use in
medicine,
surgery, gynecology, pediatrics, ophthalmology, and skin diseases.
Also Included:
534 clinical
research
studies using acupuncture are described in great depth. Videos include
an acupuncture demonstration and a comprehensive lecture by Wei Liu,
Doctor of Chinese Medicine. Also included are body charts, a glossary
of acupuncture points, over 60 diagrams, tables relating to the study
of acupuncture, full-text search, annotations, bookmarking, and more.
There is scientific
agreement that an evidence-based medicine (EBM) framework should be
used to assess health outcomes and that systematic reviews with strict
protocols are essential. Organisations such as the Cochrane
Collaboration and Bandolier publish such reviews.
For the following
conditions, the Cochrane Collaboration concluded there is insufficient
evidence that acupuncture is beneficial, often because of the paucity
and poor quality of the research and that further research would be
needed to support claims for efficacy:
For headache, Cochrane
concluded that "(o)verall, the existing evidence supports the value of
acupuncture for the treatment of idiopathic headaches. However, the
quality and amount of evidence are not fully convincing. There is an
urgent need for well-planned, large-scale studies to assess the
effectiveness and cost-effectiveness of acupuncture under real-life
conditions.". Bandolier states: "There is no evidence from high quality
trials that acupuncture is effective for the treatment of migraine and
other forms of headache. The trials showing a significant benefit of
acupuncture were of dubious methodological quality. Overall, the trials
were of poor methodological quality."
For nausea and
vomiting: The Cochrane review on the use of the P6 acupoint for the
reduction of post-operative nausea and vomiting concluded that
"compared with anti emetic prophylaxis, P6 acupoint stimulation seems
to reduce the risk of nausea but not vomiting" . Bandolier said
“P6 acupressure in two studies showed 52% of patients with
control having a success, compared with 75% with P6 acupressure."and that one in five
adults, but not children showed reduction in early postoperative
nausea. A review published by the Scientific Review of Alternative
Medicine, however, disagreed.
According to Cochrane:
"Electroacupuncture is effective for first day vomiting after
chemotherapy, but trials considering modern antivomiting drugs are
needed.".
Bandolier also stated:
"There were no high quality trials of acupuncture for stroke that
showed that it was beneficial."
In practice, EBM does
not demand that doctors ignore research outside its "top-tier" criteria.
NIH consensus statement
In 1997, the National
Institutes of Health (NIH) issued a consensus statement on acupuncture
that concluded that
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 statement was not
a policy statement of the NIH but rather the assessment of a
panel whose impartiality has been questioned by members of the The
National Council Against Health Fraud (NCAHF).
The NIH consensus
statement said that
the
data in support of acupuncture are as strong as those for many accepted
Western medical therapies
and added that
there
is clear evidence that needle acupuncture is efficacious for adult
postoperative and chemotherapy nausea and vomiting and probably for the
nausea of pregnancy... There is reasonable evidence of efficacy for
postoperative dental pain... reasonable studies (although sometimes
only single studies) showing relief of pain with acupuncture on diverse
pain conditions such as menstrual cramps, tennis elbow, and
fibromyalgia...
The NIH consensus
statement summarized and made a prediction:
Acupuncture
as a therapeutic intervention is widely practiced in the United States.
While there have been many studies of its potential usefulness, many of
these studies provide equivocal results because of design, sample size,
and other factors. The issue is further complicated by inherent
difficulties in the use of appropriate controls, such as placebos and
sham acupuncture groups. However, promising results have emerged, for
example, showing efficacy of acupuncture in adult postoperative and
chemotherapy nausea and vomiting and in postoperative dental pain.
There are other situations such as addiction, stroke rehabilitation,
headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial
pain, osteoarthritis, low back pain, carpal tunnel syndrome, and
asthma, in which acupuncture may be useful as an adjunct treatment or
an acceptable alternative or be included in a comprehensive management
program. Further research is likely to uncover additional areas where
acupuncture interventions will be useful.
The NIH's National
Center For Complementary And Alternative Medicine continues to abide by
the recommendations of the NIH Consensus Statement.
American Medical
Association statement
In 1997, the following
statement was adopted as policy of the American Medical Association
(AMA) after a report on a number of alternative therapies including
acupuncture:
"There
is little evidence to confirm the safety or efficacy of most
alternative therapies. Much of the information currently known about
these therapies makes it clear that many have not been shown to be
efficacious. Well-designed, stringently controlled research should be
done to evaluate the efficacy of alternative therapies."
