From The Scientific Review of Alternative Medicine, Fall/Winter 1999


Chinese Acupuncture For
Heart Surgery Anesthesia

By Gary P. Posner, M.D.
and
Wallace Sampson, M.D.


The August 16, 1998, issue of Parade  magazine contained an article on acupuncture written by Dr. Isadore Rosenfeld, the magazine's health editor, well-known cardiologist, professor of clinical medicine, and author. Since the 1960s he has appeared often as a guest on nationally televised talk/interview shows, discussing a wide variety of medical subjects. Parade,  a supplement to Sunday newspapers across the United States, claims a weekly adult readership of 82 million.

One paragraph of Rosenfeld's article, and an accompanying photograph taken by him, dealt with an extraordinary experience that took place more than 20 years ago during his visit to China with several other prominent American physicians, including Dr. Richard Gorlin (cardiology) and Dr. Wilbur Gould (ENT), both since deceased. In addition to the Parade  article, one of his books also contains a description of the same China incident.1

The apparent intent of the delegation's hosts was to demonstrate the effectiveness of traditional Chinese medicine -- in this case, acupuncture as surgical anesthesia. According to Dr. Rosenfeld, as the contingent stood in an empty operating room at the University of Shanghai, a 28-year-old female patient was wheeled in. While the group observed, the woman was prepped for "open-heart surgery" to repair her mitral valve. "Her only 'anesthetic' was an acupuncture needle in her right earlobe that was connected to an electrical source."2  In his book, Rosenfeld says that acupuncture "needles" [plural] were placed in her "left" earlobe. (He explained to us that this "was a typo, which was not picked up since I did not use the photo" in the book.)

The woman remained awake and alert as, according to his book, "the surgeon . . . cut through the . . . breastbone with an electric buzzsaw [and] her chest was split in two [and] spread apart with a large clamp to expose the heart." The photograph in Parade  (it does not appear in the book) shows an attractive, smiling face and a small operative field visible through the surgical drapes. Added Rosenfeld in Parade,  "She never flinched. There was no mask on her face, no intravenous needle in her arm."

While acupuncture has its adherents in the West, even now, twenty-plus years after this remarkable demonstration, few of them would profess its efficacy for deep surgical anesthesia. Dr. Rosenfeld informed us that even his hosts had expressed to him their general preference for Western anesthesia: "They use this [acupuncture] technique in only a minority of patients."

Reasons for Doubt

Upon reading Rosenfeld's account in Parade,  and subsequently the book's version, we found ourselves unable to reconcile his anecdote with scientific experience or common sense. There is no likely neurophysiological mechanism to account for how an electrode in the earlobe can insulate a human being from the effects of such major surgery. Nor could we understand how, even if acupuncture were able provide adequate analgesia, or if the patient had received a nerve block or other local anesthesia, or was quadriplegic or otherwise pain-sensory-deficient, a patient could have survived an open-chest, open-heart operation performed as described.

We wondered about: the absence of ventilatory support, since with her chest opened in the manner described, the negative pressure produced by chest-wall expansion could not be created, the lungs would collapse, and the patient asphyxiate; the absence of a heart-bypass machine, to detour the blood before and during open-heart surgery, lest the patient exsanguinate; the absence of intravenous access sites, especially for the cardiac drugs required to still the heart before it could be opened and repaired. In addition, the photograph itself appeared inconsistent with what was described, as we will discuss.

In responding to some of these concerns, Dr. Rosenfeld informed us that Dr. Michael DeBakey, one of the world's foremost cardiac surgeons, had witnessed a similar operation about a year after he did. Rosenfeld added that, as a result of our inquiry, he had telephoned DeBakey, who would be happy to address our questions.

During our telephone interview with Dr. DeBakey, we learned that he had neither read Rosenfeld's accounts nor seen the photograph, and was not aware of the precise details that were of concern to us. As for his own experience in China, DeBakey recalled that he had witnessed a mitral valve commissurotomy in a patient who had been given medication intravenously prior to and during the operation. Artificial ventilation was not needed since the operation involved only a small slit in the right atrium. And it had not been an open-heart, but rather a "closed-heart" procedure performed through a right intercostal incision. Such an operation, done in an area of low pressure (atrium), requires only a small puncture wound in the heart which remains essentially plugged by the surgeon's finger during his manipulation of the valve. This approach makes exsanguination unlikely, leaves the left hemithorax untouched, and permits the left lung to expand normally. DeBakey added that unless the left pleura were sclerosed and the mediastinum fixed, a sternal approach (such as described by Rosenfeld) would almost certainly result in collapse of both lungs, as we had previously suspected.

