“I don’t want to believe. I want to know.” ~ Carl Sagan – blog contributor Sandro Graca
As a child, I once received a set of miniature tools (back in the day before health and safety!) with all the tools I needed to do something I loved: open up my toys to see how they worked. Fast forward to my late teenage years and after a lot of days lost to migraines and no answers from doctors and consultants, acupuncture reduced the intensity first and then the frequency of my migraines. Obviously, the next step was to “open acupuncture up to see how it works”.
My name is Sandro Graca and I started learning Traditional Chinese Medicine (TCM) at a college in Lisbon in 2003, but during the first semester I moved to Dublin, so I ended up graduating at the Irish College of TCM in 2007. Moreover, I met my partner for life, Siobhan Seville at the college so literally, acupuncture changed my life.
In 2009, we went on a five-week study tour to Beijing University of Chinese Medicine and it was there that I had my first experience of working in the area of women’s health.
We sometimes hear that “when you are ready, the teacher will arrive” and for me, it was the the work of Dr Ma at one of the BUCM affiliated Hospitals that fascinated me and got my inner child “itching” to discover how does acupuncture really work for gynaecology.
What followed were years searching for answers and embarking on more specialised courses in fertility, IVF, and pregnancy – from Jani White to Jane Lyttleton, Debra Betts, and Sarah Budd – a well-known NCA MSc graduate.
Research Matters
While learning about acupuncture for in-vitro fertilisation (IVF) if became clear that research was playing a huge role in the development of the role of acupuncturists in supporting the women going through IVF treatment and also the fertility clinics. The amount of acupuncture research was increasing at a higher rate than biomedicine 1, the quality of publications was also improving 2,3, and fertility clinics were getting to know that there is more to TCM than just acupuncture to help with fertility and IVF results 4. Acupuncturists working in the fertility field are familiar with “the Paulus Protocol” and this paper by Paulus et al 5 was the first one I looked up online on PubMed, downloaded, and read in full – because I wanted to know what they had done, especially what acupuncture points they used, so that I could do the same in the clinic.
Once again, the desire to “know more” got the best of me and the modus operandi of going straight to the “Methods” section to read about the acupuncture points sparked the curiosity to know more – the desire to “know how it works” was back again.
After reading “Acupuncture Research – Strategies for Establishing an Evidence Base”, the fantastic book by the late Prof Hugh MacPherson, the path was set: I wanted to be able to fully understand how to read and disseminate the huge body of acupuncture research in order to tackle two of the most common misconceptions:
- How does acupuncture work?
- There is no evidence that acupuncture works
Although I did now know it at the time, these were my firsts steps as a researcher and enrolling on the online MSc in Advanced Oriental Medicine (research and practice) at the Northern College of Acupuncture (NCA) was the next giant leap forward. Studying at the NCA, under renowned lecturers and part of a cohort of worldwide seasoned practitioners gave me the research knowledge and the confidence to use my networking skills to connect with colleagues at conferences all over the world. Combined with constant dissemination of the research papers I was reading on my social media outlets, studying on the MSc program and the networking opened the doors and set the background for two important landmarks in my career:
- getting the call from Mel Hopper Koppelman (another well-known NCA graduate) to join the Board of Directors of Evidence Based Acupuncture (EBA), and
- taking the exam for the American Board of Oriental Reproductive Medicine (ABORM) at Yo San University in Los Angeles, California.
The advocacy work at EBA offered me the opportunity to connect with like-minded research literate colleagues and learn from world-renowned clinicians also involved in research. During one of lectures at the 2016 Integrative Fertility Symposium in Vancouver, BC, Canada, Dr Fiona McCulloch planted the seed of what would become the focus for my MSc dissertation: acupuncture for polycystic ovary syndrome (PCOS). Yet again, I was lured by the desire to learn more, this time about the complex cascade of hormones and the different PCOS phenotypes, which I was commonly seeing in the acupuncture clinic. This was what captivated me to dive deeper into the research field of acupuncture for PCOS.
The MSc at the NCA
For my MSc dissertation, I took advantage of my position as a Fellow of the ABORM and setup a cross-sectional survey of clinical practice in order to collect information from this group of experts about how they are using acupuncture to help women with PCOS in their clinics. The proposed goal was to collect, analyse, and report on the findings so that it would inform other practitioners and help us all to develop our knowledge of how to best support our patients.
The final result was far beyond my wildest dreams! On one hand, the amazing experience of working with Dr Lara McClure as my MSc Supervisor, who was supportive, motivational, strict when I needed “tough love”, and above all, taught me to always keep a critical view of my own work. On the other hand, it opened up a new door for me: one of the experts who I met through networking, Dr Mike Armour offered his expertise and advice during the early stages of my MSc research proposal and I ended up getting to know more of his research work too.
