[Congressional Record Volume 143, Number 155 (Friday, November 7, 1997)]
[Senate]
[Pages S11943-S11947]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        NIH ENDORSES ACUPUNCTURE

  Mr. HARKIN. Mr. President, earlier this week an expert scientific 
panel at the National Institutes of Health strongly endorsed 
acupuncture as an effective treatment for certain conditions. This is 
the first time that the NIH has endorsed a major alternative therapy. 
It is truly a breakthrough, and is just the type of advance that I 
envisioned when I worked to establish the Office of Alternative 
Medicine at the NIH.
  The consensus conference held by NIH involved top scientists from 
around the Nation, including those with expertise in acupuncture and 
experts in research evaluation and design. These scientists, led by Dr. 
David Ramsey, president of the University of Maryland, Baltimore, 
objectively evaluated the evidence of acupuncture's efficacy and came 
to a consensus that this therapy is safe and provides significant help 
for a number of health problems.
  They found that acupuncture is an effective treatment for 
postoperative dental pain, postoperative and chemotherapy-induced 
nausea, nausea during pregnancy, and other conditions. They also 
identified a number of other conditions, including asthma, substance 
addiction, stroke rehabilitation, headache, general muscle pain, low 
back pain, carpal tunnel syndrome, for which acupuncture demonstrates 
effectiveness but with a less degree of certainty.
  I was dismayed to read that despite this consensus agreement after 
rigorous evaluation of the scientific evidence, there is still a fringe 
element in the medical community that refuses to acknowledge the facts. 
These critics seem only to be interested in bad mouthing anything out 
of what they consider to be the medical mainstream. While we all 
benefit from a healthy dose of skepticism in the scientific process, I 
hope in the future, this small group of critics take off their blinders 
long enough to objectively look at the scientific evidence and give 
credit where credit is due.
  Mr. President, as I have said before, millions of Americans--more and 
more each day--are using alternative medical therapies. In 1993, the 
FDA reported that Americans were spending $500 million a year for 
between 9 and 12 million acupuncture treatment visits. Unfortunately, 
research has not kept pace. The NIH has failed to break through biases 
that exist and devote the attention to this area that is needed. As a 
result, American consumers have been denied information about the 
effectiveness of the therapies they are using or thinking of using.
  I am pleased to report that the conference report on the fiscal year 
1998 Health and Human Services appropriations bill has agreed to 
provide more than a 50-percent increase to the Office of Alternative 
Medicine to expand efforts like this week's consensus conference on 
acupuncture to other work and to investigate and validate complementary 
and alternative therapies. Our report also guarantees that this 
increase will be spent on grants and contracts that directly respond to 
requests for proposals and program announcements issued by the Office 
of Alternative Medicine.
  Mr. President, this week's endorsement of acupuncture by NIH is a 
positive step forward for the American public and for the medical 
research in our Nation. I hope that it will lead not only to greater 
acceptance of, and access to, cost effective acupuncture services, but 
to increased willingness on the part of NIH and the medical community 
to commit to the objective evaluation of a range of promising 
complementary and alternative medical therapies.
  Mr. President, I ask that the full text of the findings of this 
historic NIH consensus panel be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

     National Institutes of Health Consensus Development Statement


                              introduction

       Acupuncture is a component of the health care system of 
     China that can be traced back for at least 2,500 years. The 
     general theory of acupuncture is based on the premise that 
     there are patterns of energy flow (Qi) through the body that 
     are essential for health. Disruptions of this flow are 
     believed to be responsible for disease. The acupuncturist can 
     correct imbalances of flow at identifiable points close to 
     the skin. The practice of acupuncture to treat identifiable 
     pathophysiological conditions in American medicine was rare 
     until the visit of President Nixon to China in 1972. Since 
     that time, there has been an explosion of interest in the 
     United States and Europe in the application of the technique 
     of acupuncture to Western medicine.
       Acupuncture describes a family of procedures involving 
     stimulation of anatomical locations on the skin by a variety 
     of techniques. The most studied mechanism of stimulation of 
     acupuncture points employs penetration of the skin by thin, 
     solid, metallic needles, which are manipulated manually or by 
     electric stimulation. The majority of comments in this report 
     are based on data that came from such studies. Stimulation of 
     these areas by moxibustion, pressure, heat, and lasers is 
     used in acupuncture practice, but due to the paucity of 
     studies, these techniques are more difficult to evaluate. 
     Thus, there are a variety of approaches to diagnosis and 
     treatment in American acupuncture that incorporate medical 
     traditions from China, Japan, Korea, and other countries.
       Acupuncture has been used by millions of American patients 
     and performed by thousands of physicians, dentists, 
     acupuncturists,

