hopefully, what I am saying will stimulate some thoughts and questions. But don’t worry – I have brought some questions of my own to ask you as well. First, can we briefly go around the room and introduce ourselves?

Let me introduce myself, and this project. I am a professor at Drexel University, in Philadelphia. I am trained as an urban planner, with an interest in community revitalization. Before becoming an academic, I was active in arts and community development in West Philadelphia, and I currently teach courses on cultural policy and the relationship between art making and community development, a set of activities now known as creative placemaking.

My project and its context

Over the last five years or so, I have been deeply interested in cooperatives and collectives. I wrote a doctoral dissertation contrasting two grocery food co-ops in Philadelphia, specifically focusing on the politics of inclusion and exclusion in today’s co-ops, as well as the potential for consumer activism to really change economic relations in our society. All in all, I interviewed about 60 people from the food co-op world and have been publishing pieces from that dissertation, here and there.

At the same time, I was spending a lot of time volunteering on the board of a collectively managed experimental dance company. At the time, this company was celebrating 20 years of existence, and was doing well financially and artistically, which is really saying something in the world of experimental dance. I spent about a year interviewing everybody involved with that company, and attending numerous events. The focus of that research is on the role of embodiment and emotions in collaborative work, something that is also very close to all of your work!

Finally, I became deeply interested in POCA. From in 2013 and 2014, I conducted 32 in-depth interviews with acupuncture practitioners, clinic employees and volunteers. These interviewees represented 14 clinics in 11 cities. Twenty-five of the interviewees were members of POCA. Five worked at or owned acupuncture clinics that were not members of POCA. I conducted in-person visits to clinics in Philadelphia, Portland OR and Providence RI in order to make field observations. As part of those observations, I received acupuncture treatments in five clinics. I also joined POCA as a patient member in 2014 (and remain a member) in order to read the forums and keep up with the news from the movement. (Just an FYI since I will only be using quotes from POCA interviews in today’s talk: all names have been changed to pseudonyms. You might recognize yourself under a different name!)

I conducted this whole flurry of research over the last few years with a great sense of urgency, a great belief that something important stood behind these disparate cooperative practices—but I had no clue what it was! Indeed, what do food co-ops, experimental dance, and POCA have in common, anyway (except maybe falling under the category of “stuff white people like”)? Yes, they are all some kind of co-op, but there is a lot of variation in their practices. There are also lots of other kinds of co-ops out there. How does all of this fit together?

For a long time, I struggled to see the way these amazing, inspiring, and frustrating organizations have something to say to one another. However, a light bulb went off about a year ago, and has been burning brighter and brighter ever since. I realized that all of these projects are pursuing the “good” in some way. I am not saying that these co-ops are “good” in the sense of being morally perfect, beyond reproach – far from it. I mean that they are attempting to do something to ameliorate problems they have identified in our society, and they are taking a cooperative problem solving approach to address them.

So if they are pursuing some notion of the “good,” what, then, are all of these projects “good” for? I mean this in two ways. Why do they bother trying to do “good” in the world, when the incentive for most economic projects is to create wealth and perpetuate the status quo? And I meant, what are they good at? What kinds of things are possible with these kinds of arrangements, and which things are not? What are the potentials and limitations of these kinds of cooperative projects?

For starters, the work of co-ops like POCA is a response to a set of problems in our society and our economy. Cooperatives in general rose in response to labor exploitation and wealth inequality during the Industrial Revolution (which I can talk about more, if you are interested). Even though that was a long time ago, the kinds of problems faced in Europe and eventually reverberating around the world have certainly not gone away. In fact, we are standing at the precipice of a momentous and fraught moment of decision in American society – a decision that is embedded of a multitude of crises that date back to this time.

A quick rundown of our ailments: economic insecurity and conditions of massive inequality stoke the flames of racism, xenophobia, misogyny and other forms of intolerance. Systemic oppression and mass incarceration roil the land, making any kind of security or progress impossible in the lives of vast numbers of Americans. These issues have led to, and are exacerbated by a crisis of political and civil discourse. I don’t have to remind anyone here of the toxic, hateful nature of the current political contest – it rings fresh in your ears, I am sure. In response, there is apathy, helplessness, hostility, or maybe robotic, reflexive gestures of online activism, if you’re like me.

