Teeter-Tottoring with Community Acupuncture

Lately there has been much buzz concerning community acupuncture as such clinics have been popping up all over the country. These clinics offer acupuncture on a sliding scale fee from between $15-$40 per session with treatment taking place in a group setting, These patients are typically placed in a recliner rather than on a table, and remain clothed as the majority of points used are distally located. According to the Community Acupuncture Network:

Acupuncture has been a community based medicine for most of its long history. In Asia, acupuncture has traditionally been practiced in group rather than individual settings. For acupuncture to be most effective, patients need to receive it frequently and regularly -- far more frequently and regularly than most insurance plans will pay for. As acupuncture has moved toward the mainstream, it has been forced into a paradigm of one-on-one treatments and high prices, which has decreased not only patient access but treatment efficacy.

While on one hand, this may be a cost efficient delivery model, the first thing that comes to mind is "what about HIPPA?!" Where is the patient confidentiality? I suppose this differs from clinic to clinic, but I can't help getting the image of the dryer section in a beauty salon with everyone knowing each other's business. The range of reactions to treatment, especially in those with mental/emotional issues, are not often things to be shared with strangers.

I am interested in the use of the word "efficacy" when they are cutting out a good number of acupuncture points and limiting available modalities. Sure, you can get great effect using the yuan primary, xi-cleft, and eight-extra meridian points, but you mostly eliminate Mu and Shu points as well as the local ashi for pains on the back and lower abdomen. What about moxa, plum blossom and cupping? Is there time for electro-stim or tui na? Is several affordable treatments lacking in completeness truly better than one full, private session?

Also, I wonder about the patient-client relationship. Much of the reason many of us go into alternative medicine is to have a more personal contact with our clients than many of us may have experienced with our primary health providers. This model sounds dangerously close to factory mill. It also increases the possibility of mistakes or accidents.

By providing lower cost service, are you still providing the same quality care that you would one-on-one or is the client, "getting what I paid for?" You are also undercutting other practitioners by providing a cheap service that does not represent the full spectrum of the medicine. It is up in the air whether this coveted "boost in awareness" of acupuncture will serve to bring the profession up or put it on the level of the corner trend market (remember the oxygen bar?). To put it another way, you don't see internists or GPs hanging out there shingle with an advertised price. Sliding scale fees in western medicine are typically done through organizations that verify employment and income. And no one I know has a very high opinion of the "stop and doc."

Lest you think I am totally dismissive, this style does have advantages, especially for new practitioners, in that you can see more patients and gain rapid assessment skills while honing your treatment style. You can see a broad range of people and conditions that may have otherwise not had access to treatment, potentially put new clients at ease by the casual atmosphere, and, pardon the bluntness, increase your income stream in a way traditional acupuncturists cannot accomplish. There are all kinds of things you can add, such as auricular acupuncture, foot cleanses, and massaging chairs, that would add to the experience and effectiveness. Just as cognitive behavioral therapy has been found to be a good adjunct to traditional psychotherapy, perhaps group acupuncture for people with similar ailments would have have an amplified effect.

An intriguing model would be to have a duel practice similar to the Western MD "group". Partnering with another acupuncturist(s) allows for a combination of both models thereby offering more options to your patients while having a few other professionals to consult with. Hmmmmm . . . .

I'm Back

It has been a couple of months since my last post and there has been quite a bit of news in the acupuncture world. More research and testimonials as to the effectiveness of Oriental Medicine, more worldwide and national coverage of local clinics and larger hospitals, more emergence of community acupuncture clinics that, depending on who you are talking to, undercut peers and undermine the profession or provide low-cost therapy to those who could otherwise not afford treatment, . . . more "asian medicine" clinics being busted for a phony prostitution front. Any way you look at it, acupuncture has been in the news while I have been away and I am ready to pick-up and resume inserting my 2 yuan. In the meantime, here are a couple of websites/blogs I have run into in the past few days. Enjoy!

http://thelantern.com.au/

http://www.classicformulas.com/

Old Friends, New Clinic

This morning I was pleased to read that a former instructor of mine teamed up with one of my old buddies to open an integrative health clinic. Steve Swart, infamous at IICM for being the most hard line didactic and clinical instructor (and I aced his final thank you very much), and Robert Campbell, who I remember even in his first year investigating suppliers for his future herbal pharmacy, have opened an impressive center for holistic healing in an area where "alternative medicine" has become an anachronistic term. I remember reading a statistic that there were more acupuncturists per capita in Santa Fe then there were in the major cities in China! At any rate, this pair will doubtless win over the competition.

