David Ramsey, a Medicaid patient who
suffers from chronic pain after falling off a cliff in 2011,
receives acupuncture treatment in Warrensville Heights, Ohio.
Long derided as pseudoscience, acupuncture is increasingly being
used by doctors and officials seeking a new weapon in the
nation’s struggle with opioids. (AP Photo/Dake Kang)
Jennifer McDermott, Dake Kang & Mike Stobbe
Providence, R.I. (AP) -
Marine veteran Jeff Harris was among the first to sign up when
the Providence VA hospital started offering acupuncture for
“I don’t like taking pain
medication. I don’t like the way it makes me feel,” he said.
Harris also didn’t want to
risk getting addicted to heavy-duty prescription painkillers.
Although long derided as
pseudoscience and still questioned by many medical experts,
acupuncture is increasingly being embraced by patients and
doctors, sometimes as an alternative to the powerful painkillers
behind the nation’s opioid crisis.
The military and Veterans
Affairs medical system has been offering acupuncture for pain
for several years, some insurance companies cover it and now a
small but growing number of Medicaid programs in states hit hard
by opioid overdoses have started providing it for low-income
Ohio’s Medicaid program
recently expanded its coverage after an opioid task force urged
state officials to explore alternative pain therapies.
“We have a really serious
problem here,” said Dr. Mary Applegate, medical director for
Ohio’s Medicaid department. “If it’s proven to be effective, we
don’t want to have barriers in the way of what could work.”
The epidemic was triggered
by an explosion in prescriptions of powerful painkiller pills,
though many of the recent overdose opioid deaths are attributed
to heroin and illicit fentanyl. Many opioid addictions begin
with patients in pain seeking help, and acupuncture is
increasingly seen as a way to help keep some patients from ever
having to go on opioids in the first place.
For a long time in the
U.S., acupuncture was considered unstudied and unproven - some
skeptics called it “quack-u-puncture.” While there’s now been a
lot of research on acupuncture for different types of pain, the
quality of the studies has been mixed, and so have the results.
Federal research evaluators
say there’s some good evidence acupuncture can help some
patients manage some forms of pain. But they also have described
the benefits of acupuncture as modest, and say more research is
Among doctors, there
remains lively debate over how much of any benefit can be
attributed simply to patients’ belief that the treatment is
working - the so-called “placebo effect.”
“There may be a certain
amount of placebo effect. Having said that, it is still quite
effective as compared to no treatment,” said Dr. Ankit
Maheshwari, a pain medicine specialist at Case Western Reserve
University, who sees it as valuable for neck pain, migraines and
a few other types of pain problems.
Many doctors are ambivalent
about acupuncture but still willing to let patients give it a
try, said Dr. Steven Novella, a neurologist at Yale University
and editor of an alternative medicine-bashing website. He
considers acupuncture a form of patient-fooling theater.
Acupuncturists and their
proponents are “exploiting the opioid crisis to try to promote
acupuncture as an alternative treatment,” he said. “But
promoting a treatment that doesn’t work is not going to help the
Acupuncture has been
practiced in China for thousands of years, and customarily
involves inserting thin metal needles into specific points in
the ears or other parts the body. Practitioners say needles
applied at just the right spots can restore the flow of a
mystical energy - called “qi” (pronounced CHEE) - through the
body, and that can spur natural healing and pain relief.
In government surveys, 1 in
67 U.S. adults say they get acupuncture every year, up from 1 in
91 a decade earlier. That growth has taken place even though
most patients pay for it themselves: 2012 figures show only a
quarter of adults getting acupuncture had insurance covering the
The largest federal
government insurance program, Medicare, does not pay for
acupuncture. Tricare, the insurance program for active duty and
retired military personnel and their families, does not pay for
it either. But VA facilities offer it, charging no more than a
Jeff Harris signed up for
acupuncture two years ago. The 50-year-old Marine Corp veteran
said he injured his back while rappelling and had other hard
falls during his military training in the 1980s. Today, he has
shooting pain down his legs and deadness of feeling in his feet.
Acupuncture “helped settled
my nerve pain down,” said Harris, of Foxboro, Massachusetts.
Another vet, Harry Garcia,
46, of Danielson, Connecticut, tried acupuncture for his chronic
back pain after years of heavy pain medications.
Acupuncture is “just like
an eraser. It just takes everything away” for a brief period,
and keeps pain down for up to 10 days, said Garcia.
About a decade ago, the
military and Veteran Affairs began promoting a range of
alternative approaches to pain treatment, including acupuncture,
yoga, and chiropractic care.
In 2009, former Army
Surgeon General Dr. Eric Schoomaker chartered a task force to
re-evaluate the Army’s approach to pain, which had centered on
opioids. The focus was understandable - “nobody who has his leg
blown off screams for acupuncture,” said Schoomaker, who is now
a professor at the Uniformed Services University of the Health
Sciences, a military medical school in Bethesda, Maryland.
