The Uncharted Wilderness of Acupuncture (1973)
H. Doyl Taylor, Director
AMA Department of Investigation
It is indeed a privilege and a pleasure to be with you here today, even if I am trying to find a way through what still remains essentially an uncharted wilderness called acupuncture.
To find a starting place even, in talking about acupuncture, isn't a simple chore. I have read most of the literature, I think, on acupuncture—particularly its history. Even there, there are few hard facts to be found.
So, after the usual amount of historical research, I telephoned the man generally considered to be one of the best informed U. S. physicians on acupuncture, Dr. Cho-luh Li, a neurosurgeon at the National Institutes of Neurological Diseases and Stroke in the National Institutes of Health in Bethesda. I asked him about the story, repeated over and over again in the history of acupuncture, that it originated when a Chinese soldier in the Mongolian war in 2600 BC was shot by an arrow with a stone arrowhead and this miraculously "cured" an illness with which the Chinese soldier had been afflicted for some time.
Dr. Li said the wounding of the Chinese soldier was an accepted Chinese legend as the origin of acupuncture—and that 2600 years before Christ was the accepted time of the happening.
As you see, there's quite a gap between 2600 BC and today—4,573 years, to be exact. And until the year 1972, there was precious little in the scientific literature of the United States on acupuncture.
One of the first definitive discussions of acupuncture in our scientific literature that we have found was a paper by Dr. Ilza Veith, a medical historian, then of Chicago, that was printed in the May 12, 1962, edition of The Journal of the American Medical Association.
Doctor Veith's paper traces the nature and history of acupuncture, which, as she states, "from its very beginning was considered to be effective in the cure of most physical and mental ills." I'd like to repeat that quote: "From its very beginning, acupuncture was considered to be effective in the cure of most physical and mental ills." She also gave to the scientific community a workable definition of acupuncture. She wrote, and I quote: "Acupuncture, as its Western name implies, is performed by inserting sharp needles into one or several of 365 specified spots distributed over all parts of the body, including the head and the extremities. The penetration of the needles varies in depth from 1 to 5 inches; sometimes they arc rotated and withdrawn; at other times, they are left in situ for one or more days. In China, the earliest needles were made of flint; later, of gold and silver."
To deal in depth with Doctor Veith's paper would take more time than there is available here today. But, after tracing the history of acupuncture, its proponents' all-inclusive therapeutic claims for it, and its spread to Japan and then, in the 1930's to Europe, she concluded her paper with these two paragraphs:
It is obvious that a disproportionate amount of space has been devoted in this article to a single, totally inadequate, investigative report. The scientific validity of the results quoted are further questioned because of the glaring disregard of the effect of suggestion in disease conditions which might be presumed to be most amenable to it. The reason for inclusion of the article at such length is merely to indicate the curious importance accorded to this ancient therapy in what is assumed to be a modern scientific medical setting.
Over the millennia of medical history, innumerable therapeutic systems have been based on different theories as to the causation of disease. When the true nature of illness has become established, the systems have, in great part, fallen by the wayside. True, an occasional one has persisted because of merits it possessed that were incidental to the theory upon which it was based. The medical historian can but wonder as to the fate of acupuncture in this context. Founded as it is upon fanciful ideas of anatomy and physiology, it can scarcely be expected to survive as a form of rational and scientific therapy, despite its continuous popularity for over 2,500 years and its recent inclusion into some modern systems of treatment. Whether eventually it proves to be an anachronism based on error or a treatment with value confirmed by experience is not to be decided here. In either event, the modern American physician is bound to encounter it frequently in the Far East, sometimes in Europe, and occasionally even in parts of this country, and therefore it behooves him to have some awareness of it. No matter how bizarre a therapy it is, how lacking in rationale, and how uncertain its value, it is concerned with patients and disease and hence it is a phenomenon which must interest the world of medicine."
Again, there's almost a void in the U. S. scientific literature for nearly a decade after Doctor Veith's paper. But then, things began to happen. And, oh, how they've continued to happen ever since.
First, in July of 1971, James Reston, the noted political analyst of The New York Times, suffered appendicitis while visiting in Peking. His appendix was removed under local anesthetic—Xylocain and Benzocain. But, the second night after his surgery, he was in considerable pain and—here's the start of the modern clamor—three long, thin acupuncture needles were inserted into Mister Reston's right elbow and below his knees. 'l'he needles were, according to his account. “manipulated in order to stimulate the intestine and relieve the pressure and distension of the stomach.”
