Cockroaches, Acupunks and Respectability

on being "the medical equivalent of Green Day"

Art by A. Cohen

Apparently the post on placebo hit a nerve? I don’t have much of a social media presence and neither does WCA or POCA Tech (that’s a whole other topic) but my friends sent some interesting screenshots. Here’s one acupuncturist’s response:

Have to say, I am really not a fan of people in the profession (esp those in leadership) referring to those who chose this profession as Acupunks.

No, I do get it, the author (and many in this profession) enjoy(s) creative writing and wordplay. (So do I). And much of this profession moves against accepted mainstream limitations, and therefore has a rebellious undercurrent.

However, being a “punk,” while thrilling in teenage stages, isn’t a great pathway to self-respect or others’ respect. Unless you’re trying to appeal to other teenage (emotionally-immature) mindsets. Rebellion, if we study history, is always replaced by other coups, revolutions, and rebellions, is often violent and destructive of self or other, and in general, is not very mature, intelligent, or wise. Any sort of successful rebellion always requires very calm, wise, steady people to handle the ship once the “punks” have thrown the tea in the harbor. If the “punks” stay in charge, there are only more coups. Coups after coups.

So. If we can stop with all the “Hey, Acupunks!” that’d be super. It’s really not helping us to insist on remaining the medical equivalent of Green Day. Let’s grow up.

Also, I get the idea behind survivalists in this profession calling themselves “Cockroaches of Acupuncture” … And I still don’t think it’s the best in terms of a positive self-image. It does reinforce the idea of others loathing us, or crushing this profession, which is something I’m not sure we want. And yes, I get the argument that cockroaches have a place in life. And they are social, etc. But again…

It’s too bad that these sorts of self-defeating undercurrents exist in this profession, because much otherwise in this author’s posts is fantastic. The writer is brilliant in many ways. But… Acupunks? In 2025? And cockroaches? Come on, now. Let’s be better.

First, I appreciate the kind words, and I’m delighted with the comparison to Green Day! I know it’s debatable whether they’re truly a punk band, but there’s no question they’re spectacularly successful. Also, catchy! I can picture a limited run of WCA’s t-shirts with “the medical equivalent of Green Day” on the back and oh, it’s tempting.

Second, I appreciate the opportunity to use this as a teachable moment about leadership. I bet POCA Tech students, especially the Gen Z ones, will find this hilarious — although they probably don’t know who Green Day is, they’ll be entertained by somebody scolding me for acting like a teenager when I’m obviously so old.

Seriously, though, I wanted to do a 2025 acupocalypse update and this is a perfect introduction¹ … to our profession’s Boulevard of Broken Dreams.²

No matter how hard I might’ve tried to describe the acupuncture profession’s tormented relationship with respectability, I could never have done it so well as the acupuncturist who’s put off by punks and cockroaches. My friend Whitney, who came up with the “cockroaches of acupuncture” term, just coined a new one: punkroaches. #punkroaches4ever! Can I get another amen?³

Respectability politics is defined as “the process by which privileged members of marginalized groups comply with dominant social norms to advance their group's condition”. Respectability politics are complex and often racialized. Some people don’t have any choice about whether or not to engage in them.

This seems like another opportunity to recommend Tressie McMillan Cottom’s great essay, The Logic of Stupid Poor People:

I learned… that there was a price we had to pay to signal to gatekeepers that we were worthy of engaging. It meant dressing well and speaking well. It might not work. It likely wouldn’t work but on the off chance that it would, you had to try…There is empirical evidence that women and people of color are judged by appearances differently and more harshly than are white men.

Respectability pays off for some individuals and some organizations under specific circumstances, but it’s not a panacea. And for me — a white trash girl with complex PTSD that I can’t always hide even when I’m trying really hard — the cost-benefit analysis for performing respectability in the acupuncture profession has always penciled out to “nope” and “nothing to lose”. I do understand what respectability is and how it works. It just isn’t worth the effort, in my case.

