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Integrative medicine (IM)
concerns those areas of medicine that are not traditionally taught in
western medical schools. While there is a long history extending back for
literally thousands of years as an empirical science, only in the last 20-30
years have investigators begun to separate fact from fable, actual
modality-related response from placebo or biological mechanism from
psychological response using modern technological advancements. The National
Center for Complementary and Alternative Medicine (NCCAM) has grouped the
many areas of integrative medicine into seven categories, including:
1. Mind-body intervention
2. Alternative systems of medical practice
3. Manual healing methods
4. Pharmacological and biological treatments
5. Bioelectromagnetic applications
6. Herbal medicine
7. Diet and nutrition
The science behind each of these practices is still very much in its
infancy. Although this situation has been improving slowly, in part due to
increasing interest from the medical and scientific communities, as well as
from funding provided by NCCAM and the more traditional institutes at NIH,
and other funding agencies in the US and abroad, there is still much that is
not known and much skepticism that exists throughout the established
scientific communities. This is, in part, due to the low quality of much of
the science that has been conducted in these non-traditional areas of
medicine, including absence of adequate controls, use of outdated methods,
non-randomized studies, lack of hypothesis testing, inadequate statistical
analyses, unblinded or partially blinded studies, retrospective analyses and
the tendency for the results of so many investigations to be positive, even
in the absence of supporting data. Funding agencies, such as NCCAM, while
providing helpful funding to fuel research in many areas of IM, have not
always funded the best science or conferences. This problem exists partially
because there is a lack of a sufficient cadre of scientists capable or
willing to provide adequate peer review. Thus, CAM or IM can be best viewed
as an area that is truly in an immature stage of development with respect to
our understanding of its clinical role and mechanisms of action and one that
has been only modestly embraced by the western medical/scientific
communities. One remedy for the lack of sophistication and acceptance of IM
is to bring the best minds together to address the current status of our
knowledge and to suggest future productive avenues for research. Such
conferences can go a long way towards providing a prescription that will
begin to assuage doubts and to introduce our students and postdoctoral
trainees to this discipline in a thoughtful manner.
The Susan Samueli Center at the University of California, Irvine, was
created by a gift from Susan and Henry Samueli in 1999. Henry Samueli, a
resident of Orange County California, is one of the co-founders of Broadcom,
a chip manufacturing company. He and his wife, Susan, are extremely
philanthropic, having provided gifts to many charities and non-profit
organizations. Susan Samueli has a degree in holistic nutrition and
practiced homeopathy for many years. The Susan Samueli Center for
Integrative Medicine has three major missions, including:
1. education to students, faculty, practitioners and the lay public;
2. research focused at the mechanistic level;
3. clinical service in integrative medicine.
While the center conducts research in several areas of IM, its focus is in
the area of Traditional Chinese Medicine, particularly in the area of
acupuncture. Investigators in the center are supported by grants from the
NIH and voluntary health organization as well as funding from private
organizations. The group conducting research includes a mix of physicians,
scientists, practitioners, students and postdoctoral fellows from the US,
China, Japan, and Korea with a strong background of training in medicine and
neuroscience, each of whom are dedicated to the careful application of the
scientific method. The center uses its educational and clinical activities
to further its research mission. Thus, in addition to international
scientific conferences, the center provides courses in evidence-based
integrative medical practice, for example in acupuncture and herbal medicine
for allopathic and CAM practitioners and sponsors clinical research
protocols in its integrative medicine clinic, that features acupuncture.
On March 30, 2005 the Susan Samueli Center for Integrative Medicine at the
University of California, Irvine sponsored a satellite symposium for the
35th meeting of the International Union of Physiological Sciences (IUPS).
This was the third such conference sponsored by the Samueli Center, with the
second held as a satellite meeting of the IUPS, four years ago in Auckland,
New Zealand and the first two years before that in Irvine, California.