There was more to the 20-minute-long ministrations to Mr. Reston, including the holding of two pieces of an herb called "ai" close to his abdomen while his Chinese doctor occasionally twirled the acupuncture needles, and Mr. Reston said that, within an hour, there was a noticeable relaxation of the pressure and distension of the stomach and no recurrence of the problem thereafter.
As any good newsman would do, Mister Reston wrote the story of his Chinese operation—and the story was published and republished, in various versions, in newspapers across the country.
As the news traveled, so did the demand for acupuncture. Most of the news media became involved—often with a demand for medicine's opinion. Then, in September, 1971, Paul Dudley White, M.D., and E. Grey Dimond, M.D., and their wives were invited to visit China by the China Medical Association.
In the December 6, 1971, edition of JAMA, a paper entitled "Acupuncture Anesthesia" by Doctor Dimond was published. In it, he reviewed the development of Chinese medicine, emphasizing the Cultural Revolution and the implementation in the 1960's of the "total national obligation to implement the teachings or policies of Mao Tse-tung."
Said Doctor Dimond: "Among . . . .major changes was the requirement that Western or modern medicine as we know it must be fully integrated with traditional Chinese medicine."
Let's digress here briefly and return to NIH's Doctor Li. I suggested to Doctor Li that there literally had been some interpretations of Chairman Mao's mandates to the Chinese physicians that they constituted a gun at the Chinese physician's head—an order to abandon Western medicine and substitute the so-called traditional Chinese medicine, particularly acupuncture.
Doctor Li had the answer, expressed as graciously as you would expect a Chinese of his stature to express it. He said that Chairman Mao, as a young activist, always had been an advocate of traditional Chinese medicine. When Mao came to power in 1949, Doctor Li related, Mao openly advocated use of traditional Chinese medicine and two years later—in 1951—established an institute of traditional Chinese medicine. In 1959, continued Dr. Li, Chairman Mao was responsible for a national workshop on traditional Chinese medicine, with emphasis on acupuncture.
While Doctor Li didn't say so, I gained the impression that he was trying to tell me that from 1959 to date, the Chinese physician's longstanding mixture of Western and traditional Chinese medicine possibly has become weighted at least to some extent to the traditional Chinese methods.
There obviously is not time to detail Doctor Dimond's JAMA paper, but obviously he was impressed with the traditional Chinese medicine, including "a vast therapeutic variety of remedies of herb, mineral and animal origin, moxa, and acupuncture."
After exposure to the use of acupuncture as an anesthetic and an analgesic, Doctor Dimond concluded his JAMA paper with the following, and I quote:
Personal observations made in the People's Republic of China in September 1971, indicate that acupuncture anesthesia has found an accepted place in medical practice in China. Competent modern-trained physicians have accepted this procedure and consider it a definite advance. The stoicism of the Chinese and the current ideological indoctrination play a role but do not seem adequate explanations for the effective anesthesia; the existence of a neural pathway has not been proved but is suggested. Chinese herbal medicine and 'therapeutic' acupuncture are also undergoing intense and vast clinical use and analysis. Today, in China, modern Western medicine and Chinese traditional medicine are obligated to work together and combine their efforts in teaching, research, and patient care. The dross may be great, the professional travail undoubtedly severe, the therapeutic evidence confusing. However, this immense ongoing applied clinical research may bring useful surprises to the rest of the world."
The acupuncture pot continued to simmer, but you will notice that the focus on acupuncture has tightened from the panoramic therapeutic claims for it to the specific picture of its possible potential as an anesthetic.
Then, it reached the boiling point when President Nixon visited China in February, 1972. White House physicians with the President returned to relate the anesthetic and analgesic potential of acupuncture they had seen used in China.
The public was excited, perhaps rightly so, about the possibilities of acupuncture. The medical profession continued to view it generally with skepticism—also properly so.
