The Ethics of Alternative Medicine

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The Ethics of Alternative Medicine
Acupuncture
Dr . NUSHROTUL LAILIYYA, Sp.S, Sp.AK Neurologist
Acupuncturist Department of Neurology-Hasan
Sadikin Hospital-Medical Faculty-Padjadjaran
University
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Mr. Chen, a 40 y.o. patient originally from
China, had lumbar problems for one year. The
condition includes dull pain in his leg and the
inability to sit for long periods. X-ray
examination reveals a prolapsed lumbar disc. He
has been treated with conventional pain
medication with minimal effect. His physician,
Dr Robert O., recommends back surgery, but Mr
Chen reluctant to take this opinion. Instead, he
asks the doctor to refer him to an acupuncturist
because his insurance coverage requires
physicianss approval for alternative therapy.
But Dr Olsen is skeptical about any kind of
alternative therapy. He refuses to order the
acupuncture. Did the physician act ethycally?
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Akupunktur merupakan komponen penting dari
Tradisional Chinese Medicine
SAAT INI
AKUPUNKTUR MEDIK ??
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SEJARAH
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Penyebaran akupunktur

• ?Dokter Belanda - Ten Rhiyne (1683)
• - E Kampfer
  (1712)
• ?Perancis L Berlioz (1816)
• ?Belgia Y Koyen (1849)
• ?Swiss - Y Cramer (1857)
• - Soulie de Morant (1929)
  terjemahkan Pelajaran
  akupunktur dan moksibusi
• Elektro-akupunkto-kauterisator
• Elektro-detektor

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Penyebaran akupunktur

• ?Amerika 1826
• Meksiko 1940
• Argentina 1950
• Brasil 1950
• ?Korea Utara Prof Kim Bong Han ? meridian dan
• titik akupunktur
• 1949 penelitian klinis
• 1958 akupunktur anestesia
• 1963 Indonesia RSCM tim riset
• ilmu pengobatan timur
  UPF akupunktur
• 1996/97 DitJen BinKesMas (akupressure dan
• pengobatan tradisional)

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akupunktur
Diintegrasikan ke dalam sistim pelayanan formal
- Resolution WHO
44.34 - Permenkes RI NO. 1186/Menkes/
Per/XI/1996
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Dokumen - dokumen WHO ttg Akupunktur
Standard acupuncture nomenclature part 1 Standard
acupuncture nomenclature part 2 Guidelines for
clinical research on acupuncture Guidelines on
basic training and Safety in acupuncture
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DEFINISI
Bioethics is the philosophical study of the
ethical controversies brought about by advances
in biology and medicine. Bioethicists are
concerned with the ethical questions that arise
in the relationships among life sciences,
biotechnology, medicine, politics, law,
philosophy, and theology.
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PURPOSE AND SCOPE The field of bioethics has
addressed a broad swath of human inquiry, ranging
from debates over the boundaries of life (e.g.
abortion, euthanasia) to the allocation of scarce
health care resources (e.g. organ donation,
health care rationing) to the right to turn down
medical care for religious or cultural reasons.
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PRINCIPLES The National Commission for the
Protection of Human Subjects of Biomedical and
Behavioral Research was initially established in
1974 to identify the basic ethical principles
that should underlie the conduct of biomedical
and behavioral research involving human
subjects. However, the fundamental principles
announced in the Belmont Report (1979)--namely,
autonomy, beneficence and justice--have
influenced the thinking of bioethicists across a
wide range of issues. Others have added
non-maleficence, human dignity and the sanctity
of life to this list of cardinal values.
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AKUPUNKTUR
acupunkture
PASIEN TINDAKAN STERILITAS JARUM INFORMED
CONSENT KASUS/ISSUES SIAPA, DLL
BIOETHIC
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Babies, acupuncture and the secret to a good
night's sleep
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Safety in Acupuncture

• Amankah tindakan Akupunktur ?
• Ditangan yang kompeten akupunktur
• merupakan suatu tindakan yang relatif aman
• dengan beberapa kontra indikasi dan
• komplikasi.
• Perhatikan transmisi infeksi yang merupakan
• faktor resiko tindakan akupunktur

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Resiko Tindakan akupunktur - Transmisi
infeksi (hepatitis, HIV) - Jarum patah,
bengkok - Reaksi yang tdk diharapkan - Nyeri
dan rasa tidak nyaman - terlukanya organ dalam
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Pencegahan Infeksi

• Lingkungan kerja yang bersih
• Tangan pengobat yang bersih
• Persiapan bagian tubuh yang akan di akupunktur
• Jarum , alat dan kotak penyimpanan harus steril
• Tehnik aseptis
• Penanganan yang cermat untuk jarum bekas dan
  kapas bekas

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Kontra Indikasi

• Kehamilan
• Kedaruratan medik
• Kasus pembedahan
• Tumor ganas
• Gangguan pembekuan darah dan sedang dalam
  pengobatan antikuagulantia