Closer to POCA’s core concern is health and health care. This, too, is a fraught and bitterly contested issue in American public life and in the current election. The signing into law of the Affordable Care Act in 2010 is seen by some as one of President Obama’s signature policy achievements, a key component of his legacy. Since taking effect, the Affordable Care Act has provided coverage to millions of previously uninsured Americans (Sanger-Katz, 2014). Yet resistance to reform is a central ideological issue in Washington and the states; as of this writing, Congressional Republicans have voted more than 60 times (fruitlessly) to repeal “Obamacare” (Walsh, 2016).

Even as political leaders debate ad nauseum, Americans in vast numbers are dogged by chronic health problems, rising drug addiction, and premature death from a variety of causes (Rubenstein, 2013). A spike in the mortality rate of one traditionally healthy group, middle-aged White Americans, has been linked to an increase in economic and social exclusion, leading these to be dubbed “despair deaths” (Khazan, 2016).  Public health issues like these cannot be divorced from the dynamics of contemporary capitalism. Indeed, The New York Times recently reported on a 2015 study from the University of Wisconsin that uncovered a link between income inequality and poor health. Income inequality was found to be even more detrimental to health than low incomes alone – and low incomes are not supportive of robust health in the first place (Sanger-Katz, 2015).

As I said before, none of these challenges are especially new. Writing almost 40 years ago, philosopher Alasdair MacIntyre recognized the same sorts of political, economic and social dysfunction. At the time, he traced the root of much of our turmoil to our society’s inability to communicate. He said contemporary discourse was marred by intense disagreements. He found these disagreements “interminable,” meaning both that they go on and on, and that they can find no resolution. Our failure to communicate can be traced to the incommensurable nature of our discussions. We are not even in the same book, much less on the same page. Yet we all insist that we are being perfectly rational, while it’s the “other side” that has the problem. We use force and rancor to convey our ideas, ideas that we believe to be totally natural and self-evidently justified.

This trouble seeing eye to eye, according to MacIntyre, is symptomatic of a long-term decline in our society that began as far back as the 18th century Enlightenment, a time when modern liberal individualism was born. European and American society became wedded to individual achievement, to looking out for ourselves and our own, and not to any sort of communal project steeped in a moral tradition.

But this is fixable – and I believe that organizations like POCA are part of the solution. So what do we need to do to fix these issues? I am jumping onboard with MacIntyre’s recommendation and saying that we need some sort of social and economic reinvestment in sustained, complex communal projects, or what MacIntyre calls “practices.” The goal of practices is to cultivate virtue, a word that may be off-putting to some. But this vision of virtue is not the same as what many of us have been taught – to behave in ways that go against the grain of our being and our desires, because of something that traditional morality dictates us to do. No, MacIntyre emphasizes the importance of engaging in a communal search for the good life, for what is virtuous, by working “to achieve a common project, to bring about some good recognized as [the] shared good by all those engaging in the project” (MacIntyre, 2007: 151).

For this transformation to occur, for virtue to be reinstated, three things need to happen: the building up of practices, the embedding of these practices in socially enacted narratives, and the connecting of all of this to relevant traditions. So for the rest of the time I have today, I want to talk about how POCA embodies this framework of practices, narratives and traditions.


To begin, what is a practice and why does it matter? For MacIntyre, it is a “coherent and complex form of socially established cooperative human activity.” These activities provide some internal and some external benefits. The internal benefits are the ones that you derive simply from doing the thing itself, for its own sake. You learn chess to become good at chess, to train your mind, not to become rich and famous. The external benefits sometimes come—maybe you are really good at chess and win competitions all over the world, who knows?  But the pursuit of virtue is all about achieving excellence for its own sake in these cooperative practices. These kinds of projects, undertaken in community, are the foundation of the good life.

