You are confined only by the walls you build yourself

by U.S. Medicine

March 10, 2017

Editor-In-Chief,
Chester “Trip” Buckenmaier III, MD,
COL (ret.), MC, USA

“You are confined only by the walls you build yourself.” ―Professor Andrew Murphy

The free, efficient and unobstructed flow of information is critical both in business and medicine. Groups or departments within a larger organization are unflatteringly labeled with the euphemism “silo” when they are of a mindset to internalize processes and not share information. This tendency of departments within an immature organization to jealously guard information unique to their activities leads to wasted resources and “turf” wars, which can be devastating to the company overall. Although this concept originated in the business world, it is rare not to hear this same lament about the silos in medicine that slow progress to the detriment of the health system and the patients. A brief internet search using the terms “medicine” and “silo” reveals a host of commentary on the topic. 

For anyone in the healthcare profession, the tribalism inherent to medicine is no secret. In my own world of pain medicine, the factions are too numerous to count, and the different national pain organizations―all with different agendas―can be overwhelming. It seems to be deeply rooted in the human condition for individuals or small groups to seek and define how they are different and special from larger organizations. Admittedly, there is value in this innate need to be unique, in that this human drive motivates innovation and new thinking. Individuals or groups daring to be different should be encouraged and even cultivated, but only to the point where these differences become counterproductive to larger organizational and collective goals. Individual or small group differences that help the larger organization change and adapt to new challenges is positive for everyone. In contrast, being different for personal aggrandizement or reward at the expense of the overall mission and vision of the organization rarely ends well for the individual or the group. I think the following experience illustrates my point.

Regular readers of this column know that I am a state-licensed medical acupuncturist in Maryland and a proponent for increased utilization of complementary and integrative medicine (CIM―formerly complementary and alternative medicine) modalities such as acupuncture, massage, yoga and biofeedback in managing pain patients. I recently had an opportunity to attend and lecture at an auricular acupuncture seminar that included some renowned foreign experts on this type of acupuncture. Overall, it was a fantastic conference from my perspective, since the techniques being discussed were explained using our modern understanding of neurophysiology, to include empirical evidence of the effect of auricular needles on central nervous system function. During one of the question-and-answer periods, I posed a question to one of the experts concerning the auricular acupuncture technique in question and was immediately rebuffed with the statement, “I do not do acupuncture; this is auricular therapy.” 

Please allow me this short pause as I read these lines again and dejectedly sigh.

A quick internet search for the etymology of the word acupuncture reveals, “1680s, ‘pricking with a needle’ as a surgical operation to ease pain, from Latin acus ‘a needle’ (from PIE root ak-rise to a point, be sharp;” see acro-) + puncture.”1 It seems to me that acupuncture refers to any needle inserted anywhere on the body for the purpose of easing pain. To be fair, I understand the reason for the professor’s disinclination to be associated with the term “acupuncture,” because this ancient practice has considerable folklore and mysticism associated with it. Many purveyors of acupuncture explain their craft in terms of meridians, chi, five elements and other terms that defy explanation through science presently. Then again, saddling the term “acupuncture” with all this baggage seems linguistically unfair and ruinous to the beautiful simplicity of a word describing puncturing the skin with a needle for therapeutic purposes. 

Auricular acupuncture, acupuncture needles placed in the ear for therapeutic purposes, seems an exceedingly clear and precise description of what we generally were discussing at this conference. Auricular therapy seems unnecessarily confusing, since the Chinese practice of ear cauterization for sciatica (which simulated the idea of the ear as a target for acupuncture in the first place) is a type of auricular therapy. Other factions of medical providers have also played with language as they drive needles into human flesh (acupuncture) but now use terms like “dry needling” or “medical acupuncture” or “traditional Chinese acupuncture” or “auricular stimulation,” and the list goes on. I apologize now if I have “acupunctured” any “sacred cow” beliefs of my readers. (I crack myself up.)

Notwithstanding the economic practice barriers that are overcome in many states with these plays on words, is all this really necessary? I know from personal experience that this semantic mess is extremely confusing for our patients. Furthermore, all of this partisan bickering amongst the various acupuncture factions thoroughly complicates any efforts from folks like me who are trying to bring plain old acupuncture, in all its wondrous forms, to mainstream federal medicine. I have no beef with the multitude of different acupuncture styles and traditions; my only requirement is that they all be equally assessed through the hard and unforgiving lens of science. There is plenty of evidence in existence today that acupuncture (plain old needle in skin action) has therapeutic value in many patients for many conditions. If we could allow ourselves to overcome our personal biases and hubris toward any flavor of acupuncture and agree that any provider placing acupuncture needles for therapeutic purposes is doing “acupuncture,” the job of bringing these services to the masses (and regulating it appropriately) would suddenly be much easier. 

The various groups practicing their one “true” brand of acupuncture and labeling it as something different are not helping the mission and vision of bringing acupuncture to federal medicine as a covered benefit. Each separate community of providers, placing acupuncture needles in patients, has built their confining walls around their traditions, and these silos stand tall and proud to the righteousness of their point of view. How ridiculous our patients must think we all are. Perhaps Voltaire was not speaking entirely in jest when he stated, “The art of medicine consists in amusing the patient while nature cures the disease.”

I would suggest that the term acupuncture is broad and inclusive enough for all. If we would break down these self-serving artificial walls and speak with one voice concerning our desire for acupuncture services in our patients, all acupuncture factions would benefit (not to mention the benefits for our patients). 

1http://www.etymonline.com/index.php?term=acupuncture. Accessed 9 February 2017.


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