Pinning down the truth

For the past 3,000 years, acupuncture has been the ultimate ancient Chinese secret: a therapeutic technique that relies on inserting needles into specific “acupuncture points” in the body to relieve pain and recalibrate dysfunctional organs in order to eliminate disease from the body.

But despite being just the ticket for the most populous nation on earth and a host of other Asian cultures, acupuncture has also been largely disregarded by doctors and other practitioners of Western medicine.

That great divide has been particularly noticeable in California, where acupuncture has been legally practiced and supervised for the past 30 years. As California’s Asian population has exploded, so too has the practice grown to accommodate people, leading California to have 10,000 licensed acupuncturists — half of all the acupuncturists in the nation.

With that growth, however, has come a persistent battle for the acupuncture industry's survival. Facing deep-pocket opposition in varying degrees from politically influential pharmaceutical companies, medical associations and individual doctors, the industry faced a fight for its very existence this year over the future of its main supervisory organization, the California Acupuncture Board.

Smack in the middle of all the turmoil sits state Sen. Liz Figueroa, a Democrat from Fremont who has taken tens of thousands of dollars in campaign contributions from Western medical interests, but is nevertheless proud of leading the charge for what she terms reforms.

Acupuncturists, however, believe those efforts are prompted by the medical establishment and aimed at clamping down on their practices.

Combined with the fate of Assembly Bill 1113, legislation authored by San Francisco Democratic Assemblyman Leland Yee that would have allowed acupuncturists to diagnose a wide variety of medical conditions but was vetoed by Schwarzenegger because the governor felt it was unclear about the limits acupuncturists had to work within and risked enabling them to make diagnoses beyond their scope of practice, acupuncturists feel they're being stuck with a bevy of unnecessary hurdles.

“The right to make a diagnosis is not a monopoly only for MDs. Even the nurse can do a diagnosis; it's a universal term and common language that every medical profession understands,” said Dr. An York Lee, who serves as a Board of Education member in Walnut and operates an acupuncture practice in Placentia. “If we cannot diagnose, how can we use the common language to communicate with other medical professions? If we cannot diagnose, how do we bill insurance or Workmens' Comp?”

Lee argues that acupuncturists need the right to diagnose in order to refer patients to other specialists or medical professions when it is necessary to prescribe further treatment. And because of the second-class status acupuncture is often afforded by the insurance industry, doctors who accept referrals from acupuncturists often cannot receive insurance payments for those referrals.

“If acupuncturists could just issue an official diagnosis within the scope of their practice, all these problems would go away,” said Lee. “It just makes sense legally and practically.”

Chasing chi

Acupuncture has certainly made sense within Asian cultures for millennia, but perhaps one of the biggest reasons for discord with Western medicine is that acupuncture involves a highly spiritual approach to healing that relies on the meridian, a channel system that networks all the body's other systems together.

“Chi” is the term for the energy that connects with all of the body’s systems, and specific stimulation in problem areas is designed to circulate this energy more normally, helping the system function in a more vital way.

According to this belief, there are 14 meridians, or major lines along the body, for circulation, and there are 365 points on the meridians to be stimulated selectively. A session generally takes 15 to 30 minutes and can achieve results by touching on just 10 to 20 points, alleviating a wide array of problems ranging from sleeping disorders and hypertension to sprains, strains and severe pain.

According to Lee, there are numerous reasons why acupuncture has become popular enough to cross over Asian communities. In fact, he notes that 90 percent of his patients are Caucasian, and they are lured largely by the fact that acupuncture treatments are cost-effective — even when they are forced to pay an average 80 percent of their acupuncture costs out of pocket due to lacking coverage of such treatment.

For instance, Lee adds that many problems relegated to surgery by Western-oriented doctors can be cured by acupuncture at only 10 percent of the surgery cost, and that this cost-effectiveness has inspired the World Health Organization (WHO) to bring acupuncture to vastly larger groups of Third World populations.

Despite these benefits, nearly 3,000 of California's 10,000 licensed acupuncturists have headed to other states to flee both the intense competition and the legislative environment here.

Dr. Thomas Lee (no relation to An York) runs a practice in South Pasadena and Santa Monica, where he caters to numerous celebrities, a factor he attributes to celebrities being “open minded” and reaching out for multicultural views on life.

While he was reluctant to name   famous clients other than Nick Nolte due to privacy concerns, Lee did acknowledge former Chicago Bears quarterback Jim McMahon, Shaquille O'Neal and Laker coach Phil Jackson have been regulars. Stuntmen, directors and other hard-charging professionals in the film and television industry comprise the majority of his client base, which he has carefully built since earning his license in 1983.