But he added there was also
openness to acupuncture and other approaches among soldiers and
sailors who, while overseas, had tried non-drug approaches for
chronic pain. Schoomaker said he was inspired to seriously
consider alternative approaches by his wife, a yoga instructor.
Now two-thirds of military
hospitals and other treatment centers offer acupuncture,
according to a recent study.
The military’s openness to
alternatives is “because the need is so great there,” said
Emmeline Edwards of the National Center for Complementary and
Integrative Health, a federal scientific research agency.
“Perhaps some of the approaches have been used without a strong
evidence base. They’re more willing to try an approach and see
if it works.”
Her agency is teaming up
the Pentagon and the VA to spend $81 million on research
projects to study the effectiveness of a variety of nondrug
approaches to treating chronic pain.
While research continues,
insurance coverage of acupuncture keeps expanding. California,
Massachusetts, Oregon and Rhode Island pay for acupuncture for
pain through their Medicaid insurance programs. Massachusetts
and Oregon also cover acupuncture as a treatment for substance
abuse, though scientists question how well it reduces the
cravings caused by chemical dependency.
Product development scientist
Veronika Shevchenko works with patient samples at Banyan
Biomarkers Tuesday, Feb. 13, 2018, in San Diego. The company is
developing a blood test to help doctors diagnose traumatic brain
injuries. (AP Photo/Denis Poroy)
Chicago (AP) -
The first blood test to help doctors diagnose
traumatic brain injuries has won U.S. government approval.
The move means
Banyan Biomarkers can commercialize its test, giving the company an
early lead in the biotech industry’s race to find a way to diagnose
The test doesn’t
detect concussions and the approval won’t immediately change how
patients with suspected concussions or other brain trauma are treated.
But Wednesday’s green light by the Food and Drug Administration “is a
big deal because then it opens the door and accelerates technology,”
said Michael McCrea, a brain injury expert at Medical College of
The test detects
two proteins present in brain cells that can leak into the bloodstream
following a blow to the head. Banyan’s research shows the test can
detect them within 12 hours of injury. It’s designed to help doctors
quickly determine which patients with suspected concussions may have
brain bleeding or other brain injury.
Patients with a
positive test would need a CT scan to confirm the results and determine
if surgery or other treatment is needed. The test will first be used in
emergency rooms, possibly as soon as later this year, but Banyan’s hope
is that it will eventually be used on battlefields and football fields.
Dr. Scott Gottlieb said the test fits with the agency’s goals for
delivering new technologies to patients and reducing unnecessary
The test “sets the
stage for a more modernized standard of care for testing of suspected
cases,” Gottlieb said in a statement.
injuries affect an estimated 10 million people globally each year; at
least 2 million of them are treated in U.S. emergency rooms. They often
get CT scans to detect bleeding or other abnormalities. The scans expose
patients to radiation, but in many patients with mild brain injuries
including concussions, abnormalities don’t show up on these imaging
With Department of
Defense funding, Banyan’s research shows its Brain Trauma Indicator can
accurately pick up brain trauma later found on CT scans. It also shows
that absence of the two proteins in the test is a good indication that
CT scans will be normal. That means patients with negative blood tests
can avoid CT scans and unnecessary radiation exposure, said Dr. Jeffrey
Bazarian, a University of Rochester emergency medicine professor
involved in Banyan’s research.
Bazarian called the
test “a huge step” toward devising a blood test that can detect brain
injuries including concussions.
Koroshetz, director of the National Institute of Neurological Disorders
and Stroke, and other brain injury experts say the test isn’t sensitive
enough to rule out concussions.
“This may be a
beginning. It’s not the pot of gold at the end of the rainbow,”
That prize would be
a test that could detect and guide treatment for concussions and
traumatic brain injuries, similar to a blood test that hospitals
commonly use to evaluate suspected heart attacks, Koroshetz said.
“That’s what we’d
like to have for the brain,” he said.
Banyan has partnered with French firm bioMerieux SA to market the test
to hospitals using bioMerieux’s blood analyzing machines.
Other companies are
developing similar blood tests to detect brain injuries. Abbott has
licensed both protein biomarkers from Banyan and is developing its own
blood tests. BioDirection is developing a test involving one of the
proteins in Banyan’s test plus another one and using a portable device
that can yield results from a single drop of blood in less than two
Quanterix is also
working to develop a blood test to diagnose concussions and other brain
injuries. It has licensed the use of both proteins in Banyan’s test to
be used with its own technology.
In this Oct.
23, 2013 file photo, Belgium’s leading euthanasia doctor, oncologist Wim
Distelmans, speaks in Wemmel, Belgium. (AP Photo/Geert Vanden Wijngaert,
A disputed case of euthanasia in
Belgium, involving the death of a dementia patient who never formally asked
to die, has again raised concerns about weak oversight in a country with
some of the world’s most liberal euthanasia laws.
