Acupuncture and Western Medicine

In Part 2 of our Spotlight on acupuncture, we talk with Thomas Ost, a licensed acupuncturist, practicing in a hospital setting at the UPMC Center for Complementary Medicine. Given his clinical situation, Mr. Ost has gained valuable insight into the similarities and differences between Western and Traditional Chinese Medicine and how the two can complement each other. He graciously agreed to go In The Spotlight to share his insights:

How and when did you become interested in acupuncture?
O: It all started when I was living in LA. I started school in '93 - the acupuncture part - I was going through premed prior to that with my focus set on going to Med school in Sweden. I had been in LA for about 10 years and thought I'd go back to Sweden. In the process of finishing school in LA, I kept running into people with acupuncture experience, and then I happened to see a special on TV with Bill Moyers called "Healing With The Mind", and that sparked my interest. But I went to Sweden and after a year decided that medical school in Sweden wasn't going to work. I had been away for too many years and it was a culture shock. So now, back in LA, I was behind the process of going to a US med school, so I made a decision to check out acupuncture and did a lot research. I found a scientific basis for it and realized that I could help people using acupuncture.

What type of acupuncture training/education did you receive prior to obtaining your license?
O: I received a Master's Degree in Traditional Chinese Medicine. I spent four years at a school called Yo San University in Los Angeles.

Having started down the Western medical training track and then completing the Traditional Chinese Medicine training, do you think the framework for TCM - the concept of Qi, Blood, Body Fluid, the Five major organs, etc. - is in conflict with the Western model, or do they complement each other?
O: You're looking at the same things through two different eyes. Looking at TCM is a perfectly rational way to deal with healthcare. In many ways it is exactly the same way we deal with it in Western medicine, it's just that we have different means of dealing with it and more importantly a different language. It's a valid form of medicine in its ancient forms, but it is different in that it doesn't lend itself to the thoughts and theories in Western medicine. So you need to learn the differences and really become bilingual. I work in a hospital setting and have no choice.

From a clinical point of view, do you find yourself mixing the two?
O: Absolutely. In my heart and soul, I've learned TCM, I appreciate it and find it fascinating. But a lot of that I keep to myself during my evaluations, because if I go out too strongly along that path, people will lose what I'm talking about, and I need to explain things to them in a language they are familiar with. Especially so that they can relate what I say to other healthcare providers and avoid any confusion.

Do you think there is much difference between the acupuncture practiced in China and the US?
O: It depends on who you talk to. What I do is different, I'm not the traditional person. I appreciate science and medicine and think the relationship should be strong. The main thing that is different is that in China, TCM is completely integrated into their medical model, that's just the way they are. Here, although I work in a hospital based clinic, we still have very little integration. I also think the Western model has a tendency to be a little more scientific. Looking at the research that comes out of China, and not to say that all research from there doesn't have value, but it's not randomized controlled trials. In China, there isn't that requirement to be called research.

Given you've seen both sides of the coin, do you believe acupuncture works by changing the flow of Qi, or is a different mechanism in play?
O: Yes, that is the ancient theory. The problem with the Qi is that you can't measure or extract or touch it, but it is something you experience the effect of once you manipulate it. That is what instills the sense of well-being, or fixes the problem. There is a lot of research trying to explain how acupuncture works. There are studies that use functional MRI to assess what occurs during acupuncture, and that is pretty hard core science. You can't really argue the outcome of fMRI. But when you apply that technology to acupuncture, and you come up with data you can't explain, you have a dilemma. Do you discredit the fMRI or do you accept the fact we don't understand this [acupuncture].

But MRI, like any diagnostic tool, has limitations.
O: Correct, but these are current studies where they looked at a point on the little toe which ancient theory ties to improving visual disorders. So in the clinical world you would validate that by looking at the visual cortex [in the brain]. The fMRI reveals a very strong response in the visual cortex - the same response as the strongest visual stimuli, an 8hz checkered light - when the point on the toe is manipulated. As a further control, a random point on the foot generates only a random response. So there is some relationship which we do not know. In the TCM, that meridian starts in the eye and ends on the outside of the little toe. What that meridian is, we don't know. Is it Qi or do we not know the nerve paths? I don't know, but something is there.

For someone with serious neurological conditions like Chiari/SM, would you advise someone to use acupuncture as a primary treatment for the underlying condition, or more to help with the associated pain?
O: First of all, I would not be the only point of contact for a condition like that. If I suspected someone of a condition like that, I would refer them out before starting acupuncture. Once the diagnosis was confirmed, and they came back to me, we could initiate a collaborative work. I've seen a lot of people with serious neurological disorders - a spinal cord situation - where some procedures didn't turn out that great, but acupuncture was able to improve their quality of life and reduce pain.

Can acupuncture help with neuropathic pain?
O: In my clinical experience, yes. Now, to varying degrees of course. Serious nerve problems can be very complicated. Some people are hypersensitive to stimulus. But usually with time, it will work. You just have to be patient.

How long, a year?
O: I would not treat a person for a year with no results. I would expect some type of response after 10-12 treatments, 10-12 weeks. Something should change in that timeframe. If it doesn't, I might be inhibiting another form of care that might be more beneficial.

Do you think a patient's attitude towards acupuncture influences the success or failure of the treatments?
O: I think in medicine in general it does. Maybe even more so with something like acupuncture because its different. Patients are sometimes embarrassed to come to acupuncture even though they know it might be very good for them. You know, don't tell my doctor that I'm here kind of thing. It's unfortunate that it is that way. We know attitudes in general affect overall health and well being, especially with chronic pain. Attitude plays a role, whether it really affects things physiologically, I don't know.

What might a typical treatment plan entail?
O: If someone comes in with something complicated, a neurological situation, I would tell them upfront, give it 8-12 treatments. Something might happen sooner, but it might not. Most people respond to acupuncture, if not, we need to go over the situation. Some problems [of not responding to acupuncture] can be from medications that are competing for the same resources. People on serious narcotic medications may not respond in the same way because the narcotics are competing for the same type of response as the acupuncture, so the effect isn't as dramatic.

What about simple NSAID's like Alleve?
O: No, that's a whole different mechanism.

How long would a typical treatment last?
O: Appointments are scheduled for an hour. Within the hour is going over the history, questions and answers, etc.

Do you use electric stimulation with the acupuncture?
O: Yes, that's pretty much the only thing I use for something like this, for pain. The reason for that is that the body communicates with electrical impulses. We know from research that the body responds very well to certain frequencies.

Can the electrical treatments ever cause negative reactions?
O: I have never had anybody with a negative reaction, but of course that is a possibility. The important point is to know the problem you are dealing with, understand it, and know how to address it properly. The intensity used is what might irritate a nerve. An EMG, for example, uses very high stimulation. Acupuncture uses very low stimulation.