Transcript 2. Ethic of Acupuncture

Dr . NUSHROTUL LAILIYYA, Sp.S, Sp.AK
Neurologist & Acupuncturist
Department of Neurology-Hasan Sadikin HospitalMedical Faculty-Padjadjaran University
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 physicians’s
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?
Akupunktur merupakan komponen penting dari
SAAT INI
AKUPUNKTUR MEDIK ??
SEJARAH
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
7
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)
akupunktur
Diintegrasikan ke dalam sistim pelayanan formal
- Resolution WHO 44.34
- Permenkes RI NO. 1186/Menkes/ Per/XI/1996
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
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.
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.
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.
AKUPUNKTURacupunkture
PASIEN
TINDAKAN
STERILITAS JARUM
INFORMED CONSENT
KASUS/ISSUES
SIAPA, DLL
BIOETHIC
Babies, acupuncture and the secret to a good night's sleep
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
Resiko Tindakan akupunktur :
- Transmisi infeksi (hepatitis, HIV)
- Jarum patah, bengkok
- Reaksi yang tdk diharapkan
- Nyeri dan rasa tidak nyaman
- terlukanya organ dalam
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
Kontra Indikasi
•
•
•
•
•
Kehamilan
Kedaruratan medik
Kasus pembedahan
Tumor ganas
Gangguan pembekuan darah dan sedang
dalam pengobatan antikuagulantia
CONTROVERSIES ISSUES
OF ACUPUNCTURE
YIN-YANG
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Yin-yang
•
•
•
•
•
Malam
Barat/utara
Dingin
Air
Bulan
• Perut
• Permukaan dalam
• Darah
•
•
•
•
•
Kronis
Merasa dingin
Depresi
Lemah
Sakit
•
•
•
•
•
Siang
Timur/selatan
Panas
Api
Matahari
• Punggung
• Permukaan luar
• Energi/chi
•
•
•
•
•
Akut
Merasa panas
Senang
Kuat
Sehat
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ACUPUNCTURE
YINYANG
HOMEOSTASIS
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)
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Jam 3.00
Jam 5.00
Jam 7.00
Jam 9.00
Jam 11.00
Jam 13.00
Jam 15.00
Jam 17.00
Jam 19.00
Jam 21.00
Jam 23.00
Jam 1.00
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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.
What Can Acupuncture
Treat?
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.
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/flu’s and hepatitis.
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.
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
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.
Penelitian Akupunktur :
* Penelitian Akupunktur Dasar
- Titik Akupunktur
- Meridian
- Mekanisme kerja
* Penelitian Akupunktur klinis
terkait dengan setiap sistem tubuh
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
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.
• 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.
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 risk–benefit 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: +61-2-9514-7866; E-mail: [email protected]
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 article:
Richard Hammerschlag. The Journal of Alternative and Complementary Medicine. Summer 1998, 4(2): 159-171.
doi:10.1089/acm.1998.4.159. Published in Volume: 4 Issue 2: September 10, 2007
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 tensiontype headaches at least twice a month for 1 year or more.
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 <
0.001). Similarly, intensity of pain and quality of life
improvements were more pronounced in the acupuncture vs.
control group (P < 0.001). Treatment success was maintained
through 6 months.
ACUPUNCTURE - ADENOSINE - AMP - ADP - ATP
Visualisasi Meridian Menggunakan Teknik
Pemeriksaan Kedokteran Nuklir
Radiofarmaka: Tc-99m pertechnetate
Biodistribusi: Kel. ludah, kel. tiroid, lambung,
GUT.
PC1
SJ10 (?)
PC3
R
L
PC6
SJ5
SJ10
(?)(?)
SJ10
PC3
RR
L
L
SJ4
SJ5
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?)
PC1 (Tianchi)
PC6 (Neiguan)
PC8 (Laogong)
250 µCi/titik,
20 menit, WBS
PC1
Jantung
Lambung
Aliran
radiofarmaka ≈
Meridian
PC6
PC8
TERIMAKASIH