[[Page S11944]]

     and other practitioners for relief or prevention of pain and 
     for a variety of health conditions. After reviewing the 
     existing body of knowledge, the U.S. Food and Drug 
     Administration recently removed acupuncture needles from the 
     category of ``experimental medical devices'' and now 
     regulates them just as it does other devices, such as 
     surgical scalpels and hypodermic syringes, under good 
     manufacturing practices and single-use standards of 
     sterility.
       Over the years, the National Institutes of Health (NIH) has 
     funded a variety of research projects on acupuncture, 
     including studies on the mechanisms by which acupuncture may 
     have its effects, as well as clinical trials and other 
     studies. There is also a considerable body of international 
     literature on the risks and benefits of acupuncture, and the 
     World Health Organization lists a variety of medical 
     conditions that may benefit from the use of acupuncture or 
     moxibustion. Such applications include pre-vention and 
     treatment of nausea and vomiting; treatment of pain and 
     addictions to alcohol, tobacco, and other drugs; treatment of 
     pulmonary problems such as asthma and bronchitis; and 
     rehabilitation from neurological damage such as that caused 
     by stroke.
       To address important issues regarding acupuncture, the NIH 
     Office of Alternative Medicine and the NIH Office of Medical 
     Applications of Research organized a 2\1/2\-day conference to 
     evaluate the scientific and medical data on the uses, risks, 
     and benefits of acupuncture procedures for a variety of 
     conditions. Cosponsors of the conference were the National 
     Cancer Institute, the National Heart, Lung, and Blood 
     Institute, the National Institute of Allergy and Infectious 
     Diseases, and National Institute of Arthritis and 
     Musculoskeletal and Skin Diseases, the National Institute of 
     Dental Research, the National Institute on Drug Abuse, and 
     the Office of Research on Women's Health and the NIH. The 
     conference brought together national and international 
     experts in the fields of acupuncture, pain, psychology, 
     psychiatry, physical medicine and rehabilitation, drug abuse, 
     family practice, internal medicine, health policy, 
     epidemiology, statistics, physiology, and biophysics, as well 
     as representatives from the public.
       After 1\1/2\ days of available presentation and audience 
     discussion, an independent, non-Federal consensus panel 
     weighed the scientific evidence and wrote a draft statement 
     that was presented to the audience on the third day. The 
     consensus statement addressed the following key questions:
       What is the efficacy of acupuncture, compared with placebo 
     or sham acupuncture, in the conditions for which sufficient 
     data are available to evaluate?
       What is the place of acupuncture in the treatment of 
     various conditions for which sufficient data are available, 
     in comparison with or in combination with other 
     interventions (including no intervention)?
       What is known about the biological effects of acupuncture 
     that helps us understand how it works?
       What issues need to be addressed so that acupuncture may be 
     appropriately incorporated into today's health care system?
       What are the directions for future research?
       The primary sponsors of this meeting were the National 
     Human Genome Research Institute and the NIH Office of Medical 
     Applications of Research. The conference was cosponsored by 
     the National Institute of Diabetes and Digestive and Kidney 
     Diseases; the National Heart, Lung, and Blood Institute, the 
     National Institute of Child Health and Human Development, the 
     NIH Office of Rare Diseases; the National Institute of Mental 
     Health; the National Institute of Nursing Research; the NIH 
     Office of Research on Women's Health; the Agency for Health 
     Care Policy and Research; and the Centers for Disease Control 
     and Prevention.
       1. What is the efficacy of acupuncture, compared with 
     placebo or sham acupuncture, in the conditions for which 
     sufficient data are available to evaluate?
       Acupuncture is a complex intervention that may vary for 
     different patients with similar chief complaints. The number 
     and length of treatments and the specific points used may 
     vary among individuals and during the course of treatment. 
     Given this reality, it is perhaps encouraging that there 
     exist a number of studies of sufficient quality to assess the 
     efficacy of acupuncture for certain conditions.
       According to contemporary research standards, there is a 
     paucity of high-quality research assessing efficacy of 
     acupuncture compared with placebo or sham acupuncture. The 
     vast majority of papers studying acupuncture in the 
     biomedical literature consist of case reports, case series, 
     or intervention studies with designs inadequate to assess 
     efficacy.
       This discussion of efficacy refers to needle acupuncture 
     (manual or electroacupuncture) because the published research 
     is primarily on needle acupuncture and often does not 
     encompass the full breadth of acupuncture techniques and 
     practices. The controlled trials usually have only involved 
     adults and did not involve long-term (i.e., years) 
     acupuncture treatment.
       Efficacy of a treatment assesses the differential effect of 
     a treatment when compared with placebo or another treatment 
     modality using a double-blind controlled trial and a rigidly 
     defined protocol. Papers should describe enrollment 
     procedures, eligibility criteria, description of the clinical 
     characteristics of the subjects, methods for diagnosis, and a 
     description of the protocol (i.e., randomization method, 
     specific definition of treatment, and control conditions, 
     including length of treatment, and number of acupuncture 
     sessions). Optimal trials should also use standardized 
     outcomes and appropriate statistical analyses. This 
     assessment of efficacy focuses on high-quality trials 
     comparing acupuncture with sham acupuncture or placebo.

