Two Views on Acupuncture: NIH and SRAM
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NEWS AND COMMENT sensus Development Conference con- Two Views on Acupuncture: NIH and cluded that "[tjhere is sufficient evi- dence ... of acupuncture's value to SRAM Dispute Validity, Efficacy expand its use into conventional medi- cine and to encourage further studies of In November, the National Institutes of Health (NIH) issued a statement of a consensus- its physiology and clinical value." The development conference on acupuncture. The statement was widely reported in the news panel also suggested that the federal gov- media and generally interpreted as providing new scientific legitimacy to at least certain ernment and insurance companies aspects of acupuncture. Below we print the Conclusions and Recommendations section of expand coverage of acupuncture to the eighteen-page NIH report (the full report can be found on the World Wide Web at allow more people access to treatment. http:llconsensus.nih.gov) followed by a statement responding to it from the editors of the The NIH Consensus panel is the off- new Scientific Review of Alternative Medicine. spring of the NIH s Office of Alternative Medicine (OAM). The OAM was This is the Conclusions and Recom- plausible mechanisms for the therapeutic started by the NIH in 1992 to evaluate mendations section of the NIH Consensus effects of acupuncture is encouraging. alternative treatments and to provide Development Conference Statement, The introduction of acupuncture information on unconventional health- "Acupuncture," November 3-5, 1997: into the choice of treatment modalities care services. But since its formation, it that are readily available to the public is has come under harsh criticism for its Acupuncture as a therapeutic interven- in its early stages. Issues of training, bias. "The 'consensus' was a consensus of tion is widely practiced in the United licensure, and reimbursement remain to proponents, not a consensus of valid States. There have been many studies of be clarified. There is sufficient evidence, scientific opinion. The presentation of its potential usefulness. However, many however, of acupuncture's value to acupuncture for the conditions sug- of these studies provide equivocal results expand its use into conventional medi- gested by the conference is classic pseu¬ because of design, sample size, and other cine and to encourage further studies of doscience. It showed the promoters as factors. The issue is further complicated its physiology and clinical value. ideologically motivated instead of scien- by inherent difficulties in the use of tifically objective," says Sampson. appropriate controls, such as placebo What follows is the statement issued "It is outrageous to suggest that and sham acunpuncture groups. November 10 by the editors of the insurance premiums rise in order to However, promising results have Scientific Review of Alternative provide for acupuncture visits. These emerged, for example, efficacy of Medicine: conclusions do not fit with science, acupuncture in adult post-operative and rather they reflect the bias of the NIH chemotherapy nausea and vomiting and Scientists and Physicians Condemn panelists who were selected by a plan- in post-operative dental pain. There are NIH Endorsement of Acupuncture ning committee dominated by acupunc- other situations such as addiction, ture proponents," says Dr. Stephen stroke rehabilitation, headache, men- Leading physicians and scientists, all Barren, M.D., Contributing Editor to strual cramps, tennis elbow, fibromyal- editors of the Scientific Review of SRAM and head of Quackwatch, Inc. gia myofascial pain, osteoarthritis, low Alternative Medicine (SRAM), dispute Answers to the reported success of back pain, carpal tunnel syndrome, and the National Institutes of Health's acupuncture can be found in human asthma where acupuncture may be use- (NIH) endorsement of acupuncture as a psychology. "Perceived effects of acu- ful as an adjunct treatment or an accept- treatment for pain and other conditions. puncture are probably due to a combina- able alternative or be included in a com- "Acupuncture is an unproven treatment. tion of expectation, suggestion, counter- prehensive management program. The best studies of acupuncture show irritation, conditioning, and other psy- Further research is likely to uncover that it is no more effective than placebos chological mechanisms," says Barrett. additional areas where acupuncture (inactive treatments). The NIH panel The confounding influence of these psy- interventions will be useful. was conceived in all likelihood with an chological mechanism, creates a number of experimental difficulties in accurately Findings from basic research have agenda to promote the acceptance of evaluating acupuncture's