Considerations in Acupuncture & East Asian Medicine Research
Researchers and medical professionals seeking definitive proof or disproof of acupuncture are often frustrated by the myriad of studies showing strikingly different and therefore inconclusive results. The Mayo clinic acknowledges that “the lack of firm results can be explained, in part, by the difficulty of devising a realistic but inactive stand-in for acupuncture.”1 Part of this difficulty can be explained in how acupuncture is viewed by the medical paradigm. Often, acupuncture is researched as if it were a drug, when it is actually much more like surgery.
In an effort to mold acupuncture to meet randomized controlled trial (RCT) standards, researchers originally relied upon a technique they called sham acupuncture. However, sham acupuncture has proved to be an unsatisfactory placebo or control model,2 as one can devise a placebo drug, but one cannot realistically perform sham surgery. The use of sham acupuncture has been largely abandoned in favor of wait-list or other control measures. Results from studies conducted with the use of sham acupuncture may not be as useful in determining acupuncture’s effectiveness as studies that do not attempt sham acupuncture.
Another difficulty is with acupuncture research has been devising studies that allow for the individualization of treatment that occurs in a realistic clinical setting. In the clinic, even standardized protocols are adapted to fit the needs of individual patients as discovered at the time of treatment. Depending upon practitioner experience and their observation skills, the direction of treatment and any associated protocols may change drastically during the course of a treatment. In this way, again, acupuncture is more like surgery than a drug. The practice of acupuncture is simply not an algorithmic, if-this-do-that, type of approach to care, and the practice of classical acupuncture requires a great deal of flexibility in thinking. Of course, an acupuncturist can practice according to a standard protocol if that is all he or she knows, and like a by-the-book surgeon, following standard protocol interventions will usually help patients more than no intervention at all. Yet, there remains a tangible difference between by-the-book, standardized care, and deeper, conceptual, critical thinking and care.
In practitioner-based, skill-level medicines like surgery and acupuncture, it is recognized that there are differences in results due to differences between individual practitioners. As in surgery, while certain effects of acupuncture are generally reproducible, the degree of success will vary among acupuncturist practitioners. Factors potentially influencing the ability of a practitioner to generate results include the quality of practitioner training, the depth of practitioner understanding, the flexibility in practitioner thinking, the degree of practitioner dedication, the amount of practitioner experience, and the dexterity of the practitioner with needle manipulation and other acupuncture techniques. Factors influencing the result of treatment that are not attributable to the practitioner’s skill are also numerous and include, amongst others, the type, origin, and severity of disease.
As more practitioners and researchers begin to understand a perceived difference between protocol acupuncture treatment and individualization of treatment, research studies have shifted to examine the effects of individualized care. In October 2007, the Walter Reed Army Medical Center completed a 12-week, randomized, wait-list controlled trial of acupuncture for PTSD amongst 75 active-duty military personnel. The treatment intervention was 4 weeks of acupuncture with two treatments per week, or eight treatments total. Four of the treatments were individualized and four of them were based upon a standardized protocol.3 As of 2011, the results of this study have yet to be published. Regardless of its findings, the study’s design speaks to the increasing curiosity about the effects of individualization of treatment and the trend towards acknowledgment of its impact on treatment outcomes.
Note: Portions of this article were directly quoted from Erika’s thesis, Integrating Acupuncture at the Portland VA Hospital.
1 “Acupuncture: Why It’s Done,” The Mayo Clinic, 11 December 2009, 25 February 2011, <http://www.mayoclinic.com/ health/acupuncture/MY00946/DSECTION =why-its-done>.
2 McPhee, Stephen, 1612.
3 Engel, Charles, et al., “Acupuncture for the treatment of posttraumatic stress amongst military personnel,” US National Institutes of Health, Clinical Trials Identifier#: NCT00320138, 25 February 2011, <http://clinicaltrials.gov/ct2/show/study/NCT00320 138>.