Medical acupunc Physicians incorporate acupuncture into their medical prac- integrated in some medical programs, such as at Georgetown tice in a variety of ways. Some complement their conven- Harvard, and John Hopkins Universities, and "rapidly taking tional regimen of drugs and standard procedures with acu- a legitimate place as a valuable therapeutic technique. "1, 2 puncture to augment treatment or palliate adverse side Most states now license acupuncturists to practice under effects. Yet others completely transition to the sole practice of varying degrees of autonomy, and the medical acupuncturist acupuncture treatment, referring to other practitioners when may feel the impact of the changing environment of acupunc necessary,4, 5such as to an oncologist or surgeon for chemo- ture as demand for and understanding of acupuncture con therapy or mastectomy. In the United States, acupuncture is tinues to promote acupuncture into a more sophisticated and most utilized by physicians in the management of musculo- robust system of health care skeletal pain, but due to its high adaptability for treatment of both premorbid and disease states, medical acupuncture is The Legal Environment ding on the individual patient, as well as the particular of Medical Acupuncture A Matter of power nd or Historical Background State Regul A single definition of acupuncture as it is practiced in the United of Medical Acupuncture States does not exist in the legal literature supporting and/or restricting the practice. States vary widely in their regulatory role The incorporation of acupuncture into the Western medical ractio ting beganin mid-16th century Europe with various texts and ture outside of biomedical licensing (MD or DO), to practically United States, physicians were some of the first to formally im- ordaining acupuncture as the practice of medicine. The former plement acupuncture in their practices in the 18th and early while the latter is most clearly delineated in the statutes of New 9th centuries, utilizing the European Chinese medicine texts or Mexico or Florida, where the"acupuncture physician"practices accompanying Chinese herbalists practicing the art . 7 Perhaps cupuncture as a form of "primary health care"for the diagnosis the first well-known text dealing with medical acupuncture is and treatment of disease. 8 Sir William Osler's The Principles and Practice of Medicine,written So far, all states, with one exception, have included acupunc- in 1913, in which acupuncture is clearly indicated for the man- ture within the scope of practice of other health care providers, agement of lower back pain. ' The first licensed acupuncturist on though this body varies in membership across the states, from record was actually the Chinese Ah Fong Chuck, who, in 1901, only the allopathic and osteopathic doctors in most states,to won a medical license through legal action in Idaho. Acupunc ture, though, was generally not recognized as a legal practice of podiatrists, homeopaths, naturopaths, optometrists, and veteri- practice acts appearing in such states as Nevada, Maryland, and marians"in Connecticut 8 Currently, 36 states include acupunc- ture in the scope of a physicians medical or osteopathic license. 8 Oregon in 1973. 8 Recent developments in the environment of The remaining 14 states either require a minimum training of acupuncture, as one of the oldest and most widely used medical about 200 hours on average, clinical expenence, or registration procedurest--from the reclassification of the acupuncture nee- with the state medical board. Thus, the practice of acupuncture dle to a Class Il standard medical device. 9, b to the 1997 NIH by physicians is sanctioned by most state medical boards with consensus statement declaring acupuncture as"widely prac- out any kind of training or proof of experience, whereas in other ticed"and effective in a vast array of medical diseases and symp- states including Hawaii, Pennsylvania, and Rhode Island,sur- toms-has captured the attention of both the scientific comm nities skeptical and embracing of the practice, and the federal Pnsingly stringent requirements exist in initial training,clinical government concerned with patient protection, further re- experience, and registration in order to practice acupuncture &,d search, and regulation of acupuncture. 10. By examining the various licensing statutes across state Today, European medical schools formally teach acupunc one can see that the practice of acupuncture is progressively ture where it is applied in almost all fields of medicine, icine to varying degrees Not surprising, gleaned from this to States with training requirements for physicians wanting to practice acu bIn March 1996. the FDA reclassified the act puncture also include District of Columbia(250 hours), Georgia (300 experimental device to the Class ll standard medical device appropriate hours depending on time entry), Louisiana(6 months), Maryland (300 in standard practice by physicians and general non-physician acupunc- ours), New Jersey (300 hours), New York (300 hours), and virgin ture use. This reclassification a result of increased availability of (200 hours). (See ref. 8, p 12 on Hawaii,s regulations. li][r] Pennsylva- data supporting needle ia State Board of Medicine requires that all physicians must have 200 Results of the NIH consensus, include the awarding of sizable federal grants hours of Category I Continuing Education credits in acupuncture and b or acupuncture and. a federal mandate created the NCCAM to investi- gistered with the board in order to practice acupuncture. Rhode lsland gate complementary and alternative healing modalities under statute contains exemption language for physicians, but the Board of scientific study, to train CAM researchers, and produce authe Medical Licensure and Discipline requires that physicians complete 300 information on CAM to both the public and professional communi hours of acupuncture education that includes a clinical practicumPhysicians incorporate acupuncture into their medical prac￾tice in a variety of ways. Some complement their conven￾tional regimen of drugs and standard procedures with acu￾puncture to augment treatment or palliate adverse side￾effects. Yet others completely transition to the sole practice of acupuncture