International Symposium on Acupuncture and Meridian Studies: Conference Recap
By Beth Sommers, PhD, MPH, LAc and Kristen Porter, MS, MAc, LAc
The theme of the 2012 International Symposium on Acupuncture and Meridian Studies was "Moving Acupuncture Research Forward: Issues and Solutions." This conference was held in at the University of Technology in Sydney (UTS), Australia from October 5 – 7.
Over 180 individuals attended, representing Korea, China, Japan, India, United Kingdom, Norway, Hong Kong, Taiwan and the US.
The conference was co-chaired by Chris Zaslawski, PhD and Hyunmin Yoon, PhD. Professor Zaslawski is the director of the College of Traditional Chinese Medicine at UTS and the president of the New South Wales Chinese Medicine Council. Professor Yoon is an Associate Professor at Dong-Eui University and an Academic Board Member of the Korean Pharmacopuncture Institute.
Main themes addressed at the conference included clinical, mechanistic and public health research. Presentations on herbal medicine, pain, pharmacopuncture, qi gong/tai qi, and gynecological research were also featured.
The first morning of the conference was dedicated to research on acupuncture mechanisms and physiology. John Longhurst MD PhD of the University of California, Irvine is a cardiologist who specializes in acupuncture research. His talk spanned 15 years of his research on identifying mechanisms and neurotransmitters involved in producing the effects of acupuncture. Some of Longhurst's work has focused on studying the homeostatic effects of acupuncture on blood pressure. Longhurst also studies the role of cholescystokinin (hormones secreted in the small intestine that affect liver and gall bladder) in facilitating the acupuncture response, and postulated that augmenting cholecystokinin in acupuncture non-responders may boost their ability to benefit from treatment. Research from both the U.S. and China estimates that approximately 70% of individuals respond to acupuncture. Knowledge about adjusting cholescystokinin levels may result in improving clinical outcomes for the remaining 30% who are acupuncture non-responders.
Richard Harris PhD is Assistant Professor in Anesthesiology and Research Assistant Professor in Internal Medicine at the University of Michigan. He is the current Co-President of the Society for Acupuncture Research. Harris discussed central neural mechanisms of acupuncture from the perspective of pain research. His presentation described investigating the neuropathways involved in the acupuncture response, in particular the role of opioid receptors.
Acupuncture may influence the number and activity of these receptors and result in changes in levels of neurotransmitters.
Kwangsup Soh PhD, professor at Seoul National University, gave a presentation on his work related to primo vessels. These were first described in the 1950's and 1960's by B.H. Kim. According to Kim's hypothesis, there were 3 circulatory systems – blood, lymph, and primo. Primo vessels and nodes can be found in human and animal placentas and may be analogous to stem cells. These nodes contain immune cells, mast cells, eosinophils, neutrophils and histocytes. Understanding the primo system may provide fundamental information about the mechanism of acupuncture activity at the cellular level.
The role of acupuncture in pain management was the central topic of the first afternoon of the conference. Charlie Xue PhD of the Health Sciences Department of the Royal Melbourne Institute of Technology spoke about using acupuncture in the emergency room. Because the risk of adverse effects is so low with acupuncture, incorporating it into acute pain control seems to be a sensible approach. Because up to 75% of emergency department patients present with pain, offering acupuncture can be a highly effective and low-risk option for treatment.
Other presenters addressing pain management included Peter Johnstone MD of Indiana University who addressed the area of using acupuncture to treat cancer symptom clusters. These symptom clusters include nausea and vomiting, xerostomia, and fatigue, as well as sleep disturbances and hot flashes. Hugh MacPherson PhD, of the University of York, spoke on uses of acupuncture for addressing chronic knee pain due to osteoarthritis. In particular, he addressed the issue of using sham acupuncture in research. Because sham acupuncture is not inert (i.e. there are physiological effects associated with it), researchers need to appreciate that there is a small effect associated with it. Research studies should consider using other comparative models, like standard treatment, usual care, or delayed treatment. Kazunori Itoh PhD, from Meiji University of Integrative Medicine, shared some of his preliminary work on using trigger point acupuncture treatment to resolve temporomandibular disorders.
The focus of the conference shifted on the second day to public health. One of the authors (Sommers) delivered a keynote speech entitled 'Exploring Acupuncture Across the Spectrum of Public Health'. The speech focused on the work done at Pathways to Wellness in Boston that examines clinical outcomes, satisfaction with care, and associated cost-savings. Colleagues from the Network of Researchers in Public Health in CAM (Jon Adams PhD, Jon Wardle PhD, and David Sibbrett PhD) expanded on this theme by sharing their insights on developing evidence for acupuncture through avenues such as epidemiology and health services research.
Speakers discussing pharmacopuncture included Sungchul Kim, Hyunmin Yoon, Hwaseung Yoo OMD, PhD, and Jongcheon Joo. This form of treatment was developed in Korea and involves the use of both acupuncture and herbal preparations. Herbal extracts or extracts of bee venom are injected into affected areas resulting in therapeutic effectiveness.
On the third day of the conference presenters tackled the question of integration of acupuncture and biomedicine. Peter Meier PhD of UTS emphasized the importance of multi-disciplinary teams, developing evidence-based practice, and the need to reconcile diagnostic systems. He postulated that integrated practice may need to proceed within certain conditions or diseases before attempting to accomplish a full across-the-board integration. The importance of designing meaningful trials; using outcome measures such as quality of life parameters or biomarkers; conducting trials that examine cost-effectiveness or other economic indicators; and examining existing datasets were also discussed.
Professor John MacDonald of Griffith University has worked extensively in the area of researching the effects of acupuncture on allergic rhinitis. In particular, his research on anti-inflammatory effects have focused on production and regulation of cytokines, neuropeptides, and histamines. He echoed the message that sham acupuncture is not inert. His vision for the future of acupuncture research included conducting systematic reviews, improving peer review panels, and developing acupuncturists' research capacity. MacDonald encouraged acupuncturists to build bridges with neuroscientists and physiologists in order to optimize what can be learned from research.
We spoke with Christine A. Berle, M.Sc.(Research), Dip.Ac. who is a Research Assistant at the UTS College of Traditional Chinese Medicine in the Department of Medical and Molecular Biosciences. She is also a member of the Faculty of Science at UTS and currently serves as Deputy President of the Chinese Medicine Council of New South Wales. She summarized her impressions of the conference: "The highlight for me at ISAMS was seeing so many like-minded people coming together and sharing their thoughts, experience and research. In due course this culmination of academic exchange, sharing and networking flows onto the practitioner who also reaps the benefit in being able to offer patients best possible care; our discipline is better understood and ultimately this understanding facilitates further integration into mainstream health care."
Another conference attendee, Judy James BAc, BA, is the Chief Executive Officer of the Australian Acupuncture and Chinese Medicine Association. She felt that the conference "was a sign of maturity" of our profession that demonstrated our good will and desire to "broaden and enlarge" our vision for research.
Through forming multi-disciplinary teams with other professions (physicians, physiologists, biostatisticians, epidemiologists, and other academic researchers) and building our own professional capacity as researchers, our profession can look forward to unprecedented growth and improved public health. This conference provided some of the questions and resources for determining the direction for the next 10 years of acupuncture research.