Notes

Regulation of Acupuncture: A Complementary Therapy Framework

1. The Acupuncture Board also has "adopted for reference" a document prepared by a professional acupuncture association describing "standards of practice" for acupuncturists (The Council of Acupuncture and Oriental Medical Associations,1997, "Scope of Practice for Licensed Acupuncturists"). That document varies from California statute and regulation. The Acupuncture Board's attorney, Donald Chang, stated that the board's action was the equivalent of receiving a report, October 21, 2003, direct communication).
2. Larry Meyers, Ph.D., Professor, Department of Psychology, California State University, Sacramento, July 2004, written communication regarding "Standards for Educational and Psychological Measurement."
3. Kathleen Hamilton, former Director, California Department of Consumer Affairs, Sacramento, 2004, written communication.
4. California Code of Regulations, Title 16, section 1399.489: "The required number of CE Unit Hours that must be completed in a 2-year renewal period cannot be less than thirty (30)," http://www.acupuncture.ca.gov/ce/ce_require.htm, accessed 8-12-04.
5. National Institutes of Health, Consensus Panel Proceedings, November 3-5, 1997, Washington D.C., "Consensus Statement #107: Acupuncture," Journal of the American Medical Association, November 4, 1998, 280:1518-1524. Also, http://consensus.nih.gov/cons/107/107_intro.htm, accessed August 2004. Also, World Health Organization, 1999, "Guidelines on Basic Training and Safety in Acupuncture," p. 1, www.who.int/medicines/library/trm/acupuncture/acupdocs.shtmlaccessed July 2004.
6. Ted J. Kaptchuk, Associate Director, Center for Alternative Medicine Research and Education, and Assistant Professor of Medicine, Harvard Medical School, 2002, "Acupuncture: Theory, Efficacy and Practice," Annals of Internal Medicine Journal, Volume 136, pages 374-383, http://www.annals.org/cgi/reprint/136/5/374.pdf, accessed September 2004. Also, Donald E. Kendall, 2002, p. 25, "The Dao of Chinese Medicine: Understanding an Ancient Healing Art," New York, Oxford University Press.
7. World Health Organization, see footnote 5. Also, Paul U. Unschuld, 1998, "Chinese Medicine," pages 95-96, Brookline, MA, Paradigm Publications. See also, Donald E. Kendall, endnote 6.
8. William Collinge, 1997, "The American Holistic Health Association's Complete Guide to Alternative Medicine," Chapter 2, p.5, www.healthy.net/collinge/chinese.htm accessed July 27, 2004.
9. Qiao Wangzhong, 1996, "The Education of Traditional Chinese Medicine in China," Page 3, web published by Deputy Party Secretary, Beijing University of Traditional Chinese Medicine and the Geneva Foundation for Medical Education and Research, http://www.gfmer.ch/TMCAM/Hypertension/Education_Traditional_Chinese_Medicine _China.htm, accessed September 2004. Also, Linda L. Barnes, "The Acupuncture Wars: The Professionalizing of American Acupuncture - A View from Massachusetts," Medical Anthropology, 22:261-301, 2003. Also, Changzhen Gong, PhD, MS, President, American Academy of Acupuncture and Oriental Medicine, March 2004, "Educating America on Traditional Chinese Medicine : The New Mainstreaming of an Old - Very Old - Medical System," Web site accessed September 2004,http://www.tcwellness.com/issues/1998/07/modernchinese.html.
10. Linda L. Barnes, see endnote 9.
11. National Institutes of Health, see endnote 5.
12. Franklin Miller, Stephen Straus, et al, February 4, 2004, "Ethical Issues Concerning Research in Complementary and Alternative Medicine," Journal of the American Medical Association, Vol. 291, No. 5, pp. 599-605.
13. National Institutes of Health, see endnote 5.
14. National Center For Health Statistics, Centers For Disease Control and Prevention, U.S. Department of Health and Human Services, Advance Data, #343, Household Survey, May 27, 2004.
