The recent defeat of California Senate Bill 233 was a victory for our profession, but it was merely the opening battle in the war between the medical establishment and traditional East Asian medicine.
The California Acupuncture Board will sunset - it is scheduled to be terminated - in the middle of next year, unless it is renewed. SB 233 was a naked attempt to demote practitioners of traditional East Asian medicine to the status of technicians and place us under the complete domination of medical doctors. Those promoting SB 233 have thrown down the gauntlet and declared themselves to be enemies of alternative medicine. We can only anticipate another big fight to keep our board next year. In fact, we are constantly facing many battles around other issues such as protection of our herbology, dietary supplements, and our right to diagnose.
The Western medical profession is experiencing a major crisis in the areas of finance and public trust. This is reflected in the number of malpractice lawsuits against MDs, which are at record levels. Malpractice insurance premiums for MDs are astronomical. Increasing numbers of pharmaceuticals are being pulled from the market due to increased public scrutiny, even outrage and scandal. It is becoming increasingly difficult for MDs to stay in private practice and grow wealthy. At the same time, alternative medicine is on the rise, with traditional East Asian medicine in the forefront. Even fortresses of Western medicine such as Kaiser Permanente are now spinning their advertisements in the direction of gentle medicine and preventative health care, in response to the public's growing demand for something more than drugs and surgery.
The California Medical Association has never liked us and has never wanted us around. For the last 30 years, they have related to us as the dinosaurs related to those pesky, irritating, but essentially harmless little mammals. However, with the recent recall of several popular painkilling pharmaceuticals, the public is increasing its demand for safe methods of pain relief such as acupuncture. This, on top of the rising popularity of alternative medicine in California and the stagnant economy, has pushed the CMA to get serious at this time and step up its attacks on the competition.
Our profession finds itself at a crossroads at this moment in time. California State Senator Sheila Kuehl is sponsering SB 840. This bill, which was easily passed recently by the California Senate, would eliminate all health insurance plans (most of which exclude our profession), replacing them with a single-payer government-run plan; that is to say, universal health coverage for all residents of California. If we can maintain our primary health care provider status, most of us will see our practices double, triple, and quadruple overnight with the final implementation of this law. If we lose our primary health care status, the new law will not help us because MDs by and large will not send us patients.
We must at this time decide to either continue to fight rear-guard defensive actions that seek to limit the damage to our profession, or to go on the offensive, propelling our profession into the consciousness of every Californian and ultimately every American. Unless we seize this opportunity now, we face the very real danger of being seriously weakened during the next few years by those who have a vested interest in eliminating their mammalian competitors.
The offensive operation we need to plan and implement now is the ballot initiative, also known as the referendum.
The next balloting in California will be held in November 2006. That gives us one and a half years to prepare for the election. The requirements for placing a referendum on the California ballot are the following:
1. The initiative must be put together and submitted no later than August 10, 2005.
2. A filing fee of $200 must be paid at the time that the initiative is submitted.
3. Five percent of the population who voted for governor in 2004 must sign petitions requesting that the initiative be placed on the ballot, within a period of 150 days. Including a reasonable cushion to compensate for possibly invalid signatures, this means approximately one million signatures must be gathered between September 30, 2005 and March 1, 2006.
The initiative itself will be drawn up by us, the licensed acupuncturists of California. It will contain our full and complete wish list. Provisions relating to our regulatory agencies, our diagnostic rights, our scope of practice, workers compensation, educational requirements, and other issues will be decided by us and "chiseled in stone". Some concrete suggestions regarding the wish list will be presented at the end of this article.
Legally, the great advantage of a ballot initiative over a legislative bill is that the ballot initiative clearly represents the will of the people and is extremely difficult to overturn or chip away at, in fact can only be changed by another ballot initiative.
In order to get a law through the legislature, favor must constantly be curried with fickle lawmakers. This means compromises must be made and money has to be constantly raised and donated to their election campaigns. We all know that big money dominates the scene in Sacramento. If you can't come up with big money, you won't get very far. Western medicine is the medicine of big money and corporations. Western medicine is backed by the pharmaceutical and hospital corporations, whose resources dwarf those of alternative medicine. In the money arena, traditional East Asian medicine cannot compete.
