Archive for January, 2010

Some Guy: “No evidence for Acupuncture”; Real World: “Lots of Evidence!”

Acupuncture, News, Research | Posted by Philip
Jan 27 2010

This columnist, probably looking for something to write about, basically bashes ancient knowledge in general and bases his argument for acupuncture not working on the lack of physical evidence for Qi. (http://www.kansan.com/news/2010/jan/25/folmsbee-no/)  Some wonder quotes:

However, when it comes to health, ancient wisdom fails to provide a true benefit, miring us instead in a failed tradition. The modern practice of acupuncture is the best example of such an unfortunate appeal to antiquity.

That is, if acupuncture appeals ONLY to antiquity.  Acupuncture appeals not to antiquity but to lasting effect.  A lot of things can appeal to antiquity such as demonology and incantations.  However, since those don’t work, they’ve died out.  Also, ancient wisdom says walking is the best form of exercise (Hippocrates).  Is it any wonder that the countries where people use cars to go to the other side of a street, people are generally obese?

Practitioners of this ideology claim to be able to treat a huge variety of illnesses this way, from headaches to infertility.

We don’t claim.  We do.  Backed up by evidence.  Google it.

Today, there is a clear lack of scientific evidence demonstrating the presence of such meridians, or even “qi” in general. This destroys any scientific plausibility for acupuncture, making its consideration a leap of faith

Firstly, let’s not use the word “clear.”  Clear to whom. Clear to you?  Not clear to everyone!  While the mechanics of Qi and meridian flow are still being studied, the efficacy if acupuncture is clearly demonstrated for many conditions (low back pain, headache, hormonal imbalances, among others) and not for others (color blindness, post operative ileus).

And Folmsbee follows this logic.  No clear evidence = no scientific plausibility = leap of faith.  Ergo we shouldn’t believe in many viruses because we don’t have “clear” evidence of them, just bits and pieces of RNA or DNA “attributed” to them.  We should not be taking lithium for bipolar disorder because there is no “clear” evidence of how it works.  For over fifty years we’ve taken aspirin for pain and only now are we realizing it is related to the COX inhibitors.  There’s no quantification for love or respect or any of those “unclear” concepts, but no one will be stupid enough to deny they exist.

Leap of faith?  I took migraine meds with some effect.  Acupuncture kept me migraine free for five years.  That’s not as good as a randomized double blind clinical trial, but it’s much more than a mere leap of faith.

Biomedical research has ventured to unprecedented depths. It has evaluated the function of organs on a cellular, biochemical, and even atomic level. In contrast, the philosophical grounds for acupuncture remain without scientific foundation. Acupuncture simply rests on an unobserved, unsupported, and unlikely phenomenon.

Yes, biomedical research has evaluated the functions of organs down to the molecular (not atomic) level (DUH).  However, they still can’t treat certain things like chinese medicine can.  If not, how can so many patients whose chronic rhinitis is untouchable by western med suddenly find relief with the right combination of spices plus acupuncture?  If that’s placebo effect, I’ll take it over drugs.

“Unobserved” he says.  The ancient Chinese  (and ancient peoples in general), not having newspapers, television, the internet, or a self-smug sense of superiority, were MASTERS of observation.  For example, they knew that kidney problems led to anemia.  In modern scientific parlance, they’d ask for proof.  We have that proof now with the discovery of erythropoeitin as a hormone produced by the kidney.  The ancient chinese simply said that The Kidneys nourish the marrow.  Without the benefit of modern technology!  Just plain, simple repeated and reproducible observations.

The ultimate question is whether acupuncture is truly effective in treating disease. The scientific attempt to answer this question, however, has proven complicated and difficult.

Since the practice of acupuncture claims an influence over the function of the entire body and offers treatment for a huge number of diseases, it is exceedingly challenging to pinpoint a single measure of acupuncture’s efficacy as representative of the practice as a whole.

Such variety has made it problematic to compare studies and standardize the data.

Furthermore, the actual procedure of inserting needles is extremely difficult to control.