15. State of Hawaii, direct communication and document review, August 2004. Also, www.acupuncture-hi-com/history.htm, accessed July 2004. Also, Changzhen Gong, see endnote 9. Also see, William Collinge, endnote 8, Chapter 2, page 1.
16. William Collinge, page 16, see endnote 8. Also, National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), http://www.nccaom.org, accessed August 2004.
17. David M. Eisenberg, Ronald C. Kessler, Cindy Foster, Frances E. Norlock, David R. Calkins, and Thomas L. Delbanco, "Unconventional Medicine in the United States -­Prevalence, Costs, and Patterns of Use," New England Journal of Medicine , January 28, 1993. Volume 328:246-252. Also see, Qiao Wangzhong, endnote 9. Also, Timothy N. Gorski, MD, F.A.C.O.G, Assistant Clinical Professor, University of North Texas Health Science Center, Board Member, National Council Against Health Fraud, Associate Editor, Scientific Review of Alternative Medicine, Testimony to United States Senate Special Committee on Aging, hearing entitled "Swindlers, Hucksters and Snake Oil Salesmen: The Hype and Hope of Marketing Anti-Aging Products to Seniors," September 10, 2001.
18. Institute of Medicine, April 2004, "Dietary Supplements: A Framework for Evaluating Safety of Dietary Supplements."
19. Agency For Health Care Quality and Research, United States Department of Health and Human Services, Public Health Service, Acupuncture Technology Assessment, June 17, 2003 (21 CFR 901.109).
20. National Institute of Health, see endnote 5.
21. White House Commission on Complementary and Alternative Medicine Policy, www.whccamp.hhs.gov/cm.html, accessed August 2004. Also, Effie Poy Yew Chow, Member, White House Commission on Complementary and Alternative Medicine Policy, personal communication, September 14, 2004.
22. California Health Line, "Alternative Medicine Trend in Hospitals," March 28, 2004, www.californiahealthline.org/index.cfm, accessed July 27, 2004. Also, Hilary McGregor, Los Angeles Times, "His Path From Patient to Healer," July 26, 2004. Also, Cedars-Sinai Medical Center News www.csmc.edu/pdf/Orientalmed.pdf , accessed July 2004.
23. Kuo, Burke, et al, "Policy Brief: Findings from the Licensed Acupuncture Collaborative Study, Provider Perceptions of Oriental Medical Education and Practice," Los Angeles, CA, Department of Family Medicine, David Geffen School of Medicine and the Center for Health Care Provider Behavior, University of California, Los Angeles, June 2004. See also, Acupuncture Board, July 14, 2003, "Initial Statement of Reasons," page 5.
24. Letter to Governor Reagan from Assemblyman Gordon Duffy, December 6, 1972. Also, Assembly Health Committee analysis of AB 976 Duffy, November 13, 1972.
25. California Business and ProfessionCode, Chapter 267, statutes of 1975.
26. Acupuncture Board, background information for Sunset Committee, 2001.
27. Department of Consumer Affairs analysis of AB 1391 (Torres), September 4, 1979.
28. Assembly Committee analysis of AB 3040 of 1980.
29. Health and Welfare Agency analysis of AB 3040 of 1980. Also, May 27, 1980, Acupuncture Association letter (bill sponsor).
30. Acupuncture Board, Initial Statement of Reasons, Regulatory Package Hearing, July 14, 2003; Educational Curriculum Requirements.
31. Acupuncture Board, 2001, "Background Information and Overview of the Current Regulatory Program, and Response to Issues Identified by the Joint Legislative Sunset Review Committee," pages 5 and 30, referencing Business and Professions Code, Chapter 67, statutes of 1999.
32. Marilyn Nielsen, Executive Director, Acupuncture Board, 2004, direct communication. Also, Little Hoover Commission Acupuncture Advisory Committee meeting discussions, 2003. Also, National Institute of Health Consensus, see endnote 5.
