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Part3: The Future of Acupuncture
Moderator: I'm Marty Moss-Coane. Welcome to the Webcast. More and more people are considering the use of alternative therapies for the treatment of various health problems. Alternative is going Mainstream and represents an $18 billion industry here in the United States. One of the most promising treatments is actually a very old medical practice --- acupuncture, which has its roots in ancient China. It's a philosophy and practice that restores and maintains health by the
use of needles inserted into specific points in the body. That activates
channels of energy which have a beneficial affect on organs. The
result can be improved health. On our Webcast today --- How you can
incorporate acupuncture into your own healthcare. Let me introduce our
two guests.
Elizabeth Call is a licensed acupuncturist in private
practice. She is also the Dean of Clinical Training at Tri-State
College of Acupuncture in New York City. Nice to have you here.
Our other guest is Dr. Ravinder Mamtani and he is a Professor of Clinical
Preventive Medicine and Medical Director of the Occupational Health Center
at New York Medical College, Westchester Medical Center in Valhalla New
York. He is also the Director of courses in acupuncture and homeopathy
at New York Medical College. Nice to have you here as well.
And, let me begin with you, Ravi, about whether acupuncture
is compatible with western forms of medicine and whether, as an MD and
also an acupuncturist, you find that these are philosophies and treatments
that really do complement each other.
Dr. RM: Yes, and they do. And I think, as
you rightly say, a better way to characterize its role in a conventional
healthcare system is to call them ‘complementary medicine modalities’.
And, I think in combining the two, you are offering what I consider to
be an integrated, healthy and a conservative approach to your patients
--- Where you are offering the best of the both worlds, so to speak, to
your patients. And I think it’s being done. And it’s being
done in tertiary care hospitals and mainstream hospitals, where acupuncture
has been provided as an adjunct just to ensure that patients have
been worked up, and then bring it in as an adjunct and to offer it as complementary.
And, it’s being done increasingly.
Moderator: And do you find that there is any kind
of danger in mixing and matching these forms of therapy. Is there
something that both practitioners and patients have to be wary of?
Dr. RM: I don’t think there are any dangers so long
as healthcare providers who are offering these modalities share with their
patients (the) pros and cons and advise them appropriately. I think
if anything, it enhances the quality of care that we provide to our patients.
So, I see no dangers so long as the way it is being approached is appropriate
and by that I mean (that) the patients have been worked up, we have understood
the nature of the problem --- and then bring in acupuncture as a
complementary approach.
Moderator: I wonder, Elizabeth, about the doctor/patient
relationship and a lot has been said about that in recent years.
When someone is working with an acupuncturist, is there something different,
you think, about that relationship than one would find in a traditional
doctor’s office?
Ms. EC: Well, I like to actually tell my patients
this -- before the needles go in, I know more about acupuncture and after
the needles go in, they know more about acupuncture. And one of the
things that I like to elicit with my patients is that we’re working together
toward a common goal, toward their well being. And so, I like them
to participate in the feedback of what they get in terms of when I do my
evaluation, when I do the actual treatment process. I like them to
tell me what they feel with the needle, where they may feel a ‘propagating
sensation’, is what we call it, if they feel a sharp pain, then I’ll adjust
the needle, and I think that our college actually used to have a physicians’
acupuncture program. We had to discontinue it because we’re getting
kind of big and we need more space, but I think one of the things that
the physicians really enjoyed about acupuncture --- learning it --- was
that it brought ‘touch’ back into their practice and it also was a very…
a situation where both the patient and the doctor or the practitioner work
together.
Moderator: So, it’s not passive? And again,
this is helping understand that you’re not just lying on a table and having
someone put needles in you. There is a lot of conversation… that
goes back and forth.
Dr. RM: That’s right. And, in fact, the way
I put it, and similar to what Elizabeth said, it is a holistic approach.
And most practitioners treat people with problems rather than problems
in people. So, there’s comprehensiveness where you’re making contact
with your patient at an emotional level and a mental level and a psychological
level. And I think that some of our conventional healthcare providers
need to learn from such an approach. Clearly, there are physicians
who are caring physicians, who spend time with patients, but with the way
the practice of medicine is going with managed care, I think that it is
becoming increasingly difficult to spend more time with your patients.
