NAFTA Acupuncture and Oriental Medicine Commission Report
December 1, 1997

On October 3-5, 1997 representatives from Mexico, Canada and the United States met in Toronto, Ontario, Canada for the sixth meeting of the NAFTA Acupuncture and Oriental Medicine Commission. The Commission is a group of individuals - educators and practitioners, acupuncturists and medical doctors - who have met since May 1994 to exchange information regarding the practice of acupuncture and Oriental medicine within the three countries and to discuss standards of competence for the practice of acupuncture and Oriental medicine in North America.

Friday the full Commission met to up-date members regarding the events in each of the three countries. As one of the important tasks to be accomplished with academic exchange, some details were analyzed regarding the First International Congress to be celebrated in Acapulco, Mexico October 20-24, 1998. The Commission also discussed the various types of focused training programs found within the three countries, some of which are targeted toward specific needs such as chemical dependency and others which are condensed programs for other health care professionals. On Saturday, the five committees of the Commission met (Ethics, Education, Academic Exchange, Certification and Extension of Professional Practice). At the full Commission meeting on Sunday, the various committees provided reports and the Commission finalized plans for the conference in Acapulco, October 20-24, 1998. The Commission encourages all individuals and agencies within each country to promote and contribute to the conference since it will be an international showcase for the progress that has been accomplished in North America.

Country News

Canada reported that a country-wide poll by the Angus Reid Group showed that 42% of Canadians use alternative medicines and practices with acupuncture being used by 9% of all Canadians. With respect to various provinces, the regulatory body in British Columbia, the College of Acupuncturists, continues to work on bylaws for registration. Currently there are fourteen associations and eight schools of acupuncture within the province of 3.3 million. A pilot demonstration chemical dependency project for pregnant women will begin in Vancouver by the end of the year. In Quebec, approximately half of the estimated 1000 acupuncturists have registered with the Ordre des Acupuncteurs du Quebec, the regulatory body. The law states that until December 1999 all practicing acupuncturists may be grandparented but they must register and take the examination prior to that date. The Ordre has begun to sue the illegal practitioners. However, since each practitioner must be found guilty three times before the law will stop the practice, it is very difficult and expensive for the Ordre. Rosemont College, a publicly funded institution which has hosted an acupuncture program since 1986 and is the only approved training program in Quebec, accepts 25 students each year into its three year program. During their internship, students from Rosemont, who are already treating patients in the out-patient acupuncture clinic located on the premises of the college, are also offered choice amongst three hospital departments: obstetrics, family practice and rehabilitation, as well as one detox center to complete their internship. Also, three research programs are currently in their first stage of development in three hospitals. Workers compensation in Quebec is paying acupuncturists a fee of $27.00 and the Quebec Car Insurance pays $26.00 (Canadian.) Alberta representatives reported that there are 83 registered acupuncturists and 50 applicants for the next exam. Two colleges are projected to start up in Alberta in 1998, one at Grant MacEwan Community College and one at Southern Aberta Institute of Technology. The University of Alberta's Certificate Program in Medical Acupuncture is currently in its 7th class and the 8th class will begin in the spring of 1998. This program will be offered in Central and Atlantic Canada in 1998 for the first time in association with the University of Alberta and the Dalhousie University in Nova Scotia. The Canadian delegation reported that Workers Compensation in Alberta is paying acupuncturists $21.70 (Canadian) for acupuncture services. In Ontario the Health Professions Regulatory Advisory Council has still made no recommendation regarding the regulation of acupuncture within the province. A four year, 3200 hour comprehensive diploma program in acupuncture started in September at the Michener Institute for Applied Health Sciences in Toronto. This is the first full-time acupuncture program to be offered at a publicly-funded educational institution in Ontario.

Mexico reported that 69 individuals completed the eighteen month training program at the Polytechnique Institute for the members of the new college (regulatory board). A new 800 hour diploma program in acupuncture is being offered for medical doctors in addition to the 1800 hour program currently in existence. Additionally, a one year course in Chinese herbology has been started for medical doctors who have completed the acupuncture training program. MEXFAS continues to work to incorporate acupuncture into the social medicine system that serves 40 million people. The exchange program continues with the University of La Laguna, Tenerife, Canary Islands, Spain. MEXFAS has arranged with the Minister of Foreign Affairs for it to send invitations to the tri-national conference to all countries through the Mexican consulates.

