Acupuncture works, Expert panel reports
Medicaid, to consider covering the costs of acupuncture, at least for conditions where there is clear evidence of its benefits. Acupuncture, which originated in China more than 2,500 years ago involves stimulation of certain points on or under the skin, mostly with ultrafine needles that are manipulated by hand or electrically. Other acupuncture methods, used less often or still considered by acupuncturists to be experimental, involve the use of herbs and heat, or low-frequency laser beams, at the various acupuncture points.
Although acupuncture originally involved only 361 such points, there are now about 2,000 recognized by licensed acupuncturists. Acupuncture has been slow to gain acceptance by Western medicine, largely because traditional Chinese explanations for its observed effects were based on theoretical concepts of opposing forces called yin and yang, which when out of balance, disrupt the natural flow of “qi” (pronounced CHEE) in the body. It is also very difficult, if not impossible, to design “double-blind” studies that would establish acupuncture’s scientific worth. But the panel cited growing evidence of acupuncture-induced biological effects that could at least partly explain the benefits observed in scores of studies and in clinical practice. For example, the report said there is considerable evidence acupuncture causes a release of natural pain reliever substances like endorphins, as well as messenger chemicals and hormones in the nervous system. Further, it said, acupuncture appears able to alter immune functions.
“There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value,” the panel concluded after a day and a half hearing and reviewing presentations on acupuncture research. The panel established 17 scientific presentations summarizing hundreds of studies conducted recent years, primarily in Western countries. But critics of acupuncture, some of whom call it “quack puncture,” said the presentations could not have resulted in a reasoned consensus because no naysayers had been invited to give their views. “I fail to see how they can arrive at a consensus when only one view is presented,” said Dr. Wallace Sampson, a member of the National Council Against Health Fraud who prepared the council’s position paper on acupuncture, published in 1991. The 12 member panel, headed by Dr. David J. Ramsay, a physiologist who is president of the University of Maryland at Baltimore, represented a wide range of scientific disciplines and included some physicians who perform acupuncture or have been treated for it. The members were charged with determining the quality of evidence for the benefits of acupuncture, the conditions for which it might be effective and what studies were needed to further define its value.
The panel, which based its conclusions almost entirely on studies that meet criteria for well-designed research, was convened by various agencies of the National Institutes of Health, including the Office of Alternative Medicine. The panel did not issue a ringing endorsement of acupuncture. Bit it did find the procedure to be especially useful for treating painful disorders of the muscle and skeletal systems, like fibromyalgia and tennis elbow. And possibly safer than currently accepted remedies for those disorders. As for those pain problems, including post-operative pain and low back pain, the panel said, data suggests that acupuncture may be a reasonable option. Among further areas cited as possibly amenable to treatment by acupuncture, usually together with standard remedies, were drug addiction, stroke rehabilitation, carpal tunnel syndrome, osteoarthritis, headache, and asthma. Although the panel lamented the paucity of well-designed clinical studies on acupuncture, it found that in many cases “the data supporting acupuncture are as strong as those for many accepted Western medical therapies.”
Nonetheless, it said, larger, better and longer studies are needed to try to establish acupuncture’s therapeutic benefits and limitation. A major barrier to mounting such studies is a lack of financial support from commercial sources, which have no vested interest in a technique that cannot be patented.
Acupuncturists Hope for Wider Acceptance After NIH Gathering.
Acupuncture, the 2,000-year-old Chinese art of inserting needles in the body to relieve health problems, has a growing popular following in the U.S. But despite millions of treatments a year, a scarcity of large controlled studies in peer-reviewed journals has consigned it to fringe status. This week, the treatment gets its day in court, when the National Institutes of Health holds a three-day Consensus Development Conference on Acupuncture in Bethesda, Md. The meeting, which opens today, raises acupuncturists’ hopes for wider acceptance and more insurance coverage, if not the start of a convergence of Eastern and Western medical cultures. The more modest official goal is for a panel of nongovernment expert to arrive at a consensus on the quality of science now in hand. It won’t represent federal policy, but an informal assessment of the state of the art. Billed as a “scientific court” before an expert jury, these conferences weigh the evidence for and against a controversial medical technology, especially where gaps exist between research and clinical practice. Past gathering has concentrated on mainstream medical questions, such as uses of breast cancer screening.
