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Will scientific proof finally mark the end of acupuncture?

Acupuncture has the kind of history one might expect, given the premise that sticking sharp needles into people is an effective way to ease their pain. But these battles may be coming to an end--even if it's hard to decide which side actually won. Here's a snapshot of the very long and painful controversy.

Acupuncture may date back to Otzi, the 5,000-year-old iceman found in Austria, whose body was decorated with tattoos consisting of lines and dots that seem to correspond with acupuncture points. Indeed, an article in The Lancet, published in 1999 by Frank Bahr from the German Academy of Acupuncture, suggests that Otzi's markings represented a "meaningful therapeutic regimen" for the arthritis found in his lower back and the whipworm eggs in his stomach that likely caused him serious abdominal problems.

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Alas, the Chinese tend to think Dr. Bahr got it wrong. They contend the practice originated 2,600 years ago when a Chinese soldier was struck with an arrow that serendipitously cured him of a long-standing illness. The oldest written description of acupuncture appeared in the Yellow Emperor's Classic of Internal Medicine, dating from the second century BCE, which describes the manipulation of vital energy, or chi, that flows through the body via channels known as meridians. The modern resurgence of acupuncture is attributed to Chairman Mao, who needed an inexpensive health-care system and turned to the "barefoot doctors" of traditional Chinese medicine. But according to Mao's personal doctor, the chairman didn't believe in it himself.

This history and much more was recounted by Simon Singh and Edzard Ernst, M.D., in the 2008 book Trick or Treatment: The Undeniable Facts about Alternative Medicine (see S&H July 2008). Singh is a noted science writer and Dr. Ernst is a professor of complementary medicine at the University of Essex (UK) and the author of The Oxford Handbook of Complementary Medicine. Ernst began his medical career at a homeopathic hospital in Munich and was a pioneer in alternative and complementary medicine, but he had a radical change of heart and now attacks alternative medicine with a sharp mind and an evangelical fervor. This is how he describes the fundamental difference in the development of traditional Chinese medicine and Western medicine:

"Chinese medicine emerged from a society that rejected human dissection. Unable to look inside the body, the Chinese developed a largely imaginary model of human anatomy that was based on the world around them. For example, the human body was supposed to have 365 distinct components, but only because there are 365 days in the year. Similarly, it seems likely that the belief in twelve meridians emerged as a parallel to the twelve great rivers of China. In short, the human body was interpreted as a microcosm of the universe, as opposed to understanding it in terms of its own reality."

Nevertheless, his review of the scientific literature did find support for the use of acupuncture for pelvic and back pain during pregnancy, low back pain, headaches, post-operative nausea and vomiting, neck disorders, and bedwetting. In other words, those careful observations of the body based on ancient traditions did produce some treatments that stood up to the most careful Western scrutiny.

But that wasn't the end of it. Dr. Ernst and others created sham acupuncture needles that retract instead of piercing the skin--like the retractable daggers used in theatrical productions, The goal was to create better placebo controls for studies of acupuncture (and presumably to skewer the practice once and for all). Since the publication of the book, this magazine reported one major study showing that acupuncture significantly reduced nausea from chemotherapy, but so did the sham needles. Two prestigious Cochrane Reviews agreed that sham acupuncture and real acupuncture had similar results, so it seemed the real benefits of acupuncture came from the expectations of the patient and the time and care of the practitioners, rather than the needles or the rivers of chi.

But on May 30, a new study published in Nature Neuroscience turned the tables again--by reporting that the neurotransmitter adenosine is released into the central nervous system during acupuncture. Adenosine is known to help in inducing sleep and is also a natural painkiller. This is the first time a single specific mechanism has been indentified for the workings of acupuncture.

To find it, researchers at the University of Rochester (N.Y.) Medical Center took mice suffering from pain in one of the paws. They were divided into two groups, and adenosine receptors were artificially removed from the control group. Both groups of mice were then subjected to an acupuncture session of 30 minutes each. Acupuncture treatment was administered in a well-known acupuncture point in the knee. Researchers observed that acupuncture reduced pain by two-thirds in the mice that had normal levels of adenosine but not in the mice without it. When the adenosine quantity was increased in the mice, pain dulled even without acupuncture.

In regard to the sham needles that have produced similar effects, Maiken Nedergaard, M.D., D.M.Sc., the lead researcher of the University of Rochester Medical Center study, says, "Many investigators are biased against alternative medicine, and I expect that all the emotions among patients and investigators can affect the data. The best literature on acupuncture is obtained in animals that do not have expectation for the treatment."

And here's the punch line. Now that researchers have identified a specific neurotransmitter behind acupuncture, they think they can put it in a pill.
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Title Annotation:Updates & Observations: Soul + Body + Medicine
Author:Kiesling, Stephen; Sachan, Dinsa
Publication:Spirituality & Health Magazine
Date:Sep 1, 2010
Words:916
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