王澄医生写给美国总统的一封信
http://www.100md.com
2007年1月17日
2007年1月15日
大意：在中国的一位听众打电话给我，抱怨美国之音周六的《健康园地》回答听众提问的有些“医学专家”的医学知识落后，并爱提及中医的办法。因为美国之音是代表美国政府的机构，所以美国之音的医学专家本应当具有美国医学教育水平，至少要有美国医生执照。有关中医的内容，美国之音不谈为妙。
(实际上我于2006年5月给美国之音中文部寄去了我的长文，《从美国看中国大陆的医疗体系》。很显然，中文部的《健康园地》的负责人不同意我的反对中医的观点。所以，我并不对这封信抱太大希望，我只是尽一个公民的责任。Cross fingers. 但是我相信，这个问题在我，Stephen Barrett医生和美国之音中文部的中国人雇员之间会有一个很大的争论。中国人生在中医的文化中，到了美国还是这个脑袋，真是可悲。)
01-15-2007
, 百拇医药 Dear Mr. President Bush:
I received a call from an audience member of the program “Voice of America” which is a Chinese Mandarin program broadcasted for mainland China. The program hosts Chinese doctors who answer audience member's medical questions. This particular audience member complained of a recent series called “Health Forum” on Saturdays and claimed the doctors on the show gave misleading and backwards medical information to the public in China.
, 百拇医药
It found most of the specialists who answered the audience questions had training in Western medicine, but their training took place in China and compared to modern medical knowledge in the US, it is still quite backwards. Only a few specialists as hosts had medical training in the United States. Traditional Chinese medicine has been criticized in China in the last few years labeling herbal medicine as an often “ineffective, even dangerous derivative of witchcraft that relies on untested concoctions and obscure ingredients to trick patients, then employs a host of excuses if the treatment doesn't work” (see attachment 1). Many educated Chinese people including myself believe that traditional Chinese medicine is not scientific. We suggested to the Chinese government recently to discontinue the national insurance coverage for traditional medicine and that there needs to be rigorous scientific standards and obligatory Western training for traditional Chinese medical doctors. “This has hit a nerve at a time when traditional Chinese medicine is increasingly on the defensive.”
, http://www.100md.com
I have training on both sides with a NYS license and a practice in NYC as a medical doctor and agree with Dr. Stephen Barrett's point of view in that acupuncture can only be applied as a simple pain control modality in the skeletomuscular system (see attachment 2 and 3). I believe the detrimental program that is Voice of America should end its misinformation and instead spread modern medical knowledge to the world. To achieve this goal, Voice of America needs to hire qualified doctors who are at least licensed in the US to avoid further misleading the audience especially when talking about traditional Chinese medicine, often labeled as holism. Traditional Chinese medicine is not effective, so far as we know. Furthermore, no medical doctor in the USA has the position to educate people about traditional Chinese medicine because they lack the knowledge of this obviously unpromising field. Attached please find three relevant articles, one of which is copied from the Voice of America Chinese section website.
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Sincerely yours,
William C. Wang, MD, PhD
attachment 1
LA Times: China's medicine wars
An attack on the traditional healing arts has inflamed adherents and sparked a debate about Western healthcare.
By Mark Magnier, Times Staff Writer
January 8, 2007
Clinic
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click to enlargeXikou, China - THE fur is flying, not to mention the acupuncture needles, the firewort and the $15,000-a-pound bull gallstones. China's ancient healing arts, as integral to national identity as the Great Wall or steamed dumplings, have become embroiled in the country's struggle to balance tradition and modernity.
A relatively obscure professor at a regional university kicked off the controversy in October with an online petition calling for traditional medicine to be stripped from the Chinese Constitution. It has a protected status here that, at least in theory, guarantees it equal footing with its Western counterpart.
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Professor Zhang Gongyao and fellow critics have blasted Chinese medicine as an often ineffective, even dangerous derivative of witchcraft that relies on untested concoctions and obscure ingredients to trick patients, then employs a host of excuses if the treatment doesn't work.
For adherents of the 3,000-year-old system, this borders on heresy. The Health Ministry labeled Zhang's ideas "ignorant of history," and traditionalists have called the skeptics traitors bent on "murdering" Chinese culture.
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Ironically, the firestorm dovetails with a growing embrace of Chinese medicine abroad as an antidote to the perceived soulless, money-obsessed nature of Western healthcare.
On a trip to China in mid-December, U.S. Health and Human Services Secretary Mike Leavitt said the two countries planned to trade lessons on how to integrate Western and Chinese medicine.
"It's an area of interest for China and the U.S.," he said.
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Many Australians, Europeans and Americans see the limitations of advanced science, said Rey Tiquia, an expert in Chinese traditional medicine based in Australia, even as more Chinese view their traditions as old-fashioned.
"For Chinese," he said, "it's still the lure of something new and shiny, like riding a car rather than a bicycle."
Since 1949, the number of traditional doctors trained in China has fallen by nearly half to 270,000, while the number of Western-trained doctors has jumped twentyfold to more than 1.7 million.
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Criticism that traditional medicine is not scientific dates back centuries. But Zhang's prescriptive remedies - including an end to national insurance coverage for traditional medicine, rigorous scientific standards and obligatory Western training for traditional doctors - have hit a nerve at a time when traditional Chinese medicine is increasingly on the defensive.
At Beijing's prestigious Xiehe Hospital, cardiology, gynecology, internal medicine and other Western specialties are housed in a new six-story building filled with shiny equipment, well-maintained halls and renovated toilets. The traditional medicine department is relegated to eight consulting rooms and a therapeutic facility in an outer building with peeling green paint, water-stained walls and a foul smell emanating from a dimly lighted toilet.
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Some blame skewed financial incentives and a government that is forgetting its roots.
"The Health Ministry is actually the Ministry of Western Health," said Lin Zhongpeng, a researcher with the Beijing Tianren Yiyi Traditional Medicine Institute. "It's also shocking that doctors get 15% kickbacks selling Western drugs."
TRADITIONAL remedies tend to be less expensive than Western ones. At the Tongrentang traditional pharmacy and clinic along Dashila alley in Beijing, a dozen people waited for football-sized bags of herbs for a few dollars each.
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"Give me some deer sinew," said one customer, asking for a traditional cure for arthritis. "Large or small?" a clerk in a white coat asked, grabbing several from a tray.
But there are some notable, more expensive exceptions. In glass cases, beneath an ad touting an herbal tonic for avian flu, shelves brimmed with dried snakes, sea horses, ground-up pearls and deer horn powder, used for ailments such as rheumatism, paralysis, asthma, epilepsy, gastritis and acute infantile convulsions.
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Nearby sat an ornate green box lined with red satin holding a shriveled deer penis and testicles ensemble for $63 - nature's apparent answer to Viagra. "That's to improve male function," an employee explained helpfully.
Deer privates at nearly a month's average wage hardly top the price list.
"The most expensive would be bull gallstones," a clerk said, pointing at a yellowish shrink-wrapped object the size of a nickel, used for fevers and inflammation.
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In an adjoining building, third-generation traditional doctor Guan Qingwei examined several patients, prescribing different herbal combinations for insomnia, high-blood pressure and rashes.
Unlike Western medicine, which focuses on the disease, traditional medicine takes a holistic approach, he said. Adherents of "ZangXiang," one of the discipline's fundamental tenets, believe the body gives external clues to the imbalance of internal organs, which can be rectified with herbs and acupuncture. This makes knowledge of anatomy unnecessary, he said.
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Both systems have their strengths, Guan said, but judging traditional medicine according to Western scientific theory and using "double blind" tests on herbal remedies is inappropriate.
"Not only is it unfair, it's laughable," he said. "It's like judging hamburgers based on the taste of dumplings."
Although Chinese schools pump out thousands of traditional medicine graduates each year, nearly half never practice - they chose the specialty because other departments were full.
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This is in contrast with the United States, where most people who study medicine are mature, highly motivated students.
A Chinese government delegation on a recent visit to California said the U.S. could surpass China soon as the best place to learn traditional medicine, said Lixin Huang, president of the American College of Traditional Chinese Medicine in San Francisco, the nation's oldest such graduate program.
Traditional medicine in China tends to be more popular in rural areas and among older people, in part because of its lower cost.
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Each day here in the farm village of Xikou, traditional doctor Liu Huade, 92, sees as many as a dozen patients suffering from ailments such as kidney failure, "women's problems" and liver tumors. Until a few years ago, he picked all of his own herbs in the nearby mountains.
Liu Qiuyao, 59, stopped by to have his pulse checked. Privacy was hardly a concern as a dog wandered in and out of the one-room consultation area accompanied by several villagers eager to chat or buy pills.
