Turf Warfare

Don’t talk to me about it.

It seems like this is a hot topic in the acu-profession these days, both locally and nationally. Here in Oregon, local L.Acs defeated an attempt by physical therapists to get dry needling into their scope of practice, by arguing that dry needling is acupuncture. Now chiropractors, undeterred, are making the same argument. And I’m hearing all sorts of buzz on the interwebs about similar phenomena in other states, with the acu-profession working on staking out its turf a position at the national level. This post is for anyone, local or national, who might be tempted to ask me what I think, to find out if I share in the collective acu-indignation at the thought of people other than acupuncturists using acupuncture needles.

Note: this blog post is NOT about CAN — or POCA — taking a position as an organization. This is about me not wanting to have the same conversation over and over and over, and thinking a blog post might solve that problem. I am not speaking on behalf of anybody or anything. I’m just saying what I think, because I was asked, and I DON’T WANT TO BE ASKED AGAIN, EVER.

Let’s start with some of the basic arguments against PTs or DCs or anyone else doing dry needling. As I understand it, they go something like this: 1) dry needling or intramuscular therapy or whatever you call it is just acupuncture by another name. 2) Acupuncture training has been refined over hundreds of years and defined here in the US by the ACAOM, the only agency that the Department of Education recognizes for acupuncture training. 3) Licensed medical providers who didn’t go through an ACAOM-accredited program pose a significant threat to the public welfare. 4) This argument isn’t about turf warfare, it’s about identifying standards of education and practice that result in effective and safe acupuncture treatments. Changing the name of a medical procedure is confusing and misleading to the public.

Let’s see how fast I can type in response to these arguments, before I throw up on my computer.

Sure, dry needling or trigger point therapy or whatever is acupuncture. Yes. Sticking a needle in a specific location in the body with hopes of a therapeutic result is acupuncture.

But if all this hubbub really is about safe and effective treatment, I would like to hear about any instances in which a medical provider other than an L.Ac.  hurt a patient by practicing dry needling. I’d like to know the date, the location, and the nature of the injury. (And I’d like to compare those statistics with statistics of L.Acs injuring patients.) From there, it should be fairly simple to identify what additional training would be needed to prevent similar occurrences in the future. Since these are other licensed medical providers we’re talking about, and not laypeople practicing without a license, corrective training should be pretty straightforward. If a PT practiced deep needling at GB 21 and caused a pneumothorax, I’d like to know that. PTs know where lungs are; do they need help understanding how to gauge depth? But we’re not talking here about things that happen in clinics, we’re talking about things that happen in legislatures and licensing boards. This is not about the real world.

The argument about how acupuncture education is established and recognized in the US kind of makes it sound like Sun Si Miao has been a continuous Board member of the NCCAOM, the ACAOM, and the CCAOM since their founding at the dawn of time. The reality is that training in acupuncture,  relative to its long history,  for the most part did not occur in schools at all until quite recently. I have been practicing as an acupuncturist for 17 years; plenty of my teachers had no diploma or formal credentials of any kind when they became acupuncturists. They picked them up later when teaching became more lucrative. I and my MAcOM diploma are just one degree of separation away from the days of six months of training in church basements, boiling needles for sterilization, and instruction that was barely translated into English — that was what acupuncture education was for plenty of American practitioners in the generation just before mine. Amazingly, the public somehow survived.

So I would also be very interested to see the evidence that public safety has increased along with standards of education, because I’m pretty sure that it hasn’t. The statistics I know of show that acupuncture was pretty safe in that generation of practitioners before me, and is pretty safe now, regardless. The biggest variable is needle sterility, which is not time-consuming to address. (“Use single use needles and dispose of them properly!” There you go.)  If no evidence of this type exists, then what is confusing and misleading to the public is saying “safety” and “standards” when what you mean is “turf”.

I am very familiar with the standards that the ACAOM sets. Of the 705 hours required for “Oriental Medical Theory, diagnosis, and treatment techniques”,  more are devoted to Chinese medical history and theory (specifically TCM) than to treatment techniques and safety. So what acupuncturists are arguing is essentially, that without training in TCM, licensed medical providers inserting acupuncture needles are a hazard to the public welfare. That sounds like we’re suggesting that if a practitioner were to misdiagnose a patient’s kidney yin xu as spleen yang xu, and God forbid, needle Spleen 6 instead of — oh, wait. Sp 6 works great for kidney yin xu, and spleen yang xu, and pretty much everything else. There are an awful lot of licensed acupuncturists, including myself, who think TCM diagnosis is worthless when it comes to acupuncture (important for herbs, but we’re not talking about PTs or DCs writing Chinese herbal prescriptions).  We treat a lot of patients, and they get better, because somehow we manage to be safe and effective despite our lack of TCM diagnoses; otherwise, we would have to find some other way to make our living. In fact, the mind-boggling variation in the theories underlying successful acupuncture treatments is a disturbingly good argument that theory doesn’t matter much when it comes to the practice of acupuncture. And the double-blind research studies say so too — sham acupuncture, and acupuncture done on the “wrong” points, is generally more effective at pain relief than no acupuncture at all.