Well this guy is not all bad.  He understands that we should study acupuncture as a procedure and not as a pill.  But he forgets one thing.  Even in Chinese medicine, acupuncture is known to be best for some conditions, not as good in others.  He’s already laying the groundwork for saying it doesn’t work for some, so it doesn’t work, period.  He wants to eventually ignore the evidence that shows WHERE acupuncture works.

In any clinical study, the practitioner should not know whether he or she is administering the true treatment or the placebo treatment, known as “blinding.” But, in the case of acupuncture, it is very clear to the acupuncturist (and often the patient) if they are asked to perform a sham treatment or no treatment at all.

This unfairly biases the data and has allowed for some smaller clinical studies to have falsely positive results, largely due to the placebo effect of the patient being offered a novel treatment.

In ANY clinical study he says.  So when we conduct studies on surgical procedures, the surgeons shouldn’t know if they’re doing the real thing or not.  Very very nice.

Despite these limitations, there have been some consistent results in the scientific research behind acupuncture. Particularly over the last few years, the controls for these studies have improved. This includes better sham procedures, more reliable practitioner blinding, and larger groups of patients to study.

In these well-controlled studies, the gap between the supposed effectiveness of the treatment and the placebo group has shrunk accordingly, leaving the two statistically indistinguishable. When put under scientific scrutiny, acupuncture was shown to be just an ineffective ideology.

Then name those studies.  Here in my blog I’ve named studies showing they’ve worked, named studies that show they haven’t.  You haven’t named any.  You just want us to take your word for it.  Oh wait, isn’t that the very leap of faith you hate so much?

Considering the recent flux of dependable data, it appears that acupuncture truly has little use in modern medicine today. Its philosophy is ancient, and while some translate that to mean “wise”, the truly wise know it to more accurately mean “outdated.”

So eating vegetables is also outdated, and so is covering up in the cold, and so is exercise.

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Sham Acupuncture vs Real Acupuncture for Knee Pain: The Real Thing Wins Again

Acupuncture, Research | Posted by Philip
Jan 23 2010

The title says it all.

Once again, real acupuncture wins.

From Reuters:

Electroacupuncture shows promise for knee arthritis

NEW YORK (Reuters Health) – A modern twist on traditional acupuncture may bring some pain relief to people with knee arthritis, at least in the short term, a small study suggests.

The study, published in the journal Pain, looked at the effects of electro-acupuncture among 40 adults with knee osteoarthritis — the common “wear-and-tear” form of arthritis in which the cartilage cushioning the joints breaks down.

Electro-acupuncture is similar to traditional acupuncture, where fine needles are inserted into specific points in the skin. What’s different is that the practitioner fits the needles with clips that are attached to a small device that delivers a continuous electrical impulse to stimulate the acupuncture point.

Among the patients in the current study, those who had a daily electro-acupuncture session for 10 consecutive days reported greater improvement in their pain compared with patients who received a “sham” version of the therapy.

In my own practice, you don’t even need the electric current: you just have to manipulate the needles properly.

Patients in that latter group received acupuncture, but the needles were inserted at random points on the skin rather than traditional acupuncture sites. And while the needles were attached to the electrical device, it was not actually turned on.

The findings suggest that true electro-acupuncture may offer at least short-term pain relief to knee arthritis sufferers, according to the researchers, led by Dr. Sadia Ahsin of the Army Medical College Rawalpindi in Pakistan.

Acupuncture has been used for more than 2,000 years in Chinese medicine to treat a wide variety of ailments. According to traditional medicine, specific acupuncture points on the skin are connected to internal pathways that conduct energy, or qi (“chee”), and stimulating these points with a fine needle promotes the healthy flow of qi.

Modern research has suggested that acupuncture may help ease pain by altering signals among nerve cells or affecting the release of various chemicals of the central nervous system, such as pain-killing endorphins.

(and not by “breaking electrical circuits)

In their study, Ahsin and colleagues found that electro-acupuncture appeared to raise patients’ blood levels of endorphins and lower their levels of the hormone cortisol, which tends to rise during physical or mental stress. So it’s possible that these changes explain the greater pain relief, according to the researchers.

