Testimony 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 license.

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 in death.

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 referring physician.

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.

References

1. Gordon J. Manifesto For a New Medicine. Reading, MA: Perseus Books, 1996.
2. Ibid.
3. University of Arizona, Program in Integrative Medicine website: http://integrativemedicine.arizona.edu/about.html.