The Contributions of Women to the Practice of Medical Acupuncture in Michigan
A memoir by Alison Lee, MD, FAAMA
When I arrived in Michigan almost 30 years ago, physician and non-physician acupuncturists were practicing throughout the state in a disconnected and independent environment that lacked significant organization. On the regulatory level, there were no restrictions on the physician in terms of scope of practice, and any physician was free to offer acupuncture to their patients. No licensing mechanism existed for non-physician acupuncturists, so they were not recognized by the state as qualified to practice medicine or acupuncture, but the environment was lenient allowing them to freely establish acupuncture clinics.
Moving to Michigan
My journey from New York to Michigan was sudden and unexpected. In 1992, as the director of Anesthesia Pain Management at Nassau County Medical Center in a New York City suburb, I was interested in offering acupuncture to my patients, and I attended the acupuncture training program for physicians sponsored by UCLA commonly referred to as “the Helms course.” During a research year at the University of Michigan, while a Neurosurgery resident at Dartmouth, Kevin Lee also attended the Helms course. We met in the acupuncture course and were married by January 1994. To save a Midwesterner from the perils of the Big City, I moved instead to Michigan.
Introduction to Helms
Joseph Helms, MD, was one of the first physicians to systematize medical acupuncture training and develop a program accessible to active physicians. Widely regarded as the “Father of Medical Acupuncture in the U.S.,” Helms started the program in 1978. It evolved under the support of various organizations and successfully established French Energetic acupuncture as a principal form of acupuncture practiced by physicians throughout the U.S. Joseph Helms is also the founding president of the American Academy of Medical Acupuncture, the largest professional organization for physicians who practice acupuncture in the U.S. Since 2007, Helms has devoted his energy to training practitioners to treat the sequelae of military duty. For the Lee family, however, Helms’s greatest role was in developing a training program that attracted a group of physicians so diverse that an anesthesiologist from New York and a neurosurgeon from Michigan could meet and marry.
A Plan for Progress in Michigan
In 1993, I made several trips to Michigan and learned about the acupuncture community. At the time, in New York, I belonged to a regional acupuncture organization directed mainly to providing the sole pathway to state licensure for physicians. In Michigan, the non-physician acupuncturists supported a political organization, but there were no education-centered acupuncture organizations. Additionally, I wanted to bridge the disconnect between physicians who practiced acupuncture and non-physician acupuncturists by providing a common mission that would appeal to all. I envisioned an organization that would enhance the status of acupuncture in the state of Michigan by providing regular educational and networking opportunities.
The Acupuncture Society of Michigan was incorporated in late 1993, and 501(c)(3) status was gained in 1994. Solicitation for members was met with wide interest and the first meeting was attended by approximately 20 people who were glad to meet each other. With one exception, speakers were drawn from the membership. Their talks provided an excellent opportunity to learn about our local talent. The non-member was an attorney who gave a balanced discussion on regulatory considerations. Local speaker panels comprised full-day meetings twice yearly. Members expressed interest in gaining personal experience with prominent teachers, and the Michigan State Medical Society accepted a proposal to provide CME for two-day meetings. The demands of mounting administrative needs were miraculously removed from my shoulders in 1997 by my mother’s decision to retire and join me in Michigan.
A Mother’s Contributions
Ruth Pataky had extensive organizational experience. She ran a family business and, after my father was threatened with arrest for indecent exposure for running outside in shorts at night (well before I was born), her administrative work with early athletic associations helped to establish running as a legitimate athletic activity. My mother worked both behind the scenes and at the finish line to make the first New York City marathon not only a one-time success but an enduring event. After being widowed, she worked for 17 years as secretary to the Dean of Student Affairs at Columbia University Medical School in New York. There, she enjoyed working with medical students and physicians. My mother had a love of the medical field and admiration for medical practitioners, which prompted her to serve also as a long-time hospital volunteer. Favorable experiences with acupuncture for her own health issues made her an enthusiastic supporter of the specialty. My mother saw the growing needs of the Acupuncture Society of Michigan as a calling to return to volunteer work. The Acupuncture Society of Michigan became known for providing high-level educational meetings, frequently taught by esteemed members of the American Academy of Medical Acupuncture and other organizations. Over the next several years, meetings became full weekend events by recognized faculty, offering CME credit, eventually provided by the American Academy of Medical Acupuncture.