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Two years ago, Liu, an impoverished farmer, spit up blood and was told to go to a Western medicine hospital, but he couldn't afford it. So he came to the traditional doctor, who cured him with herbs.
"I'd rather come here," he said, his right eye fused shut beneath a shock of unkempt hair. "When a prescription is too expensive, Dr. Liu tells me where to pick the herbs myself."
A common criticism of Chinese medicine involves its often-unregulated ingredients.
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"Many herbal medicines considered innocuous are actually very toxic," said Fang Zhouzi, a biochemist, columnist and founder of a website that targets academic fraud. "But practitioners and proponents cover this up using various excuses."
THE U.S. Food and Drug Administration banned products marketed as Chinese herbal medicine during the 1970s and '80s after they were implicated in several deaths. In 2004, the FDA issued a ban on the controversial herb ephedra after it was linked to heart attacks and strokes.
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Chinese traditional experts blame misuse. They point to guan mu tong, which has been used for centuries to treat urinary tract infections. Problems surfaced only when Westerners used it incorrectly as part of a weight loss therapy, they say.
Nor are Western drugs free of powerful side effects, others counter.
"Why don't people talk about Western medicines that cause problems?" said Zheng Jinsheng, a professor at the Academy of Chinese Medical Sciences in Beijing, who thinks both disciplines have their place. "Why is traditional medicine always blamed?"
, 百拇医药
Chinese medicine's use of endangered animal and plant ingredients also has been cause for concern. Officially, China forbids trading in the items, but rising incomes and old habits threaten species worldwide.
Only about 30 Chinese tigers, hunted for their bones and other parts, remain in the wild, experts estimate, compared with tens of thousands a few decades ago. Tiger parts are used for rheumatism and to increase virility.
, http://www.100md.com Substances such as bear gallbladder bile are legal, but the cruel conditions under which they are "farmed" have attracted worldwide criticism.
"People in China need to change their values," said Mang Ping, associate professor at Beijing's Central Institute of Socialism. "And most of the time there are replacements in traditional medicine."
Dog bones, for example, are now recommended in lieu of tiger bones, buffalo horns for rhinoceros horns.
, 百拇医药
Western medicine was introduced to China by missionaries in the late 16th century, though it remained largely a curiosity for centuries. Starting in the early 19th century, missionary hospitals became more widespread as European nations elbowed for influence in a weakened China.
"There was a proverb that the door that couldn't be opened with a gun could be opened with a single surgery knife," said Zheng, the professor at the Academy of Chinese Medical Sciences.
, 百拇医药
In 1914 and again in 1929, pro-Western governments tried unsuccessfully to ban traditional medicine as backward and unsafe, spurred by the likes of intellectual Liang Qichao, who had his healthy right kidney accidentally removed by Western-trained doctors but still sung their praises.
Traditional doctors, threatened with the loss of their livelihoods, spread rumors that Western doctors removed Chinese organs and stored them in their churches, using children's hearts in demon rituals.
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"We must never forget our roots," said Li Jian, 46, a business consultant, accompanying his father to a traditional doctor for a liver ailment. "Western medicine always tries to judge traditional medicine from its perspective. Maybe if China becomes very powerful one day, we'll return the favor."
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mark.magnier@latimes.com
, 百拇医药
attachment 2.
Be Wary of Acupuncture, Qigong,and "Chinese Medicine"
Stephen Barrett, M.D.
"Chinese medicine," often called "Oriental medicine" or "traditional Chinese medicine (TCM)," encompasses a vast array of folk medical practices based on mysticism. It holds that the body's vital energy (chi or qi) circulates through channels, called meridians, that have branches connected to bodily organs and functions. Illness is attributed to imbalance or interruption of chi.. Ancient practices such as acupuncture, Qigong, and the use of various herbs are claimed to restore balance.
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Traditional acupuncture, as now practiced, involves the insertion of stainless steel needles into various body areas. A low-frequency current may be applied to the needles to produce greater stimulation. Other procedures used separately or together with acupuncture include: moxibustion (burning of floss or herbs applied to the skin); injection of sterile water, procaine, morphine, vitamins, or homeopathic solutions through the inserted needles; applications of laser beams (laserpuncture); placement of needles in the external ear (auriculotherapy); and acupressure (use of manual pressure). Treatment is applied to "acupuncture points," which are said to be located throughout the body. Originally there were 365 such points, corresponding to the days of the year, but the number identified by proponents during the past 2,000 years has increased gradually to about 2,000 [1]. Some practitioners place needles at or near the site of disease, whereas others select points on the basis of symptoms. In traditional acupuncture, a combination of points is usually used.
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Qigong is also claimed to influence the flow of "vital energy." Internal Qigong involves deep breathing, concentration, and relaxation techniques used by individuals for themselves. External Qigong is performed by "Qigong masters" who claim to cure a wide variety of diseases with energy released from their fingertips. However, scientific investigators of Qigong masters in China have found no evidence of paranormal powers and some evidence of deception. They found, for example, that a patient lying on a table about eight feet from a Qigong master moved rhythmically or thrashed about as the master moved his hands. But when she was placed so that she could no longer see him, her movements were unrelated to his [2]. Falun gong, which China recently banned, is a Qigong varient claimed to be "a powerful mechanism for healing, stress relief and health improvements."
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Most acupuncturists espouse the traditional Chinese view of health and disease and consider acupuncture, herbal medicine, and related practices to be valid approaches to the full gamut of disease. Others reject the traditional approach and merely claim that acupuncture offers a simple way to achieve pain relief. The diagnostic process used by TCM practitioners may include questioning (medical history, lifestyle), observations (skin, tongue, color), listening (breathing sounds), and pulse-taking. Six pulse aspects said to correlate with body organs or functions are checked on each wrist to determine which meridians are "deficient" in chi. (Medical science recognizes only one pulse, corresponding to the heartbeat, which can be felt in the wrist, neck, feet, and various other places.) Some acupuncturists state that the electrical properties of the body may become imbalanced weeks or even months before symptoms occur. These practitioners claim that acupuncture can be used to treat conditions when the patient just "doesn't feel right," even though no disease is apparent.
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TCM (as well as the folk medical practices of various other Asian countries) is a threat to certain animal species. For example, black bears-valued for their gall bladders-have been hunted nearly to extinction in Asia, and poaching of black bears is a growing problem in North America.
Dubious Claims
The conditions claimed to respond to acupuncture include chronic pain (neck and back pain, migraine headaches), acute injury-related pain (strains, muscle and ligament tears), gastrointestinal problems (indigestion, ulcers, constipation, diarrhea), cardiovascular conditions (high and low blood pressure), genitourinary problems (menstrual irregularity, frigidity, impotence), muscle and nerve conditions (paralysis, deafness), and behavioral problems (overeating, drug dependence, smoking). However, the evidence supporting these claims consists mostly of practitioners' observations and poorly designed studies. A controlled study found that electroacupuncture of the ear was no more effective than placebo stimulation (light touching) against chronic pain [3]. In 1990, three Dutch epidemiologists analyzed 51 controlled studies of acupuncture for chronic pain and concluded that "the quality of even the better studies proved to be mediocre. . . . The efficacy of acupuncture in the treatment of chronic pain remains doubtful." [4] They also examined reports of acupuncture used to treat addictions to cigarettes, heroin, and alcohol, and concluded that claims that acupuncture is effective as a therapy for these conditions are not supported by sound clinical research [5].
, 百拇医药
Acupuncture anesthesia is not used for surgery in the Orient to the extent that its proponents suggest. In China physicians screen out patients who appear to be unsuitable. Acupuncture is not used for emergency surgery and often is accompanied by local anesthesia or narcotic medication [6].
How acupuncture may relieve pain is unclear. One theory suggests that pain impulses are blocked from reaching the spinal cord or brain at various "gates" to these areas. Another theory suggests that acupuncture stimulates the body to produce narcotic-like substances called endorphins, which reduce pain. Other theories suggest that the placebo effect, external suggestion (hypnosis), and cultural conditioning are important factors. Melzack and Wall note that pain relief produced by acupuncture can also be produced by many other types of sensory hyperstimulation, such as electricity and heat at acupuncture points and elsewhere in the body. They conclude that "the effectiveness of all of these forms of stimulation indicates that acupuncture is not a magical procedure but only one of many ways to produce analgesia [pain relief] by an intense sensory input." In 1981, the American Medical Association Council on Scientific Affairs noted that pain relief does not occur consistently or reproducibly in most people and does not operate at all in some people [7].
, 百拇医药
In 1995, George A. Ulett, M.D., Ph.D., Clinical Professor of Psychiatry, University of Missouri School of Medicine, stated that "devoid of metaphysical thinking, acupuncture becomes a rather simple technique that can be useful as a nondrug method of pain control." He believes that the traditional Chinese variety is primarily a placebo treatment, but electrical stimulation of about 80 acupuncture points has been proven useful for pain control [8].
