Thursday, April 12, 2007

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Tibetan Medicine is a distinct practice of medicine derived largely from Ayurvedic medicine, but with considerable influence from Chinese medicine, and some Unani (Greco-persian) with a primary philosophical basis in Buddhism as practiced in Tibet, Nepal, Bhutan, Sikkim, and the western regions of China.
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199(3): Establishment of the NIH center for the study of alternative medicine
(a) A person who is otherwise eligible to renew a license may renew an unexpired license by paying the required renewal fee to the medical board before the expiration date of the license. A person whose license has expired may not engage in activities that require a license until the license has been renewed under this section or Section 205.254.

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According to the AC, relying on information from the National Acupuncture Foundation, 44 states currently regulate the practice of acupuncture in some fashion: 26 license, one certifies, and two register acupuncturists; and 16 specify that only physicians, osteopaths, chiropractors and or podiatrists may practice acupuncture. In some of the states, the authority to practice is restricted to acupuncture only, while other states permit an expanded scope of practice or the use of other practice titles such as doctor of acupuncture (New Mexico) or acupuncturist physician (Florida). 6 states do not appear to regulate the practice of acupuncture.
Because true integration of complementary medicines can be achieved only when coursework is incorporated into the existing curriculum, AMSA suggests that schools work toward building lectures, handouts, slides, and cases that can be introduced in existing core courses. This approach allows the students to actively compare other medical systems with allopathic and osteopathic medicine and will reinforce basic science and modern clinical practice. It will also allow exposure to all students, not only those already interested in CAM. Experiential activities such as field trips, demonstrations, and lab exercises are encouraged and can be appropriately introduced to complement didactic instruction.
Immigration from China in general has increased since 1965. A question that remains to be answered is whether immigrant acupuncturists have tended to enter the US via special categories for skilled migrants or via the general pool or through family reunification. At present, I have interview evidence that the supply of acupuncturists from China has increased significantly, beginning in the late 1980s and increasing throughout the 1990s (see illus case # ___ below). I also know that acupuncture colleges have been a “pull” factor in recruiting acupuncturists from China to teach at their schools (see e.g. illustrative case #___ below).
OF THE ACUPUNCTURE COMMITTEE
TCM thrived in the Western US in the late 19th and early 20th centuries, but none of these early TCM doctors remained in independent practice by the middle of the 20th century. TCM was affected by the same social processes that marginalized other nonbiomedical healing practices in the US in the early 20th century. Restrictions of movement of people and goods between the US and China in the middle of the century further contributed to the decline of professional TCM in the US. The late 20th century witnessed a renewed and widespread interest in TCM in the US. This could not have taken place without an increase in the number of Americans going to China to receive TCM treatment and study TCM, the increasing availability of TCM herbal medicines and other products in forms accessible to a broad US user population, a growing Chinese immigrant consumer population, and especially an increasing number of highly trained practitioners coming to the US to practice and teach.
Upon completion of the TCM/acupuncture/kampo/Tibetan medicine learning components of the curriculum, medical students should be able to:
Initial observations and analysis