The Society Grows
While the Acupuncture Society of Michigan was actively growing, Allen McDaniels, MD, requested that I chair the 1997 meeting. I felt strongly that a research component was important to bring the symposium to the level of meetings of other medical specialties, and I proposed to the board a poster competition, with an incentive of cash awards. Poster competitions are an excellent opportunity to exchange ideas with colleagues. To encourage board approval, I donated the awards for the first poster sessions from my own practice. One of my most gratifying moments in acupuncture was spent alone, witnessing from my home the excitement on the faces of research participants amidst the strange intimacy of the 2021 online conference.
In developing the program for 1997, I identified so much potential content that I ran the 1998 meeting, as well. McDaniels, aware of my interest in feline medicine and my desire to have a veterinary speaker at the meeting, introduced me to AAMA member, Narda Robinson, DO, who was also a DVM. Robinson was pioneering an acupuncture training program for veterinarians at Colorado State University. She invited me to join her at one of the first sessions to assist in teaching human point location and Five-Phase Theory to veterinarians, who would then apply the knowledge to animals. Robinson became a leading educator in her field, and early discussions of whether to include veterinary acupuncture in the symposium led to conversations about the inclusion of non-physicians as presenters.
The Acupuncture Society of Michigan additionally generated goodwill between physicians who practice acupuncture and non-physician acupuncturists. Non-physicians were making inroads in terms of obtaining formal recognition, primarily through the Michigan Acupuncture Association and the organization’s long-time head Deborah Lincoln. The non-physician scope of practice has gradually expanded over many years, largely through the efforts of Lincoln and other non-physician acupuncturists, some of whom were among the first Acupuncture Society of Michigan meeting speakers.
Not All Progress Is Easy
In addition to being asked to speak for numerous medical gatherings, I was approached in 1999 about the feasibility of designing a program to teach acupuncture to physicians and physician assistants in a Lansing health system. I proposed a curriculum teaching basic acupuncture for selected indications, utilizing existing skills in palpation and handling of needles. My opinion was that simple acupuncture protocols could increase the reach of acupuncture benefits into more conventional primary care and emergency settings and open the door for acceptance of more comprehensive acupuncture services. The idea was declined.
Change Comes to University of Michigan — Slowly
Due in large part to my proximity to the Medical School at the University of Michigan, this institution became the most frequent source of requests for me to speak about acupuncture. Members of the Department of Gastroenterology were enthusiastic about a collaboration offering acupuncture to patients with functional bowel disease, but the administrative logistics were perceived as too cumbersome.
During the early 2000s, Rita Benn, PhD, was the director of the Faculty Scholar’s Program in Integrative Healthcare at the University of Michigan, which was devoted to educating selected cohorts of staff physicians about alternative medicine modalities. Benn had a background in psychology and an interest in meditation and mindfulness-based practices. She invited me to participate in teaching the program, on which Benn worked in partnership with Sara Warber, MD. Warber, a graduate of Michigan State University School of Human Medicine, was a professor in the University of Michigan Department of Family Medicine and Co-Founder/Director of the Integrative Medicine Program. Warber was primarily interested in general holistic medicine, herbal medicine, and women’s health and in 2000 became a founding diplomate of the American Board of Holistic Medicine. Warber was devoted to changing the culture of medicine at the University while maintaining evidence-based practice. A ribbon-cutting ceremony commemorated the opening of an integrative medicine clinic 19 years ago. Warber also strongly promoted education about acupuncture in the department and was instrumental in the department’s granting approval for the first University of Michigan Family Practice resident to attend the Helms course.
The Society Evolves
Through my lectures, medical students learned about the Acupuncture Society of Michigan meetings and occasionally attended. Putting meetings together was an enjoyable process for my mother and me. She enjoyed helping to brainstorm catchy meeting titles, working together on the promotional materials, selecting venues, creating menus, collating handouts, catering to speakers and attendees, and assigning my daughter tasks, such as “name tag enforcer.” My mother’s drive and sense of humor followed her into her later years, but her ability to help organize meetings declined. Administrative aspects had become more time-consuming due to onerous reporting rules that evolved as part of Homeland Security — for even small 501(c)(3) organizations. Running operations increasingly on my own was a sad reminder of my mother’s decline to both of us. Much as I envisioned the Acupuncture Society of Michigan as a beacon of acupuncture education that would last for decades and bolster the position of acupuncture in the state, in 2013 I made the difficult decision to close the organization.
