Doctors Embrace Acupuncture

OB/GYN News,  Oct 1, 1999  by Todd Zwillich

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Dr. Rebecca Wilks isn't totally sold on the effectiveness of acupuncture. But that hasn't stopped the Phoenix ob.gyn. from offering it to her patients to treat pain, morning sickness, and even breech pregnancies.

"There is still a scientific part of my brain that has trouble with acupuncture. But the training was definitely worth it. It's a totally different way of looking at patients and at disease," she said.

Dr. Wilks is among a growing number of American physicians who are training in acupuncture techniques. Despite a dearth of data on the clinical virtues of the practice, the economic virtues are clear. Americans are spending nearly $30 billion out of pocket on alternative therapies every year.

Most of the 3-4 patients who come to Dr. Wilks' private practice for acupuncture treatment each week come because they have low back pain, arthritis, or migraines.

Patients pay $100 for the initial 1-hour visit and $50 for each subsequent visit, Most pay out of pocket, although a few insurance companies are starting to reimburse for the service.

Dr. Wilks is one of approximately 4,000 medical doctors who have spent 7 weeks and more than $5,000 to complete formal acupuncture training at the University of California, Los Angeles. Another 1,000 physicians are estimated to be practicing acupuncture with other less comprehensive training or no additional training at all.

Only a handful of the physicians who've completed the program are ob.gyns. Most come from primary care and pain management specialties, according to the American Academy of Medical Acupuncture (AAMA), headquartered in Los Angeles.

Sign-ups at UCLA have been rising by 15% each year in recent years, and 600 physicians graduated from the program last year alone, said Dr. Joseph. Helms, a family physician who directs the acupuncture training. The trend is attributable not to proven efficacy, but to the public's demand for acupuncture services.

"As it became clear that the population was willing to pay cash for acupuncture, it grabbed the attention of traditional medicine. The patients are driving the popularity of this," said James Dowden, AAMA's executive director.

And, while acupuncture is still largely a cash business, some health plans have begun covering the treatment.

"It is market driven. [Patients] are saying this is what they want," said Karen Mueblberg, head of the alternative benefits program at Oxford Health Plans, Milford, Conn., which has been covering acupuncture as part of an alternative medicine benefits package since 1997.

While there is no national training standard for physicians who perform acupuncture, Oxford and many other health plans will send patients only to physicians who've had at least 300 hours of acupuncture schooling. That's about what Dr. Wilks got when she took the course at UCLA.

Most states allow any doctor with a valid medical license to practice acupuncture, but seven states require physicians to take from 100 to 300 hours of additional training before they can practice acupuncture.

"They also have to have some time performing the service," said Vickie Ina, senior vice president at Consensus Health, a San Francisco company that assembles networks of acupuncturists for managed care plans, including BlueShield of California.

Despite its growing popularity, data supporting acupuncture's efficacy remain sketchy for most indications. In 1997, a National Institutes of Health panel concluded acupuncture can be useful in treating postoperative nausea, postoperative dental pain, and morning sickness.

Some quarters of organized medicine criticized the recommendations, saying that the panel had abandoned evidence-based standards and responded instead to the desires of acupuncture advocates. While most physicians use acupuncture primarily for treating pain, the modality is also used for many other disorders ranging from asthma to depression.

Most practitioners "are practicing placebo medicine. They are way out in front of the data," said Dr. George A. Ulett of the department of psychiatry at the University of Missouri-Columbia, who practices and teaches a form of acupuncture using electrical stimulation that he says is proven to relieve pain by stimulating endorphin release. "People have been sold on it."

But just because acupuncture's appeal is being driven more by the market than by scientific data does not mean that patients aren't seeing benefits, according to Dr. Helms, who is also founding president of AAMA.

"Most doctors are results-driven. These people see acupuncture as an extension of their capabilities as physicians, both diagnostically and therapeutically," Dr. Helms said.

The lack of hard data troubles Dr. Wilks, although the relative safety of acupuncture eases her fears about the risks outweighing the benefits.

She has used acupuncture to treat breech presentations twice "and it has worked twice, but I remain skeptical," she said.