Primum non nocere

My receptionist couldn't come in one Saturday, so I stuck my boys at the front desk (first time). I divided the duties between them. The 11-year-old was on telephone and computer re/scheduling. The 9-year-old was on greeting, sign-in, and new patient paperwork. The 9-year-old said to me: "But Mom, when do we get to stick needles in them?" I responded: “You don’t have enough education to stick needles in patients.” 9-year-old rolled his eyes at me: “Any idiot can do what you do.”

Which makes me wonder:

  1. What exactly do we do? 
  2. Can any idiot do it?

What exactly do we do?

My esteemed colleague Whitsitt wrote: “What the hell is going on with needling people? Would someone please figure out whether we’re pulling qi to an area, or pushing qi away, or what? And does it really matter whether you twist the pins one way or the other? And why on earth would sticking pins in someone’s leg make their shoulder better? Seriously. WTF, people?”

WTF is right.

Recently, there was a discussion on a 5-Element list serve, and the gist went something like this: If you don’t treat to balance the Law of the Husband-Wife, the patient can die. Now, the only practitioners who ever treat the proverbial-husband-wife imbalance are 5-Elementers, and clearly the rest of civilization is not dropping like flies from untreated H/W. Does this mean that perhaps we acupuncturists might not know exactly what it is that we are doing?

I like Skip’s thoughts here: “something does happen when we needle people or when we get needled. We do know that. There's something very powerful there; we just don't know what it is exactly. Maybe in the future we or our descendants will figure it out; right now we don't know. We don't even know what works best or why. Our medicine is so full of rationalizations that it's quite easy to lose yourself in them. The bottom line is that with all the ancient and recent theories, the field is a mess and it will be our and our descendants' jobs to untangle that mess. “

Let’s concede for a humbling moment that we don’t know what the hell we are doing. We know: a) how to stick a needle in a person, and b) that the patient will feel better afterwards. But we’re not exactly sure what is happening between a and b, or for that matter why or even how it happens.

So what about the second question: “Can any idiot do it?”

The AAAOM and NCCAOM addressed this issue in their 10/22/10 press release, stating: “not a single death has been reported to result from acupuncture in the US.”  (I wish that I could attach the release here but I can't for technical reasons, and I haven't found an online copy to hyperlink with either.  If you're really interested in seeing it, let me know and I can email you the PDF.) 

Notice that the AAAOM/NCCAOM release didn’t state that acupuncture deaths are more prevalent in lesser-trained professionals. It didn’t state that individuals with doctorates have a lower incidence of acupuncture-related-death. The educational requirements of acupuncturists range from 300 to 4,000 hour programs, but the press release didn’t make any distinction between the safety of acupuncture in the hands of RN’s, PT’s, LAc’s, MD’s, DC’s, DOM’s or any other alphabet concoction. It didn’t even matter if a practitioner was NCCAOM-certified or not. The press release very clearly and unequivocally stated that there has never been a single reported death from acupuncture in the US. Ever.

Therefore, I infer: Yes, any idiot can do it. Any PT, MD, or DC can do acupuncture. Any weekend intensive will suffice. A NADA certificate is just as safe as a Doctoral program.

We don’t know WTF the needles do; we just need to get them safely in the patient, and it seems that just about any idiot can do so. Until Community Acupuncture clinics are as common as dirt, I welcome the fact that a wide range of professionals can stick needles, because there are too many neighborhoods underserved by acupuncturists. Look at the numbers:

WE NEED MORE NEEDLERS POKING PEOPLE.

Acupuncture is the least expensive, broadest spectrum, safest medicine in our society. I don’t care what initials are behind your name. If you can legally stick a 2-cent-needle in somebody to reduce their suffering, you have a social obligation to do so.

If you have too few patients to even afford an office (go to the street view ~ hi MJ!); if you find yourself professionally obfuscating; if you blather-on about how the Republicans or Medicare or branding will save the acu-industry…then you are wasting your education and doing a disservice to the millions of Americans who need your help now.

We don’t need to understand how-the-fuck acupuncture works in order for it to work, and acupuncture is so safe that we can reasonably train any idiot to do it…therefore, the rest of you punks better take-up the call to treat your neighbors, or I will personally find a way to get those needles in the hands of some kids who want to do the work that you should be but are not doing.

