Herbal Regulation and the Acupuncture Profession – A Better Way.

We’ve got competition. PT’s, MD’s, and DC’s are excited about filiform needles and LAcs are freaking out.

While our energy has been focused on that competition (our training and skills are superior, right?) we haven’t been paying attention to increasing restrictions on our ability to practice the fullness of our medicine. Adding insult to injury, the restrictions on practice are “coming from inside the house.”

I’m talking about restrictions on our use of herbs.

Yes, herbal medicine is powerful and complex and carries both potential risk and potential benefit. Yes, it takes many thousands of hours to come close to mastery of this branch of our medicine. Yes, people have been harmed by the improper use of herbs and supplements. And, yes, at some point the damage done by the misuse of herbs may result in stricter regulation. We may indeed lose access to more herbs.

It’s good that we want to be proactive, protecting the public and the profession from harm. It’s not so good if our actions don’t have the desired result. And not good at all if our actions increase risk to the public and the profession.

Let’s consider the terrain —

  • What portion of harm from herbs/supplements is the result of poor practice by Acupuncturists?
  • What portion of harm from herbs is from the use of raw herbs, what portion is from pre-made herbal formulas?
  • Does preventing certain LAcs from recommending herbs or supplements limit public access to these products?
  • Is the average LAc, even without herbal training, likely to have a positive or negative impact on client’s proper use of herbs and supplements?
  • Which are better tailored to the individualized treatment that is a hallmark of Chinese Medicine — pre-made/patent formulas or raw herbs?
  • Which are more likely to be contaminated with banned substances or prescription medicine – patent formulas or raw herbs?
  • Is it possible to draw a bright line between dietary therapy and herbal therapy?
  • Does limiting LAc recommendation of herbs interfere with the ability of other health care providers or salespeople to recommend or sell herbs or supplements?

See where I am going with this?

Anyone can get Chinese herbs, even dangerous ones. Increasing the regulatory burden on Acupuncturists would make sense if it would protect the public or our access to the full pharmacopoeia on an ongoing basis. It would make sense if LAcs were routinely endangering the public through unregulated use of herbs.

It doesn’t make sense for a subset of our profession to become the only group of health professionals not able to recommend herbs to their clients.

If the only groups weighing in are the schools and NCCAOM, formal (and expensive) training and credentialing will be increasingly required.

Let’s stand united against unnecessary restrictions. LAcs have an excellent safety record. Stay tuned for real-time developments and your opportunity to weigh in on the regulation of herbal medicine for Acupuncturists.

 

How we Grow – The Acupuncture Profession in 2015

One Physician per 371 non-institutionalized civilians was the US average in 2012.

One Acupuncturist per 20,000 non-institutionalized civilians was the US average in 2014.

NCCAOM’s 2014 Annual Report is an important read for anyone who cares about Acupuncture in the US. From it we learn:

  • Applications for certifications dropped from 1744 in 2013 to 1494 in 2014.
  • The number of new certifications dropped from 1144 in 2013 to 972 in 2014.
  • 532 of those new certifications were in Oriental Medicine. Another 16 were for Chinese Herbology (likely existing LAcs choosing or being required to add the Herb certification).

I don’t know how many practitioners are leaving the profession, but many of my peers who were licensed 20+ years ago are stepping back from active practice.

Several current initiatives, including HR 3849 and state-level efforts to mandate insurance coverage of acupuncture would increase demand for acupuncture. (There are 49,435,610 Medicare beneficiaries in the US and 5.5 million Gulf War Vets.) If fully trained Acupuncturists aren’t able to meet the demand, who will provide those services?

At this rate, how long will it take to grow the profession to even one Acupuncturist per 2000 people?

Shouldn’t we focus on that?

I’m baffled. We’ve sued, signed petitions, and marched in the street, all to try to stop the “greatest threat to our profession” – other professions wanting to use the acupuncture needle.

But there’s been silence, or even approval, when Florida (with one DOM for every 17,760 people) changed their regulations in 2014 to require all 4 NCCAOM exams for licensure. Ditto in NJ where new practitioners will need the NCCAOM herb exam to use herbs in their practice. (How many citizens had been harmed by use of herbs by practitioners without the herbal credential? Was regulation needed?) In Nevada (approximately 1 Acupuncturist for every 47,000 citizens) the Board of Oriental Medicine is moving to require a DAOM of all licensees. Meanwhile, many insurance plans are limiting their provider pool to those with active NCCAOM certification, even in states that don’t require that credential. (After all, the vision of the NCCAOM is that “Acupuncture and Oriental medicine provided by NCCAOM credentialed practitioners [emphasis mine] will be integral to healthcare….”)

