Editorial: What's In A Title

No matter what your opinion of western allopathic medicine, no one can deny that medical school takes a great deal of drive, personal determination, and a large chunk of one’s twenties. Doctors sweat out a large portion of their youth in the troughs of sleep deprivation, condemnation from their superiors, and rigorous study in the hopes of providing a humanitarian service . . . and paying back their student loans. Whether the M.D. becomes a virtuous practitioner, or a money-grubbing autocrat, they all had to earn those initials.

Oriental Medicine training is tough. Most of us come from a western medical background and leaning TCM theories, acupuncture points, herbs, and all of the other modalities does not come easily. Those of us who have gone through the formal, master’s education route and have been nationally certified and licensed through our respective states have had our share of academic trials. While our scholastics are comparable to those of chiropractors and naturopaths, the later professions confer the designation of “doctor” on their graduates, while our titles are bestowed upon us by the state in which we practice. But for a group of complementary medical practitioners, it may seem puzzling as to why so many are eager to take the doctor title, without earning the MD credential.

While I hold a Doctor of Oriental Medicine license in New Mexico, I have never felt comfortable referring to myself as “doctor” – it seems presumptuous and misleading. I feel confident in my training and abilities as an acupuncturist and I do not feel the need to make myself seem more important or alleviate personal insecurities by putting on heirs with a title. Whenever I hear someone refer to a local practitioner as Dr. so-and-so, I cringe; especially when I find out the patient didn’t even realize they were not an MD.

But on the other hand, MDs are not the only people who call themselves “doctor.” The Associated Press states, “use Dr. only for physicians, dentists members of the paramedical professions (osteopaths, optometrists, chiropractors, podiatrists etc.) and clergymen who hold earned or honorary doctorates.” Paramedical profession? Well that “etc.” would include acupuncturists, wouldn’t it? If an RN is an RN, a DC is a DC, and an ND is an ND once they pass their respective boards, why are we a DOM, L.Ac., C.Ac., R.Ac., or OMD, plus whatever NCCAOM Diplomat status we may have earned? I am not advocating one way or another that we should be granted the title of “Acupuncture Doctor” or Doctor of Oriental Medicine,” but why do we not have one degree, with one title like the rest of our fellow healthcare professionals? Take a look at this muddled and unnecessary designation diversity:

Licensed Acupuncturist: Alaska, Arizona, California*, Colorado*, Florida, Georgia, Hawaii (“§436E-3.5 Physicians and osteopaths not exempt.” - nice touch)*, Idaho, Illinois, Indiana, Iowa, Maine, Maryland, Massachusetts, Minnesota, Missouri, Montana, New Hampshire, New Jersey, New York (“certified” if you are a physician or dentist with 300 hours training), North Carolina, Oregon, South Carolina, Texas, Utah, Vermont, Virginia, Washington, West Virginia (although OMD, DOM, and M.Ac. are used)

Certified Acupuncturist: Kentucky, Louisiana, New Hampshire (2), Ohio*, Tennessee, Wisconsin

Doctor of Oriental Medicine: Arkansas, New Mexico

Registered Acupuncturists: Michigan, Ohio* (2)

Oriental Medicine Doctor: Nevada,

Doctor of Acupuncture: Rhode Island

Note that some states allow dual titles. Those with *s specifically mention in their statutes that only the title bestowed by the state may be used and that the term “doctor” is prohibited unless you have graduated from an applicable or approved medical or PhD program.

I have personally been a Doctor of Oriental Medicine once, a Licensed Acupuncturist twice, and am soon to be a Certified Acupuncturist, yet in all four instances I held the same degrees and practiced the same medicine! To transfer my RN license to another state, I submit current license verification, pay a fee, read up on the particulars of the state’s nurse practice acts, and keep my credentials. This is sensible, reasonable, and adaptable to our profession.

Now that nearly all of the states have enacted or are in the process of enacting legislation for acupuncturists, it makes sense that as legitimate healthcare providers, we have a unanimous and uniform title. Whether that means the CCAOM requires all schools to issue the same degree titles, that the NCCAOM creates something more viable than “diplomat,” or that we empower our own National Organizations for unification, we require a clean, descriptive, professional title that transfers in the same manner as our peers in the healthcare profession.

Incongruity

Headlines are supposed to tell you the cut-and-chase of an article in a single phrase. I find the following one amusing because, while the headline implies that acupuncture doesn't work, the text demonstrates that the evidence is merely inconclusive due to the poor organization and follow-through of the cited studies. The headline should have read something like Efficacy of Acupuncture Uncertain in Stroke Patients or Evidence of Acupuncture Effectiveness Inconclusive for Treating Stroke. Of course, the study's intent was to find if acupuncture is the "most effective for improving stroke patients' rehabilitation" yet there was no mention of a control group or what the other "best" methods might be. Curious, no?

