Interview with Dr. Beltrán Carrillo, geriatrician and acupuncturist
Much has been said in recent times about the efficacy of acupuncture and its inclusion or not within the so-called pseudosciences. Beltrán Carrillo is a geriatrician and a magister in acupuncture from the Complutense University of Madrid. He chairs the Spanish Medical Acupuncture Society (SAME) and holds the position of Ambassador for Spain of the Society for Acupuncture Research (SAR).
In his clinic, authorized by the Health Department of the Community of Madrid, he performs different treatments using this ancient technique typical of traditional Chinese medicine.
–How would you define acupuncture and how would you explain its operation?
–It is a therapeutic tool that consists of inserting single-use disposable hollow metal needles into different points of the skin to induce a response from the nervous system. Basically, what we are doing is stimulating a specific point on the skin called an acupuncture point. We know that it is an area of the human body that is in the skin where the largest number of natural and neuroactive components are concentrated that will transmit the mechanical stimulus of the needle in a more powerful way to the central nervous system.
With this stimulus that we do we are going to produce a series of local changes that are going to be transmitted through different supraspinal pathways and these are going to be projected on the areas of the nervous system, which have a relationship with sensitivity, locomotion, cognition, symptoms visceral, sleep, emotions… Therefore, we are going to access those brain areas.
In both animals and humans, when we insert the needle we will notice changes at the neurobiochemical and neuroimaging levels. We are going to see different activity in areas of the brain if we put the needle in place or not. If we stick the needle well, the benefit will last much longer and if we leave it for a longer time, it will be more effective in the patient. In the same way, if we do the stimulus without pain, it varies from if we do it with pain, and we see that in magnetic resonance imaging.
So, is it an alternative to medicine?
–Acupuncture is not an alternative, it is one more tool within medicine to help people with problems. Being one more tool, sometimes it is indicated, sometimes it is not and sometimes it is combinable, but we do not like the alternative term.
Needles with which acupuncture is practiced
What illnesses do you treat most often?
–The area where we have more evidence is pain in almost any of its types (acute, neuropathic, chronic, somatic), so perhaps acupuncture should always be used almost as a first option. It is common for headaches, osteoarthritis, low back pain… There is also a lot of evidence for post-extraction dental pain to the point that many dentists want to learn about it and recommend their patients come. The same occurs with postoperative pain, which is usually acute.
With acupuncture we treat headaches, osteoarthritis, low back pain, postoperative pain or psychological problems, among many other ailmentsMaster in acupuncture from the Complutense University of Madrid
There are also psychiatric treatments, basically anxious or depressive mood disorders. Up to 1/3 of my patients come with this as the main or associated reason. Addictions are seen a lot: tobacco, obesity and alcohol are the most common. Also to improve fertility, both in men and women, to the point that assisted reproductive services send patients for acupuncture. In the United States, for example, assisted reproduction is not understood without acupuncture.
It is also used in somewhat peculiar pathologies, such as neurodegenerative disorders. There is a lot of evidence that acupuncture delays Alzheimer’s or Parkinson’s. Likewise, in patients who suffer a stroke, survive and undergo acupuncture, there is a reduction in dementia between 30 and 50%, according to cohort studies from Taiwan.
Then there is a potpourri of diseases in which it is also effective, such as insomnia, allergies, dermatitis, some pathologies related to nausea and vomiting during pregnancy or children who come from the buttocks and are turned around with acupuncture. .
–Is anyone suitable to carry out acupuncture treatment?
-A contraindication to undergo acupuncture is that the patient comes hypotensive or feverish, although there are studies that we do that are proposed in patients in the ICU. Contraindication as such does not exist, another thing is that the patient is not in the conditions or that it is not indicated at that time. What there are are techniques that cannot be done in some conditions. For example, if you have an abscess or a burn on your hand, you cannot prick at that point, just as during pregnancy you cannot prick in some places.
– Does it have any kind of side effect?
