Millions of Americans have turned to alternative medical therapies to soothe body and mind. Their faith in “new-age” options has prodded Western researchers—who once pooh-poohed the likes of biofeedback, chiropractic, and guided imagery—to sit up and take a closer look.
Many Americans have lost patience with the limits of conventional medicine. They’ve had it with whiling away hours in waiting rooms, curt doctors, and an impersonal health care system that tends to disease rather than prevention. They’re fed up with high-tech wizardry that doesn’t ease their pain. Enter alternative medicine. Once considered flaky if not sheer quackery, more and more people now insist that such therapies as acupuncture, chiropractic, homeopathy, massage and relaxation techniques succeed where all else has failed. Even hard-core skeptics are warming to Eastern approaches that acknowledge the healing connection between mind and body.
Just how widespread is the trend to alternative medicine? A Harvard Medical School study published in the New England Journal of Medicine in 1993, estimated that one-third of the population had used at least one unconventional therapy in the previous year. Perhaps even more surprising, the researchers found that three-quarters of the almost $14 billion spent on these therapies was paid by the patients themselves since few insurance companies cover alternative care. By comparison, the annual out-of-pocket expenses for hospitalizations was $12.8 billion.
Alternative medicine is a very broad term that encompasses an array of holistic techniques for preventing and treating illness. Some of these therapies, such as acupuncture and shiatsu massage, have long, venerated traditions in Asian cultures and tend to be given somewhat more credibility by Western doctors than do certain newer practices like crystal healing. But since most of the Western medical establishment remains unconvinced that alternatives are of any benefit, the techniques are not widely taught in medical school nor are they generally available in our hospitals. Many alternative practitioners are willing to take a more flexible stance. They prefer the term “complementary medicine,” accentuating a partnership between Western and Eastern-based options.
Although there are a wide variety of treatments that fall under the umbrella of alternative or complementary care, each unique therapy is governed by one guiding principle—the essence of which is to focus on prevention and take a holistic view of an individual’s physical, psychological and emotional health.
In future articles, you will find more on the disciplines of homeopathy and chiropractic. Here, in the first our series of articles on alternative care, you’ll read about one of the most intriguing and popular therapies: Acupuncture.
What is Acupuncture?
The Chinese practice of acupuncture, which goes back over three thousand years, involves inserting hair-thin surgical steel needles into selected acupuncture points in the body. But that’s just the mechanics of the technique. For an explanation of how it works, you need some background in Chinese medicine. According to that ancient tradition, health is achieved through the harmonious balance between the opposing forces of yin (spirit) and yang (blood). The attraction between them creates an energy known as qi (pronounced chee), which flows to all parts of the body through channels called meridians, pathways that run along the surface of the body and branch into the body’s interior. Any imbalance in those forces is believed to cause illness, so when needles are placed at prescribed spots along the meridians, balance—therefore, health—is restored. Several different styles of acupuncture exist mainly differentiated by how the points are stimulated, including hand pressure, electrical pulse, ultrasound, or wavelengths of light.
American doctors first learned about acupuncture from Sir William Osler, often considered to be the father of modern medicine. A century ago, he wrote in a classic medical textbook, “For lumbago, acupuncture is, in acute cases, the most efficient treatment.” But it wasn’t until 1972, when New York Times correspondent James Reston covered Nixon’s historic trip to China, that acupuncture got widespread notice. While in that country, Reston needed an emergency appendectomy and was treated with acupuncture for his postoperative pain. The report of his experience piqued the interest of dozens of American doctors who wanted to see for themselves how the Chinese operated using acupuncture as an anesthetic. Additionally, many non-physicians started training overseas or with acupuncturists who had been quietly practicing in the Asian communities of many large American cities. Some of these new converts established schools and fought for laws to allow the practice of acupuncture in many states.
Since then, the practice has grown in the United States. There are now over 50 schools of acupuncture nationwide, 21 of which are accredited by the U.S. Department of Education and over 40 states have laws or regulations governing the practice of acupuncture. The World Health Organization, the medical branch of the United Nations, issued a provisional list of 41 diseases amenable to acupuncture treatment. These include respiratory ailments, pain and chronic pain conditions, PMS and other gynecological disorders, gastrointestinal disorders and many other health problems. And, according to a 1993 FDA report, between nine and 12 million visits to acupuncturists are made every year—a number that has no doubt increased since then.
