AcuTake

AcuTake’s latest book review is of Acupuncture Is Like Noodles by Lisa Rohleder. In this followup to her first book, Remedy, Rohleder is back with her tell-it-like-it-is style, never shying away from expressing distaste for the attitudes that she says are classist and at fault for acupuncture being primarily an upper-middle-class luxury. In addition to serving as a rousing call for improvements in healthcare access, Noodles is a great how-to handbook for beginning practitioners. Read this and other reviews in Books.

AcuTake talks to Yoshito Mukaino, a physician acupuncturist whose M-test diagnostic tool makes acupuncture accessible to doctors and other mainstream-medical practitioners. As director of clinical East Asian medicine at Fukuoka University Hospital in Japan, Mukaino receives patient referrals from doctors in various specialties. Largely through Mukaino’s efforts, acupuncture has become a key component in the hospital’s coordinated approach to care. Read the whole interview here.

NPR has just published a two-part investigative report on the military’s handling of soldiers who suffer traumatic brain injuries (TBI) in combat. The series uncovers inadequate diagnosis and treatment of TBI by the military, despite its prevalence. TBI is considered the signature injury of the wars in Iraq and Afghanistan, due to frequent use of improvised explosive devices.

According to NPR, “The military says about 150,000 soldiers have suffered some form of brain injury since the wars began. But a 2008 Rand study suggests the toll is much higher, perhaps more than 400,000 troops. The most common type are so-called mild traumatic brain injuries. Most people recover quickly from such injuries, but studies have shown between 5 percent and 15 percent of patients may suffer long-term problems.”

Problems associated with TBI include memory loss, depression, dizziness, poor concentration and speech difficulties. Many patients also experience pain because of or in conjunction with their TBI. One of the most common symptoms of TBI is headaches.

Acupuncture can be helpful in this regard. A recent article in Journal of the American Academy of Physician Assistants discusses what’s known as Battlefield Acupuncture (BA), a relatively simple form of acupuncture—only five points are used, all in the ear—that offers pain relief. The protocol was developed by Air Force Colonel Richard C. Niemtzow, president of the American Academy of Medical Acupuncture and an acupuncture physician at the medical center at Andrews Air Force Base in Maryland, as an emergency pain-relief method for soldiers injured in combat. But the application of BA is now extending onto military bases at home, to help alleviate pain symptoms associated with TBI. Read more »

AcuTake talks to Caroline Radice, LAc, an acupuncturist who specializes in infertility and other gynecologic conditions. Her thorough understanding of both mainstream-Western and traditional-Chinese physiology allows for acupuncture treatments that enable the best of both medicines. Working in coordination with OB/GYN physicians, Radice sees women (and men) throughout all stages of obtaining and carrying out pregnancy. Read the whole interview here.

AcuTake’s latest book review is of Better: A Surgeon’s Notes on Performance. Author Atul Gawande, a Boston surgeon and also a staff writer for The New Yorker, weaves 11 heartfelt tales that convey both the miracles and shortcomings of modern medicine. It’s a beautifully written book that tells stories about doctors to address the universal human drive to do better—at work and in life. Read this and other reviews in Books.

CNN today looks at postpartum depression. Aside from recent evidence that links postpartum depression to increased levels of monoamine oxidase A, a brain protein involved in mood stabilization, there’s no conclusive mainstream explanation for why some women endure more emotional suffering than others after giving birth.

Many acupuncturists’ go-to assumption in depression cases is to treat the Liver. Giovanni Maciocia, in his book The Foundations of Chinese Medicine, says, “In Chinese medicine, mental depression was called yin yu, which means ‘gloominess’ or ‘depression,’ or yu zheng, which means ‘depression pattern.’ Yu has the double meaning of ‘depression’ and ’stagnation,’ which implies that…mental depression is always caused by stagnation.” And stagnation, for the most part, is associated with the Liver. The Liver is responsible for flow in the body, so when things are “stuck,” acupuncturists often select points along the Liver channel to restore smooth movement.