– Side effects in acupuncture can be classified into two groups. Some are inherent to the technique, that is, if I put a needle in you it will hurt, and when you remove the needle it is likely to bleed at some point. Post-treatment sleepiness is also inherent: it is something that can be uncomfortable for the patient, but is ultimately desirable because it means something positive has been done with the treatment. This type of side effect can occur in about 10% of cases. Then there are the potentially serious and life-limiting ones that occur when the person performing acupuncture is not a professional. Among them, that the patient has a vagal reaction [activación que se produce del nervio vago, que causa un descenso de los latidos cardíacos y una bajada de la tensión arterial] and you pass out or begin to convulse.
–How long does it take to take effect?
–If acupuncture works, it will do so in a short time. You will start to notice a change (perhaps not complete healing) after four to six sessions. If the patient has not noticed improvement, it is best to stop the treatment. If it works, the sessions will be separated over time and depending on the case it will be seen whether or not some type of maintenance is needed.
–Can anyone be an acupuncturist or do you need a specific degree?
-In Spain, to train as an acupuncturist you have to be a doctor. Know the same as any other doctor in the medical career knows. I recommend that you have a specialty. It is widely used among anesthesiologists, geriatricians, traumatologists, rehabilitators, internists, psychiatrists, neurologists…
There are many unauthorized centers where physical therapists and nurses are performing acupuncture without permission
The centers that perform acupuncture are included within “unconventional therapy” centers. For this, a doctor must be responsible for carrying out the treatment. This means that there are many unauthorized centers where physiotherapists and nurses (who are non-physicians) are performing acupuncture without permission. From the SAME we have notified all the Health ministries of the Autonomous Communities and all the medical associations and many of them have not even answered.
We have to counterbalance this intrusiveness with a very small group of doctors who are SAME. Almost all of us are there, but not all of us, there are many who live from the effort without even being associated. From SAME we fight to defend, to explain, to protect the patient.
–Is there university training in acupuncture?
-Until now we had university master’s degrees in many cities, but with the pseudoscience campaign they were all closed. We entered into a kind of denial fashion that I don’t understand, because the evidence on the benefits of acupuncture is publicly accessible.
– Is it already applied to Social Security?
-Yes. Where we are most established is in Andalusia, where the Board’s portfolio of services at the hospital level includes acupuncture in pain units. At the level of private hospital centers, such as those of Sanitas or Quirón, we also have a strong presence. Outside of Spain it is the norm, as in France, Germany, Italy, Brazil, Uruguay, USA….
Why is there this widespread rejection?
I would say it is ignorance. When I present the documents that prove the efficacy of acupuncture to the authorities, they are surprised. There is also a touch of denialism and lack of transparency. They have not wanted to talk to the experts on the subject, we have offered ourselves in every way and they have not wanted to. They claim lack of evidence that acupuncture works. However, in the usual interventions there is 10% who have evidence that it is effective and safe, 24% moderate evidence, 50% there is no evidence at all and between 3 and 5% who say that it can even be used. harm. And yet they are being applied.
–Does something depend on who is ruling?
-In Andalusia, the one who approved that acupuncture be included in the portfolio of services was the current Minister of Finance, María Jesús Montero, who was then a Minister of Health and is now in a Government that wants to ban us. The pseudoscience movement of the current executive is highly conditioned by Carmen Montón [primera titular del Ministerio de Sanidad del mandato de Sánchez que duró tres meses y dimitió por plagiar el máster]. This woman is from a town where the headquarters of the association to protect patients from pseudotherapies is located. They convinced the minister to initiate this plan.
–Why do you put homeopathy in the sack?
-I do not know. I know nothing about natural medicine: I am a geriatrician and I have a technique. They mix us up a lot and I think it’s a mistake. I don’t like it and the homeopaths want to go after us because they don’t have evidence. They are completely different fields.
Why did you decide to start practicing acupuncture?
-In Spain it has been introduced for centuries, there is a history of the Jesuits, for example. In the 1970s, when my father went to study internal medicine in Canada, he learned this technique and incorporated it into his daily life, although he was still an internist. I was a child, I was five or six years old when I started to see my father go to the courses. He has a very positive character and when he sees that something works well he is very enthusiastic, which is why when we came to Madrid on vacation we saw him puncture the whole family. I have always seen acupuncture incorporated into medicine.