To me, cooperative projects like the ones I have been studying (especially POCA) are the ultimate form of practice. These cooperatives form a critical “third way,” one that is neither truly capitalist or socialist (Gibson-Graham, 2003: 130). Cooperatives spur new narratives that propel us out of the conundrum of modern liberal individualism, out of our capitalocentric worldview; they guide us into emancipatory territory. Cooperatives have proven resilient in times of economic crisis (Birchall and Ketilson, 2009). Though cooperatives are not necessarily anti-capitalist, scholars have recognized that co-ops are able to contribute to critiques of capitalism by offering real world examples of sustainable organizations.

So how is POCA an example of a practice in the sense we have been talking about? Well, certainly acupuncture can be considered a practice. It is a complex, sustained endeavor that can only be performed by people who have apprenticed themselves to people who are really good at it. Though POCA doesn’t like to depict punks as masters who should be revered like gurus, there is nevertheless a high level of competency required. And the more you practice acupuncture, the better you get at it.

And acupuncture is inherently and unforgivingly social. Patients and practitioners are in an intimate, sometimes ongoing, relationship, body to body. This is a relationship of deep empathy. What distinguishes POCA from the rest of the American acupuncture profession is that mastery of the practice does not just include technical proficiency and empathic care. It also requires an ongoing struggle with social and economic justice, community participation, and radical inclusion. Even though these goals are not always or consistently achieved, the fact that POCA practitioners are in pursuit of them demonstrates an interest this search for the good, the telos that Aristotle thought was the purpose to which all life leads. There are three main ways in which POCA clinics and practitioners engage in this struggle: treatment in groups; low cost, high volume clinics; and the cooperative, sociocratic governance model. Each of these stands in stark contrast to the prevailing model of acupuncture, but not only acupuncture; each stands against the contemporary model of social and economic relations more broadly.

The radicalism of POCA’s project begins with treatment in groups. What could be more path breaking than the idea of communal rest, communal healing? To snore, to drool, to fart, together – to me, nothing expresses this incredible vulnerability like the cheeky POCA bumper sticker, “I nap with my neighbors.”

The radicalism of POCA continues with the position of the practitioner relative to the patient. The low cost, high volume model provides steady jobs for punks, but not particularly high wages. Punks see themselves as part of a working class project, a movement even, and the relatively low wages of POCA punks are not an unfortunate side effect of a failing acupuncture economy, but a necessary feature of being part of a community of healing. A punk from Providence who I call Carol asserted that relatively low wages are her choice, in order to do what she loves: “I need to make a moderate enough income to get by, meet my needs. Median income is enough for me. If I wanted to be wealthy, I would have chosen a different career. No different than those who choose social work over finance, or teaching over petroleum engineering. To make too much more than I do feels like it would be profiting off the suffering of others, so there's the ethical part.” She aligns herself with teachers and social workers in her desire to serve. I was struck that she did not compare her work to that of doctors, a service profession that commands high compensation, and with which many acupuncturists seek common cause (Barnes, 2003).

She went on to explain that low wages foster the growth of community acupuncture, since voluntarily capping salaries creates more jobs in the movement:
“I think one part of community acupuncture that folks have a hard time wrapping their heads around is that people would actually choose the salaries we have, even cap them for ourselves, in order to create jobs for other punks and front desk staff–create more stability with more of us involved. It's a different kind of selfish motivation, I suppose, that I feel gets rewarded in the stability of social capital and stronger network rather than strictly money.” Notably, she uses this term “acupunks” or “punks,” driving home the point that POCA practitioners do not see themselves as part of a medical establishment or an acupuncture elite. Instead, they view themselves as part of a social ecology that includes working class patients as well as punks.

Finally, the sociocratic model of shared governance, and sharing nearly everything, also sets POCA apart in its practices. Many interviewees spoke about the commitment to working together as a community of practitioners, instead of competing against one another. Tamara, who runs a practice by herself in the rural Midwest, described how POCA helps her overcome isolation: “No matter whether you’re successful or not as an acupuncturist, it sucks to be isolated. Most acupuncturists work by themselves. It’s incredible having colleagues and friends that are supportive, that are trying to build something beautiful together, and it’s inspirational…having that sense of being a co-op and doing cooperative work…it helps with the isolation of capitalism.” Carol emphasized the interconnection of all the POCA clinics: “I don’t have a financial interest in Carly’s clinic in Philly, but I have a tremendous passion for her to be successful there because I know that it’s going to be amazing for the community, and the community really needs it—and it’s also selfishly creating a place for my patients when they move to Philly or have family [who live there].” One of the defining features of each POCA clinic is the presence of a large United States wall map, with hundreds of pins in it, each one representing a clinic. The map is surrounded by business cards from other POCA clinics for patients to take in case of travel, relocation, or to send to family and friends in distant cities who need acupuncture.

