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California Acupuncturists Don’t Need to Know English!

English proficiency is not a necessary precursor to becoming a contributing citizen in California’s economy and should not be used by the Board to discriminate against talented and skilled individuals who seek to provide high-quality acupuncture services in California.

— State Senators Curren D. Price Jr. and Darrell Steinberg, letter to the California Acupuncture Board, March 22, 2013.

To appreciate the recklessness of this statement, and to illustrate the Senators’ disconnect with the reality of Oriental medicine, let’s take a look at a consummate example of services provided by acupuncturists. The following video features the “Master” Kim Nam-soo demonstrating his moxibustion technique. He conducted a similar workshop for future acupuncturists in 2010 at Emperor’s College of Traditional Oriental Medicine in Santa Monica, CA. Make sure you do not miss the part where the Master is skillfully adding his own spit to the treatment!

Kim Nam-Soo (also known as “Gudang”) is a 97-year-old acupuncturist from South Korea. In this video, he is teaching a form of moxibustion (burning of a mugwort cone on or near the skin). He is first preparing a wad of mugwort (Artemisia vulgaris), he is then placing it on an acupuncture point and burning it with an incense stick. Note that he is using his own saliva to make the mugwort more malleable before sticking it to the patient’s skin!

Besides acupuncture and moxibustion, the other services these “talented and skilled” individuals provide consist of massage, cupping, breathing techniques, and the use of herbal, animal and mineral products. In most states, bloodletting is not part of their scope of practice — except for Arkansas.

Forty years after the legalization of the profession in California, one can complete a 4-year vocational degree in acupuncture and Oriental medicine here in the Golden State — all in Chinese or Korean — and then pass a state licensing exam in the same language. The license allows the graduates to lawfully act as a “primary care provider” without having a working knowledge of English! As a result of this aberration in our healthcare laws, hundreds of unscrupulous fortune-seekers come to California each year to learn and practice unscientific mumbo-jumbo without ever learning English. Most of them could not study acupuncture in their native country because healthcare providers are upheld at a much higher standard than here, and acupuncturists are required to know modern biomedical sciences along with traditional modalities.

The Acupuncture Board of the Department of Consumer Affairs (DCA) was recently working to address this issue by limiting the California Acupuncture Licensure Examination (CALE) to English-only. On March 20, 2013, the CA Acupuncture Board organized a town hall meeting in San Francisco to present the reasons behind the necessity of an English-only licensing exam and then ask for public comments (click on the following image to read the report obtained under the California Public Records Act).

Acupuncture Board Town Hall Meeting

Yet, the initiative came to an abrupt end by a cease-and-desist letter from State Senators Curren D. Price Jr., Chair of the Senate Business, Professions and Economic Development Committee, and Senate President pro Tem Darrell Steinberg. The Senators have asked the Acupuncture Board to immediately abandon its attempts to institute an English-only exam. They are claiming that asking for language proficiency from a healthcare provider is “discrimination!”

Senate letter

Ironically, the cease-and-desist letter came from the same Senate committee that harshly criticized the Board in March 2012 for promoting the profession instead of protecting the public. Exactly a year later, it is the Senators themselves that have come to promote the profession, and to act in overt disregard for the California Business and Professions Code 4928.1:

Protection of the public shall be the highest priority for the Acupuncture Board in exercising its licensing, regulatory, and disciplinary functions. Whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount.

Also, this letter is rather curious in that it does not seem to be stating an official position of the Senate or the Business, Professions and Economic Development Committee. The letter starts “We write . . .” but it does not say that either the Senate or the Committee took a vote on the issue, nor do the Senators claim to be writing on behalf of either body. It rather seems that the letter reflects the Senators’ personal opinion, even if this request is on the official Senate stationary and the authors use their official title.

What is also strange here, is the fact that the licensing of healthcare providers without English fluency is not a real concern for the Senators. A staff member who wished to remain anonymous even confirmed that the Senators wrote this letter without consulting any conventional healthcare providers, public health officials, or anyone else with knowledge of infectious diseases, pharmacology, or drug-herb interactions.

Senators Price and Steinberg (and their advisers in this matter, LeOndra Clark, and Bill Gage) seem to have allowed the popularity of Oriental medicine in the Golden State to cloud their common sense, leading them to ignore the crucial fact that acupuncture is not without adverse effects because it is an invasive procedure. They are ignoring that many complications can arise from acupuncture and threaten the patient after needling or after the use of supplements. An acupuncturist who does not have enough English proficiency to conduct a thorough patient interview may not be able to ensure that the modalities within his or her scope of practice are not contraindicated or otherwise subject to caution.

It is therefore important to remind the Senators and their advisers, LeOndra Clark and Bill Gage, that although acupuncture does not seem very harmful, a 2012 study by Wheway et al. indicated that the total figure of needling adverse incidents is likely under-reported and underestimated. Some of these incidents are medical emergencies involving organ injury. When needles are pushed in too deeply, they can indeed injure nerves or puncture internal organs – particularly the lungs, which causes pneumothorax.

Additional dangers include bleeding or bruising due to needling, especially in cases where the patient has a bleeding disorder or takes anticoagulants. Electro-acupuncture, which involves applying mild electrical pulses to the needles — something akin to Percutaneous Electrical Nerve Stimulation (PENS) — can interfere with a pacemaker. Acupuncture can also lead to pregnancy complications. This is why an acupuncturist has to be able to effectively communicate with patients and to also make sure that emergency services are available.1

The use of herbal products also requires effective patient-provider communication. Besides the inherent toxicity of some of them, the potential for herb-drug interactions also exists and should always be a real concern. Several of herbal products have been demonstrated to compete with drugs for cellular receptors, and therefore, a mostly unknown and unreported form of “polypharmacy” exists in patients that also take conventional drugs.2

A good example is the commonly used medicinal herb dang gui (Angelica sinensis). Also known as dong quai, tangkuei, or “female ginseng,” Chinese medicine uses dang gui for premenstrual, menopausal, and other gynecological symptoms, as well as for fatigue, anemia, and high blood pressure. Pharmacological properties of this herb have been attributed to constituent coumarins, polysaccharides, fenulate and/or falvonoids.3,4 In a clinical setting, the concurrent use of dang gui and warfarin reportedly potentiates the anticoagulant effects of the latter, and increases the international normalized ratio (INR) – a measure to monitor the impact of anticoagulants. This can cause widespread bruising.5,6 Considering these factors, the use of dang gui with anticoagulants, platelet inhibitors and thrombolytic agents is contraindicated.7,8

