by Corey

Review: Effect of combined manual acupuncture and massage on body weight and body mass index reduction in obese and overweight women: A randomized, short-term clinical trial

Massage is commonly used as an adjuvant therapy with acupuncture. This research article was chosen as it attempts to test the synergistic benefits of adding massage therapy to acupuncture treatment in the reduction of body weight (BW) and body mass index (BMI). This paper will assess the research article with respect to research design, evidence information, and prospective recommendations for related research.

The evaluated article describes research using a randomized experimental design. Participants were divided into two groups based on their BMI determination as being overweight or obese. Each group was randomly divided into two groups to receive combined manual acupuncture and massage therapy (MAMT) or only manual acupuncture therapy (MAT).

The strength of this research was that anthropometric data was collected daily during the trial to evaluate the maximal time for reduction of BW and BMI as opposed to typical obesity study designs that only compare the difference of these measurements at the start and end times of the trial (Abdi et al, 2012).

Several factors limit the value of the observed outcomes in this research including not testing a control group that received sham acupuncture, sham massage, and/or no treatment. Long-term effects of the treatment groups were not evaluated for statistical differences. Follow-up to evaluate remission risk was also not conducted. The treatment groups were small and limited to only women.

Obesity is approached from a biomedical perspective with a preventive strategy including integration of multiple interventions including lifestyle modification such as diet and physical activity. Despite this approach, worldwide prevalence of obesity has nearly doubled from 1980 to 2008 (Seidell & Halberstadt, 2015). Additional medical therapies include pharmacological and surgical management of obesity.

A systematic review and meta-analysis favors acupuncture to lifestyle modification techniques like low-calorie diets, placebo treatment, and no treatment at all (Cho et al, 2009). Herbal supplementations are also used.

Obesity is becoming a growing global concern and has been closely linked to negative health impacts and a reduced quality of life (Bombak, 2014). Acupuncture can be used alone or with other interventions to provide beneficial outcomes when addressing obesity with few if any reported adverse effects. Further high-quality studies will be helpful to support acupuncture’s efficacy and determine its optimal use in the treatment of obesity.

 

References

Abdi H., Zhao B., Darbandi M., Ghayour-Mobarhan M., Tavallaie S., Rahsepar A.A., Parizadeh S.M., Safariyan M., Nemeti M., Mohammadi M., Abbasi, Parizad P., Darbandi S., Akhlaghi S., Ferns G.A. (2012). The effects of Acupuncture on Obesity: Anthropometric Parameters, Lipid Profile, and Inflammatory and Immunologic Markers. The Scientific World Journal, 2012, http://doi.org/10.1100/2012/603539

Bombak A. (2014). Obesity, health at every size, and public health policy. American Journal of Public Health, 104(2):e60-7. http://doi.org/10.2105/AJPH.2013.301486

Cho S.H., Lee J.S., Thabane L., Lee J. (2009). Acupuncture for obesity: a systematic review and meta-analysis. International Journal of Obesity, 33, 183-196. http://doi.org/10.1038/ijo.2008.269

He, J., Zhang, X., Qu, Y., Huang, H., Liu, X., Du, J., Guo, S. (2015). Effect of combined manual acupuncture and massage on body weight and body mass index reduction in obese and overweight women: A randomized, short-term clinical trial. Journal of Acupuncture and Meridian Studies, 8(2):61-65. http://doi.org/10.1016/j.jams.2014.08.001

Seidell J.C., Halberstadt J. (2015). The global burden of obesity and challenges of prevention. Annals of Nutrition & Metabolism, 66(suppl 2):7-12. http://doi.org/10.1159/000375143

by Corey

An ethical model of health care

When considering the most ethical model for the relationship between mainstream and alternative medicine, one that allows for all approaches to coexist within the current landscape of U.S. health care should be considered. The current state of mainstream medicine is a varied system that already has created a precedent for various practice models to arise. Imposing change on this will inevitably marginalize some providers and their disciplines.

