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Acupuncture: NCCAM Calls California’s Bluff

The [California Department of Consumer Affairs'] use of the term “endorsement” is inaccurate, may confuse the public, and may lead the public to falsely conclude that NIH has made certain efficacy and/or safety conclusions regarding acupuncture. Further, consensus conference reports are not a policy statement of NIH or the Federal Government… NIH asks that you correct these two points of information in your booklet and on your website.

— Jack Killen, MD, Deputy Director, NCCAM, NIH

I have to praise the Deputy Director of the National Center for Complementary and Alternative Medicine (NCCAM), Jack Killen, for asking the State of California to remove a couple of false claims in a “Consumer’s Guide” on acupuncture.

Indeed, on June 12, 2012, Dr. Killen wrote a letter to the California Department of Consumer Affairs (DCA) expressing concerns about an informational booklet which makes the unfounded claim that the NIH “formally” endorses acupuncture. The booklet also incorrectly states that NIH has “found clear evidence that needle acupuncture is effective” for a list of conditions. Here’s a snapshot of this publication:

Albeit the long letter, the message is clear and simple: “As a U.S. Federal research agency, NIH does not endorse any product, service, or treatment.”

Soon after receiving the letter, the DCA removed the booklet from circulation, deleted the online version from its website, and stopped sending out copies to new licensees.

This official booklet has been published for over a decade. There have been 3 editions since 2002, and all claim that NIH “formally” supports acupuncture and that there is “clear evidence” of its efficacy.

As a result, thousands of unsuspecting patients have since 2002 chosen acupuncture as a treatment.

I first came across the booklet in 2009. Shocked by its preposterous claims, I wrote a letter to NCCAM the same year and asked for clarifications. Their response contained the same essential message found in Killen’s recent letter:

The booklet misstates the purpose of the 1997 consensus panel on acupuncture. As a Federal research agency, the NIH does not endorse any product, service or treatment, nor are NIH consensus documents statements of policy.

— Terry Evans, NCCAM, March 3, 2009

Since 2008, I have sent Terry Evans’ letter to the California DCA and its Acupuncture Board on several occasions. In response, I was told each time that although the NIH does not explicitly state that they “formally endorse” acupuncture, “supporting statements in the 1997 report could be interpreted as an endorsement”!

In other words, according to State of California, the NIH formally endorses acupuncture, even if it the NCCAM – one of the institutes and centers that make up the NIH – explicitly says that it does not!

The latest version of this asinine statement was sent to me in May 2012 by Reichel Everhart, the DCA Deputy Director for Board and Bureau Relations:

Just 3 months prior to Everhart’s letter, DCA’s Acupuncture Board was put in the hot-seat by the State Senate, mainly for failing to protect the public. The Senate explicitly told the Board that its mission was to regulate the profession, not to promote or to protect it. But so far, the Senate criticism have fallen on deaf ears: a senior member and former Chair of the California Acupuncture Board made this baffling statement in a public meeting just around the same time Everhart wrote to me:

I think given what is in front of this Board, and the work that we are continuing to do to try to create legitimacy around the entire subject and to maintain legitimacy and to promote the profession, we should oppose anything that is so nebulous that should possibly detract from the standardized work that is being done nationally…

— Robert Brewer, former Chair and current member of the California Acupuncture Board, May 17, 2012

Brewer’s statement provides an insight on why it has taken so long to remove the booklet in California: there is an obvious resistance to any evidence that is not in favor of acupuncture or disputes its very purpose. California is not the only state with a protectionist acupuncture board: many regulatory agencies across the US have long operated as lobbies, with the sole intent of legitimizing and promoting the profession. As co-blogger Jann Bellamy recently wrote in a an article about acupuncture practice acts in the US, some even allow the practitioners to act as primary healthcare providers:

Licensing acupuncturists and oriental medicine practitioners and giving them the right to “diagnose,” “prevent” and “cure” disease and to employ other nonsensical “CAM” practices and products is most certainly not in the best interest of the public’s health, safety and welfare.