Licorice root, known as gan cao in Chinese, is another commonly used example that can cause drug-herb interactions. Licorice which contains compounds that mimic aldosterone can interfere with the renin-angiotensin-aldosterone axis and lead to hypokalaemia.9 Licorice has been demonstrated to decrease the clearance of prednisolone and to increase prednisolone bioavailability. Licorice has also been reported to potentiate the cutaneous vasoconstrictor response of hydrocortisone. In total, more than 100 drugs are known to interact with licorice, including corticosteroids, antihypertensives, diuretics, laxatives, and other potassium-depleting drugs.10

The California Acupuncture Board, whose mandate is to protect the public, has attempted several times to address the lack of proper patient-provider or provider-provider communication. But every time, groups of practitioners, students, school representatives, and trade insiders vehemently object to any change by claiming discrimination, by calling themselves “contributing citizens,” and by receiving support from politicians who know even less about acupuncture and Oriental medicine than they do about healthcare or patient safety. On March 20, 2013, they came in large numbers for a showdown at a town hall meeting in San Francisco, where the Board was presenting the reasons behind the proposal to limit the licensing exam to English only.

Immediately after, State Senators Price Jr. and Steinberg ran to their rescue with a cease-and-desist letter stating that the US is not necessarily an “English-speaking country,” and that “English proficiency is not a necessary precursor to becoming a contributing citizen in California’s economy.” The Senators also add:

We respectfully request the Board to immediately cease and desist in its efforts to adopt an English-based examination and urge the Board’s consideration of other robust examination options that require a high level of competency for licensure and also preserve the ability for applicants to take the examination in languages other than English.

The Board cancelled other town hall meetings it had scheduled and laid the issue to rest.

In many ways this setback speaks to California’s poor healthcare policies, its politicians, and the place of science in its public health arena. Making healthcare policies based on racial and ethnic politics indicates a profound lack of concern for science and evidence in medicine. Also, claiming that effective patient-provider communication and language proficiency are not necessary to provide an invasive procedure such as acupuncture irresponsibly endangers the public by reducing medicine to the rank of politics.

For those of us who put our faith in science and evidence, these non-English speaking “contributing,” “talented and skilled” citizens, are in reality ignorant voodoo-doctors who have become “primary” healthcare providers because of an enormous absurdity in California law. Since the legalization of acupuncture in the Golden State, these individuals have continuously endangered the public, and each time anyone tries to do anything about patient safety, they run to the first medically-illiterate politician they can find, and cry harassment and discrimination.

Unfortunately, now that California lists acupuncture as a benefit that insurers must include in new plans under the Patient Protection and Affordable Care, New Age hocus-pocus has taken a false sense of legitimacy and efficacy simply because it is listed as a mandatory benefit under the new healthcare law. Acupuncture joins tobacco cessation, vision screening and other benefits that insurers must cover for patients under new plans, beginning in 2014. Appallingly, this turns deluded ignorants into much needed providers; and if they do not speak any English, as long as they are contributing to California’s economy, oh well!

As for the crackpot who came to California in 2010 to teach future acupuncturists how to put spit and filth on patients, according to The Korea Times he was suspended in his native country the year before for practicing his craft without a license.11

With many thanks to Harriet Hall, Ui-Won Hwang, Paul Ingram and JooNyun Kim for their valuable assistance or comments. The opinions expressed here are those of the author.

REFERENCES

  1. Wheway J, Agbabiaka TB, Ernst E. Patient safety incidents from acupuncture treatments: a review of reports to the National Patient Safety Agency. Int J Risk Saf Med 2012;24:163-9. Return to text
  2. Chan E, Tan M, Xin J, Sudarsanam S, Johnson DE. Interactions between traditional Chinese medicines and Western therapeutics. Curr Opin Drug Discov Devel. 2010 Jan;13(1):50-65. Review. PubMed PMID: 20047146. Return to text
  3. Zhao KJ, Dong TT, Tu PF, Song ZH, Lo CK, Tsim KW: Molecular genetic and chemical assessment of Radix Angelica (Danggui) in China. J Agric Food Chem (2003) (9):2576-2583. Return to text
  4. Page RL 2nd, Lawrence JD. Potentiation of warfarin by dong quai. Pharmacotherapy. 1999;19:870-876. Return to text
  5. Fugh-Berman A: Herb-drug interactions. Lancet (2000) 355 (9198):134-138. Return to text
  6. Drug interactions between Abbokinase and dong quai: Drugs. com, Drugsite Trust, North Shore, Auckland, New Zealand (2009). www.drugs.com/drug-interactions/abbokinase-with-dong-quai-2280-3882-2366-0.html [Accessed 11 May 2013]. Return to text
  7. Dong quai (Angelica sinensis): US National Library of Medicine, Bethesda, MD, USA (2009). www.nlm.nih.gov/medlineplus/druginfo/natural/936.html [Accessed 11 May 2013]. Return to text
  8. Circosta C, Pasquale RD, Palumbo DR, Samperi S, Occhiuto F. Estrogenic activity of standardized extract of Angelica sinensis. Phytother Res. 2006;20(8):665-9. Return to text
  9. Epstein MT, Espiner EA, Donald RA, Hughes H. Effect of eating liquorice on the renin-angiotensin aldosterone axis in normal subjects. Br Med J. 1977 Feb 19;1(6059):488-90. Return to text
  10. Licorice drug interactions: Drugs.com, Drugsite Trust, North Shore, Auckland, New Zealand (2009). www.drugs.com/drug-interactions/ licorice-index.html [Accessed 11 May 2013]. Return to text
  11. Han J. Acupuncturist Causes Controversy. The Korea Times (2009-01-27). www.koreatimes.co.kr/www/news/biz/2009/07/123_38492.html [Accessed 28 May 2013]. Return to text

Posted in: Acupuncture, Politics and Regulation, Public Health, Science and Medicine, Traditional Chinese Medicine

Leave a Comment (48) ↓

48 thoughts on “California Acupuncturists Don’t Need to Know English!

