Healing Needles Once Brushed Off As New Age Silliness, Acupuncture Therapy Is Gaining Acceptance In The Medical World
Joni Riojas Hubbard doesn’t reach for the prednisone tablets anymore. After two months of acupuncture treatments, her ulcerative colitis - and its deadening fatigue - have disappeared into remission.
Following an acupuncture treatment one recent afternoon, Hubbard’s cheeks blushed cranberry red. Her dark eyes shone.
“It’s not like it’s a miracle overnight,” said Hubbard. “It’s that slowly I’ve seen an improvement.”
Hubbard is one of an estimated 1 million Americans seeking acupuncture this year. Now with the blessing of physicians and health insurance companies, many of them combine the techniques of both Eastern and Western medicine. Hubbard, a 45-year-old American Express financial adviser, plans to continue seeing her physician for annual exams, and her acupuncturist for the long, thin needles that seem to soothe her pain and energize her spirit.
Fifteen years ago, early Spokane acupuncture therapists were more worried about being arrested for practicing medicine without a license than filing insurance claims. Since then, acupuncture has evolved from an edgy New Age alternative to a licensed treatment paddling closer and closer to the mainstream.
The 1995 Washington Legislature passed a law requiring the state’s health insurance companies to begin covering it. In 1996 state Insurance Commissioner Deborah Senn issued a ruling elaborating that law. Both the law, and Senn’s ruling, have been tied up the courts and rendered unenforceable. Nonetheless, many insurance companies have continued to cover alternative treatments.
In March 1996 the U.S. Food and Drug Administration removed acupuncture needles from the “experimental” category and began regulating them like medical devices such as surgical scalpels and hypodermic needles. Disposable needles are now standard. This also opened the door to increased insurance coverage.
Last November a panel convened by the National Institutes of Health issued a consensus statement that further expanded the credibility of this ancient Chinese practice.
The NIH panel examined existing studies on acupuncture and found it clearly effective for treating the nausea and vomiting which often coincide with anesthesia, chemotherapy and pregnancy, and the pain following dental surgery.
The report also found acupuncture may be effective for treating fibromyalgia, menstrual cramps, tennis elbow and low back pain. Positive, but less convincing, reports indicate it may also help addiction, stroke rehabilitation, carpal tunnel syndrome, arthritis and headache.
“It is another step forward for the acceptance of acupuncture as a valuable tool in medicine,” says Dr. Jim Shaw, a Spokane Group Health family practice physician who treats some of his patients with this Asian technique.
“Boom, it was like the 100th monkey theory,” says Jeanette Nelson, a certified acupuncturist in private practice in Spokane. “I had so many more calls. It was a wonderful experience for all of us.”
It may be Paul Lu’s office at Second and Arthur on the eastern edge of downtown Spokane that has benefited most from the surge in acupuncture’s popularity.
Since 1996, when the state insurance commissioner ordered companies to pay for alternative health care, business in Lu’s office has doubled.
Here Lu, a friendly but earnest man with a thatch of black hair, wears a white lab coat and speaks with a Chinese accent. His vivacious wife, Nancy Chen, serves green tea in small white paper cups and fills in conversational gaps.
Lu estimates he sees an average of 10 to 15 patients a day and that 60 to 70 percent are women.
“Women are willing to try new things,” Chen explains, smiling. “More men are dragged here by their wives.”
Lu is called a doctor of acupuncture in his native China. The state of Washington calls him a licensed acupuncturist.
He trained in both places, beginning with five years at the College of Traditional Chinese Medicine in Nanjing. After moving to the United States, he took additional courses in subjects such as anatomy and physiology, pathology and microbiology at the University of Washington School of Medicine.
Acupuncture is believed to help balance and strengthen the movement of life energy, called qi (pronounced “chee”), along pathways through the body that do not correspond to any known biological system. By stimulating various points on the body with metal needles, acupuncturists aim to remove blockages and restore the free flow of qi.
Lu describes his technique with the needles. He’s always alert for an important sensation called deqi.
He feels it as a tightness, as when a fish bites. It confirms he’s hit the right point.
