Acupuncture Gains Increasing Acceptance

Acupuncture is a 2,000-year old Chinese medical practice used to relieve pain, nausea and other symptoms associated with various ailments. It is also used to help fight drug addiction and to anesthetize patients for surgery. Although Western scientists do not understand how acupuncture works, the practice is gaining favor within the medical establishment in the United States. In March 1996, the U.S. Food and Drug Administration (FDA) classified acupuncture needles as medical devices. That new classification meant that health insurance companies would be more inclined to pay for acupuncture. In September 1996, researchers discussed some of their most recent efforts to understand how acupuncture works.

Traditional Chinese acupuncturists believe that a “life force” called Qi (pronounced chee) flows through the body. They teach that Qi flows along 12 major meridians, or channels, within the body. They think Qi helps regulate various bodily functions. They believe that obstructions to the flow of Qi, caused by injuries such as tissue damage, lead to illness and discomfort. There is no scientific evidence that Qi actually exists.

Acupuncturists insert acupuncture needles into the skin at numerous sites, called acupuncture points. The needles are about the thickness of a human hair and vary in length from one centimeter (0.5 inch) to about 7 centimeters (3 inches). Acupuncturists either twirl, vibrate or send electric current through the needles to release the obstructions.

Many people favor acupuncture over pain-killing drugs because they want to avoid the potential side effects of the drugs, such as stomach upset or addiction. In 1996, about 10,000 acupuncturists and 3,000 medical doctors were certified to perform acupuncture by either state or national licensing boards. An estimated 30 million people in the United States have undergone the therapy.

Although many patients claim acupuncture worked for them, scientists do not know for sure how it works, and many doctors remain skeptical about its effectiveness.

Medical Research

Acupuncture researchers have conducted many studies to learn if acupuncture is effective. Some scientists have criticized the studies for lacking good controls. Controls are patients who do not receive an experimental treatment. The effect of a treatment can be verified by comparing patients who receive the treatment with controls who do not receive a treatment. Controls are an important part of any scientific study. [See Sagan Recommends “Baloney Detection Kit”, October 1996; Be Skeptical of Statistics and Scientific Studies, March 1995]. Two recent acupuncture studies published in peer-reviewed journals did include controls.

Researchers Lixing Lao, Richard H. Wong and Brian M. Berman, of the School of Medicine in Baltimore, tested acupuncture’s ability to ease patients’ pain after tooth extraction. Nineteen patients received acupuncture at four acupuncture points. Twenty control patients received light taps with thin plastic tubes on the same acupuncture points. The patients did not know which procedure they received. All the patients reported the length of time they were free of pain after each treatment.

The acupuncture patients lasted an average of 173 minutes without pain after each treatment. The control patients reported an average of 93 minutes of pain-free time after each treatment. The acupuncture patients mentioned no negative side effects. The researchers reported their results in the April 1995 issue of the journal Oral Surgery Oral Medicine Oral Pathology.

The same researchers conducted a second experiment with patients who suffered from osteoarthritis of the knee. This painful disease results from overuse of the knee joint and is common in the elderly. Conventional physicians treat osteoarthritis with surgery, physical therapy or pain-killing drugs. In the experiment, 19 patients received both pain-relieving drugs and acupuncture. Nineteen control patients received only the drugs. During the study, all 38 patients continued to take the same doses of drugs that they had been taking before the study began. Seventy-three percent of the acupuncture patients reported moderate or marked improvement after 12 weeks of treatment. The control patients reported no improvement.

These results appeared in 1995 in Volume 3 of the journal Osteoarthritis and Cartilage. The study was ongoing as of November 1996.
Endorphins

Some scientists believe acupuncture relieves pain by stimulating the release in the brain of chemicals called endorphins. Endorphins are natural pain killers. They block pain signals, preventing the signals from reaching nerve cells. The pain-killing drug morphine has a chemical structure similar to that of endorphins. Meditation and exercise both trigger the release of endorphins in the brain.

In September 1996, acupuncture researchers held a conference in Arlington, Virginia, entitled “The Physiology of Acupuncture.” The Los Angeles-based American Academy of Medical Acupuncture and the U.S. National Institute on Drug Abuse (NIDA) co-sponsored the conference. At the conference, scientists presented evidence that acupuncture causes changes in blood pressure and in the brain’s electrical activity. They also presented brain-scanning images showing that acupuncture causes increased blood flow to the thalamus. The thalamus is a brain region that serves as a relay station for information gathered by the senses.

Michael O. Smith, the director of the substance abuse division at Lincoln Hospital in New York, reported at the conference that acupuncture has helped him treat recovering drug addicts. Smith’s Drug Court program offers convicted drug offenders counseling and acupuncture instead of prison sentences. About 50% of those who choose the program stay in it for three months of daily treatments. Smith told the Washington Post that this retention rate is “tremendously better than any residential treatment program could imagine attaining.” He believes acupuncture eases drug-withdrawal symptoms and reduces the urge to use drugs again. Scientists do not know how acupuncture might do these things. But they suspect that the endorphins released by acupuncture mimic some of the effects of illegal drugs.

In March 1996, the FDA concluded a six-month inquiry and classified acupuncture needles as Class II medical devices for use by trained professionals. The designation means that the FDA recognizes acupuncture needles as safe for general medical use, as long as they are manufactured according to recognized specifications and used only once.

FDA officials claimed the classification does not mean they advocate acupuncture for any specific condition, or even that they think it works. Bruce Burlington, director of the FDA’s center for devices and radiological health, explained the FDA officials’ logic to the Washington Post with a comparison to surgical devices. He said, “We don’t ask, ‘Does gall bladder surgery work?’ We ask ‘Can a knife make an incision?’ So [the classification] didn’t require us to establish that acupuncture works, but that needles work in acupuncture.”

Acupuncture advocates stated that the Class II designation was important because it should make health insurance companies more willing to pay for acupuncture treatments. A handful of insurance companies covered acupuncture before the new classification, but many companies did not. Acupuncturists and patients who swear by the treatment hoped the FDA designation would help overcome the companies’ reluctance to pay for it. In October 1996, major insurance provider Oxford Health Plans announced that it would cover various unconventional therapies, including acupuncture.

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