Reported July 27, 2006
Acupuncture Lacks Evidence, Say Researchers

(Ivanhoe Newswire) -- An ancient form of treatment is under new inspection.

Acupuncture has been used in China for over a thousand years and more recently in Western countries to treat chronic stroke. Stroke ranks as the third leading cause of death in Western society, and it is the second most common cause of death in China. It is a main reason for disability and dependency in the elderly. New research reveals acupuncture's scientific data fails to provide sufficient evidence it is, in fact, most effective for improving stroke patients' rehabilitation.

Researchers came to this conclusion after a thorough systemic review. Systemic reviews draw evidence-based conclusions about medical practices after considering both the content and quality of existing trials on a topic.

Acupuncture has been used to improve patients' motor skills, sensation, speech and other neurological functions. Lead author of the study, Hongmei Wu, M.D., of the West China Hospital in Si Chuan, was very surprised by the findings. "In China, acupuncture has been well accepted by Chinese patients and is widely used for stroke rehabilitation."

The review's intent was to provide evidence that acupuncture should be routinely used to rehabilitate patients with both subacute and chronic stroke. However, the available research failed to offer sound evidence of the effects of this therapy.

Researchers analyzed trials from 368 patients between ages 24 and 86. The hemorrhagic strokes were classified as either subacute -- less than three months since onset, or chronic -- more than three months since onset.

Researchers admit there was some overall improvement after acupuncture treatment, however they warn the results need to be "interpreted with caution" due to the insufficient number and general poor quality of clinical trials.

Wu states "most studies are poor in methodological quality, so the continued recommendation for acupuncture on stroke rehabilitation is uncertain."

Seminar Style: Mary Elizabeth Wakefield Part II

One of the shortcomings of many Traditional Chinese Medicine (TCM) schools is that they are often accused of teaching Traditional “Communist” Medicine. This is because, unlike 5-Element institutions, they tend to overlook the mental, emotional, and spiritual aspects of acupuncture. Whereas in Western Medicine, diabetes is diabetes no matter who your physician is or what school he went to, diagnosis and treatment with acupuncture depends largely on where you studied and the modality you prefer. Although my TCM program did explore 5-element theory in addition to other systems, they were not the emphasis. That is why today’s session was such a pleasure – it was a review made new.

Mary Elizabeth opened with an informative Q&A period that could have gone on all day had she allowed it. She introduced elemental diagnosis using hand and facing reading as well as Hara palpation to determine one’s tendency to wood, fire, earth, metal, or water. There was also instruction on the spiritual uses of Kidney points 23 – 26, scar therapy, and the five element wrinkle patterns. Unlike day one where I was well versed with 8-principle treatment and her needling techniques, I found that these were methods that I had previously had only the barest of introductions. Needless to say, I was eager to give them a try.

The protocol taught can be utilized prior to the facial portion and in conjunction with whatever “you do what you do” style of treatment. From personal experience, I can now testify to this method’s incredible power and immediately noticeable effects.

Mary Elizabeth Wakefield is my kind of instructor: She is passionate and knowledgeable about her craft, genuinely warm and attentive to her students, adaptable and accepting of differing styles of practice, encouraging, and above all patient. This seminar awakened a host of new creative juices in my Jing, and there is no doubt I will be returning for the rest of the series.

A Wrinkle In Rhyme (a ditty to remember the treatment principle):
If deep in the skin, thread it in
If superficially muscular, use Lavier perpendicular

Diagnostic Haiku
When you spread the flesh
Wrinkles fade if in muscle
But stay if in skin

http://www.chiakra.com

Seminar Style: Mary Elizabeth Wakefield Part I

From Eden Park B&B in Takoma Park, MD:

It is going to take a while to assimilate all of the information I have learned in day one of Mary Elizabeth Wakefield's Constitutional Facial Acupuncture Renewal. After meeting a fellow TCM practitioner from California at the airport last night (4 hours later than expected due to monsoon style thunder and lightning), and hoofing it almost 1.5 miles in the heat and humidity to the seminar, I found myself in a room of local Tai Sopheia trained 5-Element practitioners. Needless to say, I felt a little bit out of my "element." However, that quickly changed when Mary Elizabeth introduced herself and began speaking about her acupuncture facial rejuvination techniques.