We then wondered what sort of procedure actually had been done. The photo shows an operative field and incision well to the left of midline. Dr. DeBakey and two other thoracic surgeons advised us that "closed" mitral commissurotomies were usually done through a right-sided incision, which gives a better anatomic exposure of the left atrium and mitral valve than does a left thoracic approach. Is it possible that Parade  reversed the negative, making it appear that a left-sided operation was done? Or did the Chinese surgeons perform such an operation through the left side for specific reasons? Or, did they do something other than a mitral commissurotomy? If they approached the heart from the left, as Dr. DeBakey somewhat skeptically hypothesized, perhaps the patient had situs inversus or dextrocardia. However, such a rare condition would likely have been brought to the observers' attention. Another surgeon told us that left-sided operations could be done, albeit with more difficulty, and that he had seen such performed under special circumstances.

Sleight of Hand?

Regardless, the question remains: Had the patient received only acupuncture anesthesia? Or, had Dr. Rosenfeld and his party been treated not to a genuine surgical procedure, but rather to something more akin to "psychic surgery," a technique commonly employed by conjuring practitioners in the Philippine Islands? Thousands of people from the world over fly to the Philippines each year to have their bodies "opened" without a scalpel, have cancer or other tissue removed, and their state of health returned to "normal." This is done within minutes and without discomfort, all by various sleight-of-hand techniques -- in other words, it is a sham operation. Peter Sellers, the movie comedian of the 1960s and 1970s, reportedly opted for such a procedure over traditional cardiac bypass, with predictably disastrous consequences. Most, if not all, of these patients go home to die of their diseases.3

In his book, Dr. Rosenfeld dismisses the possibility that he could have been "duped by Chairman Mao." But had they been hoaxed, would trained physicians' eyes be expected to have spotted such a fraud? And what motive would their hosts have had to fool them?

Twenty years ago, the world was still in a Cold War between the Western democracies and the Communist governments of the Soviet Union and China. During the Cultural Revolution, according to Arthur Taub, MD, PhD, a member of an acupuncture evaluation committee, major surgical procedures said to be performed with acupuncture entailed administration of meperidine and barbiturates.4  Victor Herbert, MD, professor of medicine at the Mt. Sinai School of Medicine, found that patients supposedly having acupuncture anesthesia for simpler operations were actually getting morphine at the time.5  Chinese surgeons admitted to all the above observers that only suggestible people were selected for "acupuncture anesthesia," and that abdominal and chest operations were not done under acupuncture because the musculature must be sufficiently relaxed in order to expose an operative field large enough in which to work.

If an elaborate hoax had been staged for the benefit of Dr. Rosenfeld's party, physicians might not make the best observers to detect such chicanery. Such hoaxes generally are unveiled not by practitioners in the field of study, but by experts in conjuring. For instance, magician James Randi has done more to expose the Philippine "psychic surgeons" than has that nation's medical community. To our knowledge, only one physician took the trouble to expose this sham, the late William Nolen, MD.6  In India, magician B. Premanand has led the educational effort regarding the so-called God Men, who claim miraculous powers. And in the U.S., it was once again Randi who exposed the demonstrations of Uri Geller, after bedazzled physicists had tested Geller and vouched for his apparent paranormal abilities.7

In 1988 while in China as part of a scientific delegation, Randi discovered how "Ch'i" or "Qigong" masters, who claim abilities to cure ills from a distance with a mere wave of their hands, used magic tricks to fool their audiences (Ch'i or Qi is the presumed circulating energy force pervading all life). One of us (W.S.) was in the follow-up delegation in 1995 and heard from Chinese scientists a similar history about such deceptive practices.8

But if Dr. Rosenfeld's anecdote is essentially accurate -- that his group observed a patient tolerate major surgery without benefit of any conventional anesthesia -- could there be a natural explanation that does not require crediting acupuncture with extraordinary anesthetic properties? Though we have not heard of examples of open-chest surgeries having been so tolerated, the seldom-credited ability of humans to withstand severely painful procedures without anesthesia has been well documented. Skrabanek and McKormick record operations done in Europe without anesthetic or acupuncture needles, including amputations, thyroidectomies, and mastectomies. As for China:

A spectacular . . . response was observed by Western delegates during the Great Leap Forward, when Chinese doctors, on orders from Chairman Mao, discovered acupuncture "anesthesia." Credulous observers . . . were unaware of many reports, both from China and from Europe, that demonstrated it was possible for people to bear, in a most stoical fashion, the pain of surgery. In 1843, an American surgeon, Peter Parker, performed a mastectomy on a Chinese patient, who, when the operation was over, "raised herself from the table without assistance, jumped upon the floor, and made a bow to the gentlemen present . . . as though nothing had occurred." Another surgeon wrote in 1863 that a large proportion of those [in China] on whom operations were performed had no chloroform. . . . Some did not even clench their hands or teeth, but lay upon the table perfectly motionless, while their muscles were being cut by the knife and their bones divided by the saw.9

Anecdotal Evidence

Whether the operation witnessed by Dr. Rosenfeld's group was genuine or a sham, there is still the matter of his photograph. According to a passage from Dr. Rosenfeld's book, "I took a color photograph of that memorable scene: the open chest, the smiling patient, and the surgeon's hands holding her heart. I show it to anyone who scoffs at acupuncture."

At one point during our enmity with China, a famous still photo of an elderly Chairman Mao swimming the Yangtze was published worldwide. Most objective observers suspected that Mao's head had been superimposed upon the body of another. We do not suggest that Dr. Rosenfeld would perform such a trick, but the photograph is curious in a number of respects. Although we were denied permission to reproduce the actual photo in this article, Fig. 1 [accompanying this paragraph] is an artist's rendering that is faithful to the original, except that it has been rotated 90 degrees counterclockwise (to place the vertex of the patient's head at the 1:00 position).*

Contrary to Rosenfeld's description, his photograph clearly shows the surgeon's hands not to be holding the patient's heart, but outside the confines of the operative field. Only the patient's smiling face and incision are visible through the gaps in the surgical sheets, and her attractive, clear visage is more evocative of a professional model than of someone in the midst of open-heart surgery. More to the point, the incision seems displaced well to the left and somewhat below the level of the patient's sternum. There does not appear to be any appreciable distortion such as might be encountered from the use of a wide-angle lens. Rosenfeld told us that this apparent leftward displacement "must be due to the angle at which [the photo] was taken."

The patient's neck appears somewhat flexed, and her eyes are focused to her left, as if she is attempting to observe her own operation in progress. Perhaps the sheets affixed to her neck region prevented her from rotating her head to the left such that her eyes could then look straight ahead. So let us assume, as the photo appears to indicate, that despite some neck flexion, her head was essentially "face up" as opposed to being significantly rotated right or left. Drawing a vertical line down the midline of her face and extending it to the bottom of the photo, the degree to which the incision appears displaced leftward becomes marked. And what appears to be a rib separator seems to be at the wrong position and angle for a mid-chest operation. The operative field appears to be beyond the left border of the patient's body (see Fig. 2 [accompanying this paragraph]).

If Dr. Rosenfeld did witness a sternal-split operation requiring a "buzzsaw," how could this be? He stated that he saw a single patient being wheeled into the operating room and that he was present as the patient was prepped and covered with the surgical drapes. But if an elaborate hoax were being perpetrated, it seems to us that the clever planting of a second body would not be beyond the means of a team of concerted conjurers. One possibility is that the second body was not another human but an anesthetized, smaller animal, placed close to the patient's left side prior to her arrival or while the observers were distracted. Magicians could certainly manage such a maneuver, and with the drapes obscuring everything but the limited operative field, it could be difficult for observers to be certain of just what was being operated on. Dr. Rosenfeld acknowledged to us that not being a surgeon, he "did not pay any particular attention at the time to the surgical technique used."

A wealth of documented human experience and history indicates that people can be easily deceived. We know that governments can be ideologically and propaganda-driven. We know that magicians can stage a sham operation with illusions that would rival, or surpass, whatever was witnessed by the Rosenfeld party. We know that memory is subject to marked alterations of recall, including filling in blanks with imagined facts and other distortions.10-14  And we know that humans can be capable of enduring painful surgeries without anesthesia.

We do not similarly know that acupuncture treatment has effects beyond nonspecific ones (suggestion, distraction, counter-irritation, compliance) that can reduce the pain of major chest/heart surgery. Nor would acupuncture "anesthesia" allow a patient to breath on her own with her chest flailed open in the manner described by Dr. Rosenfeld. A 1998 National Institutes of Health "Consensus Conference" recommended acupuncture for limited purposes, including certain painful conditions. But even though the conference was dominated by advocates, it did not conclude that acupuncture is effective for surgical anesthesia.15

An even more famous "acupuncture" anecdote than the one under discussion here concerns the late New York Times  writer James "Scotty" Reston. While in China in 1971, Reston required an emergency appendectomy. Reports circulated that the surgery had been performed with acupuncture anesthesia. In reality, his surgical anesthesia had been quite conventional, though he did receive acupuncture for post-operative discomfort.

