Dr. Tatevian was a contributor to the Southern New England Health Care Review in the 00s.
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Articles and Publications
Acupuncture: Medicine of the Fourth Kind
by Alex Tatevian, DA
Southern New England Health Care Review; 2000; Vol. 10, Issue 3.
Conventional medicine is developed from three medical milestones:
Herbs, the administration of substances that developed into allopathic medicine,
the knife, which evolved into surgery, and
the word, which gave us psychiatry.
These are used alone and in combinations to provide the most effective medical treatment. They mix, compete, interact, and invade each other's domain. For example, traditionally allopathic coronary disease now utilizes surgical applications, and H-2 Blockers and antibiotics deprive surgeons from gastrectomys.
Acupuncture does not fit into any of these three categories. Even herbology makes more sense than acupuncture for the western scientific mind. Medical professionals have to overcome intellectual and professional barriers to accept acupuncture as medicine of the fourth kind and not just as another supplementary technique.
Integration
There are basically three models of integration: multidisciplinary, interdisciplinary, and transdisciplinary.
Multidisciplinary describes the relationship between conventional and unconventional practitioners and their patients. There is no formal communication between practitioners to coordinate care. Patients are shy to tell their physicians that they go to an acupuncturist, and apologize to their acupuncturists that they see chiropractors, and so on. The patient takes the initiative and control, yet his approach to medical treatment is often trial and error.
The interdisciplinary approach to integrative medicine has become the recent trend in Rhode Island. More and more physicians feel secure to refer their patients to a licensed acupuncturist, a last resort when allopathic medicine has exhausted its options. Physicians have had little confidence in the efficacy of acupuncture, and when a positive outcome is achieved, continue the referral practice. There is no exchange of medical records, no follow up notes, and most importantly, no coordination of care.
The transdisciplinary approach is what I see as the ideal model of healthcare integration for acupuncture when it has evolved into a new entity. The best features of a trandisciplinary model are synchronized, coordinated, and optimazed care for the patient. The implementation of different therapies must be synchronized into a logical combination to effect the best possible medical outcome. To avoid poor and excessive treatment regimes, there must be coherent protocols. It is not an easy model to achieve, and we are a good distance away from actualizing it.
European Acupuncture
Traditionally associated with China, Japan, and Korea, acupuncture is incorporated into medical practice in Europe. Acupuncture was introduced in Europe by European physicians who brought it from Far Eastern colonies. That mode of introduction made it credible. The first known European acupuncture publication was dated 1671 and was published in Holland. Modern medicine as we know it today did not exist yet, and there were 300 years of parallel development, interaction, and scientific scrutiny.
There are similarities and differences in the contexts of European and Chinese acupuncture. The similarity is that there is close communication and contribution between acupuncturists practicing in Europe and China. European professional's practice based on the principles of Traditional Chinese Medicine. Chinese practitioners promptly accommodate and incorporate new European techniques such as electropuncture and concepts like auriculopuncture.
The difference is that European acupuncture coexists with highly advanced, state-of-the-art modern medicine, and Chinese acupuncture does not. Acupuncture in China quite often aims to replace conventional medicine to fill the gaps and deficits in healthcare.
The Next Step
Overloaded with sophisticated hardware, the medical field is starving without new fundamental ideas. The overwhelming advance of medical technology made possible practical realization of theoretical concepts developed by the previous generations of physicians and scientists. The medical field turned into a trillion-dollar industry and reached the point of saturation. Breathtaking achievements of modern medicine do not impress the public any more. Medicine has spent the last 100 years making people healthcare dependant.
Now we are trying to reverse that. Holistic medicine and prevention became the most recent medical paradigm and political statement. But so far it has not changed the philosophy of medical intervention. It may degrade into another round of making generally healthy people health care dependant with "all natural" supplements, life-style drugs and pointless acupuncture treatments.
Reliable statistical analyses are few as acupuncture in America is still too young. The marriage of classical acupuncture with modern technology opens new horizons for study. The problem with double blind studies can be resolved by replacing a traditional acupuncture needle with an infrared low energy laser. Modern scientific investigation of acupuncture points and meridians proved their actual existence, and has produced perhaps the only new fundamental concept formulated in the biomedical field in the last 60 years. If further research supports the idea of acupuncture channels as a new integrative system, it will be as major as the discovery of the nervous system.