Contrary to popular belief, acupuncture facial rejuvination (and don't you dare call it a facelift) is not limited to the face. It includes all of the ingredients of a typical whole body constitutional treatment that can be done whether you are a 5 Element, 8 Principle, or Zang-Fu practitioner. You perform the facial diagnosis and then, as Mary Elizabeth says "do what you do." Rather than teaching a ridged protocol system, she incorporates different styles of acupuncture allowing for the practitioner to customize the treatment according to their training and comfort level.

We spent the morning going over contraindications, benefits, wrinkle analysis, intake and release forms, a review of 8 extraordinary meridians with their opening and balancing pairs, and Jacques Lavier's diagnosis and treatment protocols. The afternoon involved a practical demonstration of a treatment involving constitutional diagnosis with applicable points, facial and motor point needling technique, uses of herbal masks, poultices, and creams, instruction in jade rolling, and a brief introduction to acutonics.

I got to play patient today and I have to admit, although we were just practicing, I had a fantastic treatment by my two partners. I felt an abundance of Qi all through my body during the facial, so much so that one of my partners commented "you look zoned out, I may have to cut you off!" This sensation was intesified by the addition of the acutonic tuning forks placed on specific areas of the body. The herbal tea mask and facial cream were excellent, but the eggwhite herbal mask needed the some essential oil to cover up the scent. The jade rollers were cooling, relaxing, and something that I may add to my daily facial regimen.

Tomorrow is chock full of new information and more practical demonstration and practice and I am looking forward to being on the other side of the table!

The Future of Hospital Care

Every year, many schools of Traditional Chinese Medicine offer internships to several different hospitals in China where students and practitioners can do intensive study of acupuncture, herbal therapy, Tui Na, or medical Qi Gong and Tai Chi. It is a system designed to allow doctors to find the best treatments for their patients and collaborate closely with other physicians.

Imagine such an intergration in a US hospital, where patients have the option of receiving alternative therapies to augment their allopathic treatment. How useful would this be to so many lying in hospital beds who are suffering from post-of pain, undergoing cancer treatment, detoxing off alcohol or drugs, or simply having trouble going to sleep in an inherently bustling environment? It is beginning to become a reality, albeit in select areas of the country.

Many Western Doctors feel threatened at the notion that medicine can be practiced by those who do not have an MD after their name and, likewise, there are a small pocket of CAM practitioners who are also exclusionists and believe alternative medicine is the only alternative. But by an large, acupuncturists believe in choosing the treatment that is best for their patient, not what is best for their ego or for their pocket. I look forward to the day when there is true collaboration within the healthcare system in this country and to the day acupuncture doctors get to be a part of it.


U.S. Hospitals Offering Alternative Medicine
Thursday, July 20, 2006
By Jennifer Warner

More than one in four U.S. hospitals now offer alternative and complementary therapies, such as acupuncture, homeopathy, and massage therapy.

A new survey of nearly 1,400 U.S. hospitals shows more mainstream medical institutions are providing complementary and alternative therapies to meet growing demand.

"More and more, patients are requesting care beyond what most consider to be traditional health services," say researchers Sita Ananth of Health Forum and William Martin, PsyD, of the College of Commerce at DePaul University in Chicago, in a news release. "And hospitals are responding to the needs of the communities they serve by offering these therapies."

Complementary and alternative medicine (CAM) includes therapies not based on traditional Western medical teachings and may include acupuncture, chiropractic, homeopathy, diet and lifestyle changes, herbal medicine, and massage therapy, among others.

A 2002 CDC survey showed that more than half of Americans thought combining CAM with conventional medicine would be helpful.

The survey, conducted and published by the American Hospital Association every two years, shows the percentage of hospitals offering one or more CAM services increased from 8 percent in 1998 to 27 percent in 2005.

Contrary to popular belief, researchers found that complimentary and alternative medicine offerings were most common in the Midwest (Illinois, Indiana, Michigan, Ohio, and Wisconsin) and less common on the West Coast. The least common areas to offer CAM services were in the South (Alabama, Kentucky, Mississippi, and Tennessee).

The top six complementary and alternative medicine services offered on an outpatient basis among hospitals offering CAM were massage therapy (71 percent); tai chi, yoga, or chi gong (47 percent); relaxation training (43 percent), acupuncture (39 percent); guided imagery (32 percent), and therapeutic touch (30 percent).

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Neck Pain

One of the major limitations with most acupuncture research is the small sample size - so many of the studies just meet the minimum 30 participants to make the study statistically significant. Fortunately, there is no shortage of people suffering with neck pain and willing to volunteer. Here is a quick survey study of recent research findings.

