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Little Hover Commission 2004

State of California
September 30, 2004

Regulation of Acupuncture: A Complementary Therapy Framework

The Honorable Arnold Schwarzenegger
Governor of California

The Honorable John L. Burton, President pro Tempore of the Senate,
The Honorable Dick Ackerman, Senate Minority Leader,
and members of the Senate

The Honorable Fabian Núñez, Speaker of the Assembly,
The Honorable Kevin McCarthy, Assembly Minority Leader,
and members of the Assembly

Dear Governor Schwarzenegger and Members of the Legislature:

In 2002, the Commission was asked by the Governor and Legislature to assess some long-standing and contentious issues regarding the State's regulation of the acupuncture profession. Specifically SB 1951 and AB 1943 requested that the Commission review the scope of practice and educational requirements for acupuncturists, the process for accrediting acupuncture schools and for examining licensees.

In conducting this review, the Commission sought out detailed and technical analysis - from experts at the University of California, California State University and RAND - to help sort through the conflicting claims that have frustrated the policy-making process. The Commission heard hours of public testimony, and engaged in even more hours of less formal public discussions. The Commission solicited and reviewed written comments from any individual and organization that desired their view to be considered, and it reviewed volumes of scientific and other treatises on acupuncture and Oriental medicine.

The Commission, as an independent and bipartisan panel, also explored the underlying tensions that have contributed to the persistent debates and probed the broader public interest aspects that are embedded in the specific regulatory issues that were before the Commission.

Through this process, the Commission developed an appreciation for the profession and for acupuncture and traditional Oriental medicine. It also developed and assembled a substantial body of technical analysis that could be used by regulators and lawmakers to resolve the precise issues that were before the Commission, as well as other challenges.

One source of confusion emanates from the Legislature's declared intent to regulate acupuncture as a primary health care profession without specifying in statute the full authority or limits of acupuncturists to diagnose and treat patients. This ambiguity - along with the legal opinions crafted to resolve confusion over the scope of practice - raise the potential for conflict between practitioners of traditional Oriental therapies and modern Western medical doctors. And when the two paradigms conflict - rather than complement - the opportunity for patient harm increases and the potential for patient benefit decreases. The Commission recommended specific ways to amend the scope of practice to resolve this issue.

Regarding educational requirements, the increased standards that will go into effect on January 1, 2005 appear to provide adequate time to teach the knowledge, skills and abilities needed for entry-level practitioners to perform this clarified scope of practice. The Commission, however, recommended ways to make sure that this training provides the information necessary to protect the public.

The Commission concluded that the Accreditation Commission of Acupuncture and Oriental Medicine should be relied upon to validate the quality of acupuncture training schools. The Commission, however, concluded that the State should continue to use its own examination as the regulatory threshold to practice in California, rather than rely on the national exam.

The Commission also identified additional opportunities for the State's consumer protection agencies, including the Acupuncture Board, to safeguard patients against practices or products that can threaten their safety and the public health - perhaps more importantly, measures to control infections. These safeguards begin with the qualifications of board members, and by making sure that vacancies on the Acupuncture Board - which currently number six out of nine seats - are expeditiously filled.

California's fundamental policy toward alternative health care has been to provide patients with the freedom to choose. That path confers onto regulators the primary responsibilities of making sure that practitioners meet minimum standards, and that consumers have the information needed to make informed choices. Disclosure statements and other consumer education materials should provide patients with information regarding treatment efficacy and safe practices.

An important underlying tension is the trend toward blending traditional Oriental Medicine with Western biomedicine. While both healing paradigms can benefit the public, those benefits will be jeopardized if the two regulatory schemes are not kept separate and distinct. The Commission's recommendations would clarify the role for acupuncturists and - if enacted immediately - would prevent greater confusion and even potential harm to consumers in the future.

The Commission sincerely appreciates the willingness on the part of state regulators, acupuncturists and other health professionals to inform its process. The Commission also appreciates the straightforward analysis provided by researchers at the University of California, San Francisco, California State University, Sacramento and elsewhere who contributed to its understanding of the issues. But as always, the conclusions and recommendations are the Commission's own.

Michael E. Albert, Chairman



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