Marchione Response

The AAAOM Media Education Committee, a working group subset of the AAAOM Media and Publications Committee, recently issued this response to Marilynn Marchione, medical writer for The Boston Globe and for AP. You can read her original article. Responses such as the following are part of a broader move to educate journalists and seek to counteract misrepresentation in the media.

Marilynn Marchione
The Boston Globe
P.O. Box 55819
Boston, MA 02205-5819
Tel: (617) 929-2931
Fax: (617) 929-2098
comments@globe.com

June 10, 2009

Re: “AP IMPACT: Alternative medicine goes mainstream”

Dear Ms. Marchione:

The American Association of Acupuncture and Oriental Medicine (AAAOM) is the national association representing professional providers of acupuncture and Oriental medicine. In my capacity as president of the AAAOM, I am writing to ask you publicly to correct or clarify several misleading statements made in your recent article “AP IMPACT: Alternative medicine goes mainstream.”

You are absolutely right to raise the engaging and challenging questions of safety and effectiveness in medical treatment. As you point out in your article, these questions particularly need to be asked in relation to cost effectiveness, as the new Administration proceeds with its healthcare reform plans – and they need to be asked regarding conventional as well as alternative treatments. When the evidence itself is regarded scientifically, there is no longer any justification whatsoever for the old-fashioned, simplistic division between “alternative” and conventional care. Specifically, there is a strong and growing body of evidence showing that acupuncture is both safe and effective for an ever-expanding list of medical conditions.

According to the Journal of the American Medical Association (JAMA), the following deaths have occurred:

The number of deaths per year due to acupuncture treatment in this country is ZERO.

In addition, several assertions in your article could be clarified accordingly:

Since 1997, the National Institutes of Health (NIH) and the World Health Organization (WHO) have both recognized acupuncture as an effective treatment for a host of conditions and have acknowledged the prominence of AOM (Acupuncture and Oriental Medicine) practice internationally. Current acupuncture research continues to illustrate the validity of the AOM for healthcare. AOM can successfully treat troublesome conditions like infertility and pain and many other ailments or conditions that often prove less amenable to conventional medicine approaches. This partially accounts for the increasing use of AOM in hospitals, on the battlefield, and in military medical treatments—including use of AOM as a successful means to treat PTSD. (See below for further resources on AOM studies).

While MDs, chiropractors and nurses may sometimes receive a long weekend’s worth of training that allows them to practice acupuncture as a modality, licensed acupuncturists (L.Ac.'s) receive between 2000 and 3000 hours of training in acupuncture and Oriental medicine. (See more extensive information on practitioner education below).

Based on the intensive education requirements, training, testing and research that have demonstrably establish the AOM field, I strongly believe that our profession, inclusive of acupuncture, deserves to be assessed independently of other modalities. I urge you to consider the AAAOM a resource to you as a journalist when you seek to educate the public on the safety, efficacy, and general use of AOM.

Below you will find point-by-point data that asserts and substantiates AOM, courtesy of Michael Taromina, AAAOM legal counsel.

I. Empirical data and research for AOM is conclusive as to its health benefits.

II. Acupuncturists are highly-trained and skilled independent health care providers.

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, both acute and 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) The rapid expansion of acupuncture in the United States is a result of the high degree of patient and physician acceptance, due in part to rigorous credentialing and examination processes—particularly by graduate level educational programs that are programmatically accredited, requiring four to six years to complete (after completing the prerequisite college course work required for matriculation). These training programs typically involve at least two years of clinical rotation, and most colleges award a master's of science degree. The licensed acupuncturist in the U.S. is a highly trained clinical specialist who provides care based on course work in biomedical sciences in addition to traditional Asian medicine.

III. Without equal access to AOM the citizens of the U.S. will be unduly denied access to affordable, preventative, effective primary care.

Today in the U.S., there are tens of thousands of patients under the exclusive care of licensed acupuncturists, which means that they are receiving primary care (without medical referrals). In this capacity, licensed acupuncturists treat issues such as acute and chronic pain, (i.e. headache, back pain, neck pain, knee pain, osteoarthritis, post-surgical pain and recovery), nausea, asthma, allergies, migraines, hypertension, weight loss, depression, anxiety, repetitive stress disorders, premenstrual syndrome (PMS), reproductive issues, male and female infertility, side effects of cancer treatments, digestive issues, irritable bowel syndrome (IBS), reduction of the side effects of medication in general, morning sickness, and for general health, wellness, and stress reduction. By restricting access to the licensed practice of acupuncture, financial barriers are erected between needy patients and skilled, available healthcare providers.

IV. Licensed acupuncturists demonstrate an exemplary safety track record, 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 a licensed acupuncturist is both safe and effective.

Below you will find citations for the information above, as well as additional references and clinical trial studies for your review. Please let us know if you would like additional background information on the field of AOM in the United States, including safety, efficacy, and cost efficiency studies.

Kind regards,

Deborah Lincoln, RN, MSN, LAc, DiplAc
President, AAAOM
866 455-7999

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), 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