Acupuncture Exceptionalism

American Exceptionalism is the idea that The United States of America is inherently different from other nations. That our founding and background gives the US a unique mission to transform the world and a superiority over all of other nations.

I’ve recently noticed that practitioners of Chinese/East Asian Medicine have their own version of this, which I call Acupuncture Exceptionalism.

The attitude of exceptionalism skews the interpretation of events. Our own actions are given the benefit of the doubt and ascribed to the best of intentions. The actions of others are considered with a critical eye.

Some examples of Acupuncture Exceptionalism:

We regularly advise clients regarding vaccinations, pharmaceuticals, procedures, and dietary plans suggested by other health care providers. When other providers advise about acupuncture and herbs we are outraged at their presumption.

We widely share studies and news reporting positive results from acupuncture treatment. Studies and news showing a negative outcome are dismissed because “they aren’t doing it right” or didn’t tell the whole story.

When a patient reports harm from “Western medicine” or a treatment done by a non-LAc we rant about the failings of the system or the provider. When a patient reports harm after a treatment provided by an Acupuncturist we find ways to deny that harm occurred, find another cause for the situation, or place responsibility on the patient.

We encourage patients who have been harmed by dry needling to report it to the authorities, and if they won’t we will. We are shocked and angry when a patient files a formal complaint pertaining to treatment received from an Acupuncturist.

We complain that PT’s are engaging in insurance fraud by using the Manual Therapy code for Dry Needling. We justify the use of pain codes for every client, because, well, everyone has pain and, after all, the system is stacked against us.

We are furious that other professions are using “our” medicine, especially without what we determine to be appropriate training. We add homeopathy to our scope without a second thought.

We support and celebrate a lawsuit filed against a PT Regulatory Board as an appropriate defense of our profession. We are outraged when a counter-suit is filed against our board.

 

An attitude of American Exceptionalism does not increase the standing of the US in the eyes of the world. You can’t learn from mistakes when they are denied or explained away. Hypocrisy and double-standards impress no one.

Likewise, Acupuncture Exceptionalism does a disservice to our medicine and to our future as health care providers. If our medicine is powerful enough to help people, it is powerful enough to cause harm. Denying risk puts our patients and our profession at risk. Dismissing valid concerns about acupuncture and herbs from other professionals prevents us from establishing collaborative and respectful connections. If we want to improve our skills and training and service, we must take a clear-eyed look at where we are succeeding and where we could do better.

I’m confident enough about the benefits and overall safety of this medicine that I’m not afraid of looking inward with a critical eye. Are you?

 

 

Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2018. Unauthorized use and/or duplication of this material without express written permission from Elaine Wolf Komarow is prohibited. Excerpts and links are encouraged, provided that full and clear credit is given with specific direction to the original content.

9 thoughts on “Acupuncture Exceptionalism

  1. Dear Observer,

    This post is a great opening for a discussion about the social psychology at work in acupuncture land. But I will give you the long version, including the chicken, the egg, the henhouse, and the foxes, which seem to outnumber the chickens. I will tell you why acupuncture is so full of nuttiness as well as why it isn’t going to change unless you take on ACAOM and the schools, and by take on, I mean remove and start over.

    I discovered, by living through many years as an acupuncture student and later research what you have at work, especially in the schools, is a pyramid scheme, a prison of belief (to use Alex Gibney’s term), and a situation of total regulatory capture. I don’t think this education system trains anyone to think logically or critically about anything. A pyramid scheme by its very nature must enforce irrational loyalty, not critical judgement.

    Inside of acupuncture schools, students were accepted as long as they were not felons. Most students were not prepared through experience or education to be professionals or to practice any kind of medicine. Magical thinking, unprofessional behavior, and even a total lack of academic achievement were tolerated at the school in Roseville. I saw students pass through class and clinic without actually being in class or clinic most of the time. Students made up bizarre excuses for these absurd conditions by saying that what really mattered was their own efforts and passion for “the medicine” or “for healing.” The school could make small efforts to create social cohesion, such as newsletters, or speeches, which played out to create a melodrama of a group struggle toward positive social change. What I was witnessing within two different schools, was the curation of a charismatic group experience holding the conduits for earnings in a psychological and financial trap. A real medical school challenges students to attain a high level of competency. These acupuncture schools avoided challenging the students’ incompetence. They worked, not like schools, but like summer camps, offering the wonders of Chinese medicine as optional entertainment with special seminars and other over-hyped crap as part of the required credits.