Fortunately, the Californian Senate seems to be fully aware of the absurdity of regulating acupuncturists as primary care providers. They also know that the Board has a long history of acting as a shield for acupuncture training programs and professional organizations. In March 2012, the Senate Business, Professions and Economic Development Committee made the following comment that supports my argument:

Both the [Little Hoover Commission] and Legislative Counsel did not believe that the law creating the Acupuncture Act intended for an acupuncturist to be the primary care professional responsible for coordinating (or being the “gatekeeper”) for the ultimate care of a patient.

The Senate Committee was referring to the 2004 findings of the Little Hoover Commission, an independent state oversight agency that investigates the government and makes recommendations to promote efficiency and to improve service. The commission’s report (Report #175, September 2004) to the Governor and the Legislature had observed:

The policy choice to give patients direct access to acupuncturists was clear, but the statutory intent to regulate acupuncturists as a “primary care health care profession” is not. The term has many potential meanings. While some people may turn to acupuncturists first for everything that ails them (one potential meaning), it is difficult to see how practitioners of an alternative healing paradigm can be responsible for coordinating care with biomedical specialists (another potential meaning).”

— (Regulation of Acupuncture: A Complementary Therapy Framework, page 25.)

After the 2012 sunset review, the Senate gave the Acupuncture Board two years to address a long list of problems and concerns. My hopes are that at the end of this deadline (or even before) the Senate realizes the futility of having a separate board for acupuncture.

Meanwhile, what should be done with the 10,000 or more active licensees in California? Even if they use “a smorgasbord of implausible and unproven diagnostic methods and treatments” — as Jann Bellamy puts it — I do not foresee an immediate end to their licensing, especially during an economic downturn. However, the state also has the obligation to place the protection the public at the highest priority.

In my opinion, the best way out of this quagmire is to disallow acupuncturists to work as primary care providers, and to require prior consulting and screening by a physician, a nurse practitioner or a physician assistant. This is in the best interest of the public, for it leaves the responsibility of coordinating the ultimate care of a patient in the hands of a competent primary care provider.

But at least for now, witchdoctors in California can no longer bluff out that the NIH formally endorses their craft, and that there is clear evidence that it is works for anything!

With many thanks to Daniel Bederian-Gardner, Jann Bellamy and Paul Ingraham for their valuable comments. The opinions expressed here are the author’s.

 

Posted in: Acupuncture, Traditional Chinese Medicine

Leave a Comment (19) ↓

19 thoughts on “Acupuncture: NCCAM Calls California’s Bluff

  1. windriven says:

    This is what happens when the camel’s nose is allowed in the tent. First there is the effort to establish legal licensure ostensibly to protect the public from improperly trained or ad hoc quacks. But this gives the state’s imprimatur to properly trained quacks. With the state’s stamp of legitimacy everything from that point is negotiable.

    Quacks and their rubes are, unfortunately, a subset of a larger group called voters. It is politically inconvenient to stamp the licensed quacks out (think committee meetings with weeping mothers relating miracle cures … maybe televised) so we end up with the never ending battle to keep the nose from becoming the head from becoming the camel.

    The message is clear: don’t license stupidity. Just say no.

  2. Ben Kavoussi says:

    @ windriven

    Thank you for your comments. Indeed, this is what happened in CA: the state created a board to regulate the profession and protect the public. Once the board in place, acupuncture organizations, liability instance providers and training programs placed their people on the board. From then on, the board became a lobby for theses organizations and to promote the profession — instead of regulating it.

    This is also what the CA Senate told the board last February. Now they have two years to fix this mess.

  3. ConspicuousCarl says:

    …while [the DCA] does not view the 1997 NIH consensus statement as a formal endorsement of the use of acupuncture, it nevertheless holds that certain supporting statements in the report could be broadly defined as and endorsement.

    This basically says, “we don’t believe what we said, but we are going to continue saying it because people who don’t know any better would conclude that it is true”.

    My mind has been relieved of its previous unboggled condition.

  4. Cymbe says:

    Why is the California Department of Consumer Affairs not actually protecting customers, but quacks? Why is it that it has a more positive view of acupuncture, than the organization established by Harkin et al. with the aim of promoting quackery?

