It is for pain relief that acupuncture is perhaps best known. The NIH consensus report (which had been published in JAMA) cited its demonstrated ability to relieve post-operative dental pain. There were "reasonable studies" that it was effective for menstrual cramps, tennis elbow, and fibromyalgia. More recent studies show acupuncture to be efficacious for osteoarthritis of the knee. This is the most common type of knee arthritis, particularly in older people, and this 2004 study in the Annals of Internal Medicine enrolled 570 patients. The three treatment groups got true acupuncture, "sham" acupuncture (the needles didn't actually puncture the skin, but were taped to it), or group-education sessions. True treatment reduced pain by 40 percent, which was greater than the results in the other two categories, although the "sham" subjects did better than the education group.
The results of a single study are often promising but need independent confirmation. The Annals published a 2005 analysis of twenty-two trials of acupuncture for chronic low-back pain. Needling was more effective than doing nothing, but only comparable at best to massage or medication, and not as good as spinal manipulation.
Two studies of acupuncture for headache demonstrate another problem. A study of 401 patients in England, in the British Medical Journal (BMJ), compared twelve acupuncture treatments over three months with "usual care." It concluded: "Acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. Expansion of National Health Service acupuncture services should be considered." A 2005 paper in JAMA comparing twelve sessions (over eight weeks) of true, sham, or no acupuncture found real and sham acupuncture equally effective and better than no treatment. Sham therapy in this case was the needling of non-acupuncture points.
This highlights a recurrent problem in evaluating acupuncture studies. Since the "placebo effect" of any medical intervention is improvement, at least temporarily, in about 40 percent of' patients, any proof of a treatment's effectiveness must use a comparison group of people who only believe they were treated. This is easy enough with pills: the placebos only need to look like the real thing. But subjects know whether or not they're being stuck with pins. True acupuncture uses known, specific points where needles are applied for particular conditions. Sham treatment may use other points. Surprisingly, such "pretend" treatment sometimes appears effective, as in the JA4IA headache study above. The.JA1lA authors conclude, as if unimpressed, that "Acupuncture was no more effective than sham acupuncture in reducing migraine headaches," but remark that both fared better than no needles at all. The British study, where the control group simply got their usual medical care and nobody got simulated acupuncture, is more enthusiastic. Even though both studies note that treatment helps, acupuncture is found no better than placebo by.JAt{IA and worthy of government investment by the Bill!.
A 2000 .I:L{IA paper looked at women with breast cancer receiving chemotherapy, to see if acupuncture could reduce the associated nausea and vomiting. This time electroacupuncture was used; this means the needles were connected via alligator clips to a battery (some believe this enhances the effect). Control patients were lightly needled at non-points and the battery, although connected, was not turned on. A third group got neither of the above. Electroacupuncture was clearly better than mock therapy, and mock treatment was better than nothing at all. This is more in line with what researchers hope to achieve: There is a real and measurable effect of just believing one has been treated, but the response to true therapy is better than placebo.
Acupuncture has an interesting history in treating addictions. Some of medicine's best discoveries (like penicillin) have been accidental. In 1972, Dr. H. L. Wen, a Hong Kong neurosurgeon, was in the process of anesthetizing a patient who happened to be an opium addict, and when a needle was applied to the ear, the patient unexpectedly announced that he had lost his craving for opium. British surgeon Dr. Margaret Patterson was training in Hong Kong at the time; she learned about the technique and brought it back to England, with a few refinements. Her patients did well with it, as did the cocaine-addicted patients of Dr. Michael Smith at Lincoln Hospital in the Bronx, New York, but randomized, controlled trials-considered a research gold standard-have mostly failed to demonstrate a benefit.
