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The Scope and Opportunity of Oncology Acupuncture

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Hello, everybody. I am Dr. Yair Maimon, and I would like first to thank the American Acupuncture Council for hosting this show. Today I will focus on something which is very close to my practice and my experience, which is oncology acupuncture. In the last years, I can say there’s been an amazing opportunity for acupuncture because there is so much evidence and because we can do so much for oncology patients. So the whole field of oncology has been opening up. I’ve been practicing all my life, also in hospital setups and being a head of oncology, integrative oncology acupuncture departments. So I can see both from my practice, I can see from the response of the other oncologists and regular medical care that is seeing more and more the importance of acupuncture in this field.

It’s almost hard to believe how much we can help in oncology. I can just tell you it just now I’ve seen a patient, I’m still just after my clinic, she came with so much pain. She has a sarcoma in her lower abdomen that was just removed. Recently. She came all kinds of hunched in with her husband and I said just lie down, and I just need column four, stomach 37, stomach 39, and waited a few minutes. And then she started to look at me and said, “Wow, this is the first time in days that I’m back to my power, back to myself,” and this kind of changes, especially in oncology, because the patients are very deficient. They’re very weak.

We’ll talk more about the indications that we see. They’re responding both extremely well, they’re able to tolerate their cancer, their treatments, cope better with the disease emotionally and mentally. So to me, this has been an amazing kind of journey, which I didn’t really plan, but I saw how much I just found myself doing oncology acupuncture is … Actually, especially because about almost 20 years ago when I started, everybody were afraid of treating oncology with acupuncture. I was in China, saw the amazing results and went back and started to treat patients. And since then, I’ve been treating a lot of oncology patients, doing a lot of research. If you’re interested, you can read my research. I have more than 20 peer reviewed publications, most of it around the oncology, but also around other areas. So in this talk, I would like to speak about the opportunity and the scope of oncology acupuncture, because the scope is quite remarkable. So, I will start with the slideshow, please.

First of all, the reason there is so much awareness about oncology and the field of acupuncture is because we get more and more evidence. The amount of evidence is even … I think even people are practicing Chinese medicine and not aware to the amount of evidence of the effectiveness and the safety that oncology acupuncture has. So, first I’ll say just some words about evidence, because when people say evidence, they always expect human studies, comparable studies in human, but the world of evidence, I just want to point out, is actually based also on clinical experience. It’s based on patients and patients’ report. And also obviously the best external evidence that we can have, by peer review by different studies that were done. Oncology is one of the really robust area where there’s more and more studies that are repetitively showing their effectiveness.

When we’re talking about studies, we’re talking about the pyramid of evidence, and in the top of the pyramid there is systemic reviews. Under this, there is the randomized controlled trials, then there’s cohort studies case reports. So, all of these are building the evidence that is trusted in Western medicine. And one of the things that we have to understand that the higher we go on this pyramid, the strongest the evidence of what we are showing and what we are knowing. So for us, it’s really translating then what we know in the clinic, which has been known for years to be effective, into a scientific kind of objective and reflection. So I just want to point out that if there is enough randomized clinical trial, you can do a systemic review. It means you can take a lot of trials together and look at them from above and see if a field is effective.

From a scientific point of view, it’s a very kind of robust and high way to look at Chinese medicine. So I decided to start and we’ll talk about especially the amount of studies that are in oncology acupuncture, also to show you there’s quite a lot of studies in the acupuncture overall. I just recently looked, there’s 32,000 studies in PubMed and I think around about … I can estimate around 1400 studied just in cancer care. That’s quite a lot more than usually people would think there is.

When I want to talk about the scope, I would like actually to show one of the quite recent, it’s only been around for a few years, one of the systemic review of the effectiveness of acupuncture on related therapies, [inaudible 00:07:05] acupuncture, and it’s an overview of systemic reviews. So this is like, if we talk about systemic reviews, this is even one above it, and it was published in one of the publications of Nature, Scientific Report. We have a very high level looking at effectiveness of a field and on the scope of a field.

