University Times

Complementary and alternative medicine (CAM) is gaining acceptance among Western physicians, but one doctor's CAM can be another's sham.

Take acupuncture, as a pointed example.

Dating back thousands of years, the Chinese technique of puncturing the body with needles at key points is supposed to stimulate positive energy flow, relieving pain and curing allergies. It may be the oldest continuously practiced system of medicine.

"What remains mysterious about acupuncture is that we don't know why it is effective," David Servan-Schreiber, medical director of UPMC Shady-side's Center for Complementary Medicine, said in an interview. "Acupuncture doesn't seem to work through any of the physiological or anatomical systems that we have identified and studied in the last 150 years of Western medicine.

"But there is no question that acupuncture is effective. Its value is not even up for debate."

Not true, says Pitt psychology professor Donald McBur-ney.

In a letter published in the Pittsburgh Post-Gazette last fall, in subsequent correspondence with Servan-Schreiber and in a recent University Times interview, McBurney criticized UPMC Health System's foray into alternative medicine. He has sought to poke holes in acupuncture and a number of other CAM treatments.

After Servan-Schreiber quoted a 1997 statement on acupuncture by the National Institutes of Health ("The data in support of acupuncture are as strong as those for many accepted Western medical therapies"), McBurney replied that the NIH statement "represents less than meets the eye."

McBurney maintained that the NIH conference that issued the statement was organized by CAM supporters; critics were not invited. He added that the NIH statement in its entirety was "surprisingly lukewarm."

McBurney quoted the following excerpt from the statement: "According to contemporary research standards, there is a paucity of high-quality research assessing the efficacy of acupuncture compared with placebo or sham acupunc-ture….Many of these studies provide equivocal results because of design, sample size and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebo and 'sham acupuncture' groups."

Studies have indicated that "sham acupuncture" (sticking needles into arbitrary rather than traditional acupuncture points) seems to produce effects similar to those of authentic acupuncture, McBurney said.

Servan-Schreiber countered that the NIH supports several therapeutic uses of acupuncture — for example, in relieving nausea following chemotherapy. "There is only a tiny fraction of what we do in Western medicine for which the NIH requires the same extremely high standard of evidence that it requires for acupuncture," he said.

The World Health Organization, using less rigorous standards, endorses acupuncture for treating some 40 health conditions, Servan-Schreiber added.

"And everyone has heard stories of Western surgeons and anesthesiologists who have visited China and witnessed operations performed entirely with acupuncture anesthesia, where patients were alert and talking despite the fact that their bellies or chests had been opened," he said.

McBurney noted that acupuncture is based on the ancient Chinese theory of Qi, vital energy that cannot be measured. "This supposed energy flows through channels in the body that do not correspond in any way to known anatomy and physiology," McBurney said.

Creation of the Qi theory "is not surprising because the theory of acupuncture was developed when dissection of the human body was not permitted in China," McBurney allowed.

But he asked: "What does Qi help us to understand? That sticking needles in people produces effects that may or may not be any greater than a placebo? This is why a mechanistic understanding of acupuncture would not validate alternative medicine — it would only validate sticking needles into people. All mechanisms that have been proposed to account for acupuncture come from modern science: endorphins, placebo, counter irritation, etc. If and when acupuncture meets scientific muster, Qi would evaporate, and acupuncture would be absorbed into modern science."

Servan-Schreiber likened the current "estrangement" of acupuncture and other CAM treatments from mainstream medicine to earlier treatments that were ridiculed at first.

"For example," Servan-Schreiber wrote in a letter to McBurney, "in the early 19th century an Austrian physician demonstrated that hand washing prevented the spread of childbirth fever. However, the germ theory of disease was described only in the next 30 years, and in the meantime Dr. Semmelweis was ostracized and ridiculed by his colleagues who persisted in delivering babies without first washing their hands, even after they had just completed an autopsy."

As recently as the 1980s, Servan-Schreiber added, researchers were ridiculed for suggesting that peptic ulcer disease often was caused by an infectious organism. "Yet, this model is now a pillar of treatment for this condition," he wrote.

McBurney agreed that medicine frequently adopts practices and prescribes drugs simply because they work, even though scientists don't know why. "Aspirin may be the best example, because it was used for decades before its analgesic mechanism was elucidated," he wrote.

The medical establishment resisted hand washing in the absence of a known mechanism for the spread of infection, McBurney pointed out. "Semmelweis, however, was not following any principles of CAM, but traditional scientific methodology, because he hypothesized that a then-unknown agent was causing the infection," he wrote. "In addition, his procedure resulted in a dramatic reduction in mortality that far exceeds anything claimed for CAM."

— Bruce Steele