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The Honolulu Advertiser
Posted on: Friday, February 8, 2002

Acupuncture's popularity ignites state licensing tussle

By Alice Keesing
Advertiser Health Writer

Joni Kroll slips a needle into her patient's arm, feeling for the "deqi," the small tug as the needle enters the body's energy channels mapped by ancient Chinese acupuncturists thousands of years ago.

Acupuncturist Joni Kroll of the Kailua Acupuncture Clinic treats patient Diana Warrington for a sinus condition by inserting acupuncture needles in her face. Many medical doctors now acknowledge the benefits of acupuncture.

Bruce Asato • The Honolulu Advertiser

Her patient, Patrick Spadinger, came to her with serious allergies, sinusitis and fibromyalgia. The only food his body would tolerate was pork. He had trouble breathing, trouble sleeping and was constantly tired.

Spadinger still sees a medical doctor, but since he began his visits to Kroll he said his condition has improved dramatically.

Western medicine has traditionally cast a skeptical eye at healing methods such as acupuncture. But as research has validated them and as people across the nation increasingly turn to alternative treatments — spending more on them than they do on doctors — they are slowly being embraced by the mainstream.

Embraced so much, in fact, that a turf battle has ignited as doctors in Hawai'i fight for the right to practice acupuncture. Hawai'i is the only state where doctors cannot practice medical acupuncture.

Doctors want to combine acupuncture with conventional medicine and bring the benefits to more people. But licensed acupuncturists say 600 acupuncturists are already practicing in Hawai'i and that medical doctors would use only a part of the ancient traditional Chinese medicine, which may not give the best results.

"What we're encountering now is a transitional phase in the cultural evolution of how healthcare is being practiced and received," said Dr. Ira Zunin, who has spearheaded the effort to get doctors cleared to do acupuncture in Hawai'i. "In two years it will be over but right now it is just a very unfortunate flashpoint."

State licensing boards for doctors and acupuncturists disagree over whether doctors should be allowed to practice acupuncture. And the Department of Commerce and Consumer Affairs has been unable to bring the two professions to common ground.

A bill that would have allowed doctors to practice acupuncture was buried at the Legislature last year and has yet to be revived this year.

But the Hawai'i Medical Association, which represents doctors, is considering taking the issue to court to resolve what it says is a conflict in state law that is preventing doctors from doing acupuncture, said Richard Botti, who manages government relations for HMA.

Zunin said doctors are lobbying legislators and that momentum is building to allow doctors to practice acupuncture.

Kroll said there is concern that doctors could take business away from licensed acupuncturists.

"What has happened is now there is insurance coverage, so there is a profit motive for medical doctors who can now bill and collect for it," she said.

But Zunin said the current reimbursement for acupuncture is less than other medical treatments.

"This isn't physicians knocking off what acupuncturists do because they can make more money," he said.

At the heart of the debate is the question of how much training is enough.

The medical community is proposing a 200-hour video course on top of their medical training, which Zunin said is consistent with national and international standards.

But that's not enough, say licensed acupuncturists who must complete more than 2,000 hours of training, including clinical experience.

The video program amounts to "cookbook acupuncture," according to Kroll, a board member and past president of the Hawai'i Acupuncture Association.

Fortunately, she said, the potential harm from someone using needles incorrectly is minimal.

"You could have bruising; if you really didn't know what you were doing you could puncture a lung in a worst-case scenario," she said. "But from our perspective, the worst thing that might happen is that they might not get the results, and they're just going to give a bad name to acupuncture; the patients are going to say it doesn't work."

The problem as Kroll sees it is that doctors who do acupuncture ignore large parts of theory and treatment of traditional chinese medicine. While a medical doctor may use the Western diagnosis of sinusitis, an acupuncturist differentiates between four different types of the ailments such as wind heat or wind cold and then treats the patient accordingly.

In addition to using needles, a licensed acupuncturist also may prescribe herbs, breathing exercises or dietary changes.

"We treat the person who has the disease, not the disease that the person has," she said.

However, Zunin said doctors are not trying to follow traditional Chinese methods. He differentiates what doctors do as "medical acupuncture," a form that the French Jesuits adopted from the Chinese more than 200 years ago.

"It's a distinct tradition that integrates modern forms of acupuncture and (conventional) medicine," he said.

Medical acupuncture already is practiced by 5,000 doctors on the Mainland and is the fastest growing medical specialty, Zunin said.

But Kroll said the term "medical acupuncture" is misleading and also implies that licensed acupuncturists are not practicing a valid form of medicine.

"I think it's confusing to the public because people who know nothing about acupuncture may think, 'Oh, if my doctor says he does acupuncture maybe it's safer,' although he won't have to tell them what his training is," she said.

Zunin recognizes that the issue could sow confusion for patients and has suggested that practitioners be required to reveal the extent of their training. Kroll counters that this step has not been successfully carried out on the Mainland.

Reach Alice Keesing at akeesing@honoluluadvertiser.com or 525-8014.