“In the past, before we knew anything about Western medicine, this was the health care for Chinese people for over 3,000 years,” said Lee.  “Just in the most recent 100 years did Western medicine become the mainstream worldwide, and there's a new trend even in China where they're trying to reform the health care system with both medicines going together.

“They will have each medicine work separately, but will have a common ground to communicate through a national convention with a lot of joint research. When Western medicine fails because quite a number of health problems can't be solved by Western meds alone, the acupuncture community has developed supportive care for patients and has helped patients recover much sooner and stop nausea during chemotherapy.”

Yet Lee notes that the American Medical Association (AMA) still stirs conflicts about how scientifically sound and accepted acupuncture is. Anyone can do the math: If acupuncture is becoming radically more popular, and is able to shake up the medical profession and move it away from reliance on surgeries and antibiotics, then the medical and pharmaceutical industries stand to lose a lot of money.

Lee feels that the answer to these bureaucratic hassles is to provide more research funding to prove that acupuncture is scientific and effective, counteracting the vastly better funded power interests that stretch from the AMA to the California Medical Association (CMA) to the countless pharmaceutical companies that stand to take a beating if enough people become convinced throwing medicines at every medical problem may not be the best answer.

But therein lies a major Catch-22, for research funding would likely have to come from the government, and acupuncturists don't have the financial power to donate to legislators or hire lobbyists, as do their counterparts in the medical and pharmaceutical industries.

“Whatever gets patients well should be covered by insurance. I keep donating my limited money but not all the acupuncturists have that kind of opportunity,” said Thomas Lee. “It would be a much healthier situation if medicine and acupuncture could consistently work together rather than being opponents.”

For their part, the California Medical Association (CMA) would like nothing more than to peacefully co-exist with the acupuncture profession, according to CMA’s media relations manager, Ron Lopp. He claims that the CMA did not take a position on the legislation, choosing instead to just apply a “watch” status to Figueroa’s Senate Bill 233, which attempted to eliminate, or sunset, the state Acupuncture Board.

Lopp did note, however, that the CMA opposed AB 1113, which sought to give acupuncturists the right to officially diagnose a wide range of conditions, “because that ability defines what a medical doctor is allowed to diagnose and treat after years and years of medical school.

“By and large, we support acupuncture and there are many examples in medicine where doctors and acupuncturists work together. Medicine does recognize the value and use of acupuncture in use and treating chronic pain, and my own medical doctor just referred me to an acupuncturist for back pain I was having,” said Lopp. “The CMA's concern is when an allied health professional goes beyond their scope of practice and training and might want to diagnose and treat diseases that go beyond their training, such as cancer, for example.”

The money trail

As actor Gary Coleman likes to remind us in those pathetic easy loan commercials, money makes the world go ’round.  That's perhaps truest when it comes to California politics.

A search of the California Secretary of State’s Web site (www.ss.ca.gov) reveals that while Schwarzenegger didn't receive a vast array of contributions from the health-care industry, the ones he accepted stood out enough to merit a spotlight on the Web site RecallMoneyWatch.com. His Total Recall to Recall Gray Davis Committee received a total of $40,000 in two donations from a doctors’ collective called A.B. Health Care Associates of Sherman Oaks.

Schwarzenegger also received $21,200 from the Cooperative of American Physicians’ Trust Legislative Committee, and $5,000 from the good folks at Pacific West Pharmacy, Inc. in Rochlin. By comparison, no funds from acupuncturists, or related figures or groups were found.

But those four contributions were just a drop in the bucket compared to the number of donations from the medical profession to Figueroa. Whether raising money to attain her Senate seat or for her political action committee (PAC) for a run at lieutenant governor, Figueroa collected the cash, checks, money orders and credit cards from dozens of individual doctors who paid anywhere from $150 to $1,000 to Rancho Mirage physician Dr. Stephen L. Kreizenbeck's pack-leading $3,200 to show their support for her in the lieutenant governor’s race alone.

The California Pharmacists’ PAC was even more generous, doling out at least two contributions of $3,000 and $1,500 to the planned Figueroa campaign. Pasadena’s highly esteemed Phoenix Wellness Center was one of several individual pharmacies to pay at least $500, with fellow Pasadena pharmacy Berry & Sweeney kicking in $100.