Postpartum depression from an acupuncture perspective, however, is a type of depression all its own. It has some Liver involvement, but the main pattern for postpartum depression is Heart Blood Deficiency. According to acupuncture theory, the Heart governs the blood, so when something like childbirth takes place, where there is a lot of blood loss, it ultimately affects the Heart. Regarding the Liver involvement, this is because the Liver also is intimately involved with blood and is normally what’s first affected by any blood-related pathology. But over time, a Liver Blood Deficiency, if left untreated, can lead to Heart Blood Deficiency. Read more »

Another AcuNews item warrants mention in the main blog. The New York Times today reported on patients’ growing embrace of acupuncture despite insurance companies’ reluctance to cover it. The article headline, “Acupuncture Is Popular, by You’ll Need to Pay,” accurately sums it up. More and more patients are turning to acupuncture—at the same time that doctor support and research demonstrating efficacy mounts—yet it still remains prohibitively expensive for many people.

The Times quotes statistics from the National Center for Complementary and Alternative Medicine, a division of NIH: 3.1 million adults reported using acupuncture on a 2007 survey, up from 2.1 million in 2002. Despite this heightened interest, the majority of people pay out of pocket, with many acupuncturists charging upwards of $100 per visit, usually for ailments that require at least three or four sessions.

The article misspeaks on its description of community acupuncture, a style that involves treating multiple fully clothed patients at once, usually in an open-room setting, in chairs (opposed to the massage tables used in private-practice sessions). The reporter says community acupuncture is only appropriate for conditions that are “not serious or complicated,” calling it the “acupuncture equivalent of a chair massage.” This is not true. Many of the most powerful acupuncture points are located below the elbows and knees—they are known as the antique or transporting points. Using just these points, community acupuncture clinics across the country frequently and effectively treat patients with such complicated conditions as diabetes, chronic pain, irritable bowel syndrome, and rheumatoid arthritis, among many others. Acupuncture does not cure these conditions, but it can provide significant relief from symptoms and from medication side effects. Read more »

Check out AcuTake’s latest book review, of Julie Salamon’s Hospital. Salamon, a former reporter for The New York Times and The Wall Street Journal, spends one year inside a storied Brooklyn hospital following doctors on rounds, listening in on administrative meetings, and gathering internal gossip. The result is a page-turning expose that captures the good, the bad and the ugly of how hospitals run. Read this and other reviews in Books.

In today’s The New York Times Magazine appears a bravely written, thoroughly researched piece called “The Estrogen Dilemma.” The most compelling part of the article (although not the most entertaining—author Cynthia Gorney’s first-hand descriptions of what it feels like to go through menopause are hilarious) is focused on the Women’s Health Initiative (WHI). This well known study was halted in 2002, three years ahead of schedule, after evidence surfaced to suggest the hormone-replacement therapy being given to some women was causing more harm than good. The risk of heart problems, stroke and blood clots went up, in addition to the shocking and much publicized 24-percent increase in breast-cancer risk. The media coverage of WHI was relentless, causing millions of women to stop taking their hormone pills.

None of this is news, but Gorney looks beyond the mainstream coverage of WHI. It turns out, the average age of women in the study was 63, many years past their last menstrual period and significantly older than the age that women typically start considering hormone replacement. Gorney says, “Because women generally make decisions about hormones while they are in the throes of perimenopause…you may find this as perplexing as I did. Why would the largest drug trial in the history of women’s health select, for most of its participants, women already long past the critical phase?”

The article goes on to explain how important this point may be—current research suggests that estrogen reacts differently in the body depending on how healthy our cells are. In other words, if the WHI participants had been younger, they may not have experienced such increases in breast-cancer and other risks. Maybe a whole slew of women in their 50s stopped taking estrogen for nothing.

The jury is still out on the risk-benefit profile of hormone-replacement therapy. But the Times piece highlights the inherent challenges of treating menopause, due to its array of symptoms and drastically different manifestation depending on who’s going through it, and when. Gorney gives brief mention to some non-drug therapies—exercise, deep breathing, yoga and black cohosh—but does not include acupuncture. Acupuncture can be of great help to women going through menopause, but as Gorney’s article demonstrates is also the case with pharmacologic treatment, an accurate diagnosis based on all contributing factors is critical to achieving positive outcomes. Read more »

Media coverage of acupuncture is tracked in AcuNews. But a piece from today’s Wall Street Journal is worthy of mentioning here as well, because it specifically addresses the issue of language. AcuTake was created to help bridge the gap that exists between mainstream and other forms of healthcare in large part due to their lack of common language. By “translating” mainstream medical news into acu-speak (explaining how an acupuncturist would view the topic), we hope to improve communication among all healthcare practitioners whose goal is better patient care.

