The world of acupuncture research continues to be vibrant and ever-evolving to meet the needs and demands of healthcare consumers, payers, and policy-makers. Going beyond paradigms of research design that include randomized clinical trials and physiological mechanisms, researchers have been seriously exploring other aspects of acupuncture including cost effectiveness, factors influencing utilization, and best practices for integrating acupuncture into the healthcare milieu.
Clinical trials and translational research that bridge the laboratory-clinic gap will remain important and relevant by continuing to describe fundamental bio-scientific aspects of acupuncture treatment. The value of these types of studies continues to be paramount because, without continued evidence of efficacy and safety, other types of evaluation are meaningless. Clinical evidence of favorable outcomes and safety must continue to be documented and maintained.
The next decade of research will bring innovative study designs that address questions related to the actual practice of acupuncture and the context in which it is practiced. Issues of interest will include economic evaluations; legal and ethical considerations; social science dimensions; and public policy recommendations. As acupuncturists we've witnessed the potential for transforming health and lives with our work; associated research questions will examine factors related to transformation in the social dimension.
Questions of interest in this domain may include who has access to acupuncture care; role of health disparities in determining who is able to use acupuncture; the role of acupuncture in addressing health concerns of military veterans or survivors of natural disasters or other traumas. Examining acupuncture in these contexts, as part of a broader and more integrated healthcare system, may promote the development of robust and inventive solutions to complex healthcare problems.
Acupuncturists and researchers will continue to have expanded capacity to work in multi-disciplinary settings. Clinical settings situated in hospitals, medical centers, community health clinics and other community-based organizations offer researchers the opportunity to examine integrative care and to explore how these partnerships work to achieve optimal clinical results and client satisfaction. New conceptual frameworks describing integrative care can be hypothesized and tested, and strategies for research can continue to be developed.
Considering the trans-disciplinary nature of acupuncture research, opportunities have already become more available to work in ways that incorporate professionals from different backgrounds. In particular, social scientists and anthropologists are already making significant contributions to our understanding of integrative care. In the public health arena, trans-disciplinary collaborations focus on translating research findings into practical solutions to healthcare issues, emphasizing the role of research as producing action for the benefit of society.2
By its nature, public health embodies the intersections of biomedicine, traditional healthcare, complementary and integrative approaches. In the editorial introducing the public health issue of the European Journal of Integrative Medicine, the authors write:
"…given the rising burden of chronic illness, aging populations, and the global 'new age of austerity' providing further squeeze upon healthcare budgets, it is not difficult to identify the potential of rigorous public health and health services research for governments and other policymakers on the international stage."1,3
Acupuncturists and researchers in the U.S. and internationally are recognizing the role of public health approaches in our work. Three international conferences held in the past year contributed significantly to our understanding of the public health ramifications of acupuncture research. Specifically, these conferences were the following:
The Society for Acupuncture Research held its conference in April 2013 in Ann Arbor MI. Volker Scheid PhD delivered a keynote speech entitled "The Elusive Nature of Facts and the Subtle Effects of Power: Why We Need More Than the Natural Sciences for Acupuncture Research." Scheid argued for the inclusion of medical humanities in our research, explaining that contributions from this field could substantively confer 'added value' to our understanding of the benefits of acupuncture. A panel discussion in which Scheid was joined by Kristen Huntley PhD, Wayne Jonas MD, Lixing Lao PhD, MD, and Claudia Witt MD, focused on frontiers of research in the 21st century. Research perspectives will include those from federal supporters (National Institutes of Health, National Center for Complementary and Alternative Medicine), public health, military medicine, epidemiology, and anthropology.4
Acupuncturists and researchers convened at the International Symposium on Acupuncture and Meridian Studies held in October 2012 in Sydney Australia. The theme of the gathering was "Moving Acupuncture Research Forward: Issues and Solutions."5
More information can be obtained through the conference website.
Symposium organizers planned a public health track as part of the gathering and featured speakers who focused their presentations on the need for multidisciplinary teams of researchers. Acupuncture researchers were encouraged to include social scientists and public health specialists in our work as we continue to develop evidence-based practice. Communicating with our colleagues in biomedicine is a priority as we compare and contrast diagnostic and therapeutic systems, working toward a meaningful integration of best practices.
The International Research Congress on Integrative Medicine and Health was held in May 2012 in Portland, Oregon. A congress summary report is available. Although the congress venue encompassed a full array of healthcare disciplines, acupuncture featured prominently.4
Acupuncture-related topics ranged from the micro level (e.g. documenting effects using brain imaging) to the macro level (e.g. evaluating clinical effects on particular populations, like children or individuals living with chronic illness). Claudia Witt MD described her group's work with designing comparative effectiveness studies that also incorporate economic analyses. These types of studies provide data for evaluating the "value for the money" that can be associated with using acupuncture in particular clinical settings. Comparative effectiveness research, as well as health economic studies, offer results that more fully address the concerns of efficacy, safety, and cost. Consumer satisfaction and access to acupuncture care are also fundamentally critical in providing a more comprehensive understanding of the role of acupuncture in improving public health.
It's an exciting time to be involved in acupuncture research, whether we're actively engaged in conducting it, reading about it, or explaining it to our patients and communities.
The promise of increased collaboration and integration can translate into improvements in both individual and societal health and wellness. Acupuncturists are well-positioned to offer the benefit of our medicine and philosophy to creating trans-disciplinary partnerships that can potentially result in salutary benefits and improve public health globally.
References
Structured water (H3O2) can be considered a fourth state of water between liquid and solid. It has the hexagonal structure of ice; however, missing a critical bond, it behaves more like a gel than a solid, but retains some of its crystalline structure.
In the past five years of my clinical practice, I have seen an astonishing upsurge in the chronic use of proton-pump inhibitor (PPI) medications for the gastrointestinal issue diagnosed by allopathic medicine as GERD. It is not uncommon to encounter patients taking these prescriptions for five-plus years.
Working with chronically ill patients entails acknowledging the reality that not all patients will survive their diagnosis. Chinese medicine and acupuncture play a crucial role in palliative and end-of-life care, addressing medication and disease side effects, alleviating pain associated with death, reducing anxiety and stress, and helping patients find peace during the dying process.
