Tuesday, May 29, 2007

Acupuncture Point Physiology 2007: still mirages in the desert

Acupuncture efficacy has been under increasing scrutiny during the last several years. Although there are scant good quality studies regarding actual mechanisms of action and associated physiological mechanisms, there seems to be no shortage of recent investigations discussing specific acupuncture point effects as well as at least one apparently newly proposed theory of acupuncture mechanisms.

A variety of recent reports discuss the effects of acupuncture point (AP) therapy on varying conditions including beneficial results of AP on canine toxicology , the reduction of hot flashes in menopausal women, and anxiety related hyperventilation syndrome. Other studies review the composition of anatomical areas relating to specific AP in an attempt to associate them to some larger physiological effect.

Although the implications of many of these studies are potentially interesting, it is important to note that the origin of much of this research raises major concerns. Many of these studies are published in sources such as the Journal of Alternative and Complementary Medicine, BMC Complementary and Alternative Medicine, or originate from countries implicated in significant research bias. Complementary and alternative medicine (CAM) is not immune from interpretive problems and questionable evidence.

In addition, there are continuing attempts to relate AP sites directly to physiological effects that can influence disease processes. A recently published study “A musculoskeletal model of low grade connective tissue inflammation in patients with thyroide associated ophthalmopathy (TAO): the WOMED concept of lateral tension and its general implications in disease” claims, among other things, to establish a real link between acupuncture sites and the treatment of musculoskeletal disease. This 2007 paper caught my eye because there is an attempt to link specific AP sites to at least one disease if not to many diseases by implication. This is a paper many in the CAM arena might jump on and run with.

The study supports the familiar concept of combining a spectrum of loosely associated findings such as inflammation, biochemical mineral abnormalities, and posture associating them with an “integrative” medicine philosophy.

“The WOMED concept of medical care can be summarized as an integral care of the individual. Within this concept elements of TCM and Western medicine are intermingled. Some of the evaluation parameters used in each patient are posture, locomotion, structural cohesion, previous infectious diseases, nutrition habits, nutritional status, internal medicine evaluation, and gynecological evaluation when needed. In addition to this both endocrinological and immunological aspects are included. Examples of this medical approach have been published.”

This approach becomes much stranger on closer inspection. One of the published medical approaches referenced is replete with pseudo science. It seems the very foundation of WOMED and any implications towards a new theory of acupuncture point anatomy or efficacy is based to some degree on older “holistic” concepts that comprise a confusing litany of unsubstantiated links.

One of the alluded to references “New diagnostic and therapeutic approach to thyroide associated orbitopathy based on Applied Kinesiology and homeopathic therapy, Altern Complement. Med 2004” uses two unrealistic CAM approaches as the basis for the study. Remember this is a paper with which the WOMED authors use to support their medical philosophy.

One interesting 2007 study however was published in the American Journal of Chinese Medicine by a more reliable group with regards to objectivity. The research group, including Ernst, a well known CAM supporter who applies critical evidence base research techniques when evaluating alternative medicine, concludes that acupuncture's effectiveness continues to be “controversial” , finding some emerging evidence implying support that acupuncture is effective for some conditions. This is hardly neither impressive nor conclusive information for establishing acupuncture as a well defined modality.

To date, there is no new information that can clearly define what an acupuncture point is or that there is any difference between “needling” anywhere on a body or on an AP. Additionally, the phenomena of counter irritation, natural inflammatory responses to a foreign object, and placebo effects among others seem plausible explanations for any perceived AP, non AP, or sham AP exercises.

Therefore, as information regarding AP technique, physiology, and theory continue to be reported, it is critical to step back and allow this information to be processed and filtered through scientific analytic methods so that coherent and significant information can be properly interpreted.

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