Oh come on.  Any review of literature will tell us we know this since at least the 80s.

Larger, longer-term studies are still needed to see whether electro-acupuncture can have lasting benefits — and to find out how often patients would need treatment to gain those benefits.

For now, Ahsin’s team writes, the current findings suggest that, for people who are interested in trying it, electro-acupuncture can be added to conventional treatment for knee arthritis.

Acupuncture and electro-acupuncture are generally regarded as low-risk therapies. Among patients in this study, there were no major side effects apart from bruising at the needle site in three patients, the researchers note.

SOURCE: Pain, online December 15, 2009.

The thing is that if there is structural damage to the knee cartilage, acupuncture will only relieve the pain temporarily.  Think of it this way: acupuncture restores the “flow”, but because the knee is anatomically damaged, the flow WILL get mucked up again.  Hence, acupuncture becomes a glorified pill – giving temporary pain relief.  Where will it come in? It will come in in patients who, for some reason or another, cannot take too many drugs for a long time.  Kidney disease, esophageal varices… any reason to avoid more pills.

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They Should Have Called It “Tiger”

News | Posted by Philip
Jan 22 2010

This is just too good to pass up.

Illegal aphrodisiacs branded ‘Clinton’ sold in Taoyuan
TAOYUAN, Taiwan — An old man was caught yesterday for selling illegal aphrodisiacs in a park in Taoyuan. He branded one as “Clinton” with Bill Clintons face on the label, and another one “Gold Kungfu” with Jet Li’s face on.

p20b They Should Have Called It Tiger

I'm thinking "Tiger" would bring up images of... endangered animals.

There were 339 boxes of 29 kinds of aphrodisiacs found at a street stall. The aphrodisiacs claimed to be Chinese medicine and safe for heart disease and high blood pressure patients.
After sending to the Department of Health for tests, more than 90 percent of these aphrodisiacs are proved to contain western medicine and anesthetics. Public Health Bureau of Taiyuan County warned that taking these pills can be fatal, especially for people with heart problems. Aphrodisiacs should be prescribed by registered doctors. Taking of aphrodisiacs from unknown sources may cause headaches, hot flushes, illusions, dizziness and tinnitus.

from http://www.chinapost.com.tw/taiwan/local/taoyuan/2010/01/20/241509/Illegal-aphrodisiacs.htm

Speaking of aphrodisiacs, I was once again interviewed for RJ Ledesma’s column.  Link : http://www.philstar.com/Article.aspx?articleId=542165&publicationSubCategoryId=446

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Acupuncture DOESN’T Work Sometimes

Acupuncture, Research | Posted by Philip
Jan 20 2010

Acupuncture is only “human”.  It doesn’t always work.  In this research, it doesn’t seem to work for post operative ileus.

http://www.medicalnewstoday.com/articles/176167.php

A research article published on January 7, 2010 in the World Journal of Gastroenterology addresses this question. In this prospective randomized clinical trial, the authors examined if acupuncture could prevent prolonged postoperative ileus (PPOI) after intraperitoneal surgery among patients with colon cancer in Shanghai, China. Acupuncture did not prevent PPOI in this population. Subset analyses in patients who developed PPOI also suggested acupuncture was not useful in this setting to treat PPOI once it developed.

The study was part of a unique collaboration between researchers in the United States at The University of Texas M. D. Anderson Cancer Center in Houston, Texas and China at the Fudan University Cancer Hospital in Shanghai. Only one previous randomized trial, conducted in the United States, has examined the use of acupuncture to prevent PPOI in cancer patients. According to Meng and colleagues, standard postoperative care is very different in China than in the United States, and some of these treatment differences could play an important role in postoperative gastrointestinal motility and development of complications such as prolonged ileus. The authors state that future studies examining the use of acupuncture to prevent or treat PPOI should include assessment of activity, diet, and postoperative medication for pain control.