If we want the public to obtain services from well-trained Acupuncturists we need to make sure providers are available. One thousand new practitioners a year and growing self-inflicted restrictions on where and how we can practice aren’t going to do it.

The greatest threat to our future is an Acupuncture workforce insufficient to meet demand or effectively advocate for ourselves. Allowing or supporting credential creep, educational bloat, and practice restrictions are sowing the seeds of our demise.

Can we please focus on growing our profession?

 

Demographic Information From:

Acupuncture Today Density Map

Physician Data

Population Data

Medicare Data

Veteran Data

November ’15 Acupuncture News Update, Chapter 1

It isn’t easy keeping up with Acupuncture News. Now and then a “clear the decks” post (or two, or three) is needed. Here goes:

HR 3849: Representative Judy Chu (CA) introduced “The Heroes and Seniors Act ” which would add acupuncturist services to Medicare and would increase the availability of acupuncture to members of the military and Veterans. The bill has a long list of endorsing organizations. Supporters should share their analysis of what would happen in the twenty states with fewer than 100 LAcs*. In a business with competitors, creating demand for a service without the ability to provide it is a bad move.  I’d be more worried if I didn’t agree with govtrack.us – there is a 0% chance of the bill being enacted.

Dry Needling: In late September the North Carolina Acupuncture Licensing Board filed a complaint in the General Court of Justice against the North Carolina Board of Physical Therapy Examiners, asking the court, among other things, to declare dry needling the unlawful practice of acupuncture. In early October the North Carolina Board of Physical Therapy filed their counter suit in US District Court seeking triple damages for the NCALB’s illegal and anticompetitive acts. Not surprisingly the same LAcs who cheered on the NCALB suit were outraged that the NCPTE would return fire. Given the SCOTUS ruling from this past year I believe the acupuncture community is in a risky place. If the PT’s prevail it will be a game changer nationwide. Did the AG’s office (which had previously ruled that Dry Needling could be within PT scope) advise the NCALB on their complaint? Are all North Carolina Licensees picking up the legal tab for what looks like outside counsel?

In other news the acupuncture community has been touting the revised AAMA Policy on Dry Needling. The Middle Eastern saying “The enemy of my enemy is my friend” comes to mind. It’s a strategy that can win battles, and can create more of them. I don’t think of Medical Acupuncturists or PT’s as enemies. I do remember our insistence that the 200 (or 300?) hour training of the MD Acupuncturists is insufficient. And I wonder whether the PT’s could increase their training to 200 (or 300?) hours and then argue that all of acupuncture is open to them.

Nevada: The minutes of the November 5th Nevada Board of Oriental Medicine haven’t yet been posted, but I understand from attendees that the Board is planning to hire legal counsel, the cost of which will fall on existing licensees. Why does the Board need to hire legal counsel? Because they continue to pursue actions that go against existing code and legislation, rejecting the counsel of the Attorney General’s office. The news from Nevada is a reminder that having an independent acupuncture board isn’t necessarily great for the public or the profession.

Looks like there will be at least one more “Clear the Decks” post. Coming soon  – news about: acupuncture and insurance, NCCAOM’s annual report and more, ACAOM’s hot news, regulation in the District of Columbia, Lamar Odom and the future of herbal regulation, and what’s happening in the AAAOM.

 

* I use LAc to refer to all professionals holding the proper government license to provide primarily acupuncture and TCM services. Having no clear way to refer to, define, or describe this group of individuals is representative of our challenges!

Acupuncture Licensing and Regulation – The Future

Imagine that your acupuncture license meant you could easily practice in every state.

Imagine that licensure exams focused on the skills and knowledge needed to practice safely.

Imagine that acupuncture schools used the time spent teaching things “you won’t need in practice but they’ll be on the exam” to teach things that you really will need in practice, including all that business stuff.

Imagine that acupuncture boards, associations, and organizations worked to make it easier and less expensive for practitioners to obtain and maintain licenses and practice within their skill set.

I wish I could say “it’s easy if you try” – but for most of us it isn’t. (Unless you look to other professions.)

