NIH smiles on acupuncture - National Institutes of Health

Business & Health, Dec, 1997 by Janet Gemignani

Acupuncture prior to the administration of surgical anesthesia can reduce the intensity and length of postoperative nausea and vomiting by as much as half. Acupuncture alleviates nausea and vomiting caused by chemotherapy or pregnancy. It incontrovertibly works against the pain following dental surgery.

A National Institutes of Health Consensus Panel announced these categorical conclusions after an exhaustive literature review - and three days of scientific presentations and public discussion in early November. Much more significantly, the panel endorsed a positive attitude toward acupuncture in almost all contexts where it is currently used. The pronouncement is likely to influence health care purchasers, who are already responding to increasing consumer interest in alternative care. (See Have employers missed the signs? on page 36.)

A million Americans undergo acupuncture each year for an array of reasons, ranging from relief of pain and stress to immunity and fertility enhancement, smoking cessation and drug detoxification. The panel judged such treatments as often worth trying, especially in conditions where biomedical interventions do not solve the problem - for example, chronic pain.

The panel based its recommendation on the observation that patients have been reporting benefits from acupuncture for millennia. Moreover, although most uses of acupuncture still lack firm support from randomized controlled clinical trials, other types of evidence point to possible efficacy. These include animal and human studies showing biochemical and blood circulatory responses to needling. Finally, even if a treatment does not work - either because the patient is a nonresponder or the technique is truly ineffective - the risk of adverse effects is small.

According to C. D. Lytle, PhD, of the Food and Drug Administration, when acupuncture and medication are used for the same purpose, acupuncture's adverse effects are almost always less frequent and less severe.

Although few managed care organizations or government programs currently offer acupuncture, this seems likely to change. The reason is not only that the NIH panel has bestowed new respectability on the modality, but also that there appear to be prospects for large cost savings. Of special interest to employers would be potential reductions in absenteeism should acupuncture prove very effective for low back pain, headache and repetitive stress disorders such as carpal tunnel syndrome.

Finally, FDA reform

After much debate and contention, Congress approved and President Clinton signed into law a bill streamlining the Food and Drug Administration's approval of drugs and medical devices. Alan F. Holmer, president of the Pharmaceutical Research Manufacturers of America, said the new legislation will shave at least a year off the time it takes a company to market a new drug.

In ironing out the kinks in the reform measure, House-Senate conferees compromised on several contentious issues:

* The user-fee program, which requires drug manufacturers to help pay the costs of FDA review, is extended for another five years.

* The FDA has "fast track" authority in approving urgently needed treatments for diseases like AIDS.

* Health and Human Services can accredit independent third-party groups to speed up reviews of low-risk medical devices.

* Companies must disseminate warnings about medical devices if the FDA anticipates that the products would be used for "off label" purposes.

* Drugmakers can disseminate articles from medical journals supporting the use of drugs for unapproved purposes - a provision they fought hard for - provided they seek federal approval of and conduct the required research for the off-label use in question.