How has the practice of acupuncture in this country evolved?
Acupuncture [is] a very good illustration of the potential of alternative medicine. When I was in medical school Nixon went to China and James Reston wrote about his experience with acupuncture. What had seemed bizarre and arcane suddenly became fashionable in a country that once again was interested in things Asian...Today, forty years later, acupuncturists practice in every major medical center in every state and in every strip mall throughout the country.
Americans are fascinated by acupuncture, millions have had acupuncture, and many individuals think it works. Now, what happened in those thirty years? Part of it is a cultural and social phenomenon, part of it has to do with the fact that the community of acupuncturists were aggressive and seeded themselves throughout the country. Part of it had to do with huge immigration waves from Asia that brought those techniques as well as the acceptance of those techniques.
But two other very important things happened...There was decent evidence emerging that it was useful for some indications, and there were data suggesting how it works. Starting in the 1970s, scientists in China and elsewhere began to show that acupuncture activates certain parts of the nervous system and engages processes that can relieve pain the same way that morphine relieves pain. So if you understand the mechanism and you have some evidence that it works, it becomes a lot easier to accept it as a rational alternative to other approaches.
What do the data say about the benefits of acupuncture?
There are thousands of publications; most of them are not worth their salt. Many are decent studies, but they're small. There are few large studies and we today at the National Center for Complementary and Alternative Medicine are funding the largest ever studies of acupuncture.
We do not yet know whether it is better than conventional non-steroidal anti-inflammatory drugs for the pain of degenerative arthritis. That's a common use, and we don't know. There was enough data to suggest that it was a worthwhile investment. The study at the University of Maryland is enrolling hundreds of aging Americans who have degenerative painful arthritis in the knee and asking whether acupuncture is successful in relieving them of that pain.
Why is there reasonable data that acupuncture is good for dental extractions, but not for degenerative arthritis of the knee? It's because dental extractions are common, it's a very good model to study acute, temporary pain. It's sometimes harder to intervene effectively in chronic pain, so in research you'll often study that from which you can get the best answers. It's not that dental pain is as important a public health problem as arthritis.
When it comes to acupuncture, physicians today struggle to provide comfort for their patients...Now, acupuncture makes sense for pain, because there's a great deal of data saying that it's beneficial for pain. We just don't have data saying it's as good as our other treatments or that it's better than our other treatments or it's more cost-effective than our other treatments.
But for a given individual who is struggling with pain, and you want comfort for that person, acupuncture is practiced widely, there are standardized needles, there's reasonable agreement on approaches for certain uses of acupuncture, and there's reasonable data for certain uses and we have reasonable explanations of how it works. That's enough for physicians to recommend it. It's not enough for physicians to say, "I'm going to use it to treat your lung cancer, I'm going to use it to treat your brain tumor."