Which to Believe?

Acupuncture, Herbal Medicine, Research | Posted by Philip
Mar 11 2010

Sometimes I wonder just how long is a study’s “shelf life.”

Acupuncture ‘does not aid fertility treatment’ (http://www.telegraph.co.uk/health/healthnews/7405852/Acupuncture-does-not-aid-fertility-treatment.html) – March 2010.  ”New” research says so.

Seems to contradict:

Acupuncture helps women have babies (http://www.telegraph.co.uk/health/3042006/Acupuncture-helps-women-have-babies.html) – September 2008. “New” research (at the time) says so.

Okay the first article refers to a meta-analysis of previous studies, the bottom one included.  This means they didn’t actually do new research but reviewed old ones.

Here’s where I believe that acupuncture is truly practitioner dependent.  I’m usually good with neurologic problems but others are admittedly better than I when it comes to infertility.  Dr. Regina Liu, a friend of mine who is licensed in China and the US in acupuncture has carved a niche for herself when it comes to infertility.  Her office is lined with pictures of the “proofs” of her successes.

All I can say is that given what I know about statistical manipulation – you can twist the numbers to say almost anything you want – I value clinical experience more than anything else when it comes to treatment evaluation.  Good practitioners learn from experience what works and what doesn’t.  I can safely say, in good conscience, NOT that acupuncture is beneficial in treating infertility, but that there are doctors like Dr. Liu (and myself too – I’ve gotten quite a few patients pregnant… wait that didn’t sound right…!) who are quite skilled in USING acupuncture and herbs in treating infertility.  Acupuncture is a procedure, not a pill, and is practitioner dependent.

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Cow Gallstones Bowl Over Parasite

Herbal Medicine, News, Research | Posted by Philip
Mar 07 2010

Schistosomiasis is caused by a species of liver fluke that basically plants a flag in the blood vessels in your liver and claims it as it’s own territory.  It can damage internal organs, increase the chances for bladder cancer, and cause retardation of growth and development in children. A brief look at wikipedia (http://en.wikipedia.org/wiki/Schistosomiasis) can give a better overview.

Schistosoma japonicum

Imagine this little bugger in your liver or bladder. Call Ellen Ripley!

A particular problem related to this is the effect that the screwed up circulation in the Portal venous system in the liver leads to hypertension in that portal system and thus, lung problems.

A look at Portal Hypertension: (from www.medicinenet.com) Symptoms include gastrointestinal bleeding, ascites or fluid in the abdomen, mental problems due to liver failure and lung problems, since the blood from the liver goes to the lungs.  This entry deals more with the lung problems.

The actual journal article abstract can be quoted thus :

Portal hypertension is a vascular lesion that initially arises in liver, but structural and functional changes of blood vessels in extrahepatic portal system, systemic circulation and pulmonary circulation also accompany, which now collectively called portal hypertensive vascular lesions. In clinical practice, much attention has been paid to the prevention and treatment of complications such as ascites, esophagogastric variceal bleeding; however the management of pulmonary complications is ignored which affects the prognosis of patients. Hence, drugs used for prevention and treatment of pulmonary complications seem to be very important.

We now find an article (http://www.physorg.com/news186923469.html) entitled “Treatment of portal hypertensive pulmonary lesions induced by schistosomiasis”  Okay, looks interesting, let’s have a go at it!

Calculus Bovis compound preparation can effectively prevent pulmonary complications of portal hypertensive rabbits with schistosomiasis. The successful development of Calculus Bovis and the preliminary study on portal hypertensive pulmonary lesions caused by schistosomiasis suggest that it is of great significance and prospects for further basic and clinical research, development and clinical application of new drugs and preparations to treat portal hypertensive pulmonary lesions induced by schistosomiasis.

I just find it interesting that the chinese name of calculus bovis is not used.  It is Niu Huang, a common ingredient for controlling inflammation.  Famously known as part of the formulas Niu Huang Jie Du Pian (Cow Gallstone Clear Toxicity Pill), An Gong Niu Huang Wan (Calm the Palace Cattle Gallstone Pill) and Niu Huang Qingxin Wan (Cattle Gallstone Clear the Heart Pill), it is famous for rapidly draining fire and clearing inflammation.

To evaluate efficacy of Calculus Bovis compound preparation (ICCBco) in the treatment of lung lesions in portal hypertensive rabbits with schistosomiasis as the experimental animal model, a research group in China performed a randomized, double-blind, controlled trial to observe pathological changes and pathological effect mechanism of expression of fibronectin and laminin in the lung tissue of portal hypertensive rabbits with schistosomiasis.

