Category Archives: Acupuncture

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

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

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/>

National Institutes of Health (NIH). (2018) Acupuncture: In depth. Retrieved from:<https://nccih.nih.gov/health/acupuncture/introduction>

Reddy B. (2018). A model for integrative health in the U.S.. Acupuncture Today, 2018, 19(6):1526-7784

The Council of Economic Advisers (CEA). (2017). The Underestimated cost of the Opioid Crisis. Washington, DC: U.S. Government Printing Office.

Vickers A.J., Cronin A.M., Maschino A.C., Lewith G., Macpherson H., Foster N.E., Sherman K.J., Witt C.M., Linde K. (2012). Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Archives of Internal Medicine, 2012 Oct 22; 172(19):1444-53. http://doi.org/10.1001/archinternmed.2012.3654

by Corey

The Affordable Care Act and Acupuncture

The Affordable Care Act (ACA) attempted to create wider access to health care services for patients in America and reframed some of the guidelines that insurance companies and other payers must oblige when evaluating coverage of services by acupuncturists and other alternative medical providers. Section 2706 of the ACA, also known as “Nondiscrimination in Health Care,” aimed to create professional parity for state-licensed providers like acupuncturists who render services within their legal scope of practice. By mandating coverage of these services and eligibility for reimbursement for treatment of health conditions covered in an insurance plan, state-licensed heath care professionals can no longer be excluded from insurance plans on the basis of their profession.  Section 2706, however, does not create parity in terms of reimbursement rates, which creates a loophole for insurers that concerns many acupuncturists. Also, in states where professional licensing of some alternative medical providers is not in place, coverage may still be denied for services that may be covered elsewhere. It is clear that the nondiscrimination provision is a start to addressing egalitarian recognition for some alternative health care professionals, but there is still much to address to ensure interpretation of this provision is not tailored to the needs of insurers instead of to patients and related providers. Section 3502 of the ACA, also was an attempt to legitimize acupuncture and other alternative medical services through its mention of establishing interdisciplinary community heath teams that may include licensed professionals offering complementary and alternative medicine (CAM), a.k.a. complementary integrative health (CIH). This language opened the discussion of inclusion of CIH services in essential health benefits but, again, more attention will be needed to see implementation of CIH as a mainstay in the common delivery of health care in America. Regardless, these provisions do favor the recognition and use of acupuncture and other services, which have been historically marginalized in the insurance marketplace. This is surely a positive start to mainstream integration.

by Corey

Acupuncture for postoperative pain

Acupuncture can be helpful in postoperative care after back surgery or joint replacement, specifically for patients interested in or recommended for non-pharmacologic pain management.

Acute pain resulting from surgical trauma can present significant challenges by delaying the ability of patients to move about and begin to perform rehabilitation exercises that are important to help reduce the development of scar tissue, improve range of motion, and increase the chances for a successful recovery. In addition, patients who undergo spinal and joint replacement surgery are at greater risk for developing a deep vein thrombosis and their risk may increase if pain continues to limit physical movement after surgery.

While opioid medication are typically effective to reduce pain, they also can cause unwanted side effects like nausea, vomiting, dizziness, sedation, pruritus, constipation, and urinary retention. These can further delay recovery and lead to a decreased sense of satisfaction with the surgical procedure by the patient.

Acupuncture can offer an alternative to opioids and is commonly uses for pain management. It can provide a safe and effective non-pharmacologic option to manage acute postoperative pain. Several related systemic reviews of randomized controlled trials have been conducted on this subject and found acupuncture to be effective in reducing post-surgical pain intensity and lead to a lower incidence of opioid-related side effects when used alongside conventional interventions for pain. Citations for these reviews are included at the end of this article. One meta-analysis specifically summarizes the effectiveness of acupuncture treatment for pain reduction after back surgery.

Further studies have shown the pain modulating effects of acupuncture to be due to its ability to augment the peripheral and central nervous system to inhibit pain-signaling pathways and increase the threshold for pain tolerance. Acupuncture has been recognized to trigger the release of specific neuropeptides including beta-endorphins, enkephalins, and dynorphins to elicit a self-healing response and create analgesia.

When being used for surgical pain, acupuncture has been found to be especially helpful when received within 24 hours before surgery as well as within the first week after surgery. Additionally, acupuncture can address pain or debility that may occur during and after the rehabilitation phase and can be useful in a multi-modal approach for patients experiencing lowered signs of progress with standard care alone.

