June 1 - June 7, 1995

There's no solid scientific reason why acupuncture should work--but it does.

B y  S a m  N e g r i

IT WAS AN easy date to remember: It was December 1 and I was flat on my back at the Santa Cruz River Park staring up at five or six paramedics who were going to lift me onto a board and cart me over to the emergency room at St. Mary's Hospital. This was the slightly ignominious end to a lunch hour bike ride. It was also, strangely enough, the end to my lengthy battle with tobacco addiction, but I didn't realize that at the time.

All I knew for certain on that sunny afternoon in December was that I had miscalculated a curve. My front wheel collided with a steel post. The bike stopped and I did not. No sir. I went up into the air, did a less than graceful pirouette and came down on the pavement feeling, in the process, that every muscle and ligament in my lower back had been hit by napalm. After I finished screaming at every god in the Greek pantheon, I wiggled my toes and decided I probably wasn't going to end up in a wheelchair.

The first thing the emergency room doctor said after he came back with the X-rays was, "Well, you broke your back," which turns out to be a meaningless phrase. I had a compression fracture in the first lumbar vertebra. Rest for four to eight weeks and the bone will heal itself, he said. Then he gave me some Demerol to ease my pain and suffering, and some anti-inflammatory medicine, and I was back to being a happy if somewhat immobile camper.

A few weeks later I suddenly realized that, not only was my back getting better, but I was no longer feeling the cravings associated with nicotine withdrawal. I had smoked a pipe for 29 years and quit nearly two years ago. However, in the six months before I had the bike accident, I was beginning to have relapses, and since I no longer had any pipes, I resorted to cigarettes. I wasn't buying cigarettes; I would just bum one from time to time.

Of course, that worked fine until the night the craving came on like gangbusters, and I went to Circle K and bought a pack of smokes. I went back to my porch and smoked around six of them, back to back.

The next morning, I had a heavy dose of self-loathing, simultaneously acknowledging the craving was still there and that I hated what I was doing. Soon after that, I went out and attacked a steel post with my bike. I never expected the accident could have anything whatsoever to do with smoking until that day I realized the craving was practically gone. I was elated. I was jubilant. I was stupid to think it would last forever.

After the accident, when I felt my back was almost completely healed, the craving for cigarettes returned as though it had never taken a vacation at all. I was frustrated and perplexed. What could be going on? Was it possible that the scrunched vertebra had been pressing on something and affecting a neurotransmitter? Was some chemical that affected the brain and addictive cravings being blocked by the impact of the compression fracture, and was there any way to duplicate that process without smashing my back into the pavement every now and then?

WHY THOSE QUESTIONS prompted me to think about acupuncture, I have no idea. It's not as though I was predisposed toward acupuncture. I am, more or less, a cynic, with a conventionally smug prejudice against doctors, regardless of whether they are AMA types with big egos, Indian medicine men with sandpaintings, or needle-wielding acupuncture practitioners. You can have 'em all. Of course, I might not have been as pompous if I'd had a history of chronic illness or been accident prone. I didn't like MDs, yet I acknowledged that western thought had traveled a route from magic to religion to science, and even though I wasn't prepared to worship science, I was still not sure I was ready to take a few steps backwards and embrace some extinct superstition.

Still having reservations about the acupuncture link, I made a trip to Los Angeles shortly after my convalescence. I mentioned my musing about the back injury and cravings and acupuncture to a friend over there.

"Oh yes," she said, "I heard they're using something like that in the court system here, treating addicts with acupuncture. I have some articles about it in my files." By addicts, she meant heroin, crack cocaine, serious stuff. Not cigarettes. But, if it were true that acupuncture could help people on hard drugs, it seemed likely it could do wonders for someone who was only dealing with nicotine.

But, I wondered, how did it work? Was it merely a placebo? My questions led me from various published sources of information to the sedate home/office of Bob Stagnitto, a 44-year-old acupuncturist in Tucson. Stagnitto did not win my immediate confidence. He was not wearing a sharkskin suit and a $40 tie and his home looked as unassuming as my own. It wasn't that I necessarily wanted to see the conventional signs of success; but I did want something--anything--that might prove reassuring. After all, this was the person who was going to poke between 10 and 20 needles into my body during the next 10 weeks.

