INTEGRATIVE MEDICINE ELSEVIER Medical Acupuncture: The Legal Environment as Practiced by the Physician Deborah L. Wirsing, BBA, MS, and Sherman L Cohn, BSFS, LLB, LLM Acupuncture has been practiced for 2000 to 5000 years A medical acupuncturist, on the other hand, is generally It is no more experimental as a mode of medical treat defined as the conventional physician, MD or DO, who ment than is the Chinese language as a mode of commu- adopts acupuncture into his or her conventional medical nication. What is experimental is not acupuncture, bu practice Professional training is usually limited to about 200 Westerners'understanding of it and their ability to uti hours and state regulation is highly variable. The American lize it properly Academy of Medical Acupuncture(AAMA)nationally repre U.S. District Court for the Southen District of Texas sents and supports medical acupuncture and its practitioners Andrews v. Ballard, 498 F Supp. 1038 in education, training, and legislation, and in many ways (SD.Tex.1980) promotes solidarity among medical acupuncturists as A cupuncture is a two millennia-old system of health care merging body of health care providers. The AAMA more that involves the insertion of needles into the body at specifically defines medical acupuncture as"acupuncture distinct points that correspond to underlying channels of an performed by a doctor trained and licensed in Western med energetic flow called qi(pronounced"schee"). Underlying icine who also has thorough training in acupuncture as a specialty theory of acupuncture holds that this therapeutic insertion of practice"italics added for emphasis. 2 A more encompassing he needles, sometimes in conjunction with other stimulating definition can be found to describe medical acupuncture as techniques, encourages the flow and rebalancing of this en- acupuncture that has been successfully incorporated into ergy, qi, and thus a subsequent relief of the gamut of ailments medical or allied health practices in Western cour and diseases treated in traditional Chinese medicine for the purposes and focus of this article, only MD and DO In the United States, acupuncture is legally practiced in acupuncturists will be discussed. variety of styles and settings by conventional physicians, al Medical Acupuncture integrates both the conventional un- lied health professionals, and non-physician acupuncturists derstanding of neuromuscular anatomy, pain physiology, Non-physician acupuncturists are trained in Acupuncture and disease states with a classical Chinese ideology of the and Oriental Medicine programs accredited by the national imperceptible flow of vivifying energy that supports life, bal- governing body, the Accreditation Commission for Acu ance, and well-being to the whole person. Both pure forms of puncture and Oriental Medicine(ACAOM), certified through acupuncture, where treatment is based on traditional Chi- a proficiency examination by the National Certification nese concepts, and hybrid forms, in which treatment is ad Commission for Acupuncture and Oriental Medicine ditionally supported by conventional diagnostic tools, exist (NCCAOM), and are licensed for legal practice by states un- in medical acupuncture. Hybrid acupuncture, the most com- der varying requirements. Accredited acupuncture programs mon approach, enables the medical acupuncturist to orga- include both didactic and clinical training over the course of nIze and address patients symptoms such as recurring pain, 3 years, with the completion of at least 1,905 resident hours nausea and malaise which are so elusive in standard medical evaluation and treatment. 2 a growing body of about 6000 practicing physicians, including mainly neurologists, anes- Medical College of Georgia, Augusta, GA thesiologists, pain specialists, and general practitioners con- gEorgetown University Law School, Washington, DC. Note that membership to the AAMA or any professional organization has stitute those physicians practicing medical acupuncture. many advantageous elements of services, information, and prestige that beyond the scope of this paper This paper was initially prepared for Seminar on Alternative and Comple aConventional c include examination of past medical records, ra mentary Medicine Legal Issues(L] 065-05)at Georgetown University ory evaluations, for example, used to confirm or Law School, under the direction of Professor Sherman L Cohn and even iden disorders not readily identified in the traditional djunct Professors Peter C. Cohen, MD, and Jonathan Missner, JD Chinese evaluation. This becomes especially important when consider Address reprint requests to Deborah L. Wirsing, BBA, MS, MCG Box 672 ing malpractice issues of misdiagnosis or the overlooking of a disease 112015thSt,Augusta,Ga30912-0006.e-mail:diawirsing@yahoo.com such as early stages of cancer. 