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From the Townsend Letter for Doctors & Patients
June 2005

Pathways to Healing
by Elaine Zablocki
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Acupuncturist Finds Profession More Than She Expected
In the early 80s, Patricia Culliton decided to quit her job, travel to Asia and study Oriental Medicine. She had a master's degree in rehabilitation counseling, and she'd spent ten years as a state mental health counselor in Colorado. Since she was interested in Taoism and Buddhism, she thought Asian medicine would be a useful adjunct to her counseling practice.

She had no idea she'd end up using acupuncture to treat back pain and infertility, as well as mental problems. Or that she'd become the head of an alternative medicine clinic affiliated with a major academic center, with a $1 million annual budget, serving more than 5,000 people a year.

Patricia CullitonUsing Acupuncture to Treat Addiction
In Asia, Culliton traveled in China, Japan and South Korea, studying acupuncture and other aspects of Oriental Medicine. While she graduated from a program in South Korea, most of her training was informal, a one-on-one tutorial experience. When she returned to visit her family in Minneapolis, she studied and practiced at a Chinese acupuncture clinic there.

"I had a strong public health background, and I wanted to apply my acupuncture skills to treat addiction and substance abuse," she says. "I called all the mental health and addiction services, just calling places endlessly until finally, Hennepin County, where I still work to this day, let me in the door. Basically they said 'we'll do a research pilot study and if it works then we'll talk about developing clinical services.'"

The pilot study found that when chronic street alcoholics received acupuncture they stayed sober longer, stayed out of detox longer, and decreased government costs for treatment significantly. Two studies were published in '87 and '89, and sparked the growth of acupuncture in addiction programs in the United State and internationally.

But when the first study ended, the people who'd participated had no place to go for continuing help. Culliton convinced hospital administrators it would be only ethical to offer aftercare for study participants. She recalls, "they probably thought, 'we'll let her have a room for one hour a day, and see whether anyone shows up.'" Study participants did show up, and they brought their friends, their relatives, and other people off the street. Within a month, Culliton had approval to expand the program and establish a public health clinic to treat substance abusers.

Today, the public health aspect of her program treats about 1,000 people a month. Licensed acupuncturists travel three times a week to residential substance abuse treatment facilities, where they offer group-style acupuncture for about an hour and a half. "We use ears as our primary area of treatment, but we also do a lot of head and arm work," Culliton says. "We consider acupuncture to be an adjunct service, to be used together with conventional psychotherapy and supportive social counseling. It's essential to deal with issues like housing and jobs, and to have all these interventions working together."

Acupuncture Helps Infertility and Interstitial Cystitis Patients
Today Culliton is the director of the Alternative Medicine Division at Hennepin Faculty Associates (HFA), a physician group which practices at Hennepin County Medical Center, a large teaching hospital in Minneapolis. The clinic started out very simply. "All the works of art on the walls were pictures I took out of my house," Culliton recalls. "I'd been doing research and offering clinical services for several years when we were given an opportunity to establish the clinic. Since I was already treating patients, our schedule was partly filled the week we opened. Hospital administrators took a big risk when they decided to establish the clinic, and they told us we had to break even within the first few months. By the end of the first quarter, we had done so."

The clinic offers many services in addition to acupuncture. It now has 18 practitioners on staff offering seventeen modalities, including herbal medicine, chiropractic, and several forms of massage therapy and energy work. Clinic staff meet together once a week to discuss their cases, but informal case consultations go on all the time. "The staff share office space, with the desks all together in one large room," Culliton says. "That's not an accident; it's designed to encourage open discussions."

Culliton started out using acupuncture to help people deal with substance abuse, but she soon began seeing people with back pain, headaches, knee pain, and other common chronic musculoskeletal programs. "Since Hennepin County Medical Center is the training hospital for the University of Minnesota Medical School, there are lots of residents and medical students. Whenever the residents came across an unusual case, and they really didn't have anything to offer that patient, they'd send them over to the acupuncture clinic! I started treating cases where I had no idea whether acupuncture could be helpful."

Musculoskeletal problems continue to form a large part of the practice, and nowadays many insurers cover acupuncture treatment for musculoskeletal pain. The clinic has also had substantial success using acupuncture for functional problems such as liver disease, infertility and bladder disorders. Today about 25% of the clinic's patients present with chronic functional problems, even though insurance doesn't cover acupuncture for these conditions.

"Infertility has become a BIG area for us. We get referrals now from OB-GYNs all around the city," Culliton says. "We treat men with low sperm motility and women who've been told there's only a 40% chance they'll ever get pregnant. We work hand-in-hand with people who are actually getting in vitro fertilization, primarily using Chinese medicine, as well as a fair amount of abdominal massage. We've been very pleased with the results."

Culliton has also used acupuncture successfully for interstitial cystitis, a chronic condition that causes frequent, urgent and painful urination. "When I first started here, the wife of one of the hospital physicians had it. I wasn't familiar with the Western medicine terminology, and when he called me to discuss her case, I had to tell him I didn't know what 'interstitial cystitis' was! But once he described her symptoms, I told him acupuncture could be helpful in these cases," she says. The hospital urology department had been following this patient, and when she recovered, the chief of urology called Culliton to say, "I can't believe your results!"

That was 19 years ago. Today Culliton sees a substantial caseload of patients with interstitial cystitis, working closely with the urology department. The clinic gathers outcomes data, and about 80% of the interstitial cystitis cases report significant improvement in their condition, she says.

Culliton and her co-workers have written numerous publications about the utilization patterns and efficacy of acupuncture. The HFA Alternative Medicine Division was the first academically affiliated CAM clinic in the nation to be accredited by the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO). "When I was getting the program started, and sometimes felt overwhelmed by obstacles, I used to daydream that someday major institutions like the Mayo Clinic would have CAM programs," Culliton says. "Now Harvard, Columbia and the University of Arizona all have CAM programs. I'm consulting with Mayo Clinic. It is a dream come true."

Elaine Zablocki is the editor of CHRF News Files, a bimonthly emailed newsletter about the emerging integrative medicine industry, published by the Collaboration for Healthcare Renewal Foundation.


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