In vitro cultivated ICCBco is composed of Calculus Bovis, Chinese Paris Rhizome, polygonum cuspidatum, appendiculate cremastra pseudobulb, frankincense, and myrrh, and has the functions of clearing away heat and toxic materials, removing blood stasis, reducing swelling, eliminating blood stasis and promoting tissue regeneration, according to the principle of traditional Chinese medicine. However, the topic has not been unequivocally addressed.

I can’t help it.  Frankincense and myrrh?  I’ve blogged about this before (http://qi-spot.com/2009/12/30/the-wise-mans-gift/) talking about myrrh and it’s benefits for the heart.  Let me elaborate now about blood stasis though, since this is not an easily understood concept for laymen.  Wikipedia, quoting Dan Bensky, sort of got it right thus:

Described in TCM theory as a slowing or pooling of the blood due to disruption of Heart Qi, it is often understood in biomedical terms in terms of hematological disorders such as hemorrhage, congestion, thrombosis, and localischemia (microclots) and tissue changes.

So let’s look at the research from the World Journal of Gastroenterology (http://www.wjgnet.com/1007-9327/16/749.asp)

Effects of in vitro cultivated Calculus Bovis compound on pulmonary lesions in rabbits with schistosomiasis
Ox Gallstone Cow Bezoar Calculas Bovis 300x254 Cow Gallstones Bowl Over Parasite

Niu Huang or Calculus Bovis - won't kill the bug, but will make you breathe easier

Tao Li, Zhen Yang, Hong-Jiao Cai, Li-Wei Song, Ke-Yu Lu, Zheng Zhou, Zai-De Wu

ISSN 1007-9327 CN 14-1219/R  World J Gastroenterol  2010 February 14; 16(6): 749-754

AIM: To explore the interventional effects and mech­anism of in vitro cultivated Calculus Bovis compound preparation (ICCBco) on pulmonary lesions in portal hypertensive rabbits with schistosomiasis.

METHODS: The experimental group included 20 portal hypertensive rabbits with schistosomiasis treated by ICCBco. The control group included 20 portal hypertensive rabbits with schistosomiasis treated by praziquantel. The morphological changes of the pulmonary tissues were observed under light and electron microscopy. The expression of fibronectin (FN) and laminin (LN) in the lung tissues was analyzed by immunohistochemistry.

RESULTS: Under light microscope, the alveolar exudation in the lung tissue was more frequently observed in the control group, while the alveolar space was fairly dry in the lung tissue of ICCBco group. Under electron microscope, more alveolar exudation in the lung tissue, and more macrophages, alveolar angiotelectasis and the blurred three-tier structure of alveolar-capillary barrier could be seen in the control group. In ICCBco group, fibers within the alveolar interspace slightly increased in some lung regions, and the structure of type Ⅰ epithelium, basement membrane and endodermis was complete, and no obvious exudation from the alveolar space, and novascular con­gestion could be observed. There was a positive or strong positive expression of FN and LN in the lung tissue of the control group, while there was a negative or weak positive expression of FN and LN in ICCBco group.

CONCLUSION: ICCBco can effectively prevent pul­monary complications in portal hypertensive rabbits with schistosomiasis by means of improving lung micro­circulation and lowering the content of extracellular matrix.

In English… well look at the above caption.

Peer review says that it is “interesting research” but “not well planned” – I wish the reviewer were more specific…  It’s a good initial study though for others to use as a stepping stone.

More information: Li T, Yang Z, Cai HJ, Song LW, Lu KY, Zhou Z, Wu ZD. Effects of in vitro cultivated Calculus Bovis compound on pulmonary lesions in rabbits with schistosomiasis. World J Gastroenterol 2010; 16(6): 749-754. http://www.wjgnet.com/1007-9327/16/749.asp

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Got Milk? NOT.

Dietary Therapy | Posted by Philip
Mar 06 2010

One of the statements I make during lectures that always causes a virulent reaction from the audience refers to milk.  Specifically, I unabashedly declare that feeding milk to children beyond two years of age, from a Chinese medicine point of view, is ludicrous, unnecessary, and downright harmful.  I often say that if God had intended for children to drink milk all their formative years, then their mothers should naturally produce milk for more than two years.