Until recently, nearly all reports of acupuncture’s effectiveness have been anecdotal. In the last decade, however, credibility for alternative therapies has emerged from research done at the very bastions of conventional medicine, including the National Institutes of Health, Oxford University and Boston University School of Medicine. These studies suggest that acupuncture dramatically controls pain because the stimulation of acupuncture points affects the nervous system, triggering the release of endorphins and enkephalins (natural pain-killing chemical substances similar to morphine). Other research suggests that acupuncture may also prompt the release of certain brain hormones, including serotonin, which transmit nerve impulses. Acupuncture may also cause the pituitary gland to discharge pain-blockers and to initiate a process that releases anti-inflammatory agents into the bloodstream.
But for many acupuncturists, this explanation isn’t satisfactory since activating the release of endorphins would require a certain amount of needle stimulation, which, in fact, does not take place in all styles of acupuncture. The problem, they assert, is that you cannot understand acupuncture from a Western perspective, which tries to isolate parts of the whole without considering abundant factors that may affect the individual, including environment, nutrition, emotional and psychological status, and medical history. Still, as detailed in the FDA’s 1993 report Overview of Acupuncture, some small well-designed Western trials have demonstrated that acupuncture may be effective in treating the following:
• Menstrual cramps. Forty-three patients diagnosed by a physician as having dysmenorrhea (menstrual pain that cannot be attributed to a known condition) were randomly assigned to one of four groups: 11 were treated with real acupuncture, 11 with “sham” acupuncture (needles are placed in points other than the meridian points specified by acupuncture without the patient’s knowledge), 10 visited a physician monthly, and 11 received no treatment. Nine months later, 91 percent of the first group reported a significant reduction in symptoms. In comparison, relief was experienced by only 40 percent of the second group, 18 percent of the third group, and 9 percent of the last group.
• Chronic low back pain. In a study involving 50 patients who had suffered low back pain for six months, 83 percent of those treated with acupuncture showed improvement after a month. Only 31 percent of those who were not treated felt better in the same period of time. And, after nine months, 53 percent of those who had acupuncture continued to report significant pain relief while none of the untreated people did.
• Neck, arm, and hand pain. Twelve of fifteen patients who had had neck, arm, or hand pain for six months experienced improvement after 12 weeks of acupuncture treatment. Of the untreated participants, two also improved and one did not.
• Substance abuse. Acupuncture’s effectiveness in helping alcoholics quit drinking was examined in a couple of studies in which problem drinkers were randomly assigned to get treated with either real acupuncture or sham acupuncture. The drinkers’ response to therapy was evaluated by panelists who didn’t know which group the participants had been a part of. In both studies, there were substantially fewer drinking episodes and hospitalizations for detoxification among people who had been treated with acupuncture.
As with any medical procedure, acupuncture is not risk-free. The biggest concern is infection. According to one study, improperly sterilized needles are used by about 35 percent of practitioners. To minimize your risk, insist on disposable surgical steel needles.
In addition, some isolated lung and bladder punctures, broken needles, and allergic reactions to needles made of materials other than surgical steel have been reported. Acupuncture may also stimulate production of hormones in pregnant women that help initiate labor and can be harmful to the fetus in early pregnancy. However, in the hands of a good acupuncturist, the risk of such complications is extremely low.
In 1994, Consumer Reports estimated that nationwide 3,000 medical doctors had studied acupuncture and used it in their practices. Another 7,000 non-physicians were using acupuncture to treat health problems, sometimes in combination with herbs, massage, and other Eastern techniques (the publication also noted that at least 80 private insurers and Medicaid programs in some states cover acupuncture for some conditions).
Physicians are allowed to perform acupuncture anywhere in the United States, but regulation of non-physician acupuncturists varies among states. Some states require a physician’s referral to see an acupuncturist, while others, like California, consider acupuncturists to be primary health-care providers who can treat patients without a doctor’s referral.
The American Association of Acupuncture and Oriental Medicine (AAAOM) recommends that physicians who practice acupuncture have a minimum of 200 hours of acupuncture training at a recognized acupuncture school. Non-physicians should also be licensed or registered in your state or should be certified by the National Commission for the Certification of Acupuncturists. For a list of qualified acupuncturists in your community, call the AAAOM at 610-266-1433. In addition, the American Academy of Medical Acupuncture (800-521-2262) can provide information about physicians in your area who use acupuncture in their medical practice.
