Dr. Ralph Coan: a hero in establishing acupuncture as a profession in the United States

Dr. Ralph Coan: a hero in establishing acupuncture as a profession in the United States

Journal of Integrative Medicine: Volume 11, 2013   Issue 1

http://www.jcimjournal.com/jim/FullText2.aspx?articleID=jintegrmed2013007

1.         Arthur Yin Fan (McLeanCenter for Complementary and Alternative Medicine, PLC. Vienna, VA22182, USA )

2.         Ziyi Fan (McLeanCenter for Complementary and Alternative Medicine, PLC. Vienna, VA22182, USA )

DOI: 10.3736/jintegrmed2013007 Fan AY, Fan Z. Dr. Ralph Coan: a hero in establishing acupuncture as a profession in the United States. J Integr Med. 2013; 11(1): 39-44. Received July 23, 2012; accepted August 25, 2012. Open-access article copyright ? 2013 Arthur Yin Fan et al. Correspondence: Arthur Yin Fan, PhD, MD, LAc; Tel: +1-703-499-4428; Fax: +1-703-547-8197; E-mail: ArthurFan@ChineseMedicineDoctor.US

Figure 1  A recent photograph of Dr. Ralph Coan This photograph was taken during the interview. He had recently partially recovered from a stroke while also suffering from heart disease.

1 Introduction

Dr. Ralph Coan is not well known to the general public. Originally, we had wanted to interview him as he was the medical director of the first acupuncture center in the United States that opened in the early 1970s[1]. We wanted to know more about that center’s history. Prior to visiting Dr. Coan, we found an article written by Dr. Sherman Cohn that mentioned Dr. Coan. The article noted that Dr. Coan was the founder of the American Association of Acupuncture and Oriental Medicine, which is the national association of acupuncturists and Chinese medicine practitioners in the United States[2]. While interviewing Dr. Coan on February 18, 2012, it became apparent that he truly is a leading light in establishing acupuncture as a profession in the United States.?Dr. Coan is 75 years old and retired several years ago from his busy medical practice in Kensington, Maryland, USA. As he had recently partially recovered from a stroke while also suffering from heart disease, he could not talk much (Figure 1, Dr. Coan was in the interview). To collect further information about him, we also consulted his former colleagues and relatives, and researched articles written about him.

 

2 An acupuncture believer

“I put an advertisement in the Washington Post stating Looking for a Physician Position. To my surprise, I immediately got a call in the same day. He said, ‘Are you interested in working in an acupuncture clinic? If so, please come.’ I was not familiar with acupuncture before this. However, I had to get a job to support my family after I left the United States Army. At that time, most of the medical doctors (MDs) and politicians did not believe in acupuncture; some media treated acupuncture as a ‘quack’ profession. I started the work with great suspicions. It was at the beginning of 1973.” Dr. Coan recalled 40 years later.

Dr. Coan graduated from the Georgetown University School of Medicine in Washington, D.C. in 1963 as an honors student, had a one-year internship in the University of Chicago Hospitals, and completed his residency at WalterReedArmyHospital in Washington, D.C. He joined the United States Special Army and served at Fort Bragg, North Carolina, in the Canal Zone, Panama, at Lowry Air Force Base, Colorado, and Walter Reed in Washington, D.C. In 1972, Dr. Coan left the Army after serving for eight years due to the end of the Vietnam War. He was one of the three earliest staff physicians, with six Chinese medicine doctors or acupuncturists, to work for the Acupuncture Center of Washington, the first legal acupuncture center in the United States[1]. At that time, Western-trained MDs performed the diagnoses and decided which patients needed acupuncture, and the Chinese medicine doctors would perform acupuncture treatment under the MDs’ supervision. The first MD director of the Center was Dr. Arnold Benson, a New York internist and one of the three founders. Dr. Coan became the second MD director a year later, since Dr. Benson was busy and could not work full-time. As the staff director and co-founder, Dr. Yao Wu Lee recalled that Dr. Coan worked part-time initially, then became a full-time doctor, and at last, served as the MD director, while Dr. Chingpang Lee, a Chinese medicine doctor, served as the office manager.

“I was not sure whether acupuncture was safe and effective, so I wanted to do a little research by myself before I finally decided to work there. I collected the contact information of the first 50 contiguous patients and examined them — the Center had an official copy; I collected by myself secretly. Over approximately two months, I called all of those patients. The results were very encouraging: more than 80% of the patients told me that they got better without any obvious adverse effects. I became a believer, so I decided to work full-time there. I stayed in that Center for approximately 10 years.” Dr. Coan said.

At that time, there were very few acupuncture clinics, and patients came from throughout the United States as well as from many other countries. The Center was immensely popular and had to split into two separate clinics: the Acupuncture Center of Washington and the WashingtonAcupunctureCenter. At their peak popularity, both clinics saw about one thousand patients per day. Within one year, there were thirteen acupuncture clinics open in Washington, D.C., leading it to become a capital of acupuncture. The acupuncture business was so successful that buses full of patients came from New York, New Jersey, and other cities daily to visit the Center[1]. Such scenes and the effectiveness of acupuncture amazed many open-minded MDs like Dr. Coan[2]. However, the booming acupuncture business aroused anxiety and unease within conservative Western style medical institutions and drug manufacturers. In 1974, the Washington, D.C. Board of Medicine gave the Center orders to close acupuncture offices six times. To save the acupuncture profession, as well as the Center, the directors decided to respond. From mid-1974 to the early 1975, they were involved in two lawsuits in the Superior Court of the District of Columbia. The court conducted a serious hearing on acupuncture. Judge Fred Ugast listened to the testimonies of the Washington, D.C. Board of Medicine, the Acupuncture Center of Washington and WashingtonAcupunctureCenter, as well as the public for three months. Dr. Coan was one of the key MDs who attended the hearing and played an important role[2,3].

Dr. Coan remembered very clearly, “One day I was in court. I testified that in Washington, D.C. there were no MDs or dentists trained in acupuncture. It is impossible to get rid of acupuncturists in an acupuncture practice, because they are the experts. Then, Judge Fred Ugast let the doctor who was in charge of the Washington, D.C. Medical Board in. The judge asked him, ‘Dr. Robinson, your regulation wants to limit the right to practice acupuncture to licensed physicians and dentists in Washington, D.C. Do you know how many Western-trained doctors in Washington, D.C. were trained in acupuncture? How many patients need acupuncture everyday?’ The doctor replied, ‘I don’t know.’ Then the judge said, ‘Oh, you can go now.’”

“I predicted that we would win the case. At last, the judge announced that the new Washington, D.C. regulation which wanted to limit the right to practice acupuncture to licensed MDs and dentists is unconstitutional. The rights of physicians to choose proper treatment based on his best judgment, acupuncturists to perform acupuncture, and patients to get professional acupuncture services have been protected. So, acupuncturists could continue to perform acupuncture as long as it is under a MD’s supervision.”

Dr. Coan was a diligent doctor and held at least six qualifications in subspecialties of internal medicine, such as endocrinology and infectious diseases, which is many more than what doctors today may have. He worked with those acupuncturists in his office from 1972 until late 1990s. He said, “I am a believer of acupuncture, although I did not insert any acupuncture needles into any patient. When my family members were sick, I always suggested them to use acupuncture first. Acupuncture works!”

3 A pioneer in acupuncture research

There was very little acupuncture research reported in the 1970s and 1980s, Dr. Coan was one of the pioneers in conducting acupuncture clinical trials. When I mentioned his name to Dr. Lixing Lao, a well-known researcher in acupuncture and Chinese herbology, and a Chinese medicine doctor at the Center for Integrative Medicine of the University of Maryland, he gave Dr. Coan very high praise, “Dr. Coan was an important acupuncture researcher with historical status. His two papers in acupuncture clinical trials on neck pain and low-back pain have been cited by many researchers today.”