33. Acupuncture Board, Strategic Plan, June 7, 2004, Sacramento, CA, page 5.
34. Linda L. Barnes, see endnote 9. Also, David Eisenberg and Ted J. Kaptchuk, March 2002, Harvard Medical School, Center for Complementary Therapies, Boston, MA, "Acupuncture: Theory, Efficacy and Practice," Annals of Internal Medicine , p. 374-383.
35. Linda L. Barnes, see endnote 9.
36. National Institute of Health, see endnote 5.
37. National Institute of Health, see endnote 5.
38. Linda L. Barnes, see endnote 9.
39. Robin Martin Okada, Study Coordinator, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, August 24, 2004, written communication. For additional studies, see Acupuncture Clinical Trials, National Center for Complementary and Alternative Medicine, http://www.nccam.nih.gov/clinicaltrials/acupuncture.htm, accessed 2003 ­September 2004.
40. Joannie Shen, MD, MPH, PhD, 2001, "Research on the Neurophysiological Mechanisms of Acupuncture: Review of Selected Studies and Methodological Issues," Journal of Alternative and Complementary Medicine , Volume 7, Supplement 1, pp. S-121-S127, Bethesda, MA, National Institutes of Health, Clinical Center.
41. Harris, et al, U.S. Preventative Services Task Force, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 2003, "Current Methods of the U.S. Preventative Services Task Force: A Review of the Process," Web site www.ahrq.gov/clinic/ajpmsuppl/harris3.htm, accessed July 29, 2003. Also, Stephen Straus, NIH, see endnote 12. Also, Ted J. Kaptchuk, Associate Director, Center for Complementary and Integrative Medical Therapies and Assistant Professor, Harvard Medical School, direct communication, 2004.
42. Donald Chang, Acupuncture Board and Department of Consumer Affairs attorney, written communication to the Commission, December 12, 2003, legal opinion 03-07.
43. Council of Acupuncture and Oriental Medical Associations, Scope of Practice for Licensed Acupuncturists, 1997. Also, Donald Chang, see endnote 42.
44. Business and Professions Code, "Legislative Intent," Section 4926.
45. The Acupuncture Board's Strategic Plan states: "Subsequent legislation in 1978 established acupuncture as a ‘primary care profession' by eliminating the requirement for prior diagnosis or referral." In actuality, that intent language was added in 1980, but more importantly, as intent language, the Legislature arguably did not "establish acupuncture as a 'primary health care profession'." Also, see appendix G, Diane F. Boyer-Vine, Legislative Counsel opinion #8545, April 16, 2004, Sacramento, CA, Legislative Counsel Bureau.
46. Department of Consumer Affairs, Executive Office written communication, July 8, 2004, and 1980 "Annual Report," page 70, Sacramento, CA.
47. Legislative Counsel, see endnote 45.
48. California Department of Consumer Affairs Legal Office, Legal Opinion No. 93-11, Sacramento, CA, December 14, 1993, page 4.
49. Legal Opinion No. 93-11, see endnote 48.
50. Letter from the Department of Consumer Affairs to Peter Betcher, Practice Manager, and Mark Denzin, C.A., February 14, 1986.
51. Legal Opinion 93-11, see endnote 48.
52. University of California, Center for the Health Professions, May 2004, "Acupuncture in California: Study of Scope of Practice," page 5, San Francisco, CA.
53. Marilyn Nielsen, Executive Director, Pei Li Zhong-Fong, Chair, Acupuncture Board, Sacramento, CA, August 8, 2003 written testimony to the Commission.
54. California Code of Regulations, Title 16, Section 1399.436.
55. Council of Acupuncture and Oriental Medicine Associations, August 1996, "Standard of Care for Licensed Acupuncturists, Revision 2.3, page 19, Sacramento, CA.
