In the March 1998 issue of the Journal of the American Chiropractic Association (JACA), the cover article and headline was, "Acupuncture: Chiropractic's Perfect Partner?" My initial reaction to this cover story was enthusiastic, as the ACA has never really taken too much of a role in acupuncture. I thought it was about time.
After reading the article, I was appalled. Obviously, hundreds to thousands of other doctors of chiropractic were likewise disgusted, judging by the sheer numbers of letters, faxes and phone calls I personally received by doctors who were sending letters of dismay and protest to the JACA for the horrendous, degrading article which they presented to our profession and the world.
Acupuncture has been extremely prominent in the chiropractic profession since its introduction to America in 1972, following President Richard Nixon's delegations to the People's Republic of China. I remember well the first officially organized acupuncture programs in this country. My dear friend Dr. Richard Yennie brought to the United States on multiple occasions "masters" of acupuncture from Japan, Taiwan, and Hong Kong who taught the ancient art of acupuncture to hundreds of physicians in a series of programs from all disciplines of healing.
Dr. Yennie and others would translate the lectures into English. This was in 1972, and continued for years. Since tourism to the People's Republic of China would not open until the latter part of 1979, and since there were strict travel restrictions for the doctors of China in this communist nation, the majority of acupuncture education in this country prior to 1979 came from outside the People' Republic of China, but was still Asian medicine and acupuncture.
By the time I personally visited the People's Republic of China in the spring of 1980 for the first of 13 visits, I had already studied and practiced acupuncture for eight years. I had also accompanied a group of 35 chiropractic and medical physicians to Japan, Taiwan and Hong Kong in 1973 for the express purpose of studying acupuncture and observing it in the Asian environment. Acupuncture had become a vital part in the clinical procedures of many chiropractic and medical physicians.
New York Chiropractic College, with a faculty of five postgraduate professors of acupuncture (three of whom were of Asian descent and considered "masters" by their Chinese colleagues), conducted the first certification program in clinical acupuncture. The year was 1973. This program was 100 hours of didactic, theoretical, philosophical, clinical and practical acupuncture procedure. This was not a program in traditional Chinese medicine, but dealt with the meridian approach to acupuncture. It also focused its therapeutic application on the Japanese and Taiwanese styles of modern electro-acupuncture. Even though needle stimulation was certainly a major factor in this program, the main focus was on electro-acupuncture.
Just as there are numerous techniques in chiropractic adjustive techniques, and since we have seen that not all chiropractors share the same philosophical approach to their profession, the same can be said of acupuncture. All acupuncture is not traditional Chinese medicine (TCM); in fact, acupuncture is only a small but integral part of traditional Chinese medicine. The way acupuncture is practiced in the People's Republic of China differs widely from the way it is practiced in Korea (which I have visited twice) and differs dramatically from the Japanese style. British, French, German, Italian, Australian and Russian acupuncture all are rooted in Asia, but not necessarily the People's Republic of China. They are all similar but do differ.
Shortly following the acupuncture certification program presented by New York Chiropractic College (Columbia Institute of Chiropractic) in 1973, many other accredited chiropractic colleges began to offer 100-hour certification programs in meridian-style, clinical acupuncture. This postgraduate program has been offered by National College of Chiropractic, Logan College of Chiropractic, Cleveland Chiropractic College, Parker Chiropractic College, Texas Chiropractic College and Northwestern Chiropractic College. I personally have addressed classes on the topic of acupuncture at Los Angeles College of Chiropractic, Canadian Memorial Chiropractic College, and the Sydney Institute of Chiropractic, even though these three have no official postgraduate program. Seven of our CCE accredited chiropractic colleges offer 100-hour didactic programs in acupuncture. Thousands of doctors have been taught the art of meridian style clinical acupuncture in these programs. None of these acupuncture programs were (or now are) programs in TCM, nor were they ever intended to be.
The chiropractic practitioners who have taken these programs are dedicated, caring professionals who have incorporated an acceptable Asian style of acupuncture into their chiropractic practices to enhance it, not to replace it. They do not admit to practicing traditional Chinese medicine, nor do they necessarily want to. The chiropractic colleges that offer the 100-hour certification programs in acupuncture do so to provide the practitioner with a well-rounded education into theory, application, philosophy, and technique. Twenty-eight chiropractic state boards require the chiropractic physician to take postgraduate hours of education in acupuncture from a CCE approved program, the majority of which are 100 hours. Virginia requires 200 hours from both medical and chiropractic physicians, but most states do not require any additional hours of training from MDs or DOs. Acupuncture is currently being practiced by an increasing number of MDs with their new found interest in "alternative medicine." The number of MDs who practice acupuncture, according to NIH, is approximately 3,000.