The scientific process is the foundation upon which scientific medicine in America was founded and has grown. To point out to you what that scientific process entails, obviously, is superfluous. We all know it requires that when a new hypothesis is advanced for the treatment of human illness, it must be made available to all who practice scientific medicine—through the literature and otherwise—and must be proven by qualified research, whether it be a new drug, a new device or a new treatment modality, such as acupuncture.
First to respond publicly to the growing public clamor about acupuncture was the American Society of Anesthesiologists, which issued a news release that said, and I quote:
The American Society of Anesthesiologists is gravely concerned over the premature application of acupuncture to American patients for relief of pain during surgery. The safety of American medicine has been built on the scientific evaluation of each technique before it becomes a widely accepted concept in medical practice. The premature use of acupuncture in the United States at this time departs from this traditional approach.
A potentially valuable technique which has been developed over thousands of years in China is being hastily applied with little thought to safeguards or hazards. Among the potential hazards is the application to the patient who has not been properly evaluated psychologically. If acupuncture is applied indiscriminately, severe mental trauma could result in certain patients.
Another hazard is the possible misuse by quacks in attempting to treat a variety of illnesses, including cancer and arthritis, thus diverting the patient from obtaining established medical therapy. Exploitation may delude the public into believing that acupuncture is good for whatever ails you.
Acupuncture may indeed have considerable merit and may eventually find an important role in American medicine. That role can only be determined by objective evaluation over a period of years.
As the discipline most seriously concerned, the ASA, whose membership is comprised of 11,500 physicians, feels a great responsibility to learn what it can through dialogue with Chinese acupuncture specialists. The value of acupuncture cannot be learned by a three-week junket to the People’s Republic of China.”
The ASA believes that a team of American scientists, including anesthesiologists, neurophysiologists, psychiatrists, surgeons, and medical hypnotherapists should visit China under official auspices for an indeterminate period to give prolonged and serious study to acupuncture.
The ASA has established its own task force to coordinate all activities concerned with acupuncture. It also has placed its resources and expertise at the disposal of the Federal Government in pursuing acupuncture studies.
The Anesthesiology Society had just about said it all—the need for scientific research and, above all, it had run up the storm signals on possible misuse of acupuncture by quacks.
At about the same time, there was another vital development in shaping the future of acupuncture in the United States. On July 26, 1972, the National Institutes of Health announced a research program into the use of acupuncture for surgical anesthesia and the relief of chronic pain.
And this brings us back again to Doctor Li, the neurosurgeon with the National Institutes of Neurological Diseases and Stroke of NIH. In my conversation with Doctor Li, he told me the acupuncture research program is intended as both intramural and extramural, with the extramural program involving some NIH funding. The intramural part of the research program, Doctor Li said, would include workshops, the gathering of scientific data and actual laboratory research under Doctor Li's direction at Bethesda.
How long does NIB envision for the research program? Doctor Li said: "A minimum of two years and possibly as much as five years."
Again, let's digress briefly, to consider the research course charted by NIH. On August 8, 1972, for example, The New York Times printed a letter to the editor from Arthur Taub, M.D., who is director of the Neurosurgical Research Laboratory and the Pain Diagnostic and Therapeutic Division of the Neurosurgery Section at Yale University.
I hope I'm not taking out of context what Doctor Taub intended in his thoughtprovoking letter when I quote only two paragraphs from it. They are, and I quote:
"While evidence for acupuncture anesthesia appears on the surface to be striking, it must be recognized that, in its present form, it is purely anecdotal, and, generally, represents reportage to the West from non-Chinese-speaking guests of the Chinese People's Republic visiting China for other purposes.
"While it would appear legitimate to arrange for the travel to China of an experienced, Chinese-speaking anesthesiologist, it seems premature to convene 'workshops' to discuss such matters. It is difficult to understand how the award of funds for the study of a modality of therapy for chronic pain can be envisaged when neither evidence for its efficacy nor a plausible hypothesis for its action can be advanced."
I hasten to add that the Times, about a week later, printed two letters defending the NIH research program into acupuncture—and the use of public funds for this research.
Since that opening flurry of published opinions on the NIB-announced program, there has been little or no public comment. So, let's take a look at the NIH program.
