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.
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