In mid-September, 1973, the National Institutes of Health (NIH) held a special workshop for acupuncture scientific study. Dr. Benson and Dr. Coan reported their clinical observation of acupuncture’s effectiveness in 36 cases of rheumatoid arthritis (RA)[4] which was conducted by Dr. Coan.

The presentation at this NIH meeting showed that during the first six weeks after the center was established in December 1972, there were 64 patients with RA who were treated with acupuncture. The first follow-up was conducted three months later. They were able to contact 55 patients, of whom 36 had been given 5 to 24 acupuncture treatments (average 6.6). Of the 36, 25 patients (69%) reported improvement, including less need for pain medications and in some cases, reduction of the nodules which occur on arthritis sufferer’s joints. Of 19 patients who had fewer than 5 treatments, only 5 cases (16%) reported improvement. The second follow-up was conducted six months later, which showed continued improvement by 16 of 27 patients (59%) from the original group. The average age of patients in this study was 55 years, and they had been suffering from RA for an average of 11.5 years.

Many newspapers in the United States reported this news, which encouraged more patients to try acupuncture.

An article entitled The acupuncture treatment of low back pain, a randomized controlled study[5] was reported by Dr. Coan and his colleagues in 1980. The study was conducted within the Acupuncture Center of Washington and Acupuncture Center of Maryland.

Acupuncture treatment was effective for the majority of patients with lower back pain, which was shown by the use of short-term controls and long-term controls, although the latter were not intended in the study design. After acupuncture, there was a 51% pain reduction in the average pain score in the immediate treatment group. The short-term controls and the delayed treatment group showed no reduction in their pain scores at the comparable follow-up period. Later, the patients in the delayed treatment group were also treated by acupuncturists, and 62% of patients reported less pain. When these two treatment groups were compared at 40 weeks with long-term controls (inadequate treatment group), the inadequate treatment group still had the same pain scores, on the average, as when they enrolled in the study. Both treatment groups, on average, had 30% lower pain scores. Furthermore, 58% of patients in the treatment groups felt that they had definitely improved at 40 weeks, while only 11% of the inadequate treatment group felt definite improvement at 40 weeks. There was a significant difference between the groups.

Another article entitled The acupuncture treatment of neck pain, a randomized controlled trial[6] was reported in 1981 by Dr. Coan and his colleagues.

Thirty patients with cervical spine pain syndromes, course of disease 8 years on average, were assigned randomly equally into treatment and control groups. After 12 weeks, 12 of 15 (80%) of the treatment group felt improvement, some dramatically, with a mean 40% reduction of pain score, 54% reduction of pain pills, 68% reduction of pain hours per day and 32% less limitation of activity. Two of 15 (13%) of the control group reported a slight improvement after 12.8 weeks. The control group had a mean 2% worsening of the pain score, 10% reduction in pain pills, no lessening of pain hours and 12% less limitation of activity.

Such study design may be seen as flawed if judged by today’s criteria. However, they were considered impressive by the researchers at that time, especially the studies were the first time in history endorsed by NIH, the United States Food and Drug Administration (FDA), and the American Medical Association (AMA), whichis the main stream medical society. The reports had been documented in the United States Congress in 1979 and was one of key documents used for FDA relabeling acupuncture needle as a medical device from an investigational device in 1994. The later two studies were conducted by local acupuncturists and MDs using their own money, time and labor, with great difficulty, and totally followed the restrict NIH clinical trial rule (control, and random) at that time, which might be the only case in the United States medical research history. Dr. Coan was invited to give lectures throughout the United States. Such studies do therefore have some value. Dr. Coan said, “Acupuncture is a process of a needle piercing the body, to some extent, it is similar to a small operation. As a clinical doctor, I strongly believe it cannot be compared with so-called ‘sham’ acupuncture (which is used as a placebo, mimicking that in medication’s clinical trials; however, it is a real piercing or similar to that). We used the methods of comparing the effectiveness and adverse effects before and after acupuncture in the same patient group, or between the treatment group and waiting-list group. Like an operation, how can we compare the cut of a scalpel with the ‘sham scalpel cut’?”

I agree with him. Indeed, acupuncture is very different from medication; the design of the study should not be the same as the drug model, the so-called “golden criteria”.

4 A key person in establishing acupuncture as a profession in Maryland

“I was an MD who had witnessed so many patients getting better after acupuncture treatment and became an acupuncture believer. In the 1970s, I had strong motivation — I felt that I should do something to push the acupuncture profession forward in the United States. I decided to change something at the local level first. I convinced ten more local acupuncturists, and established a professional organization Acupuncture Association of Washington Metropolitan (AAWM). I was its president for more than 10 years. We met every Saturday morning to share news with each other and discuss the role of the acupuncturists. One day, we met in SuburbanHospital (which was the affiliated hospital of NIH). We were aware that the first quarter of each year is the legislation season in every state, so we decided to remove the obstacle in law for acupuncture in Maryland.” Dr. Coan recalled.

The members of AAWM included local acupuncturists mainly from Hong Kong and Taiwan of China and Korea, such as Grace Wong, In-Su Kim, Hansheng Gu (Hanson Koo) and Sumei Zhang. They met once a month in China Garden Restaurant on Wisconsin Avenue, Bethesda, Maryland. The basic procedure was: ate lunch together (about half hour), and then discussed something new and what needed to be done — like most societies today but we met more often and sometimes held seminars. Maryland was one of the earliest states that allowed acupuncturists to practice acupuncture (Fan notes: similar to the nurses working under the supervision of MD, without license) in the United States in 1973. However, in the early 1980s the Board of Medicine with the conservative Western-trained doctors did not want acupuncturists to have a license and wanted to deprive the acupuncturists’ rights. During 1981 to 1982, Dr. Coan and his colleagues were involved in acupuncture licensing legislation in Maryland.

“At that time, there was a five-person committee representing the Governor and State of Maryland in the hearing. The MD’s representative who attended that hearing was a very, very famous neurosurgeon from JohnHopkinsHospital, a ‘top guy’ in the Western medical field, who did not like acupuncture and tried to block the acupuncture licensing legislation.” Dr. Coan reminisced about the great achievement, “I am a nasty person. I knew him well and I knew he would oppose acupuncture. So I brought three local patients who had surgery from him, which is a secret weapon I used later all the time.” The neurosurgeon told the committee: “acupuncture is just a no-use therapy, especially for neurological issues, such as spinal disc problems that cause back pain and sciatica; only surgery could cure such disorders.” Then it was Dr. Coan’s turn. Dr. Coan brought out patients and asked them, “Do you know that doctor (the neurosurgeon)?” The patients replied, “We were patients of his and had operations from him.” “Did the operations help?” Dr. Coan asked. “No, after the operation, the pain got worse. However, acupuncture stopped the pain.” one of patients replied. The surgeon felt embarrassed and left the hearing immediately. And then Dr. Grace Wong, Dr. Coan’s partner and a well-known acupuncturist, made testimonies for acupuncture. So, acupuncture licensing legislation was passed very smoothly and successfully in Maryland in 1982 [Fan notes: due to the special political environment in Maryland, the Acupuncturist Licensing Act was changed to Acupuncturist Registering Act in 1982. So, the legislation passed in that year was the Acupuncturist Registering Act. The Acupuncturist Licencing Legislation was passed at last in 1994, 12 years later].

“You should understand it is so important to bring patients with you when you try to make testimonies in court and convince people about acupuncture. The patients will give you great support,” Dr. Coan said.

Dr. Lixing Lao once was Dr. Coan’s colleague. He recalled, “I participated in the events of AAWM, because I taught a point-locating class for National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) acupuncture examination preparation for the Tai Sophia Institute in 1986 as a part-time job, while I was a PhD candidate of physiology in the University of Maryland. Tai’s teaching, focusing on five-element acupuncture from England, is very different in content from traditional Chinese medicine (TCM), the main stream of current Chinese medicine. Dr. Yin-sue Kim attended that class and invited me to participate in Dr. Coan’s monthly events. I actually joined them in 1987. One day, we got interest to start an acupuncture school with focus on TCM in Maryland. So, several people became involved in this topic. After the normal meeting completed and other acupuncturists left, we discussed the school issue. The school was started in late 1991, and the first class was in 1992.”

