Makeshift Medicine
more about the mindset of community acupuncture, plus an intro to 5NP
Two of our readers, Mickey Foley and Cris Monteiro, separately sent me the same article, “Makeshift medicine is a response to US health system failures”. Mickey and Cris are AAT trainers for the POCA Cooperative (more about that in a minute). Recently they trained some people from Brown University, who pointed out how neatly community acupuncture and 5NP fit into the idea of “makeshift medicine”, which is a concept that a colleague of theirs is researching.
Here’s the abstract of the article:
The ‘makeshift medicine’ framework describes how individuals address healthcare needs when they are unable to access the US healthcare system. The framework is applied to gender-affirming care, the health of people who inject drugs and abortion access. Recommendations for future research, advocacy and policy are made.
And here’s the whole thing (it’s a quick read):
The gist is that various people who face barriers to accessing healthcare are getting creative by engaging in makeshift medicine, or “the practice of meeting healthcare needs outside of formalized settings as a response to exclusion from the healthcare system”. If you think about what kinds of settings are considered formalized for acupuncture, and if you think about the barriers as either not having insurance that covers acupuncture or not being able to afford conventional private room rates (or both), then definitely, community acupuncture qualifies as makeshift medicine.
I can imagine some acupuncturists, maybe even some community acupuncturists, bristling at this description on the grounds that makeshift sounds limited, crude or unprofessional — but I like it. Of course I like it.
According to Merriam-Webster, the verb form make shift means to cope, make do, get along, survive. Which is what you do when the status quo is unwelcoming and the system wasn’t built for you. The adjective makeshift means alternate, backup, or stopgap, as you might expect. But it can also mean refuge (lovely), and it can even mean new, as in “taking the place of one that came before”.
Let’s talk about 5NP, also known as the Five Needle Protocol or Acudetox. It’s five points in the ear that together treat stress, trauma, and addiction. It was developed by activists in the 1970s who were mostly laypeople, not acupuncturists.
5NP or Acudetox is where the core of community acupuncture came from. There would have been no Working Class Acupuncture and no POCA Cooperative and no POCA Tech if there had been no Lincoln Acupuncture Detox Collective in the Bronx fifty years ago. It’s a remarkable story, and fortunately there are books, documentaries, and podcasts to tell it. You can find some of them on WCA’s “history of community acupuncture” webpage.
We can’t talk about 5NP without talking about 5NP laws. A 5NP law is a state law that basically creates a limited exception to acupuncture licensing laws, a makeshift arrangement that allows non-acupuncturists to legally provide 5NP. More than half US states have some legal provision for 5NP. Here’s an example, in the form of HB4487 introduced last week to the Illinois General Assembly by Rep. Hoan Huynh:
Amends the Acupuncture Practice Act. Provides that none of the provisions of the Act shall prevent an unlicensed person from engaging in a standardized 5-needle protocol if the person satisfies specified conditions. Provides that the treatment utilizing the 5-needle protocol shall be limited to the insertion of disposable, sterile acupuncture needles into the ear and only in compliance with the 5-needle protocol. Provides that the application or insertion of needles anywhere else on the body of another person by a person shall be considered engaging in the practice of acupuncture without a license.
5NP was mostly developed before occupational licensing for acupuncture got established in the US, so 5NP laws are a way of returning Acudetox to the kind of people who originally created it. The Utah Acudetox website has a great overview here.
The makeshift medicine framework is helpful for pointing out two aspects of the community acupuncture mindset that are important to highlight, especially for students:
The US healthcare system excludes different people in different ways. Acupuncturists occupy a marginal position in relationship to the healthcare system as a whole — in a sense we’re right on the edge (as in, hellstrip) which means we feel the discomfort of that, if we’re paying attention, and also we have to make a decision. Are we trying to get ourselves off the edge and into the center, to do whatever it takes to have that particular system let us in? Or are we looking around to see who else is on the margins with us and how we can serve them? In my experience, you have to get clear about your priorities.
Creativity and adaptability are required to survive on the edge. (See also: hellstrip.) There are jobs where you can give very little of yourself, where you can clock in and clock out, and then there’s community acupuncture. You have to decide whether that kind of commitment and investment will be good for you.
Responding to failures of the healthcare system by creating resources for people to use on their own terms is what we’re all about. I’ve found that to be a very empowering response. One of my favorite quotes from early in the pandemic was “Stay alive and make things”. Makeshift medicine is about doing both.