Tag Archives: mutual respect

P.S.

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I apologize for two posts in less than 12 hours.  I knew I shouldn’t have been working until 11:00 last night .  I accidentally published a draft of the Mine! post. Subscribers, please visit the site for the correct version of the post.

In the meantime, this morning I had a chance to review yesterday’s Health & Science section in The Washington Post and came across this article on myofascial pain.  I suppose I could get my knickers in a twist that the author finds relief from dry needling done by an MD, maybe even posting a comment about how she was putting life and limb in danger by seeing someone other than an LAc for this procedure.  Instead, I’m happy that she got relief. And, to be honest, I’m doubtful that my acupuncture training and experience taught me what I would have needed to know to give this particular patient that relief she’s found.

It’s Not Fair!!!

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A Virginia colleague asked – “How is it that Chiropractors can do acupuncture and LAcs cannot do manipulations?”

Exploring why things are the way they are (here in Virginia, anyway) might help us move beyond the usual “we’re getting the short end of the stick again” attitude and could teach useful lessons about how the system works.

1)     How is it that DC’s can do acupuncture?

DCs, MDs, and DOs were doing acupuncture in Virginia, without incident, prior to licensure for LAcs. You can imagine the strong opposition that would have arisen from that powerful lobby if, despite our position that acupuncture was safe and effective, we now attempted to pass legislation that would have removed this technique from their scope. The role of regulation is to protect the public from danger, not ensure that people are limited to the “best” care. When the Dieticians introduce licensure legislation in Virginia (not yet successfully) – the Advisory Board on Acupuncture indicates that support of the Acupuncture community depends upon the LAcs retaining the ability to make dietary recommendations. The Dieticians might think our training in this area is grossly insufficient, but we can show a history of safe practice, and the state has no compelling reason to choose a winner and loser among professions in this case.

2)     Why can’t LAcs do manipulations?

The Virginia legislation specifically rules out PT, Chiropractic, and Osteopathic manipulations.  Since acupuncture training does not typically include Osteopathic, Chiropractic or PT adjustments, and since our exams don’t test knowledge of these techniques, it would have been difficult to counter the arguments of the existing providers that this should be excluded from our scope.  When the ND’s introduce legislation for licensure (so far unsuccessfully and not fully supported even within the ND community) the Advisory Board on Acupuncture always reports that support is dependent on language that would specifically exclude acupuncture from the ND scope.

If a Licensed Acupuncturist could show evidence of education in Tui Na manipulation techniques, included the technique in their informed consent, and was careful with insurance coding it would probably be acceptable.  A few years ago I would have suggested that a formal request be made to the Advisory Board to explore whether Tui Na manipulations were within scope. The board could have explored the issue and developed recommendations regarding education and documentation that would have put practitioners on solid ground.  However, our profession’s recent behavior regarding the PT Board’s similar discussions on TPDN have given our fellow health care providers many arguments they might be itching to throw back in our direction. You might want to check out Scope and Dry Needling for more background. This is probably not the best timing for requesting a formal ruling.

 

More Cross-Pollination

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Once again, here is some writing I did for one of my listserve groups. This is in response to a conversation about the proper translation of jingmai from the Huang Di Nei Jing.

I’ve been hesitant to participate in this dialogue. I am not a Sinologist or deeply familiar with the Chinese Classics. Furthermore, my past experience with these sorts of debates is that at the conclusion we are all likely to feel further justified that we are right and everyone else is an idiot.  It isn’t all that unusual for these debates to devolve into personal attacks. The early comment in this thread regarding “their emotional but ungrounded negative responses” put the brakes on my initial desire to participate.

However, Matt’s inquiry re. the thread subject “Use of the concept of Meridians has Crippled the promotion of Acupuncture in the West” touches on issues that are near and dear to me.  Combined with his hope that others would get involved, I am finally going to offer a contribution.

Regarding the thesis that the term jingmai in the HDNJ was the blood vessels, again, this is not an area in which I have the expertise to come to a conclusion. Personally, I’d want to find out what Elizabeth Rochat and Heiner Fruehauf had to say on the matter. They are my personal experts when it comes to the Classics, the Chinese of the Classics, and a deep knowledge of Chinese Medicine itself. In Heiner’s case he also works and studies with practitioners with long unbroken lineages going back many generations.

From my initial training as a cultural anthropologist, I’d caution against the belief that there could be any direct one-to-one translation from a Classical Chinese term to the current use of Western anatomical term. Not only are we dealing with different languages, but different language families and different cultures.  I think Matt Bauer’s posts and writings addressed this.

My rudimentary knowledge of the Classics, along with my somewhat more developed experience as a practitioner, along with a quick read of even the most recent articles and our own conversations about mechanism of action make it seem unlikely that any practitioner or scholar of the past or present would think that when we are talking about the effective pathways of acupuncture that we mean the blood and blood vessels.

I don’t know what the myth of the Meridians is, exactly.  Can one of you explain? It seems like we have something of a straw man (or red herring?) here. Much of this conversation centers on dismissing a myth that none of you have described. Certainly I don’t know of any LAcs who refuse to accept any sort of modern scientific theory. I do know many LAcs who are, I believe, appropriately skeptical that the latest study or current understanding of how the body works is the total and complete truth.  Within my years of practice probiotics have gone from something that the western establishment dismissed with an eye roll to something they prescribe, and the appendix has gone from a worse than useless evolutionary vestige to a structure that may have important roles in the immune system and maintaining gut flora, to give only two examples.

Given the ever-evolving understanding of physiology and appreciation for the limits of what we currently know, along with the knowledge that the effect of acupuncture cannot be fully explained by blood vessels, I can’t see how insisting that the jingmai are blood vessels would serve the profession at all. Wouldn’t it be far more helpful to explore our languaging of the Meridians, making sure that all practitioners could describe their complexity, rather than substituting a term that doesn’t address that complexity? I fear using the term blood vessels would only further confuse the establishment.

As for what is behind the crippled promotion of acupuncture in West, is it crippled? Just this week I received an email Can Acupuncture Relieve Your Pain from WebMD, various emails about PT’s, MD’s, and others who are trying to “steal” our medicine, a notice of a job opening from one of the three acupuncture schools (of questionable quality) that have opened within 10 miles of my office, numerous requests for referrals for LAcs around the country, links to three different studies looking at acupuncture efficacy and mechanism of action, and news that POCA clinics did over 600,000 treatments in 2012 .  I also began treating an MD, and had several new clients referred to me by their MD’s, DC’s, or other providers. Overall, I’d have to say that Acupuncture is doing pretty damn well for itself in the West.

The promotion of the “profession”, though, that is a different question entirely. The debate over terminology does point to what I believe is the crux of the dysfunction within the profession.  When it comes to the risk/benefit analysis of accommodating ourselves to the trappings of the western medical establishment, most of us have strong feelings, and are rarely consistent about them even on a personal level, never mind across professional communities. Combine that conflict with the lack of trust, connection, mutual respect, and the venue necessary for exploring these issues in a productive way and the profession itself is certainly limping.