The quality of TCM research in China has been extremely poor. A recent analysis of 2,938 reports of clinical trials reported in Chinese medical journals concluded that that no conclusions could be drawn from the vast majority of them. The researchers stated:
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In most of the trials, disease was defined and diagnosed according to conventional medicine; trial outcomes were assessed with objective or subjective (or both) methods of conventional medicine, often complemented by traditional Chinese methods. Over 90% of the trials in non-specialist journals evaluated herbal treatments that were mostly proprietary Chinese medicines. . . .
Although methodological quality has been improving over the years, many problems remain. The method of randomisation was often inappropriately described. Blinding was used in only 15% of trials. Only a few studies had sample sizes of 300 subjects or more. Many trials used as a control another Chinese medicine treatment whose effectiveness had often not been evaluated by randomised controlled trials. Most trials focused on short term or intermediate rather than long term outcomes. Most trials did not report data on compliance and completeness of follow up. Effectiveness was rarely quantitatively expressed and reported. Intention to treat analysis was never mentioned. Over half did not report data on baseline characteristics or on side effects. Many trials were published as short reports. Most trials claimed that the tested treatments were effective, indicating that publication bias may be common; a funnel plot of the 49 trials of acupuncture in the treatment of stroke confirmed selective publication of positive trials in the area, suggesting that acupuncture may not be more effective than the control treatments. [9]
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Two scientists at the University of Heidelberg have developed a "fake needle" that may enable acupuncture researchers to perform better-designed controlled studies. The device is a needle with a blunt tip that moves freely within a copper handle. When the tip touches the skin, the patient feels a sensation similar to that of an acupuncture needle. At the same time, the visible part of the needle moves inside the handle so it appears to shorten as though penetrating the skin. When the device was tested on volunteers, none suspected that it had not penetrated the skin [10].
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In 2004, a University of Heidelberg team proved the worth of their "sham acupuncture" technique in a study of postoperative nausea and vomiting (PONV) in women who underwent breast or gynecologic surgery. The study involved 220 women who received either acupuncture or the sham procedure at the acupuncture point "Pericardium 6" on the inside of the forearm. No significant difference in PONV or antivomiting medication use was found between the two groups or between the people who received treatment before anesthesia was induced and those who received it while anesthetized [11]. A subgroup analysis found that vomiting was "significantly reduced" among the acupuncture patients, but the authors correctly noted that this finding might be due to studying multiple outcomes. (As the number of different outcome measures increases, so do the odds that a "statistically significant" finding will be spurious.) This study is important because PONV reduction is one of the few alleged benefits of acupuncture supported by reports in scientific journals. However, the other positive studies were not as tightly controlled..
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Risks Exist
Improperly performed acupuncture can cause fainting, local hematoma (due to bleeding from a punctured blood vessel), pneumothorax (punctured lung), convulsions, local infections, hepatitis B (from unsterile needles), bacterial endocarditis, contact dermatitis, and nerve damage. The herbs used by acupuncture practitioners are not regulated for safety, potency, or effectiveness. There is also risk that an acupuncturist whose approach to diagnosis is not based on scientific concepts will fail to diagnose a dangerous condition.
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The adverse effects of acupuncture are probably related to the nature of the practitioner's training. A survey of 1,135 Norwegian physicians revealed 66 cases of infection, 25 cases of punctured lung, 31 cases of increased pain, and 80 other cases with complications. A parallel survey of 197 acupuncturists, who are more apt to see immediate complications, yielded 132 cases of fainting, 26 cases of increased pain, 8 cases of pneumothorax, and 45 other adverse results [12]. However, a 5-year study involving 76 acupuncturists at a Japanese medical facility tabulated only 64 adverse event reports (including 16 forgotten needles and 13 cases of transient low blood pressure) associated with 55,591 acupuncture treatments. No serious complications were reported. The researchers concluded that serious adverse reactions are uncommon among acupuncturists who are medically trained [13].
, 百拇医药
Moe recently, members of the British Acupuncture Council who participated in two prospective studies have reported low complication rates and no serious complications among patients who underwent a total of more than 66,000 treatments 14,15]. An accompany editorial suggests that in competent hands, the likelihood of complcations is small [16]. Since outcome data are not available, the studies cannot compare the balance of risks vs benefit. Nor do the studies take into account the likelihood of misdiagnosis (and failure to seek appropriate medical care) by practitioners who use traditional Chinese methods.
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Questionable Standards
In 1971, an acupuncture boom occurred in the United States because of stories about visits to China by various American dignitaries. Entrepreneurs, both medical and nonmedical, began using flamboyant advertising techniques to promote clinics, seminars, demonstrations, books, correspondence courses, and do-it-yourself kits. Today some states restrict the practice of acupuncture to physicians or others operating under their direct supervision. In about 20 states, people who lack medical training can perform acupuncture without medical supervision. The FDA now classifies acupuncture needles as Class II medical devices and requires labeling for one-time use by practitioners who are legally authorized to use them [17]. Acupuncture is not covered under Medicare. The March 1998 issue of the Journal of the American Chiropractic Association carried a five-part cover story encouraging chiropractors to get acupuncture training, which, according to one contributor, would enable them to broaden the scope of their practice [18].
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The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) has set voluntary certification standards and certified several thousand practitioners. By November 1998, 32 states had licensing laws, with 29 of them using NCCAOM examination as all or part of their educational, training, or examination requirement, and three with addditional eligibility criteria. The credentials used by acupuncturists include C.A. (certified acupuncturist), Lic. Ac. (licensed acupuncturist), M.A. (master acupuncturist), Dip. Ac. (diplomate of acupuncture), and O.M.D. (doctor of Oriental medicine). Some of these have legal significance, but they do not signify that the holder is competent to make adequate diagnoses or render appropriate treatment.
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In 1990, the U.S. Secretary of Education recognized what is now called the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) as an accrediting agency. However, such recognition is not based on the scientific validity of what is taught but upon other criteria [19]. Ulett has noted:
Certification of acupuncturists is a sham. While a few of those so accredited are naive physicians, most are nonmedical persons who only play at being doctor and use this certification as an umbrella for a host of unproven New Age hokum treatments. Unfortunately, a few HMOs, hospitals, and even medical schools are succumbing to the bait and exposing patients to such bogus treatments when they need real medical care.
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The National Council Against Health Fraud has concluded:
Acupuncture is an unproven modality of treatment.
Its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge
Research during the past 20 years has not demonstrated that acupuncture is effective against any disease.
, http://www.100md.com Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, conditioning, and other psychologic mechanisms.
The use of acupuncture should be restricted to appropriate research settings,Insurance companies should not be required by law to cover acupuncture treatment,Licensure of lay acupuncturists should be phased out.
Consumers who wish to try acupuncture should discuss their situation with a knowledgeable physician who has no commercial interest [20].
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The NIH Debacle
In 1997, a Consensus Development Conference sponsored by the National Institutes of Health and several other agencies concluded that "there is sufficient evidence . . . of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value." [21] The panelists also suggested that the federal government and insurance companies expand coverage of acupuncture so more people can have access to it. These conclusions were not based on research done after NCAHF's position paper was published. Rather, they reflected the bias of the panelists who were selected by a planning committee dominated by acupuncture proponents [22]. NCAHF board chairman Wallace Sampson, M.D., has described the conference "a consensus of proponents, not a consensus of valid scientific opinion."
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Although the report described some serious problems, it failed to place them into proper perspective. The panel acknowledged that "the vast majority of papers studying acupuncture consist of case reports, case series, or intervention studies with designs inadequate to assess efficacy" and that "relatively few" high-quality controlled trials have been published about acupuncture's effects. But it reported that "the World Health Organization has listed more than 40 [conditions] for which [acupuncture] may be indicated." This sentence should have been followed by a statement that the list was not valid.
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Far more serious, although the consensus report touched on Chinese acupuncture theory, it failed to point out the danger and economic waste involved in going to practitioners who can't make appropriate diagnoses. The report noted:
The general theory of acupuncture is based on the premise that there are patterns of energy flow (Qi) through the body that are essential for health. Disruptions of this flow are believed to be responsible for disease. The acupuncturist can correct imbalances of flow at identifiable points close to the skin.
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Acupuncture focuses on a holistic, energy-based approach to the patient rather than a disease-oriented diagnostic and treatment model.
Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points," the definition and characterization of these points remains controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and the five phases theory, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture.
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Simply stated, this means that if you go to a practitioner who practices traditional Chinese medicine, you are unlikely to be properly diagnosed.