The California Physical Therapy Association's PAC threw in at least $1,000, as did a Radiological PAC and the California Psychological Association PAC.

But the Big Kahuna of in-state contributions came, ironically, from another oft-questioned medical field, as the California Chiropractic Association's PAC kicked in a whopping $5,000.

And the money didn't just come from in-state interests, either. Bayer Healthcare, LLC, which is based in Pittsburgh, Pa., sent in $1,000 to Figueroa. So did fellow pharmaceutical giant Bristol-Myers Squibb of Princeton, NJ. And there was a $500 contribution from physician Linda Phillips at the University of Texas Medical Center in Houston.

The money trail extends back to the senator’s 2003 campaign for Senate in which the United Pharmacist Network in Glendale gave a total of $6,000. National money also came in that year, as New York City-based Pfizer, another big daddy of pharmaceuticals, handed over $3,000, while big pharmaceuticals rounded out the fund with $1,500 from Pennsylvania-based Merck & Co., $2,000 from New Jersey-based Johnson & Johnson, and $1,000 from Harrisburg, Pa.-based Rite Aid Corp.

“Figueroa is also supported by some of the national groups, because in other states acupuncture is not growing as fast as in California, and most of the schools in other states are catching up with the growth of California,” said Thomas Lee. “They try to stop the California schools and exam standards from growing faster than them.”

That isn’t to say that the acupuncture industry hasn't learned to finally play the money game. In fact, in the 2005-06 lieutenant governor’s race, records show the Tao Acupuncture & Oriental Medicine office in Fremont ponied up a $75 and a $25 contributions, with Ping's Acupuncture in Fremont also following suit. Skye Sturgeon, a Berkeley acupuncturist, managed to pay $100 in one contribution.

Clearly, despite their best efforts to compete, the acupuncturists are vastly outfunded.

“We've been through many state audits and always done really well. We've survived the sunsetting process before in 1997, and never had a major problem until the issues that Sen. Figueroa brought up came out,” said Shari Asplund, who has served as the chair of the California Acupuncture Board for four years. “Figueroa does stand out as someone who has a vendetta against the board and chairs the Committee on Boards, Commissions and Consumer Protections, which has the oversight of our board.

“She also chairs the Senate Business and Professions Committee, which takes the recommendations of her first commission and votes on whether to accept them. Since she's in charge of both groups, what do you think happens? Her proposals get approved.”

The most vexing recent proposal, in Asplund's eyes, was Figueroa's introduction of a bill that would have eliminated the board.

The other side

Consideration of whether any sort of state board or commission should be sunsetted is a common occurrence, as it keeps their members on their toes and forces the boards to prove their ongoing viability for an average three-to-five-year period. Sunsetting the Acupuncture Board — and all medically-related boards — was part of Schwarzenegger's plan for his California Performance Review (CPR) program to eliminate wasteful government spending and organizations.

However, Asplund and others claim that Figueroa's focus on getting her board eliminated showed an obvious prejudice against the field. Sunsetting the board would have placed all oversight of the industry into the hands of the government, which Asplund claims will hurt all involved because the board is currently made up of civilians and has a strong link to the consumer community due to public hearings.

Replacing it with government oversight, under a one-person bureau at the Department of Consumer Affairs, would have distanced the consumer from the complaint process, in her eyes. Even more harmful to the acupuncture industry, the switch in oversight power could have made it next to impossible for future acupuncturists to receive their licenses.
But Figueroa, in a series of press releases as well as in emailed responses to several Pasadena Weekly questions, said that the issue and her involvement in it are much more complicated and open-minded than it appears.

While her only response to questions about the medical contributions to her campaign was, “Anyone who knows me knows that I have one thing in mind and that is doing right by the constituents I represent,” she wrote at much greater length about her history in the sunsetting process.  

“When Western physicians centuries ago were still using leeches and bleeding to treat illnesses, acupuncturists were providing real relief to their patients. So I want to say one thing to any licensed acupuncturists listening today: this hearing is not about you,” Figueroa told the board during the review process earlier this year. “I'll say it again. This hearing is not about your value, your competence, your status, or your integrity. When this committee reconstituted the Dental Board, we were not attacking dentists.

“When this committee issued a very tough report on the performance of the Medical Board in 2002, it was not attacking physicians. And when this committee gave the Medical Board the exact same two-year sunset review extension, as we gave the Acupuncture Board, we were not attacking physicians either. This hearing is about whether the board — without legal approval from the Legislature — is moving to blur the difference between licensed physicians and acupuncturists, thus possibly depriving Californians of a true alternative therapy.”