Dr. Rosenfeld told us that in publicizing his own China story, his motivation was simply "to draw attention to the possible use of acupuncture to alleviate chronic pain and suffering. . . . I thought acupuncture was worth looking into. I still do, as does a panel convened recently by the NIH. . . . I continue to keep an open mind on the subject." While we expressed our appreciation of that position, we also conveyed our concern that many of Parade's 80-plus-million readers, as well as some practitioners who might be inclined towards dabbling with acupuncture for major surgical anesthesia, could easily have drawn a conclusion that Dr. Rosenfeld says he did not intend -- that acupuncture appears to possess mysterious and unexplained analgesic properties.

Rosenfeld also mentioned to us that Dr. Gould had taken photographs of his own during the operation, and that Gould's widow no doubt still has them in her possession. We were unable to locate her, and were equally unsuccessful in obtaining Rosenfeld's assistance in this endeavor. But even if Dr. Gould's photos were to confirm Rosenfeld's claim of a midline, sternal surgical approach, one could not survive such an operation without ventilatory support, suggesting a sham operation on a second body. A letter (from W.S.) to Parade's editor, suggesting a photographic or other hoax, was unanswered and unpublished.

In summary, the surgical procedure described in Dr. Rosenfeld's Parade  magazine article and book would seem impossible for a patient to endure without ventilatory support. Upon inspection, Rosenfeld's photograph does not correspond to the midline, open-heart operation he described, but rather suggests either a lateral approach, or a sham operation performed on a second body. The conclusion that an acupuncture needle was the sole source of the patient's surgical anesthesia can be supplanted by other possibilities, including one that renders anesthesia of any kind unnecessary.

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Postscript: Dr. Sampson has more recently received a call from a Nevada cardiac surgeon who states that, despite Dr. DeBakey's comments, the patient may very well have undergone an older type of mitral valve commisurotomy that can be performed from the left side. However, this would not correlate with Dr. Rosenfeld's description of the surgeon cutting through the breastbone with a buzzsaw and splitting her chest in two.

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Artwork by Don Addis.

All personal communications with Dr. Rosenfeld were conducted by Dr. Posner via e-mail.
Additional communications cited in this paper were conducted by Dr. Sampson.
The authors also thank Jerome Riebman, MD, of Santa Clara Valley Medical Center for helpful information.

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* Click here to see the relevant portion of Dr. Rosenfeld's Parade article, including the actual photo.

  Click here to see the actual photo, enlarged and rotated as per the artwork in this critique.

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References

1. Rosenfeld I. Dr. Rosenfeld's Guide to Alternative Medicine.  New York, NY: Fawcett Columbine; 1996: 30-32.

2. Rosenfeld I. Acupuncture goes mainstream (almost). Parade.  August 16, 1998: 10-11.

3. Nolen W. Healing: A Doctor in Search of a Miracle.  New York, NY: Random House; 1974.

4. Taub A. Acupuncture. In: The Health Robbers.  Barrett S, Jarvis W, eds. Amherst, NY: Prometheus Books; 1993.

5. Herbert V. Personal communication.

6. Nolen. Healing: A Doctor in Search of a Miracle. 

7. Randi J. Flim-Flam.  Amherst, NY: Prometheus Books; 1982.

8. Beyerstein B, Sampson W. Traditional medicine and pseudoscience in China: a report of the second CSICOP delegation. Part 1. Skeptical Inquirer.  1996;20(4):18-26.

9. Skrabanek P, McCormick J. Fads and Fallacies in Medicine.  Amherst, NY: Prometheus Books; 1990.

10. Loftus E. Memory.  Menlo Park, CA: Addison-Wesley; 1980.

11. Loftus E. Eyewitness Testimony.  Cambridge, MA: Harvard University Press; 1979.

12. Wiseman R. Deception and Self-deception.  Amherst, NY: Prometheus Books; 1997.

13. Gilovich T. How We Know What Isn't So.  New York, NY: Free Press; 1991.

14. Reed G. The Psychology of Human Experience.  Amherst, NY: Prometheus Books; 1988.

15. Sampson W. On the National Institute of Drug Abuse consensus conference on acupuncture. Scientific Rev Alternative Med.  1998;2(1):54-55.


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