Only once before in a 1995 conference on relaxation and biofeedback for pain and insomnia has it ventured into alternative therapy. Acupuncture shows promise in helping treat chronic pain and nausea, among other conditions. It is widely regarded as safe, although unsterile or improperly placed needles have resulted in transmission of hepatitis B, or lumbar puncture ( a piercing of the sheath around the spinal cord). In expert hands, using disposable needles now required by the Food and Drug Administration, it has few side effects. Is it possible to harness an ancient Asian art with tools of the Western scientific method, including placebo-controlled trials? “No only is it possible, it’s essential,” says Wayne Jonas, director of the NH Office of Alternative Medicine, which is sponsoring the conference.
The meeting is a chance for OAM to build a scientific bridge between the establishment and alternative medicine, thus providing it is more than a cheering squad for New Age practitioner, as critical scientists have long charged. American health care, however, has entered the era of evidence-based medicine, where proof of benefit is required before an expense is justified. Many traditional practices, such as the annual physical, are being re-examined for hard proof they improve American’ health. Tradition is good, the reasoning goes, just show me the data. Now is acupuncture’s chance to marshal its research. For the past couple of decades, acupuncture has been amassing harder data in pain relief and nausea control. One of the key witnesses for acupuncture in the consensus conference will be Lixing Lao, a Shanghai-trained acupuncturist who earned a doctorate in physiology at the University of Maryland. There, he administers acupuncture to patients, including injured athletes, while pursuing studies of acupuncture for pain relief in dental surgery and osteoarthritis of the knee. He also is testing its use as a treatment for chemotherapy-related nausea.
In a continuing study of 40 patients after wisdom tooth extraction, he says the acupuncture group remained pain-free longer than the placebo control group. Among patients with osteoarthritis of the knee, a group treated with acupuncture plus usual pain medications had better pain control and less disability than a control group on drugs alone. He says. But because the study wasn’t placebo-controlled, Dr. Lao wants to repeat the experiment. Gary Kaplan, an osteopath in Arlington, Va., explains that acupuncture relieves pain because needles affect nerve fibers leading to the spinal cord and brain. This releases endorphins, the brain’s natural opiates, along with ACTH, a substance which signals the adrenal glands to secrete steroids for an anti-inflammatory effect. “I don’t think we know the whole picture yet,” says Dr. Kaplan, who heads the Medical Acupuncture Research Foundation. Watching as your child is wheeled into an operating room, ranks near the top of life’s stressful moments. An anesthesiologist at Yale University School of Medicine, however, has found that a simple acupuncture device can reduce parents’ anxiety at such times.
Shu-Ming Wang, M.D., divided the mothers of children who were going to have surgery into two groups, In one group, she inserted tiny acupuncture needles called press needles into each mother’s ear at a specific point that’s known to produce relaxing effects. (A press needle is a short, fine needle attached to a wire loop covered with an adhesive bandage, which make it look similar to a thumb lack.) In the other group, Dr. Wang inserted needles into spots that aren’t known to produce a calming effect. The mothers then spent 30 minutes with their children before the kids were anesthetized for surgery. When the women were surveyed about their anxiety levels, those who received the “real” acupuncture treatment were found to be significantly less upset than the moms in the other group. The children of the less anxious moms were also significantly less anxious as they went into the operating room. According to Dr. Wang, who has taught this acupuncture should be able to offer this type of anxiety reducing treatment. And a pressing needle designed for self-care home use, called Pyonex, will be available in 2005.