Acupuncture an Alternative Healthcare Choice by Doctor Ackerman

IS "BORN-AGAIN" MEDICINE TAKING US BACK TO THE MIDDLE AGES OR INTO THE FUTURE?
Are We Finally Becoming More Open Minded or is it Just a Question of Demand Must be Supplied?

Alternative medicine may have finally broken the barrier into conventional realms. I did not have the pleasure of reading the initial foray into the subject by the prestigious Journal of the American Medical Association along with the AMA back in 1997 when the editors selected alternative medicine as the topic for their annual coordinated theme issues. All ten of their Archives Journals joined in the project. However, I did spot it the following year while perusing the JAMA November 11, 1998 issue.

Several very important concessions were made. The most important of these was the admission that a nationwide survey had concluded that a great many therapists are now into it, but they tempered this with the finding that most alternative therapy is still in the hands of practitioners or patients unsupervised by physicians or even alternative therapy practitioners. A second somewhat scary report stated that from 1990 to 1996 "malpractice claims against chiropractors, massage therapists, and acupuncturist's occurred less frequently than against physicians and the injuries were less severe." That's scary indeed!

One of the primary rallying cries against unconventional treatments has always been that proper scientific scrutiny, in the form of well-run and well-supervised studies, was always missing. Nothing, other than solicited testimonials, was consistently offered to show that these approaches had value. In that JAMA, however, six randomized trials were presented which addressed common clinical conditions. In an attempt to set the record straight, an editorial was devoted to the opinion that "alternative therapies must be evaluated by rigorous empirical testing."

I, personally, always practiced my medicine in a conventional manner, although I must admit that at times my approach to a difficult problem may have occasionally strayed into the realm of the unknown. As the malpractice issue began to rear its ugly head, I, like so many of my more adventurous colleagues, tended to throw caution to the wind with a great deal less abandon. It was a stifling sensation, to say the least. So, it's refreshing to observe the current attempt of conventional wisdom involved in trying to capture the essence of a once verboten realm.

The topics that follow will all be devoted to this question. I will leave it to the reader to form his or her own opinions. They all come from the JAMA or Archives articles and letters.

Don't Worry. Having Needles Stuck in You May Sound Icky, But It's Really Not All That Bad

The information for this portion comes from a letter about adverse events related to acupuncture. Let's get the serious ones out of the way first. They include such frightening things as entry of air into the lung cavity, blood infection, and damage to the spine. At least in Norway it seems that chest wall puncture, fainting, local infections where the needles go in, and increased rather than reduced pain are fairly common. The six Japanese who cooperated in writing this letter decided to check the results of their preceptors and interns on about 10,200 patients who had received 55,291 treatments with acupuncture at Tsukuba College of Technology Clinic. That should give us a pretty good idea as to what kind of trouble a bunch of novices can get into.

Well, what were the results? I find it a bit hard to swallow that only 64 adverse events were reported including 11 different types. Of course, the Japanese are noted for their honesty, but I still remain a bit skeptical that these young trainees are going to readily reveal all their faux pas. The most common problem turned out to be the most expected. Sixteen forgot to remove all the needles when the job was done. Annoying? You bet; however, not serious and obviously a good thing for students to report to show that they're conscientious. Nothing ever happened anyway after the errant needles were finally removed. Next came 13 with dizziness, discomfort, or perspiration, probably due to a temporary drop in blood pressure from the treatment. All these are good adverse events to report since they are not the fault of the acupuncturist, but that of the patient. Here are the rest of the events in descending order with burns being the highest (7); bruise with pain (6); bruise without pain (5); feeling poorly (5); minor bleeding (3); worsening of the original complaint (3); itch and/or redness (3); pain where the needle was placed (2); and fall from bed (1). They didn't say whether the fall from the bed was due to writhing in agony.

The conclusion was, 'come to our clinic to learn' - couched in the following language, "it is essential to provide acupuncturist's the opportunity for adequate training such as internship in a medical facility."

My conclusion? Maybe I'll give it a try for my sore leg.

Let's go through those six studies, which tested some alternative medicine approaches, and see how they fared in the light of control trials. Bove and Nilsson ran the first of these. The idea was to see if patients complaining of tension-type (episodic) headaches would benefit more from the first or second following approach:

1. A primary group receiving a combination of joint manipulation of the spine of the neck plus friction massages of the appropriate muscles (including trigger-point therapy, if indicated).

2. A control group receiving the same friction massages, but instead of manipulation, low power laser light to the upper neck. The laser was assumed to be a fake treatment of no value.

The results will surprise a lot of people who believe in chiropractic manipulation. Although both groups improved significantly, there was no difference between them. The manipulation apparently had no good or bad effect.

Have you ever heard of moxibustion? Of course not, unless you were pregnant and had a breech presentation baby at 33 weeks that had to be rotated into a head down presentation by an acupuncturist. Well, moxibustion is the application of heat from burning herbs to an acupuncture point - and guess what! It worked according to Cardini and Weixin. Head (cephalic) presentation increased significantly by the 35th week and also at birth when compared to patients without it. One thing though; I could find no reference to whether any one had ever compared moxibustion to just plain moist heat, and no explanation as to what value lay in the use of the herbs.

If you have irritable bowel syndrome you'll be happy to know that the Chinese herbal medicine also made out better than placebo in this study reported by Bensoussan and his group. The herbal combination was apparently a tried and true but secret formula. A Chinese herbalist, the patients, and a gastroenterologist evaluated the study. Now all we have to do is find out where to get the stuff.

The next one was a flop for both acupuncture and amitriptyline (a common standard treatment) for pain due to HIV-related peripheral neuropathy. Shlay and his group concluded that a placebo worked just the same as the other two approaches.

Heymsfield and his colleagues did number five. They tried comparing weight loss and decrease in fat mass using a high-fiber, low-energy diet plus Garcinia cambogia to just diet and placebo. Another strikeout. There was no difference between the two.

Finally, Garfinkel's group found a definite advantage in using yoga and relaxation techniques for carpal tunnel syndrome. They didn't compare the method to any other approach, but they did measure grip strength and pain reduction. There was significant improvement.

Well on the surface, it looks like a standoff; three for the alternative approach; three against. However, that does seem unfair if you consider that we may actually have discovered three techniques possessing distinct value, each of which might be added to our armentarium of therapies. Of course, more extensive investigation is essential, but we must keep our eyes and minds open to such ancient and time-honored practices.