Our greatest resource is people: 10,500 licensed practitioners, 30 years of accumulated patient files and satisfied patients, enthusiastic students from eight major schools, and dedicated leaders such as the board of directors of CSOMA. Alternative medicine in general, and traditional East Asian medicine in particular, is the medicine of the people. Only a mandate of the people can safeguard our professional existence.
The following needs to happen in order to carry this plan through successfully. Let's examine each point separately.
All of the resources of CSOMA must be mobilized and focused for this effort.
All Licensed Acupuncturists in California must be united behind one organization -- in my opinion, CSOMA.
Allies and opponents must be clearly delineated and recognized as such.
Students and practitioners must be organized as petitioners and campaigners.
1. All of the resources of CSOMA must be mobilized and focused for this effort.
A ballot initiative must be written up and agreed on by a conclave of all major representatives of the profession by August 10 of this year. Then we have until March 1 of next year to gather signatures, and another half-year to campaign for it. There is no time to waste. If we do not succeed in passing a ballot initiative in 2006, there is a very real possibility that we will have to practice our medicine "underground" like in the days before legalization, until the next election opportunity in 2008.
CSOMA is involved in many important endeavors. All of these will have to take a back seat for the next year and a half. Every director will need to take on major responsibilities in regards to the campaign for a ballot initiative.
2. All licensed acupuncturists in California must be united behind one organization - in my opinion, CSOMA.
From its legalization in the mid-seventies, the profession in California has been horribly split into many different associations. At this time, there are approximately 14 different Chinese-language associations, three English-language associations, two Korean-language associations, two Japanese-language association, and one Vietnamese-language association. By far the largest and best organized of these is CSOMA, but still the profession in California is seen by many as contentious and unreliable. The mere existence of a plethora of associations is an indication of a weakness, a lack of communication and direction, and will hamper our efforts to fight back with one voice.
A major project like a ballot initiative not only requires a unified effort to insure success, but is also an opportunity to unite the profession behind one association. CSOMA must step forward at this time and assume sole responsibility for this project. By doing so, its membership will grow exponentially.
The most important obstacles are the differences in language and culture. The different language groups reflect patient demographics. As long as people continue to immigrate from East Asia, we can expect to have to work around language differences.
Right now, translation equipment is of the highest priority for CSOMA. Whatever the cost in money and effort, all future board meetings and public events sponsored by the association should become multilingual. Simultaneous language interpreters will be found and used. The board of directors could and should be expanded as soon as possible to include representatives of Asian languages.
This campaign for a ballot initiative will become a call to arms for the entire profession. People will flock to the standards. CSOMA must be seen as a welcoming place for all segments of the profession. Only in this way will practitioners lose interest in other associations and unite behind one organization.
3. Allies and opponents must be clearly delineated and recognized as such.
We will need as many allies in this struggle as possible, because we will need their help. At the same time, we should know who our opponents are so that we can watch them and defend ourselves from attack. Allies are those with whom we share common philosophical and financial interests. Opponents are those whose philosophy of medicine is diametrically opposed to ours and who have a financial interest in weakening and destroying our profession.
At this point we need to analyze the field of medicine as it is practiced in California today. For our purposes, medicine can be divided into three general areas:
Safe medicine refers to all medical disciplines that can be considered as part of "alternative" medicine or "holistic" medicine. Safe medicine moves with nature, helping nature heal itself by offering gentle methods which, if applied correctly, get good results and elicit no ill effects. Safe medicine cannot be beat in most areas of non-emergency medicine, which could be labeled "general medicine". Included are East Asian medicine, chiropractic, homeopathy, naturopathy, therapeutic massage, ayurveda, psychological counseling, and dental hygiene, to name the most common disciplines.
All practitioners of safe medicine are our natural allies. We share the same philosophy of medicine. We also share a common financial interest in promoting all forms of alternative medicine.
Emergency medicine refers to that branch of Western medicine that functions in the arena in which Western medicine was designed to function. Emergency medicine is heroic medicine, and its purpose is to halt or reverse the movement of nature, using strong methods (drugs and surgery) that usually cause side effects. It is the job of emergency medicine to save lives, limbs, organs, tissues, minds, and teeth from destruction. In this application it is second to none.