                             Response rate

       As with other interventions, some individuals are poor 
     responders to specific acupuncture protocols. Both animal and 
     human laboratory and clinical experience suggest that the 
     majority of subjects respond to acupuncture, with a minority 
     not responding. Some of the clinical research 
     outcomes, however, suggest that a larger percentage may 
     not respond. The reason for this paradox is unclear and 
     may reflect the current state of the research.

                    Efficacy for specific disorders

       There is clear evidence that needle acupuncture is 
     efficacious for adult post-operative and chemotherapy nausea 
     and vomiting and probably for the nausea of pregnancy.
       Much of the research is on various pain problems. There is 
     evidence of efficacy for postoperative dental pain. There are 
     reasonable studies (although sometimes only single studies) 
     showing relief of pain with acupuncture on diverse pain 
     conditions such as menstrual cramps, tennis elbow, and fibro-
     myalgia. This suggests that acupuncture may have a more 
     general effect on pain. However, there are also studies that 
     do not find efficacy for acupuncture in pain.
       There is evidence that acupuncture does not demonstrate 
     efficacy for cessation of smoking and may not be efficacious 
     for some other conditions.
       While many other conditions have received some attention in 
     the literature and, in fact, the research suggests some 
     exciting potential areas for the use of acupuncture, the 
     quality or quantity of the research evidence is not 
     sufficient to provide firm evidence of efficacy at this time.