Acupuncture vs. Hypnosis
Unlike hypnosis, acupuncture has been unsuccessful in published trials for alleviating irritable bowel syndrome. Also, there are no significant papers to suggest that it will rid you of warts (as hypnosis might). Yet it is tempting to make some comparisons. Both have been used since time immemorial; both can provide surgical anesthesia and pain relief, and can lessen chemotherapy-associated vomiting. Both are hard to study by comparison to "control" subjects. And both require considerable practitioner skill along with amenable patients. Acupuncture can be used on animals, who presumably don't bend to the power of hypnotic suggestion. Human fetuses are also not presumed to be suggestible, but a 1994 study in the Archti'es of Faint/yMeStcine achieved conversion of breech to normal delivery position in about the same proportions of women as in the moxibustion paper, above, only they used hypnosis.
Acupuncture versus hypnosis was tested in a 1997 study on male sexual dysfunction in Istanbul, Turkey. Sexual function improved by about 45 percent with placebo (as would be expected), 60 percent with acupuncture, and 75 percent with hypnosis. The numbers of patients treated were insufficient, however, to reach statistical significance. In a 2001 comparison at the University of Pennsylvania's dental school, patients with head and neck pain were studied. Acute (recent onset) pain benefited most from acupuncture, while those with psychogenic pain (having a psychological rather than a physiological origin) did better with hypnosis. In "Mechanism of Analgesia Induced by Hypnosis and Acupuncture: Is There a Difference?" in the journal Pain in 1991, a Swiss team, using volunteers who immersed their hands in ice water until it hurt, found that acupuncture and hypnosis both significantly reduced the pain, but that neither seemed to work through the body's natural opiate (endorphin) system.
How It Works
The bulk of the evidence, however, seems to favor an endorphin link to acupuncture's effect. Much of this work has been done in animals. An experiment on rabbits in the 1970s showed that the fluid that bathes the brain and spinal cord taken from one rabbit following acupuncture and then injected into a second rabbit appeared to confer pain relief; something in the fluid was transferable.
In other studies, the drug naloxone, which blocks the effects of opiate (i.e., narcotic) pain killers, also blocks the paindiminishing quality of acupuncture. It was discovered in the 1970s that our brains contain receptor sites for opiates, as if these narcotic-type drugs serve some physiologic purpose. Since everything the body does must ultimately make sense, soon afterward came the discovery that the body makes opiates, which we call endorphins, to bind to these sites, providing in a natural way what painkillers accomplish.
Acupuncture, and particularly electroacupuncture, where an electric current is applied to the needle, have been shown to increase the body's production of these endorphins, particularly at certain currents. This could explain why pain is relieved. Other explanations propose that the pin-sticking sensation may jam other pain signals to produce anesthesia. Although this sounds a little like telling someone to pinch their thigh real hard so as not to notice that they have a toothache, the purported mechanism is more complex.
The Chinese view acupuncture as a way to manipulate the flow of energy (which they call "Qi") through channels they know as meridians. These meridians, twelve in all, are elusive when searched for by Western scientific techniques. But the acupuncture points themselves can be demonstrated electrically. An American team consisting of two biophysicists and an orthopedist published "Electrical Correlates of Acupuncture Points" in a MEDLINE-indexed electrical engineering journal in 1975.
They showed that many of the centuries-old traditional Chinese acupuncture points could be found electrically, and in the same spots in different patients. These tiny ar
eas had a slightly positive charge relative to surrounding tissue. They conducted electricity better, which is to say that their electrical resistance was lower. This fact is the basis for gadgets sold as acupuncture-point finders. While a metal plate touches the skin elsewhere, a metal probe slides around the skin searching for points. Encountering one, a circuit is completed through the body via the plate, causing a buzzer in the device to sound or a bulb to light. No self-respecting acupuncturist would use one of' these things (why would they steed to, anyway?), and readings can be thrown off by moisture on the skin or how hard you push the probe, but I've played around with an inexpensive point finder (prices now begin at about $150), and I can tell you that the same points buzz/light consistently, whether I slide it over my own hand or my cat's ear. Acupuncture points are real; you can't Find them with a microscope, but proper electrical equipment does the trick.