Some conventional doctors have chosen to opt-out of contracts with insurance companies and third-party payers and deal directly with patients themselves. This approach, for all intents and purposes in the context of this analysis, is analogous with an opposition model. Whether collecting fees at the time of services rendered or as a retainer system like in direct primary care, both mainstream and alternative providers are already choosing to practice outside the mainstream insurance payment model.

An integrative approach is ethical to include in health care as it widens the marketplace and offers more services to benefit patients and potentially reduce overall costs for payers. An integrative model typically implies a collaborative multi-disciplinary approach to integration and not an opportunity for complete assimilation of one form medicine by another. This would need to hold in order to respect ethical concerns related to practitioners’ boundaries and scope of practice issues.

Plauralism offers a compatible model aligned with the values of today’s health care industry. If the U.S. decides to move to a universal coverage system, tolerance for the opposition model would still be most ethical, however, regulation of quality and safety of services would still be needed if those type of providers want to self-identify with practicing with medically-based relevance.

A health care system that reinforces an open exchange of ideas and cooperative efforts can support progress in methodology and policy arenas, both of which are imperative to address as ongoing reform continues.

by Corey

Randomized controlled trials

Randomized controlled trials (RCTs) were originally designed for testing drug treatments. While this has become a gold standard model for research in general, it is not necessarily a one-size-fits all design for any medically relevant treatment. This type of simplistic thinking does seem to be endemic to the conventional system and can even be seen in conventional treatment plans, i.e. treating many presentations of headache with the same methods.

Just like Chinese Medical practitioners choose different treatment plans (designs) based on more subtle and individualistic patterns, research scientists could better broaden range of evidence beyond conventional interventions by also adopting various models of evaluation that could be selected based on the intervention being investigated.

For this to happen, a paradigm shift would need to occur in conventional thinking. There is a hierarchical framework that gets applied to many things and creates judgments of something as superior or inferior. Currently, RCTs are seen as the superior form of research but if it could be seen as part of a system of designs that coexist together and each correlate to different applications in research, perhaps some equanimity with other forms of evidence could be achieved. Case studies and qualitative evidence would be among this list. Instead of being deemed inferior and cast aside, different research methods could be applied to new studies with a more individualized approach. This may even create more effective methods for obtaining accurate evidence.

by Corey

Acceptance of an integrative model of health care

As alternative medicine practitioners, we have reached the time where integration into the conventional U.S. medical system is occurring regardless of member’s resistance or support of it happening. While past efforts to promote this integration have helped provide a path to the present state, our patient population has quickened the process by growing in numbers as users of alternative practices such as acupuncture, herbal supplementation, and energy therapies while concurrently seeking conventional health care. Even though more and more doctors are being exposed to positive patient experiences with alternative medicine, it is clear that this is not sufficient evidence for the current conventional model to accept patient claims as actionable “truth” and include alternative therapies in their care plans. Efforts have been taken within alternative professions like acupuncture, already in existence with thousands of years of documented clinical expertise, to expand their practice to include a conventional medical understanding as well as advancement of their training to a doctorate level. This growth towards integrative practice can provide a segue towards a more collaborative approach, however, currently, qualitative patient testimonials and clinical expertise together do not create an adequate basis for comfort in most medical professionals to recommend alternative therapies as a common practice.

Research appears to be a key element that could lead to more widespread adoption of alternative therapies in the conventional system. By providing a systematically measurable and analyzable body of information and accepted facts, research is what motivates the current medical system to support new ideas into practice. However, varying paradigms among conventional and alternative approaches precipitates the need for a common agenda, language, and reporting guidelines for research and new evidence for it to be “universally” accepted. This can help to validate patient’s qualitative experiences, making this useful in research along with quantitative data.

