ISSN 10471979, International Journal of Clinical Acupuncture, 2015, Vol. 24, No. 3, pp. 149–155. © Allerton Press, Inc., 2015. ACUFORUM Acupuncture Storms JAMA Changzhen Gong American Academy of Acupuncture and Oriental Medicine 1925 West County Road B2, Roseville, MN 55113 email: [email protected] Received August 22, 2015 DOI: 10.3103/S1047197915030035 INTRODUCTION The energy flow through acupuncture meridians has never been successfully attributed to physiological Acupuncture has had a dynamic—even controver structures, leading to doubt as to the validity of merid sial—history over the last fifty years since scientific ians and qi flow. The publication of BongHan Kim’s research methodology started to scrutinize its under findings created a sensation in China. Doctors of tra lining mechanism and clinical effectiveness. This arti ditional Chinese medicine and Western medicine cle starts an early example of disputed claims in China quickly organized a visit to Dr. Kim in North Korea to and Korea; mentions modern applications of acu verify his astounding results. Unfortunately, Dr. Kim’s puncture therapy which have generated debate, and claims and findings couldn’t be reproduced, and he examines in detail the recent highprofile academia committed suicide in the aftermath of this debacle, and media storm triggered by the publication of the which became the most dramatic event in acupunc Hinman paper in the Journal of the American Medical ture research history [5]. Association (JAMA) [1]. Throughout the 1970’s, leading physicians, health Strictly modern applications of acupuncture may advocates and published research increased awareness be said to have begun in 1958, when Chinese surgeons of the various medical applications of acupuncture discovered that acupuncture anesthesia could be either and traditional Chinese medicine. Dr. H. L. Wen, a substituted or administered in conjunction with anes Hong Kong neurosurgeon, is credited with the appli thetic pharmaceuticals during surgical procedures [2]. cation of acupuncture to addiction issues due to a ser This news was widely disseminated in the Chinese endipitous observation he made in 1972. Dr. Wen’s media, as well as through scientific research journals, groundbreaking work [6] on acupuncture for addic fueling a surge of both professional and popular inter tions was introduced to America for chemical depen est. In fact, it was acupuncture analgesia/anesthesia dency and substance abuse problems. Ultimately, over which brought the ancient therapeutic technique of 2000 chemical dependency programs were established acupuncture to the attention of the American public in across the United States: thousands of Americans have 1971, when New York Times journalist James Reston been treated for alcoholism, smoking cessation, drug published an article about his personal experience in a addictions and other substance abuse with acupunc Chinese hospital following an appendicitis attack [3]. ture [7]. From the 1960's many Asian scientists were In 2002, German clinicians and researchers8 found engaged in efforts to find a physiological basis for the compelling evidence that acupuncture could increase acupuncture meridian system. BongHan Kim, a sur the pregnancy rate of women who received in vitro fer geon educated at Seoul National University identified tilization (IVF). This discovery opened another new what he called the Kyungrak system. As a professor at frontier for integrative acupuncture medicine. Due to the Pyung Yang Medical School in North Korea, the indisputable increased success ratio for IVF Dr. Kim mapped out an intricate network of anatomi implants which incorporate acupuncture, fertility cal structures within the skin, vascular and organ sys clinics around the world have adopted the use of pre tems that he associated with the energetic acupuncture and postIVF acupuncture treatments. meridian system. He suggested these previously uni Since 1958, the application of acupuncture to dentified structures represented an anatomical basis anesthesia, fertility and chemical dependency has for the acupuncture meridians [4]. sparked controversy, as well as inspiring further Dr. Kim’s research was groundbreaking, as much research studies. The validity, effectiveness and scope of the resistance to the acceptance of acupuncture the of use of acupuncture have drawn both supportive and ory and practice stem from the invisible nature of the oppositional debate from scientists, medical doctors, body’s energy system expressed as meridian and qi. acupuncture practitioners, patients, and the general 149 150 CHANGZHEN GONG public. A recent example of the sort of passionate McMaster (WOMAC) Universities Osteoarthritis debate which acupuncture research can generate is Index subscale. Secondary