Guest guest Posted July 14, 2000 Report Share Posted July 14, 2000 >NIH on Acupuncture > > > > SITE KEY > > Home > > About CSOM > President’s Msg. > > TCM Articles > Herbs > Avascular Necrosis > Moxa for Pediatrics > > Practice Aids > Diagnosis Codes > Management > Writing Reports > CPT Codes > Managed Care > > Legal/Political > Legislation > Legislation History > IMC Guidelines > FDA on Ephedra > FDA on Herbs > W.H.O. Codex > Herb Sales Tax > > News > Director’s Notes > Illegal Referrals > Medicare Fraud > Avoid Malpractice > Medical Waste > Insurance Issues > Selected Physician > Patient Compliance > Western Drugs in > Patent Medicines > Year of the Tiger > Herbal Fen Phen > NIH - Acupuncture > UK on Back Pain > > Event Calendar > > > > The National Institute of Health Consensus Development Panel - >Acupuncture is Effective > > The recent National Institute of Health (NIH) consensus >development conference (CDC) held in Washington D.C. is being lauded as a >landmark for the practice of acupuncture in the United States. Conferences >such as the one held November 3-5, 1997 are held to evaluate the scientific >information on emerging or established technologies. The main purpose of >the conference is to develop a consensus statement put forth by a broad >based independent panel that has evaluated the available scientific >information on the subject. The consensus statement is used to advise >health care professionals and the public at large. The statement is not a >policy statement of the NIH or any other government branch, but is meant to >clarify issues especially regarding safety and efficacy. The conference >was sponsored by the Office of alternative medicine and the office of >medical applications of research. It was cosponsored by many government >groups among them, the National Cancer Institute, National Heart, Lung and >Blood Institute, National Institute of Allergy and Infectious Diseases, and >the Office of Research on Womens Health. > > The panel that reviewed the presentations was composed of 13 >people and was headed by David Ramsay, President of the University of >Maryland. There were specialists from the fields of neurology, family >medicine, pharmacology, statistics, psychiatry, drug abuse, and healthcare >administration. While the publicity following the conference was extremely >positive for the acupuncture profession, we who attended the conference >held our breaths during the two day presentation. The panel was extremely >rigorous in evaluating the information and made a strong effort to be very >objective. They often asked tough questions of the speakers, which was >compounded by the lack of positive research data in many health problems >that we as acupuncturists take for granted that acupuncture can be used to >treat. Below is a synopsis of what took place at the meeting. This is >given in the order that the speakers appeared. > > The panel was charged with answering the following questions: > > 1. What is the efficacy of acupuncture, compared with placebo >or sham acupuncture, in the conditions for which sufficient data are >available to evaluate? > > 2. What is the place of acupuncture in the treatment of >various conditions for which sufficient data are available, in comparison >or in combination with other interventions (including no intervention)? > > 3. What is known about the biological effects of acupuncture >that helps us understand how it works? > > 4. What issues need to be addressed so that acupuncture can >be appropriately incorporated into todays health care system? > > 5. What are the directions for future research.? > > Introduction: The introduction was lead off by Lorenz Ng, >M.D. Clinical Professor of Neurology at the George Washington School of >Medicine and Medical Director of the pain management program at the >National Rehabilitation Hospital. He spoke of the history of acupuncture >and the transportation of ancient concepts into modern medicine. He >suggested that we need to look into various aspects of acupuncture to >determine what makes it effective. He spoke of neurohumoral mechanisms and >somotosensory pathways as methods of how acupuncture works and cautioned >that this alone is not sufficient to explain the entire process which could >be and probably is multifactional. > > Ted Kaptchuk, O.M.D. spoke of the history of acupuncture and >how it was used in the era of western medicine before the Randomized >Controlled Trial (RTC) became a standard. He raised the important >question of is the RTC the best way to evaluate medical techniques, and how >can acupuncture fit into this model. > > Kevin Ergil, M.A., L.Ac. of Pacific Institute of Oriental >Medicine, gave an excellent overview of acupuncture training and licensure >in the United States. Some important points were: California had the first >acupuncture law that allowed non-physicians to practice with physicians for >the purpose of research. Maryland and Nevada were the first states to adopt >a system of licensure in 1973. Today 35 states license, 26 use NCCAOM >certification. 20 states allow independent practitioners, and 15 require >supervision or referral by an M.D. Currently there are 10,000 people >practicing acupuncture in the United States. 5000 - 7000 are L.Ac.s. >2-3000 are M.Ds. There are currently 10,000 students enrolled in schools >which means that by the year 2000 the acupuncturist population will double. > twelve States require less then 250 hours of training and four States >allow D.C.s to practice while there is no provision for L.Ac.s. > > Patricia Culliton, M.A., L.Ac. of the Hennepin County Medical >Center gave an overview of how many people use acupuncture. According to >1996 figures, 24.4 million people used alternative medicine. One million >people used acupuncture. It is estimated that 15 million people have tried >acupuncture over the last 15 years. 150 million acupuncture needles were >estimated to have been used in 1996, which would account for about 12 >million acupuncture visits provided annually. Estimates are that between >70-75% of users are female, and that Caucasians between the ages of 25-50 >are the majority of patients. > > The next part of the agenda dealt with issues affecting >incorporation of acupuncture into todays healthcare system. Richard >Hammerschlag, Ph.D. of Yo San University gave an excellent presentation on >issues in acupuncture research. He grouped research into four categories: >1. Acupuncture compared with no other form of treatment. 2. Acupuncture >compared to a control treatment, such as sham acupuncture (the needling of >non traditional acupuncture points) TENS, or fake needling ( tapping an >empty tube against the skin). 3. Acupuncture versus standard care such as >medication or physiotherapy. 