The Florida Acupuncture Board now requires all new practitioners to spend thousands of hours and tens of thousands of dollars on additional education and testing to become Board-certified in herbs. Even though there was no evidence of public harm under the previous rules, and even for those who won’t use herbs in practice.

The Nevada Board is trying to change the regulations to require a DOM or DAOM of all applicants (about 40K on top of an 80K MAOM). Not because there is evidence of public harm, but because that’s the way it is in China. And never mind that the entire state is served by fewer than 50 acupuncturists.

In July 2015 the White House released Occupational Licensing: A Framework for Policymakers. While acknowledging that licensing can provide health and safety protections to consumers and benefits to workers, it concludes,

“State legislators and policymakers should adopt institutional reforms that promote a more careful and individualized approach to occupational regulation that takes into account its costs and benefits, and harmonizes requirements across States. If they are successful, the collective effect of their efforts could be substantial: making it easier for qualified workers to find jobs and move where they choose, increasing access to essential goods and services, and lessening heavy burdens on certain populations….”

Acupuncturists are the policymakers in our profession. Wouldn’t it be great to determine what’s truly needed for public safety and to adjust educational and licensing requirements accordingly? Rather than blaming others for our difficulties, wouldn’t it be more productive to direct our energy to changing the things we can control? We can demand that the insurance companies pay us more because our education cost so much, or we can make our education less costly. We can sue the PT Boards to try and protect our turf, or we can make sure that anyone who wants acupuncture is able to access convenient and affordable services from an acupuncturist.

I’ll be sharing actions you can take to change our practice environment for the better. Like the Acupuncture Regulation US page on Facebook and stay tuned in here, at The Acupuncture Observer, for updates.

 

 

 

NCCAOM Code of Ethics & Grounds for Professional Discipline, Part II

The NCCAOM’s call for comments on the Code of Ethics and Grounds for Professional Discipline ends September 12, 2015 .We owe it to ourselves and our profession to share our thoughts with them.

Here’s what I’ll tell them —

Dear NCCAOM,

Thank you for the opportunity to comment on the Code of Ethics and Grounds for Professional Discipline. My significant concerns with these documents can be traced to three overarching issues —

  1. The NCCAOM credential is required to maintain state licensure for many acupuncturists. You advocate for this arrangement. Yet the current Code of Ethics is more suitable for a voluntary exceptional standard adopted by choice.
  2. States that require NCCAOM credentials have their own regulatory boards, ethical codes, and disciplinary process. The NCCAOM Grounds for Professional Discipline empowers you to pull a practitioner’s credential, removing them from practice, even when a state board would allow continued practice for the same violation. This turns the NCCAOM into de facto regulators and creates double jeopardy for practitioners.
  3. The NCCAOM reserves the right to take disciplinary action against any practitioner who violates the Code of Ethics. The Code covers behaviors ranging from serious threats to the public safety to those in the realm of Public Relations. The NCCAOM should explicitly limit the use of disciplinary action to violations that risk the public safety.

A few specific examples —

  • “Exceeding the scope of practice as defined by law or certification” is grounds for discipline. Scope is defined by the state, and may not be accurately determined by written language in code or regulation. Since state regulatory boards ultimately rule on whether or not a procedure is within scope, and since that board would determine proper discipline for any violation, no action from the NCCAOM is needed. References to scope should be removed from the NCCAOM document.
  • “I will continue to work to promote the highest standards of the profession” is listed in the Code. Must practitioners promote the FPD or DAOM, the addition of herbal exams to licensure requirements, and the expansion of the NCCAOM credential requirement to all states? Who determines the highest standard? This language is coercive at best.
  • The Code of Ethics requires credential holders to report peers who violate the Code. It is untenable to expect Diplomates to report every peer in violation of any aspect of this far-reaching code, and it is unfair to wield the power to hold us responsible for any failure to do so.

I support rigorous professional ethics and respect the NCCAOM’s intent to establish high standards for the benefit of our patients and our profession. However, your role for the profession is to validate entry-level competency. Much of the current Code of Ethics and Grounds for Professional Discipline goes far beyond this role. Continued overreach into areas best left to regulators and voluntary affiliations puts at risk the NCCAOM’s position as a credentialing organization.

Thank you for your consideration of these comments,

Elaine Wolf Komarow, L.Ac, Dipl. Ac. (NCCAOM)

Those of you who would like more background on the role of the NCCAOM in our profession should look at Part I of this post.  I encourage those who are interested in another viewpoint of the NCCAOM and its impact on the profession to review these comments and consider signing this petition.