When I reviewed the March 1998 issue of the JACA devoted to acupuncture I couldn't believe what I was seeing. There was no mention of or article from the prominent DCs who have formed, developed, created and established the postgraduate acupuncture programs at our chiropractic colleges. I knew I had not been asked to contribute to the JACA issue despite the fact I have just finished my 100th article (10-years worth) for Dynamic Chiropractic on the subject. However, JACA did contact me to advertise.
Where was the article or interview from Dr. Richard Yennie, the person who introduced acupuncture to the U.S.? Where were the articles or interviews from Dr. Paul Jaskoviak, Dr. Jon Sunderlage, Dr. John Stump, Dr. Larry Jaggers, or Dr. Linda Zange (an ACA state delegate who headed National College of Chiropractic's acupuncture postgraduate program)?
What we did see, however, was an interview from a Dr. Lao, PhD, LAc (licensed acupuncturist) who is an assistant professor of the University of Maryland School of Medicine and clinic director and instructor at the Maryland Institute of Traditional Chinese Medicine (TCM). The entire gist of his interview was to focus on the idea that the 100 or 200-hour course offered by our chiropractic colleges are inadequate and that no practitioner can understand and use the full TCM system within a "short course." He says: "Health care professionals who take the short courses may not even be aware that TCM is more than acupuncture or that acupuncture is more than needles and symptoms." Does he really think we are that stupid? What an insult, and the ACA is endorsing him. As mentioned earlier, "Acupuncture is not just TCM."
Besides this slap in the face, which was endorsed by our largest national organization, the ACA, printed in the journal were the names of 37 accredited acupuncture colleges or candidates for accreditation and the states where they're located. This was under the heading, "Acupuncture Schools Pick the Best." These are professional colleges of the three year variety which teach the basic sciences and traditional Chinese medicine. I wonder when the ACA last counted the number of accredited chiropractic colleges in the United States (or the world, for that matter). Guess what? It's not 37.
Incidentally, where were the names and addresses of the chiropractic colleges which have Council of Chiropractic Education approval and which conduct postgraduate programs in acupuncture (not TCM) to meet the requirements of the 28 states which currently license acupuncture for the chiropractic profession? They were not included.
Under the heading "National Acupuncture Organizations" there was no mention of the International Academy of Medical Acupuncture (which I preside over), or the Acupuncture Society of America (presided over by Dr. Richard Yennie). The combined directory of these two historic organizations numbers over 25,000. The JACA did print the name and address of the American Association for Acupuncture and Oriental Medicine (AAAOM), which has recently shortened its name to the AAOM. Here is our largest national chiropractic organization giving the name and address of the AAOM in its journal for those who want to learn more about acupuncture.
In the December 1, 1997 issue of Dynamic Chiropractic, I wrote the article "Acupuncture Statistics -- Very Interesting." I quoted from an earlier study which had been conducted in the state of California by the Center for Oriental Medical Research and Education with Terry Oleson, PhD, and Karin Hillsdale, PhD, LAc. This article raised a considerable amount of rage amongst the acupuncture community who were not happy with my report. Don't blame the messenger for the message. I issued a warning to all states that do not include acupuncture into their chiropractic practice act to do it now, as the acupuncture profession appears to be taking great strides to eliminate us. I also mentioned that it is not necessary for us as nationally and state board certified chiropractic physicians to have to retake the multitude of basic science programs which are a vital part of the acupuncture 2,400 hour program for us to utilize acupuncture in our practices. I also mentioned that "all acupuncture is not traditional Chinese medicine (TCM); there are numerous styles of acupuncture just as their are different martial art forms and chiropractic techniques."
I wrote the article for DCs in Dynamic Chiropractic, which is for chiropractors. If you could see some of the correspondence I have received from acupuncturist about this article, you would be shocked. Dynamic Chiropractic even went as far as printing one of the letters from an irate reader who feels chiropractors have no business using acupuncture because we are not properly trained according to some magical number of hours which one must have to make them competent. The Dynamic Chiropractic article I wrote hit the Internet at [url=http://www.acupuncture.com]http://www.acupuncture.com[/url]. The letter is in the correspondence section under the heading, "A Sad Day for Oriental Medicine ... Any Comments?"
