by Bob Flaws

Recently there's been a controversy within our profession in New Mexico over scope of practice issues. Arguably, New Mexico has the broadest, most permissive legal scope of practice for "acupuncturists" in the country. (New Mexican practitioners of acupuncture/Asian medicine are licensed as DOMs, Doctors of Oriental Medicine.) In New Mexico, DOMs are permitted not only to do shui zhen (water needle, i.e., injection therapy), they can even administer intravenous infusions. Using this authority, a minority of DOMs are treating patients intravenously with vitamin "cocktails" and, up until recently, even with oxygen and hydrogen peroxide. Recently, the Board in New Mexico has stepped in and removed the intravenous administration of a number of medicines from DOMs' scope. None of the medicines involved are in any way traditional Chinese or even more broadly "Oriental" medicinals.

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From reading about this controversy in New Mexican newspapers, it seems the majority of New Mexican DOMs are in favor of reigning some of their more progressive co-professionals. These "conservatives" point out that these medicines are not and have never been part of Asian medicine and, therefore, practitioners using them are no longer practicing "Oriental medicine." Nevertheless, these "progressive" (these characterizations are my own) continue to hold themselves out to the public at large as DOMs, Doctors of Oriental Medicine. From their point of view, they are merely at the forefront of expanding the horizons of Asian medicine in their efforts to provide the most effective care to their patients.

Personally, I appreciate both sides of this argument. On the one hand, for a profession to be a profession, it needs to have certain standards which become its defining characteristics. However, standards also imply limits. It is a profession's right to decide what those standards or limits are (regardless of any other limits imposed on the profession from the outside, such as by governmental agencies). In fact, the word "profess" means to profess to the public and to each other certain standards in terms of theories, practices, and ethical obligations which then bind the profession together and separate it from other professions and the "lay" world at large. Once stated, such declarations or professions of practice become covenants both within the profession and with the society as a whole.

In terms of Asian medicine, I think all licensed American practitioners agree that acupuncture, Chinese herbal medicine, tuina, qigong, and Chinese dietary therapy all fall (or should fall) within the boundaries of our profession. This is because these modalities have all traditionally been included within the field of Asian medicine in China, Japan, Korea, and Viet Nam. However, even in China, practitioners of so-called Traditional Chinese Medicine are continuing to push those boundaries. After all, water needling is a relatively new addition to the field of acupuncture as is dian jiu, electric moxibustion via infrared heat lamps, and researchers in China are working on incorporating echinacea into our materia medica. My guess is that the Board in New Mexico only agreed to include water needling/injection therapy in DOMs' scope of practice because water needling is routinely taught and used in China under the rubric "acupuncture."

On the other hand, if new theories and techniques are being added to Asian medicine all the time, where does one draw the line? Asian medicine has never been and currently is not a fait accompli, a closed system. In fact, some doctors in China do administer infusions of Chinese medicinals intravenously. So I wouldn't necessarily say that water needling is "in" but intravenous administration is "out." However, I have never seen any Chinese source talk about the intravenous administration of vitamins as "Chinese medicine." Actually, Chinese doctors writing in Chinese medical journals routinely refer to vitamin therapy as "Western medicine."

So it seems our profession has two competing needs. One, to continually "push the envelope" with the creation of new theories and therapies, but, two, also create standards which bind the profession together as a whole and set it apart from competing health care professions. We don't want the profession to stagnate, but, as a profession, we also need for there to be some limits. So what's the solution to this conundrum? For me, I think the solution is consensus. My Webster's Dictionary defines consensus as "general opinion," and general opinion to me means what the overwhelming majority in the profession believe. Such consensus is reflected in the curricula of our schools and the requirements for national certification (NCCAOM), both educational and informational. As stated above, most of us agree that acupuncture (including moxibustion, cupping, bleeding, and guasha), tuina/anmo massage, Chinese herbal medicine, qigong, and Chinese dietary therapy form the core of our methods of treatment. Where we may disagree is about the specifics of those modalities. E.g., are intravenous therapy and aromatherapy ok means of administering Chinese medicinals, and what are and are not Chinese medicinals?

When a practitioner chooses to do something that the vast majority of the profession would not consider a part of Asian medicine, then I think the practitioner needs to disclose that to the patient the same way practitioners are supposed to disclose experimental treatments. In fact, often these are one and the same thing, i.e., not Asian and experimental. Simply by stating that one is not making any claims that what he or she is doing is currently a standard part of Asian medicine seems to me the way to balance the need for innovation with the need for standards within the profession. It is also the intellectually honest thing to do. If such non-standard practice enrages the profession enough, members of the profession will exert pressure on the powers that be to deny that new theory or therapy within the profession's legally mandated scope of practice as has happened in New Mexico. When and if that occurs, then continuing to administer that therapy becomes a legal matter, not simply a professional matter.

Several days ago, I wrote a blog on soteriology and Chinese medicine explaining how standard professional medicine is not spiritually salvific. Thinking further about that, I think it is perfectly acceptable for professional practitioners of Chinese medicine wanting to make Chinese medicine soteriological to simply disclose what they are doing. (Note that here I am talking specifically about Chinese medicine, not Asian medicine as a whole.) Instead of arguing that there is a spiritual soteriology inherent within standard professional Chinese medicine, which I believe is dubious historically, they should explain that they think there should be a soteriology and that they are supplying one. Then they can add onto Chinese medicine any elements of an existing soteriology they want or they can make up their own. By making such an addition, such practitioners may be adding to the advancement and evolution of the medicine. However, by making such a disclosure, they are also being intellectually honest to the rest of the profession and the public at large. Thus disclosure seems to me to be the middle way, harmonizing the legitimate but competing needs of innovation and conservatism.

Copyright Blue Poppy Press, 2009. All rights reserved.