The Journal article specifically addresses the word qi, the mysterious and oft-mistranslated basis for acupuncture theory. To most acupuncturists, qi is a phenomenon that is not necessarily understood but that becomes intuitive through practice. To much of the Western medical community, qi, understandably, sounds like a bunch of new-age speak with no validity whatsoever. This is not an issue of mainstream medicine caring about objective proof while acupuncturists are willing to blindly accept an “unproven” phenomenon—the field of acupuncture research is thriving and rigorous. Rather, it’s an issue of semantics.

Joseph Helms, president of the Helms Medical Institute, an organization that teaches acupuncture to physicians, tells the Journal, “We’ll say, ‘A 27-year-old female appears moribund; she doesn’t respond to stimuli. Or an 85-year old woman is exhibiting a vacant stare.’ We’re talking about the same energy and vitality, we’re just not making it a unique category that we quantify.”

In other words, we say someone is Qi Deficient. Western docs say that same person is moribund. Same idea. Different terminology.

Insomnia is one of the most common medical complaints in the United States. The National Sleep Foundation’s 2002 Sleep in America poll found that 58 percent of adult Americans suffer from at least one symptom of insomnia—difficulty falling asleep, waking up too early, frequent awakenings, or waking up unrefreshed. Now, the Foundation’s 2010 poll is suggesting that distinctions can be made among ethnic groups regarding sleep patterns.

A University of Pennsylvania professor tells BBC News that while genetic variation might play some role in how much sleep people need, socioeconomic factors are a more likely explanation for the disparities. The survey found that more African-Americans and Hispanics than Caucasians and Asians lose sleep because of financial stress. African-Americans are most likely to do job-related tasks before bed.

“Many of these people are sleeping short, not because they don’t understand the importance of sleep, but because of the pressures of their lives, having two jobs and all that type of stuff,” UPenn’s Allan Pack tells BBC.

In TCM, insomnia is primarily associated with the Heart. Common patterns that involve insomnia include Kidney and Heart Disharmony, Heart and Spleen Disharmony, and Deficiency of Heart and Gallbladder Qi. (Liver Fire Flaring Upwards and Phlegm Fire are other possible considerations.)

In one style of Japanese acupuncture, Kiiko Matsumoto’s, insomnia often suggests what Matsumoto refers to as an Autonomic Nerve Imbalance due to Sympathetic Dominance. She and co-author David Euler, in their book Kiiko Matsumoto’s Clinical Strategies: Volume I, explain the pattern: “The lifestyle in the modern Western world requires a strong and healthy autonomic nervous system to cope with society’s stresses and demands. Very often, the balance between the components of the autonomic nervous system is chronically compromised and diseases may arise from this imbalance. The overuse of stimulants like coffee, or depressants like alcohol, exposure to daily stress, lack of ample vacation time, relaxation and irregular food intake, are all very common examples of chronic abuse of the autonomic nervous system.” Read more »

Discovery News and other outlets are reporting today on a preliminary study that links persistent headaches to World Trade Center exposure around 9/11. The study says that roughly half of people who lived or worked near the site around the time of the attacks are still experiencing frequent headaches today. Headaches are just one of several ailments that have plagued local people since the attacks—respiratory issues, sinus flare ups, PTSD, depression, and gastrointestinal symptoms are common complaints—but it’s a useful example for demonstrating how an acupuncturist’s approach differs from, in this case, a neurologist’s.

This study, while important for confirming the link between 9/11 and physical illness, does not offer a solution. The Discovery News piece says, ”Further research will have to zero-in on what types of headaches are involved and why they’re happening….One possibility is that headaches in 9/11 survivors are a result of depression and post-traumatic stress disorder, which are known triggers. Respiratory symptoms and sinus issues could play a role. It’s also possible that patients inhaled toxic particles of pollution released in the buildings’ collapse, which got into their blood streams and affected their brains.”

