Chinese Medicine

.. tions. A parallel survey of 197 acupuncturists, who are more apt to see immediate complications, yielded 132 cases of fainting, 26 cases of increased pain, 8 cases of pneumothorax, and 45 other adverse results [10]. However, a 5-year study involving 76 acupuncturists at a Japanese medical facility tabulated only 64 adverse event reports (including 16 forgotten needles and 13 cases of transient low blood pressure) associated with 55,591 acupuncture treatments. No serious complications were reported.The researchers concluded that serious adverse reactions are uncommon among acupuncturists who are medically trained [11]. Questionable Standards In 1971, an acupuncture boom occurred in the United States because of stories about visits to China by various American dignitaries.

Entrepreneurs, both medical and nonmedical, began using flamboyant advertising techniques to promote clinics, seminars, demonstrations, books, correspondence courses, and do-it-yourself kits. Today some states restrict the practice of acupuncture to physicians or others operating under their direct supervision. In about 20 states, people who lack medical training can perform acupuncture without medical supervision. The FDA now classifies acupuncture needles as Class II medical devices and requires labeling for one-time use by practitioners who are legally authorized to use them [12]. Acupuncture is not covered under Medicare. The March 1998 issue of the Journal of the American Chiropractic Association carried a five-part cover story encouraging chiropractors to get acupuncture training, which, according to one contributor, would enable them to broaden the scope of their practice [13].

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The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) has set voluntary certification standards and certified several thousand practitioners. As of November 1998, 32 states have licensing laws, with 29 of them using NCCAOM examination as all or part of their educational, training, or examination requirement, and three with addditional eligibility criteria. The credentials used by acupuncturists include C.A. (certified acupuncturist), Lic. Ac.

(licensed acupuncturist), M.A. (master acupuncturist), Dip. Ac. (diplomate of acupuncture), and O.M.D. (doctor of Oriental medicine).

Some of these have legal significance, but they do not signify that the holder is competent to make adequate diagnoses or render appropriate treatment. In 1990, the U.S. Secretary of Education recognized what is now called the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) as an accrediting agency. However, such recognition is not based on the scientific validity of what is taught but upon other criteria [14]. Ulett has noted: Certification of acupuncturists is a sham.

While a few of those so accredited are naive physicians, most are nonmedical persons who only play at being doctor and use this certification as an umbrella for a host of unproven New Age hokum treatments. Unfortunately, a few HMOs, hospitals, and even medical schools are succumbing to the bait and exposing patients to such bogus treatments when they need real medical care. The National Council Against Health Fraud has concluded: Acupuncture is an unproven modality of treatment. Its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge Research during the past 20 years has not demonstrated that acupuncture is effective against any disease. Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, conditioning, and other psychologic mechanisms. The use of acupuncture should be restricted to appropriate research settings, Insurance companies should not be required by law to cover acupuncture treatment, Licensure of lay acupuncturists should be phased out.

Consumers who wish to try acupuncture should discuss their situation with a knowledgeable physician who has no commercial interest [15]. The NIH Debacle In November 1997, a Consensus Development Conference sponsored by the National Institutes of Health and several other agencies concluded that 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. [16] The panelists also suggested that the federal government and insurance companies expand coverage of acupuncture so more people can have access to it.

These conclusions were not based on research done since NCAHF’s position paper was published. Rather, they reflected the bias of the panelists who were selected by a planning committee dominated by acupuncture proponents [17]. NCAHF board chairman Wallace Sampson, M.D., has described the conference a consensus of proponents, not a consensus of valid scientific opinion. Although the report described some serious problems, it failed to place them into proper perspective. The panel acknowledged that the vast majority of papers studying acupuncture consist of case reports, case series, or intervention studies with designs inadequate to assess efficacy and that relatively few high-quality controlled trials have been published about acupuncture’s effects. But it reported that the World Health Organization has listed more than 40 [conditions] for which [acupuncture] may be indicated.