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CONTROVERSIES ISSUES OF ACUPUNCTURE
YIN-YANG
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Yin-yang

• Siang
• Timur/selatan
• Panas
• Api
• Matahari
• Punggung
• Permukaan luar
• Energi/chi
• Akut
• Merasa panas
• Senang
• Kuat
• Sehat

• Malam
• Barat/utara
• Dingin
• Air
• Bulan
• Perut
• Permukaan dalam
• Darah
• Kronis
• Merasa dingin
• Depresi
• Lemah
• Sakit

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ACUPUNCTURE

• YINYANG

• HOMEOSTASIS

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Aktivitas energi di meridian

• Meridian I (Paru-paru)
• Meridian II (UB)
• Meridian III (Lambung)
• Merridian IV (Limpa-pankreas)
• Meridian V (Jantung)
• Meridian VI (UK)
• Meridian VII (KK)
• Meridan VIII (Ginjal)
• Meridian IX(Sampul jantung)
• Meridian X (Tri pemanas)
• Meridian XI (K.Empedu)
• Meridan XII (Hati)

• Jam 3.00 5.00
• Jam 5.00 7.00
• Jam 7.00 9.00
• Jam 9.00 11.00
• Jam 11.00 13.00
• Jam 13.00 15.00
• Jam 15.00 17.00
• Jam 17.00 19.00
• Jam 19.00 21.00
• Jam 21.00 23.00
• Jam 23.00 1.00
• Jam 1.00 3.00

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Medical ethics is the study of moral values
and judgments as they apply to medicine. As a
scholarly discipline, medical ethics encompasses
its practical application in clinical settings
as well as work on its history, philosophy,
theology, and sociology.
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What Can Acupuncture Treat?
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While acupuncture is often known to its
effectiveness in pain control, The World Heatlh
Organization (WHO) recognizes the use of
acupuncture in the treatment of a wider range of
medical problems, including Muscular and
Skeletal Disorders arthritis, tennis elbow,
frozen shoulder, neck pain, TMJ, sciatica, low
back pain, fibromyalgia, carpal tunnel syndrome,
knee pain.
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Acupuncture is most commonly used for pain, such
as back, neck and spine pain, herniated discs,
nerve irritation, sciatica, headache, facial
pain, jaw pain (TMJ), menstrual pain, arthritis,
sprains, muscle strain, repetitive strain
injuries, tendonitis, sports or auto injury.
Acupuncture and Chinese medicine are also very
effective for viral infections such as
colds/flus and hepatitis.
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Are there ailments acupuncture isn't effective
to treat? WHAT IS ACUPUNCTURE ? Cancer is not
treatable by acupuncture, although it is
effective in resolving the nausea associated
with chemotherapy treatment. AIDS also does not
respond to acupuncture, although acupuncture can
be used to boost the immune system, it cannot
reverse the effects of HIV.
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Safety in Acupuncture

• Amankah tindakan Akupunktur ?
• Ditangan yang kompeten akupunktur
• merupakan suatu tindakan yang relatif aman
• dengan beberapa kontra indikasi dan
• komplikasi.
• Perhatikan transmisi infeksi yang merupakan
• faktor resiko tindakan akupunktur

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Medical ethics tends to be understood narrowly
as an applied professional ethics, whereas
bioethics appears to have worked more expansive
concerns, touching upon the philosophy of
science and issues of biotechnology. Still, the
two fields often overlap and the distinction is
more a matter of style than professional
consensus. Medical ethics shares many principles
with other branches of healthcare ethics, such
as nursing ethics.
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• Penelitian Akupunktur
• Penelitian Akupunktur Dasar
• - Titik Akupunktur
• - Meridian
• - Mekanisme kerja
• Penelitian Akupunktur klinis
• terkait dengan setiap sistem tubuh

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• Berbagai penelitian telah membuktikan
• keberadaan titik akupunktur,
• yg berbeda dengan sembarang lokasi bukan titik
• akupunktur dalam hal
• Struktur anatomi dan histologi
• Fenomena khas
• Efek rangsang

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• Struktur Anatomi dan Histologi Titik Akupunktur
• Kellner (1965) melalukan 12.000 mikroseksi pada
  11 titik
• akupunktur tidak ditemukan sesuatu yang
  unik, kecuali
• akhiran saraf pada lokasi titik akupunktur
  lebih padat
• Pada lokasi akupunktur, satu reseptor untuk
  2,80 mm2 dan
• lokasi bukan titik akupunktur 12,83 mm2.
• Gunn et al (1976) meneliti 70 buah titik
  akupunktur
• 47 terletak pada titik motorik (tipe I)
• 11 terletak di garis sagital, pertemuan
  saraf superfisial kedua
• belah tubuh (tipe II)
• 12 terletak pada pleksus saraf atau saraf
  kutaneus superfisial
• (tipe III)
• 1977 titik akupunktur terletak di atas
  otot tendon (tipe IV)
• kesimpulan titik akupunktur terletak di
  area kaya saraf
• superfisial.