This story was posted on October 31 2010 by Jessica Feltz.
Tags: doubters

Comments

  • October 31 2010 at 10:55 AM
    crismonteiro writes:

    Jessica you are clear in what you mean by social obligation.

    I am clear on what you mean by social obligation.  That much is clear, now let’s get to some poking.

      0 likes
  • October 31 2010 at 3:51 PM
    keithananda writes:

    Thanks Jess for the

    Thanks Jess for the perspective, these numbers have been in the back of my mind for some time.  With all the recent topdown talk of lobbying,  alphabet org membership/participation, medicare/insurance inclusion, bringing acupuncture education into the 21st century world medical model with an FPD, and turf wars, it’s good to step back and understand where the real change happens - it’s with the people.  

    It comes down to that nagging question?

    Whom do you serve?  The patients, yourself, your employer?  What’s your mission?  your passion?

    While the orgs and schools will do what they think best from their perspective,  most acupuncturists need to keep on doing what we do best, continuing the grassroots effort locally to treat as many people as possible with affordable, simple, effective treatments.   Get the word out, promote promote promote. This is the local public education campaign that is shifting the acupuncture landscape everywhere everyday across our country, regardless of how long it takes for the  alphabet orgs and schools to organize anything nationally resembling a public education campaign, besides a random press release once a year for world AOM day.  Seriously, how many schools market and promote acupuncture via their clinics to patients on a regular basis ? 

    On another note, there are around 850,000-900,000 MDs in the U.S. today, and in 2005 the HRSA put the number of primary care physicians at 264,000, or about 90 physicians per 100,000 people or 1 PCP per 1100 people, and this can vary widely based on location across the country.

    30,000 is a generous estimate of active acupuncture licenses across the country.  My sense is less than 2/3 of those have anything resembling a practice (or around 20,000 ).  So by my math the average number is closer to one “practicing” acupuncturist per 15,000-20,000 people, with regional density variations. (by state and by urban, suburban, rural)  

    Here are the state by state by state density variations:

     

     

     
    Population 2009
    L.Ac.s 2009
     
    ratio, 1 LAc per thousands people
     
     
     
     
     
     
     
