Since it was first discussed at length in the March 2001 issue of AT, the question of whether medical doctors and chiropractors have the right to practice acupuncture -- whether or not they have proper training -- has continued to spark debate throughout the acupuncture and Oriental medicine profession. In the past few months, several practitioners have sent faxes, e-mail messages and letters to the editor to Acupuncture Today voicing their opinions on the subject. As a result, we have decided to share selected letters with our readership to give an idea how practitioners feel about the issue.
"I Hope That an Open, Honest and Well-Intentioned Dialogue Continues"
Dear Editor:
Thank you for opening a dialogue which is in sore need of a beginning - the Point-Counterpoint printed in the March 2001 issue between Dr. John Amaro and Mr. David Molony, LAc.
Mr. Molony makes the valid contention that an acupuncturist should have a certifiably demonstrated minimum proficiency to be allowed to practice acupuncture. This protects the public from untrained practitioners. I believe that any healer whose primary intention is to help suffering humanity would (or should) agree on this point.
The National Board of Chiropractic Examiners provides parts I, II, III and IV of the national board exams which must be successfully passed to obtain licensure. Upon successful completion of these four parts, the person must pass individual state boards for licensure in a given state. I truly believe that any professional health care provider (MD, DO, PT, LAc, etc.) who demonstrates minimal proficiency of the philosophy, science and art of chiropractic by passing these required board exams should be licensed as a doctor of chiropractic. This protects the public from untrained practitioners. I would welcome any practitioner who is able to demonstrate this minimum level of proficiency as a fellow doctor of chiropractic, regardless from whence they achieved their knowledge/training.
If there were a fair, impartial board to test, certify and license any practicing professional health care provider who seeks to include acupuncture in their existing practice, I would happily agree to be tested. If there is not currently such a board, there should be one formed; now would be an excellent time to begin the process. I would suggest a "National Board of Physician Acupuncture Licensing" to test doctors of medicine, chiropractic, osteopathy, etc. Dr. John Amaro currently provides an excellent educational program for practicing doctors (MD, DC, DO, etc.) which includes a rigorous exam and certification, so the program, testing and board (consisting of DCs and MDs) is already in place. The designation earned is FIAMA (Fellow of the International Academy of Medical Acupuncture).
For the benefit of all concerned, I hope and pray that an open, honest and well-intentioned dialogue continues. Perhaps a website could be opened to continue discussion on Mr. Molony and Dr. Amaro's points of disagreement. I believe that each issue will be resolved inevitably at some point in the future. Surely common ground found in a spirit of understanding, compassion and love is preferable to that resolved in a contentious spirit of distrust, fear and hatred.
James J. Derbes, DC
Brentwood, Tennessee
Standards Should Apply to "All Who Wish to Practice Acupuncture and Herbal Medicine"
Dear Editor:
I was quite disturbed by the tone of the exchange of viewpoints in the Point-Counterpoint article in the March 2001 issue.
No one may practice medicine, dentistry, nursing or chiropractic without having attended an accredited school, passing the required examinations and becoming licensed to practice in a specific state. The same applies to the practice of acupuncture and Chinese herbal medicine.
All practitioners in these disciplines should be diplomats of an accredited school and should take the national written and practical examinations. This establishes the individual's competency to practice acupuncture and/or herbal medicine no matter what other professional credentials the person may possess.
Calling the attempts of legitimate practitioners to adhere to standards of practice and education "turf wars" is only to achieve standards of vulgarity. Since standards have been duly and law set by the NCCAOM, they should be adhered to by all who wish to practice acupuncture and herbal medicine.
Regina Bodenheim, PhD, PT, Dipl.Ac., LAc
Bethel, Alaska
Turf: Them's Fightin' Words
Dear Editor:
It seems Dr. Amaro is in a fighting mood. That makes sense, since chiropractors have had to truly struggle throughout difficult times to establish political power and professional credibility in the light of allopathic attacks. But is his call to arms appropriate? Is his threat of professional isolation and defeat for acupuncturists real, appropriate or moral?
I would say it is real. The acupuncture community would be isolated without allies in the chiropractic and allopathic communities. We would rely on the support of the citizenry, as did the chiropractors of the 1940s and 1950s. But what is the nature of this threat? Why is it being presented? What acupuncturists like David Molony, others and myself are asking is to follow the rules as set up by the profession. Surely chiropractors can trace their lineage to allopathic and osteopathic sources as does Amaro with acupuncture, but did this promote MDs to do chiropractic without the appropriate training? No! The professions split into DOs and DCs, and they elaborated on the educational training needed to meet basic standards. What is wrong with acupuncturists establishing their own standards and asking others to follow it? Furthermore, what is wrong with the concept of establishing acupuncture as part of the field of Chinese medicine? It seems to me that chiropractic has many similar historic parallels that Dr. Amaro is conveniently ignoring.