On your first visit to an acupuncturist, you will probably be asked to fill out a questionnaire regarding your health history and lifestyle habits. You might be asked to describe any digestive problems, sensitivity to temperature, urine color, eating and sleeping patterns, and stress. After reviewing this information with you, the acupuncturist will decide upon the most appropriate treatment. He or she will dab some rubbing alcohol on each point where the needle—as fine as a strand of hair—will be inserted. The number of needles and their length, as well as the depth they are inserted vary depending upon the practitioners assessment of your condition. Generally, 10 to 12 needles about two inches long are inserted about one inch into the acupuncture points.
While many people say they barely feel anything, some describe a slight tingling or a sensation resembling a mild electric shock. Others have reported a vague tugging or aching feeling that usually lasts no longer than a few minutes. A sense of fullness and heaviness in the muscles or limbs is also common. There may be minor bleeding from the needle prick.
The needles are usually left in place between 15 and 60 minutes, and the acupuncturist may twirl them to enhance stimulation of the acupuncture points. In some instances, needles may be connected to a low-voltage electrical source. Heat and massage are occasionally applied to pressure points too.
That is a very personal decision, but here are some tips to keep in mind:
• Decide if you feel more comfortable with a physician who practices acupuncture or with a non-physician practitioner. In some states, such as Arizona, Georgia, Ohio and New Hampshire, the practice of acupuncture is limited to physicians, so you won’t have a choice. Other states, including California, Colorado, Florida and Vermont, license, certify or register non-physician acupuncturists.
A physician has the benefit of extensive medical training. On the other hand, a non-physician may be more open minded and have a greater belief in alternative medicine, as well as the body’s innate ability to heal itself.
• Make sure the practitioner you choose has the proper training and certification and uses disposable, surgical steel needles.
• Find out what your insurance will cover. Sometimes properly worded requests for acupuncture will be covered. Talk to your regular physician to see if he or she can prescribe acupuncture treatment.
• Tell your regular physicians about your acupuncture and don’t abandon them altogether. Most experts agree that alternative medicine is best as a complement to modern medicine. There are even medical practices that work in conjunction with alternative practitioners. You might want to explore one of these if your current doctor is against alternative care. By the same token, if the acupuncturist urges you to leave your physician or stop taking medications, be wary.
• Discuss your expectations with the acupuncturist to find out when you should expect to see improvement. If you don’t get some relief after four to six treatments, re-evaluate the treatment and/or practitioner.
Conditions Commonly Treated By Acupuncture
• Back/Neck/Shoulder/Knee Pain
• Bladder/Kidney Problems
• Gynecological Disorders
• High Blood Pressure
• Sexual Dysfunction
• Drug Addiction/Smoking
• Vision Problems
Acupuncture Embraced by Drug Courts
Positive results in helping people recover from drug addiction may give acupuncture its firmest stamp of approval. For over 20 years, Lincoln Hospital in New York City, has been treating addicts with a combination of acupuncture and counseling. Over 60 percent of patients stay in the program for more than three months—an enviable record in a field where high drop out rates are the rule, especially since many are not seeking rehabilitation on their own but have been ordered to do so by a judge. Today, the Lincoln model is being used in more than 400 detoxification programs in the United States and Europe.
From New York to California, criminal justice officials are sending addicts for court-approved acupuncture treatments in an effort to stem exploding jail populations and the loss of money from addicts who get stuck in the system’s revolving door. In cities where these programs exist, people arrested for felony drug possession are given the choice of standing trial or going for drug treatment, which includes acupuncture. After such a program was used in Miami for two years, officials there reported that only three percent of the first-time offenders who went through the program were arrested in the year after they graduated (the usual rearrest rate is 40 to 60 percent).
An Oregon law mandates that no addict enter methadone treatment unless he has first tried acupuncture and counseling for a year and failed. The executive director of the National Association of Criminal Justice Planners says he has promoted drug court programs that feature acupuncture to association members.
Despite all this, critics claim enthusiasm for using acupuncture for drug and alcohol abusers lacks strong, scientific support. Proponents defend such protests by pointing to two preliminary studies. One in the British medical journal, The Lancet in 1989, suggests that acupuncture can help alcoholics quit. And the other one, performed at the Yale University School of Medicine, indicates cocaine addicts, too, are helped by acupuncture.
Furthermore, those who favor acupuncture for substance abuse, stress that the therapy is only part of the treatment picture. Acupuncture should be used to give physical relief from the cravings and withdrawal symptoms associated with quitting an addiction, thus allowing patients to concentrate on the critical counseling part of the program.