NCCAOM Code of Ethics & Grounds for Professional Discipline

The NCCAOM is preparing to update the Code of Ethics and Grounds for Professional Discipline and is asking for input. Informed comment requires not only a review of the documents, but also an understanding of the role of the organization.

The path to become an MD in the US is straightforward. Go to college and medical school, sit the licensing exams, complete a residency, apply to a state regulatory board, and, if desired, obtain a board certification in a specialty.  (It is not necessary to be board certified to become a licensed medical doctor, and it is not possible to become an m.d. without successful completion of the licensing exams.)

When the NCCAOM (then the NCCA) was established in 1982 few states had formal licensure. Rigorous credentialing was thought necessary to gain acceptance by the medical establishment. Having a group supported by the profession to ease the regulatory burden on states regarding this new profession was also helpful. Some states weren’t (and still aren’t) at all interested in licensing acupuncturists. In those states, a formal credential to attest to an ongoing fitness to practice was appealing.

But conflict in the early days of the profession, both within the community and from the outside led to disparate paths to practice. There was disagreement about how to test and evaluate the huge knowledge base and varied traditions of the medicine, and how much power to give to any one group. Additionally, the political climate in the various jurisdictions differed greatly.

The NCCAOM‘s official role is to validate “entry-level competency in the practice of acupuncture and Oriental Medicine through professional certification.” But, the NCCAOM is really a chimera, a hybrid, due to the factors mentioned above. It has become a quasi-regulatory agency in some states, establishing practice standards and acting as a disciplinary agency. In other ways it is more like a specialty board — attesting to a particularly high level of qualification (but not exactly, since some states require NCCAOM certification for entry level practice). And, the ongoing weakness and dysfunction of the AAAOM (I’m still waiting on membership numbers, but the practitioner search function reveals the weakness) has led the NCCAOM to fill promotional needs and provide professional support, roles typically handled by professional organizations.

So, does the Code of Ethics and Grounds for Professional Discipline support the NCCAOM’s role of validating entry-level competence? Should it fill the role of a regulatory agency with control over whether or not individuals can obtain or maintain their license? Should it uphold a particularly high standard of practice, suitable for a selected subset of practitioners? Should it fulfill a PR need for the profession? These all need to be considered as we get ready to provide feedback to the NCCAOM.

The NCCAOM has requested input by September 12th.  In part II of this post, coming soon, I’ll share more background information and provide my own thoughts about the documents. I look forward to hearing what you think about the documents and encourage all of us to offer input by September 12th.

Acupuncture and Oriental Medicine in Nevada, What’s the Deal?

A regulatory board working against the best interests of the public and the profession  — it’s tragic, and it happens too often.

It has never been easy to become an acupuncturist in Nevada. Despite having the country’s first licensing law, passed in 1973, there are only about 50 individuals now practicing in Nevada, the 7th largest state.

It’s not only the $1,000.00 application fee, or the $1,000.00 practical exam fee. In the 2001 the press explored how Nevada’s unique rules caused problems for the profession.  The regulations may have changed, but similar issues remain.

Given the excellent safety record of practitioners licensed in states with less stringent educational requirements and via the widely accepted NCCAOM credential, it’s long overdue for the Nevada Board of Oriental Medicine to change their regulations, making it possible for the citizens of Nevada to get access to the safe and effective acupuncture and Oriental Medicine services that are available in so many other states.

The board is moving to update the regulations. To make it harder, not easier, to get a Nevada license. Not in response to harm to the public, not to bring the process in line with other states, but, because “the degree of MSAOM is odd and absurd.” Look for the “Justifications to amend,” on page 18 in this set of Nevada workshopdocs. You’ll shake your head.

The workshop docs show two sets of proposed revisions. The set dated June 16, 2014, was proposed by a previous Board, has made its way through the regulatory process, and could quickly be officially adopted after two more public meetings. However, the newly appointed Board members have decided not to act on those regulations, and have proposed new revisions. The lawyer in the Attorney General’s office isn’t quite sure what will happen now — it seems that “our” Board is unique in introducing a new set of revisions at this point in the process. (See ** below for more info on the Nevada Regulatory Process.)

The Nevada 2014 proposed regulations would have been somewhat problematic. The Nevada 2015 proposed regs would be a disaster. The reasonable aspects of the 2014 proposed regs are discarded and more restrictive provisions are introduced. The “grandfathering” provision, specifically excluding CEU’s from the 3000 hour requirement, takes away the one avenue for licensure available to most experienced practitioners. The insistence on a DOM or DAOM for all graduates after November 2017 is a significant financial burden for practitioners.