More valid and accepted data will likely create a tipping point for recognition of proven alternative therapies but true acceptance, collaboration, and creation of integrative care plans by members of the conventional system will be necessary for integration on a national scale. Biases must be uncovered and shed by some of these conventional practitioners towards acceptance of new extrinsic ideas that may change or even challenge what they have established into the monolithic system in the U.S. This bias can extend to mistaking faith in a familiar paradigm and self-preservation for truly knowing that evidence is factual and actionable. By taking a deeper look into the underlying beliefs that influence their practical clinical relationship with scientific research, conventional practitioners may be more open to effectively evaluate alternative medical research and become more amenable to realizing a robust integrative model of health care in our country.

by Corey

Review: Acupuncture for obesity: A systematic review and meta-analysis

This review published in 2009 (Cho et al) reviewed 29 randomized controlled trials (RCTs) that compared acupuncture with a control group receiving no treatment, a placebo, pharmacological treatment, or non-pharmacological interventions. RCTs were only included if statistical heterogeneity was not observed. Acupuncture was analyzed to be favored to lifestyle modifications like dieting and exercising, as well as to placebo or sham treatment, and groups receiving no treatment. Improvement to the risk rates for a remission of obesity was also observed when acupuncture was used with diet than to when diet was used alone. Publication bias was identified. Minimal adverse effects were observed including redness, pain or discomfort, and bleeding in ears in an auricular acupuncture group. Bruising and abdominal discomfort after electroacupuncture was reported. This review concludes that acupuncture for obesity has some beneficial effect although there was insufficient data available with acceptable methodological quality and narrowed clinical heterogeneity. As a result, the study placed limited value on its findings and cannot conclusively answer if acupuncture should be widely recommended and which form of acupuncture is most effective.

 

Reference

Cho S.H., Lee J.S., Thabane L., Lee J. (2009). Acupuncture for obesity: A systematic review and meta-analysis. International Journal of Obesity, 33, 183-196. http://doi.org/10.1038/ijo.2008.269

by Corey

Review: The effects of acupuncture on obesity: Anthropometric parameters, lipid profile, and inflammatory and immunologic markers

This study (Abdi et al, 2012) included 196 subjects from Quem Hospital in Mashhad, Iran with a body mass index (BMI) between 25 and 45 kg/m2. They were randomized into 2 groups of equal size. The case group received body acupuncture with manipulation and electroacupuncture while the control group received sham acupuncture with very superficial needling at inaccurate locations and disconnected electric lines. A standard point selection protocol was administered plus one of two sets of points chosen if patients had higher or lower energy. Each subject received two treatments per week for 6 weeks while on a low-calorie diet. After, a low-calorie diet with no treatment was continued for six weeks. Body weight (BW) and other anthropometric measurements, as well as blood samples were collected at the start of the trial, after six weeks, and after 12 weeks. 79 subjects in the case group and 82 subjects in the control group completed the 12 week trial. Analysis showed acupuncture was more effective in reduction of WC and HC than in the sham group and had lowered levels of immune-related inflammatory markers. Hs-CRP was not significantly changed in both the case and control groups. Acupuncture produces reduced levels of anti-heat shock protein antibodies while the control did not.

 

Reference

Abdi H., Zhao B., Darbandi M., Ghayour-Mobarhan M., Tavallaie S., Rahsepar A.A., Parizadeh S.M., Safariyan M., Nemeti M., Mohammadi M., Abbasi-Parizad P., Darbandi S., Akhlaghi S., Ferns G.A. (2012). The effects of acupuncture on obesity: anthropometric parameters, lipid profile, and inflammatory and immunologic markers. The Scientific World Journal, 2012, 603539. http://doi.org/10.1100/2012/603539

by Corey

Review: Electroacupuncture Modulates Reproductive Hormone Levels in Patients with Primary Ovarian Insufficiency: Results from a Prospective Observational Study

