Acupuncture in the United States
Little Hover Commission 2004
Regulation of Acupuncture: A Complementary Therapy Framework
In the United States, acupuncture had been used primarily by Asian immigrants until President Nixon traveled to China and re-established diplomatic ties in 1972.13 Since that time, acupuncture has gained increasing acceptance with the public and the complementary medicine clinics of academic medical centers. In 2004, the National Center for Health Statistics at the U.S. Centers For Disease Control reported that 1.1 percent of the U.S. public had used acupuncture in the previous12 months and that 4 percent had used it at some time.14
Following President Nixon's visit to China, the U.S. Food and Drug Administration (FDA) began investigational regulation of acupuncture needles. In 1974, Nevada became the first state to issue licenses to non-physician practitioners of acupuncture and the following year Hawaii established the first board of acupuncture.15
In the mid-1980s, the National Commission for Certification of Acupuncturists was founded with the mission of promoting national standards for safe and competent practice.16 Soon afterward, the American Academy of Medical Acupuncture was established to train and certify physicians in acupuncture.
In 1988, the U.S. Department of Education approved the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) as the authorized accrediting body for schools of acupuncture.
Due to the public's growing interest and use of complementary medicine, the National Institutes of Health (NIH) opened the Office of Alternative Medicine Research in 1993. The same year, interest was further fueled when The New England Journal of Medicine published a study indicating that one-third of surveyed Americans had tried some form of alternative medicine, including acupuncture, and that $10 billion was being spent annually on such therapies.17 Because the acupuncture scope of practice also includes the use of herbs and dietary supplements, it is notable that in 1994 the United States passed the controversial Dietary Supplement Health and Education Act, establishing "that dietary supplements are to be regulated like foods instead of drugs, meaning that they are to be considered safe unless proved otherwise and are not required to be clinically tested before they reach the market."18
In 1996, the Food and Drug Administration reclassified acupuncture needles as regulated class II (unproven) medical devices for "general acupuncture use" by licensed, registered or certified practitioners. This decision came with the stipulation that manufacturers label needles for single use only and conform to requirements of prescription devices.19
In 1997 NIH embarked on a major review of all research results on acupuncture and at the end of the year issued an expert consensus statement. It found: "Promising results have emerged, for example, showing efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations, such as stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofacial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma where acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program."20
In 1999, New Hampshire implemented one of the most rigorous education requirements in the nation for acupuncture. Applicants for licensure in New Hampshire must possess a baccalaureate, be a registered nurse or have a physician's assistant degree, in addition to graduation from an accredited acupuncture program. It also made business, management and insurance courses ineligible for continuing education credits.
The following year, President Clinton named four acupuncturists to a 20-member White House Commission on Complementary and Alternative Medicine Policy, including two from California.21
As of 2003, more than 100 medical centers nationally had added complementary medicine clinics, many of which include acupuncture. They include the University of California medical centers, Cedars-Sinai and Stanford University.22 And a preliminary release of a UCLA study indicates that by 2003, a majority of both practitioners and patients in California were Caucasian women.23