The school was called the Acupuncture School of Maryland, and later, Maryland Institute of Traditional Chinese Medicine (MITCM). After eight years of preparation, the school was initially started in a Catholic elementary school where it held lectures in the evening. After several years, it moved into a professional building in Bethesda, Maryland, which was very close to a metro station, and had all lectures during normal hours. “I was the founder and the first president of the school, and ran the school by myself for two years. My daughter worked there as a secretary.” Dr. Coan said. According to Dr. Lao, Dr. Coan spent a lot of energy, time, and even his own money for the school. Before the school could become financially independent, Dr. Coan lent his money to the school for support. The teachers at the school, mostly from mainland China and well-trained in TCM, included Drs. Lixing Lao, Jingyuan Gao, Eugene Zhang, and more. “Dr. Lao and Dr. Gao were fantastic teachers and scholars, when I was the president there, I attended their lectures for two years. I should give them my heartfelt praise,” Dr. Coan said. The first graduates were twelve students in December 17, 1994. MITCM was very sound in its academic and financial condition. It was a prestigious TCM school on the east coast. However, it closed at the end of 2002.

During the 1980s to 1990s, Drs. Coan, Wong, Lao and Bob Duggan (the founder of Tai Sophia Institute) worked as the main board members in the Acupuncture Board of Maryland for many years. The Board is a state government agency that is in charge of acupuncture licensing and administrates acupuncturists’ practice.

5 The founder of the American Association of Acupuncture and Oriental Medicine

Almost ten years passed from the opening of the first acupuncture center of the United States in 1972. In more and more states, such as Nevada, Maryland and Massachusetts, acupuncture legislation got passed. More and more patients considered acupuncture as an option, and more and more students studied acupuncture and Oriental medicine in the United States and became acupuncturists. These led to the birth of a national organization for the acupuncture profession[2].

Dr. Coan and Louis Gasper, PhD, were co-founders of the American Association of Acupuncture and Oriental Medicine (AAAOM). Dr. Gasper, who died in 2004, was a professor at Los AngelesInternationalUniversity. They sent letters nationally to invite people to attend the first AAAOM meeting at the Los AngelesInternationalUniversity on June 27, 1981. Neither Dr. Coan nor Dr. Gasper practiced acupuncture; however, they are acupuncture believers. The 75 attendees included MDs and dentists who used acupuncture, acupuncturists (non-MDs), and MDs who did not use acupuncture themselves but supervised acupuncturists, like Dr. Coan, as well as friends of acupuncture or those with interest in acupuncture, like Dr. Gasper. The first board was elected at that meeting, and consisted of seven members: two MDs, four acupuncturists, and another doctor without indicating designation. Dr. Coan served as the treasurer. At that time, MDs were the largest groups represented at that meeting. The second AAAOM meeting, held at the Del Coronado Hotel in San Diego in March, 1982, had a much higher attendance than the first. Most of attendees were acupuncture and Oriental medicine (AOM) practitioners. In the third AAAOM meeting, held at the Shoreham Hotel in Washington, D.C. in May, 1983, non-MD AOM practitioners strongly protested MD members’ intentional delay of AOM development, tension between the MD acupuncturists or supervisors, and the non-MD practitioners surfaced without resolution, resulting in all of the MD members walking out of AAAOM except for Dr. Coan. In that difficult time, Dr. Coan was elected as the new president of the AAAOM, which just became AOM practitioners’ own organization. “I was president of the second board and then vice-president of AAAOM for over ten years. During those years, I helped thirteen states finalize acupuncture legislations,” Dr. Coan said.

“I gave testimonies in person in twelve states’ hearings for acupuncture legislation, gave testimony over the phone for Alaska (I did not go there, it is too far),” Dr. Coan said. He wrote the name of thirteen states for us on a paper with his hand, slight-shaking due to the stroke: Alaska, Delaware, Maryland, Missouri, New Hampshire, New Jersey, New York, North Carolina, Rhode Island, Utah, Vermont, Virginia, and Washington, D.C.

“In Utah, there were twelve MDs who were strongly against acupuncture that attended the acupuncture legislation hearing. A representative of the AMA came too. The side that is in favor of acupuncture had only two people in attendance: one acupuncturist and me. The MDs tried to make the law to block all non-MD acupuncturists to perform acupuncture. The reason is that such non-MD acupuncturists had not had the appropriate medical education as MDs. I asked, ‘In your MDs’ clinics, there are nurses who use needles. How many years were these nurses required to study in Nurse Schools?’ They replied, ‘Three years.’ ‘Acupuncturists have education and training for four to six years, longer than the nurses. If the nurses have right to use needles, acupuncturists should be overqualified to use the needles under the supervision of a MD.’ I protested. And then, a MD stood up and said, ‘acupuncture is not useful to treat carcinoma. Acupuncture will cause carcinoma patients delay in getting the right treatments. So, acupuncture will harm patients.’ I stood behind the sponsor who wanted to introduce the acupuncture legislation and gave him the reply of our side. He responded according to my words, ‘Okay, you said acupuncture harms patients. Could you call your clinic and let your secretary use expedited mail to mail me a real medical record which indicates that acupuncture harmed your patients by tomorrow? I will pay the shipping fee.’ The doctor could say nothing. So we won the hearing, and acupuncture legislation passed.” Dr. Coan smiled, “Acupuncturists should remember, never say you could treat cancer (by acupuncture only, although you may help such patients to some extent). In the hearings, the MDs always used this as an example to block acupuncture legislations.”?Regarding Vermont, Dr. Coan said, “During the hearing there were also only two people in favor of acupuncture: a local acupuncturist and me. We won. The weather there that year was extremely cold, and this lady (the acupuncturist) had no money to pay for a hotel for me. So, I stayed in her house, without any heating, for one night. I used ten cotton blankets. That is an unforgettable experience.”

“In 1988 in Virginia, there were five surgeons in attendance who tried to block legislation which allows acupuncturists to practice acupuncture; I went there with In-Su Kim, a Korean acupuncturist, to fight with them,” Dr. Coan recalled. According to a report from a newspaper[7], at that time in VirginiaState, the law made by MDs only allowed licensed MDs to practice acupuncture. Such MDs only had 100 hours of study and 100 hours of practice in acupuncture training. The acupuncturists, mostly with 4 to 6 years extensive training, could not practice acupuncture. Dr. Coan protested in the statehouse, “This law is unjust, unfair, and immoral.”

Per the arrangement of Dr. Coan, on June 22, 1979, George Brown, Jr., an acupuncture skeptic, had acupuncture during a hearing in Congress of the United States. Dr. Grace Wong, Dr. Coan’s partner, did acupuncture on him for smoking cessation; it was very successful. At that time, Brown was the Chairman of the House Science, Research, and Technology subcommittee. It was a breaking news, reported in many newspapers[8].

As another pioneer in the acupuncture profession, Dr. Finando, commented on Dr. Coan[9], “He campaigned and lobbied anywhere and everywhere to lobby for acupuncture.” Not only did he campaign and lobby for acupuncture anywhere and everywhere, his mother influenced by him, also became a volunteer lobbyist for acupuncture.

It is true that Dr. Coan is a great hero of the acupuncture profession, even though he did not insert an acupuncture needle in any patient. He is an MD, but he has contributed his dedication and whole life to support and promotion of acupuncture; all of this as a volunteer.

6 Acknowledgements

The authors would like to thank Dr. Lixing Lao, Dr. Yick-chong Chan, Dr. Sherman Cohn, Ms. Judy Coan-Stevens and Mr. John Coan who provided some detail information about Dr. Ralph Coan, and Ms. April Enriquez for English editing. The interviewer was Dr. Arthur Yin Fan.