One of the organizers of POCA Tech spoke to me in 2013 about the perfect student for this school, saying she was looking for: “Someone who can develop a plumber-like mentality about acupuncture rather than the acupuncturist as high, effete, fancy…more like a trade than a profession.” This emphasis on a tradesperson’s mentality is designed to ensure a kind of humility on the part of punks that I know is very much rooted in Lisa’s values, which have broadly influence POCA’s values. But one of the core principles of MacIntyre’s practices is that the practitioners are meant to achieve “excellence,” which is something that I struggle with, because it seems to set up a hierarchy of practice where others may be considered not excellent. But MacIntyre intends something different: he is talking about excelling relative to a continuum of practice and tradition that is in constant need of reinvention.

Therefore, I submit that POCA at its best embodies excellence, and punks should strive for the kind of excellence that means reinventing acupuncture to be truly patient-centric and focused on developing a community of well-being as opposed to those traditions which emphasize creating a cult of personality, and a culture of dependence, intended to attract only the wealthiest patients. But in order to do this, POCA needs to embed its practices within a set of narratives that redefine not only acupuncture but cooperative practice.


MacIntyre affirms that human actions occur in narrative settings, that humans are essentially story-telling animals. MacIntyre’s key insight about narrative is this: “I can only answer the question ‘What am I to do?’ if I can answer the prior question ‘Of what story or stories do I find myself a part?’ (216). In the case of POCA, there are plenty of narratives about what health should be, who has squandered it and who is entitled to it. There are narratives about what you have to do, or give up, to earn a healthy life, and what you can achieve if you are in the business of delivering health to people who are suffering. POCA is attempting to rewrite a bunch of narratives, yet must remain at the helm of its narrative destiny in order to ensure the success of the project.

I noticed the way certain people were written into, or out of, the acupuncture narrative when reading Fractal.  As she was starting out, Lisa struggled with the gulf she perceived in the acupuncture world between boutique practices for the upper and middle class and public health acupuncture for poor addicts. As she put it, “People who had functional lives and modest resources did not exist as potential patients. They were completely invisible… If acupuncture clinics were restaurants, there would be only soup kitchens and four star bistros, with nothing in between” (2013: 32). That’s a narrative problem, in part. Some people are being written entirely out of the story! A big part of POCA’s contribution has been to start telling a story about acupuncture that includes working class and poor people.

Another narrative about acupuncture that POCA seeks to dismantle is the myth of the wealthy private acupuncturist, having enough wealthy patients to sustain a lucrative practice. To be sure, there are people who live out this story. But it was not the story in which a lot of punks I spoke to felt they were participating in. Emma, an acupuncturist from a small clinic in the Bay Area described her frustration with trying to treat people with disposable income, when she herself had little money: “It was just frustrating. It was just incongruent being really poor and always struggling and not having access, and then coming out of that to set up a practice where no one like me would have access to it.” When she discovered Lisa and Skip’s work, she set up a practice that could treat people like her.

One narrative that really irks some POCA punks is the expectation that they should treat people who mirror their own demographic image. Carly, a Philadelphia clinic owner, explained how acupuncture school encouraged her to build a clientele that matched her demographic profile: “You’re taught in acupuncture school that you are going to attract people that are like you and that the people who are going to see you the most often are the people that resonate with you like a friend, that have things in common with you. I was told that I should court people who are Jewish, who look the same, like the same things I do, read the same books, play the same sports…So you do have to kind of shake that off so you can come outside of it and treat more people.” She had to work to overcome the idea that her patient base would be people just like her, to tell a new story about whom she should treat. In some interesting ways, this is a mirror image contrast to Lisa’s experience treating people like her from the working class.

