为什么说2019年将是美国针灸立法成败的关键一年？

 

经常关注针会天下或者美国针灸的朋友可能了解，为了应对日益严峻的鸦片类止痛药泛滥的危机，2018年美国卫生部开启了一个寻求替代药物和替代疗法的新征程，并通过总统签署法令，10月24日成为正式法律，其中针灸作为一种替代疗法也被写入立法进程，被要求在一年之内给出明确的报告，是否纳入美国医保，这个时间节点就在2019年。

 

美国卫生部在2018年12月的时候对针灸疗法发布了第一次评估报告，并将在公示3个月后定稿。半个月后的2019年1月，美国医保部门（MEDICARE）展开了对针灸治疗腰痛的调查，并让美国卫生部出具更多的临床证据证明针灸的有效性，2019年7月将对针灸治疗腰痛是否纳入医保做最终决定。

 

在此期间，美国的鸦片类药物生产商损失惨重，他们不甘失败，动用大量游说资金，通过学术界、政界、立法界等向国会施加压力，阻止其他疗法取代鸦片类药物，甚至组织美国大妈使用“一哭二闹三上吊”的撒泼方式大闹国会，哭诉因吃不到鸦片造成的身体和精神的痛苦，试图恢复使用鸦片类药物。

 

各利益团体在此间激烈博弈。

 

有人说，美国的针灸立法跟我们有什么关系？我们中国的针灸不需要美国的承认。这其实是极其狭隘的民族主义。为什么呢？因为针灸是我们中国发明的，我们如果不去主导针灸在世界上的推广，不去制定以我们中国为主导的针灸标准，包括穴位标准、经络标准、治疗标准、科研标准、考试标准、执业标准等，也阻止不了针灸在世界上的传播，也阻止不了别的国家通过各种途径获取针灸，从而变成他们国家的针灸，最后中国在世界针灸中的话语权就会丧失。

 

目前世界上对针灸应用和立法的国家越来越多，前有日、韩、越南，后有澳大利亚、泰国、巴西、智利、欧洲等，即使非洲也有了广泛的应用，可以说遍布全世界，但是这些都不足惧，无法撼动中国在针灸行业的地位，唯有美国可以。

 

美国拥有世界上最强大的综合实力，美国的标杆作用明显，美国针灸立法的好坏足以影响全世界。从历史的长河来看，针灸的临床有效性会自发推动其在世界上的广泛传播，未来每个国家都会使用针灸，针灸立法将是未来的必然，是某些个人或者团体阻止不了的，即使暂时阻止也不会改变将来的趋势。与其被动地接受别国自发的针灸立法行为，不如通过来自中国的针灸力量的帮助，在立法时保留更多的中国元素，使中国继续在针灸领域保持领先和话语权。

 

当然，这次美国针灸立法并不是真正意义上的完全的“针灸法”，而是一次目标比较单一的针灸纳入美国医保的立法行动，针灸的治疗范围也仅仅局限在疼痛。但是，一旦成功，其历史意义仍然是巨大的，全面的针灸立法也未可期。

 

为此，各方面都在努力，请看下面两个转自其他媒体的报道。

 

 

 

美国卫生部下属的国立卫生研究院（NIH）召开“针灸科学研究临床转化研讨会”，讨论了针灸纳入医保的问题

 

2019年2月11－12日，NIH有关部门在马里兰州的美国医学图书馆召开了“针灸科学研究临床转化研讨会”。会议的议题是针灸科学研究在癌症辅助治疗、疼痛、及药物滥用方面的临床转化。会议邀请了近年来NIH资助的项目负责任人及相关研究人员报告他们在针灸领域研究的进展，讨论了目前面临的主要问题及未来研究计划。会议讨论的一个焦点是针灸基础研究同临床实践的分离及如何改变现状。参会者对针灸定义和范围、穴位的特异性和非特异性、针灸的安慰剂作用、针灸的神经通路和分子生物学机理及目前积累的临床随机对照试验证据等多个话题进行了热烈的讨论。

 

NIH癌症研究所替代补充医学办公室主任White 主持了大会，新任NIH补充整合医学中心主任Langevin 做了发言并主持了讨论。另有NIH多个部门及项目责人主持了讲演并介绍了相关基金，讨论了针灸对阿片药物危机的价值及联邦保险支付针灸的问题。NIH希望收集针灸界及公众的意见，改善未来研究的质量，推动针灸研究的发展及缩小基础研究和临床的距离。

 

中国大陆针灸界代表刘保延、杨会龙、景向红、朱冰梅、韩松平等也应邀参加了会议发言或讨论。(来自纽约中医论坛，李永明报道)

