When Eva Sato's physical therapist told her she had to choices for treating her bad shoulder - drugs or acupuncture - Sato didn't hesitate. "I spent the first half of my life taking too many antibiotics. I didn't want to spend the second half of my life taking anti-inflammatory drugs," she says.
And so Sato, 46 and not particularly fond of sharp objects, willfully bared her skin to a handful of wire-thin needles and let her Stanford physician manipulate them. "From the very first treatment, my pain was relieved," says the Mountain View resident. No drugs. No discomfort. And best of all, she says, her insurance provider paid for it all.
In response to growing patient demand, a number of health maintenance organizations are now offering complete or partial coverage of acupuncture. In some cases, patients can select their own acupuncturist don't even need a referral from their primary physician.
That is good news, say patient advocates. But it's also a potential headache for consumers who have little way of knowing if acupuncture is their best option - or even whether their neighborhood acupuncturist is legitimate or not.
"It's very hard to get accurate information," says Dr. Stephen Barren, chairman of the "Quackwatch" Web site and author of "Health Robbers: A Close Look at Quackery in America"
"There's not a lot of good research on acupuncture;" he says, and several reliable studies have merely focused on how popular alternative medicine is - and not on whether it actually works. The truth is, Western medicine isn't sure it works, or how it works if it does.
"Some studies show that it's helpful. Some studies say that it's not. And there's a good deal of studies that fall in the middle," says Harley Goldberg, regional coordinator of Kaiser Permanent's complementary and alternative medicine program.
In 1997, a National Institutes of Health panel concluded that data on acupuncture is "equivocal," largely because past studies have been poorly designed or too small in scope. But the group added that "promising results have emerged," particularly in treating postoperative pain and chemotherapy-related nausea and vomiting.
The panel also stated that acupuncture could be "useful as an adjunct treatment" for stroke rehabilitation, headaches, menstrual cramps, tennis elbow, fibromyalgia, arthritis, low back pain, carpal tunnel syndrome and asthma.
| HMOs take the plunge |
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Their statements haven't been enough to convince the entire medical community that acupuncture has a place in Western medicine. But HMOs such as Kaiser Permanente and Blue Cross of California have decided patients should have free or discounted access to the procedure.
Under one of its membership plans, Blue Cross of California offers members several options for acupuncture treatment; the number of treatments varies greatly by plan. And Kaiser Permanente physicians determine how many treatments their patients need. Each is provided by the insurer.
Americans without acupuncture coverage typically pay about $40 to $60 per visit. "It was our opinion that if this is a treatment option that may help our patients, and there aren't any significant adverse effects, then it would be reasonable for us to try it," Goldberg says.
Of course, people have been trying acupuncture for ages. The procedure has been a major component of the Chinese health care system for at least 2,600 years and is based on the premise that the body is made up of channels through which energy, called qi (pronounced chee), circulates. Easterners have long believed that if the energy flow is disrupted, pain, illness or disease can result. Acupuncture is thought to correct imbalances in circulation at points close to the skin.
Western researchers view it a little differently. Some hypothesize that by putting a needle through the skin we stimulate chemical reactions that produce pain-modulating chemicals. As a result, acupuncture may decrease pain.
"There's probably much more that we dolt know about, that happens and that's still under investigation," Goldberg says.
While the verdict may still be out on whether acupuncture is effective, anecdotal evidence has been compelling. There are many reports of headaches and menstrual cramps easing and low-back pain all but disappearing in patients who have undergone acupuncture.
"We use it for all different types of back problems, for different types of tendinitis, for anything where there's inflammation," says Dr. Michael Fresericson, a physician with Stanford's sports medicine program who regularly uses acupuncture on athletes. "It's a very reasonable thing to offer people. |
| Few known side effects |
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Part of acupuncture's allure, say opponents, is that it has very few known side effects. The NIH panel concluded that it has fewer risks than "many drugs or procedures used for the same conditions."
But there have been a few known cases of infectious diseases such as hepatitis being spread by dirty acupuncture needles. In several instances, needles also have damaged patients' lungs.
The fact that not everyone responds to acupuncture also troubles skeptics.
"Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, conditioning and other psychologic mechanisms," the National Council Against Health Fraud believes.
"And it doesn't influence the course of any disease;" says Barrett. At best, he believes, acupuncture may just mask symptoms.
The American Medical Association has maintained a relatively neutral stance on the topic, calling for more studies. In the interim, patients are encouraged to make their own informed choices. "It's important for the buyer to beware," says Dr. Yank D. Coble, a Florida endocrinologist and AMA trustee.
People should put as much thought into undergoing acupuncture as they would arty other medical treatment, Coble says. And they should take the time to find an acupuncture practitioner who is respected and makes them feel comfortable.
Beyond relying on word of mouth, consumers can check with the State of California Acupuncture Board, which tracks complaints against practitioners. Several organizations also license acupuncturists, but that doesn't mean their credentials are always reputable. "There isn't any scientific literature on which to base the (acupuncture) curriculum;" Coble says.
Consumers also need to be wary of providers who claim that acupuncture must be performed two or three times a week for an extended period.
"Patients ... shouldn't (have) a question in their minds if they're getting better or not," says Stanford's Fredericton. "Either they are or they aren't If they're not," after several treatments, "they need to pursue a different approach." |
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