As he slides his thin needle into the skin, he thinks of three layers: one for heaven, one for humans and one for the earth. He pushes through the first layer into the second. If he feels deqi, he stops. If not, he goes even deeper, all the way to the earth.
Depending on the various points, Lu may place the needle perpendicular, at a 45-degree angle, or horizontal to the skin.
Patients describe a tightness, a tingling or a tugging sensation, but not pain.
He treats people from 18 months (babies get massage, not needles) to 92 years. His fees: $65 for the first visit, $55 for follow-ups.
Most of his patients pay only co-payments. His office bills nearly every local insurance company.
The couple find Medical Service Corp. the easiest company to work with. Group Health sometimes limits patients to five visits. Chen has written a letter to Group Health explaining that, in China, doctors prescribe eight to 10 visits in a row, called a course, and that some ailments require two to three courses.
Lu estimates that 80 percent of his patients show improvement.
“It works,” Lu says. “You don’t have to believe it.”
Dr. Jim Shaw should pay Group Health’s public relations person a commission. Her tone melts into awe as she describes him over the telephone. She uses the word “spiritual.”
“Oooh, like Jesus,” she says.
In person Shaw is much more the serious Dartmouth-trained physician. His eyes are intelligent, maybe even contemplative. But he doesn’t look likely to walk across large bodies of water anytime soon.
He talks about acupuncture, for which he was trained during a sabbatical at the University of California at Los Angeles, in measured, clinical tones.
“I wasn’t initially sure I’d use it in my practice. I saw it more as an intellectual exercise,” he says.
“It created a positive change in so many different clinical situations that it has become a very valuable tool in my practice.”
Shaw uses acupuncture about 20 percent of the time. He finds it particularly useful for inflammatory conditions such as bursitis and tendonitis. He treated himself for tennis elbow once, shortening what might have been two weeks of misery to only a day or two.
He points out that he finds the results of Western medicine every bit as remarkable. Sometimes a patient will appear near death from an acute infection. Shaw writes a prescription for antibiotics, and several days later the patient recovers.
“That still amazes me as well,” he says.
For most Westerners examining acupuncture, the most perplexing question is, “How does it work?”
Shaw believes acupuncture has an anti-inflammatory effect, rather like ibuprofen. It also seems to affect the neurotransmitter serotonin and leaves people feeling mildly euphoric or relaxed.
But the answer cannot be fully explained.
“It remains part of the mystery for me,” Shaw says. “The most difficult part for me in practicing acupuncture is reminding myself not to try to answer that question all the time.”
The Washington State Department of Health lists five acupuncturists with current licenses in the Spokane area, and two with expired licenses. Acupuncturists in Idaho do not have to be licensed.
Among the Spokane group is Kim Krull, a former University of California biology student who fell in love “philosophically and spiritually” with Oriental medicine and 15 years ago opened a practice in Spokane.
“We are physical and energetic beings, and the movement of life energy through our bodies and minds is what our health depends on,” Krull says.
She is wary of incorporating acupuncture into a conventional Western medical framework.
“That’s not where you’re going to get the gifts of Oriental medicine,” she says.
Krull treats one patient at a time in one-hour meditative sessions ($65 for the first session, $50 thereafter.)
She has a waiting list, and she has found that filing insurance paperwork complicates her practice.
She now routinely works only with Group Health.
“I decided to opt out of it,” Krull says. “It’s a tremendous amount of work and aggravation.”
Like Krull, Jeanette Nelson, a former biochemistry major, and Howard Lee, a biology major, were headed for medical school when they decided instead to pursue acupuncture.
Nelson attended Bastyr University, now in Bothell, and completed an internship in Shanghai. She arrived in Medical Lake five years ago to perform acupuncture on inmates at the Pine Lodge Pre-Release Center.
She now has a private practice in Spokane.
Nelson compares Western and Eastern medicine.
In the West, the diagnosis is very specific and the treatment is very general. Every asthma patient, for example, has a similar inhaler, she says.
