[Paleopsych] NYT: Acupuncture Moves Toward the Mainstream

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Acupuncture Moves Toward the Mainstream
NYT September 28, 2004
By ANAHAD O'CONNOR

[Did the Sage of Baltimore ever say anything about acupuncture? He 
denouced chiropractic many times.]

Three years ago, Alfred Szymanski could not seem to get his
blood pressure under control. He ran 10 miles a week, stuck
to a healthy diet and was on a hypertension medication, all
to no avail. His doctor suggested switching medications,
but Mr. Szymanski, wary of side effects, decided to try
something he had always wondered about: acupuncture.

After three 20-minute sessions, each covered by his medical
plan, his blood pressure plunged 20 points.

"Every time I left I was so relaxed; it was like euphoria,"
said Mr. Szymanski, 61, who lives in New York. "My blood
pressure stayed down for quite a while."

Acupuncture, long shunned by mainstream medicine but for
centuries considered the crown jewel of alternative
therapy, is slowly gaining ground in doctors' offices
around the country. While some experts still question its
effectiveness, studies in recent years - including one at
Duke last week - have thrown scientific weight behind its
benefits, supporting its usefulness in alleviating
conditions from morning sickness to carpal tunnel syndrome.


In the past few years, the number of hospitals offering
acupuncture and other alternative therapies has doubled. At
the same time, postgraduate training programs in
alternative medicine have sprung up at universities around
the country, most recently at Harvard and the University of
San Francisco.

"There's a greater demand for these programs now because so
many physicians are interested in learning acupuncture,"
said Dr. Nader E. Soliman, an anesthesiologist in
Rockville, Md., and president of the American Academy of
Medical Acupuncture. "A lot of physicians who used to be
extremely reluctant to refer patients for the treatment are
now doing it regularly."

Patients curious about alternative medicine and
increasingly skeptical of the drug industry are also
seeking out the procedure, experts say.

A visit to an acupuncturist can cost $50 to $100. For
people working at the right companies, however, it runs a
lot less. More and more employers looking for low-cost
additions to medical plans are embracing the treatment.
Nearly 50 percent of workers with benefits received
coverage for it in 2004, compared with just over 30 percent
two years ago, according to a survey this month by the
Kaiser Family Foundation and Health Research and
Educational Trust.

The trend, it seems, is not limited to humans. In a society
of people attached to their pets, it may be no surprise
that veterinarians around the country say they are also
seeing a greater demand for the service. Dr. Barbara Royal,
a vet in private practice in Chicago, says she has been
fully booked virtually since the day she received her
acupuncture license eight years ago. "People were desperate
for it," she said.

Dr. Royal uses the technique mostly on cats and dogs
hobbled by arthritis, but recently she has been summoned to
treat more exotic animals. At Brookfield Zoo in Chicago,
she regularly uses acupuncture to alleviate arthritis in a
1,600-pound Bactrian camel, now able to run again for the
first time in years.

"I think the trend in animals is correlating with what's
happening in humans," she said. "There's a holistic
movement out there, and if people have found something that
works for them, they want it for their pets, too."

But as acupuncture slowly blends into the mainstream, some
experts are calling for tighter regulation. Dr. Joseph J.
Fins, a member of the White House Commission on
Complementary and Alternative Medicine Policy two years
ago, said that while acupuncture was relatively safe and
effective, there was no system for tracking harmful side
effects. Without closer monitoring, he said, a careless
acupuncturist who reuses needles that become infected with
hepatitis, for example, might easily go unnoticed.

"Because of how many people are using it, it's important
that we have some kind of surveillance system in place,"
said Dr. Fins, who is chief of the division of medical
ethics at Weill Medical College of Cornell University in
New York City. "There's no real mechanism to collect
information about the safety and efficacy of these
treatments. It's the same problem with over-the-counter
supplements."

Experts say that a vast number of alternative therapies,
like oil drips and aromatherapy, have little scientific
base or have yet to be studied properly. But government
financed research on acupuncture dates from the 1970's,
about the time the treatment first started gaining
popularity in the United States. It originated in China
over 2,000 years ago.

"Of the many different alternative therapies, this was
really the first one to be studied seriously by the
National Institutes of Health," said Dr. Richard Nahin,
senior adviser for scientific coordination and outreach at
the National Center for Complementary and Alternative
Medicine in Bethesda, Md.

Some of the results of the decades of research on
acupuncture have been ambiguous. Because it involves
inserting needles into the skin, creating the equivalent of
placebo pills for control groups in some studies can be
complicated, experts say. And, in some cases, acupuncture
has been shown to help ease certain conditions - like drug
addiction - when combined with other treatments, but not
necessarily when used alone.

For other ailments, however, acupuncture has been found to
work better than standard medications - and without side
effects. It has been widely used for years to ease chronic
pain conditions, and studies have repeatedly endorsed its
usefulness.

Last week, researchers at Duke showed that it was far more
effective for postoperative sickness and vomiting in a
group of subjects than Zofran, a widely used antinausea
drug. Roughly a quarter of all people who undergo major
surgery in the United States experience retching and
illness afterward, usually brought on by anesthesia.
Antinausea medications offer relief, but because they
sometimes cause severe headaches and cramps a number of
patients are reluctant to take them, said Dr. Tong J. Gan,
an author of the new study, published in the journal
Anesthesia & Analgesia.

Dr. Gan's study looked at a group of 75 women who were
either given Zofran before major breast surgery or hooked
up to an electroacupuncture machine that delivered low
doses of current during the operation. The high-tech
acupuncture technique prevented illness in all but 27
percent of those who received it, while about half of the
women given the antinausea drug complained of sickness the
next day. The rate of sickness in a control group that
received neither treatment was about 60 percent.

"This is sort of an interesting time right now," Dr. Gan
said. "We are seeing more and more evidence suggesting that
alternative therapies are beneficial, and patients are
gradually demanding it."

To some extent, the increased acceptance of acupuncture
reflects a growing understanding of its biological
mechanism, Dr. Gan said, which until now has largely been a
mystery. Research suggests that stimulating acupuncture
points somehow prompts the flow of endorphins and other
hormones that soothe pain. Other studies find that it
affects parts of the central nervous system that mediate
blood pressure and body temperature, among other things.

Dr. Nahin said several imaging studies that can shed light
on how the treatment influences brain activity are under
way.

But whatever acupuncture's underlying effects turn out to
be, experts say its gradual merger with conventional
medicine will have broad implications, eventually opening
the door to closer examination of other popular therapies
that lie outside the mainstream.

"Until now, we've had very little in the way of credible
scientific evidence to compare Eastern or traditional
medicine to a pharmaceutical approach," said Dr. Steven
Eubanks, chairman of the department of surgery at the
University of Missouri. "Hopefully, this will add to our
willingness to evaluate other alternative therapies, and to
do so with our usual scientific scrutiny."

http://www.nytimes.com/2004/09/28/health/policy/28acup.html