MN_HF_286_Support Letter_DN_MT Revised
March 20, 2009
Re: HF 286
Health Care and Human Services Policy Committee
Chair: Rep. Paul Thissen
351 State Office Building
St. Paul, MN 55155
Dear Representative Thissen:
As legal counsel for the American Association of Acupuncture and Oriental Medicine (AAAOM) please accept this letter of support for HF 286, commonly cited and hereafter referred to as the Equal Access to Acupuncture Act.
The AAAOM was founded in 1981 as the unifying force for American acupuncturists committed to high ethical and educational standards and a well-regulated profession to ensure the safety of the public. As the sole national professional acupuncture and Oriental medicine (AOM) association, its mission statement is "To promote excellence and integrity in the professional practice of acupuncture and Oriental medicine in order to enhance public health and well-being."
For the past fourteen years I have served as counsel, educator, and advocate for AOM. In my capacity as chair of the National Certification Commission for Acupuncture and Oriental Medicine’s Professional Ethics and Disciplinary Committee, I co-wrote the Code of Ethics and Grounds for Professional Discipline, and I personally oversee the adjudication of the majority of AOM professional disciplinary actions filed in the U.S. My expertise in AOM statutory and case law, ethics, and liability is extensive, and accordingly I hereby respectfully ask for your consideration of my following counsel with respect to the Equal Access to Acupuncture Act:
The reasons for this conclusion are summarized as follows:
- Empirical data and research for AOM is conclusive as to its health benefits
- Presently there are nearly 26,000 licensed acupuncture practitioners in 42 states and the District of Columbia. Acupuncture offers a minimally invasive option for many conditions, including chronic. It has little to no negative interaction with concurrent prescription drugs and no serious side effects. It can simultaneously alleviate symptoms while decreasing the need for prescription drugs, thus reducing costly hospital stays. As acupuncture has become part of the medical landscape, it has been scrutinized more than any other CAM therapy. "Numerous surveys show that, of all the complementary medical systems, acupuncture enjoys the most credibility in the medical community. It (acupuncture) is being acknowledged broadly by the medical profession, seen with the advent of certification licenses for medical doctors, including neurologists, anesthesiologists, and specialists in physical medicine." (NCCAM 2007; NIH, 1997; Kaptchuk, 2002) Acupuncturists are highly-trained and skilled independent health care providers
- Without equal access to AOM the citizens of Minnesota will be unduly denied access to affordable, preventative, effective primary care
- The Equal Access to Acupuncture Act is supported by the exemplary safety track record of licensed acupuncturists, particularly in comparison to licensed physicians
Studies have proven that acupuncture is safe when administered by a licensed professional who has training in anatomy and who has the skill set required for needling. The ratio of treatments to adverse incidents is statistically extremely low. For instance, the York Study included 574 acupuncturists giving 34,407 treatments, with 43 minor adverse effects. The majority of these were a mild bruising or bleeding at the needled site. Two point eight percent of patients reported a temporary worsening of symptoms following treatment, but 86% of this same group had improvement after the initial aggravation. In general, the most commonly reported reactions consisted of patients feeling either more relaxed or more energized, indicating an overall positive response to the experience. Another study of 31,822 treatments reported that of the 48 reported minor incidents, none was serious, and 70% of the cases showed improvement of conditions following treatment. (McPherson, et al. 2001; White, et al. 2001) This is in stark contrast to the number of side effects often occurring with medications. Acupuncture should be considered as a useful, low-cost intervention to treat chronic as well as acute conditions.
It should also be noted that the percentage of misconduct complaints and filed lawsuits against the 26,000+ licensed acupuncturists in the U.S. is extremely low when compared with other health care providers. The past thirty-five years of data overwhelmingly shows that the quality of care offered by an acupuncturist is both safe and effective.
I thank you for your time and for your support for the Equal Access to Acupuncture Act (HB 458) in light of the above facts. Enclosed please find citations for the information contained herein, as well as additional references and clinical trial studies for your review. Please let me know if you would like additional background information on the field of AOM in the United States, including safety, efficacy, and cost efficiency studies.
Finally, I would welcome the opportunity to speak with you or your colleagues about this important matter in greater detail. You may contact me directly at 201-638-3344 or at michaeltaromina@yahoo.com.
Respectfully submitted,
Michael Taromina, Esq.
AAAOM Legal Counsel
AAAOM Public Board Member (Alt.)
References:
Astin JA, Marie A, Pelletier KR, Hansen E, Haskell WL (1998). A review of the incorporation of complementary and alternative medicine by mainstream physicians. Archives of Internal Medicine, I58: 2303-10
Audette JF, Ryan AH (2004): The role of acupuncture in pain management. Phys Med Rehab Clin N Am 15 (4), 749-772
Ballegaard S, Johannessen A, Karpatschof B, Nyboe J, (1999): Addition of acupuncture and self-care education in the treatment of patients with severe angina pectoris may be cost beneficial: an open, prospective study. Journal of Alternative and Complementary Medicine, 5(5):405-13. Retrieved 1/9/09 from PubMed: http://www.ncbi.nlm.nih.gov/sites/entrez
Barnes PM, Powell-Griner E, McFann K, Nahin RL. (2004) Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report #343.