Allow me to quote in part directly from the response of Harvey Kaltsas, DAc, the president emeritus of the AAOM. Remember, this is the association the ACA listed "to learn more about acupuncture."
"Unfortunately, most state chiropractic boards license chiropractors to practice acupuncture with training far below what the NCCA deems necessary for minimal competency. This is a disservice to the needs of medical consumers, who often receive acupuncture care from poorly trained DCs, find little or no relief from such treatments, then dismiss the possibility that there is something in the realm of acupuncture and Oriental medicine which would be of relief to them and resign themselves to suffer needlessly from complaints which could be well treated by properly trained acupuncturists.
"It is for this reason that our acupuncture profession has not lobbied the many state acupuncture boards across the country to include spinal manipulation in our scope of practice -- even though such care has been delivered by acupuncture physicians for centuries. AAOM feels that spinal manipulation requires an elaborate body of knowledge to perform properly and objective norms have been established for its proper use. Without satisfaction of those objective norms, we do not think acupuncturists should be performing spinal manipulation.
"We wish for the sake of your patients that chiropractors would afford acupuncture the same respect as we show spinal manipulation. Clearly, you would not suggest that acupuncture boards across the USA license acupuncturists to perform spinal manipulation with 100 hours of training contrary to objectively established norms for patient care?"
The president emeritus of the AAOM mentions in his response letter the initials NCCA, which has recently changed its name to the NCCAOM or the National Certification Commission for Acupuncture and Oriental Medicine. The JACA listed this well-known and prestigious acupuncture organization along with its full name and address. The JACA article states that 32 states plus the District of Columbia use the NCCAOM certification as a portion or in full for licensure of acupuncturists, with 11 additional states introducing similar legislation. They have as an organization established criteria for acupuncturists and have become the standard for education in the acupuncture community.
The chiropractic community does not routinely practice TCM. The medical community does not routinely practice TCM. The vast majority of the medical/chiropractic practitioners are practicing high technology diagnostics with the application of electronic stimulation, in addition to general needle stimulation. Many of these procedures are from Japan and the Republic of China. The medical and chiropractic professions should not have to come under the same guidelines as acupuncturist who routinely practice the People's Republic of China's TCM. Even with all the hoopla, the president of the AAOM states about the acupuncturists not performing manipulation and "we wish for the sake of your patients that chiropractors would afford acupuncture the same respect as we show spinal manipulation."
Quite ironically, the same day I read his letter, I received in the mail a flyer advertising a 9:00 a.m. to 5:00 p.m. Saturday/Sunday seminar specifically designed for "licensed doctors of oriental medicine, acupuncturists as well as third and forth (sic) year students of oriental medicine." The seminar brochure for "Tui Na Manipulation and Structural Alignments" says: "This seminar will give you the basic understanding on manipulating the spine, how to detect and correct subluxation as well as correcting other common misalignments."
The brochure goes on to say: "Your practice will attract more patients when you can offer more services." The real kicker is that prominently displayed in bold letters, the brochure reads: "This seminar is NCCA approved." So much for Harvey!
The JACA goes on to take statements from a DC who attended an acupuncture college in California and three years later completed his education. We are not talking the same kind of schedule which you attended in chiropractic college all day, every day, five to six days a week. Many of the acupuncture colleges I am personally acquainted with conduct classes on weekends and several hours a night several nights a week.
This acupuncturist states: "I consider it scandalous that in many states chiropractors are permitted to perform acupuncture with zero to 200 hours of training which means that the public gets the wrong impression that acupuncture is no more than a limited modality for pain control." He adds: "Because of the rigorous education chiropractors undergo, their coursework meets at least half of the national acupuncture examination requirements, so when they get trained in acupuncture the process is not an onerous one."
