The acupuncture wars

I found this letter to the editor of Acupuncture Today somewhat disturbing. While I am sure the intent is sincere, it reflects a profound lack of knowledge and understanding about the history and practice of Acupuncture. The writer is an MD who used to practice acupuncture after completing a 300 hour training course. For a number of reasons, she decided to complete a 3600 hour training program at one of the local Acupuncture programs in Portland, OR. She nows holds the view that those who practice any form of acupuncture with less than 3600 hours of training are not only ineffective, but unsafe, and thus the practice should be banned. There are several problems with the argument.

1. In the 30 plus years that Acupuncture has been practiced in Oregon, there is very little incidence of adverse effects. The rate might be slightly lower amongst those with more training, but the difference is statistically insignificant. In any event, adverse incidents can be prevented without an additional 3300 hours, that is for sure.

2. According to the world's leading authority on the history of chinese medicine, Paul Unschuld, the vast majority of acupuncture practitioners throughout the centuries have not been trained in what the letter writer calls the science of oriental medicine. Most have been illiterate, and most of those who could read practiced what could only be described as a cookbook form of the medicine. In other words, they followed recipes for treating various symptoms and did not make much use of any of the complex diagnostic techniques described in the Yellow emperor's classic of medicine. In addition, the concepts of chinese medicine do not even remotely meet the definition of a science. They are at best a set of dogmas that, while based upon empirical observations, can never be subjected to any form of "proof," as they do not describe anything material that can be studied. (It can be proven that certain herb formulas or acupuncture protocols are effective for this or that disease, but the existence of Qi and the meridian systems remains outside the realm of experimentation.))

3. While it is indeed complex to master the diagnostic techniques and treatment strategies described in the so-called medical classics, there is little empirical evidence that mastery of such methods leads to superior clinical results. Most of the chinese research demonstrating efficacy relies on point prescriptions that may or may not be based on traditional chinese concepts in varying degrees. In addition, all of the large, rigorous studies going on in europe and the US have likewise relied on such point protocols. In other words, symptoms and diseases, as defined by modern medicine, are treated with on standardized protocol that could easily be carried out by anyone with minimal technical training and no knowledge at all of traditional concepts. To claim otherwise is disingenuous and the burden of proof regarding safety and efficacy is on the letter writer and her cohort.

Since there is no evidence that acupuncture is actually no less safe and effective regardless of the level of training, when performed by any licensed primary care healthcare professional, to to institute such restriction on MDs, DOs, and DCs would serve no other purpose than to deprive the public os access to these services through providers they already see, often with a greater likelihood of insurance reimbursement. While the letter writer is an MD and thus is not personally motivated by territorial economics, she is no doubt in league with those whose primary motivation is to restrict competition for personal reasons under the guise of increased safety and efficacy. Unless this assertion can be proven, I hope the libertarian spirit of Oregon will prevail in this matter. If there is no need for government regulation to protect the public, then none should be instituted.