The US delegation reported that three additional states had passed acupuncture statutes, bringing the number of states with legal practice to 35 plus the District of Columbia. The Federal Acupuncture Coverage Act, HR 1038, which would provide coverage for acupuncture under Medicare, has been reintroduced into the US House of Representatives. The National Institutes of Health will hold a consensus conference on acupuncture this November. The Council of Colleges of Acupuncture and Oriental Medicine has finalized a proposal for a Doctorate in Oriental Medicine. An increasing number of colleges are providing rotations for students in public health clinics and hospitals and more colleges are developing affiliations with universities, including medical schools. The Accreditation Commission for Acupuncture and Oriental Medicine (formerly NACSCAOM) has 24 accredited colleges, 10 in candidacy status and 12 applications. The NCCAOM (formerly the NCCA) has 500-600 candidates taking the bi-yearly examinations in acupuncture and over 120 applicants for Credentials Documentation Review in Oriental Bodywork Therapy. The National Acupuncture and Oriental Medicine Alliance is establishing training programs to bring practitioners into compliance with Occupational, Safety and Health Administration (OSHA) standards. The American Academy of Medical Acupuncture (AAMA) has over 1200 members, has offered its first proficiency examination, is moving toward board certification and is developing intermediate and advanced workshops in several traditions of acupuncture.

Committee Reports and Actions Taken

The Ethics Committee continues its development of a model code of ethics for organizations and requests input from any agencies with such a code. The Committee reviewed the Seattle Statement and recommended that the Commission sign it. Members of the Commission volunteered to translate the Seattle Statement into Spanish and French so that it may be considered for adoption at the next meeting

The Education Committee reported that it has almost completed its work on an aspirational entry-level curriculum for a comprehensively trained acupuncturist and hopes to present the final document at the next meeting of the Commission for discussion. The Committee began reviewing several focused training programs for medical doctors.

The main focus of the Academic Exchange Committee has been on the October 1998 conference. The Committee is also exploring reciprocal visits to evaluate outcomes of didactic and clinical teaching in order to create further ideas regarding academic exchange. The Committee is also discussing possible exchange programs for students.

The Certification Committee reported that it is working on a flowchart of legislation and governmental structure within each of the three countries. It also proposed several programs for the 1998 conference to illustrate the progress within the three countries with respect to legal and public acceptance, certification and accreditation, which were accepted.

The Extension of Professional Practice Committee continues its focus on research issues within the three countries.

The Conference Committee outlined its proposals to the Commission and received suggestions.

The Commission discussed its structure and membership and established a subcommittee to propose more specific guidelines for membership in and invitation to the Commission.

The next meeting of the Commission will be in the United States May 29-31, 1998.

NAFTA Acupuncture and Oriental Medicine Commission Report
March 24, 1997

On January 10-12, 1997 practitioners from Mexico, Canada and the United States met in San Diego, California for the fifth meeting of the NAFTA Acupuncture Commission. The NAFTA Acupuncture Commission is a group of private individuals - educators and practitioners, acupuncturists and medical doctors - who have met since May 1994 to exchange information regarding the practice of acupuncture in the three countries and to discuss standards of competence for the practice of acupuncture and Oriental medicine in North America.

During the first two days of the meeting, the Ethics, Education, Academic Exchange, Certification and Extension of Professional Practice Committees met. At the full Commission meeting on the last day, the countries up-dated the Commission on changes within their boundaries. The Commission also changed its name and adopted Bylaws and a Model Code of Ethics for practitioners.

Country News

Canada reported that the British Columbia government has established a regulatory body or college for acupuncturists. The College is charged with establishing all rules and regulations by July of this year for the province's practitioners. It is estimated that there are 300-500 acupuncturists in the province. Also in British Columbia seven schools are forming a council of schools. Alberta gave its fourth examination and now has more than seventy registered acupuncturists. The regulatory board in Alberta is preparing to review its eligibility criteria and examination. Ontario is still awaiting the decision of the government regarding whether acupuncture will be considered a 'controlled act' and therefore regulated within that province. It is estimated that there are approximately 1,500 regulated individuals from other health care professions such as medical doctors, physical therapists, chiropractors and naturopaths currently practicing acupuncture and 3,000 unregulated acupuncturists. The Michener Institute for Applied Sciences, a college funded by the Ministry of Health of Ontario, is opening a 4 year, 3200 hour comprehensive acupuncture program this fall.

