GUEST BLOG: “Has CAN Figured Out How to Place Acupuncture in the Mainstream?”  by Steven Stumpf

The Community Acupuncture Network: Grass Roots Needling Therapy

The marriage of working class politics and acupuncture might on the face of it seem an unlikely match. After all, working class politics and grass roots organization conjures images of class struggle, marching in the streets and fighting for one or another form of liberation. Images of acupuncture could not be further afield: meditative contemplation, pursuit of harmony and balance with a strong dose of zen references and the ubiquitous Taijitu (yin-yang) symbol. Of course, pursuing balance in Chinese philosophy involves resolving conflicts...and this is where CAN defines its own qi.

Lisa Rohleder is the Founder of the Working Class Acupuncture (WCA) Clinic in Portland, Oregon. She is also one of the founders of CAN, the Community Acupuncture Network which has become a national and international network of private clinics that adhere to the specific CAN principles: group treatment spaces, sliding fee scale not to exceed $40 per visit or $15 for the initial visit, and the clinic must be open a minimum 3 days a week.

These principles differ greatly from positions taken by the national professional organization - AAAOM - on the same issues. In fact they differ greatly from probably every healthcare profession that is profit-based. This is an important distinction because it forecasts the growing healthcare reform movement where the single-payer model will establish flat rate fees for providers. It is highly unlikely anyone will see $15 flat rate fees for an initial appointment with a physician. In fact, the initial visit is usually more costly than the standard follow-up.

How can CAN set the fee so low? Don't they know how they are damaging the acupuncture profession by limiting the ability of providers to earn a living?

Setting a fee at $15 is the flash point for sending a message to the entire profession, in particular the leadership of the acupuncture establishment. Much is out of balance within acupuncture. It is time to support the providers and patients by radically increasing access which in turn radically impacts income. A $15 fee on a scale that tops at $40 puts treatment within reach for many "working class" folks. And it gives licensed acupuncturists that have given up a chance to go to work in their chosen field.

Unemployment and under-employment in acupuncture is no longer a secret. The word is out as the most recent survey by the national certification body - the NCCAOM - has found that half the licensees (LAcs) are working less than full-time and 70% gross less than $60,000 annually (pg 19). These already grim findings are carefully reported so as to conceal what is likely the even more grim truth; a substantial number of LAcs have left the field because they are unable to work at all.

CAN is the only organization that seems to offer a solution with their cash and carry model. Many LAcs who find their way past the vilification CAN suffers from the "establishment", and are not ready to give up, adopt the CAN model. While their success is anecdotal their gross numbers are impressive. CAN boasts 162 clinics and ~1,000 individual members. Pretty good for an a decentralized start-up group. By comparison AAAOM counts ~3,000 members.

If the fight was to win recognition and endorsement by the acupuncture leadership then CAN would be fighting an uphill battle. However, this is not the case. CAN's fight is to win the hearts and minds of LAcs disenchanted with AOM leadership. And CAN may be winning this battle on the ground, if not yet in the media.

Which brings me back to acupuncture stereotypes.

A May 1, 2010 article in the New York Times titled "Acupuncture is Popular, But You'll Need to Pay" would seem to be a huge endorsement of the CAN model where fees have been brought down to street level. Unfortunately, it actually damaged CAN by reinforcing acupuncture stereotypes which CAN seeks to undo.

After the writer glided through the research supporting clinical effectiveness of acupuncture including osteoarthritis, depression during pregnancy, and chronic headaches she began to describe fees that begin at $65 and can hit $120. She noted how the general absence of insurance coverage helped impede access to care. She closed by suggesting options and specifically referencing the CAN model and their extremely friendly low fees. Then she made an about face.

"If your problem is not serious or complicated -- say you are suffering from stress or headache pain -- consider visiting a community acupuncture setting, where fees can be as low as $15 a session. You receive a brief assessment and then are treated, fully clothed, in an open room with other patients. It is the acupuncture equivalent of a chair massage."

The suggestion is that acupuncture in a CAN clinic is not "serious"....because the fee is too low...or because you did not change out of your clothes...or because you are sitting in a chair when poked. This is too bad. Of course, there is no research that associates fees or wearing a gown or lying on a table with treatment effects. The writer's sudden and illogical switch can only be attributed to not checking with CAN first and more likely consulting with someone outside CAN for "insight".