The proposed changes would slow access to and increase the expense of acupuncture in Nevada. They won’t help the schools meet those new gainful employment figures. The proposal dismisses the attempt (for better or worse) to defer to ACAOM for school accreditation, instead establishing an expensive and closely held accreditation process. A change which would allow applicants to sit the practical exam (offered only twice yearly) while their training and background is being vetted is discarded. The regs allow for an increase to $1,000.00 to the license renewal fee, rather than $500.00, and deletes a section on professional ethics from the current regulations. It’s hard to imagine that such awful regulations were written by our colleagues, not acupuncture-hating skeptics. Amazingly, the President of the Board certifies that, “having made a concerted effort” to determine the impact of these regulations on small businesses, there is none.  (See the workshop docs.)

My suggestions on what the profession could and should do in response to these regulations will come soon in a separate post. In the meantime, review the documents and consider how the changes would impact the profession Even those of us who don’t know a soul in Nevada and expect that we’d never practice there will see problems. At the moment, the LCB has not put these proposed revisions on the agenda.  Stay tuned.

 

** Nevada regulatory process —  the Legislature meets only every other year, for 120 days. Nevada law establishes a Legislative Commission, made up of 6 legislators from each house, that can approve regulations when the legislature is not in session. See more here, (generalize since this was written for a particular commission). Regulatory changes do not need to be approved by either the governor or the full legislature.

 

FPD/DAOM required, Schools, ANF, Dry Needling — and more Acupuncture News….

New news:

Word is that the Nevada acupuncture board is poised to require an FPD (or is it a DAOM?) for licensure, even though citizens there are already under-served. I’m trying to get more information. Stay tuned for updates. State actions that limit our profession tend to stay under the radar until it is too late.

The acupuncture school landscape is changing. Last week brought news that Bob Duggan and Dianne Connelly will no longer be part of MUIH faculty or staff. For those who have been paying attention as The Traditional Acupuncture Institute morphed into MUIH, it shouldn’t have been a surprise. But it is sad. While TAI had its good and its bad, many who attended did so because of Bob and Dianne’s contributions. The announcement was quickly followed by a letter, in perfect TAI-speak, that, for the sake of the students, we shouldn’t get caught up in stories about this. As in, don’t even ponder what it is we aren’t telling you.

This week also included the news that NESA is merging with MCPHS, and ACTCM is merging with CIIS.  (Thanks, Integrator Blog.) Is the age of the stand-alone acupuncture school coming to an end?

Have you heard of The Acupuncture Now Foundation? They aren’t a membership organization, and they don’t want to get involved in acupuncture-politics. They just want to educate the public about our training, our skills, and the great results from our medicine. Please, support ANF! Marketing the medicine shouldn’t have to be an individual effort.

Older News:

Developments in dry needling, with the hope that we might learn from history:

  • Louisiana joined other states with an AG opinion that dry needling is within scope for PT’s and DC’s. Other AG opinions can be seen here.
  • Tennessee’s Governor signed Legislation formally adding dry needling to scope for PT’s, joining Utah and Arizona which saw similar legislation in 2014.
  • The Maryland Acupuncture Society came out in strength behind HB 979 and SB 0580 that would have set limits for dry needling by PT’s and DC’s. The bills went nowhere, perhaps a blessing in disguise as “success” would have opened a can of worms.  (The bills did not define dry needling, MAS support put the acupuncture community’s stamp of approval on a 200 hour standard for acupuncture training that had been previously unacceptable, and the wording opened the door for PT’s with 200 hours of training to argue that they were now, indeed, doing acupuncture.)

The AAAOM website has been updated with board bios and a revamped committee list, but still no answers for any of my sixteen questions for the AAAOM.

ACAOM responded to the petition in response to their Gainful Employment letter in the ACAOM Fall Newsletter.  The good news — they heard us. The bad news, they continue to believe that significant student debt is helpful for those who want to serve low-income communities.

There you have it, at least some of the news you aren’t seeing in Acupuncture Today.

 

It was Twenty Years Ago Today

….. that I was granted my Virginia Acupuncture License (#4). I’d been licensed in Maryland for a few months, but the Virginia License was special. Throughout my years of acupuncture school I’d been involved with the Acupuncture Society of Virginia, working to establish a practice act. We were finally successful in 1994, and my documents were ready and waiting when the regulations were promulgated.