Stagnitto was not at all interested in reassuring me of anything. Instead of a shirt and tie, he wore what I later regarded as his uniform: a pair of nondescript black Levis, a sport shirt, and freshly scrubbed hair pulled back in a ponytail. Obviously oblivious to my early misgivings, Stagnitto simply compounded them by telling me, in the first few minutes of our initial visit, that he had never treated anyone specifically for addictions. So, you may ask, what was I doing there?

Listening, I suppose, is the best response, and Stagnitto had plenty to say, very little of which made much sense to me at the outset.

To his way of thinking, it made no difference that he had never treated someone for an addiction. "There are different kinds of acupuncture practitioners around," he said. "There are those who do what I call 'cookbook' acupuncture. You say you're having trouble with allergies and they treat that; you say you have a problem with over-eating and they treat that. That's not what Chinese medicine is all about. What I do is called constitutional acupuncture. You treat the whole body. The whole thing with acupuncture is not simply to get people symptom-free. The objective is to get them to a higher level of physical, emotional and mental health.

"A lot of medical doctors in this country are now practicing acupuncture, but they have pretty much relegated it for use in certain categories. They've accepted it as a treatment for pain and addictions, for example. But, in China, acupuncture has been used as a whole healthcare system, and they've kept themselves healthy for many, many years." Stagnitto, who learned acupuncture in a year-long program at Guang An Men Hospital in Beijing, added:

"Don't think of acupuncture as a pain relief thing, or a stop smoking thing," he said. "In reality it's based not on suppressing symptoms but on promoting balance energetically between all of the organs long before the symptoms manifest as a full-blown disease process."

My head was spinning and I had a million "buts" to inject. He was a step ahead of me, however.

"For the most part, acupuncture does not make sense to our western rational minds," he explained. "There are a lot of theories about how acupuncture works, but they're all just that, theories. Nobody knows for sure why it works, but it does. When I say acupuncture is a whole healthcare system, I'm saying acupuncture doesn't treat any diseases. You treat the body and if the organs are functioning healthily, the body will treat itself. Look at the smoking problem. If you smoke, over time your organs become conditioned to requiring that nicotine. The combination of the acupuncture and Chinese herbs helps to detoxify those organs so they're no longer calling for that substance. In this process, you not only reduce the craving, you start to feel healthier in general. You don't just treat the person for the nicotine craving. If you only treat one thing, the craving will manifest itself some other way. You have to treat the whole person. This means you do the acupuncture, you increase your physical exercise, watch your diet more carefully, even change your attitude toward some things.

"What happens then is that people start to sleep more, and they sleep better. You feel more relaxed and you see a gradual increase in energy. It's also true, though, that the acupuncture itself won't make you stop smoking. You have to decide to stop.

"The acupuncture can help alleviate the withdrawal symptoms by minimizing the cravings."

That said, Stagnitto was not making any promises. "You'll end up feeling a lot better, but I never make any promises because everybody's different, and what works for one person may not necessarily work for another."

There was also the matter of chi, which is the foundation of all Chinese medicine, but a concept that is practically untranslatable in English. It means energy, harmony, overall well-being. No one can really measure it, any more than a western doctor could measure something like love, yet Chinese doctors have for thousands of years maintained that chi not only exists, it travels along meridians that link the various organs.

Acupuncture is based on the notion that most conditions can be traced to blockages along these meridians. By inserting very thin needles at specified points along the meridians, it is said that the blockages are removed and chi then flows normally again.

This doesn't sound like science, does it? And since most of us have been conditioned to believe science rendered God and magic extinct, how could we attach any credibility to such ideas? My theory is that Americans are seduced by things that work, whether it's a reliable cordless screwdriver or an inexplicable treatment that helps them to quit smoking. In fact, a patient survey, reported in the newspapers in February, said roughly 15 million Americans have used acupuncture to deal with back pain, headache, sports injuries and stress.