“Where will they get their calcium?” I am asked.  I answer: fruits and vegetables.  Traditional Chinese Medicine holds that cow’s milk is too rich for the delicate digestive system of children.  Heck, because of lactose intolerance, it is too rich for asian adults as well!

But now we have an article from the Philippine Daily Inquirer that supports my TCM based belief:

Lactose intolerance proof cow’s milk not for humans (http://business.inquirer.net/money/features/view/20100305-256871/Lactose-intolerance-proof-cows-milk-not-for-humans)

…Physiologically, after infancy, many individuals lose their ability to digest simple sugar, or lactose, that cow’s milk is rich in…The result is that undigested lactose travels to the large intestine where bacteria break this sugar down, producing anything from gas, to cramps, to diarrhea. Lactose intolerance appears to be the main factor in as many as a third of cases of recurrent abdominal pain in children…

The article goes on to say that the undigested proteins can ultimately lead to autoimmune reactions resulting in diabetes, and that only 25% of calcium in milk is absorbed.  Hence, again, the Chinese were right.  Cow’s milk screws up the kids’ digestive systems, and you’re better off getting calcium from vegetables.  A bit of noteworthy correction, though: the article seems written in a way that implies that lactose is the only simple sugar.  It is A simple sugar but not the only simple sugar.  Fructose and glucose are simple sugars also.

So what is the ideal breastmilk substitute for infants, if not cow’s milk?  In Traditional Chinese Medicine it is pressure cooked rice porridge – cooked long enough to crush the rice and making it look like milky water.  This is different from just the water used to boil rice or “am” here in the Philippines.

If the mum is having a hard time lactating, there are TCM herbal and acupuncture solutions for her.

But NOT cow’s milk.

EDIT: added one sentence re: lactose as a simple sugar.  7:50 AM March 7, 2010.

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A More Balanced View

General, News, Western Medicine | Posted by Philip
Feb 28 2010

Remember how I wrote about biased headlines? (http://qi-spot.com/2010/02/09/another-biased-headline/)  In that previous article, I had mentioned that one can subtly affect comprehension by careful(?) selection of words to use in a headline.  The headline in question then read “Researcher Warns on Herbal Medicines”.  Only when you read the article itself will you see that it actually warns against misuse of herbal medicines or potential side effects from mixing with western meds.  The typical reaction, however, is to just glance over the headline – giving one the impression that herbal medicines PER SE are something generally unsafe and thus there is a need to warn the public about it.

Compare that with this headline: “Mixing medicine with herbal remedies can be risky.” (http://news.medill.northwestern.edu/chicago/news.aspx?id=158237)  This is much better and not misleading at all.

A few quotes from the article proves the spirit of the writer’s intent.  Allow me to refresh you:

Dr. Arshad Jahangir, a cardiologist at the Mayo Clinic in Phoenix/Scottsdale Arizona, who wrote the review, said the main reason patients look to herbal remedies is because they want to preserve their health.
“They think it’s natural and probably safe to use,” he said. “We’re not saying anywhere in the review that people should not take these products. But they should, at the very least, consult with their doctors who can look at their other medications and identify the potential for harm.”Herbal medications readily found over-the-counter can adversely affect the way prescription drugs are absorbed by the body by either enhancing or reducing their effectiveness.” (emphasis mine)

Yes! The article fits the headline!  And for the record, I perfectly agree. Next we see that integration between “eastern” and “western” medicine is promoted.  (albeit in a method I don’t agree with 100%, but I’ll take what is given.)

Christina Ferrari-Noonan, an acupuncturist and herbalist at Ancient Healing Chicago downtown, said patients who want to take herbal remedies should consult their doctors first.

“Patients should definitely go by the physician’s recommendation and see what they’re comfortable with,” she said. “There are definitely a lot of over-the-counter herbs that can be considered dangerous.”

Ferrari-Noonan, who has a background in Eastern and Western medicine, said herbalists should work in conjunction with doctors “We’re diagnosticians in traditional medicine not in western medicine,” she said. “Patients need to go their doctor first to get diagnosed. That diagnosis needs to be in place, and then as herbalists, we can go from there. Blood tests are especially valuable as a starting point.”

What I don’t agree with is the last sentence.  At times, people present with discomforts that cannot be classified in western medicine (how do you translate “Spleen Qi deficiency leading to weakness of the four limbs” into western medicine?  It isn’t CFS, it isn’t a movement disorder, etc etc) or do not appear in blood tests.

Jahangir agreed that herbalists and physicians should work together. “We’re not at war with herbalists and they are not against what we do,” he said. “Our goals are common, which is to serve our patients and to give them medicine or products that will do the job it’s supposed to do without causing harm.”