outcomes included quality centered around the Hinman Paper, which is exam of life, global rating of change scores and additional ined in detail, below. (The clinical trial by Hinman, measures of pain (other NRS and WOMAC subscale) et al. [1] will be referred to as the “Hinman Paper,” or and physical function measures (NRS). Followup “Hinman Study” throughout this article). assessments were conducted after one year. Relative costeffectiveness was determined by health service usage and outcome data. The statistics gathered were THE HINMAN PAPER to be used to determine the efficaciousness and cost In October 2014, Hinman, et al. [1] published the effectiveness of laser and/or needle acupuncture in the results of a clinical trial in the Journal of the American management of chronic knee pain, specifically in peo Medical Association (JAMA), claiming that their find ple over 50 years old. ings do not support the use of acupuncture therapy for In 2014, Hinman, et al. [1] completed their clinical patients older than 50 years who have moderate or trial and published their study. Study participants and severe chronic knee pain. These findings were imme familyphysician acupuncturists were blinded to laser diately disputed by clinical acupuncturists, whose and sham laser acupuncture. Patients in the control experience supports the effectiveness of acupuncture group were unaware of the trial. Analysis was by inten in kneepain patients of all ages. The attention gener tiontotreat using multiple imputation for missing ated by this article has opened a dialogue between acu outcome data. Dropout rates were assessed: 26 par puncture supporters and detractors, and has raised ticipants had discontinued by week 12 (9%), and 50 meaningful questions about how to effectively assess participants had discontinued by the end of the first the benefits of acupuncture. year, (18%). Results showed that neither needle nor laser acupuncture significantly improved pain (mean The clinical trial by Hinman, et al. [1]originated in difference; –0.4 units; 95% CI, –1.2 to 0.4, and –0.1; 2009, when the authors registered their proposal with 95% CI, –0.9 to 0.7, respectively) or function (–1.7; the Australia/New Zealand Clinical Trials Registry. 95% CI, –6.1 to 2.6, and 0.5; 95% CI, –3.4 to 4.4, The trial started in 2010, data collection was com respectively) compared with sham at 12 weeks. The pleted in 2012, and the results were published in Octo study showed that needle and laser acupuncture ber, 2014. resulted in modest improvements in pain (–1.1; 95% In 2012, Hinman, et al. [9] published their prag CI, –1.8 to –0.4, and –0.8; 95% CI, –1.5 to –0.1, matic Zelendesign randomized controlled trial pro respectively) at 12 weeks, but not at 1 year, compared tocol in BMC Complementary and Alternative Medi with control. The study also showed needle acupunc cine, the official journal of the International Society ture resulted in modest improvement in function com for Complementary Medicine Research. Zelen pared with control at 12 weeks (–3.9; 95% CI, –7.7 to design allows for randomization to take place before –0.2), however, was not significantly different from informed consent. The purpose of the study was to sham (–1.7; 95% CI, –6.1 to 2.6) and was not main investigate both the efficacy and costeffectiveness of tained at 1 year. No differences for most secondary both needle and laser acupuncture for chronic knee outcomes and no serious adverse events occurred in pain in patients over 50 years of age. The study was the study. The study concluded that neither laser nor administered by medical practitioners. needle acupuncture conferred benefit over sham for The study recruited 282 community volunteers pain or function in patients older than 50 years who aged over 50 years with chronic knee pain from metro have moderate or severe chronic knee pain. politan Melbourne and regional Victoria, Australia. The Hinman Study [1] was conducted in the Cen Participants originally consented to participate in a tre for Health, Exercise and Sports Medicine, Depart longitudinal natural history study but were then covertly ment of Physiotherapy, School of Health Sciences, randomized into one of four groups. Participants were Faculty of Medicine Dentistry & Health Sciences, the divided thusly: control (71 patients), acupuncture University of Melbourne, VIC, Australia and pub (70 patients), laser acupuncture (71 patients), and sham lished in JAMA. Funding was provided by the National acupuncture (70 patients). Acupuncture treatments Health and Medical Research Council in Australia. were performed with a combined Western and Tradi tional Chinese Medicine style were delivered by gen eral practitioners. Participants received 8–12 visits PUBLIC REACTIONS AND MEDICAL over a consecutive