On April 1 2013, Traditional Chinese Medicine (TCM) doctors and acupuncturists in Ontario will need a license to practice their unique brand of healing. This is the first of three vitalistic and unscientific healing practices to start accepting members in Ontario; the naturopaths will be next, followed by the homeopaths. This kind of "legislative alchemy" as described by Jann Bellamy from Science Based Medicine is spreading across jurisdictions all over North America in the under the auspices of protecting the public from substandard care.
Without a licence on April 1 2013, you will not be able to diagnose heat stagnation by looking at the tongue. Without a licence on April 1 2013, you will not be able to discern the state of the organs through the pulse in patient's wrist. Without a licence on April 1 2013, you will not be able to diagnose a fever caused by the wind, or needle the meridians of the body to unblock stagnant Qi, or, if all else fails, set alight a bundle of mugwort atop those same needles and let it burn until a small scar forms on the skin, to strengthen the blood. No foolin'.
I feel safer already.
The Ontario government is following in the footsteps of British Columbia, Alberta, Saskatchewan, Quebec and Newfoundland and Labrador, to license acupuncture and TCM. It doesn't seem to matter that in the years since the original report on the college of TCM acupuncture has shown to be nothing more than an placebo.
It does not matter where you insert the needles, or even if you insert the needles, all you get are "non-specific therapeutic effects". In the absence of any efficacy beyond placebo, it is not ethical to expose the patient to the small but real risks of acupuncture, but soon you will have the overt permission of the province of Ontario to do so.
TCM relies on ideas of physiology and anatomy that were left behind by science over a hundred years ago. Qi or Chi is a magical energy field that has never been shown to exist, and "meridians" that are supposed to carry Qi do not correspond to any physical structures of the body, including the nerves or facia.
There are plenty of studies on the herbal remedies offered by TCM doctors and herbalists, and this is probably the only promising part of the entire venture, although it is telling that most do not use the traditional TCM diagnosis, like a blockage of Qi, and instead use modern medical problems.
However, in the light of the extreme detail we have about how the body works, the idea that discrete areas on the tongue correspond to the condition of the stomach, or the liver, or that the tongue is a continuation of the heart is about as absurd as the idea that the pulse can tell you anything other than the rate, rhythm and output of the heart. We have moved beyond these magical ideas.
We are faced with one striking dilemma, however: people are continuing to seek help from these professions, so what responsibility does the state have to its citizens when they seek help from non-traditional sources? After failing to win the scientific debate, professions like TCM, acupuncture, naturopathy and homeopathy in the past 10 years have turned to the government to gain legitimacy.
This is the point that Ballamy makes above. The public sees government regulation as a stamp of approval, when outsiders are brought into the mainstream, and professional associations know this. However, while acupuncture and TCM are used by many people, this argument from popularity does not make it true. The government should be focused on treatments known to work; we have the tools to test their claims, and to ignore these tools in favour of ideology is to deliver the public into the hands of the charlatans.
That word has a lot of baggage, and I don't use it offhandedly. I use it with the caveat that I don't think that most TCM or acupuncture practitioners are willingly deceiving the public, but are instead deceiving themselves. Their earnest belief in a system that is much closer to religion than science also leaves us with no recourse when our pleadings for science go ignored or brushed off; you cannot reason someone out of something they did not first reason themselves into.
One note on the question of harm. Most jurisdictions in Canada that have a council that develop recommendations on which professions should be regulated take into account any possible harms offered by the trade. One harm that is continually ignored, to all our peril, is the harm of misdirected care.
Tunring to alternative medicine for a cure when mainstream medicine has an effective medicine already in place puts the public at risk. Many cry that mainstream medicine results in many deaths through its use, but they forget also to factor in the benefits. Both risk and benefit should always be included in this equation. Most mainstream medicines have risks, to be sure, but so does TCM and acupuncture. With no demonstrable benefit, any risk becomes too much, whether economic or physical: this cannot be forgotten when choosing who to turn to for help.
Come April 1, choose wisely.
