Context for Policy-making in California
Little Hover Commission 2004
Regulation of Acupuncture: A Complementary Therapy Framework
In the course of its study, the Commission identified a number of contextual issues important to formulating policies related to acupuncture.
- Patient safety. Government's first concern is patient safety, the bedrock for answering the legislative questions. Herb-drug interactions, infection control, Western diagnosis and coordination with other health practitioners emerged as patient safety concerns. For example, the scientific safety guidelines from the Centers for Disease Control and National Institutes of Health offer the State a baseline for policy-making, but federal recommendations for single-use disposable needles have not been adopted in California.32
- Limited record of complaints. The number of complaints recorded by malpractice insurers and the Acupuncture Board is small. Absent evidence of a pattern of significant consumer problems in California, questions were raised about the purpose of increasing education requirements or other changes to examination, school accreditation, or scope of practice. The majority of enforcement cases pursued by the board involve unprofessional conduct, ethical issues, practice management issues and sexual misconduct.33
- Alternative medicine is in demand. Consumer demand has pressed Western medical practitioners and insurers toward accepting acupuncture as a complementary addition to the health system. This in turn has pressed the field of acupuncture to adopt some of the standards of Western medical and insurance practices.
- Minimum competency for acupuncture license is Eastern, not Western training. Californians seeking acupuncture can choose among practitioners who have different types of training, including those only trained in ancient Eastern teachings. California-licensed acupuncturists (LAcs) must demonstrate knowledge of specific traditional Asian healing practices. Practitioners who wish to also practice Western medicine can obtain dual-licensure, such as nurse-acupuncturists (RN-LAcs), chiropractor-acupuncturists (DC-LAcs) and medical doctor acupuncturists (MD-LAcs). In contrast, the scope of practice of Western medical doctors is so broad that MDs are not required to hold separate licenses to practice acupuncture. While not legally required to be trained in acupuncture to perform it, professional norms and malpractice concerns are incentives for MDs to seek training. Dentists and podiatrists are the only other California licensees who are permitted to perform acupuncture without holding an acupuncture license. However, the use of acupuncture must be within their scope of practice and they must undergo acupuncture training that is approved by their respective licensing boards.
- Cultural perspective and different basic belief system. In California, there has been an effort to fit the traditional belief system that underlies acupuncture into a Western scientific framework. This creates pressure to incorporate into traditional acupuncture education Western scientific training in microbiology, chemistry, physiology, virology, etc. The practice of acupuncture that has been passed down from generation to generation has been based on beliefs about energy fields, spiritual factors, and connectivity between Yin, Yang and Chi.34 The stated goal and philosophy of acupuncture is enhancing health through balancing energy. In contrast, Western medicine is based on physical science and focuses on repair and prevention of disease and injury.35
- Within acupuncture, wide spectrum of beliefs and practices. Even experts in acupuncture disagree about how acupuncture works and whether it can be explained in scientific terms.36 There also is disagreement about appropriate points for needle placement, how deeply the needles should be placed and how many needles are needed. 37 Some of this disagreement is attributed to different countries and different schools evolving different practices over thousands of years of trial and error. A fundamental disagreement in the acupuncture community is whether there is an underlying spiritual basis to this traditional healing, and whether it should not be melded into a Western scientific model.38 How one answers that question influences whether traditional teaching and practice should be required to incorporate Western science.
- Preserving traditional healing methods. There are age-old and emerging diseases for which Western science has yet to find clear answers or effective antidotes. As a case in point, antibiotic-resistant bacteria is heightening interest in other approaches to battling infections. Thus, treatments such as herbal therapy and acupuncture have gained attention and heightened scientific scrutiny. Efforts to collect reliable evidence of efficacy and needle placement are ongoing.