Getting to the Point : As More and More Patients Turn to Acupuncturists, California Moves to Beef Up Standards and Controls

It starts with a shallow, sharp prick of the skin, which dulls or heats up depending on your nerves--and, possibly, your state of mind. Then, with a quick twirl of the needle, a flood of natural painkillers rushes to the brain.

As a treatment for stress and chronic pain, acupuncture--at least in California--has become almost mainstream. MediCal pays for it and so do some private insurers.

But is it medicine or mysticism?

For the several hundred thousand Californians who have been “needled,” the practice might symbolize a confluence of East and West, of traditional and modern.

The Chinese have been practicing acupuncture for more than 2,500 years. In California, home to more than half the acupuncturists in America, it has been practiced legally for just 16 years. But that decade and a half has been marked by controversy, uneven enforcement and charges of criminal activity.

Although California’s acupuncture laws are among the toughest in the nation, state observers say the number of practitioners operating outside the law is “not small.” State Consumer Affairs Director Jim Conran on Monday swore in the latest in a string of acupuncture committees charged with improving enforcement.

“We can’t ensure anything is risk-free, (but) I can say that the role of this board will be to ensure that (acupuncturists) serve the public and not professional interests,” says Conran.

Legend has it that in ancient China, acupuncture patients were not expected to pay if they got sick during treatment.

Apart from the novelty of such an arrangement, the “We-keep-you-healthy-or-you-don’t-pay” plan reflects a potent--and continuing--belief in the powers of acupuncture by those who practice it.

But even in China, where acupuncture was born, the system has gone through various degrees of acceptance and application. The last 40 years have seen a boom in its popularity there as many forms of Eastern medicine enjoy government-sponsored revivals. In the West, disenchantment with modern medicine has led patients to ancient paths of healing.

Although U.S.-trained doctors have generally viewed acupuncturists with suspicion, recent studies have begun to change that. In such reputable journals as The Lancet and Pain, researchers have reported that acupuncture may work well for some patients with chronic back pain, arthritis and rheumatism.

And there has been great fanfare in New York City and elsewhere over acupuncture’s dramatic success in easing the torturous withdrawals of alcohol and drug addicts.

Yet, when it comes to success with such conditions as allergies, high blood pressure and sexual dysfunction, the proof is not there--at least not by Western scientific standards.

But that skepticism, say critics of Western medicine, says more about cultural differences than it does about bad science.

“Much of the richness of (acupuncture) comes from the Orient and from that way of looking at the world,” says Lynn Morris, executive officer of the state Acupuncture Committee. “There is no question that one’s philosophical outlook has much to do with the way you practice acupuncture and the way you evaluate its methods.”

East-West misunderstanding was not a factor in California’s most famous acupuncture scandal.

Three years ago, 47 acupuncturists were indicted in connection with a bribery scheme to fix state licensing exams. Committee member Chae Woo Lew was charged with taking as much as $500,000 to rig exams during his six years on the board. He pleaded no contest and was sentenced to five years in prison.

Even before Lew’s removal, acupuncturists and others had complained for years that the politically appointed panel operated with little accountability despite persistent charges of corruption.

As a result of the scandal, the entire examination process was reformed, the committee was reconstituted and state standards for acupuncturists were dramatically raised. Although the successor committee retained oversight of education, licensing and discipline, it was ordered to give outside professionals much of the work.

The majority of the new committee was replaced Monday when Conran swore in five members in hopes of breaking up a philosophical logjam that he says distracted the panel from its main purpose: enforcement.

The problem of unlicensed acupuncturists is widespread, particularly in the Asian communities of Los Angeles, state officials say. That may be partly because the higher standards require even the most venerable and well-trained acupuncturist from China to obtain a master’s degree before practicing in California.

“Certainly, it is very difficult for some people to go back to school and get that degree,” says Lynn Morris, the committee’s new executive officer. “But it is essential that they do. The (acupuncture) community is becoming more aware. They know those who operate without a license will be closed down once they’re found out.”

One of the biggest challenges, though, is finding out. Already, Morris has doubled the enforcement budget to pay state medical board investigators to look into consumer and agency complaints. But until there is a complaint, says Morris, there is no way of knowing who is practicing illegally.

There are almost 4,000 licensed acupuncturists in the state, all of whom must prominently display their licenses where they do business. (That includes several hundred physicians and dentists who are certified to practice the technique.) About 400 new acupuncture licenses are issued each year in California, about half of them to immigrants from Asia, mostly China.

As enforcement has stepped up, so have the volume and variety of complaints. Of the 100 or so complaints the state has received in the last year, most concerned false advertising and unlicensed practitioners. The balance included charges of sexual misconduct, including molestation.

Viewed by some medical doctors as a harmless ritual, acupuncture has been only rarely cited in medical literature for causing physical injury. There have been reports of dermatitis, activation of the herpes virus and puncture of the lungs from extremely long needles, but such incidents are very rare.

Although there is a risk of transmitting blood-borne infectious diseases, like the AIDS virus and Hepatitis B, there are no such cases on record. And the proper use of disposable needles dramatically reduces such risk.

Western scientists agree that acupuncture can work. Why, they cannot say.

Acupuncturists see the body as a bioelectric system with definite energy pathways. According to the classical Chinese method, there are 14 meridians, or energy channels, running through the body. Along those meridians are 361 acupuncture points.

Some practitioners also identify 48 “extra points” as well as additional lines along the scalp. And, in the last 20 years, some schools of thought have added still another set of needling points in the ear, which, they say, can be viewed as an inverted fetus with each kink or whorl representing a part of the human body.

Disruptions in the energy flow along the meridians cause pain and illness, say acupuncturists. By using needles to stimulate points along those channels, acupuncturists say, they can balance the flow and restore health.

There is no single way to insert the needles. Some twist or jiggle them into the skin; some apply a smoldering stick--filled with herbs--to the point to enhance effectiveness.

In 1989, UC Irvine neurologists went to China to measure the brain waves and nerve impulses of patients who were undergoing surgery with acupuncture as their primary anesthetic. Acupuncture clearly blocked the pain, but not in any way the doctors could measure.

Perhaps, the research suggested, the acupuncture worked only to block the perception of pain. That theory is popular among Westerners and some acupuncturists who believe that the needles trigger the release of endorphins, the body’s natural opiates.

Other recent research on the electricity of the human body suggests that there are standard, predictable routes of current and impulse.

That, say acupuncturists like Wei Chao, a UCLA dentist, sounds like West is moving closer to East.

“Perhaps one day,” he smiles, “they will at last meet. . . .”