Dr. Amaro spends a lot of time in the historic development of acupuncture but fails to understand that it was the acupuncture vanguard that opened the way for a "profession." It was this vanguard that helped to promote students, who had no ties to other professions, to fight for separate legislation for acupuncture (albeit often with the help of MDs and DCs). Furthermore, the acupuncture school often stood in the way of "independence" because of its financial interest in training anyone who walked in the door. The rank and file practitioner recognized this conflict and acted. The rank and file practitioner, along with the Chinese community, made the legal changes necessary for professional independence. What is important to recognize is that professional support is different than vanguard activity and perspective.
Dr. Amaro is clear to explain that the chiropractic colleges had conducted the first studies on acupuncture. This can be paralleled to the work and research that allopathic and osteopathic schools had done before chiropractic colleges were "accepted." He goes on to explain that the "first practitioners and students of acupuncture in the United States" were DCs and MDs. Historically Dr. Amaro is correct, as is the fact that chiropractic grew out of medicine and osteopathy. Is this an argument for osteopaths to absorb the chiropractic field, or for osteopathy to "claim" ownership of chiropractic? Maybe, with Dr. Amaro's logic.
Dr. Amaro wants to claim ownership by historic association. I contend that he should look at the historic roots of his "primary" field of practice, chiropractic, to understand that historical relatedness does not preclude the apparent need for autonomy in any given field of study or practice. After all, dialectics can work both ways. I can understand the interest in acupuncture and Chinese medicine by the chiropractic field, since it truly holds a holistic view of the human condition. Personally, I think this is the most important reason for the practitioners of any given field to make clear the distinction between acupuncture as a physical therapy and acupuncture as practiced in the scope of Chinese medical and philosophical theory. It should be noted at this point that TCM is a politicized version of a traditional form of medicine the Chinese practiced. TCM was an attempts to base Chinese medicine in the scientific process. This was the beginning of compartmentalizing and Westernizing a health care practice that was based in a cosmic, "holistic" algorithm.
I find it very interesting that Dr. Amaro is more interested in creating historic links to acupuncture in the U.S. rather than addressing the issue of educational competence. This seems to be the real issue that the "100-hour brigade" is avoiding. We are not here to argue who is responsible for the existence or acceptance of acupuncture in the U.S. It is the Chinese culture that has preserved it for eons, and it was the Chinese people that forced Mao to accept more traditional applications of Chinese medicine since they were unwilling to give up their traditional medicine for Western medicine. Mao realized this, as well as the practical and effective use of traditional Chinese medicine.
I see Dr. Amaro, Dr. Helms, and others as advocates of the dedicated practice of Chinese medicine. This may be the reason Dr. Seem quotes Dr. Helms. It is not in the interest of the community to attack MDs or DCs just because they hold that title, which Dr. Amaro seems to suggest in his aggressive tone. He fails to glean the essence of the acupuncture community that is asking for other professionals to aspire to the educational goals all professionals aspire to - basic competence training. When Dr. Amaro writes, he seems to be building a fortress around the professions he allies with. It is not the acupuncture Oriental medical community; it is the established professions of medicine and chiropractic he allies with, and that is his true tone.
I commend Dr. Amaro for his support of the Idaho acupuncture community. That is another reason why the acupuncture community would support and note the value of Dr. Amaro's efforts. But because Dr. Amaro feels it important to support "us," does it than make us obliged to exclude comment on our goals and aspirations for our chosen profession?
I do agree with Dr. Amaro's observations that educators don't necessarily act altruistically. I do not see Dr. Seem as a representative of the acupuncture community, though. He and other educators have a serious conflict of interest which has been addressed by others in the struggle for legislative changes. In New York, where Dr. Seem is based, legislative victory was accomplished by breaking ties with the educators. It was the practicing acupuncturists who were able to understand their own interests and strategize to make legislative changes possible. To his credit, Dr. Seem recognized this at the time. It would be a shame for Dr. Amaro not to see the difference. It would also be a shame for him to miss the parallel between acupuncture and chiropractic as independent fields of study.
It further confuses me when Dr. Amaro agrees with Mr. Molony and others that Chinese medicine deserves more educational emphasis and refuses to understand that is exactly what the acupuncture community is saying. "Traditional Chinese medicine is a very complete system of healing that goes well beyond simple acupuncture administration. How can Dr. Amaro and the "100-hour brigade" explain that? What is at issue here is turf, not educational standards, and Dr. Amaro is on the side of those fighting for turf. I find that unfortunate for the practice of acupuncture and Chinese medicine in America.
Hari Khalsa, LAc
Phoenix, Arizona
Full Text of Discussion Available Online
Due to space restricitions, not all of the letters addressing the issues presented by Drs. Amaro and Molony could be published in this issue. In the issue of fairness, we have decided to make those letters available online. Interested parties can read the views of these (and other) practitioners at www.acupuncturetoday.com/amaromolony.php.
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