Sometimes, understanding one’s background can clarify their particular point of view. So in the spirit of “full disclosure” I would like to tell you a little about mine.
I began my medical career in 1979 when I received my MD degree from Albany Medical College. I trained in diagnostic radiology at George Washington University Hospital in Washington, DC. I entered private practice and spent 20 years doing full-service hospital radiology. It was at the end of these 20 years that changes occurred in my life, changes that made me look at my direction and commitments. It was at that time in my career when I discovered acupuncture, and the power this medicine has to heal. Please understand, I was awestruck at the conditions acupuncture could effectively treat —- conditions that from my previous medical training I knew were precisely those no one wanted to get stuck with because there was no effective treatment. I am a fellowship-trained interventional radiologist, and I have put needles into arteries, veins, solid organs, abscesses, tumors, pleural cavities, peritoneal cavities….you name it. But I had never felt the pull of Qi on a needle, I had never intentionally manipulated a needle to achieve a specific energetic effect, I had never contacted the energy of a meridian, nor used needles themselves, as instruments of healing. Here was a whole new science to learn. And the amazing thing is that it has a 3000 year history with millions upon millions of people undergoing clinical trial in China for 30 centuries!
So I enrolled in a course for physicians to learn “medical acupuncture”. I attended two weekend sessions, watched videotapes, and read one book. This course was based on the work of one physician. The book we read was his book – the videotapes we listened to were him talking, and he gave nearly all of the lectures at the 2 weekends of instruction. On the last day of training, I happened to be sitting next to a doctor from San Diego, and I overheard him say, “My wife knows so much more about acupuncture than I do.”
I subsequently found out this doctor’s wife was a licensed acupuncturist. One thing led to another, and before I knew it, I was enrolled at the National College of Natural Medicine in Portland, Oregon in a Master’s degree program in Classical Chinese Medicine. I will graduate from this same program in June. It is a 4-year program, and I have been able to complete it in 3 years by transferring credits from my medical school training. I feel very strongly that, in order to practice acupuncture at the level of competency which this medicine deserves, one must learn from many professors, observe with many clinical supervisors, and spend at least a few years to learn how to approach a patient in a holistic way with an entirely new set of diagnostic principles.
Remember, I am a scientist at heart, and this is the finest science that I have encountered. As a physician who has gone through Western medical training and now training in acupuncture and Oriental Medicine, I assure you that abbreviated courses in acupuncture for physicians pose a serious problem. That problem has to do with efficacy of treatment. Without a comprehensive education in the fundamentals of this science, and without appropriate hours spent in learning complex needling techniques, followed by supervised clinical application of all of this learning, it is not possible to effectively treat the list of diseases which the world now recognizes are amenable to acupuncture intervention.
The World Health Organization recognizes the ability of acupuncture to treat the following diseases: asthma, menstrual cramps, arthritis, sciatica, TMJ problems, allergies, anxiety, depression, bladder problems, kidney problems, childhood illness, colds, influenza, cough, bronchitis, constipation, diarrhea, dizziness, ear-nose & throat disorders, fatigue, gynecological disorders, genital herpes, herpetic neuralgia, heart palpitations, immune system deficiency, infertility, insomnia, numbness, poor circulation, PMS, sexual dysfunction, impotence, skin problems, stress-related illnesses, and weight gain or weight loss…and the list goes on.
Acupuncture is not a nice, short topic that can be covered during a seminar lasting for a few weekends. Suffice it to say, that it is not possible to treat the difficult diseases listed above after watching videotapes, reading one textbook, and attending two weekends of lecture with needling practice on a few other course participants.
I would like to give you a brief case presentation now, to try to illustrate in a nutshell why I am writing this letter. A 57 year old man presented 4 days earlier to the OHSU emergency room with sudden and complete blindness in his right eye. He was seen by an ophthalmologist, underwent carotid ultrasound, an MRI of his brain and MRI angiography , and was told that he had occlusion of his central retinal artery and would have permanent loss of vision in that eye. At the time of presentation his medications included lisinopril, metformin, and aspirin. Fortunately, the patient happened to have an appointment with his chiropractor, who heard the story of this man’s sudden blindness and grim prognosis, and referred the patient to the acupuncture practitioner who worked in the same building. The patient was seen daily for 7 consecutive days for acupuncture treatment. On the second day, he could see a small circle of light in the center of his vision in the blind eye. Day by day that circle of light enlarged, and became clearer. At the end of 7 treatments he had 20/40 vision in the previously blind eye.
This is the power of this medicine in the hands of a skilled practitioner. This is what can be accomplished in Oriental Medicine. Someone in Integrative Medicine has given me a definition of their subspecialty as the medicine that “fills in the gaps”. I think this is an apt definition, and there are many gaps in western medicine which need filling. Please give Oriental Medicine a chance by ensuring that practitioners who enter this field are adequately trained. Let’s up the ante, and see whether we can embrace this amazing alternative healing science with practitioners who have enough didactic hours of lecture from a variety of acupuncture faculty, and enough supervised hours of clinical practice so that they are familiar with treating patients with all sorts of maladies such as cancer, asthma, palpitations, constipation, allergies, menstrual disorders….to name just a few common problems.
The way forward has been paved by the state of Hawaii. Hawaii requires that medical doctors be trained and tested for competency prior to administering acupuncture to patients. The Attorney General for the state of Hawaii issued a statement on August 18, 2003, declaring that “medical acupuncture” as performed by physicians is not substantially different from any other type of acupuncture, and therefore, physicians performing “medical acupuncture” should be subject to the same laws of licensure and proof of competency as everyone else.
We in the acupuncture field are at a crossroads. We can condone physicians doing acupuncture under-trained, unsupervised, unevaluated in terms of competency, or we can strive to raise the standard. I feel strongly that this is a public health issue. I feel strongly that allowing medical doctors with minimal training & without oversight by a non-professional organization is a dangerous and foolhardy policy. I’d like to respectfully remind you that we are talking here about a healthcare profession; we are talking about peoples’ health & well-being; we cannot afford to have a double standard. The general public deserves parity in licensing so that competency can be maintained.
I therefore propose that the American Association of Medical Acupuncture evaluate their own training programs and consider complying with the World Health Organization’s recommendations of 1500 hours of training in acupuncture for physicians interested in pursuing this medicine. The WHO standards for physicians performing “medical acupuncture” include 1000 hours of didactic (including needling technique labs) and 500 hours of supervised clinical training, which ensures adequate training for entry level acupuncture. In addition, I feel that physicians should be required to pass the NCCAOM examinations to ensure their competency in acupuncture evaluation and treatment. If the AAMA is willing to adopt these standards of 1500 hours and NCCAOM testing, I believe the future of “medical acupuncture” in the United States would be shifted from a position of tenuous efficacy to one of competency and powerful healing.
Dr. Marilyn M. Walkey MD