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HB 4710: Acupuncturists are trying again to license their quackery—and more

Last month, HB 4710, a bill to license acupuncturists, was considered by the Michigan House of Representatives Health Policy Committee. If passed into law, HB 4710 would do far more than license the quackery that is acupuncture. It would also expand the scope of practice of acupuncturists to include homeopathy, “health coaching”, and dietary advice, and is yet another example of what practitioners of pseudoscientific medicine crave: State-granted legitimacy.

If there’s one thing that practitioners of pseudoscientific medicine and quackery crave, it’s respectability. They want to be taken seriously by patients and physicians, because with respectability means no longer being viewed as quacks or even fringe and acceptance as legitimate health care providers. This is a fight that they’ve been waging at least 50 or 60 years, and it’s a battle raging in my state now with a new bill, HB 4710, which would license acupuncturists. The success that they’ve had can be seen in the evolution of how a lot of quackery is described. As I discussed several years ago, way back in the mists of time, say, 50 years ago, “quackery” was the preferred term used to refer to ineffective and potentially harmful medical practices not supported by evidence. Not surprisingly, quacks and charlatans did not like this.

Beginning in the 1960s and 1970s, supporters of quackery decided that they would never get anywhere selling their products, except to a small minority of people, if they continued to allow physicians to define their favorite quackery as being…well, quackery. Thus was born the term “alternative medicine”. Although practitioners of alternative medicine liked this term better than the terms “quackery” and “quacks”, they were, not surprisingly, still not satisfied. Thus was born in the 1990s the term “complementary and alternative medicine” (CAM). Because CAM therapies are used in addition to real medicine, over a relatively brief period of time the name change had its intended effect. No longer did many physicians automatically view modalities that were once considered quackery, later considered “alternative”, and now considered “CAM” as quackery, and those that still did were dismissed as close-minded, stubborn, and dogmatic, relics who were trying to swim against the coming tide of wonderful CAM magic that would transform medicine in the future.

Of course, the latest evolution of this term is “integrative medicine”. It came about beginning around 20 years ago because “complementary” in CAM implied that the nostrums that fell under the rubric of CAM were somehow less than real medicine (which, of course, they are—much less—but that’s not what their advocates belief). They were, after all, “complementary” or “alternative”. Medicine was the cake, and their wares were just the icing. That wasn’t good enough. They craved respect. They wanted to be co-equals with physicians and science- and evidence-based medicine. The term “integrative medicine” (IM) served their purpose perfectly. No longer were their treatments merely “complementary” to real medicine. Oh, no. Now they were “integrating” their treatments with those of science- and evidence-based medicine! The implication, the very, very, very intentional implication, was that alternative medicine was co-equal to science- and evidence-based medicine, an equal partner in the “integrating”. Further permutations are evolving as well, the most common of which is “integrative health”, in order to imply that “integrative medicine” is about more than just medicine, but rather overall health. Unfortunately, this moniker for integrating quackery into medicine (or health) is catching on.

That, of course, was still not enough. What’s the ultimate demonstration that a medical practice is accepted by society? Obviously, it’s licensure by the state. Practitioners of unscientific modalities, such as chiropractors, acupuncturists, naturopaths, and others crave licensure by the state. Chiropractors have been the most successful, having achieved licensure in all 50 states, and we’ve frequently written about attempts by naturopaths to claim licensure and be accepted as equivalent to primary care physicians, but acupuncturists have not been idle. They’ve been trying to be licensed in my state, and last week I did my part to oppose the licensure of acupuncturists. I’ll discuss the current state of the legislation and then provide an example of what can happen in a state that actually does license acupuncturists to show the consequences of licensing a pseudoscientific mystical modality that’s far more based on a prescientific superstitious understanding of how the body works than it is of anything resembling a modern scientific understanding of human physiology, genetics, and biochemistry.

HB 4710: Michigan acupuncturists try to claim licensure and expanded scope of practice

Less than two weeks ago, Jann Bellamy and I got an email from CFI-Michigan asking for assistance opposing HB 4710, a bill that was going to come before the Health Policy Committee later that week. Unfortunately, Thursday is my main clinic day, and I only had two days’ notice. I couldn’t very well cancel clinic on such short notice, particularly given that I’m going to miss a clinic this week because of the July 4 holiday. That didn’t mean I wasn’t willing to help. Of course, these sorts of legislative hearings are often announced on short notice, which means in many cases that only those without jobs or the most passionately engaged can manage to drop everything they’re doing and journey to Lansing to attend these meetings. I had experienced the same thing a few years ago when misbegotten right-to-try legislation was pushed through the Michigan legislature.

First, however, let’s take a look at HB 4710 itself. Before I discuss the content of HB 4710 itself, I should point out that in the State of Michigan, acupuncturist is a title that is a registered profession. Basically, right now all that acupuncturists have to do is to register with the state, submit a background check, and pay a $275.75 fee.

So what would HB 4710 do? It would change the profession of acupuncturist in Michigan from a registered profession to a licensed profession. It would also turn “acupuncturist” into a protected term that can only be used by licensees and seems to establish a presumption in favor of being awarded a license as long as an individual has education or training “appropriate to the practice of acupuncture”. There would also be a continuing education requirement for acupuncturists seeking license renewal.