It is functioning under the direction of the NIH Ad Hoc Committee on Acupuncture, whose chairman is Dr. John J. Bonica, professor and chairman of the department of anesthesiology in the School of Medicine at the University of Washington. Other Ad Hoc Committee members are Dr. Morris B. Bender, professor and chairman of the department of neurology at the Mount Sinai School of Medicine in New York; Dr. Henrik H. Bendixen, chairman of the department of anesthesia at University Hospital at the University of California in San Diego; Dr. James Y. P. Chen of Santa Monica, Cal.; Dr. Ronald Katz, professor in the department of anesthesiology at the College of Physicians and Surgeons of Colunbia University in New York; Dr. Frederick F. Kao, of the department of physiology of Downstate Medical Center of the State University of New York in Brooklyn; Dr. Choh-Luh Li, of NIH; and Dr. Patrick Wall, professor in the department of anatomy and embryology of University College in London.
The Ad Hoc Committee is directly under the umbrella of the National Institute of General Medical Sciences, which, as you know, is a branch of NIH. This committee, shortly after its organization, recommended that the most valuable first approach to acupuncture in the United States would be studies on its use for surgical anesthesia and 1'01' the alleviation of chronic pain syndromes. Of particular interest were acupuncture's mode of action and its relative effectiveness as compared to well established forms of medical therapy.
At the request of the committee, all U. S. medical schools were also surveyed to determine if there was a significant research effort already underway. A total of 26 medical schools and universities responded affirmatively. As a result, February 28 and March I of last spring, the first national acupuncture research conference, sponsored by the National Institute of General Medical Sciences, brought together about a hundred American scientists and physicians to report studies already under way or about to be started. In all, 45 separate reports were presented at that conference.
Most of the reported research was in chronic pain treatment. Several reports also were included on the use of transcutaneous peripheral nerve or dorsal column stimulators for chronic pain. Also included were those on a number of minor surgical procedures, including dental applications, under acupuncture anesthesia.
Other applications included treatment of drug withdrawal symptoms, treatment of sensorineural deafness and treatment of post-operative pain. Data also were presented from physiological and neurophysiological studies of the acupuncture effect in animals or on human volunteers. These studies also included attempts to identify the location and measure the properties of skin acupuncture points with various electrical instruments.
On the basis of the results presented at the conference, the NIH Ad Hoc Committee on Acupuncture concluded that "acupuncture holds some promise as an anesthetic for certain surgical operations and for the treatment of some acute and chronic painful conditions."
And I'd like to read a few more paragraphs from the statement by Doctor Bonica, chairman of the Ad Hoc Committee, after that February 28-March 1 meeting. I quote:
From these preliminary studies, however, it is not possible to specify how acupuncture works or even to say how well it compares with drug-induced anesthesia or with well-established methods of treating painful conditions.
Moreover, it is clear that acupuncture is no panacea—that many more well-designed and well-controlled scientific studies are needed before it could be considered for wide use in clinical practice in the United States.
One of the serious problems in evaluating acupuncture for relief of pain is that pain itself is a complex phenomenon which also should receive greater scientific research efforts. Since it is now well established that environmental, genetic, cultural, ethnic, and other factors influence pain and a patient's response to drugs, it is essential to assess the effects of acupuncture and its efficacy in American patients. (See attached list of those participating in February 28-March 1 meeting who have started or are planning acupuncture research programs).
It is our understanding that NIH intends to make public the printed proceedings of that February 28-March 1 conference—in fact, we understand those proceedings now are being printed. So, they should be available soon, hopefully detailing all of the research reports made at the conference.
The obvious question now is what research programs have been given the approval of NIH? I regret to report that to our knowledge, NIH has made no public announcement of any such approved programs, whether. they are to be NIB-funded or not. However, we have, through other channels, been able to identify some of these programs. For example, we have learned, that the National Institutes of Health have approved, in one form or another, the following research programs:
The University of Missouri Medical School to do research into acupuncture as an analgesic. We understand this program will be under the direction of Dr. George A. Ulett of the Missouri Institute of Psychiatry.
Emory University School of Medicine at Atlanta, to do research also in the field of analgesia—and also in anesthesiology. This program, we understand, will be under the direction of Dr. Yung-Fong Sung of the medical school's department of anesthesiology.
Grasslands Memorial Hospital at Valhalla, N. Y., for research and evaluation of the therapeutic effects of acupuncture. We understand this program will be under the direction of Dr. Kinichi Shibutani, director of anesthesiology at Grasslands Memorial.
