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ACUPUNCTURE, A QUESTION OF EDUCATIONAL AND PRACTICE STANDARDS - CATEGORIES AND DEFINITIONS OF FRINGE, METAPHYSICAL, PARANORMAL, AND PSEUDOSCIENTIFIC PRACTICES - AMMA POSITION STATEMENT Muskegon, Michigan November 2005 - AMMA Board of Advisors The American Manual Medicine Association Board of Advisors in conjunction with the AMMA professional and associate membership has formulated this position statement regarding categories and definitions of TCM acupuncture. TCM is becoming increasingly popular and has long enjoyed a position of ascendancy within the acupuncture community. The AMMA has outlined in previous position statements its position regarding the composition of core acupuncture curriculum, and under no circumstances does the AMMA support the inclusion of fringe, metaphysical, paranormal or other pseudoscientific subject matter under the guise of core educational standards leading to certification or state regulation. A number of leaders and individuals within the acupuncture community have entertained the idea of creating a tiered system of education and regulation for the various kinds of acupuncture practiced in the U.S. As acupuncture continues to grow and mature serious differences are arising between practitioners of Traditional Chinese Medicine (TCM) and medical acupuncture. One of those differences is related to the widespread and common use of fringe, psychic, metaphysical and paranormal practices, and pseudoscientific information. Under existing acupuncture laws and criteria established by certification and accrediting bodies, all acupuncture education and practices are subject to the same standards. Considering the extreme divergence between medical acupuncture and TCM acupuncture this is increasingly becoming an intolerable problem that begs for legislative solution. The AMMA notes that the TCM acupuncture community has largely adopted the criteria of the Accreditation Commission of Acupuncture and Oriental Medicine ACAOM and the National Certification Commission for Acupuncture and Oriental Medicine NCCAOM. These organizations base their accreditation and testing criteria upon TCM and a shamanistic approach to education and practice. It is impossible for a student of acupuncture in the U.S. to learn the health profession of acupuncture without having to study certain archaic shamanistic practices and the religion of Daoism. It is the position of the AMMA that hours of instruction within an acupuncture curriculum should be specifically organized around core acupuncture courses, allied health sciences, biomechanics, and biomedicine, and not shamanistic acupuncture. The amount of time dedicated to acupuncture history, philosophy, Daoism, and review of shamanistic practices needs to be greatly curtailed. A repeated and major criticism expressed by the more fervent believers in the inherent purity of TCM acupuncture practices is that professionals who are not fully trained in TCM theory will cause harm to their patients through adverse effects on a patients chi. This assertion is without merit. Even a brief review of the massive number of acupuncture and related therapeutic systems and techniques, the vast complexity of opinion and recommendations related to diagnosis and treatment, the bewildering array of absolute fringe and metaphysical claims and practices, including levitation, psycho kinesis, telepathy and other paranormal practices, suggests that the proponents of these statements are either sincerely misinformed and poorly educated or delusional. In addition, the body is not so fragile that the inappropriate treatment of an acupuncture point would cause serious consequences any more than sitting or lying on any protruding object would cause adverse stimulation of acupressure points. To think otherwise expresses a profound ignorance of the physiology of the body, specifically the neurological system. TCM acupuncturists largely study "energy" anatomy, and view their theoretical understanding of the body as separate and distinct from western anatomy and physiology. The medical acupuncturist views the TCM theories of the body as largely archaic knowledge and embraces a modern concept that identifies a universal science of the body that unifies years of scientific advances relative to human physiology. The medical acupuncturist accepts current scientific studies related to mechanoreceptor stimulation, the Gate Theory, immunological responses, humoral responses, higher brain function, electro energy reactions via mechanical stimulation and mediated along lines of connective tissue, and other unifying discoveries and research related to acupuncture, manual therapy, and biomechanics. The TCM acupuncturist views knowledge dualistically and sees archaic knowledge as good and modern western science as bad. The medical acupuncturist sees two concepts leading to a universal and unified system of medicine. The AMMA has in previous statements defined and elaborated upon definitions and standards of medical acupuncture, medical acupuncture education, medical acupuncture terminology, approved medical acupuncture techniques and treatment protocols, and medical acupuncture research. Since 1999 the AMMA has led the acupuncture profession in establishing these definitions and standards and in embracing and promoting a holistic model of acupuncture firmly welded to medical principles and research The AMMA has adopted the same research standards and ethical values as the medical profession and as such only utilizes methods of treatment that are evidence based. The AMMA accepts that medical ethics and medical acupuncture ethics are one in the same, and that it is unethical to promote the use and practice of pseudoscientific or shamanistic acupuncture as patient care. The AMMA believes that minimum standards of education containing elements of fringe, metaphysical or paranormal acupuncture are not standards at all. Some subjects taught in acupuncture schools and practices of the TCM acupuncture community are extreme in nature and most likely constitute health care fraud. The AMMA has established the following categories of fringe acupuncture:
Energy "Acupuncture" Energy "Acupuncture" is composed of a number of systems of metaphysical practices such as Chi Kung, Reiki, Polarity Therapy, Quantum Touch, Therapeutic Touch, and other approaches involving the transference or "channeling" of energy by a therapist and in some cases with the aid of "spirit guides." Spirit guides may include departed souls, angels, or aliens from other dimensions or worlds. Commonly an energy therapist may use clairvoyance, mediumship, or other psychic practices. Psychic Practices Combined with Acupuncture Psychic practices are commonly combined with TCM acupuncture and may simply involve a therapist's belief in directed intent and the transmission of healing energy into a patient; in more extreme cases this practice may include psychic diagnosis and psychic psychotherapy. Metaphysical Practices Metaphysical practices are based upon beliefs and practices that are not considered to be part of how the normal physical world works. Examples of a metaphysical practice would include elements of faith and belief seen in religions. Examples of metaphysical beliefs and rituals used by acupuncture therapists are frequently based upon New Age religion. Paranormal Practices Paranormal practices may include a belief in contact with departed souls, fortune telling, a belief in magic, ESP, levitation, shape shifting, and psycho kinesis. Pseudoscientific Educational Instruction Pseudoscientific educational instruction constitutes the largest and most misunderstood educational problem within acupuncture. The TCM acupuncture community has demonstrated a profound lack of knowledge of the importance of educational information based upon rational scientific concepts and a failure to understand the basic health sciences, specifically valid concepts of human physiology and biomechanics. Indeed, health science knowledge within the acupuncture community can be summed up as high school level information within the fields of anatomy and physiology. At this level of education the information provided is little more than subject definitions and terminology, and doe not lead to the higher levels of education and knowledge seen in nursing, physical therapy or health care doctoral programs. It is the use and reliance upon pseudoscientific educational instruction that has lead to a confusing array of acupuncture theories, popular acupuncture practices, and franchised acupuncture systems. There are several hundred of these divergent and non scientifically based acupuncture theories and practice systems utilized by acupuncturists in the U.S. The AMMA has published several position papers regarding this problem along with the production of numerous educational materials including manuals, booklets, audio CD's and DVD's. In addition, AMMA members have access to the Journal of the American Medical Massage Association, JAMMA, which is a scientific journal that publishes accepted scientific studies related to manual medicine. The JAMMA does not accept any form of advertising. The AMMA has established educational, membership, and certification requirements at a higher level than those found within the TCM acupuncture community. The AMMA will not accept for membership or certification applicant transcripts containing energy "acupuncture", psychic practices combined with acupuncture, metaphysical and/or paranormal practices, but because of the overwhelming proliferation of pseudoscientific educational information, acupuncture techniques, and systems of treatment, the AMMA has accepted members with this background and training and has attempted to reeducate and retrain these therapists in correct physiological principles and methods of care based upon current biomechanical and biomedical research. Further the AMMA will not accept or approve providers of pseudoscientific acupuncture as AMMA continuing education providers, and will not accept pseudoscientific acupuncture courses as CEU's for its membership. The AMMA recognizes the mystery of faith and respects the beliefs and practices of people of faith including prayer, laying on of hands, and spiritual healing but it is not within the purpose or mission of the AMMA to engage in or promote such forms of faith healing. The purpose and focus of the AMMA is the promotion of manual medicine and therapy that is evidence based, and corrective and restorative in application. The AMMA also recognizes that some elements of the TCM acupuncture community have adopted metaphysical and paranormal practices, make claims for spiritual healing abilities and provide such on a fee for service basis. It is the opinion of the AMMA that such practices do not constitute the ethical or legitimate practice of corrective and restorative acupuncture therapy and in a significant number of cases constitute health care fraud. The AMMA Board of Advisors believes that the situation regarding pseudoscientific acupuncture education and practices within the TCM acupuncture community has advanced to the point of becoming a serious problem that is adversely affecting the overall professional image and reputation of acupuncture in the U.S. Techniques, Practices and Systems of Acupuncture not Accepted by the AMMA: (Abbreviated) The following list of techniques, practices, and systems of acupuncture is submitted as an example of the types of acupuncture or related therapies that are not accepted or recommended practices for AMMA members or for patient treatment within the medical acupuncture profession:
In previous scientific papers published by the AMMA the subject of pseudoscientific information and practices based upon non physiological theories of body function have been outlined in detail. Pseudoscientific theories and practices based upon non physiological theories of body function are rampant within the acupuncture community. Included within this collection of popular acupuncture concepts and practices would be the underlying theories contained within treatment methods such as trigger point therapy. In addition the acupuncture and general massage communities are sharing continuing education courses and many of these courses from both disciplines are based upon non physiological theories and pseudoscientific information. An example of this kind of low level educational subject matter and practice includes acupoint muscle release and aroma reflex therapy. When a health care discipline raises to the level of a regulated health care profession it is incumbent upon its members to subscribe to a higher level of accountability. Basing accountability upon minimum numbers of hours in training, and not upon the scientific integrity of educational content represents a failure of the governing and leading bodies within the acupuncture community to competently direct the profession. More important than membership numbers are the values and ethics upon which we define ourselves. When a profession lays claim to the domain of human pain and suffering and purports to provide relief and comfort to the public for such conditions, then the ethical bar is set higher. American Medical Acupuncture Association
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