Diagnostic Studies
In 1998, following his lecture at a local college, an experienced TCM practitioner diagnosed me by taking my pulse and looking at my tongue. He stated that my pulse showed signs of "stress" and that my tongue indicated I was suffering from "congestion of the blood." A few minutes later, he examined a woman and told her that her pulse showed premature ventricular contractions (a disturbance of the heart's rhythm that could be harmless or significant, depending on whether the individual has underlying heart disease). He suggested that both of us undergo treatment with acupuncture and herbs-which would have cost about $90 per visit. I took the woman's pulse and found that it was completely normal. I believe that the majority of nonmedical acupuncturists rely on improper diagnostic procedures. The NIH consensus panel should have emphasized the seriousness of this problem.
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A study published in 2001 illustrates the absurdity of TCM practices. A 40-year-old woman with chronic back pain who visited seven acupuncturists during a two-week period was diagnosed with "Qi stagnation" by 6 of them, "blood stagnation" by 5 , "kidney Qi deficiency" by 2, "yin deficiency" by 1, and "liver Qi deficiency" by 1. The proposed treatments varied even more. Among the six who recorded their recommendations, the practitioners planned to use between 7 and 26 needles inserted into 4 to 16 specific "acupuncture points" in the back, leg, hand, and foot. Of 28 acupuncture points selected, only 4 (14%) were prescribed by two or more acupuncturists. [23] The study appears to have been designed to make the results as consistent as possible. All of the acupuncturists had been trained at a school of traditional Chinese medicine (TCM). Six other volunteers were excluded because they "used highly atypical practices," and three were excluded because they had been in practice for less than three years. Whereas science-based methods are thoroughly studied to ensure that they are reliable, this appears to be the first published study that examines the consistency of TCM diagnosis or treatment. I would expect larger studies to show that TCM diagnoses are meaningless and have little or nothing to do with the patient's health status. The study's authors state that the diagnostic findings showed "considerable consistency" because nearly all of the practitioners found Qi or blood stagnation. However, the most likely explanation is that these are diagnosed in nearly everyone. It would be fascinating to see what would happen if a healthy person was examined by multiple acupuncturists.
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For Additional Information
CSICOP Investigation of TCM and Pseudoscience in China
NCAHF Position Paper on Acupuncture
Questioning Dr. Isadore Rosenfeld's Acupuncture Story
References
Skrabanek P. Acupuncture: Past, present, and future. In Stalker D, Glymour C, editors. Examining Holistic Medicine. Amherst, NY: Prometheus Books, 1985.
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Kurtz P, Alcock J, and others. Testing psi claims in China: Visit by a CSICOP delegation. Skeptical Inquirer 12:364-375, 1988.
Melzack R, Katz J. Auriculotherapy fails to relieve chronic pain: A controlled crossover study. JAMA 251:1041?1043, 1984
Ter Reit G, Kleijnen J, Knipschild P. Acupuncture and chronic pain: A criteria-based meta-analysis. Clinical Epidemiology 43:1191-1199, 1990.
Ter Riet G, Kleijnen J, Knipschild P. A meta-analysis of studies into the effect of acupuncture on addiction. British Journal of General Practice 40:379-382, 1990.
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Beyerstein BL, Sampson W. Traditional Medicine and Pseudoscience in China: A Report of the Second CSICOP Delegation (Part 1). Skeptical Inquirer 20(4):18-26, 1996.
American Medical Association Council on Scientific Affairs. Reports of the Council on Scientific Affairs of the American Medical Association, 1981. Chicago, 1982, The Association.
Ulett GA. Acupuncture update 1984. Southern Medical Journal 78:233?234, 1985.
, 百拇医药
Tang J-L, Zhan S-Y, Ernst E. Review of randomised controlled trials of traditional Chinese medicine. British Medical Journal 319:160-161, 1999.
Streitberger K, Kleinhenz J. Introducing a placebo needle into acupuncture research. Lancet 352:364-365, 1998.
Streitberger K and others. Acupuncture compared to placebo-acupuncture for postoperative nausea and vomiting prophylaxis: A randomised placebo-controlled patient and observer blind trial. Anesthesia 59:142-149, 2004.
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Norheim JA, Fennebe V. Adverse effects of acupuncture. Lancet 345:1576, 1995.
Yamashita H and others. Adverse events related to acupuncture. JAMA 280:1563-1564, 1998.
White A and others. Adverse events following acupuncture: Prospective surgery of 32,000 consultations with doctors and physiotherapists. BMJ 323:485-486, 2001.
MacPherson H and others. York acupuncture safety study: Prospective survey of 24,000 treatments by traditional acupuncturists. BMJ 323:486-487, 2001.
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Vincent C. The safety of acupuncture. BMJ 323:467-468, 2001.
Acupuncture needle status changed. FDA Talk Paper T96-21, April 1, 1996
Wells D. Think acu-practic: Acupuncture benefits for chiropractic. Journal of the American Chiropractic Association 35(3):10-13, 1998.
Department of Education, Office of Postsecondary Education. Nationally Recognized Accrediting Agencies and Associations. Criteria and Procedures for Listing by the U.S. Secretary For Education and Current List. Washington, D.C., 1995, U.S. Department of Education.
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Sampson W and others. Acupuncture: The position paper of the National Council Against Health Fraud. Clinical Journal of Pain 7:162-166, 1991.
Acupuncture. NIH Consensus Statement 15:(5), November 3-5, 1997.
Sampson W. On the National Institute of Drug Abuse Consensus Conference on Acupuncture. Scientific Review of Alternative Medicine 2(1):54-55, 1998.
Kalauokalani D and others. Acupuncture for chronic low back pain: Diagnosis and treatment patterns among acupuncturists evaluating the same patient. Southern Medical Journal 94:486-492, 2001.
, 百拇医药
Quackwatch Home Page
This article was revised on January 29, 2004.
attachment 3.
针灸在美国 记者： 萧敬 (acupuncture in USA, VOA)
华盛顿
2006年12月11日
山东一位听众最近打来电话说，中医博大精深，针灸更是中国的国宝，不知在美国治病用不用针灸疗法？
*纽约时报记者将针灸介绍到美国？*
关于针灸是怎样传入美国的，长期以来有着各种各样的说法。流传最广的一种说法是这样的：1971年7月，纽约时报发表了记者詹姆斯.赖斯顿撰写的一篇介绍他在中国接受针灸治疗的文章，这篇文章的发表就是针灸传入美国的历史性标志。
, 百拇医药
当时担任纽约时报副社长的赖斯顿应中国政府的邀请访华，在中国期间突然患了阑尾炎，住进北京的协和医院。做完阑尾切除手术后，赖斯顿感到腹部胀痛，于是接受针灸治疗，效果非常好。赖斯顿在病床上把治疗经过写成一篇报导，第二天发表在纽约时报上，在美国引发了针灸热。不久前，美国中医药专业学会向赖斯顿的家人颁发奖状，感谢赖斯顿对针灸传入美国所做的贡献。
其实，自从18世纪中国劳工来到美洲，美国就有使用针灸治病的记载，但只是局限在华人社区，美国主流社会对针灸几乎一无所知。据1970年出版的《人类，神话，魔术》杂志介绍，当年全美只有几十位针灸师。当然，这个数字显然是不包括华人社区的。
在美国刚刚兴起针灸热的时候，针灸人才奇缺，针灸师生意红火，应接不暇，甚至要雇用助手帮忙从病人身上拔针。1972年，美国第一家针灸中心在纽约成立，两星期之内，接待的病人超过8千人。
*针灸在美国遍地开花*
, 百拇医药
现在，美国有44个州通过了有关针灸的法律，而且针灸正在逐步纳入正规的医学教育体系。全美现有50多所针灸学校，两万多名针灸师。尽管美国目前大多数州还没有以立法的形式确认中医的地位，但针灸已经先行一步，在美国遍地开花。
值得注意的是，很多美国的西医参与了针灸的临床应用和研究。比如，美国西海岸有一个针灸学会，30多年来，几乎每年都有一批美国西医到中国大陆学习针灸，足迹遍及中国的各大中西医院。
另外，中国也为美国的针灸发展输送了很多人才，他们一般都接受过正规的中西医基础教育，因此跟美国同行交流起来比较容易。
针灸进入美国之后，在规范化、现代化方面进行了一系列改革。比如，针灸用针已经纳入受美国食物与医药管理局监管的第二类医疗用品，研制出了更细、质量更好的针灸用针。随着针灸师的培训和针灸器械的显著改善，针灸已经成为几乎无痛的过程，得到越来越多美国人的认可。, http://www.100md.com
大意：在中国的一位听众打电话给我，抱怨美国之音周六的《健康园地》回答听众提问的有些“医学专家”的医学知识落后，并爱提及中医的办法。因为美国之音是代表美国政府的机构，所以美国之音的医学专家本应当具有美国医学教育水平，至少要有美国医生执照。有关中医的内容，美国之音不谈为妙。
(实际上我于2006年5月给美国之音中文部寄去了我的长文，《从美国看中国大陆的医疗体系》。很显然，中文部的《健康园地》的负责人不同意我的反对中医的观点。所以，我并不对这封信抱太大希望，我只是尽一个公民的责任。Cross fingers. 但是我相信，这个问题在我，Stephen Barrett医生和美国之音中文部的中国人雇员之间会有一个很大的争论。中国人生在中医的文化中，到了美国还是这个脑袋，真是可悲。)
01-15-2007
, 百拇医药 Dear Mr. President Bush:
I received a call from an audience member of the program “Voice of America” which is a Chinese Mandarin program broadcasted for mainland China. The program hosts Chinese doctors who answer audience member's medical questions. This particular audience member complained of a recent series called “Health Forum” on Saturdays and claimed the doctors on the show gave misleading and backwards medical information to the public in China.
