Crossing the research pond
Having just submitted my PhD thesis, I was ideally placed to present a poster abstract on my final study into how patients can be supported to make lifestyle changes in acupuncture practice.
Founded in 1993 by Patricia Culliton, Hannah Bradford and Stephen Birch, SAR’s aim is to foster scientifically sound inquiries in acupuncture and East Asian medicine. They host biannual conferences in the US to highlight research in the field.
Support from the US National Center for Complementary and Integrative Health (NCCIH) provided 30 scholarships for next-generation acupuncture researchers as travel stipends. Also on offer were reduced registration and membership fees for students and junior practitioners/researchers.
The four-day event centred on the theme ‘From Mechanism to Patient-Centered Care’ and there were many fascinating presentations looking into the physiological mechanisms of action of acu-point stimulation.
The keynote presentation from Helene Langevin, director of NCCIH, dived into the tricky issue of Acupoints in Acupuncture Research. Following on from her 2018 paper co-authored with Peter Wayne – What is the point? The problem with acupuncture research – she asked, Does the concept of acupuncture points have scientific validity?
Dr Langevin suggests we need a rigorous study of the biological basis for point specificity, in order to explore questions such as, are points distinct anatomical locations? Or a set of anatomical locations with shared attributes? Or both? Speculating that perhaps a combination of a neural and interstitial model of acu-point physiology will emerge.
An incredible new research project was announced to look at this area. The NCCIH are to fund a major five-year project to work towards producing an open access repository for information on anatomical and physiological correlates for acu-points. The Topographical Atlas and Repository for Acupoint Research (TARA) database will be based at Harvard Medical School and Drs Vitaly Napadow, Karl Helmer and Richard Harris are leading the project.
After the main keynote presentations we broke out into smaller symposia and I had a chance to hear about the work of Christine Guirguis who is working on a project which aims to Bring Evidence in Complementary Medicine to Wikipedia.
Guirguis explained how important Wikipedia is in dissemination of information on research into acupuncture and CM, due to the sheer number of views of pages and how it is used as a source by the public, patients, medical professionals and journalists. The project takes a long view of how to improve Wikipedia – by understanding the editing rules and processes, building relationships with editors, and making structural changes to improve pages such as the low back pain page.
The group are looking for people to assist with this Wikipedia project. They will provide advice and guidelines on how to get involved in editing in order to make sustained changes and improvements. Just get in touch if you’re interested or want to know more.
A major area of research within the conference was integrative oncology which is huge in the US. Dr Jun J Mao, SAR co-president, chaired a panel on the Cycle of Oncology Clinical Research. He emphasised the importance of involving patient advocates in all stages of the research cycle – although not your own patients! He also explained how contacting patient advocacy groups and listening to their concerns and interests can be a useful starting point for producing research which can have real impact.
Dr Ting Bao presented promising findings from efficacy studies of acupuncture for chemotherapy induced peripheral neuropathy – and Dr Suzie Tick presented new clinical practice guidelines on pain in oncology which make six specific recommendations for use of acupuncture.
Dr Jun J Mao discussed findings from comparative effectiveness trials for insomnia – explaining how comparing acupuncture to cognitive behavioural therapy (CBT) found CBT more effective. But when patients have both pain and insomnia acupuncture is more effective. This highlights the difficulty of selecting best outcomes measures in trials, focusing trials on single outcomes may not reflect reality of clinical practice and reality of patient presentations and experience.
Policy decision making
I was interested to see a symposium called From Acupuncture Evidence to Clinical and Policy Decision Making: Where are we and the ways forward? It was led by the team who published an extensive acupuncture collection in the British Medical Journal in 2022 which analysed the progress of developing high quality trials on acupuncture and the current status of acupuncture research.
This panel discussion led by Yu-Qing (Madison) Zhang explored the team’s findings of the underuse of proven acupuncture treatment in healthcare systems and went on to cover problems of dissemination and implementation.
A specialist in economic evaluations, Patricia Herman, gave an overview of producing economic analyses of new treatments. She explained how costing is always specific to each setting, and that economic evaluations should consider who’s costs we are describing – cost to the patient, a health institution or wider society? Typically economic evaluations of acupuncture tend to show improvement in outcomes has a small additional cost – however, it’s important to factor in longer term economic savings such as reduced use of further health services.
A wider discussion considered the role of government and insurance companies in policy decisions and some of the structural problems in implementing widespread acupuncture services. For example, the reduced number of enrolments in acupuncture courses, lack of clear career path and financial security for acupuncturists, and need for better links between research findings and training courses.
We had an opportunity to hear from acupuncture researchers around the world. Six SAR global ambassadors from Brazil, Romania, Norway, Netherlands, France and South Korea outlined the current place of acupuncture research in their countries – demonstrating the great variety in restrictions to practice, availability of acupuncture and involvement with health organisations.
Dr Elisabetta Casaletti from Italy, Dr Olivia Poer from Austria and Sandro Graca from Ireland presented on the latest research and clinical experience in reproductive health. They explored the risk factors for both males and females and the role of acupuncture and East Asian Medicine within an integrated systemic approach to addressing infertility trends.
One highlighted issue was the importance of dosage when translating the findings from research into a successful evidence-informed acupuncture practice. Their advice: when using acupuncture alongside fertility treatment, the emphasis should be on more acupuncture treatments before the day of embryo transfer – along with using individualised protocols combining aspects of the outdated Paulus protocol with findings from Professor Elisabet Stener-Victorin on uterine and ovarian blood flow.
Similarly, higher acupuncture dosage continues to yield better results for menstrual health, as seen recently from research findings on dysmenorrhea and polycystic ovary syndrome, when treatments were performed two or even three times per week.
One of the most extraordinary presentations looked into Future Digital Health. Claudia Witt described a Digital Society Initiative at the University of Zurich which is exploring digital transformation across society, including health.
Various future case scenarios are being considered, including the potential role of multi-purpose implants – think of a super updated version of your health tracking watch, holographic health coaches, and ‘digital twins’ – your digital double used for testing potential treatments you might need.
Slightly more current was a project led by Dr Suzie Zick which has produced an app for patients to self-apply acupressure for cancer fatigue. This has been developed for research but is available in app stores for anyone to use: Apple or Google Play
A big highlight of the weekend was a gala dinner and old school disco which saw everyone up and strutting on the dance floor, with lots of friendly faces and positive conversations. I even managed to see a little of New York on my final day and came home feeling incredibly lucky to be part of a forward looking profession which has so many possibilities.
Jonquil with Terje Alraek (left) and Sandro Graca (centre)