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(3) maintain a course of instruction in anatomy-histology, bacteriology, physiology, symptomatology, pathology, meridian and point locations, hygiene, and public health; and
The Immigration Act of 1965 “profoundly affected the composition and the size of Chinese communities. The Chinese population increased dramatically: from 236,084 in 1960 to 1,079,400 in 1985. Today, the Chinese are the largest Asian group in the United States” (Kwong 1992 (1987):22). It is possible that the expansion of TCM will turn out to be seen to be in part an unintended consequence of the changing organization of immigration, such that immigration legislation intended to increase the supply of professionals to support the status quo (e.g., mainstream medical institutions and industries) also increases the supply/power of groups who offer a challenge or alternative to that status quo. [An important question here would be what types of visas the acupuncturists have entered with.] Another view might look at the ways this professional migration brings in new ideas, creativity, and helps fuel experimentation and innovation.
Some results of this growth are increasing professionalization (and resistance to professionalization), competition, differentiation, changing entry standards.
Definitions
(b) A temporary license is valid for 100 days after the date issued and may be extended only for another 30 days after the date the initial temporary license expires.
(1) a knowledgeable health care provider; or
(3) course content requirements.
(a) A reputable acupuncture school, in addition to meeting standards set by the acupuncture board, must:
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§205.207. RECIPROCAL LICENSE.
(5) meets all the qualifications for a license under this chapter but is waiting for the next scheduled meeting of the medical board for the license to be issued.
BACKGROUND AND DESCRIPTION OF THE COMMITTEE
(2) has passed a national or other examination recognized by the acupuncture board relating to the practice of acupuncture;
1976: Gov. Jerry Brown signed legislation approving a licensing exam for acupuncturists in CA
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(4) if licensed in another state, is in good standing as an acupuncturist; and
The Acupuncture Licensure Act (Business and Professions Code Sections 4925 - 4979) and its related administrative regulations (Title 16, California Code of Regulations, Sections 1399.400 et seq.) regulates both the practice of acupuncture and the use of professional titles by its practitioners. The AC licenses and regulates acupuncturists, establishes standards for and approves acupuncture training programs and schools, and establishes requirements and approves acupuncture tutorial programs. As part of its licensing function the AC also administers its own two part licensing examination, the California Acupuncture Licensing Examination (the CALE), composed of a written examination and a practical examination.
The scope of practice of acupuncture is defined in B&P Code Section 4937 to include acupuncture, prescribing and use of oriental massage, acupressure, breathing techniques, exercise, or nutrition, including the incorporation of drugless substances and herbs as dietary supplements to promote health. “Acupuncture” is defined by B&P Code Section 4927 as the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body and includes the techniques of electroacupuncture, cupping and moxibustion.
SUBCHAPTER F. LICENSE RENEWAL
History of acupuncture regulation and the Acupuncture Committee
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(1) submits an application on a form prescribed by the acupuncture board;
Committee regulation of the practice and practitioners
AC program improvement efforts
There is struggle over credentialing. Some Americans complain that the licensing exam is controlled by acupuncturists from China and that they favor ethnic Chinese. Some acupuncturists want to raise the entry standards to the profession, others don’t.
Data and Methods

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1979: Acupuncture becomes “primary care” in CA
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(a-1) The acupuncture board shall establish written guidelines for granting continuing education credit that specify:
(d) In reviewing an acupuncture school or degree program as required by Subsection (c), the Texas Higher Education Coordinating Board shall seek input from the acupuncture board regarding the standards to be used for assessing whether a school or degree program adequately prepares an individual for the practice of acupuncture.
1990: Immigration Act of 1990
All of these systems are based upon phenomenology, cosmology, the observation of natural events including the course and outcome of disease, which is considered caused by internal imbalances for emotional states, external factors such as trauma and environmental factors, and other pathological factors. Ultimately, health and disease, according to Chinese medicine, is dependent on the regulation of the two complementary yet opposing forces of yin and yang, the underlying principles that manifest in everything from plant growth, effects of herbal remedies, differentiation of the sexes, as well as health, disease, and healing. In addition, besides observational anatomy, Chinese medicine proposes that there are currents of energy in the body, called meridians that are modulated by the effects of yin and yang, and influenced by environmental and emotional events.
An understanding of this context, I believe, helps to explain the ways that the acupuncturists I spoke with, interviewed, and videotaped as part of my dissertation research (which focuses on the communication and relationship-building between acupuncturists and patients) presented themselves during interviews and present themselves to patients during consultation and treatment visits. It may also help to explain developments on the “mezzo” levels of professional AOM associations and organizations, and state and local AOM-related legislation.
Faculty and community lecturers should be familiar with the topic from a traditional and clinical perspective, not merely an academic exposure. Emphasis on accurate portrayal of the CAM modality from professionals is essential to accurate teaching. The resources within this module should serve that goal and assist educators in providing timely, relevant, and professionally reviewed materials to medical students.
US acupuncture colleges recruit acupuncturists from China to teach the upper division courses in their curricula and supervise the students clinical internships. The availability of teachers from China has improved the quality of acupuncture education, improving the reputations of the schools, and attracting increasing numbers of new students. Many of the teachers from China eventually settle in the US and open private practices. Acupuncturists from China who enter the country via other channels set up practice here, too, after passing the necessary licensing exams. Thus, immigrant acupuncturists both increase the number and skill level US native acupuncturists and compete with them for patients.

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