    The social and psychological forces which academics describe as operating within a “charismatic cult” are the ones which I saw operating within the acupuncture schools I attended. I watched students go through the development of shared beliefs and group cohesiveness. Students were volunteering to do advertising for the school even while they were being used as unpaid employees in the clinic. Students professed magic powers and took to practicing a whole array of techniques they picked up on the side. While terrible students played magic user, terrible teachers played guru. There was a teacher at AOMA who the school identified as a “Master” in literature. He bragged some and taught some Tai Chi and then disappeared to China during the last three weeks of class. He left a former student in charge who professed to not knowing what she was supposed to do. Did he mean to channel his mastery during class while he was gone but got mixed up about the time difference? There were so many ridiculous ironies about experiences with the people getting paid to pretend like they were something special at these schools. This example is by far the mildest of the many stories I have of about instructors being the worst role models.

    I believe most acupuncture schools are basically the same. I see them as financial suicide cults. Chinese medicine is great but the schools are a financial and social nightmare. I experienced being part of a circus where low-income students were paying large sums of money to buy substandard education in order to receive entrance into a profession which could very likely to be a financial dead end in itself. The acupuncture mortgage is actually an underwater mortgage.

    I believe one of the strongest psychological forces keeping people in acupuncture school and practicing acupuncture is sunk costs. When a student gets 15k or 20k in debt, they force themselves to forge through the circus so they don’t lose their investment. They invest more money in the prison of belief which causes them to be uncomfortable whenever they are shown real economic figures. To be comfortable they must put on the t-shirt with the Chinese characters and sit through another class with twenty other people who really should have had a little more basic science in college. This all produces a group of people with high debt and financial and cultural PTSD.

    Those who survive drinking the Kool-Aid through graduation will get to go through another round of psychological and financial red flags. Last I remember of my cult school there were some of the worst students installed in administrative jobs at the school. I know of one guy who has a stable job – at a school. The community acupuncture movement has provided a way for some of the graduates to practice and treat people of all types. The other graduates struggle to run businesses that have little to do with medicine and a lot to do with marketing. I think you can see that among this group of people what really divided them was how they reacted when faced with the ethical dilemma of what to do when they realized, or did not, that their idealistic career was really part of a pyramid scheme. (Here is where community acupuncture headed for financial reality while others were headed for another sixer of Kool-Aid.)

    I have heard some bizarre justifications for continued involvement with the albatross around their neck by former classmates. They complain and swear loyalty at the same time. It reminds me of Bill Hicks talking about how people compulsively watch terrible things like the tv show COPS, like playing with a sore tooth. I have some hope that community acupuncture is bringing critical reasoning skills to the community, but the damage is really done in the sick schools.

    Now about the henhouse: The federal government is now the great subprime mortgage lender for the acupuncture mortgage. All of the trappings of the subprime mortgage market are going on in the student loan field. The world of acupuncture has the addition of a closely associated accreditation-certification-education complex, a revolving door of individuals who depend on this parasitic economic complex for jobs. In the world of finance, these people are called rent-seekers. They hold the hoops, and you pay them for the privilege of jumping through them. The hoop is held low to the ground and the price tag is astronomical for the student-investor.

    In both mortgages and education people believed that there were what Michael Lewis called “adults in the room,” regulation. The truth is that there are regulations and they are pathetically weak. I heard that the government is going to cut off federal loans to a school if the default rate reaches 30%. 30%! With income based payment everyone can pay nothing. It would be hard for a school to even force that to happen. There is no regulation.

