A panel of experts concludes the ancient practice of
acupuncture was an effective therapy for certain medical
conditions, especially those involving nausea and pain,
and should be integrated into standard medical practice
for these problems.
The panel emphasized that acupuncture was remarkably
safe, with fewer side effects than many well-established
therapies.
Currently, more than one million Americans are believed
to be relying on acupuncture to treat a wide range of
ailments, from headache and bowel disorders to arthritis
and stroke.
The panel's findings, summarized in a 16-page consensus
report of the (US) National Institutes of Health, are
expected to encourage more patients and physicians to
consider acupuncture as an alternative or complementary
treatment for some common health problems, including
nausea associated with pregnancy and cancer
chemotherapy, and pain following dental surgery. The
report may also foster the use of acupuncture to treat
chronic problems, like low back pain and asthma, for
which standard treatments are inadequate or costly or
may entail serious side effects.
The panel said its report should prompt medical
insurers, including Medicare and 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 manually 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
upward of 2,000 recognized by licensed acupuncturists.
Acupuncture has been slow to gain acceptance by the
Western medical establishment, 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.
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 that
acupuncture causes a release of natural pain-relieving
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 evaluated 17 scientific presentations
summarizing hundreds of studies conducted in recent
years, primarily in Western countries. But critics of
acupuncture, some of whom call it "quackupuncture," 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.
Sampson pointed out that for the most part, the
best-designed studies of acupuncture showed the poorest
results for it, a fact also mentioned by several experts
who made presentations to the panel.
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 by 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. But 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 other pain
problems, including postoperative pain and low back
pain, the panel said, data suggest 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 of 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 establish properly acupuncture's
therapeutic benefits and limitations. A major barrier to
mounting such studies is lack of financial support from
commercial sources, which have no vested interest in a
technique that cannot be patented.
Most presenters here focused only on the relatively few
studies that met the "gold standard" for modern clinical
research: those entailing random assignment of patients
to treatment and control groups, and independent,
well-documented assessments of the results. Even some of
these studies were considered limited, a number of them
because they involved too few or too infrequent
acupuncture treatments, or even incorrect acupuncture
points.
Further, a major problem in designing acupuncture
studies is selection of a control treatment that does
not prejudice the results. For example, most studies
have used other, nearby points on the skin for
comparison with the effects of manipulating real
acupuncture points. But this "sham acupuncture" has some
biological effects as well, and they make it harder to
determine the true benefit of real acupuncture.