    .Alabama
    4,708,708
     
    50
     
    94174
     
    .Alaska
    698,473
     
    93
     
    7510
     
    .Arizona
    6,595,778
     
    482
     
    13684
     
    .Arkansas
    2,889,450
     
    33
     
    87559
     
    .California
    36,961,664
     
    9402
     
    3931
     
    .Colorado
    5,024,748
     
    1035
     
    4855
     
    .Connecticut
    3,518,288
     
    350
     
    10052
     
    .Delaware
    885,122
     
    40
     (2010 est)
    22128
     
    .District of Columbia
    599,657
     
    146
     
    4107
     
    .Florida
    18,537,969
     
    1900
     
    9757
     
    .Georgia
    9,829,211
     
    175
     
    56167
     
    .Hawaii
    1,295,178
     
    624
     
    2076
     
    .Idaho
    1,545,801
     
    160
     
    9661
     
    .Illinois
    12,910,409
     
    631
     
    20460
     
    .Indiana
    6,423,113
     
    85
     
    75566
     
    .Iowa
    3,007,856
     
    60
     
    50131
     
    .Kansas
    2,818,747
     
    100
     
    28187
     
    .Kentucky
    4,314,113
     
    44
     
    98048
     
    .Louisiana
    4,492,076
     
    18
     
    249560
     
    .Maine
    1,318,301
     
    120
     
    10986
     
    .Maryland
    5,699,478
     
    800
     
    7124
     
    .Massachusetts
    6,593,587
     
    961
     
    6861
     
    .Michigan
    9,969,727
     
    100
     
    99697
     
    .Minnesota
    5,266,214
     
    358
     
    14710
     
    .Mississippi
    2,951,996
     
    3
     
    983999
     
    .Missouri
    5,987,580
     
    82
     
    73019
     
    .Montana
    974,989
     
    147
     
    6633
     
    .Nebraska
    1,796,619
     
    10
     
    179662
     
    .Nevada
    2,643,085
     
    45
     
    58735
     
    .New Hampshire
    1,324,575
     
    110
     
    12042
     
    .New Jersey
    8,707,739
     
    700
     
    12440
     
    .New Mexico
    2,009,671
     
    700
     
    2871
     
    .New York
    19,541,453
     
    3312
     
    5900
     
    .North Carolina
    9,380,884
     
    392
     
    23931
     
    .North Dakota
    646,844
     
    25
     
    25874
     
    .Ohio
    11,542,645
     
    147
     
    78521
     
    .Oklahoma
    3,687,050
     
    125
     
    29496
     
    .Oregon
    3,825,657
     
    947
     
    4040
     
    .Pennsylvania
    12,604,767
     
    468
     
    26933
     
    .Rhode Island
    1,053,209
     
    150
     
    7021
     
    .South Carolina
    4,561,242
     
    89
     
    51250
     
    .South Dakota
    812,383
     
    25
     
    32495
     
    .Tennessee
    6,296,254
     
    108
     
    58299
     
    .Texas
    24,782,302
     
    842
     
    29433
     
    .Utah
    2,784,572
     
    103
     
    27035
     
    .Vermont
    621,760
     
    152
     
    4091
     
    .Virginia
    7,882,590
     
    406
     
    19415
     
    .Washington
    6,664,195
     
    1142
     
    5836
     
    .West Virginia
    1,819,777
     
    35
     
    51994
     
    .Wisconsin
    5,654,774
     
    401
     
    14102
     
    .Wyoming
    544,270
     
    20
     
    27214
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     

     

    and here is the same list sorted, with the most densely packed states at the top:

    Surprise #1 - Hawaii !

     
    Population 2009
    Lacs ‘09
     
    ratio 1 LAc per thousands people
     
     
     
     
     
     
     