    The things that brought people to believe that education was a regulated industry have turned out to be a sick joke, as they were in the financial investment sector. The Department of Ed: The Department of Education fudged its own investigation and allowed Navient/Sallie Mae to continue defrauding soldiers. The Department of Education makes money hand over fist on defaulted loans, they aren’t going to stop anything. Accreditation: I sent ACAOM written complaints about the AAAOM (heck I even met with the accreditation team and met the ACAOM’s own version of Wing Chau.) They didn’t even respond to my complaints, but ACAOM’s guy told me, “we don’t police the schools.” Very true. ACAOM is to the acupuncture school what Moody’s was to the credit default swap. Licensure: Licensure does seem to mean anything if it just requires paying for the degree. That makes licensure just another false advertisement for the validity of the profession.

    Now let’s get to the heart of this scam that needs to be forced out of slumber city: The State Boards of Higher Education and the States Attorney Generals. These two entities are incredible at having incredibly low standards. When I complained about my school, the AG said they would only act if the Board of Higher Ed told them to. The Board of Higher Ed took my lengthy complaints to the owner of the school and received a lengthy list of justifications. Neither of these regulators either asked for further details from me or provided any evidence of any investigatory process, although they suggested that they had investigated. I figure that’s why ACAOM relocated to Minnesota. Or maybe they heard that Corinthian College’s Everest building is available in Eagan. It took a federal false claims case to fold that Corinthian scam, not the state’s AG or Board of Higher Ed. Those false claims cases are low hanging fruit for lawyers dropping off a bumper crop of for-profit fraud that has been feeding the worst people in education for decades.

    The Bureau of Labor Statistics still posts their misleading suggestion that acupuncturists have a median wage of 73k on the O-net Online site. That is thanks to this great category 29-1199.00 Health Diagnosing and Treating Practitioners, All Other. Their figure relies on their survey methods which I assume are as bad as their collection of data on for-profit schools which is trying to play catch up with reality. Did I hear this is the subject of a change.org petition?

    So the world of acupuncture is a case of exceptional craziness in a financial world where bad actors are incentivized to live off of fraud. If acupuncture schools were held to the real standards like those required for plumbing or electrical code compliance, then the state Boards of Higher Education would shut every acupuncture school down tomorrow. Chinese medicine isn’t based on magical thinking as many people mistakenly believe, but forcing people to pay to pretend that this is a profession with a “bright outlook” as the O-net Online suggests, is all about practicing magical thinking. The psychology of a profession that is trying to justify coming from these schools explains all of that “exceptionalism.”

    • There’s a lot in your comment! I could quibble with a few points, but there’s more than enough that’s accurate. I know the profession has been working to get a separate category with the BLS and touting how important that will be for us. But I haven’t heard anybody mention that getting an accurate read on job statistics might, indeed, send potential students running the other way.

      I’ll add that, when it comes to determining competency, it’s interesting to ponder what the schools would even look at. One of the good things about TAI, imo, was that at least we had to show that we could attract a clientele and do what we did well enough that those clients would return. I don’t actually recall any exploration or discussion about whether an improvement in the patient’s condition should also be considered. I’ve come to see the ability to establish rapport and small business skills as the most relevant factors in practitioner success. The schools could put more emphasis on that. On the other hand, it ignores the part where patients are actually getting better. And, yes, then we get to have the conversation about what better means and how we judge that. I suppose as we get more fully involved in the third party payer system others will have some input (and control) over how we determine the quality of care.

      These are big questions.

      • I think you summarized things pretty well. Let me continue in order to discuss the psychology of the acupuncture establishment which applies to many groups which involve guru types.

        Compared to more functional programs with well-organized professionally delivered degrees that lead to high paying positions of employment, acupuncture education is simply and clearly a crazy rent seeking rip-off sold to idealistic individuals lured into a debt circus.

        The price of acuschool say between 50k and 80k dollars is also the range I see for the cost of a physician’s assistant program. That is a very high paying job with opportunities by the bushel. It is also only about a two year program. That is a very clear cut opportunity to become a high paying member of the healthcare field actually taking care of the public with job stability, as opposed to a huge investment in a financial burden. That is what a sane investment in professional education looks like to me.

