Executive Summary - Underlying Tensions
Little Hover Commission 2004
Regulation of Acupuncture: A Complementary Therapy Framework
As a destination for dream seekers, California has inherited the treasures of cultures Occidental and Oriental. Predictably, government is occasionally required to arbitrate, even regulate, how some traditions and practices are used in the public interest.
Such is the case of acupuncture and Oriental medicine, a healing art with ancient roots and modern branches. In 30 years, the State has evolved a full-scale professional regulatory scheme that licenses more than one in four acupuncturists in the United States.
This practice has flourished in the Golden State in part because of Asian immigration and influence in California. Increasingly though, Californians from all cultural perspectives have sought holistic approaches to maintaining health and have turned to traditional healers to complement or as an alternative to Western medicine.
Throughout this evolution, acupuncturists have sought to define and expand their authority, their role in the health care system, and their standing among health care professionals. These ambitions, however, have at times conflicted with the purpose of state regulation and created controversies that have been difficult for policy-makers to resolve. In two measures, SB 1951 and AB 1943, the Governor and the Legislature asked the Commission to review the scope of practice and the educational requirements for acupuncturists. The Commission also was asked to compare the State's procedure for approving acupuncture schools and administering the licensing examination with the national organizations that accomplish those tasks for other state regulators.
In examining these issues, the Commission identified three underlying tensions or conflicts that make it difficult to assess and reconcile the demands of the profession with the role of state government:
- The nexus between traditional Oriental and Western medicine is poorly defined. The two paradigms are based on different understandings of how the body works and how it is healed. While allowing acupuncturists to practice independent of Western medical doctors, the State has not defined when and how the two systems should work together. In turn, some acupuncturists are advocating for authority to make Western diagnoses using Western diagnostic tools.
- The profession has sought to elevate its standing through the regulatory process. While educational requirements were recently raised, the profession asserts that still higher minimum standards are needed to achieve "parity" with Western primary health care providers. The purpose of the government's educational requirements, however, is clear and limited to preparing entry-level practitioners to perform their scope of practice. They are not intended to serve as a measure of professional status or to favor one sector of the profession over another.
- Acupuncturists and the Acupuncture Board are concerned that relying on national standards and procedures will hold back the profession in California. Some professional acupuncture associations in the state have strongly resisted efforts to create a national framework for accreditation and examination, which has become the norm in Western medicine. While California acupuncturists are among the nation's leaders in the profession, the national organizations and experts in other states have much to offer the profession as it continues to mature.
Identifying these tensions is important to understanding the controversies, and hopefully providing a clear path for government regulators and the profession. Policy-makers must remember that the regulatory structure exists for the sole purpose of protecting the public. Licensure is not intended to advance the profession or ensure the economic prosperity of a segment of practitioners. Other health professionals can and do use other mechanisms - most of them private - for encouraging excellence among practitioners or integrating health care services.