It is not clear why needling of non-points, in controlled, clinical studies, sometimes produces the same effect as true point treatment. Some trials with electroacupuncture show endorphin release that's independent of where the stimulus is placed. Psychiatry professor George Ulett of the University of Missouri, writing in the Skeptical Inquirer (2003), feels acupuncture to be "a potent technique giving lasting relief from chronic pain." Endorphin release explains its effects, he says, not a metaphysical system of meridians and Qi.
Endorphins, as I mentioned, were discovered during the 1970s. Does that mean that acupuncture was witchcraft in 1970 and science in 1980? Much of what is in this book simply awaits the scientific discoveries that will pull it from paranormal/metaphysical into mainstream respectability. Remember that in 1972, Stanford University's medical school wouldn't host an acupuncture conference. Now, even a skeptic realizes that the technique works, and offers a scientific explanation. Progress.
When I first read Dr. Rosen's report of how one pin stuck and twirled in the forearm allowed a chest to be cracked open, I wondered if there was an organ system in the body that had not been discovered. Perhaps this system had to do with the flow of electricity through the body and its resultant effects on the body's chemistry. Acupuncture anesthesia may be accomplished through endorphin release, but you cannot give someone enough morphine to operate on them while they're still conscious. Nerve signal interference doesn't quite seem to explain how a man comfortably takes a few sips of tea while there's a gaping hole in his chest. And why would stimulation of certain parts of the skin trigger endorphin release in the brain, anyway? Why does the stimulation have to be done in a specific way, whether it's by applying an electric current (only certain currents work) or twirling a needle? We don't know, but we're getting there. Acupuncture is respectable now, and its mechanisms are at least partially understood.
Seventeen
Life as a Hologram
Karl Lashley, mentioned earlier, ended his quest for the physical mechanisms of memory in frustration, as he could not localize storage sites. In 1946, a young neurosurgeon named Karl Pribram came to work with him.
The Hologram is Born
One year later, the Hungarian physicist Dennis Gabor was looking for a way to get better resolution through an electron microscope. He used a form of calculus (devised by the Frenchman Jean B. J. Fourier in the eighteenth century) that showed how any pattern could be translated into waveforms, which could then be converted back to the original pattern. Using light beams, made of waves, he produced the first-albeit crudeholograms. Since each light wave used bounced off the object and then spread onto the entire surface of the film, each point on the film contained information sufficient to reconstruct the whole object. More points merely meant better clarity. Impressed by this, Gabor christened the image a hologram, Greek for the "whole message." He would later win a Nobel Prize for it.
When lasers came along in 1960, their unique light was ideal for producing holograms, and these are the sort you see today. They are formed when two laser beams coming from the same source intersect, one coming off the object to be "photographed," the other acting as a reference. The resulting interference pattern contains the information needed to reconstruct the image. This is a difficult concept for most of us to grasp (I don't fully understand it either), but the three-dimensional holograms that ensue can be stunning. Some holographic images are projected in such a way as to allow us to walk around them, full circle, seeing the object as it would look from all sides.
Holographic Memory
Karl Pribram became fascinated by memory's anatomic mystery and by the fact that removing sizeable chunks of brain tissue only made it fuzzier without obliterating anything, just like in a hologram. But Pribram carried this past the metaphor stage. In his book Lanquage+ of the Brain (1971), he theorized that neural activity and perception produce hologram-like interference patterns within the brain. These patterns could serve as the basis for memories that behave as if they were somehow distributed through large parts of the brain. Dr. Pribram, currently a Distinguished Research Professor at Georgetown University, has recently embellished his theory with some mathematics and quantum physics.
