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low-cost alternative to traditional treatment. But the powerful State
Medical Society says only physicians should practice acupuncture.
So far the doctors have won
Kurt Weston, 36, knows the acupuncture treatments he receives at a Chicago clinic won't stop the HIV infection that is slowly killing him.
"I realize there is no cure for AIDS, but acupuncture therapy has been very beneficial to me," said Weston, who has been treated by a volunteer nonphysician acupuncturist at North Side HIV Treatment Center for the past two years.
"It's helped me with the side effects of AZT and other drugs, as well as helping me fight off opportunistic infections and controlling a case of drug-resistant herpes. More importantly, acupuncture improves the lethargy — my depleted life force — associated with HIV. It picks me up. Acupuncture is an integral part of what's keeping me alive."
Whether Weston and others like him will continue receiving acupuncture treatments, however, is not clear.
In what is virtually a textbook study of the politics of health care, the powerful medical establishment in Illinois has blocked passage of a law that would result in a lower cost treatment for a seemingly endless list of ailments, including chronic fatigue and high blood pressure, headaches and migraines, pain and gynecological disorders, drug addiction and smoking.
Currently, Illinois law limits the practice of acupuncture to physicians, osteopaths and chiropractors. None of them is required to have any formal training in this procedure introduced for the first time to most Americans in 1971 during President Richard Nixon's visit to China.
The latest in a decade of attempts to change this situation is being spearheaded by the Illinois State Acupuncture Association (ISAA), which represents some 200 to 300 nationally certified nonphysician acupuncturists, like the one treating Kurt Weston, living — and practicing illegally — in Illinois.
The ISAA lobbied in Springfield last spring for passage of the Illinois Acupuncture Act, a bill that would allow certified, nonphysician acupuncturists to qualify for state licensing. HB 1957 would bring Illinois in line with 29 states and the District of Columbia where nonphysician acupuncturists legally practice and are regulated to varying degrees.
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Four ISAA acupuncturists provided legislators with information about acupuncture as well as treatments. Their efforts helped gamer a 104-12 victory in the House, although the bill was not as fortunate in the Senate. According to Dr. Jon Sunderlage, assistant chairperson for the ISAA board's legislative committee, the bill was assigned to the insurance and pension practices committee where it was stripped of its language, passed as a shell bill and referred to the rules committee. "The reason we were given for that was the committee wanted to comply with the wishes of the Illinois State Medical Society to give them time to look at the issue," said Sunderlage, a chiropractic physician and nationally certified acupuncturist. |
He said the ISAA is now looking for new Senate sponsors of the bill later this year. HB 1957 was sponsored by state Rep. Dan Burke of Chicago last year. "Having been exposed to other alternative forms of treatment through a bill to license practitioners of naprapathy [a therapeutic system involving manipulation of tissue], I was approached to support the bill," Burke said. "I had no difficulties supporting it because I felt the practice should be made available to the people of Illinois. "It depends upon the individual, but acupuncture could ben-
22/January 1994/Illinois Issues
efit many people who aren't responding to traditional treatment," the Democrat from the 23rd District continued. "It's an opportunity for them to benefit from a treatment that's been proven to relieve pain. My opinion is, if people want it, and it isn't harmful, it should be given to them."
To qualify for licensure under the proposed act, applicants would need to complete two years of post-secondary education, or its equivalent; be a graduate of an approved school with at least 1,400 hours of training in acupuncture, including at least 500 hours of supervised clinical experience; or be certified by the National Commission for the Certification of Acupuncture.
The bill would require acupuncturists be trained in clean needle techniques, treat patients with potentially serious disorders only upon physician referral and maintain written confirmation, signed by patient and acupuncturist, acknowledging the patient has been advised to consult a physician regarding the conditions for which he or she seeks acupuncture treatment. The act would not prohibit or restrict other health care professionals from practicing acupuncture, if their current license permits.
Burke is not optimistic about the fate of the acupuncture bill. "The climate for passage of the bill is very unfavorable at this point, with a Republican Senate that is inclined to take the positions of the medical society. There are some overwhelming obstacles at this time. I think it would be a very difficult lobbying effort in the Senate," he said. "Basically it's a dollars and cents issue. The doctors sure don't want to endorse a procedure that might be in competition with them.
"The state medical society came down hard on this bill, so it's not gone any further. They were able to stop it at the Senate level, even though we bent on any number of issues in the House to make it more palatable to the traditional medical profession, including doctor referrals." Burke referred to one of the conditions of the bill requiring acupuncturists to receive a consultation or written diagnosis from a physician prior to beginning or continuing acupuncture evaluation or treatment of a patient with serious disorders.
