ACUPUNCTURE WORKS

By Dick Thompson

For an ancient Chinese custom that turns patients into human pincushions, acupuncture is surprisingly popular these days. America's growing interest in alternative medicine and the quasi endorsement of the Food and Drug Administration (which last year took acupuncture's extra-fine needles off its list of "experimental" medical devices) have helped create a sharp spike in demand for the prickly procedure. About a million Americans spend $500 million a year on acupuncture for complaints ranging from gallstones to migraines to low-back pain; today even dogs and horses are trotting off to see their acupuncturists.

But does it work? Most Western-trained physicians remain skeptical. Explanations that acupuncture restores the balance of yin and yang by tinkering at critical points along life-force meridians sound to scientists suspiciously like quackery. Advocates counter that their claims are supported by hundreds of research studies--as well as a successful track record that extends back 2,500 years.

To sort through the controversy and assess the quality of that research, the National Institutes of Health last week assembled a panel of experts in a scientific court known officially as a consensus conference. After three days of analyzing studies and interrogating practitioners, the panel was unexpectedly upbeat. "It's time to take acupuncture seriously," said its chairman, David Ramsay, president of the University of Maryland. "There are a number of situations where it really does work."

The panel found acupuncture effective in treating painful disorders of the muscle and skeletal systems, such as fibromyalgia and tennis elbow--even more effective, in some cases, than conventional therapies. It was judged to be a "reasonable option" for the relief of postoperative pain and low-back pain. And it won qualified endorsement as a supplement to standard remedies for drug addiction, carpal-tunnel syndrome, osteoarthritis and asthma.

Acupuncture's one great advantage over Western medicine is that it does no harm; unlike drugs and surgery, acupuncture has virtually no side effects. For acupuncturists who have been saying this for years, it was recognition long overdue. "[The panel's report] is a great step toward breaking down the barriers," said Larenz Ng, a pioneer of acupuncture research and now a professor of neurology at George Washington School of Medicine.

One big barrier remains: acupuncture springs from a system of faith that scientists find almost incomprehensible. The treatment rests on the Taoist belief that two life forces, yin and yang, combine to produce a vital life energy, called ch'i (or qi), that flows through the body along pathways known as meridians, which were charted thousands of years ago. People get sick when these life forces are knocked out of balance, and the job of the acupuncturists is to nudge ch'i back into equilibrium. They do this by pushing needles through the skin, sometimes several inches into the body, at specific points along the meridians, and then twisting or twirling them or pulsing them with a low electric current.

What puzzles scientists is that these points and meridians don't correspond to any biological system in the body. How, then, can sticking a needle into the ear, for example, affect a distant organ like the gallbladder? One possible explanation, for which the panel found "considerable evidence," is that acupuncture works at least in part by releasing opioids, natural morphine-like substances, into the central nervous system.

However it happens, scientists know that acupuncture produces measurable changes in the brain. Some of the most compelling evidence presented last week was a series of brain scans taken by Dr. Abass Alavi, chief of nuclear medicine at the University of Pennsylvania Hospital in Philadelphia. Alavi's images showed dramatic changes in regions of the central nervous system that coordinate the perception of pain. "Acupuncture definitely changed the landscape of pain we see in the brain," Alavi told the panel.

Not everyone was persuaded. Dr. Wallace Sampson, a member of the National Council Against Health Fraud, complained that the panel had not invited the naysayers. And although the studies presented were mostly conducted in Western countries using accepted scientific methods, several critics pointed out that the best-designed experiments showed the poorest results.

The future of acupuncture in the U.S., however, will probably not rest on the quality of these experiments. If it's cheaper and less painful than going to the hospital, and if it gets results, Americans will use it. A Boston University researcher told the panel that the saving from just faster stroke rehabilitation and effective carpal-tunnel-syndrome treatment could cut the nation's annual medical bill by $11 billion. Such a saving is sure to catch the eye of HMOs and private health insurers. As Daniel Cherkin, a senior scientific investigator for a large HMO in Seattle, puts it, "Why something works is not of interest to those individuals and organizations providing care." What matters these days is that it works for less.