Moderator: Well, you mentioned the word managed
care, is acupuncture covered by health insurance or most health insurance?
Dr. RM: In my experience, many insurance carriers
are covering it. Some HMOs are. But I would say they’ve been
slow in forthcoming. I think there is room for improvement in providing
coverage to patients that they cover.
Ms. EC: Especially since they are called health
maintenance organizations. Acupuncture may be may contribute to that
aspect of health maintenance.
Moderator: How do you find an acupuncturist?
I mean, in a way, your training… each of your training is quite different.
Dr. RM: You have a medical degree and then got training in acupuncture
and Ms. EC: you trained specifically in acupuncture. How does one
go about finding someone that they think has the kind of training that
is required?
Ms. EC: Well, I’d like to just talk a little bit
about the training of licensed acupuncturists since most people probably
don’t know very much about it. First of all, there is the Accreditation
Commission for Acupuncture in Oriental Medicine, that is a federally
recognized body by the U.S. Department of Education that ensures quality
in acupuncture training programs. So there is that aspect.
It ensures quality for the student that they’ll get a good education.
There is also the National Commission for the Certification of Acupuncture
in Oriental Medicine. And of the 33 of the 37 states that license
acupuncture, those 33 states require the NCCAOM exam. And so, the
NCCAOM has set competency standards --- national competency standards ---
for acupuncturists. So, I think that’s basically a good place to
start… is state licensure… finding a licensed acupuncturist if your state
has an enabling law. And then also finding someone who is certified
by NCCAOM.
Moderator: And what are the letters you might find
after someone’s name that would tip you off that this person is licensed?
Ms. EC: LAc. And in some states they register
acupuncturists, so that would say Rac, and then the acupuncturists
who maintain their board certification are allowed to say, Board Certified,
or Diplomative acupuncture.
Moderator: Again, you took a slightly different
route to acupuncture… from medical school.
Dr. RM: Yes, I did. And the reason for that
is… and I might use the example of New York State for example… the certification
in acupuncture is conferred to an MD, contingent upon his or her having
an MD license. So, they’ve already met that requirement in terms
of being licensed as a healthcare professional, which is different from
a licensed acupuncturist. Additionally, New York State requires
that they complete 300 hours of training. And as sequential training,
it entails taking instructions in basic acupuncture plus clinical training.
And that is, again, done with the view that MD(s) have already spent four
years in anatomy, physiology, medicine, surgery, evaluation and management.
And, so my recommendation is to look for an acupuncturist who has been
certified, who has successfully completed 300 hours of training.
A quicker way might be to call the American Academy of Medical Acupuncture,
which is an association that has members who are physicians
and who are certified. They are based in L.A. in California and there
is an 800 number for them. You can call them and ask for a listing
of physicians located near the patient, and they are more than
happy to provide that list.
Moderator: Do you know that number off the top of
your head?
Dr. RM: I don’t, unfortunately. But I will
say that the listeners should ask for American Academy of Medical Acupuncture
based in Los Angeles, California.
Moderator: Okay. We have an e-mail from Deborah
from New York City. Do you think generally healthy people should
get yearly or semi-regularly check-ups, the way we do in conventional medicine
to ensure our health and our chi are in order? Do you suggest (that)
people do that?
Ms. EC: I suggest whatever the patient wants to
do, actually. Everyone has a different experience of how they want
to maintain their health and I try to support that. But traditionally
it is thought that you should receive treatment at the change of the seasons
so that you can prepare yourself and your body for the next season.
So, that is the traditional point of view.
Moderator: I mean, a kind of a’ booster’ shot, as
the seasons’ change, to get you ready for that next… whatever it’s
going to be.
Ms. EC: Right, the treatment just before, for example
in the winter it maybe a treatment using moxibustion warming techniques
and then maybe in the summer, a treatment at certain points that are said
to stimulate more yin energy, might be in order for certain people.
Moderator: Do you use it preventively? Acupuncture?
Ms. EC: I have a few patients in my practice who
like to do that, but no, for the most part, people come for very specific
goals and disorders.
Moderator: Do you suggest a little something before
the seasons change?
