The status of acupuncture and oriental medicine in the United States.

Since its first mention in U.S. media in the early 1970s, the practice of acupuncture and Oriental medicine (AOM) has grown in stature from a fringe, counter-culture movement to a valid, evidenced-based treatment option for patients. In the last 40 years, AOM schools and colleges have been accredited by the U.S. Department of Education, offering both masters and doctoral degree programs. To date, forty-seven states and the District of Columbia license or certify acupuncturists based on competency proven through state examination or professional certification by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). As acceptance of AOM in the U.S. has increased through both the assurance of psychometrically sound certification and the education of the American public on this topic, many challenges have emerged. Problems such as the underemployment of AOM clinicians, methodological hurdles for the investigation of mechanisms, and efficacy of acupuncture and other AOM treatment techniques have been observed. Investigative challenges also include gaps in research training as well as a dearth of the basic resources needed to conduct randomized controlled trials (RCTs). As AOM research has sought integration into the Western research model, problems have been identified in the design of AOMRCTs, and strategies for their resolution through methods such as translational research have been examined. Incorporating these strategies as well as efficacy, effectiveness, and qualitative measures will strengthen the evidence base and thus provide clinical decision makers with more tools that can be used to design patient treatment regimens.