Headaches—and other chronic conditions—that stem from any number of potential causes can be greatly helped by acupuncture. Until the information discerned from this study gets further broken down into what’s happening physiologically during these headaches, they’re difficult for a neurologist to treat. Yet acupuncture is based on the premise that there is not one physiological response at play. Read more »

The New York Times ran a piece today—oddly, in the Thursday Styles section (it shared the cover with a story about how social media outlets like Facebook have made breakups more difficult)—questioning our healthcare system’s acceptance of physical therapy. In large part due to insurance companies’ willingness to cover physical therapy sessions, there’s a somewhat unfounded assumption among physicians and patients that it works. But it turns out, there is limited evidence to demonstrate the efficacy of many tried-and-true PT modalities, according to the Times.

The president of the orthopedic section of the American Physical Therapy Association tells the paper that the ice-and-heat routine recommended by many PTs isn’t much more than a bandaid. He says ice and heat “can control pain a little bit” but “are not going to take care of the problem.” A doctor at New York’s Hospital for Special Surgery calls ice and heat “a waste of time” in many cases.

Acupuncturists have known this for thousands of years. In Chinese medicine, cold is thought to promote stagnation, one of the primary causes of pain and functional breakdown in the body. To an acupuncturist, the idea of icing an injury runs counter to some of the most basic principles of our medicine.

There’s a degree of justice in PT being exposed for some of its shortcomings. Despite being less effective than acupuncture for many conditions, PT has for years received blind—and arguably, excessive—support from insurance companies. But it also hits a soft spot for acupuncturists, who have spent decades trying to demonstrate the efficacy of a medicine that’s not conducive to being studied within a research framework that’s designed to study pharmaceuticals and medical devices.

Read more »

Our latest book review is on The Practical Application of Meridian Style Acupuncture, by John Pirog. It’s is a great resource for understanding the differences between modern Chinese acupuncture and meridian acupuncture, two widely practiced styles in the United States. Handily laid out in chart-form, key characteristics of each style are accessible to acupuncturists interested in learning meridian basics as well as to patients who are trying to decide which style of acupuncture is best for them. Read this and other reviews in Books.

The New York Times this week reported on the stress-reducing effects of exercise. Researchers have been looking at this for years but the latest thinking is that through exercise, we condition our brains to the feeling of being stressed—exercise, after all, is a form of stress—so that when life presents us with others stressful situations, we’re used to it. In other words, stress doesn’t come as a shock to the system.

One Dartmouth researcher who specializes in how exercise affects emotions told the Times, “It looks more and more like the positive stress of exercise prepares cells and structures and pathways within the brain so that they’re more equipped to handle stress in other forms.”

Discovering ways in which people can reduce their stress levels is of great interest to the entire medical community. Western researchers and doctors have been fishing around for a link between stress and disease for a while now. In 2007, a Carnegie Mellon psychologist did a literature review on the topic and concluded that stress directly contributes to certain chronic diseases, especially depression, heart disease, and the progression of HIV/AIDS. A large amount of research money has gone toward adding cancer to that list, but a clear connection between stress and cancer remains unfounded. Still, there is evident growing recognition that stress plays a role in physical illness.

The first person to introduce this notion that physiological stress responses can cause disease was Hans Selye, an Austrian endocrinologist. After performing studies that showed deterioration of the thymus gland and the production of ulcers in rats that were exposed to various stressors, Selye developed his General Adaptation theory. The idea, extended to humans, is that any form of stress—emotional, environmental, physical injury, etc.—causes a breakdown in the hormonal system that leads to what Selye called diseases, or patterns, of adaptation. Disease, according to Selye, isn’t directly caused by an external pathogenic factor, but rather, is the result of our body’s inability to adapt to those factors.