Dr Armour is a key element of the team at the National Institute of Complementary Medicine (NICM) at Western Sydney University in Australia and I had been a follower of his work and his colleagues at NICM, such as Prof Caroline Smith and Dr Carolyn Ee. For acupuncturists working in the field of women’s health, these are household names, since Dr Armour produced research in the field of endometriosis 6 and dysmenorrhea 7, Prof Smith has been involved in landmark research on acupuncture for IVF which changed the dosage and timing of treatment around embryo transfer 8, and of course, Dr Ee is one of the top PCOS researchers with important work around multidisciplinary care 9 and of course, management of PCOS symptoms 10.
Moreover, using the NICMAN Scale 11 for my dissertation and the connections made with these researchers led to them to know more about my work, my commitment, and proudly asking me to:
- take on further Cochrane training to join them on a Cochrane Review Group (on acupuncture for assisted reproductive technology),
- collaborate on a paper focusing on the importance of research literacy for acupuncturists working in women’s health 12, and most importantly,
- start working on my PhD research proposal in order to apply to further my research career in the field of acupuncture for PCOS at NICM in Western Sydney University.
The satisfaction of “job done!” with the final result of a Merit on the MSc would normally constitute the cherry on top of years of work towards the MSc, but the “research gods” seem to have other plans for me and I am enjoying the journey.
Working as an acupuncturist alongside my partner and other top fertility and IVF experts in Dublin, helping patients and helping those fertility experts to get better results in their IVF clinic, being involved in research advocacy with the EBA, and continuing to write papers with colleagues which will contribute to the body of knowledge constitute what I would consider dream jobs.
Are you ready to change your life?
Studying acupuncture and TCM really changed my life. Personally, it was how I met my partner and professionally, it gave me the opportunity to help many patients in my clinic. Studying at the NCA improved on those changes: I met fantastic colleagues on the MSc cohorts, felt the passion of the NCA lecturers and staff, and eventually the curiosity of “how things work” led me to accept the invitation to become one of the lecturers and supervisors on the online MSc course. It made me even more aware that learning acupuncture and TCM is not just about the needles and the herbs –
it is also about standing on the shoulders of giants and passionately give back to the community. We often hear our patients say in our clinics that our treatments changed their lives. Doing the MSc at the NCA empowered me to change people’s lives in clinic and gave me the tools and the critical thinking to stand tall and confidently guide future clinicians through their journey into acupuncture research.
What about you? What do you want to “open up and see how it works”?
References:
1. Ma Y, Dong M, Zhou K, Mita C, Liu J, Wayne PM. Publication Trends in Acupuncture Research: A 20-Year Bibliometric Analysis Based on PubMed. PLOS ONE 2016; 11(12): e0168123.
2. Svenkerud S, MacPherson H. The impact of STRICTA and CONSORT on reporting of randomised control trials of acupuncture: a systematic methodological evaluation. Acupunct Med 2018; 36(6): 349-57.
3. Ma B, Chen Z-M, Xu J-K, et al. Do the CONSORT and STRICTA Checklists Improve the Reporting Quality of Acupuncture and Moxibustion Randomized Controlled Trials Published in Chinese Journals? A Systematic Review and Analysis of Trends. PLOS ONE 2016; 11(1): e0147244.
4. Hullender Rubin LE, Opsahl MS, Wiemer KE, Mist SD, Caughey AB. Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes. Reproductive BioMedicine Online 2015; 30(6): 602-12.
5. Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility and Sterility 2002; 77(4): 721-4.
6. Armour M, Dahlen HG, Zhu X, Farquhar C, Smith CA. The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: An exploratory randomised controlled trial. PLOS ONE 2017; 12(7): e0180177.
7. Armour M, Smith CA. Treating Primary Dysmenorrhoea with Acupuncture: A Narrative Review of the Relationship between Acupuncture ‘dose— and Menstrual Pain Outcomes. Acupuncture in Medicine 2016; 34(6): 416-24.
8. Smith CA, Armour M, Shewamene Z, Tan HY, Norman RJ, Johnson NP. Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis. Reproductive BioMedicine Online 2019; 38(3): 364-79.
9. Ee C, Templeman K, Grant S, et al. Informing the Model of Care for an Academic Integrative Health Care Center: A Qualitative Study of Primary Care Stakeholder Views. J Altern Complement Med 2020; 26(4): 300-15.
10. Ee C, Smith CA, Costello M, et al. Acupuncture or auricular electro-acupuncture as adjuncts to lifestyle interventions for weight management in PCOS: protocol for a randomised controlled feasibility study. Pilot and Feasibility Studies 2020; 6(1).
11. Smith CA, Zaslawski CJ, Cochrane S, et al. Reliability of the NICMAN Scale: An Instrument to Assess the Quality of Acupuncture Administered in Clinical Trials. Evidence-Based Complementary and Alternative Medicine 2017; 2017: 1-8.
12. Armour M, Betts D, Roberts K, Armour S, Smith CA. The Role of Research in Guiding Treatment for Women’s Health: A Qualitative Study of Traditional Chinese Medicine Acupuncturists. International Journal of Environmental Research and Public Health 2021; 18(2): 834.