 

Acupuncture for Postoperative Pain Research Citations

Systemic Reviews and Meta-analyses

Liu X.L., Tan J.Y., Molassiotis A., Suen L.K., Shi Y. (2015). Acupuncture-point stimulation for postoperative
 pain control: A systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2015;2015:657809. http://doi.org/10.1155/2015/657809

Sun Y., Gan T.J., Dubose J.W., Habib A.S. (2008). Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. British Journal of Anaesthesia, 101(2):151-160. http://doi.org/10.1093/bja/aen146

Wu M.S., Chen K.H., Chen I.F., Huang S.K., Tzeng P.C., Yeh M.L., Lee F.P., Lin J.G., Chen C. (2016). The efficacy of acupuncture in post-operative pain management: A systematic review and meta-analysis. PloS One, 11(3). http://doi.org/10.1371/journal.pone.0150367

 

Acupuncture Mechanism of Action Studies
Mayor D. (2013). An exploratory review of the electroacupuncture literature: clinical applications and endorphin mechanisms. Acupuncture in Medicine, 31(4):409-15. s

Wang J.Q., Mao L., Han J.S. (1992). Antinociceptive effects induced by electroacupuncture and transcutaneous electrical nerve stimulation in the rat. Int J Neurosci. 1992; 65: 117–129.

Zhao Z.Q. (2008). Neural mechanism underlying acupuncture analgesia. Progress in Neurobiology, Aug;85(4):355-75. http://doi.org/10.1016/j.pneurobio.2008.05.004

by Corey

Is acupuncture painful? The concept of deqi

There is a range of different styles that have been developed throughout the history of acupuncture that incorporate a variety of different needling techniques. While some, like seen in Japanese acupuncture, use a very superficial insertion of needles just under the skin with an extremely gentle stimulation of the point locations, it has become a commonly accepted practice in Traditional Chinese Medicine to elicit a strong needle sensation experienced by the patient at each point location by inserting a needle to the desired depth (based on anatomical location) and manipulating the needle manually by lifting and reinserting it or by twirling the needle.

This can be felt by patients in a various ways and described as a soreness, numbness, distension, heaviness, or pain. Yes, pain. Acupuncture has long been touted as not being painful but this is not always the case. This may be due to this technique being central to the clinical practice of acupuncture for over 2000 years that this strong needle sensation was recognized to have unique therapeutic value and experienced separate from pain. For many Americans, though, who are new to acupuncture, acupuncture can be described as being painful.

The needling sensation can also be observed by the practitioner as a gripping quality around the needle when tugged, an involuntary twitching of the muscles, and sometime redness of the skin around the needle site.

If you’ve read any research trials that utilize acupuncture treatment, you may have seen this technique described in the Methods section as “needling sensation, “acupuncture with stimulation,” or sometimes by the pinyin term “deqi” which is commonly translated as “obtaining the vital energy”. Interestingly, researchers have also studied this needling sensation with neuroimaging using fMRIs and have found stronger activation of different regions of the brain than when using only tactile superficial stimulation of acupuncture points.

In the scientific community, this local sensation felt by patients has long been associated with stimulation of afferent nerve fibers but more recent research suggests that involvement of the deformation of connective tissue through acupuncture may play a strong part with the mechanism of acupuncture. Local vasodilation also results from needle stimulation along with the local release of substances like histamine, nitric oxide, prostaglandins, and many others which are currently being studied for their relationship in explaining how acupuncture works.

by Corey

Fanaticism: Addressing a common response to the topic of acupuncture, “I don’t believe in it.”

Enthusiasm and passion are qualities often seen as being supportive to achieving goals and explaining ideas. Increased interest in any subject manner boosts people’s engagement level when speaking to others and often makes their message richer with details and personal insights. Zeal commonly has an interdependent relationship with a person’s beliefs and behaviors. Extreme enthusiasm can correlate with having a more defined belief system, yielding self-affirming behaviors and a use of language that reinforces faith in defined ideas. When this narrows tolerance for other ideas that may challenge those established, fanaticism can limit people’s discourse on any subject in view. Defensive arguments, judgments, and blind faith can grow while a person clings to their ideas as being infallible and integral to their perception of self-identity.

In the context of an inter-professional health care team, there is fanaticism in both the conventional and alternative communities. Fanaticism reinforces independence, which can be counter-productive to collaboration and the exchange of ideas from all members of the team. For acupuncturists interested in integration, I’m not sure if there’s clarity that we are even included yet on the “team” by the conventional medical community to reputably participate in the exchange of ideas and potentially be heard by their members.

As the position to have acupuncture firmly instated into our modern health care system is gaining traction, the focus seems to be about growing the amount of evidence in the form of data to carry the decision into common acceptance. However, for fanatics on both the conventional and alternative sides whose belief systems may be influencing their critical analysis of the efficacy of acupuncture, maintaining an impartial and inclusive perspective in our language and actions will be helpful to build bridges towards the open-mindedness that will be required, despite meeting the undefined threshold for a conclusive amount of data.