Berman, BM, Lao L, Langenberg P, Lee WL, et al. (2004): Effectiveness of Acupuncture as Adjunctive Therapy in Osteoathritis of the Knee: a Randomized, Controlled Trial. Annals of Internal Medicine, 141 (12), 901-910
Ceccherelli F, Gagliardi G, Ruzzante L, Giron G (2002): Acupuncture modulation of capsaicin-induced inflammation: effect of intraperitoneal and local administration of naloxone in rats. A blinded controlled study. The Journal of Alternative and Complementary Medicine, 8 (3), 341-349
Community Acupuncture Network. Retrieved 12/19/08: http://www.communityacupuncturenetwork.org/
Consortium of Academic health Centers for Integrative Medicine. Retrieved 7/15/07: http://www.imconsortium.org/cahcim/home.html
Center for Disease Control website (2007). Retrieved 7/11/2007: http://www.cdc.gov/nchs/nhis.htm
Center for Disease Control website (2008). Retrieved 12/19/08: http://www.cdc.gov/nchs/about/major/nhis/released200812.htm
Dhond, RP, Kettner N, and Napadow V, Neuroimaging acupuncture effects in the human brain. J Altern Complement Med, 2007. 13(6): p. 603-16.
Eisenberg DM, Kaptchuk, TJ (2002): Acupuncture: Theory, efficacy, and practice. Annals of Internal Medicine, 136, 374-383.
Ernst E (2006): Acupuncture- a critical analysis. Journal of Internal Medicine, 259 (2),125-137
Kim SY, et al. (2006) The anti-inflammatory effects of low- and high-frequency electroacupuncture are mediated by peripheral opioids in a mouse air pouch inflammation model. The Journal of Alternative and Complementary Medicine, 12 (1), 39-44
Kaptchuk T (2002). Acupuncture: Theory, efficacy, and practice. Annals of Internal Medicine, 136 (5), 374
Langevin, H M, et al. (2006) Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: Evidence for a mechanotransduction-based mechanism. J Cell Physiol, 207(3): p. 767-74.
Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D, Fazekas F, Ebner F (2004): Acupuncture using laser needles modulates brain function: first evidence from functional transcranial Doppler sonography and functional magnetic imaging. Lasers in Medical Science, 19 (1), 2-11
MacPherson H, et al (2001): The York acupuncture safety study: prospective survey of 34,000 Treatments by traditional acupuncturists. British Medical Journal, 323 (7311); 486
National Center for Complementary and Alternative Medicine website. Retrieved 12/19/08: http://nccam.nih.gov/health/acupuncture
Pomeranz, B and Chiu D, Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci, 1976. 19(11): p. 1757-62.
Pomeranz B, (1996). Scientific Research into Acupuncture for the relief of pain. Journal of Alternative and Complementary Medicine, 2 (1), 53-60
Ratcliffe J, Thomas KJ, MacPherson H, Brazier J, 2006) Ratcliffe J, Thomas KJ, MacPherson H, Brazier J (2006): A randomized controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis. British Medical Journal, 333(7569):626. Retrieved 1/9/09 from British Medical Journal: http://www.bmj.com/cgi/content/full/333/7569/626
Reinhold T, Witt CM, Jena S, Brinkhaus B, Willich S (2008) Eur J Health Econ, 9; 2009-219
Scharf, HP, et al. (2006). Acupuncture and Knee Osteoarthritis. Ann Intern Med, 145 (1); 12-20
White A, Hayhoe A, Hart A, Ernst E (2001): Adverse events following acupuncture: prospective survey of 32,000 consultations with doctors and physiotherapists. British Medical Journal, 323 (7311), 485-486
Witt CM, Brinkhaus B, Reinhold T, Willich SN (2006). Efficacy, effectiveness, safety and costs of acupuncture for chronic pain-results of a large research initiative. Acupuncture in Medicine, 24(Suppl); 533-539.