[LAUGHTER]
Dr. RM: And, again, I think it is important to look
at patients’ perception on this in terms of their understanding.
If a treatment is going to help a patient from a psychological, from a
stress and what-have-you standpoint, then, by all means, consider it. ,
But again, the patient should be informed as to what is being done,
and that it is not addressing any complaint. And, again, I keep going
back to information and education. I think that is the single most
important thing --- that you inform your patients in terms of what the
goals of therapy, and what you are trying to achieve. And I
think in that way, you are practicing what I consider to be a good practice
of medicine.
Moderator: We are talking, however, about a very
ancient and venerable medical tradition. Is acupuncture changing
and by that I mean that as it, sort of, bumps up against western medicine,
does acupuncture borrow from contemporary western traditions or does it
kind of stick to its original philosophies and procedures?
Ms. EC: I think throughout the 2,000 years, acupuncture
has always changed. You see significant changes in the literature
from the move of acupuncture from China to Japan, for example, into Korea
and of course to America. I think each culture, each point of view,
each orientation has changed acupuncture and the great thing about acupuncture
is that it’s very malleable. There are a number of different styles
and so sometimes . A practitioner may combine different styles based on
training and understanding and clinical experience. So, I think acupuncture
will always change to a certain extent.
Moderator: And by size I mean, you’ve mentioned
Japan, certainly China, and then there are other traditions, and then,
I guess, as you become more experienced there are certain techniques that
you probably evolved out of your own experience.
Ms. EC: A little bit, yes. Or, based on traditional
techniques, and you kind of expand on a traditional technique.
Moderator: Do you do that too?
Dr. RM: Yes, absolutely. And I think it is
changing as Elizabeth mentioned . Certainly, electrical acupuncture
I think is a change that has occurred from olden days. Laser acupuncture
is another component of acupuncture. And, I think in changing it,
I view this as a constructive process --- A process that will help us understand
what are appropriate standards of care with regard to acupuncture.
A case in point may be agreeing on this principle or standard of care related
to 8 to 10 treatments, as an example. So I think there is an emergence,
if you will, of standards of care in acupuncture and I think that is beneficial
to our patients and to the profession itself.
Moderator: I want to make sure our audience understands.
When you talk about laser treatments or electrical treatments, tell us
what you mean. I think I know what you mean, but tell us what
you mean by that.
Dr. RM: Well I must add, first of all, that FDA
does not approve laser for acupuncture. So, I think the listeners
should be aware of that, nor is it being recommended by the FDA .
Electrical acupuncture, on the other hand, is a fairly accepted procedure
and the procedure entails connecting electrodes to the handles of the needles
and doing it either low-frequency stimulation --- you turn the dial up
and you ask the patients if they feel a sensation of the pulse (and) when
they say they do, then that’s when you stop it. That’s another way to stimulate
points, similar to moxibustion or twirling the needles. So, when
you are using electrical acupuncture, it is a variant, and the objective,
again, is to stimulate the acupuncture points.
Moderator: We’ve talked about acupuncture as something
that is gaining in much more acceptance and popularity in this part of
the world. Do you see this trend continuing and will acupuncture
become even more accepted than it is today?
Ms. EC: I think so. I think patients will
really drive that. And, already the consumer has driven it.
A few HMOs and a number of insurance companies, Oxford, for example, have
started to pay for acupuncture because of the consumer.
Moderator: And do you think that by putting it under
the, sort of, rigorous double-blind studies that’s done in western medicine,
that it will stand up to that kind of scrutiny?
Dr. RM: I think it will and it has. And I
think it’s a step in the right direction. It’s important for the
government and NIH to take a stand on this. Health consumers and
professionals understand or tease out the difference between acupuncture
done for certain conditions where it is helpful, as compared to conditions
for which it may not be helpful. And I think that’s a constructive
process. And, I think in doing so you are providing another viable
option to your patients that can benefital .
Moderator: Well, we've covered a lot of territory and I want to thank you both very much for talking about acupuncture and
joining us tonight. Thank you very much.
Ms. EC: Thank you.
Dr. RM: It was a pleasure.
Moderator: It was a pleasure for us too. And I want to thank you very much for joining us. I'm Marty Moss-Coane.
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