John Scott, DOM wrote the following to stimulate thoughts and discussion in advance of NMSAAM’s annual meeting, and to remind us of the history of our profession in this state.
Please allow me to share some thoughts on the state of Oriental Medicine in New Mexico and maybe beyond. To start I have included several definitions of OM. I think that there is a thread that connects these definitions. I will start my thoughts on the other side of these definitions.
What is Oriental Medicine? Oriental medicine has been practiced for more than 2,500 years and includes acupuncture, herbal medicine, moxibustion, Oriental massage and Oriental nutrition. It is a system of medicine that categorizes body patterns into specific types of diagnoses with corresponding treatment plans.
According to the World Health Organization:
The Cochrane definition of “Traditional Medicine”
Traditional medicine is the knowledge, skills and practice of holistic health care, recognized and accepted for its role in the maintenance of health and the treatment of diseases. It is based on indigenous theories, beliefs and experiences that are handed down from generation to generation.
A recent modification of the well-known Cochrane definition described CAM as including “all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being.
From the (former) OMANM site on the page “All about Acupuncture”:
“Oriental medicine is a refined medical system which has been used for more than three thousand years to diagnose and treat illness, prevent disease and improve well-being. It is effective for physical, psychological and emotional problems. Acupuncture is one of oriental medicine’s most important treatment modalities.”
According to the National Cancer Institute:
Oriental medicine (OR-ee-EN-tul MEH-dih-sin)
A medical system that has been used for thousands of years to prevent, diagnose, and treat disease. It is based on the belief that qi (the body’s vital energy) flows along 20 meridians (channels) throughout the body and keeps a person’s spiritual, emotional, mental, and physical health in balance. Oriental medicine aims to restore the body’s balance and harmony between the natural opposing forces of yin and yang, which can block qi and cause disease. Oriental medicine includes acupuncture, diet, herbal therapy, meditation, physical exercise, and massage. Also called traditional Chinese medicine and TCM.
From another source:
The most striking characteristic of oriental medicine is its emphasis on diagnosing disturbances of qi, or vital energy, in health and disease. Diagnosis in oriental medicine involves the classical procedures of observation, listening, questioning, and palpation, including feeling pulse quality and sensitivity of body parts.
According to an unnamed NM DOM:
“OM is a traditional medicine, practiced in East Asia. It is a practical application of the world-view common throughout East Asia for the past two thousand years. OM diagnosis and treatment are both performed directly by its practitioners, using substances readily found in nature and tools available to pre-industrial societies.”
A Very Short History
While there is an apparent thread through these definitions, throughout the long several thousand year history of OM or TCM or CCM there has been very passionate disagreement regarding the recent and current direction of OM. Currently, in the US and other countries and regions there is not always agreement on what we should even call OM.
I was taught that the Huang Di Nei Jing, the Han era classic on Chinese medicine, was compiled to codify medicine and differentiate the official practice from the shamans. The creation of medical orthodoxy is not unique to modern medicine. I read an account that the renowned Ming Era teacher Li Shi-Zhen was murdered because of his teachings and writings. We can imagine that throughout history in Asia that there were many instances of conflict and competitions between the various schools of thought.
In New Mexico we have had our own history of conflict and competition. In the early 1980s there was considerable tension and competition between the DOMs taught at the Kototama Institute and the DOMs who practiced in Chinese and other traditions. This competition became very lively when it was time to appoint members to the BAOM and to administer the exams given in New Mexico to grant licenses. This was the time before the NCCAOM exams were available. When New Mexico adopted the NCCAOM exam for licensure this tension eased greatly.
By 1989 there was enough unity in our OM community to pass significant legislation in New Mexico. Our legal designation was changed from Licensed Acupuncturist to Doctor of Oriental Medicine. We were also granted primary care status and our scope of practice was expanded to allow DOMs to order laboratory testing and to legally perform injection therapy.
The 2001 legislative session brought a big change to our NM AOM practice act. There was and is now a separate licensure designation for some DOMs. They were called RX and now Expanded Practice. This extra designation gave DOMs expanded injection therapy, chelation, bioidentical hormone therapy and some other modalities that the proponents called “cutting edge.” Injection therapy was then removed from the regular scope of practice. DOMs would now have to enroll in additional expensive courses to continue to provide the services that they already were providing.
