Blindness and Acupuncture Licensing in America:

The social philosopher Ortega Y Gasset wrote: “Legitimacy is the function of the whole life of a people.” When I first started reading about Juliana Cumbo’s attempts as a blind acupuncturist to get licensure in Texas, I realized that this case directly addresses contemporary American cultural, legal and ethical questions that define us as a society—within the profession and also beyond the context of AOM. As managing editor of The Qi-Unity Report, I sought out Will Morris, president of Ms. Cumbo’s acupuncture school, to look into the terms of this precedent-setting case.

QUR: Would you kindly introduce yourself and your position?

WM: Certainly. My name is Will Morris and I serve as president of the Academy of Oriental Medicine, also called AOMA, in Austin, TX.

QUR: I understand, based on various articles I’ve read, that Juliana Cumbo has recently graduated from that school. Is that correct?

WM: Yes, that's correct. Juliana Cumbo is a graduate in good standing of AOMA.

QUR: She received her master’s degree?

WM: Correct. We offer a master of acupuncture and Oriental medicine degree, which is a four-year program with 3210 hours. There is a deep focus on Chinese herbal medicine as well as acupuncture, theory, and biomedical studies.

QUR: Would you say that she was a good student?

WM: My teaching experience with her was as a supervisor in the clinic where she performed at an exemplar level. Yes, Juliana was a good student.

QUR: Are you familiar with something of the history of blind acupuncture in Japan?

WM: Yes. I was first exposed to Japanese models of practice in the mid 1980s. I am familiar with blind acupuncture in Japan and have studied systems such as Toyo Hari and Shaku Ju; both schools are associated with blind acupuncturists. While serving in academic leadership in Los Angeles, I had the opportunity to host the president of the Japanese Blind Acupuncture Association in 2001.

QUR: So you know a little bit about Sugiyama, the father of acupuncture in Japan who was blind?

WM: Yes, a little. The origins of acupuncture in Japan are a little more complex than that. Sugiyama did develop the guide tube method in the 17th Century. It is believed that Chiso brought acupuncture to Japan from the Wu in China in the 6th century.

QUR: Well, according to one article there are roughly 30,000 blind acupuncturists currently practicing in Japan. That's more than the total of acupuncturists practicing in America, isn't it?

WM: Yes, that is my understanding as well.

QUR: This means the public in Japan probably doesn't have a problem going to a blind acupuncturist?

WM: Apparently not. And if we look at what's going on here, Juliana has really changed the terrain of acupuncture in the U.S. The media have asked the question, "Would you go to a blind acupuncturist?" The question is no longer, “Would you get acupuncture?” This represents a significant change in public perception. The question is no longer will you get acupuncture, but rather, will you get acupuncture from a blind person?

QUR: Alright. I think, perhaps, this is a good discussion on a number of levels about the inclusiveness of acupuncture as a profession, isn't it?

WM: That's the idea. Juliana is a hero, and she has changed the conversation in this culture about acupuncture.

QUR: Do you sense any ulterior motives in this case?

WM: I can’t answer that since it would require speculation.

QUR: Okay.

WM: Juliana had demonstrated competency and safety with an immaculate record in treating patients throughout the course of her program. She passed her national licensing exams and met the standards that any sighted individual has to meet.

I think that what we're looking at here is really a problem of culture. It is the culture of the sighted individual versus the culture of the non-sighted individual. It is difficult for a sighted individual to conceive of what a non-sighted individual can do. The possibilities are in fact extraordinary. The human tendency is to see the world from our own point of view. So naturally the sighted person has difficulty imagining the capacities of the non-sighted.

QUR: Please continue.

WM: This is very true in terms of collecting clinical information because the non-sighted individual constructs their world differently. The palpatory skills for the purpose of data collection and case management are heightened, and the olfactory and auditory skills extended beyond those of the sighted individual. But this is assuming that these senses are the only way of building knowledge. New research models defining the feeling plane as a valid instrument for assessment have indicated the possibilities are extensive.

QUR: That makes sense.

WM: Some opposing opinions included: what if the patient faints in the room? and that question did come up. How would she know? The non-sighted person has many sensory mechanisms by which to perceive changes in the environment. Not only does she have that, but the non-sighted acupuncturist often stays in the room the whole time. On the other hand, the sighted acupuncturist often leaves the room and would actually have no way of knowing if the patient fainted after they left the room.

QUR: Interesting point.