        The repetitive roster of individuals benefitting from this scam, including all individuals involved in these private scam schools, live off of an unethical fraud machine that uses students as conduits for the capture of student loan money. That includes anyone’s favorite teacher at scam school.

        The monopoly control of the entrance to the practice of Asian medicine by the private ACAOM schools makes this practice a special study in rent seeking. This closed system of non-transferable classes makes this system an incredible debt trap coercing students through the power of sunk costs. These schools are without real standards because students are without real options. My experience proved that the ACAOM will stand behind a school that is a total unethical mess without any standards. And the state Boards of Higher Education won’t take any action.

        What do you call a group of people who are good strategists and have discovered a way to get what they want by exploiting the weaknesses in the protections surrounding the individuals from whom they get what they want? Predators. The acupuncture establishment is predatory. For-profit education predators are a trending thing right now if you haven’t noticed. Do you notice a particularly smarmy, manipulative character in certain persons who’s names keep showing up in “leadership” positions in the acu-world?

        The messed up psychology of acupuncture makes quite a bit of sense when you realize it is a culture of financial and psychological manipulation. I see predation of the young by their elders, of the inexperienced by the experienced, and of students by schools. I see Stockholm syndrome, personal connections, and making a living have kept acupuncturists from stopping the schools. So I think it’s high time to warn the public at large.

        • I do want to say that what you describe does not appeal to all schools equally. I’m not sure the non-profit/for-profit distinction is the most relevant one. And, I some programs to offer a quality education and a more realistic picture of what the future is likely to hold for their graduates.

          I was also going to point to PA programs in a compare and contrast. That being said, the work environment of the PA, and their perspective on health and healing, and the way they interact with their patients is far different from most who are drawn to the world of acupuncture. One of the reasons I chose acupuncture over becoming a Certified Nurse Midwife because, 20+ years ago, CNM’s worked under the closed supervision and control of MD’s, and that was not appealing to me. I also wanted to treat without the hot breath of the insurance companies on my neck. Though the acupuncture community seems set on that warming oversight, many of us still have greater opportunities to interact with our patients directly and without interference.

          I wouldn’t even be that concerned with the lack of transferability of acupuncture school credits if 1) schools were very clear about this with prospective students, 2) schools were very clear about the (lack of) employment options for recent grads (someone in my area is offering a six month unpaid internship) and expected time to profitablity of new practices, and better business training, and 3) there were standards of licensure so that graduates of acupuncture programs would be able to practice in every state.

          I see more variation in the world of acupuncture education than you do, but that doesn’t mean you aren’t raising important issues.

          • When we consider our friends and the institutions with which we involve ourselves; we see exceptionally good things in general. However, this is the very essence of exceptionalism. It is based on the fantasy of us and them, . . . or the US and them depending on what fantasy world is being projected.

            The behavior of actors in a market is determined by incentives and regulated by laws. The fraud which characterizes financial markets currently shows brazen regulatory capture and the incentivization of fraud inside businesses. Instead of going to jail, the largest fraudsters all get compensation packages worth huge amounts. The reason that these markets do not change is that the regulations continue to be absurdly weak and fraud continues to make it rain.

            This is the same reason for the massive fraud in the for-profit education industry. The rules and their application, or lack thereof, determine the behavior in these businesses. Last year’s tough proposed regulations for student lending were defeated by a coalition of public and private lobbying afraid that the gravy train would halt. Remember ACAOM’s letter in defense of a total lack of responsibility for schools? The lack of ethics and the crazy behavior of instructors at my acupuncture school was not an accident. The fact that some unethical chiropractor who had been a worker’s compensation insurance company shill works at this kind of school is no accident.

            The government settlements with mega fraud actors in the education field are a fraction of the fraudulent earnings and a sliver of monies that companies were liable to pay under 3x damage requirements for false claims judgement. Additionally the scum are not required to admit guilt and students are left paying for fraud.