If that were all that HB 4710 would do if passed into law, that would be bad enough, but licensing acupuncturists is not all that it would do. Come, my friends, let’s read a bit of the text. Basically, the bill expands the scope of practice of acupuncturists to include:

(A) “ACUPRESSURE” MEANS A FORM OF MANUAL THERAPY IN WHICH PHYSICAL PRESSURE IS APPLIED TO VARIOUS POINTS ON THE BODY. (B) (a) “Acupuncture” means the insertion and manipulation of needles through the surface of the human body. at specific locations on the human body for the prevention or correction of disease, injury, pain, or other condition

. ACUPUNCTURE INCLUDES, BUT IS NOT LIMITED TO, LASER ACUPUNCTURE, ELECTROACUPUNCTURE, PRICKING THERAPY, DRY NEEDLING, AND INTRAMUSCULAR STIMULATION. (C) (b) “Acupuncturist” means an individual who practices acupuncture and is registered, or otherwise authorized, LICENSED under this part TO ENGAGE IN THE PRACTICE OF ACUPUNCTURE. (D) “CUPPING” MEANS THE PLACEMENT OF A SPECIALLY DESIGNED CUP ON THE BODY TO CREATE SUCTION. (E) “DERMAL FRICTION” MEANS THE USE OF REPEATED, CLOSELY TIMED, UNIDIRECTIONAL PRESS-STROKING WITH A SMOOTH-EDGED INSTRUMENT OVER A LUBRICATED AREA OF THE BODY. (F) “DIETARY COUNSELING” MEANS THE PROCESS OF ADVISING A PATIENT ABOUT HEALTHY FOOD CHOICES AND HEALTHY EATING HABITS IN ACCORDANCE WITH EAST ASIAN MEDICAL THEORY. (G) “DRY NEEDLING” MEANS A REHABILITATIVE PROCEDURE USING FILIFORM NEEDLES TO PENETRATE THE SKIN OR UNDERLYING TISSUES BY TARGETING ONLY MYOFASCIAL TRIGGER POINTS AND MUSCULAR AND CONNECTIVE TISSUES TO AFFECT CHANGE IN BODY STRUCTURES AND FUNCTIONS FOR THE EVALUATION AND MANAGEMENT OF NEUROMUSCULOSKELETAL PAIN AND MOVEMENT IMPAIRMENT. DRY NEEDLING DOES NOT INCLUDE THE STIMULATION OF AURICULAR POINTS OR OTHER ACUPUNCTURE POINTS. (H) “EAST ASIAN MEDICINE TECHNIQUES” INCLUDES, BUT IS NOT LIMITED TO, ACUPUNCTURE, MANUAL THERAPY, MOXIBUSTION, HEAT THERAPY, DIETARY COUNSELING, THERAPEUTIC EXERCISE, ACUPRESSURE, CUPPING, DERMAL FRICTION, HOMEOPATHY, LIFESTYLE COACHING, AND TREATMENT WITH HERBAL MEDICINES. (I) “HEAT THERAPY” MEANS THE USE OF HEAT IN THERAPY, SUCH AS FOR PAIN RELIEF AND HEALTH. (J) “HERBAL MEDICINE” MEANS THE INTERNAL AND EXTERNAL USE OF A PLANT OR A PLANT EXTRACT, A MINERAL, OR AN ANIMAL PRODUCT, THAT IS NOT A PRESCRIPTION DRUG AS THAT TERM IS DEFINED IN SECTION 17708. (K) “HOMEOPATHY” MEANS THE USE OF A HIGHLY DILUTED NATURAL REMEDY FROM THE PLANT, MINERAL, AND ANIMAL DOMAIN. (L) “LIFESTYLE COACHING” MEANS THE PROCESS OF ADVISING A PATIENT ABOUT HEALTHY LIFESTYLE CHOICES AND HABITS IN ACCORDANCE WITH EAST ASIAN MEDICAL THEORY. (M) “MANUAL THERAPY” MEANS THE APPLICATION OF AN ACCURATELY DETERMINED AND SPECIFICALLY DIRECTED MANUAL FORCE TO THE BODY, EXCLUDING A HIGH-VELOCITY, LOW-AMPLITUDE THRUST TO THE SPINE. (N) “MOXIBUSTION” MEANS BURNING THE DRIED PLANT Artemisia vulgaris ON OR VERY NEAR THE SURFACE OF THE SKIN AS A FORM OF THERAPY. (O) “PRACTICE OF ACUPUNCTURE”, SUBJECT TO SUBSECTION (2), MEANS THE USE OF TRADITIONAL AND CONTEMPORARY EAST ASIAN MEDICAL THEORY TO ASSESS AND DIAGNOSE A PATIENT, TO DEVELOP A PLAN TO TREAT THE PATIENT, AND TO TREAT THE PATIENT THROUGH EAST ASIAN MEDICINE TECHNIQUES.

Of all of these, H is the key. Basically, if passed into law, this provision would grant acupuncturists the scope of practice to do anything that is associated with “East Asian Medicine”, including acupuncture, manual therapy, moxibustion, heat therapy, dietary counseling, therapeutic exercise, acupressure, cupping, dermal friction, homeopathy, lifestyle coaching, and herbal medicine. Two of these stand out. For instance, since when has homeopathy ever been a part of “East Asian medicine”? When has homeopathy had anything whatsoever to do with traditional Chinese medicine or acupuncture? It’s its own quackery, “Western” or European quackery! Homeopathy was invented by Samuel Hahnemann in the late 1700s…in Germany! Yet, for some reason, acupuncturists in Michigan want to embrace it. It’s almost as though the acupuncturists promoting HB 4710 want to grab as much quackery as they can get away with and codify it into law allowing them to do almost anything, as long as it isn’t chiropractic (which this bill would prohibit them from doing, although it would let them do “manual therapy”) and they can claim it as part of “Eastern Asian medicine.”