The Mexican Federation of Acupuncture Societies (MEXFAS) reported that the training program for the members of the new college (regulatory board) is almost complete. Over 70 individuals, with an average of 10 years of experience, have participated in the eighteen month training course. The course was designed to ensure that the members of the board achieved the highest standard of training for all members. Once the training is completed, the college will be recognized by the National Academy of Medicine and the Health Ministry and will then establish regulations for practitioners and schools in Mexico. The new college hopes to give its first certification examination in October of this year. MEXFAS reported that fifty-six medical doctors completed the 1715 hour course at the Polytechnic University to qualify for the government recognized medical specialty and an additional thirty-eight doctors have enrolled in the new course. Twelve Mexican doctors participated in the first exchange program with China. The next step will be a visit by Chinese medical doctors to Mexico. Finally, MEXFAS has established agreements with two institutes in Spain to discuss acupuncture. MEXFAS noted that its goal is to work for the recognition of acupuncture, regardless of who is practicing. In Mexico, however, it is necessary to first establish regulations for the practice of acupuncture by medical doctors, then work for recognition of the practice by non-medical doctors.

The US delegation reported that there are now twenty-four accredited schools and nine in candidacy in the national accreditation process. Another dozen applications are pending and an additional seven schools have indicated interested in becoming accredited. One naturopathic college has a comprehensive acupuncture programs and the other two are developing one. Additionally, two chiropractic colleges are starting comprehensive programs. The first regionally accredited college, Mercy College in New York, has started an acupuncture program and the University of Miami is starting a comprehensive program for acupuncturists within its medical school. The Council of Colleges reported that it now has thirty-three member colleges and that one Canadian college has applied. The CCAOM will focus this year on reviewing the CNT Course, the core curriculum, the criteria for doctoral program and the clinical component of the herbal program. The Council will also begin looking at curriculum for an independent herbal program. NCCA reported that its acupuncture certification program was adopted by West Virginia, South Carolina and Illinois, for a total of 27 states plus the District of Columbia, and that NCCA plans to administer examinations in Korea in 1997 and possibly Switzerland in 1998. The Credentials Documentation Review portion of the NCCA Oriental Bodywork Therapy certification program opened in July and the Computer Based Testing has been delayed for approximately a year.

Committee Reports

The Ethics Committee forwarded to the Commission a Model Code of Ethics for practitioners, which was approved by the Commission. The Model Code will be distributed to acupuncture and Oriental medicine organizations in the three countries for comment. For a copy, please contact the Commission at the address below. The Ethics Committee was charged by the Commission to develop a Model Code of Ethics for organizations. Organizations who have such a code of ethics are encouraged to send them to the Commission for consideration in the discussion.

The Education Committee reported on its work to date to develop a vision of an entry-level curriculum for a comprehensively trained acupuncturist. The Committee has focused recently on the biomedical component. It is hoped that a final document will be presented to the full Commission at the next meeting, after which the Committee will move on to discussions of various types of focused training. The Committee also reported that it had concluded that there is a need for both comprehensive and focused training programs.

The Academic Exchange Committee continues to work on encouraging the establishment of mechanisms to facilitate academic exchange. Much of the Committee time recently has been focused on planning the Tri National Congress to be held in Acapulco the weekend of October 24-25, 1998. The Congress will feature speakers from all three countries and provide a multitude of presentations ranging from educational workshops and research to up-dates on the status of acupuncture and Oriental medicine in each country.

The Extension of Professional Practice Committee has divided into two working groups. The first will work on developing language regarding the need for research and the problems involved in conducting research in this field. The second will continue discussions of the relationship between scope of practice, standards of competency and recognition of limits of training and need for referral, whether to acupuncture and Oriental medicine or allopathic practitioners. The goal is to develop a recommendation in this area for regulatory bodies.

The Certification Committee reported that MEXFAS is working toward establishing its own certification program. Canada as yet has none. The Committee determined that it will not serve as a certifying body but will now begin to look at model standards of certification. It noted that it has looked at the existing measurements of competency for comprehensively trained acupuncturists within each country and has recognized the excellence of the NCCA certification program and the process NCCA follows.

Actions Taken

On Sunday the Commission unanimously voted to change its name to the NAFTA Acupuncture and Oriental Medicine Commission. This reflects the continued growth and acceptance of Oriental medicine within the three countries. The Commission then adopted Bylaws and the Model Code of Ethics for Practitioners. The Code of Ethics will be distributed to the public for comment.

MEXFAS proposed that the Commission declare October 24th of each year as Acupuncture Day. This follows the World Health Organization declaration of October 22nd as the Day of Traditional Medicine and the Mexican tradition of observing October 23rd as the Day of the Doctor. The Commission approved the motion and will work with acupuncture and Oriental medicine associations to promote October 24th as Acupuncture Day within the three countries.

Finally, following the several discussions regarding focused and comprehensive training that took place during the weekend, the Commission decided that it will work on a statement regarding its recognition of the need for and value of both types of training for health care practitioners.

The next meeting will be hosted by the Canadians in Ontario in October 1997.

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