  1. Stephen H says:

    This story is unworthy, and attacks the wrong target. The fact that a service provider does not speak the local language is not the problem. There are many medical practitioners and other professionals who provide services to migrants and with whom those migrants feel more comfortable because the provider shares a common background. While I personally would like my doctor to speak fluent English, not everyone does. My wife is of Italian descent, and even forty years after moving to Australia her grandparents could not speak a word of English, and there are one or two aunts and uncles who likewise remain unable to speak the local language. The fact that a doctor speaks English is of no use to someone in that situation.

    There is every reason to attack people for using pseudo-science and quackery. There is less reason to complain simply because they do not share a common language. If there is to be a complaint on that basis, it needs to be focussed on why English is important. As it stands, this article is a scatter-gun approach, and does not clearly state why a health provider needs to speak English. Does a similar complaint hold against doctors who speak Spanish, and only serve the Mexican community in California? If so, why is that not raised in the article? Why is it targeted at acupuncturists?

    There are plenty of reasons to attack acupuncture. Unfortunately, this article presents acupuncturists with an opportunity that no doubt some will gleefully jump on. I expect we will see complaints of “racism” or “the debasing of cultural medicine”, simply because an article like this attacks the wrong thing and creates a diversion. The language doesn’t matter, the sham does.

    1. windriven says:

      @Stephen H

      “There is less reason to complain simply because they do not share a common language.”

      I wonder if we can step back a bit and ask how it is that we can have a shared community without a shared language? How can we have political discourse? How can we exchange experiences and aspirations and build a consensus in matters legal, medical, political or economic?

  2. Carl says:

    Even if the patient happens to speak the practitioner’s foreign language, the practitioner can’t read laws, warnings, and anything else likely to be written in english. It also means that the fake doctor can’t speak the same language as the real doctor to whom they must refer patients with real medical problems. So much for integrative medicine, eh?

    Not that it matters, since acupuncturists are quacks and they probably don’t actually do any of that stuff anyway. But the least they could do is PRETEND that they might do those things.

  3. “An acupuncturist who does not have enough English proficiency to conduct a thorough patient interview may not be able to ensure that the modalities within his or her scope of practice are not contraindicated or otherwise subject to caution.”

    And what is changed in that statement if the practitioner speaks perfect English?

    I agree with Stephen Hays that English is not so much the issue as the quackery itself. Is the test of quackery more valid if it is passed in English rather than Korean? Isn’t that Tooth Fairy Science?

    My Medical Center lists languages spoken by its many foreign born or first generation English-speaking doctors. Admittedly these doctors are at least functional in English, but it is a big advantage to many of their patients that they can still speak their native language as well. Even if someone has acquired English, the nuance of some things might well be better explained in the native language. I’m not defending the Senators in California or saying that you don’t support multi-lingual doctors, nor am I implying I’m not alarmed by the actions of those Senators, but I do think you’ve missed the point a bit.

    1. windriven says:

      “And what is changed in that statement if the practitioner speaks perfect English?”

      Irene, do you really not see the difference? Have you ever had to seek medical care in a nation where you do not speak the language? Can you envision the difficulties and opportunities for potentially tragic misunderstandings?

      Forget English. You’re right, English isn’t the issue. A common means of communication IS the issue.

      1. Ben Kavoussi says:

        @ windriven
        Yes, absolutely. I agree, having the common means of communication with other health professionals is the main issue here.

  4. Ben Kavoussi says:

    @ Stephen H:
    This is not only a patient-provider issue. As Carl points out, these providers cannot read laws, warnings, and anything else likely to be written in English. They cannot read the patient charts, medication list, lab results, SOAP notes, etc, they cannot communicate with the hospital and emergency services. They cannot call the patient’s primary care provider and they cannot call the state to report communicable diseases.

    In the modern world, healthcare is not an isolated event. It is teamwork across time and space. If you do not speak English fluently you should not practice medicine anywhere where the majority of the care is delivered in English. A healthcare provider is not just a “service provider;” this is not dry-cleaning or lawn maintenance. A healthcare provider is responsible for the death and life of an individual and sometimes a whole community. Remember the SARS and avian flu epidemics?

    This is also not about speaking other languages along with English. This is about understanding a patient’s past medical history and the input of other providers.

    I am not sure if you know or not, but I am a Central-Asian and English is my third language. I come from a traditional culture where some people still get treated with bloodletting and leaches. So, people who complain of “racism” or “the debasing of cultural medicine” in my writings don’t really know what they are talking about, and I don’t usually listen to them.

  5. Ben Kavoussi says:

    @ Stephen H:

    Also, there are no licensed doctors in the US who do not speak English fluently. You are apparently not a healthcare provider.

    In order to practice medicine in the US you have to take the United States Medical Licensing Examination (USMLE), which is offered in English only and then do a residency in a US teaching hospital. All foreign-trained physicians who are licensed to practice medicine are fluent in English, including those who work in minority neighborhoods and conduct their patient care in another language.

  6. Ben Kavoussi says:

    @ goodnightirene,

    Healthcare providers need to know the patient history and the input of other providers, even if the modalities they use are bogus. This is not about acupuncture’s efficacy, this about understanding the patient’s past medical history, current medications, allergies, social history, etc. The patient’s medical records need to go seamlessly from provider to provider, so that the patient and the community are protected. This can only happen if it is in English.

  7. Ben Kavoussi says:

    @ Carl,
    Yes, you are absolutely correct: non-English speaking can’t read laws, warnings, and anything else likely to be written in English.
    This is why the initiative came from the CA Department of Consumer Affairs, which has the duty of protecting the public and enforce the law.

  8. vadaisy says:

    Having been the unsuspecting patient of an unlicensed, non-English speaking physician who practices medicine in the U.S. during his regular visits from his foreign country home, I agree with Ben’s review.

    Since the doctor I saw could not speak or read English, I questioned why he even asked for any written information from me at all. In the end, it turned out to be a scam obviously, but nonetheless, I fully support the requirement that all physicians practicing in the U.S. be fluent in English. Amongst other concerns, I question whether the foreign medications and herbs I was sold interacted with my other medications, and did not receive a adequate response.