4. Acupuncture plus standard care versus >standard care alone. This discussion included ethical issues like can you >have someone in a study who is not receiving any treatment. It also brought >up the whole issue of sham acupuncture and double-blind controls. For >example, because an acupuncturist always knows when he or she is inserting >a needle, and whether it is an acupuncture point or a non point, there >cannot be a blind situation. And also can we be sure that there is no >effect from needling non traditional points. How about those ah shi points? >Dr. Hammerschlag concluded in his abstract that serious consideration >should be given to the argument that most clinical trials of acupuncture >have undervalued its efficacy. > > David Lytle, Ph.D of the FDA spoke about safety issues and >regulation of acupuncture needles. He said there are four types of >potential problems from acupuncture. 1. Infectious diseases being >transmitted and local infection. 2. Improper needling causing pneumothorax >or nerve damage, organ puncture including fatal cardiac tamponade. 3. >Broken needles that migrate to the spinal cord or heart. 4. Transient >effects such as nausea, dizziness, hematoma, fainting, or dermatitis. He >said a literature search showed that over the last ten years there have >been only a few hundred adverse events with acupuncture and that half of >those events occurred in the United States. A Norway study showed that >transient effects were the most commonly reported problems. A number of >skin infections were reported, there were no reports of broken needles. >Pneumothorax was the most common serious problem. With an estimate that an >acupuncturist might cause less than one serious event per 100 years of full >time practice, the overall conclusion of the study was that acupuncture is >a relatively safe therapeutic measure. > > The fact that there was more fatalities caused by M.D. >practitioners then L.Ac.s (2 as opposed to 1) caused a cheer from the >audience and underscored a clearly felt tension between the M.D.s in >attendance and the non M.D.s. > > The third part of the conference, which was really the most >important part, dealt with presentations of acupuncture being used to treat >various conditions. These included analgesia, pain, including low back >pain, headaches, face and neck pain, osteoarthritis, neuropathic pain, >dental and post-operative pain, nausea and vomiting, neurological >rehabilitation,carpal tunnel syndrome, addiction, respiratory diseases, >gastrointestinal diseases, imunosupression and induction of ovulation. >Much of the research was shown to be questionable in terms of the designs >of the studies. This was a double edged sword. In other words maybe the >results of the study that showed acupuncture to be ineffective was because >the study was designed poorly. Conversely, could the results that showed >acupuncture to be effective also be because the study was not done >properly? In the end many of the studies were weeded out and only those >that were clearly well-designed were mentioned. For example, in the >presentation on general pain, over 90 studies were reviewed by the >presenter but in the end he could only comment on around 15 which seemed to >meet the criteria of a good, well- designed study. Another example was a >study done on neuropathic pain in HIV infected individuals. This study >showed that acupuncture was ineffective in treating peripheral neuropathy. >Ted Kaptchuk, among others, raised the objection that a predetermined set >of acupuncture points was used on every patient, which is not the way >acupuncture is supposed to be used. So again we are left with the question: >Is acupuncture ineffective?, or are those points not the right points to >use in treating that disease ( an example of a poorly done study) which >gives a poor outcome. > > There was enough information to point out that acupuncture >definitely has promise in treating many pain conditions. The research on >dental pain and post-operative pain was solid and convincing as to the >efficacy of acupuncture. Promise was also shown in the areas of >gastrointestinal and respiratory disorders. > > Everyone agreed that more well designed studies are needed. >There was also agreement that sham acupuncture is not the way to properly >determine if acupuncture is effective. It is interesting to note that two >very good presentations on acupuncture to induce ovulation and the >protective effect of acupuncture on immunosuppresion were not mentioned in >all the media hype following the conference. Bruce Pomeranz, M.D. provided >research that left no doubt that acupuncture releases brain endorphins. >This was the physiological information that was needed to confirm How does >acupuncture work? The conference was closed with a presentation by Alan >Trachtenberg, M.D. one of the principal organizers, who should be >thoroughly praised for his efforts in organizing the conference. He urged >more and better designed research on acupuncture but firmly impressed upon >the audience that acupuncture is genuinely deserving of a place in our >current healthcare system. > > The conclusion of the conference was the statement issued by >the panel which made the headlines in many newspapers across the country as >well as the evening news. As one of those in attendance at the entire >conference I was actually shocked at the good publicity that came out of >the meeting. The panel which had been asking tough questions and at times >appeared to be negatively inclined, made a very promising statement at >their press conference. Stay tuned for more information on this in our >next newsletter. > > Highlights of Research at the NIH Conference > > Ji Sheng Han, M.D. Beijing Medical University - 2-Hz >electroacupuncture increased the release of b-endorphin in the brain and >enkephalin in the whole central nervous system. 100-Hz electroacupuncture >releases dynorphin in the spinal cord. Using a dense- disperse wave which >is 2-Hz for 3 seconds and then 100-Hz for 3 seconds continually shifting >back and forth provides the strongest form of analgesia because it causes >the release of all three opioid peptides. Continued use of electric >acupuncture does induce tolerance and should therefore have treatment be >spaced appropriately. > > A. Alavi, M.D. Chief of the Division of Nuclear Medicine at >the Hospital of the University of Pennsylvania used single photon emission >computed tomography (SPECT) to examine the blood flow and cerebral >activity in the brain of individuals before and after acupuncture. He >reported almost a 20% increase in radiotracer uptake in the thalamus after >acupuncture was administered. Prior baseline asymmetry of uptake was >diminished and cerebral blood flow was shown to increase. This would >appear to be a new method of analyzing the physiological effects of >acupuncture. ______________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com Quote Link to comment Share on other sites More sharing options...
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