The case is described in a letter
provided to The Associated Press, written by a doctor who resigned from
Belgium’s euthanasia commission in protest over the group’s actions on this
and other cases.
Some experts say the case as documented
in the letter amounts to murder; the patient lacked the mental capacity to
ask for euthanasia and the request for the bedridden patient to be killed
came from family members. The co-chairs of the commission say the doctor
mistakenly reported the death as euthanasia.
Although euthanasia has been legal in
Belgium since 2002 and has overwhelming public support, critics have raised
concerns in recent months about certain practices, including how quickly
some doctors approve requests to die from psychiatric patients.
The AP revealed a rift last year
between Dr. Willem Distelmans, co-chair of the euthanasia commission, and
Dr. Lieve Thienpont, an advocate of euthanasia for the mentally ill.
Distelmans suggested some of Thienpont’s patients might have been killed
without meeting all the legal requirements. Prompted by the AP’s reporting,
more than 360 doctors, academics and others have signed a petition calling
for tighter controls on euthanasia for psychiatric patients.
Euthanasia - when doctors kill patients
at their request - can be granted in Belgium to people with both physical
and mental health illnesses. The condition does not need to be fatal, but
suffering must be “unbearable and untreatable.” It can only be performed if
specific criteria are fulfilled, including a “voluntary, well-considered and
repeated” request from the person.
But Belgium’s euthanasia commission
routinely violates the law, according to a September letter of resignation
written by Dr. Ludo Vanopdenbosch, a neurologist, to senior party leaders in
the Belgian Parliament who appoint members of the group.
The most striking example took place at
a meeting in early September, Vanopdenbosch writes, when the group discussed
the case of a patient with severe dementia, who also had Parkinson’s
disease. To demonstrate the patient’s lack of competence, a video was played
showing what Vanopdenbosch characterized as “a deeply demented patient.”
The patient, whose identity was not
disclosed, was euthanized at the family’s request, according to
Vanopdenbosch’s letter. There was no record of any prior request for
euthanasia from the patient.
After hours of debate, the commission
declined to refer the case to the public prosecutor to investigate if
criminal charges were warranted.
Vanopdenbosch confirmed the letter was
genuine but would not comment further about the specific case details.
The two co-chairs of the euthanasia
commission, Distelmans and Gilles Genicot, a lawyer, said the doctor
treating the patient mistakenly called the procedure euthanasia, and that he
should have called it palliative sedation instead. Palliative sedation is
the process of drugging patients near the end of life to relieve symptoms,
but it is not meant to end life.
“This was not a case of illegal
euthanasia but rather a case of legitimate end-of-life decision improperly
considered by the physician as euthanasia,” Genicot and Distelmans said in
Vanopdenbosch, who is also a palliative
care specialist, wrote that the doctor’s intention was “to kill the patient”
and that “the means of alleviating the patient’s suffering was
Though no one outside the commission
has access to the case’s medical records - the group is not allowed by law
to release that information - some critics were stunned by the details in
“It’s not euthanasia because the
patient didn’t ask, so it’s the voluntary taking of a life,” said Dr. An
Haekens, psychiatric director at the Alexianen Psychiatric Hospital in
Tienen, Belgium. “I don’t know another word other than murder to describe
Kristof Van Assche, a professor of
health law at the University of Antwerp, wrote in an email the commission
itself wasn’t breaking the law because the group is not required to refer a
case unless two-thirds of the group agree - even if the case “blatantly
disregards” criteria for euthanasia.
But without a request from the patient,
the case “would normally constitute manslaughter or murder,” he wrote. “The
main question is why this case was not deemed sufficiently problematic” to
prompt the commission to refer the case to prosecutors.
Vanopdenbosch, who in the letter called
himself a “big believer” in euthanasia, cited other problems with the
commission. He said that when he expressed concerns about potentially
problematic cases, he was immediately “silenced” by others. And he added
that because many of the doctors on the commission are leading euthanasia
practitioners, they can protect each other from scrutiny, and act with
Vanopdenbosch wrote that when cases of
euthanasia are identified that don’t meet the legal criteria, they are not
forwarded to the public prosecutor’s office as is required by law, but that
the commission itself acts as the court.
In the 15 years since euthanasia was
legalized in Belgium, more than 10,000 people have been euthanized, and just
one of those cases has been referred to prosecutors.
Genicot and Distelmans said the group
thoroughly assesses every euthanasia case to be sure all legal conditions
have been met.
“It can obviously occur that some
debate emerges among members but our role is to make sure that the law is
observed and certainly not to trespass it,” they said. They said it was
“absolutely false” that Vanopdenbosch had been muzzled and said they
regretted his resignation.