, 百拇医药
It found most of the specialists who answered the audience questions had training in Western medicine, but their training took place in China and compared to modern medical knowledge in the US, it is still quite backwards. Only a few specialists as hosts had medical training in the United States. Traditional Chinese medicine has been criticized in China in the last few years labeling herbal medicine as an often “ineffective, even dangerous derivative of witchcraft that relies on untested concoctions and obscure ingredients to trick patients, then employs a host of excuses if the treatment doesn't work” (see attachment 1). Many educated Chinese people including myself believe that traditional Chinese medicine is not scientific. We suggested to the Chinese government recently to discontinue the national insurance coverage for traditional medicine and that there needs to be rigorous scientific standards and obligatory Western training for traditional Chinese medical doctors. “This has hit a nerve at a time when traditional Chinese medicine is increasingly on the defensive.”
, http://www.100md.com
I have training on both sides with a NYS license and a practice in NYC as a medical doctor and agree with Dr. Stephen Barrett's point of view in that acupuncture can only be applied as a simple pain control modality in the skeletomuscular system (see attachment 2 and 3). I believe the detrimental program that is Voice of America should end its misinformation and instead spread modern medical knowledge to the world. To achieve this goal, Voice of America needs to hire qualified doctors who are at least licensed in the US to avoid further misleading the audience especially when talking about traditional Chinese medicine, often labeled as holism. Traditional Chinese medicine is not effective, so far as we know. Furthermore, no medical doctor in the USA has the position to educate people about traditional Chinese medicine because they lack the knowledge of this obviously unpromising field. Attached please find three relevant articles, one of which is copied from the Voice of America Chinese section website.
, http://www.100md.com
Sincerely yours,
William C. Wang, MD, PhD
attachment 1
LA Times: China's medicine wars
An attack on the traditional healing arts has inflamed adherents and sparked a debate about Western healthcare.
By Mark Magnier, Times Staff Writer
January 8, 2007
Clinic
, http://www.100md.com
click to enlargeXikou, China - THE fur is flying, not to mention the acupuncture needles, the firewort and the $15,000-a-pound bull gallstones. China's ancient healing arts, as integral to national identity as the Great Wall or steamed dumplings, have become embroiled in the country's struggle to balance tradition and modernity.
A relatively obscure professor at a regional university kicked off the controversy in October with an online petition calling for traditional medicine to be stripped from the Chinese Constitution. It has a protected status here that, at least in theory, guarantees it equal footing with its Western counterpart.
, 百拇医药
Professor Zhang Gongyao and fellow critics have blasted Chinese medicine as an often ineffective, even dangerous derivative of witchcraft that relies on untested concoctions and obscure ingredients to trick patients, then employs a host of excuses if the treatment doesn't work.
For adherents of the 3,000-year-old system, this borders on heresy. The Health Ministry labeled Zhang's ideas "ignorant of history," and traditionalists have called the skeptics traitors bent on "murdering" Chinese culture.
, 百拇医药
Ironically, the firestorm dovetails with a growing embrace of Chinese medicine abroad as an antidote to the perceived soulless, money-obsessed nature of Western healthcare.
On a trip to China in mid-December, U.S. Health and Human Services Secretary Mike Leavitt said the two countries planned to trade lessons on how to integrate Western and Chinese medicine.
"It's an area of interest for China and the U.S.," he said.
, http://www.100md.com
Many Australians, Europeans and Americans see the limitations of advanced science, said Rey Tiquia, an expert in Chinese traditional medicine based in Australia, even as more Chinese view their traditions as old-fashioned.
"For Chinese," he said, "it's still the lure of something new and shiny, like riding a car rather than a bicycle."
Since 1949, the number of traditional doctors trained in China has fallen by nearly half to 270,000, while the number of Western-trained doctors has jumped twentyfold to more than 1.7 million.
, 百拇医药
Criticism that traditional medicine is not scientific dates back centuries. But Zhang's prescriptive remedies - including an end to national insurance coverage for traditional medicine, rigorous scientific standards and obligatory Western training for traditional doctors - have hit a nerve at a time when traditional Chinese medicine is increasingly on the defensive.
At Beijing's prestigious Xiehe Hospital, cardiology, gynecology, internal medicine and other Western specialties are housed in a new six-story building filled with shiny equipment, well-maintained halls and renovated toilets. The traditional medicine department is relegated to eight consulting rooms and a therapeutic facility in an outer building with peeling green paint, water-stained walls and a foul smell emanating from a dimly lighted toilet.
, 百拇医药
Some blame skewed financial incentives and a government that is forgetting its roots.
"The Health Ministry is actually the Ministry of Western Health," said Lin Zhongpeng, a researcher with the Beijing Tianren Yiyi Traditional Medicine Institute. "It's also shocking that doctors get 15% kickbacks selling Western drugs."
TRADITIONAL remedies tend to be less expensive than Western ones. At the Tongrentang traditional pharmacy and clinic along Dashila alley in Beijing, a dozen people waited for football-sized bags of herbs for a few dollars each.
, 百拇医药
"Give me some deer sinew," said one customer, asking for a traditional cure for arthritis. "Large or small?" a clerk in a white coat asked, grabbing several from a tray.
But there are some notable, more expensive exceptions. In glass cases, beneath an ad touting an herbal tonic for avian flu, shelves brimmed with dried snakes, sea horses, ground-up pearls and deer horn powder, used for ailments such as rheumatism, paralysis, asthma, epilepsy, gastritis and acute infantile convulsions.
, http://www.100md.com
Nearby sat an ornate green box lined with red satin holding a shriveled deer penis and testicles ensemble for $63 - nature's apparent answer to Viagra. "That's to improve male function," an employee explained helpfully.
Deer privates at nearly a month's average wage hardly top the price list.
"The most expensive would be bull gallstones," a clerk said, pointing at a yellowish shrink-wrapped object the size of a nickel, used for fevers and inflammation.
, http://www.100md.com
In an adjoining building, third-generation traditional doctor Guan Qingwei examined several patients, prescribing different herbal combinations for insomnia, high-blood pressure and rashes.
Unlike Western medicine, which focuses on the disease, traditional medicine takes a holistic approach, he said. Adherents of "ZangXiang," one of the discipline's fundamental tenets, believe the body gives external clues to the imbalance of internal organs, which can be rectified with herbs and acupuncture. This makes knowledge of anatomy unnecessary, he said.
, http://www.100md.com
Both systems have their strengths, Guan said, but judging traditional medicine according to Western scientific theory and using "double blind" tests on herbal remedies is inappropriate.
"Not only is it unfair, it's laughable," he said. "It's like judging hamburgers based on the taste of dumplings."
Although Chinese schools pump out thousands of traditional medicine graduates each year, nearly half never practice - they chose the specialty because other departments were full.
, http://www.100md.com
This is in contrast with the United States, where most people who study medicine are mature, highly motivated students.
A Chinese government delegation on a recent visit to California said the U.S. could surpass China soon as the best place to learn traditional medicine, said Lixin Huang, president of the American College of Traditional Chinese Medicine in San Francisco, the nation's oldest such graduate program.
Traditional medicine in China tends to be more popular in rural areas and among older people, in part because of its lower cost.
, http://www.100md.com
Each day here in the farm village of Xikou, traditional doctor Liu Huade, 92, sees as many as a dozen patients suffering from ailments such as kidney failure, "women's problems" and liver tumors. Until a few years ago, he picked all of his own herbs in the nearby mountains.
Liu Qiuyao, 59, stopped by to have his pulse checked. Privacy was hardly a concern as a dog wandered in and out of the one-room consultation area accompanied by several villagers eager to chat or buy pills.
, http://www.100md.com
Two years ago, Liu, an impoverished farmer, spit up blood and was told to go to a Western medicine hospital, but he couldn't afford it. So he came to the traditional doctor, who cured him with herbs.
