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H.R. 646, The Federal Acupuncture Coverage Act of 2009 (287 comments ↓)
H.R. 646 would amend title XVIII of the Social Security Act to provide for coverage of qualified acupuncturist services under part B of the Medicare Program, and to amend title 5, United States Code, to provide for coverage of such services under the Federal Employees Health Benefits Program.
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luke643
July 23, 2009, 9:45pm (report abuse)ok, now we are talking together. Firstly, the info on Wang Qingren is not all that accurate. I would assume it has suffered in the translation - I have to look at sources, but a statement in chinese suggesting the blood of the arteries is oxygenated could easily be mis-translated and interpreted as saying there was "air" in the arteries.
On the studies - an adequate sham procedure has not been developed, hence the success of "sham" procedures. The problem is that "sham" procedures use actual points and stimulate the surface of the skin - this is almost identical to japanese and korean acupuncture techniques, and therefore does not represent a form of "fake" acupuncture. Therefore, the future of acupuncture studies, must find a better form of "sham" to compare with "real" acupuncture.
luke643
July 23, 2009, 9:50pm (report abuse)well, now you have given me a more recent ernst paper, but even in that paper he includes a graph showing "real" acupuncture's superiority, particularly in treating osteoarthritis.
the 2002 of the langevin is not important, i was bringing up old ernst stuff to compare it to his critical analysis that was far newer.
luke643
July 23, 2009, 9:56pm (report abuse)part of the inadequate powering of the trials is that there is the need for a "non-acupoint" group, which doesn't often occur. in the ernst paper you linked the study he looks at from germany has the problems I discussed above. It's sham group uses "shallow" needling. Again, this is not sham. If the sham group used non=points then it would be stronger.
luke643
July 24, 2009, 8:30am (report abuse)additionally, clinical trials may significantly under-power acupuncture treatments. It is not a pill, so testing it is very difficult. It is closer to psychotherapy, but with a physiological component. Therefore, allowing for variation in treatments and methodology is important from practitioner to practitioner.
Also like psychology, Acupuncture must rest its western scientific backing on non-clinical tests.
Has psycho therapy been adequately tested? Is it not just as pseudo (in your estimation) as acupuncture? and yet it is fully covered by insurers.
shanna62
July 25, 2009, 8:00pm (report abuse)Hallstrom
>>>"However since acupuncture in itself is clearly not creating the physiological response who cares what the acupuncture points may or may not correspond with anatomically?"
It is precisely that acupuncture is only one of many ways to stimulate a point (visualization also being a way) that we should care what points correspond to anatomically. The effects are because of the points, not the needles per se. Practitioners have long used meditation on points for treatment (ie qi gong). There is too much focus on needles and skin puncture and not enough on the points and meridians themselves.
Robert O. Becker (The Body Electric), 2 time Nobel nominee, spent his life studying bioelectromagnetic effects in organisms. Concerning healing/acupuncture mechanisms, much is to be learned from his work concerning microcurrents at injury sites which inspire spontaneous healing and regeneration. And from Matsumoto and Birch (Hara Diagnosis)concerning piezo-electric properties of facia.
C Hallstrom
July 27, 2009, 1:06pm (report abuse)Luke, the evidence does not support your argument. Acupuncture is a placebo.
“Guess what? It doesn’t matter where you put the needle. It doesn’t matter whether you use a needle at all. In the best controlled studies, only one thing mattered: whether the patients believed they were getting acupuncture.”
http://www.sciencebasedmedicine.org/?p=252
“ It does not matter where you stick the needles, or even if you stick them through the skin. Since these two variables are specific to acupuncture it is safe to conclude that acupuncture does not work.”
http://www.sciencebasedmedicine.org/?p=492
Again I am with you by in large on the psychotherapy point. The number of idiots masquerading as therapists is quite large. However, it does have some basis in science but a two year degree should not entitle one to go messing with peoples heads.
C Hallstrom
July 27, 2009, 1:18pm (report abuse)Shanna , "visualization" are you kidding? You know that magic and the tooth fairy are not actually real don't you? And"bioelectromagnetics"?
That's quack central. Let's take a review of some of the defenders of acupuncture; We have had astrologers,alchemists,neo-eugenicists,creationists and now visualizers and bioelectromagneticists to name but a few. Wow that's quite the company to be keeping I must say.
