I’ve spent the last few years researching and preparing academic articles that document a neurological, trauma-informed approach to acupuncture. This was due, in large part, to my own journey through neurogenic illness. These aren’t casual musings—they were hard-earned insights shaped by my own trauma recovery, a long term background as a toxicologist, and five years of post-graduate coursework and clinical study in reflex integration and neuroscience. All of this was confirmed in treatment rooms, backed by clinical data, and crafted with care.
I was delighted recently when my first articles on a polyvagal approach to acupuncture were conditionally accepted for publication. But the edits needed for submission—which include typesetting, formatting, editing and clarifying concepts for editors—will take another 40–60 hours to complete, placing the man hours required for each article somewhere between 150 and 200 hours. In real-world terms, that is five full-time weeks of unpaid work simply to publish in an academic journal for which I receive no compensation, no ability to charge more or leverage my expertise, and which no one will read since it is limited to subscribers.
As a former research scientist practicing in a medical field that has admittedly poor documentation and outcomes, I wanted to contribute rigorous, clinically relevant research. I am, however, expected to support the journal’s content pipeline with free labor, while being unable to afford the dues for the professional society that produces it. Over the last two years, as I was preparing my research for publication, multiple editors of acupuncture journals told me that I am not welcome to submit articles for their publication unless I was a member of the association or subscribed to the journal. I have stacks of these journals that I never read!
Another example, I was recently invited to provide peer review to potential authors for another publication, but I would be required to maintain membership in their 'association.' After several years recovering from my own medical trauma, I cannot afford to be a member of every society that wants my unpaid labor. Bluntly, neither can any acupuncturist in the U.S., where our educational costs now rival that of any medical professional but for whom salaries will never allow us to pay off the student loans.
Meanwhile, a flood of low-quality, predatory pay-to-publish journals continue to clog the system. The result? Poorly constructed science rises to visibility, while slow, clinically grounded work is buried—unfunded, unpaid, and inaccessible.
As a solo researcher and clinician working well below a middle-class salary in the U.S., I have to ask: Who is this system really for?
It’s time we rethink what it means to publish. And who we expect to carry the cost.
Right now, the sheer time investment needed to publish—hundreds of uncompensated hours per article—is simply unsustainable. Not for solo practitioners. Not for clinicians working outside major institutions. And certainly not for those of us who aren't paid to publish.
Let’s be honest: in the U.S., most academic articles are written by faculty whose time is subsidized by university salaries or research grants. Their institutions often cover the $3,000 to $15,000 open-access fees. Meanwhile, valid research from smaller institutions or independent clinicians without grant funding is routinely excluded from U.S. journals, not because of quality, but because they can’t afford the cost of entry.
Worse, if these researchers try to fund publication through small grants or community-based programs, the FDA may reclassify the resulting article as “commercial speech”—even when it’s published in a peer-reviewed journal. Under current FDA guidelines, any financial support for publication—even from a university or non-profit—can trigger restrictions under the agency’s rules on off-label promotion. This means rigorously conducted, peer-reviewed research is now reclassified as commercial. It is delegitimized not for its content, but simply for how the authors paid for the cost of publication. (Friedman, 2009).
The “publish or perish” mentality, long a feature of mainstream academia, has infected Traditional Chinese Medicine. But unlike tenured university faculty, most of us in TCM aren’t salaried researchers—we’re clinicians, often working solo or in small practices, with no institutional support, and massive student loans. We're expected to produce peer-reviewed articles, serve as unpaid reviewers, and pay thousands just to publish—while also being unable to afford access to the very journals we’re contributing to. This isn’t a system designed to elevate the best science. It’s a system designed to favor the most resourced voices, while extracting free labor from the rest, all in the name of academia. Some of the best acupuncture research being done today comes from smaller European medical institutions, often led by MDs with academic appointments and clinical grounding. Yet their work is effectively shut out of the U.S. publishing pipeline unless they can personally—or institutionally—absorb thousands of dollars in processing fees. Even then, it may be rendered unusable in clinical discourse due to who paid for the publication.
As an independent clinician and unfunded researcher, this isn’t just demanding—it’s exploitative. This is extraction disguised as research.
To be clear, I’m not throwing shade at real academics doing meaningful clinical science. I applaud them. I’ve admired them. I want to be one of them. But the bloom is off the rose. For those of us barely scraping by while carrying a full-time clinical load, we are being asked to donate our knowledge, our time, our voice—and then pay to access our own work.
At this point, I’ve had to ask myself: What am I doing this for? And more importantly: Who am I doing this for?
I’ve written a couple of dozen research articles grounded in integrative neurology for TCM. They’re ready. But I’m not spending hundreds more hours just for the credentials after my name, and when no one in my field can read them without institutional access or a subscription. This is a system that looks like scholarship, but it’s just intellectual strip-mining. It's the illusion of progress while practitioners go broke and patients stay underserved.
Scary thought—I am not sure I want to publish my work in academic journals anymore. Not under these terms. Not when the cost is five unpaid weeks of my life per article. Not when the payoff is a citation no one sees and a copy I have to buy.
We don’t need more citations. We need access. We need community. We need connection and communication. We need research that is relevant for clinicians and thinkers, not for gatekeepers and tenure committees.
This entire model—where the unpaid, unfunded, and overworked are expected to donate their expertise, their time, and their labor to journals they can’t afford to read is not “advancing medicine.” This is indentured scholarship.
The job now is not to get published. The job is to be heard. And perhaps I can find better ways to do that, certainly more enjoyable ones.
When I got sick 5 years ago (and especially after treating through COVID), I was so destroyed emotionally after 20+ years in practice that didn't care if I ever touched another human being again. I certainly did not expect to keep practicing, to rediscover my love for medicine, or to find clinical solutions for neurogenic disease within TCM.
Perhaps it's time to part ways with the U.S. publish-or-perish academic system that runs on unpaid labor from clinical faculty and props up a for-profit model of care that causes harm. I left my faculty appointment at UCSD after being expected to teach for 8 weeks each year without pay. How many medical students know that much of their education is provided by unsalaried clinical faculty (themselves burnt out) and unpaid graduate students?
If you're an independent clinician, unfunded researcher, or practitioner-scholar who's questioning the publishing grind: you’re not alone. The work is still valuable. But maybe it’s time we stop donating our brilliance to institutions that don’t feed us and start building channels that do.
Citation: Suzanne M. Friedman, FDA Regulation of Industry-Supported Scientific and Educational Activities: Moving Beyond the First Amendment, 64 Food & Drug L.J. 275, 276–81 (2009).
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