Note also how this bill would let acupuncturists embrace “lifestyle coaching” and dietary advice as well. Apparently acupuncturists don’t think that acupuncture is woo enough for them and want to expand their scope of practice as much as possible, in much the same way naturopaths try to expand their scope of practice to be able to prescribe actual pharmaceutical drugs and represent themselves as primary care providers. (Never mind all that vitalistic nonsense and how strongly antivaccine most naturopaths are.)

Of course, there would be a board to regulate acupuncturists:

Sec. 16525. (1) The

WITHIN 12 MONTHS AFTER THE EFFECTIVE DATE OF THE AMENDATORY ACT THAT AMENDED THIS SECTION, THE department, in consultation with the board, shall promulgate rules setting forth the minimum standards for registration as an acupuncturist. The department, in consultation with the board, may adopt by reference the professional standards issued by a certified program that is recognized by the national commission for certifying agencies or by a nationally recognized trade association.

THAT ESTABLISH THE MINIMUM STANDARDS FOR LICENSURE AS AN ACUPUNCTURIST AND IMPLEMENT THE LICENSURE PROGRAM FOR THE PRACTICE OF ACUPUNCTURE. IN PROMULGATING RULES FOR PURPOSES OF SECTION 16515(1), THE DEPARTMENT, IN CONSULTATION WITH THE BOARD, MAY ADOPT BY REFERENCE THE PROFESSIONAL STANDARDS ISSUED BY A CERTIFIED PROGRAM THAT IS RECOGNIZED BY THE NATIONAL COMMISSION FOR CERTIFYING AGENCIES. IN PROMULGATING RULES FOR PURPOSES OF SECTION 16515(2), THE DEPARTMENT, IN CONSULTATION WITH THE BOARD, SHALL CONSIDER WHETHER AN APPLICANT HAS COMPLETED SYSTEMATIC ACUPUNCTURE EDUCATION THAT INCLUDES LIVE LECTURES, DEMONSTRATIONS, AND SUPERVISED CLINICAL TRAINING SPECIFIC TO ACUPUNCTURE.

That’s the problem with the state regulating quackery. It isn’t science-based practitioners defining the standard of care and educational requirements for “professions” like acupuncture. It’s the quacks themselves. We’ve seen this issue with naturopaths, whose board in California, for instance, sought to sweep the particularly egregious death of a patient due to quackery under the rug. It’s why I argue that licensed quack “professionals” (like naturopaths) are no safer or less quacky than unlicensed ones.

Let’s look at an example in acupuncture.

Arizona acupuncture board “takes on the opioid crisis”

Acupuncture is a licensed profession in Arizona, complete with an Acupuncture Board of Examiners, as are so many other forms of quackery, such as homeopathic physicians, naturopaths, and more. On Friday, I came across an article on Cronkite News by Tim Ryan entitled “Arizona acupuncture board takes on the opioid crisis“:

The State of Arizona Acupuncture Board of Examiners has entered the fight against opioid abuse, approving chemical dependency programs for a form of acupuncture that involves the outer ear. Supporters say auricular acupuncture helps people break free of addiction, but a skeptic says there’s zero evidence acupuncture relieves any condition. “I don’t think (auricular acupuncture is) the complete answer, but I think it can really help change the tide,” said Dr. Mario Fontes, clinic director of Natural Medicine & Detox in central Phoenix, which offers a board-approved chemical dependency program.

That skeptic, as you’ll see, is our very own Steve Novella. Unfortunately, this article plays out as a typical annoying article about quackery in mainstream press, full of false balance. Basically, it’s a “he said/he said” article, pitting Novella against a member of the State of Arizona Acupuncture Board of Examiners, Mario Fontes. You can tell where the reporter’s sympathies lie in the way that he gives Fontes the last word. After listing Novella’s reasonable criticisms of acupuncture that any regular reader of this blog or Neurologica Blog would be familiar with (acupuncture is a theatrical placebo; acupuncturists cherry pick studies; acupuncture is not benign; licensing acupuncture grants legitimacy to pseudoscience), Ryan allows Fontes to dismiss it all thusly:

Fontes said he has faced critics like Novella his entire career, but he remains undeterred. “Anytime there’s something that’s not mainstream, eventually, it becomes integrated, and there’s always going to be the people opposed to that,” he said. “The people who want our help, we’re here for. The people who don’t, that’s OK.” Noting that acupuncture has been practiced for millennia, Fontes contends that something more than a placebo effect is occurring, while medicines we’ve had for only a century, such as antibiotics, already are failing. “It’s the predominant belief that the true path to health is drugs, radiation and surgery,” Fontes said. “I just don’t believe that.”