    I don’t know why the medical boards and law enforcement agencies allow such physicians from other countries to come to the U.S. and practice without a license. It seems common knowledge that this particular doctor is seeing patients in the U.S.

  9. Ben Kavoussi says:

    @ vadaisy
    Thank you very much for giving us the patient’s perspective. All foreign medications and herbal remedies interfere at some level with mainstream medications we use in the US, Alas, most of the times tings are not reported and documented. It is ultimately the unsuspecting patient that pays the heavy price.

    1. vadaisy says:

      All foreign medications and herbal remedies interfere at some level with mainstream medications we use in the US, Alas, most of the times tings are not reported and documented.

      @Ben, I’m sure you’ve heard this before, but I’ve been told by integrative and alternative medicine doctors that those those foreign medications are all plant-based and natural, and as such they would not interact with any prescription medications or supplements. I’ve also been told the same about herbs sold legally in the U.S.

      The doctor practicing without a license was reported to the state where I saw him. I was never told that my complaint for this particular physician was accepted as a case for investigation. Instead, I was told that they they only investigate doctors who are licensed to practice in their state. I called law enforcement in another state where this same foreign provider allegedly sees patients, but since I had not seen him in that state, they would not open a case. Round and round like a merry-go-round, and I’m sure he still practices illegally.

      1. Ben Kavoussi says:

        @ vadaisy,
        I am sorry to hear that. Did you contact the medical board of the state he practices in? What about the district attorney’s office?

  10. vadaisy says:

    The medical board was closed for the day. They were at the vets office being neutered.

    1. Ben Kavoussi says:

      I would go to the District Attorney’s office. They are in charge of prosecuting people who violate the law.

  11. WilliamLawrenceUtridge says:

    I do have to agree with Stephen H to a certain extent – we’re pretending that acupuncture needs to integrate with real medicine. This post, valid and interesting, and outrageous as it is (in the sense that it’s outrageous the politicians interfered this much, and that it’s an issue), to a certain extent can only be made in the spirit of pretending acupuncture is a real medical treatment that has actual benefits and some sort of rational interaction with the rest of the medical system. It would be nice to take a step back and deal with it from a genuinely rational perspective – it’s placebo medicine of extremely limited utility. It shouldn’t quite be banned, but it definitely shouldn’t be privileged. This seems a bit like the age-old argument between prevention, harm reduction, treatment and ultimately the prison system :)

    @Ben – which other languages?

    1. Ben Kavoussi says:

      @ WilliamLawrenceUtridge:

      I agree with your point. Acupuncture legislation came to existence to (1) the need to regulate and control what was being done in back-alley herb shops, and (2) out of consumerism. It is a mishmash of ethic politics, pubic safety concerns, lobbying, and the ignorance of politicians

      As a result, we have a legislation that I would qualify of “schizophrenic.” For instance, look at the the following page on the CA Acupuncture Board:

      Two-thirds down the page, it state that :

      “An acupuncturist is considered a primary care provider and a referral may or may not be required for insurance purposes.”

      But further down, it also states that:

      “Pursuant to California Code of Regulations, Title 16, Section 1399.451(b) it is improper for an acupuncturist to disseminate any advertising which represents in any manner that they can cure any type of disease, condition or symptom.”

      Let me reiterate this to highlight its asinine absurdity: acupuncturists are considered as primary care providers but cannot cure any type of disease, condition or symptom!

      I am at a loss for words!

      So what are the 10,000 or so California licensed acupuncturists who by law cannot cure any type of disease? Well, to keep themselves gainfully employed, they are treating conditions that can only exist in a fairytale, such as the “running piglet syndrome”, “damp-heat in the lower burner”, or “liver fire blazing upwards” (I am not making this up!); and then they are treating these mind-boggling absurdities with acupuncture, herbs, massage, etc.!

      Here in California, reality is stranger than fiction.

      1. Ben Kavoussi says:

        The link did not post for some reason. it is:

        http://www.acupuncture.ca.gov/consumers/consumer_faqs.shtml

  12. Joe says:

    “Forty years after the legalization of the profession in California, one can complete a 4-year vocational degree in acupuncture and Oriental medicine here in the Golden State — all in Chinese or Korean — and then pass a state licensing exam in the same language.”

    You cannot get a degree in any California acupuncture school without knowing any English. There are NO schools that offer all classes only in Chinese or Korean, although one or two schools offer a few classes in those languages. You can, however, take the state board exam in those languages. Sloppy research there, amigo.

    1. Ben Kavoussi says:

      @ Joe:

      Research? No amigo. I went to Dongguk-Royal University (DRU) — Now Dongguk University Los Angeles — at 440 Shatto Place, in Los Angeles’ Korea town for 3 years before I transferred to Southern California University of Health Sciences in Whittier.

      There were people at DRU in the Korean program that did not speak a word of English. Most graduated, got licensed and went on to in the Korean community.

      Before you criticize any of the articles here on SBM, consider that perhaps us skeptics actually know a little more than you do about the topic in question…

      1. Joe says:

        I think you mean “debunker”, not skeptic; you are hardly a skeptic. DRU and maybe SAMRA are the exceptions that I mentioned. They are pretty much the “bargain basement” schools, along with South Baylo. I graduated from ECTOM in 2009, so I too know what I’m talking about. By the way, both schools you attended are not particularly well respected in the community, as the do so poorly on the State Boards and are known for cheating. Yo San, PCOM and ECTOM are essentially the top three schools in the area, as well you know, so I’m not sure how much credibility you actually have when you comment. I do know you are not particularly well-regarded by most people in the TCM community, including most teachers. You also failed to mention that the main reason it’s encouraged to have the multi-lingual tests is to give those who have come from China or Korea the chance to share their wealth of knowledge without having to wait years to be completely proficient in English. It allows them to teach as well as to practice, which is easy enough if they have a translator, as some do. You would really just do well to drop your degree and license and stick to writing your debunking articles, as poorly researched and thought out as they are. At least you can drop the facade of having any in-depth knowledge of TCM or Classical Chinese Medicine.

        1. WilliamLawrenceUtridge says:

          You also failed to mention that the main reason it’s encouraged to have the multi-lingual tests is to give those who have come from China or Korea the chance to share their wealth of knowledge without having to wait years to be completely proficient in English.

