As Ben Kavoussi observed recently,
[o]nce considered archaic and obsolete, Oriental Medicine has greatly benefited from the postmodern attitudes towards science and knowledge. This is because postmodernists consider the ‘truth’ as being relative to one’s viewpoint or stance. They do not see science as a superior process of acquiring knowledge, but as a ‘belief system,’ a ‘language game,’ which does not give more access to truth than other conceptual constructs.
This “postmodern fallacy,” he continued,
has allowed the return of mass professional delusions under the label of Chinese, Oriental or Asian Medicine. As an unfortunate byproduct, dangerous and outdated therapies have been legitimized, and quacks and charlatans can overtly defraud those who cannot distinguish scientific medicine from lore and fantasy.
There is probably no better example of this “unfortunate byproduct” than the state acupuncture and oriental medicine practice acts. These laws have indeed legitimized dangerous and outdated therapies, allowing quacks and charlatans to defraud the public.
State practice acts
Via the magic of legislative alchemy, acupuncture, or sometimes, more broadly, Oriental or Traditional Chinese medicine, is a licensed health care practice in 44 states in the U.S. and the District of Columbia. As with all licensed health care practices, each state defines the acupuncturists’ scope of practice via legislation commonly referred to as a practice act.
Some states, perhaps unwilling to let the genie fully escape the bottle, allow acupuncture only by prescription or under the supervision of a physician. Others, like New Jersey and New York, at least require that an acupuncturist advise patients about the importance of consulting with a licensed physician regarding the patient’s condition. In Louisiana, only physicians can become acupuncturists.
Yet in many states acupuncturists enjoy a broad and unsupervised scope of practice. Here’s a sample of practice acts typical in their definition of acupuncture and oriental medicine.
New Mexico:
‘acupuncture’ means the surgical use of needles inserted into and removed from the body and the use of other devices, modalities and procedures at specific locations on the body for the prevention, cure or correction of any disease, illness, injury, pain or other condition by controlling and regulating the flow and balance of energy and function to restore and maintain health.
‘oriental medicine’ means the distinct system of primary health care that uses all allied techniques of oriental medicine, both traditional and modern, to diagnose, treat and prescribe for the prevention, cure or correction of disease, illness, injury, pain or other physical or mental condition by controlling and regulating the flow and balance of energy, form and function to restore and maintain health.
Florida:
‘Acupuncture’ means a form of primary health care, based on traditional Chinese medical concepts and modern oriental medical techniques, that employs acupuncture diagnosis and treatment, as well as adjunctive therapies and diagnostic techniques, for the promotion, maintenance, and restoration of health and the prevention of disease.
Maryland:
‘Practice acupuncture’ means the use of oriental medical therapies for the purpose of normalizing energetic physiological functions including pain control, and for the promotion, maintenance, and restoration of health.
Colorado:
‘Acupuncture’ means a system of health care based upon traditional oriental medical concepts that employs oriental methods of diagnosis, treatment, and adjunctive therapies for the promotion, maintenance, and restoration of health and the prevention of disease.
Arkansas:
‘Acupuncture’ means the insertion, manipulation, and removal of needles from the body and the use of other modalities and procedures at specific locations on the body for the prevention, cure, or correction of a malady, illness, injury, pain, or other condition or disorder by controlling and regulating the flow and balance of energy and function of the patient to restore and maintain health.
New Hampshire:
‘Oriental medicine means the distinct system of health care that diagnoses and treats illness, injury, pain, or other conditions by controlling and regulating the flow and balance of energy to restore and maintain health.
Nevada:
Nevada is even more expansive in its definition of Oriental medicine, which includes both the practice of acupuncture and herbal medicine. “Oriental medicine” is
that system of the healing art which places the chief emphasis on the flow and balance of energy in the body mechanism as being the most important single factor in maintaining the well-being of the organism in health and disease.
“Acupuncture” is defined as
the insertion of needles into the human body by piercing the skin of the body to control and regulate the flow and balance of energy to cure, relieve, or palliate:
(a) Any ailment or disease of the mind or body; or
(b) Any wound, bodily injury or deformity.
“Herbal medicine” is
Suggesting, recommending, prescribing or directing the use of herbs for the cure, relief or palliation of any ailment or disease of the mind or body, or for the cure or relief of any wound, bodily injury or deformity.
Public health and safety?
A state’s constitutional authority to regulate health care practices is based on the state’s power to protect the public health, welfare and safety. Indeed, some of the practice acts begin with a statement about how the state needs to regulate acupuncture and oriental medicine in the interest of the public’s health and safety. Of course, as Dr. Edzard Ernst pointed out, “the most meticulous regulation of nonsense must still result in nonsense.” With acupuncture and oriental medicine, the nonsense is pernicious.
A cure for disease?
Note how each practice act assumes acupuncturists and oriental medicine practitioners can diagnose and effectively prevent or cure actual disease, among other supposed benefits. One can accept this as true only by believing in the entire traditional oriental medicine myth, aptly defined almost 80 years ago by a Chinese medical school dean as a “weird medley of philosophy, religion, superstition, magic, alchemy, astrology, feng shui, divination, sorcery, demonology and quackery.” I can only assume the good Southern Baptist lawmakers who populate the legislatures here in the deep South, where I live, had no clue about oriental medicine’s true nature when they voted for these practice acts. In fact, I’ll bet the vast majority of state legislators who made acupuncture and oriental medicine a licensed health care practice had no idea that they were legalizing superstition, magic, astrology, sorcery and demonology. They really should pay more attention to what they are voting on.