                            Sham acupuncture

       A commonly used control group is sham acupuncture, using 
     techniques that are not intended to stimulate known 
     acupuncture points. However, there is disagreement on correct 
     needle placement. Also, particularly in the studies of pain, 
     sham acupuncture often seems to have either intermediate 
     effects between the placebo and Oreal' acupuncture points or 
     effects similar to those of the Oreal' acupuncture points. 
     Placement of a needle in any position elicits a biological 
     response that complicates the interpretation of studies 
     involving sham acupuncture. Thus, there is substantial 
     controversy over the use of sham acupuncture as control 
     groups. This may be less of a problem in studies not 
     involving pain.
       2. What is the place of acupuncture in the treatment of 
     various conditions for which sufficient data are available, 
     in comparison with or in combination with other interventions 
     (including no intervention)?
       Assessing the usefulness of a medical intervention in 
     practice differs from assessing formal efficacy. In 
     conventional practice, clinicians make decisions based on the 
     characteristics of the patient, clinical experience, 
     potential for harm, and information from colleagues and the 
     medical literature. In addition, when more than one treatment 
     is possible, the clinician may make the choice taking into 
     account the patient's preferences. While it is often thought 
     that there is substantial research evidence to support 
     conventional medical practices, this is frequently not that 
     case. This does not mean that these treatments are 
     ineffective. The data in support of acupuncture are as strong 
     as those for many accepted Western medical therapies.
       One of the advantages of acupuncture is that the incidence 
     of adverse effects if substantially lower than that of many 
     drugs or other accepted medical procedures used for the same 
     conditions. As an example, musculoskeletal conditions, such 
     as fibromyalgia, myofascial pain, and ``tennis elbow,'' or 
     epicondylitis, are conditions for which acupuncture may be 
     beneficial. These painful conditions are often treated with, 
     among other things, anti-inflammatory medications (aspirin, 
     ibuprofen, etc.) or with steroid injections. Both medical 
     interventions have a potential for deleterious side effects, 
     but are still widely used, and are considered acceptable 
     treatment. The evidence supporting these therapies is no 
     better than that for acupuncture.
       In addition, ample clinical experience, supported by some 
     research data, suggests that acupuncture may be a reasonable 
     option for a number of clinical conditions. Examples are 
     postoperative pain and myofascial and low back pain. Examples 
     of disorders for which the research evidence is less 
     convincing but for which there are some positive clinical 
     reports include addiction, stroke rehabilitation, carpal 
     tunnel syndrome, osteoarthritis, and headache. Acupuncture 
     treatment for many conditions such as asthma, addiction, or 
     smoking cessation should be part of a comprehensive 
     management program.
       Many other conditions have been treated by acupuncture, the 
     World Health Organization, for example, has listed more than 
     40 for which the technique may be indicated.
       3. What is known about the biological effects of 
     acupuncture that helps us understand how it works?

[[Page S11945]]