7 Competing interests

The authors declare that they have no competing interests.

References

1.         Fan AY. The first acupuncture center in the United States: an interview with Dr. Yao Wu Lee, WashingtonAcupunctureCenter[J] J Chin Integr Med, 2012, 10(5) : 481-492.

2.         Cohn S. Acupuncture, 1965-85: birth of a new organized profession in the United States (pt. 2). Am Acupuncturist. 2011; Spring: 22-25, 29.

3.         Superior Court of the District of Columbia Civil Division. Civil action No. 11005-74. Urie, Coan v. Washington. cited by the records: Lewis v. District of Colombia Court of Appeals (1978). [2012-06-26]. http://www.tx.findacase.com/research/wfrmDocViewer.aspx/xq/fal.19780427-0003.dc.htm/qx.

4.         Sawislak AB (UPI). Two-third of 36 patients treated with acupuncture had pain relief. Williamson Daily News, 1973-09-20 (15).

5.         Coan RM, Wong G, Ku SL, Chan YC, Wang L, Ozer FT, Coan PL. The acupuncture treatment of low back pain: a randomized controlled study[J]. Am J Chin Med, 1980, 8(1-2) : 181-189.

6.         Coan RM, Wong G, Coan PL. The acupuncture treatment of neck pain: a randomized controlled study[J]. Am J Chin Med, 1981, 9(4) : 326-332.

7.         Criticism of acupuncture laws called racist by Asian groups. Afro-American. 1988-08-16(3C). [2012-06-26]. http://news.google.com/newspapers?id=LEpAAAAAIBAJ&sjid=WvUFAAAAIBAJ&pg=2980,674502&dq=ralph+coan+in+su+kim&hl=en.

8.         How to prevent mildew. The Spokesman Review. 1979-06-23(10). [2012-06-26]. http://news.google.com/newspapers?id=yeURAAAAIBAJ&sjid=Ie4DAAAAIBAJ&pg=5438,3626027&dq=wong+grace+acupuncture&hl=en.

9.         Finando S. AOM pioneers and leaders 1982-2007, a commemorative book of challenge and courage. Vol. 1. AAAOM, NCCAOM, CCAOM & ACAOM. 2007: 29-32. [2012-06-26]. http://www.aaaomonline.info/docs/pioneers_and_leaders_vol1.pdf.

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The first acupuncture center in the United States: an interview with Dr. Yao Wu Lee, Washington Acupuncture Center. By Dr.Arthur Yin Fan

http://www.jcimjournal.com/en/FullText2.aspx?articleID=jcim20120502
Journal of Chinese Integrative Medicine: Volume 10 May, 2012 Number 5
Arthur Yin Fan (McLean Center for Complementary and Alternative Medicine, PLC. Vienna, VA 22182, USA )

Received March 23, 2012; accepted March 26, 2012; published online May 15, 2012. Full-text LinkOut at PubMed. Journal title in PubMed: Zhong Xi Yi Jie He Xue Bao. Correspondence: Arthur Yin Fan, PhD, MD, LAc; Tel: +1-703-499-4428; Fax: +1-703-547-8197; E-mail: ArthurFan@ChineseMedicineDoctor.US

Forty years ago, President Nixon’s visit to China was a sign of the start of the normalization of Sino-American relations. Before and after President Nixon’s journey, the Chinese government’s “acupuncture diplomacy” was very effective. American reporters, politicians and well-known medical doctors or scholars visited many Chinese hospitals and witnessed numerous and various operations performed on patients under acupuncture anesthesia. When they returned, they reported these miraculous stories occurring in China and expressed their impressions. They were also interviewed on television shows. These reports activated American’s curiosity about China and the magic of acupuncture. One story especially, “Now, Let Me Tell You About My Appendectomy in Peking” written by James Reston, the vice-president and the most famous columnist of The New York Times, about his own experience in Beijing, directly triggered American’s interest in acupuncture. What’s interesting is that Reston’s story appeared on the front page of The New York Times along with the Apollo 15 liftoff, on July 26, 1971, which seems to hint that acupuncture would land in the United States of America like Apollo landed on the moon. We consider Reston’s acupuncture article as the most effective “ignition” of the long lasting fire of American’s acupuncture fever. The first real big wave of “acupuncture fever” was actually started by the Washington Acupuncture Center, also known as the Acupuncture Center of Washington, which was established by Dr. Yao Wu Lee (Sam, 李耀武), Dr. Arnold Benson and Mr. Charles Newmark. It is the first widely reported acupuncture center in modern history of the United States and was influential in furthering the development of acupuncture fever. The center was established in May, 1972, and initially named as Acupuncture Center of New York. It opened to patients on July 12, 1972, but closed shortly after due to the order of the New York Board of Medicine. Then it got approval to operate and moved to Washington, D.C. and re-opened on December 28, 1972.
There were several firsts achieved by this center. (1) There were more than 280 domestic and international newspapers that reported the opening of the center. (2) During its “golden time”, there were about approximately one thousand patients treated per day. (3) At the federal level, as per this center’s request, in the category of professions, the United States Citizenship and the Immigration Services created a totally new profession — acupuncturist, and defined acupuncture as a medical practice. Since 1973, there were opportunities for acupuncturists to immigrate to the United States. (4) In 1973, the Internal Revenue Service of the United States announced that patients could claim their acupuncture spending as medical expense in their tax returns. (5) Due to a win of a lawsuit in the Federal Court in 1974, a patient’s right to choose acupuncture treatment by his own judgment and an acupuncturist’s right to practice acupuncture were protected. At the federal level, acupuncture started to become an independent profession in the United States and started to diversify control held by the Western medicine-trained physicians. It also laid a basis for acupuncture or oriental medicine legislation in each state. We should remember that Washington, D.C. was the first local authority to approve non-physician (acupuncturists) to practice acupuncture in the history of the United States.
Washington Acupuncture Center is the first acupuncture center, with the longest history in the United States. To record the history of acupuncture, in December of 2011, the author, Dr. Arthur Fan interviewed Dr. Yao Wu Lee, one of founders of this center, who is 80 years old and still in practice.