There was an article in our professional newsletter that implied that in the future RX DOMs would be called upon to supervise DOMs who did not choose to embrace this style of practice. This RX practice ignited a discussion or argument about the nature of OM. There were some DOMs who did not believe that these modalities belonged under the umbrella of OM. They felt that many of these modalities were alien to the philosophy of the tradition of OM. The proponents of RX believed or stated that because their world view was that of OM that these modalities easily fit into OM practice. This became the basis of a deep divide in our NM OM community that has been present ever since that time.
In the year 2007, legislation was passed that split RX into 4 modules. This was done to allow more DOMs access to the modalities in RX. With the passage of this legislation a DOM would have the opportunity to become trained in only one area of expanded practice instead of the entire program. This was considered an improvement that all DOMs could abide by. Following this legislation there were attempts to expand the list of substances included in the scope of practice by rule. The opinion of the Attorney General’s office was that these additions were not supported by our Practice Act. There were considerable conflicts over what was in scope, what was out of scope, what was implied and included. These conflicts lead to great delays to making access to these trainings possible for the DOMs who were interested in pursuing this style of practice. Recently the first basic injection course was given. Some of the delays were caused by lawsuits filed against the BAOM by a DOM who is a primary advocate of the Expanded Practice specialty.
Since 2001, our AOM profession in New Mexico has split into various factions and groups over the EP issues and the resulting conflict. In 2001 we had one united AOM professional association.
There are various perspectives in our community and organizations that represent these perspectives.
One perspective is that EP or at least some aspects of this specialty do not belong under a DOM board and the DOM license and should be regulated under a different supervising agency. They feel that these practitioners no longer practice what they feel is OM and are performing something totally based on western and non-Asian theories and modalities.
The EP DOMs seem to feel that there ought not to be any restriction on the substances that they have access to or the modalities that they are allowed to employ. They seem to feel and express that any restriction or questioning by any medical or governmental authority is an unwarranted impingement on their freedom to practice as they see fit. The perception and experience of some DOMs is that some of these EP practitioners have sometimes been very aggressive in pursuing their agenda. Their communications and actions in recent years have been instrumental in creating the split in our community that did not exist before 2001.
Another perspective is that as long as everyone is practicing within the scope of their training with patient and public safety as their first concern we should all coexist peacefully.
There are a great many streams of thought and practice in AOM. There is classical Chinese medicine, Korean, Japanese and Vietnamese styles of acupuncture practice. There are Five Element Worsley style and various distal point and microsystem styles. In New Mexico we have Kototama style acupuncture. With the great diversity of treatment approaches in can be quite a challenge to educate the public about what AOM is all about. With the introduction of EP into this stream the challenge is even more difficult. When one is referring to a DOM can one be confident in what kind of care the patient will receive?
In the past I have heard discussions about bringing the profession forward and progress for our profession. It is my impression that some DOMs and in particular EP DOMs see progress as adding ever increasing additional “cutting edge” modalities to the professional toolbox.
In my own opinion, progress would look like creating access to AOM services to every citizen in our society in every social and economic constituency. Progress for our profession is also deepening the understanding of the classical roots of OM for all DOMs and educating our patients to help them understand the process.
Of great concern to DOMs as a profession in New Mexico is that the fractioning of the last 13 years diminishes our former representation and positive reputation at the Roundhouse and with our New Mexico Legislature. Our representatives in our state government do not want to contend with several competing AOM professional associations. They want to hear from only one united voice.
Is it possible to bring our community together? I don’t know. At this point in time I believe the chances are rather remote. It would require huge efforts to create bonds of trust and cooperation after the many bitter and personal conflicts and communications that have happened.
Let me please finish with some questions. What can we as NMSAAM do to better serve our patients and our community? How can we better communicate the essence of traditional Asian medicine as we currently practice? Can we please practice mindful communication between our fellow DOMs for a better future?
John Scott, DOM