Of course, acupuncture, at least as we know it, has not been “practiced for millennia.” Acupuncture evolved from the Eastern version of a very well known European form of ancient medical practice, namely bloodletting. As Steve Novella noted, needles were originally lancets and acupuncture points were located over veins to be opened. Qi, or the Chinese concept of the life force, was believed to be at least in part in the blood, and bloodletting was thus thought to free the flow of qi. Unsurprisingly once you know this, this concept was closely related to the Galenic concept of using bloodletting to free the flow of static blood in the tissue. It’s also been argued that some acupuncture points are based on astrology. Indeed, reading descriptions from as recently as 106 years ago of the use of acupuncture in China by a Scottish surgeon named Dugald Christie produces horrifying examples of how acupuncture was practiced in the far more recent past than advocates would have you believe:

Chinese doctors own that they know nothing at all of surgery. They cannot tie an artery, amputate a finger or perform the simplest operation. The only mode of treatment in vogue which might be called surgical is acupuncture, practised for all kinds of ailments. The needles are of nine forms, and are frequently used red-hot, and occasionally left in the body for days. Having no practical knowledge of anatomy, the practitioners often pass needles into large blood vessels and important organs, and immediate death has sometimes resulted. A little child was carried to the dispensary presenting a pitiable spectacle. The doctor had told the parents that there was an excess of fire in its body, to let out which he must use cold needles, so he had pierced the abdomen deeply in several places. The poor little sufferer died shortly afterwards. For cholera the needling is in the arms. For some children’s diseases, especially convulsions, the needles are inserted under the nails. For eye diseases they are often driven into the back between the shoulders to a depth of several inches. Patients have come to us with large surfaces on their backs sloughing by reason of excessive treatment of this kind with instruments none too clean.

That bit about “excess of fire in the body” reminds me of something, namely how the traditional Chinese medicine (TCM) concepts underlying acupuncture involve “imbalances” in the “Five Elements”. In that, TCM is very similar to “ancient Western concepts”, namely humoral theory, which posited that disease is due to an “imbalance” in the four humors. As I like to say (sarcastically, of course), TCM is so very trendy, but where’s the love for traditional Western medicine? Indeed, TCM isn’t even very ancient. What we know today as TCM was a result of Chairman Mao, who was facing a dire shortage of real physicians, instructing his medical authorities to harmonize the many forms of Chinese folk medicine into a seemingly consistent whole and promote its “integration” with “Western medicine”. Basically, the history of TCM as promoted by its advocates has been retconned to leave that aspect out. Indeed, acupuncture itself, at least as practiced now, is not ancient. In the 1930s a Chinese pediatrician named Cheng Dan’an proposed that needling therapy be resurrected because (he thought then) its actions could be explained through neurology. He also replaced the previously used coarse needles with the fine filiform needles in use today. No wonder there are so many “styles” of acupuncture.

Of course, I’ve written many times about how acupuncturists and other advocates of integrative medicine have been co-opting the opioid addiction crisis to promote whatever pseudoscientific medicine they believe in. Basically, the claim is that acupuncture, naturopathy, or whatever pseudoscience the advocates believe in can alleviate the opioid crisis by providing “nonpharmacological treatments” to relieve chronic pain. This has led to acupuncture advocates, for instance, to lobby various states to have Medicaid programs cover acupuncture. Some of the ways this misuse of the opioid crisis have been quite horrible, such as the proposal in Oregon to require that Medicaid patients be involuntarily weaned from opioids in favor of these “integrative” nonpharmacological approaches to pain, damn the evidence. Not surprisingly, three acupuncturists and a chiropractor sit on the committee that made this proposal.

Of course, one aspect of this article is that, whether intentionally or not, it reveals just how much other quackery is associated with acupuncture. This occurs through the focus on Mario Fontes, whose interest in alternative medicine “began with homeopathy, and later he expanded into acupuncture.” Yes, that’s homeopathy, or, as I like to call it, The One Quackery To Rule Them All. He’s also the one pushing auricular acupuncture as a treatment for opioid addiction:

First developed by French physician Paul Nogier in the 1950s, auricular acupuncture, also known as acu-detox, uses needles placed in one to five acupuncture points in the outer ear. Proponents say the practice offers a non-pharmacological approach to managing a range of issues, from pain to stress to post traumatic stress disorder to opiate withdrawals. The acupuncture board has made efforts to make it easier for auricular acupuncturists to gain certification for the past few years to help address the opioid crisis, said the board’s executive director, David Geriminski.

Unfortunately, auricular acupuncture has become popular in the military in the form of “battlefield acupuncture” (no, I’m not kidding; they’ve even started teaching acupuncture to medics in Iraq) and in the Veterans Health Administration. It is, unsurprisingly, even more quacky than regular acupuncture.

That’s not all, though. Mario Fontes offers quite the cornucopia of what I and skeptics consider quackery himself, as the perusal of his website, Natural Medicine & Detox, quickly reveals. For instance, here he is in his role as a clinical instructor at the American Medical College of Homeopathy and the Phoenix Institute of Herbal Medicine and Acupuncture, waxing poetic about combining The One Quackery To Rule Them All (homeopathy) with acupuncture:

Hilariously, Fontes goes on about how the “energetics” of acupuncture can be applied to the “energetics” of homeopathy and how homeopathy is safer than herbal medicine, which is probably true (because most homeopathic remedies are diluted to the point of being just water) but irrelevant. He also offers colon hydrotherapy; homeopathy (of course!); detox foot baths (the quackiest of quacky); “nutritional IVs” (also very quacky); chelation therapy (dangerous quackery); and much, much more.

Basically, acupuncturists often offer far more quackery than just acupuncture, and HB 4710 would license them in Michigan to do just that.