From The Scotsman Wed 19 July 2006

Study proves acupuncture can aid neck pain and stiffness

ACUPUNCTURE is effective in helping people suffering neck pain, a review of evidence has concluded.

Some sceptics have claimed any benefit from using the technique is down to a patient's expectation that the treatment will work - a placebo effect.

Now a group of researchers has analysed ten trials, with a total of 661 patients, which investigated whether acupuncture alleviated neck pain.

It is estimated that between 26 per cent and 71 per cent of adults suffer neck pain or stiffness.
The Canadian researchers said that in many cases, pain could last for months.

The review found that overall, people who received acupuncture reported better pain relief immediately after treatment than those who received dummy treatments, such as laser methods with the machines switched off, or acupuncture with the needles inserted in the wrong places.

Today, Its Official!

I post a lot about this, but I cannot help but be excited over the validation of my profession in this state . . . especially since we, thankfully, are not the last one to pass a regulatory law!

Acupuncture now regulated health care in Kentucky
Associated Press

LEXINGTON, Ky. - Thousands of years after the Chinese invented the procedure and three decades after states first began overseeing its practice, Kentucky is making acupuncture a regulated form of medical care.

Beginning next year acupuncturists in Kentucky who want to practice the art of sticking hairlike needles into various pressure points around the body to relieve pain will have to be certified.
The law - which Gov. Ernie Fletcher signed on April 26 - went into effect on Saturday.

The regulations will require acupuncturists who want to practice in Kentucky to pass a national certification program from the National Certification Commission for Acupuncture and Oriental Medicine. They must also receive 1,800 hours of education from an accredited acupuncture training program.

Non-certified acupuncturists who are already working in the state have until July 1, 2007 to meet the requirements.

For Dr. Maureen Flannery, who runs an acupuncture practice in Berea, the new law validates her belief that the practice is a legitimate form of medicine.

"This was a long time coming," Flannery said. "I think it's important for consumers and practitioners to know who is trained when they're accessing care. Before this, there was no way for people to judge who was well trained."

Nancy Butler of Lexington began receiving acupuncture to recover from a rotator cuff injury and became such a fan that she's allowed her dog to go under the needles. She said the law will open the practice to people who previously may have been reluctant to try it.

"It's just really important for people to have access to something inexpensive that could help them terrifically," she said. "It's a form of healing that for thousands of years has worked."

The Kentucky Board of Medical Licensure - which monitors the practices of medical doctors and physicians' assistants - will oversee the practice of acupuncturists. An eight-member advisory committee will meet with the board regularly to keep it updated.

There are 18 acupuncturists currently working in Kentucky according to the certification commission. However, the new guidelines could lure more practitioners to the state.

"It's becoming more mainstream," said Kathleen Fluhart, a nationally credited acupuncturist. "It makes us be more acknowledged and recognized."

Verification Optional

I was ordering from an acupuncture supply company today and I was bothered by something during check-out. Unlike many herbal suppliers, such as Crane Herbs or Kan, several distributors of needle, moxabustion, and Electro Therapy products, including Acu-Market and Lhasa OMS, do not require license verification before allowing you to buy. I merely had to check boxes stating that I legally met the criteria to purchase such products, but there was no process to ensure I was who I claimed to be. By making professional products easily available to the public, it can encourage quack practitioners and lead to dangerous experimentation, particularly with those companies that sell herbal formulas. Of course they have the usual "hold-harmless-no-medical-claims-intended-the-herbs-are-just-food-supplements" disclaimers, but the open access still seems odd.

I have to remind myself of all the other "herbal" products on the market that any laymen can self-prescribe while standing in the natural section of their local grocery store, then pick-up a box of lacnets at the pharmacy. I must also admit, however, the side pet peeve is that there is no "practitioner pricing" on these sites and I have to pay the same for Tiger Balm as everyone else. But truly, my concern is more about the right tools in the right hands. I understand that mail-order companies are in the business of making money, but there should be some sort of license verification process before they will ship things like acupuncture needles, plum blossom hammers, and direct moxibustion - it keeps the profession honest.

Cupping with Fire

Since my first lesson, I have been a big fan of fire cupping. It is powerful, dramatic, and can leave marks that may have friends lifting eyebrows and inquiring if everything is okay at home. While most of the press dedicated to cupping focuses on it's use for pain management, I have to interject it is a first-rate modality for preventing the progression of a cold. At the first sniffle or scratch in the throat, I reach for the plum-blossom hammer, my fire cups, some Po sum On oil and my jade Gua Sha stone. These tools can knock out a wind-cold invasion before it has a chance to knock the client out. Not to mention, it feels really good. I have found that while they can be cumbersome, glass cupping is the most versatile as you can perform multiple techniques that are impossible with plastic suction and, unlike bamboo styles, you are able to see the strength and effectiveness of the suction during the treatment. It was brought to my attention several years ago that cupping is not exclusive to China and has been practiced in Mexico for centuries as well; the article below also reports its use in the Middle East. Fire away!