This prospective case series study (Zhou et al, 2013) investigated the effects of acupuncture on serum FSH, E2, and LH levels and changes in menstruation in 11 female patients with Primary Ovarian Insufficiency (POI). Researchers used a commonly associated definition of POI as having reported amenorrhea for four or more months and elevated FSH levels measured at least twice. Patients stopped all medications that could influence reproductive hormones for one month before treatment. Electroacupuncture treatment was given daily, five times a week for four weeks and then once every other day, three times a week for two months. Reported symptoms and serum samples were collected at baseline, at the end of treatment, and at a three-month follow-up after treatment. Significant changes to E2, FSH, and LH were recognized after treatment when compared to baseline values and the effects were maintained at the time of follow-up. After treatment, all but one patient regained menstrual flow and two patients reported amenorrhea at follow-up. The study demonstrated that acupuncture could decrease FSH and LH levels, increase E2 levels, and help regain menstruation in women with POI with little to no side effects, however, the value of the study is limited as it had a small sample size and did not control for confounding factors. Also, symptoms of POI were subjectively reported and documented by researchers leading to possible bias in data documentation. Researchers suggest that further randomized control trials are needed to confirm the efficacy of results and investigate the mechanism of action of the associated outcomes.

 

Reference

Zhou K., Jiang J., Wu J., Liu Z. (2013). Electroacupuncture Modulates Reproductive Hormone Levels in Patients with Primary Ovarian Insufficiency: Results from a Prospective Observational Study. Evidence-Based Complementary and Alternative Medicine, 2013, 657234. http://doi.org/10.1155/2013/657234

by Corey

Review: “I Felt Like It Was God’s Hands Putting the Needles In”: A Qualitative Analysis of the Experience of Acupuncture for Chronic Pain in a Low-Income, Ethnically Diverse, and Medically Underserved Patient Population

This qualitative analysis published in 2015 (Kligler et al) was conducted to understand the experience of acupuncture treatment in specifically low-income, ethnically diverse, and medically underserved populations as part of the parent trial, ADDOPT (Acupuncture to Decrease Disparities in Outcomes of Pain Treatment). Probe questions were asked in phone interviews to 37 participants of ADDOPT, 6 to 18 months after the trial completed. Participants for this study were recruited from two equal-size lists, generated from patients who demonstrated a significant improvement in pain and another from those who did not. 8 initial interviews were conducted and subjected to a preliminary analysis, after which several questions were added for the remaining 29 interviews. An inductive thematic analysis demonstrated that three main themes of the acupuncture experience were mentioned during the interviews. The participants’ decision-making process to try acupuncture was one theme. Willingness to try something new, feeling that medications were not working, and a sense of desperation were cited as factors. The treatment process experience was another theme. Participants described different ways that acupuncture was different than their usual medical experience. Patients didn’t feel that they needed to know how acupuncture worked in order for it to be effective but many patients felt that being open to the power of the mind would produce positive results. The third theme was the impact of acupuncture on their health. Many reported the positive effects acupuncture had on stress, depression, anxiety, sleep, and gynecological issues. One limitation mentioned by the researchers was the delay in time before interviews could be started after trial due to the need to ensure with quantitative analysis that an adequate sampling of responders and non-responders in the parent trial were included. This could have led to biased perspectives from participants. Cost and access were cited for further review to address acupuncture’s potential use for care in this patient population.

 

Reference

Kligler B., Buonara M., Gabison J., Jacobs E., Karasz A., McKee M.D. (2015). “I Felt Like It Was God’s Hands Putting the Needles In”: A Qualitative Analysis of the Experience of Acupuncture for Chronic Pain in a Low-Income, Ethnically Diverse, and Medically Underserved Patient Population. The Journal of Alternative and Complementary Medicine, 2015, 21(11):713-9. http://doi.org/10.1089/acm.2014.0376

by Corey

Environmental Health in Manhattan Community District 6, New York City

Manhattan Community District 6: Community Assessment

Manhattan Community District 6, located in New York County, New York, covers 1.4 square miles and includes the neighborhoods of Beekman Place, Murray Hill, Gramercy, Stuyvesant Town, Sutton Place, Tudor City, and Turtle Bay. Its boundaries include East 59 Street to the north, East 14 Street to the south, Lexington Avenue to the west extending to Madison Avenue between 34 to 40 Streets, and the East River to the east. According to census data collected in 2016, District 6 has a population of 141,162 with a median age of 35.6 years old. 55% of residents are female and 69% are white. The per capita income is $90,056 with a median household income of $110,401. There are 75,794 households with an average of 1.8 persons per household. 34% of the population is married and 80% have a bachelor’s degree or higher. 22.1% of residents were born outside the U.S., with 48% from Asia. 25.6% of people speak a language other than English at home (U.S. Census Bureau).