Astrid, a patient volunteer from Portland, contrasted POCA’s approach with the approach that is taught in acupuncture school: “So you park yourself with the right attitude in the right place and wait, and when people who look different from you and who eat badly, or vote for God knows who, or carry guns or whatever, you’re delighted to see them—and you treat them exactly the way you treat the organic food-eating hippies.” This kind of active engagement of people from outside the acupuncturists’ own subcultures marks the POCA co-op as striving to be different from other businesses, including many cooperatives, which can be homogeneous and exclusive (Zitcer, 2015). This is not to say that POCA always succeeds in this aim, but this is the story about acupuncture it wants to tell.

So when it comes to embedding practices in narratives, it is clear that POCA has accomplished a lot. But it has a lot of work to do to transform the perception of acupuncture in our society. There are many fronts to that battle, including the work of convincing people that acupuncture is for them, on their own terms. And there is also a project of continuing to shape the stories that govern acupuncture in the US. Part of that work lies in the connection between narratives and traditions, the third element of the quest for virtue and the good life.


The work of securing the place of practices in the transformation of society is to emphasize that nothing is done in isolation from anything else, or anyone else. For MacIntyre, that work requires acknowledging our history and what he calls our “accumulated debts.” He says that traditions “constitute the given” of our lives, and gives us our “moral particularity.” This can be challenging in a society like America, where we want to believe we are all self-made and transcend where we came from. He gives a few examples, like the white Southerner who rejects reparations because she was not a slaveholder, or the young German who feels no responsibility for the Holocaust because it occurred before his lifetime.

However, to MacIntyre, these individuals act as selves with no history. In a way, they are playing into the myth of individualism. Instead, he urges us to own up to the connection between the story of our lives and broader stories, saying: “For the story of my life is always embedded in the story of those communities from which I derive my identity. I am born with a past; and to try to cut myself off from the past, in the individualist mode, is to deform my present relationships. The possession of an historical identity and the possession of a social identity coincide.” But it is entirely possible, perhaps desirable, to rebel against tradition with all of its moral limitations. He says, “Traditions, when vital, embody continuities of conflict.” (222)

POCA has an interesting, and sometimes contentious relationship with the traditions of which it is a part. The primary tradition that influences POCA is the provision of acupuncture. I won’t rehash the prevailing narratives that govern acupuncture in the largely white, private acupuncture establishment. What I think is notable is that POCA sees itself as the inheritor of a rival tradition: the radical tradition of acupuncture that goes back to the Black Panthers and the Young Lords. By calling upon different traditions and narratives, there are significant consequences for the contemporary practices of the community acupuncture movement. As one clinic owner in Providence told me, “We’re calling ourselves community organizers with needles.” That is a very different narrative, pointing towards a very different telos.

But there is another tradition that informs POCA: that of cooperatives.  Lisa Rohleder writes that the community acupuncture movement stumbled on traditions of cooperation as a result of trying to comprehend what was already happening in the clinics: “By 2010, we recognized that there was a name for this phenomenon. It’s called the principle of mutual aid, or the spirit of mutualism, and it is the cornerstone of the cooperative movement. Because none of us knew much about business, let alone cooperatives, it didn’t dawn on us that what we were doing was more like a cooperative than it was like anything else” (2013: 68).

Successful cooperatives are based in a tradition of cooperation and community participation. They just cannot succeed on the backs of a few people, doing all the work. Yet this is difficult to sustain in our individualist, capitalist culture. Mark in Portland maintained that it is necessary to cultivate a spirit of participation, even when people are not used to participating in political or community life. He explained: “Participation is strangely a sort of a foreign concept for most Americans. It’s always intriguing me, the idea that we call it a democratic country…but at the same time everything that we do, every dollar that we spend, we work for companies 40 hours a week that are entirely not democratically run and we make money from them and then we go grocery shopping at a shop that is not democratically run…That’s been a big challenge with us with POCA, you know—how do you sell that?” The ongoing work of maintaining robust participation in POCA governance is a testament to that struggle. Nevertheless, the ongoing work of running clinics in an interconnected web, a knowledge commons as I call it in another paper, is a testament to the cooperative tradition that emerged over the course of human history.