24 1543-1150/05/S-see front matter O 2005 Elsevier Inc. All rights reserved doi:10.1016 J-sigm.2005.03.003Medical Acupuncture: The Legal Environment as Practiced by the Physician Deborah L. Wirsing, BBA, MS,* and Sherman L. Cohn, BSFS, LLB, LLM† Acupuncture has been practiced for 2000 to 5000 years. It is no more experimental as a mode of medical treat￾ment than is the Chinese language as a mode of commu￾nication. What is experimental is not acupuncture, but Westerners’ understanding of it and their ability to uti￾lize it properly. U.S. District Court for the Southern District of Texas Andrews v. Ballard, 498 F. Supp. 1038 (S.D. Tex. 1980) Acupuncture is a two millennia-old system of health care that involves the insertion of needles into the body at distinct points that correspond to underlying channels of an energetic flow called qi (pronounced “schee”). Underlying theory of acupuncture holds that this therapeutic insertion of the needles, sometimes in conjunction with other stimulating techniques, encourages the flow and rebalancing of this en￾ergy, qi, and thus a subsequent relief of the gamut of ailments and diseases treated in traditional Chinese medicine. In the United States, acupuncture is legally practiced in a variety of styles and settings by conventional physicians, al￾lied health professionals, and non-physician acupuncturists. Non-physician acupuncturists are trained in Acupuncture and Oriental Medicine programs accredited by the national governing body, the Accreditation Commission for Acu￾puncture and Oriental Medicine (ACAOM), certified through a proficiency examination by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), and are licensed for legal practice by states un￾der varying requirements. Accredited acupuncture programs include both didactic and clinical training over the course of 3 years, with the completion of at least 1,905 resident hours.1 A medical acupuncturist, on the other hand, is generally defined as the conventional physician, MD or DO, who adopts acupuncture into his or her conventional medical practice. Professional training is usually limited to about 200 hours2 and state regulation is highly variable. The American Academy of Medical Acupuncture (AAMA) nationally repre￾sents and supports medical acupuncture and its practitioners in education, training, and legislation, and in many ways promotes solidarity among medical acupuncturists as an emerging body of health care providers. The AAMA more specifically defines medical acupuncture as “acupuncture performed by a doctor trained and licensed in Western med￾icine who also has thorough training in acupuncture as a specialty practice” [italics added for emphasis].2 A more encompassing definition can be found to describe medical acupuncture as “acupuncture that has been successfully incorporated into medical or allied health practices in Western countries,”2 but for the purposes and focus of this article, only MD and DO acupuncturists will be discussed. Medical Acupuncture integrates both the conventional un￾derstanding of neuromuscular anatomy, pain physiology, and disease states with a classical Chinese ideology of the imperceptible flow of vivifying energy that supports life, bal￾ance, and well-being to the whole person. Both pure forms of acupuncture, where treatment is based on traditional Chi￾nese concepts, and hybrid forms, in which treatment is ad￾ditionally supported by conventional diagnostic tools,a exist in medical acupuncture. Hybrid acupuncture, the most com￾mon approach, enables the medical acupuncturist to orga￾nize and address patients’ symptoms such as recurring pain, nausea, and malaise, which are so elusive in standard medical evaluation and treatment.2 A growing body of about 6000 practicing physicians,3 including mainly neurologists, anes￾thesiologists, pain specialists, and general practitioners con￾stitute those physicians practicing medical acupuncture.4 *Medical College of Georgia, Augusta, GA. †Georgetown University Law School, Washington, DC. Note that membership to the AAMA or any professional organization has many advantageous elements of services, information, and prestige that are beyond the scope of this paper. This paper was initially prepared for Seminar on Alternative and Comple￾mentary Medicine Legal Issues (LJ 065-05) at Georgetown University Law School, under the direction of Professor Sherman L. Cohn and Adjunct Professors Peter C. Cohen, MD, and Jonathan Missner, JD. Address reprint requests to Deborah L. Wirsing, BBA, MS, MCG Box 672, 1120 15th St, Augusta, GA 30912-0006. E-mail: diawirsing@yahoo.com a Conventional diagnostics include examination of past medical records, ra￾diographs, and laboratory evaluations, for example, used to confirm or even identify organic disorders not readily identified in the traditional Chinese evaluation. This becomes especially important when consider￾ing malpractice issues of misdiagnosis or the overlooking of a disease, such as early stages of cancer. 24 1543-1150/05/$-see front matter © 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.sigm.2005.03.003