I’m happy I found this wonderful medicine when I did. I feel lucky to be doing this work, and look forward to continuing to practice for decades to come. And yet, these days, I’m mostly sad about the acupuncture profession.

Back in the day, when only MD’s could do acupuncture in Virginia, we argued that the public should have the right and the ability to choose their provider.

We discussed how our medicine could treat the whole person, and that treatments were uniquely tailored to the individual.  We didn’t see patients as a collection of ailments, to be sent from one specialist to the next.

We talked about the good value of our medicine and our belief that it could reduce health care spending.

We got used to the medicine being dismissed by the medical establishment, but held out hope that, some day, they would see the value of what we did.

We knew that this medicine would require lifelong study and learning, but experience told us that about 1500 hours of training was sufficient to produce competent practitioners.

We were happy when we were finally able to receive student loans to attend acupuncture school.

We had concerns about relying on one standardized exam as a precursor to licensure, especially one that was based primarily on one tradition. But we knew that it would relieve some of the burden on the states, and so might help with national acceptance.

It was a time of promise.

Now, my Facebook feed is full of rants — we’ve now decided that, just as the MD’s wanted to protect the public from us, we now must protect the public from the PT’s.

Rather than celebrating the professionals who see the value in this medicine and want to offer it to their clients, we scream that they are stealing our medicine and must be stopped.

We’ve justified our increasing fees (after all, if the MD’s deserve it, we deserve it), and, then chased the insurance dollar so that our patients can afford our services. We’ve adopted the billing games that come along with that, fudging fees, adding services, figuring out what diagnoses to use to get reimbursement, and expressing outrage when we’re called on our behavior. Some of us have gone so far as to attack those who have designed a system to make acupuncture truly affordable to the majority of the population.

We decided that more education would get us more respect, and so increased and increased, and increased again the hours required for entering the profession.  The number and complexity and cost of the exams increased. In a solution to a problem that didn’t exist, practitioners in some states decided an acupuncture education was not enough.  Acupuncturists now must also learn and be tested on herbal medicine, whether they want to use it or not. Various states added additional requirements, so any relocation runs the risk of shutting a practitioner out of the profession. The student loans we celebrated enabled schools to ignore the disconnect between the cost of the education and the likely income of graduates.

I could go on. I won’t.

Shaking my head at the missteps we’ve made, I comfort myself with the confidence that the medicine will survive, even if the profession won’t. Happy Anniversary.

 

 

 

More on Acupuncture Education

The for-profit schools don’t want to take responsibility for the circumstances of their graduates. And they won’t let the new gainful employment regulations go into effect without a fight.  Within days of the posting they filed suit to block the regulations. They did the same thing when similar regulations were announced in 2012, so I expect the DOE wrote the new regulations carefully to withstand an expected legal challenge.

However, with a pro-business and anti-regulation majority in the House and Senate as a result of last week’s election, even regulations found to be legal might not be enforced.  If the funds to track compliance aren’t in the budget, for instance, enforcement can’t happen.

Of course, if the schools and alphabets were committed to doing the right thing — producing the best possible graduates at the lowest possible cost to the students, regulations wouldn’t be needed, and wouldn’t threaten the schools even if they were adopted. I don’t expect that commitment from large businesses like Corinthian. I wish I could expect it from acupuncture schools. But most acupuncture schools seem to have little interest in what happens to their grads, and continue to present an unrealistic picture of life after graduation to potential students.

We’ve gotten to the point where even prominent conservatives acknowledge that the current system is a “bad deal for students and parents” and at least some are advocating for change. And it’s true that regulations, however carefully written, often have unintended negative consequences. All too often the well-off and powerful find ways to exploit loopholes and other tricks to avoid regulation, while smaller businesses find themselves significantly disadvantaged. (Consider what happened with the organic label.)

If the schools were on the hook for the money students borrowed no doubt things would be a lot different — from materials provided to prospective students, to the admissions process, to the education provided, to alumni support.

I don’t expect that will happen. And with the change in the political picture here in the US, who knows what will happen with the gainful employment regulations. For now, all acupuncturists can help the market work by helping prospective acupuncturists look past the pitch. Anyone entering the profession should do so with eyes wide open.

(Read this for more on how the November elections will impact the future of acupuncture and complementary medicine in the US.)