56. Gary Klapman, former Board Member and Chair of Competency Task Force, Acupuncture Board, Sacramento, CA, August 28, 2003, testimony to the Commission.
57. Elmar Peukar, 2001, "Risk Information and Informed Consent In Acupuncture - A Proposal From Germany," page 137, Bochum, Germany, The Gronemeyer Institute of Microtherapy, www.medical-acupuncture.co.uk/aimintro.htm, accessed November 2003.
58. Little Hoover Commission based on direct communication with Andrew T. Weil, Clinical Professor of Medicine and Director, Program in Integrative Medicine, College of Medicine, Tucson, AZ, October and December 2003; Elad Schiff, former Chair, Israel's Task Force on Complementary Medicine and Fellow, Program in Integrative Medicine, College of Medicine, Tucson, AZ, September 2003; Effie Poy Yew Chow, President, East-West Academy of Healing Arts, San Francisco, CA, May 2004; Ted J. Kaptchuk, Associate Director, Division of Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, MA, April 2004. Also, Eisenberg, et al, December 17, 2002, "Credentialing Complementary and Alternative Medicine Providers," Annals of Internal Medicine , volume 137, page 968.
59. University of California San Francisco, Center for the Health Professions, see endnote 52, Page 31.
60. Lawrence S. Meyers, Professor, California State University, Sacramento, July 2004, written communication regarding "Standards for Educational and Psychological Measurement."
61. Department of Consumer Affairs, Sacramento, CA, July 30, 2004, written communication.
62. Reference: Herbsleb, J. D., Sales, B. D., & Overcast, T. D., 1985, "Challenging Licensure and Certification," American Psychologist, 40 (11), 1165-1178, page 1166.
63. Department of Consumer Affairs analysis of AB 1391 (Torres), September 4, 1979.
64. SB 86 (Moscone-Song), Chapter 267, Statutes of 1975.
65. Kathleen Hamilton, former Director, California Department of Consumer Affairs, August 11, 2004, written communication to the Commission.
66. Board proposed regulations to implement new-3000 hour curriculum, pending.
67. University of California, Center for the Health Professions, May 2004, "Study of Education Issues and Current Educational Programs for Acupuncture and Oriental Medicine," p. 4, San Francisco, University of San Francisco (see also appendix).
68. UCSF, see endnote 67, p. 4.
69. Acupuncture Board, 2003, "Statement of Reasons, Educational Curriculum Requirements" Regulatory Package Hearing, July 14, 2003.
70. World Health Organization, see endnote 5, Pages 6 - 9.
71. Kuo, et al, see endnote 23.
72. Michelle Lau, President, Council of Acupuncture and Oriental Medicine Associations, August 2003, written testimony to the Commission.
73. Acupuncture Board, September 2003, written testimony to the Commission.
74. Lynn Morris, former Deputy Director, Department of Consumer Affairs and former Acupuncture Committee Executive Officer (now named Acupuncture Board), June 30, 2004, written communication to the Commission.
75. Michelle Lau, see endnote 72.
76. Brian Fennan, Executive Director, Council of Acupuncture and Oriental Medicine, Sacramento, CA, August 28, 2004, testimony to Commission, p. 9 and questionnaire. See also, Michelle Lau, endnote 72.
77. Andrew Weil and Elad Schiff, Integrative Medicine Program Director and Fellow, respectively, University of Arizona, School of Medicine, Tucson, 2003, joint response to Commission questionnaire. See also, Qiao Wangzhong, endnote 9, charts on variety of education in China, http://www.gfmer.ch/TMCAM/Hypertension/Images/serrano005.jpg, and http://www.gfmer.ch/TMCAM/Hypertension/Images/serrano006.jpg, accessed September17, 2004.
78. Alan Trachtenberg, former Planning Director, NIH Consensus Conference on Acupuncture Efficacy, September 25, 2003 testimony to the Commission.