effectiveness. begun to elucidate the mechanisms of acupuncture by the public, press, insur- Few studies have satisfied control action of acupuncture, including the ance plans, HMOs, and federal and requirements, leaving supportive scien- release of opioids and other peptides in state medical plans," says Dr. Wallace tific evidence insufficient or nonexistent. the central nervous system and the Sampson, M.D., Editor of SRAM and periphery and changes in neuroen- Clinical Professor of Medicine at "It is easy to reach a consensus when docrine function. Although much needs Stanford University. dissenters are systematically excluded to be accomplished, the emergence of On November 6, the NIH Con- from the discussion. At this point I SKEPTICAL INQUIRER March/April 1998 5 NEWS AND COMMENT would have to say that the consensus Scientist, November 15)- hypervelocity impacts into the Earth report is seriously flawed because con- "It was a conference of believers [who] and other planets, and have been instru- trary and cautionary voices were not recited their delusions as fact," said mental in other projects in the earth and heard," says Barry Beyerstein, Ph.D., Victor Herbert, professor of medicine at geophysical sciences. Sandia's workforce Professor of Psychology at Simon Fraser the Mount Sinai School of Medicine in of 7,540 includes 1,350 technical staff University, British Columbia. New York. He dismissed acupuncture as members with Ph.D.s. In addition to Traditionally acupuncture has been "pseudo-religious cultism" (Nature, their research, many Sandia scientists based on the premise that there are pat- November 13). have helped to advance science educa- terns of energy flow (Qi) through the The organizers of the conference nev- tion, including serving as part-time body that are essential for health. ertheless vigorously defended the panel "science advisors" in New Mexico Disruptions of this flow are believed to and the process as fair. schools. be responsible for disease. The acupunc- Sandia physicist Mark Boslough, one turist can supposedly correct imbalances To read the National Council Against of many Sandians who has promoted of flow at identifiable points close to the Health Fraud's position paper on acupunc- stronger science education standards for skin. However, despite considerable ture, visit the Web site for Quackwatch Inc. the state's schools, drafted a letter of efforts to understand the anatomy and at http:llunvw.quackwatch.com/acu.htmL response and circulated it to colleagues physiology of the "acupuncture points," For more information about the at Sandia. The letter was carefully the definition and characterization of Scientific Review of Alternative Medi- phrased to assert an unassailable pro- these points remains controversial. Even scientific position and narrowly focused more elusive is the scientific basis of cine call 1-800-421-0351 • not to raise side issues. On November some of the key traditional Eastern medical concepts such as the circulation 26, their letter appeared in the of Qi, the meridian system, and the five 32 Sandia Scientists Sign Albuquerque Journal. It was signed by phases theory, which are difficult to rec- Statement on Validity of thirty-two Sandia scientists, including oncile widi contemporary biomedical Boslough and Rick Buss, a principal information but continue to play an Earth Dating member of rhe technical staff. important role in the evaluation of Consensus at Sandia Behind patients and the formulation of treat- Scientists' sensitivities were rubbed par- Radiometrics ment in acupuncture. ticularly raw when a reader, steeped in creationism and upset about an earlier Re: "Geological Clues or Red Concludes Sampson: "The report article by Albuquerque Journal science Herring?" letter by John Woffard— states that '[t]he data in support of reporter John Fleck ("N.M.'s Rocks acupuncture are as strong as those for Hold Clues to Earth's Age"), published a Woffard incorrectly stated that many accepted Western [. .] medical critical letter to the editor in the news- many of the top scientists at Sandia therapies.' The 'consensus' stretches the Labs agree with Bishop Ussher's 17th paper's November 3 issue. Referring to century proclamation that the Earth point to unacceptable conclusion. When Bishop Ussher's proclamation that the is approximately 6,000 years old. consensus conferences are held at the Earth was six thousand years old, the let- On the contrary, Sandia has con- NIH on controversial methods with as ter writer asserted that "many top scien- tributed to (he body of modem little evidence for them that acupuncture tists agree with Ussher, including many research that supports the Earth's true has, the usual scientific response is to of the top scientists at Sandia Labs." age of about 4.5 billion years. Some recommend against use