 

 

 

美国陆军医疗副司令在国会参议院作证说“针灸帮助减少鸦片类止痛药的使用”（Acupuncture Helping Reduce Use of Pain Killers）

 

来自华盛顿的消息，针灸和其他形式的替代和补充医学正在帮助减少阿片类药物的使用，以阻止军队病人的疼痛，该服务的助理外科主任说。

 

周三，美国陆军医疗司令部副司令、军力预测助理总干事诺维尔·V·库茨准将在参议院退伍军人事务委员会关于药物过量问题的听证会上作证。

 

库茨说，2011 年，26%的服务人员至少开了一种阿片类药物。库茨继续说，这个数字去年下降到了24%，部分原因是针灸、瑜伽和其他替代药物的使用。

 

库茨告诉委员会说：“这是一个很小的差别，但我认为它仍然代表着一个巨大的文化变革和前进。”

 

库茨说，自2010 年疼痛管理工作队提出建议以来，军队医学一直在努力改变其文化。陆军领导的工作队，包括其他部门和退伍军人健康管理局的成员，在28 个医疗中心检查了疼痛管理的最佳实践。

 

工作队的建议之一是探索针灸、冥想和生物反馈等替代疗法。生物反馈是通过传感器和仪器来提高人们对身体功能的认识的过程。目的是控制脑电波、肌肉、心率和疼痛感知等功能。生物反馈有时用于治疗头痛，尤其是偏头痛。库茨说，在过去的几年里，军队在替代药物的使用上有了很大的增长，它的使用也被写入了陆军的综合疼痛管理行动中。库茨告诉委员会说：“所有的统计数据都显示，随着这些替代模式的整合，文化变革正在大力推进，我们看到，整个军队的阿片类药物的使用量都在下降。”

 

退伍军人事务部卫生部副部长Robert Petzel 也在听证会上作证。他说，VA在其疼痛治疗计划中增加了脊柱护理、按摩、正念冥想、运动疗法和放松疗法。佩泽尔说：“退伍军人承受的痛苦是巨大的。”

 

2011 年美国医学研究所的一份报告指出，超过1.16 亿美国人患有慢性疼痛。在美国，这一痛苦的年度成本估计为5，600 亿美元，其中包括医疗费用、收入损失和生产力损失。库茨在提交给委员会的书面声明中列入了这一数字。这份声明是凯文·T 上校合著的。加洛韦，陆军疼痛管理项目主任，在听证会上站在库茨身边。他们的声明指出，多学科疼痛管理中心，被称为IPMCs，正在陆军的八个医疗中心中的每一个建立。IPMCs 将配备一个多学科的提供者团队，通过一个包括替代治疗的项目来帮助患者康复。提交给委员会的书面声明还讨论了一项涉及IPMC 工作人员的远程指导倡议。被称为陆军疼痛管理扩展社区医疗保健成果，或回声，这一倡议是以新墨西哥州大学的一个项目为蓝本。事实上，美国陆军正在与该大学完成为期两年的合作，以适应这一计划。本质上，Echo 使用每周视频远程会议将IPMC 专家与远程初级保健提供者联系起来。库茨说：“治疗疼痛是医学最古老和最基本的职责之一，但现代医学仍在努力理解疼痛机制，减轻患者的疼痛和痛苦。”

 

库茨说，疾病控制中心将处方药滥用确定为美国的一种“流行病”，并补充说，“军方也不能幸免于这些挑战。”陆军正在将临床药剂师加入其病人护理团队，作为另一项阻止药物滥用的举措。临床药剂师可以识别有多种药物风险的士兵-使用多种药物造成的危险-并将这些担忧传达给医疗服务提供者。库茨报告说，临床药剂师的增加意味着总成本的降低、不良药物相关事件的减少、住院治疗的减少和病人预后的改善。“有效的解决方案必须包括创新的战略，全面的解决方案和合作努力，”库茨告诉参议员。(来自美国针灸中医杂志2019-2-15)

 

 

 

附英文原文如下：

 

Translating Fundamental Science of Acupuncture into Clinical Practice for Cancer Symptom Management, Pain, and Substance Abuse

 

Workshop Agenda

Day One February 11, 2019

 

8:30-8:45 a.m. Opening Remarks:

David Shurtleff/Emmeline Edwards, NCCIH

Jeffrey White, NCI

 

8:45-9:15 a.m. Overview and Charge of Workshop:

Helene Langevin, Director, National Center for Complementary and Integrative Medicine (NCCIH)