So from the perspective of the real world of acupuncture practice, these arguments are laughable. But making them in this way isn’t funny, because it’s also just wrong. Immoral. I know I’m quaint in this regard, but I’m going to revert back to my working class Catholic upbringing and say that turf warfare is a sin. Because that’s what I really think about it. That’s the summary, soup to nuts, I don’t care if we’re talking about PTs or DCs or MDs, it’s all BS. And it’s a sin. For those of you who managed to avoid years of CCD (that’s what they called Catholic Sunday school when I was a kid, only it wasn’t on Sunday), sins are sins because they harm your relationship with God, your relationship with others, and your relationship with yourself. I’m going to leave God out of it, but the other two categories do apply here.

Turf warfare doesn’t just harm our relationship with others, it harms others, period. Like I keep saying (it’s tiresome, I know), I have done nothing else to make a living other than practice acupuncture for 17 years. I have seen over and over that acupuncture is literally the difference between life and death for certain patients. Restricting the practice of acupuncture to people who are (over)trained in TCM theory means that an uncountable number of patients will suffer who didn’t have to suffer, and some will die. A lot of the people who see L.Acs or PTs or DCs are chronic pain patients. Chronic pain is often a kind of living hell, and by some estimates, 30% of Americans are in it. I have treated patients who told me that acupuncture was the reason that they didn’t kill themselves. I didn’t do anything special, anything a PT couldn’t do with dry needling. There simply aren’t enough L.Acs in the US to offer those 30% of Americans in pain access to a thing that might make them want to keep living — acupuncture, whatever it’s called.

And turf warfare harms our relationship with ourselves as practitioners because it’s fundamentally disempowering. It places the blame for our failure as a profession on other professions competing with us and stealing our medicine. It keeps us from putting our energies into addressing the real reasons for our failure, which have to do with economics, our lack of sanity around them, and our reluctance to roll up our sleeves and tackle the real world problems of how to provide actual acupuncture to actual people. As a profession, we prefer to hang out in the ether. For individual acupuncturists trying to make a living, indulging in turf warfare is a poisonous distraction. It’s the worst thing you can do. Running your own business demands constant focus, persistence, and a determinedly positive attitude. You need to give all your attention to what you are providing, not to what you want to keep other people from providing. Every second you spend fuming about chiropractors is a second you could have spent thinking about how to offer better service to your patients. Acupuncture leaders who encourage other acupuncturists to distract themselves in this way are doing the profession a disservice.

And besides, the more people get acupuncture, the more people get acupuncture.

So, if you were wondering, there you have it. Don’t ask me again, because I have better things to do than think about turf warfare. And so do you.

lisafer
Author: lisafer

Related Articles

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. Thanks for laying it down

    Lisa,

    Thanks for laying it down so clearly. I agree wholeheartedly, and plan to spend some portion of my professional energy in the future helping support other qualified medical practitioners in their efforts to get access to using acupuncture (by any name) in their scope of practice.

    We had a similar issue come up while I was still a student in Colorado, and I put my thoughts on this out in an open letter to our school community. Within a day, my letter had been intentionally flyered over by another student who was soliciting student membership in one of the alphabet orgs. That’s the immaturity level and the unconscious and unconscionable stance of anyone perpetuating a turf war.

    – Michelle Faucher, Chico Community Acupuncture

  2. I, personally, am against

    dry needling, but only because it sounds painful, like in the way that dry ___________ sounds painful, as in, can someone hand over some lube here please?  

    I am only speaking for myself here, not for CAN or POCA or anyone else for that matter.  

    Also, if there’s turf warfare going on, I want to see it happen where it counts:  the jello-pit.  Nothing dry about that:  lube on a slip n’ slide!   Because the more people get lube, the more people get lube.  

  3. smoke on your pipe

    and put that in!

    Seriously, are we a bunch of teenagers?  The scarcity mentality underlying this turf protectionism is weird to me.  The turf is plenty fertile.  There’s no scarcity of potential patients for acupuncture; there continues to be, however, a scarcity of accesible and affordable acupuncture for folks in probably 97% of communities in the U.S.  If other people are “stealing our moves,” isn’t it because they are good moves?  Helpful moves?  Can’t we just be glad they’re treating patients that probably weren’t going to come to us anyway (because they’re too sick, or there are no acupuncturists around them, or they can’t afford the going rates for acupuncture in their area – NOT, primarily, because they’re “confused”)?  Let the PTs and whomever else have their dry needling in their sterile clinics and hospital settings, and more power to them.  We’ll be around, too, celebrating our rich, fecund (dare I say moist) traditions and styles.  The more people get acupuncture, the more people get acupuncture, indeed.

  4. Acu-indignation!

    Oh my god, I love this new word! I need to use it in a sentence right now. I have a lot of acu-indignation, but not at the idea that more people might be giving people acupuncture. My problem is that there are so many acupuncturists who went into the field of health care but obviously do not *care* about anyone’s *health.* Otherwise, they would actually want to see people get better, and as such would focus their time on finding ways to treat people, instead of obsessing about all this crazy bullshit. 

