Acupuncture safety: Is the Clean Needle Technique exam a scam?
At my school, and I believe elsewhere in the US, we are required to take the Clean Needle Technique (CNT) exam before doing acupuncture in the clinic as primaries. My exam is coming this weekend in Portland and boy am I excited. (Yes, that’s sarcasm). To tell you the honest truth, I haven’t thought too much about it - positive or negative. The basic procedure is like this - well in advance of the exam nearest you, you submit a sizable chunk of change (135 dollars right now) and an application. Some time later you receive word that you’re accepted or not. You’re then required to buy a copy of the CNT manual (another 20 bucks plus shipping if your school doesn’t carry it) and assemble a “clean needling” kit consisting of various items. You’re meant to study and practice before the exam, and then give up an entire day where you will apparently be lectured to about blood borne pathogens, the importance of controlling your workspace and using the tube insertion method of needling.
The idea, I think, is to ensure the general public that acupuncturists know about blood-borne pathogens and are doing their best to minimize the risk to patients. I don’t think this is a bad thing. The public, especially the American public, is germ phobic to an extreme. Letting them know that we’re doing our utmost to ensure their safety can only be helpful for the profession. Right? That could be the end of the conversation, but many folks have raised questions about the exam and the whole practice of “clean needling.” I’d like to graze over a few here in hopes of starting a conversation and maybe quieting some of the questions in my own mind.
The “course” and exam
The Clean Needle Technique “course” and exam are administered by the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) based in Maryland. One of the major gripes I hear about the CNT course revolves around this organization. The question embedded in most of the complaints I have heard is whether or not this group is exploiting students for a profit motive. The assumption is that the group does nothing more than CNT, that CNT is not necessary or even useful and that the group charges unnecessarily for the service. As determined from their website, CCAOM’s primary aim is to improve the consistency and quality of Chinese medicine education in the US through the establishment of applicable standards for acupuncture and Asian medicine schools. They created a separate commission for the accreditation of Chinese medicine schools, now known as the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). They also have committees on a variety of topics not related to CNT and their newsletter suggests that they are still intimately involved in the continuing development of acupuncture and Asian medicine educational standards. For this reason, I do not support the assertion that CCAOM exists solely for the purpose of administering the CNT exam.
Regarding the profit motive… I have no idea how much profit the CCAOM makes from the CNT exam nor do I know what they would do with such a profit. I am always willing to give people the benefit of the doubt with regards to this issue. I know how much work goes into running an organization like this, and I’m disinclined to believe that they are profiting significantly from this practice. However, the regulations around the CNT Manual are absurd. Every person is required to buy their own manual ahead of time, photocopies and reuse of others’ manuals are prohibited. The manual is republished semi-frequently, so even if you had a friend’s - you may not be able to use it. While I understand the need to have an updated book because of the changing understanding of blood borne pathogens, I cannot think of a viable reason to require every student to spend 20 dollars on the manual. Allow photocopies and sharing of manuals - it’s the right thing to do.
There have been questions raised about the efficacy of the CCAOM in administering the exam from the perspective of enhancing patient safety. You can read a recent article in the Chinese Medicine Times about this issue titled OSHA Compliance: How Clean Needle Technique Falls Short in the US. Personally, I feel that the article goes too far in the WRONG direction - which I will discuss in the next section of this post. But the thought that the CNT exam doesn’t even do what it is intended to do very well is disturbing. That’s a lot of money to not even get the job done.
The practice
It is part of the Oregon Acupuncture Association’s code of ethics states that it is a legal requirement to follow Clean Needle technique to practice acupuncture in Oregon. I have not been able to locate that section in the Oregon statues that govern licensure, but several agencies refer to the requirement and I believe it may be a requirement in some way in the national board examinations. It would be interesting to know whether it is an actual legal requirement, and if not, why not.
The question is this - has there ever been any evidence that blood borne pathogens are transmitted by modern acupuncture needles? It seems certain that the risk would be much higher if you were reusing needles or using needles between patients. Few people do this - and it doesn’t seem like a 135 dollar course and exam would be necessary to teach us not to reuse needles. Assuming you are using disposable needles and using them only once - what is the risk? Several articles, such as this one in the Medical Acupuncture Journal indicate that the evidence is quite scarce that acupuncture poses a serious risk of transmitting blood borne pathogens even in highly risky situations. I personally know of no situation in which acupuncture caused any problems, blood borne pathogen or otherwise. In China, it is my understanding that very few if any people practice Clean Needle Technique and I am not aware of any outcry around the propagation of disease by acupuncturists. It seems exceedingly unlikely that the risk is significant. So why the obsession?
