Yes I Do Medical Acupuncture and No I’m Not Crazy
About a year ago, shortly after I gave up primary care to start an acupuncture practice, I attended a social gathering of physicians in my community. I was eager to mingle with my peers and share the news of my new career, and I envisioned a universal embrace for my new venture. After all, I live in the progressive city of Austin and with millions of Americans suffering with chronic pain and desperate for relief, I, a respected internist with a new skill, was poised to offer an alternative to opioids and invasive procedures.
My delusions of grandeur collided with reality about 5 minutes into the evening.
I had grabbed a beverage and was chatting amiably with a young fellow who had just moved to Austin to start a plastic surgery practice. We were having a nice dialogue when up walked another doctor who introduced himself and shook hands with each of us. He inquired of my new friend as to his specialty and paid appropriate homage to the response. Turning to me, he asked, “And what do you do?”
“I do medical acupuncture,” I answered smartly.
“Hmm,” he said with a faint nod. Based on his expression, a casual observer might have hypothesized that I had just told him that I was recently released from prison. Without further ado, he turned back to my surgical colleague and began a conversation that did not include me. I shook it off and ambled away to find another conversation. The rest of the evening went something like this: “Acupuncture eh? I think my cousin’s wife tried acupuncture for her back pain but I’m not sure if it helped.” No questions about the science of acupuncture or how or why I entered the field. Nothing hostile mind you, just a general lack of interest.
Finally, my confidence shaken, I slipped away and shuffled off to my car, pondering the events of the evening and mulling over the feeling of being an outsider. I mean, it’s not like I was dressed in a Nehru jacket with a medallion around my neck. I was wearing dress slacks, a button down oxford, and a blue blazer for gosh sakes. No, it wasn’t my attire. It was the acupuncture.
I shouldn’t have been surprised, given that 5 years earlier I probably would have had a similar reaction to a colleague “going holistic”. But the fact is that after researching acupuncture extensively and then going through training, I was so convinced of its benefits that I was overflowing with eagerness to spread the word. I was certain that all my colleagues needed was the benefit of my knowledge to bring about enlightenment.
Unfortunately I had grossly overestimated my power to change the medical community’s attitude about acupuncture.
Physician reluctance to embrace acupuncture is completely understandable. The ancient Chinese approached health and wellness from a philosophical rather than scientific direction. There is both beauty and wisdom in this approach (more on this subject in future musings) but the paradigm is completely foreign to the Western mind. Notions of universal vital energy and illness due to “blocked Qi” are not rooted in science, and when acupuncture’s mechanism of action is explained as restoring or re-balancing the flow of vital energy in the body, most physicians justifiably tune out.
Additionally acupuncture research leaves much to be desired. Methodologies are not sufficiently standardized among studies and so results of clinical trials can be difficult to interpret and compare. And then, because many studies show that “sham” acupuncture is nearly as effective as true acupuncture, there is that “So it’s all placebo” assertion that just won’t go away.
But the facts are that basic science research over the past 50 years has confirmed a number of measurable effects of acupuncture, including release of endorphins, serotonin, norepinephrine, and cortisol, plus a variety of other actions that can modify the experience of pain and stress. Research also shows us that inserting needles anywhere on the body will produce some of the same effects as needling at “true” acupuncture points. Thus “sham” acupuncture (which typically involves inserting needles a couple of inches away from traditional points) is not a true placebo intervention. Animal studies further negate the placebo hypothesis (i.e. animals respond favorably to acupuncture and laboratory animals are not subject to placebo response). And ample research supports acupuncture’s benefits for chronic pain and a host of other conditions.
I don’t believe in Qi or in re-balancing energy flow along invisible meridians, but I do believe in acupuncture. It’s not a replacement for western medicine nor is it a treatment to be applied indiscriminately. But it is a valuable tool in the medical toolbox and when used appropriately in an evidence based fashion, it can produce some remarkable results. Its value deserves recognition by insurance companies as well as by the medical community.
And so I will continue my efforts to enlighten my colleagues about acupuncture while advocating for better research and working to insure that acupuncture gets the respect it deserves as a legitimate therapeutic intervention. This will take time but the fight is worth it. I am certain.