- The Washington Times - Monday, March 4, 2002

With health care costs again rising at double digit figures, federal budget surpluses giving way to deficits, and the U.S. engaged in a war while in the midst of a recession, the fiscal atmosphere is not promising for congressional passage of liberal health care legislation. We can anticipate lengthy debate over prescription drug benefits for the elderly and increased coverage of the uninsured, disabled and unemployed.
Faced with resistance to higher insurance premiums, third-party payers, often more concerned with the bottom line than with medical-care quality, increasingly offer health care on the cheap alternative medicine, the "largest growth industry in medicine today."
Alternative medicine, which largely fosters unproved health-care remedies based on speculative assertions, untested theories and anecdotal reports in short, quackery … thrives on such relatively inexpensive therapy as herbal supplements and acupuncture.
Sad to say, our own National Institutes of Health, one of Washington's most sacred cows, has also abetted this pseudoscience.
In contrast, conventional medicine's acceptance of remedies involves extensive laboratory and clinical studies, including randomized, "double-blind" placebo trials (to eliminate researcher and subject bias), statistical analysis (to obviate results due to chance), exposure to peer review through medical journals and scientific meetings, and final FDA approval. This "gold standard" process is tedious, lengthy and costly. But shortcuts and less-than-adequate testing are not compatible with the profession's dictum first do no harm.
Medical errors involve humans, not machines. General Motors can recall and repair 250,000 autos found to have defective brakes. But how do physicians repair the limbs of babies born to mothers prescribed Thalidomide during their pregnancies or restore the sight of prematurely born infants blinded by excessive oxygen in their incubators?
These questions must be raised with the entry of alternative medicine into the health care arena.
In 1992, the NIH opened an Office of Alternative Medicine (OAM), to solicit alternative medicine research. Funded were such research projects as macrobiotic diets for treating cancer (50 percent brown rice, 20 percent beans, 30 percent greenery, including seaweed), and guided imagery (e.g. visualizing cancer as meat and blood cells as barking dogs tearing the meat apart).
None of this voodoo science reached the level of acceptance for publication by reputable, peer-reviewed medial journals.
Not discouraged, the OAM broadened the scope of its funding in 1997 with the publication of a Classification of Complementary and Alternative Medical Practices. Added were 64 treatments to OAM's medical armamentarium, including blue light treatment, past life therapy, Tibetan medicine and reflexology (treatment of various organ disorders by massaging the soles of the feet).
This article cannot analyze all the bizarre therapies listed in the Classification but is limited to one of the most popular acupuncture.
Acupuncture was developed in China more than 2,500 years ago based on the theory that qi (energy) flows through the body along specific channels (meridians). Illness allegedly results from blockage of the meridians, upsetting the balance between the contrasting forces of yin and yang. Needling specific acupuncture points, charted by ancient Chinese, is said to remove the blockage and restore smooth energy flow.
In 1997, the NIH organized a Consensus Development Conference on Acupuncture that turned out a Consensus Statement concluding: "There is clear evidence that needle acupuncture is efficacious for adult postoperative and chemotherapy nausea and vomiting." The audience, heavily weighted with acupuncture enthusiasts, greeted the reading of this conclusion with a standing ovation that smacked of show business.
The conference announcement evoked a wave of front-page headlines across the country with variations of the theme, "NIH endorses acupuncture." the headlines were reinforced by a press comment from the conference chairman, "There are a number of situations where it really does work the evidence is very clear-cut."
We find the evidence for the conclusions is far from "clear-cut" and, indeed, seriously flawed. The Conference Planning Committee was comprised entirely of acupuncture advocates. This committee only chose speakers who put a positive face on all aspects of acupuncture.
The specific role of acupuncture in the relief of postoperative nausea and vomiting was covered by a single NIH researcher with no personal experience with the procedure. Neither qi nor meridians have ever been demonstrated by anatomical dissection, microscopic examination or physiological studies. But the speaker found "convincing evidence" of acupuncture's efficacy from a review of the literature dominated by J.W. Dundee, a Belfast anesthesiologist, author of 20 articles on this subject.
Inquiries at the Belfast hospitals where Dr. Dundee conducted his research, Belfast City, Belvoir and Royal Victoria, disclosed that acupuncture for postoperative nausea and vomiting had never been used in clinical practice certainly not in 1997 when the NIH conference was held. Thus, the conference lauded a proceedure based on research not accepted at the very hospitals where the research was conducted.
The conference also had access to a 2,000-article bibliography on acupuncture, accompanied by caveats of "equivocal results," and study designs "inadequate to assess efficacy."
These reservations were well-warranted. Perusing the acupuncture literature, one learns of acupuncture points covering the entire body or restricted to the ear; training periods varying from 5 years to 5 minutes; baldness and graying as signs of kidney weakness and respond to acupuncture; the importance of the patient's underwear color in acupuncture treatment the absurdities continue. Fortunately, however, deaths from piercing the heart or lungs are rare.
The most significant line in the entire Consensus Statement: "Acupuncture focuses on a holistic, energy-based approach to the patient rather than a disease-oriented diagnosis and treatment model."
So the sick are not restricted to a Hobson's choice; they have treatment options. For the ailing who want to find out what is wrong and what to do about it, evidence-based mainstream medicine is a rational choice. But the services of an acupuncturist should be sought if illness is approached as an imbalance of energy flow in the body.
We conclude that the NIH Consensus Statement did not measure up to the standards of a scientific presentation. The statement's conclusion of "clear evidence" upon futher reading was downgraded to "promising results," and this wobbling was justifiable. The conclusion that acupuncture was efficacious in treating postoperative nausea and vomiting was borne out by neither the presentations nor the accompaying bibliography.
The NIH disassociated itself from the conclusions in the NIH Consensus Statement, but the agency must bear the responsibility for appointing a rigged planning committee. And in not publicly denying its role in the conference conclusions, the NIH contributed its prestige to public perception that a green light was given to acupuncture therapy.
By implicitly sanctioning the credibility of acupuncture as a useful tool in medicine's armamentarium the NIH has tarnished its image.
A final discouraging note: President Bush's new budget provides an increase in funding for the OAM the agency promoting medical quackery.

Alex Gerber, a clinical professor of surgery emeritus at the University of Southern California, formerly was a health care consultant to the White House and the U.S. Department of Health and Human Services. Roy Perkins is a clinical professor of medicine emeritus at USC.


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