Because the effort is substantial. Presenting as respectable demands significant energy, especially if it means performing a class and a culture that aren’t yours (even without factoring in the mental health stuff). Leadership is hard, self-revealing work and — note to POCA Tech students — respectability isn’t automatically part of it. Trying to lead when you’re in disguise is awful and I wouldn’t recommend it. Regardless, I’m bad at disguises so the whole thing’s a nonstarter. But just as importantly, I’m in a field where I can get away with being publicly weird — while not being publicly weird doesn’t advance my condition or other acupuncturists’ condition as much as you might think. More about that in a minute.

Since the topic of history came up, let’s talk about punk for a minute. I’ve written elsewhere about what community acupuncture has in common with punk rock. But punk is more than music and my introduction to punk in the late 80s wasn’t actually music (I can’t handle loud music, or loud anything, really) — it was Keith Haring’s art along with AIDS activism.⁴

Art by Keith Haring

Working in a grassroots AIDS organization in 1989 is where I discovered acupuncture; the people I worked with were using it as a radical form of self-care. Since I learned about acupuncture at the same time and place I encountered punk art, I guess I just assumed they were aligned. Acupuncture has a long history of being outsider medicine.

AIDS activism was absolutely a rebellion — and it’s also why effective, accessible pharmaceutical treatment for HIV came into being, because queer activists demanded it. They fought back. They fought back while they were dying. Punk is about community, about grassroots efforts, about people who have little or nothing to lose engaging in D.I.Y. collective action. For certain people under certain circumstances, it’s a creative, life-affirming, healing alternative to respectability — especially when respectability isn’t even on the table. Many people with AIDS were shunned and treated like pariahs; I met some who described encounters with medical providers who refused to touch them. Taking care of each other, and taking political action, was a way of reclaiming their humanity.

I wouldn’t dismiss punk as a lack of self-respect.

Anyway, getting back to the present: The acupuncture profession has put all its eggs into the basket of respectability politics: doctorates, white coats, Medicare coverage⁵, any and all props required to be admitted into the Medical Industrial Complex. Except the Medical Industrial Complex isn’t having it. Or us. It’s not about whether we call ourselves acupunks or doctors, it’s about money; the Medical Industrial Complex just doesn’t want to spend money on acupuncture, no matter how hard we comply with their social norms, no matter how many times we tell them it’s worth their while.

I haven’t had to perform respectability because in the acupuncture profession, respectability doesn’t necessarily translate into material benefit.⁶ Maybe it pencils out for some individual acupuncturists or some particular businesses, but not for the profession as a whole (which is why POCA Tech puts so much effort into teaching entrepreneurship — there are no guaranteed rewards for trying to fit into the establishment.) Overall I’ve had more economic stability than most acupuncturists. It turns out you can be a successful small business person AND let your freak flag fly; they’re not mutually exclusive. Just like leadership, small business is always hard but it’s much easier when you get to be yourself.

And for the acupuncture profession, performing respectability can’t make up for huge structural problems. (This is a public service announcement.⁷) Respectability politics aren’t designed to be used indiscriminately. Sometimes they get in the way of survival, because they take up energy that can’t be spared, energy you’ll need if you’re actually trying to address huge structural problems. Attempting to describe that particular dynamic is how I found myself writing about cockroaches.

Art by A. Cohen

Last year I wrote that the giant vacuum cleaner of Gainful Employment regulations was an existential threat to the acupuncture profession. I wasn’t quite right, though, as subsequent events have shown. It’s not Gainful Employment, which was initiated by the Democrats, that’s a threat; it’s any accountability measures for acupuncture schools that relate to employment outcomes. The Republicans just unveiled their own version of accountability for federal student loans and wow — it looks more destructive for acupuncture schools than the Democrats’.

And since not just acupuncture schools but most of the infrastructure of the acupuncture profession is directly or indirectly dependent on federal student loans, we’re in more trouble now than we were this time last year. For anybody who’s new to this topic, here’s how the cash flow goes:

Students take out federal loans to pay tuition to their schools; the schools use that income to pay accreditation fees to ACAHM (the Accreditation Commission for Acupuncture and Herbal Medicine) and membership dues to CCAHM (the Council of Colleges of Acupuncture and Herbal Medicine). CCAHM also earns money directly from students for administering the Clean Needle Technique exam. In most states (California being a notable exception) once students have graduated, they pay the NCCAOM (the National Commission for Acupuncture and Oriental Medicine)⁸ to sit for their exams and get certified, in order to eventually apply for state licensure. (The NCCAOM also receives revenue from acupuncturists re-certifying, but more than half of their income comes from applications for first time certifications and exam administration.) In most states, ACAHM and NCCAOM, and sometimes even CCAHM because of Clean Needle Technique, are written into state licensing laws.

