Evolving Directions for Acupuncture Research: Report from the International Research Congress on Integrative Medicine and Health
By Beth Sommers, PhD, MPH, LAc
The Consortium of Academic Health Centers for Integrative Medicine and the International Society for Complementary Medicine Research combined their resources in co-sponsoring the International Research Congress on Integrative Medicine and Health (IRCIMH), which was held in Portland Ore. from May 15-18. Over 1,000 attendees from the international community spent 3-4 days networking, sharing, and providing a vision for integrative health.
The conference created a high-energy think-tank for researchers as well as practitioners to engage in debate and discussion, and allowed the cross-fertilization of ideas from many fields of professional specialties.
Over 40 organizations lent their partnership and commitment to the conference. Those of particular interest to our readers include: Society for Acupuncture Research, National Certification Commission for Acupuncture and Oriental Medicine, Council of Colleges of Acupuncture and Oriental Medicine, International Society for Kanpo Medicine, and the Center for Integrative Medicine in Public Health. Presenters represented the wide range of integrative health practices, including acupuncture and East Asian Medicine, yoga, bodywork and massage, Ayurvedic Medicine, art and music therapy, homeopathy, meditation, relaxation response, nutrition, Tai Chi and naturopathic medicine.
Site visits were arranged to four of Portland's schools: National College of Natural Medicine, Oregon College of Oriental Medicine, Oregon Health and Science University, and Western States College of Chiropractic Medicine, Massage Therapy, and Integrative Medicine. These visits offered a great opportunity to get "up close and personal" with faculty, staff, and students. One of the most interesting pieces of information that we learned was that students enrolled at of these schools have the opportunity to be guest-students at each of the other three schools. This is certainly an innovative and unique way of sharing culture and underlying philosophies of education, as well as promoting genuine understanding of each type of approach. Kudos to these schools for fostering this type of collegiality!
There were at least 55 oral and poster presentations that specifically addressed acupuncture and other aspects of East Asian Medicine. Dr. Wang Lizhen and colleagues from Shanghai University of Traditional Chinese Medicine presented a workshop on laser moxibustion in the treatment of knee osteoarthritis. Dr. Young Dal Kwan from Wonkwang University in Korea discussed laboratory findings on the use of pharmacopuncture with bee venom for addressing neuropathic pain. In addition to these acupuncture-specific presentations, other presenters focused on their work that included acupuncture along with other approaches for special populations (e.g. children, people with particular diagnoses) or in certain contexts (e.g. rural healthcare, hospital settings).
Dr. Claudia Witt, from the University Medical Center Charite in Germany, discussed the value of study design approaches including comparative effectiveness research and economic analyses. Unlike randomized clinical trials, which compare an intervention to a sham or placebo control, studies incorporating comparative effectiveness research may compare the intervention of interest to the current standard of care. The roles and potential input of all stakeholders involved in a study - including patients - are taken into consideration in order to maximize the feasibility, acceptability, and generalizability of these approaches. Study results are also contextualized into the economic realities of healthcare funding, which calls for insurers, managed care systems, and the public to participate in the discussion of "value for the money". We'll be seeing much more of comparative effectiveness research in our field, and it's a welcome change from study designs that may not be feasible, are costly, and ultimately lack generalizability.
The evolving role of acupuncturists in U.S. hospitals is exciting and heartening to see. Dr. Arya Nielsen, of the Integrative Medicine Department of Beth Israel Medical Center (BIMC) in New York City, discussed strategies and logistics related to designing inpatient- specific policy and procedures, credentialing, supervision and standards of safety for acupuncture therapy. BIMC established an outpatient integrated medicine clinic in 2000.This clinic offers primary care and a number of modalities including acupuncture. After establishing a record of safe and efficacious treatment, BIMC was sufficiently impressed and inspired to develop a post-graduate Fellowship training program in inpatient care for licensed acupuncturists in 2008.
Fellows worked two four hours shifts per week for one year. The Fellowship director gave lectures on acupuncture research relevant to specialties at Department
Grand Rounds. Discussions about scope of practice and other relevant clinical issues resulted in creating policies that continue to contribute to acupuncturists' professional education and development.
Since 2008 Acupuncture Fellows have worked over 5000 hours with over 5,000 inpatient and staff encounters across departments of General Surgery, Orthopedic Surgery, Family Medicine, Internal Medicine, Oncology, Pulmonary Rehabilitation, Pediatrics,and as a full consult service hospital-wide. Acupuncture therapies include acupuncture needling, ear needling, ear seeds, palpation,Tui na and Gua sha as well as explanation and recommendations in terms of traditional East Asian medicine principles. The only reported adverse event was the report of a patient fainting; however, the incident was eventually attributed to the patient's use of his wife's cardiac medication.
The use of imaging and seeing into the "window of the brain" were discussed by Dr. Vitaly Napadow, of the Martinos Center for Biomedical Imaging at Massachusetts General Hospital in Boston. Techniques such as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS), positron emission tomography (PET), and electro-encephalography (EEG) allow researchers to better understand neurophysiological effects of acupuncture, acupressure, and sham approaches.
Dr. Sivarama Vinjamury, of the Southern California University of Health Sciences in Fullerton, acted as both a presenter as well as a representative of the American Public Health Association's specialty group on Alternative and Complementary Health Practices. He presented a poster describing a randomized clinical trial of the efficacy of acupuncture for fibromyalgia.
When asked about the value of the conference, Vinjamury replied that "the conference validated the growing importance of acupuncture and Traditional Chinese Medicine within the Integrative Medicine field based on the number of papers and sessions on these topics." He also speculated about the use of sham acupuncture:
"It is very interesting to know from the presentations, especially, the presentations by Karen Sherman and Claudia Witt that verum (real or true) Acupuncture is superior to Sham acupuncture, but the effect size is small. More interestingly, verum acupuncture when tested against any other control such as standard treatment, exercise, waitlist controls, or physical therapy, is far superior and the effect sizes are big. These conclusions were based on a meta-analysis done by collecting data of individual patients from many randomized clinical trials that were done earlier. The results of this meta-analysis are important because they guide us to steer away from clinical research using sham controls. The authors strongly suggested that we need to adopt comparative effectiveness research to demonstrate the effectiveness of acupuncture for specific conditions."
Overall, the conference generated not only food for thought, but a rich banquet of ideas and perspectives that will influence our field in the future. All acupuncturists, whether involved in research or not, can benefit from learning about the contributions that all types of study make to our field. The next IRCIMH conference will be held in Miami FL in May 2014.