          Considering what they’re sharing “wisdom” about, I don’t see how this is a good thing. It’s like praising someone who can show you how to bloodlet in the original Greek (Latin?) of Galen. The nice thing about science is, the results transcend language – in this case the results are, acupuncture appears to be mostly placebo, alleviating only two symptoms, for a short period of time. Don’t you think effort would be better spent teaching or incentivising doctors to learn, or retain a non-English language so non-English speakers can get real medicine?

          Also, you pulled a bit of a “No True Scotsman” there. Oh, sure, you’re right that your school doesn’t require English – but real schools do! Well, if all are granting the same degree, then it hardly matters that your particular “good” school doesn’t allow it. Why not just get into one of the cheaper, easier schools? It’ll save money, probably time, and you won’t have to learn as much nonsense as you might otherwise. You could even just take a basic gross anatomy class. Learn how to avoid organs, nerves and blood vessels, and boom – your automatically better than 97% of the practitioners out there ’cause you won’t pop a lung.

        2. cowboybill says:

          Joe – SAMRA closed in 24 hours in 2010 leaving its student body high and dry. SAMRA was “highly regarded” as one of the first acu schools in the nation. The former SAMRA owner also owned a “baby bar” law school one floor above. Scam breeds scam. Dongguk and South Baylo have the largest enrollments and have the most graduates who take the Calif Licensing Exam each year. Unfortunately, the pass rate for all Calif Licensing Exam test takers averages 60% since 2000. At least one can find exam outcomes by language groups, schools and first vs repeat takers on the Calif Acu Board website. The national exam is very shy about producing anything like that. With test outcomes like these comparing schools is like deciding which turtle moves fastest. Your post is enthusiastically uninformed.

  13. Ben Kavoussi says:

    Joe,
    Thanks for your sharing your depth knowledge and insight. I take pride in not being well-regarded by the charlatans of the TCM community, including most teachers…

    1. Joe says:

      So you basically spent around 30,000 to 40,000 dollars, or more, on an education so you could say that? I think that pretty much says it all.

      1. Ben Kavoussi says:

        Again, we are delighted to have you here and we truly benefit from your expansive and expensive education in Asian medicine. Please keep reading the posts and share with us the ancient wisdoms which are being transmitted to you by the white-bearded Masters that come from China or Korea.

  14. This is ridiculous. In order to obtain my medical license I must have documented English proficiency. In fact, for ANY medical doctor to do so they must have such documentation – it is called the USMLE Step 2 CS. It isn’t perfect and it doesn’t solely test English proficiency but you can fail the entire exam if your English proficiency is not rated highly enough. And if you come from a foreign country you could be required to provide further evidence of English proficiency. This sort of requirement is common for many fields and in many states.

    It is a ludicrous double standard.

    1. Ben Kavoussi says:

      @ Andrey Pavlov:

      Indeed, there is a ludicrous double-standard here. But this is what happens when medically-illiterate politicians and their “advisors” make healthcare policy decisions or recommendations. Price and Steinberg with the help of Clark and Gage have made this laughably unintelligent decision because their goal was to satisfy the acupuncture lobbies, organizations and schools, rather than to protect the public. Their letter explicitly states:

      “Moreover, of the approximate 30,000 acupuncturists in the United States, 10,000 practice in California. These numbers illustrate how significant the practice of acupuncture is to California`s economy and reinforce the Wisdom of providing
      acupuncturists an option to demonstrate their competencies in languages other than English.”

      Obviously, “Wisdom”here means the economic interest of the providers, not the interest of the public.

      This is just pathetic!

      1. cowboybill says:

        It is true that California has the plurality of LAcs. In fact one must combine total LAcs in the next 12 states with lots of LAcs to equal the number in Calif. however, workforce data suggests the great majority of LAcs do not earn enough to have a “significant” impact on the state’s economy. The NCCAOM reported in 2008 that 70% earn $60K or less. Other data sources suggest 30% may earn less than $20K. The language issue has nothing to do with providing competent care and everything to do with sustaining a system that bilks students – especially internationals who come to Calif to train in Korean or Chinese (Joe misspoke) – and the public.

  15. newcoaster says:

    “…As Carl points out, these providers cannot read laws, warnings, and anything else likely to be written in English. They cannot read the patient charts, medication list, lab results, SOAP notes, etc, they cannot communicate with the hospital and emergency services. They cannot call the patient’s primary care provider and they cannot call the state to report communicable diseases…”

    This is making the assumption that they actually would do any of the above. Even if they did have access to patient charts, medication lists, lab results etc would they understand any of it? Would they be aware of drug interaction from the herbs they prescribed? Would they actually call the PCP and say ” I think I’m in over my head here, this patient needs a real doctor” ? No, of course not.

    I had a patient several years ago who developed jaundice after taking some herbs from a TCM practitioner who claimed he could cure her vitilogo (the skin condition Michael Jackson supposedly had where there are areas that lack melanin) When she began turning yellow, he suggested she cut the dose in half. When that didn’t work, he didn’t tell her to stop, but wanted to treat her with a different concoction of herbs. Fortunately simply stopping the original herbs led to resolution of the jaundice over several weeks, and no active treatment or hospitalization was needed.

    I contacted the TCM practitioner personally, and even wrote a letter of complaint to the “disciplinary” body. Nothing happened. All I got back from the TCM doctor was a list of the herbs he had used, and that he had “100% success rate” and “many happy customers”.

    1. WilliamLawrenceUtridge says:

      She’s lucky she didn’t develop permanent hepatotoxicity and die. Happened with TCM and kidneys…

  16. Gary says:

    I get the impresssion that it would be hard to find a non-Asian acupuncturist who uses moxibustion. It’s almost never shown in ads (and what about veterinary acupuncture, which is becoming widespread)?

    1. Jon says:

      I’m an acupuncturist in Washington State, not asian, and I never used moxibustion. If you understand what’s being done (I do have a background and degrees in physics and biochemistry) it’s a primitive version of the modern cold laser. Essentially any smoldering ember emits light at wavelengths 630 to 1200nm that penetrate the skin to considerable depth, possibly up to 6 centimeters depending on the wavelength. It’s been shown that that red to near infrared light stimulates cell activity through direct simulation of cytochrome c in the mitochondria, it also causes the production of nitric oxide local to the area that it’s being applied thereby increasing blood flow. So it facilitates healing and blood flow in the area applied.

