Acupuncture in 2000:
Working its way into mainstream medicine

This ancient healing system continues to make inroads in modern health care. Are your patients among the 1 million Americans who have signed on?

By Deborah Grandinetti
Senior Editor

David Bole practiced acupuncture in Gainesville, FL, for more than a decade without getting a single referral from a physician—including any of those who were seeing him on the sly for their own health problems. It didn't matter that he had arranged for a local physician to supervise him. The medical community considered the discipline too fringe.

Things began to change in the mid-'90s—around the time the FDA decided that acupuncture needles no longer had to be labeled for "investigational use," and the National Institutes of Health found "sufficient evidence of acupuncture's value to extend its use into conventional medicine." Now Bole gets a lot of referrals, particularly for conditions like carpal tunnel syndrome or migraines where, he says, "doctors don't want to use a drug or do surgery."

That's not the only shift. Now one in every 10 enrollees in the Florida School of Acupuncture and Oriental Medicine, which Bole directs, is a physician. They'll join an estimated 3,000 to 5,000 medical acupuncturists practicing in the US.

Some medical groups are embracing acupuncture with enthusiasm. For example, Minor & James Medical, a Seattle multispecialty group with more than 80 physicians, refers patients to on-site acupuncturists as part of the treatment protocol for fibromyalgia. (The regimen also includes physical therapy, nutritional counseling, psychotherapy, and meditation training.) At the Center for Complementary Medicine at Advocate Medical Group in Park Ridge, IL, the acupuncturists on staff participate in the weekly case review conference, which allows everyone on the physician-led team to learn the appropriate use of the discipline and to see how patients respond.

But this level of integration is still rare, despite the estimated 10 million treatments received each year by more than 1 million American patients. Experts say it will take another 10 years for the integration to become seamless.

For now, acupuncture and conventional medicine remain largely separate. Relatively few of the 12,000 licensed nonphysician acupuncturists practicing in the US work in medical settings. And the overwhelming majority of their patients self-refer. Although specific figures for acupuncture aren't available, a study by the Yale University Departments of Psychiatry and Public Health, published in JAMA in August 1999, found that only 8.8 percent of individuals who used an unconventional therapy, such as acupuncture, received a physician referral.

That number isn't likely to increase much any time soon. Although some insurers reimburse patients for acupuncture treatments only if a physician refers them, popular new "affinity" programs—which offer discounts to individuals who use the alternative practitioners in a network—don't require it. These programs allow the insurers to respond, at least minimally, to marketplace demand for complementary and alternative medicine (CAM).

But their approach isn't likely to bring physicians and acupuncturists closer together. Few of these affinity programs actively foster dialogue between the CAM practitioner and the patient's physician. And that may pose risks to patients. For example, a cancer patient may be using Chinese herbs along with acupuncture to stimulate her immune system, even while her medical team is managing the cancer by temporarily suppressing the immune system. Even if a patient mentions to her physician that she's using Oriental medicine, problems still can arise. The physician won't necessarily understand what specific treatment the patient is undergoing if the caregivers don't talk to each other.