"I'd rather come here," he said, his right eye fused shut beneath a shock of unkempt hair. "When a prescription is too expensive, Dr. Liu tells me where to pick the herbs myself."
A common criticism of Chinese medicine involves its often-unregulated ingredients.
, 百拇医药
"Many herbal medicines considered innocuous are actually very toxic," said Fang Zhouzi, a biochemist, columnist and founder of a website that targets academic fraud. "But practitioners and proponents cover this up using various excuses."
THE U.S. Food and Drug Administration banned products marketed as Chinese herbal medicine during the 1970s and '80s after they were implicated in several deaths. In 2004, the FDA issued a ban on the controversial herb ephedra after it was linked to heart attacks and strokes.
, http://www.100md.com
Chinese traditional experts blame misuse. They point to guan mu tong, which has been used for centuries to treat urinary tract infections. Problems surfaced only when Westerners used it incorrectly as part of a weight loss therapy, they say.
Nor are Western drugs free of powerful side effects, others counter.
"Why don't people talk about Western medicines that cause problems?" said Zheng Jinsheng, a professor at the Academy of Chinese Medical Sciences in Beijing, who thinks both disciplines have their place. "Why is traditional medicine always blamed?"
, 百拇医药
Chinese medicine's use of endangered animal and plant ingredients also has been cause for concern. Officially, China forbids trading in the items, but rising incomes and old habits threaten species worldwide.
Only about 30 Chinese tigers, hunted for their bones and other parts, remain in the wild, experts estimate, compared with tens of thousands a few decades ago. Tiger parts are used for rheumatism and to increase virility.
, http://www.100md.com Substances such as bear gallbladder bile are legal, but the cruel conditions under which they are "farmed" have attracted worldwide criticism.
"People in China need to change their values," said Mang Ping, associate professor at Beijing's Central Institute of Socialism. "And most of the time there are replacements in traditional medicine."
Dog bones, for example, are now recommended in lieu of tiger bones, buffalo horns for rhinoceros horns.
, 百拇医药
Western medicine was introduced to China by missionaries in the late 16th century, though it remained largely a curiosity for centuries. Starting in the early 19th century, missionary hospitals became more widespread as European nations elbowed for influence in a weakened China.
"There was a proverb that the door that couldn't be opened with a gun could be opened with a single surgery knife," said Zheng, the professor at the Academy of Chinese Medical Sciences.
, 百拇医药
In 1914 and again in 1929, pro-Western governments tried unsuccessfully to ban traditional medicine as backward and unsafe, spurred by the likes of intellectual Liang Qichao, who had his healthy right kidney accidentally removed by Western-trained doctors but still sung their praises.
Traditional doctors, threatened with the loss of their livelihoods, spread rumors that Western doctors removed Chinese organs and stored them in their churches, using children's hearts in demon rituals.
, http://www.100md.com
"We must never forget our roots," said Li Jian, 46, a business consultant, accompanying his father to a traditional doctor for a liver ailment. "Western medicine always tries to judge traditional medicine from its perspective. Maybe if China becomes very powerful one day, we'll return the favor."
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mark.magnier@latimes.com
, 百拇医药
attachment 2.
Be Wary of Acupuncture, Qigong,and "Chinese Medicine"
Stephen Barrett, M.D.
"Chinese medicine," often called "Oriental medicine" or "traditional Chinese medicine (TCM)," encompasses a vast array of folk medical practices based on mysticism. It holds that the body's vital energy (chi or qi) circulates through channels, called meridians, that have branches connected to bodily organs and functions. Illness is attributed to imbalance or interruption of chi.. Ancient practices such as acupuncture, Qigong, and the use of various herbs are claimed to restore balance.
, 百拇医药
Traditional acupuncture, as now practiced, involves the insertion of stainless steel needles into various body areas. A low-frequency current may be applied to the needles to produce greater stimulation. Other procedures used separately or together with acupuncture include: moxibustion (burning of floss or herbs applied to the skin); injection of sterile water, procaine, morphine, vitamins, or homeopathic solutions through the inserted needles; applications of laser beams (laserpuncture); placement of needles in the external ear (auriculotherapy); and acupressure (use of manual pressure). Treatment is applied to "acupuncture points," which are said to be located throughout the body. Originally there were 365 such points, corresponding to the days of the year, but the number identified by proponents during the past 2,000 years has increased gradually to about 2,000 [1]. Some practitioners place needles at or near the site of disease, whereas others select points on the basis of symptoms. In traditional acupuncture, a combination of points is usually used.
, http://www.100md.com
Qigong is also claimed to influence the flow of "vital energy." Internal Qigong involves deep breathing, concentration, and relaxation techniques used by individuals for themselves. External Qigong is performed by "Qigong masters" who claim to cure a wide variety of diseases with energy released from their fingertips. However, scientific investigators of Qigong masters in China have found no evidence of paranormal powers and some evidence of deception. They found, for example, that a patient lying on a table about eight feet from a Qigong master moved rhythmically or thrashed about as the master moved his hands. But when she was placed so that she could no longer see him, her movements were unrelated to his [2]. Falun gong, which China recently banned, is a Qigong varient claimed to be "a powerful mechanism for healing, stress relief and health improvements."
, 百拇医药
Most acupuncturists espouse the traditional Chinese view of health and disease and consider acupuncture, herbal medicine, and related practices to be valid approaches to the full gamut of disease. Others reject the traditional approach and merely claim that acupuncture offers a simple way to achieve pain relief. The diagnostic process used by TCM practitioners may include questioning (medical history, lifestyle), observations (skin, tongue, color), listening (breathing sounds), and pulse-taking. Six pulse aspects said to correlate with body organs or functions are checked on each wrist to determine which meridians are "deficient" in chi. (Medical science recognizes only one pulse, corresponding to the heartbeat, which can be felt in the wrist, neck, feet, and various other places.) Some acupuncturists state that the electrical properties of the body may become imbalanced weeks or even months before symptoms occur. These practitioners claim that acupuncture can be used to treat conditions when the patient just "doesn't feel right," even though no disease is apparent.
, http://www.100md.com
TCM (as well as the folk medical practices of various other Asian countries) is a threat to certain animal species. For example, black bears-valued for their gall bladders-have been hunted nearly to extinction in Asia, and poaching of black bears is a growing problem in North America.
Dubious Claims
The conditions claimed to respond to acupuncture include chronic pain (neck and back pain, migraine headaches), acute injury-related pain (strains, muscle and ligament tears), gastrointestinal problems (indigestion, ulcers, constipation, diarrhea), cardiovascular conditions (high and low blood pressure), genitourinary problems (menstrual irregularity, frigidity, impotence), muscle and nerve conditions (paralysis, deafness), and behavioral problems (overeating, drug dependence, smoking). However, the evidence supporting these claims consists mostly of practitioners' observations and poorly designed studies. A controlled study found that electroacupuncture of the ear was no more effective than placebo stimulation (light touching) against chronic pain [3]. In 1990, three Dutch epidemiologists analyzed 51 controlled studies of acupuncture for chronic pain and concluded that "the quality of even the better studies proved to be mediocre. . . . The efficacy of acupuncture in the treatment of chronic pain remains doubtful." [4] They also examined reports of acupuncture used to treat addictions to cigarettes, heroin, and alcohol, and concluded that claims that acupuncture is effective as a therapy for these conditions are not supported by sound clinical research [5].
, 百拇医药
Acupuncture anesthesia is not used for surgery in the Orient to the extent that its proponents suggest. In China physicians screen out patients who appear to be unsuitable. Acupuncture is not used for emergency surgery and often is accompanied by local anesthesia or narcotic medication [6].
How acupuncture may relieve pain is unclear. One theory suggests that pain impulses are blocked from reaching the spinal cord or brain at various "gates" to these areas. Another theory suggests that acupuncture stimulates the body to produce narcotic-like substances called endorphins, which reduce pain. Other theories suggest that the placebo effect, external suggestion (hypnosis), and cultural conditioning are important factors. Melzack and Wall note that pain relief produced by acupuncture can also be produced by many other types of sensory hyperstimulation, such as electricity and heat at acupuncture points and elsewhere in the body. They conclude that "the effectiveness of all of these forms of stimulation indicates that acupuncture is not a magical procedure but only one of many ways to produce analgesia [pain relief] by an intense sensory input." In 1981, the American Medical Association Council on Scientific Affairs noted that pain relief does not occur consistently or reproducibly in most people and does not operate at all in some people [7].