Legitimizing this “weird medley” has real consequences for the public. Acupuncturists claim they can treat a wide range of diseases and conditions. A small sample includes malaria, anorexia, fever, parasitic diseases, asthma, dementia, depression, epilepsy, paralysis, uterine bleeding, convulsions, heart palpitations, diabetes and jaundice. And it is perfectly legal for them to do so under many of the state practice acts.
Acupuncturists as primary care providers?
In enacting these practice acts, the states give acupuncture and oriental medicine an undeserved imprimatur of legitimacy by making it a form of “health care.” In Florida and New Mexico, it is specifically described as “primary health care.” After declaring oriental medicine is “a system of primary health care,” here’s how New Mexico defines “primary care provider,” and therefore defines an oriental medicine practitioner, in the practice act:
a health care practitioner acting within the scope of the health care practitioner’s license who provides the first level of basic or general health care for a person’s health needs, including diagnostic and treatment services, initiates referrals to other health care practitioners and maintains the continuity of care when appropriate.
Even without such explicit language, by allowing oriental diagnostic methods and treatment “for the promotion, maintenance, and restoration of health and the prevention of disease” the scope of acupuncture practice in some states approaches that of an M.D. or D.O. Compare this to the standard definition of the practice of medicine, this from Florida:
the diagnosis, treatment, operation, or prescription for any human disease, pain, injury, deformity, or other physical or mental condition.
It would appear the only real difference is in the methods of diagnosis and treatment employed. For example, by law an M.D. can treat with surgery and prescription drugs, whereas an acupuncturist cannot. Yet, according to the language of their respective practice acts, both can diagnose and treat any disease.
Adjunctive quackery
As well, these practice acts, and the regulations enacted pursuant to them, give acupuncturists the right to use a smorgasbord of implausible and unproven diagnostic methods and treatments that go far beyond simply using needles to manipulate “qi.”
For example, by incorporating “modern oriental medicine concepts,” the door is left open to add to the existing implausible and unproven “oriental diagnosis and treatment” methods currently being passed off as “ancient.” Simply by labeling a “concept” as “modern,” new “concepts,” no matter how ill conceived, can legitimately fall within the permissible scope of practice.
In addition to “oriental medical diagnosis and treatment,” “adjunctive” or “related” treatments are legally permissible. Because that term is left undefined, again the door is left open to add whatever acupuncturists deem “adjunctive,” whether it be additional forms of quackery or legitimate means that acupuncturists would seem ill-suited to employ. For example, in Florida, the Board of Acupuncture has decided the following are “adjunctive:” reflexology, laser biostimulation, Kirlian photography, thermograpy, nutritional counseling, lifestyle and stress counseling, and recommendation of homeopathic remedies.
In Arkansas’s practice act, “related techniques” include magnets, cold laser, ion pumping cord, lifestyle counseling, eating guidelines, massage incidental to acupuncture, and exercise techniques. The Arkansas State Board of Acupuncture and Related Techniques has enacted regulations which take the scope of acupuncture practice even further to include ordering radiological, laboratory or other diagnostic tests, Oriental medicine injection therapy, physical medicine modalities and techniques, biofeedback, and prescription or administration of homeopathic medicine, enzymes, and glandulars. The regulations also permit:
The stimulation of points or areas of the body using needles, heat, cold, light, lasers, sound , vibration, magnetism, electricity, bleeding, suction, pressure, Gua Sha, or other devices or means.
That’s right. The barbaric practice of bleeding is legal in Arkansas.
Bleeding is also legal in New Hampshire, thanks to regulations adopted by the New Hampshire Board of Acupuncture Licensing. The Board’s regulations also permit “insertion and retention, for days or weeks, of intradermal needles or press tacks in acupuncture points.” And the Board allows acupuncturists to use (as defined in the regulations):
craniosacral therapy – “a treatment approach using gentle massage pressure to rebalance the craniosacral system”
polarity therapy – “a holistic therapy that combines bodywork, dietary adjustments, and exercises to restore the balance of the body’s vital energy through correction of the electromagnetic field of the body”
reiki – “a Japanese energy therapy that uses energy transmission to balance the biofield that surrounds the human body”
therapeutic touch –“ an energetic therapy . . . that employs a laying-on-of-hands technique based on oriental theories of energy flow”
zero balancing — “a touch technique for aligning the body’s energy and musculoskeletal system”
Which raises a few questions in my mind, if you’ll permit me a bit of digression. If you are sick, how does the New Hampshire acupuncturist know which system is out of whack? Or does being sick automatically mean that all of your systems – craniosacral, electromagnetic, energy flow, biofield and the alignment of your energy and musculoskeletal system – are malfunctioning? If so, it’s going to get awfully expensive to treat your illness. Time consuming too, what with having to spend all that time in treatment. And how does the acupuncturist know when your systems are properly aligned or balanced or flowing or whatever it is they are supposed to be doing?
Conclusion
Just yesterday, Steve Novella observed how the pseudoscience of homeopathy is a fraud being perpetrated on the public and how governments and regulatory agencies which are supposed to protect the public from medical fraud have failed to do so. Here we have yet another example of a pseudoscientific “CAM” practice foisted off on the public as legitimate medicine with the blessing of the government.
Acupuncture and oriental medicine belong in the Middle Ages, not in modern health care. We know acupuncture doesn’t work. And while some of the herbs used in oriental medicine may work, we can’t know that until they go through properly conducted drug trials. Licensing acupuncturists and oriental medicine practitioners and giving them the right to “diagnose,” “prevent” and “cure” disease and to employ other nonsensical “CAM” practices and products is most certainly not in the best interest of the public’s health, safety and welfare. Unfortunately, the problem is only getting worse as acupuncture schools crank out more graduates who then get their state licenses and go into practice.