There are numerous issues with the acupuncture profession that inadvertently support this kind of misinformation. I have addressed some of these issues in a forthcoming publication titled Mainstreaming Acupuncture: Barriers and Solutions in the CAM journal Complementary Health Practice Review.

The irony is that the NYT article complains about how fees obstruct access to acupuncture treatment and correctly points out that CAN offers the only model in this country that seeks to immediately address this barrier to access to care. Maybe the old marketing axiom that bad publicity is better than no publicity will hold true.

CAN makes their model available to LAcs willing to embrace the three basic principles: treat in groups, keep the fee unquestionably affordable, and open your doors at least 3 days a week. The CAN model is definitely disruptive to the other model which is to think of LAcs as MDs who practice a medicine cloaked in mystery that cannot be understood by anyone except the provider.

As Richard Dawkins has said ""There is no alternative medicine. There is only medicine that works and medicine that doesn't work."

Acupuncture is a medical treatment works well for certain conditions such as pain. The CAN movement makes acupuncture affordable.

Posted at http://www.stevenstumpf.com/

This story was posted on May 19 2010 by Jessica Feltz.

Comments

  • May 24 2010 at 5:18 PM
    bottley writes:

    Kind of curious

    that there hasn’t been more comment related to this post. Maybe because we’re just sitting back and basking in the glow of having someone outside the group GET IT without us having to explain stuff that seems so blindingly obvious until we’re blue in the face? Nonetheless, I’m very happy about this.

      0 likes
  • May 25 2010 at 1:03 PM
    andy wegman writes:

    Feel the same way, B.

    Like waiting for the ‘but’ at the end somewhere…

    Steven has seemed consistent and conservative in the writing I’ve seen of his online, while focusing on the job market for LAcs (or lack thereof).

    This piece no exception.

      0 likes
  • May 26 2010 at 7:12 PM
    tessmcginn writes:

    It seems nice that someone else is

    sticking up for CAN without that twisty dig at the end of the sentence.  So different.

      0 likes
  • May 26 2010 at 8:12 PM
    Guest writes:

    comments and my interests

    Thanks for the comments. I also wonder at the low rate of comments that follow my posts. I posted at the AAAOM FPD page several months back and was able to get into a somewhat pissy string with a couple of folks who IMO were being pretty cavalier about LAc unemployment. I got pissed off and said so. Otherwise, I try to stay somewhat neutral or objective when I post. I can see my style being described consistently conservative. However, I do not think of myself as a conservative person. My background is academic writing and I have published quite a bit. I also review what I write for typos, clarity, and poor logic. I often find posts by LAcs are anecdotal and passionate. That is fine but I also appreciate posts with data to support a claim. There are a number of LAcs who write on the various CAM and acu blog sites I have visited that seem mostly interested in letting everyone know they are the last word on whatever. I know some of these people from my brief experience in acupuncture. I have also read quite a bit of the “literature” by published AOM leaders. When I was a DAOM director I graded some of their papers. My interest is in upgrading the profession. In order to do this I believe the group that presently represents the profession has to go. I do not think much of “turning the profession around.” Having worked with Calif Acu Board for the past 2 years I have helped that board come to a stalemate. While we seem to have stopped the folks who would have ACAOM and the CCAOM run the show we have not achieved my goal which is to prepare LAcs to work under the coming healthcare reform movement in a primary care role. If I could help pull this off it would be a win-win-win for patients-providers-clinics. LAcs are among the providers. I think CAN has a model that fits with the coming changes in healthcare. It is best described as a discount healthcare plan. It will be emulated in dentistry and medicine. The model proposed by the acu establishment is grounded in a system that is on the way out. The CAN model will survive. The other model - the one that seeks absurd fees under a mystery medicine - has already failed. I write about employment because it is the most basic yardstick for measuring success of a profession. I am not a TCM expert but I also do not believe in qi or meridians. I have had plenty of acupuncture treatments. I think it is wrong to train people who want to work in a field without telling them their chances of doing so are no better than a coin flip. Hey! Thanks for the chance to say all this.