A FEW WEEKS after my initial talk with Stagnitto, I called Dr. Lane Johnson, one of several Tucson physicians who now are supplementing their standard practice with acupuncture treatments. Johnson provided me with a copy of a detailed article from the Journal of Substance Abuse, written by Alex Brumbaugh of the Council on Alcoholism and Substance Abuse in Santa Barbara, Calif. That article, which documented numerous experiments and actual clinical applications, showed that acupuncture --especially auricular (ear) acupuncture--had been so successful in treating hardcore addicts and alcoholics that it had been adopted as part of the sentencing process in at least three areas of the country (Manhattan, L.A. and Dade County, Fla.). In those communities, felony drug offenders are given a chance to join an intensive counseling program coupled with daily acupuncture treatments--usually for a year--as an alternative to prison. The article, written in the restrained cadence required in academic journals, actually made Stagnitto sound conservative.

Even though the Substance Abuse article listed a half dozen alpha and beta endorphins affected by acupuncture, I still wondered whether it wasn't possible that acupuncture cured the way a placebo "cured"--simply by suggestion. Bruce Pomeranz, a physiologist at the University of Toronto, wondered about the same thing, and decided to test the placebo implications by performing acupuncture on cats. Pomeranz admitted that he was certain at the outset that acupuncture was merely a mind game, and he was going to prove beyond a doubt that it was all nonsense.

Using Chinese charts showing the location of acupuncture points in animals (veterinary acupuncture is a specialty unto itself), Pomeranz and his associates inserted needles into some cats and used electrodes to measure the pain responses in individual nerve cells. "To my chagrin," he told a reporter, it worked. Nerves that he expected to transmit pain simply didn't fire in the animals given acupuncture.

Pomeranz' experiments were done in the 1970s, before scientists had discovered endorphins, the natural opiates produced in the brain as a response to pain which are responsible for the "high" experienced by many runners and cyclists after an energetic outing.

AT SOME POINT I decided I'd been reading and talking to too many people, and it was time either to try the acupuncture or go back on Nicorette, a gum containing small doses of nicotine.

It's available by prescription only and sells for around $37 a box. Nicorette had worked for me in the past, but it was hard on my stomach.

The "course" of acupuncture--10 treatments at $40 a visit--begins with an "Oriental diagnosis." Chinese doctors believe you can discern the health of various organs by looking at the condition of the tongue, which they see as sort of a breaker box for the entire body. Stagnitto glanced at my tongue and then took my pulse in both wrists, and muttered something about heart fire and "a lot of heat." As near as I could figure out, these are part of a Chinese lexicon and translate to the fact that I was under stress (the heart fire) and that organs were inflamed (hence the heat).

Stagnitto did not spend a lot of time discussing his diagnosis before he reached for the packets of needles. Oh God, I thought, here it comes! This is what I've been dreading. I tensed up. I heard a soft tear as he ripped open the package with the first needle and then I felt a light thump, as though someone had poked my wrist. The first needle was in place and--how about this?--it didn't hurt at all!

"When people find out I do acupuncture," Stagnitto told me several weeks later, "the first thing they ask is, 'Does it hurt?' the second thing they want to know--because of the concern over the spread of AIDS--is whether I use disposable needles. For the record, acupuncture usually doesn't hurt--though for a second or two you might feel a slight tingling or an electric shock--and I only use stainless steel, disposable needles."

The day before I started the acupuncture treatments, I smoked a couple of cigarettes, and I haven't had anything since. For the first four visits, I went twice a week and Stagnitto inserted between 13 and 22 needles. Some were in my wrists, some in my feet, a couple of times he placed a needle in each of my cheeks and several times there was one sticking out of my forehead.

Once he inserted one in the top of my head. The only one that ever hurt--and he only did this once--was a needle inserted in the skin under my mustache.

On each occasion the needles were left in place for about 20 minutes. After my first visit ended, at 3:30 p.m., I had to leave immediately for a meeting in Phoenix. I left Phoenix at 9:15 that night to return to Tucson. It had been a long day and yet I still felt tremendously energetic. That night, I eased into a deep and restful sleep.