       Many studies in animals and humans have demonstrated that 
     acupuncture can cause multiple biological responses. These 
     responses can occur locally, i.e., at or close to the site of 
     application, or at a distance, mediated mainly by sensory 
     neurons to many structures within the central nervous system. 
     This can lead to activation of pathways affecting various 
     physiological systems in the brain as well as in the 
     periphery. A focus of attention has been the role of 
     endogenous opioids in acupuncture analgesia. Considerable 
     evidence supports the claim that opioid peptides are released 
     during acupuncture and that the analgesic effects of 
     acupuncture are at least partially explained by their 
     actions. That opioid antagonists such as naloxone reverse the 
     analgesic effects of acupuncture further strengthens this 
     hypothesis. Stimulation by acupuncture may also activate the 
     hypothalamus and the pituitary gland, resulting in a broad 
     spectrum of systemic effects. Alteration in the secretion of 
     neurotransmitters and neurohormones and changes in the 
     regulation of blood flow, both centrally and peripherally, 
     have been documented. There is also evidence that there are 
     alterations in immune functions produced by acupuncture. 
     Which of these and other physiological changes mediate 
     clinical effects is a present unclear.
       Despite considerable efforts to understand the anatomy and 
     physiology of the ``acupuncture points,'' the definition and 
     characterization of these points remains controversial. Even 
     more elusive is the scientific basis of some of the key 
     traditional Eastern medical concepts such as the circulation 
     of Qi, the meridian system, and the five phases theory, which 
     are difficult to reconcile with contemporary biomedical 
     information but continue to play an important role in the 
     evaluation of patients and the formulation of treatment in 
     acupuncture.
       Some of the biological effects of acupuncture have also 
     been observed when ``sham'' acupuncture points are 
     stimulated, highlighting the importance of defining 
     appropriate control groups in assessing biological changes 
     purported to be due to acupuncture. Such findings raise 
     questions regarding the specificity of these biological 
     changes. In addition, similar biological alterations 
     including the release of endogenous opioids and changes in 
     blood pressure have been observed after painful stimuli, 
     vigorous exercise, and/or relaxation training; it is at 
     present unclear to what extent acupuncture shares similar 
     biological mechanisms.
       It should be noted also that for any therapeutic 
     intervention, including acupuncture, the so-called ``non-
     specific'' effects account for a substantial proportion of 
     its effectiveness, and thus should not be casually 
     discounted. Many factors may profoundly determine therapeutic 
     outcome including the quality of the relationship between the 
     clinician and the patient, the degree of trust, the 
     expectations of the patient, the compatibility of the 
     backgrounds and belief systems of the clinician and the 
     patient, as well as a myriad of factors that together 
     define the therapeutic milieu.
       Although much remains unknown regarding the mechanism(s) 
     that might mediate the therapeutic effect of acupuncture, the 
     panel is encouraged that a number of significant acupuncture-
     related biological changes can be identified and carefully 
     delineated. Further research in this direction not only is 
     important for elucidating the phenomena associated with 
     acupuncture, but also has the potential for exploring new 
     pathways in human physiology not previously examined in a 
     systematic manner.
       4. What issues need to be addressed so that acupuncture may 
     be appropriately incorporated into today's health care 
     system?
       The integration of acupuncture into today's health care 
     system will be facilitated by a better understanding among 
     providers of the language and practices of both the Eastern 
     and Western health care communities. Acupuncture focuses on a 
     holistic, energy-based approach to the patient rather than a 
     disease-oriented diagnostic and treatment model.
       An important factor for the integration of acupuncture into 
     the health care system is the training and credentialing of 
     acupuncture practitioners by the appropriate state agencies. 
     This is necessary to allow the public and other health 
     practitioners to identify qualified acupuncture 
     practitioners. The acupuncture educational community has made 
     substantial progress in this area and is encouraged to 
     continue along this path. Educational standards have been 
     established for training of physician and non-physician 
     acupuncturists. Many acupuncture educational programs are 
     accredited by an agency that is recognized by the U.S. 
     Department of Education. A national credentialing agency 
     exists that is recognized by some of the major professional 
     acupuncture organizations and provides examinations for 
     entry-level competency in the field.
       A majority of States provide licensure or registration for 
     acupuncture practitioners. Because some acupuncture 
     practitioners have limited English proficiency, credentialing 
     and licensing examinations should be provided in languages 
     other than English where necessary. There is variation in the 
     titles that are conferred through these processes, and the 
     requirements to obtain licensure vary widely. The scope of 
     practice allowed under these State requirements varies as 
     well. While States have the individual prerogative to set 
     standards for licensing professions, harmonization in these 