C Hallstrom
July 27, 2009, 1:33pm (report abuse)Luke, as to Wang Qingren there is something goofy with my quote. I think it's the dates. Regardless, what I could find said that Wang Qingren was greatly impacted by his exposure to western anatomical medical texts and wished to bring that anatomical accuracy to medicine in China.” To his credit, Wang lobbied strongly for less stringent regulations against dissection, saying that healing without knowledge of internal organs was "like a blind man walking in the dark." http://www.csicop.org/sb/200003/qi.html
In fact it seems that he, like his European counterparts believed enough in the need to know anatomy that he risked his life to do human dissection. Weirdly enough he did this I think by cultivating a relationship with the local executioner.
As to problems with translation I tend to doubt that as an explanation. Do you speak and read Chinese Mandarin or even Cantonese?
luke643
July 27, 2009, 4:14pm (report abuse)indeed I do, at an beginner/intermediate level at the moment, and I will continue my study in the next few years as I pursue a PhD in Chinese History.
did you think you were arguing with the housekeeper?
Your biographical info on Wang is accurate as far as I have learned.
It is important to note that Want Qingren is one of the most influential of Ming physicians, and his linking of western and eastern practice was not lost on future generations.
The translation explanation holds - particularly in that Wang knew that blood travelled in and out of the heart, and he knew it received "air" via the lungs.
His medical theories and treatment prescriptions rest on using the distal blood vessels and "luo" points which are, according to Wang, points in which blood and circulation can be influenced powerfully. His discussion of circulation is complex and simply leaves no room for a base confusion such as thinking "air" and not blood travels away from the heart.
C Hallstrom
July 27, 2009, 7:20pm (report abuse)Luke;“However, there is not one word in Yiling Gaicuo about how the blood circulates in the body. In addition, Wang himself made many mistakes as he attempted to correct the anatomical errors of previous generations. For example, in regard to the anatomical and physiological aspects of the heart, vessels and blood, Wang, based on the empirical ‘facts’ he gathered from observing some children’s corpses shallowly buried in a public commentary, claimed that that there exits no blood in the heart. He called the arteries the ‘vessels of qi (air)’ because he thought there was no blood in them either. When he refers to ’vessels of blood’ in his anatomical dictionary he meant only the veins.18"
NIE JING-BAO1
University of Otago http://www.nzasia.org.nz/downloads/NZJAS-Dec01/Jingbao.pdf
I am pretty sure this guy got his translation correct.
luke643
July 28, 2009, 1:01am (report abuse)read the article. It is problematic. First, it focus' on the Neijing, rather then the Nanjing (written some 400 years later). Nanjing is a more interesting text in terms of physiology, as the neijing is more the philosophical underpinnings of the medicine and Nanjing the practical manual.
on Wang - his treatment methods suggest using the Heart channel to assist the movement of blood away from the heart and the pericardium channel to assist the movement of blood to the heart. Added to this is the idea that Qi and Blood are governed together and have the same impetus - i.e. Qi is a metaphor for the aspect of blood that moves it from one place to another, and blood in turn has an aspect, in its nourishing of the body that is referred to metaphorically as "ying Qi". So again, we are talking about metaphors that get lost in translation.
luke643
July 28, 2009, 1:07am (report abuse)more on the article you linked: Nie's agenda is a bit overwhelming, and as such he gets caught using straw man arguments fairly often in the article. Such as claiming that the neijing is not valid because it does not prescribe to established rigorous scientific methods. These are methods that are distinctly european and modern, and they are reductionist and lacking in systemic vitality. Hence the breakdown of physical science with the introduction of QED.
Chinese medicine, as Unschuld suggests, is a method of "systematic correspondances", or an intuitive and practical system of reading the basic physiological signs of the body, and then using acupuncture, herbs, massage, dietary therapy and exercise to essentially right the listing ship.