Alex Tatevian, DA
Southern New England Health Care Review; 2000; Vol. 10, Issue 3.
Last updated: 24-July-2024
The State of Acupuncture in Rhode Island
by Alex Tatevian, DA
Southern New England Health Care Review; 2000; Vol. 10-10.
Four years of state legislative effort by acupuncturists of Rhode Island have resulted in all insurance companies in the state being obligated to provide optional coverage for acupuncture by April 2000. This will give the general public much better access to acupuncture benefits. Insurance companies that offer better coverage for acupuncture possess a considerable marketing advantage and likelihood of great savings to their organizations.
There are 35 jurisdictions (34 states and DC) that have passed a statute regulating acupuncture and Oriental medicine. Local political philosophies and needs create considerable variance in the laws from state to state. Eleven states have independent boards. In twelve others, acupuncturists are under the board of medical examiners. In the last third, acupuncturists are regulated by the Department of Commerce, regulatory agencies, health, professional regulation, or occupational licensing. Rhode Island's acupuncturists are regulated by the Department of Health.
Rhode Island's Educational Standards
The RI Department of Health recently proposed a regulation for educational standards for acupuncture practice. The requirement states that physicians who want to practice acupuncture will need 300 hours of formal acupuncture education and training. Acupuncturists are required to have 2,500 hours of education and 20 hours of continuing education per year. This makes Rhode Island a model for the highest educational standards for acupuncture for both physicians and acupuncturists.
Although Rhode Island does not require patients to receive prior diagnosis or referral, one-third of the states require some form of western medical intervention prior to, or in conjunction with, Oriental medical treatment. This intervention is usually a referral or prior diagnosis by or collaboration with an MD, DO, DDS, or DC. New York requires that the acupuncturist advise the patient as to the importance of consulting with a licensed physician.
This type of language in statutes is usually the result of unfamiliarity with the safety record of the acupuncture profession. This language is becoming less popular with legislators who view it as a restriction on consumer access. Medical boards also are increasingly scrutinizing this language under the theory that it may place their licensees in a legally vulnerable position by requiring them to supervise or refer to a practice that is not included within their normal professional training. Maryland and Massachusetts have removed these requirements from their law. Pennsylvania, Virginia, and Texas have introduced bills to do so.
Rhode Island's acupuncturists practice in a wide variety of settings around the state. There are practitioners with small, home-based offices, as well as those with a traditional medical clinical setting. Regardless of the diversity of their practice, all are subject to rigorous license requirements, education, and standards of practice overseen by the Department of Health.
The incredible progress in Rhode Island's state regulation in the last 25 years is a tribute to the quality and enormous hard work of our fellow professionals. As we discuss our vision of the future, we must take into account what is politically and legislatively realistic as well as to responsibly examine the impact on practitioners and patients.
Benefits of Acupuncture
There are more and more models of protocols used in mainstream medicine that engage acupuncture to treat conditions such as chronic pain, asthma, hypertension, back pain, and spinal related conditions. They clearly demonstrate that the same or better results can be achieved in combination with less invasive "alternative" approaches for a fraction of the cost. Early acupuncture intervention can reduce the number of back surgeries by half with better outcomes, and can dramatically reduce the number of admissions of asthma patients to emergency rooms. Acupuncture also has proved to be effective for nausea and other side effects of chemotherapy.
University Anesthesiologists Inc. (UAI) Pain Management and Acupuncture Center is the first serious attempt to integrate acupuncture into medical practice in Rhode Island. This integrative approach, enacted through the vision of Kathleen Hitner, MD, is cost effective and clinically efficient, and returns the patient to the center of healthcare. The protocol for management of postoperative nausea and vomiting, developed by UAI, has a good chance to be put into practice at Roger Williams Medical Center, where I have the privilege to be an acupuncturist on staff.
Chronic pain is the perfect field to implement integrative medicine. It is logical, effective, and perhaps the only way to achieve positive results and avoid haphazard, chaotic treatment. Coordination of care takes commitment and willingness to be open minded about therapies that physicians are not accustomed to. Acupuncturists must develop medical terminology and language to better communicate with physicians, and physicians would benefit from a greater understanding of the concepts of acupuncture. It is time to put aside the struggle of paradigms and focus on the benefits to the patient.
