News Release

Acupuncture: Does It Work And Is It Safe

Meeting Announcement

Novartis Foundation

The Novartis Foundation brought together experts from both complementary and allopathic medicine to discuss the mechanism, efficacy and safety of acupuncture.

Eastern theory holds that acupuncture balances the body's energy flow or Qi by placing needles at certain points along the twelve energy channels or meridians of the body. Western experts, on the other hand, believe that it might act by triggering the production of various chemicals including pain-killing endorphins and mood-lifting serotonin.

In the US alone, more than one million people a year undergo acupuncture most commonly for pain relief or to treat addictions. Although it is still not clear exactly how acupuncture works, it is nonetheless gaining respect after decades of being spurned by the western medical establishment.

Since 1993 the US National Institutes of Health (NIH) have sponsored US$2 million worth of acupuncture research. In 1996 the US Food and Drug Administration took the experimental label off acupuncture needles and in 1997, the NIH held their first consensus development conference on acupuncture.

Many argue that there is considerable evidence that acupuncture is effective against nausea, pain, and some psychological, respiratory and digestive problems. Others feel that acupuncture has little more than a placebo effect and that trials of its efficacy have been scientifically inadequate.

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SARA ABDULLA, B.Sc., M.Sc.,
Science Writer in Residence at the Novartis Foundation
13 March 1998
Notes for Editors:

1. During 1996, it was announced that the Ciba and Sandoz companies were to merge leading to the creation of a new enterprise, Novartis. The Ciba Foundation was established as an independent charitable trust by the Ciba company in 1947, formally opening on 22 June 1949. Since that time, the Foundation has pursued its mission to promote international cooperation in scientific research, independent of, but with continuing financial support from, the Founder company. The Foundation's Trustees and Executive Council decided, with the approval of the Charity Commissioners, that we should change our name, to The Novartis Foundation, with effect from 1 September 1997.

2. The Novartis Foundation is a scientific and educational charity no. 313574. For further information please contact: Fiona Watt, Administrative & Publicity Officer, The Novartis Foundation, 41 Portland Place, London W1N 4BN
Tel: + 44 (0) 171 636 9456
Fax: + 44 (0) 171 436 2840
Email: fwatt@novartisfound.org.uk

3. A calendar of forthcoming meetings can be found on the Novartis Foundation web page: http://www.novartisfound.demon.co.uk

Summaries of Papers:

Physiological mechanisms: Circulatory, Immune and Gastrointestinal Systems
Dr Thomas Lundeberg
Department of Physical Medicine & Rehabilitation, Karolinska Hospital, Stockholm, Sweden
Fax: + 46 8 30 46 13
E-mail: thomas.lundeberg@fyfa.ki.se

The age-old Chinese method of counter-irritation with acupuncture is recognised as an afferent stimulus and provides possibilities for the treatment of a variety of conditions. However, doubts about it persist because to date studies have been based on the percepts of protoscientific traditional Chinese medicine and results have been highly contradictory.

Circulatory disorders and associated pain are not merely descriptive symptoms relating to pathology or region. Broadly, the aetiology of pain may either be nociceptive, when the nervous system is substantially intact or neuropathic, when the nervous system is injured. Patients with differentiated pain, whose pain control systems are variably activated, may respond well to acupuncture because it uses endogenous systems.

During the last decade we have focused our interest on the effects of acupuncture and afferent stimulation in ulcer healing, xerostomi (failure of the salivary glands due to inflammation), post-menopausal problems, and infertility due to endocrinological disorders. Our findings suggest that acupuncture may be an effective complement to conventional medicine in selected subgroups of patients.

Is Acupuncture Safe?
Dr Hagen Rampes (of the South Kensington & Chelsea Mental Health Centre, London, UK)
spoke at the press conference on the issues of safety in acupuncture treatments
(A copy of the summary prepared by Dr Rampes is available by fax. Please contact Fiona Watt - telephone: 0171 636 9456, fax: 0171 436 2840 or email: fwatt@novartisfound.org.uk)

Chinese Acupuncture
Dr Ted Kaptchuk (of the Center for Alternative Medicine Research, Beth Israel Deaconess Medical Center, Boston, USA)
made a presentation during the main meeting on acupuncture history, philosophy, theory and the basic epistemological framework.
Western acupuncture
Dr Jacqueline Filshie
Department of Anaesthetics, Royal Marsden Hospital, Sutton, Surrey, SM2 5PT, UK
Contact Tel: +44 (0) 171 352 8171 (Rebecca Molesey, Press Office, Royal Marsden Hospital, Fulham, London, UK)

'Western Acupuncture' is a term used to describe the scientific use of acupuncture as a form of therapy, following orthodox medical diagnosis, rather than implying a geographical limitation on the practice. Conventional medical diagnosis based on history, clinical examination and the interpretation of special investigations, always precedes the selection of an appropriate therapy from a wide range of treatment options, one of which is acupuncture. Without this conventional diagnostic approach the use of acupuncture could mask important symptoms and delay the diagnosis of a serious condition, which needs early treatment.