Dr. Arthur Yin Fan (Fan): Dr. Lee, I heard that in 1972, you started the first legal acupuncture center in the United States. Could you tell me why and how you set up this center, and what challenge you met?
Dr. Yao Wu Lee (Lee): This center has three stages: initially it was in New York, then in Washington, D.C., at last, moved to the south of Florida. I came to the United States to resume my academic career from Israel at the end of 1971. I was appointed by an educational training center in Manhattan, called the Education Solution, Inc. The head of the company was Dr. Katana, a very tall and strong Jew, with nine PhD degrees. The company got contracts from the American government and focused on training of the teachers from New York’s elementary and middle schools, and unifying the teaching contents. My task was to develop software for the teaching and making the management more efficient, which I completed quickly. At the same time, Dr. Katana had strong interest in Chinese medicine and let me develop a Chinese medicine diagnosis system. He had known that I had developed an acupuncture point-detector in Taiwan between 1954 and 1960 (at that time, there was no policies supporting Chinese medicine in Taiwan, so this acupuncture point-detector actually was not in use at that time). His idea was to apply a machine to collect the data of patient’s pulse and then automatically reach a diagnosis. This plan required a lot of time and needed a large investment, i.e. at least more than a million dollars. Another issue was that there have been so many different judgments among different Chinese medicine doctors regarding diagnosing from the pulse information for the same patient, due to both objective and subjective reasons. So, I felt that this task was not easy to achieve during a limited time. I planed to go to the National Aeronautics and Space Administration (NASA) and resume my original career in electronics and automation.
During the beginning of 1972, around President Nixon’s China visit, there were many reports about acupuncture in China in newspapers and on television. In such a social environment, I started to have a desire to practice acupuncture in the United States. I was busy remodeling my acupuncture point-detector and developing an electric stimulator. At the same time, I visited several Chinese medicine doctors in Chinatown of the New York city, such as Dr. Shuyu Li (李树酉), Dr. Ching Y. Ting (丁景源), Dr. Huoren Fang (方活人), and Dr. Chingpang Lee (李静平). I stayed with them for three months. My feeling was that they mainly practiced in their own homes, in buildings that were very old, and the space was very small, dark and to some extent poor in hygiene. On average, the fee for acupuncture was $3 to $5. Acupuncture needles could be ordered in stores without any limitation. At that time, acupuncture was not a formal, accredited medical field, and there was no acupuncturist as a profession in legal documents in the United States.
Fan notes: At that time in the “Chinatowns” of major cities in the United States such as those in California and New York, there were a few Chinese medicine doctors practicing acupuncture or Chinese herbology without license. The majority of their patients were mostly Chinese. Because there were no descriptions, definitions or explanations for Chinese medicine or acupuncture, the practice of Chinese medicine or acupuncture was in a “gray area”, between the legal and the illegal. There were no obvious conflicts between a Chinese medicine doctor and a Western doctor. In most states, the Boards of Medicine did not administer Chinese medicine or acupuncture at all.
In my spare time, I performed acupuncture treatments for my neighbors and the teachers who were trainees in the company I worked with. I have learned Chinese medicine before when I was in the mainland China. I knew two Jewish friends through Dr. He, an old Chinese medicine doctor, and Dr. Chingpang Lee. One was Dr. Arnold Benson, who was a graduate of the New York Medical College, and had served as an army physician of the United States in Korea between 1962 and 1964, and knew of acupuncture. Another was Mr. Charles Newmark, a real estate developer, with experience in administration. Both of them, like me, were interested in opening an acupuncture clinic and visited Chinese medicine doctors. At that time, I was 39 years old and they were in their fifties. There was no big difference in age; they treated me as a “half Jew” because I spent several years in Israel. In April 1972, after several discussions, we, as a partnership, made a decision to start an acupuncture center. A formal application to the New York Board of Medicine was made in May 1972, but we did not get a response.
I felt that we had no time to wait, so we mailed a report to the New York Board of Medicine, explaining that the clinic would be operated by Dr. Arnold Benson, a Western-trained doctor, while other hired Chinese medicine doctors and I would perform acupuncture (similar to the nurses or assistants performing injections or drawing blood in clinic) under the doctor’s supervision. I felt this explanation should be accepted by the New York Board of Medicine and ordinary people. However, we did not get a response. We decided to just do it. The clinic was located at the East 73rd Street and called the Acupuncture Center of New York or also known as the New York Acupuncture Center.
Fan notes: “Chinese medicine doctors performing acupuncture under the supervision of (Western-trained) medical doctors” or “(Western-trained) medical doctors performing the diagnosis and Chinese medicine doctors performing acupuncture treatment” was a strategy under a special political climate at that time. This was first applied by Dr. Yao Wu Lee, and later, many legislation agencies in many states applied such terms in their acupuncture regulations. After 40 years of development, most of the states in the United States removed the requirement of medical doctors’ supervision. However, in most states, acupuncturists still have no rights for clinical diagnosis.
On July 5, 1972, Wednesday, we held a press conference for a news release in New York to announce the opening of the acupuncture center. Because Chinese medicine and acupuncture clinic was totally new in the United States, it caused many concerns. More than 90 journalists and reporters came from famous newspapers, journals and television companies, such as the National Broadcasting Company (NBC), the Canadian Broadcasting Company (CBC), the American Broadcasting Company (ABC), Times, Newsday, The East West Journal, The New York Times and News Week, and may have also included some other professionals and medical doctors. We arranged 12 patients to introduce their health issues, acupuncture experience and the results. I remembered one of the patients was a famous priest and violinist in Manhattan, Rev. Norman Catir, who had headaches and mild memory loss. Another was Mr. Don Lamond who had “osteoarthritis of the left hip” or “sciatica”. At about 11 o’clock, I as the Chinese medicine representative, Benson as the medical doctor representative and Newmark as the administration representative introduced acupuncture and the operation method of the clinic to the media, and replied to their questions. Benson talked first. He knew some acupuncture in Korea, but lacked knowledge of Chinese medicine theory and clinical experience in acupuncture. His personality was simple, modest but not very good at debate. He could not continue to reply when some reporters questioned him again and again, only replying ‘we are not a quack operation, we are a medical practice’. The questions were related to legality of the practice of acupuncture without the approval from the Board of Medicine, the lack of scientific evidence, and the use of acupuncture to only making money. One very extreme reporter of The New York Times said, ‘China is an under-developed country; there is no medicine at all’ — he wanted to deny acupuncture as a medical practice.
I came from Shandong Province, China and was very angry with the insults to China and acupuncture. I found that there was chaos and I had to control the situation. I stood up and questioned the reporters loudly with broken English, ‘What is medicine? What is science? I ask you everyone, who could explain clearly?’ At that moment, Newmark pulled my clothes to let me calm down and speak slowly. ‘I believe Chinese medicine is a science, also a philosophy. Ask you — why Aspirin is effective? I believe that there is not any scientist or medical doctor who could explain it very clearly. Medicine actually is an interdisciplinary science and clinical experience. No one could explain very clearly. Many conditions actually are unsure. The Western medicine is also developed from clinical experience. Chinese medicine has more than 3 000 years of history and has treated billions of patients. It is still useful today; it should have a scientific basis. Sure, acupuncture mixes some clinical experience. However, you could not say it is not a science before you try to understand it. If I use Hebrew to explain the scientific knowledge, you will say I don’t understand, but you could not use ‘I don’t understand’ as a criterion to judge if what I say is belonging to the scientific or the nonscientific. It is the same thing — you do not understand Chinese medicine theory, so you treat acupuncture as witchcraft. It is wrong in your attitude. I am a scientist, also a clinical doctor, here I give you an explanation — acupuncture is using external stimulation to heal internal disorder or illness.’ I invited Mr. Lamond and wanted to show acupuncture on his body. At this moment, a reporter of The New York Times interrupted me and wanted me to explain it in medical terms. ‘You sit down. I will give you an explanation later,’ I replied loudly. I showed an acupuncture point to everyone on the patient’s body, the Huantiao point, with an acupuncture point-detector. It has six instruments, one indicating lamp and a buzz. When it finds the acupuncture point, the machine will flash the lamp and comfortable music will be heard. Dr. Chingpang Lee inserted a 4-inch needle to the patient’s Huantiao point. The patient’s hip pain was decreased immediately. At the same time, Catir’s headache was also treated by acupuncture. He felt much better. The patients and we replied to reporters’ questions. The atmosphere was very active. I felt that the press conference reached its purpose, and it was completed on time. That night, the New York television evening news showed our press conference, especially our magic machine, which caused a big shock. Over three hundred patients called us for appointments or consultations and our eight assistants were busy for a whole night. The next day on July 6, there were more than 280 domestic and international newspapers reporting our acupuncture center’s opening. The United States is a country trusting of science and evidence. People got a strong interest in acupuncture by understanding the theory preliminarily and seeing the results. I predicted our center would be a big success. (Notes: Figure 1 is a photo taken at that time).

Figure 1 Dr. Yao Wu Lee using an acupuncture point-detector to locate Yingxiang point on a young lady’s face on July 5, 1972 in New York. Provided by Yao Wu Lee.

