"The Heart of the Matter"

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Transcripts: 507-1 to 507-5

Week: 507.1 Guest: Robert Duggan Topic: Acupuncture - Part One Host: Richard Roeder Producer: Ed Graham

NEMA: This is a five part series on acupuncture. My guest is acupuncture practitioner Bob Duggan from the Traditional Acupuncture Institute in Columbia, Maryland.

NEMA: Mr. Duggan, what is acupuncture? I think it's likely to be a little bit confusing to most Americans who are used to going to the family doctor. It's a different way of looking at the body and looking at disease. Would you briefly explain first what is acupuncture?

DUGGAN: Acupuncture is one of the most ancient forms of health care in the world and in fact today it's probably the guiding principles of acupuncture that are the underlying system of health care for maybe 25% of the world's population. It's the insertion of needles on various parts of the body that seems to have an effect in which people say they feel better. It goes back in recorded history about 2000 years B.C. and the original kind of stories about it are that people got well when they got poked with an arrow or you have these kind of mythologic stories but the ancient Chinese were very aware of the body and they could describe these internal pathways and channels in the body and then began to stimulate them with needles. Those pathways are also controlled by breathing. A lot of yoga, tai chi helps to keep the pathways clear. Now when you come to modern times, people will often think of acupuncture not in that way. They'll think of it as - oh, that's that unusual kind of Chinese healing that helps with pain but in fact now they've begun to measure these pathways. They know they have electrical conductivity. They know that when you put a needle into a pathway on the wrist, it changes the chemistry in the brain, that you can negate that change by administering a drug called Maloxone and pain will return so we're at the beginning of some scientific research about these meridians. People who were aware through meditation or paying attention to their body have known that there were these kind of movements and channels and that they could be controlled and a lot of natural healing processes, not only acupuncture, functioned based on the balance of this - what the Chinese called the "chi" or the life force and so the pathways are stimulated. I can put a needle in a point and the effect of that will run all the way along the body and often people will say - "Oh, I suddenly feel relaxed," or "You know that pain in my hip just began to ease when you put that needle in my toe." No one actually at this point understands how it works. There's scientific evidence beginning to show that there are pathways, that it has an effect on chemistry. There are outcome studies showing "My lord, yes this is effective for reduction of pain, for asthma, for a variety of things but like aspirin, no one understands the mechanism.

NEMA: Now certainly historically in this country, there's been resistance to different alternative health technologies. Is acupuncture relatively accepted by the standard medical community in the United States now?

DUGGAN: I think in the past five years, Richard, there's been an enormous change. The literature has actually moved acupuncture from being alternative to almost being mainstream. There's enough evidence showing that it helps. It has enough credibility. There's been enough done in terms of control of training and accreditation and certification. On the other hand, one of the issues is that acupuncture itself is being torn into two kinds of acupuncture.

NEMA: Join me for part two on acupuncture with Robert Duggan.

Transcripts:

Week: 507.2 Guest: Robert Duggan Topic: Acupuncture - Part Two Host: Richard Roeder Producer: Ed Graham

NEMA: This is part two in a five part series on acupuncture. My guest is acupuncture practitioner Bob Duggan from the Traditional Acupuncture Institute in Columbia, Maryland.

DUGGAN: Acupuncture itself is being torn into two kinds of acupuncture. One is what I'd call a more medical acupuncture. It's acupuncture being used to fight disease whereas acupuncture in its more original forms enabled a person to be stronger in themselves so they were less vulnerable to disease, so they could manage disease themselves so it was originally and in many ways in which it's practiced in this country is part of enhanced wellness. So very often, my patients will say to me - "You know I feel better in myself. Yes, I still have the pain or I still get asthma but I'm feeling better in myself." And that shows up enough in the research that we're starting to do that it may be that what acupuncture does is actually stimulate the immune system, stimulate the person's own healing process because most people may come in with pain or they come in with headaches, but in truth most people have several symptoms going on and acupuncture seems to relieve those and have a person be able to control it so that it moves to the least burdensome side of the disease or the disease clears. Now I think it's four years ago, Time/CNN did a survey and they found that something like 15 million Americans had used acupuncture at that point and 85% of them had a favorable experience with it so I think between the shift in the medical literature, the shift in public opinion, simply the numbers of people who have benefited, acupuncture is more and more on the mainstream side of the alternative.

NEMA: What are some of the conditions that acupuncture seems to be the most effective in treating or mitigating?

