By Henry Buchtel
Which state do you think was the first to legalize the practice of acupuncture? You are probably thinking California, right? Or maybe New York? Did any of you guess Nevada?
If you got this question right, then perhaps you happened to have been living in Carson City, Nevada in the spring of 1973 and saw the line of patients with canes and wheelchairs waiting outside a hotel across the street from the state legislature. Perhaps one of the patients told you that they were waiting hopefully for a free acupuncture treatment made legal for a three-week period by a special “emergency bill” passed by the state senate. This unlikely scene was the result of a concerted effort by a prominent Las Vegas businessman, Arthur Steinburg, to bring Dr. LOK Yee Kung, then the president of the Hong Kong College of Acupuncture, to Nevada to demonstrate the miraculous efficacy of what was, at that time, an illegal activity.
This effort resulted in the collection of over 17,000 signatures, the treatment of dozens of legislators, and several sensational “miracle cures.” And it was successful. On April 20, 1973, the governor of Nevada signed the first state law to license the practice of acupuncture, and a new chapter in the history of acupuncture
in the United States began.
The practice of East Asian medicine in the U.S. is hardly new — herbal clinics in particular have existed since the 1800s — but the twin firewalls of language and culture caused it to remain hidden from the English-speaking public within the country’s Asian communities. It was Nixon’s famous 1972 visit to China, and the related press in Readers Digest and The New York Times, that brought acupuncture into the popular consciousness. But by doing so, this traditional medicine was also brought into direct conflict with the cultural and political clout of the biomedical paradigm.
The American Medical Association lost no time in promoting legislation to restrict the practice of acupuncture to physicians or medical researchers. Although this effort backfired in Nevada, where popular support of acupuncture overwhelmed the efforts of the Nevada State Medical Association, it was more successful in states like Michigan, where in 1974, then Attorney General Frank J. Kelley determined that “Acupuncture, as a total system of diagnosis and treatment of a patient, clearly falls within the statutory definition of the practice of medicine…” and could therefore only be practiced by a licensed allopathic or osteopathic physician.
As the earliest state to license the practice of acupuncture, Nevada was under pressure to set a high bar for entry to the profession, and they created the highest and most stringent educational requirements of any state in the country – a license to practice medicine in China, Japan, or Korea, and 20 years clinical experience, rather than the entry-level masters degree used today.
In the years after Nevada’s groundbreaking law passed, many other states followed suit, with California legalizing acupuncture in 1975 and New York shortly after in 1976. In the intervening years, all but four states have licensed the independent practice of acupuncture. As one of those four states, in Michigan we are in the unique position of being the only state where the practice of acupuncture continues to be illegal except under the delegation and supervision of a physician. This, of course, is a direct continuation of the 1974 A.G. opinion that acupuncture is the practice of medicine.
A few years back I had the opportunity to ask Mr. Kelley, through his biographer Jack Lessenberry, what his intent was with this influential opinion, and he wrote back that he saw acupuncture as “an advancement in science,” and that this opinion was intended to protect and support the practice of acupuncture in the state. If you put his determination in the context of the conversation about acupuncture in the 1970s, one can see how farsighted this opinion was.
Take the range of training that existed at the time. Although acupuncturists from China were trained as physicians, in the U.S. a 1973 A.M.A. conference presentation stated: “Another area of concern throughout the country are the so-called ‘quickie courses’ in acupuncture, many of which must fall into the category of outright quackery. For example, some courses […] are of the weekend, three-day variety, after which participants are granted some kind of a certificate that, based on those three days, states they now are ‘qualified acupuncture practitioners.’”
And in the popular media one saw both fascination with and harsh criticism of this mysterious art. As the New York Times reported in 1972, “The American Society of Anesthesiology, while calling acupuncture ‘a potentially valuable technique,’ has warned that ‘severe mental trauma’ could result if acupuncture was applied indiscriminately to patients not properly evaluated psychologically and that quacks could misuse the treatment and divert patients from obtaining effective, established medical cures.”