     

     

  5. Down playing acupuncture

    The following quotes are examples of how some Colorado physical therapists are down playing acupuncture to their patients and to the general public:

    The following quote is from Scott Wacker, a Colorado physical therapist, (https://www.vailphysicaltherapy.com/pdfs/IMT-needling12-09.pdf):

    “Is IMT similar to acupuncture? – There are similarities and differences between IMT and acupuncture. The main similarity is both techniques use a solid filament needle for treatment application. The primary difference is that acupuncture is an ancient philosophy, and its diagnosis and practice in Traditional Chinese or Oriental Medicine are not based on modern science. What was a great approach four thousand years ago can be improved with today’s medical knowledge. IMT relies on neurology and a Western understanding of anatomy for diagnosis and direct treatment.”

    The following quote also is from Scott Wacker, a Colorado physical therapist, from a Vail Daily newspaper article (https://www.vaildaily.com/article/20091117/BIZ/911179970/1078&ParentProfile=1062):

    “It is very important to understand that Trigger Point Dry Needling is not acupuncture. The distinction is that acupuncture is an ancient philosophy, and its diagnosis and practice in traditional Chinese or Oriental Medicine are not based on modern science. Trigger Point Dry Needling relies on a Western understanding of neurology and anatomy for diagnosis and a more direct treatment.”

    The following quote is from the Colorado Physical Therapy Specialists website (https://www.colpts.com/tdn):
    “Trigger Point Dry Needling is a treatment that uses acupuncture needles, but that is where the similarity to acupuncture stops. Acupuncture tends to be a more superficial treatment that focuses on restoring energy to the body. Trigger Point Dry Needling treats the neuromuscular system affecting muscle tightness, joint mobility, and symptoms of pain and irritation. During the treatment patients often feel a significant cramping sensation but then feel an immediate improvement of their symptoms.”

  6. all good examples

    of what happens in turf warfare.  

    Now, this is pure speculation, but imagine if they could just call it acupuncture because there weren’t any acupuncturists who were obsessing about “their turf,”  I bet they wouldn’t feel such a need to explain how what they are doing is different from and better than acupuncture.   

  7. Ditto

    I’m with Lisa on this one.  Who cares if PT folks are doing dry needling, wet needling, lubed-up trigger point penetration, or the sign of the two humped camel needling?  Are people getting relief from pain?  Then, good for them. My only beef with dry needling from other medical folk is if they charge too much for it. 

    On the list of priorities that our profession should be addressing, PT dry needling is extemely low on that list.  Next topic please.

     

    David L f’ing Ac (my earned title)

  8. Ditto for me too. Next Topic….jobs!

    To be clear…I’m not talking ‘opportunities’.  I’m talking real paying jobs. Our profession isn’t addressing this one, because they rarely exisit outside the AOM education monster. 

    Follow the money, if PTs and DCs can pull acupuncture under their scope….acupuncture schools and the acupuncture alphabet organizations’ pocketbooks will take a direct hit. Right now AOM students are the vehicle that funnels taxpayer money in the form of guaranteed FFEL programs (ie: student loans) into the operating budgets of most AOM schools today. Think on that one……blog post coming soon.

  9. This is the reason I won’t support our Oregon state association

    I got some serious stinkeye from an LAc in Portland during the last Tan class for making a bunch of these same arguments to her when she brought up some “you won’t believe what they’re doing!”  Seems like PTs and whatnot are maybe even better trained than us to use needles on trigger points, and acu needles are a much better alternative to using saline injections or even dry hollow needles.  I say let them go for it.

    Also dig on Mark Seem promoting this approach to acupuncture in his books (New American Acupuncture for one).  Is that irony?  I don’t know, but I think it’s funny that the same cat who wants us to have even more training has to contend with people taking up his ideas without even an LAc to their name.

  10. Agreed.

    Some like it in a group, in a chair, alone, on a table, wet, dry, frequently, seasonally, cheaply, boutiquely.  Some want vigorous thrusting and twirling, while others prefer shallow insertion.  I’ve heard that many even (*gasp!*) fall asleep in the middle of it!  Let the people get their pokes however they choose…there’s no need for any of us to get into the private affairs of consenting adults. 

    Free Love, Baby.

    This statement is not endorsed by the Boards on which I serve.

  11. OCD

    that’s the only explanation.  It doesn’t matter what else is going on, what other opportunities or issues present themselves, somehow “the profession” can’t stop obsessing about this shit.  Or, to mix metaphors, like a dog with a little sore who then worries at it and licks it and chews it until it is a huge effing sore.  They need one of those big cone collars — limit the damage they can do.

  12. What if Colorado PT Scott Walker

    simply said:  “A big difference between dry needling and acupuncture is that those practicing the former have actual jobs.”

    That’s clear and it more accurately shows that the acupuncture profession is actually who is downplaying acupuncture (and instead focusing its energy on politics and acu-indignation.) 