The bill's supporters made other compromises as well. "We initially were going for primary care status, but settled for referrals even though by doing that, we were restricting access to acupuncture for a lot of people who could benefit from it. And we didn't try to restrict any physician who is currently practicing acupuncture within the scope of their licensure," explained Sunderlage. "It shows we are willing to work alongside them. The attitude we wanted to convey is that doctors have nothing to fear from nonphysician acupuncturists."
I n Illinois, the courts have upheld the constitutionality of the Medical Practice Act of 1987, which limits the practice of acupuncture to physicians, osteopaths and chiropractors, thereby outlawing nonphysician acupuncturists from practicing.
In the most recent case, the Seventh Circuit Court of Appeals asserted that acupuncturists have no constitutional right to practice their profession and the right to privacy does not include the right to choose a particular medical treatment that the state has reasonably prohibited.
Nationwide, however, roadblocks to acupuncture practiced by nonphysicians are falling. With practitioners in virtually every state, acupuncture law in other states ranges from extensive statutes and regulations covering several pages to those with one or two paragraphs. In a handful of states, the question of nonphysician acupuncturists has not been presented or resolved.
There are more than 30 schools of acupuncture offering course work and degrees in the United States. The National Commission for Certification of Acupuncturists (NCCA) has established rigorous national standards and testing for certification of competence in the field of acupuncture and Chinese herbology. Eighteen states currently use the NCCA examination to satisfy all or part of their requirements for licensure.
On the federal level, national acupuncture proponents are lobbying to get Medicare/Medicaid reimbursement included in the national health insurance plan being discussed in Washington, D.C. They also have met with President Bill Clinton, who's shown interest in acupuncture as an alternative form of health care.
According to a report presented at the 1992 American Bar Association tort and insurance practice section, despite initial reluctance to embrace acupuncture, the health insurance community is beginning to recognize its importance. Depending upon the legal status in individual states, insurance companies are providing coverage for treatment by both physician and nonphysician acupuncturists.
Sunderlage sees acupuncture as a means of lowering health care costs. "By providing more qualified people to perform acupuncture, we can turn around the health care situation in the United States," he contends. "Health care costs are out of control because we have been trained to let doctors take care of our health instead of being responsible for our own. Acupuncture allows us to fix what's short-circuiting the body, while teaching people preventative methods of staying healthy."
According to the ISAA, the average cost of an acupuncture treatment ranges from $35 to $50. When compared to the average cost of a visit to a physician's office and a hospital stay for surgery, acupuncture costs are relatively cheaper in the long run for some conditions it is able to treat effectively.
Sunderlage uses a combination of chiropractic and acupunc-
January 1993/lllinois Issues/23
ture on all of his patients for what he calls myriad conditions, claiming the combined regimens restores health three times faster.
Weston, the AIDS victim from Chicago, said his physician encourages him to continue acupuncture treatments. "He finds it a great adjunct to my therapy, although he does not recommend I rely solely upon acupuncture," said Weston. "But my
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acupuncturist doesn't either. He knows the limits of
acupuncture." Weston said the acupuncturist is able to spend more time
with him than his physician. "He explains things to me, helps me
understand and alleviates my anxiety. These improvements didn't happen with one
treatment, but over a period of months. It has facilitated the healing process.
Whether people believe it or not, acupuncture works."
One physician who endorses acupuncture is Chicago obstetrician/gynecologist Dr. Veronica Kolder, who refers patients to nonphysician acupuncturists. "I know many acupuncture practitioners and am very impressed with both their professionalism and the medical help they have given my patients," said Kolder. "It's a serious field and a very helpful treatment and approach. They are highly trained professionals who have dedicated their lives to this work." Kolder said she refers many patients to acupuncturists for relief from painful menstrual cycles, premenstrual syndrome, pelvic pain, nausea in early pregnancy and pregnant asthma sufferers who could not take medication. "There are never any adverse side effects. The worst that's happened is that acupuncture doesn't work for them. Having studied the world literature, I found there are very few complications, and those are usually in countries where acupuncturists use needles longer than those in the U.S. are trained to use," she said. "I think if you compare the side effects of acupuncture to those of Western medicine, acupuncture is impressively safe." Safety is the biggest concern of the Illinois State Medical Society, which is not opposed to acupuncture as a treatment, said the organization's president. Dr. Arthur Traugott. "The concern of the medical society is that anyone seeking medical treatment should first undergo the benefits of a medical examination, not just be treated by acupuncture," Traugott explained. "It's in the best interest of the patient that a serious medical problem not be overlooked. "Our stand is that acupuncture is the practice of medicine. Therefore, the public must have protection [from malpractice]. The medical society would not oppose such a bill provided that it was in the public's best interest." Protecting the public by requiring that licensed practitioners receive rigorous training and pass a required examination is just what laws like the proposed acupuncture practice act would do, said a national expert on state laws regulating acupuncture. "If you assume that the purpose of legislation is to protect the welfare and safety of the public, and provide low cost health care, it makes sense to pass a law that will provide people with access to qualified individuals," said Barbara Mitchell, chairwoman of the NCCA board. "These regulations are yardsticks legislators can use to provide acupuncture to the |
24/January 1994/Illinois Issues
public."
