Abstract
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Consider how Newton's Theory of Gravity morphed into General Relativity. It was not because of some new discovery, a finding that contradicted the old theory. Rather, the revolution was entirely the product of Einstein's creative mind and his realization that, if one were in an elevator that was in free fall, it would feel no different than being at rest…until one reached the bottom, that is. This got him thinking about accelerating reference frames, the effect of gravity on space and time, etc. However, that is another story. The point is that hard science is not just about massaging data until it makes sense. There is an important component of, for lack of a better word, intuition. Sometimes the universe drops its guard and lets one of its secrets slip. Like Einstein, one has to be ready to catch it, though.
In the established scientific hierarchy, the biologic sciences, including medicine, occupy an intermediate position, wedged between the hard sciences and soft sciences, such as sociology. There are difficulties, shall we say, in both the intermediate and soft categories. Too many independent variables and a wide range of interactions among dependent variables make analysis of data challenging. Unlike with physics or chemistry or astronomy, with the biologic or social sciences, one cannot usually write a system of solvable differential equations to describe what is happening and only in the coarsest sense do statistics apply. It is very difficult to come up with testable hypotheses. Investigator bias is a considerable risk. Data tend to be all “over the map,” meaning large standard deviations and wide confidence intervals.
Acupuncture research is, at all levels, a difficult undertaking. This is so, for all the reasons mentioned above, plus a 2500-, 3000-, 4000-year (no one can quite agree) history, markedly disparate approaches to diagnosis and treatment, and strongly held personal opinions among practitioners. What is a researcher to do? The answers are to plan and execute experimental protocols meticulously, to be objective in interpreting results, and to share those methods and results so that other scientists are able to confirm or refute the findings. Claims about underlying mechanisms or clinical effectiveness are not substantive unless there is evidence to back up those claims.
The good news is that researchers are doing excellent work on our behalf. We owe them a debt of gratitude. Most of you are aware of the recent trend of systematic reviews and comparative benefit studies that have provided evidence for the clinical effectiveness of acupuncture. It has been my privilege, in preparation for this Special Issue, to read many basic science manuscripts. This work is important too; it is forming the foundation for comprehending the underlying mechanisms of acupuncture. There are tantalizing bits but not enough is known, yet, to tell your colleagues, this is how it works. It is complex. So, in light of that reality, the researchers keep chipping away. Sooner or later, the pieces will all fall into place and perhaps we will have our own Einstein.
In this issue, you will read original articles: by Sik et al. on the effect of acupuncture on hemodynamic resistance in cerebral circulation; by Mori et al., on whether regional blood flow is affected by electroacupuncture (EA) and if the response is point-specific; by Wu et al. on evidence that EA may limit both myocardial and brain injury during acute myocardial infarction, and that this effect is mediated by the autonomic nervous system; by Zhang et al. demonstrating that acupuncture benefits allergic contact dermatitis by regulating inflammatory pathways; and by Kim, in which an experimental model for mapping electrical potential on the skin surface shows promise for future acupuncture research.
Scholarly reviews fulfill the role of integrating current findings in research and thus providing an overview. You will read a review by Muthmainah and Nurwati of possible mechanisms of acupuncture for the treatment of depression, pointing to multiple pathways, and an article by Karst and Fink that proposes a biomedical information model for acupuncture, based on a translational survey.
Case reports are important because they allow us to share experiences and also because they frequently point to areas where additional research is indicated. We offer very interesting case reports by Shubov et al., on myofascial sequelae to visceral disease (in this case abdominal pain after resolution of autoimmune pancreatitis), and by Koda and Niemtzow on a patient who had significant improvement in control of hypertension while being treated for xerostomia.
We do hope that you enjoy our second Special Basic Science Issue of Medical Acupuncture and find that it affirms a scientific basis for what we do. Clearly, there is much work remaining in order for us to have full understanding of acupuncture effects, but progress is being made and the future is bright.
I should not close without mentioning that barriers remain in acupuncture research, with funding being one. However, despite all, there are those dedicated women and men doing the science with professionalism and expertise. They need and deserve our support.
So, which are the truly “hard” sciences”? My opinion: If done well, they all are.