Alex Tatevian, DA
Southern New England Health Care Review; 2000; Vol. 10-10.
Last updated: 24-July-2024
Acupuncture in the Multidisciplinary Cancer Treatment Setting
by Alex Tatevian, DA
Southern New England Health Care Review; 2001, Vol. 11, Issue 3.;
The relationship between alternative and traditional medicine has been carefully researched and nurtured in Rhode Island. Alternative medical practices have become widely embraced by patients and the healthcare industry. As popularity and demand have increased, so has the range of treatments being offered in mainstream settings such as Woman and Infants' Hospital.
When the medical staff of the Women's Oncology Program surveyed their patients in 1994 about the need for complimentary medical therapies, the response was overwhelmingly favorable. Today this Women and Infants' program aptly named Complimenting Care offers a full range of services for patients who are in the midst of active treatment, for those who are recovering, and their families. It remains the only program of its kind in the state of Rhode Island.
Dr. Cornelius O. "Skip" Granai, Director of the Program in Women�s Oncology and a gynecological surgeon at Women and Infants' created and supports the Complimenting Care team. Dr. Granai writes, " As currently organized, medicine finds itself in increasingly anachronistic boxes, more cynically described as turfs. In many clinical instances, turfdom has its roots in the logic of history, but over time such compartmentalization can approach irrelevance and even become counterproductive. This phenomenon, as well as its consequences, is occasionally apparent in cancer management. Into what medical-box does "cancer", its practice and administration, fit? "
The Complimenting Care program breaks through this anachronistic paradigm, offering patients a broad spectrum of holistic treatments. While not a substitute for proven cancer treatments, the program offers thoughtfully selected therapies including acupuncture, chiropractic, therapeutic massage, meditation, hypnotherapy, aroma therapy, seaweed body wraps, foot massage nutrition and wellness, an art support group, breast cancer support group, an ovarian cancer support group, an animal companion program, and a poetry project that sooth the adverse side effects that cancer treatment and its aftermath often bring.
Acupuncture has been a part of this program since September of 2000. Acupuncture is the stimulation of specific points on the body by insertion of hair-thin, sterile single use needles or by other means of physical stimulation. Acupuncture is very effective in treating the symptoms of nausea, vomiting, anxiety, fatigue and pain. In 1997, the National Institute of Health's consensus panel endorsed acupuncture's effectiveness in these areas. Acupuncture is a useful adjunct to cancer treatment, enabling patients to remain on schedule with their chemotherapy protocols. I believe that acupuncture may improve the quality of life of the patient, and beyond that, positively influence the clinical outcome of the treatment. This statement must be supported by additional committed research programs to collect and analyze data.
MedLine yields over 6,000 articles about acupuncture. Of the 2,302 acupuncture studies recently cited in a 158 page bibliography published by the National Institutes of Health, at least 81 of them were directly related to the use of acupuncture to prevent nausea and vomiting. The advantage of acupuncture is that it has no adverse side effects. The adverse side effects of commonly used antiemetics are primarily restlessness, drowsiness, fatigue, diarrhea, headache, and hypotension.
A well-controlled study completed at the UCLA School of Medicine reported significant reduction of nausea and vomiting among chemotherapy cancer patients when pre-treated with acupuncture. It is now routinely administered before, after, and between chemotherapy treatment sessions for control of nausea and vomiting. Its effectiveness helps in minimizing the use of standard, expensive multi-drug anti-nausea regimens with their attendant side effects, given along with the chemotherapy agents.
In Rhode Island, many women and their families have maintained their integrity and recaptured their strength through grueling, frightening, and uncertain times. The entire Complimenting Care team and staff of the Program in Women's Oncology are to be commended for providing a life-enhancing program.
Alex Tatevian, DA.
Southern New England Health Care Review, 2001, Vol. 11, Issue 3.
Last updated: 24-July-2024
Integrating Education and Change for Acupuncturists
by Alex Tatevian, DA
Southern New England Health Care Review; 1999; Vol. 9-10
Three years of legislative activity by acupuncturists has resulted in Rhode Island insurance companies offering optional coverage for acupuncture beginning in April 2000. Integrative medicine brings together the best of complementary medicine practiced in conjunction with allopathic medicine. The momentum supplied by an enthusiastic public has taken integrative medicine from an underground movement to an increasingly mainstream practice.
