shareEditor's Note: Dr. Fratkin was chosen to give the commencement speech for Southwest Acupuncture College (SWAC)–here is an excerpt from his address.
It is my honor to be chosen by the graduating class of 2018 to represent practitioners in the field. I salute you for completing an arduous course of study, and for your present task of navigating the national exams. Every one of you entering this profession have worked hard to get to this place, and now, finally, you can start applying your skills to patients in need of help. Because you will certainly be helping them. Oriental medicine, and I include acupuncture, herbal medicine, and tui-na, as you have discovered, is remarkably effective at treating illness and injury, and promoting health and vitality.
In my own career, I have seen the profession of acupuncture and Chinese herbal medicine blossom and develop. In fact, this week marks my 40th year in clinical practice, charging money. When I started my studies in 1975, there were no acupuncture schools in the U.S.–at all. I came up through an apprenticeship approach, in both acupuncture and Chinese herbal medicine.
My Path to AOM
I came to Oriental medicine first through my undergraduate studies in Chinese philosophy and history, and then through my passion for taijiquan and qi gong. At that time, I was introduced to teachers who would guide my path. First there was a Korean master, who I apprenticed with off and on for seven years. It was here that I learned meridian therapy.
As my attraction to Chinese herbs developed, I was able to apprentice in a Chinatown herb store in Chicago, and later, to study with a superb herbalist who recently arrived from China. From him, I learned pulse, tongue and symptom diagnosis. With him, together, we taught materia medica and classical prescriptions.
In 1978 I started seeing patients, and in 1982 I started teaching in the developing acupuncture schools. In 1987 I was finally able to go to China, where I studied over the course of a year in Beijing. I studied in the hospitals, and came out very aligned with what we now call modern TCM medicine. Realizing that TCM herbal medicine applied to 45 percent of the population was mind-blowing. And to take part in that! Fifteen-hundred outpatients a day, 350 in-patient beds. Extraordinary!
I was here at the beginning of this profession, and I worked nationally on school accreditation and school curriculum development. You can blame me for being an early voice advocating national exams, and I was later able to participate in the creation of the herbal exams. I was in charge of NCCAOM's development of the PDA/CEU continuing-education requirements, so think of me every time you groan to fulfill your 15 hours a year for recertification. But as Bette Midler would say, enough about me. (Which she followed with, "Now you talk about me!")
The Changes I've Seen
Our profession is now mid-cycle in its trajectory - established, and on the cusp of integration with mainstream medicine. You are entering the profession when hospitals are seeking out acupuncturists; IVF clinics are seeking out acupuncturists; orthopedic clinics are seeking out acupuncturists; the VA is seeking out acupuncturists, especially for PTSD. And now with the looming opioid addiction crisis, it is only inevitable that the effectiveness of acupuncture interventions will be recognized – for both getting off the opioids, and for finding true healing of the original pain, using acupuncture.
I know it is difficult to run and maintain your own practice, especially at the beginning, but there are opportunities out there. Many insurers are including acupuncturists, there is coding in place for the services we render. And we continue to press Medicare to cover us.
Medical clinics will increasingly embrace and offer acupuncture for several reasons. First and foremost, patients will attest to its efficacy, and will in fact demand it. This can be seen now with Kaiser Permanente offering acupuncture services. This will be the trend in all the large providers, because it saves them money!
Right now, veterans hospitals are beginning to offer acupuncture for PTSD. In IVF, the clinical evidence clearly supports that integration with acupuncture has much better outcomes than medical IVF alone.
We have challenges, of course, that we are currently facing, and that needs to be addressed. All of these inhibit our integration with mainstream medicine, which I think needs be one of our primary goals.
The Challenges Ahead
In the acupuncture field, our biggest challenge to integration is rejection of our core energetic physiology. This especially applies to the existence of acupuncture meridians and points, and the idea that various points can affect distal parts of the body. There is staunch resistance from the scientific medical community on this, who insist the evidence is not there to support it. Well, there is research and evidence, but it is coming from distant shores – China, Japan, South Korea, Taiwan, Russia, Germany. It is only a matter of time before this information becomes mainstream, but seriously, that could take many years.
Second, the expansion of dry needling among physical therapists is growing. It is a way for medical doctors to be comfortable with patients receiving acupuncture, without admitting the reality of acupuncture meridians. All of that is local ah shi needling, usually done poorly. When my patients ask me, what is dry needling? I reply, it is acupuncture without any training. I truly believe that when patients experience real acupuncture, they will prefer it to painful dry needling. But dry needling has the support of medical doctors, and the real problem is that it competes with the integration of real acupuncture into mainstream medicine. Addressing this will take political will, clout and money to sort out.
As for herbal medicine, well, there is steadfast rejection by the medical community. "The evidence for their effectiveness is not there. The herbs are polluted or contaminated." I know this is not true. For every individual herb and product in my pharmacy, I can produce a certificate of purity, done by independent labs in the U.S. I am talking about GMP products - Good Manufacturing Practice. China itself has stringent regulations required before exportation, and then most of the importers will also do independent lab testing once herbs and products arrive here.
Moving Forward
What will ultimately raise TCM’s reputation in the U.S.? Two factors. One, the American public will recognize its benefits and demand it. Second, the evidence that Western science clamors for. But this won’t come from the U.S. It’s too expensive to generate locally. It will come from China. Placebo studies, double blind studies, scientific explanation of the mechanisms, safety, and so on.
China is very proud of TCM, and allocates large amounts of government funds for research. This research will eventually reach the ears of the West, especially regarding the integration of Chinese herbs with Western therapy. I am specifically thinking of combining Chinese herbs with conventional medical treatment for cancer. Studies in China are conclusive that the combined approach increases recovery time, reduces side effects of surgery, radiation and chemotherapy, and inhibits reoccurrence, that is, long-term survival rates.
As you now enter your professional life, you are riding the crest of a wave, and will experience a wider acceptance and a wider integration. Take advantage of that. Learn how to work within the insurance billing system. Make effort to integrate with conventional clinics, let the medical world know of your ability. �For your acupuncture skills, continue to study the cutting edge treatment modalities. Develop your manual dexterity, where your hands become your both your diagnosis and your instrument of delivery. For herbal skills, continue to study the wisdom of the masters of antiquity, but also pay attention to the widespread application of herbal medicine in China.
The Politics of Health Care
Equally important is the need to be politically involved, politically active – not just with letter writing, but with contributing money to the state and national associations. As a profession, we need political clout. Chiropractors fought, and won, expensive battles with the AMA in the 60s, and have continued a strong political lobby ever since. They never kowtowed to the AMA.
And finally, if you have a spiritual connection to our medical art, please continue to practice and keep it a focus in your professional life. Patients gravitate to sincerity, and of course it deep-ens your ability, and connects you to the roots of TCM. Keep reading, keep studying, keep attend-ing workshops. I truly believe that you will become a better and more successful practitioner with continued study. But your best teachers will be your patients, and your clinical experience with them.
We have a medicine that is remarkably effective, especially for the most common outpatient applications. Know that you are applying a uniquely effective art that will benefit your patients. I wish you all the success, and encourage your perseverance. Thank you.