At my school, and I believe elsewhere in the US, we are required to take the Clean Needle Technique (CNT) exam before doing acupuncture in the clinic as primaries. My exam is coming this weekend in Portland and boy am I excited. (Yes, that’s sarcasm). To tell you the honest truth, I haven’t thought too much about it – positive or negative.
The basic procedure is like this – well in advance of the exam nearest you, you submit a sizable chunk of change (135 dollars right now) and an application. Some time later you receive word that you’re accepted or not. You’re then required to buy a copy of the CNT manual (another 20 bucks plus shipping if your school doesn’t carry it) and assemble a “clean needling” kit consisting of various items. You’re meant to study and practice before the exam, and then give up an entire day where you will apparently be lectured to about blood borne pathogens, the importance of controlling your workspace and using the tube insertion method of needling.
The idea, I think, is to ensure the general public that acupuncturists know about blood-borne pathogens and are doing their best to minimize the risk to patients. I don’t think this is a bad thing. The public, especially the American public, is germ phobic to an extreme. Letting them know that we’re doing our utmost to ensure their safety can only be helpful for the profession. Right? That could be the end of the conversation, but many folks have raised questions about the exam and the whole practice of “clean needling.” I’d like to graze over a few here in hopes of starting a conversation and maybe quieting some of the questions in my own mind.
The “course” and exam
The Clean Needle Technique “course” and exam are administered by the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) based in Maryland. One of the major gripes I hear about the CNT course revolves around this organization. The question embedded in most of the complaints I have heard is whether or not this group is exploiting students for a profit motive. The assumption is that the group does nothing more than CNT, that CNT is not necessary or even useful and that the group charges unnecessarily for the service.
As determined from their website, CCAOM’s primary aim is to improve the consistency and quality of Chinese medicine education in the US through the establishment of applicable standards for acupuncture and Asian medicine schools. They created a separate commission for the accreditation of Chinese medicine schools, now known as the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). They also have committees on a variety of topics not related to CNT and their newsletter suggests that they are still intimately involved in the continuing development of acupuncture and Asian medicine educational standards. For this reason, I do not support the assertion that CCAOM exists solely for the purpose of administering the CNT exam.
Regarding the profit motive… I have no idea how much profit the CCAOM makes from the CNT exam nor do I know what they would do with such a profit. I am always willing to give people the benefit of the doubt with regards to this issue. I know how much work goes into running an organization like this, and I’m disinclined to believe that they are profiting significantly from this practice. However, the regulations around the CNT Manual are absurd.
Every person is required to buy their own manual ahead of time, photocopies and reuse of others’ manuals are prohibited. The manual is republished semi-frequently, so even if you had a friend’s – you may not be able to use it. While I understand the need to have an updated book because of the changing understanding of blood borne pathogens, I cannot think of a viable reason to require every student to spend 20 dollars on the manual. Allow photocopies and sharing of manuals – it’s the right thing to do.
There have been questions raised about the efficacy of the CCAOM in administering the exam from the perspective of enhancing patient safety. You can read a recent article in the Chinese Medicine Times about this issue titled OSHA Compliance: How Clean Needle Technique Falls Short in the US. Personally, I feel that the article goes too far in the WRONG direction – which I will discuss in the next section of this post. But the thought that the CNT exam doesn’t even do what it is intended to do very well is disturbing. That’s a lot of money to not even get the job done.
It is part of the Oregon Acupuncture Association’s code of ethics states that it is a legal requirement to follow Clean Needle technique to practice acupuncture in Oregon. I have not been able to locate that section in the Oregon statues that govern licensure, but several agencies refer to the requirement and I believe it may be a requirement in some way in the national board examinations. It would be interesting to know whether it is an actual legal requirement, and if not, why not.
The question is this – has there ever been any evidence that blood borne pathogens are transmitted by modern acupuncture needles? It seems certain that the risk would be much higher if you were reusing needles or using needles between patients. Few people do this – and it doesn’t seem like a 135 dollar course and exam would be necessary to teach us not to reuse needles.
Assuming you are using disposable needles and using them only once – what is the risk? Several articles, such as this one in the Medical Acupuncture Journal indicate that the evidence is quite scarce that acupuncture poses a serious risk of transmitting blood borne pathogens even in highly risky situations. I personally know of no situation in which acupuncture caused any problems, blood borne pathogen or otherwise. In China, it is my understanding that very few if any people practice Clean Needle Technique and I am not aware of any outcry around the propagation of disease by acupuncturists. It seems exceedingly unlikely that the risk is significant. So why the obsession?
It seems to me that it would be smarter and easier for students to make Clean Needle Technique a mandated portion of their acupuncture curriculum (perhaps a couple weeks of the first class) and have a few salient questions concerning it on the national board exam. I cannot at this time think of a substantial reason to support the course and exam as it now stands. I would be delighted to hear any opinions to the contrary with supporting evidence.
Have any of you practitioners been involved in any efforts to change or get rid of the requirement?
About Eric Grey
Hi - I'm the founder of Deepest Health. When I'm not writing here, you can find me reaching out to the Chinese Medicine community across the web and in my own backyard. I currently teach Chinese herbs at my alma mater, the National College of Natural Medicine. Additionally, I'm the founder of Watershed Community Wellness, a thriving local clinic in Southeast Portland in Oregon. No matter where I'm working, you'll find my focus on the Classical approach to Chinese medicine laced throughout everything I do.