      That being said you can get better, more controlled results using a cold laser or just by strapping some LEDs of the right wavelength together. I’ve built several for about $10 that work fairly well. Actually they work better by puting out more light of the right wavelengths than many of the commercially available ones, which can run upwards of $5000. Even us fake doctors get screwed on the cost of medical equipment (technically I’ve never claimed to be a doctor). I feel wrapping the ones I built in electrical tape keeps them together and gives them that home-made look that makes people comfortable…either that or really trashy, but they still work, don’t stink up a building, and I don’t have to worry about burning anyone.

      TCM as it’s being taught is also bunk. There is no mystical force, vital energy, meridians, or even acupuncture points. A French guy named Morant translated the works in 1950 incorrectly and everyone, including the Chinese, decided to just go with it….I guess? The word Qi (or Chi) never did, and currently doesn’t mean energy, there was no word for meridians in the Chinese language at the time the medical texts were written.

      Philologists, people who study language, culture, and literature works in the context they were written, have all stated that Qi, which either means “air” or “proper function of something,” when you look it up in a Chinese/English dictionary, when looked at the in the context it was used, meant vital air. The word Mai, incorrectly translated as meridian, means vessel. In the context in which it was used it meant blood vessel. Finally the word used to describe acupuncture points wasn’t points, it was nodes.

      Essentially Qi, or “vital air” was a 700BC word for oxygen. The ancient Chinese recognized there was an important component of air that circulated in the blood vessels (but so did the Greeks and Vedics of India). The acupuncture points correctly translated as “nodes” are simply clusters of venules, capillaries/arterioles, and lymphatic capillaries that branch off more major vessels (the “meridians”). When the nodes are stimulated by acupuncture needles it causes increased blood flow at points distant to the needling site, and it’s all mediated by the nervous system.

      That’s pretty much the function of acupuncture: to increase highly oxygenated, nutrient rich blood to areas of the body. Improving blood flow can facilitate healing while concurrently relaxing tight muscles and fascia in the area. Actually works pretty good if you know what you’re doing, and you generally don’t even need to insert needles anywhere near the site of the pain.

      So now you can tell people there are no Meridians only blood vessels, there are no acupuncture points only nodes, and Qi means Air or proper function of something and when used in the context of acupuncture it means oxygen (vital air). Be careful when you tell certain people there is no mystical forces involved here. They get really upset and combative sometimes.

      Chairman Mao and his commie regime is also complicit in this weird mistranslation/misapplication of acupuncture, but I’ll spare you the details, this post is already long winded enough.

      If for some strange reason anyone wants more information, like journal articles that demonstrate this distant needling-improved blood flow phenomenon I’ll see if I can’t dig them out of the pile.

      1. windriven says:

        ” it also causes the production of nitric oxide local to the area that it’s being applied thereby increasing blood flow.”

        It happens that we have a frequent commenter in these pages, daedalus2u, who is exceptionally knowledgeable about the role of nitric oxide in biology. I hope he happens to be following this thread and will weigh in.

        “If for some strange reason anyone wants more information, like journal articles that demonstrate this distant needling-improved blood flow phenomenon I’ll see if I can’t dig them out of the pile.”

        Are you suggesting distant needling to be different from a bee sting or other local insult on blood flow, yes, I’d be most interested.

        1. Jon says:

          Moxibustion/Cold Laser/LEDs do cause the generation of nitric oxide local to the area.

          *Therapeutic photobiomodulation: nitric oxide and a novel function of mitochondrial cytochrome c oxidase. Discovery Medicine. 2011 Feb;11(57):154-9.
          “Three recent findings provide important new insight. First, nitric oxide has been implicated. Second, cytochrome c oxidase, an enzyme known to reduce oxygen to water at the end of the mitochondrial respiratory chain, has been shown to have a new enzymatic activity–the reduction of nitrite to nitric oxide. This nitrite reductase activity is elevated under hypoxic conditions but also occurs under normoxia. And third, low intensity light enhances nitric oxide synthesis by cytochrome c oxidase without altering its ability to reduce oxygen.”

          If points are stimulated distally with red to near infrared light, I’m unsure if there is an effect with respect to nitric oxide at the area of interest.

          With acupuncture I can only say it’s likely that nitric oxide is playing a role at improving blood in areas distant to the needling site. I’ve read papers that both suggest it is and suggest the opposite occurs in others, these effects are likely dependent on the chosen needling site and the needling sites are chosen based on the desired effect. Other unknown (at least to me) factors are likely playing a role as well. The following paper sums it up.

          *Hemodynamic changes in the brachial artery induced by acupuncture stimulation on the lower limbs: a single-blind randomized controlled trial. Evidence Based Complementary Alternative Medicine. 2012;2012:958145.
          This paper demonstrates that brachial artery blood flow volume increased, measured at the cubital crease, when the point LIV3 (on the dorsal foot between the 1st and 2nd metatarsals) was needled. However when ST36 (approximately 3 inches below the inferior and lateral border of the patella and just lateral to the tibia) was needled there was a decrease in blood flow. Also a non-acupuncture point was needled in the study with same effect of decreased blood flow.

          So depending on where the bee stings you it might or might not increase the blood flow at a distant site.

          There is actually a convoluted way to explain this from the acupuncture perspective, but to do so it’d end up having to be a dissertation using non-scientific metaphorical language. There just aren’t enough studies on it for a concrete scientific explanation.

          1. weing says:

            “There is actually a convoluted way to explain this from the acupuncture perspective, but to do so it’d end up having to be a dissertation using non-scientific metaphorical language. There just aren’t enough studies on it for a concrete scientific explanation.”

            But, but, non-scientific metaphorical language is the cutting edge of science. So we have to accept it as scientific, it’s just too advanced a science for us.

          2. windriven says:

            My background is physics, not biochemistry so there may be a perfectly rational answer to my question: so what?

            Assuming that needling and/or stimulation at near IR triggers production of NO2, what are we to take away? What is the therapeutic benefit? How is the benefit thus derived superior to similar benefit derived using other modalities?

