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Acupuncture Moves Toward the Mainstream

NYTimes, September 28, 2004
By ANAHAD O'CONNOR

Three years ago, Alfred Szymanski could not seem to get his blood pressure under control. He ran 10 miles a week, stuck to a healthy diet and was on a hypertension medication, all to no avail. His doctor suggested switching medications, but Mr. Szymanski, wary of side effects, decided to try something he had always wondered about: acupuncture.

After three 20-minute sessions, each covered by his medical plan, his blood pressure plunged 20 points.

"Every time I left I was so relaxed; it was like euphoria," said Mr. Szymanski, 61, who lives in New York. "My blood pressure stayed down for quite a while."

Acupuncture, long shunned by mainstream medicine but for centuries considered the crown jewel of alternative therapy, is slowly gaining ground in doctors' offices around the country. While some experts still question its effectiveness, studies in recent years - including one at Duke last week - have thrown scientific weight behind its benefits, supporting its usefulness in alleviating conditions from morning sickness to carpal tunnel syndrome.

In the past few years, the number of hospitals offering acupuncture and other alternative therapies has doubled. At the same time, postgraduate training programs in alternative medicine have sprung up at universities around the country, most recently at Harvard and the University of San Francisco.

"There's a greater demand for these programs now because so many physicians are interested in learning acupuncture," said Dr. Nader E. Soliman, an anesthesiologist in Rockville, Md., and president of the American Academy of Medical Acupuncture. "A lot of physicians who used to be extremely reluctant to refer patients for the treatment are now doing it regularly."

Patients curious about alternative medicine and increasingly skeptical of the drug industry are also seeking out the procedure, experts say.

A visit to an acupuncturist can cost $50 to $100. For people working at the right companies, however, it runs a lot less. More and more employers looking for low-cost additions to medical plans are embracing the treatment. Nearly 50 percent of workers with benefits received coverage for it in 2004, compared with just over 30 percent two years ago, according to a survey this month by the Kaiser Family Foundation and Health Research and Educational Trust.

The trend, it seems, is not limited to humans. In a society of people attached to their pets, it may be no surprise that veterinarians around the country say they are also seeing a greater demand for the service. Dr. Barbara Royal, a vet in private practice in Chicago, says she has been fully booked virtually since the day she received her acupuncture license eight years ago. "People were desperate for it," she said.

Dr. Royal uses the technique mostly on cats and dogs hobbled by arthritis, but recently she has been summoned to treat more exotic animals. At Brookfield Zoo in Chicago, she regularly uses acupuncture to alleviate arthritis in a 1,600-pound Bactrian camel, now able to run again for the first time in years.

"I think the trend in animals is correlating with what's happening in humans," she said. "There's a holistic movement out there, and if people have found something that works for them, they want it for their pets, too."

But as acupuncture slowly blends into the mainstream, some experts are calling for tighter regulation. Dr. Joseph J. Fins, a member of the White House Commission on Complementary and Alternative Medicine Policy two years ago, said that while acupuncture was relatively safe and effective, there was no system for tracking harmful side effects. Without closer monitoring, he said, a careless acupuncturist who reuses needles that become infected with hepatitis, for example, might easily go unnoticed.

"Because of how many people are using it, it's important that we have some kind of surveillance system in place," said Dr. Fins, who is chief of the division of medical ethics at Weill Medical College of Cornell University in New York City. "There's no real mechanism to collect information about the safety and efficacy of these treatments. It's the same problem with over-the-counter supplements."

Experts say that a vast number of alternative therapies, like oil drips and aromatherapy, have little scientific base or have yet to be studied properly. But government financed research on acupuncture dates from the 1970's, about the time the treatment first started gaining popularity in the United States. It originated in China over 2,000 years ago.

"Of the many different alternative therapies, this was really the first one to be studied seriously by the National Institutes of Health," said Dr. Richard Nahin, senior adviser for scientific coordination and outreach at the National Center for Complementary and Alternative Medicine in Bethesda, Md.

Some of the results of the decades of research on acupuncture have been ambiguous. Because it involves inserting needles into the skin, creating the equivalent of placebo pills for control groups in some studies can be complicated, experts say. And, in some cases, acupuncture has been shown to help ease certain conditions - like drug addiction - when combined with other treatments, but not necessarily when used alone.

For other ailments, however, acupuncture has been found to work better than standard medications - and without side effects. It has been widely used for years to ease chronic pain conditions, and studies have repeatedly endorsed its usefulness.

Last week, researchers at Duke showed that it was far more effective for postoperative sickness and vomiting in a group of subjects than Zofran, a widely used antinausea drug. Roughly a quarter of all people who undergo major surgery in the United States experience retching and illness afterward, usually brought on by anesthesia. Antinausea medications offer relief, but because they sometimes cause severe headaches and cramps a number of patients are reluctant to take them, said Dr. Tong J. Gan, an author of the new study, published in the journal Anesthesia & Analgesia.

Dr. Gan's study looked at a group of 75 women who were either given Zofran before major breast surgery or hooked up to an electroacupuncture machine that delivered low doses of current during the operation. The high-tech acupuncture technique prevented illness in all but 27 percent of those who received it, while about half of the women given the antinausea drug complained of sickness the next day. The rate of sickness in a control group that received neither treatment was about 60 percent.

"This is sort of an interesting time right now," Dr. Gan said. "We are seeing more and more evidence suggesting that alternative therapies are beneficial, and patients are gradually demanding it."

To some extent, the increased acceptance of acupuncture reflects a growing understanding of its biological mechanism, Dr. Gan said, which until now has largely been a mystery. Research suggests that stimulating acupuncture points somehow prompts the flow of endorphins and other hormones that soothe pain. Other studies find that it affects parts of the central nervous system that mediate blood pressure and body temperature, among other things.

Dr. Nahin said several imaging studies that can shed light on how the treatment influences brain activity are under way.

But whatever acupuncture's underlying effects turn out to be, experts say its gradual merger with conventional medicine will have broad implications, eventually opening the door to closer examination of other popular therapies that lie outside the mainstream.

"Until now, we've had very little in the way of credible scientific evidence to compare Eastern or traditional medicine to a pharmaceutical approach," said Dr. Steven Eubanks, chairman of the department of surgery at the University of Missouri. "Hopefully, this will add to our willingness to evaluate other alternative therapies, and to do so with our usual scientific scrutiny."