     areas will provide greater confidence in the qualifications 
     of acupuncture practitioners. For example, not all States 
     recognize the same credentialing examination, thus making 
     reciprocity difficult.
       The occurrence of adverse events in the practice of 
     acupuncture has been documented to be extremely low. However, 
     these events have occurred in rare occasions, some of which 
     are life threatening (e.g., pneumothorax). Therefore, 
     appropriate safeguards for the protection of patients and 
     consumers need to be in place. Patients should be fully 
     informed of their treatment options, expected prognosis, 
     relative risk, and safety practices to minimize these risks 
     prior to their receipt of acupuncture. This information must 
     be provided in a manner that is linguistically and culturally 
     appropriate to the patient. Use of acupuncture needles should 
     always follow FDA regulations, including use of sterile, 
     single-use needles. It is noted that these practices are 
     already being done by many acupuncture practitioners; 
     however, these practices should be uniform. Recourse for 
     patient grievance and professional censure are provided 
     through credentialing and licensing procedures and are 
     available through appropriate State jurisdictions.
       It has been reported that more than 1 million Americans 
     currently receive acupuncture each year. Continued access to 
     qualified acupuncture professionals for appropriate 
     conditions should be ensured. Because many individuals 
     seek health care treatment from both acupuncturists and 
     physicians, communication between these providers should 
     be strengthened and improved. If a patient is under the 
     care of an acupuncturist and a physician, both 
     practitioners should be informed. Care should be taken so 
     that important medical problems are not overlooked. 
     Patients and providers have a responsibility to facilitate 
     this communication.
       There is evidence that some patients have limited access to 
     acupuncture services because of inability to pay. Insurance 
     companies can decrease or remove financial barriers to access 
     depending on their willingness to provide coverage for 
     appropriate acupuncture services. An increasing number of 
     insurance companies are either considering this possibility 
     or now provide coverage for acupuncture services. Where there 
     are State health insurance plans, and for populations served 
     by Medicare or Medicaid, expansion of coverage to include 
     appropriate acupuncture services would also help remove 
     financial barriers to access.
       As acupuncture is incorporated into today's health care 
     system, and further research clarifies the role of 
     acupuncture for various health conditions, it is expected 
     that dissemination of this information to health care 
     practitioners, insurance providers, policymakers, and the 
     general public will lead to more informed decisions in regard 
     to the appropriate use of acupuncture.
       5. What are the directions for future research?
       The incorporation of any new clinical intervention into 
     accepted practice faces more scrutiny now than ever before. 
     The demands of evidence-based medicine, outcomes research, 
     managed care systems of health care delivery, and a plethora 
     of therapeutic choices makes the acceptance of new treatments 
     an arduous process. The difficulties are accentuated when the 
     treatment is based on theories unfamiliar to Western medicine 
     and its practitioners. It is important, therefore, that the 
     evaluation of acupuncture for the treatment of specific 
     conditions be carried out carefully, using designs which can 
     withstand rigorous scrutiny. In order to further the 
     evaluation of the role of acupuncture in the management of 
     various conditions, the following general areas for future 
     research are suggested.
       What are the demographics and patterns of use of 
     acupuncture in the U.S. and other countries?
       There is currently limited information on basic questions 
     such as who uses acupuncture, for what indications is 
     acupuncture most commonly sought, what variations in 
     experience and techniques used exist among acupuncture 
     practitioners, and whether there are differences in these 
     patterns by geography or ethnic group. Descriptive 
     epidemiologic studies can provide insight into these and 
     other questions. This information can in turn be used to 
     guide future research and to identify areas of greatest 
     public health concern.
       Can the efficacy of acupuncture for various conditions for 
     which it is used or for which it shows promise be 
     demonstrated?
       Relatively few high-quality, randomized, controlled trials 
     have been published on the effects of acupuncture. Such 
     studies should be designed in a rigorous manner to allow 
     evaluation of the effectiveness of acupuncture. Such studies 
     should include experienced acupuncture practitioners in order 
     to design and deliver appropriate interventions. Emphasis 
     should be placed on studies that examine acupuncture as used 
     in clinical practice, and that respect the theoretical basis 
     for acupuncture therapy.
       Although randomized controlled trials provide a strong 
     basis for inferring causality, other study designs such as 
     used in clinical epidemiology or outcomes research can also 
     provide important insights regarding the usefulness of 
     acupuncture for various conditions. There have been few such 
     studies in the acupuncture literature.
       Do different theoretical bases for acupuncture result in 
     different treatment outcomes?
       Competing theoretical orientations (e.g., Chinese, 
     Japanese, French) currently exist