      0 likes
  • May 27 2010 at 10:55 AM
    bottley writes:

    Data to support a claim…...

    You point out something that’s been talked about a lot around here, namely that there really isn’t much data to draw from. There are a fair number of “surveys” and people who spout stats, but at the end of the day, relatively little material that stands up to much scrutiny as far as ground level verifiability goes. A friend of mine who’s not a CAN person made the very incisive comment recently that we as a profession are running the discussion pretty much on hunches and building institutional positions based mostly on who happens to be most effective in driving their hunches through committees. You’re right, it’s a problem. 

      0 likes
  • May 27 2010 at 12:57 PM
    bottley writes:

    What I forgot to say

    was that the above problem seems to be the big reason Ann and Andy and the board have put so much effort and resource into at least polling our own group cpmprehensively and honestly so we can speak with more backup, at least about CAN’s efforts.

      0 likes
  • May 27 2010 at 9:22 PM
    Guest writes:

    the importance of data

    The acupuncture field is notably devoid of data, especially workforce data which includes earnings, hours worked, employment levels, patient demographics. This is one reason why the Bureau of Labor Statistics does not list acupuncture in the occupations table. You can find acupuncture listed as an occupation but not in the “big book” of occupations for which every profession listed is expected to track its own members. Acu does not, has not, and seems to care not. NCCAOM says it means to correct this but their effort also looks suspicious. In the least the AAAOM’s failure to track its own members per BLS requirements is an oversight or a function of poor understanding about what constitutes a profession. At worst, it is omission by commission that is purposeful and whose goal is to keep stakeholders - from patients to practitioners to regulators - in the dark.

    Therefore, the ability to produce data that has been collected according to standard conventions (methods) and that simply and clearly describes these the particulars about a workforce is HUGE. It shows a commitment to transparency in practice and principle. It shows understanding of how the world of funding, regulation and mainstream medicine works. It moves the group with the data from the outskirts of medicine to the interior. It does not compromise the profession even when the news is not good because collecting and sharing data that is not flattering says we are willing to start HERE and make things right.

    I get that CAN is an outsider within acu. Keep in mind acu is an outsider by its own practices when it comes to being recognized and respected by medicine. IMO CAN has the fix, is pursuing the right path, and will prosper accordingly. Your audience is not AAAOM or ACAOM. It is the medicine that those groups want to be a part of but never will long as they stick to their current misguided strategy. This creates an opportunity to fill the gap.

      0 likes
  • May 27 2010 at 10:48 PM
    bottley writes:

    These are painful truths,

    but truths nonetheless. Now we get to find out if we have the stones to stand up to that kind of scrutiny.  The emperor is undeniably naked, and not only naked but geez! He’s really let himself go….....!

     

      0 likes
  • May 28 2010 at 9:16 AM
    andy wegman writes:

    Steven

    what got you you interested in the worlds of the LAc?

      0 likes
  • May 30 2010 at 2:30 AM
    keithananda writes:

    number crunch

    I think there is much merit to outside the box thinking of retraining some portion of DC’s, ND’s , and LAcs, those who want to be primary care in this fashion, how many do you see annually to be sufficient to bridge the gap you estimate to be 40,000 in the coming years? 

    At last glance, i thought BLS puts the number of DC’s in the US at about 50,000.  Not sure how many new DC grads each year and / or attrition rates. ND’s number a lot less than that nationwide, while there are about 5 ND schools graduating maybe 500 max a year total.  New LAcs number about 2,000 per year, with about 25,000-30000 active licenses.    I’m just trying to guess how many from the invisible workforce would take the plunge, and would it be enough to help in a significant fashion to bridge the 40,000 gap?

      0 likes
  • June 1 2010 at 12:13 PM
    Guest writes:

    I was recruited by a USC

    I was recruited by a USC colleague who was working as Academic Dean at an acu school in LA. She introduced me to the school President who asked me to take a leadership role. I became the Provost and Director of the DAOM program. Unfortunately, the President who recruited me left soon as I arrived. I shepherded 3 classes of DAOM students and was able to implement a joint vision of an integrative medicine training curriculum. I went through two ACAOM site visits and attended one AAAOM/CCAOM annual conference. I met many good people involved with integrative medicine. I entered with eyes open and disbelief suspended. I left after one year with a more grounded view of the profession. I stayed involved by attending the California Acu Board meetings with a group of critics who the acu leadership finds generally disagreeable. I think they make some good points and deserve an audience. Just as I was losing interest I developed this idea about the PC LAc program. It fits with the current healthcare reform movement and, in fact, is robust to acupuncture training.