The fact that holograms can be reconstructed from any part of' the picture is also a feature of memory. Since different areas of the brain process, for example, vision, hearing, smell, or emotion, it has never been quite understood how any part of a memory can bring up all the parts. A rose-red, fragrant, thorny, beautiful, perhaps associated with sunshine or being outdoors-flashes into memory in its entirety, even though the memory is evoked by only one of its components (like seeing something red). Holographic patterning within the brain would explain this. In Pribram's words, "What better mechanism can be operating than the associative recall provided by the holographic process?"
Holograms also have the ability to store huge amounts of easily retrievable information in tiny spaces-as does the brain. Although the movement of molecules within the nervous system generates electrical activity, including waves, Pribram notes that holography does not necessarily depend on waves. He cites a computer program that uses Fourier's mathematics, upon which holography is based, that constructs holograms that are not based on light.
Pribram goes on to describe experiments on human vision that show a relationship with Fourier holograms. He believes that the junctions between nerve cells (synapses) generate small electrical waves, in addition to simply passing an impulse from one nerve fiber to the next. The interaction, or superposition, of these waves would behave holographically, and in accordance with Fourier's mathematics.
This Looks Familiar
Now let's mention deja vu. Again. Literally it means "already seen." This phenomenon of suddenly having a feeling of familiarity, like you've been there before, can be found in 30 to 96 percent of the population, depending on the study. Most of these feelings qualify as normal-just another aspect of the human experience. Occasionally, in the context of an ongoing mental illness, they can be prolonged, frightening, and realitybending. An interesting article in The American Journal ,f Psych in 1990 is appropriate here.
In "The Deja Vu Experience: Remembrance of Things Past?", two Dutch psychiatrists take a comprehensive look at the process. Common as it is, the cause is generally not clear. In rare cases, electrical activity in the brain's temporal lobes, which are intimately associated with memory, triggers d&ja vu. Wilder Penfield, the neurosurgeon (described earlier) who evoked memories by electrical stimulation of the temporal lobes as he searched for the source area of a patient's epilepsy, was able to find a spot that reproduced a sense of deja vu in six of 214 patients. In some patients, a temporal lobe-based seizure disorder manifests only with recurrent, strong d&ja vu sensations. This is unusual, but it has been known to happen. Why activation of a particular brain area would elicit a sense of having "been there before" is another story.
The authors review all the published speculations as to why most of us occasionally feel like we've seen it all before. Anxiety. Exhaustion. Emotional trauma. Stress. Fatigue. Drugs. None of these does it justice, as most deja vu is ju
st ... normal. Paranormal explanations would include intrusions from past lives, telepathy, or recall of things seen during an outof-body episode. These don't settle the issue either. Freud wrote that deja vu could be the result of a dream, or could even occur during a dream. Enter holography.
The article ends with a discussion of technological models. The authors believe that holograms would explain how a complete memory is reconstructed by stimulating only one section of the brain, and why a memory fails to disappear if this section is removed. They speculate that an indistinct, out-of-focus fragment of a holographic memory might match an entering image as it begins to form in memory. The result: a brief sense of recognition.
Oh ... the Pain
In the journal Geriatrics (2002), Dr. Albert L. Ray, medical director of the Miami Pain and Integrative Medicine Center, talks about the pain hologram. Here, the term is metaphoric: Pain is a complex interaction of input signals from the damaged area, a localization process so you know just where you hurt, an emotional reaction based on your baseline level of inner peace and a remembrance of pains past. Ray calls it "a projection of multiple components that come together." Holograms, as mentioned, are formed by projections of interacting rays of' light. Ray gives examples of older patients with neck and shoulder pain from spinal disc disease; fear or ongoing stress turns up the volume; another patient with the same disc herniation feels no pain at all.
The Holographic Universe
But wait, there's more. Jacob D. Bekenstein, professor of theoretical physics and laureate of the Israel Prize in physics in 2005, wrote an article for Scientific American (August 2003). With the title "Information in the Holographic Universe," this astrophysicist likens our universe to one giant hologram.
The Witch in the Waiting Room: A Physician Investigates Paranormal Phenomena in Medicine Page 17