Cupping runneth over By LEIGH WOOSLEY

Alternative treatment for pain is drawing attention

Bearing marks on your back bigger than silver dollars may not seem all that healing, but it is for many people who have taken to Chinese fire cupping, an ancient, though somewhat offbeat, practice that supposedly releases toxins that cause aches, pains and irregularity in the body.
It's often an alternative or an addition to traditional acupuncture treatment and commonly is used to treat soreness, stiffness, pain and breathing problems such as bronchitis. It's used for other ailments, as well.

Here's how cupping is done. Glass, bell-shaped cups are heated, usually with an open flame to remove all the oxygen. The flame is swirled around the cup and immediately put on the body.

As the cup cools, it creates a sort of vacuum that sucks the skin into the cup. This suction causes blood vessels to expand and is supposed to release toxins from beneath the skin so they can be excreted from the body.

The cup stays on the skin for five to 15 minutes and leaves behind obvious red marks that can last a couple of weeks.


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And the Research Continues

From the Boston Channel

Acupuncture may help knee pain more than taking anti-inflammatory drugs, according to new researchers.

Researchers studied 1,000 patients with osteoarthritis in the knee. Twenty-nine percent of those who had medication and physical therapy for six weeks reported less pain, compared to 53 percent of those who had acupuncture reporting less pain.

Fifty-one percent of those who had a placebo form of acupuncture also said their pain had decreased. It's possible, experts said, that just thinking a treatment may work will actually alleviate pain.

From the Annals of Internal Medicine

What is the problem and what is known about it so far?
Knee osteoarthritis is a common condition in which changes in the knee joints lead to pain. Treatments include drugs to decrease pain and inflammation; weight loss, if needed; physical therapy; and exercise. Unfortunately, these treatments do not always help and some have side effects. Consequently, many people with knee osteoarthritis seek alternative treatments, such as acupuncture. Acupuncture is an ancient Chinese treatment that involves putting special needles into specific points on the body to treat medical conditions. Mainstream medicine is increasingly recognizing acupuncture as an effective treatment for some disorders. Past studies about acupuncture for osteoarthritis have had inconsistent results.

Why did the researchers do this particular study?
To find out whether acupuncture is an effective treatment for knee osteoarthritis.

Who was studied?
1007 patients with osteoarthritis knee pain for at least 6 months.

How was the study done?
The researchers assigned patients to receive either 10 sessions of traditional Chinese acupuncture (TCA), 10 sessions of sham acupuncture, or 10 doctor visits without acupuncture over 6 weeks. Traditional Chinese acupuncture was "real" acupuncture according to Chinese protocols that specify the location and depth of needle placement in the treatment of knee pain. Sham acupuncture was "fake" acupuncture in which the acupuncturist placed the needles at a shallow depth in places other than the TCA points. Patients in all 3 groups could receive 6 physical therapy treatments and could take anti-inflammatory medications as needed up to a certain amount. The researchers compared changes in patients' pain after 26 weeks.

What did the researchers find?
After 26 weeks, patients in the TCA and sham acupuncture groups had greater improvement in pain than those in the no acupuncture group. Surprisingly, the changes in pain were not different in the TCA and sham acupuncture groups. However, patients in the TCA group reported higher satisfaction with treatment than those in the sham acupuncture group, but both acupuncture groups reported higher satisfaction than the no acupuncture group. Of note, patients in both acupuncture groups had more contact with health care providers during the study than did those in the no acupuncture group.

What were the limitations of the study?
Patients knew whether they were getting acupuncture. The researchers did not monitor whether the acupuncturists were following the TCA and sham protocols exactly as the study plan specified.

What are the implications of the study?
Compared with patients with knee osteoarthritis treated with physical therapy and anti-inflammatory drugs alone, patients who also received TCA or sham acupuncture had improvements in pain at 26 weeks. Surprisingly, the researchers found no difference in pain reduction between real and fake acupuncture. Several potential explanations are possible. First, because of psychological effects, patients who know they are getting special types of treatment report feeling better regardless of whether the treatment really works. Second, patients who received acupuncture had more intense contact with health care providers, which could explain why they felt better. Third, sticking needles into the body may have a physical effect on pain, regardless of whether the needles are placed according to TCA principles.