So now that I have described how POCA sustains a practice that is embedded in evolving narratives, informed by tradition, now what? I want to return to my original question: what is cooperation (as practiced by POCA) good for? And what is cooperation good at? The answers are fairly clear. POCA is really good at supporting clinics that share information and resources in order to support a tremendous volume of treatments all over the country. POCA is good at giving everyone a sense of belonging in this project of rewiring acupuncture in America. POCA is good at getting a school of its own off the ground, so it can train people in its particular methods. And there is more, I am sure.

What is POCA good for? It is good for people who think acupuncture, or relief from pain and suffering is not possible for them. It is good for punks who thought they couldn’t earn even a modest living doing something they love. It is good for our understanding of cooperation, because POCA is innovating the cooperative form, by testing the limits of the definition of a co-op, away from financial ownership to mutual aid and service. And there is more, I am sure.

Yet, this talk might not be very useful if I didn’t try to point out some of the limitations POCA faces. And I want to issue a huge caveat here: I know a lot less about POCA than all of you do, all of you who constitute it. So feel free to correct me where I am wrong. But there are challenges for sure. I want to highlight three: one that has to do with punks, one that has to do with patients, and one that has to do with the co-op itself.

The first challenge has to do with punks, and their livelihood and risk of burnout.  Even though the practitioners are getting paid, their wages are relatively low for their level of training and skill. One acupuncturist from Providence spoke to this point quite candidly: “A week doesn’t go by where I am not like ‘I need to do something else!’ Because I don’t have a partner or family who has got any money. It’s not really sustainable unless we keep growing.” It is admirable that POCA seeks to create new jobs for punks, and new clinics, over the income of existing punks. And it makes some sense, as there is a limit to the number of patients even the most efficient punk can treat in a day. Yet any occupation that requires professional certification and training but has low wages is susceptible to practitioners exiting and looking for something more remunerative. For some, that might look like another career. For others, it might look like trying to find a successful private boutique acupuncture clinic to join. I know that POCA Tech is an attempt to address the debt burden side of the equation, but the issue of wages remains important.

On that last point, there is a threat to POCA that comes from competing non-POCA clinics. Though the focus of this talk has been on POCA’s very idealistic definition of community acupuncture, there are clinics all around the country that have adopted part of POCA’s model (high volume treatment in groups) without the ideological baggage. These clinics, which also call themselves “community acupuncture clinics,” may charge a sliding scale fee, but it is often higher than POCA’s range. Or they may have certain “community” days on which they charge low fees and other days when they charge higher fees, or certain services for which low rates are available. I interviewed practitioners in several of these clinics; they are often quite patient-centric, and see their work as embodying many of the same politics of care found in POCA. These practitioners are simply put off by POCA’s class rhetoric and rigid requirements for co-op membership. These clinics often compete directly with POCA clinics, and their operators have indicated that they can make more money than POCA clinics (which I did not verify by looking at their finances). The internecine struggles between private, non-POCA community acupuncturists, and POCA punks is beyond the scope of today’s talk, but it was a theme of my interviews and a source of concern for practitioners on all sides. And we can talk about it if you want.

Second, I want to address the issue of the diversity of the patient population. I am not saying that POCA clinics don’t serve people of all backgrounds – my informal census of the patients at my West Philly clinic and the other clinics that I have visited seems to bear that out. And POCA certainly draws different patients from the private boutique acupuncture clinics I have visited. But it’s hard to quantify how effective POCA clinics are at outreach, and in building the racial, ethnic, gender, age and other forms of diversity of their patient base. It might be interesting to conduct more research on this, and perhaps more has been done since Maria Chao and Kim Tippens looked at it a few years ago.

Finally, POCA’s long-term sustainability as a cooperative is an open question. The movement rests almost entirely on volunteer labor, from patients and punks. There is a very lean administrative staff, supported by member dues. The board members receive no compensation or relief from their work duties. And it is not clear how robust the participation is from patients, which are the largest membership group. Because most of the content on the POCA website is geared towards running a clinic or giving acupuncture, it is not clear what the patients’ role should be. I was told that many of the members are working class patients who either are not online, or do not spend a lot of time online. While it is admirable that these patients want to join the co-op out of solidarity with POCA’s, the vast majority of the co-op’s activities take place on the Internet. It is hard to imagine a patient without a significant Internet savoir faire contributing to the governance of the cooperative. So, a lot of the work falls on a small group of people. This can be dangerous, both in terms of financial robustness and diversified leadership.