treatment, referring to other practitioners when necessary,4,5 such as to an oncologist or surgeon for chemo￾therapy or mastectomy. In the United States, acupuncture is most utilized by physicians in the management of musculo￾skeletal pain,2 but due to its high adaptability for treatment of both premorbid and disease states, medical acupuncture is used in preventative, primary, and complementary care, de￾pending on the individual patient, as well as the particular orientation of the provider.2 Historical Background of Medical Acupuncture The incorporation of acupuncture into the Western medical setting began in mid-16th century Europe with varioustexts and treatises published and used by European physicians.6 In the United States, physicians were some of the first to formally im￾plement acupuncture in their practices in the 18th and early 19th centuries, utilizingthe European Chinese medicinetexts or accompanying Chinese herbalists practicing the art.6,7 Perhaps the first well-known text dealing with medical acupuncture is SirWilliam Osler’s The Principles and Practice of Medicine, written in 1913, in which acupuncture is clearly indicated for the man￾agement of lower back pain.7 The first licensed acupuncturist on record was actually the Chinese Ah Fong Chuck, who, in 1901, won a medical license through legal action in Idaho.6 Acupunc￾ture, though, was generally not recognized as a legal practice of health care until the early 1970s, with some of the first licensing practice acts appearing in such states as Nevada, Maryland, and Oregon in 1973.8 Recent developments in the environment of acupuncture, as one of the oldest and most widely used medical procedures4—from the reclassification of the acupuncture nee￾dle to a Class II standard medical device,9,b to the 1997 NIH consensus statement declaring acupuncture as “widely prac￾ticed” and effective in a vast array of medical diseases and symp￾toms—has captured the attention of both the scientific commu￾nities skeptical and embracing of the practice, and the federal government concerned with patient protection, further re￾search, and regulation of acupuncture.10,c Today, European medical schools formally teach acupunc￾ture where it is applied in almost all fields of medicine, whereas in the United States, acupuncture is beginning to be integrated in some medical programs, such as at Georgetown, Harvard, and John Hopkins Universities, and “rapidly taking a legitimate place as a valuable therapeutic technique.”11,12 Most states now license acupuncturists to practice under varying degrees of autonomy, and the medical acupuncturist may feel the impact of the changing environment of acupunc￾ture as demand for and understanding of acupuncture con￾tinues to promote acupuncture into a more sophisticated and robust system of health care. The Legal Environment of Medical Acupuncture A Matter of Power and Opinion: State Regulation A single definition of acupuncture as it is practiced in the United States does not exist in the legal literature supporting and/or restricting the practice. States vary widely in their regulatory role in acupuncture practice from complete disregard of acupunc￾ture outside of biomedical licensing (MD or DO), to practically ordaining acupuncture as the practice of medicine. The former case is demonstrated by states such as Delaware and Alabama, while the latter is most clearly delineated in the statutes of New Mexico or Florida, where the “acupuncture physician” practices acupuncture as a form of “primary health care” for the diagnosis and treatment of disease.8 So far, all states, with one exception, have included acupunc￾ture within the scope of practice of other health care providers, though this body varies in membership across the states, from only the allopathic and osteopathic doctors in most states, to “medical doctors, chiropractors, dentists, physical therapists, podiatrists, homeopaths, naturopaths, optometrists, and veteri￾narians” in Connecticut.8 Currently, 36 states include acupunc￾ture in the scope of a physician’s medical or osteopathic license.8 The remaining 14 states either require a minimum training of about 200 hours on average, clinical experience, or registration with the state medical board.8 Thus, the practice of acupuncture by physicians is sanctioned by most state medical boards with￾out any kind of training or proof of experience, whereas in other states including Hawaii, Pennsylvania, and Rhode Island, sur￾prisingly stringent requirements exist in initial training, clinical experience, and registration in order to practice acupuncture.8,d By examining the various licensing statutes across states, one can see that the practice of acupuncture is progressively becoming acceptable apart from the scope of practice of med￾icine to varying degrees. Not surprising, gleaned from this bIn March 1996, the FDA reclassified the acupuncture needle from a Class III experimental device to the Class II standard medical device appropriate in standard practice by physicians and general non-physician acupunc￾ture use. This reclassification came as a result of increased availability of data supporting needle use. c Results of the NIH consensus, include the awarding of sizable federal grants for acupuncture and...a federal mandate created the NCCAM to investi￾gate complementary and alternative healing modalities under rigorous scientific study, to train CAM researchers, and produce authoritative information on CAM to both the public and professional community. dStates with training requirements for physicians wanting to practice acu￾puncture also include District of Columbia (250 hours), Georgia (300 hours depending on time entry), Louisiana (6 months), Maryland (300 hours), New Jersey (300 hours), New York (300 hours), and Virginia (200 hours). (See ref. 8, p 12 on Hawaii’s regulations.) [i][r] Pennsylva￾nia State Board of Medicine requires that all physicians must have 200 hours of Category I Continuing Education credits in acupuncture and be registered with the board in order to practice acupuncture. Rhode Island statute contains exemption language for physicians, but the Board of Medical Licensure and Discipline requires that physicians complete 300 hours of acupuncture education that includes a clinical practicum. Medical acupuncture 25