  13. yep, i agree too

     

    i wish more folks knew first hand what acupuncture can do for them and getting
    those acupuncture needles into more hands  and more patients is the way to do it. if the
    schools will not wake up and create an accesible acupuncture training that
    allows more people to practice in the real world, then let other medical  professionals help pick up the slack.

    i especially resonate with the idea that thinking and obsessing about this stuff is poisonous for the mind and a waste of time.

    many PTs in European countries are trained to do acupuncture as matter of course, i do not know what the big deal is and i am too damn busy to care.

    ~tatyana

    Sarana Community Acupuncture

    Albany, CA

     

     

  14. Lisa, Lisa, Lisa

    *Hurrumph!*

    I commend your focus and concern for reducing the suffering of other people through acupuncture. It’s admirable and rather quaint. But surely you understand that *reasonable acupuncturists* are also concerned with maintaining market share and exercising a keenly developed propensity for social closure.

    *cough!cough!*

    It goes without saying that easing ‘Sally’s’ debilitating osteo-arthritis is satisfying. But keeping those snotty PT’s and godforsaken DC’s from doing the same?! Now *that’s* better than chocolate.

    *Hurrumph!*

  15. I’m all for PTs practicing

    I’m all for PTs practicing acupuncture, but those PTs are acting like A holes with those comments.  It’s just rude.  I don’t want patients thinking they HAVE to see a PT, and pay what are probably high rates to get the same treatment I do for much less.  While I know it has no effect on patient care, I do happen to care about science, and don’t appreciate the BS they are spreading.  

  16. imagine the day when

    imagine the day when acupuncture needles are sold in walgreens with simple instructions and point locations for self-treatment for headaches, backaches, etc.

  17. I just don’t see

    how that’s any worse than what many acupuncturists are saying about what the PTs do – it’s just the nature of war, people are going to talk shit about each other.  The price thing, yes, like David said, that’s the beef.  

  18. Right; haters gonna hate

    Those comments may be rude or misleading or downright false, but doing things like passing legislation to try to control language should not be the (main? only?) counter-offensive here.  A more efficacious way to get people to know about acupuncture isn’t by arguing about it with other health care providers (or other acupuncturists, LOL), or paying lawyers to lobby legislators, but by facilitating them actually experiencing acupuncture as an everyday option for healthcare.  By which I mean: being able to afford a whole course or courses of treatment; knowing other people who make acupuncture a normal part of their healthcare; knowing several nearby places where they could actually get acupuncture; knowing their neighborhood acupuncturist.  And a huge part of making that scenario possible is making acupuncture education possible, rather than increasingly impossible (another mind-boggling tactic). 

  19. Years ago

    a chronic pain patient stopped coming to me and started seeing an MD for “medical acupuncture.” A couple months later, she came back in for treatment and said: “That guy was terrible! All he did was ask where the pain was and stick a bunch of needles where it hurt. It didn’t work at all and my pain just got worse and worse. If I hadn’t had acupuncture with you I wouldn’t have known that really wasn’t acupuncture.” We had her back free of pain in a few treatments. Since then I’ve had several patients do the same thing–and always come back to me for treatment. That isn’t to say that MD’s couldn’t be good acupuncturists. But mostly they’re not, perhaps because they insist on this medical acupuncture nonsense. I think it does damage to the acupuncture “brand” personally. But I’m hopeful the marketplace will sort it out in the end. Recently I had the experience of going to a PT and being treated with the Graston Technique (TM) which was highly touted with trademark and all on the company’s internet site. It turned out it was gua sha!! And gua sha done very poorly, to boot. The PT didn’t know to let the marks go away first and kept whaling away on it every visti until I was deeply bruised and having worse symptoms than when I first came in. Perhaps this guy was just an idiot, who knows. But it does kind of piss me off when people co-op these techniques then trademark them with their own name!

  20. helping patients

    I refer patients to a great PT here who does dry needling, especially for severe and chronic back pain. He has saved two of them so far from getting surgery and from a life time of intense and debilitating pain. Dry needling as he does it is not acupuncture as I do it, or want to do it. It is deep, very precise, and often painful. But, also very effective done by someone who is experienced as this man is. I am thankful he is so good at it, that he helps these patients, and that when they come to me for other ailments, I can see the light in their eyes again now they are not suffering so intensely.

  21. Reply re Turf Warfare

    Ok here goes…… I am a PT who treats and teaches Triggerpoint dry needling. Please dont come to my house with signs, pitchforks and torches!

    First of all Thank you Lisa for your eloquent, thoughtful and humorous posting.

    I work in Boulder County , CO and primarily in Boulder, CO. I am surrounded by great acupuncturists, physical therapists, DO’s, and MDs. All these professions needle, some with an acupuncture needle some with a hypodermic needle. The TDN treatments I have received, learned and taught are originally based on Janet Travell MD and David Simons MD research and treatments. How many acupuncturists rely on her charts? If you are not using them, take a look at them. The charts are an embodiment of a lifetime of work, by a couple of doctors who were pretty darn intelligent.