Let me explain. This is the overview of systemic reviews. This is this paper that I’m going to present. It looks on systemic reviews, which is based on individual studies. So, if there is enough individual studies let’s say on nausea and vomiting, they do a systemic review. Enough studies on pain, they do a systemic review on the studies on pain. In this one there’s been enough systemic reviews, so it overviews them. In this study, they took 23 systemic reviews, which included almost 250 individual research studies and about 17,000 people who have been involved in these individual studies.

So, this is kind of quite a big pyramid to look at the way acupuncture is effective in oncology. So we are looking really at the top of the top of the pyramid, really this kind of tip of the pyramid. We look at 23 systemic reviews, which is looking at almost 250 individual research. Most of them are actually randomized clinical trials, and it looks on a population of 1700 cancer patients.

This is the type of scope that they’re looking at. So there is enough research. It doesn’t mean that everything reached the level of saying, okay, the evidence are extremely conclusive, but there is enough research in these areas and that shows you the scope of acupuncture in cancer care. So, if you look at fatigue and by the way, if fatigue is one of the most common. Almost all cancer patients suffer from fatigue, either chronically or at some period, and acupuncture is extremely effective in relieving fatigue. This in itself is a phenomena. And then reducing those and vomiting, but also in leukopenia. These three I marked in red here, because in this systemic reviews, they found out that these three indications have enough scientific rigorous studies to show the effectiveness. So just these three are quite impressive. So we see the effect in fatigue. We see nausea and vomiting, which is related to a lot of chemotherapies and other therapies that patients are getting. And also sometimes for the cancer itself, if they’re in the digestive system, and to reduction of leukopenia, white blood cells.

I’ve done extensive research in herbal medicine for leukopenia and in neutropenia. So, Chinese medicine is very good in really protecting and invigorating the bone marrow, which is producing the white and red blood cells. Then cancer related pain and pain is accompanying many cancer or cancer treatments. Hot flashes. We’ll talk about hot flashes in this show or in this lecture. Hot flashes is side effect, especially for gynecological cancer and breast cancer, because many of these patients are receiving anti-hormonal therapy and suffering from severe hot flashes, which are really every part of it. But this is just a good example. And I’ll talk about it more extensively later. It’s really reducing the quality of life, and sometimes to the point where patients want to stop the anti-hormonal therapy, which has its own effect, because the quality of life is diminished.

Then hiccups. I had a few cases of hiccups that nothing stopping it and believe me if you have hiccups all the time, it’s a real terror. So this is like … and the acupuncture can stop it just usually within a treatment or two. They’re quite rare, but if there are, remember that acupuncture is very effective. Improving patient general quality of life management, management of the xerostomia, which is the dryness of mouth, especially from radiation. There’s many studies on this. Acupuncture is one of the effective treatment for that and large intestine too, which I extensively also lecture about studying of the large intestine, too. It’s actually been proven to increase the salivation in the mouth and it’s good, not just for cancer, all of it. Also, when you learn how to treat it, you also learn how to treat it in other patients that suffer from these symptoms. The same with shortness of breath.

Lymphedema actually hasn’t shown up to be extremely good, but was studied extensively. This is where the lymph system is not working well, especially for patients with breast cancer, that some of their lymph nodes were removed, so they have this kind of [inaudible 00:12:46] edema and lymphedema, so they tried acupuncture for it. I generally don’t treat lymphedema, but it was part of what they reviewed in this study. Then general improvement of physical wellbeing. So, you can see quite a lot of indication that there is a lot of studies. Like I said, the top ones are the ones that there is enough evidence to say that we can conclude that this intervention, which is acupuncture, is helpful, but the scope is actually what we see in the clinic and the scope is what you see coming up more and more in different research.

One of the most important things is safety, and acupuncture has been strongly proven safety, and here is a study of 1700 people that says that there is no serious side effects that were reported in any of the studies. So, acupuncture could be considered as a very safe complementary in cancer care. When we’re talking about any intervention to medical system, then there’s two concerns, efficacy and safety. And definitely for safety, we are winning. There’s more studies on safety actually, but this study is just a great example, which is specific for cancer care, showing the level of safety that acupuncture has. To us maybe it’s obvious, but if you communicate with the medical community and you can say this word, we have proven safety, it is very meaningful. That’s what I find acupuncture is now, and especially in the United States has been practiced more and more in different medical centers and hospitals, and it provides today the knowledge and ability to treat oncology patients. I think it’s a great opportunity for acupuncturists and I’ve been extensively teaching courses and specialization all around the world and in the States. If you’re interested, probably follow my website and see when a course is coming soon and if it’s interesting for you.

