Dr. Amaro's Official Response to attacks on The Bottom Line
John A. Amaro D.C., FIAMA, Dipl.Ac. (NCCAOM)
Dr. Amaro's official response is as follows:
Thank you for allowing me to respond to the extremely negative letters to the editor concerning my recent article "The Bottom Line" which appeared in the March 2004 issue. Acupuncture Today is to be commended for living up to its mission statement of being "committed to bringing an open forum to the acupuncture profession." To respect the diversity, techniques, styles and philosophies of the acupuncture community as a whole is tantamount. Recognizing the vast variety of cultures and styles of acupuncture being practiced in America and around the world is of extreme importance.
After reading the letters of response to my article, I re-read "The Bottom Line" four or five times to glean why these respondents were so adamant, especially since my intention was to offer a very significant solution to what is obviously a very significant problem. I specifically brought to the attention of the reader that there seems to be a disproportionate number of academic hours of education between those studying "Oriental medicine" and medical and chiropractic physicians who learn "medical/clinical meridian acupuncture." This has prompted a vehement response from some in the Oriental medicine community. It was my intention to offer a potential understanding and possible solution to what has obviously developed into a significant turf war over who owns the right to practice acupuncture.
Please understand I am both a traditional and contemporary-trained Oriental medicine and acupuncture practitioner, having graduated from the Chinese Medical Institute in Kowloon, China in 1976. My formal studies, however, go back to 1967. I am both a diplomate of the National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM) and a licensed acupuncturist (LAc) in Arizona, in addition to my DC license and degree. I was appointed by the governor of Arizona to serve on the first Arizona Acupuncture Board of Examiners, which I successfully and honorably served for three years during its establishment.
Having served on that board, I approved close to 200 acupuncture and Oriental medicine practitioners who came from very diverse backgrounds. Some were TCM trained; some were not. All of those approved, however, after review of their credentials, were deemed to be competent and qualified regardless of their different schools, countries of origin, or cultural heritage. There were Five Element practitioners, meridian medical/clinical acupuncture practitioners, and of course, those who were TCM trained. There was never a thought process amongst the board that "this person could join the club because they were TCM trained and this person would be refused licensure because they were not."
It became very apparent that the individuals responding to my article through the letters to the editor, as well as the president of the American Association of Oriental Medicine (AAOM), who represents an entire national organization, do not endorse, recognize or accept any style or cultural form of acupuncture other than traditional Chinese medicine (TCM). I find this exceptionally disturbing. It is obvious that acupuncture is practiced around the world in a variety of forms to include meridian acupuncture, and TCM is only one of those specific types of acupuncture. To deny this fact would be "unethical" and "unprincipled," to use the words of the president of the AAOM in his letter.
The National Institutes of Health (NIH) states in its Consensus Statement: "Competing theoretical orientations (e.g., Chinese, Japanese, French) currently exist that might predict divergent therapeutic approaches (i.e., the use of different acupuncture points)."
Medical/clinical meridian acupuncture is practiced by a vast number of practitioners throughout every European and Scandinavian nation; North America; South America; the Middle East; Africa; the former Soviet nations; Indonesia; Taiwan; Korea; Japan; and Australia. These practices utilize acupuncture in conjunction with Western medical practices as a part of their armamentarium to assist the patient's clinical response. As a matter of fact, to quote directly from the AAOM's Web site: "Americans from all walks of life now look upon acupuncture as a form of treatment which can be used in conjunction with Western medical practice."
The NIH Consensus Statement also clearly states: "Acupuncture describes a family of procedures involving stimulation of anatomical locations on the skin by a variety of techniques. There are a variety of approaches to diagnosis and treatment in American acupuncture that incorporate medical traditions from China, Japan, Korea, and other countries," and that "Acupuncture has been used by millions of American patients and performed by thousands of physicians, dentists, acupuncturists, and other practitioners for relief or prevention of pain and for a variety of health conditions."
Dr. Bruno's letter specifically states: "In short, the study and practice of acupuncture is a part of, and not separable from the study and practice of Oriental medicine. The basic theoretical and practical education for acupuncture is the same basic education as is required for the study of acupuncture and practice of herbal medicine, or Oriental medicine in its totality. Any attempt to argue that a minimal study of technique by other professions not schooled in the thought and diagnostic work required of the practitioner in any branch of Oriental medicine is arrogant and flawed in its entirety."
The National Center for Complementary and Alternative Medicine (NCCAM) defines traditional Chinese medicine as "an ancient system of medicine and health care that is based on the concept of balanced qi or vital energy, that flows throughout the body. Among the components of traditional Chinese medicine are herbal and nutritional therapy, restorative physical exercises, meditation, acupuncture, acupressure and remedial massage." According to Dr. Bruno's definition of acupuncture, which he states cannot be separable from the study of Oriental medicine, this would mean that every medical, chiropractic, naturopathic or ancillary practitioner, regardless of background, who practices massage, nutritional therapy, or prescribes exercise, would fall directly under OM, and these practitioners are unworthy to practice unless they have taken the full course of study of Oriental medicine only because those procedures are a part of the study of Oriental medicine. Shall we discuss "arrogance" and "flaws"?