    According to wikipedia, Janet Travell MD coined the term triggerpoint in 1942. Janet Travell MD was President John Kennedy’s personal physician and the White house physician from 1960-1965. Given the time frame I imagine she was way smarter than “most of the boys”.

    As a patient who has received acupuncture and derived great benefit, I consistently recommend acupuncture to patients. I work closely with two practitioners in Boulder who I highly respect. It is a collaborative effort.

    When a “turf war” is created it polarizes the situation. There is a great opportunity here for both professions to enhance one another’s professions and keep the patients safe. It is more than holding hands and singing Kumbaya! I dont profess to know much about meridians, chi, or chinese pharmacology, I would like to learn from an experienced pracitioner. Not to “steal” your ideas, but have a better understanding of your profession, and maybe you of ours. When I received herbs from an “old school acunpuncturist”, I cooked and took them. They smelled horrible, looked like something Shrek would eat, but they worked, have no idea why.

    I truly feel that PTs are not out to steal patients, encroach on the acupuncture practice, or practice in an unsafe manner. If I may be so bold to propose an online symposium, so we can have an exchange of ideas, maybe this will help us stop the “turf war”

    After all maybe it is about putting down the “shields and the swords”. Presently there are too many turf wars in the world already.

    Mike Kohm PT

  22. Thanks, Mike!

    You’re proposing something awfully radical, though. Learning from each other? PTs and acupuncturists and MDs and God forbid, chiropractors, sharing information with each other, and admitting the possibility that none of us actually knows EVERYTHING? My God, man! Have you taken leave of your senses? 🙂

    But if the meeting happens, sign me up. And could that possibly be something to consider for a future CANference?

  23. 🙂

    Every sector of the medical world has the good and the bad (or a mix of the two) as the previous posts illustrate.  We all have our share of horror stories we’ve heard, like a patient of mine who said her previous acupuncturist said she had to be naked for treatment (draped, of course).  Can you see my eyes rolling?  I’m trying my best to focus on the good I can bring to the world through acupuncture and helping my patients feel better, whether that’s getting needled by me or referring them to a different type of practitioner.  Beyond that I’m just letting it be, not only because it’s my inclination to do so, but also because I want to spend my energy on more productive pursuits.

     

    Edit:  I want to add that the idea of working and learning collaboratively with other practitioners (i.e. LAcs, PTs, MDs, DCs) for the benefit of the PATIENT is something useful to put my energy toward.

  24. The PT and the DCs who

    The PT and the DCs who follow Graston have NOT the faintest idea. You are 1000% correct. They co-opt traditional techniques from various cultures and in this case from China (Gua Sha) and porrly administer. This is a similar analogy to the PTs and DCs doing acupuncture and calling it “dry needling”. Although with some it is about turf war…but for those who really care about the patients it should be about “first doing no harm”.

    My technique….(yes I said MY technique)…which I redesigned and combined using a modified form of both Gua Sha and Ba Guan (cupping) into BA GUA FA which name was coined in 1997 by Dr. Wu, Boping OMD MD PhD (China). After 17 years of FOCUSED daily use in over 20,000 patient treatment visits…..I was invited to present my work at the First International Fascia RESEARCH Symposium hosted at Harvard Medical/University in Boston in December 2007. While I was there I met Arya Nielson, a well known author and practitioner of Gua Sha and needling. She was worried about Graston suing her. I really laughed hard. I told her I wasn’t worried. Graston may have trademarked HIS technique and TOOLS (made of metal) but he could NOT prevent thousands of years of use of Gua Sha and its tools. I am not worried about other wannabee-copy-cat losers who think they can steal techniques. There is no question that there is a HUGE difference between the hands of someone who has applied such a combination technique over 20,000 times and someone who is first trying it out or even tries using it once in awhile.

    Although I did copyright the name to protect me from being prohibited from using it…… I never bothered to Trade Mark it.

    There are many sides to the “dry needling” issue but for sure UNEDUCATED non physician practitioners have no business using acupuncture needles and that has nothing to do with turf war.

    The actual FDA classification of an acupuncture needle IN FACT states that it is to be used BY A PHYSICIAN or those which the states determine to have PRESCRIPTIVE RIGHTS to the acupuncture needle but more importantly it clearly states that the acupuncture needle is to be used in and for an ACUPUNCTURE TREATMENT.

  25. I haven’t heard the comments

    I haven’t heard the comments acupuncturists have made about PTs, but if I had I would feel the same way about it. Those comments make it sound like a person would have to see a PT for “dry needling” to get a good treatment since acupuncturists are basically practicing voodoo from thousand of years ago, and ignore all modern medicine, and current scientific studies.  A lot of potential patients might believe that crap and miss out on affordable acupuncture.  

  26. Hi Linda,
    Two patients, who

    Hi Linda,

    Two patients, who were each referred to a physical therapist, told me that their respective physical therapist told them that trigger point dry needling was very safe, and that acupuncture was dangerous because it could cause a pneumothorax. After being told this, I was curious to find out what else physical therapist were saying about acupuncture. So, I read through several physical therapist’s websites that were advertising trigger point dry needling.