WM: So the fainting issue becomes an inquiry from which one doesn't produce a lot of quality information about the capacities of the individual. Rather, it continues to overlay the blind practitioner with the belief and values of the sighted practitioner, and this is the ongoing cultural problem.

We see a similar cultural problem for Chinese practitioners in the U.S. They have appropriate recognition as physicians and doctors in China but cannot use the doctoral title in much of America. This is an example of laws being created that prevent the Chinese physicians from fully expressing their competency in medical care. It is a similar cultural phenomenon as that between the sighted world and the unsighted world and in particular with respect to beliefs about competency. It comes down to an issue of belief. In fac,t Juliana has an excellent safety record—she has demonstrated her competency on hundreds of patient visits.

QUR: Apparently there have been zero complaints from all of the patients she's worked upon?

WM: Well, it's not just zero complaints; there are a high number of rave reviews and a very high number of return patient visits.

QUR: Okay, so really, we're dealing with a set of expectations that are biased from our sighted experience.

WM: That's part of what's going on, certainly.

QUR: That's part of what's happening with the cultural expectation.

WM: Acupuncture performed by non-sighted individuals is not just occurring in Japan. One of our faculty members participated in the training of a non-sighted acupuncturist in China as well.

It is often the case that if we have not experienced something before, it seems impossible that it could exist. This is true for people walking into a snow-filled environment with the Inuit people who have an extraordinary number of descriptions of colors of white for snow.

The issue of belief is conceptual, perceptual, and cultural.

QUR: Okay. So perhaps even in our legal structures, when encountering something for which we don't have a ready-made place we respond with fear?

WM: Well, I suppose that's a possible interpretation. I think it is important to identify the reality of the standards of practice for blind acupuncturists in the world today. But further, the legal obligation for any agency that receives funds from the federal government requires compliance with the Americans with Disabilities Act. In essence, this requires that reasonable accommodations be made for practice by the visually impaired.

QUR: So part of this has to do with a focus that is not sufficiently international?

WM: Well, I did render it globally because we don't have standards of practice particularly here in the U.S...But upon review of a few different licensing boards, the response was "we have nothing in our code which prevents the blind acupuncturist from practicing."

QUR: Is there any opposition at your school in terms of other staff members or students when responding to the idea of a blind practicing acupuncturist?

WM: AOMA stands in solidarity behind Juliana. The trepidations for faculty and staff emerged when she was admitted; they weren't certain that she would be able to do it. The institution performed due diligence, taking the time to identify concerns that any agencies might have. Of course the agencies said they couldn't make a determination in advance, but they didn't say she couldn’t; they said that being visually impaired shouldn't be a reason. And, yes, that shouldn't be a reason, because the Americans with Disabilities Act provides for people in Juliana’s case to be able to pursue a career and with reasonable accommodations. So the question here becomes "what are the reasonable accommodations for an individual in Juliana’s situation?"

The school went to the accreditation commission, the national certification commission, and to the council of colleges and deliberated extensively at the faculty level. Ultimately, the faculty did make the decision that Juliana could be admitted and would be watched very closely. They did watch her progress very closely and were ultimately satisfied. The faculty signed off on her diploma. She is a successful graduate in the institution, having performed all the roles and obligations that any other student would have to perform.

QUR: Where do things stand now in terms of her status as she endeavors to become licensed?

WM: The process is still underway, and we can follow up as soon as there is a resolution.

QUR: Do you feel that this case will have repercussions throughout licensing of acupuncturists in the United States?

WM: Absolutely. Juliana is a pioneer, and her situation--depending on how this case goes-- will determine the state of training and employment of blind acupuncturists in the U.S.

QUR: Is it correct to say that should she prevail legally, this will be an inspiration to blind people who may be contemplating a career in acupuncture?

WM: Well, let's just leave it at “she prevails.” I say this because I believe her case supersedes the domain of legality and enters the realm of the moral. This is the morally correct thing to do: allow Juliana Cumbo licensure, and not just for Juliana, but for the patients that she would serve. And not just for her and her patients, but also for all the patients for whom blind acupuncturists would serve. This is because they serve in a different way--in a way that touches people differently than the sighted practitioner can--and there's a significant contribution potential with this group for our society.

You know, we did our "long nights of lost sleep" determining our role in accepting Juliana into a graduate program. We now believe that we sleep soundly because of having vetted her qualifications fully in the very beginning, and we will continue to stand behind her all the way.