            The acupuncture schools are allowed to mint grads no matter what market conditions exist for acupincture. Student loan money goes to schools, student loan debt goes to students, and the educational product has no real regulator. In the face of more understanding that acupuncture school is a terrible investment the acupuncture schools rollout the first professional doctorate program, for another, what is it, $20k? Upcharge your mark, supersize your scam. That should be ACAOM’s new motto.

            Without real regulation, fraud is a certainty. The rent-seeking accreditation agency claims/admits/brags that they don’t police the schools. Only the fantasy of exceptionalism would make anyone believe that acupuncture schools would police themselves.

  2. What you are talking about is true Elaine. There are deeper roots to the problem though. Modern U.S. Acupuncturists want to be part of the decaying U.S. medical system where their predecessors before them like MDs had a good long run in insurance and selling high-cost and high profit margin procedures or programs, but are now getting savaged by the corporate interests they sold out to. The MDs have recently banded together to form practice groups in order to lower costs and attempt to preserve their levels of income and lifestyles. This is a slippery slope if you consider that starting income for a new Md has not risen since 1985. They are fighting a losing battle as corporations continue to relegate MDs to employee status. So the U.S. Acupuncturist also wants to jump over this cliff maybe in hopes that like the MD the first ones to jump are the ones to profit. So therein lies the problem, we have taken an excellent therapeutic modality that excels at treating chronic disease and are trying to make it into a means to pursue a lifestyle that will make us mimic our MD counterparts while we really should be using our skills to treat the greater population that cannot affords high fees and costly programs. We should not be holding our skill set ransom for higher fees as many acupuncturists do. This hurts the practitioner and the client/patient. We should be making our services affordable to all and in that way we will not only earn a decent income, but have steady businesses and elevated social status as well in response to our service provided. Who knows, maybe one of us will get elected to public office and be able to serve on health committees? Just a thought.

    • Yes, there are many other mindsets that underlie our current predicament. Acupuncture Exceptionalism doesn’t even fully address the ways in which we are Hypocrites with Double Standards. It’s just a piece of the puzzle.

      (The results of having an LAc in public office would depend a lot on the particular LAc!)

  3. You’re wikipedia citation on American exceptionalism offends me and shows how the hatred on the left has corrupted our nations character which is typical of the left.

    American exceptionalism has nothing to do with anything but freedom and liberty.
    American exceptionalism does not mean that we’re better, special, more qualified, smarter people – none of that. It’s not about bragging rights – that’s such a narrow-minded view.

    Our policies are not what make us exceptional. It’s about our founding which is the basis for those policies where you’ll find the exceptionalism. Yes there were problems just like any other country but the exception is in where the power comes from – by, for and of the people. People left Europe to escape tyranny. For the first time in human history, a government and country was founded on the belief that leaders serve the population. This was the EXCEPTION that made us exceptional! American Exceptionalism.

    The US, for the first time in the history of the world, created a government organized with a Constitution laying out the rules, that the individual are supreme and dominant, and that is what led to the US becoming the greatest country ever because it unleashed people to be the best they could be. Nothing like it had ever happened. That’s American exceptionalism.

    As for the rest of the article I get your point but your analogy with American Exceptionalism is just wrong.

    • Chris —

      I’ll go ahead and approve the comment since I moderate only for spam, for personal attacks, or for factually incorrect content. This comment is taking us off on a tangent, though, and it’s not a path I really want to spend much time on.

      So I’ll just say that there has already been a huge amount written about the myth (http://foreignpolicy.com/2011/10/11/the-myth-of-american-exceptionalism/) or reality or meaning of American Exceptionalism elsewhere. I don’t see that anything that’s been written has done much to change the opinions of the folks who have an opinion. I think the critical issue is whether acting from the “American Exceptionalism” worldview is helping or hindering the US in its relationships with other countries. My belief is that it is hindering us. You may disagree, but I’m not sure you have the perspective to make the determination that I’m wrong.

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