The planning committee consisted of Peng Li (UCI, USA), Thomas Lundeberg, (Karolinska
Institute, Sweden) and myself. Because of our past experience with previous
conferences, our knowledge of the field of acupuncture and our scientific
contacts throughout the world in this area of research, we were able to
select a group of 12 speakers with an interest in research on the mechanisms
underlying acupuncture. In addition, we offered an engaging and interactive
poster session during which junior faculty, fellows and students had an
opportunity to present their research. Faculty from Fudan University, China;
Nagasaki University, Japan; Tokyo Metropolitan Institute of Gerontology,
Japan; Showa University, Japan; Karolinska Institute, Sweden; Göteborg
University, Sweden; Massachusetts General Hospital, USA and the University
of California, Irvine, USA, presented a wide range of topics.
Hui discussed the latest research using functional magnetic resonance
imaging to detect cerebro-cerebellar and limbic regions of the brain
influenced by acupuncture. Lundeberg discussed the influence of acupuncture
on pain and anxiety. Hisamitsu presented research on acupuncture and
moxibustion in treatment of collagen-induced arthritis. Toda provided his
understanding of the antinociceptive action of acupuncture in the spinal
trigeminal nucleus. Chen discussed the mechanism of acupuncture treatment of
the perimenopausal syndrome. Stener-Victorin provided her results on the
response of the polycystic ovarian syndrome to electroacupuncture. Uchida
discussed the influence of stimulating somatic afferents on uterine and
ovarian function. Li talked about the role of the hypothalamus and midbrain
in electroacupuncture-cardiovascular responses. Tjen-A-Looi provided an
understanding of acupuncture’s point specific action on the cardiovascular
system. Jafari discussed herbals, acupuncture and longevity. Cho discussed
his imaging based data on the neurological mechanism of acupuncture in
inflammation. I discussed the role of the medulla, specifically the rostral
ventrolateral medulla, in regulation of blood pressure by electroacupuncture.
Posters presented a wide range of topics, including evaluation of
inflammatory cytokine mRNAs in the ischemic rat brain after acupuncture, the
induction by acupuncture of c-Fos expression in the medulla and midbrain and
the relationship of these neurons to enkephalins and endorphins, the
influence of acupuncture in epilepsy with respect to its action on
excitatory and inhibitory neurotransmitters, behavior changes caused by
electroacupuncture in combination with antidepressants, inhibition of
thalamic neuronal responses to visceral nociception by electroacupuncture,
somatic afferent and medullary neuronal mechanisms underlying acupuncture
modality and frequency-dependent cardiovascular responses and the effect of
acupuncture on glutamate-related excitation in the medulla and the resulting
cardiovascular responses.
During the day and evening of this symposium, discussion was lively and
probing. Thoughtful criticism was raised, some ideas were put to rest but
many new and potentially productive areas were considered. I think the
students were exposed to a level of science that set the stage not only for
an understanding of the current state of our knowledge but also for a belief
that science still has a long way to go to fully understand the
neurophysiological mechanisms underlying acupuncture. I hope that productive
collaborations will result and that we will have an opportunity to re-engage
in four years to evaluate new knowledge and future directions.
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| Group photograph of
conference attendees. Those clearly identifiable in the picture are
(listed alphabetically): Ella Ashabi, Stanley Behrens, Bo-Ying Chen,
Zang-hee Cho, Debra Clydesdale, Liang-Wu Fu, Zhi-ling Guo, Tadashi
Hisamitsu, An-Fu Hsiao, Lonela Hubbard, Kathleen Hui, Mahtab Jafari, Yu
Jin, Mari Kimoto, An York Lee, Peng Li, John Longhurst, Thomas Lundeberg,
Shulami Park, Yihong Peng, Heather Rice, Elisabet Stener-Victorin,
Stephanie Tjen-A-Looi, Kazuo Toda, Sae Uchida, Angela Wang, Hiromi
Yamamoto, Ru Yang, Jianliang Zhang, Hong Zhao and Wei Zhou. |
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