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People ask me many questions about acupuncture. They seem to be especially interested in learning how I came to study the discipline, and this is among the toughest questions to answer. I still can't quite fathom why I chose to spend a couple of days in the clinic of a college of Chinese Medicine. Once I got there, I was fascinated by patients' satisfaction with acupuncture treatment and the individual approach to the patient. I remember most vividly an asthmatic child whose improvement after treatment was striking and objective.
Neck-deep in the medical education system, the experience was relegated to the back of my mind. I certainly didn't expect it to change my life.
Several years after beginning a busy practice of Obstetrics and Gynecology, I began to develop a sense of our limitations as physicians. Though I felt I was doing a great deal of good, I was troubled. I thought about people with problems which appear identical, yet respond very differently to therapy. My training was not helping me to address the diversity among human beings. Some symptoms almost never seem to respond to my 'MD' armamentarium, and some treatments had undesirable side effects. I was intrigued with the prospect of an additional type of treatment strategy, especially for the illnesses and patients that do not seem to be addressed well by conventional medicine.
According to my first teacher, Joseph Helms:
"Perhaps the most fertile ground for acupuncture intervention is for disorders in their premorbid state, problems commonly encountered by primary care providers but rarely associated with positive laboratory findings, definitive medical diagnoses, or successful therapies. [For example,] Fatigue…mild depression, stress-related myofascial symptoms, diminished libido…anxiety, sleep disturbances, bowel dysfunction and immune dysregulation disorders."
I was not alone, of course. There has been an unequivocal public groundswell of interest in a variety of complementary therapies. Total United States visits to alternative medicine practitioners in 1997 are estimated at 629 million, exceeding total visits to all US Primary care physicians.
Increasingly, I was thinking about my experience with acupuncture. Reading sparked my interest further. I learned that most of the physicians in the United States had trained in what we now call the 'Helms Course.' The three hundred-hour UCLA continuing education course is taught by Joseph Helms, a practitioner of Family Medicine and Acupuncture and a gifted instructor. Through a combination of lecture, practical, and self-paced videotape sessions, I built a base of knowledge and skill, and I joined a network of fascinating, like-minded physicians.
The discipline of Medical Acupuncture, acupuncture practiced by physicians, continues to grow. The American Academy of Medical Acupuncture (AAMA) has over 1800 members. The American Board of Medical Acupuncture was founded in 2000, establishing rigorous certification standards. Several hundred physicians are diplomates (board certified). Further information is available at the AAMA website.
The World Health Organization has adopted guidelines on training and standards for safe practice of Acupuncture. Over forty specific indications have been delineated as well. Further information is available at the WHO and AAMA web sites.
In November 1997, The NIH published a consensus statement on acupuncture. The document acknowledges:
…efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and post-operative dental pain. There are other situations…where acupuncture may be…included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.
The discipline is increasingly joining the realm of evidence-based medicine. Challenges include obvious difficulties with blinding and controls, and sparse sources of funding. More subtle difficulties stem from the very nature of the discipline. Individualized treatment plans are the ideal, often formulated from a combination of acupuncture and western diagnoses. This integral feature of the discipline complicates experimental design tremendously.
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