  5. Ben Kavoussi says:

    @ Cymbe

    This is a very good question for which I do not have an answer.

    If you are a CA resident, please write to the Governor and cc the Director of the DCA, Denise Brown, and the Senate Business, Professions and Economic Development Committee.

  6. windriven says:

    @Cymbe

    Why is the California Department of Consumer Affairs not actually protecting customers, but quacks?

    A less charitable person than I might suggest this is because rubes are running DCA. Anyone of a skeptical bent would ask themselves your same question. But apparently in DCA’s distorted view of reality, acupuncturists are great and wise healers despite any and all proof to the contrary. And really, given the herculean efforts of NCCAM and other apologists, it is easy enough for the gullible and the clueless and the scientifically illiterate to jump to swallow the hook.

  7. Eugenie Mielczarek says:

    Ben, thanks for the post.
    This weeks Research News from NCCAM on acupuncture would not dissuade a chronic pain sufferer from choosing acupuncture. ” The authors noted that these findings suggest that the total effects of acupuncture, as experienced by patients in clinical practice, are clinically relevant. They also noted that their study provides the most robust evidence to date that acupuncture is more than just placebo and a reasonable referral option for patients with chronic pain.” The News also mentions that the above conclusion is from a NCCAM sponsored study.

  8. pmoran says:


    This weeks Research News from NCCAM on acupuncture would not dissuade a chronic pain sufferer from choosing acupuncture. ” The authors noted that these findings suggest that the total effects of acupuncture, as experienced by patients in clinical practice, are clinically relevant.

    That is a reasonable statement. We may choose to believe that the largest contributor to total “benefit” is reporting bias, but we have no direct evidence of that. Meanwhile the evidence for significant placebo responses is quite strong, as is also the plausibility of minor physiological effects from a course of acupuncture sessions such as distraction, counterirritation, “time outs” and relaxation, and possibly endorphin and other neurotransmitter activity from the needling (or from the thought of it.).

    I would have added “in at least some populations” to the above, for further scientific precision, and in recognition of the fact that .it would be pointless considering the procedure for a population of skeptics or one that has had this well completely poisoned for them by well-meaning skeptical opposition.

    They also noted that their study provides the most robust evidence to date that acupuncture is more than just placebo and a reasonable referral option for patients with chronic pain.”.

    That is also a fair statement to the extent to which the authors achieved their aim of selecting studies in which — “allocation concealment was determined unambiguously to be adequate.” How was that done? Were exit polls performed? What measures were taken to stop acupuncturists consciously or unconsciously breaking the “blinding” and again, what direct evidence do we have for that happening ?

    We thus cannot say for certain that there are no physiological effects of acupuncture (which should per se on its own permit its use where overall benefits are cost-effective). Steve Novella and David Gorski can only point out that they are small, if they exist.

    We accuse the proponents pf acupuncture and even those choosing to investigate it with some rigour of having an “agenda” and being guided by biases other than that of wanting to help patients with difficult and disabling conditions such as chronic pain. So there is no excuse for us allowing our own reasonably legitimate biases against acupuncture (as a procedure that has undoubtedly been largely based on a mixture of ancient Chinese superstitions and pseudoscience) to cloud our normally guarded approach to subjects where the evidence is not yet clear. Here there is the additional consideration of potential for helping patients with difficult and disabling conditions like chronic pain.

    It is not clear to me why this has to be an all-or-nothing judgment. The evidence certainly does not produce a such a knife edge. The Gods of science do not preclude us having a “provisional/conditional” tolerance of dubious treatments where there is both uncertainty about physiological effects and potentially worthwhile gains for patients.

  9. windriven says:

    @pmoran

    Peter, while you make some interesting points, the burden is on the proponents of acupuncture to prove the validity of the therapy, not on us to disprove it.

    I would go on to ask, given the huge range of therapies (drugs, surgical interventions, PT, etc.), under just what conditions would a reasonable physician choose acupuncture as the best therapy available? I know that if my physician recommended acupuncture I would question her closely as to why she thought this was the best choice, then I’d probably start looking for a new internist.