, 百拇医药
In 1995, George A. Ulett, M.D., Ph.D., Clinical Professor of Psychiatry, University of Missouri School of Medicine, stated that "devoid of metaphysical thinking, acupuncture becomes a rather simple technique that can be useful as a nondrug method of pain control." He believes that the traditional Chinese variety is primarily a placebo treatment, but electrical stimulation of about 80 acupuncture points has been proven useful for pain control [8].
The quality of TCM research in China has been extremely poor. A recent analysis of 2,938 reports of clinical trials reported in Chinese medical journals concluded that that no conclusions could be drawn from the vast majority of them. The researchers stated:
, http://www.100md.com
In most of the trials, disease was defined and diagnosed according to conventional medicine; trial outcomes were assessed with objective or subjective (or both) methods of conventional medicine, often complemented by traditional Chinese methods. Over 90% of the trials in non-specialist journals evaluated herbal treatments that were mostly proprietary Chinese medicines. . . .
Although methodological quality has been improving over the years, many problems remain. The method of randomisation was often inappropriately described. Blinding was used in only 15% of trials. Only a few studies had sample sizes of 300 subjects or more. Many trials used as a control another Chinese medicine treatment whose effectiveness had often not been evaluated by randomised controlled trials. Most trials focused on short term or intermediate rather than long term outcomes. Most trials did not report data on compliance and completeness of follow up. Effectiveness was rarely quantitatively expressed and reported. Intention to treat analysis was never mentioned. Over half did not report data on baseline characteristics or on side effects. Many trials were published as short reports. Most trials claimed that the tested treatments were effective, indicating that publication bias may be common; a funnel plot of the 49 trials of acupuncture in the treatment of stroke confirmed selective publication of positive trials in the area, suggesting that acupuncture may not be more effective than the control treatments. [9]
, 百拇医药
Two scientists at the University of Heidelberg have developed a "fake needle" that may enable acupuncture researchers to perform better-designed controlled studies. The device is a needle with a blunt tip that moves freely within a copper handle. When the tip touches the skin, the patient feels a sensation similar to that of an acupuncture needle. At the same time, the visible part of the needle moves inside the handle so it appears to shorten as though penetrating the skin. When the device was tested on volunteers, none suspected that it had not penetrated the skin [10].
, 百拇医药
In 2004, a University of Heidelberg team proved the worth of their "sham acupuncture" technique in a study of postoperative nausea and vomiting (PONV) in women who underwent breast or gynecologic surgery. The study involved 220 women who received either acupuncture or the sham procedure at the acupuncture point "Pericardium 6" on the inside of the forearm. No significant difference in PONV or antivomiting medication use was found between the two groups or between the people who received treatment before anesthesia was induced and those who received it while anesthetized [11]. A subgroup analysis found that vomiting was "significantly reduced" among the acupuncture patients, but the authors correctly noted that this finding might be due to studying multiple outcomes. (As the number of different outcome measures increases, so do the odds that a "statistically significant" finding will be spurious.) This study is important because PONV reduction is one of the few alleged benefits of acupuncture supported by reports in scientific journals. However, the other positive studies were not as tightly controlled..
, 百拇医药
Risks Exist
Improperly performed acupuncture can cause fainting, local hematoma (due to bleeding from a punctured blood vessel), pneumothorax (punctured lung), convulsions, local infections, hepatitis B (from unsterile needles), bacterial endocarditis, contact dermatitis, and nerve damage. The herbs used by acupuncture practitioners are not regulated for safety, potency, or effectiveness. There is also risk that an acupuncturist whose approach to diagnosis is not based on scientific concepts will fail to diagnose a dangerous condition.
, http://www.100md.com
The adverse effects of acupuncture are probably related to the nature of the practitioner's training. A survey of 1,135 Norwegian physicians revealed 66 cases of infection, 25 cases of punctured lung, 31 cases of increased pain, and 80 other cases with complications. A parallel survey of 197 acupuncturists, who are more apt to see immediate complications, yielded 132 cases of fainting, 26 cases of increased pain, 8 cases of pneumothorax, and 45 other adverse results [12]. However, a 5-year study involving 76 acupuncturists at a Japanese medical facility tabulated only 64 adverse event reports (including 16 forgotten needles and 13 cases of transient low blood pressure) associated with 55,591 acupuncture treatments. No serious complications were reported. The researchers concluded that serious adverse reactions are uncommon among acupuncturists who are medically trained [13].
, 百拇医药
Moe recently, members of the British Acupuncture Council who participated in two prospective studies have reported low complication rates and no serious complications among patients who underwent a total of more than 66,000 treatments 14,15]. An accompany editorial suggests that in competent hands, the likelihood of complcations is small [16]. Since outcome data are not available, the studies cannot compare the balance of risks vs benefit. Nor do the studies take into account the likelihood of misdiagnosis (and failure to seek appropriate medical care) by practitioners who use traditional Chinese methods.
, 百拇医药
Questionable Standards
In 1971, an acupuncture boom occurred in the United States because of stories about visits to China by various American dignitaries. Entrepreneurs, both medical and nonmedical, began using flamboyant advertising techniques to promote clinics, seminars, demonstrations, books, correspondence courses, and do-it-yourself kits. Today some states restrict the practice of acupuncture to physicians or others operating under their direct supervision. In about 20 states, people who lack medical training can perform acupuncture without medical supervision. The FDA now classifies acupuncture needles as Class II medical devices and requires labeling for one-time use by practitioners who are legally authorized to use them [17]. Acupuncture is not covered under Medicare. The March 1998 issue of the Journal of the American Chiropractic Association carried a five-part cover story encouraging chiropractors to get acupuncture training, which, according to one contributor, would enable them to broaden the scope of their practice [18].
, http://www.100md.com
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) has set voluntary certification standards and certified several thousand practitioners. By November 1998, 32 states had licensing laws, with 29 of them using NCCAOM examination as all or part of their educational, training, or examination requirement, and three with addditional eligibility criteria. The credentials used by acupuncturists include C.A. (certified acupuncturist), Lic. Ac. (licensed acupuncturist), M.A. (master acupuncturist), Dip. Ac. (diplomate of acupuncture), and O.M.D. (doctor of Oriental medicine). Some of these have legal significance, but they do not signify that the holder is competent to make adequate diagnoses or render appropriate treatment.
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In 1990, the U.S. Secretary of Education recognized what is now called the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) as an accrediting agency. However, such recognition is not based on the scientific validity of what is taught but upon other criteria [19]. Ulett has noted:
Certification of acupuncturists is a sham. While a few of those so accredited are naive physicians, most are nonmedical persons who only play at being doctor and use this certification as an umbrella for a host of unproven New Age hokum treatments. Unfortunately, a few HMOs, hospitals, and even medical schools are succumbing to the bait and exposing patients to such bogus treatments when they need real medical care.
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The National Council Against Health Fraud has concluded:
Acupuncture is an unproven modality of treatment.
Its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge
Research during the past 20 years has not demonstrated that acupuncture is effective against any disease.
, http://www.100md.com Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, conditioning, and other psychologic mechanisms.
The use of acupuncture should be restricted to appropriate research settings,Insurance companies should not be required by law to cover acupuncture treatment,Licensure of lay acupuncturists should be phased out.
Consumers who wish to try acupuncture should discuss their situation with a knowledgeable physician who has no commercial interest [20].
, 百拇医药
The NIH Debacle
In 1997, a Consensus Development Conference sponsored by the National Institutes of Health and several other agencies concluded that "there is sufficient evidence . . . of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value." [21] The panelists also suggested that the federal government and insurance companies expand coverage of acupuncture so more people can have access to it. These conclusions were not based on research done after NCAHF's position paper was published. Rather, they reflected the bias of the panelists who were selected by a planning committee dominated by acupuncture proponents [22]. NCAHF board chairman Wallace Sampson, M.D., has described the conference "a consensus of proponents, not a consensus of valid scientific opinion."
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Although the report described some serious problems, it failed to place them into proper perspective. The panel acknowledged that "the vast majority of papers studying acupuncture consist of case reports, case series, or intervention studies with designs inadequate to assess efficacy" and that "relatively few" high-quality controlled trials have been published about acupuncture's effects. But it reported that "the World Health Organization has listed more than 40 [conditions] for which [acupuncture] may be indicated." This sentence should have been followed by a statement that the list was not valid.
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Far more serious, although the consensus report touched on Chinese acupuncture theory, it failed to point out the danger and economic waste involved in going to practitioners who can't make appropriate diagnoses. The report noted:
The general theory of acupuncture is based on the premise that there are patterns of energy flow (Qi) through the body that are essential for health. Disruptions of this flow are believed to be responsible for disease. The acupuncturist can correct imbalances of flow at identifiable points close to the skin.
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Acupuncture focuses on a holistic, energy-based approach to the patient rather than a disease-oriented diagnostic and treatment model.
Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points," the definition and characterization of these points remains controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and the five phases theory, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture.