      0 likes
  • June 1 2010 at 12:33 PM
    Guest writes:

    The current healthcare

    The current healthcare reform movement is creating new opportunities for multiple provider groups. The mainstream medicine bias is always to look to its own family for resources. The May 2010 issue of Health Affairs, which is devoted to primary care reform,  includes several key ideas about how to fill this 40k gap however they are all about growing the number of PAs, NPs, etc. That is fine and will occur. However, it will not be enough. Besides, the need is urgent so the opportunity is greatest for providers who can go to work yesterday. 15M newly insured who generally seek care in community clinics come on board in 2014. The cycle for training and graduating NPs, PAs and Fam MDs is also long; 3 years for PAs and long as 8 for NPs and MDs. Furthermore, the trend is for new graduates in all 3 professions to choose specialty roles instead of PC. I am skimming the surface here.

    I am writing a summary of the 28 articles in the journal that I will share. You will be able to read the data on these issues without my bias (unless you read my summaries which are certainly biased). Several articles suggest that MAs can be “extended” to fill a role of “care coordinator” which is a new role that is being created. The big picture for reform is in better focus than the finer details. If MAs who have virtually ZERO clinical experience (and certainly less than LAcs or DCs) are getting support to become a new PC team member as “care coordinator” then at least the range of providers that will fill these 40,000 positions has been defined: from MAs to MDs and everyone in between.

    Given this it is my opinion is that mainstream medicine - I am including policy makers that are NOT MDs - will eventually turn to the CAM professions for a quick and dirty fix. With crisis comes opportunity. The CAM professions have never seen the door to healthcare open this wide to them before. The number that is important to watch is how many can be placed in these new roles PERIOD. The more the better. If the under- and unemployment figures collected by CAB and NCCAOM (from the same time frame - 2009) are correct then, conservatively, there are at least 5,000 LAcs that might welcome the chance to work in a community clinic where the need is greatest. Of course, I am not considering the cultural resistance that comes with the profession. I am hoping the opportunity to actually work in one’s chosen field will overcome that.

      0 likes
  • June 3 2010 at 7:08 AM
    crismonteiro writes:

    clarification please

    What/who  are MAs as referred to above?

      0 likes
  • June 3 2010 at 9:08 PM
    Guest writes:

    MAs

    I think MA refers to Medical Assistant—much different than a Physician Assistant.

      0 likes
  • June 4 2010 at 1:00 AM
    Guest writes:

    MAs are…

    Medical Assistants complete a 9 month training course that prepares them to work in the medical practice back office. This is the person who takes your blood pressure, weight, etc. If you are diabetic they will take your standing glucose. They maintain medical files, let the doctor know the patient is ready. They are integral to the medical practice. They often jump to a better paying position (with training) like imaging or rad tech or LVN. Some have the eventual goal of becoming a RN or PA. Some go into the business side of healthcare such as owning and operating a medical billing service that handles billing for small MD practices. They use their experience with CPT and ICD9 codes to get the docs to sign on. In the May 2010 issue of Health Affairs - the policy journal for healthcare - there are several articles that describe how an MA can be “extended” to do more than just back office work. With another 9 months of “training” they can actually interact with patients as a “health coach” which means they would handle the chronically ill patients such as diabetics who need routine management - get your quarterly HbA1c and other lab work, keep a diet journal, sign on to a patient disease registry, etc. They are salaried employees who earn between $30K and $40K. In an extended role they could increase their earning potential to $50K and $60K. Personally, I find it incredible that someone with no clinical experience or background and 9 months training can hold a secure position in healthcare; and now that MA is being groomed for job and income growth! I feel confident an LAc could do this work. I want to set up a 1 year training program that prepares LAcs to work in primary care. There has never been a better opportunity. I think it fits nicely with CAN which is already on the outs with the the acu establishment and not afraid to try something different.