Acupuncture in Michigan

Checking out the website of a member of the State of Arizona Board of Acupuncture Examiners and observing all the quackery this board member offers led me to wonder whether the same would be true in Michigan. Some Googling rapidly led me to a listing of acupuncturists in Michigan. One practice that’s seemed to have well-optimized its SEO such that it shows up high on Google searches for acupuncture in Michigan is, appropriately enough, Michigan Associates of Acupuncture and Integrative Medicine. It offers the usual unproven acupuncture treatments along with TCM, craniosacral therapy, herbal medicine, and “nutrition”. Another large acupuncture practice, Acupuncture of West Michigan, offers acupuncture and herbal medicine, claiming that acupuncture and TCM can treat cardiac conditions (angina pectoris, atherosclerosis, anemia, hypertension, palpitations, coronary heart disease); neurological disorders (Bell’s palsy, dizziness, headaches, migraines, neuralgia, stroke, paralysis, tics, tremors); addictions (smoking, drugs, alcohol); GI conditions (low appetite, food sensitivities, peptic ulcer, constipation, colitis, Crohn’s disease, diarrhea, indigestion, irritable bowel syndrome, nausea, vomiting, gastritis); and, well, basically almost everything except, fortunately, cancer, noting:

With our modern diet and lifestyle, Acupuncture and Herbs are usually needed to effect a cure. But, making these changes will almost always get people better faster and help them stay healthy. Acupuncture is for treatment. Lifestyle is for prevention.

Other prominent acupuncture clinics include the Family Wellness Center, which in addition to acupuncture offers BioSET (R) Allergy Treatment and herbal therapy; Grand Wellness, which also offers reiki, distance healing, and crystal therapy; and Michigan Laser and Acupuncture Center, which offers something called Meridian Regulatory Acupuncture (MRA), which “introduces electrons where they are needled in the body to activate its defense, compensatory and regulating mechanisms in the control of pain and of disorder. MRA is a standardized acupuncture application, and controls the delivery of pure flow of electrical energy into the precise points making the treatment more efficient and effective”.

Yes, I think that, should acupuncturists in Michigan become licensed, they will expand their offerings of quackery to match those of acupuncturists in Arizona.

Oppose HB 4710 and bills licensing acupuncture, wherever they are introduced

Fortunately, my state representative (Matt Koleszar) is on the Michigan House Health Policy Committee. Unfortunately, one of the sponsors of HB 4710 (Hank Vaupel) is the chair of the Health Policy Committee. Still, I wrote to both Rep. Kolezar and cc’ed the secretary responsible for organizing testimony and statements before the committee:

Dear Rep. Koleszar: As a constituent in your district, I am writing to express the strongest opposition that I can to HB 4710, the bill currently before the House Health Policy Committee to change the profession of acupuncturist from a registered profession to a licensed profession. My presumption is that you—along with everyone on the Health Policy Committee—will agree that medicine should be based on solid science showing that the interventions used are effective and safe. Thus, state licensure should only be granted to medical professions whose practices are supported by science and evidence. The reasons are two-fold: First, to protect the public from dubious and potentially dangerous practitioners and, second, because state licensure confers the imprimatur of the state, with all the respectability that provides, on the profession. Contrary to what its practitioners and supporters claim, acupuncture is supported by neither science nor evidence. Although I do not presume to speak for anyone other than myself on this topic, to make you aware of my qualifications, I will state that I currently hold the title of Professor of Surgery at Wayne State University. I am also a surgical oncologist and breast cancer researcher at the Barbara Ann Karmanos Cancer Institute and have been a medical blogger for nearly 15 years. In that latter role, I write my personal blog (respectfulinsolence.com) and serve as managing editor of Science-Based Medicine (sciencebasedmedicine.org), a group blog dedicated to discussing the interface of science, pseudoscience, and medicine, and there is copious material published on both blogs to support my arguments here. Acupuncture has no basis in human physiology or science. “Meridians” used by acupuncturists to guide the insertion of their needles have no basis in anatomy, and “qi,” the “life energy” whose flow, acupuncturists claim, is unblocked or redirected, has no basis in physics or chemistry and has never been detected or characterized. It is claimed that acupuncture is effective for a wide variety of conditions with little or no relationship in pathophysiology (cause), which, in my experience, is a huge red flag that it doesn’t work for anything, other than through nonspecific effects. Indeed, there is a reason why acupuncture has been referred to as a “theatrical placebo,” because that’s what it is. (Please see attached PDF for an excellent discussion of this.) I would remind you and the committee that the usual standard that the FDA uses for approving a new treatment is that it be more effective than placebo. Although there are individual studies that report acupuncture to be better than placebo for some ailments, when you critically examine the totality of the evidence, the effects of acupuncture are indistinguishable from sham acupuncture. Basically, it doesn’t matter where you stick the needles, and it doesn’t even matter if you stick the needles in. Consistent with the lack of specificity of acupuncture effects, there is a 2009 German study [Arch Intern Med.2009;169(9):858-866] that shows that twirling toothpicks against the skin is just as effective as “true” acupuncture. If all this bill did were to license acupuncturists, that would be bad enough, but it goes beyond that. If passed, it would expand the scope of practice to include moxibustion, homeopathy (which has nothing to do with acupuncture or Traditional Chinese Medicine), acupressure, cupping, and dermal friction (otherwise known as gua sha) among other “treatments.” Homeopathy, in particular, is pure quackery based on pseudoscience and mystical thinking that has nothing to do with acupuncture. Acupuncture originated in Asia, although it is unclear how long ago; homeopathy originated independently in Germany in the late 1700s and has never been part of traditional Chinese medicine. From a historical and factual point of view, to claim, as this bill does, that homeopathy is part of “East Asian medicine” is so inaccurate as to be risible. As for why I call homeopathy “pure quackery, I will explain. Homeopathy is based on two “Laws”: (1) the Law of Similars, which states that, to relieve a symptom you need to use something that causes that symptom; and (2) the Law of Infinitesimals, which states that a remedy becomes stronger the more it is diluted. The Law of Similars has no basis in science, physiology, or biology; it is, in essence sympathetic magic turned into medicine by Samuel Hahnemann, the creator of homeopathy. The Law of Infinitesimals is even more ridiculous. Chemists know that any dilution more than around 12C (twelve 100-fold dilutions) is unlikely to have any starting substance left. This is because a mole of a substance only has around 6 x 10^23 molecules, and a 12C solution is a 1 x 10^24 dilution. I would point out to the committee that many homeopathic remedies are diluted to 30C (a 10^60-fold dilution) or even 100C—or even higher. I would also point out that the number of atoms in the known universe is only estimated to be around 10^78 to 10^82. The math and chemistry of homeopathy are ridiculous. Not surprisingly, homeopathy is no better than placebo, because it is, in essence, water. The other treatments encompassed by the scope of practice expansion granted acupuncturists by this bill are scarcely any better in terms of their evidence base. Traditional Chinese medicine, for instance, is based on prescientific beliefs about how the body works not validated by science and includes such diagnostic modalities as “tongue diagnosis” and “pulse diagnosis,” neither of which is validated by science. In addition to the issue of state licensure conferring respectability to pseudoscience, a major problem with licensing a specialty that is not based in science is that it will be members of that specialty who form a board to oversee the practitioners of that specialty, which means that there will be no scientific standards regulating that specialty. In other words, acupuncture will be what acupuncturists claim that it is, and the standard of care will be what acupuncturists dictate it to be. Neither will be based in science, and, contrary to the intent of the bill, the public will not be protected from bad actors any more than they are by the present system. In addition, the reason practitioners of unconventional specialties like acupuncture so crave state licensure is that it is the first step to requiring insurers to pay for their services. This, if it comes to pass (as it likely will if acupuncture is licensed), will result in a diversion and waste of precious health care resources to pay for ineffective therapies. In conclusion, acupuncture does not meet the minimal requirements for a medical specialty to be licensed by the state. It is not based in science, but rather in prescientific mysticism; there is no clear standard of care to guide regulation; there is no clear standard of education for practitioners; and available scientific evidence is most consistent with its effects being all nonspecific or placebo effects, an expected finding given the scientific implausibility of the practice. Worse, HB 4710 would broaden the scope of acupuncturists to include the use of modalities that, like homeopathy, can only be described as pure quackery. I urge you and the committee to reject this bill and not send it to the full House for consideration and request that my email and the accompanying article be included in the evidence presented during the June 20 committee meeting. Sincerely Orac’s real name