MacIntyre talks a bit about the connection between practices and institutions. He finds institutions both vital for the sustaining of practices, but also institutions can have a corrupting influence. It’s important to think this through both in the context of the relationship between community acupuncture and POCA, and the relationship between POCA and the acupuncture establishment. Going forward, POCA needs to continue to reflect on the goals of the movement, not just as a cooperative, but as a federation of very different kinds of clinics that make up the Big Damn Clinic. And how does POCA’s work in contrast with the acupuncture establishment help or hinder energy that can be doing into building up the movement. I am not raising any particular criticism here, just emphasizing that ongoing reflective practice is called for, and is probably already a feature of the way POCA does its work. I just want to highlight its importance as a key part of a truly democratic and cooperative project.

Ok, I am ready to conclude. I began this talk by referencing the concept of virtue, and the pursuit of the good, as the cardinal goal of the practice of cooperation. For MacIntyre, and I suspect for us, the pursuit of the good is intimately linked to the pursuit of justice. For justice is the ultimate virtue, and it stands in contrast to all of the crises and disorder I enumerated at the beginning of this talk. But for justice to come to pass, MacIntyre asserts that we need to seek what he calls the “virtue of acknowledged dependence.” We depend on each other, whether we like it or not. And if the practice of cooperation is to succeed, in all of its diverse manifestations, we need to stay focused and attuned to the complexities of making it thrive. I believe that by studying and being part of POCA I have learned a lot about these virtues. And I am sure I still have a lot to learn. So, with that, I want to say thank you for your time and your attention, and let’s see if we can get a dialogue going.

Works Cited

Barnes LL (2003) The acupuncture wars: The professionalizing of American acupuncture-a view from Massachusetts. Medical Anthropology 22(3): 261–301.
Birchall J and Ketilson LH (2009) Resilience of the cooperative business model in times of crisis. Geneva: International Labour Organization.
Gibson-Graham JK (2003) Enabling Ethical Economies: Cooperativism and Class. Critical Sociology 29(2): 123–161.
Khazan O (2016) Why Are So Many Middle-Aged White Americans Dying? The Atlantic. Available from: (accessed 2 February 2016).
MacIntyre AC (2007) After virtue: a study in moral theory. University of Notre Dame Press.
Rohleder L (2013) Fractal: About Community Acupuncture. 1 edition. People’s Organization of Community Acupuncture.
Rubenstein G (2013) New Health Rankings: Of 17 Nations, U.S. Is Dead Last. The Atlantic. Available from: (accessed 27 January 2016).
Sanger-Katz M (2014) Is the Affordable Care Act Working? The New York Times, 26th October. Available from: (accessed 27 January 2016).
Sanger-Katz M (2015) Income Inequality: It’s Also Bad for Your Health. The New York Times, 30th March. Available from: (accessed 27 January 2016).
Walsh D (2016) House votes to repeal Obamacare; sends bill to Obama. CNN. Available from: (accessed 27 January 2016).
Zitcer A (2015) Food Co-ops and the Paradox of Exclusivity. Antipode 47(3): 812–828.

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.


  1. Sorry comrades, but I find this point: “This trouble seeing eye to eye, according to MacIntyre, is symptomatic of a long-term decline in our society that began as far back as the 18th century Enlightenment” to be patently ludicrous.

    Our society has been in decline since the height of the Atlantic slave trade!? Really? Since no one but landed gentry could vote? Pretty sure force and rancor were the hallmarks of the day at that point.

  2. Thank you I so appreciate the perspective and analysis of POCA and cooperatives in the context of our now. Much of what was addressed here is current of reflection and action in the Circles, and at POCATech.(and trying to be in the clinics). How do we continue to cooperate, find mutual ground, and participate fully in community. brilliant!