Even when we look at the NCI, the National Cancer Institute, I can say overall acupuncture has been reviewed in a very positive way. You have to read it always because it’s updating, changing. I’ve been following this webpage so I can see there is always the work there, but just for the scope also they’re stating that cancer patient is using acupuncture and they’re giving you the scope from pain management to nausea, vomiting, fatigue, hot flashes, dryness of mouth. Neuropathy is another big field which has been proven that acupuncture is helping neuropathies, these kind of pains and lack of sensations that patients get, especially from chemotherapy and especially from different taxanes and other chemos. If it’s become chronic, it is a really debilitating condition and acupuncture is one of the best thing to help it and also help to recover from it to prevent a chronic state. There’ve been a lot of studies on the neuropathy.

Anxiety. The whole field of anxiety and the whole field of emotional side, this is very close to my heart and practice. To me, acupuncture is a transformative medicine. It can really transform on the very deep level how patients to get in touch with their Shen, with their spirit. And one of the worst thing that follows cancer patients is fear. It’s understandable for a certain period, but it’s definitely taking away one’s power from getting healed and even the opposite. When there is a lot of fear, to me, the prognosis is not good. I see very difficult patients with difficult cancers in very difficult stages. When I see no fear there, I know they will do well. Even if they won’t live full span of whatever we can say about life, they will have a better quality of life and they will exceed usually what is expected. In my clinic, we’ve been looking at many patients and we recall there is a lot of what you call exceptional patients. I think exceptional patients, a lot of them, are due to this connection of Shen to the body and that’s where healing is really coming from.

So, acupuncture has been studied for anxiety, depression, but also general wellbeing and also sleep. So obviously if the Shen is disturbed, the sleep is difficult. So this is from the NCI. You can go, there is more evidence there. This is just for the scope of this lecture. I’m more talking about scope or opportunities. We don’t go deep into all their research projects and all the research that we have. And even they’re showing the laboratory animal studies on different aspects of cancer care and they show that acupuncture has a very strong effect on the immune system, on immune regulation.

Immune modulation is really the key thing. If you help the immune system to reach a better balance, you are helping another also pathway of treating cancer, helping another way of patient to avoid secondary infection, to deal better with their medication if they’re taking. You’re preventing a lot of other potential side effects. Now we are seeing different pathways, how acupuncture is affecting immune system and in animal models there’s been a lot of studies that has been out there, but there’s also a few studies in humans. One of them is from Dana-Farber Hospital. That was part of Harvard Medical Center that was published by Weidong a few years ago, but we see more and more studies coming up on the effect of acupuncture on immune system and obviously I, a lot of time, combine with herbal medicine or specific formulas which I am studying.

From the JCO, the Journal of Clinical Oncology, again if you want to talk about scope, especially with oncologist or medical team, you have to quote very reputable journals. This is definitely a very reputable journal. It has a lot of studies on acupuncture, surprisingly. This was a systemic review of acupuncture, not the one I liked the best, but again some papers you like the design more than others, but again it’s a good review and you can see more showing the scope. So again, most of the things that we talk about are coming up, but there is prolonged postoperative ileus, which is another area of study. A lot of patients, and especially cancer patients, undergo surgery. And because of the anesthesia, there is lack of bowel movement. So acupuncture can really increase bowel movement. And that’s also what I find in the clinic. We have a very strong effect on bowel movement and a lot of patients are suffering from constipation because of their antiemetic medicine or because of their cancer or other disturbances, especially lack of appetite, which is sometimes the killer because people are really dying from malnutrition.

