A Retrospective Look at 50 Years of Acupuncture in the United States

Abstract

This article describes several key events concerning the introduction of acupuncture to the United States, considers the mainstream acceptance of acupuncture and the development of the acupuncture “infrastructure” for the past 50 years, and speculates on acupuncture's future trajectory. In the author's opinion, “the two factors which will contribute the most to the continuing development of acupuncture are acupuncture consumers and scientific research.”

INTRODUCTION

The summer of 2021 marked a significant anniversary for American acupuncturists: it has been 50 years since acupuncture was “introduced” to the American public. July 26, 2021 marks 50 years since acupuncture was “introduced” to the American public in the form of a first-person story published by journalist James Reston in the New York Times. Since then, Reston's experience receiving acupuncture therapy after an emergency appendectomy in a Beijing hospital has been told and retold so often, by so many people around the world, that it has entered the realm of legend. And, as is the case with a good legend, countless versions of the story have circulated over the intervening decades, some with only a loose connection to the actual facts. In 1 version, it was President Nixon himself who received acupuncture due to an injury from a fall. Finally, 1 man was driven to set the record straight. Dr. Yong Ming Li interviewed the surviving witnesses of James Reston's experience and published the true facts of the incident in the first chapter of his popular book, Acupuncture Journey to America.¹

However, Mr. Reston's story is too well known to warrant further discussion in this article. Instead, some of the earliest history of acupuncture in America is recalled, followed by a discussion of the current state of acupuncture as it has developed through clinical practice and scientific research.

FIRST HIGH-PROFILE CLINIC

In the wake of the general interest in acupuncture and all things Chinese after Nixon's groundbreaking trip to China, the first high-profile acupuncture clinic in the United States opened in New York City on July 12, 1972. The clinic was founded by Dr. Yao Wu Lee, Dr. Arnold Benson, and Mr. Charles Newmark. Almost immediately, the New York Board of Medicine and the FBI intervened to close it. Dr. Lee and his partners then relocated their clinic to Washington, DC, where it opened on December 28, 1972 as the Washington Acupuncture Center. The Washington Acupuncture Center was a notable success and received a lot of attention from media outlets around the world. The clinic employed up to 65 practitioners and staff and treated up to 1000 patients a day who came from all over the United States. In 1974, due to misleading reports by journalists and some administrative changes in Washington, the Acupuncture Center was challenged by the Washington, DC Medicine Board, and was ordered to close. The Washington Acupuncture Center contested the closure, and eventually won its lawsuit, but in the meantime the clinic suffered from business losses and administrative changes. As a result, most of the clinic staff scattered to other states: some started clinics in Massachusetts, New York, and New Jersey. Most of the staff followed Dr. Yao Wu Lee to the new clinics he set up in Florida.

Even though the lifespan of the first acupuncture clinic in the United States was brief, the Washington Acupuncture Center was significant for several reasons. For one thing, the experience of the Washington Acupuncture Center was a blueprint for the treatment of acupuncture practitioners during the 1970s when regulations on acupuncture were not in position. On a somewhat more positive note, the U.S. Immigration Bureau added the classification of “acupuncturist” to its list of recognized occupations in 1973, and set a specific immigration quota for acupuncturists. In 2012, the 83-year-old Dr. Yao Wu Lee was interviewed by Dr. Arthur Yin Fan. At this time, Dr. Yao Wu Lee was still working in his Florida clinic. Dr. Fan's interview was published in Journal of Chinese Integrative Medicine, as “The First Acupuncture Center in the United States.”²

FIRST ACUPUNCTURE LAW

The story of the first regulation of acupuncture professionals by a state legislature is an epic tale. At the time, an interested observer might have expected the first acupuncture-related legislation to occur in California, which has a large Asian population and a reputation for accepting the unusual; or in progressive New York, where the first acupuncture clinic was set up. Instead, it was Nevada, in 1973, which became the first state to recognize and regulate acupuncture as a medical modality. This was brought about through the combined efforts of 3 men: New York attorney Arthur Steinberg, a Chinese medicine doctor from Hong Kong named Lok Yee-kung, and a professional lobbyist James Joyce. Mr. Steinberg was determined to introduce legalized acupuncture into the United States after being persuaded of its value by his Chinese-born wife. Seeing that the medical establishments in California and New York were determined to confine the practice of acupuncture to licensed medical doctors, Mr. Steinberg decided to submit his test-case legislation to the legislature of Nevada, which often sanctioned unexpected legislation and was seen as more libertarian or independent than the legislative bodies of most other states. He hoped to obtain support from Nevada's Legislative Committee on Health Care for his proposed legislation to legalize acupuncture performed by trained acupuncture practitioners. Mr. Steinberg apparently decided to try a more public and theatrical approach. He enlisted the aid of lobbyist James Joyce, and brought in Dr. Lok Yee-kung, who had previously treated Mrs. Steinberg in Hong Kong.^1,2

