5 Myths of Community Acupuncture

Since 2006 there has been a new style of medical clinic popping up all over the country that goes by the name “community acupuncture.” Practitioners at these clinics treat multiple patients at the same time in the same room, dividing their overhead costs among a higher volume of patients. This allows them to charge a lower rate per treatment, which makes their services accessible to more people. However, this system requires that they divide their time and attention among that many more patients. Because treatments are done in a common room, it also significantly limits which acupuncture points can be used. While I agree that healthcare in our country is overpriced and that the more people receiving acupuncture the better, imitating the high-volume model of mainstream medicine negatively affects the quality of care. Paradoxically, those who practice community acupuncture advertise their services as more traditional and more effective than private one-on-one sessions. Below are five points that are commonly found on the websites of community acupuncture clinics and a refutation of each.

1. "Acupuncture has been a community-based medicine for most of its long history. In Asia, acupuncture has traditionally been practiced in group rather than individual settings."

In the long history of medicine in Asia, acupuncture has been practiced in many different ways. For example, there were the traveling healers (the famous "barefoot doctors") who made a living doing the rounds of nearby villages on foot. Then there were the practitioners who worked for the upper class and royal families, who offered private treatments on a strict one-on-one basis, considered to be the optimal ratio for the highest quality health care. Often, these highly skilled acupuncturists would be hired exclusively by a wealthy family to be their personal physician. Yes, there were also clinics where patients were seen together in large rooms.

Even today in China practitioners work in a variety of settings, including community clinics, just as they do here in America. However, there are two very important distinctions between Chinese and American community clinics. First, in China, it is not considered taboo to disrobe in front of strangers like it is here in America, especially in a medical setting. Because of this, Chinese patients may completely undress, even if there are others around. Since this is not done in America, it means that community acupuncture here is limited to the points that can be accessed only while fully clothed. Second, in China clinics use regular examination tables for treatments while here community acupuncture is usually done with patients reclining in armchairs. This means that in America community acupuncture is typically limited by the inability to access any of the points on the back of the body. So in community acupuncture, as it is practiced in America, over half of the total acupuncture points are inaccessible. This is especially problematic when dealing with chronic conditions, which respond best when the area is treated directly.

2. "For acupuncture to be most effective, patients need to receive it frequently and regularly."

In Chinese medicine, there is no frequency of treatment that is considered to be ideal for all conditions. This is actually determined in many ways, especially by how long you have had your condition and by your overall state of health. For example, the longer you have had something, the less often you will need treatments. This is because chronic conditions tend to both develop and resolve more slowly, gradually shifting over time. Also, if your health is poor your ability to heal can be compromised, meaning that your condition will resolve more slowly. On the other hand, conditions that come on fast, like acute injuries or viral infections, will respond and change faster, so more frequent treatments are ideal. Other factors that can influence the frequency and regularity of treatment include your age, the severity of your symptoms, and your compliance with taking herbs and making dietary and lifestyle changes. So, for some conditions frequent treatments may be ideal, while for others treatments every other week would be better. If the patient's goal is to utilize acupuncture for preventive medicine or to maintain wellness, they will need treatments even less often, say once per month to once per season.

3. "As acupuncture has moved toward the mainstream, it has been forced into a paradigm of one-on-one treatments and high prices, which has decreased not only patient access but treatment efficacy."

While I agree that the high price of health care needs to be addressed so that more people can afford it, there is no absolute correspondence between cost and treatment efficacy. Efficacy has much more to do with the skill of the practitioner, especially their ability to make an accurate diagnosis. On the contrary, I would argue that the limitations of community acupuncture have a greater potential to negatively affect treatment efficacy. First is the limitation on time. Optimally, a proper initial appointment will include questions not only about the patient's chief complaint, but also about other systems and functions, as well as a physical exam, dietary and lifestyle counseling, and a discussion of the treatment plan. In addition, there should be time allotted to answer the patient's questions and, especially in the case of pain, to do some of the other traditional therapies that practitioners of Chinese medicine are also trained in, like acupressure and cupping. There is simply no way to complete all of this when you are seeing multiple patients per hour. Second is the significant limitation on which acupuncture points can be used, as mentioned above.

I don't think the best way to address the high cost of healthcare is for the practitioner to increase patient volume, especially if this means sacrificing the quality of care. More effective solutions include simply charging less per patient, reserving a certain number of appointments per week for low-income individuals, or volunteering a certain amount of your time for free as a practitioner.

4. "Community acupuncture clinics represent a return to tradition."

Actually, throughout the centuries, this medicine has been practiced in many different cultures and in many different ways. In China, there has been everything from traveling doctors to court physicians, from integrative hospital practitioners to guarded family lineages. In India, there is an ancient form of acupuncture that is part of Ayurvedic medicine that is based upon the Suchi Veda, a 3,000-year-old text that predates the written record of Chinese medicine. In this tradition, the needles were dipped in herbal liquids before insertion. In Japan, traditional acupuncturists use needles that are much thinner than those used by the Chinese. There is even one particular style in which only one point is needled per treatment. The Japanese also developed shoni-shin, a type of pediatric treatment in which various metal tools are used to stimulate the acupuncture channel system without piercing the skin. They even have a 400-year old tradition of blind acupuncturists, representing about a third of all acupuncturists in that country today. In Korea, there is a focus on needling the hands only. This is a kind of "microsystem" acupuncture in which the different areas on the hands are said to have a one-to-one correspondence with other specific areas of the body. Another microsystem form is auricular (ear) acupuncture, which is used extensively in America by members of the National Acupuncture Detoxification Association to help patients break drug addictions. There are also separate traditions in other countries like Vietnam and Tibet. In truth, there have been many different ways in which this medicine has been practiced, and community acupuncture represents something new.

5. “As with any kind of intentional group endeavor—such as meditation or prayer, for example—when you do something with other people it raises the energy for everyone. It’s the same with acupuncture: receiving treatment in a room with others raises the Qi dynamic and healing is enhanced.”

I agree that receiving a treatment in a group can raise the qi dynamic and enhance healing, but it can also lower it. For example, I have heard from multiple people who have tried community acupuncture that being in a room where people are constantly coming and going, snoring, listening to music on headphones, and having emotional releases can be very distracting. While I do agree that under certain circumstances group endeavors can raise the energy, I think it is important to acknowledge that this is not the only circumstance under which this can happen. In my experience, the more deeply we can rest during a healing session, the better. A private, quiet room free of distractions, with soft music and low lighting can also be very effective at raising the qi dynamic. The qi dynamic also depends on the practitioner's approach, especially their intention, skill, and bedside manner. If the room you are in has a peaceful ambiance, if you are comfortable and warm, and if you feel like the practitioner is attentive and caring, healing will also undoubtedly be enhanced.

 
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