Witt CM, Jena S, Brinkhaus B,Liecker B, Wegscheider K, Willich SN (2006). Acupuncture in patients with osteoarthritis of the knee or hip. Arthritis & Rheumatism, 54 (11); 3485-3493
Wonderling D, Vickers AJ, Grieve R, McCarney R (2004). Cost effectiveness analysis of a randomized trial of acupuncture for chronic headache in primary care. British Medical Journal, 328(7442):747. Retrieved 1/9/09 from PubMed: http://www.ncbi.nlm.nih.gov/pubmed/15023830
Zhang RX, Lao L, Wang X, Fan A, Wang L, Ren K, Berman BM (2005): Electroacupuncture attenuates inflammation in a rat model. The Journal of Alternative and Complementary Medicine, 2 (1), 135-142
Human Clinical Trials that Show Acupuncture Effects:
Over 500 clinical trials, measuring the efficacy of acupuncture, have been conducted in the past three decades. A variety of disease conditions or their symptoms have been the subject of these studies; many, but not all, are musculoskeletal origin. For example, the etiologies of osteoarthritis (OA) of the knee, fibromyalgia, and rheumatoid arthritis (RA) differ: OA is mechanical wear-and-tear, fibromyalgia is believed to be caused by a dysfunction in neurotransmitter signaling, and RA is an autoimmune disorder. All three affect the musculoskeletal system, but two have an internal etiology.
There are 50 systematic reviews of acupuncture in the Cochrane databases. Overall, the trend has been favorable, advocating the use of acupuncture in a clinical setting as an adjunctive treatment with conventional therapies, where suitable. (Witt CM, Brinkhaus B, Reinhold T, Willich SN, 2006)
1) Acupuncture for osteoarthritis of the knee
Title: Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee: A Randomized, Controlled Trial
Conclusion: Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.
Berman BM, et al. (2004) Ann Intern Med, 141 (12) 901-10
Title: Acupuncture in Patients with Osteoarthritis of the Knee or Hip
Conclusion: These results indicate that acupuncture plus routine care is associated with marked clinical improvement in patients with chronic OA-associated pain of the knee or hip.
Witt et al. (2006) Arthritis & Rheumatism, 54 (11) 3485-3493
2) Acupuncture for chronic low back pain
Title: German Acupuncture Trials (GERAC) for Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel-Group Trial with 3 Groups
Conclusion: Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy.
Haake, et al. (2007) Arch Intern Med, 167 (17), 1892-1898
Title: Meta-Analysis for low back pain
Conclusion: In a survey of 33 RCTs, Manheimer et al concluded acupuncture effectively relieves chronic low back pain.
Manheimer et al. (2005) Ann Intern Med, 142, 651-663.
3) Acupuncture for fibromyalgia
Title: Improvement in Fibromyalgia Symptoms With Acupuncture: Results of a Randomized Controlled Trial
Discussion and conclusion: A Mayo Clinic prospective, partially blinded, controlled, randomized clinical trial found acupuncture to be more effective than sham acupuncture in the treatment of fibromyalgia symptoms. Total fibromyalgia symptoms were significantly improved in the true acupuncture compared to the sham controls, with the greatest improvements in symptoms of fatigue and anxiety.
Martin D, Sletten CD, Williams BA, Berger IH, (2006) Mayo Clinic Proceedings, 81(6):749-757
4) Acupuncture for rheumatoid arthritis
Title: Ottawa Panel Evidence-Based Clinical Practice Guidelines for Electrotherapy and Thermotherapy Interventions in the Management of Rheumatoid Arthritis in Adults
Discussion and conclusion: The Ottawa panel recommends the use of low-level laser therapy, therapeutic ultrasound, thermotherapy, electrical stimulation, and transcutaneous electrical nerve stimulation for the management of rheumatoid arthritis.
Brosseau L, et al. (2004) Physical Therapy, 84 (11) 1016-43
5) Acupuncture for chemotherapy-induced nausea and vomiting
Title: Acupuncture: role in comprehensive cancer care- a primer for the oncologist and review of the literature
Conclusion: Antiemetic studies are the most prevalent and contain the most promising results [that] acupuncture significantly reduces the number of emesis episodes for patients receiving chemotherapy.
Cohen AJ, Menter A, Hale L (2005) Integrative Cancer Therapies, 4(2), 131-43
6) Acupuncture for peri- and post-operative nausea and vomiting
Title: Perioperative acupuncture and related techniques
Discussion: Acupuncture can be used for treatment and prophylaxis of postoperative nausea and vomiting in routine clinical practice in combination with or as an alternative to conventional anti-emetics when administered before induction of general anesthesia.
Chernyak GV, Sessler DI (2005) Anesthesiology, 102 (5), 1031-1049
7) Acupuncture for TMJ (temporomandibular joint dysfunction)
Title: The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a randomized controlled trial
Conclusion: Acupuncture had a positive influence on the signs and symptoms of temporomandibular joint myofascial pain.
Journal of Dentistry (2007), 35(3), 259-67
8) Acupuncture for headaches
Title: Acupuncture for chronic headache in primary care: large, pragmatic, randomized trial
Conclusion: Acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine, at a small additional cost, conclude the authors. Expansion of existing services should be considered.
Vickers, AJ, et al. (2004) BMJ, 44 (8): 846-850