Not-so-new healing center often a 'last resort'
By Cindy Bellinger For The New Mexican May 1, 2007

After a lot of renovation that included new walls, carpeting and the re-routing of electrical wiring, the Integrative Holistic Healing Center finally opened two years ago, and word is slowly getting around.

"We seem to be the last resort, though," said Robert Campbell, doctor of Oriental medicine and co-owner. "When people have tried every treatment in town for their health problems, they turn up here."

Steve Swart, who is also a doctor of Oriental medicine and a partner in the business, said that he doesn't see the work at the center as "alternative."

"We work with doctors of Western medicine to dovetail the treatments," he said.

That's what Nancy King finally did. She'd had leukemia, and when she began experiencing various symptoms, she knew it was coming back.

"I had a high fever and had some idea about what was happening," she said. "My oncologist knew about Steve and recommended that I go see him. (Swart) has really helped me find a level of management for my cancer."

Treatments offered at the Integrative Holistic Healing Center include acupuncture, biofeedback, neuromuscular therapy, massage and counseling. Swart and Campbell also have a hypnotherapist, herbalists, energy workers and those practiced in advanced levels of blood work on staff. Eight people, who work at the center on a contract basis, organize collective discussions when they feel a patient could benefit from several approaches.

http://www.santafenewmexican.com/news/61017.html

Upcoming Battle

Great, the FDA got board again. I understand the need for regulation, but juice? How do they plan to enforce banning vegetables and stones? And Mr. McGreggor though Peter Rabbit was a nuisance!

The FDA is proposing stricter regulations for herbs, vitamins, vegetable juices and even “devices” such as massage oils, massage rocks, and acupuncture needles under a new guidance document up for review.

According to the document produced by the FDA, use of CAM therapies has risen substantially over the last few years, with one third of adults reporting using some form of CAM in the last year. Interestingly, the docket also reports that visits to CAM practitioners outnumber visits to primary care physicians each year.

The FDA claims that their regulations are simply a “guidance” as to what constitutes regulated CAM items. The CAM community disagrees. They see the defining of regulated items as an attempt to control the use of CAM within the United States—and possibly incorporate CAM devices and medicines into what some refer to as “Big Pharma,” the pharmaceutical industry.

The guidance document essentially defines any item used to treat, mitigate, cure or prevent a disease as regulated by the FDA. This means that if someone claims their vegetable juice helps cure cancer, the FDA then has the right to regulate that vegetable juice as a drug. It also means that if someone is using massage rocks as part of their therapy for a disease or disorder, those massage rocks are regulated as medical devices.

What impact does that have on the CAM practitioner and consumer? If something is regulated by the FDA as a drug or medical device, its use is restricted. People will no longer be able to legally grow or distribute herbs in their garden if those herbs are used for medicinal purposes or administer juice if that juice is said to have health benefits.

http://www.anxiety-and-depression-solutions.com/articles/news/FDA_alt_med_0407.php

Self Acupuncture and the Fractal Body

When I first read the title I thought of one of my former classmates yelling about "recycled qi!" I have done my share of self-treatments and given many lessons to patients on how to use self-acupressure. However, I believe no matter how great of an acupuncturist or massage therapist you are, there is nothing like having it done by a fellow professional.

The title nonwithstanding, Dr. Ye has developed a "fractal needle" system drawing on concepts from the Yellow Emperor's Classic and the use of one-needle treatments. A fractal is a repatative geometric figure within a structure. In acupuncture, you can think of the ear, hands, or feet being a fractal of the whole body. This is a bit on the esoteric side, so for a more complete description with case studies and treatment protocols, visit http://www.positivehealth.com/permit/Articles/Acupuncture/ye62.htm

If it works, it would be an excellent tool for patients who could benefit from more frequent treatments but are unable to afford or schedule them. As a main treatment, however, I am a little skeptical.

Self Acupuncture
Alien Sheng
April 15, 2007

Mention acupuncture and people tend to get images of an ancient Chinese man with a long, white beard and needles. The practice of self acupuncture puts this to rest.

