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Acupuncture Today – February, 2009, Vol. 10, Issue 02

Bridging the Gap

By Bruce H. Robinson, MD, FACS, MSOM (Hon)

The desire of many in the OM profession to forge better connections with the Western health care system is not one held by all practitioners. Oriental medicine has stood the test of time without Western medical support. On a naturalistic and spiritual level, the Taoist and Confucianist roots of OM do not embrace modern scientific rationality and evidence-based deductive reasoning, and they seem to do fine without it. Many do not wish to dilute this powerfully pragmatic and undeniably effective medicine by tying it to neurotransmitters and electrical impulses traced into the thalamus.

We've observed the emergence of two camps in recent years: those who wish to hold on to these powerful traditions and leave Oriental medicine the way it has always been; and those who want to move the profession forward into the scientific age. The professionals who favor closer integration with the West are confident Chinese medicine will hold up well under rigorous scientific analysis and will then fit better into the scientific paradigm of the 21st century. Such a transition, however, carries with it an underlying fear that a deductive dissection of this ancient, time-honored medicine will somehow diminish it.

I don't see this as happening, but I do see limitations to truly integrating these differing medical paradigms and their widely divergent epistemological bases. No matter how scientific we get, the "spiritual" power and everyday pragmatism of Chinese medicine will remain, because of its very nature and its deep insights that are often scientifically unexplainable. 

Whether or not an OM practitioner wants to connect their practice with Western medicine and increase the interactions between the two paradigms is a personal choice. There will always be many who do not wish to bridge this gap, but for the profession as a whole, this bridging is important and will ultimately benefit patients. There are literally millions of Americans who do not receive OM treatments but would be better if they did. This applies especially to those who are really sick, but also to those who are basically healthy. Integration will expand the reach of Oriental medicine. It will bring more acupuncture into the hospital setting. It will spawn fruitful research. It will increase practitioners' earnings and promote their holistic involvement in the health care industry, which is much in need of this counterbalancing force.

Researching Unanswered Questions

We don't know what happens in the body when we place these fine needles in acupuncture points, although research has been trying to answer this fundamental question for many years. How well does Oriental medicine do in treating posttraumatic stress disorder compared with drug treatment or psychological interventions? How does OM treatment for ADD and autism compare with pharmacological approaches? How are the nerves, blood vessels and collagen structure affected by facial acupuncture? Are the effects of acupuncture due to nerve stimulation, cytokine release or a reordering of the collagen matrix? How do the fine-needling Japanese techniques compare to the more aggressive methods of Chinese needle insertion? What is going on right under the skin that masters palpate so sensitively?

Underneath these questions is a more fundamental one: How much of the beneficial effects that patients experience as a result of Oriental medicine treatment is based on the confidence and personal energy of the practitioner or the patient's expectations? Many talk about placebo effects, but I personally dislike this overused term. As a professor of health psychology, I can tell you these expectancy effects are real, but they ignore the fact there is something powerful going on when we are in the presence of a great healer who transcends these effects. It is an infusion of energy, but what energy is it? How does it work? The field is wide open for more research, and OM practitioners who are well-grounded in biomedicine are most likely to pursue such research.

What about Medical Acupuncture?

Some doctors take 150 or 200 hours of training and then include acupuncture as part of their practice. Are these doctors in competition with OM practitioners? Many LAcs and OM educators are critical of these programs, pointing out that the World Health Organization and other prestigious organizations such as the Pew Charitable Trusts have stated that one needs 1,500 hours or more of training to be able to perform effectively as an acupuncturist. Many of our better OM educational programs, which also include herbal training, are well over 2,500 hours long. Our master's degree program at AIMC Berkeley is 3,400 hours. OM practitioners have pointed out that doctors who have only 150 hours of training and then perform acupuncture can give it a bad name. These inadequately trained MDs may not have success rates comparable to OM practitioners because they don't know Oriental medical theory and pattern-recognition diagnosis, and may not have a holistic approach to the patient and the healing process. 

Whether or not medical doctors should really be taking these programs depends on how they are taught. If the doctors are simply instructed that acupuncture is a quick fix for pain syndromes, such training programs may be harmful for the practice of Oriental medicine. Some of these programs, however, are taught by OM practitioners who set precise limits for such treatment and instill in their doctor students an abiding respect for the infinitely richer 2,500-year-old tradition of Asian medicine as it is taught to students at OM colleges. Such enlightened programs can result in increased referrals to OM practitioners by awakening awareness and respect in these doctors.

I personally do not feel we should fear the incursion of medical acupuncture so long as we also embrace the importance of integration. There is a vast potential for the growth of our medicine and its expansion across America, and it will grow best when other professionals know about it and refer patients to us. They will do so if we know and respect each other. They will do so if we can talk with each other about patients and their medical problems.

The expanded role of OM practitioners

What will doctorate-level OM practitioners be doing that is different from what they do now? Will they be competent and qualified enough as primary care practitioners to make Western medical diagnoses such as hypertension, asthma or emphysema? I don't see that as part of this expanded role. Such expertise belongs in the realm of physicians and other medical specialists. Even a relatively straightforward diagnosis such as hypertension may require many office visits and much testing and reflection on the part of a physician expert. 

Many OM practitioners ask me, "Why even bother with acquiring more biomedicine if we can't use it to make diagnoses?" They may point out that a little knowledge can be a dangerous thing. I respond that there are many exceptional benefits of OM practitioners learning more biomedicine. Professional dialogue is one of these benefits. Let's take lupus erythematosus as an example of the need for knowledgeable dialogue. The OM practitioner won't likely be making this diagnosis, but the more depth of understanding they have about the myriad manifestations of this disease, the better they and the referring physician can discuss the patient and how they can benefit from OM treatments.

OM practitioners who know more about biomedicine also become more confident in the world of health care medicine, more likely to make that call to the physician and more likely to apply for hospital privileges so they can help those who are really sick.

Many OM practitioners have felt brushed off by Western physicians. A few such experiences can make a practitioner feel discouraged about making better connections. The gap between the two worlds needs to be bridged from both sides. This expanded enlightenment is definitely happening, although slowly, in the world of Western medicine. Increasing numbers of doctors are learning about the power of Oriental medicine, often from their own patients, as well as from the many articles in the media and in medical research journals. There remains a long way to go.

Another approach to this problem rests with the licensed acupuncturist who takes the initiative to learn more about Western medicine, medical terminology and common treatments for disease. The next step is to reach out to the local doctors, offering acupuncture services as a resource and backup to help patients get better faster.

I believe Oriental medicine professionals will need to be the most proactive if the goal of full professional co-respect is to be reached, and I believe that OM practitioners will do the most to bridge the gap, bringing Oriental medicine and biomedicine together for the benefit of all.

Click here for previous articles by Bruce H. Robinson, MD, FACS, MSOM (Hon).

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