The district is home to 44 medical clinics including five major hospitals and about 90% of residents have health insurance. 90% of people reported their own health as good to excellent with an average life expectancy in District 6 of 85.3 years. There are many retail shops and grocery stores, health food stores, and restaurants are easily accessible making access to good quality food convenient.

13% of residents smoke (under the national average) and 93% eat at least one serving of fruits or vegetables per day, similar to residents in Manhattan and NYC as a whole. However only 12% consume one or more 12-ounce sugary drinks per day (best rate in NYC), and 85% reported engaging in physical activity in the previous 30 days. District 6 has the lowest rates in NYC for obesity (only 8% compared to 24% in all of NYC) and diabetes (only 3% compared to 10% in all of NYC). District 6 is just below the NYC average for alcohol and drug-related hospitalizations. They also have the lowest rates of stroke hospitalizations and low rates for avoidable hospitalizations due to adult asthma and adult diabetes. The rate of adult psychiatric hospitalizations, however, is above the overall NYC rate. District 6 ranks the second highest in air pollution in NYC and has the smallest percentage of park space out of all the NYC districts. Similar to most New Yorkers, the leading cause of death in District 6 is cancer and heart disease yet the district’s mortality rate due to diabetes is less than half the citywide average (NYC Health, 2015).

 

The Need to Improve Environmental Health in District 6

The top three pressing issues perceived and identified by Manhattan Community Board 6 are affordable housing, parks, and senior services. Addressing the lack of tree cover and park space has been identified as a health matter by the board (NYC Planning, 2018). It is clear from the statistics that District 6 residents care about their health and engage in behaviors to support that. Avoiding sugary drinks, exercising, and eating well are reflected in their low obesity rate and incidence of diabetes. However, it is concerning that these healthy behaviors are doing little to reduce the cancer rates and cardiovascular disease in their area, which continue to remain an issue for New Yorkers at large. On the HealthyPeople.gov website within the 2020 Topics & Objectives section for Cancer, it mentions that many cancers are preventable by reducing risk factors like use of tobacco products, physical activity and poor nutrition, obesity, and ultraviolet light exposure (ODPHP, 2018). But in Manhattan’s Community District 6, the apparent reduction of these cited risk factors do not appear to be making the difference needed and thus, cannot be the only variables to take into account.

It is difficult to ignore that District 6 is ranked second only to Midtown for air pollution. This could be an often-overlooked connection to cancer and mortalities related to cardiovascular disease. In 2013, the International Agency for Research on Cancer (IARC), part of the World Health Organization (WHO), has classified outdoor air pollution, and specifically particulate matter, as a carcinogen (American Cancer Society, 2013). In NYC, poor air quality is linked to the high volume of automobile traffic and exhaust emissions. NYC is aiming to convert its public bus system to all electric vehicles by 2040. In 2005, they mandated that all diesel-powered vehicles owned by the city be powered by ultra-low sulfur diesel fuel. While NYC has launched initiatives to reduce industrial emissions to lighten the city’s impact on air pollution; this is not capturing the extent of the problem. The influx of cars and trucks from commuters and businesses continue to increase in numbers and automobile traffic is recognized as an issue. The link to health, aside from conditions like asthma and other respiratory diseases, is not commonly highlighted, and pollution is often framed in the context of climate change and geo-environmental impact.