For good measure, I included Steve Novella and David Colqhoun’s famous article, “Acupuncture is a theatrical placebo: the end of a myth“. If anyone else wants to comment on the licensure of acupuncture in Michigan, feel free to use my letter as a template. In addition, Jennifer Beahan, executive director of CFI-Michigan, testified in person, providing more points to make:

If you live in Michigan, now is the time to contact your state representative to express opposition to HB 4710, particularly if your representative sits on the Michigan House Health Policy Committee, as my representative does. This isn’t the first attempt by acupuncturists to attain licensure, and it surely won’t be the last; that is, assuming they are unsuccessful, an outcome that I will do my best to help to bring about. Unfortunately, I have been unable (yet) to find the online transcript of the meeting. The Health Committee webpage seemed not to be working properly Saturday night as I was finishing this. I had hoped to briefly note the status of the bill now, but I was thwarted.

If you don’t live in Michigan, keep an eye out for these sorts of bills in your state. Often they are introduced on the down-low, and that results in only advocates writing to legislators and showing up to testify at meetings of the relevant committees. It truly is, as Jann Bellamy describes it, legislative alchemy.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

27 replies on “HB 4710: Acupuncturists are trying again to license their quackery—and more”

I haven’t been able to find out if it’s gotten out of the Health Policy Committee yet. The last time acupuncturists pushed a bill, they did it in the Senate, and it didn’t get out of committee, IIRC. This bill is virtually identical.

Acupuncture and chiropractic have already inserted themselves into the supposed mainstream by winning Medicare coverage and now with the explosion of cannabis oil (all my neighbors are passing samples around to treat their multiple complaints mostly caused by booze, obesity and cigarettes. State legislators largely come from the ranks of their supporters and here in Wisconsin, we have a State University System that includes “pre-chiropractic” in the undergranduate curriculum right alongside pre-med and pre-dental. I applaud your efforts, and I hope your letter is heeded, but I’m worried that the ship has sailed. I think they want to be licensed so they can clean up on the insurance payments already sadly enshrined in law.

“DERMAL FRICTION” MEANS THE USE OF REPEATED, CLOSELY TIMED, UNIDIRECTIONAL PRESS-STROKING WITH A SMOOTH-EDGED INSTRUMENT OVER A LUBRICATED AREA OF THE BODY.

So, wait, you get greased up and this is supposed to produce friction?

I used to have way too much second-hand knowledge of this business, for reasons that I don’t recall. “Soapy massage?”

Then again, there was all the low-rent stuff in Berwyn.

If acupuncturists are granted state licenses to act as medical professionals, does that mean they have a fiduciary duty to their patients? How do they provide services under the umbrella of fiduciary duty when their services are bogus and they have all manner of conflicts of interest (i.e. selling supplements out of their offices)?

