Provided by William D. Rutenberg, MD,
Chair, Medical Acupuncture Advisory Committee,
American Academy of Medical Acupuncture,
to White House Commission on Complementary and Alternative Medicine Policy
December 7, 2001
The American Academy of Medical Acupuncture is committed to making medical
acupuncture safe, effective and accessible to an informed public. Medical
acupuncture is an important complement to traditional physician practice.
Precedents have been established, that it is in the purview of the medical
specialty society to determine the course of study and clinical expertise
necessary to achieve proficiency. Credence for this is found in hospitals'
privileging physicians to practice acupuncture, and in state laws granting
physicians the right to practice acupuncture under the scope of their
The AAMA's 2000 members, residing in all 50 states, are dedicated to
creating a uniformed voice among acupuncture providers, immune to interprofessional
politics and special interest groups. Our goals include education of physicians,
peers and the general public. To this end, we publish the journal Medical
Acupuncture and the AcuBriefs newsletter. We sponsor local
meetings and a national annual symposium. But more importantly, as people
trust their physician to be their primary source for health care information,
Western physicians will open to door to CAM therapies for most of America.
The results of a national study published in JAMA in 1998 found
that most CAM users first seek out conventional medical treatment and
subsequently turn to CAM practitioners. They use CAM in conjunction with
conventional medical therapy, integrating the best of a variety of approaches.
Endorsing physician practice of medical acupuncture will increase access
to holistic coordinated medical care.
The health and safety of the public must be ensured. Physicians have
practiced medical acupuncture in this country effectively and safely for
25 years. American physicians are held to the highest standard of patient
care and safety. Outcome measures have borne out the quality of physician
preparation. In recent studies published in the British Medical Journal
(Sept. 2001, Vol 323), physicians reported 43 minor adverse events associated
with 34,047 treatments, an incidence 0.8 to 2.0 per thousand treatments,
and there were no reports of serious adverse events, defined as events
requiring hospital admission, leading to permanent disability, or resulting
Our patients know that we are applying Western pathophysiology to their
problems, but they also value that we are looking at the mind-body relationship
through an Eastern paradigm. I have repeatedly found that when people
see my AAMA certificate on my office wall, they become open and discuss
freely their desires for a more holistic approach to their healthcare,
their desire for me to incorporate acupuncture into their care and, to
the limits of my knowledge, other forms of complementary medicine. My
training has also allowed me to become a more informed, more knowledgeable
Congruent with health and safety is appropriate training. Based on the
1999 World Health Organization Guidelines on Basic Training and Safety
in Acupuncture, one criterion for full membership in the AAMA is the completion
of a minimum of 220 hours of formal training in a medical acupuncture
program that meets AAMA standards. These guidelines, endorsed by the World
Federation of Acupuncture and Moxibustion Societies and WHO, have become
the international standard. Last year, the British Medical Association
Board of Science and Education (BMABSE) published its recommendations
calling for a "core curriculum for practitioners, including aspects of
anatomy and physiology, research methodology, acupuncture techniques,
fundamentals of orthodox diagnoses, and ethics." Graduates of American
colleges of medicine and osteopathic medicine, whose training in acupuncture
meets the AAMA standard, have more than satisfied this core curriculum.
We understand that our membership requirements are not the end of a physician's
education in medical acupuncture, but the foundation. Therefore, every
three years, members must complete 50 hours of approved continuing education.
Diplomates of the American Board of Medical Acupuncture (ABMA) must have
an additional 100 hours of formal training, a minimum of 500 patient treatments,
and pass the ABMA examination.
A career in medicine is a journey in continuing education, and as new
technologies evolve, they must be applied so that new skills may be acquired.
The BMABSE stated, "There are a variety of ways in which acupuncture can
be taught and practiced ... a certain amount of diversity ... is healthy
in catering for the individual needs of students and the different approaches
and expertise among the teaching staff." The information age has created
new educational opportunities providing a model for selected aspects of
training in medical acupuncture by physicians. Matriculating students
at accredited colleges and universities take courses on the Internet,
telecourses and CD-ROM, and attend only a limited number of classroom
sessions. It is unlikely that even in a one- or two-year fellowship, with
15-20 areas of study, that formal training in acupuncture would exceed
the 200 hours recommended by the WHO and subscribed to by the AAMA.
It is in the purview of each medical specialty society to determine and
recommend the course of study and clinical experience necessary to achieve
the proficiency necessary to become credentialed in its discipline. Precedents
include short intensive courses certifying cardiologists in interventional
cardiology, certifying gastroenterologists in endoscopic retrograde choliangiopancreatography
(ERCP), certifying physicians to administer moderate or deep sedation
during a procedure, and ophthalmologists to perform Lasik eye surgery.
In Western society, the demand and need for evidence-based medicine is
inescapable. We offer a mode of health care that is unique, even from
other providers of acupuncture. Schooled in Western medicine, we evaluate
clinical results from a scientific, evidence-based foundation that American
patients understand and trust and that third-party payers require. Physicians,
trained in medical acupuncture, are presenting and publishing research
based on sound scientific principles, at national medical meetings and
in well-recognized peer reviewed journals (and) are making believers of
Western trained physicians. Recent examples include:
- "Electroacupuncture for Control of Myeloablative Chemotherapy-Induced
Emesis," JAMA, December 6th, 2000.
- "A Randomized Controlled Trial of Auricular Acupuncture for Cocaine
Dependence," Archives of Internal Medicine, August 14/28, 2000.
- "Acupuncture Inhibits Sympathetic Activation during Mental Stress
in Advanced Heart Failure Patients," Abstracts of the Scientific
Sessions of the American Heart Association, 2001.
We envision, as Chairman Gordon so eloquently outlined in his book, A
Manifesto for A New Medicine, medicine in the 21st century that will
combine "conventional and alternative therapies, authoritative treatment
with respectful care" (Gordon, 1996, page17).1 This new medicine
"makes use of the most sophisticated modern diagnostic techniques and
research studies, but also puts a value on the learning and experience
that humans in all parts of the world have accumulated over millennia.
It is the synthesis of modern technology and perennial wisdom, of powerful
and definitive treatment and compassionate care, of Western and Eastern,
high technology and indigenous and folk healing traditions" (Gordon, 1996,
p.17).2 For that reason we are disheartened by the division
in the acupuncture community. While David Molony, stated in his October
5, 2001, testimony before the Commission that "The AAOM (American Association
of Oriental Medicine) is working to bring all professionals to the table
to begin a dialogue which will create a basic entry-level training standard
of oriental medicine modalities," the AAMA was not invited to join with
our colleagues in the formation of the Acupuncture and Oriental Medicine
Coalition Steering Committee. It is, therefore, my hope, (that) the Commission
will adopt "a philosophy that neither rejects conventional medicine nor
accepts alternative medicine uncritically" and recognizes "that good medicine
should be based in good science, inquiry driven and open to new paradigms."3
Endorsement of medical acupuncture by this commission will create a cadre
of physicians who will bring acupuncture, and by association CAM, into
our medical centers, into our medical school curricula and to our patients.
1. Gordon J. Manifesto For a New Medicine. Reading, MA: Perseus
3. University of Arizona, Program in Integrative Medicine website: http://integrativemedicine.arizona.edu/about.html.