It can be tough knowing where to start when beginning any new kind of treatment. First things first: know what to look for in your practitioner. <a href="http://www.healthwithacupuncture.com/" target="_hplink">Moores</a> says "you should always check that [your acupuncturist is] licensed and in good standing." Visit <a href="http://www.nccaom.org/" target="_hplink">www.nccaom.org</a> to find someone reputable. He or she should be licensed in your state and also nationally by the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine). If you are turning to acupuncture to treat a specific condition, mention it ahead of time to your practitioner. Moores says to ask if he or she has any specific experience in treating that ailment. "Usually hearing the answer will give you a good idea of whether or not you can trust him or her," she points out. Since you will be working intimately with your accupuncturist, it is imperative to ensure you're comfortable together. Even if the accupuncturist is well-regarded, if <em>you</em> don't feel at ease, then Moores says "you are cutting yourself and your healthcare short." <em>Flickr photo by Kara Ally</em>son
In order to entirely reap the benefits of this treatment, try your best to come to the appointment with an open mind. Moores explains: "Acupuncture works whether you believe it in or not. However, people will say you have to believe in it to work." Moores says that the shifts that occur from acupuncture are "subtle changes," meaning that those who are more in touch with their bodies can more easily notice them, while those who are less in-tune may take a longer time to feel any differences. <em>Flickr photo by James Qualtrough</em>
Prepping for an acupuncture treatment consists of many different variables: it's best to be conscious of when you arrive, what you eat and even how you smell! Food-wise, Moore suggests eating something light before your appointment. "If you don't eat anything before, you can feel weak after the treatment because a lot of energy is moving around," she says. It's also best to stay away from caffeine for the day, if you can. And consider skipping the coffee before your visit, since it acts as a stimulant. Acupuncture shouldn't be stressful (just the opposite -- it is meant to relieve stress!). Come to your session early so you can relax. "You do not want to be rushing though an acupuncture session," Fitzgerald notes. She also reminds us of the golden rule: use the bathroom before you go! Solid advice, as you may be on the table for a half hour or longer. If possible, do not wear any scented creams or fragrances the day of your appointment. Moores explains that "a lot of people are sensitive. I treat things like headaches ... plenty of patients say 'what's that smell? It's giving me a headache."' While <em>you</em> may not be affected by certain scents, it's best to be mindful of other patients who might be particularly sensitive. Lastly, the omnipresent question -- <em>what should I wear? </em> -- has an easy solution. While your acupuncturist will likely provide a gown, Dr. Fitzgerald suggests wearing loose-fitting clothing for comfort. <em>Flickr photo by nicolasnova</em>
Both Fitzgerald and Moores recommend bringing medical records, even if you think they are unrelated to your treatment. "The acupuncturist will spend a lot of time asking questions that might not even seem related to your condition," Fitzgerald says. He or she may ask about digestion, sleep paterns, gynecological history, mental health issues and more. Chinese medicine looks at all conditions as "interrelated," even if there's no obvious connection in the Western view. Moores agrees: "If you have a history of medications, diagnostic tests, MRIs, always bring them; when you have any diagnostic test, blood test or anything, you should keep a copy. Those results can help us." <em>Flickr photo by breahn</em>
Even if you're a rookie to this old practice, make sure you're understanding everything that's happening. "Remember it is <em>your</em> visit and <em>your </em>health," Fitzgerald says. "Make sure you communicate your needs and everything you can about your condition so the acupuncturist can have as much information as possible for your assessment. If something is not clear, don't be shy to ask for clarification." Speak up to advocate for yourself. "Your practitioner could explain things in Eastern terminology," she continues. "Be sure to ask for clarification and don't hesitate to make sure you understand your treatment protocol." <em>Flickr photo by paparutzi</em>
It's normal for the acupuncturist to check your tongue to assess the general health of your organs and meridians. Your practitioner will also check your pulse, which Moores says can reveal a lot. "It can tell you what's going on in the body as far as stagnation and stress," she explains. "We're not really checking for the rate." <em>Flickr photo by nathanmac87</em>
If you're Trypanophobic, we'll give it to you straight: more likely than not, your acupuncturist will be using needles. If you're feeling just a little wary, know that, as Moores puts it, "acupuncture needles are sterile, one-time use disposable needles." They are also incredibly flexible and not at all like those used to draw blood. But do they hurt? "That's the one big question," Moores says. "I don't think [it hurts]," she continues, "most people don't think so." But while it's not necessarily a painful experience, you may feel sensitivities on different areas of the body. "Sometimes you can feel a little qi sensation -- we call it a 'zing.' It's when the needle hits the nerve," she says, comparing it to the feeling you get when you hit your funny bone. Some spots may bleed once the needles are removed -- the ears are a particularly sensitive area. If this happens, the blood is usually less than a drop, and the bleeding will stop before you leave the office. <em>Flickr photo by SuperFantastic</em>
After the session, be sure to rehydrate. "Definitely drink water because we're getting the energy to circulate because you want to be hydrated," Moores says. Once you leave, you should be a-OK to continue about your day. In fact, you may not feel a thing. "As you start getting regular treatments," Moores says, "you may notice feeling more uplifted. <em>Flickr photo by Svadilfari</em>
This health video focuses on the different benefits acupuncture can provide for many different illnesses.
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