At the Community Acupuncture Clinic in Boulder, Colorado, tranquil office music harmonizes with the vibrations of total relaxation: snoring. Shamahitta Jones considers that a happy sound at her clinic. "Some people fall asleep and stay here for 2 or 3 hours," she laughs. "We won't wake them up, unless they ask to be woken up."

Ms. Jones uses tiny needles, inserted just under the skin, to help her clients ease conditions ranging from high blood pressure and chronic pain to stress. Most acupuncturists treat each patient in a private room, and when the next client arrives, the first one must leave. People can stay longer at Ms. Jones's clinic because everyone gets their treatment in one large room. Most clients nestle in comfortable recliners, while a few stretch out on treatment tables hidden behind attractive screens. One woman, with tiny needles in her feet, whispers that she enjoys being around other people, all tuning in to this ancient healing journey. "Samahitta is so knowledgeable and kind, and it's a great atmosphere. And I feel better. It works!"

This communal approach reduces the clinic's operating cost and makes it possible for Ms. Jones to charge only half what conventional practitioners do. "Any follow up treatment is between $35 and $20, [on a] sliding scale," she explains, "and if you come a second time in the same week, it's even lower."

While she often spends over an hour with a new client, Samahitta Jones says that when someone's coming in regularly, she knows their needs so well that putting in the needles can take less than 15 minutes. That efficiency lowers her expenses even more. And because she charges less, many clients come more often. "We have people coming in anywhere from once a month to 3 or 4 times a week. Many come twice a week, most people come once a week. I have several people who come twice a week, and we have had incredible improvements with lowering blood pressure and treating sinus infections and all kinds of conditions." Ms. Jones says acupuncture tends to be more effective when it's done repeatedly.

That makes sense to Brian Berman, a medical doctor at the University of Maryland who recently conducted the largest study of acupuncture in the United States. Among his findings: people with arthritic knees had less pain and better function when they received adequate acupuncture. By adequate Dr. Berman means 26 treatments: starting with twice a week for 2 months. "We found that we needed at least 8 weeks of intensive acupuncture, and then we wanted to see if we could maintain that effect by tapering the dose of acupuncture. So then it became like once every couple of weeks and then once a month for several months."

The insurance industry has taken note of studies like Dr. Berman's, and growing consumer demand. According to Mohit Ghose, of the industry association America's Health Insurance Plans, more than 2/3 of their companies now cover at least part of the cost of acupuncture treatments, "anywhere from 20% to 100%," he says, if it's part of the plan's benefit package. "We believe that that number has probably gone higher, as demand has grown and specifically, as the evidence base continues to be built to show the efficacy of such treatments."

But adequate treatment may exceed what a patient's insurance will pay for, and the additional visits many be too expensive. The 45,000,000 Americans who don't have health insurance may not be able to afford any visits at all. But acupuncture "is not

meant to be a luxury for people who have money to spend on luxuries," according to Lisa Rohleder. The founder of Working Class Acupuncture, a low-cost acupuncture clinic in Portland, Oregon, says "It's meant to be simple, preventative, affordable care for everybody."

At a typical U.S. clinic, an acupuncturist sees fewer than 20 people a week. With group treatments and lower costs, Ms. Rohleder says she occasionally sees nearly 80, and most are regular clients. "It's an incredible level of freedom to be able to say to someone, 'To really deal with this problem, I need to see you twice a week for 6 months. Can we do that?' If I were charging $65 a treatment, and I said that to most people, they'd laugh. They'd say, 'I'm sorry. No!' But to be able to base my treatment plans on what I feel needs to be done, rather than what the client can pay for, just makes me feel so happy I'm doing this. It makes me glad I'm an acupuncturist."

Ms. Rohleder has distilled the principles of Working Class Acupuncture into a guidebook for other clinics, showing how they can use her methods to reduce their costs, provide affordable therapy and remain a professional and profitable practice.