79. Pew Health Professions Commission, 1998, "Strengthening Consumer Protection: Priorities for Health Care Workforce Regulation," Page i., San Francisco, CA, Pew Charitable Trusts.
80. Acupuncture Board, 2003, "Statement of Reasons, Educational Curriculum Requirements" Regulatory Package Hearing, July 14, 2003, page 2.
81. UCSF, see endnote 67.
82. John Gemello, Provost and Vice President for Academic Affairs; Donald Zingale, Dean, College of Health and Human Services, Adam Burke, Associate Director, Institute for Holistic Healing Studies, San Francisco State University, February 2004, written communication.
83. San Francisco State University, Office of the Provost and Vice President of Academic Affairs, February 20, 2004, written communication, "It is our strong recommendation that California acupuncture schools be required to have a minimum entrance standard of a bachelor's degree or its equivalent, or higher..."
84. Qiao Wangzhong, see footnote 9. Also, Teri A. Reynolds, Lawrence M. Tierney, Jr., May 5, 2004, Student Journal of the American Medical Association, 2004; 291:2141, http://jama-assn.org/cgi/content/full/291/17/2141, accessed July 14, 2004. Also, Anna Chan Chennault, Chair, Chinese Medicine Research Association of Hong Kong, July 15, 2004, telephone interview.
85. Qiao Wangzhong, see endnote 9. Also see Anna Chan Chennault, endnote 84.
86. Effie Chow, see endnote 21.
87. Qiao Wangzhong, see endnote 9. Also see Anna Chan Chennault, endnote 84.
88. Qiao Wangzhong, see endnote 9. Also see Anna Chan Chennault, endnote 84.
89. Sohachi Tanzawa, President, the Japan Society of Acupuncture and Moxibustion, "Acupuncture and Moxibustion in Japan," 2004, www.jsam.jp/english/admission/janmeeting.htm, accessed August 2004.
90. Bill Moyers, 1993, "Healing and the Mind," Public Broadcasting Service. Also, Mathew Bauer, advisory committee member, Sacramento, CA, September 18, 2003, written testimony to the Commission. Also, among the examples: Department of Health, England, March 2004, "Regulation of Herbal Medicine and Acupuncture: Proposals for Statutory Regulation," London, England, http://www.Dh.gov.uk/Consultations/LiveConsultations/LiveConsultationsArticle/fs, accessed April 16, 2004. Also, Acupuncture Today, "British Columbia Creates New Registration System for TCM Practitioners," July 2003, http://www.acupuncturetoday.com/archives2003/jul/07/bc.html, accessed September 16, 2003.
91. Anna Chan Chennault, see endnote 84.
92. Chinese Medicine Registration Board of Victoria, Australia, www.cmrb.vic.gov.au/cgi-bin/cmweb.exe/intro, accessed July 27, 2004.
93. University of Technology, Sydney, Australia, 2000, "Handbook 2000, Traditional Chinese Medicine."
94. Diane Applebaum, US Director, MEDICC, April 2004, written communication.
95. World Health Organization, see endnote 5.
96. Department of Consumer Affairs, September1979, Enrolled Bill Report on AB 1392 (Torres), Sacramento, CA.
97. Acupuncture Board, August 18, 2004, written communication. "Of the 10,003 licenses ever issued in California, only 7,069 are still valid and of those, 482 of the licensees have moved out of state and 159 live in other countries."
98. CCR, Title 16, section 1399.489: "The required number of CE Unit Hours that must be completed in a 2-year renewal period cannot be less than thirty (30)" http://www.acupuncture.ca.gov/ce/ce_require.htm, accessed August 8, 2004.
99. CCR, Title 16, section 1399.489, see endnote 98, http://www.acupuncture.ca.gov/ce/ce_require.htm, as of August 12, 2004.