Over the next few weeks, I began to notice the craving for tobacco diminishing, but the weekend after my fourth visit I took an emotional dive. I found myself irritable, short-tempered, restless and tired. I couldn't trace these feelings to anything in particular. I mentioned all of this to Stagnitto and asked whether it may have been caused by acupuncture.

"It sounds to me like classic symptoms of detoxification," he said. "For a lot of people the body's energy is sustained by nicotine, caffeine, various drugs. You take all that away and now you have to rely on your own body, and until you build it up you're going to experience these other symptoms. You'll find, for example, that you have to sleep more during this period, but all of this should pass."

When I went for my seventh visit I told him I felt like I'd reached a threshold in the craving. I still felt some cravings--not powerful ones--but I couldn't seem to get beyond this point, and I was feeling frustrated. He said that would change but it might help to modify other behaviors. For example, it would be helpful to eliminate coffee or use a coffee substitute, he said.

He was undoubtedly correct--most smokers realize the craving for tobacco is enhanced by coffee and spicy foods. But, my immediate reaction was, forget it! I have two or three cups of strong coffee a day; I'm not giving up all my vices!

The cravings still haven't vanished, but I'm seldom aware of them. The first time I knew the acupuncture had a genuine impact was near the end of my 10 visits when I was over at my friend John's place. I had developed a little routine at John's. We'd sit in his office surrounded by computers and chitchat about this or that software or hardware problem, and after John had smoked two or three cigarettes, I'd invariably say, "Hey, let me have one of your cigarettes."

But, one day, I was in his office for a half hour, and he was smoking, and I never considered asking for a cigarette. It simply never entered my mind because there was nothing in my system craving one. That hit me as I was leaving his house. Subsequently, I discovered that the cravings grew milder and milder and came at wider intervals.

Wouldn't the same thing have happened if I had simply stopped cold turkey? Certainly. You stop giving your brain and organs nicotine, and after awhile everything goes away. For most people, however, that first month or so is a wretched time, and relapses are frequent. The value of acupuncture--not only for nicotine addictions but, according to various studies, for alcoholism and hard drug addictions--is that it minimizes the impact of the withdrawal symptoms. That's why it's widely used, from huge places like Lincoln Hospital in the Bronx to private treatment centers like Sierra Tucson, as part of the substance abuse detoxification protocol.

Why does acupuncture work? I spoke to one physician who speculated it was stimulating the immune system. "For all our expertise in western medicine, we still know very little about the immune system," said Dr. Larry Hughes. "If we did we'd have a cure for AIDS by now. I've seen amazing things done with acupuncture, and my guess is it's somehow stimulating the immune system."

Elaine Komarow, an acupuncture practitioner in Virginia whom I met on the Internet, had another explanation:

"There have been some studies that, when the receptor sites for various neurotransmitters are blocked, acupuncture loses its effectiveness. It has been shown that the skin's electrical resistance at the site of acupuncture points is different than the resistance on the skin in general. (This fact was discovered by Dr. Paul Nogier in France in 1955). I think it's possible that by entering the skin at those points, we might stimulate the firing of certain nerves, which then brings about the release of certain neurotransmitters.

"This explanation, of course, is limited to the level of understanding we currently have about how the body (and life itself) works. I certainly believe there is plenty we don't know yet, and plenty we don't have the technology to measure, so we might be at a place where we don't have the technology or understanding even to conceive of how acupuncture might work. So I always come back to the traditional explanation--acupuncture balances the qi (chi), reestablishing the natural harmony of body, mind, and spirit."

Precisely what all of this means, I couldn't say, but I can tell you beyond a doubt that I'm not smoking, and the withdrawal symptoms were minimal. Was it a placebo? Maybe. But, if so, it was a placebo that worked.

Photo 4: Getting to the point: Bob Stagnitto's acupuncture treatment helped reduce the author's craving for tobacco.

Photo 5: "For the most part, acupuncture does not make sense to our western rational minds," says acupuncturist Bob Stagnitto.

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June 1 - June 7, 1995

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