Unfortunately, the acupuncturists are totally convinced that there is some magic number of hours which everyone must attend in school to obtain an education. Frankly, I find it ludicrous for anyone to think they can learn traditional Chinese medicine in three years. With my 30 years studying acupuncture and TCM throughout Asia and Europe, I am insulted by the accusations that the chiropractic profession cannot teach our colleagues an exceptional form of acupuncture without relying on TCM. Even according to California statistics, 71 percent of acupuncturists use commercially prepared Chinese medicinal formulas, which means few practitioners are practicing as they are taught in school. We are seeing acupuncturists performing the 60 second pulse diagnosis and establishing all of the correct diagnoses. The Asian counterpart may employ pulse diagnosis for 10 minutes per wrist.
One of my primary concerns is why the acupuncturists are willing to take on the chiropractic profession and accuse them of a lack of education. They do not mention the medical practitioner, who in many instances has nothing but a home video program or at best a short course which I know from personal experience is nothing like what is available in the chiropractic profession. However, it is easy to understand. Can you imagine the Journal of the American Medical Association (JAMA) publishing the same article which was published by JACA? Hardly!
A letter I saw as a response to the AAOM posting of my earlier Dynamic Chiropractic article on the Internet stated: "All states should follow California, which as of 9/97 stopped all untrained people (DCs, PTs, PAs, NPs, etc.) from practicing acupuncture or Oriental medicine without the full four years of education."
Where is the MD amongst this list of untrained? MDs can perform acupuncture in California because they are MDs without any education. Do you think the acupuncturists are going to take on the medical profession? Did you ever notice who bullies pick on? People who never fight back.
So in essence, of the three articles which appeared in JACA, two of them were specifically about chiropractors having no business performing acupuncture with a 100-hour postgraduate program through a CCE college of chiropractic; the other was a general chiropractic/acupuncture article authored by a Canadian who was referred to as the chief instructor of a traditional academy of acupuncture. Why didn't the ACA have someone from a CCE chiropractic college postgraduate program discuss their program, and why it is so valuable to the chiropractic profession as well as the patients whom we treat?
The bottom line of the whole report is when Dr. Lao of the Maryland School of Medicine states that a more acceptable route for a chiropractor to utilize acupuncture is to take a 1,000 hour TCM training program. He suggest this would be appropriate. The first 300 hour phase would prepare the doctor to work with the basic acupuncture points and some of the simpler diseases. Practitioners could use what they learned in their own clinics, but would not be licensed acupuncturists.
The second phase (also 300 hours) would include additional theory and techniques for working with more complicated cases. The final 400 hours would teach how to balance the entire body in a holistic framework including herbs and other TCM elements. Licensing would be possible once the 1,000 hours were satisfactorily completed. Dr. Lao would like to see this model established and made standard across the United States.
Is this the future of acupuncture and the chiropractic profession? The JACA's endorsement of the multitude of statements by acupuncturists of what we as a profession need and what we have currently as being totally inadequate is an insult to the thousands of doctors and colleges which have learned and taught the clinical applications of acupuncture for the last 25 years without becoming immersed in TCM.
Where do they come up with 1,000 hours? Why not 1,200 hours or 980 hours? How do you arrive at this figure? Is it because the chiropractic colleges can now jump into another arena? By offering an additional 1,000 hours of acupuncture training, you can now become acceptable? Forget about all of the hundreds or thousands of people you have helped with acupuncture remember, you can not be acceptable unless you take the 1,000 hour program. Who are they trying to kid?
To put the whole thing into its proper perspective, the JACA reported in a bold column: "Why does the public use acupuncture?" Other than for addictions, Americans mostly use acupuncture for the treatment of pain. According to one 1997 study, 65 percent of patients had musculoskeletal complaints. Another 14 percent suffered from headaches. A second recent study reported that the top 11 conditions treated by medical acupuncturists are pain related, and by far the most frequent location of that pain is in the lower back."
These are startling statistics. No wonder acupuncturists are vehement against DCs using acupuncture, because the kind of patients we see are the same people who are seeking acupuncture. Chiropractors are well adapted to treat the vast majority of musculoskeletal and back conditions which come into our offices, unless of course you ask an MD or PT, who will tell you we are not trained to deal with these conditions. Does this whole acupuncture issue sound kind of familiar? Sounds like we have another fight on our hands. Not only do we have to deal with the outsiders of our profession who are constantly chipping away at us, but we historically have fought amongst ourselves.
The American Chiropractic Association let down a lot of wonderful doctors in the March 98 issue of JACA. You owe this profession an apology!
John A. Amaro, DC, FIACA, Dipl.Ac.
Carefree, Arizona
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