100. American Board of Internal Medicine, Web site accessed summer 2004, http://www.abim.org/info/IM_Cert_Instructions.htm. Also, Lawrence S. Meyers, Professor, Department of Psychology, California State University, Sacramento, June 2004, "The Acupuncture Regulation Project: Evaluation and Comparison of California's License Examination and NCCAOM's Certification Examinations," report to the Commission (See Little Hoover Commission Web site www.lhc.ca.gov to download the full report.)
101. Lawrence S. Meyers, Professor, Department of Psychology, California State University, Sacramento, June 2004, "The Acupuncture Regulation Project: Evaluation and Comparison of California's License Examination and NCCAOM's Certification Examinations," report to the Commission.
102. Norman R. Hertz, former Chief, Office of Examination Resources, California Department of Consumer Affairs, September 25, 2003, written testimony to the Commission.
103. Christina Herlihy, former Chief Executive Officer, National Certification Commission for Acupuncture and Oriental Medicine, Alexandria, VA, August 28, 2003, written testimony to the Commission.
104. Lawrence S. Meyers, Professor, Department of Psychology, California State University, Sacramento, June 21, 2004, written communication.
105. Acupuncture Board, November 1, 2002, staff meeting notes.
106. These requirements do not apply to schools outside of the US and Canada, (Sections 4938 and 4939, Business and Professions Code). In 2002, 36 graduates from foreign equivalency programs passed the California examination (January 2002 Examination Results).
107. John Barth, United States Department of Education, personal and written communication, 2004; www.ed.gov, accessed July 2004. However, a newly formed organization, The National Oriental Medicine Accreditation Agency, intends to apply for accreditation status with the US Department of Education for the purpose of accrediting "entry-level doctorate accreditation," http://www.nomaa.org/index_m.htm.
108. Meeting notes from initial Little Hoover Commission staff meeting with Acupuncture Board chair and executive director, November 2002.
109. John Barth, United States Department of Education, personal and written Communication, June 2004. Also, www.ed.gov , accessed July 2004.
110. John Barth, July 13, 2004, written communication: "The State of California Acupuncture Board would not be eligible under our criteria to be recognized as an accrediting agency." The only exception is the state of New York, which was grand­fathered in at the inception of the USDE deputizing program. (34 CFR 602 and 603).
111. Business and Professions Code, Section 4939.
112. University of California, San Francisco, Center for the Health Professions, May 2004, "Study of School Approval and Accreditation of Acupuncture and Oriental Medicine Programs," report to the Commission.
113. www.acaom.org, accessed August 2004. Also, University of California, see endnote 112.
114. University of California, see endnote 112.
115. University of California, see endnote 112, page 13.
116. Gary Klapman, former Acupuncture Board member, 2003, questionnaire submitted to the Commission.
117. University of California, see endnote 112.
118. Acupuncture Board Web page http://www.acupuncture.ca.gov/what/fact.htm, accessed August 11, 2004. Also, see NIH, endnote 5. Also, see Ted J. Kaptchuk, endnote 6.
119. Brian Fennan, Executive Director, Council of Acupuncture and Oriental Medicine Associations, written materials submitted with written testimony, August 28, 2003, "Oriental Medicine Education Standards: Need for Improvement," p. 7, 2001, Sacramento, CA.
120. E. Ernst and K.J. Sherman, 2003, "Is Acupuncture a Risk Factor For Hepatitis? Systematic Review of Epidemiological Studies," Exeter, England, Journal of Gastroenterology and Hepatology, pages 1231-1236.
121. Marilyn Nielsen, Executive Director, California Acupuncture Board, October 21, 2003, personal communication and written communications, 2003-2004 (written requests for related information October 9, 2003, April 9, 2004, May 11, 2004). See also, NIH, endnote 5.
122. Marilyn Nielsen, see endnote 121.
123. Marilyn Nielsen, Acupuncture Board Executive Director, statement, October 21, 2003.
124. Woo, et al, Department of Microbiology, The University of Hong Kong Queen Mary Hospital and Hong Kong University-Pasteur Research Center, Hong Kong, "Relatively Alcohol-Resistant Mycobacteria Are Emerging Pathogens in Patients Receiving Acupuncture Treatment," Journal of Clinical Microbiology, April 2002, p. 1219-1224.