          3. WilliamLawrenceUtridge says:

            One of the things acupuncture research will eventually have to control for is the cerebral homunculus. There is a substantial difference between needling the hand and needling the back, purely in terms of nerve sensitivity. So I question whether an appropriate control is hand-versus shin, or lip-versus-back. Particularly when talking about systematic effects. I cut my hand while chopping vegetables, I get a whole-body reaction like I was dunked in cold water. I can cause significant lacerations to my arms and legs while walking in the woods and I’ll hardly notice until the blood stains my clothes.

            And even assuming needling can increase blood flow – so what? We have myriad ways of doing this that don’t involve penetrating the skin. Why not use those?

  17. WilliamLawrenceUtridge says:

    it’s a primitive version of the modern cold laser. Essentially any smoldering ember emits light at wavelengths 630 to 1200nm that penetrate the skin to considerable depth, possibly up to 6 centimeters depending on the wavelength.

    Citation needed. And if true, wouldn’t you be better off with a laser, that doesn’t require you to break the skin? Are you advocating for the banning of moxibustion in favour of the use of cold lasers, for the purposes of patient protection?

    So it facilitates healing and blood flow in the area applied.

    Well that’s an asserted objective fact, it should be trivial to support this with a citation.

    Essentially Qi, or “vital air” was a 700BC word for oxygen….That’s pretty much the function of acupuncture: to increase highly oxygenated, nutrient rich blood to areas of the body.

    That is an astonishing projection of modern knowledge onto a populace that has no way of knowing any of it.

    If for some strange reason anyone wants more information, like journal articles that demonstrate this distant needling-improved blood flow phenomenon I’ll see if I can’t dig them out of the pile.

    Please do, we love citations.

    1. Jon says:

      References are at the end of this
      ***Citation needed. And if true, wouldn’t you be better off with a laser, that doesn’t require you to break the skin? Are you advocating for the banning of moxibustion in favour of the use of cold lasers, for the purposes of patient protection?***

      With regard to moxibustion/cold lasers, my opinion/experience is that only provide a relatively short window of time of relief from pain when compared to acupuncture. However in many conditions they are better/stronger at resolving issues particularly with gastrointestinal issues when only one simple, short treatment is needed such as stimulating gastric emptying.

      Acupuncture/electro-acupuncture is a longer lasting effect, usually two or three days, sometimes as long as 1 week (this assumes it’s a typical patient with a typical musculoskeletal complaint). Successive acupuncture treatments give progressively longer spans of time before the pain returns, and 95% of the time the pain is at a successively lower level with each treatment.

      I wouldn’t ban anything myself, I’m not sure why this “it’s dangerous” meme keeps going around. There is very little danger with acupuncture or moxibustion. This is reflected in the cost of my, and other acupuncturist’s, malpractice insurance of a whopping $300 per year. In my state malpractice isn’t even required for acupuncturists. There is one and only one significant danger, a punctured lung. How to avoid doing that gets drilled into the head of every acupuncturist to the point of Ad nauseam.

      I should’ve edited my previous post. I directly implied that at six centimeters laser/light therapy was effective. That was wrong. The therapeutic window for “light therapy” is around 1.5 perhaps up to two centimeters. There are photoacoustic imaging studies that can get to around that 6cm depth in tissue, but the several factors like intensity, duration of exposure, and quantity of light present at that depth makes them unfeasible for any kind of therapy.

      **That is an astonishing projection of modern knowledge onto a populace that has no way of knowing any of it. **

      It’s not any kind of stretch of the imagination to think that the ancient Chinese (and others) were well aware that there was a vital component in air that was needed for life. It’s a certainty that least one of the ancient physicians ran across a patient who was cyanotic and suffering a heart attack, asthma, had emphysema/bronchitis, or someone that died from asphyxiation in a mine where there was apparently plenty of air available. They were able to put two and two together and understand when someone wasn’t getting sufficient “vital air.” Why even use the adjective vital when they could’ve just called it air?

      ——————————————————————————————————-
      Acupuncture, Moxabustion, and Cold Lasers/LEDs + blood flow
      All the journals were pulled off of pubmed or google scholar so that they’d be easy to find. Plus I didn’t want go through the trouble of typing in everything. The journals are either complementary medicine or Chinese for obvious reasons. Without going into a great deal of depth on the specifics, they all demonstrate increased blood flow either locally or distally from the site of needling or applied light therapy on the body.
      ——————————————————————————————————-
      ****Acupuncture****
      Watanabe M, Takayama S, Hirano A, Seki T, Yaegashi N. “Hemodynamic changes in the brachial artery induced by acupuncture stimulation on the lower limbs: a single-blind randomized controlled trial.” Evidence Based Complementary Alternative Medicine. 2012;2012:958145. doi: 10.1155/2012/958145. Epub 2012 Nov 25.
      .
      Shinbara H, Okubo M, Kimura K, Mizunuma K, Sumiya E. “Participation of calcitonin gene related peptide released via axon reflex in the local increase in muscle blood flow following manual acupuncture.” Acupuncture Medicine. 2013 Mar;31(1):81-7. doi: 10.1136/acupmed-2012-010253. Epub 2013 Jan 10.

      Chen SP, Gao YH, Wang JY, Liu JL.”Effects of electroacupuncture at different points on colorectal distention-induced changes in blood pressure, electrogastrogram, gastric tension and gastric blood flow.” Journal of Traditional Chinese Medicine. 2011 Dec;31(4):360-6

      Li H, Hou ZW, Bai YL, Gu SZ. “Comparative study on curative effects of stroke treated with acupuncture by NIRS.” Zhongguo Zhen Jiu. 2011 Nov;31(11):998-1002.

      Wang GM, Li LX, Wen FY, Song YQ, Tong RG. “Impacts of Taichong (LR 3) on blood flow velocity in patients with vertebrobasilar insufficiency.” Zhongguo Zhen Jiu. 2011 Mar;31(3):216-8.

      Hsiu H, Huang SM, Chen CT, Hsu CL, Hsu WC. “Acupuncture stimulation causes bilaterally different microcirculatory effects in stroke patients.” Microvascular Research. 2011 May;81(3):289-94. doi: 10.1016/j.mvr.2011.03.001. Epub 2011 Mar 9.