Selye’s theory had much influence over the development of Acupuncture Physical Medicine (APM), a style of acupuncture that emphasizes freeing up muscular holding patterns. In fact, “holding patterns” is essentially just another term for Selye’s patterns of adaptation. Both APM and Selye’s theory (applied to musculoskeletal complaints) goes like this: Neuromuscular and skeletal changes in the body represent a record of a person’s attempt to adapt to stress. Repeated postural patterns, traumas, and/or emotional tensions over time result in the appearance of tense, contracted fibrous tissue. This bunched up tissue is what the founder of APM, Mark Seem, named a holding pattern—and what Selye called a pattern of adaptation. When muscle fibers harden in this way, not only can pain result, but nerve currents are prevented from conducting properly, which causes decreased strength and range of motion. Read more »

Med News Today reported last week on preliminary research from Temple University that says too much texting can lead to neck and shoulder pain. Texting may be a new popular cause, but neck and shoulder pain ails a huge number of people, and not just those who are addicted to their BlackBerrys. It is one of the most commonly seen complaints in acupuncturists’ offices.

“Shoulder pain” can mean a lot of different things. It is a broad complaint that’s often used to describe conditions that actually are unrelated to, or at least not limited to, the shoulder. TCM acupuncturists address this issue—common in many musculoskeletal complaints, not just shoulder pain—by performing a thorough intake that allows them to diagnosis the pain according to TCM pathology.

In TCM, shoulder pain (and most musculoskeletal complaints) is considered a Bi syndrome, a category of conditions characterized by localized discomfort in the muscles, joints and tendons. Bi syndromes are caused by invasion of exterior pathogenic factors—such as wind, cold, dampness and heat—which obstruct the channels and collaterals, disturbing the flow of qi and blood. Shoulder pain Bi syndrome may present with one or several of the following symptoms in the shoulder region: soreness and pain, numbness, heaviness, difficulty moving, red swollen joints that are warm to the touch, or deformity of the joints. Based on the patient’s description of pain, combined with whatever is seen and felt by the practitioner, the Bi syndrome is broken down into one of several types:

Read more »

Thirty-seven-year-old Derartu Tulu of Ethiopia was the first woman to cross the finish line in the 2009 New York City Marathon. Marathoning is growing in popularity. According to The New York Times, 425,000 people completed a marathon in 2008, up from 143,000 in 1980. And in that time, marathoning among women has more than doubled: Over 33% of entrants to the 2008 New York City Marathon were female, while in the 1980 running of the event, women accounted for only 14% of racers.

There are many physical and psychological benefits of long-distance running—weight maintenance, cardiovascular health, stress reduction, among others. But female runners, particularly those of low body weight, can experience menstrual irregularities as they up their mileage. There are many forms of menstrual disorders that are considered “irregular.” There’s amenorrhea, which refers to the absence or cessation of menstrual periods. There’s metrorrhagia, which is actually not menstrual bleeding but rather any irregular, acyclical nonmenstrual bleeding from the uterus (bleeding between menstrual periods). There’s also oligomenorrhea, which means that periods are infrequent or light, and its opposite, polymenorrhea, referring to menstruation that is too frequent. When it comes to long-distance running, amenorrhea is most common. Last month, The American College of Sports Medicine officially declared amenorrhea as a condition of concern among female athletes.

Different styles of acupuncture view amenorrhea in different ways. In TCM, amenorrhea is normally considered one of four patterns of disharmony: Liver and Kidney Deficiency, Qi and Blood Deficiency, Qi and Blood Stagnation, or Stagnation of Damp Phlegm. Diagnosis and treatment are determined according to the woman’s other symptoms. For example, a woman presenting with amenorrhea and dizziness, shortness of breath, fatigue and poor appetite would probably fall into the Qi and Blood Deficiency category. A woman with amenorrhea who also complains of low back pain and tinnitus would be treated for Liver and Kidney Deficiency.

In Acupuncture Physical Medicine (APM), an acupuncture style that deals primarily with muscular holding patterns, any kind of irregular menstruation, including amenorrhea, usually falls within what’s called the Pelvic Collapse pattern of visceral agitation. Amenorrhea, according to APM, is a disorder of the lower heater, Yang Ming zone, and the quadratus lumborum in the Tai Yang zone. Read more »

The New York City Marathon takes place this Sunday. In its honor, health and exercise journalists around the world have been justified in exhaustively covering the act of running: why we do it, how we do it, whether we should do it, and what it’s doing to us. A great number of these articles have focused on barefoot running, which, advocates say, can reduce the likelihood of injury. (Just watch out for that piece of glass!) One very common running injury, medically diagnosed as plantar fasciitis, is one for which acupuncture can offer relief.