It seems to me that it would be smarter and easier for students to make Clean Needle Technique a mandated portion of their acupuncture curriculum (perhaps a couple weeks of the first class) and have a few salient questions concerning it on the national board exam. I cannot at this time think of a substantial reason to support the course and exam as it now stands. I would be delighted to hear any opinions to the contrary with supporting evidence. Have any of you practitioners been involved in any efforts to change or get rid of the requirement?
Eric
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Tags: Acupuncture, ccaom, clean-needle-technique, education, exams, law, Learning, professional-developmentRelated posts
Chinese herb of the week: The qualities and uses of Ma Huang
I hope you’ll excuse me for getting this out a little later than I had hoped - the weekend was jam packed!
Ma Huang - Ephedra - 麻黄
Ma Huang is one of the most famous herbs in the Chinese Materia Medica - and with good reason. In a world where medicine is mostly unable to deal with the most common illnesses that people encounter, colds and flus, an herb that can handily address these symptoms has a right to be respected. Unfortunately, some of the popularity of this herb exists for more nefarious reasons. Ephedra has been implicated in a number of exertion related deaths, particularly in young football players and people seeking to lose weight.
Unfortunately, many people are unable or unwilling to learn the whole story. These deaths did not come from the controlled use of appropriate doses of the whole herb under the supervision of an appropriately trained Chinese medicine physician. In many cases, the herb is broken down to isolate the desired alkaloids (for example, L-ephedrine) and often mixed with other stimulating compounds to increase the metabolism of the imbiber. It is not used using the principles of formula science - and thus is dangerous. When Ma Huang is used in its natural or minimally prepared form, prescribed by a physician within a carefully constructed formula appropriate to the patient’s condition and constitution - it is absolutely safe and, even, quite beneficial.
Read more
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Chinese medicine: NOT just for pain!
It’s summer between my second and third year of school in Classical Chinese medicine. I’ve had these past two summers “off” which means I do a lot of studying and thinking and many odd jobs along with caring for my daughter. The time is always a little disconcerting without the steady pendulum effect of classes and assignments. Last summer I spent most of my time just getting over the mind-blowing effect of learning about Chinese culture and symbolism. I couldn’t tell you in any way what kind of medicine I would like to practice at that point. This summer is disconcerting in a new way. I find that the kind of doctor I want to be is becoming too broad! I want to treat everyone for everything!
Trying to narrow this down has led me to consider the “scope of practice” for Chinese medicine. In Oregon we have a Board of Medical Examiners defined Scope of Practice:
77.757 Definitions for ORS 677.757 to 677.770. As used in ORS 677.757 to 677.770 (current as of 2005, I don’t think any major revisions have been made, but I’m looking into it):
(1)(a) “Acupuncture” means an Oriental health care practice used to promote health and to treat neurological, organic or functional disorders by the stimulation of specific points on the surface of the body by the insertion of needles. “Acupuncture” includes the treatment method of moxibustion, as well as the use of electrical, thermal, mechanical or magnetic devices, with or without needles, to stimulate acupuncture points and acupuncture meridians and to induce acupuncture anesthesia or analgesia.(b) The practice of acupuncture also includes the following modalities as authorized by the Board of Medical Examiners for the State of Oregon:
(A) Traditional and modern techniques of diagnosis and evaluation;
(B) Oriental massage, exercise and related therapeutic methods; and
(C) The use of Oriental pharmacopoeia, vitamins, minerals and dietary advice.
(2) “Oriental pharmacopoeia” means a list of herbs described in traditional Oriental texts commonly used in accredited schools of Oriental medicine if the texts are approved by the Board of Medical Examiners for the State of Oregon. [1993 c.378 §1]
There is another section of interest - 677.190, section (9). It explains that a physician’s license can be revoked because of “unprofessional conduct” if the doctor is found to be, “Making statements that the licensee knows, or with the exercise of reasonable care should know, are false or misleading, regarding skill or the efficacy or value of the medicine, treatment or remedy prescribed or administered by the licensee or at the direction of the licensee in the treatment of any disease or other condition of the human body or mind.”