Just before the acupuncture-licensing bill came up for a vote in Nevada's Senate, Dr. Lok Yee-kung set up an acupuncture demonstration area in the conference room of a casino located directly across the street from the State Legislative Building. As media outlets excitedly covered the event, Dr. Lok selected 70 demonstration patients out of the thousand who volunteered. Thirty of the selected volunteers just happened to be state legislators, who comprised about half of the total number of legislators who would be voting on the acupuncture bill. In April 1973, the first legislation legalizing acupuncture practice by non-MDs was a total victory for Steinberg and company. The State Senate passed it on a 20-0 vote. And the House of Representatives passed it on a 34-2 vote. Governor Mike O'Callaghan signed the bill into law on April 20, which was the first acupuncture law in the world. The national press took note of this outcome. Time magazine arranged stories reporting the passage of the first acupuncture legislation and Deng Xiaoping's comeback side-by-side in their April 1973 issue. In March 1974, Playboy magazine recounted the Nevada legislation story in an article, “The 300 Needles of Dr. Lok,” charting the fighting between the dragons and snakes. People magazine jumped on the acupuncture bandwagon in their April 15, 1973 issue, which featured a cover photo of Bonanza star Lorne Greene with acupuncture needles in his ear, accompanied by the title “Acupuncture Gets Popular.”¹

PRESENCE OF ACUPUNCTURE

As acupuncture gained traction through the 1980s and 1990s, it began to be practiced in hospitals, pain clinics, and drug treatment centers across the country. The practitioners in these Western-based venues were either M.D.s or non-M.D. acupuncturists working under the supervision of an M.D. In 1993, Hennepin County Medical Center (HCMC) in Minneapolis opened an acupuncture clinic that was staffed by independently operating acupuncturists (including the author's wife, Wei Liu, who was one of the first group of acupuncturists employed by HCMC). The acupuncture department was directed by Dr. Milton Bullock. This made HCMC the first hospital in the United States to employ independently operating non-MD acupuncturists. HCMC's acupuncture department was successful from its inception, with patient appointments booked a month in advance.

Now 50 years have passed since the early days of acupuncture in America. “Acupuncturist” is a recognized profession, accepted by the medical establishment and the general public. Licensed acupuncturists work in Western-medicine hospitals and clinics. Legislation regulating acupuncture practice has been passed in 47 states and Washington, DC, driven largely by the efforts of acupuncture practitioners themselves and the public demand. Many private insurance companies cover acupuncture treatments. At the federal level, Medicare is beginning to cover acupuncture for low back pain, Veteran Administration hospitals are offering acupuncture therapy, and the National Institutes of Health include the National Center for Complementary and Integrative Health that sponsors scientific studies of acupuncture. The Department of Defense offers acupuncture in many medical facilities worldwide. American independent acupuncturists have constructed a complete system for education, certification, and licensing. The Accreditation Commission for Acupuncture and Oriental Medicine has accredited 60 schools of Chinese medicine and acupuncture. The National Commission for the Certification of Acupuncture and Oriental medicine has certified 21,000 acupuncture and Chinese herbal medicine practitioners.³

In place of its initial reaction of hostility and suspicion, the Western medical establishment has accommodated the growing acceptance and popularity of acupuncture by establishing its own independent certification system for certifying M.D.s in medical acupuncture. A significant development has been the adaptation of acupuncture techniques to medical devices and procedures used in Western medicine, including transcutaneous electrical nerve stimulation, subcutaneous nerve injection therapy, peripheral nerve stimulation therapy, and dry needling. These science-based medical acupuncture techniques are used to varying degrees by Western doctors, chiropractors, and physical therapists. Acupuncturists also integrate some of these techniques into their practice.

What about the next 50 years? In the author's opinion, the 2 factors that will contribute the most to the continuing development of acupuncture in America are acupuncture consumers and scientific research.