[[Page S11946]]

     that might predict divergent therapeutic approaches (i.e., 
     the use of different acupuncture points). Research projects 
     should be designed to assess the relative merit of these 
     divergent approaches, as well to compare these systems with 
     treatment programs using fixed acupuncture points.
       In order to fully assess the efficacy of acupuncture, 
     studies should be designed to examine not only fixed 
     acupuncture points, but also the Eastern medical systems that 
     provide the foundation for acupuncture therapy, including the 
     choice of points. In addition to assessing the effect of 
     acupuncture in context, this would also provide the 
     opportunity to determine if Eastern medical theories predict 
     more effective acupuncture points, as well as to examine the 
     relative utility of competing systems (e.g., Chinese vs. 
     Japanese vs. French) for such purposes.
       What areas of public policy research can provide guidance 
     for the integration of acupuncture into today's health care 
     system?
       The incorporation of acupuncture as a treatment raises 
     numerous questions of public policy. These include issues of 
     access, cost-effectiveness, reimbursement by State, Federal, 
     and private payors, and training, licensure, and 
     accreditation. These public policy issues must be founded on 
     quality epidemiologic and demographic data and effectiveness 
     research.
       Can further insight into the biological basis for 
     acupuncture be gained?
       Mechanisms which provide a Western scientific explanation 
     for some of the effects of acupuncture are beginning to 
     emerge. This is encouraging, and may provide novel insights 
     into neural, endocrine and other physiological processes. 
     Research should be supported to provide a better 
     understanding of the mechanisms involved, and such research 
     may lead to improvements in treatment.
       Does an organized energetic system exist in the human body 
     that has clinical applications?
       Although biochemical and physiologic studies have provided 
     insight into some of the biologic effects of acupuncture, 
     acupuncture practice is based on a very different model of 
     energy balance. This theory may provide new insights to 
     medical research that may further elucidate the basis for 
     acupuncture.
       How do the approaches and answers to these questions differ 
     among populations that have used acupuncture as a part of its 
     healing tradition for centuries, compared to populations that 
     have only recently begun to incorporate acupuncture into 
     health care?


                    conclusions and recommendations

       Acupuncture as a therapeutic interventions is widely 
     practiced in the United States. There have been many studies 
     of its potential usefulness. However, many of these 
     studies provide equivocal results because of design, 
     sample size, and other factors. The issue is further 
     complicated by inherent difficulties in the use of 
     appropriate controls, such as placebo and sham acupuncture 
     groups.
       However, promising results have emerged, for example, 
     efficacy of acupuncture in adult post-operative and 
     chemotherapy nausea and vomiting and in post-operative dental 
     pain. There are other situations such as addiction, stroke 
     rehabilitation, headache, menstrual cramps, tennis elbow, 
     fibromyalgia myofascial pain, osteoarthritis, low back pain, 
     carpal tunnel syndrome, and asthma where acupuncture may be 
     useful as an adjunct treatment or an acceptable alternative 
     or be included in a comprehensive management program. Further 
     research is likely to uncover additional areas where 
     acupuncture interventions will be useful.
       Findings from basic research have begun to elucidate the 
     mechanisms of action of acupuncture, including the release of 
     opioids and other peptides in the central nervous system and 
     the periphery and changes in neuroendocrine function. 
     Although much needs to be accomplished, the emergence of 
     plausible mechanisms for the therapeutic effects of 
     acupuncture is encouraging.
       The introduction of acupuncture into the choice of 
     treatment modalities that are readily available to the public 
     is in its early stages. Issues of training, licensure, and 
     reimbursement remain to be clarified. There is sufficient 
     evidence, however, of its potential value to conventional 
     medicine to encourage further studies.
       There is sufficient evidence of acupuncture's value to 
     expand its use into correctional medicine and to encourage 
     further studies of its physiology and clinical value.