Stanford University's department of material science and engineering, for study of the electrical property of acupuncture points. We understand that William A. Tiller, Ph.D., of the Stanford engineering school, will direct this project.
The University of Hawaii Hilo College's department of psychology, for study of what is called Okyuu and acupuncture's effect on personality and I.Q. We understand this project will be directed by Paul W. Dixon Ph.D., of the school's psychology department. (Parenthetically, we should try to tell you what we understand this project is all about. As I get it, Okyuu is the Japanese word for moxibustion, which has been used in the Orient in the past by some parents and others to both treat and punish children. Moxibustion, oversimplified, is the addition to acupuncture needles of a substance that burns, causing heat, of course, or the direct application of this substance (usually a variety of herbs) to the skin and igniting it for similar heat causation. As I understand the Hawaii project, it will be to determine whether the past use of moxibustion has, in fact, affected a child's learning ability. It will be done by means of questionnaires to Hawaii's large Oriental population.)
The University of North Carolina Medical School, for research into acupuncture in the treatment of hypertension. We do not know at this time who will be in charge of this project.
We also have learned of several other "approved" research projects. The Cornell University School of Medicine in New York, with approval of the National Institutes of Mental Health, is conducting research into the sociology of acceptance of acupuncture therapy. The Veterans Administration Hospital at Syracuse, New York, under auspices of the U. S. Veterans Administration, is doing research on the use of acupuncture in the treatment of deafness and NIH's own National Institute of Neurological Diseases and Stroke is doing research on the neurology bases of acupuncture analgesia.
Obviously, these research projects we have listed are those that have received some type of federal government "approval." We know that there are others, such as the one being conducted, we're told, by the Arthritis Foundation.
Hopefully, before long there will be available information on all of the valid acupuncture research projects that are going on. There are other acupuncture developments—at both the national and state levels—that I should report to you, at least briefly.
At the federal level, the Office of Medical Devices of the U. S. Food and Drug Administration, exercising its responsibilities under the labeling act, has ruled that acupuncture devices must be labeled to indicate that they are experimental devices limited to investigational use by or under the direct supervision of a licensed medical or dental practitioner.
At the state level, all of the states that have taken any form of definitive action—with one exception—have held, by one method or another, that acupuncture is a medical procedure that can be practiced legally only by or under the supervision of licensed physicians. The one exception, as you probably all know, is the State of Nevada, whose legislature last year adopted a bill that, in effect, legalizes acupuncture and sets up a licensing board for acupuncture practitioners, among other things. And, that bill does not require that those who apply for licensure must be physicians, nor does it require medical supervision of those who may be licensed as acupuncture practitioners.
Another area of concern throughout the country are the so-called "quickie courses" in acupuncture, many of which must fall into the category of outright quackery. For example, some courses promoted and sponsored by a chiropractor named Richard D. Yennie, who bills himself as "founder of the Acupuncture Society of America," are of the weekend, three-day variety, after which participants are granted some kind of a certificate that, based on those three days, states they now are "qualified acupuncture practitioners."
Throughout all that we have discussed here today there is one message that comes through loudly and clearly—that there must be valid, scientific, clinical research into acupuncture to establish what, if any merit, it has for the American people—and that this research is going to take a number of years.
And, in conclusion, to give you some insight into the quackery dangers involved with anything less, I'd like to tell you about an incident involving Chiropractor Yennie. An enterprising reporter on the staff of the Bethlehem, Pennsylvania, Globe-Times, interviewed chiropractor Yennie after Yennie had put on a one-day—not a three-day—acupuncture "seminar" there. During that "seminar," according tothe Globe-Times' published accounts, Chiropractor Yennie performed his acupuncture miracles on six persons before 20 chiropractors in a room closed to reporters.
Then, afterward, the enterprising reporter asked Chiropractor Yennie a few questions. The key question was whether a single day's exposure to acupuncture qualified one to administer needles. Yennie's answer, as reported in the Bethlehem Globe-Times, was: "I can teach you to do it in 10 minutes."
Need more be said?
Mr. Taylor presented this paper on October 5, 1973, at the National Conference on Physicians, Schools, and Communities held at the LaSalle Hotel in Chicago.
This page was posted on February 16, 2005.