Many New Yorkers boast how their tap water is piped into the city from mountain reservoirs yet it’s safety has come under question after the U.S. Environmental Protection Agency (EPA) has identified violations of federal health-based drinking water standards in 2017. Six known cancer-causing contaminants have been found and eight other chemicals associated to increase the risk of cancer have been detected in tap water. Some of these are frequently seen to be associated with agricultural, industrial, and urban runoff, but others like bromodichloromethane and chloroform are due the result of using chlorine and other disinfectants to treat drinking water by government institutions (EWG, 2018). Regular consumption and use of unfiltered contaminated water in food preparation undoubtedly have an impact on cancer rates and overall health. However, this environmental health concern has not been acknowledged by the city and NYC announced in December of 2017 that they received a 10-year waiver to continue delivering unfiltered drinking water from its mountain water supply (NYC.gov, 2017).

If you’ve ever walked around the streets of New York City in the summertime, it would be surprising to not notice the smells of trash and grime of the city. With garbage collection typically, being a curbside event, pedestrians encounter NYC’s waste products on an intimate scale. Also, the need for wide-spread infrastructure maintenance and the constant activity of new construction projects, residents of NYC get exposed to many toxins and chemicals used in the demolition of old structures containing many harmful products. New building materials and furnishings add to the City’s levels of toxic chemicals, and industrial-strength cleaning and disinfection methods add even more. In addition to the toxins one might encounter in the streets, many residential and commercial interiors provide additional exposure to toxins. According to EWG’s Healthy Living: Home Guide (2018), “the air inside our homes is 2 to 5 times more polluted than the air outside”.

 

Solutions to Improve Environmental Health in District 6

Improving air pollution globally and in urban environments is a complex issue and one that is being addressed on all levels of government and within the corporate sector. NYC is continually monitoring levels of fine particulate matter and other air contaminants and trying to advance standards towards a cleaner and healthier city. While asthma and respiratory diseases are sometimes mentioned in the context of discussing air pollution, greater awareness can be placed on the many other health detriments, like cancer and cardiovascular disease, which air pollution can influence. As Manhattan Community Board 6 has recognized, growing the park space in their district should be a priority and will offer a means to help with pollution for their residents. Increasing park space can potentially benefit health in many ways in District 6. As typically mentioned with such initiatives, increased park space can provide residents with more opportunity for exercise and physical fitness. Planting trees has been recognized to offset carbon dioxide levels and remove dust and other pollutants from the air. Trees can also lower temperatures in the summer, provide wildlife habitat, and increase community pride and district appeal (MillionTrees NYC, 2015). Also, by reclaiming land currently allocated for automobile traffic and rezoning transportation routes, adding park space can result in redistributing exposures to pollution in District 6 from cars and trucks. For individuals, as it may be difficult to limit time spent in their own neighborhood, pollution masks are available to wear that can filter dust and small particulate. These type of safety masks are not commonly used in NYC, which underscores the shift in awareness that is necessary to alter people’s understanding of the breadth of health risks associated with regular exposure to harmful air pollution.

Promotion of NYC tap water as “some of the cleanest and best tap water in the world, “ by Mayor de Blasio, and Health Commissioner Dr. Mary T. Basset statement referring to it as “the champagne of tap water,” are not helping to reinforce public perception that concern should be given to the quality of their tap water (NYC.gov, 2017). For now, home filtering systems using carbon filtration, or even better, reverse osmosis, is a good start for all NYC residents to help lower the intake of harmful chemicals and carcinogens identified in the water system.

To improve environmental health in the home and commercial spaces, NYC Department of Buildings could begin by raising environmental standards for all construction projects to adhere to the highest level and require LEED and Energy Star certifications as the minimum benchmark for all city projects. In the home, there is a lot that people can do to reduce their exposure to harmful chemicals. EWG’s Healthy Living: Home Guide (2018), includes many areas that people can make changes to and improve the health in their home. Using air filters and cleaning and replacing them regularly can improve indoor air quality. Adding plants in the home can also help with this. Switching to cleaning products with Green Seal or Ecologo certification can reduce exposure to toxins. Additionally, avoiding furniture and mattresses with stain-guards, flame-retardants, and choosing products using natural latex or low-VOC certified foam can contribute to a healthier home.