    Here’s an excerpt from Edo Zylstra’s website (https://www.kinetacore.com/physical-therapy/TDN-Overview/page34.html) (He offers physical therapy lectures and courses on trigger point dry needling to Colorado and out-of-state physical therapists.):

    “To the patient
    TDN [trigger point dry needling] is a treatment that uses acupuncture needles, but that is where the similarity to acupuncture stops. Acupuncture tends to be a more superficial treatment that focuses on restoring energy or “Qi” to the body. It is thought there are blockages that can be restored by properly placing needles along energy channels called meridians. TDN directly treats the neuromuscular system affecting muscle tightness, joint mobility, and symptoms of pain and irritation.”

    David Fishkin, DC, the owner of the Dry Needling Institute (https://www.dryneedlinginstitute.com) charges $1000 for healthcare providers belonging to their state professional organization or $1200 for nonmembers to take his 12-hour class on dry needling. (Scroll down to the bottom of his home page to see a picture that shows about 20 acupuncture needles inserted into the lower back of a patient. Hmm?! Trigger point dry needling?!)

    Petter

  27. I would like to add

    I would like to add additional comments to Lisa’s main points. I am trying to keep it simple. It would be too easy to ramble on endlessly. 1) dry needling or intramuscular therapy or whatever you call it is just
    acupuncture by  another name. TRUE with an important caveat. Acupuncture is just needling therapy by another name.  It is a European word for “needling therapy”. The Chinese characters/pictographs “translate”to needling. The notion that acupuncture is Chinese is therefore false. This raises questions about pliability as a Chinese cultural trait. Bottom line – acupuncture is a term invented by Euros.

    2) Acupuncture training has been refined
    over hundreds of years and defined here in the US by the ACAOM, the only
    agency that the Department of Education recognizes for acupuncture
    training. TRUE but ACAOM acupunture is a US cult not found in China (the arguable gold standard). ACAOM is the only body that has been approved by the USDE. The NGAOM made a valiant to create an alternate accreditation org they called NOMAA. The AAAOM and partner orgs were able tocreate sufficient resistance to the alternative accreditation body that the NOMAA application was stalled. The NGAOM ran out of $$ and the effort ended right there. Victory to ACAOM/AAAAOM/CCAOM. There were weaknesses in the NOMAA application to USDE to be sure and their premise to raise standards to 4,000 hours was onerous. As a result ACAOM whose “standards” are less than standard remains the onlybody that accredits AOM training programs. While the leadership orgs(see above) thinks this is asomethign to be proud of, the fact is the ACAOM should be decertified. Their record of approving phony AOM programs speaks for itself. Look – they were caught with their pants down when SAMRA = tehseiminal historical AOM training program – folded without notice leaving dozens of students without viable options. Conclusion? There are no viable options in AOM training.

    3) Licensed medical providers who didn’t go through an
    ACAOM-accredited program pose a significant threat to the public
    welfare. FALSE. Acupunture is practically harmless as a modality. You have to be absolutely bone-headed to hurt someone. It is not a medicine. It is a modality. Like bone setting or chiropractic or antibiotics or massage. Deke Kendall wrote a book “The Tao of Chinese Medicine” that describes the roots of Chinese medicine based in cardiovascular knowledge and the longitudinal organization oif the human organismthat he claims are th true roots of Chinese medicine. He is not alone in his opinions. Who cares? What does it matter? It is a small step from understanding Kendall’s and others’ arguments toconsidering that the way TCM is taught in the USA is idiosyncratic at best and fraudulent at worst. If what Kendall and Unsachuld and Ullett and Kavoussi say is true then ACAOM is a tool of a controlling elite.

    4) This argument isn’t about turf warfare, it’s about
    identifying standards of education and practice that result in effective
    and safe acupuncture treatments. Changing the name of a medical
    procedure is confusing and misleading to the public. ABSOLUTELY TRUE. The idea that using a needle to provide analgesic relief is propriteary is indefensible. You can argue all you ewant about the prorpietary natur eof TCM but is simply does not hold up. Most of us just never get to hear the other side. The dissenters have argued that attempting to control or restrict or claim as proprietary the use of a filiform needle that did not even exist 60 years ago is in the least disingenuous if not downright dishonest. Acupuncture is piercing the skin with a needle. As Michael Jabbour has correectly pointed out it is a surgical procedure. This is tantamount to saying it is medical. Right. Patients seek medicine. One class of licensees cannot control any class of medicine…or modalities. ObGyns howled when Family MDs started doing their own ultrasound procedures. All it took was 20 hours CME. How tough is it to squeeze goo on the belly and run a device over it? The pictures could be read by anybody. Despite what we have been told acupuncture is not medicine. It is a modality. Why shouldn’t anyone qualified to use it be able to offer it to patients. The only question is what does it take to administer needling such that the public is protected?