While acupuncture is often associated with pain control, in the hands of a well-trained practitioner it has much broader applications and is a complete medical paradigm. The improved energy and biochemical balance produced by acupuncture results in stimulating the body's natural healing abilities, and in promoting physical and emotional well-being.
Acupuncture can be effective as a singular implemented treatment, or adjunct to other treatments in many medical and surgical disorders. The World Health Organization recognizes the efficacy of acupuncture for the treatment of a wide range of medical problems.
Progressive academic medical centers and physicians are pushing toward new frontiers of incorporating acupuncture into their repertoire. Very often it is the most highly respected and trusted physicians who introduce new concepts and methods into the bastions of conventional medical care. This integrative approach is practiced at University Anesthesiology Pain Management and Acupuncture Center in Pawtucket under the leadership of Kathleen Hittner, MD. Dr. Hittner and her staff integrate acupuncture into the treatment of patients with chronic and acute pain.
Fifteen million acupuncture treatments are performed safely each year in America alone and the number is growing rapidly. Anecdotal evidence indicates a high degree of patient satisfaction. Scientific research indicates that acupuncture must be considered a serious alternative or complement to conventional pain management.
When physicians are approached with good data, most are open to new medical treatment options. Numerous published studies prove acupuncture's efficacy. There may be only a handful of decent double-blind studies examining acupuncture, but there are many case-controlled studies that are dependable in seeking out reliable outcomes. It took a lot of prodding, though, to convince the average allopathic physician that acupuncture was even worth exploring. Recently, physicians brought proposed regulations to practice acupuncture before the Rhode Island Department of Health.
Patient demand has moved physicians to engage in integrative medicine, and in 1998 patients spent 52 billion out-of-pocket dollars on alternative medicine. The National Institute of Health's National Center for Complementary and Alternative Medicine (NCCAM) conducts and supports basic and applied research and training and disseminates information on complementary and alternative medicine to practitioners and the public.
Acupuncture is practiced side by side with physicians in hospitals and clinics in Rhode Island. Acupuncturists must augment their considerable knowledge base with conventional medical concepts to practice compatibly with physicians, and most importantly for the benefit of the patient.
Rhode Island requires its licensed acupuncturists to have 20 hours of continuing education per year, along with 2500 hours of education and training prior to licensure. These requirements are among the most stringent in the country. Professional development is encouraged and sponsored by the Rhode Island Society of Acupuncture and Oriental Medicine.
Acupuncturists from the United States and Canada recently convened to discuss pain management at the Pacific College of Oriental Medicine in San Diego. A pronounced emphasis on integrative medicine threaded numerous workshops and discussions. A lively panel of physicians and acupuncturists debated the transdisciplinary assessment and team approach. The problems of the existing health care delivery system and the growth that is necessary to accommodate new methods was the focal point of debate. However, no one debated the common goals of patient care: to improve function, reduce disability, eliminate medication dependency, decrease health care system dependency, and decrease chronic suffering.
While some issues still separate the integrative movement from mainstream medical practice, the gap will continue to narrow. Whether it's a conventional treatment or the latest integrative technique, doing what works best is still the best medicine.
Alex Tatevian, DA
Southern New England Health Care Review; 1999; Vol. 9-10
Last updated: 24-July-2024
Continuing Education Conference Provides Acupuncture Education Opportunities
by Alex Tatevian, DA
Southern New England Health Care Review; 1999, Vol. 9-12;
Rhode Island requires its licensed acupuncturists to have 20 hours of continuing education per year, along with 2500 hours of education and training prior to licensure. These requirements are among the most stringent in the country. Professional development is furthered through programs that the Rhode Island Society of Acupuncture and Oriental Medicine sponsor.
Acupuncture is becoming an integral part of mainstream medicine.
Acupuncturists must learn conventional medical terminology and concepts to practice compatibly with physicians.
This integrative approach is practiced at University Anesthesiology Pain Management and Acupuncture Center in Pawtucket. Dr. Hittner and her staff integrate acupuncture into the treatment of patients with chronic and acute pain.