Let me try to explain what’s worse this year compared to last year without putting everyone to sleep — because what’s probably going to kill the acupuncture profession is pretty boring. Spoiler: it’s not our failure to comply with dominant social norms, it’s paperwork.

Before I helped build an acupuncture school, I think I assumed — which a lot of people do — that people who run acupuncture schools that charge a lot of money are lolling around in bathtubs full of cash. They’re not, though. The economic math of operating an acupuncture school is brutal even when students graduate with $250K in student loans. Most schools are small and barely making it (which is why they keep closing!). Accountability measures for student loans, whether they’re enacted by Democrats or Republicans, will add a daunting new level of bureaucracy and will require data that acupuncture schools probably won’t be able to get.⁹

The new paperwork will be a burden for all higher ed institutions, but it’ll push small, precarious colleges over the edge. And it will give larger, multi-disciplinary institutions strong incentive to cut programs like acupuncture that can’t show acceptable debt-to-income ratios. Last year, a lot of acupuncture schools struggled to comply with Gainful Employment reporting (we’re not talking about enforcement or consequences, just the part where they had to try to gather the data and fill out the forms). They breathed a sigh of relief when the Democrats lost because they hoped the whole thing was over. By all accounts the Republicans’ requirements will be even more labyrinthine and punitive. And that’s not even taking into account the new borrowing caps on Grad PLUS loans.

This isn’t about a coup where punks take over the acupuncture profession; at this rate, there’s not going to be anything left to take over. We’re not throwing the tea in the harbor, we’re trying to get people to notice that the ship has a big hole in its side.

What acupuncture schools really need to do is pivot away from student loans and their new, crushing paperwork. The era of free money appears to be over, regardless of whether Democrats or Republicans are in power. That would be a tall order under any circumstances (see above: acupuncture schools are mostly small, cash-strapped, and overwhelmed — in other words not in a great position to overhaul their business model). But it’s currently impossible due to the acupuncture profession’s fixation on respectability, which is sucking all the air out of the room.

With some effort, goodwill and luck, POCA Tech will be able to survive conditions that other acupuncture schools can’t. We don’t have to fill out the new paperwork, because we don’t offer federal student loans. That was a #punkroach decision and I recommend it. We were only able to pull it off, though, because 1) we focus on small business as opposed to respectability and 2) we’re undeterred by the acupuncture profession’s disapproval — no matter how withering. I wish more people were. Especially people in leadership.

1. It’s going to be a major challenge not to fill this post with Green Day lyrics. Let’s see if I have any self discipline.

2. Guess not.

3. Amen!

4. There’s an opinion piece in the New York Times, “Today’s Young People Need to Learn How to Be Punk” that references punk in AIDS activism: “… I learned about punk in a 1990s downtown drag scene that was in no danger of landing brand deals for sponsored content. I recommend the 2012 documentary “How to Survive a Plague,” which chronicles a particularly queer brand of AIDS activism that negotiated with Big Pharma (You may hate us, but if you save us you could make billions) while also taking to the streets to shame their greed with eye-catching art... Protesters slipped a monster-size condom over the home of the monstrous homophobe Senator Jesse Helms and poured the ashes of fallen comrades onto the White House lawn. Now, that was punk.”

5. HR 1667, with a zero percent chance of becoming law according to GovTrack.us

6. If you don’t believe me, please read Amy Zahm’s excellent series of posts about getting a DAOM, creating a hospital job, and still making $40K per year while carrying a huge student loan burden.

7. Warning!

8. It sounds like they’re finally changing their name? To the National Certification Board for Acupuncture and Herbal Medicine (NCBAHM)?

9. No, Medicare cannot fix this problem even if the legislation were to pass which it won’t. Medicare will not instantly create jobs that solve the acupuncture profession’s debt to income problems because that’s not how job creation works. The Medical Industrial Complex is not going to rescue us.

I too wish people in the acupuncture profession would grow up.