It is not necessary in this system to know exactly where cappillaries are, and which nerves innervate which muscles, the systematic correspondances metaphor stays on the surface and yet effects the inner landscape.
luke643
July 28, 2009, 1:26am (report abuse)to add to my previous point about blood and qi - if qi is an metaphor for directionality of the movement of blood, and blood is a form of Qi, then how can we attack wang for thinking that Qi flows in and out of the heart - Nie did not specify what kind of Qi Wang wrote about in the piece he quoted, and this is precisely the kind of issue that is full of translation pitfalls.
lastly - try Nathan Sivin for better scholarship all around, without Needham's or Nie's bias. His work on china and science is excellent. here is a quote that is pertinent to the Wang Qing Ren discussion:
"How progressive a given early idea seems to moderns is besides the point. The point is rather what it meant and how it was used in its time"
in this case, wang's treatments imply clear knowledge of circulation via the heart, there is no other explanation for their prescription. why else would he suggest using a specific heart point to assist distal circulation?
LauraDawsonLAc
(logged in user) July 28, 2009, 10:18am (report abuse)Having participated in the NIH Consensus Conference in 1997, we looked at many of the factors that are perplexing so many of the commentors. It is important to note the longevity of the primary principles used to diagnose disease, thus generating a treatment model. Simple principles such as extremes in hot and cold, excesses in contrast to deficiencies, internal or external topically visible and/or expressed will endure the test of time. Acupuncture points for treating disease have been noted and recorded for their propencity to reduce fluids or the presence of excess heat. Some are used to increase generation of fluids within areas of the body; all of which alter the activities experienced by the patient who has requested to be relieved of suffering and/or pain. Many acupuncutist focus on one of the other of the Four Pillars of treatment, 1.Lifestyle, 2.Nutrition/food choices and absorption of nutients,3.Herbal prescriptions, 4. Acupuncture. Let us include them all now!Yes on HR646!!
shanna62
July 29, 2009, 12:36am (report abuse)Hallstrom
If bioelectromagnetics is "quack central", then why was Becker twice nominated for the Nobel Prize? Why do you not even bother to peruse the references? I know it's not a tidy, neat little paper but surely you can manage a few hundred pages. It is precisely that this information is truly revolutionary to medical thinking that it can't be wrapped up in some tidy package. Get The Body Electric from ILL, review it, then shoot it down if you will.
By the way, radiation therapy for Cancer is included in the field of bioelectromagnetics. Get a clue please.
smc
shanna62
July 29, 2009, 12:48am (report abuse)Hallstrom
And as for "visualization" being associated with "magic and the tooth fairy"; are you saying that visualization has no physiological effects on the body? Ever had a sexual fantasy/visualization? Was there no physiological effect? Too bad.
Must I waste my time looking up the studies that prove this too? Are you incapable of conceding the obvious? Are you incapable of reading anything longer or more in depth than a scientific "study". Have you any grasp at all of biology and physics?
smc
bias
(logged in user) July 29, 2009, 1:44pm (report abuse)acupuncture, reiki, and homeopathy are all indistinguishable from placebo and sham.
People feel better but that does not mean that their disease has been treated.
Massages and pedicures make people feel better but no one would ever fund them under medicare.
shanna62
July 30, 2009, 1:26am (report abuse)Bias
>>"People feel better but that does not mean that their disease has been treated."
Speaking from the patient's point of view, is it not MOST important that s/he come away from treatment feeling better. Isn't this the point?
Have we gotten so far away from patient-centered treatment that it no longer matters how the patient feels--only wheather the doctor or scientist is satisfied?
If a doctor gives me drugs or surgery and I feel worse for side effects and yet my disease has been "treated", am I really getting my money's worth here?
If I feel better, does it matter how it works? If it's also cheaper than the aforementioned approaches, doesn't this save medicare/tax money in the long run? If the patient is feels better, there are no more doctor visits--how can this be bad?
smc
luke643
July 30, 2009, 10:30am (report abuse)shanna - why did you engage somebody who's name is "bias"?
:)
and watch out with hallstrom s/he is cagey!! thanks for jumping in though, i was getting tired of doing all the fighting!