DUGGAN: The ones that its known for, I mean it's spoken widely as acupuncture for headaches or acupuncture for backache, or acupuncture for asthma, acupuncture for irritable bowel syndrome, those are things that very often people come to acupuncture for. Now there's evidence beginning to show that it reduces the side effects of chemotherapy and radiation. It's widely being used in drug addictions. In fact, Dade County in Florida and Oregon have mandated that persons who have an addiction must use acupuncture before they can enter any other program to deal with their addiction. They've found in Oregon 95% of the people who enter an acupuncture program never go on to a methadone or any other maintenance program and it cuts the cost by about two thirds. In New York City, they use acupuncture dealing with addictions and they tell us that there's a reduction in costs of 50% in the kind of counseling and teaching because a person who's addicted, if they have treatment with acupuncture, are often more accessible. They're able to be present to instruction and learning and therapy and counseling. So the spectrum I think is widening and now I think you get more and more people. We now have young people coming to study - I'm a president of a three-year graduate training program in acupuncture - we now have young people coming out of college coming into that program where acupuncture has been their basic form of health care since they were small children.

NEMA: Join me for part three on acupuncture with Robert Duggan.

Week: 507.3 Guest: Robert Duggan Topic: Acupuncture - Part Three Host: Richard Roeder Producer: Ed Graham

NEMA: This is part three in a five part series on acupuncture. My guest is acupuncture practitioner Bob Duggan from the Traditional Acupuncture Institute in Columbia, Maryland.

NEMA: Certainly there are plenty of people around the country that call themselves acupuncturists. Is there a certification process and is it one that it is controlled on the federal level, the state level or the local level?

DUGGAN: Licensing in the United States in all health professions is a state matter so state licensing varies widely. There are I think now 36 states that have some regulations about who can practice acupuncture. In many many states, doctors can practice with no training. In other states, doctors can do acupuncture if they have 200 hours of training. Most of the other states have accepted a national standard of training which means either graduation from an accredited acupuncture school which is at least 2000 hours, three year academic program and/or passing the national certification examination and those standards are pretty high. The national examination was set up I think 14 years ago and is now pretty widely accepted. I think there's something like 500 or 600 people who take the examination each year. There is something like 25 schools in the accreditation process across the country and if a person has a state license - now there are a few states, I think it's Vermont where an acupuncturist can simply register. You go in and you sign the book and you're registered whether you have any qualifications or not so a person can't just go from a state registration and say - oh, this person is qualified. You have to ask - what did it mean to get registered? But if a person asked - did you graduate from an accredited school, from the National Acupuncture Accreditation Commission or did you have the NCCA certification, the National Commission for the Certification of Acupuncturists, and the NCCA is based in Washington, D.C. and the Accreditation Commission is based in Silver Spring, so people can call them to find out, to double check if they have any questions. The other thing that I think in terms of knowing who to go to is to spend some time. A good acupuncturist will take time, will want to know more than the primary symptom. They'll be asking a lot of questions. They'll take a regular history of what's been going on. They will not just immediately start to treat. They probably will spend some time reading the patient's pulses, slightly different than the blood pulse. They're reading a number of specific qualities on the artery at the wrist. They will be checking for pressure points and heat points on the body. A good acupuncturist will be taking time. A good acupuncturist will not be making claims. They will be saying - I've never seen you before. I have to look at you uniquely." They rarely can say "I cure arthritis" or "I fix headaches." They're saying "I can work with you," and yes, very often it will help those things. And I think we're also seeing increasing collaboration between medical doctors and acupuncturists. I saw a study last year in the Journal of Neurology where they added simple acupuncture to the treatment of individuals who had suffered a stroke and the healing time from the stroke was cut in half and the cost - these were serious patients - the cost was cut by $26,000 per patient.

NEMA: Join me for part four on acupuncture with Robert Duggan.

Week: 507.4 Guest: Robert Duggan Topic: Acupuncture - Part Four Host: Richard Roeder Producer: Ed Graham

NEMA: This is part four in a five part series on acupuncture. My guest is acupuncture practitioner Bob Duggan from the Traditional Acupuncture Institute in Columbia, Maryland. I asked Mr. Duggan about research on acupuncture.

DUGGAN: There is a research project going on at the University of Maryland. This Institute here in Columbia - we've been invited to be part of delivering a four week elective to medical students at Johns Hopkins. There are now a number of collaborative programs going on in research and so a person who's thinking about using acupuncture can ask a lot of questions and a good acupuncturist will be able to show reasonable credentials.

NEMA: What is the status of coverage for the expense of acupuncture by health insurance companies?

