Two views on acupuncture: NIH and SRAM dispute validity, efficacy – National Institutes of Health; Scientific Review of Alternative Medicine
In November, the National Institutes of Health (NIH) issued a statement of a consensus-development conference on acupuncture. The statement was widely reported in the news media and generally interpreted as providing new scientific legitimacy to at least certain aspects of acupuncture. Below we print the Conclusions and Recommendations section of the eighteen-page NIH report (the full report can be found on the World Wide Web at http://consensus.nih.gov) followed by a statement responding to it from the editors of the new Scientific Review of Alternative Medicine.
This is the Conclusions and Recommendations section of the NIH Consensus Development Conference Statement, “Acupuncture, “November 3-5, 1997:
Acupuncture as a therapeutic intervention is widely practiced in the United States. There have been many studies of its potential usefulness. However, 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 placebo and sham acunpuncture groups.
However, promising results have emerged, for example, efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in post-operative 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 where 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.
Findings from basic research have begun to elucidate the mechanisms of action of acupuncture, including the release of opioids and other peptides in the central nervous system and the periphery and changes in neuroendocrine function. Although much needs to be accomplished, the emergence of plausible mechanisms for the therapeutic effects of acupuncture is encouraging.
The introduction of acupuncture into the choice of treatment modalities that are readily available to the public is in its early stages. Issues of training, licensure, and reimbursement remain to be clarified. There is sufficient evidence, however, of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.
What follows is the statement issued November 10 by the editors of the Scientific Review of Alternative Medicine:
Scientists and Physicians Condemn NIH Endorsement of Acupuncture
Leading physicians and scientists, all editors of the Scientific Review of Alternative Medicine (SRAM), dispute the National Institutes of Health’s (NIH) endorsement of acupuncture as a treatment for pain and other conditions. “Acupuncture is an unproven treatment. The best studies of acupuncture show that it is no more effective than placebos (inactive treatments). The NIH panel was conceived in all likelihood with an agenda to promote the acceptance of acupuncture by the public, press, insurance plans, HMOs, and federal and state medical plans,” says Dr. Wallace Sampson, M.D., Editor of SRAM and Clinical Professor of Medicine at Stanford University.
On November 6, the NIH Consensus Development Conference concluded that “[t]here 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 panel also suggested that the federal government and insurance companies expand coverage of acupuncture to allow more people access to treatment.
The NIH Consensus panel is the offspring of the NIH’s Office of Alternative Medicine (OAM). The OAM was started by the NIH in 1992 to evaluate alternative treatments and to provide information on unconventional healthcare services. But since its formation, it has come under harsh criticism for its bias. “The ‘consensus’ was a consensus of proponents, not a consensus of valid scientific opinion. The presentation of acupuncture for the conditions suggested by the conference is classic pseudoscience. It showed the promoters as ideologically motivated instead of scientifically objective,” says Sampson.
“It is outrageous to suggest that insurance premiums rise in order to provide for acupuncture visits. These conclusions do not fit with science, rather they reflect the bias of the NIH panelists who were selected by a planning committee dominated by acupuncture proponents,” says Dr. Stephen Barrett, M.D., Contributing Editor to SRAM and head of Quackwatch, Inc.
Answers to the reported success of acupuncture can be found in human psychology. “Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counterirritation, conditioning, and other psychological mechanisms,” says Barrett. The confounding influence of these psychological mechanism, creates a number of experimental difficulties in accurately evaluating acupuncture’s effectiveness. Few studies have satisfied control requirements, leaving supportive scientific evidence insufficient or nonexistent.
“It is easy to reach a consensus when dissenters are systematically excluded from the discussion. At this point I would have to say that the consensus report is seriously flawed because contrary and cautionary voices were not heard,” says Barry Beyerstein, Ph.D., Professor of Psychology at Simon Fraser University, British Columbia.
Traditionally acupuncture has been based on the premise that there are patterns of energy flow (Qi) through the body that are essential for health. Disruptions of this flow are believed to be responsible for disease. The acupuncturist can supposedly correct imbalances of flow at identifiable points close to the skin. However, despite considerable efforts to understand the anatomy and physiology of the “acupuncture points,” the definition and characterization of these points remains controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and the five phases theory, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture.
Concludes Sampson: “The report states that ‘[t]he data in support of acupuncture are as strong as those for many accepted Western [. . .] medical therapies.’ The ‘consensus’ stretches the point to unacceptable conclusion. When consensus conferences are held at the NIH on controversial methods with as little evidence for them that acupuncture has, the usual scientific response is to recommend against use of those methods, not to approve and adopt them.”
Those weren’t the only criticisms. “There really aren’t any good studies,” said John Loeser, director of the Multidisciplinary Pain Center at the University of Washington at Seattle. Allan Basbaum, a pain researcher at the University of California at San Francisco agreed: “I don’t find the evidence compelling that it’s any different than a placebo” (New Scientist, November 15).
“It was a conference of believers [who] recited their delusions as fact,” said Victor Herbert, professor of medicine at the Mount Sinai School of Medicine in New York. He dismissed acupuncture as “pseudo-religious cultism” (Nature, November 13).
The organizers of the conference nevertheless vigorously defended the panel and the process as fair.
To read the National Council Against Health Fraud’s position paper on acupuncture, visit the Web site for Quackwatch Inc. at http://www.quackwatch.com/acu.html.
For more information about the Scientific Review of Alternative Medicine call 1-800-421-0351.
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