Acupuncture, Dry Needling, and the AMA

Acupuncture, Dry Needling, and the AMA

There is an ongoing battle between physical therapists (PT) and acupuncturists over whether or not dry needling is within the scope of practice of PT or, as is asserted by the acupuncturists, a form of acupuncture and so falls under their regulatory purview.

I have written about dry needling at Science-Based Medicine and there is a recent update on the legislative brouhaha at Acupuncturists say "dry needling" is acupuncture and requires specialized training.

Is dry needling a form of acupuncture? I hate to be a weasel, but the answer is yes and no.

If putting superficial needles into the skin to alter disease is your definition of acupuncture, then yes, dry needling is a form of acupuncture.

But then damn near anything can be called acupuncture given that acupuncture are probably  infinite in its variation. I want to declare phlebotomy in my hospital as a form of acupuncture and see if patients feel less pain, but our phlebotomists would probably then be out of their scope of practice.

But the underlying theory behind dry needling is more in the framework of science-based medicine and its narrow application to musculoskeletal pain make it unlike acupuncture.

I discovered today that the AMA has a position on dry needling:

**The AMA adopted a policy that said physical therapists and other non-physicians practicing dry needling should – at a minimum – have standards that are similar to the ones for training, certification and continuing education that exist for acupuncture.

"Lax regulation and nonexistent standards surround this invasive practice. For patients' safety, practitioners should meet standards required for licensed acupuncturists and physicians," AMA Board Member Russell W. H. Kridel, M.D**

Lets see. Acupuncture

  • is based on a prescientific fantasy of meridians and qi
  • bases diagnosis on worthless tongue and pulse examination
  • has no standard application
  • can be 'learned' in as little as 100 hours to 300 hours (that's a month) of education
  • has never been shown to be effective for any process
  • is no more than a theatric placebo
  • to judge from test questions, their education provides an understanding of medicine that is rudimentary at best
  • gloves are rarely if used, ignoring basic infection control

Although there are issues with dry needling and its use for pain and trigger points, at least it is being done under the concepts of reality-based medicine, anatomy and physiology.

Me? I would take a PT over an acupuncturist any day. They are not trained in the nonsense of chi and meridians, with the somewhat-more-plausible trigger point as a clinical guiding principle. PTs are grounded in reality-based medicine, and I want my pseudo-medicines with a modern patina. PTs are not going to needle for fertility, blindness, schizophrenia, and more. And I suspect we will never see the equivalent of "A case of perforating injury of eyeball and traumatic cataract caused by acupuncture" from a dry needler. Or so I would hope.

But more importantly, as often as not practitioners of dry needling use gloves during their needling, which is virtually NEVER seen in the practice of acupuncture. Give me good infection control with my pseudo-medical practice any day.

Perhaps it would be better if we required acupuncturists to undergo the training, certification and continuing education that exist for dry needling.

It would be a start.

Points of Interest 09/09/2016
Points of Interest 09/08/2016

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