COLUMN: Stuck on Acupuncture

From Bertie Bregman's "On Call," Fall '93 From Bertie Bregman's "On Call," Fall '93 Tell us when it hurts."From Bertie Bregman's "On Call," Fall '93 Tell us when it hurts.""OK, now. Leg...my leg," he replied.From Bertie Bregman's "On Call," Fall '93 Tell us when it hurts.""OK, now. Leg...my leg," he replied.An acupuncture student reached down and brushed a smoldering piece of moxibustion, or incense, from the patients thigh. Kiiko Matsumoto, a diminutive Japanese woman with the energy of a small crowd runs an acupuncture clinic once a month in Stamford, Connecticut. She had ordered that the patient get "20 ouches" and that was only his first. As I filled out a medical history form and prepared to be treated next, I kept a watchful eye on the situation, prepared to make a run for the door. I came for acupuncture treatment partly due to a few chronic complaints – a recurrent winter cough, extreme sensitivity to cold, tendinitis in both knees – and partly out of curiosity. I do believe that curiosity is a virtue, but my mama didn't raise no fool. As it turns out, I had nothing to fear. Aside from the mild humiliation of stripping down to my Marilyn Monroe boxers in front of a roomful of tittering students, I hardly felt a thing. Kiiko reviewed my medical history, outlined a treatment strategy that centered around my "kidney deficiency", and instructed the advanced students on where to insert the needles and burn the moxibustion. Japanese style Acupuncturists use small, thin needles, and I barely noticed as students tapped them at an angle into my skin. One man skillfully burned the moxibustion and flicked off the embers immediately after each brief sting. Acupuncture treatment requires that the needles remain inserted for at least 20 minutes. So as I lay on my back, needles protruding from both wrists, both ankles, one knee and either side of my chest, I had plenty of time to think. Why is it, I wondered, that Western doctors are so resistant to acupuncture and other forms of alternative medicine? Ask a doctor or researcher that question, and he will likely tell you that alternative medicine is unscientific, the archaic theories behind it don't make any sense, and besides, it doesn't work. Let's examine those assertions a little more closely. The claim that alternative medicine is unscientific assumes that medical knowledge grows directly out of scientific advances. Certainly, this is sometimes true, and modern medical theory would not exist without an understanding of physics, chemistry and biology. But most of the great therapies and cures of Western medicine came about empirically, by accident or luck. Penicillin floated in through the kitchen window. Aspirin was discovered by a reverend, who noticed that willow bark could bring down malarial fevers. A country doctor named Edward Jenner discovered an inoculation against smallpox by investigating an old wive's tale that milkmaids were immune. Even today, pharmaceutical companies search for the cure for cancer by painstakingly combing through a haystack of thousands of "random" compounds, with the hope of discovering a precious needle within. To be sure, once we discover a drug, we refine it and mass produce it through sophisticated chemical means. But drugs that are rationally designed based on an intrinsic understanding of physiology are still a dream of the future. Mostly, drug development goes like this: first, you find a new chemical; second, you test it on vegetable and animal to see what it does; third, you try to figure out how it works. Strictly speaking, nature concerns itself with stage one, clinical medicine concerns itself with stage two, and basic research concerns itself with stage three. From this angle, the true science of medicine is not physics, chemistry, or even biology, but epidemiology – the humble science of statistics, where even accountants snooze to tread. All drugs must first pass a battery of rigorous studies before the FDA approves them for use. Once clinical trial show that a drug's benefits are not simply due to chance or the natural course of disease, then doctors feel backed up by science. If we know the mechanism, so much the better; if we don't, too bad. In medicine when we say a therapy is scientific, we don't mean that we understand it, we mean that we know it works. Alternative medicine should fit right into such a pragmatic framework. Take acupuncture as an example. To practice acupuncture, you need to learn volumes of Chinese medical philosophy, dealing with the flow of chi, the body's vital force, through internal meridians. By manipulating chi with needles and stimulating it with moxibustion, you restore the body's intrinsic balance and remove the source of illness. Too much talk about chi and meridians raises the hackles of scientists, but it shouldn't prevent them from determining whether acupuncture works. To do so, all you need is an accupuncturist, some patients with a specific disease, and a good study design. All medical systems come with elaborate biologies and cosmologies to explain them, ours included. But behind every therapeutic arsenal lies years, sometimes millennia of basic, empirical research. Traditional Chinese medicine employs thousands of herbs to treat the full spectrum of clinical disorders. Acupuncture has a similarly ancient history of clinical use. So does Indian Ayuverdic medicine and North and South American tribal medicine. Only the most foolish and arrogant among us would reject such extensive clinical experience simply because we don't like the accompanying theories. Indeed, many of the drugs of the future will surely come from this source. Our most powerful new antimalarial drug is called Arteminisin, a.k.a. Quinghaosu, a Chinese herbal remedy. And I read in the Science Times recently that Chinese medicine uses an extract from the kudzu plant, a scourge of the American South, to treat alcoholism, another scourge of the American South! From my own limited personal experience, acupuncture seems to hold a great deal of promise. Although my complaints were not acute enough to notice any change, the chronic pain patient gained markedly increased mobility after only one treatment. Another patient suffered from an atrophied left arm. Kiiko demonstrated that his left pulse vanished when she held his arm in a certain position (by contrast with a normal right pulse), indicating a lack of circulation. She made an elegant anatomical diagnosis, explaining that the left subclavian artery was compressed by two small muscles in the neck. I don't mean to suggest that alternative medicine invariably cures disease. No therapy works for everyone, and there is no shortage of frauds and quacks ready to prey on the desperation of the ill. My point is that a well-designed clinical trial is modern medicine's most powerful tool, and we should use it liberally to evaluate all medical treatments, whether alternative or mainstream. Despite significant cultural resistance, we are starting to move in the right direction. Most doctors who use alternative medicine in their practice are still seen as flakes. But last year, the NIH established a Department of Alternative Medicine, which intends to run an array of clinical studies. And a 1992 Medicine database search under "acupuncture" turned up over 100 entries from American medical journals. The medical community has begun to realize that by exploring traditional medical systems we have no scientific integrity to lose, and an entire world of therapies to gain. Bertie Bregman is a second year Medical School student from New York, New York. On Call appears alternate Thursdays.