So, acupuncture has very strong effect on the justice system. So I brought also the scope, to show the scope from different studies. So this is a systemic review before I’ve shown systemic reviews and also the NCI view on that field. So you can see from many different directions, what we call conventional points of view. It’s quite surprising how acupuncture is accepted and is looked into the science that we can see by now. Even when I looked at clinicaltrial.gov, where you register clinical trials, there is almost 150 registered trials on oncology acupuncture. So there is a vast amount of effort in proving the efficacy of acupuncture in oncology and even some phase three trials. Phase three means … Usually a trial will go from a pilot, phase one, phase two. That’s randomized clinical trial. Phase three means there is enough people to compare between two groups, usually placebo and real or control and real.

And after a phase three trial, in Western medicine, it’s almost a level of this is what patients should get. So this is like beyond any doubt that this intervention is proven effective and that’s when we talk evidence. So we see that acupuncture is moving up in oncology acupuncture in phase three trials and this is a very interesting. I’m actually now in the midst of taking all the trials that we have until now and putting it into a book, which is evidence based oncology acupuncture. It will summarize the trials, but not just would summarize, but also would show the acupuncture points and what we can learn from different trials, if there’s interesting acupuncture points that we use. And also the frequency. I think many times we have to understand the frequency of treatments and when we don’t see good results, a lot of time it relates either to the frequency of treatment, the design of the trial.

So we are now kind of compiling, me and a colleague of mine, Dr. [inaudible 00:23:13], are compiling all the current and the good trials to see what we can learn from them as far as points and the evidence and then also that you can show … learn for yourself, but also show people who are in regular medical care the amount and kind of depth of studies in oncology acupuncture. I want to go to one trial. I like it very much. Also the people who did it, to me, very active at the SIO, which is the Society of Integrity of Oncology, both in their clinical practice, in their acupuncture. We have a special acupuncture group there and a research group and Eleanor Walker, she’s the head of the department of radiation oncology in Henry Ford Hospital in Detroit, and she carried a few trials with her team. They’re very good team there.

This is not … It’s one of the what we call older, if there is such few years as older, but actually it’s not true. It’s still very relevant. I like the trial, and I like that the design and also what we can learn from it. So I would like to share with you this trial and some points that we use, so maybe there’s some take home message from here. There have been few trials on the same idea of the reduction of hot flashes, and especially the reduction of hot flashes in cancer patients is important because it’s very common, especially in breast cancer and other gynecological cancer, especially if they’re hormone sensitive, to give this patient anti-hormonal therapy, and this anti-hormonal therapy creates different side effects.

The main one is hot flashes. The other one is joint pain. Both have been shown to be effectively treated by acupuncture. Many patients are stopping their treatment, this anti-hormonal treatment, which is designed to prevent reoccurrence of their cancer because of the side effects. So we are both increasing their quality of life, but also allowing them to adhere to the treatment, which is important for them. And so in this trial, although not big, but they’re interesting, they did what we call it head to head trial. So, they compared venlafaxine, which is an irregular SNRI drug. Here we call it Effexor, so I’ll call it Effexor, comparing to acupuncture. So it’s a head to head, drug intervention compared to acupuncture intervention. So you’re looking which one is more side effect, which one is better. But interestingly enough, they also follow this trial a year later. So, this was 12 weeks. So for 12 weeks, patients receive either acupuncture or venlafaxine and they looked at different outcomes and they measured it also and followed one year later. So, after 12 weeks, both were stopped and then they’re following up the effect, if there is any of the effect in the group of the acupuncture or of the venlafaxine.

So the results, especially immediately after when they administered both the acupuncture and the drug, both groups had significant decrease in hot flushes, so both were effective, so they had less symptoms and better quality of life. The first thing is acupuncture was as effective as venlafaxine, so that’s quite impressive. But two weeks after the treatment, when they stopped the both acupuncture and the drug, there was an increase in hot flashes in the venlafaxine group, but not in the acupuncture group. So, in the acupuncture group there was still a effect of the treatment also two weeks after the it was stopped, while in the drug, once you stop the drug, you stop the effect. Which carries always a lot of thought about acupuncture, because acupuncture is a curative medicine. It’s not a palliative. So it doesn’t just affect that the moment that you are given the treatment. It changes something in the body, allowing it better healing mechanism.