    It is reasonable to believe that acupuncture might have a statistically significant impact on the subset of patients who are conditioned to expect it to work. That is fine for parlor tricks but medical therapies don’t rely on credulity for their effectiveness.

  10. Ben Kavoussi says:

    @ windriven

    Yes, rubes seem to run the DCA, and they run it under the malignant effects of political correctness…

  11. Ben Kavoussi says:

    @ Eugenie Mielczarek,

    Thank you, hopefully soon one of us at SBM will write a post about this study.

  12. Thomas says:

    This is the sort of legitimacy that the board provides for an acupuncturist who graduated a year and half ago and does not even practice acupuncture. He consults by phone and webcam for $250 an hour. This is a shame!

    http://chriskresser.com/clinic/faq

    The acupuncturist seems so logical until you pick it apart:

    “What kind of training do acupuncturists receive?

    I am a licensed acupuncturist in the state of California. In California, acupuncturists complete training in the biological sciences such as anatomy, physiology, pathophysiology and pharmacology, as well as conventional medical diagnosis and treatment. In addition, acupuncturists receive extensive training in needle therapy, clinical nutrition, botanical medicine, energy cultivation practices (Tai Chi & Chi Gong), stress management and lifestyle counseling

    [What biological training? I went to his school, there are not even basic chemistry classes!]

    Are acupuncturists doctors?

    No, acupuncturists are not licensed as medical doctors.

    Acupuncturists are considered primary care providers in California and many other states. We are trained to evaluate patients using professionally recognized standards and medically-based criteria (physical exams; consultation between other providers, conventional medical diagnoses; and ordering x-rays and laboratory tests).

    [What is a primary care provider?]

    However, the laws regulating the care that can be provided by acupuncturists vary from state to state. In some states, acupuncturists are unlicensed providers. Therefore, I do not practice medicine and do not diagnose or treat diseases or medical conditions. I focus my practice on promoting health and optimal function. My services are not meant to substitute or replace those of a licensed physician and clients in my practice are advised to be under the care of a licensed physician wherever they reside.

    [I don't practices medicine, I just tell people how to get healthy?]

    Do acupuncturists prescribe medications?

    No. Acupuncturists are not licensed doctors, and do not prescribe or make recommendations about prescription medications or controlled substances.

    I use natural, noninvasive methods such as nutritional therapy, herbs, supplements, stress management techniques and lifestyle changes to address the underlying causes of disease and promote optimal function and health.”

    [I don't prescribe medicine, I tell my patients to buy processed herbs in pill form intended to have medicinal effects.]

  13. Thomas says:

    And what is the impact on patients? I think we need to provide a human dimension here about the impact of legitimizing acupuncturists:

    http://paleohacks.com/questions/107178/tell-me-about-your-personal-experience-with-chris-kresser#axzz25sgEX2ov

    A key quote:

    I tend to be more of a lurker than a poster, but I think it’s important to share that I didn’t have a good experience with Chris Kresser, either. The other reviews here touch on all the same problems I had: he is very expensive, ‘prescribes’ excessive amounts of expensive supplements without checking in on their efficacy, comes off as arrogant and didn’t seem to really like talking during our phone consultations, seems fairly indifferent to patient health issues, and has unpleasant and sometimes unresponsive office staff. I saw another review on another site where the poster said he was uncomfotable with Chris’s “aggressive business practices” and I very much agree. We all need to make a living, but this seemed to bleed a little bit too far into the realm of taking advantage of people.

    Most importantly, many rounds of testing and more than $1000 later, (yes, I’m a fool, but I felt desperate) he didn’t enlighten me to anything that led to any resolution of my symptoms. My impression of him is one of someone who speaks with great respect and deference to people he wants to impress, such as other big names in Paleoland, but treats others, like his patients who are paying him huge sums of money, with a dismissive and somewhat condescending attitude.