Tell that to the skeptics who insist that only commercial pharmaceuticals are worthwhile.

Mary Helen Lee, an herbalist at Chicago’s White Moon Healing Center, said herbal supplements could be beneficial as a compliment to chemical-based drugs, if taken correctly. “It’s definitely possible to take herbs to reverse the toxic side effects and lessen the harm the chemicals medications can have on your body,” she said. (I do this a lot with cancer patients on chemotherapy – Phil)

Lee said incorrect dosage amounts could also cause problems. “Either people are taking too much or too little, which can have a major effect,” she said. “Obviously, there are some dangerous herbs out there and people should be cautious. Patients should see a professional and get the correct herb and the correct dose for their problem.”

Experts agree that the biggest mistake people make is to self-diagnose on the Internet and treat themselves with over-the-counter herbal remedies without consulting doctors first. (emphasis mine)

“The Internet can be very helpful in educating yourself about herbs and possible effects, but it can also be very dangerous,” Ferrari-Noonan said.

So there you have it – a more balanced view that can be summarized thus:

a) herbs can work if used properly

b) always tell any healthcare professional about everything you’re doing for your health.  If they become biased against you because of that, then it’s time to find another provider.

c) never self medicate – there ARE herbal scammers out there who are only out to sell you stuff.

d) physicians of all traditions CAN and SHOULD work together.

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More Magic Numbers: This Time It’s Celebrex

News, Western Medicine | Posted by Philip
Feb 22 2010

Sweet Mother of God.  How can anyone have the gall to accuse Traditional Chinese Medicine of having little or no “evidence” to back it up when the “evidence” for some western medicine is even more immaterial than how these skeptics perceive qi.  Qi is hardly immaterial, by the way.

Doc Accused of Faking Celebrex Study from nbcconnecticut.com states that a physician was able to publish a clinical study saying that the drug had post surgical benefits…with NO patients enrolled in the study.

All of a sudden “evidence based” and “peer review” lose their luster.

These skeptics say Chinese medicine relies more on anecdotal evidence or small sample size.  Right now I’ll take small sample size over NO sample size.

Here’s the article:

A Massachusetts doc, who is also a former member of Pfizer Inc.’s speakers’ bureau, is accused of launching what is being called “one of the biggest research frauds in medical history,” according to The Day of New London.  And he has agreed to plead guilty, according to a Massachusetts newspaper.
Dr. Scott Reuben, who is accused of faking medical research studies, including some that were published in medical journals, was charged with health care fraud Thursday in federal court in Boston, according to the U.S. Department of Justice.
He’s accused of accepting a $75,000 grant from Pfizer to research the effectiveness of the pain medication Celebrex for a 2005 study, the Day reports.
His research, which the Day reports was pioneering at the the time, indicated that there are post-surgery benefits from painkillers. But no patients were actually enrolled in the study, according to a U.S. Department of Justice news release.

Health care fraud.  $75,000 grant.  For the nth time, I recall a famous comment by “some guy who knows some guy”… I’ve quoted that comment in the post previous to this one so forgive me if I’m too tired of copying and pasting it.

The Wall Street Journal reports that he also falsified information about Pfizer’s Bextra and on Merck’s Vioxx.
“Anesthesia & Analgesia” had to retract 10 papers Reuben wrote and medical experts say at least 21 journal articles by the anesthesiologist appear to be fabricated, the Day reports.
Reuben was the chief of acute pain at Baystate Medical Center inSpringfield, Massachusetts, and The Day reports that the hospital let him go last March, after an audit revealed he had been inventing data for as many as 13 years.

Reuben has reached an agreement in which he will plead guilty and prosecutors will recommend a more lenient sentence…

He would also have to forfeit assets of at least $50,000 he got from allegedly fake research, the Journal reports.

The Republican, of Springfield, Massachusetts, reports that Reuben has signed a plea agreement and must return $420,000 to pharmaceutical companies.

Here’s how I see it.  We can say that this guy is just ONE bad apple and should not be used as a basis to judge western medicine as a whole.  In that case we can also say that cases of Chinese medicine causing problems are also due to isolated bad apples.  On the other hand if we are to accept these events as being representative of the pharmaceutical industry in general, then such industry has no right to accuse Chinese medicine for being wanting of evidence.  Either way, the truth is somewhere in the middle: be critical, be wary.  Caveat Emptor, it is said.

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