125. Woo, et al, see endnote 124.
126. Consumer Reports, May 2004, "Dangerous Supplements Still At Large." Also, Richard Ko, Senior Research Scientist, California Department of Health Services, direct communication, April 2004.
127. Consumer Reports, see endnote 126. Also, James Kirkland, Holly F. Mathews, et al, "Herbal and Magical Medicine : Traditional Healing Today," New England Journal of Medicine , volume 328: 215-216, January 21, 1993. Also, World Health Organization, Traditional Medicine Strategy 2002-2005, see endnote 5, states: "The natural resource base upon which certain products and therapies depends must be protected. Raw materials for herbal medicines, for instance, are sometimes over-harvested from wild plant populations." Policies should consider the implications for the ongoing availability of the plants, animals, sea life and coral that are the basis of natural medicines, but can be damaged or ruined if overly or ineptly harvested. Increasing global consumer demand for natural healing substances creates an intense economic interest from potential suppliers that may threaten endangered species.
128. Richard Ko, Senior Research Scientist, California Department of Health Services, September 17, 1998, letter, New England Journal of Medicine , volume 339; http//www.dhs.ca.gov/common/PrinterFriend.htm, accessed April 28, 2004.
129. Richard Ko, see endnote 126.
130. Institute of Medicine, 2002, "Proposed Framework for Evaluating the Safety of Dietary Supplements," Washington, D.C., National Academy Press.
131. Consumer Reports, see endnote 126.
132. Kent Olson, Medical Director, California Poison Control Center, April 28, 2004, telephone interview. Also, American Herbal Products Association, notice, June 7, 2004, Silver Spring, MD. Also, American Medical Association, Chicago, IL, Policy H-150.954, provided April 2004.
133. Richard Ko, See endnote 128.
134. Aileen Trant, herbal researcher, Stanford University Medical School, telephone interview, June 2004.
135. Aileen Trant, see endnote 134.
136. Aileen Trant, see endnote 134, direct communication, May 27, 2004.
137. Consumer's Union, June 2004, telephone interview.
138. Acupuncture Board, written communication to the Commission, December 18, 2003.
139. The board has devoted significant board meeting time and resources to raise educational requirements -apparently at the expense of adequately examining concerns about the spread of harmful blood-borne diseases. While recent changes in law increased the required number of hours of study as of January 1, 2005, the scope of practice was not expanded. However, the proposed regulations require the teaching of Western clinical science and practices (such as on p. 3, item C-5 ordering diagnostic imaging, radiological, and laboratory tests) that are not explicitly within an acupuncturist's scope of practice as stated in Section 4937 of the Business and Professions Code. The proposed regulations also require learning Oriental practices that are not covered by the authorized scope of practice, such as, on page 3, item 2(J): "Adjunctive acupuncture procedures, including bleeding, cupping, gua shua and dermal tacks." While "cupping" is specified in the scope, the other three items are not. Also, while Oriental diagnoses may possibly be inferred from their authorized scope, Western diagnosis cannot be according to the UCSF legal analysis, 2004.
140. Federation of Acupuncture and Oriental Medicine Regulatory Agencies, "United States Regulatory Agencies and Medical Boards and Laws for Acupuncture and Oriental Medicine," http://taotoearthpmpubs.com/links_mb_us-a.html, accessed August 5, 2004.
141. State of New Hampshire Statutes of 1999, Acupuncture, 302.03, Degree Requirements, http://gencourt.state.nh.us/rules/acp100-600.html, accessed April 16, 2004.
142. Mary Jo Kreitzer, Director, University of Minnesota, Center for Spirituality and Healing, 2003 testimony to The Institute of Medicine and telephone interview, May 13, 2004.