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• Fan et al (1990) dengan mikroskop elektron pada
  pembesaran 20.000 kali
• mendapatkan celah antar sel (gap junction)
  di epidermis pada lokasi titik
• akupunktur dua kali lebih banyak dibanding
  lokasi bukan titik akupt.
• Croley Carlson (1991) mendapatkan papila dermis
  pada lokasi titik
• Akupunktur dua kali lebih banyak
• Kawakita (1993) reseptor rangsang akupunktur,
  mekanis maupun termis,
• adalah sama yaitu reseptor polimodal, yg
  merupakan akhiran bebas yang
• teranyam dari saraf sensorik tak bermielin
  (serabut C), saraf sensorik
• kecil bermielin (serabut A-delta) dan saraf
  sensorik besar bermielin
• (serabut A-beta)
• reseptor polimodal sensitisasi memunculkan
  nyeri tekan
• eksitasi menimbulkan rasa jarum, reaksi
  inflamasi lokal, aktivasi sistem
• analgetik (dimediasi opioid atau mediator
  kimiawi lainnya), serta aktivasi
• sistem regulatorik.

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Ethical Considerations for Acupuncture and
Chinese Herbal Medicine Clinical Trials A
Cross-cultural Perspective Christopher Zaslawski
College of Traditional Chinese Medicine,
Department of Medical and Molecular Biosciences,
Faculty of Science, University of Technology,
Sydney, Australia Many ethical concerns revolve
around the four basic principles of research
merit and integrity, respect for human beings,
weighting of riskbenefit and justice. These
principles form the basis for any discussion
concerning human research ethics and are
applicable to all areas of research including
acupuncture and Chinese herbal medicine. World
Health Organisation document, Guidelines for
Clinical Research on Acupuncture, states that
consideration should be given to the different
value systems that are involved ..
For reprints and all correspondence Christopher
Zaslawski, College of Traditional Chinese
Medicine, Department of Medical and Molecular
Biosciences, Faculty of Science, University of
Technology, Sydney 2007, Australia. Tel
61-2-9514-7856 Fax [phone] E-mail
chris.zaslawski_at_uts.edu.au
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The Journal of Alternative and Complementary
Medicine Methodological and Ethical Issues in
Clinical Trials of Acupuncture
Richard Hammerschlag, Ph.D. Yo San University
of Traditional Chinese Medicine, Santa Monica,
California. In this review, controlled clinical
trials of acupuncture are placed into five
categories on the basis of the treatment with
which acupuncture is compared. Methodological and
ethical issues relevant to each category are
discussed. Wait list (or no treatment) controls,
which are ethically acceptable for stable,
chronic conditions, assess the efficacy of
acupuncture relative to the natural history of
the condition but do not control for nonspecific
treatment effects. Placebo controls, defined here
as noninvasive procedures such as inactive
transcutaneous electrical nerve stimulation
(TENS) or mock needling, assess whether
acupuncture has an effect beyond that of the
therapeutic milieu. Sham controls, defined as
invasive but inappropriate procedures such as
shallow needling at nonacupoint sites, assess
whether acupuncture efficacy depends on the style
and location of needling.
To cite this articleRichard Hammerschlag. The
Journal of Alternative and Complementary
Medicine. Summer 1998, 4(2) 159-171.
doi10.1089/acm.1998.4.159. Published in Volume
4 Issue 2 September 10, 2007
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The largest "randomized" acupuncture study ever
done Category Alternative medicine Clinical
trials Medicine
For the current study, published in the journal
Cephalalgia, German researchers followed more
than 15,000 adults with chronic headaches all
had been suffering from either migraine or
tension-type headaches at least twice a month for
1 year or more.
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RESULT

• At 3 months, the number of days with headache
  decreased from 8.4 7.2 (estimated mean s.e.)
  to 4.7 5.6 in the acupuncture group and from
  8.1 6.8 to 7.5 6.3 in the control group (P lt
  0.001). Similarly, intensity of pain and quality
  of life improvements were more pronounced in the
  acupuncture vs. control group (P lt 0.001).
  Treatment success was maintained through 6 months.

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ACUPUNCTURE - ADENOSINE - AMP - ADP - ATP
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Visualisasi Meridian Menggunakan Teknik
Pemeriksaan Kedokteran Nuklir

• Radiofarmaka Tc-99m pertechnetate
• Biodistribusi Kel. ludah, kel. tiroid, lambung,
  GUT.

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SJ10 (?) R
L SJ4
Statik 5 menit, aliran ke atas / ke PC1
(Tianquan) (?)
SJ5 (Waiguan), statik 10 20 mnt Kiri Titik
Akup(Deqi), Kanan intradermal Kiri aliran ke
atas ke SJ10(Tianjing?)
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PC1 (Tianchi) PC6 (Neiguan) PC8 (Laogong) 250
µCi/titik, 20 menit, WBS
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MAU CANTIKK..
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TERIMAKASIH