When the idea of writing on the subject of self acupuncture was first considered, it created a feeling of outrage. It would appear that the idea that self acupuncture was possible seemed as idiotic and dangerous as offering a guide to self-brain surgery. It seemed to insult the entire idea of Traditional Chinese Medicine and lump it into a classification with other New Age self help treatments. The theories that provide the foundation for acupuncture are grounded in centuries of experimentation, study, and philosophical contemplation. To think that you could go to Wal-Mart and buy a copy of “Acupuncture for Dummies” was insulting.

This is not really wrong either. Acupuncture is not something that can be done by someone who does not have a great deal of training. On the other hand, it is not really a dangerous thing. If the needles used are at least sterile, and the insertion points are clean, there is not a lot of harm that can be done by an amateur. There is not a lot of good that can be done either.

There is a legitimate form of self acupuncture, however. It was developed a few years ago by a Dr. Zu De Ye while he was at the University of Arizona. It has since spread and is being offered in clinics in several countries. It is founded on a theory known as the “fractal theory.” This theory was developed using the principles of Traditional Chinese Medicine, but taking some of them a step further. To understand exactly how it works, one must be able to accept the concept that the Universe is made up of parts that are microcosms of the whole.

For example, the human body is a microcosm of the Universe itself. The forces that are at play in the Universe are also at play inside the human body. When the human body is out of harmony with this cosmic oneness, illness occurs. When the body is in harmony, wellness occurs. The fractal theory takes this a step further. Parts of the body can also represent the whole. This idea is behind such things as ear acupuncture where the ear is seen as representing a human form curled into a fetal position. It also appears in Korean Hand acupuncture where all of the points and Meridians of the body are located in the hand.

The fully developed fractal theory has led to the discovery of certain points on the human body that are actually microcosms of entire organ systems. Results can be obtained by stimulation of these points with very small needles. It involves only one needle placed in certain very specific and easily located key points on the body. Dr. Ye’s treatment regime has allowed patients to practice this form of self acupuncture. The needles are small, and the points in safe locations, so the danger is minimal. The advantages of self acupuncture is that no practitioner is needed for the treatments and time and money are saved. Although much more research needs to be done here, there is some indication that the self acupuncture following principles of fractal theory might one day become another tool in the healer’s arsenal.

Job Opening, Please!

The success of this hospital based holistic program makes me want to start my own business proposal. I think one of the misconceptions about CAM practitioners is that we all believe "it's my way or the highway." Granted, there are some who do shun all things western medicine, but the vast majority believe intergrating as many modalities as possible to bring about health and wellbeing is the preferred method of practice.

Acupuncture meets antibiotics: Mercy Hospital supplements traditional care with holistic treatments
Miami Herald, The (KRT) - Mar. 27, 2007

Mar. 27--Two years ago, Ivan Toirac was admitted to Mercy Hospital in a coma following a drug overdose.

"All the doctors told us he was going to die, or was going to be like a vegetable for the rest of his life," recalled his father, Arturo Toirac.

Then Patty Hutchison began working with the hospital's doctors. Founder of Mercy's holistic care program, she began acupuncture therapy on him.

"The first thing that happened was his kidneys, which were totally closed according to the doctors, opened up," Arturo says. "My son is alive, talking to us and recognizes us."

"Patty, she's all right," adds Ivan, his voice labored but clear.

And while Hutchison is the first to acknowledge Toirac's treatment was -- and still is -- a group effort, she is at the forefront of a new era in medicine, blending Western conventions with Eastern alternative methodology under one hospital roof. Indeed, U.S. hospitals offering some form of complementary alternative medicine grew from 7.7 percent in 1998 to 18.3 percent in 2004, according to the American Hospital Association's 2005 survey of hospitals, the most current survey year.

What makes Mercy's program unusual is that Hutchison practices on site, integrating her primary treatments -- acupuncture, homeopathy and cupping -- with that of the hospital's 700 doctors.

"There is not just one way of doing things . . . we integrate," Hutchison says. "If you need an antibiotic, that is fine. But after you take the antibiotic, there are probiotics to put the intestinal flora back in so you don't catch something else."

The medical community is starting to take notice.

"It's growing because our medical knowledge only takes us so far," says Dr. Hugo Gonzalez, chief medical officer for Sister Emmanuel Hospital, a Coconut Grove facility that treats long-term care patients, in stays of 25 days or more. "Holistic offers an additional way to help people."