Given the variety of opinions that existed in the US in the early 1970s, ranging all over the spectrum from wholehearted approval of acupuncture to scorn and denial, Mr. Kelley's balanced conclusion in Opinion No. 4832 is fascinating to me. For him to have taken the time and effort to look past even the contemporary popular opinion of acupuncture as a straightforward remedy for pain, a simple technique to be used by any professional, and conclude that "...the separation of the practice of acupuncture with its concern for the maintenance of an equilibrium of energy forces, and the selected use of some of the techniques to produce an anesthetic effect, is premature" was quite forward looking and has had a lasting influence across the decades.
During these decades since the determination that acupuncture is the practice of medicine, a professional class of trained acupuncturists has emerged. The current minimum requirements for national certification in acupuncture are completion of an accredited program consisting of 3 years/1905 hours of education, including 660 hours of supervised clinical training and 450 hours of biomedical clinical sciences, as well as passage of national certification exams. These are individuals trained to practice acupuncture "...as a total system of diagnosis and treatment of a patient," and carry on the living tradition of what the WHO has described as one of the humanity’s most valuable intangible cultural heritages.
The new chapter in the history of acupuncture that opened in Nevada in 1973 has still not closed here in Michigan, as the state acupuncture and oriental medicine association, M.A.A.O.M., which successfully fought for title protection in 2006, is now leading an effort to make Michigan the 47th state to license the independent practice of acupuncture.
Why is this struggle still important in Michigan? Although it has been many years since an acupuncturist was arrested for “practicing medicine without a license,” recent times have brought new challenges to the profession. Just as there was a boom in popularity following President Nixon’s visit to China, more recent affirmations of acupuncture’s efficacy by the medical research community has led to an interest on the part of other healthcare professions in adding acupuncture to their scope. The same sort of “quickie courses” in acupuncture techniques (now called “dry needling,” or “intramuscular stimulation”) that proliferated for a few years in the 1970s are showing up in Michigan today, advertising that students can “offer this to your patients the very next day” after taking a 3-day course.
In Michigan, physical therapists, physician assistants, nurses, and other professions are operating in a legal grey area where there are no specified minimum training standards required before sticking acupuncture needles into one’s patients. It is truly a case of “let the buyer beware.” Licensure of acupuncture would bring Michigan up to the level of the 46 states that have already done so, while allowing time for the development of clear standards for how much additional training is necessary for each of these professions to practice safely.
Currently in Michigan there are a little over 200 acupuncturists (with the highest number practicing in Washtenaw county) who are nationally certified and could practice legally in other states. Michigan’s imperfect regulation of the profession has led to slower growth than we’ve seen in other Great Lakes states – Illinois has 850 licensed acupuncturists, for example – despite the fact that Bureau of Labor Statistics data shows that it is one of the fastest growing healthcare professions in the country.
What has this multi-decade movement to regulate and legalize acupuncture meant for the public and for practitioners? The intent is certainly to make it safer to seek out an acupuncturist, as weekend courses for laypeople have given way to master’s degrees at accredited colleges. But has this meant that fewer people could study and practice the medicine, creating the spike in health costs that we see in the conventional healthcare models?
We are fortunate to have many activists that have worked to prevent such a bottleneck from developing, ranging from the Working Class Acupuncture movement, which created low-cost community acupuncture clinics all over the country, to the National Acupuncture Detoxification Association, which has taught the 5-point auricular protocol for substance abuse to more people in Michigan than any other state in the country. As the profession grows, in time acupuncture treatments will be available in settings ranging from traditional private practices to hospital-based integrative-medicine departments, and from low-cost community clinics to inpatient addiction-treatment centers.
No government regulation of a healthcare profession comes without costs. But from the earliest lurches and miss-steps towards licensing in Nevada, with their requirement of foreign doctorate-level education to the present-day entry-level master’s degree and national certification, a standard for the profession has emerged that promises safety and efficacy, while not closing the door so far as to prevent the development of a variety of delivery models and kinds of training.
Henry Buchtel completed his acupuncture and herbal medicine studies at the Hunan University of Traditional Chinese Medicine in southern China, where he lived for more than a decade. In 2011 he moved back to his home state of Michigan to continue his clinical practice at The Lotus Center of Ann Arbor and at Michigan Oriental Medicine in Grand Blanc. He is in his second term as president of the Michigan Association of Acupuncture and Oriental Medicine. He can be contacted at firstname.lastname@example.org. For more information, visit www.dynamicpoints.com.