These solutions and practical strategies could be of benefit to all of NYC, not just those in District 6 and Midtown where air pollution is at its worst. Expansion to the existing understanding of environmental health factors on a local, national, and global level will be needed to increase awareness to these issues. Both government agencies and the corporate sector will have to do their part to improve the conditions for environmental health. Individuals, however, do not need to wait for change to come from the top and should be encouraged to take action in their daily lives to set up healthier environments and improve their own health, tat of their loved ones, and their community as a whole.

 

References

American Cancer Society. (2013). World Health Organization: Outdoor air pollution causes cancer. Retrieved from <https://www.cancer.org/latest-news/world-health-orsganization-outdoor-air-pollution-causes-cancer.html>

Environmental Working Group. (2018). EWG’s healthy living: Home guide. Retrieved from <https://www.ewg.org/healthyhomeguide/>

Environmental Working Group (EWG). (2018). New York City system. Retrieved from <https://www.ewg.org/tapwater/system.php?pws=NY7003493#.WzIsyxJKh24>

MillionTrees NYC. (2015). NYC’s Urban Forest. Retrieved from <http://www.milliontreesnyc.org/html/about/forest.shtml>

NYC.gov. (2017). High quality NYC tap water receives new filtration waiver. Retrieved from <https://www1.nyc.gov/office-of-the-mayor/news/779-17/high-quality-nyc-tap-water-receives-new-filtration-waiver>

NYC Health. (2015) Community Health Profiles 2015: Stuyvesant Town and Turtle Bay Community District 6 health profile. Retrieved from <https://www1.nyc.gov/assets/doh/downloads/pdf/data/2015chp-mn6.pdf>

NYC Planning. (2018). Manhattan Community District 6. Retrieved from <https://communityprofiles.planning.nyc.gov/manhattan/6>

U.S. Census Bureau. (2016). American Community Survey 1-year estimates. Retrieved from Census reporter profile page for NYC-Manhattan Community District 6–Murray Hill, Gramercy & Stuyvesant Town PUMA, NY <https://censusreporter.org/profiles/79500US3603808-nyc-manhattan-community-district-6-murray-hill-gramercy-stuyvesant-town-puma-ny/>

U.S. Department of Health and Human Services (ODPHP). (2018). Cancer. Retrieved from <https://www.healthypeople.gov/2020/topics-objectives/topic/cancer>

 

by Corey

A snapshot of acupuncture health policy

In recent years, there has been a growing demand from the public for acupuncture services in the U.S., leading to increased interest and scientific investigation into its effectiveness, safety, and potential uses within the U.S. health care system. The National Center for Complementary and Integrative Health (NCCIH), formerly known as the National Center for Complementary and Alternative Medicine (NCCAM), has funded the most rigorous acupuncture research to date to evaluate its use to ease the pain of chronic conditions such back and neck pain, osteoarthritis, shoulder pain, and headache (Vickers et al, 2012). Findings of this meta-analysis suggest that acupuncture’s effects on chronic pain are clinically significant, supporting the recommendation by NCCIH of referrals for acupuncture as a reasonable treatment option for people with chronic pain (NIH, 2018).

For most doctors practicing within the biomedical paradigm of the heath care system, these findings along with the growing base of evidence for acupuncture’s effectiveness may not be enough to promulgate regular referrals for acupuncture treatment in the context of standard care. However, amidst a growing concern for the widespread misuse of prescription opioids contributing to over 17,000 deaths in 2016 and $504 billion in economic costs (CEA, 2017), many in the health care system are looking to non-pharmacologic alternatives to manage chronic pain. This response to the Opioid Epidemic has drawn interest towards promoting acupuncture and other integrative therapies and inclusion of them in legislation like the Comprehensive Addiction and Recovery Act (CARA), signed into law in 2016, that mandated the Veterans Administration (VA) to expand acupuncture and other integrative health services as well as related research and education.