Shhh. Don’t confuse people with facts. Nothing to see here. Ignore the little man behind the curtain.

This has already happened in Oregon. In fact, the same board that licenses physicians also licenses acupuncturists.

At least in Oregon, when I lived there anyway–some years ago–at least acupuncture had to be done by an MD to be covered by insurance. I used to be naive enough to think that meant it had some kind of legitimacy!

Shouldn’t licensings require them to submit to oversight and regulatory control first? That should be a basic condition of anyone wanting government authorization and support for their business.

Of course they should, but they don’t. That is, the established paradigm for oversight is self-policing in the form of state medical boards for MDs. These are, almost universally, a joke. Of course, extending that model to chiros, naturos, or needlers is only going to be worse not better,. If we had real oversight and regulatory control for MDs, it would sure be easier to demand that from alt-med. But you can imagine how MDs have reacted to the idea of “oversight and regulatory control” over the decades. I would also note that most MDs seem nowhere near as concerned about quackery as Orac and the other docs who are regular commenters here. Rather, the majority seem to be what Orac refers to as “shruggies”.

Like many weird and inefficient things about the way the American medical system works (or doesn’t), fear of Communism is partly to blame.
It’s astonishing how many systems that exist in the rest of the developed world were specifically and deliberately not implemented in the US because some people (people in charge) feared it would lead down a slippery slope to Communism. (Or they said that they were afraid of Communism, and if the alternative policies gave them power and money, gee, that’s nice.)

So, no independent oversight of MDs? Blame people blaming Communism.

[Please note the use of Communism with a capitol C, to denote a 20th century political philosophy that may or may not have much relationship with small-c communism. Also note that the way Communism was depicted in the USA at that time was not particularly accurate.]

“If there’s one thing that practitioners of pseudoscientific medicine and quackery crave, it’s respectability. […] As I discussed several years ago, way back in the mists of time, say, 50 years ago, “quackery” was the preferred term used to refer to ineffective and potentially harmful medical practices not supported by evidence. Not surprisingly, quacks and charlatans did not like this.”

Well… couldn’t agree more. Moreover, in France, where homeopathy is practiced by regular doctors, there has been some pressure to stop covering the cost of homeopathy by Socialized Medicine. Notably by this collective of doctors.

http://fakemedecine.blogspot.com

And that’s how it’s going down in the media… Let me introduce the participants in the “debate”. Blandine Brocard: Member of parliament (in Macron’s ruling political party) who supports homeopathy (against Macron’s government). Daniel Scimeca: Regular doctor and homeopath. Pierre Bremond d’Ars: Regular doctor, anti-homeopathy. Frédéric Bizard: Economist specialized in medical matters, against insurance coverage of homeopathy.

Now here’s the show. Go straight to 14:18

Pierre Bremond d’Ars (14:18): “What triggered the whole controversy, on should not forget it, were the lawsuits that were directed at us, which were dealt with by the French Medical Board,”

Journalist: “Very violent, it’s very violent, I’ve seen that.”

Pierre Bremond d’Ars: “at this level, because we….”

Daniel Scimeca (14:25): “Because you did not have a brotherly behaviour [which is a behavioral requirement in French medical deontology not to criticize other doctors], and you designated your brothers [i.e. other doctors] as quacks, and it’s illegal”.

Bottom line: Never get in a situation like France where doctors are supposed to cover each other to the extent that calling a quack out for being a quack is deemed illegal.

Very interesting.

As an American visiting France (had a lovely time! People were very nice!), the pharmacies were interesting. Several seemed to sell a lot of perfumes and lotions and stuff like that, and I had to get a prescription (which they wrote and filled for me right at the register) in order to buy some Sea-Bands (yes, they’re silly, but motion sickness is at least partly about expectations, so because I wanted them to help, they did).

What was weird, as someone from the Pacific Coast of the US, is that pharmacies in Europe use a green cross (rather than Rx or a mortar and pestle) on their signs. Where I live a green cross means “weed sold here”, so I was very confused for about a day.

@ F68.10

where homeopathy is practiced by regular doctors

Yep. Would-be homeopaths follow the main 6-years cursus like every other would-be doctor, and then select homeopathy during their internat for their last 3-4 years at medical school, where others would select e.g. generalist, urologue, cardiologue, or anesthetist.
I was stunned to learn that.
That brings to memory Coluche’s old joke about politicians: “6 ans de droit, tout le reste de travers”.

And yep, ‘brotherly behaviour’ is expected between ‘colleagues’. There is some refreshing course to be done about differences between unions, syndicates (in the US sense) and guilds.

@ JustaTech

re: green cross, Rx and other symbols for pharmacy.

Now that you said it…
I am a French who have lived in North America for a while, and I have to admit, I never realized these differences. I mean, I knew there wasn’t any green cross on sight, and I eventually came to associate Rx with medical prescription, but I never integrated the info at the cultural level, and wondered how it would look then seen from the other direction, as you experienced yourself.
Sorry, just a long way for me to say the penny dropped, almost a decade after the facts.

Uh, if I had visited California and had the need to look for a pharmacy, I guess I may have embarrassingly stumbled into interesting shops…

“Electrons activate body self-defense”
Actually, foreign proteins (usually quite big) activate immune system. Problem is, that people seems to accept any random combination of scientific words.