I can't resist-Tim
July 30, 2009, 12:58pm (report abuse)there is a DRAMATIC correlation between feeling better and the correct functioning/integration of physiological checks-and-balances:it is pretty much how we are wired. It is easy to see that "feeling good" is equated with such and such a neurotransmitter load. This becomes chicken or the egg-as changing one's outlook will change the number of cellular receptors, stc.-sorry, I have no studies;just know that I have read some, somewhere. And just because I don't have that at hand-doesn't mean it is a moot point.///Hallstrom & Bias-have you read Love, Medicine, and Miracles; old book by Bernie siegel-surgeon. It explains "the exceptional patient"-the 99th percent people on a bell-shaped curve. They have non-ordinary correlations that, nonetheless, allow them to be the exceptional statistical successes of cancer survival.
shanna62
July 30, 2009, 1:30pm (report abuse)Hi Luke
WRT Bias: Couldn't resist--the post was so ill-composed. Not thought out at all.
WRT Hallstrom: I'm not afraid. Evidence on paper is always trumped by evidence en vivo which is how truth is ultimately expressed. As a scientist myself, I wasn't initially convinced about the effectiveness of acupuncture by reading studies; to the contrary. I was convinced by personal experience of the work initially through shiatsu treatment and then acpuncture itself. It will take a long time to fully explain via western scientific means the results and theory. That's why I think it's so important to examine what we do know of the bioelectromagnetic underpinnings of self-healing (Becker) and the processes occuring during embryogenisis and fetal development as they relate to explanations concerning the existance and function of channels (Matsumoto). Of course, all this is just to satisfy skeptics, the medicine itself already being very advanced clinically. A sad waste of money really.
smc
C Hallstrom
July 30, 2009, 3:50pm (report abuse)Shanna, any "scientist" who is convinced by personal experience is not a scientist at all. That would be the antithesis of the scientific method. As to the Nobel issue, as I SAID getting nominated is easy winning is not.
Bias, you hit the nail on the head. They complain about your punctuation but ignore your argument. you've got it right.
Luke, it seemed to me the article was strong and well documented in the section on circulation. However I would agree that the author seems to have an axe to grind about the "scientism" issue, though I'm not exactly sure what it is. However as to Reng I believe the point made is valid and well supported. Pieces where understood by a number of ancient healers but due to the disappearance of the blood from part of the system after death its true nature eluded them. Regardless,it is interesting history but does nothing to enlighten us as to the efficacy of acupuncture. Even were I to concede the point it does not change anything does it? Nope
C Hallstrom
July 30, 2009, 4:09pm (report abuse)Laura, The NIH conference concluded "quality research" was needed. That was over 10 years ago. Please present the results. My studies occurred in many cases because of that very NIH meeting. You just don't like the results. I have presented large double-blind controlled studies supporting acupuncture being a placebo. What have you got?
Tim, you are explaining the placebo effect. I am NOT arguing the human body does not have a near miraculous ability to heal itself, it does. All I am saying is it has been proven that acupuncture is not the causal factor. It is belief in acupuncture(or something else) that does it not the thing itself. Meaning we are curing ourselves with our mind(???). Totally Jedi. However just like a number of other things in life, nobody can really do it for you. You just think their doing it for you and many times so do they. You would both be wrong. That is the essence of the placebo effect, in fact the only "magical" thing ever proven.
luke643
July 30, 2009, 11:48pm (report abuse)no, it changes nothing. We are at the impasse of a phenomenon which science cannot yet adequately describe. At these kinds of impasses we have three historical methods of understanding:
1. Magic - believing that the phenomena is magical - a common one!
2. Skepticism and disbelief based on lack of evidence - i believe this is your position.
3. acceptance of both the item at hand (acupuncture) and also the limitations of science in being able to describe it (shanna's position). This does not negate her position as a scientist. This is also my position. You would find this one uncomfortable and a bit wobbly, so you stand on the firmer ground.
luke643
July 30, 2009, 11:59pm (report abuse)we do not kill it because western science can't explain it yet...western science will eventually be able to explain some things about it, but it is slippery, like Physics is slippery.
Would you like to show me a single experiment that demonstrates String theory's existence? (you won't, and it is fast being abandoned)
Or, for that matter, let's get simpler - what is Kinetic and Potential energy? The definitions of these foundational concepts are shamefully vague in science texts - they involve a measurement, but what is their substance? There is a facet of matter that seems to behave by mathematical rules that can measured and counted, but there is no explanation of substance or drive, or indeed what the "energy" is - this could be interpreted as an elaborate mathematical metaphor for reality, just as chinese medicine is a cosmological metaphor. Neither being reality itself.
luke643
July 31, 2009, 12:09am (report abuse)and yet you trust fully in the mathematical metaphor, because it is comforting, it is firm, it is beautiful in its consistency.
