San Francisco Chronicle; Sunday, November 16, 1997 - Page 8

Two weeks ago, after studying research that met the standards of Western science, a panel of 12 independent scientists and doctors concluded that there is strong evidence that acupuncture is effective for treatment of pain after surgery or dental procedures and for control of nausea and vomiting caused by cancer chemotherapy or pregnancy.

There was some suggestion -- but not yet enough evidence -- the panel said, that acupuncture can relieve tennis elbow, carpal tunnel syndrome, menstrual cramps and other painful conditions.

"It is time to take it seriously," said panel chairman David Ramsay, president of the University of Maryland Medical Center.

While at least a third -- and probably more -- of Americans have turned to "alternative medicines" like acupuncture, biofeedback and herbal remedies, the medical establishment has been dismayingly silent on the phenomenon, and mainstream doctors seem in no hurry to take a stand one way or the other on the myriad "alternative" or "complementary" therapies increasingly being used.

The NIH statement is a significant recognition that there are alternatives to Western medicine, and it is hoped that this first major official sanction will spur further scientific tests of alternative methods that are being used by many people.

It is not that consumers are demanding wholesale scientific seals of approval of alternative health care. The rigor of the scientific method is still very much respected and no one wants American medicine to turn into shamanism. It would be as irresponsible for the NIH to come to a conclusion in favor of an alternative therapy because that therapy was in favor with large numbers of people as it has been for scientists to defer researching the medical effects of marijuana because of political pressure.

But the unwillingness to even investigate, the refusal to step into the fray and instead force baffled patients and consumers to fend for themselves in what can seem like an Alice in Wonderland world of homeopathy, naturopathic medicine, Ayurvedic medicine, chiropractic and craniosacral therapy is a dereliction of duty.

The debate over use of marijuana illustrates how official science plays catchup. In general, state and federal officials have been opposed to efforts to legalize pot for medical purposes, such as relieving nausea and vomiting, stimulating appetite and easing the pressure of glaucoma.

But the officials' opposition was not based on sound medical evidence that marijuana lacked palliative effects (nor, for that matter, was advocacy based on scientific evidence) because there was no such evidence. And the reason there was no evidence was that no one had the courage to push for or find the money for such government-sanctioned studies. Rather than seek the truth, the officials buried their heads in the sand and hoped the issue would go away.

It did not. Californians last November approved Proposition 215, to legalize medical marijuana. Frustrated citizens took what should have been a medical issue into their own hands because no one in a position of authority would even study the touchy subject of the medical effects of marijuana.

As with acupuncture, consumers would like to know the scientific basis for what they see works. Plenty of people -- even many who have benefitted from the procedure -- are uncomfortable with the traditional Chinese explanation that acupuncture works because it unblocks the flow of energy through the body known as "qi" (pronounced chee). When the flow is interrupted -- when the opposing forces of Yin and Yang are out of balance

--Chinese practioners say, disease occurs. Needles manipulated manually or electrically are used to stimulate certain points on or under the skin.

The NIH panel's explanation is more reassuring to many Americans distrustful of methods that cannot be explained in terms of Western medicine. In advocating for use of acupuncture in limited instances, the panel report explained that considerable evidence supports the claim that natural body chemicals that ease pain known as opioid peptides are released during acupuncture. The needle treatment may also activate the hypothalamus and the pituitary gland, both of which are responsible for secreting important hormones, the panel's report said. While the American Medical Association of late has called for more scientifically controlled studies to evaluate alternative therapies, it is far from taking a leadership position in making sure those studies get underway. When the NIH panel's acupuncture advocacy statement was released, AMA President Percy Wootton gave it a cautious reception: "We look forward to reviewing the evidence used and findings from the National Institutes of Health," Dr. Wootton said." The AMA is now encouraging doctors to ask patients whether they are using alternative treatments, although the reason is less to gain understanding than to ensure that dual therapies do not conflict and cause harm to the patient. The tendency in mainstream medicine still does seem to be to condemn unconventional therapies even without knowing whether they might have a scientific basis.

Numerous studies have suggested that 40 percent to 70 percent of patients with HIV infection in the United States use alternative therapies. However, Dr. Donald Abrams, assistant director of the AIDS program at the University of California at San Francisco, has found that the use of those treatments declines as the availability of conventional, but equally successful, therapies increases.

The NIH endorsement sent a strong message that members of the medical establishment should train their scientific eyes on therapies they have routinely disdained.
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