• Defining the scope of Acupuncture-related research

• Map of the anatomical locations for the site of stimulation

• Heterogeneity – challenges and opportunities

 

9:15 a.m.-12:30 p.m. Session One Chair: Wen Chen, NCCIH

Specific Effects of the Interventions: Neural Mechanisms and Pathways

 

9:15-10:00 a.m. Keynote - Qiufu Ma, Dana Farber Cancer Institute

Somatosensory Systems in Brain-Body Connections

 

10:00-10:25 a.m. Jianghong Ye, UMDNJ,

Electroacupuncture Attenuates Hyperalgesia in Rats Withdrawn from Chronic Alcohol Drinking via Habenular Mu Opioid Receptors

 

10:25-10:45 a.m. Break

 

10:45 – 11:10 a.m. Rick Harris, University of Michigan

Chronic Pain Biotypes Predict Differential Analgesic Response to Verum and Sham Acupuncture

 

11:10-11:35 a.m. Jun Mao, Memorial Sloan Kettering Cancer Center

 

11:35 a.m. -12:00 p.m. Weidong Lu, Dana Farber Cancer Institute

 

12:00 p.m – 12:30 p.m. Panel Discussion

 

1:30 – 5:00 p.m. Session Two Chair: Woody Lin, NIDA

 

Specific Effects of the Interventions: Extra-Neural Mechanisms of Acupuncture

 

1:30 – 2:15 p.m. Keynote – Maiken Nedergaard, University of Rochester,

The Glymphatic System and Pain

 

2:15-2:50 p.m.: Helene Langevin, NCCIH

Biophysical model/connective tissues

 

2:50-3:15 p.m.: RuRong Ji, Duke University

Modulation of Neuroinflammation and Neuropathic Pain by Electroacupuncture

 

3:15-3:35 p.m. Break

 

3:35-4:00 p.m. Suzanna Zick, University of Michigan, Mechanistic Clinical Studies: Chronic pain, cancer related fatigue

 

4:00-4:25 p.m.: Elisabet Stener-Victorin, Karolinska Institutet

Endocrine and Metabolic Regulation by Acupuncture

 

4:25-4:55 p.m. Panel Discussions

 

Day Two February 12, 2019

 

8:30-10:35 a.m. Session Three Chair: Libin Jia, OCCAM

Non-specific Effects of the Interventions

 

8:30-9:15 a.m. Keynote: Ted Kaptchuk, Harvard Medical School

Placebo Effects of Acupuncture: Clinical and Genomic Findings

 

9:15-9:40 a.m. Jian Kong Harvard Medical School

Neuroimaging of placebo effects of acupuncture

 

9:40-10:05 a.m. Vitaly Napadow, Harvard Medical School

Brain Concordance Supports Patient/Acupuncturist Therapeutic Alliance and Modulates Analgesia: A Hyperscan fMRI Approach

 

10:05-10:30 a.m. Panel Discussion

 

10:30-10:50 a.m. Break

 

10:50 a.m. – 3:10 p.m. Session Four Chair: Jeff White, OCCAM

Overcoming Barriers for Clinical Research of Acupuncture

 

10:50 a.m. -12:00 p.m. Clinical Observations/Case Studies

 

10:50-11:35 a.m. Keynote – Hugh MacPherson, University of York, U.K.

The Challenges of Evaluating Specific and Non-Specific Effects in Clinical Trials of Acupuncture

 

11:35 a.m.-12:00 p.m. Richard Niemtzow, Joint Base Andrews

Overcoming Barriers of Acupuncture Research

 

12:00 a.m.-12:50 p.m. Lunch

 

12:50 p.m. -1:15 p.m. Paul Crawford, Nellis Air Force Base, Las Vegas

Observational clinical study; reducing opioid prescription

 

1:15 p.m.-1:40 p.m. Songping Han Peking University

 

1:40 p.m. -2:05 p.m. Rosa Schnyer, University of Texas

 

2:05 p.m. -2:30 p.m. Gary Deng, Memorial Sloan Kettering Cancer Center

Reduction of Opioid Use by Acupuncture during Hematopoietic Stem Cell Transplantation: a Randomized Controlled Trial

 

2:30 p.m. -2:55 p.m. Wenli Liu, MD Anderson Cancer Center

 

2:55 p.m. -3:10 p.m. Break

 

3:10 p.m. -3:35 p.m. Jiang-Ti Kong, Stanford University

 

3:35 p.m. -4:00 p.m. Panel Discussion: Brian Berman, University of Maryland

Panelists: Hugh MacPherson, Gary Deng, Wenli Liu, Jiang-Ti Kong, Baoyan Liu, Xianhong Jing, Bingmei Zhu

