The First in a Recurring Feature —
As I was leaving an Acupuncture Advisory Board meeting I had a brief discussion with a Medical Acupuncturist (an MD who does acupuncture) who had attended the meeting as an observer. It left me pondering one of the “truths” trotted out whenever acupuncturists talk about non-LAcs using acupuncture (and even sometimes when folks from one acupuncture lineage talk about a different tradition) – that treatment from “one of those” practitioners might reduce pain and symptoms and the patient might feel better, but, because the underlying imbalance wouldn’t be treated, the patient would be harmed.
I’ve heard it said about PT’s doing dry needling, and in the past I’ve said it myself about Medical Acupuncturists. In the conversation I was having, the Medical Acupuncturist said he had concerns with patients going to LAc’s if they hadn’t first been seen by an MD. After all, he said, in what I’m sure he thought was a respectful and honoring way, you guys are SO GOOD at treating pain, you could mask an underlying serious condition.
I set aside my immediate desire to respond, hey, that’s what we say about you because your acupuncture training is so pathetic (yes, old habits die hard). I tucked away for future action my shame that after all these years we LAcs haven’t done a better job educating and connecting with the MD’s who respect and use our medicine. (No doubt they have much to teach us about things like participating in Medicare and could be allies in some of our political work.) And I have continued to ponder this idea that acupuncture, done by anyone, could really treat symptoms well while leaving a festering problem untouched. Can this happen? Does it? I mean sure, maybe for a week or two, but isn’t one of the underlying teachings of our paradigm that if we don’t treat the underlying imbalance the problem will continue to reveal itself?
I’ve begun to think that this belief is nothing more than a Sacred Cow. What do you think? I don’t need to hear about MD’s missing medical diagnoses, or about the harm done by western treatments. I’m looking for the specifics in which acupuncture treatments relieved symptoms but did not address the underlying imbalance, thereby doing harm.
Hi Elaine – I have been so busy with my site’s Forum that I have been slow to check-in with your work. Great topic. One of the many (maybe too many?) missions I have been on is trying to get acupuncturists to see the simple fact that acupuncture works by helping the body to better use its own resources. I believe understanding this one simple fact answers most every question people have about acupuncture including this issue of if it will “mask” more serious “ticking time-bomb” disorders. It doesn’t and the idea that since it is so good with pain it might mask underlying pathologies is common with medical doctors because modern medicine is all about trying to fix problems from the outside-in like a mechanic fixing a machine. They just can’t begin to see that acupuncture takes a very different approach by helping the body to help itself and we in the AOM field don’t do ourselves any favors by not being clear on this in our own minds. Maybe this is a topic you would like to explore? Since acupuncture works by helping the body to better heal/manage itself, it won’t make any significant progress in reducing pain unless it is helping the cause of the pain. In fact, acupuncture can be a great way to better determine if someone needs the mechanical fix of modern medicine.
I see hundreds of low back patients a year many sent from a major HMO pain management department who have been seen by their PCP and a Physical Medicine Doctor with all their tests. Some of these patients require surgery but the doctors aren’t able to distinguish those who do from those who don’t. I can tell this from a short round of acupuncture treatments based on the way they respond or don’t respond. I then find myself in the strange position of advocating a patient have surgery when the doctors want to keep waiting! By the way – patients who actually need low back surgery usually recover well. The poor success rate of lumbar surgery is mostly because many who had it did not require it and the surgery was done on something not causing the problem. And that leads to the second problem with the idea that patients should be seen by an M.D. before seeing an acupuncturist to “rule out” more serious underlying disorder: the false idea that physicians are good at accurate diagnosis. I have seen many patients over the years that were not correctly diagnosed by their doctors, including a few cases of serious cancers that were missed by some of the most prestigious cancer centers in Southern California! I wish it were true that physicians could be counted on to always catch serious underlying problems. If that were true, I might support a policy of patients being screened by M.D.s. first. But when they are seeing 8-10 patients an hour and often unable to run the tests they want, I don’t see that as helpful at all. I had to learn the hard way to not assume that just because a patient had been seen by medical doctors that did not rule-out serious underlying problems.
Thanks for your input Matt. I’m primarily interested in how this belief impacts us strategically. And, because it’s easier to change our own beliefs than to change what others believe, I’m really looking at how we use it against other professionals (like PT’s or DC’s or MD’s). If we do hold on to it as a true thing, then it isn’t a surprise that it is used against us as well. I think “the profession” will have a hard time letting go of this belief because they depend upon it as an argument to support their desired monopoly on the acupuncture needle. Though, of course, they are deeply offended when it is used against us by the MD’s. No doubt being willing to admit that this masking of conditions doesn’t really happen would allow for an honest conversation between various groups of providers, and it would serve the public.
Great post and great topic!
I have 18 years experience and I agree with Jenny completely. Acupuncture may provide pain relief, but it is not a narcotic; it does not “mask” underlying problems, no matter what style of acupuncture it is. Some of my experience is in hospice, which means trying to relieve pain for serious conditions which can’t be treated, palliative care for people who are dying of the cause of the pain. I have never seen acupuncture alone successfully control that kind of pain. It can help in conjunction with excellent palliative prescribing of serious pain medication, but that’s all.
Also, if acupuncture were *that good* at relieving pain, everybody would know about it, and we’d have people addicted to acupuncture — after all, it’s cheaper than an opiate addiction.
Where do you think that this sacred cow came from?
I suspect it comes from some combination of over-compensation for a subconscious lack of self-esteem (I secretly harbor doubts about my abilities, so I’d better cast doubt on the abilities of others) and fear (how will I survive if what I do isn’t better then what they do, and, did I just spend a lot of time and money getting a degree which might not have been worth it). I suppose many of us were taught this sacred cow in acupuncture school. If I were trying to fill an expensive degree program I’d probably find this line served me well.
Don’t get me wrong, I love the theory of Chinese Medicine. I believe there is a lot of wisdom there and I have no buyer’s remorse for the education I received. The depth of knowledge serves me and my clients well, I think, and I’m glad I have it. But I no longer fear that clients who choose to receive treatment from other providers will be harmed by acupuncture that somehow manages to relieve their symptoms while leaving the underlying imbalance untouched.
Elaine,
My experience over 16 years of practice is that, when someone doesn’t get better with acupuncture, there is often an underlying, more serious condition that warrants allopathic medical attention. I have NEVER had the experience that acupuncture treatment masked a more serious, underlying condition. I don’t think it is possible.
I haven’t seen it either. Although another question is — if people want superficial relief (as could be case of having a trigger point released by a PT), isn’t that the client’s choice?