And when we look deeper at the result, venlafaxine had a lot of adverse effects. So there was nausea, dry mouth, dizziness, anxiety. There’s a lot of symptoms that patient that took it experienced. While with the acupuncture, there was no negative side effects, even the opposite. They had some additional benefits like increase in sex drive in some women and most reported improvement in their energy, clarity of thoughts, a sense of wellbeing. This is from the real article, so this is a good reflection on the total effect that we see from acupuncture, which is different than drugs. Again, for us, an acupuncturist, people who do Chinese medicine, it’s obvious. But believe me, to see this kind of results in a trial, in a high reputable journal, it is very impressive and to me, it’s the beginning of a change. Beginning of a change that the scope of our medicine and the effectiveness are viewed in a different way.

That’s why I’m I call this a lecture the scope, but also the opportunity. Once you see more and more respect to this form of medicine, there’s a greater opportunity for us, both to effect patient, and to enter into a best care. And to me, the best care is always integrity of care. So the conclusion, acupuncture is appeared to be equivalent to the drug therapy in these patients. It is safe. Again, we see safety, effective and durable. Treatment for vasomotor symptoms, which means hot flushes secondary to longterm anti-estrogen hormone used in patients with breast cancer. So, this kind of summary, this kind of a conclusion in this type of journal, it’s definitely meaningful and meaningful to the whole profession. Now let’s look at the points they use. I mean, nothing outstanding, but they did a good design, which means they gave … Some points were all the acupuncturists used and some were like secondary points that the practitioner could choose a point according to the condition.

And to me, this is a much better design of trials than fixed points because we know acupuncture, we don’t give the same treatment to all the patients. We adjust and we do personalized medicine. So if you do a trial, you can take this aspect out and suddenly create a fixed treatment and just hope that it’s always worked. I can talk about it quite a lot. I think in herbal medicine, some things we can do. In acupuncture, certain places maybe a little bit. But overall a better design is a design like this, which is closer to real life and closer to good acupuncture when we are able to adjust and tailor the treatment to the patient. So they use different points. I kind of group them in my own way. The grouping is my grouping in the article is just a list and explanation.

So when there was more Yang, probably more Heat, they added Du-14, especially if there’s a lot of Heat in the patient. Or Du-20 to [inaudible 00:31:56]. If there mores Qi complaints, then use stomach 36, Ren-6 and Lung-9. And I put Hun, but a lot of mental side and difficulty in sleeping can be treated through the Hun. I extensively teach about the Hun and palm and how they interact, and I think it’s a core understanding of how to use points in Chinese medicine. So gallbladder-20, liver-3 for pains and for Hun and for the liver, and for the Shen, pericardium-7 and heart-7. So this is the points that they could choose one point out of this in order to make a personalized approach. It was carried for 12 weeks at the beginning, for the first four weeks, twice a week, and then another, I think, four weeks, once a week.

So this is kind of completing a good … I think 12 sessions is a good period to have a sustainable change. And I mean sustainable, when they looked at one year later there was still difference obviously between the group and still many women that got this 12 week treatment are experiencing the benefit of it and also in general wellbeing. So, I think this is impressive. Again, there’s more trials, but if you want to follow me, you will see me talking about more trials and more possibilities how to treat oncology patients. But I think it is showing the scope, showing the opportunity and really strengthening this, that we can feel very confident about the effect of acupuncture and especially in this group of patient and for these kind of conditions.

So I would like to finish up with one of my mentors, Father Larre. I was lucky to have two very good mentors along my studies and really to take us a bit above just research, but into the worth of acupuncture in the 21st century, in the words of Chinese medicine in this century, especially with Western medicine on one hand is very developing, but on the other hand, I think there is a great need to integrate with what we are doing in there’s a great need for what we can provide to patients. “By returning to the classical roots of Chinese medicine, we can make a truly significant contribution to the medicine of the future.”

And to me, combining the medicine that we are doing that comes from an ancient roots with the modern medicine and its ability also to look at in a kind of objective way, where we are effective or not effective. That’s why I’m carrying a lot of research. And I have my own lab and we look even on a cellular level and we look at different biomarkers. All this it’s strengthening what we are seeing in the clinic and all this is helping to create a better future medicine. So to me, whatever we are doing is key and important.

Thank you for joining the show and I will just wish you all the best of health, especially in these times. Be well and safe and healthy. Thank you very much for watching it. All the very best.

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