In Eastern medicine, the diagnosis is very general but the treatment very specific. Doses of herbs and acupuncture treatments are designed individually for each patient.
“For asthma they would say, “Lung qi deficiency,” or “Kidney qi does not grasp the lung qi,” she says. “That’s how they talk in China.
“I’d like to see a marriage of the two where you get a real specific diagnosis and a real specific treatment,” she says.
Lee, born in Korea, wears his bristly salt and pepper hair short, with a pink Oxford cloth shirt and a navy silk tie. A member of Post Falls Baptist Church, he’s upbeat, cheerful and delighted that his practice attracts so many Christians.
“A lot of people think acupuncture is a demonic religion,” Lee says. “It has nothing to do with religion.”
Lee often weaves a gospel message into his conversation with patients, and he appreciates acupuncture’s portability - for religious reasons.
“It’s easy to go anywhere and treat people,” he says. “Coming from a Christian background, my mission is helping other people.
“I can go to Russia or Red China; I can go anywhere, just using my little needles and cotton.”
Lee treats several physicians, dentists and nurses in his practice.
“It’s not hush-hush anymore,” he says.
Lee keeps one room of his Wellesley Avenue office filled with Oriental herbs. Large, clear plastic jars shaped like bears - the former containers of the Costco animal cookies his children love - are filled with curled, dried leaves. One jar holds dark velvety slices of dried deer horns, used for increasing a patient’s energy and treating impotence.
Lee says he can usually tell within four or five treatments whether acupuncture will work. He won’t use it to treat infectious disease, however, and finds it helpful only for cancer pain management.
“This is not something you want to play around with,” says Lee. “I tell (patients) to see their medical doctors while they see me.
“If they don’t want to, I say, ‘You have to go see your M.D.”’
One of the arguments most often repeated about acupuncture is that since it has lasted for at least 2,000 years, it must be valid.
But, Shaw says, “There are a lot of things that have been around 2,000 years that aren’t very effective. I don’t think that’s a very good argument.”
Some people have seen acupuncture as a panacea, useful for curing all ailments.
“It clearly,” says Shaw, “is not that.”
Acupuncture should not be used to cure cancer or to heal conditions requiring surgery, he says.
Nonetheless, Shaw believes acupuncture can be a useful tool.
“I know it’s safe,” he says. “I know I can count on a high percentage of positive outcomes with minimal, if any, side effects. I’m no longer very surprised by remarkable outcomes when they occur.”
Washington insurance companies are no longer forced to pay for acupuncture treatments. But many of them continue to do so.
“There’s an irony at work here,” says Robert Harkins of the state insurance commissioner’s office. “We’ve seen clearly this is a publicly popular law and the insurance carriers are responding to that.”
Group Health’s associate medical director, Dr. Ruth Langstraat, oversees the review process for acupuncture referrals.
At Group Health, physicians found acupuncture useful for some patients whose symptoms had not otherwise been helped, Langstraat says.
“We felt this was an important kind of therapy to have in the armamentarium of the family practice doctor,” she says.
Acupuncture in Spokane, says acupuncturist Kim Krull, appears “poised to take off.” Yet it’s difficult to predict how this ancient practice will be woven into the region’s future.
Nelson believes the day will come when acupuncturists work in hospital emergency rooms, inserting needles to prevent more invasive procedures. She also believes that one day quantum physics will prove the existence of qi.
In the meantime, it will be the steady trickle of patients into acupuncturists’ waiting rooms and the word of mouth they generate that will grow local practices.
Joni Hubbard hopes never to need a 50 milligram dose of prednisone or to worry about the drug’s serious long-term side effects again. She’s back on her treadmill for 40-minute workouts and planning skiing and sailing trips for the new year. Her renewed vigor has become obvious.
“Someone at work today said, ‘Joni, you look like you have so much energy,”’ she says. “I’m enjoying what I’m doing again. It’s a great feeling.”
As for how acupuncture actually contributes to that well-being, Hubbard is cheerfully unconcerned.
“If it’s working for me, it’s working,” she says. “I don’t need to know any more than that.”
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