Sunderlage agreed. "Certified acupuncturists are trained professionals and we want to assure the public that we are qualified to practice. That means standards and that means licenses. They don't want people to ignore their medical doctor. They want them to work with Western medicine, not against it." he said.
Mitchell described the differing opinions about acupuncture held in the medical community. "Often in states where acupuncture practitioners are not yet legal, they are tolerated," Mitchell said. "In states where it is legal, physicians overall are supportive and in several states the primary support for acupuncturists comes from physicians. Resistance comes from a lack of understanding and familiarity of acupuncture and Oriental medicine. Practitioners find once they become established in a community and their patients return to their doctors with good reports, physicians not only refer patients but family members as well."
Mitchell also said the lack of scientific research studies has slowed acceptance by the medical community. "There have not been any double blind, clinical trials that doctors like to see. Acupuncturists here have been treating people, not using half their patients as a control group. We have not done the research they are accustomed to seeing in the U.S. But if they look at the safety record, that shows dramatically few problems with it."
An acupuncture safety record compiled by the NCCA supports her assertions. The report classifies potential harm to the public in two categories: the risk of accidental injury to internal organs and complications due to improper sterilization of needles. In the United States, only 10 incidents of injury have been reported since 1972. Only one of the reports stated the treatment had been performed by a licensed or certified acupuncturist and that individual was licensed without examination or standards of competency. In the seven years the NCCA has been certifying acupuncturists, it has received no reports of accidental injury by any of its 3,000 certified acupuncturists. All NCAA-certified acupuncturists are trained in a clean needle technique developed in conjunction with the federal Centers for Disease Control in Atlanta. Of seven reported complications due to unclean needles, only three were due to an acupuncturist.
According to the report, the only significant danger to the public lies in a lack of standards and in performance of acupuncture by improperly or poorly trained individuals.
T he state medical society president concedes that acupuncture can help some people. "The benefits have primarily been when it's used in clinics which treat chronic pain. Some have responded to acupuncture. The acupuncture people will claim there are benefits far beyond that, but we believe that is the limit," Traugott said.
Whatever limits are placed on acupuncture in individual states, the dynamic changes Mitchell is seeing take place aren't likely to be stopped. "Acupuncture is absolutely taking off. Right now it is the hottest item in chemical dependency treatment. Businesses are asking how to get acupuncture into their health care plans. HMOs across the nation are including acupuncture because consumers are demanding it," she said. "I have no doubt that eventually we will see licensure in all 50 states. When a consumer is looking for an acupuncturist, they want somebody who is certified. That identifies them as somebody who meets national standards."
"I think eventually the law will change because of the pressure of satisfied clients," agreed Kolder. "There is grass-roots support growing for the licensing of acupuncturists. I'd like to see a licensure program developed in Illinois to guarantee a standard of training. I'd like to see the day when acupuncturists don't have to live in fear of being arrested," continued Kolder, who explains the legal questions about acupuncture practitioners to every patient she refers to an acupuncturist. "I have no qualms about referring my patients to a certified acupuncturist. I'm sorry to see them harassed."
Until the legal question is resolved, certified acupuncturists will most likely continue to leave Illinois for states with fewer restrictions, said one acupuncturist who declined to give her name. "It's frustrating," she said. "Until we get licensed, we're illegal. Many are leaving for Wisconsin, California and Florida. The list of states where acupuncture is legal goes on and on. But Illinois isn't on it. I have already looked into moving to states where I am licensed, like Florida or Wisconsin. "What's frustrating is that this is a valuable service we could be providing to more people at an affordable price. It's a shame that Illinois lags so far behind, especially when President Clinton is looking at acupuncture for the national health care plan. Illinois would be left out," she said.
"It's time to get this situation resolved," said Sunderlage, who noted that the Illinois Department of Professional Regulation recently fined a nonphysician acupuncturist for practicing medicine without a license. "It's time to stop creating havoc and despair among patients and situations in the courtroom.
"I think it's time that acupuncture was brought to the masses. There are too many acupuncturists who have received as good an education as you can get, yet are risking their professional lives because it is illegal," he added. "And the people of Illinois will not stop seeking acupuncture treatment. It's time to let them take their health back into their own hands."
Rick Wade is a free-lance writer and a reporter for the Observer in Peoria.
January 1994/Illinois Issues/25
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