In further written comments to the Weekly, Figueroa noted that the Athletic Commission is due to sunset next year, that she has also imposed dramatic changes on the Medical Board and Accountancy Board, and that she put the Dental Board through exactly the same treatment as the Acupuncture Board, in having the board members and senior staff removed and demanding appointments of new members.

She also claimed that the Acupuncture Board has been the acupuncture profession’s worst enemy, and that the bi-partisan, investigative Little Hoover Commission said that the board has acted “as a venue for promoting the profession rather than regulating the profession.”

Figueroa went on to claim the Little Hoover report accused the Acupuncture Board of failing to act to ensure clean needles were used and failed to act to prevent teenaged assistants “from doing things that only trained and licensed acupuncturists should do.” Additionally, she claimed that the former executive officer of the board had said “the board could pass whatever regulations it wanted — even if they violated statutes.”

“Bottom line: this board's stubborn incompetence as a pro-consumer watchdog has for years unfairly cast a bad light on the acupuncture profession as a whole and the board's bad reputation has been used by those who really, truly oppose acupuncture to marginalize acupuncturists,” wrote Figueroa. “Those factions who have run this board into the ground routinely try and accuse anyone who criticizes the board as somehow criticizing the profession.

“I was not going to be intimidated by such scare tactics.  Period. I care enough about the reputation of those who practice an art that was healing people when Western doctors were using leeches to fight for a board worthy in every way of the profession that it regulates.”

A Figueroa staff member claimed separately that Schwarzenegger had specifically targeted the Acupuncture Board for cuts, and that the overall sunsetting process is designed to be a “fantastic, pro-consumer” means of leverage because a governor can force pro-consumer reforms to be passed by the boards in exchange for letting them survive.

‘The acupuncture dude’

Thanks largely to Democratic Assemblywoman Judy Chu, who represents Monterey Park and heads the nine-member Asian Pacific Islander Legislative Caucus, a compromise was finally reached between Figueroa, the governor and the board in order to keep the board in existence.

Senate Bill 248 was the legislation that made it happen, forcing the eventual resignation of Asplund as the board's chair and replacing members with a majority of consumers.

While Chu terms the board's survival until 2009 “a victory,” she also noted that Figueroa’s treatment of the Acupuncture Board seemed harsher than the treatment she has afforded other boards and commissions.  And there is one more disconcerting aspect to the process, offered in comments from Democratic Assemblyman Paul Koretz of West Hollywood, who served with Figueroa on the Joint Committee on Commissions and Boards.

“I never understood where she was coming from and why, and what her expertise was on the issue. She definitely had it in for the board from the beginning, and to some degree the profession as well,” said Koretz. “I have my own bias because I'm a consumer of acupuncture myself and my daughter had a very serious autoimmune disease and is now fully recovered partly due to acupuncture treatment that helped her even get over being paralyzed for three months.

“One of the many requirements I would question in California law is that acupuncturists can't be called doctors. My daughter would jokingly call him ‘the acupuncture dude.’ He dealt with life and death issues and deserves be able to be called doctor. I've only had wonderful experiences with it.”  

Furthermore, Koretz noted that he had never heard complaints “about unsterilized needles being used and passing on diseases" — one of Figueroa's prime complaints against the profession.

“In the industry, I'm not aware of a single case where someone claimed they got a disease because of not using a clean needle. The staff report was highly critical at every turn and I couldn't see why they were so aggressively negative towards the board and profession, and back in May, I was thinking this just isn't right, but I couldn't convince anyone in the press to go looking into this.”

Ultimately, the showdowns between acupuncture and Western medical interests represents a fight more important than a mere cultural battle; one that seeks to determine which way we're going to go in an age of ever-spiraling health care costs and the compulsion to always find the next best pill to cure all of our problems.

In a war like this, one might find it important to keep steady hands of experience in charge. But according to Asplund, who has devoted years of service to the cause of acupuncture, that level of quality and concern is threatened by the board's changes.

“This bill and the negative attitudes from Sen. Figueroa are very frustrating. I don't know what they think they're gaining by reconstituting the board, because our executive officer had to step down and she was very effective,” said Asplund.

“I guess Sen. Figueroa wants a clean slate, but I don't know how she thinks that's beneficial for the consumers of acupuncture in California. When there's many facets to regulate, new people coming in hardly seem to be the best way to deal with this. There's a real learning curve here.”