This sentence should have been followed by a statement that the list was not valid. Far more serious, although the consensus report touched on Chinese acupuncture theory, it failed to point out the danger and economic waste involved in going to practitioners who can’t make appropriate diagnoses. The report noted: The general theory of acupuncture is based on the premise that there are patterns of energy flow (Qi) through the body that are essential for health. Disruptions of this flow are believed to be responsible for disease. The acupuncturist can correct imbalances of flow at identifiable points close to the skin.

Acupuncture focuses on a holistic, energy-based approach to the patient rather than a disease-oriented diagnostic and treatment model. Despite considerable efforts to understand the anatomy and physiology of the acupuncture points, the definition and characterization of these points remains controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and the five phases theory, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the, evaluation of patients and the formulation of treatment in acupuncture. Simply stated, this means that if you go to a practitioner who practices traditional Chinese medicine, you are unlikely to be properly diagnosed. In 1998, following his lecture at a local college, an experienced TCM practitioner diagnosed me by taking my pulse and looking at my tongue. He stated that my pulse showed signs of stress and that my tongue indicated I was suffering from congestion of the blood.

A few minutes later, he examined a woman and told her that her pulse showed premature ventricular contractions (a disturbance of the heart’s rhythm that could be harmless or significant, depending on whether the individual has underlying heart disease). He suggested that both of us undergo treatment with acupuncture and herbs — which would have cost about $90 per visit. I took the woman’s pulse and found that it was completely normal. I believe that the majority of nonmedical acupuncturists practice in this manner. The NIH consensus panel should have emphasized the seriousness of this problem.

References 1. Skrabanek P. Acupuncture: Past, present, and future. In Stalker D, Glymour C, editors. Examining Holistic Medicine. Amherst, NY: Prometheus Books, 1985. 2.

Kurtz P, Alcock J, and others. Testing psi claims in China: Visit by a CSICOP delegation. Skeptical Inquirer 12:364-375, 1988. 3. Melzack R, Katz J.

Auriculotherapy fails to relieve chronic pain: A controlled crossover study. JAMA 251:10411043, 1984 4. Ter Reit G, Kleijnen J, Knipschild P. Acupuncture and chronic pain: A criteria-based meta-analysis. Clinical Epidemiology 43:1191-1199, 1990.

5. Ter Riet G, Kleijnen J, Knipschild P. A meta-analysis of studies into the effect of acupuncture on addiction. British Journal of General Practice 40:379-382, 1990. 6.

American Medical Association Council on Scientific Affairs. Reports of the Council on Scientific Affairs of the American Medical Association, 1981. Chicago, 1982, The Association. 7. Ulett GA.

Acupuncture update 1984. Southern Medical Journal 78:233234, 1985. 8. Tang J-L, Zhan S-Y, Ernst E. Review of randomised controlled trials of traditional Chinese medicine. British Medical Journal 319:160-161, 1999. 9. Streitberger K, Kleinhenz J.

Introducing a placebo needle into acupuncture research. Lancet 352:364-365, 1998. 10. Norheim JA, Fennebe V. Adverse effects of acupuncture. Lancet 345:1576, 1995.

11. Yama*censored*a H and others. Adverse events related to acupuncture. JAMA 280:1563-1564, 1998. 12.

Acupuncture needle status changed. FDA Talk Paper T96-21, April 1, 1996 13 Wells D. Think acu-practic: Acupuncture benefits for chiropractic. Journal of the American Chiropractic Association 35(3):10-13, 1998. 14.

Department of Education, Office of Postsecondary Education. Nationally Recognized Accrediting Agencies and Associations. Criteria and Procedures for Listing by the U.S. Secretary For Education and Current List. Washington, D.C., 1995, U.S. Department of Education.

15. Sampson W and others. Acupuncture: The position paper of the National Council Against Health Fraud. Clinical Journal of Pain 7:162-166, 1991. 16.

Acupuncture. NIH Consensus Statement 15:(5), November 3-5, 1997. 17. Sampson W. On the National Institute of Drug Abuse Consensus Conference on Acupuncture.

Scientific Review of Alternative Medicine 2(1):54-55, 1998. Quackwatch Home Page This article was updated on July 30, 1999. Religion.

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