Legislative Alchemy 2017: Acupuncture
Acupuncture is nothing more than a theatrical placebo. Yet acupuncturists, defined as primary care practitioners in some states, are succeeding in licensing and practice expansion efforts in state legislatures.

Acupuncture is a theatrical placebo. Its proposed mechanism of action is highly implausible and:

after decades of research and more than 3000 trials, acupuncture researchers have failed to reject the null hypothesis, and any remaining possible specific effect from acupuncture is so tiny as to be clinically insignificant.

In layman’s terms, acupuncture does not work – for anything.

Even the very CAM-friendly National Center for Complementary and Integrative Health (NCCIH), in its own weasel-worded way, comes close to conceding the point:

Research suggests that acupuncture can help manage certain pain conditions, but evidence about its value for other health conditions is uncertain. [Emphasis added.]

Somebody tell the state legislatures. Via the magic of Legislative Alchemy, 47 states have legalized the practice of acupuncture along with, in some cases, Traditional Chinese, Oriental or East Asian medicine. In several states, acupuncture practice acts describe acupuncturists as primary care practitioners and/or give them the authority diagnose and treat any condition or disease. For example, in my state, Florida, the practice act says that 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. [Emphasis added.]

In Nevada,

“Acupuncture” means 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 in the body and to cure, relieve or palliate:

(a) Any ailment or disease of the mind or body; or

(b) Any wound, bodily injury or deformity. [Emphasis added.]

And in New Mexico:

“doctor of oriental medicine” means a person licensed as a physician to practice acupuncture and oriental medicine with the ability to practice independently, serve as a primary care provider and as necessary collaborate with other health care providers . . .

“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. [Emphasis added.]

As with state chiropractic and naturopathic licensing, most states rely on a closed-loop system of education and examinations that is completely controlled by acupuncturists in determining who is qualified to become licensed. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) administers the certification exams recognized by the states. Applicants for certification must have either graduated from schools accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) or foreign schools meeting criteria set by the NCCAOM.

While the ACAOM is approved as an accrediting agency by the U.S. Department of Education, the Department does not review the scientific validity of what is taught or perform any independent analysis of the graduates’ ability to competently and safely practice. Its focus is on administrative matters and the financial stability of the schools. The ACAOM standards do not require a college degree for admission to an accredited acupuncture/Oriental Medicine school and only 500 hours of supervised patient care are required in accredited programs to graduate with a Master’s in acupuncture (700 hours for a Master’s in Oriental Medicine). A Master’s allows one to sit for the NCCAOM exam. In sum, someone with no college degree and 500 hours of clinical training can become a “primary care provider” in some states.

2017 bills

Today we look at bills filed in eleven states to license, or expand the practice of, acupuncturists during the 2017 state legislative sessions. Six were successful. Two bills were defeated; three remain pending.

Prior to last year, acupuncturists did not have a practice act in Wyoming. This year they succeeded in gaining one, although the Wyoming legislature stopped short of giving them the right to practice Oriental Medicine, which was eliminated in the final bill. Acupuncture is somewhat narrowly defined as inserting needles, with or without electric current or heat, into the body for:

therapeutic purpose of promoting, maintaining and restoring health, including [but, we note, not limited to] the treatment of dysfunctions of the body involving pain.

Wyoming also joins several states who’ve been bamboozled into thinking sticking needles into peoples’ ears, otherwise known as “auricular acupuncture,” is effective for substance abuse and mental health issues. Promoted based on an unpublished and cherry-picked review of the evidence by an organization called the National Acupuncture Detoxification Association (NADA), it is a perennial favorite with state legislatures looking to address mental health issues and drug abuse on the cheap.

New Hampshire enacted legislation creating something called a “Certified Acupuncture Detoxification Specialist,” who must be trained in the NADA protocol and supervised by an acupuncturist, although the “Specialist” needn’t be an acupuncturist himself. They can use “acu-detox” for:

behavioral health applications, including addictions, mental health, and disaster and emotional trauma.

One version of the bill specified that “acu-detox” could be used only in conjunction with other therapies but that bit of consumer protection against the ineffectiveness of pseudoscience in treating serious conditions was rejected.

Likewise, in Maine, a new law requires the state Department of Health and Human Services to develop a pilot project that will treat alcohol and substance abuse using the unproven NADA protocol. Fortunately, more sober minds prevailed in West Virginia, where a bill allowing the practice of NADA auricular acupuncture for chemical dependency failed.

Like their fellow CAM practitioners, naturopaths and chiropractors, once licensed, acupuncturists will return again and again to the state legislatures for practice expansion. In 2017, they succeeded in a big way in Illinois. There the legislature added the practice of “East Asian” medicine to the acupuncturists’ scope of practice, defined to include needle acupuncture, moxibustion, herbal medicine, and dietary supplements, among others, to:

normalize physiological functions, or for the treatment of diseases or dysfunctions of the body.

Acupuncture itself is broadly defined to include not only traditional needle acupuncture, but also far-infrared, electro- and magnetic stimulation, cold laser, cupping, dry needling (discussed below), and the bruising massage practice known as gua sha:

In a move reminiscent of the chiropractic lobby’s efforts to make chiropractic schools the arbiter of what chiropractors can and cannot do, Illinois practitioners of acupuncture and East Asian medicine are permitted to perform a differential diagnosis via principles and techniques taught in acupuncture schools, like the fanciful tongue and pulse diagnosis.