This is interesting given that earlier in the statutes it is explained that,
(b) For purposes of this subsection, the use of an alternative medical treatment shall not by itself constitute unprofessional conduct. For purposes of this paragraph:
(A) “Alternative medical treatment” means:
(i) A treatment that the treating physician, based on the physician’s professional experience, has an objective basis to believe has a reasonable probability for effectiveness in its intended use even if the treatment is outside recognized scientific guidelines, is unproven, is no longer used as a generally recognized or standard treatment or lacks the approval of the United States Food and Drug Administration;
(ii) A treatment that is supported for specific usages or outcomes by at least one other physician licensed by the Board of Medical Examiners; and
(iii) A treatment that poses no greater risk to a patient than the generally recognized or standard treatment.
So, despite the fact that some treatments may not be FDA approved or may not be within contemporary Western scientific guidelines they do not constitute unprofessional conduct, and thus cannot be said to violate the statute that recommends dismissal for licensed CM docs claiming that their medicine can treat conditions if such claims are supported by the medical philosophy under which they operate. OK. What does this mean for me?
Many people talk about the effectiveness of Chinese medicine for pain. The general public has also begun to understand that Chinese medicine is good for a few chronic conditions, including infertility. However, Chinese medicine is capable of much more than this. It is effective in treating acute stages of many illnesses, including febrile diseases, the common cold, trauma and even more life threatening conditions. One needs only to find an excellent practitioner with experience in this realm.
To provide an example, my daughter came down with something during the winter that involved an extremely high fever, sinus congestion and extreme throat pain - to the point where she couldn’t swallow. You’re all thinking strep throat, right? Well, me too. I wrestled with the thing for a while - just giving her fluids, keeping her cooled down. However, she wasn’t eating and her fever wasn’t breaking and I know better than to try to break the fever with over the counter medications. I debated taking her to urgent care (Western) or to my school’s clinic. It was difficult because even as committed to Chinese medicine as I am, I still have a lot of embedded beliefs that make me pause. I decided that I had to give it a shot. I took her to the clinic in the early evening and she was given acupuncture and an herbal formula. The formula was meant to be taken at a high frequency - we followed the instructions perfectly. The next morning she awoke with no fever, no sore throat, no sinus congestion and - most important - good energy and a smile on her face.
This isn’t an isolated incident. A well trained CM doctor can take care of any medical situation that comes up, save transplant situations or some similar condition that requires surgery. It may be a little fringe to suggest this is the case, but it has been my experience and the experience of many people I know personally.
Eric
Tags: Acupuncture, Acute conditions, law, Personal Development, scope-of-practiceRelated posts
Chinese medicine and (sometimes endangered) animal ingredients
You may have heard of the recent raid in Wisconsin (US) of a home suspected of harboring contraband bear bile. Bear bile? Yes, bear bile.
In Chinese herbal medicine, included animal ingredients are also considered to be “herbs” insofar that they are natural substances that have a medicinal effect. This includes shells, bones, organs, whole bodies (of, for instance, lizards) and various items the animals expel more or less willingly (dung, for example). For many Westerners, this is unbelievably gross. However, these herbs are often very effective and certainly no more worthy of disgust than some of the poisons peddled by pharmaceutical companies as medicine today.
The market for the most fanciful, and from some perspectives the most effective, of these ingredients has become a black market. This is because many of them are derived from animals that are now or soon will be endangered. To be fair, it isn’t because the items are Chinese herbs that the animals have become endangered - at least not entirely. Most of these animals are endangered because of other human activity. Being in the materia medica just doesn’t help.
Scrupulous practitioners will not use these endangered herbs. There are alternatives, though most of them require a much higher dosage to be effective. This should be no deterrent to a practitioner - we should always seek to do our best to preserve the fabric of nature. It is the very ground from which our medicine grows. Any practitioner that seeks to disrupt this balance farther than it already has been probably shouldn’t be practicing the medicine.
But what about animal ingredients in general, even the ones that aren’t endangered? Some people choose not to use them because of their beliefs about animal welfare. Some people will use them in critical circumstances - situations where the use of that product would be so advantageous that it warrants the use in their mind. Others have no problem with using them - believing that their charge to safeguard human health is the most important directive they must follow.
If you are vegan or vegetarian, or if you simply have a high regard for animal welfare, consider asking your doctor to leave them out of your formula. If he insists that those products are necessary in your formula, try to understand his reasoning. Like any decision, this is one you should make in a fully informed state. If you are vehemently opposed to the use of those ingredients, insist that they be left out of your formula. You have a right to control what goes into your body, and your doctor will respect that.