      0 likes
  • June 4 2010 at 3:28 PM
    Deborah writes:

    Why people don’t comment on this board

    First, you have the verification to post something.  It took me 6 times to satisfy the requirement.  The form you read is illegible.  I have never had such a hard time doing the “captcha” blank before.

     

    Also, people here do not actually use Paragraphs in their posts.  It makes for very tedious reading.

    Please use paragraphs!

      0 likes
  • June 4 2010 at 9:35 PM
    Guest writes:

    I write in paragraphs but

    I write in paragraphs but they get lost when posting. Thanks for comment. I also find the captcha tool requires multiple attempts.

      0 likes
  • June 5 2010 at 5:49 AM
    crismonteiro writes:

    formatting

    Try changing your Input format (below comment box) to Full HTML before posting.

    Captcha snafu is a mystery 

      0 likes
  • June 5 2010 at 11:27 AM
    Linda inDetroit writes:

    Yeah, if you have a mac you

    Yeah, if you have a mac you have to change the input format each time, or your post will just come out as a big blob.

      0 likes
  • June 9 2010 at 12:48 AM
    tatyana writes:

    why MA’s?

    steve, i am not sure i am understanding you correctly. why would LAc’s want to do MA’s job, when they trained to do acupuncture? i would personally have no interest in doing the things you are describing MAs do - if i did, i would just go ahead and do the 9-month training and not be 60K in debt. of course the steady income is nice, but i would guess the MA’s duties are about as interesting to an acupuncturist as working in a cafe or an office or any other regular salaried job out there. the healthcare setting does not make it feel any closer to actually using my knowledge of acupuncture, in fact it would prpbably frustrate me more. or are you saying that they could be employed under this umbrella and also be paid to provide acupuncture in a western medical setting?

    -tatyana

      0 likes
  • June 10 2010 at 2:19 AM
    Guest writes:

    mainstreaming acupuncturists? why it is a good idea…

    Tatyana - I was thinking I would have to explain the idea once more until I read your last statement and could see you answered your own question. I do not mind explaining why it is a good idea for LAcs to be in mainstream medicine however I recognize it is a concept so antithetical to acupuncture training that it seems absolutely untenable. Here are the basic precepts that underlie the concept. 1. There is no alternative medicine. There is only medicine. This does not mean TCM is worse or better than Western medicine. It means we are all in the field to help people feel better. 2. LAcs receive insufficient training in what I call mainstream medicine. This is fairly easily remedied with 1 year exposure or immersion in a mainstream clinical setting(s). 3. It is better to work than not work; to get paid than not get paid. Once an LAc gets past the us vs them defensive stance and understands it would be a good to work in mainstream medicine as an acupuncturist the next question is how best to get this done. Current AOM leadership believes the best way is to acquire a doctor title, charge MD like fees and make claims that TCM is the equivalent of mainstream medicine therefore LAcs should be paid and recognized on par with MDs or NPs or PAs. It is a consistently unsuccessful strategy. LAcs need to earn their way into the system by finding a role they can occupy that actually fits in the system, relieves a burden to the system, and shows we belong. The timing has never been better than now when the medical system has this incredible number of newly insured coming on board and not nearly enough providers to treat them. Cut to the point: if LAcs could “speak doctor” and had experience working in a primary care setting they would be able to practice acupuncture in that setting along with doing things that the system needs to get done; such as triage, i.e., basic assessment and referral for conditions described in “western” diagnoses. LAcs treat the pain patients in the clinic. My point about MAs is that the system is opening up in ways that allow for new provider roles for MAs. The system looks to its own first to fill these roles. LAcs are on the outside looking in. Always have been. With some initiative and a program that recognizes the system’s deficits LAcs could carve out a path for themselves in a new role. In the least it would be along the lines of the new extended MA. For the ambitious LAc I believe that new role could be much more. This is not about not practicing needling. It is about finding a scheme to get to do it alongside other providers in the mainstream setting…where the jobs are now and are going to be reshaped in the near term.

      0 likes
  • June 10 2010 at 12:34 PM
    keithananda writes:

    What’s still missing from

    What’s still missing from the equation in my mind is widespread acceptance of AOM, and its benefits.  In 2007, 3.1 million  (or 1%) of Americans used acupuncture (NHIS study). As a numbers comparison, Chiro and Massage Therapy was used by 18 million each, or 6%. 