This study was funded by a grant from the National Cancer Institute. The Principal Investigator of the international collaboration, Dr. Lorenzo Cohen, stated the focus of the International Center of Traditional Chinese Medicine (TCM) for Cancer is to study TCM within its traditional context. Although the study was a negative trial, it is consistent with a similar trial conducted in the United States. We learned from this study that the specific use of certain acupuncture points in combination with standard postoperative care in China had no effect on PPOI, but it also demonstrated that we can conduct rigorous multinational research to examine TCM for cancer. Conducting rigorous research on TCM is an important step towards understanding the potential efficacy and mechanisms of many ancient therapies such as acupuncture.

Reference: Meng ZQ, Garcia MK, Chiang JS, Peng HT, Shi YQ, Fu J, Liu LM, Liao ZX, Zhang Y, Bei WY, Thornton B, Palmer JL, McQuade J, Cohen L. Electro-acupuncture to prevent prolonged postoperative ileus: A randomized clinical trial. World J Gastroenterol 2010; 16(1): 104-111 http://www.wjgnet.com/1007-9327/16/104.asp

Source: Lin Tian
World Journal of Gastroenterology

I assume they used a standard set of points for everything.  Nonetheless, this shows that acupuncture, like any other valid mode of treatment, has limitations.  It can’t cure everything.  While skeptics will take this to question it’s efficacy for anything, the proper attitude should be just the opposite: it works for some, doesn’t work for others.

Research is important to determine which is which.

Like anti-cancer drugs working by killing people faster *ahem*.

Some questions though: what were the specific operative procedures?  Did they involve cutting any meridians?  What were the diseases present indicating surgery?  These are all important in setting up a study.  Some procedures end up cutting meridians, obviously affecting acupuncture.  Also, what anesthetics were involved?  Naloxone has been shown to block acupuncture’s beneficial effects.

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The Smoking Gun on Low Back Pain; Does Life Expectancy Prove Chinese Medicine Ineffective?

News, Research | Posted by Philip
Jan 16 2010

Not exactly chinese medicine, but still an important fact to be re-emphasized

http://www.drcutler.com/general-health/study-links-smoking-to-low-back-pain-19554062/

On another note, a brief rant.  I read some “crusader” against “quackery” today say that how can Chinese medicine be proven ineffective?  Look at life expectancy, they said.  In 1900, the life expectancy of a Chinese was 30.  Now it’s 71, after the introduction of western medicine.  So WOW Chinese medicine must suck right? Wrong.

Let’s look at China in 1900.  What was happening? Civil War.  Boxer Rebellion.  Lots of poor babies dying before the age of 1 because of lack of access to health care, skewing the numbers.  I believe that if we take away babies dying at age 1 and 2 due to inaccessibility of health care and proper nutrition, the number should jack up to the 40s and mid 40s.    Why do I assume that?  In 1900, lots of young people died – babies, young adults in war.  Hence, you have people dying in their 00s and 20s… that will definitely pull the average down.  To compare, US life expectancy was at 49 at the time.

Look at wikipedia: <http://en.wikipedia.org/wiki/Life_expectancy>

Sometimes, mainly in the past, life expectancy increased during the years of childhood, as the individual survived the high mortality rates then associated with childhood. A pre-20th century individual who lived past the teenage years could expect to live to an age comparable to the life expectancy of today.

So, get rid of high infant mortality – which was a UNIVERSAL PROBLEM then, and you improve life expectancy.  Given that the US was NOT in a civil war in 1900, what does that say about life expectancy in the US – probably just the same as in China.

So what DID make a difference: something that helped both? antibiotics.  Antibiotics helped fight off previously lethal pediatric infections, allowing kids to live and people in general to live longer.

So let’s take another indirect method of measuring the effectivity of chinese medicine.  Research has shown that people in China have less heart disease, less fractures despite more osteoporosis, and generally require less babying than their western counterparts.  How many homes for the aged are there in China?  Look at Japan, which uses both Chinese medicine (aka Kampo) and western medicine – their average life expectancy is GREATER than the American one – HIGHEST IN THE WORLD.

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