One young lady who identified herself as an acupuncture student took exception to the fact that there are professionals who are learning meridian medical/clinical acupuncture and are doing so in 100-300 hours, whereas she elected to study an Oriental medicine program, which will amount to 2,600 hours. There are those who wonder how someone can honestly feel qualified to practice the extreme complications, diversities and overwhelming amount of academia of TCM in just 2,600 hours. As Dr. Bruno so aptly put it, "The Council of Colleges of Acupuncture and Oriental Medicine is already working diligently on a degree at the doctoral level … well beyond even 3,000 hours of study." I agree completely. If one is going to study and become proficient in the complexities of Oriental medicine, didactic and clinical hours should at least approximate that of every other healing arts professional in the nation - which, I might add, is over 4,500 hours. She also said, "My belief on the issue of medical/chiropractic practitioners being able to practice acupuncture with 100-300 hours of training is that it is not in the best interests of the public or the profession of acupuncture. As an acupuncture student in New York, I have written letters to help prevent the passing of any future legislation allowing it… ." Something tells me every chiropractic and medical practitioner of meridian medical/clinical acupuncture in the country will find this mentality extremely disturbing. When I stated in my article that "there seems to be an increasingly growing resentment between acupuncturists and medical/chiropractic physicians who are also engaged in the practice of acupuncture," it was this person's mentality that I referred to. This person will do what she can to censor and eliminate a procedure out of an established profession, denying patients the right to be treated by their choice of practitioner only because she has elected to study another form of acupuncture and apparently fears the possible competition. This mentality is totally inexcusable!
Dr. Bruno proudly quoted the only state in the union - Hawaii - that does not allow medical practitioners to use acupuncture. He failed to mention the other 49 that do allow it as part of their scope of practice. Concerning the chiropractic profession, toward which some in the Oriental medicine community have taken a personal vendetta of practicing meridian Euro/Asian medical/clinical acupuncture, allow me to share some very significant information.
The National Board of Chiropractic Examiners, in its most recent survey analysis and summary of the practice of chiropractic in the United States, showed specifically that 13.6 percent of the practicing DCs in the nation utilize needle acupuncture as a routine procedure in their clinical practice. The College of Acupuncture of the American Chiropractic Association estimates this figure to be 18 percent. This amounts to approximately 8,500 to 11,000 chiropractic practitioners who utilize needle acupuncture daily. In addition, the latest survey specifically shows that 58.2 percent of the profession, or 35,743 chiropractors, utilize the principle of meridian acupuncture thru non-invasive meridian therapy in their daily practice. Please note, this is not Oriental medicine nor is it called traditional Chinese medicine. It is clearly meridian therapy, which bases itself on the principle of meridian acupuncture but utilizes non-needle forms of stimulation.
When I wrote "The Bottom Line," which I highly recommend everyone re-read, my intentions were completely constructive. It is very obvious to me there is a severe animosity towards medical and chiropractic physicians practicing acupuncture by many in the Oriental medicine community, and it further appears the problem revolves around the use and title of the word acupuncture. This is precisely why I stated, "The acupuncturists should hold themselves out to be the uncontested authority in 'Oriental Medicine.'" The word "acupuncture" is firmly established within the medical, chiropractic and naturopathic professions as well as the public's perception of what is acupuncture.
To quote the AAOM Web site again: "In recognition that acupuncture was just one part of the entire scope of Oriental medicine, the AAOM has streamlined its name to be the American Association of Oriental Medicine (AAOM). Our members are regarded as the highest qualified practitioners of Oriental medicine in the United States." This is precisely the point. Let the public know the practice of Oriental medicine is a specialty in its own. Now I realize that to be a member of the AAOM and to be "regarded as the highest qualified practitioners of Oriental medicine in the United States," all one needs to do is join. I will not be as catty as the student who specifically stated of those practitioners taking the 100-300 hour programs, "Practitioners just have to show up for class and in the end are deemed able to practice acupuncture." Again, this mentality is totally inexcusable!
Dr. Bruno states emphatically, "It is significant to note that he (Amaro) does not mention the very strong feelings that are held by chiropractors, who have taken fully accredited programs in acupuncture, toward those who promote and sell abbreviated workshops in acupuncture …Certainly there is a measure of gullibility if a provider actually thinks that he or she could be qualified in acupuncture, or any other complete medical system, after 100 or 200 hours of training." Again, remember that we are not referring to the complexities and cultural approaches of Oriental medicine, but a complete and distinct style of meridian acupuncture with rules and laws complementary to TCM but a treatment approach based on Five Elements and the meridian system. Yes, it respects the factors of TCM, but it is not learned or practiced in the same way. It is a totally different system. Regardless of the AAOM's stance, all acupuncture is not TCM-based. This is not my opinion; it is an empirical fact of life. Incidentally, as to the argument of "How would the chiropractic profession like it if we were to take 200 hours of manipulation and receive a certificate in chiropractic" - please remember, we in acupuncture have an incredible form of manipulative therapy known as tui na. Why not develop it? Again, this is a bad argument.