      0 likes
  • June 10 2010 at 12:50 PM
    bottley writes:

    Again, there is much to like here.

    I’ve been in favor of abolishing “alternative” and “CAM” and all other such terms for years. They’re red herrings that distract us from the really important discussions. I also agree that institutional acupuncture’s vision of parity with medical doctors is ridiculous, not because we’re somehow better or worse, but because it aspires to mimic a model that’s already failing and morphing into something else on the mainstream side. That’s wny I also agree with you that the “us and them” ideas have to go. I don’t trust the leadership on either side of the divide, but the legitimate basis of that mistrust isn’t really about the medicine. It’s about the money, and to the degree that it drives any process ON EITHER SIDE OF THE EQUATION, it’ll be working against the welfare of both patients and front line practitioners. That’s where my concerns about the issues around  “mainstreaming” all reside. It’s time to drop the divides and make it about medicine in general, but that won’t happen with any integrity if we forget that it’s about patients first, not about practitioners or existing systems. That isn’t happening nearly well enough in mainstream medicine either, so it’s something that we have to be vigilant about as we discuss these issues, IMHO.

      0 likes
  • June 11 2010 at 1:38 AM
    Guest writes:

    how to be accepted

    If you want to see acupuncture accepted by mainstream medicine and gain access to more patients as well as be accessible to more patients then you have to become a part of the mainstream. There is plenty of room for differences and treatments. When I worked for the acu college in 2005 and put together the integrative med program I “discovered” the world of “integrative medicine” physicians - as in MDs - up and down the Wilshire corridor in Santa Monica. Who knew there were all these chelation, detox, vitamin B drip physicians thriving out there. The were completely hip to acu. Knew shit about it but they accepted it as a useful treatment. For this kind of acceptance to go viral however LAcs have to be willing and prepared to enter the entire world and not just sit on the fringe, outside the inner rings. I call this living in the swamp, the backwaters. Not only is this a poor strategy to getting recognized or accepted or having patients referred to you by MDs who have the patients, it is inevitable that the profession will dwindle to a few “specialists” or die out altogether. CAN is the only viable option for folks who wish to remain on the outside. I respect that choice. However, if you want to swim in the ocean then you have to get trained to do that. No widespread acceptance without spreading yourself widely.

      0 likes
  • June 11 2010 at 8:33 PM
    keithananda writes:

    If I think you’re saying

    If I think you’re saying what I think you’re saying, I have to disagree.  Although it’s a nice thought,  I don’t believe for a minute that having acupuncture in hospitals or western community clinics will make any AOM usage go viral, in or out of hospitals.  AOM will make its most significant inroads into hospitals as an afterthought in a couple of decades after CA has changed the cultural landscape through affordability and efficacy, thus creating the demand from the outside.  Just my two cents.

      0 likes
  • June 11 2010 at 10:51 PM
    tatyana writes:

    it’s clearer now…

    but i lean more in keith’s direction on this. the problem i see with the picture you are presenting is that i do not trust western medical establishment anymore that the AOM establishment to provide a good structure for bringing acupuncture to the masses.

    i think there is just too much fundamental difference in the way the body is viewed and the way patients are treated. i think we will have much more opportunity to control how acupuncture is incorporated into mainstream once it is more established as something commonplace thorugh the many many community acupuncture clinics all over.

    i do do think AOM education needs a major overhaul (as in start from scratch and actually teach something practical),  and within that i think that there should be an option for those acupuncture students that are interested in the arrangement you are describing—training to deliver acupuncture in community style within western medical settings. but somehow i doubt that many of the elements that are integral part of a CAN clinic now will be doable in say, a hospital setting - they will have to tweak the model and it will change (some people are already doing this). and i think it will take a long while on all fronts before we will see acupuncture mainstreamed the way you are describing. thanks to WCA and CAN, we have glimmer of hope that acupuncture will not totally die out in this country, the rest of the story is a mystery.-tatyana

      0 likes
  • November 4 2011 at 4:57 PM
    Guest writes:

    acupuncture sarasota florida

    Such a great post about acupuncture sarasota florida. Keep on posting!

      0 likes

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