    .Hawaii
    1,295,178
     
    624
     
    2076
     
    .New Mexico
    2,009,671
     
    700
     
    2871
     
    .California
    36,961,664
     
    9402
     
    3931
     
    .Oregon
    3,825,657
     
    947
     
    4040
     
    .Vermont
    621,760
     
    152
     
    4091
     
    .District of Columbia
    599,657
     
    146
     
    4107
     
    .Colorado
    5,024,748
     
    1035
     
    4855
     
    .Washington
    6,664,195
     
    1142
     
    5836
     
    .New York
    19,541,453
     
    3312
     
    5900
     
    .Montana
    974,989
     
    147
     
    6633
     
    .Massachusetts
    6,593,587
     
    961
     
    6861
     
    .Rhode Island
    1,053,209
     
    150
     
    7021
     
    .Maryland
    5,699,478
     
    800
     
    7124
     
    .Alaska
    698,473
     
    93
     
    7510
     
    .Idaho
    1,545,801
     
    160
     
    9661
     
    .Florida
    18,537,969
     
    1900
     
    9757
     
    .Connecticut
    3,518,288
     
    350
     
    10052
     
    .Maine
    1,318,301
     
    120
     
    10986
     
    .New Hampshire
    1,324,575
     
    110
     
    12042
     
    .New Jersey
    8,707,739
     
    700
     
    12440
     
    .Arizona
    6,595,778
     
    482
     
    13684
     
    .Wisconsin
    5,654,774
     
    401
     
    14102
     
    .Minnesota
    5,266,214
     
    358
     
    14710
     
    .Virginia
    7,882,590
     
    406
     
    19415
     
    .Illinois
    12,910,409
     
    631
     
    20460
     
    .Delaware
    885,122
     
    40
    (2010 est)
    22128
     
    .North Carolina
    9,380,884
     
    392
     
    23931
     
    .North Dakota
    646,844
     
    25
     
    25874
     
    .Pennsylvania
    12,604,767
     
    468
     
    26933
     
    .Utah
    2,784,572
     
    103
     
    27035
     
    .Wyoming
    544,270
     
    20
     
    27214
     
    .Kansas
    2,818,747
     
    100
     
    28187
     
    .Texas
    24,782,302
     
    842
     
    29433
     
    .Oklahoma
    3,687,050
     
    125
     
    29496
     
    .South Dakota
    812,383
     
    25
     
    32495
     
    .Iowa
    3,007,856
     
    60
     
    50131
     
    .South Carolina
    4,561,242
     
    89
     
    51250
     
    .West Virginia
    1,819,777
     
    35
     
    51994
     
    .Georgia
    9,829,211
     
    175
     
    56167
     
    .Tennessee
    6,296,254
     
    108
     
    58299
     
    .Nevada
    2,643,085
     
    45
     
    58735
     
    .Missouri
    5,987,580
     
    82
     
    73019
     
    .Indiana
    6,423,113
     
    85
     
    75566
     
    .Ohio
    11,542,645
     
    147
     
    78521
     
    .Arkansas
    2,889,450
     
    33
     
    87559
     
    .Alabama
    4,708,708
     
    50
     
    94174
     
    .Kentucky
    4,314,113
     
    44
     
    98048
     
    .Michigan
    9,969,727
     
    100
     
    99697
     
    .Nebraska
    1,796,619
     
    10
     
    179662
     
    .Louisiana
    4,492,076
     
    18
     
    249560
     
    .Mississippi
    2,951,996
     
    3
     
    983999
     

     

     

     

      0 likes
  • October 31 2010 at 5:11 PM
    Nora writes:

    Mississippi Goddamn

    My Puncture the South campaign continues…and the Midwest…and the Plains…

    Awesome blog, Jess.  

      0 likes
  • October 31 2010 at 8:18 PM
    chaitime writes:

    .

    great blog jessica. but now i feel like im just a monkey with a handful of sharp shiney objects. guess i’ll have to start sprinkling magic pixie dust with my treatments if i want to feel special. not aanyone can do that!

     

     

    sort of off subject, but in reference to nora’s response.  “mississippi goddamn” has become one of my favorite expressions as of late! so satiisfying on so many levels to say.high five.

      0 likes
  • November 1 2010 at 5:59 PM
    emily writes:

    Timely article

    It discusses if dental therapists should be allowed to perform simple dental procedures in remote areas where there isn’t easy access to a dentist.

    Apparently, the ADA thinks it’s better for people to suffer in pain!

     

      0 likes
  • November 1 2010 at 10:53 PM
    alexa writes:

    Mississippi indeed

    I feel so cool - I know two of the three licensed acupuncturists in Mississippi!  Yes, we need to puncture the South!  Seriously people, move to here.  Patients are waiting for you.

    Another brilliant blog, Jess.

      0 likes
  • November 3 2010 at 6:54 PM
    Ben writes:

    How does acupuncture work?

    It doesn’t.  Our bodies work just fine.  Just like the sun rises in the east… everyday.  When that doesn’t happen, acupuncture will no longer work.

    What do we do?

    We move Qi.  Acupuncturist = Qi Technician.

    Can anyone do it?

    No.  Not everyone can.  Not everyone can fix cars.  Not everyone can help the body heal.  Just read about the five failings of physicians in the Neijing.  How it all works is right there.  Most of us are just handicapped.  We do not read and write our medicine’s language.

    Do we need to find more Qi Technicians.  Absolutely.

    all good medicine,

    Ben 

    The People’s Acupuncture Clinic

    “health for the people… by the people.”

    http://www.thepeoplesacupunctureclinic.com

      0 likes
  • November 3 2010 at 9:23 PM
    tessmcginn writes:

     “We don’t know WTF the

     “We don’t know WTF the needles do; we just need to get them safely in the
    patient, and it seems that just about any idiot can do so. Until
    Community Acupuncture clinics are as common as dirt, I welcome the fact
    that a wide range of professionals can stick needles, because there are
    too many neighborhoods underserved by acupuncturists.”

    It does matter who does the sticking; and we do need more pokers.  If anyone can do the poking, just watch, it will be M.D.s at $80 a whack.  So much for community acupuncture.

     

    Tess Bois (formerly McGinn)

    One World Community Acupuncture

    Fitchburg, MA

      0 likes
  • November 3 2010 at 11:16 PM
    Whitsitt writes:

    Or acupuncturists doing the

    Or acupuncturists doing the poking at $80 a wack, like it is in so many places now.