A note on scientific
methodology and acupuncture
One of the major
criticisms of studies which purport to find that acupuncture is
anything more than a placebo is that most such studies are not (in the
view of critics) properly conducted. Many are not double blinded and
are not randomised. However, double-blinding is not a trivial issue in
acupuncture: since acupuncture is a procedure and not a pill, it is
difficult to design studies in which the person providing treatment is
blinded as to the treatment being given. The same problem arises in
double-blinding procedures used in biomedicine, including virtually all
surgical procedures, dentistry, physical therapy, etc.; the NIH
Consensus Statement notes such issues with regard to sham acupuncture,
a technique often used in studies purporting to be double-blinded. See
also Criticism of evidence-based medicine. Tonelli, a prominent critic
of EBM, argues that complementary and alternative medicine (CAM) cannot
be EBM-based unless the definition of evidence is changed. Tonelli also
says "the methods of developing knowledge within CAM currently have
limitations and are subject to bias and varied interpretation. CAM must
develop and defend a rational and coherent method for assessing
causality and efficacy, though not necessarily one based on the results
of controlled clinical trials.".
Safety and risks
Because acupuncture
needles penetrate the skin, many forms of acupuncture are invasive
procedures, and therefore not without risk. However, injuries are rare
among patients treated by trained practitioners. Forms of acupuncture
such as the Japanese Tōyōhari
and Shōnishin
often use non-invasive techniques, in which specially-designed needles
are rubbed or pressed against the skin. These methods are common in
Japanese pediatric use.
Hematoma may result
from accidental puncture of any circulatory structure. Nerve injury can
result from the accidental puncture of any nerve. Brain damage or
stroke is possible with very deep needling at the base of the skull.
Also rare but possible is pneumothorax from deep needling into the
lung, and kidney damage from deep needling in the low back. Needling
over an occult sternal foramen (an undetectable hole in the breastbone
which can occur in up to 10% of people) may result in a potentially
fatal haemopericardium.
Certain acupuncture
points have been shown to stimulate the production of
adrenocorticotropic hormone (ACTH) and oxytocin; these points are
contraindicated for use on pregnant women to avoid inducing abortion or
harming the fetus.
The Parliamentary
Committee on the Health Care Complaints Commission in the Australian
state of New South Wales commissioned a report investigating
Traditional Chinese medicine practice. They recommended the
introduction of a government appointed registration board that would
regulate the profession by restricting use of the titles
"acupuncturist", "Chinese herbal medicine practitioner" and "Chinese
medicine practitioner". The aim of registration is to protect the
public from the risks of acupuncture by ensuring a high baseline level
of competency and education of registered acupuncturists, enforcing
guidelines regarding continuing professional education and
investigating complaints of practitioner conduct. The registration
board will hold more power than local councils in respect to enforcing
compliance with legal requirements and investigating and punishing
misconduct. Victoria is the only state of Australia with an operational
registration board. Currently acupuncturists in NSW are bound
by the guidelines in the Public Health (Skin Penetration) Regulation
2000 which is enforced at local council level. Other states of
Australia have their own skin penetration acts. The act describes
explicitly that single-use disposable needles should be used wherever
possible, and that a needle labelled as "single-use" should be disposed
of in a sharps container and never reused. Any other type of needle
that penetrates the skin should be appropriately sterilised (by
autoclave) before reuse.
The report noted that:
Environmental
Health Team leaders classified acupuncture as a high-risk area.
Procedures like bloodletting were being performed in one council area
using un-sterilised needles. Other breaches of a serious nature include
the re-use of single use needles.
and - - :The evidence
provided by City of Sydney Council concerning their results of their
regular hygiene inspections convinced the Committee that the public
would best be protected by leaving acupuncturists under local council
jurisdiction until the profession as a whole has been upgraded to
higher clinical and professional standards.
Dr Stephen Li, Senior
Vice President of the Australian Chinese Medical Association, in
supporting the recommendations of the report, said:
we
often have to deal with patients who develop very serious adverse side
effects because of TCM or other herbal medicine … most of
the complaints that we receive from the Chinese Australian community
are that they have been victimised, they have been ripped off by people
who claim to be TCM practitioners … Some of these patients
have terminal illnesses and they rip them off before they die.
The NIH consensus
panel said:
"Adverse side effects
of acupuncture are extremely low and often lower than conventional
treatments
and "the incidence of
adverse effects is substantially lower than that of many drugs or other
accepted medical procedures used for the same condition. For example,
musculoskeletal conditions, such as fibromyalgia, myofascial pain, and
tennis elbow... are conditions for which acupuncture may be beneficial.
These painful conditions are often treated with, among other things,
anti-inflammatory medications (aspirin, ibuprofen, etc.) or with
steroid injections. Both medical interventions have a potential for
deleterious side effects but are still widely used and are considered
acceptable treatments."
Needles that are not
properly sterilized can transfer diseases such as HIV and hepatitis.
Most acupuncturists in the USA use sterile one-time-use needles (rather
than resterilizing needles after use). In 1996, the FDA changed the
status of acupuncture needles from Class III to Class II medical
devices, meaning that needles are regarded as safe and effective when
used appropriately by licensed practitioners.