July 12, Wednesday, was the actual opening day. Many reporters of the media came with patients for further observation and follow-up reporting. One week later, the number of patients reached 150 per day; after three weeks, more than 200 per day. We had to rent more office space and expanded to 4 000 square feet (Fan notes: about 400 m2). The “acupuncture fever” caused concern of the New York Board of Medicine. It sent an order to our center telling us to close, stating that ‘Acupuncture is a medical practice. Only licensed medical doctor can practice it.’ At that time, our center had more than ten thousand dollars income per day. Closing the clinic would cause a big loss. In addition, there were many patients from various places awaiting the acupuncture treatments, which also caused us a big stress. On the third day, our administration director Newmark got a new idea of making medical doctors perform the acupuncture under the Chinese medicine doctor’s supervision, which meant our clinic could resume. However, the medical doctors were not familiar with acupuncture. In most cases, both the Chinese medicine doctors and the medical doctors performed acupuncture together. After two weeks, the second order from the New York Board of Medicine came stating that ‘Acupuncture is a medical practice. Only licensed medical doctors can practice it in a medical school or a teaching hospital.’ We tried to contact a teaching hospital. However, the hospital wanted to totally control our finances and operations. At this moment, we got the third order stating that “Acupuncture is a medical practice. Only licensed medical doctors can practice it. It must be performed in an approved research project in a medical school.” This actually aimed to ban any Chinese medicine doctor or Western doctor treating patients with acupuncture. Our lawyer started an appeal, and we believed such orders lacked a legal basis. We practiced medicine legally, and we believed we should continue the practice until the court says we can’t. As the Board forced us to close, we insisted on continuing the practice. The Federal Bureau of Investigation (FBI) got involved and a court order caused us to close. They froze our bank account. The reason for the court to order closure was that ‘the FBI does not want people to cause political storm and affect the election’. At noon of November 19, the second day after President Nixon was re-elected, more than 20 FBI agents and police with black suits came to close our center.
Fan notes: I heard from a New York Chinese medicine doctor that, at that time when the doctor heard the FBI coming, he rushed down the stairs, lost his shoes on the way, and ran out of the rear door with the help of a nurse. The situation was really scary!
At that time, our doctors and nurses, other assistants and administrators responded calmly except for one Chinese medicine doctor you mentioned who was overwhelmed with panic. He thought the FBI would arrest all the doctors, so he ran out. On that day, Benson and Newmark were not at the clinic, so I handled the situation. I requested to the FBI agents to allow all patients who had already paid to complete the treatments, which would be fair with the patients. They discussed and then agreed. So, on that day, the center actually closed at 5:30 PM. The whole procedure was under control.
A lot of our patients went to the court to protest. The New York State Attorney General worried that the events would expand and mediated between the Board and us, and let both parties reach a settlement out of the court. The last settlement was “the Board withdrew the lawsuit, and our center agreed to close the office temporarily”. The next day, our bank account was freed and the attorney received payment. The New York State Attorney General sent a special notice and put pressure on the New York Board of Medicine to prepare the acupuncture legislation as soon as possible so that acupuncturists are able to be in a legal practice.
Fan notes: Dr. Arnold Benson was a medical doctor. His opening of a clinic using acupuncture as a therapy was totally legal. However, because of the wrong attitude of the New York Board of Medicine, which wanted to ban acupuncture and was forced by the special political climate, this acupuncture center intermittently opened for five months, and then had to shut down. The ban of the authorities brought disaster not only to the Acupuncture Center of New York but also to the original practice in the Chinatown. All the New York Chinese medicine practitioners or acupuncturists had been banned. In 1976, the New York State started to allow acupuncturists to practice acupuncture under the supervision of a medical doctor. But it was not until 1991 that the acupuncture regulation was able to go through.
That night, we partners ate dinner quietly, and then held a meeting. For the future, there were different views among us. The other two said: “Lee, just close down.” Especially Newmark, who wanted to change direction, was engaged in real estate. However, I insisted to continue to do acupuncture. There was a friend who was the boss of a large cruise ship company in New York. He suggested bringing the patients to the cruise, and as long as they were three nautical miles out of New York, the Board would have no control. I said, on the contrary, that even if it ends in court, we should open acupuncture clinic in the United States itself. We debated until three in the morning. Everyone was tired. Then Newmark said, ‘Benson and I are two Jews, Lee worked as half a Jew. The Jews have always been indomitable, and we admit Lee’s views. The bank account still has $300 000 left (equivalent to about 3 million now, since breakfast at that time cost only $1.20), which could be used for the clinic development in the future.’ They finally agreed with me.
Considering the difficulty of recruiting the staff, I arranged all the doctors and nurses to work part-time. We could not see patients, so we had training and taught ourselves. Our lawyer wrote letters to the Governor of each state talking about the misfortune of acupuncture in New York and hoping to find a place to continue the opening. We proposed to have a medical doctor supervising, while a Chinese medicine doctor performed the acupuncture. The governor of Puerto Rico agreed that we could go there, but it is far away and is not a domestic state of the United States. We were hesitant to go. During this period, there were sympathizers to our ideas. They thought, for example, an aircraft company, using a Boeing 747 to transform it into a clinic in the international airport. Then local governments would have no control for doing acupuncture there. This company wanted to use acupuncture to make money. I think this is heresy, so we declined. They said as long as I want, they could help us at any time. Some newspapers reported sympathy for our situation. There were some patients who called their State Governor and Attorney General to request help for us.
At the occasion of being unable to do anything, in the afternoon of Friday, December 22, I received a call from the Washington, D.C. Board of Medicine. The director said: “We invite you to Washington, D.C. The political climate here is much better than New York. You can come at once.” I was in disbelief and asked: “Can you give me a formal letter of invitation?” He said his secretary would issue that, so I could come and pick it up next Monday at noon time. At that time, Washington, D.C. was directly managed by the Congress and was not an independent city. Its Board of Medicine consisted of non-medical staff and was very open-minded. On Saturday morning, we left New York and went to Washington, D.C. Doctors and management staff took the car, while other supporting staff went by train. Many journalists and reporters also followed us to the station.
Our clinic in Washington, D.C. was at the intersection of I Street and 18th Street. It was next to the Pennsylvania Avenue, and not far from the George Washington University. The White House could be seen very easily. The clinic was located in the fourth floor, with 4 500 square feet space (about 450 m2) and called the Acupuncture Center of Washington (also known as Washington Acupuncture Center). Newmark rented 30 dormitories in Arlington, Virginia for our staff. In the first week, we quickly renovated the clinic. In the second week, on December 28, 1972, our clinic reopened. Many newspapers reported this exciting news. After two and half months, the number of patients sharply increased to more than 250 per day. The clinic space was insufficient, so I decided to open a second clinic at 1717 Massachusetts Avenue, which was a few blocks away from the first clinic, with the space of 12 000 square feet (about 1 200 m2), and located on the 7th floor of an embassy. At peak time, there were 650 patients per day at this clinic. In the two clinics, there were nearly a thousand patients (plus family members, more than 2 000 people) per day. Due to the existing of these acupuncture clinics, the hotel business in the surrounding area (including Washington, D.C., Virginia, and Maryland) and the business of transportation of patients to Washington, D.C. were extremely flourishing. At that time, Washington, D.C. became the capital of “acupuncture”. (Notes: Figure 2 is a photo taken at the end of 1972. Dr Lee was using electroacupuncture to treat a patient)

Figure 2 Using electroacupuncture technique to treat a patient by Dr. Yao Wu Lee on December 28, 1972 in Washington, D.C. I Street clinic. Provided by Arthur Fan.