There are a few different types of these ingredients, and your willingness to use animal products as an adjunct for health may depend on which type you are being offered. There are products that include the entire body of the animal. One example is Ge Jie (蛤蚧), the gecko - used for tonification of Kidney Yang. There are products that include only a part of the animal, but surely require the killing of the animal. One example is Xiong Dan (熊膽), bear gallbladder - once used as a strong clearer of heat, especially Liver heat of a severe nature. There are products that likely do not require the killing of the animal, but may wound or otherwise harm it. One example is Lu Rong (慮茸), deer antler velvet. While taking of the velvet is done regardless of its use as an herb and it is also done under anesthetic, there is a reasonable chance that harm will come to the deer and there are other ethical objections aside. Finally, there are products that come from the animal but do not require the processor to kill or hurt it. One example is Wu Ling Zhi (五靈脂), flying squirrel feces - used to invigorate and enliven the blood.
I am currently doing research regarding the processing of animal herbs, because while those in the last class listed above do not require harm to the animal - sloppy processing may cause harm anyway. I would like to be able to provide full information to my future patients.
What do you think about animal ingredients in herbal formulas? Please discuss in the comments.
Eric Grey
Tags: chinese-herb, chinese-herbs, endangered-animals, Ethics, exotic-herbs, lawRelated posts
Top 5 Reasons to make Classical Chinese medicine your medicine of choice
1. Clinical effectiveness: Chinese medicine, particularly when it is practiced in a Classically-based manner, works. In my scant year of clinical observation, I have seen miracles transpire. I have seen people shackled by various conditions, sometimes all their lives, be simply TRANSFORMED after only a few treatments. Many of you have probably seen this as well. It works for patients - and that’s what medicine is supposed to do.
Yes, I’ve read THAT study, too. Studies have flaws - THAT study has been roundly denounced by a number of people in a number of different ways. I’d be glad to discuss it in another post. Think also about this - Chinese medicine works in a manner entirely different from Western medicine. It’s so different, in fact, that placebo controlled double blind studies may simply be ineffective for displaying what it is that Chinese medicine can do. Clinical studies are another matter, and many show the great effectiveness of Chinese medicine. Where those studies have been negative or inconclusive, I feel that it probably has something to do with the level of Chinese medicine being practiced in the study. That’s why I’m hoping to do (and encourage others to do) clinical studies through Helfgott Research Institute. I’ll certainly post about any future results.
2. Doctors who take their time: When you see a Chinese physician for the first time, you will probably be amazed by the intake process. The process is extremely detailed, and Chinese physicians take all of your concerns under advisement - not just those that fit neatly into a simple diagnostic category. Chinese medicine physicians will not dismiss your concerns as “irrelevant” or “psychosomatic,” they will integrate each manifestation of disease into a full diagnosis that will guide a treatment to rectify the balance of your ENTIRE system.
3. Fewer environmental impacts than Western medicine: Chinese medicine doesn’t employ pharmaceuticals or other chemicals in carrying out treatment or diagnostics. The pollutants dumped into our waterways by the pharmaceutical industry are a significant problem. That being said, there are real environmental issues that the CM profession must grapple with, including the problems inherent in importing herbal products from China. Although that is most certainly a post in itself - I want to point out that many American companies are working to find pesticide-free and sustainably produced herbal products. More of this is surely to come.
4. Good cost-benefit ratio: As we all know, the escalating costs of healthcare are leaving many Americans uninsured, causing nearly unbearable pressure on the hospital system and social services. That the wealthiest nation in the world leaves so many people without access to basic care is reprehenisble. Natural medicine in general represents an answer to this problem. Many treatments by Chinese medicine physicians use food therapy and economically priced herbal supplements. Further, you will find that the average office visit for a Chinese medicine doctor is very reasonable considering the great depth of care you receive. Insurance companies are beginning to pick up the cost of these office visits, which is an encouraging sign.
5. Total integration: This medicine doesn’t “rob Peter to pay Paul,” as the saying goes. When your chief complaint is treated, it is treated in order to integrate your entire self - mind, body and spirit. So, for instance, your ongoing treatment for seasonal allergies isn’t going to create dryness in your mucus membranes, difficulty sleeping and pervasive feeling of anxiety. This will reduce your overall discomfort, as well as keeping costs down - you won’t need to buy medicine to treat the problems that your medicines produced!
There are certainly many more reasons you should make Classical Chinese Medicine your medicine of choice - but I hope this list will provide you with some food for thought as you contemplate your health care options. Remember - YOU DO HAVE OPTIONS!
Tags: balance, china, clinic, disease, ego, environment, food, health, helfgott research institute, law, service, study
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