      Guangjun W, Yuying T, Shuyong J, Tao H, Weibo Z. “Change of blood perfusion in Hegu acupoint after contralateral Hegu acupoint was stimulated.” Journal of Alternantive and Complementary Medicine. 2012 Aug;18(8):784-8. doi: 10.1089/acm.2011.0440. Epub 2012 Jul 13.

      Shin Takayama, et al, “Evaluation of the Effects of Acupuncture on Blood Flow in Humans with Ultrasound Color Doppler Imaging.” Evidence Based Complementary Alternative Medicine. 2012; 2012: 513638. Published online 2012 June 21. doi: 10.1155/2012/513638

      ****Lasers and LEDs****
      Desmet KD, et al. “Clinical and experimental applications of NIR-LED photobiomodulation.” Photomedicine and Laser Surgery. 2006 Apr;24(2):121-8.

      Eells JT, et al. “Mitochondrial signal transduction in accelerated wound and retinal healing by near-infrared light therapy.” Mitochondrion. 2004 Sep;4(5-6):559-67.

      Poyton RO, Ball KA. “Therapeutic photobiomodulation: nitric oxide and a novel function of mitochondrial cytochrome c oxidase.” Discovery Medicine. 2011 Feb;11(57):154-9.

      ****Moxibustion****
      Guo XT, Dong QJ, Cao YQ. “Effects of mild moxibustion on angiogenesis and microcirculation in wound repair after operation of anal fistula in rats.” Zhong Xi Yi Jie He Xue Bao. 2009 Dec;7(12):1154-8. doi: 10.3736/jcim20091212.

      Sun YH, et al. “Effect of mild-warm moxibustion on microcirculation in the raw surface tissue of chronic refractory wound in skin ulcer rats.” Zhen Ci Yan Jiu. 2011 Oct;36(5):321-6.

      1. WilliamLawrenceUtridge says:

        Regards your citations, people aren’t rats. Regards citations to Chinese journals, it’s well recognized that Chinese journals have significant publication biases, to the point that investigations have found more than 99.9% of all journal articles published in China have been positive. Results outside of China are far more equivocal.

        Regards lasers – the “citation needed” is for moxibustion being a cold laser. That’s a rather astonishing claim.

        Regards electroacupuncture, that’s just TENS, isn’t it? I don’t believe the Chinese had batteries or generators before 1900, did they?

        Does increased blood flow translate to any clinically significant healing or changes? Lots of things can increase blood flow, why not just use an ice back, or warm water? It doesn’t involve skin penetration.

        Regards the “patients go for longer periods pain free”, how do you distinguish that from the acute pain relief effects of acupuncture (i.e. short term placebo) simply distracting the patient, giving them something to do or focus on, while they heal naturally? I mean, the natural process of healing takes care of most complaints over a long enough timespan, right?

        Acupuncture isn’t “dangerous”, it “has risks”, like all treatments (including no treatment). But generally patients aren’t told of the risks of things like lung collapse, or death. I don’t think anyone here would necessarily ban acupuncture (Dr. Novella might be an exception), we’re more for a realistic appreciation of its efficacy and risks. I myself have argued in the past, with Dr. Novella, for a limited use of acupuncture (on this very comments thread, see here, Dr. Novella’s reply is here and here is my reply to his reply). I’d be happier if it were simply abandoned, certainly that it were not paid for under public health care or insurance, and would prefer no more research funding be expended on the topic.

        Regards “vital air” versus “air”, sure you can grant them the trivial observation that one needs to breathe air to survive, and that not all gasses are adequate or safe. To compare that to our current knowledge of oxygen on the other hand, strikes me as disingenuous. I prefer to draw a rather bright line at around the 18th century, and say most of what was known previously was correct only by accident, but what is known now is essentially certain.

  18. I sent him an email and asked if he had the time to comment to please do so. To me, it sounds highly suspect and I’d be willing to bet I could dissect the studies and demonstrate why they are likely not true, but daedalus has much more expertise in that field than I and can certainly do it with much more alacrity. That said, even if it were correct, I would still be pretty confident in saying that whatever effect there is is so miniscule as to be utterly irrelevant in a clinical context, though further research into actual lasers would be warranted (since it makes no sense to research moxibustion as the means for generating this EM radiation).

    1. WilliamLawrenceUtridge says:

      By “EM radiation”, do you mean extremely low frequency wavelengths (i.e heat!!!)? Why not use a hot pack?

      And anyway, rat studies aren’t good enough for drug and surgical trials, why are they adequate for acupuncture? Why does acupuncture get to leapfrog over the extensive and exhaustive process that is imperfect, but at least increases the likelihood of producing a safe and effective intervention?

      I look forward to D2U’s comments, they are always fascinating. I really hope his intervention ultimately works out, he’s put an impressive amount of erudition into it.

  19. Andrey Pavlov says:

    @windriven:

    It is necessary to point out that NO is a very, very short lived molecule that has profound but extremely short lived and very localized effects. That is, in part, why daedalus is so focused on his bacteria – you need something to constantly stimulate NO production in order to actually do anything. So even if everything is actually correct then we would anticipate the effect to cease almost immediately after the acupuncture has. There is no basis for increased duration of effect.

  20. windriven says:

    @Andrey

    Domo arigato.

    I really wish I’d taken a few biochem classes.

  21. daedalus2u says:

    I got Andrey’s message, but haven’t gotten a chance to respond. I am busy commercializing my bacteria :), for real, with funding, IRBs, and all. Due to the vagaries of the FDA regulatory process, we will very likely first commercialize it as a cosmetic, probably as a deodorant for foot odor.

    The three most important aspects of NO signaling are location, location, location, after which there is concentration, duration, O2 levels, NO species and many other things.

    Whacking NO physiology with non-physiologic NO sources is only going to screw it up.

    If moxibustion is a poor-man’s IR delivery system to modulate NO status, then I am sure the FDA would be interested in measurements of the IR wavelengths and levels and how they correlate with NO levels. Those values have been submitted to the FDA for medical device approval?

    There is an old saying “fools rush in, where angels fear to tread”. The same goes with quacks.

  22. WilliamLawrenceUtridge says:

    Good luck Daedalus! Post some pubmeds when you’ve got ‘em.

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