DUGGAN: It's not covered by Medicare. It's not covered for federal employees which is a big issue in the Washington area. In this area, the "Blues" in Washington do not cover it. The "Blues" of Maryland have covered it for the past 14-15 years. I think we're moving in two directions with this. In the Baltimore area over the years, I think about 68% of all treatments were covered, that if you moved to another area of the country, that might drop to 20 or 30%. At the moment, there's like two different things going on. With managed care, they're cutting out anything that they declare non-essential so I would suspect acupuncture coverage is decreasing for many people. On the other hand, there are now insurance companies appearing around the country that are deliberately fostering acupuncture and other alternatives because the one company in California reported in the Wall Street Journal that by using acupuncture or naturopathy or homeopathy, they had cut the cost in many areas from - I think they quoted from 40% to 70% of delivering health care for certain specified diseases so some of the insurers are now beginning to realize that they can keep people well, keep them away from the more high expense forms of care by using acupuncture and other natural forms so I think we're in a big moment of flux in that.

NEMA: If acupuncture is administered by someone who might not be qualified to do so, is it potentially harmful in any way that's ever been proven?

DUGGAN: No. Nothing has ever been proven that way. You do have to be careful. If all the needles used by a qualified person will be individually sterilized and disposed of right after use - so one of the dangers is somebody who wasn't trained using an unsterilized needle which would leave you open to infection. That's one concern. You also have the concern that somebody who wasn't properly trained might puncture an artery or something else using a needle. But those are very rare. They're very minor complications. No body has ever proven harm from the inappropriate placement of needles or points or wrong treatment. On the other hand I think we will see over the years that there's an enormous difference between somebody who is highly qualified and somebody who is not and I suspect that we'll find that there can be harm for some people who are very susceptible. You know, acupuncture in Asia, the massage of the points - not necessarily needles, virtually everyone knows how to use some of those points to relieve a symptom much as we know how to go into a pharmacy and pick up an over-the-counter medication.

NEMA: Join me for part five on acupuncture with Robert Duggan.

Transcripts:

Week: 507.5 Guest: Robert Duggan Topic: Acupuncture - Part Five Host: Richard Roeder Producer: Ed Graham

NEMA: This is part five in a five part series on acupuncture. My guest is acupuncture practitioner Bob Duggan from the Traditional Acupuncture Institute in Columbia, Maryland.

NEMA: You have been a practitioner of acupuncture for over 20 years. How have seen the landscape change, both in the technology of acupuncture and how it works in the medical system and are you optimistic about the future in light of all the health insurance changes that are taking place right now?

DUGGAN: That's a big question. First of all, the changes - when I started practicing in 1972-73, acupuncture was basically illegal in most parts of the United States. I studied in England and practiced there for three years and when I came here, there were only seven of us in the state of Maryland. Fortunately Maryland had a very simple law which let us work provided there was medical supervision. Now there are almost 300 acupuncturists in the state. It's widely accepted. We're licensed. We have our own board. Clearly acupuncture is growing in that way. Over that time, there's been a lot of fads in acupuncture - electrical acupuncture for anesthesia, there's been a lot of use of electrical acupuncture to reduce pain. One of the things that intrigues me as I look at all of the accredited teaching institutions is every one of them has stayed to the more simple non-technologic, non-electrical acupuncture doing it in a simple way, I think both out of concern that when you add electric currents to these things, I mean it may be useful in certain cases where there's extreme pain or where a person is in a terminal illness or during a childbirth to relieve some discomfort but used in the context of a complete pattern of acupuncture so simple acupuncture - I don't see many new technologic developments there. Certainly much more available, much better trained people - I think that's clearly happening. There are now something like 10,000 certified practitioners across the country. On the other hand, I think the future is extraordinarily bright because we can't go on having a health care system that's basically opposed to pain and death. It's just too expensive. No culture has ever gotten rid of pain and death and acupuncture is basically a system that enables people to live well with pain, with suffering, to manage illness, to be stronger and clearer in themselves, to begin to think of life as a process of movement and eventual acceptance of death rather than, I mean I think a third of our health care expenditures in this country are in the last six months of life which may produce a very low quality of life where a person's alienated from their family in their last days. Acupuncture's bringing a different philosophy to that so to me the key issue is - will acupuncture become part of a system that's trying to prevent illness, prevent pain, prevent death in kind of an opposition or will it give us a more graceful way to live with life and to dance with pain and suffering and not to complicate it by trying to suppress it so I don't think that there's any way economically to go in this country except to teach people how to take care of themselves, enhance their own ability to be better in themselves and then to use western medicine much more appropriately. I think the data is that 70% of the people going to a doctor on any given day don't have any pathology that a doctor's been trained to treat. They have symptoms. They have functional disorders that don't require the intervention of somebody trained to deal with a disease and a pathology.

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