Corie Tillman Wolf

Executive Director

Board of Physical Therapy

Department of Health Professions

9960 Maryland Drive, Suite 300

Richmond, VA 23233

Re: Proposed Regulations 18VAC112-20-121.

Dear Ms. Wolf:

The Washington East Asian Medicine Association thanks you for the opportunity to comment on the recent proposed regulations pertaining to the procedure known as “dry needling” that is currently under review. We oppose this proposal.

“Dry needling is indistinguishable from acupuncture,”[1] according to the American Medical Association. It is acupuncture with insufficient acupuncture training. The proposal to allow physical therapists to perform an invasive medical procedure that is outside the physical therapy scope of practice is a violation of state law. In Washington, the Attorney General issued an opinion that this is the case here, and a subsequent formal scope expansion request by physical therapists to include “dry needling” was found to fail all three criteria required for such an expansion. These criteria are to: protect the public from harm; provide assurance of professional ability to perform the increased scope of practice (such as education and training); and to provide the most cost-beneficial option to protect the public.

Changing the name of procedure does not in any way change the actual procedure itself, nor does it lessen the inherent risks. Perpetuating the falsehood that acupuncture relates only to “energy flow and meridians” is a common strategy of the proponents of “dry needling.” By describing acupuncture in this manner, this proposal serves as clear evidence that physical therapists “do not know what they don’t know,” in that they show ignorance about both the actual procedure itself, as well as the intention behind acupuncture treatment. This is a gross misrepresentation of the modern practice of acupuncture. Acupuncturists complete extensive study of modern biomedicine, and often needle with specific biomedical intent in conjunction with traditional theories.

The people of Virginia should be assured that an approved medical procedure is safe, and that adequate training standards have been fully met before unsupervised practice is allowed. No adequate safety studies exist (the only significant safety study I am aware of, the “Brady” study,[2] failed to meet its own research criteria and therefore lacks an acceptable sample size for a medical safety study). Furthermore, while the Federation of State Boards of Physical Therapy (FSBPT) is assumed to log reports of injury by “dry needling,” we know that such injuries are going unreported. (This was revealed in the course of a scope expansion request (and subsequent denial) to include “dry needling” in the practice of physical therapy in Washington state. In that process, we discovered that there was a 400% increase in liability claims related to “dry needling” between 2011 and 2015, as reported by one liability insurance provider,[3] yet the injuries included in that report were not included in FSBT data.)

Finally, there also exists no relevant measure of what may constitute competency on the part of a physical therapist utilizing acupuncture needles for therapeutic benefit. Even the oft-cited “HumRRO” report[4] that was commissioned by the FSBT advises that “any practice hour metric should be theoretically or practically linked to the professional standard for safe and effective practice (AERA, APA, NCME, 2014).” This has not been done in Virginia, nor anywhere else.

“Dry needling” is acupuncture with insufficient training. Minimum benchmarks and testing standards have been established for the practice of acupuncture and should therefore be met by anyone utilizing an acupuncture needle for therapeutic purpose, such as is intended in the practice of “dry needling.”

Respectfully,

Ash Goddard, MSOM, EAMP/LAc., President, Washington East Asian Medicine Association

[1] The official Policy on Dry Needling of the American Medical Association (H-410.9491) is: “Our AMA recognizes dry needling as an invasive procedure and maintains that dry needling should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed medical physicians and licensed acupuncturists.”

[2] Brady S., McEvoy J., Dommerholt J., Doody C. “Adverse Events Following Trigger Point Dry Needling: A Prospective Survey of Chartered Physiotherapists.” The Journal of Manual & Manipulative Therapy 22.3 (2014): 134–140. PMC.

[3] https://www.cna.com/web/wcm/connect/2d3eaa76-aca2-4f6f-bfd8-

[4] Caranagno J, et al. Analysis of Competencies for Dry Needling by Physical Therapists. July 10, 2015. https://www.fsbpt.org/Portals/0/documents/freeresources/DryNeedlingFinalReport_20150812.pdf