All practitioners and staff of emergency medicine are our natural allies. Most probably do not know it yet. It is our job to win their support and drive a wedge down the middle of the Western medical profession, thereby strengthening our side and weakening our opponents.
Unsafe medicine refers mostly to that branch of Western medicine that vainly attempts to practice general medicine. This includes most MDs and their associations, the California Medical Association and the American Medical Association. In the absence of an emergency, their methods of fighting nature using drugs and surgery heal nothing and cause injuries, and are largely responsible for the declining popularity and financial liability of unsafe medicine. Their associations are our opponents.
Unsafe medicine is backed by huge financial interests. The pharmaceutical corporations promote the prescriptions of pharmaceuticals, and the hospital corporations promote surgeries, pharmaceuticals, and testing. These corporations and their associations are also our opponents.
For purposes of clarification, we and our allies do not constitute "complementary" medicine. We do not complement unsafe medicine. "Complementary" refers to the mint you find on your pillow when you check into a hotel. "Complementary" refers to the free peanuts and pretzels offered in a pub. We are the alternative to unsafe medicine, and our ultimate aim must be to supplant unsafe medicine, just as mammals once supplanted dinosaurs.
Safe medicine and unsafe medicine cannot coexist for very much longer. This town ain't big enough for the both of us. In the short term or the long term, it's them or us. It will be a fight to the finish between these two forms of medicine, and the opening shots of this battle were fired by our opponents (SB 233).
"The enemy of my enemy is my ally." Chiropractors are our most important allies. Chiropractors and licensed acupuncturists are the only two safe medicine providers who are licensed by the state of California as primary health care providers. Over the years, chiropractors have fought many battles with the medical establishment in California and nationwide, and have won most of them. Their battles include their own ballot initiative in 1922, which shields them from CMA attack. It has been amended (by ballot initiative) four times since its adoption, the last time being in 1978. California was the first state to establish chiropractic medicine by ballot initiative.
We will need their public endorsement of this ballot initiative. We can learn from their experiences with their own ballot initiatives. Most importantly, we need to open the discussion with our chiropractic allies regarding the formation of an alternative medicine coalition. At some point (and the sooner the better), all safe medical disciplines will need to join forces to withstand the ferocious attacks that will be launched by the pharmaceutical and hospital corporations and their medical and public relations representatives. We have to work to dispel the mistaken belief that we must continue to compete against each other for the crumbs that fall from the dinner table of big medicine.
A safe medicine coalition will campaign for its own ballot initiative that would likely establish some sort of separate department of alternative medicine, under which each branch of safe medicine will have its own regulatory board. Unfortunately, there isn't enough time to build this coalition, (which must have the full participation of the chiropractic profession), and do all the other things we need to do to prevent our profession from "sunsetting" next year. Our profession will have to organize its own house before it is ready to focus on the formation of a safe medicine coalition.
4. Students and practitioners must be organized as petitioners and campaigners.
Every battle needs foot soldiers. These ranks will be filled by students of East Asian medical colleges and by practitioners, especially first- and second-year practitioners.
The recent student response to SB 233 was and is truly unprecedented within our profession. Some colleges, in particular Samra and Baylo, went into full mobilization to defeat this bill. Entire rooms full of student leaders spontaneously came forward to organize committees and other colleges, contact the media, jam fax lines and e-mail addresses, and lead public protests. The lessons they are learning and the contacts they are making will be valuable in the coming campaign. The freshness and enthusiasm of these students will inspire the entire profession.
CSOMA must continue to develop the strongest relationships possible with student organizing committees. Schools will serve as local coordination centers for petitioning, leafleting, and the rest of the work that has to be done on a local level.
This ballot initiative campaign will be the greatest practice-building tool that CSOMA has ever handed its membership. Every signature that is collected and every campaign leaflet that is handed out can and should be accompanied by a business card or brochure. Every hour of campaigning will elicit discussions about our medicine that will educate the public and win new patients. ("Can acupuncture help my neck problem?") This will become a golden opportunity to strengthen our profession where it really counts - our private practices. Once this is understood, every practitioner who is struggling financially or who just wants new patients will be standing in line for signature clipboards and leaflets.
Douglas Kihn, OMD, LAc is the author of Chinese Medicine for Americans, and currently operates a clinic in West Los Angeles. He can be reached through his website at www.DrKihn.com.