 

o Re-define the scope and recommendations – languages

o Key barriers and building blocks for clinical trial studies of acupuncture:

o Key Issues – Blinding; Specific vs. Non-specific effects;

 

4:00 p.m.-5:30 p.m. Concluding Session: (Helene Langevin & Jeff White)

o NIH Resources to support acupuncture research:

 

• 4:00 p.m. -4:25 p.m. Marge Good, NCI Clinical Trial Resources:

 

• 4:25 p.m. -4:50 p.m. Linda Porter, NIH

HEAL Initiatives Pain Basic Research Resources and Clinical Trial Networks

 

• 4:50 p.m.-5:15 p.m. Betty Tai, NIDA

 

 

Acupuncture Helping Reduce Use of Pain Killers

Army.mil/News | By Gary Sheftick

 

WASHINGTON -- Acupuncture and other forms of alternative and complementary medicine are helping reduce the use of opioids to block pain in Army patients, the service's assistant surgeon general said. Brig. Gen. Norvell V. Coots, deputy commanding general of the U.S. Army Medical Command and assistant surgeon general for force projection, testified Wednesday, at a hearing of the Senate Veterans Affairs Committee about overmedication concerns. In 2011, 26 percent of all service members were prescribed at least one type of opioid medication, Coots said. That number was brought down to 24 percent last year, Coots continued, partly due to the use of acupuncture, yoga and other alternatives to medication.

 

"It is a small difference, but I think it still represents a big cultural change and a move ahead," Coots told the committee. Army Medicine has been working to change its culture since 2010, when the Pain Management Task Force issued recommendations, Coots said. The Army-led task force, which included members of other services and the Veterans Health Administration, examined best practices for pain management at 28 medical centers. One of the task force recommendations was to explore alternative treatments such as acupuncture, meditation and biofeedback. Biofeedback is the process of gaining greater awareness of the body's functions, often using sensors and instruments. The goal is to try to control functions such brainwaves, muscles, heart rate and pain perception. Biofeedback is sometimes used to treat headaches, especially migraines. The Army has had a large upswing in the use of alternative medicine in the past few years, Coots said, and its use has been written into the Army's Comprehensive Pain Management Campaign. "All the statistics are showing now that with a big push for cultural change with integration of these alternative modalities, that we're seeing a downturn in opioid usage across the military, particularly across the Army," Coots told the committee. Robert Petzel, under secretary for Health, Department of Veterans Affairs, also testified at the hearing. He said VA has added chiropractic care, massages, mindfulness meditation, exercise therapy and relaxation therapies to its treatment plan for pain. "The burden of pain on veterans is considerable," Petzel said. A 2011 Institute of Medicine report noted that more than 116 million Americans suffer from chronic pain. The annual cost of that pain in the U.S. was estimated at $560 billion, including health care expenses, lost income, and lost productivity. Coots included that figure in his written statement to the committee. That statement was co-authored by Col. Kevin T. Galloway, Army Pain Management program director, who stood by Coots' side at the hearing. Their statement pointed out that Interdisciplinary Pain Management Centers, known as IPMCs, are being established at each of the Army's eight medical centers. The IPMCs will be staffed by a multidisciplinary team of providers working to rehabilitate patients through a program that includes alternative treatments. The written statement to the committee also discussed a tele-mentoring initiative involving the IPMC staffs. Called the Army Pain Management Extension for Community Healthcare Outcomes, or ECHO, this initiative is modeled after a project at the University of New Mexico.

 

In fact, the Army is completing a two-year collaboration with the university to adapt this program.Essentially, ECHO uses weekly video tele-conferencing to link IPMC experts with remote primary care providers. "Treating pain is one of medicine's oldest and most fundamental responsibilities, yet modern medicine continues to struggle in its efforts to understand pain mechanisms and to relieve pain and suffering of our patients," Coots said. The Centers for Disease Control identified prescription medication abuse as an "epidemic" in the United States, Coots said, adding "The military is not immune to these challenges." The Army is adding clinical pharmacists to its patient care teams as another initiative to stop medication abuse. Clinical pharmacists can identify Soldiers with polypharmacy risk -- dangers due to using multiple medications -- and communicate those concerns to health care providers. Coots reported the addition of clinical pharmacists translates into decreased overall costs, fewer adverse drug-related events, reduced hospital admissions, and improved patient outcomes. "Effective solutions must involve innovative strategies, comprehensive solutions and collaborative efforts," Coots told the senators.