Barefoot running is obviously not new—it dates back to the earliest of times, when running from predators was par for the course during hunting and gathering expeditions. But the concept was brought back to life earlier this year (just around the time people started training for New York) with the publication of Born to Run, by Christopher McDougall, a former correspondent for the Associated Press. The book focuses on an Indian tribe in Mexico that runs for miles on end, through treacherous terrain, in nothing but thin sandals. Since the book’s publication, McDougall has been on the press circuit, making stops everywhere from CNN to The Daily Show, not only promoting the benefits of barefoot running but also claiming that our shoes might actually be causing our running injuries.

Whether that’s true is a question that probably concerns Nike and Asics more than the average runner. But this extensive coverage of running in recent months has brought to light an undeniable fact—a lot of people suffer from running injuries. According to The Washington Post, roughly one-third to half of all runners deal with some form of injury each year. Most of those are injuries to the lower leg or foot. If you buy into the anti running-shoe argument, it goes something like this: The cushioning in shoes raises them up in the back, which encourages the runner to land on her heel. This is not the way we were made to run—landing on the ball of the foot is more natural. This altered stride forces us to use muscles in ways that are out of balance with how we’re meant to use them, which over time, can cause injuries and pain. Read more »

The cover story in this weekend’s The New York Times Magazine, “Understanding the Anxious Mind,” looks at whether anxiety is an inborn condition or something we develop in reaction to life’s mounting pressures. The research outlined in the piece, while shedding some significant light in favor of predisposition, leaves the question up for debate.

Anxiety is a broad topic in Chinese medicine. It is normally associated with the Heart, but can manifest in a variety of symptoms and be linked to multiple root causes. One manifestation can look a lot like what might be medically diagnosed as cardiac neurosis. Also sometimes referred to as Da Costa syndrome, cardiac neurosis is a form of anxiety associated with palpitations, chest pain, or other symptoms that mimic a heart attack but are not actually due to heart disease. It’s basically a fancy term for panic attack. Although panic attacks are fairly common, when they’re actually happening, they’re scary. For this reason, patients experiencing cardiac neurosis fill many emergency room beds and cardiologists’ waiting rooms. A more worthwhile and cheaper trip might be to an acupuncturist who knows how to release trigger points. Read more »

Leon Eisenberg, a Harvard Medical School professor who is credited with conducting the first-ever studies on autism and attention-deficit hyperactive disorder, died last week of prostate cancer. In addition to Dr. Eisenberg’s pioneering achievements in childhood developmental diseases and social activism—he also is remembered for establishing Harvard Medical School’s affirmative action program—Eisenberg founded the school’s social medicine department in 1980.

Among other things, Harvard’s Department of Global Health and Social Medicine looks closely at how environment affects disease. For example, how does socioeconomic status worsen or improve a case of diabetes? What role does culture play in treating a case of depression? How does a patient in Minneapolis experience low back pain as compared to a patient in Mumbai?

These are the kinds of questions that intrigued Eisenberg, whose department was eventually taken over by Arthur Kleinman, a psychiatrist who now teaches medical anthropology at Harvard. Kleinman is perhaps best known for his book The Illness Narratives: Suffering, Healing and the Human Condition. In it, he advocates a shift in medical education and practice, away from stressing objective disease diagnosis and toward a style of medicine that takes into account the patient’s subjective experience of illness. This concept informs Acupuncture Physical Medicine (APM), a style of acupuncture that focuses on freeing up muscular holding patterns to facilitate regulation of the whole person—physically, emotionally and spiritually.