      0 likes
  • November 4 2010 at 7:50 AM
    Spartacus writes:

    As I understand it, MDs can

    As I understand it, MDs can get trained very quickly.  I’ve never known one that does it (just one DO connected with my school, and she went through a master’s program, not the several-months’ course for doctors). 

      0 likes
  • November 4 2010 at 12:40 PM
    tessmcginn writes:

    in my area there are lots

     lots and more everyday.  In principle I don’t think it’s a bad idea, it’s just that there should be some minimal qualifications to trained in it.  Just like minimum qualifications to be a nurse practitioner or an RN.

    Tess Bois (formerly McGinn)

    One World Community Acupuncture

    Fitchburg, MA

      0 likes
  • November 4 2010 at 1:29 PM
    calambert writes:

    This applies to us!

    I am a L.Ac and when we decided to open a community clinic, I “allowed” my husband who is a DC to get his Acu license.  I say allow because for years I shot down his interest in Acupuncture because I was hung up on the “I went to school for 3 years to do this, its not fair for him to do it in a couple hundred hours.”  I think this also stems from my school’s elitist ideas that Acupuncturists need to have a Masters/Doc to perform the job.  While practicing in my solo clinic I often thought to myself “Why am I even taking pulse/tongue, why am I asking tons of constitution questions when the patient is only here for their shoulder?”  Attending the CAN seminar really opened my eyes up and I knew having a CA clinic I didn’t want to practice alone.  We attend Acu seminars together and I find myself saying “what should I do for this?” because he has learned Tung and other techniques more than I have.  

    A few other LA.c’s (outside of CAN) have expressed their dislike for MD/DC’s practicing, and I always say “The more people getting acupuncture the better.”  Sure I think there are issues with safety/technique training, but I have also had patients who have had negative experiences with LAc’s (ie: continuning to ‘stimulate’ a needle that is burning, and leaving with continued site pain.)

    Great blog!  Another example of CAN’s core beliefs, alot people need Acupuncture and it should be accessible!  Now if I could just ‘get over’ my ridiculous school loan bill!!!

    Christina

    Alpine Community Acupuncture, Flagstaff, AZ

      0 likes
  • November 4 2010 at 6:58 PM
    tessmcginn writes:

    I’m not sure you get my reasoning.

    M.D.s don’t make bad acuncturists but they do by and large make expensive ones.  So do D.C.s.  But an acu tech license should have some minimum qualifications.   

     

    Tess Bois (formerly McGinn)

    One World Community Acupuncture

    Fitchburg, MA

      0 likes
  • November 5 2010 at 7:39 AM
    Guest writes:

    Any idiot???

    I speak here as an MD who has a little traditional training in acupuncture (I apprenticed for a while years ago, and have no formalized training and thus do not use it anywhere outside myself and family).  I was directed to your blog by a dear friend whom I have great respect for who is training in DC.  I enjoyed your post very much and it is quite a conversation starter.  I would like to make two comments.

    First, the comment about any idiot can do it.  What your article shows is safety, not efficacy.  It shows that “any idiot” can try to do acupuncture and not kill someone.  I find this reassuring personally, but this does not address whether any idiot can facilitate healing using this modality.  So, can any idiot do this?  I can’t tell from what you presented (and from experience I don’t think so, but that is just opinion).

    Second I want to say that it is true that often we don’t know how something works, and in medicine (where we have very significant potential to harm) this often leads to bad things.  An example might suffice.  For about thirty years, doctors gave women hormone replacement therapy to prevent heart attack and strokes.  The “thinking” was that women did not get these problems until menopause and thereafter their risk within a year or two sharply increases to match that of men with similar risk factors (matched for smoking, family history, etc.)  Since we “knew” menopause was just caused by a fall in estrogen, and giving estrogen stopped the symptoms of menopause, estrogen was heart healthy.  Sounds good right?  We did this for 20 years.  Then we did a huge study (around 7000 women if memory serves) and low and behold, there is a small but significant increase in heart attack and stroke in the women taking hormone replacement.  Our theory of heart disease and our theory of menopause were both much too simplistic.  My point - base treatment on results, studies and experience, not theory.  You may be pushing, pulling, moving or fricasseeing Qi, or not.  Nobody I have met knows for sure.  Don’t treat based on theory unless you have nothing else to go on, and then at least in medicine where there is potential for harm, be up front about it.