PUBLIC DEMAND

Dr. Arthur Yin Fan of the U.S.-based American Traditional Chinese Medicine Association led a research team that calculated and compared the number of acupuncturists in China and the United States. They estimated that the number of acupuncture doctors in mainland China in 2018 was 18,404⁴; whereas the number of acupuncturists in the United States in 2018 was 37,886.⁵ American acupuncturists are primarily concentrated in 10 states: California, New York, Florida, Colorado, Washington, Oregon, Texas, New Jersey, Maryland, and Massachusetts.⁵ According to Dr. Fan's team, the acupuncture doctors in mainland China provided 33.71 million acupuncture treatments in 2018.⁴ A national health inquiry survey conducted in 2012 estimated that acupuncturists in the United States had provided 33.01 million acupuncture treatments,⁶ and noted that there had been a rapid increase in acupuncture services in the past decade. The number of acupuncturists in the United States was estimated at 11.63 acupuncturists per 100,000 people.⁵ In 2018, U.S. consumers spent 3.5 billion dollars for acupuncture services.⁷ These statistics are rudimentary, but quite remarkable. They show that in the space of 50 years, the United States has established an acupuncture consumer market, comparable with that of China.

The U.S. consumer market has also expanded in terms of the types of conditions treated in clinical practice. Initially, acupuncture was primarily thought of as an alternative approach to pain relief and drug addiction. Even now, a report⁸ published in the American Journal of Chinese Medicine shows that pain-related disorders account for more than 50% of acupuncture visits, with low back pain as the most commonly treated condition. However, the report also shows that acupuncture practitioners are beginning to resemble the general practitioners of Western medicine in the type and diversity of conditions they address. The top 10 conditions in acupuncture clinics today are low back pain, depression, anxiety, headache, arthritis, general pain, allergies, female infertility, insomnia, and neck pain. This report on commonly treated conditions also suggests opportunities for further development and diversification of acupuncture “specialties” as the U.S. market matures. One clinical application that is rapidly becoming popular is the use of acupuncture for symptom control in cancer patients.

ACUPUNCTURE RESEARCH

Today, acupuncture research from both Asian and Western sources is well represented in the mainstream journals of modern medicine. The fact that medical journals now routinely publish acupuncture studies has had a huge impact on the credibility of acupuncture as a medical system. Reports from research projects in Germany early in this century, which conducted 8 parallel studies of acupuncture on neuropathic headaches, tension headaches, osteoarthritis, and low back pain, were published in The Lancet, Journal of the American Medical Association, British Medical Journal, JAMA Internal Medicine, Annals of Internal Medicine, and Journal of Headache and Pain.^9–16 Clinical trial studies demonstrating clinical effectiveness of acupuncture organized by multiple research teams in China have been published in the Journal of the American Medical Association, JAMA Internal Medicine, Annals of Internal Medicine, American Journal of Gastroenterology, and Arthritis and Rheumatology.^17–24 After acupuncture came to the United States, more than 7,000 clinical trials on acupuncture have been conducted globally.²⁵

In the field of clinical research studies, the United States is rapidly assuming a leading role. Scientific articles designated the Science Citation Index (SCI), the Science Citation Index Expanded (SCI-E), and the Social Sciences Citation Index (SSCI) represent the highest quality of research. One study²⁶ showed that during the 18 years from 1991 to 2009, the United States published 1,097 SCI acupuncture research articles, while China published 583. In terms of institutional publication of SCI studies in the 1991–2009 period, Harvard University ranked third with the publication of 98 acupuncture research articles, following Kyung Hee University, South Korea (149 studies) and Fudan University, China (132 studies). A broader study by Kung et al.²⁷ that covered the period from 1988 to 2015 noted that the United States published 1,638 research articles in SCI-E and SSCI journals in those 27 years, which was close to China's publication total of 2,076 articles. Harvard University again ranked third with 163 published acupuncture research articles, following Kyung Hee University, South Korea (365) and China Academy of Medical Science, China (175).

CONCLUSION

Fifty years ago, acupuncture had no place in this country. Now it has achieved a significant presence. In certain areas, such as supportive therapy for cancer patients²⁸ and auxiliary treatment of infertility,²⁹ acupuncture practitioners are pioneering new territories. The gains of the past 50 years are very impressive in acupuncture legislature, education, and research. It is hoped that the next 50 years will see new forefronts of clinical research and innovation in the treatment of disease with acupuncture.

AUTHOR DISCLOSURE STATEMENT

No competing financial interests exist.

FUNDING INFORMATION

No funding was received for this research.