The Growth of CAM and Integrative Medicine
I had become increasingly aware over the years of the strides made in Complementary and Alternative Medicine (CAM) at the University of Michigan. Benn and Warber, along with Suzanna Zick, MPH, performed much research in CAM. Zick had a degree in Naturopathy from the National College of Natural Medicine. Following a family experience with cancer, Zick was especially interested in studying CAM, including acupressure, in oncology settings. This team’s research laid the groundwork for evidence-based clinical programs to develop in the future.
An Endowment Is Created
There was no systematized source of acupuncture education for residents; in this area, I saw an opportunity for funds saved by the Acupuncture Society of Michigan to provide a legacy. Under the management of Amy St. Amour, a gifts officer at the University of Michigan, these funds became an endowment to benefit the education of physicians through the Integrative Medicine Program. No promises could be made that the funds would be used specifically for acupuncture-related programs, but the endowment ensured that funds would be available to sponsor important integrative medicine educational causes indefinitely.
Re-Writing the Script
Zick is now the co-director of Integrative Family Medicine, along with Jill Schneiderhan, MD, who worked with Benn and Warber until Benn left the University and Warber retired. Schneiderhan is a graduate of Southern Illinois University School of Medicine. She includes manual and mind-body medicine and chronic pain among her clinical interests. Schneiderhan recalls that a major shift in receptivity to ideas occurred during a large-scale change event hosted by the University of Michigan called Re-Write the Script. The goal of this summit was to address opioid-related harm and pain management. One initiative to emerge was the expansion of non-pharmacological pain management. Schneiderhan was on both the larger planning committee and led the subcommittee for non-pharma recommendations. One recommendation was to expand acupuncture within the institution.
Battlefield Acupuncture Emerges
Schneiderhan collaborated with Paul Hillard, MD, of the Department of Anesthesiology. Hillard is the chair of the Hospital Pain Committee and Medical Director of Institutional Opioid and Pain Management Strategy with research interests in opioid tapering. This led to the development of a non-pharma pain clinic within the Department of Anesthesiology. Hillard was also interested in bringing Battlefield Acupuncture to the University because this modality constituted a protocol that could easily increase the use of acupuncture, as the University was now open to the idea. Battlefield Acupuncture was developed by Richard Niemtzow, MD. Niemtzow was the first full-time physician who practiced acupuncture in the armed forces. The Battlefield Acupuncture technique is notable for providing quick pain relief and is easily taught to clinicians, stands up to evidence-based analysis, and lends itself to teaching in conventional medical teaching settings. Niemtzow’s success with military patient populations inspired Helms to focus on the needs of this group, as well. Now, the effectiveness of acupuncture for military populations facilitates institutional approval of acupuncture for more widespread use.
Schneiderhan analyzed procedures in other institutions where Battlefield Acupuncture was offered. She and Hillard then worked out the logistics necessary to institute Battlefield Acupuncture, including education, credentialing, and billing. Unlike my interaction with the Department of Gastroenterology years before, this time the administration facilitated clearance on every level. The program evolved so that several physicians are regularly performing Battlefield Acupuncture, and training is being offered through the University. I recently learned from St. Amour that this endeavor was being supported in part by the 2014 Endowment from the Acupuncture Society of Michigan. I also learned from Schneiderhan that the University recently hired physicians trained in acupuncture and is taking steps to add non-physician acupuncturists following Governor Gretchen Whitmer’s 2019 signing of legislation licensing acupuncturists — rewarding the longtime efforts of Deborah Lincoln and associates.
Female Pioneers in Medical Acupuncture
I was reminded of my early dreams for the Acupuncture Society of Michigan to serve as a long-lasting vehicle to provide exchange and education that would help to make Michigan a leading state for acupuncture. Though the name is different, Acupuncture Society’s energy is still helping those goals to become realized. I was also gratified to learn that additional people behind the acceptance of acupuncture at the University included my fellow AAMA member, Richard Niemtzow, and mentor, Joe Helms. I also realized that no single person transformed acupuncture in the state of Michigan. Instead, change was brought about by a chain of women fulfilling different roles over time, jumping onto successive opportunities, carrying each a few steps further, and moving the ancient practice of acupuncture into the future.