Blessed with a healthy constitution, I have never tried acupuncture. But many people, the world over, swear by it. The US National Center for Contemporary and Alternative Medicine (NCCAM) estimates that more than one million Americans receive acupuncture each year, resulting in approximately 10 million treatment visits. In 2002, the World Health Organization (WHO) reported that acupuncture was being used in at least 78 countries. Although there is some clinical evidence that it does work, there is no definitive explanation for how it works.
Acupuncture has been practiced in China for more than 3,000 years. According to the traditionalist view, one’s life force, qi (pronounced “chee”), flows through the body via invisible channels known as meridians. There are said to be 12 main and eight secondary meridians. These meridians surface at acupuncture points, which, in current theory, number at approximately 2,000.
Treatment involves inserting hair-thin needles into these points, usually to a depth of 0.5 to 1.0 inches (1.27 to 2.54 cm). The length of time a needle remains in the body (from a few seconds to many minutes), the number of needles, and the number of visits vary according to the condition being treated. Needles may be rotated or have an electrical charge applied to them, depending on the condition. Most people do not report discomfort; some report tingling or heaviness.
The controversy over acupuncture rages between three different schools of thought. For adherents of traditional acupuncture theory, qi is the key. Those who believe there may be something to acupuncture, but who balk at what they consider to be mystical hocus-pocus, suggest its efficacy stems from more mundane causes, such as the release of endorphins. Skeptics, those delightful curmudgeons who strive to keep our feet firmly on the ground, think that acupuncture is simply nonsense.
In Search of an Explanation
WHO Traditional Medicine Strategy 2002-2005 notes that the increased use of acupuncture and other traditional medicine/complementary and alternative medicine (TM/CAM) “has not been accompanied by an increase in the quantity, quality and accessibility of clinical evidence to support TM/CAM claims.” At the same time, the report states that acupuncture’s efficacy in relieving pain and nausea has been “conclusively demonstrated and is now acknowledged worldwide.”
There are several Western-friendly theories for why acupuncture may work. One says that inserting needles causes the body to release endorphins, its own feel-good drugs. Another states that the levels of certain neurotransmitters (such as serotonin and norepinephrine) are affected by acupuncture. A third suggests that acupuncture can constrict or dilate blood vessels, which allows pain and spasms to diminish.
The Continuum Center for Health & Healing at Beth Israel Medical Center in New York City offers a possible explanation for the flow of the elusive qi. The site suggests that the tiny wound caused by the needle results in the delivery of platelet-derived growth factor to the site, which “induces DNA synthesis and stimulates collagen formation in the connective tissue. The effects of this stimulation last several days, until the tiny wounds heal. Since connective tissue is a contiguous fabric wrapping the entire body, as well as every organ, muscle, vessel, nerve, down to every single cell, it is theorized that the channel system for the streaming of qi lies in the connective tissue.”
Another theory suggests that acupuncture causes pain impulses to be blocked at various “gates” along the central nervous system (CNS). This theory suggests that overstimulating a specific gate in the CNS will cause it to close. (Interestingly, in a study published in a 1999 issue of Radiology 212(1):133-141, MRIs showed acupuncture’s stimulation path in the CNS.)
Some suggest that pain relief from acupuncture is caused by a diversion effect: being poked with a needle in one location distracts a person from the pain felt elsewhere.
Skeptics have other explanations. Some propose spontaneous remission, while others credit successes to the standard medical treatment that accompanied the acupuncture. Many suggest it’s the placebo effect: some people want relief from their condition so much, they are willing to believe anything.
And for the cynical skeptic, there is another explanation for the treatment’s popularity: it’s all about money. The US National Institutes of Health (NIH) news release regarding their 1997 Consensus Development Conference Statement on acupuncture reported Americans were spending US$500 million (C$792 million) per year on the treatment. Meanwhile, a 1999 report by Canada’s Fraser Institute estimated that in 1997, Canadians spent more than C$1.8 billion (US$1.1 billion) on visits to alternative medicine providers (not just acupuncturists).
An April 13, 2002 article in The New York Times stated: “Hospitals in search of paying patients and a competitive edge are increasingly offering their patients some form of alternative medicine.” Indeed, alternative medicine is being offered at respected facilities in both the United States and Canada, with some examples including: Beth Israel Medical Center in New York City; Stanford Hospitals and Clinics in Stanford, California; Duke University Health System in Durham, North Carolina; Mount Sinai Hospital in Toronto, Ontario; and Vancouver General Hospital of Vancouver Coastal Health in Vancouver, British Columbia.
The Good, the Bad, and the Confusing
There is some regulation of acupuncture, but training standards and licensure requirements vary greatly. About 40 US states have established training standards for acupuncture certification and have varying requirements for obtaining a license to practice. Some states require only 100 hours of theory and practice, while others require more than 1,000 hours of theoretical training (generally combining Western science and medicine with Chinese medicine and acupuncture), plus 300 to 800 clinical hours, followed by writing the National Certification Commission for Acupuncture and Oriental Medicineexamination. In some states, only medical doctors can practice acupuncture, and a trained acupuncturist may not practice even under a doctor’s supervision. Surprisingly, there are locations where doctors, dentists, chiropractors, and/or podiatrists may practice acupuncture without any specialized training.
In Canada, acupuncture is regulated in three of the 10 provinces: British Columbia, Alberta, and Quebec – plus the city of Toronto, Ontario. The regulations differ from province to province. In addition, BC offers four possible practitioner titles based on the applicant’s education, training, and (if grandfathered) practice experience.
Why Argue with Success?
So there is no standard licensure and accreditation process. So you don’t recall meridians from your anatomy and physiology classes. So you think qi is a load of hooey.
Maybe this doesn’t matter.
Acupuncture may work on one person, but not on another – the same can be said for any number of drugs and treatment modalities. In our pill-popping society, is it a bad thing to have a non-pharmacological way to handle pain and other conditions?
In the past 10 years, studies have been published on acupuncture’s effective use in treating angina, cancer pain, depression, knee osteoarthritis, stroke, and neck pain, as well as for post-operative control of pain, nausea and vomiting. Studies concerning acupuncture’s use in fibromyalgia, addictions, dental pain, and more are in process. As of March 2002, the NCCAM (part of the NIH) supports 16 specialty centers for research into CAM.
The risks seem to be minimal – generally minor problems such as fainting, bleeding, and dizziness, and these seem most often due to an acupuncturist’s inadequate training and practice. In 1998, theJournal of the American Medical Association published a study entitled Medical Malpractice Implications of Alternative Medicine that found, based on a worldwide literature search, only 193 reports of adverse effects following acupuncture. On the other hand, in their 2002 report, the WHO acknowledged that surveillance systems that monitor and evaluate adverse events are rare.
Use of acupuncture and other types of TM/CAM is increasing. We all want as many safe and effective treatment alternatives as possible. In order to keep options open, research must continue, and something must be done about the hit-or-miss training and licensing requirements for all TM/CAM practices, including acupuncture.
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