Fan notes: “Acupuncture Center of Washington,” or “Washington Acupuncture Center” was the first “totally legal” acupuncture center in the United States. It was the only one that opened to the public, not for research. The approved date was on December 22, 1972. After that, there were 11 other acupuncture clinics getting approved in Washington, D.C. in 1973 and 1974.
Fan: I heard that you organized buses to bring patients to Washington, D.C. for acupuncture treatment. Is that true?
Lee: A seriously sick patient in a desperate situation came to our acupuncture center. After about one month of acupuncture treatments, he recovered. His Chinese medicine doctor was Ms. Susan He. The patient felt that acupuncture has unexpected effects on many diseases or disorders. In order to help patients from everywhere, he launched chartered coaches to send patients to our center, mainly from New York, New Jersey, Philadelphia and other places several times a week. Basically, the buses shuttled patients back and forth in the same day, with two or three buses a day (120 to 180 patients). Many patients were grateful to him for his help. At that time, there was very few acupuncture clinics and our patients came from throughout the United States. We also had many foreign patients.
Due to the booming of acupuncture business and the differences in thinking, acupuncture had once again aroused the anxiety and unease of Western medicine-dominated medical institutions and drug manufacturers throughout the United States. They united and sued the government of Washington, D.C., but they lost. However, the condition was changing in their favour. In early 1974, Washington, D.C. adopted the “home rule” and became an independent city, which means that it was no longer managed by the Congress. It established a new Board of Medicine, which consisted of local conservative medical doctors. Acupuncture once again became the object of attack. They invited some reporters to engage in a so-called investigation. A reporter named Mike, from The Washington Times, spent one week in our clinics, talked with our patients, and listened to our lectures. One morning, his article was published in the newspaper with a half inch high headline “Acupuncture is an art of deception or a liar?” He allegedly interviewed more than 80 patients who said they were not feeling better after acupuncture. Most people felt disappointed in acupuncture. Even more damaging, he said he didn’t know where the acupuncture doctors came from. He called for the immigration service to investigate the background of theses doctors.
In fact, our Chinese medicine doctors or acupuncturists, in addition to those hired from New York, were recruited from Taiwan, Hong Kong and Macao through the legal procedures into the United States. In 1973, our immigration lawyer applied for a filing to the Manpower Committee of the Congress to employ acupuncturists in the health care services (Medical Practice). This was the first time that the name of “acupuncturist” was used in the federal legal documents and the definition of acupuncturists was engaged in the medical service.
In 1974, the new Board of Medicine of Washington, D.C. gave us orders and let us close our acupuncture offices six times. The American Medical Association combined with the Board of Medicine, Washington, D.C., sued our acupuncture center in Washington, D.C. federal court. The reason they did not use a local court was to deny acupuncture at the federal level. In order to save the acupuncture profession, as well as our acupuncture center, we had to respond seriously.
When we were involved in the lawsuit, there were warm responses throughout the country. Many of our former patients, acupuncturists, and the medical doctors who knew and liked acupuncture came to help out, which gave us great support. The court convened a serious acupuncture hearing. The judge continuously listened to the testimonies from the public for three months. Our patients from all over the country came to testify. The testimonies of many patients moved the judge. For example, a female patient from New York called Barbara, 45 years old, was seriously ill. Her husband left her and forced her to divorce. She was emaciated and even unable to speak. She ate very little and her complexion was bloodless. The conventional doctors of New York estimated that she could only live for 20 days. When sent by a friend to our center, our medical doctors checked her and also felt there was no hope for survival and suggested that she should not receive acupuncture. It was me who saved this patient with acupuncture. She totally recovered after six months of acupuncture treatments. I noticed that when Barbara told her story, the judge, more than 80 years old, removed his glasses with a handkerchief. People present were deeply touched. Another three months passed and the court announced the decision — patients have the right to choose acupuncture and acupuncturists lawfully have rights to practice. In addition, the court emphasized that it was the final decision and it will not accept the appeal.
We eventually won the lawsuit at the federal level. The legal status of acupuncture and the operating rights of our clinic were protected. At the same time, many acupuncturists and enthusiastic people started to actively fight for acupuncturists’ rights in each state. Acupuncture legislations were started in some states. No doubt, we won our lawsuit and helped acupuncture throughout the United States, and we were very glad. However, we were also exhausted — we put in a boundless energy and time and spent a lot of money.
The subsequent experience was even more severe.

Fan: How about the situation of the center afterwards?
Lee: False and negative reports about acupuncture in some newspapers resulted in a large negative impact on our practice. It had significant impact on the numbers of our patients. Initially, it was reduced to 600 patients per day, then 500, 400 and so on. The rapid decline of patients caused us to be unable to afford the rent for large space of the clinics. Both clinics on the I Street and the Massachusetts Avenue closed in 1974. The partnership was broken. The shares were distributed to the partners. Many doctors and nurses also went away. Acupuncture legislation in Massachusetts was earlier than many other states so there was a better political climate there. We sent Dr. Yufan Jiang (江玉凡) and Dr. Yulin Jin (金玉林) to Boston and Princeton, to set up new acupuncture centers. Doctors originally from New York basically went back to New York. Dr. Benson, Mr. Newmark, Dr. Chingpang Lee, Dr. David P.J. Hung (洪伯荣) and others re-started acupuncture centers in two different locations of the New York City. However, a few months later, all of these centers were closed due to the crisis of internal management.
My colleagues and I moved the Washington Acupuncture Center to the Connecticut Inn which located in the middle of the Connecticut Avenue, Washington, D.C., with a total of eight rooms. We worked there for about two years. In 1976, I let our staff Dr. Greg Chen (陈一强) handle the management (in 1980, he moved the clinic to Chinatown, Washington, D.C.). It could be said that between 1974 and 1976, our center experienced a great turn of events, and we were all very depressed. However, I thought if we could continue, there will be hope.
In 1976, I moved the major part of Washington Acupuncture Center to Florida. Until now, it still has three clinics.

Fan: You are an acupuncture pioneer in Florida. Is the experience of your acupuncture practice very smooth there? Do you think there are some relationships between certain obstacles, setbacks in Chinese medicine or acupuncture met in the United States, and Chinese medicine or acupuncture itself, as well as clinic organizers themselves?
Lee: In 1976, per invitation of a patient, also my friend, I moved the major staff of our acupuncture center to Florida and set up several clinics over the time. It was still called the Washington Acupuncture Center. At the beginning, I flew to St. Petersburg and took a taxi for two hours, found and rented an office of 4 000 square feet at the Central Avenue. Our clinic had six Chinese medicine doctors and six Western medicine doctors, from Washington, D.C. There were 60 to 70 patients per day. In 1977, we opened a center in Palm Beach with more than 80 patients per day, but the parking lot was too small to accommodate more patients. Later, we opened another center in West Palm Beach. Now we focus on Florida’s southeast. In order to facilitate patient treatment, we have three clinics in Boca Raton, West Palm Beach and Sunrise. I also work part-time in a local hospital to provide acupuncture services for rehabilitation patients.
Our patients have trusted us throughout, but there were unfriendly people. In 1978, a reporter of the Florida Sunset News, a local newspaper of the Washington Star News, took the pamphlet from my clinic. She noticed that this pamphlet listed many disease names that acupuncture can treat. Then, the responsible person called us saying: “The Medical Association will sue your acupuncture clinic; the clinic should be closed because only (Western) medical doctors can make medical claims.” I asked her: “What is the background of the person who proposed that I should close the clinic? Is it a doctor or an acupuncturist? Has the person ever experienced acupuncture before?” She said: “I do not think so.” I counterattacked her: “Since you are not a doctor, and not experienced in acupuncture, what qualifications do you have to force me to close the clinic? If you want to continue to harass me, I’ll sue you.” She was at a loss with words so I used some minutes to introduce the principles of acupuncture. This newspaper did not come back asking for trouble.
I feel that the Chinese medicine doctors and acupuncturists should spend more time on public education, because the principle and theory of Chinese medicine is too foreign to the Western people. We must safeguard the basic rights and interests of our profession. We, Chinese medicine doctors and acupuncturists should fight the rights for ourselves. The professionals of Chinese medicine and acupuncture have been generally too humble and timid for fear of backfire. I would like to engage in the second revolution, if I were younger. We are in a legal medical practice. Why won’t many health insurance programs pay the cost of acupuncture treatments? At the federal level, why does the Medicare not cover acupuncture? We are the same as a healthcare provider. The Medicare pays for the work of other healthcare practitioners, but does not pay for acupuncture. If we do not struggle and do not fight, it will be in the same condition even after a hundred years. No one will help us for that right except ourselves. If we win, acupuncture will be accessible by all the healthcare programs. Our generation invests more, but the benefit is not necessarily greater. However, the next generation of Chinese medicine practitioners and acupuncturists can reap the benefits. A non-profit organization established by my patients (I am a consultant), specifically called on governments at all levels to attach importance to acupuncture and has sent many letters to President Obama, who could vigorously support acupuncture legislation at the federal level, and help acupuncture become covered by the Medicare. Until now, however, it seems to be with little success. It seems that we have to put more investment and more financial resources into gaining the rights to fight in a federal court. This method’s efficiency is much higher than other options. I hope acupuncturists and Chinese medicine professionals could recognize this.