Yes, I do receive hate mail from DCs who have gone to the sanctum sanctorum and taken the "accredited program." They write to tell me that any form of acupuncture other than TCM is not valid; only theirs is. That suggest I "turn from the dark side" and join them for enlightenment, and hat the so-called "abbreviated program" has no merit. The chant is TCM, TCM. Please bear in mind, I have never received a letter from a DC in the U.S. who is critical of the meridian medical/clinical Euro/Asian style of acupuncture that was from a state in which acupuncture was a part of their scope of practice. I find that very significant. I wonder how many DCs in New York, New Jersey, Washington, Oregon, California and a few others would truly feel compelled to attend an Oriental medicine school if their state included acupuncture within its scope.
Currently in 30 states (and growing), DCs may practice needle acupuncture by licensure or by scope of practice inclusion. The remaining states allow for electronic or laser stimulation of the body utilizing the principle of acupuncture through meridian therapy. As stated earlier, 49 states allow for the practice of acupuncture by the allopathic physician. As a reminder to the Oriental medicine profession, there are approximately 11,000 DCs practicing acupuncture, and over 35,000 utilizing the principles of acupuncture through meridian therapy. When one adds the approximately 17,000 medical, osteopathic, naturopathic, podiatric and dental practitioners practicing medical acupuncture, this should certainly be a wake-up call to the acupuncture profession that perhaps developing the reputation as "Oriental medicine" authorities may be a very viable solution.
So, what's "the bottom line?" As I suggested in my article, those medical and chiropractic physicians utilizing acupuncture who have an academic or clinical interest in exploring the full range of Oriental Medicine in their busy practices are few in number. I specifically stated the acupuncturists today should make the stand that they are the experts in "Oriental medicine," recognizing that the word and practice of acupuncture is being used by a variety of professions. Oriental medicine practitioners can stand out from other practitioners who perform just the principles of acupuncture. It would make them so much different than the other practitioners using acupuncture, and they would become authorities in a complete system of healing (Oriental medicine), which would include acupuncture, tui na, herbal medicine, nutrition, restorative physical exercises and meditation as suggested by the National Center for Complementary and Alternative Medicine.
If I had one thing to change about the chiropractic profession, I would divide it into two separate and completely distinct professions. I would recognize chiropractors who limit themselves to adjustment of the spine and the correction of subluxation and who are philosophically and professionally completely different from chiropractors who utilize the full range of therapeutic applications to include nutritional therapy, physiotherapy, rehabilitation procedures, acupuncture, meridian therapy and more. They are both chiropractors and practice chiropractic; however, they are completely different in their mission and philosophy. The public is not confused as to competence; in fact, they are both very competent - they just practice two different approaches to chiropractic. I would let the subluxation-based DCs be "chiropractors," which is what they want, and allow the fully trained, therapeutic-based DCs to be "Doctors of Chiropractic (Medicine)," and perhaps change their title to DCM. There would be a definite distinction drawn. The public who wish to seek out the doctor of chiropractic (medicine) would then recognize the difference in name alone from the Chiropractor, even though ultimately, when it comes to adjustment of the spine, it would be the same procedure, but with a different philosophical and academic approach.
There are many parallels the acupuncture and Oriental medicine profession could explore via the above comment. Should the Oriental medicine profession find this suggestion worthwhile, I would be happy to volunteer my time and insight into its exploration and possible development.
I urge the acupuncture profession as a whole to re-read "The Bottom Line" from the March issue, and instead of reading it as someone who was being critical, look upon it as being constructive, and perhaps entertain the message I tried to convey. The acupuncture profession must recognize the fact that in the United States alone, there are close to 30,000 medical/chiropractic physicians utilizing acupuncture as a part of their scope of practice. This is regardless of any argument as to their competence due to the fact they are practicing a form of acupuncture, which is totally accepted around the world, but only differs from what is being taught in Oriental medicine schools.
It is totally unreasonable to think those in the medical/chiropractic community are going to give up their scope of practice and license to include acupuncture in their practice regardless of accusations of incompetence and foot stomping by the OM profession. All of the insults, name-calling and arguments in the world are not going to change the practice. All it will do is polarize the professions, which should be working together as opposed to fighting. Again, I will repeat from "The Bottom Line": "We can all co-exist and thrive together as professions as long as we are able to put aside the animosities, which have inundated our professions from the beginning … It is my wish for 2004 that the professions may move forward with peace, harmony and mutual respect for each other."
John A. Amaro DC, LAc, Dipl. Ac.(NCCAOM)