    AOM training programs – ACAOM – claim 2800 hours are needed to learn how to put the neddle there. Yet the Helms trainingis less than 1,000 hours and 90% of those hours are on tape. What does this mean? The acustablishemtn suggests it emans the profession must protect itself from interlopers. Maybe it means something else.Maybe it means acupuncture is a modailty that does not require 2800 or 3000 hours (or an FPD for that matter). Maybe only 800 hours are needed.

    Here is where I diverge. Acupuncturists are healthcare providers. All healthcare providers need minimum training in the basics of healthcare. LAcs do not get this. They do not train alongside other providers. They do not learn how to diagnose in the same language of all other providers. IMO this is immoral. This is the height of conceit. This compromises patients’ health.

    OK. I am being righteous. The facts are acupuncture is pretty darn harmless. Puncturing a lung is about the worst thing that can happen. However, not knowing when a situation is grave is reckless. Recently, a patient in SoCal died after a needling procedure. It probably wasn’t the needling that killed the patient. However, the failure to recognize a grave situation might have made a difference. This knowledge can only be learned by learning and practicing in mainstream clinical rotations like every other  clincal training program requires, alongside providers who work in mainstream settings where the rare and terminal circumstance happens every week.

    Healthcare is not a cult. Acupuncture works and it belongs in the mainstream.

  28. I’m in total agreement.

    I’m in total agreement.  I’m very frustrated with acupuncture still being “alternative” medicine, there is no reason we shouldn’t be working in mainstream health care.  My schooling did include western medicine, and learning to recognize medical problems and knowing when to refer was strongly emphasized.  I think most schools now include western medical training.  I would have loved training alongside other healthcare practitioners.

  29. correction

    M.Ac. current standards are 1905 hours, rather than 2800.  The 2800 hour curriculum is for OM programs and includes herbal medicine. Also, isn’t the Helms program for MDs? So the 1k hours would be aside from the science courses, and if 90% of those are canned then that wouldn’t include a clinical component, unless i’m mistaken.  If that is the case, then it is more theory than M.Ac.s get, since the ACAOM didactic is IIRC 705 hours – and that includes the herbal med theory and treatments for drowning or whatever.

     

    If anything,  IMO ACAOM standards are based too much on Chinese school curricula.  I never understood why M.Ac. programs are required to include Shang Han Lun/Wen Bing, for example.  I have long thought we should take a look at Japanese curricula instead, where acupuncture is separately licensed from herbal med (the latter requires an MD or Pharm D), and the status of acupx education is more along the lines of technical school.

  30. do most AOM schools include “Western” training?

    Western medical training is what I refer to as mainstream training. The terms “complementary” and “alternative” are meant to place acupuncture and chiropractic (and other kindred approaches) outside the mainstream. Of course, there are plenty of people in these CAM professions who want to be outside the mainstream. As a result there is little urgency within and outside the CAM programs to train alongside mainstream providers. It is not surprising that very few LAcs work in mainstream settings. Best data available shows 1% to 4% working in hospitals or mainstream clinics/practices. ACAOM does not require any clinical placement in a mainstream setting. LAcs do not learn how to make a mainstream diagnosis and are largely unable to communicate clinically with a mainstream provider. Except for CAN/POCA there is no initiative underway at an AOM school or through an AOM professional org – of which I am aware – that seeks to increase workforce opportunities for LAcs. In an era where the shortage of primary care providers is tremendous and the willingness within mainstream healthcare to “extend” the roles of midlevels (RNs, PAs, MAs, LVNs) to play bigger roles as primary care providers, the opportunity for marginal players to move into better working roles has never been greater.

  31. corrected and more

    Thanks for pointing out there are two tracks. I support needling training. The TCM is for advanced study for those who want it. The modality is technical, as are all modalities. The Helms course is for physicians and it is heavily padded with TCM. Helms program linked below. I do not see any clinical practice although the term “clinical” is used throughout. Note new emphases on primary care vs. pain management. Lots of good words but underlying it all is the same old French energetics so I am not sold on the “theory”.

