Acupuncture and Biomedicine

Integrative medicine is an emerging and evolving paradigm in medical education and practice, and one that increasingly includes acupuncture. There is public and professional interest in acupuncture and in medical practices that include acupuncture and other complementary therapies. I agree with Marilee Murphy, who wrote in the January 2008 issue of Acupuncture Today: "Integrative medicine brings exciting opportunities to the future profession of AOM in the United States. Integration promotes growth and acceptance of AOM, increases patients' access to care and leads to earlier intervention for certain conditions, and may provide solutions for problems facing our current medical system."

My own personal experience of working in an integrative medicine practice has fostered a strongly held belief that this type of patient care should be more widely available. Every Tuesday, I work as an acupuncturist in Dr. John Lichtenstein's family medical practice in Ulster County, N.Y., 80 miles north of New York City. This is a small-town integrative medical practice I joined a year after graduating from acupuncture school. Sixteen years later, I am still affiliated with this office because I continue to enjoy working in an integrative team, always learning more about medicine and improving my patient care and acupuncture skills.

In New York state, physicians and dentists may become certified acupuncturists (CAs) upon completion of a 300-hour course of study, and are then able to practice acupuncture within their area of medical specialization, and to hire acupuncturists to work with them. Dr. Lichtenstein is a CA, as distinguished from a licensed acupuncturist (LAc) like myself.

Dr. Lichtenstein realized (as many CAs do) that he doesn't usually have the time to devote to providing acupuncture and medical care, and he doesn't do much of the acupuncture in his office, where another acupuncturist and I provide most of the acupuncture services.

Presently there are three medical practices in Ulster County where acupuncture is available, all provided entirely or primarily by licensed acupuncturists in the employ of the medical practice. We enjoy a valuable working relationship with the physicians with whom we work. Because of the physicians' knowledge of acupuncture, they know when to refer patients. Working in the office together, we can confer about a patient's medical condition and immediately seek input on a potential medical red flag or other concern. The patient, physician and acupuncturist all benefit from this arrangement.

Each year, AOM colleges send new graduating classes out into an uncertain future, faced with the difficulties of establishing a private practice and few opportunities for employment. I would like to see more opportunities for them to work in integrative care settings. One way to generate more opportunities for AOM professionals is to educate medical professionals and physicians about acupuncture, to be knowledgeable about our training and thus, be appreciative of what acupuncture can offer to patient care.

Another aspect of educating medical professionals is the production of acupuncture practice guidelines, which would inform the medical professional or medical institution as to the kinds of conditions acupuncture treats well, and what are the expectations for frequency, duration and outcomes of treatment.

In addition to my clinical work, I work at the Tri-State College of Acupuncture in New York City. Last year, the college developed acupuncture practice guidelines after surveying the clinical practices of 17 college faculty members over time to determine the conditions and complaints we treat and the expected frequency, duration and outcomes of treatment. The purpose was educational: so that we could provide students and alumni with this information. When placing graduates in externships in medical institutions, we received a request from one medical institution for practice guidelines so the institution would know how best to utilize and integrate acupuncture care. Fortunately, the college had already developed the guidelines, so the institution accepted our externs.

Acupuncture programs for physicians do exist, with the acupuncture instruction taught by physicians allied with medical education programs, not AOM colleges. If the AOM colleges were providers of acupuncture training for medical professionals, the likely outcome would be that AOM college faculty and students would develop mutually beneficial professional relationships with medical professionals. Physicians and others trained at AOM schools would have a positive experience with, and appreciation for, the training and clinical abilities of the licensed acupuncturist. They would understand our practice guidelines and know when to refer patients for acupuncture care; and be able to supervise and hire licensed acupuncturists to work in integrative care teams in hospital-based and other medical settings.

The AOM profession can help to facilitate the integration of acupuncture into medical care by becoming active participants with medical practitioners in the integrated medicine movement. We can take the responsibility to be proactive in promoting the training of physicians and medical professionals, and in fact to provide that training. This could only improve the cooperation between the mainstream medicine and alternative medicine systems, and between the medical acupuncturists and the AOM acupuncturists.

The challenge to AOM colleges is to develop limited acupuncture programs that instruct medical practitioners how to develop acupuncture treatments for medical diagnoses, not AOM diagnoses. AOM colleges can look to the World Health Organization (WHO) guidelines and the board-certification requirements of the American Association of Medical Acupuncturists (AAMA) when developing training programs. The WHO guidelines describe the basic training of "qualified physicians (and certain other medical graduates) who wish to include acupuncture as a technique in their clinical work; and limited training of other health personnel (modern Western medicine) working in the primary health care system of their country."

Let's promote acupuncture integrative medicine for all that it can bring to patient care, the AOM profession and the medical system.