Fan: I heard that you were involved in many works during and after 1980’s acupuncture legislation in Florida.
Lee: In 1981, a Florida congressman who was a medical doctor wanted to rectify the acupuncture market, and let the state issue acupuncture licenses. The state authority proposed six categories of healthcare professionals, including medical doctor (MD), orthopedic surgeon (DO), chiropractic physician (DC), naturopathic physician, etc., who can directly get the right to perform acupuncture. Acupuncturists, however, should participate in an examination in order to get the license. I hired a lawyer to appeal because the above requirements were illogical. I proposed as long as Chinese medicine professionals or acupuncturists practice acupuncture for more than two years under the supervision of Western medical doctor (there should be evidence such as a contract, or payroll records, medical records and so on), it is not necessary for them to pass the exam and get the license. Later, I was hired by a committee which drafted the Florida Acupuncture Regulation (Ad hoc Committee). I insisted that regardless whether one was a Chinese medicine professional, Western medicine doctor or other professionals, as long as one wants to practice acupuncture, he/she must be treated equally and must pass an acupuncture examination. At the beginning, there were 59 people who applied for an acupuncture license including 29 ethnic Chinese and 30 of other ethnic groups. After a three-day examination, including acupuncture theory, acupuncture points and the actual operation, with acupuncture examiners hired from California, there were 19 people (including all Chinese medicine practitioners from our clinic. There were several Western medical doctors as well.) qualified to get an acupuncture license. However, there were quite a number of Chinese medicine professionals, acupuncturists, and some Western medicine doctors who had practiced acupuncture for more than two years who boycotted the examination. With coordination with the state authority, a Grandfather Law was applied to them. There were more than 100 people who got the license without taking the acupuncture examination.
When drafting acupuncture regulation, some Western medicine doctors added harsh requirements, such as acupuncture clinics must have two restrooms. I argued that many acupuncturists do not need a large clinic space. Patients for acupuncture would not come at the same time. Many clinics of other professions actually only have one restroom. So the finalized regulation stated that acupuncture clinics are just required to have one restroom. At the same time, I insisted to change the regulation name of the licensed acupuncturist as Acupuncture Physician (AP), who no longer practices under the supervision of Western medical doctor. Unlicensed acupuncturists still could continue to practice acupuncture under the supervision of medical doctors. A majority of Chinese medicine practitioners and acupuncturists were very satisfied with the work I did, and understood my situation. However, there were very few Chinese medicine practitioners and acupuncturists who were unhappy with that regulation. There was a lady from Thailand who was angry with me, who did not meet the exemption requirement, and also did not want to practice acupuncture under the supervision of medical doctors.
Later, I served three terms as a Florida Acupuncture License Examiner, two terms as president of the Florida State Acupuncture Association and two years as Chairman of continuing education (1989-1990) for the Florida State Acupuncture Association. After 1985, I also taught acupuncture for pre-med students in the Florida Atlantic University and the professionals in the rehabilitation department of the Boca Raton Community Hospital.
In appreciation for my contributions to acupuncture in the United States, I received the first national “Acupuncturist of the Year” Award for 1983-1984 from the Center of Chinese Medicine in California.

Fan: Dr. Lee, could we discuss the fee schedule of your clinics? Is there any difference in your patients between the present and the past? In addition, it is said that the Jewish people played an important role in acupuncture legalization in the United States and were driven by their interest that in it, what is your opinion?
Lee: When we were in New York and Washington, D.C., the fee for initial visit was $50 and that for the subsequent visit was $20 to 25 (later, increased to $35). Forty years ago, one dollar is roughly equivalent to current $10. For example, if we talk about the price of a car, in the early 1970s, the price of a Lincoln was $6 000 and a luxury Ford car was $4 000. Now their prices are $60 000 and $80 000, respectively. So, if we still apply the fee schedule of that time, the fee for the initial visit and the second visit should be $500 and $350, respectively. However, under the real conditions, our fee schedule is $80 for self-pay patient, as 1/6 to 1/4 of the original fee schedule. Some patients have insurance for acupuncture, which may pay us at about $200 per time with limited times. The fee schedule is much lower than before, so the model of both Western and Chinese medicine doctor seeing the same patient is no longer affordable. Hiring a good Chinese medicine doctor is sometimes also difficult.
Before, there were very few acupuncture clinics in the United States. Patients from all over the country, even from all over of the world came to us, so our center could have 1 000 patients per day (two clinics combined). There were many patients with intractable diseases or very serious conditions. Later, the business of our center was no longer as successful as that time due to the malicious newspaper reports which caused patient’s misunderstanding of acupuncture and bad influence from the lawsuit (although we won). The number of patients was not as many as before. Furthermore, due to acupuncture legislation in many States, more acupuncturists could open acupuncture clinics. The number of acupuncturists, both migrating from all over the world and graduating from accredited schools in the United States, have increased. The increasing of clinics has caused the number of patients to decrease in each clinic. Currently, I have about 30 patients per day from the surrounding area and not many with serious conditions.
To improve the income of Chinese medicine practitioners and acupuncturists and to match the income of other practitioners, such as medical doctors and physical therapists, we should make efforts to promote insurance companies to pay for the acupuncture treatment. Currently, however, many Chinese medicine practitioners and acupuncturists are “comfortable” with their individual business and not many are aware of the need to engage in this important area.
For those who feel that the Jewish people played an important role in the development of acupuncture in the United States due to their interest in money (or say, “greed”), it is unfair statement about our Jewish friends. From my personal experience, there were two Jewish friends of mine involved in our center’s establishment and operation. They did get certain compensation. However, it was not as much as many people thought. Like me, they were driven by the passion to promote acupuncture. In our clinics, eighty percent of the income was used to pay the employees’ wages, operational expenses (including renting, employee training), and the expenses of litigation. Litigation expenses were considerable. For example, there was over $500 000 spent for the lawsuit in 1974 in Washington, D.C. In order to change the resentment of Western medical doctors, to improve the external environment of the acupuncture profession, and to reduce the external pressure on the Board of Medicine (handled by the Congress), in 1973 we invested tens of thousands of dollars to open acupuncture training programs for Western medicine doctors (MDs and DOs) in the George Washington University School of Medicine. Each class had 30 doctors, lasting three months (40 h per week), which was one of the earliest acupuncture training programs for Western medical doctors in the United States. We had a total of five classes. From 1973 to 1975, we invested over $70 000 at the Department of Medical Biology, George Washington University School of Medicine, to conduct the studies of acupuncture on rheumatoid arthritis. Therefore, from the perspective of return, investing in another field, such as real estate, would benefit more. However, my Jewish friends and I chose to promote acupuncture.
Personally, if I made another choice, such as returning to Taiwan to continue my previous career, obtaining a “General” title should be predictable. If I chose to work in the United States Space Center, I would be a good scientist. The reason I chose Chinese medicine and acupuncture was that the acupuncture profession brings me a sense of accomplishment. I am 80 years old, and until now, I still work in the clinic (see Figure 3).

Figure 3 Dr. Yao Wu Lee treating a patient with acupuncture in Florida (2012). Provided by Arthur Fan.

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