  Mr. HARKIN. I yield the floor.
  Mr. FEINGOLD addressed the Chair.
  The PRESIDING OFFICER. The Senator from Wisconsin is recognized.
  Mr. FEINGOLD. Mr. President, I would like to take this opportunity to 
respond to my friends, the Senators from Vermont, Mr. Leahy and Mr. 
Jeffords, who just spoke with regard to a recent decision by the 
Federal District Court of Minnesota. It also gives me an opportunity to 
not only present a different perspective on that ruling, but to also 
hail the ruling, which is the first ray of hope that the dairy farmers 
in the upper Midwest, and in particular the farmers in my home State of 
Wisconsin, have had for a very, very long time.
  I think the judge in this case ruled correctly. In the Minnesota Milk 
Producers versus Dan Glickman, Secretary of the U.S. Department of 
Agriculture, Federal Judge David Doty finally said what Wisconsin dairy 
farmers have long known is the case, and that is that the current 
Federal milk marketing order system is outdated and is, in fact, 
illegal, given the realities of our national dairy market today. This 
system was set up some 60 years ago, because at that time it was not 
always possible for consumers in other parts of the country, 
particularly the South and the Southeast, to get fresh milk because of 
inadequate refrigeration and transportation technology. So this system 
was set up on the basis of how far a farmer lived from Eau Claire, WI--
the supposed reserve supply of milk in the United States. In other 
words, the closer a farmer lived to Eau Claire, WI, the less he got as 
an add-on for his class I fluid milk. The system worked, and it 
certainly provided the needed fresh milk for virtually every marketing 
order in the country east of the Rocky Mountains.
  Times have changed. During the past 60 years these areas, such as the 
Northeastern, Southwestern and Southcentral regions of the United 
States, are now able to produce enough milk to provide for their fluid 
milk needs and then some. Yet there is still a gross discrepancy 
between what a dairy farmer gets, let's say in Texas or Vermont, for 
his or her class I milk, and what a farmer in Wisconsin gets for the 
same type of milk. For example, farmers in Wisconsin may receive $1.20 
per hundredweight in addition to the base price for milk, but in other 
regions more distant from Wisconsin, dairy farmers might receive $2 or 
$3 or even $4 more than Wisconsin farmers.
  These are very serious disparities and these differentials have led 
to an extremely unfair situation to the dairy farmers in the upper 
Midwest. The decision by the district court this week finally says, 
``Enough is enough.'' It takes note, in effect, of the fact that in the 
last 17 years, Wisconsin alone has gone from having 45,000 dairy farms 
to less than 25,000. We have lost over 1,000 dairy farms per year each 
year. And when upper Midwest dairy farmers talk about all of the 
problems facing their industry, the complaint that arises most often is 
the unfairness of the Federal milk marketing order system.
  In contrast to what the two Senators from Vermont were saying--one of 
them actually indicated there had to be these disparities in order for 
milk to be supplied to consumers--the fact is, current market 
conditions and existing technologies no longer necessitate a system 
that prices milk based on distance from Eau Claire. In fact, in recent 
years, when our dairy farmers have tried to sell their milk in Chicago, 
have been beaten out of that market by milk from southcentral and 
southwestern producers. How can that be if these regions can't produce 
enough milk for their own needs in that area? Obviously, they can meet 
their needs and still afford to export milk to other regions because 
they are receiving a higher class I milk price. And the result is that 
this system subsidizes the farmers in the Southeast, Northeastern, and 
regions of the United States and provides them an unfair advantage and 
competitive advantage over our farmers in the upper Midwest. It has had 
a lot to do, in my view and the view of almost every farmer in 
Wisconsin, with the loss of so many of our dairy farms in our State.
  It is ironic, at a time when the Federal Government, including 
Congress with the passage of the 1996 farm bill, has made it a policy 
to reduce Government pricing interference in agricultural markets, that 
it is still interfering in a very serious and detrimental way with a 
free and open national dairy market. This decision by the judge in the 
U.S. District Court of Minnesota--a Federal court--is an excellent 
decision. It is a decision that finally tells it like it is--and that 
is that there is no legitimate basis for these discriminatory class I 
price differentials which provide one farmer in the Northeastern part 
of the United States and another farmer in Texas far more for the same 
type of milk than the hard-working farmers in Wisconsin or Minnesota.

  Mr. President, we in Wisconsin and the upper Midwest praise this 
court ruling. We believe it is an important, proper and very overdue 
decision. It gives us some hope that the remaining

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farmers in our State, in the upper Midwest, will be allowed to survive 
without the interference of an outdated and unfair system--in fact, as 
now indicated by the court, a system that is unlawful, given the 
changes in the dairy market and given the changes in the times.
  Mr. President, this court decision was, at long last, the right one 
and I look forward to the positive consequences that can flow from it.
  I yield the floor.
  Mrs. FEINSTEIN addressed the Chair.
  The PRESIDING OFFICER. The Senator from California.

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