Legal Precedent

By John Amaro, LAc, DC, Dipl. Ac.(NCCAOM), Dipl.Med.Ac.(IAMA)
My last article, "Do Chiropractors Have the Right to Practice Acupuncture?" (July 12th issue), spawned as much favorable commentary and response as any article I have written in 11 years. Obviously, the message conveyed struck a note throughout the chiropractic profession.

Now we find some of our chiropractic colleges adding full programs in the traditional Chinese medicine (TCM) style of acupuncture, which bases itself largely on myth, folklore and esoteric rationale to teach doctors of chiropractic to become acupuncturists. Even though DCs are allowed to practice acupuncture in approximately 35 states, I feel the effort of the profession should be to secure the right to practice in the additional 15. Instead, schools of acupuncture are being developed which may undermine the nature of our profession for doctors to become acupuncture technicians.

Is this the beginning of the end of the chiropractic profession, when our own schools begin to focus on another healing art? Of course acupuncture is complementary to chiropractic, but so is physical therapy and in some instances, so is pharmacology. Should we expect our chiropractic colleges to establish schools of physical therapy so doctors of chiropractic can become PTs? How about adding a pharmacology school so that we can become pharmacists instead?

How many medical schools do you think are going to rush out and begin teaching traditional Chinese medicine (TCM) so that the MD can become an acupuncturist? The medical profession has automatically laid claim to acupuncture as the chiropractic profession should be doing, especially since we are the original pioneers of acupuncture in North America. Acupuncturists are regulated by the medical and chiropractic professions in a number of states.

Why would a doctor of chiropractic want to become an acupuncturist? The answer is simple. Only in states that do not allow for the practice of acupuncture by a DC do you see the doctor going to acupuncture school. This is an effort to compete in the health care field. As it has been so aptly said, "If you are going to compete in the health care industry, you better have something to compete with." California, New York and New Jersey are prime examples.

The medical physician does not seek acupuncture education through acupuncture school, nor does the chiropractic physician, who may practice with additional approved hours of education. Both seek to learn the art and science of contemporary Asian medicine and medical acupuncture through programs specifically designed for professionals that focus on "meridian style acupuncture." All states (with the exception of Kansas, which includes acupuncture in its scope of practice) require a postgraduate program in the academics and clinical applications through a CCE-accredited college. Numerous medical physicians attend these chiropractic programs or ones whose credits are given through the American Medical Association.

Remember that acupuncturists do not want anyone performing acupuncture other than someone who attended one of their TCM schools. As a result, some states (New York, New Jersey, California, Wisconsin, Washington, Oregon and a few others) literally force doctors of chiropractic to attend acupuncture school for them to practice traditional Chinese medicine.

As a result, these DCs (acupuncturists only because they were forced to attend an acupuncture school to practice) express sour grapes for those DCs and MDs who are allowed to practice acupuncture as a part of their scope of practice. They become critical, vehement and vocal. Just because they had no choice but to be sucked into the politics of the American acupuncture school system, they feel everyone should. Had their state allowed them to practice acupuncture as 35 states already do, how many of these DCs turned acupuncturists do you think would exist?

Here is what Barbara Mitchell, former executive director of the National Commission of the Certification of Acupuncture and Oriental Medicine (NCCAOM) and current executive director of the National Acupuncture and Oriental Medicine Alliance, stated in the last Alliance newsletter:

"One of the hottest issues in several states recently has been the practice of acupuncture by other health care providers. States with established practice acts (such as Maine, Washington, California and Montana) have been challenged by medical doctors, chiropractors, naturopaths and chemical dependency specialists who want to practice acupuncture. The new laws in Idaho and Indiana (and last year's law in Missouri) were strongly impacted by the desires of other health care practitioners who want to, or already have, acupuncture in their scope. The May meetings of the Council of Colleges and the Accreditation Commission debated whether their member colleges should be allowed to train other health care providers to practice acupuncture and/or Oriental medicine."

Barbara Mitchell sees the practice of acupuncture and Oriental medicine by other health care providers as one of the "major issues facing our profession today. It is one that we must discuss and come to grips with. Increasingly, it appears from viewing the legislative arena that the issue is not whether other health care providers should practice acupuncture. The issue is how we choose to relate to the fact that they do." (emphasis added). She continues:
"The Alliance has taken the position that it best serves our patients and our practitioners to be proactive, work with other health care providers and discuss standards of competency to practice acupuncture. This is based on the founding principle in our bylaws that mandate that we respect diversity and encourage discussion among practitioners, network within the community of acupuncture and Oriental medicine practitioners, support consumer access to and freedom of choice in health care, support appropriate educational and competency standards, and work cooperatively with other health care providers for the wellness of our clients."

Barbara Mitchell is one of the most respected and admired people in acupuncture in North America and perhaps the world. As the history of acupuncture is continually being written, as it has been for literally thousands of years, Barbara Mitchell will no doubt have an entire chapter devoted to her accomplishments. Most of us would hope for a footnote.

It is with this that I call upon my chiropractic and medical colleagues and suggest that we adopt the position of the National Acupuncture and Oriental Medicine Alliance. Realize that we are all here for a common goal, and that is to help the sick and suffering regain health.

Most of the fighting has clearly been one-sided, with the acupuncturists throwing stones at the chiropractic and medical professions. We have been accused of having inferior acupuncture education because we have adopted a different form of acupuncture other than TCM. With the awareness that Barbara Mitchell can and is generating among the acupuncture profession, we can practice in peace and harmony and refer to acupuncturists as peers and colleagues in the future.

One of my friends in Delaware just last week faxed me a note saying how he had tried to establish a relationship with a couple of acupuncturists who moved to his neighborhood. He stated the acupuncturist would have nothing to do with him, would not return phone calls and refused to speak to him on a personal visit. I urge you to clip this article and keep it for future reference. I would then suggest presenting the position of the National Acupuncture and Oriental Medicine Alliance regarding its relationship to "other health care providers." It will take a while for this position to become reality amongst the acupuncture profession; in the meantime, continue practicing acupuncture and helping people regain their health.

Just recently, Idaho, Maine and Indiana have gained the right to practice acupuncture with state certification. Tennessee is close to adopting regulations. Don't be surprised to see Georgia joining the list. If we can just get California, Oregon and Washington to wake up, I bet New York, New Jersey and Pennsylvania will be close behind.

Every year, more states are allowing the practice of acupuncture by doctors of chiropractic. Most recently, the Nebraska Office of the Attorney General has deemed acupuncture is within the scope of practice of chiropractic physicians. The decision was based in part on a 1979 Supreme Court case of the Acupuncture Society of Kansas vs. the Kansas State Board of Healing Arts. I was president of the Acupuncture Society of Kansas during those tumultuous years. What an experience that was!

Should anyone who practices in one of these holdout states which do not allow for the practice of acupuncture for DCs with a copy of the Nebraska attorney general's opinion, contact me with your request. If you do not have a law that allows you to practice, then change it. Your future (and our family's future) are definitely at risk. I urge all chiropractic boards of examiners who do not have acupuncture within their scope of practice to realize you are in the minority. For those practitioners who reside and practice in one of those states, you have no choice but to do what it takes to get acupuncture as part of your scope of practice. As acupuncture gains more practitioners and more awareness by the average American, you cannot continue to have a limited practice act.

Remember: "If you are going to compete in the health care industry, you better have something to compete with!"

Click here for previous articles by John Amaro, LAc, DC, Dipl. Ac.(NCCAOM), Dipl.Med.Ac.(IAMA).

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