In fact, the VA has championed integrative health delivery on a national level through the creation of the Integrative Health Coordinating Center, a branch of the Office of Patient Centered Care and Cultural Transformation (OPCC&CT). The VA offers acupuncture or other integrative services in 93 percent of its nation-wide centers that treat more than six million veterans annually (Reddy, 2018). In addition, the VA’s 2018 policy to establish an occupational qualification standard for employment positions of state-licensed acupuncturists within the VA Health Administration further recognizes the advanced professional education, training, and experience of state-licensed acupuncturists and distinguishes their knowledge and skills from that of a certified acupuncturist physician with less acupuncture-specific training (NCCAOM, 2018). This status for licensed-acupuncturists to be acknowledged by a government standard (GS) rating of GS 9-12 helps to lend credibility to the profession of acupuncture and its perception in the national health care arena.

Similarly in 2018, acupuncturists earned a distinct Standard Occupational Code (SOC) by the Bureau of Labor and now have their own federally recognized labor category based on data that confirmed growth within their profession (NCCAOM, 2018). These developments in understanding on a government-level will undoubtedly help to advance the acupuncture profession as it continues to establish itself as a mainstay in standard medical care and make its way into future public policy initiatives.

Preserving the integrity of the profession of acupuncture by its licensed members has long been a priority within the community as most biomedical physicians are also permitted to practice acupuncture within the scope of their medical practices with little to no additional related training. Only three states (Hawaii, Montana, New Mexico) require that physicians obtain acupuncture licenses by completing an accredited program and two states (Vermont and Rhode Island) decreased their requirements over the past two decades, allowing physicians to deliver acupuncture within their scope of practice where in the past this was prohibited. State regulations for training and competency have been focused on safety, recognizing contraindications and complications, and observing the procedures of clean-needle technique (Lin & Tung, 2017). Licensed acupuncturists, who provide acupuncture according to East Asian medical theories of diagnosis and treatment, often criticize the lack of this holistic basis of understanding by certified acupuncture physicians and cite it as a key motivation in preserving the extent of their scope. Further investigation into the differences in outcomes by the two approaches to acupuncture is necessary to address the associated strengths and weaknesses.

Similar issues regarding preserving scope of practice and safety have recently come into question with regard to the use of acupuncture techniques by practitioners other than acupuncturists, specifically physical therapists, who are using a procedure called intramuscular manual therapy, commonly called “dry needling.” This physical therapy service involves the insertion needles into trigger-points of muscles and is sometimes being sought after in lieu of services by licensed acupuncturists because of its access through insurance coverage of physical therapy and rehabilitative services. State regulations in California, Utah, New York, Idaho, Hawaii, and Florida do not allow dry needling in their states because it involves puncturing the skin (Kinetacore, 2018). The American Academy of Physical Medicine and Rehabilitation (AAPMR) recognizes the risks associated with dry needing, such as bruising, hematoma, pneumothorax, nerve injury, vascular injury, and infection. Despite the legality of physical therapists being able to utilize this controversial procedure in most states, The AAPMR maintains their position that dry needling “should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed acupuncturists or licensed medical physicians” (NCCAOM, 2012).

With the potential of future legislation providing greater access of acupuncture to a vast number of Americans, it is clear that may factors and stakeholders will be taken into consideration when crafting related policies and regulations. Licensed acupuncturists may continue to practice a form of the medicine most true to its origins and traditions but they also may need to share in the delivery of acupuncture with other health care providers to meet growing demand. Their role in shaping what that ultimately becomes will be a critical part in establishing the competencies required to maximize the impact that acupuncture can have within the wider landscape of America’s evolving health care system.

 

References

Kinetacore. (2018). Scope of practice. Retrieved from: <https://www.kinetacore.com/about/scope-of-practice/>

Lin K., Tung C. (2017). The regulation of the practice of acupuncture by physicians in the United States. Medical Acupuncture, 2017, 29(3):121-127. http://doi.org/10.1089/acu.2017.1235

National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). (2012). AAPM&R policy on dry needling. Retrieved from: <http://www.nccaom.org/resource-center/press/press-releases/aapmr-policy-on-dry-needling/>

National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). (2018). Acupuncturists now included in the Veterans Health Administration. Retrieved from: <http://www.nccaom.org/blog/2018/03/01/acupuncturists-in-va/>

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