Global Visions: Acupuncture as an International Public Health Modality
By Beth Sommers, PhD, MPH, LAc and Kristen Porter, MS, MAc, LAc
In the past decade acupuncture's position at the public health table has expanded significantly. The American Public Health Association has continued to sponsor a special interest group on alternative and complementary approaches to health, with many of the group's leaders being acupuncturists or others involved in Asian medicine.
On an international level, the vision of exploring synergies between public health and acupuncture is being addressed by colleagues in Australia who founded a group called Network of Researchers in the Public Health of Complementary and Alternative Medicine (NORPHCAM).
"NORPHCAM is the first international collaborative network dedicated to promoting and advancing the public health and health services research of traditional, complementary and alternative medicine and integrative health care. Central to NORPHCAM's mission is the need to address a number of issues crucial to the rigorous, systematic investigation of contemporary CAM: 1) the need to supplement and contextualise clinical research and inquiry to ensure practice and policy relevance; 2) the need to introduce and highlight a broad range of scientific and methodological approaches and methods to the investigation of CAM; 3) the need to ensure research adequately investigates the range of remedies, practices, technologies and practitioners that constitute the broad field of CAM as practiced and used around the world; and 4) the need to provide linkage and communication between researchers and practitioners and to actively encourage research capacity building around CAM."
NORPHCAM further explains its mission as follows:
To promote excellence in public health and health services research focusing upon CAM use, CAM practice and workforce, CAM-conventional health care integration, economics of CAM, CAM policy and regulation.
To lead and advance the empirical investigation of CAM drawing upon health social science, epidemiology, biostatistics, health economics, health geography and related disciplines.
To help widen the CAM research gaze and supplement clinical research in the area of CAM.
To promote and foster closer ties between CAM researchers and practitioners to ensure scholarship includes practitioner input where relevant and is reflective of practice-realities and needs.
To develop research capacity in CAM research (including promoting research skills amongst practitioners)."
One of the group's founders, Jon Adams PhD, is a professor of public health on the faculty of Nursing Midwifery and Health at the University of Technology in Sydney. NORPHCAM currently has about 200 members from the U.S., Canada, Europe, and Australia. A number of members will be attending the upcoming North American Research Conference on Complementary and Integrative Medicine to be held in May in Portland, Ore. You can find further information at: http://imconsortium-congress2012.org/).
Although NORPHCAM embraces the spectrum of complementary, alternative, and integrative spheres, members of the group who are involved in Traditional Chinese Medicine and acupuncture have been actively contributing to the TCM knowledge base in a variety of ways. Acupuncture is one of the most popular and successful CAM treatments used in Australia. Three papers related to NORPHCAM members' contribution to the literature are of interest to readers in the U.S. as well. The topics covered in these papers are setting standards for acupuncture education; status of TCM in Australia; and women's use of complementary and alternative approaches for back pain. These issues have universal significance for practitioners of Asian medicine and indicate some of the vital areas of overlap between public health and acupuncture.
Janz and Adams1 examine training and education standards in Australia, where there are four categories of acupuncture providers: Chinese medicine practitioners; medical practitioners; registered allied health practitioners; and non-registered health practitioners. Training for Chinese medicine practitioners demonstrates the highest and most rigorous educational standards. These practitioners have completed a 4-year undergraduate degree program, whereas training for the other groups may be minimal and include only 2 or 3-day professional development courses. Although current accreditation processes lack transparency, the National Registration and Accreditation Scheme for the Health Professions (NRAS) was established to create a unified strategy for review and approval of all health professionals. This group's primary objective is to protect public health and safety by implementing standards that ensure that registered practitioners demonstrate ethical behavior, appropriate training and qualifications. Additionally, NRAS will promote high standards of education and training among all health professionals.
On July 1, 2012, restrictions will be in place to limit the use of the title "acupuncturist" in order to clarify those practitioners who have received appropriate training and approval. Health policy analysts are now in discussion about how to optimally define what this training should include. Issues of this debate include the practice of "dry needling" as performed by other health professionals and length and content of training.
Stephen Janz, BAc BN, GCCHM, GCPH, Clinic Director of the Kenmore Center for Health at The University of Queensland, is an acupuncturist who is working toward mainstreaming acupuncture within the health system. He has been working to develop educational standards and states that he has investigated "the practice of dry needling from a public health perspective. My current work has identified the risk to public health and safety posed by the short training courses and deep needling techniques, which typify the practice of dry needling. The attempt to re-label ah shi acupuncture also known as myofascial acupuncture or trigger point acupuncture as dry needling appears to be an exercise to circumvent the qualified acupuncture workforce and replace it with other health professions with only the most rudimentary understanding of one tool in acupuncturists' tool-kit. While acupuncture offers a great contribution to public health, I believe that dry needling (as performed by non-acupuncturists) poses a real threat."
An article by Sibbritt and Adams2 describes health-seeking behavior by women in Australia. Similar to the U.S., back pain is a highly prevalent condition in Australia that is associated with significant health care costs. In this longitudinal assessment of almost 9,000 women over three years, the authors questioned women about their use of both conventional biomedicine as well as CAM approaches. Other researchers have demonstrated that back pain and related issues are the main conditions for which individuals seek CAM. Furthermore, pain is the principle reason that individuals seek acupuncture and other manipulative therapies.
In the surveys conducted by the authors, women with back pain were likely to use CAM in conjunction with conventional medical approaches, rather than instead of conventional medicine. Although acupuncture represented one of the main modalities used, most women sought treatment for their back pain from massage therapists and chiropractors. This study demonstrates the importance of understanding both the choices and the decisions made by the public in seeking care for back pain.
Xiaoshu Zhu and colleagues3 contribute an analysis of the use of TCM in Australia and suggest ways in which western biomedicine and TCM can communicate more effectively. Underscoring the growing acceptance and use of TCM, the authors propose implementing techniques from evidence-based medicine in order to evaluate and integrate TCM into the Australian health care system. They encourage dialogue and developing a "common language" in order to create a new health care paradigm.
The importance of acupuncture as a public health initiative is being more widely understood nationally and internationally. Acupuncturists have important roles to play in conducting evidence-based research; in providing safe clinical care that improves health outcomes; in advocating for accessible, reimbursable care; and in protecting the public's health by upholding the highest standards of training and professional review.
Janz S, Adams J. Acupuncture education standards in Australia: a critical review. Australian Journal of Acupuncture and Chinese Medicine 2011;6(1):3-15.
Sibbritt DW, Adams J. Back pain amongst 8910 young Australian women: a longitudinal analysis of the use of conventional providers, complementary and alternative medicine (CAM) practitioners and self-prescribed CAM. Clinical Rheumatology 2010;29:25-32.
Zhu X, Carlton AL, Bensoussan A. Development in and challenge for Traditional Chinese Medicine in Australia. Journal of Alternative and Complementary Medicine 2009;15(6):685-688.
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