The University of Miami's medical school, for example, has provided alternative medical care through its Complementary Medicine Program for a decade. The program is housed in a building on the grounds of the Jackson Memorial Hospital campus.

"It's an important program for patients," says Dr. Pascal Goldschmidt, dean of the UM's Miller School of Medicine.

Hutchison, who faced initial resistance before Mercy administrators green-lighted an in-patient program in 2005, has a therapy room on the first floor of the Coconut Grove hospital. There are two cots, New Age music floating from a desktop stereo, and a multicolored lamp sending a mist lazily toward the ceiling. The colors are used for therapy: orange, for instance, is effective as an antidepressant, she notes, while switching the lamp from Tang orange to a more mellow yellow and bold blue.

Hutchison works on a wide variety of patients, from cancer survivors to those suffering from stiff necks, lower back pain and mental health issues.

"With the patient population I work with . . . cancer therapy . . . Patty works on relaxation and to ease nausea and some of the vomiting," says registered nurse Karen Stephenson, oncology clinical specialist coordinator at Mercy.

Hutchison says she has treated approximately 300 patients since 2005. Each patient is visited an average of five times. Doctors are coming along, too. "It's tough to accept something new; most doctors are not educated about this in medical school. I would like to see it grow. It's a good tool to have here," Stephenson says.

Teaching hospitals, such as UM's medical school, now require courses in complementary alternative medicine (CAM). In fact, 78 percent of medical schools required courses in CAM in 2004, up from 26 percent in 2001, according to the Association of American Medical Colleges.
Some studies on acupuncture have shown promise. A 2005 study by the University of Maryland School of Medicine found that Chinese-style acupuncture -- which Hutchison practices -- had a "statistically significant effect" on easing chronic lower back pain in the short term. A Mayo Clinic study in 2006 found acupuncture reduces the symptoms of fibromyalgia, characterized by chronic musculoskeletal pain, fatigue, joint stiffness and sleep disturbance.
There is no evidence, however, that acupuncture can be directly linked to bringing someone like Ivan Toirac out of a coma, says substance abuse expert Dr. Lauren Williams, assistant professor of psychiatry for the University of Miami.

"Acupuncture has been used in the treatment of addiction, but it's always been an adjunct to psychosocial programs. Proponents say acupuncture works for them, but it's not mainstream
and not a stand-alone treatment by any means," Williams says.

Goldschmidt, the UM medical school dean, urges caution when weighing conventional medicine with alternative therapies.

"There is specific management of a heart attack to save a life. There's little room in that treatment for integrative medicine or holistic to be a part of that intervention," he said. "When I was at Duke we conducted a study on various approaches to patients with heart attacks. . . . Music, massage, etc. In general, it didn't really improve the acute treatment of heart attacks. There's no replacement for that."

That's the point of programs like Mercy's.

"Cancer, in particular, is a multidisciplinary disease," says Dr. Jorge Antunez De Mayolo, a hematologist oncologist at Mercy. "It requires multiple medical specialties to handle each aspect. Patty does Oriental medicines, helps with massage, acupuncture, the control of pain. Physical therapists help us keep patients ambulatory. Nutritionists regulate caloric intake to help patients overcome the side effects of medicines. Psychologists help with coping. None of us has a predominant role."

New Information for the Conciarge

We all know spas have been expanding to include acupuncture services, but now hotels are starting to get into the game. And believe it or not, the treatment rates are decent and the hotels are not grossing a large profit of their customers! If you ever wanted to break in to hospitality, you may want to use this piece in your sales pitch.

'Sticking' Your Guests for Profit
3/19/2007 5:09:46 PMBy David Wilkening

Highly competitive hoteliers looking for the next new innovative service might consider acupuncture. While the 5,000-year-old practice has been around a long time, it’s certainly far from commonplace, but some hotels are seeing green by sticking it to their guests.

The reaction when it was offered recently at the Spencer Hotel in Chautauqua, New York, was all positive, says owner Helen Edginton. She decided to introduce it after her personal experience.

“I was having some pain in my legs and toe and I used it. It worked fine,” she says. “It’s great for arthritis or for any kind of pain. You can also do it as a face lift. They’ve had quite a lot of success with that.”

Acupuncture may be best known as a surgical anesthetic but the hotel variety is perhaps more inclined to be cosmetic, though in some cases it offers relief from a variety of illnesses. Edginton says the acupuncture she offers through a licensed therapist is “fast, luxurious and painless.”

Read More