I also love it, but I respect and love the cosmological metaphor with equal vigor.
in this piece - http://ccat.sas.upenn.edu/~nsivin/limit.pdf
nathan sivin talks about the "limits of empirical knowledge" discussed by generations of Chinese Scholars. In it Sivin basically describes the interaction of these two metaphors (mathematical and cosmological).
luke643
July 31, 2009, 12:13am (report abuse)I look at the mathematical metaphor as I look at digital music, and the cosmological as analog music. One is consistent, detailed, finely tuned, perfect. It will play the same exact way over and over again ad infinitum. but it can never have ALL the sounds made in the live setting. Analog conversely, impresses a completely real version of the live sound, though it is subject to physical decay and disrepair.
One is trustworthy, but ultimately just short of true. The other is untrustworthy, but if right, wholly true.
John Howard L.Ac Dilp Ac
July 31, 2009, 9:00am (report abuse)I do not support this bill!
Medicare comes with to many strings. Most acupuncturists in this country could not handle the paper work of medicare.
Madeleine
August 1, 2009, 7:33pm (report abuse)Acupuncture was working for me but I had to quit because I couldn't afford it anymore. I met with the neurosurgeon and he told me that he only wants to do it if the acupuncture wasn't working. I'm playing the lottery and borrowing from my uncle so I can go back. We'll see.
Karen Andersen
August 3, 2009, 5:15pm (report abuse)Acupuncture services have been repeatedly studied and proven to treat a number of ailments, including pain, safely without side effects.. at SIGNIFICANTLY LESS COST then traditional western medical approaches. IT IS TIME for the US Congress and the Medical Community to embrace the 1000's of years experience and success of Chinese based acupuncture treatment as a safe, effective and cost reducing approach to treating multiple ailments.
Why should US seniors continue suffering with long term ailments and debilitating pain that could be successfully treated with acupuncture, because it is not a Medicare covered benefit. The cost of pain medications, pain management clinics and secondary health problems due to the failure of these approaches far exceed the cost of providing Medicare coverage for acupuncture.
Commercial health care insurers have included acupuncture coverage for many years because they know acupuncture works, & at lower overall costs then other approaches.
tim-L. Ac.
August 3, 2009, 10:40pm (report abuse)I have a few patients that are being reimbursed via Blue Cross 80-100% after the patient and I have jumped through about a thousand paperwork hoops-I find this encouraging. Two of them will be going back to Mayo for their follow-ups9neurological), and they are very excited as they are both well ahead of the neurologist's prognostic timeline. I find it highly encouraging that for the rest of their lives, this is all the proof they will need.
Michele C
August 4, 2009, 1:33am (report abuse)Accupunture didn't work for my migranes, but that doesn't mean it wont work for other people. I'd like to purchase products like these ala-carte on my insurance plan, but I don't want to be forced to pay for something that is of no benefit to me.
tim L. Ac.
August 10, 2009, 2:56pm (report abuse)to John Howard-please describe "too many strings"-if you mean the paperwork of coding for diagnosis, treatment, etc. ,then I think I understand. If you mean otherwise-please explain. thanxu2so0
john howard
August 11, 2009, 10:06pm (report abuse)to tim L.Ac. I just tried to post a comment of almost 1000 words regarding insurance and medicare and it must have timed out. I'll explain more t'row. Good night and thx for your patience!
Susan Richey LAc
August 16, 2009, 10:41pm (report abuse)This board is being dominated by someone with a strong personal agenda against acupuncture in a way that is way out of balance. C Hallstrom, I think you would benefit from some acupuncture sessions.
Speck
August 18, 2009, 9:51am (report abuse)So, if it's so inexpensive, why can't the people that want to use it pay for it themselves?
tim L. Ac.