    https://www.hmieducation.com/course_desc.htm

  32. I think most schools include

    I think most schools include the western training, we had courses in anatomy, physiology, medical terminology, pharmacology, physical exam, western diagnosis and treatment… it was a large part of my education, I think about half of the non clinical study, and I think that is standard. We aren’t really trained to think in terms of making a western diagnoses because it’s not within our scope of practice, but we are definitely trained in western medicine and fully able to know when to refer.   It’s hard for me to say what I learned in school because I have done so much self training in western medicine, but I can talk to an MD, I know what my patients are talking about when they tell me their disease names, and if they tell me sx, I often know what their disease is, but I can’t say it, I can only refer.  I think it would be wonderful if we were required to do some of our clinical hours in a mainstream setting.  It would certainly help OM be accepted if the results could be seen on a regular basis by nurses and MDs.  When you see the results constantly, over and over again, it becomes much more difficult to simply say it’s just a placebo. If it were up to me we wouldn’t be alternative medicine, we are starting to learn the science behind acupuncture, and can explain it in western terms.  I don’t really understand why some people want to keep it outside the mainstream, maybe they think if it remains mystical, they can justify the high price of education and treatment.  If it become just another medical modality it would make sense for nurses, and other medical professionals to practice it with less training than an L.Ac goes through, maybe that scares the schools and professional organizations.  I don’t know if that’s the case, it could also be that many acupuncturists don’t want to become part of mainstream medicine because of the problems in modern medicine, there are many reasons to want to stay outside that system.  It’s probably a combination of a number of different things.   I eventually came to oriental medical school through my passion for medicine, I had certainly thought of western medical school, nursing, or some other western route into medicine, but I just couldn’t do it, I couldn’t put my focus on pharmaceuticals, surgeries, and in some ways ignore the person.  I love modern medicine, we can do some amazing things with it to make people’s lives better, but I also kept seeing what was wrong with it, and decided that I needed to focus on what was missing from the usual western medical treatment.  I would like our field to become more mainstream, but it would be tragic for OM to completely lose itself into that system.  

  33. “dry needling” is a fraud

    Hello All,

    Thanks for the insightful comments. I’ve been reading all of them. Lisa, I appreciate you opening up this discussion on your blog, and I enjoyed reading your post.

    When I first started hearing all this “dry needling” hulabaloo among acupuncturists, I was very reticent to get involved. A lot of medical professionals put needles into people, so what’s the big deal, I thought.

    I have to say, the more I research “dry needling,” the more my perspective is changing. First of all, “dry needling” IS acupuncture, no matter what the PTs & DCs tell you. There ARE risks involved in having people place needles in the body with only 24 hours of training (and no clinical practicum or credentialing requirements). I also think that some of the physical therapists and chiropractors teaching and practicing “dry needling” are motivated not by a deep love for the healing arts but rather by the opportunity to make a lot of money.

    No one wants to get into a “turf battle.” It sounds distasteful, don’t you think? But honestly, if we don’t protect the integrity of our medicine, who else will. Should we all go belly up, stand idly aside, and observe as our medicine is redefined and adopted by other medical professionals who know far less about acupuncture than we do?

    The one argument that has really stirred me up in recent weeks is hearing the proponents of “dry needling” discuss it in that rather patronizing way, “Oh, you don’t have to worry about us practicing dry needling. It’s not acupuncture. We don’t get into meridians or qi or anything like that. It’s just putting needles into trigger points.” Interesting. But if you look at the texts for “dry needling” you’ll see that most of them have “acupuncture” in their titles. So “dry needling” IS acupuncture. And if you search “dry needling” on pubmed, you’ll find that distal points and paraspinal points are now being needled, not JUST trigger points. And if you look at a photograph of dry needling on David Fishkin, DC’s website, my oh my, you’ll see six acupuncture needles placed in a row and RETAINED in the body, and I’m wondering how this is different from acupuncture.

    And finally, I’d like to present to you one quote from Acupuncture, Trigger Points, and Musculoskeletal Pain, Third Edition, 2005, written by Peter Baldry (one of the “founders” of “dry needling.” In reading the first several pages of the book, I found myself cringing in reaction to words wrought with European ethnocentrism, the casual discounting of ancient ways of looking at the world, the way an MD seems to feel justified in re-creating acupuncture (“dry needling”) to be more valid and correct than what was practiced in China for thousands of years. Please read for yourself, below:

    from the Preface:

    “It is because traditional Chinese acupuncture is perforce inextricably bound up with archaic concepts concerning the structure and the function of the body that most members of the medical profession in the Western world view it with suspicion and scepticism and assign it, together with various other seemingly esoteric forms of therapy, to what is called alternative or complementary medicine. … My reason for writing this book is to bring to the attention of doctors and physiotherapists a 20th century-evolved scientific approach to acupuncture for the relief of pain emanating from trigger points in the myofascial pain syndrome and from tender and trigger points in the fibromyalgia syndrome, and to take acupuncture (so far as the alleviation fo nocieptive pain of this type is concerned) out of the category of alternative or complementary medicine by describing a method of employing it that has been developed as a result of observations made by physicians during recent years and is now fast becoming incorporated within the framework of present-day orthodox medical practice.”

    So stand aside, if you like, fellow Licensed Acupuncturists in Oregon and elsewhere, but I do not intend to casually watch as our medicine is distorted and re-branded and sold under a different name. I hope you won’t either.

  34. I kinda get it… but part of me doesn’t.

    So – I totally hear Lisa’s thoughts loud and clear and once again her brilliant voice rings true. Turf wars are bullshit. 

    And here is my But – there is a huge power differential and systemic imbalance of power/representation btween acupuncture (performed by LAc) and anyone operating in the Western medical arena.

    Are we just giving up our power and rolling over with this issue? Why is ok to  OCCUPY WallSt but not OCCUPY acupuncture?

  35. the way to occupy acupuncture

    is by helping lots of people with acupuncture. Not by trying to keep other practitioners from helping people with acupuncture. They are not stopping us from treating people; we’re stopping ourselves.