“Daniel Scimeca (14:25): “Because you did not have a brotherly behaviour [which is a behavioral requirement in French medical deontology not to criticize other doctors], and you designated your brothers [i.e. other doctors] as quacks, and it’s illegal”.”

This “behavioral requirement” would be hilarious to anyone who’s attended an American hospital tumor conference (where patient cases are discussed) and heard the oncologists attacking other physicians and squabbling among themselves.

“This “behavioral requirement” would be hilarious to anyone who’s attended an American hospital tumor conference (where patient cases are discussed) and heard the oncologists attacking other physicians and squabbling among themselves.”

It may well be that there is overt disagreement between physicians within situations such as hospital tumor conferences. Behind closed doors, it may well be that disagreements are allowed (though I have no evidence of that, and I have a feeling that there is quite a dictatorial behaviour in French hospitals…).

However, whenever you discuss things with the public, a patient, or, more disturbingly, even in written documents that are for the eyes of physicians only (on a given case only), this “brotherly behaviour” means not criticizing other doctors’ decisions. And even less other doctors’ personalities.

It is a legally binding requirement with potentially rather severe consequences for a doctor that doesn’t abide by this rule. In the case I mentioned of doctors criticizing homeopathy, two doctors critical of homeopathy were condemned on that motive. 68 were sued and maybe more are coming.

https://translate.google.com/translate?hl=en&sl=fr&tl=en&u=https%3A%2F%2Fwww.whatsupdoc-lemag.fr%2Farticle%2Ffakemed-deux-medecins-convoquees-devant-la-justice-temoignent

Google translation: “The avalanche of trials and convocations before the disciplinary chambers of the Order for having signed the #Fakemed platform is just beginning. Because so far, only three trials have been held, which resulted in two convictions and one acquittal. The National Order of Physicians has also appealed the conviction of two doctors Champagne sentenced . As a reminder, of the 124 doctors who signed the forum that denounced homeopathy as a false medicine, only 68 doctors were prosecuted, mainly by the national union of homeopaths. New convocations have just been issued to signatory doctors.”

In other news, a Canadian former chiropractor has been ordered to pay $100 000 for her anti-vaccine publications.
https://www.cbc.ca/news/canada/nova-scotia/dena-churchill-chiropractor-discipline-vaccines-1.5200017

There is a chiropractor who used to show up in the comments on all vaccine-related articles on the CBC website. He was called out as a chiropractor and disappeared. It seems he still may be around under a pseudonym. Here’s hoping he is also nailed by his “professional” association.

I suppose I will probably will have people jump all over me. Many medical cleaning staff have alt health and anti vaccine leanings. I can think of a few who have done it a long time, and say they no longer go to the doctor. I think a component of this is I don’t want those fuckers touching me. I mean doctors can have some strange views too. One where I work had anti toilet paper sentiments. Had to get up at 2am for 4 am shift that part of the area involved picking up his poop rags off the bathroom floor in the shared doctor sleep room area (always wondered what the other doctors thought of that guy, they shared the bathroom) Anyways I know I don’t want that guy touching me.

“In other news, a Canadian former chiropractor has been ordered to pay $100 000 for her anti-vaccine publications.
https://www.cbc.ca/news/canada/nova-scotia/dena-churchill-chiropractor-discipline-vaccines-1.5200017

This was my favorite part of the article:

“Churchill had been scheduled for a hearing in late May on 15 allegations of professional misconduct and one count of conduct unbecoming a chiropractor.”

“Conduct unbecoming a chiropractor”? Did she also refer a patient with a heart condition to a cardiologist?

I don’t think anyone will come back here, but I have a major conflict of interest. I am firmly fixed against acupuncture and all the other forms of S-CAM,and though I am retired I consider myself bound by professional ethics even now, I have to also deal with my daughter. She’s a lovely young woman, great in so many respects, even sometimes awe-inspiring. She has a degree in psychology, a science-influenced field, from McGill U. She is now studying for a “degree” in acupuncture and Oriental medicine. In other words she is training in all sincerity to practice quackery, and it upsets me. I have to hold my tongue around her, and not for tongue diagnosis, WETF that is.
It very nearly caused a serious rift between us, and I have loved her with all my heart since she began to kick in utero. I try not to think about it, but whenever she is home it burns my ass to think of her wasting her great and caring heart and mind on rank nonsense. Worse, her personality will probably carry a placebo effect of its own. Patients will love her and will want to feel better for that reason added to all the others.

Old Rockin’ Dave,

Well, I’m back here. Maybe nobody else will be though. I’m not so bad …

My mom & I went round & round on these matters & I was an awful child. Mom held dual PhDs & I was a ‘justanurse’.

My mom knew how to work me, though. She’d show me something one time & then she’d let it go. Ten years later I’d see it in headlines & she would be right. The first few times I said nothing but she knew how much I read & she never said ‘I told you so’. Finally, I started grudgingly acknowledging things: Um, I saw something about those amino acids in the paper

Not only did I have to know I was wrong but the worst was that the person who had been right was my mom? Ugh! She never did say; ‘I told you so’.

Your daughter sounds amazing & I’m sure she got that from you. It’ll work out just fine.

[…] As I’ve said before many times, it doesn’t matter where you stick the needles in (“acupuncture points” or not) and it doesn’t even matter if you stick the needles in (toothpicks work as well), the effect is the same, nonspecific and placebo. As we say, acupuncture is a theatrical placebo. In its present form, it isn’t even ancient, particularly for animals. Indeed, the filiform needles currently used by acupuncturists were only introduced in the 1930s. […]

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