Acupuncturists treat patients with multiple sources and symptoms of pain. Most patients simultaneously receive treatment from physicians and acupuncturists. Acupuncture professionals recognize the need to integrate their care with conventional medical therapies for their patient's benefit. Professional development offerings are increasingly satisfying this need.
I recently attended a Pain Management conference in San Diego with acupuncture professionals from around the country. There was a pronounced emphasis on understanding and practicing integrative medicine. A lively panel discussion with physicians and acupuncturists debated the transdisciplinary assessment and team approach. However, no one debated the common goals of patient care: to improve function, reduce disability, eliminate medication dependency, decrease health care system dependency, and decrease chronic suffering.
Alex Tatevian, DA
Southern New England Health Care Review; 1999, Vol. 9-12;
Last updated: 24-July-2024
Bio-morphological rationale for laser stimulation of myofascial trigger points and acupuncture points (abstract).
by Alex Tatevian DA and Artem Grush MD,
Foundation for Research in Acupuncture & Integrative Medicine; Department of Anesthesia, Harvard School of Medicine, Boston, MA.
Annals of Clinical & Laboratory Science, 2004, Volume 34, Issue 3:357-372
Routine techniques of myofascial trigger points (MTrP) treatment include needling procedure with an injection of pharmacological substances or without (dry needle technique). Dry needle technique, not much different from acupuncture needling, adds to similarities between MTrP and acupuncture points (AP), including their location and distribution, pain and referred pain patterns, etc. The scientific basis for either MTrP injection or acupuncture is still unclear, although there is a body of evidence relating response in both cases to neuro-transmitter and neuro-hormone release, notably that of the endogenous opioids.
With various means of point stimulation granting comparable effect, the least invasive techniques appear most attractive. We investigated the effect of Low Energy Lasers (LEL) in MTrP and AP stimulation. LEL's are laser devices in which power densities and energy densities of laser beam are lowered to a point where no photo-thermal effects occur, but the photo-osmotic, photo-ionic, and photo-enzymatic effects are still operative. Penetration of a laser beam into tissues falls off at an exponential fashion. Thus, increase of laser power does not result in a linear increase in the penetration depth and in a linear increase of biological effect. The prime determinant of tissue penetration is the wavelength (color) and pulse regime, which makes pulsed Infrared Laser the most suitable laser device.
LEL has distinct advantages over needling of MTrP and AP: it is aseptic, non-invasive, and painless; if used properly, it has no reported side effects; it is ideal for children and patients with needle-phobia. Infrared Laser is the only tool for a double-blind, randomized, placebo-controlled study to investigate the effectiveness of acupuncture.
Presented at the 124th Annual Meeting of the Association of Clinical Scientists. ;
Session C: Frontiers of Clinical Science;
The University of Texas, Houston, Texas
12 to 16 May 2004
Last updated: 24-July-2024
Needle counterpoint: Acupuncture eases its way into modern medicine
...The ancient theory holds that Qi moves along meridians, or channels, in the body, nearing the surface at some 350 "points." Each point corresponds to a different aspect of the body or the spirit. A needle inserted in the point can adjust the flow of Qi to the affected system, restoring balance and thus health. ...
...Alex Tatevian, an acupuncturist who was a medical doctor in his native Russia, has no doubt that "there is actually something moving in there."
"We can't identify what it is," Tatevian adds. "That's why we call it Qi, which makes doctors puke."
In Russia, acupuncture is regarded as a specialty of medicine, and Tatevian learned it in a postgraduate program. When he emigrated to the United States in 1991, he found that acupuncture here is "alternative medicine" and that it would be difficult for him to practice both.
So he chose acupuncture because he believed it had more potential. "Acupuncture is the most remarkable opportunity to advance the medical field beyond what it is now," Tatevian says.
"Putting acupuncture in the position of alternative medicine creates a lot of problems," Tatevian adds. "Acupuncture is most effective if combined wisely with conventional medicine." ...
From "Needle counterpoint: Acupuncture eases its way into modern medicine", Providence Jornal, 02.11.2001
By FELICE J. FREYER;
(https://www.providencejournal.com/)
Last updated: 24-July-2024
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