Chang_Interview

QUR: How did you go from working in private practice to working with soldiers recovering from battle?

JC: I did not believe the saying “It’s who you know” until I met the vice-president of Med-National. His company is hires healthcare professionals to work in the military healthcare system. One day in my private practice I simply asked him, “So, what do you do for a living?” He explained that he creates contracts for the government, and he employs healthcare professionals to work through these contracts. Then I asked him if he ever came across any opportunities for acupuncturists. He said, “You know, I had two opportunities but did not know who to approach.” So, two weeks later, he approached me with an opportunity about a pilot program for PTSD at Ft. Bliss, TX, and I jumped at the opportunity.

QUR: Why is the military funding CAM research?

JC: What the military is realizing is that the current standard treatment protocols are not working. Standard mental health therapies have primarily included pharmacotherapy and cognitive-behavioral therapy. And if the soldier did not get better and had difficulty coping with the standard treatment, they were forced out of the military against their wishes. This means life-long veteran benefits that the Congressional Budget Office (CBO) estimates to be between $7 and $9 billion over the period 2008 through 2017 are paid to Afghanistan and Iraq veterans.

So there is a big push for evidence-based research for treating PTSD and depression. The RAND Corporation estimates that the government could save as much as $1.7 billion, or $1,063 per returning veteran, through evidence-based research. The savings come from increases in productivity as well as from reductions in the expected number of suicides. So far in 2008, the Pentagon has spent $5 million seeking new ways to treat troops suffering from combat stress or brain damage by researching alternative methods such as acupuncture, meditation, yoga, and the use of animals as therapy.

QUR: You mentioned that soldiers returning from tours of duty experience social problems adjusting to society, and that the military is short on medical staff. Is this part of the shape of opportunity for practitioners in that environment? Please explain.

JC: There is definitely a shortage of staff to treat soldiers with mental health issues. And because there is a shortage of staff, and in addition to the research that has shown positive outcomes for CAM, there is a tremendous opportunity for acupuncturists in military medicine.

In terms of a soldier’s problems adjusting back to society, they tend to adjust better with treatment that includes cognitive-behavioral therapy, pharmacotherapy and CAM therapies (i.e., meditation, acupuncture, reiki, yoga). If they do not get treatment, then they tend to have problems such as DUIs.

QUR: Are there examples of allied health-care workers already integrated into the military model?

JC: So far, there are chiropractors working in Army hospitals throughout the United States. This has been very beneficial in that they have paved the way for acupuncturists as well to work in military hospitals. And because of our predecessors, I have been fortunate to have met many different CAM practitioners at Ft. Bliss. So far, we have a reiki practitioner, a naturopathic physician, a chiropractor, massage therapists, movement therapists (yoga, tai-chi), and art therapists all working towards a common goal.

QUR: You currently work on PTSD patients at Fort Bliss in El Paso, Texas. What percentage of soldiers experiencing PTSD return to the front? What complications present themselves in your treatments?

JC: In our program, we have been able to return 66% of the soldiers back to their duties. The complications that tend to hinder our treatments hinge on compliance. If we cannot get the soldiers to adhere to our program, we will not get the results. Some of the complications include soldiers dropping out of our program due to relocation and physical conditions that limit a soldier’s participation in the program (i.e., traumatic brain injury, or shrapnel that causes severe pain).

QUR: Do the soldiers respond well to the prospect of having acupuncture treatment? That is to say, do you encounter barriers to treatment among them?

JC: One of the keys to success in the treatment of soldiers is that they just want someone to help them. If you show them that you are there to help get them better, you have opened up trust and future dialog with the soldier as a patient. That is the key.

QUR: You mentioned that there are 15,000 soldiers who have already been screened to qualify for PTSD treatment at Fort Hood—the largest army base in the U.S. That’s a huge number of prospective treatments! Will you be recruiting other practitioners to help treat them?

JC: Well, so far I will be the only acupuncturist to be working at Ft. Hood. So I have a lot of work ahead of me. I am trying to not look at the numbers, but instead, I am looking at standard acupuncture treatment protocols that I have used for my patients instead of the customized approach that is common in TCM. By using a standard protocol, I can cut down on the time spent on TCM diagnostics (i.e., differentiation of syndromes, tongue & pulse diagnosis) and get straight into the treatments themselves.

QUR: Please describe the forthcoming project Med-National has on the horizon for inmates in Washington D.C. How do you see that medical model working? Do you anticipate that the inmate population will have similar needs to soldiers?

JC: Right now, we’re working on a contract for a re-entry and sanctioned facility for inmates who are on parole. This will be a pain management position for an acupuncturist. I believe this particular population is similar to the military population in that you do not have enough healthcare professionals to take care of the needs of both of these populations. In addition, the cost for medical care is rising each and every year. So from an economic perspective, it is more economical to incorporate acupuncture as a treatment modality not only for pain but for depression and anxiety as well.

QUR: Based on what you have reported, it seems like the federal government may be able to save substantial amounts of money compared to conventional medical care. Where can our membership read more about this and get those numbers?

JC: In a study by The RAND Corporation titled “The Invisible Wounds of War,” researchers estimate that PTSD and depression among returning service members will cost the nation as much as $6.2 billion in the two years following deployment -- an amount that includes both direct medical care and costs for lost productivity and suicide. For a typical service person returning from Iraq or Afghanistan (an E-5 with 5 to 7 years of service), baseline scenario predicts that two year post-deployment costs range from $5,635 to $13,935 for PTSD. Therefore, investing in more high-quality treatment could save close to $2 billion within two years by substantially reducing those indirect costs (lost productivity and suicide. This study can be found at www.rand.org)

QUR: Do you think VA hospitals in the future will have AOM practitioners employed to the same degree they have chiropractors now? Where is this trend heading?

JC: So far, the trend looks more and more towards integrative medicine. Through the funding of research by the Department of Defense and the National Center for Complementary and Alternative Medicine (NCCAM), there are numerous studies that show significant benefits in acupuncture. I believe in a year to four years, there is a good possibility that an acupuncturist will be employed in VA hospitals throughout the United States.

QUR: Can AAAOM members contact you if they wish to participate in the programs you are pioneering? How should interested practitioners get in touch with you?

JC: AAAOM members can contact me via email at . I will be happy to answer any questions on the programs that we are starting up.

AUTHOR INFORMATION
Joe C. Chang, MAOM, DiplOM, LAc, is a second-generation acupuncturist. Currently, he is working as an acupuncturist at the Ft. Bliss Restoration & Resilience Center, Ft. Bliss, TX. This center is a two-year pilot program that provides an integrated approach in the treatment of post-deployment soldiers who are diagnosed with posttraumatic stress disorder (PTSD). He is the first acupuncturist in the United States to be selected for this program. His successes as an acupuncturist at the Ft. Bliss Restoration & Resilience Center- William Beaumont Army Medical Center led to the integration of acupuncture as a treatment modality for PTSD at the Ft. Hood Restoration & Resilience Center at Carl R. Darnall Army Medical Center. He is an invited speaker at the upcoming American Association of Acupuncture and Oriental Medicine’s International Conference. He has co-authored for Occupational Therapy International and Medical Acupuncture, and he is a member of the Military Acupuncture Society for Military Physicians.