Quality Issues Of
a previous editorial in Medical Acupuncture (Volume 13/Number 3), I
addressed the quality issue of electroacupuncture stimulators used for
clinical and research practices. I was concerned that the manufacturers
specifications may not be as reliable as previously thought. It is now
my opinion after co-authoring the paper in this issue, Are Frequency
Outputs of Commercial Electroacupuncture Stimulators Accurate? (Pilot
Project) that my apprehension was justified (see page 41). We
cannot assume that the current electroacupuncture stimulators meet the
manufacturers specifications. For example, dial up 4 Hz to stimulate
a patient and the instrument may be way off target.
Is its waveform output clean or unintentionally distorted? Does all
this make a difference? The answer is obvious. If our electronic stimulating
device is not accurate, our research data are compromised. Patient care
may not be entirely compromised as we do not know if 10% or 20% deviation
from a given frequency is physiologically relevant. But, do we wish
to accept such errors?
Equipment is expensive. It is necessary that I know that the instrument
I am using is calibrated properly and traceable to the National Institute
of Standards and Technology (NIST). I would also like to know that the
device is actually working. One instrument that I was using flashed
its lights and made all the right sounds. But when the output was measured
by several test equipment, there wasnt any. This supported my
clinical observation that patients were not responding when I used this
stimulator. Lucky for me and my patients, I had access to test equipment.
Many of these instruments come with analog scales. You eyeball a number
to coincide with a cursor. Even a few millimeters off the cursor may
be a difference of several hertz at high frequencies. So why not demand
that the manufacturer use a digital meter so you can see the exact output?
Most of these stimulators use small batteries. With use, a battery runs
down and its output is reduced. This can affect the quality output of
the instrument and even cause distortion of the waveform. There should
be a safeguard to this situation.
It is now more apparent to me than ever before that electronic instrumentation
being sold for acupuncture use must be certified by the manufacturer
that its specifications are as advertised. In my opinion, an independent
testing agency must be established to oversee and protect the practitioner
and patient from fraudulent instruments. This agency would be responsible
for ensuring that the instruments are reliable and safe. In addition,
all electronic stimulators might benefit by a voluntary annual certification
and calibration requirement. I would strongly recommend that an article
for future publication state that the stimulator was calibrated to the
NIST standards, and require a copy of the calibration report.
Research must be established to determine the optimal way to stimulate
an acupuncture point. Different types of waveforms are actually the
summation of electrical harmonics. Might sinusoidal stimulation be a
consideration as it is devoid of harmonics? Safety is another issue.
A case was brought to my attention that a patient was burned from the
output of a stimulator, not because the current was turned up too high,
but because of a lopsided waveform. Even symmetrical square waves may
cause this, if the frequency is very slow, the on-time of the pulses
is long, and a point electrode in the skin exists where the current
density is high at the needle tip.
We must demand from the manufacturers that stimulators be precise and
of the highest engineering quality. We must avoid being appliance users.
Our interests in these instruments must be more than just the knowledge
of how to turn them on or off. If we continue in the present manner,
we risk compromising our patients and our research efforts. Also, this
field is embryonic, and we know little about the local cellular, tissue,
and distant physiological effects of electroacupuncture stimulation.
But, research indicates that the potential exists for great advancement
in electroacupuncture as an extraordinary therapeutic tool. More than
5000 articles are published each year on the biophysics of voltage gated
ion channels. When we incorporate this information into practical applications
and manipulate the body physiologically with electrical impulses, we
will begin to utilize the possibilities inherent in electroacupuncture
technology. Electroacupuncture should take its rightful place in the
field of clinical electrotherapy, and higher standards of training and
education are appropriate.
I wish to thank our Editorial Board for volunteering their time and
Jim Dowden, Executive Administrator of the AAMA, and Deborah Odell,
President of The Odell Group, our custom publications design firm, for
their persistent efforts to better the journal. And, as always, our
thanks go to Roz Royal for her devotion and efforts beyond the call
of duty to get the job done, and Stacy Christiansen-Krol for her tireless
assistance in this endeavor.
And lastly, by the time you read this, I will have moved to Malcolm
Grow Medical Center, Andrews
Air Force Base, Maryland, to continue practicing acupuncture full-time,
and as a Consultant to the Air Force Surgeon General.
Richard C. Niemtzow, MD, PhD, MPH
Dr Richard C. Niemtzow is a Colonel in the United States Air Force and
a Radiation Oncologist. He practices medical acupuncture full-time with
oncology and general patients, and is also involved in research. Effective
July 31, 2002, Dr Niemtzow was transferred to Malcolm Grow Medical Center,
Andrews AFB, Maryland to continue his full-time acupuncture endeavors,
and as a Consultant to the Air Force Surgeon General. Dr Niemtzow is
President of the Medical Acupuncture Research Foundation (MARF).
Richard C. Niemtzow, MD, PhD, MPH
9800 Cherry Hill Rd
College Park, MD 20740
Phone: 301-937-7424 Fax: 301-937-3205 E-mail: firstname.lastname@example.org
Colonel (Dr) Richard C. Niemtzow
89 Medical Group (AMC)
Malcolm Grow Medical Center
Andrews AFB, MD 20762