Worldwide research has indicated the importance of the nervous system in mediating the beneficial effects of acupuncture, and has suggested the involvement of a multitude of chemical messengers, including endorphins - the body's natural painkillers. Acupuncture treatment is applied widely to a variety of both painful and non-painful conditions. Several reports have shown significant relief in about 70% of patients presenting with pain in General Practice, although treatment of chronic pain is less successful. A number of clinical trials have shown particular success with conditions such as osteoarthritis of the knee, headaches, tennis elbow, facial pain, back pain and dysmenorrhoea. There is compelling evidence for the specific efficacy of acupuncture in the treatment of nausea and vomiting from a number of causes. A recent study of acupuncture for stroke has demonstrated improved quality of life, and considerably reduced rehabilitation time and cost compared with intensive physical and occupational therapy. Further studies are investigating this area of great potential benefit.

Future priorities should include the increased and specific funding for specialist research departments, which will ensure rigorous trial methodology, adequate numbers of patients, and the collaboration of experts in the field. Total cost-benefit analysis of acupuncture in primary care should be undertaken to confirm the likely savings attainable from reduced drug prescribing and fewer referrals for specialist care.

Ideally an introduction to acupuncture will be included in undergraduate medical school curricula when it gains universal acceptance as first-line therapy for certain conditions.

Chairman's Overview
Professor Edzard Ernst
Department of Complementary Medicine
Postgraduate Medical School
University of Exeter
25 Victoria Park Road
Exeter, UK
Fax: +44 (0) 1392 424 989
E-mail: E.Ernst@exeter.ac.uk

Acupuncture has been around for a good three thousand years. This, many proponents claim, is ample justification for its popular use today. We believe, however, that acupuncture (like other complementary therapies) should be assessed and tested like any other therapeutic intervention. This conference is aimed at establishing what we know about a number of key issues related to acupuncture. Most crucially it will ask how it is practised, how it might work, whether it is effective for defined conditions, and what its risks are. Several internationally acclaimed experts will summarize these subjects in an unemotional, balanced way and will provide the totality of the evidence rather than just those bits that fit their hypotheses.

Does acupuncture work?
Dr Adrian White
Department of Complementary Medicine, Postgraduate Medical School University of Exeter, 25 Victoria Park Road, Exeter, UK
Tel: +44 (0) 1392 424 839
E-mail: a.r.white@exeter.ac.uk

There are plenty of anecdotal reports of dramatic cures with acupuncture. Clearly, acupuncture is likely to have quite a powerful placebo effect: it offers an aura of Eastern mystique, the time spent with the patient, and the impact of treatment with needles. What we need to know is whether acupuncture has any effect over and above the placebo effect?

Despite intensive research, nobody has found any convincing scientific evidence for the existence of meridians or 'energy' flow, and even the existence of specific 'acupuncture points' is still disputed hotly.

It is clear that acupuncture can have an effect on the body, through the nervous system. Acupuncture can clearly stimulate cells deep within the brain to release transmitters; the best known are the 'endorphins' which should correctly be called 'opioid peptides'. However, just because we now have a possible mechanism for acupuncture doesn't mean it necessarily works in particular conditions: we still need evidence from clinical trials in every condition.

Much of the experimental work is concerned with acupuncture's effect on the threshold of experimental pain. Can that effect be useful for treating diseases? To decide that question, we need good quality controlled trials which test acupuncture against either a placebo or another therapy.

Unfortunately, there is a surprising lack of good quality studies of acupuncture for most diseases. There is enough good evidence to say it works for nausea and vomiting, for back pain and for dental pain. There is promising evidence that acupuncture may help patients recover from stroke, but as yet we don't know if this is just the extra interest and attention which the patients get. In the remaining areas it is difficult to draw conclusions: asthma may be helped by acupuncture although it doesn't seem to prevent future attacks.

Surprisingly, there is a great lack of good evidence whether it can help osteoarthritis, although this is one of the commonest conditions for which acupuncture is given. And finally, it doesn't seem to help people lose weight and, although it can certainly help people stop smoking, there is no evidence that it is any better than placebo.



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