Acupuncture and Oriental medicine's (AOM) popularity and ever-increasing use in integrative medical settings is influencing its evolution. As conventional health care expands to include AOM, numerous issues arise including appropriate referrals, herb-drug interactions, collaborative research, and the preservation of a full and traditional scope of practice.
Excerpts from the modern Hippocratic Oath include, "I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug," and "I will prevent disease whenever I can, for prevention is preferable to cure." AOM enhances preventative care and brings warmth and understanding to an industry where managed care, escalating costs and technology have often eclipsed sympathy and prevention.
The primary obstacle to the integration of AOM within our conventional health care system may be the lack of research supporting it. Most integrative medical clinics are now willing to include therapies that have been proven through appropriate research to be effective, but will disallow those therapies supported solely by anecdotal evidence or popular support. Although this conservative approach is understandable, it will omit and overlook many potentially viable therapeutic approaches to difficult presentations. Very little has been done to examine integrative models and determine safe and effective combined therapeutic approaches. This is a multifaceted issue, but does not in any way imply that AOM has been proven to be ineffective. Rather, we know that only a very small percentage of research money is channeled into complementary and alternative medicine (CAM). This leads to the inability to fund valuable research projects, does not allow for the evolution of a research infrastructure, and deters highly trained scientists from entering the field.
Fortunately, there is a trend to expand collaborative research efforts in the U.S. with various teams of experts involved, including representation from within our profession. Many of the studies not only examine the success of a specific protocol or approach in treating a condition, but also may compare acupuncture's success to other therapeutic approaches. Unfortunately, given the inability of modern science to begin to assess the pharmacological actions of a traditional Chinese herbal formula, and the fact that few studies, if any, allow AOM practitioners to employ their full scope of practice (acupuncture, Chinese herbal medicine, tuina, qigong, dietary and lifestyle counseling), no research is truly yet examining the efficacy of the combined therapies most often taught and used clinically in the United States.
Another major obstacle that we must overcome is the potential for interactions between AOM and conventional therapies. Although acupuncture may pose some limited risk, the most critical area remains herb-drug interactions. Herbal medicine can potentially increase or decrease the serum level of a specific drug or its actions. Therefore, herbal medicines must be administered carefully in conjunction with pharmaceuticals. Helpful Web sites on the subject include those at the Institute for Traditional Medicine (www.itmonline.org/arts/herbdrug2.htm) and Memorial Sloan-Kettering Cancer Center (www.mskcc.org/mskcc/html/11570.cfm). On the other hand, it is likely that herbal medicine might reduce the side-effects of drugs, or even increase their efficacy. However, little or no research is underway in the U.S. to further investigate this remarkable potential.
One of the most overlooked yet effective tools for integration remains the appropriate referral. Practitioners of all disciplines must consider what therapy or approach will offer their patient the greatest potential benefit and least potential risk. This may mean an AOM practitioner referring a patient to a physician for antibiotics or intravenous fluids if indicated, or a physician referring to an AOM practitioner when their patient would potentially receive greater benefit with less risk from AOM, or has not responded well to conventional approaches.
I have been fortunate to work in several unique integrative clinical settings. Since 2001, I have served as a member of Maui Memorial Medical Center's allied health staff, which has enabled me to integrate AOM in a conventional inpatient hospital. I was recently called in to treat a patient with Stevens-Johnson syndrome, and was able to assist in quickly reducing the amount of analgesic medication being administered and shortening the patient's hospital stay. Thus, an integrative approach served the patient well, and I gained professional experience unavailable in private practice by treating a condition only seen in a hospital setting. Prior to that, I worked at Maui Health Center, managed by a neurologist, where a multidisciplinary team of professionals met regularly to discuss optimal patient care and treatment options. In the future, I envision integrated teams working together to provide the preliminary evaluation and assessment of a patient's therapeutic needs and then referring that patient to the appropriate therapy/therapies.
One useful tool for assisting Western-trained practitioners to understand acupuncture is to include in chart notes a pictograph illustrating where acupuncture needles are placed during each treatment. This is helpful to inform and educate MDs and others about where and how acupuncture is applied to treat a particular illness. For example, chart notes might clearly show that no needle was placed in a patient's arm affected by lymphedema. It is also of great value for the AOM practitioner to chart any relevant observations that may or may not have been considered by practitioners from different disciplines, as those findings may be of clinical significance to other providers.
Essential to the success of integrative medicine is the education of health care providers and the public. Providers need to have a deeper understanding of each other's approaches and strengths, and will best serve their patients by advising them of all reasonable and appropriate therapies in a timely manner. The public needs to be educated about the benefits of integrative medicine and learn that many professionals are now qualified to guide patients in the safest and most effective way to combine therapies, as opposed to simply trying a bit of this and a bit of that.
As we evolve to be better able to handle appropriate referrals, herb-drug interactions and collaborative research, and as the public becomes more aware of the efficacy of AOM and the value of integrative medicine, we are becoming partners in the creation of a new health system. Integrative clinics are beginning to appear, and those with visionary leaders will include the full scope of practice that AOM offers as an essential and valuable branch of the emerging health paradigm.
Click here for previous articles by Kabba Anand, DAc, LAc, Dipl. Ac., Dipl. CH.
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