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Simply stated, this means that if you go to a practitioner who practices traditional Chinese medicine, you are unlikely to be properly diagnosed.
Diagnostic Studies
In 1998, following his lecture at a local college, an experienced TCM practitioner diagnosed me by taking my pulse and looking at my tongue. He stated that my pulse showed signs of "stress" and that my tongue indicated I was suffering from "congestion of the blood." A few minutes later, he examined a woman and told her that her pulse showed premature ventricular contractions (a disturbance of the heart's rhythm that could be harmless or significant, depending on whether the individual has underlying heart disease). He suggested that both of us undergo treatment with acupuncture and herbs-which would have cost about $90 per visit. I took the woman's pulse and found that it was completely normal. I believe that the majority of nonmedical acupuncturists rely on improper diagnostic procedures. The NIH consensus panel should have emphasized the seriousness of this problem.
, 百拇医药
A study published in 2001 illustrates the absurdity of TCM practices. A 40-year-old woman with chronic back pain who visited seven acupuncturists during a two-week period was diagnosed with "Qi stagnation" by 6 of them, "blood stagnation" by 5 , "kidney Qi deficiency" by 2, "yin deficiency" by 1, and "liver Qi deficiency" by 1. The proposed treatments varied even more. Among the six who recorded their recommendations, the practitioners planned to use between 7 and 26 needles inserted into 4 to 16 specific "acupuncture points" in the back, leg, hand, and foot. Of 28 acupuncture points selected, only 4 (14%) were prescribed by two or more acupuncturists. [23] The study appears to have been designed to make the results as consistent as possible. All of the acupuncturists had been trained at a school of traditional Chinese medicine (TCM). Six other volunteers were excluded because they "used highly atypical practices," and three were excluded because they had been in practice for less than three years. Whereas science-based methods are thoroughly studied to ensure that they are reliable, this appears to be the first published study that examines the consistency of TCM diagnosis or treatment. I would expect larger studies to show that TCM diagnoses are meaningless and have little or nothing to do with the patient's health status. The study's authors state that the diagnostic findings showed "considerable consistency" because nearly all of the practitioners found Qi or blood stagnation. However, the most likely explanation is that these are diagnosed in nearly everyone. It would be fascinating to see what would happen if a healthy person was examined by multiple acupuncturists.
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For Additional Information
CSICOP Investigation of TCM and Pseudoscience in China
NCAHF Position Paper on Acupuncture
Questioning Dr. Isadore Rosenfeld's Acupuncture Story
References
Skrabanek P. Acupuncture: Past, present, and future. In Stalker D, Glymour C, editors. Examining Holistic Medicine. Amherst, NY: Prometheus Books, 1985.
, http://www.100md.com
Kurtz P, Alcock J, and others. Testing psi claims in China: Visit by a CSICOP delegation. Skeptical Inquirer 12:364-375, 1988.
Melzack R, Katz J. Auriculotherapy fails to relieve chronic pain: A controlled crossover study. JAMA 251:1041?1043, 1984
Ter Reit G, Kleijnen J, Knipschild P. Acupuncture and chronic pain: A criteria-based meta-analysis. Clinical Epidemiology 43:1191-1199, 1990.
Ter Riet G, Kleijnen J, Knipschild P. A meta-analysis of studies into the effect of acupuncture on addiction. British Journal of General Practice 40:379-382, 1990.
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Beyerstein BL, Sampson W. Traditional Medicine and Pseudoscience in China: A Report of the Second CSICOP Delegation (Part 1). Skeptical Inquirer 20(4):18-26, 1996.
American Medical Association Council on Scientific Affairs. Reports of the Council on Scientific Affairs of the American Medical Association, 1981. Chicago, 1982, The Association.
Ulett GA. Acupuncture update 1984. Southern Medical Journal 78:233?234, 1985.
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Tang J-L, Zhan S-Y, Ernst E. Review of randomised controlled trials of traditional Chinese medicine. British Medical Journal 319:160-161, 1999.
Streitberger K, Kleinhenz J. Introducing a placebo needle into acupuncture research. Lancet 352:364-365, 1998.
Streitberger K and others. Acupuncture compared to placebo-acupuncture for postoperative nausea and vomiting prophylaxis: A randomised placebo-controlled patient and observer blind trial. Anesthesia 59:142-149, 2004.
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Norheim JA, Fennebe V. Adverse effects of acupuncture. Lancet 345:1576, 1995.
Yamashita H and others. Adverse events related to acupuncture. JAMA 280:1563-1564, 1998.
White A and others. Adverse events following acupuncture: Prospective surgery of 32,000 consultations with doctors and physiotherapists. BMJ 323:485-486, 2001.
MacPherson H and others. York acupuncture safety study: Prospective survey of 24,000 treatments by traditional acupuncturists. BMJ 323:486-487, 2001.
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Vincent C. The safety of acupuncture. BMJ 323:467-468, 2001.
Acupuncture needle status changed. FDA Talk Paper T96-21, April 1, 1996
Wells D. Think acu-practic: Acupuncture benefits for chiropractic. Journal of the American Chiropractic Association 35(3):10-13, 1998.
Department of Education, Office of Postsecondary Education. Nationally Recognized Accrediting Agencies and Associations. Criteria and Procedures for Listing by the U.S. Secretary For Education and Current List. Washington, D.C., 1995, U.S. Department of Education.
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Sampson W and others. Acupuncture: The position paper of the National Council Against Health Fraud. Clinical Journal of Pain 7:162-166, 1991.
Acupuncture. NIH Consensus Statement 15:(5), November 3-5, 1997.
Sampson W. On the National Institute of Drug Abuse Consensus Conference on Acupuncture. Scientific Review of Alternative Medicine 2(1):54-55, 1998.
Kalauokalani D and others. Acupuncture for chronic low back pain: Diagnosis and treatment patterns among acupuncturists evaluating the same patient. Southern Medical Journal 94:486-492, 2001.
, 百拇医药
Quackwatch Home Page
This article was revised on January 29, 2004.
attachment 3.
针灸在美国 记者： 萧敬 (acupuncture in USA, VOA)
华盛顿
2006年12月11日
山东一位听众最近打来电话说，中医博大精深，针灸更是中国的国宝，不知在美国治病用不用针灸疗法？
*纽约时报记者将针灸介绍到美国？*
关于针灸是怎样传入美国的，长期以来有着各种各样的说法。流传最广的一种说法是这样的：1971年7月，纽约时报发表了记者詹姆斯.赖斯顿撰写的一篇介绍他在中国接受针灸治疗的文章，这篇文章的发表就是针灸传入美国的历史性标志。
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当时担任纽约时报副社长的赖斯顿应中国政府的邀请访华，在中国期间突然患了阑尾炎，住进北京的协和医院。做完阑尾切除手术后，赖斯顿感到腹部胀痛，于是接受针灸治疗，效果非常好。赖斯顿在病床上把治疗经过写成一篇报导，第二天发表在纽约时报上，在美国引发了针灸热。不久前，美国中医药专业学会向赖斯顿的家人颁发奖状，感谢赖斯顿对针灸传入美国所做的贡献。
其实，自从18世纪中国劳工来到美洲，美国就有使用针灸治病的记载，但只是局限在华人社区，美国主流社会对针灸几乎一无所知。据1970年出版的《人类，神话，魔术》杂志介绍，当年全美只有几十位针灸师。当然，这个数字显然是不包括华人社区的。
在美国刚刚兴起针灸热的时候，针灸人才奇缺，针灸师生意红火，应接不暇，甚至要雇用助手帮忙从病人身上拔针。1972年，美国第一家针灸中心在纽约成立，两星期之内，接待的病人超过8千人。
*针灸在美国遍地开花*
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现在，美国有44个州通过了有关针灸的法律，而且针灸正在逐步纳入正规的医学教育体系。全美现有50多所针灸学校，两万多名针灸师。尽管美国目前大多数州还没有以立法的形式确认中医的地位，但针灸已经先行一步，在美国遍地开花。
值得注意的是，很多美国的西医参与了针灸的临床应用和研究。比如，美国西海岸有一个针灸学会，30多年来，几乎每年都有一批美国西医到中国大陆学习针灸，足迹遍及中国的各大中西医院。
另外，中国也为美国的针灸发展输送了很多人才，他们一般都接受过正规的中西医基础教育，因此跟美国同行交流起来比较容易。
针灸进入美国之后，在规范化、现代化方面进行了一系列改革。比如，针灸用针已经纳入受美国食物与医药管理局监管的第二类医疗用品，研制出了更细、质量更好的针灸用针。随着针灸师的培训和针灸器械的显著改善，针灸已经成为几乎无痛的过程，得到越来越多美国人的认可。, http://www.100md.com