APM was coined by the founder of Tri-State College of Acupuncture, Mark Seem, who, in his own book, Acupuncture Physical Medicine: An Acupuncture Touchpoint Approach to the Treatment of Chronic Fatigue, Pain, and Stress Disorders, says that all healing models—including Traditional Chinese Medicine (TCM)—because of their insistence on categorizing conditions according to textbook signs and symptoms, neglect the actual experience of illness and therefore alienate the patient from the process of healing. In accordance with the theories put forth by Kleinman, Seem promotes APM as a palpation-focused style of acupuncture through which the practitioner can resonate with a patient’s true experience of illness. Read more »

The New York Times reports on University of Washington medical students who spent their summers witnessing first hand a healthcare system that devalues primary care and prevention. The experience was part of a month-long program that sends second-year med students into the field, to provide primary care in rural or underserved areas. More than half of the class took part in the elective program, and several came away enlightened—and disheartened—by what they saw.

“I don’t think you can practice optimal medicine,” said one of the students, who worked in a pediatrician’s office in Gillette, Wyoming. “There is too little incentive after going through all this education and being in school for the majority of your life to want to pursue a career just in primary care.”

Reimbursement for primary care is an issue that has led to fewer and fewer aspiring doctors selecting the specialty. According to the Times, only a third of med school graduates in the U.S. today go into internal or family medicine. Twenty-five years ago, the figure was closer to 50 percent. Physicians who do choose primary care often find themselves working long hours and spending limited time treating patients in order to cover the costs of their practices.

The problem lies in the fact that our reimbursement system does not prioritize chronic disease management. Instead, coverage is heavily allocated toward treating acute conditions with catastrophic interventions, many of which are avoidable if the condition is managed properly through preventative measures. The irony is that most of these preventative treatments—acupuncture is one; dietary therapy is another—are infinitely cheaper than the last-ditch efforts that are made once something becomes an emergency. Read more »

Bone health experts are busy debating the World Health Organization’s new online tool for evaluating bone loss. Known as FRAX, the tool considers a variety of risk factors, including bone mineral density and family history, to determine whether it’s time for a patient to start taking medication for bone loss. At issue is whether FRAX is actually a beneficial advancement or a sophisticated way of convincing people that they are destined to become osteoporotic if they don’t start popping bone-loss drugs.

A doctor from the University of Cincinnati’s Bone Health and Osteoporosis Center told The New York Times, “FRAX is coming from the same people who came up with osteopenia in the first place.” Osteopenia is a relatively new condition that refers to below-normal bone density, but not quite low enough to be called osteoporosis. Docs like this one from the University of Cincinnati claim that both osteopenia and tools such as FRAX are inventions by the pharmaceutical industry to scare people into thinking they need to be on medication.

We’re not going to make a dent in that debate anytime soon, but it’s a timely excuse to discuss osteoporosis from an acupuncture point of view. In Chinese medicine, bone loss is considered to be a problem of deficient Kidney essence, which is a combination of pre-natal and post-natal essence. As the name suggests, pre-natal essence is inherited from our parents and is what determines our basic constitutional makeup. Pre-natal essence nourishes the fetus and governs growth and development after birth. It is also responsible for growth and vitality and is thought to be linked to issues related to sexuality, such as impotence and infertility. Post-natal essence is derived from the foods we eat and the lifestyle we choose. Read more »

In recent months, The New York Times has dutifully covered the shifting role of primary care doctors. This article is about a cohort of primary care physicians who are committing themselves to giving more personal attention to patients. These doctors are investing in technology and making other changes in their practices to cut costs so that they can afford to see fewer patients. The Obama administration is on the side of primary care doctors, doing what it can to incentivize med school students to go the primary care route—one of the main reasons primary care doctors have so little time with patients is because there isn’t enough of them to go around. Relatively low salaries in primary care is a big driver for specialization. The Times reports, “According to a 2008 survey of physician salaries by the American Medical Group Association, [a primary care doctor's] average annual salary is $201,555, versus $356,166 for a general surgeon and $614,536 for a neurological surgeon.”

It could be years before Obama’s hopes for primary care are carried into action, so some PCPs are taking matters into their own hands, cutting back on patient loads or transferring to practices that don’t require them to see as many patients per hour. The Times says, “These doctors spend more time with patients, emphasize prevention and education to keep them healthy and can handle many medical problems without referrals to specialists.” Sounds a bit like Acupuncture 101. Read more »