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Joan Wilentz, MA, Department Editor
Joan Wilentz, MA
EDITOR'S NOTE: When I arrived at the press conference held at the end of the National Institutes of Health Consensus Development Conference on acupuncture, I was aware that the large audience was waiting expectantly. There had been 2 days of testimony and discussion, and friends had told me that acupuncture supporters had seemed to be present in abundance, clapping or cheering at the presentation of positive evidence. The press turnout was large; it included reporters from The New York Times, The Washington Post, and The Los Angeles Times, plus the television networks. Reporters sought clarification from the panelists on some of the data reported and raised the usual issues and concerns about placebo effects, patients' attitudes and beliefs, the role of personality, and other intangibles in the acupuncturist-patient interaction.
The reporters also asked whether the panelists had come to the conference with already-formed opinions. Not all answered, but some panelists clearly were disposed favorably toward acupuncture because they employed acupuncturists in their practices. Others said they had been skeptical about acupuncture but had conscientiously read the documentation and felt comfortable with findings that the procedure works in the treatment of specific kinds of pain conditions. One conclusion, mentioned more than once, is that in contrast to most traditional treatments for pain, which come with unwanted side effects, acupuncture appears benign. One physician commented that if a patient with chronic pain reported that drugs or other traditional approaches were providing no relief and asked if it would be all right to try acupuncture, he would not hesitate to reply, "Sure, why not?"
Expect NIH to follow up on the panel's recommendations, which clearly indicate the need for more research.
The panel also concluded that acupuncture may be an effective therapy for addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, low-back pain, carpal tunnel syndrome, and asthma, but in these cases, the scientific data supporting the procedure's effectiveness are less convincing. Panel chairman David J. Ramsay, DM DPhil, said: "We need more high-quality research to validate what appears to be useful for the millions of Americans that have used acupuncture in this country. The challenge in studying acupuncture is to integrate the theory of Chinese medicine into the conventional Western biomedical research model and into the conventional healthcare arena."
Acupuncture is one of the oldest and most commonly used forms of medicine in the world, dating back at least 2,500 years. Needle acupuncture, the most well-known of the family of acupuncture procedures, involves the penetration of specific anatomic locations, or acupuncture points, on the skin. The needles that are used are thin, solid, and generally metallic. The procedure is based on the premise that patterns of energy flow, called Qi, are present throughout the body and are essential for optimal health.
Public awareness and use of acupuncture in the United States have increased during the latter part of the 20th century. In 1993, the Food and Drug Administration reported that Americans spent $500 million per year on acupuncture. The World Health Organization reports that in the United States, there are approximately 10,000 acupuncture specialists and an estimated 3,000 practicing acupuncturists are physicians.
The acceptance of acupuncture as a legitimate medical therapy, however, is not a given. Because acupuncture is based on theories that are unfamiliar to Western medicine, improved understanding of perspectives between acupuncture practitioners and the conventional healthcare community is essential. While the NIH panel commended the ongoing improvements in the training of acupuncturists in the United States, it also called for more uniform licensing, certification, and accreditation. Such measures will help patients identify qualified acupuncturists, ensure quality of service, and increase the likelihood of widespread acceptance of acupuncture. Thirty-four states currently license or otherwise regulate the practice of acupuncture by nonphysicians and have established training standards for certification.
The panel noted that although side effects from acupuncture are rare, they do sometimes occur. It recommended that patients considering acupuncture should seek comprehensive information about treatment options, expected prognosis, relative risk, and safety practices. Because many patients seek treatment from both acupuncturists and physicians, the panel also advocated stronger communication between the two healthcare provider groups to minimize the risk of overlooking important medical problems.
Financial barriers frequently limit public access to acupuncture treatment. These barriers could be minimized or removed, the panel said, by urging insurance companies, federal and state health insurance programs including Medicare and Medicaid, and other third-party payers to expand their coverage to include acupuncture treatment.
The panel stressed the importance of further research on acupuncture, and in particular, on evaluating acupuncture by using study designs that can withstand rigorous scientific scrutiny. "The acceptance of acupuncture as a reliable therapeutic choice in Western medicine will depend on such rigorous studies," said Dr. Ramsay.
NOTE: The panel's full consensus statement is available on the Consensus Development Web site, http://consensus.nih.gov.
