Culture and Access…. and, a loss.

A colleague recently posted a question related to a book of acupuncture case studies from China — “I was wondering if anyone could provide some insight into why the book lists only a handful of points used in their treatments and why the practitioners I’ve seen from China use many many more?  Does anyone have the back story of this book? …. 

 They also consider one course of treatment: 10-15 treatment daily with 2-3 days off. 

 In one of the cases they listed 30 daily treatments until some improvement was noticed…i find that amazing!  Here in the US if there’s no change in 5-8 treatments they’re done.   

 Thanks in advance for any insight….”

An expanded and edited version of my reply —

I believe the 5-8 treatment paradigm is relatively recent, somewhat local, and at least somewhat related to matters of time and money. Treatments multiple times/week for several weeks at the start of treatment is not unusual in China or the Asian community in the U.S.

Regarding factors other than time and money — because 5 Element acupuncture typically focuses on constitutional issues the idea of allowing time for the treatment to “ripple” through the system makes sense. Also, a 5 E appointment can be similar in structure to a therapy appointment, with time spent talking about feelings and emotions, for example. The population our U.S. predecessors were working with was familiar with that structure, so it made sense to present acupuncture in a similar way.

Still, issues of access shouldn’t be ignored – 30 visits at $80.00 is $2,400, so if someone has no experience with this medicine (or even if they do) that’s a big commitment, and more than many people can afford.  (Even if the cost is shared between a client and a third party payer, the same bottom line will be a factor.) Any study exploring the cost effectiveness of acupuncture is obviously impacted by the number of treatments given and the cost of each treatment — it is easier to show cost effectiveness after ten treatments than after thirty.

One of the things I like about my sliding scale is that if people do need to come more frequently, or come weekly on an ongoing basis, it is easier for them to do so.  Many practitioners who have gone from conventional private practice to community acupuncture find that more people come more frequently in the early weeks of treatment and report that patients make faster and more consistent progress.

Another consideration is the “time cost.” Many of my patients couldn’t manage to get to my office 2-3 times a week even if they wanted to and could afford to. I have limited evening hours and no weekend hours, traffic in this area is horrible, and most clients are already over-committed and over-scheduled. A clinic close to a metro station with drop-in hours and/or lots of early mornings or late evenings would make it possible for more clients to get treatment more frequently.

As for the number of points used – I have not yet seen studies comparing treatment protocols.  Miriam Lee wrote that a very limited number of points could help in most cases.  As more insurance companies start covering acupuncture it will be interesting to see if the data shows that more units of acupuncture per visit equals better results.

I’m not an acupuncture historian or scholar — just sharing my thoughts.  We should consider how much of how we practice is determined by the culture of our schools and communities. The results of greater data collection and the emphasis on EBM (evidence based medicine) could rock our world.

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And, a loss in the community —

I just saw the very sad news that Al Stone died.  I never met him, but I did have the privilege of working with him a bit over the years, and that was always a pleasure.  Al developed acupuncture.com back in the early days of the internet (and later sold it) and was also the creator of gancao.net.  It is a big loss to the community that he’s gone.

Thankful that he was.

Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2017. 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.