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U.S. News & World Report Stacey Schultz
12-18-2000
There is nothing New Age about the Lincoln Hospital Recovery Center in New York's South Bronx. Broken glass glitters outside the main entrance, where drug-addicted men and women wait in line for the clinic to open at 7:30 a.m. Inside, the decor is institutional drab. Yet the treatment of choice might seem more at home among the hot tubs of Marin County: a set of small acupuncture needles in each ear. Psychiatrist Michael Smith, who runs the clinic, says acupuncture helps addicts overcome their cravings. "It has a relaxing effect," he says. "The person feels comfortable, more able to listen and cope."
Acupuncture is no longer just an upscale alternative treatment. It is turning up in drug-abuse centers--over 700 of them nationwide-- dental clinics, cancer centers, and gynecologists' offices. Millions have tried it to relieve hard-to-treat conditions such as pain, headaches, nausea, and addictions like smoking. The National Institutes of Health estimates that as of 1996, 70 percent to 80 percent of insurers covered at least some of the costs. Even some doctors, who are typically wary of alternative medicine, are learning the ancient Chinese technique. The American Academy of Medical Acupuncture (AAMA), an organization of doctors with acupuncture training, has more than doubled its membership since 1995 to over 2,000.
Yet while some doctors have become converts because they see real benefits in their patients, many remain deeply skeptical, saying there' s little scientific evidence about how acupuncture might work--or whether it really is effective. "You could throw away 95 percent of the studies," says David Mayer, a professor of anesthesiology at the Medical College of Virginia in Richmond, "because they are all so poorly designed." But that may be changing. One study, published last week in the Journal of the American Medical Association, showed measurable benefits in women nauseated from chemotherapy; the other, in the August Archives of Internal Medicine, presented evidence that acupuncture blunts cravings among cocaine addicts. Meanwhile, other research is unmasking how the treatment might affect the brain. The findings are moving acupuncture much closer to the mainstream. But so far, the studies show it works best as an adjunct to conventional therapy-- not as a substitute.
Pins and needles. In 1997, the latest year for which numbers are available, acupuncture visits exceeded 5 million, mostly for muscle and joint pain. In multiple sessions over a few weeks or months, a practitioner typically inserts hair-thin needles to a depth of less than an inch at prescribed points on the body--and sometimes just on the ear. The needles, which can be twirled or attached to electrical stimulators, are left in for about 20 minutes. A treatment may cost $100 or more.
For some people, the effects can be dramatic. Juan Londono, 68, who monitors substance abuse for the Harris County Health Department in Texas, had recurring lower-back problems. One bout "was so bad I felt suicidal," he says. His wife encouraged him to try acupuncture, and "by the end of the week, I could do almost everything." Not everyone gets that kind of relief. Dan Kent, a 31-year old data manager in Portland, Ore., suffers from a herniated disk in his lower back. Acupuncture treatments over the past few months have given him "partial relief, " he says. "It isn't groundbreaking."
Why does acupuncture work for some and not others? Traditional Chinese accounts say acupuncture aids the flow of energy, called qi (pronounced chee), along pathways in the body. Barry Beyerstein, a professor of psychology at Simon Fraser University in Burnaby, British Columbia, dismisses that as "ancient nonsense," and many doctors agree. Until recently, they tended to credit any benefits to the power of suggestion--the so-called placebo effect. Acupuncture treatments involve invasive needles, long sessions with a practitioner, and an aura of exoticism--all likely to provoke a strong placebo response. Last week' s JAMA article, however, suggests that more is going on. The researchers studied 104 breast-cancer patients who were undergoing chemotherapy. Some were given standard antinausea medication; others got the drugs plus either electrically stimulated acupuncture or a "sham" treatment on acupuncture points that aren't meant to treat nausea. The sham group had fewer vomiting episodes than those who received no acupuncture at all--a placebo effect. But those who got electroacupuncture did better still, implying a real physical benefit.
Natural painkillers. Brain studies are beginning to show what that might be. One mapped brain activity with functional MRI and found that stimulating an acupuncture point on the little toe, used for eye disorders, triggers activity in the brain's visual cortex. "There is no question it is working through the nervous system," says Zang- Hee Cho, the study author and a radiologist at the University of California- Irvine. Other research suggests that acupuncture may trigger the release of endorphins, the body's natural painkillers, and other brain chemicals. That effect might explain how acupuncture fights nausea, say researchers in the JAMA chemotherapy trial. And Arthur Margolin of Yale University School of Medicine, an author of the August addiction study, says acupuncture activates the "parasympathetic" part of the nervous system, which has a calming effect that reduces cravings.
The new work is swaying some doubters. "I'm willing to concede that acupuncture is more than a placebo," Beyerstein says. Yet while it may offer real benefits for pain, nausea, and addiction, practitioners also tout it for many other conditions where studies are just beginning, including depression, carpal tunnel syndrome, and menopausal symptoms. "The claims are greatly overblown and oversold," says Beyerstein.
Still, most experts agree that acupuncture is safe when provided by a certified practitioner. Referrals can be found at www.nccaom.org, the Web site of the National Certification Commission for Acupuncture and Oriental Medicine, or through the AAMA, at 800-521-2262 and medicalacupuncture.org.
If you choose acupuncture, have a doctor, not an acupuncturist, diagnose your condition, and stay under a doctor's care while receiving treatments. Even Michael Smith, who is certain that acupuncture has benefited the addicts he works with, advises caution. "As a magic bullet," he says, "acupuncture is not much good."