    Just my two cents as an unqualified MD (who refers to acupuncturists quite a lot).

      0 likes
  • November 5 2010 at 4:06 PM
    Jessica Feltz writes:

    Hi Unverified MD

    Here’s a blog which addresses the efficacy of acupuncure: https://www.communityacupuncturenetwork.org/blog/statistics-and-acupuncture  I didn’t talk about it in this post, because it’s already been discussed.  Thanks for participating.

      0 likes
  • November 5 2010 at 4:08 PM
    Jessica Feltz writes:

    Tess wrote:

    That there are “minimum qualifications to be a nurse practitioner or an RN.”  I am thinking more along the lines of minimum qualifications for being an LPN or even CNA.

      0 likes
  • November 6 2010 at 7:45 PM
    Darlene writes:

    monkeys

    if you put a bunch of needles in a room with a bunch of monkeys, will they eventually become acupuncturists?!

      0 likes
  • November 6 2010 at 8:07 PM
    Darlene writes:

    studies

    the trouble with studies—as you also pointied out—is that so often they are constantly changing the party line, the standard of care, making it a moving target. take mamograms, for example; first it was get one done at age 35 and then anually (I think) thereafter. Later we heard about all the false-positive mamograms causing a lot of people a lot of stress about disease they didn’t have. not sure this was ever resolved.

    Certain things we *know* are good for us, like getting enough exercise, eating enough veggies and fruit. I think acupuncture is in this category.

    Makes “theory” a lot more attractive as a guideline for treatment plans.

      0 likes
  • November 7 2010 at 2:07 AM
    Skip writes:

    Dig deep!

    Dig deep!

      0 likes
  • November 8 2010 at 5:50 PM
    Whitsitt writes:

    They did at my school!

    They did at my school!

      0 likes
  • November 13 2010 at 3:18 PM
    ja_conti writes:

    who matters

    Murray Hill Neighborhood Acupuncture and Chinese Medicine, LLC

    Address: 1926 East Park Place Milwaukee, Wisconsin 53211

    Open seven days a week by appointment. Phone 414 906 8881.

    6 comfortable recycled lounge chair

    It all depends on who matters. If it is the patient who really matters, then if the patient says they feel better, (for example, pain or other symptoms),then, that’s valid and the end of the story, regardless if it corresponds with scientific “fact,” or not.  If the patient really matters, then the more people who do acupuncture the better, and it doesn’t matter which profession is doing it. If the patient matters, you do want some minimum standards to prevent harm and you want to keep the costs down. If the patient matters, then other practitioners’ experiences matter, because those come directly from patients in their clinic who tell them if they are helped or not and what techniques worked or not. When it is the patient who matters, all the arguments become clear and the right answers become compassionate and obvious.

      0 likes
  • November 13 2010 at 3:38 PM
    ja_conti writes:

    menopause

    Murray Hill Neighborhood Acupuncture and Chinese Medicine, LLC

    Address: 1926 East Park Place Milwaukee, Wisconsin 53211

    Open seven days a week by appointment. Phone 414 906 8881.

    6 comfortable recycled lounge chair

    And how about viewing the ageing process and a woman turning into a loving and wise grandma as a beautiful and natural treasure instead of a dysfunctional machine with body parts breaking down requiring horse urine for repair?

      0 likes
  • November 19 2010 at 11:55 PM
    Guest writes:

    Citation of Data, so I can use it too, please smile

    Can you please provide a reference or citation of the data chart of acupuncturists per state, so that I can use it in my business plan/marketing research?  Thank you!

      0 likes
  • November 20 2010 at 5:58 PM
    keithananda writes:
      0 likes
  • February 15 2011 at 6:38 PM
    Guest writes:

    As an acupuncturist who

    As an acupuncturist who “gets it” I am horribly offended by this article and think this is the quickest way to get our sophisticated and complex medicine illegalized.  In China acupuncturists have 6 years of schooling and are doctors, this is the direction that the US should be heading rather than assuming that you can simplify it to a technicians position or under a weekend trained MD who had no concept of the intricacies of TCM.

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