  14. lilady says:

    @ Thomas: So, am I expected to infer that your experiences with this acupuncturist were somewhat less than satisfactory. :-)

    From Chris Kresser’s website you provided:

    “In general, treatment programs for chronic illnesses last between three and six months, but most patients start seeing improvement within the first month. Patients may elect to continue with a maintenance program after their initial treatment plan is finished.

    How much will my treatment cost?

    This also depends on several factors, including the complexity of your condition, the extent of lab testing required, the combination of supplements, herbs and other therapies needed during treatment, and the number of consultations you receive.”

    BTW, he doesn’t take *insurance payments*, but you can pay through PayPal or credit card (so convenient if you are receiving *long distance treatments* via Skype). He will accept personal checks from patients who actually receive *treatments* in his office.

    Chris Kesser also *treats* Thyroid conditions the *natural way* His page on the *treatment* of GERD is a gem:

    http://chriskresser.com/what-everybody-ought-to-know-but-doesnt-about-heartburn-gerd

    In another of his articles on GERD, he barely mentions that rarely some patients will need *other interventions* such as surgery for the treatment of GERD. Would he would *recommend* a patient with GERD consult an MD for a medical opinion? It *might* be a good idea for patients who have GERD to see a medical doctor…

    http://www.nlm.nih.gov/medlineplus/ency/article/001143.htm

  15. Thomas says:

    Iliady, no I am a confirmed skeptic and have never seen him. I got interested in him because fairly prominent figures in the community dedicated to applying evolutionary theory to diet and exercise kept mentioning him. I lost 35 pounds and improved my health following what is sometimes referred to as “paleo” guidelines.

    I then noticed more and more these “paleo” types promoted woo and people, including Peter Attia–a doctor who works closely with Gary Taubes (who I respect)–kept referencing a Kresser. I started investigating him and found him a perfect example of a woo practitioner cloaking himself in skeptic-scientific language while promoting a pseudo-scientific agenda and getting rich in the process. I then dug deeper and deeper and was outraged. He even had a podcast called the “Health Skeptic” I think he is the perfect “face” for contemporary alternative medicine nonsense and acupuncturists.

    He charges 550 dollars for the initial consultation and then 250 an hour for his webcam and phone consults. I especially enjoy the irony of an acupuncturist treating patients by phone!

  16. lilady says:

    I especially “enjoy” the irony (and the practicing of medicine without a medical license), for his advice and *treatment* of thyroid disorders and GERD. :-)

  17. BillyJoe says:

    ” I especially enjoy the irony of an acupuncturist treating patients by phone!”

    He has probably heard that you don’t need to use the presribed acupuncture points, you don’t need to stick the needles in, and you don’t even need to use needles because a toothpick will do. He has just taken it one step futher…

    ” It *might* be a good idea for patients who have GERD to see a medical doctor…”

    Yes, a common cause is Helicobacter Pylori which would need to be eradicated as part of the treatment if present, and a possible complication is oesophageal cancer for which the precursor (Barrett’s Oespahgus) may already be present, if not the cancer itself. For all of these reasons, a gastroscopy might be a good idea.

  18. Thomas says:

    Thanks–interesting information and great wry comment! He also, of course, has taken his rigorous approach to babies and even found an alleged Harvard medical school instructor to endorse it:

    http://healthybabycode.com/signup

    My favorite is the shout out to medical doctors and scientists:

    “There’s a good reason why most mainstream and natural health professionals don’t have clearer answers for you:

    They don’t have time to read the most recent research studies, which means their understanding of nutritional science might be years or even decades out of date.

    They discount hundreds of thousands of years of traditional wisdom about natural, food-based approaches to fertility and a healthy pregnancy.”

    Take that all you pediatricians and obstetricians who prefer science to the approaches taken by Babylonians and Medes!

  19. Sadly, the NCCAM and NIH are one of the leading distribution points for woo … they may refuse to outright endorse it, but do everything but on their website. There’s been other recent articles here about Dr. Briggs and her seemingly endless tolerance of misinformation and poor research standards, so I won’t belabor the point.

    http://nccam.nih.gov/health/acupuncture

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