August 19, 2009, 9:53am (report abuse)Speck-many of then do (pay) after virtually any encouraging sign, or comment from our perspective of a more holistic medicine. The real trick, it seems, is that of getting the American public to transition from a mental outlook of basically helplessness ("the doctor said that there is only one thing to do, etc"), to one of empowerment. By that I mean that they actually stick with this type of medicine long enough to change a habit, posture, food preference, etc. along with the actual acupuncture/herbs. In general, in my experience; the minute they acknowledge almost any betterment whatsoever, based on Chinese medicine's assistance with their transition, they run with it. Patient's are amazed when they find out, for instance, that if they actually DO eat a few celery stalks per day, and keep a blood pressure journal, that they will most likely be able to severely curtail, or eliminate their blood pressure prescriptions, in conjunction with their physician's OK, etc.
tim L.ac.
August 19, 2009, 10:01am (report abuse)Indeed, my (and most) patients are a special breed within this country's framework; they tend to be optimistic, seeking empowerment, etc. Hallstrom would say that they are the natural recruitments for a placebo study-which reminds me; Why don't they market placebo's if they work so well? Anyway, this medicine is CHEAP, has anyone compared ANY of the actual HIDDEN, DRIVING COSTS of the current healthcare system-litigation, the huge middle-man expenses of and to the court system, the dollar cost of the ramifications of the supposedly SAVE Vioxes, Statins, etc and the havoc they have reaked on patients. Has anyone heard of any multi-million dollar settlements awarded because of acupuncture, herbs, tui-na, etc. Apples to apples.
nerd
September 1, 2009, 11:51pm (report abuse)I support the bill.
Its not going to really do acupuncturists any big favors/low pay for a lot of work. where does "cheaper" come in?
sbwertz
October 9, 2009, 9:25am (report abuse)I always thought acupuncture worked because people thought it would work. That was before I watched a vet perform acupuncture on a horse who could barely walk and see the horse walk away sound after the treatment. They horse didn't "believe" in acupuncture, but the pain was gone.
Everett H. Churchill, L.Ac.
October 11, 2009, 4:56pm (report abuse)I think that Mr. Hallstrom spends entirely too much time in his left brain with total faith in a scientific method that is just as rife with error, assumption, and parameter tweaking as CAM is full of "voodoo". Anecdotal evidence, at the everyday clinical level, is far more valuable than the vast majority of any studies I have ever seen. (That being said, no offense intended.)The trick in the future will be to design high-quality studies with experienced acupuncturists helping to define study parameters to satisfy nay-sayers. Acupuncture does work when it's indicated, just as any other procedure works when it's indicated.
Christina Waldman, Esq.
November 3, 2009, 11:03pm (report abuse)Of course acupuncture should be covered by all medical insurance plans. Dr. Kaltas is right: NIH studies have proven acupuncture is effective. We need to get away from cheap reliance on drugs that mask symptoms but do not address causes or true healing. We need to push for insurance coverage of these alternative therapies that give people a better quality of life.
David Stoeber, L.Ac.
November 9, 2009, 9:31pm (report abuse)The Mayo Clinic completed a study on Acupuncture and Fibromyalgia in August 2005 showing that patients showed "significant" improvement for up to 7 months after completion of a series of acupuncture treatments. Although there is no cure for Fibromyalgia, this offers hope for those who suffer with this health issue.
Karen-Lynette Bauer
November 11, 2009, 9:09pm (report abuse)I don't know where people get their information when they state that acupuncture has not been proven effective.
First, most major university hospitals, which are considered by the medical establishment to provide the highest standard of care, have acupuncture clinics in their medical centers or hospitals.
Second, in technologically highly developed countries like Korea and Japan, acupuncture is an integral part of the medical fabric, a viable option available to all patients.
Third, in China, despite Chairman Mao's efforts to institute Western medicine, the ancient system of acupuncture is still widely practiced, researched and taught. There are acupuncture hospitals in all major cities, staffed by university professors.
Malpractice insurance premiums for acupuncturists are extremely low, attesting to the marketplace's recognition that it has virtually no harmful side effects, a claim that Western medicine cannot make.
Barclay F. Benjamin
November 12, 2009, 4:27pm (report abuse)When American medicine and Oriental medicine work together, WE ALL WIN!!!
George Tooker
November 27, 2009, 8:04am (report abuse)My wife has been receiving acupuncture for several years. It has been the most effective approach in treating her chronic arthritis. If health care reform is going to cover faith healing, as currently proposed, it seems only logical that a treatment mode proven successful for thousands be included as well.
George Tooker
November 27, 2009, 8:06am (report abuse)Thank for championing this cause