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Mainstream Medical Journals say Acupuncture Works; Skeptics Irritated.

September 5th, 2010 1 comment

I’m a bit tired so I’ll just quote this article and comment on it:

Outrage over Acupuncture Evidence Attacks NIH (http://www.healthcmi.com/index.php/acupuncturist-news-online/291-outrageacupunctureproofnih)

Doctors from the University of Maryland School of Medicine, Baltimore and the University of Vermont College of Medicine, Burlington published a case vignette in the New England Journal of Medicine recommending acupuncture for the treatment of lower back pain. The article cites that patients with lower back pain account for over $90 billion in annual health care expenses in the US. The doctors conclude that acupuncture is an effective means for treating lower back pain based partly on a recent study of 6,359 patients published in Spine1. For the lower back pain patient in the case study presented, 10-12 acupuncture treatments over an 8 week period are recommended.

Hmmm, why do these names sound familiar?  Oh I recall!  I had cited the University of Maryland Medical Center for it’s excellent website resource on astragalus root (Huang qi) research.  (http://qi-spot.com/2009/10/20/astragalus-root-for-swine-flu/).   Apparently, those guys are quite open minded.

So anyway, what this means is that some doctors published their opinions that acupuncture should be recommended.  Fair enough.  Everyone’s entitled to an opinion, right?  If it’s wrong, let it be proven wrong through tact and reasoning.

NOT.

The pro-acu docs cite extensive evidence:

The doctors cite physiological phenomena that measure the effects of acupuncture. Local anesthesia at needle insertion sites block the the analgesic effects of acupuncture showing that acupuncture is dependent upon neural innervation2. Acupuncture has been proven to cause the release of endogenous opioids in brain-stem, subcortical, and limbic structures3,4. Acupuncture has also been proven to induce the secretion of adrenocorticotropic hormone and cortisol from the pituitary gland thereby creating a systemic anti-inflammatory response5. Functional MRI studies in humans reveal that acupuncture stimulates limbic and basal forebrain areas involved in pain processing6. PET scan MRIs (positron-emission tomography) show that acupuncture increases opioid binding potential in the brain for several days7. Acupuncture has also been proven to mechanically stimulate connective tissues8, release adenosine at the site of needle stimulation9, and increase local blood blow10. The doctors then cite clinical trials showing the efficaciousness of acupuncture in the treatment of thousands of patients10-15.

So what do some skeptics do?  Do they try to base their argument on refuting the evidence?

Despite this overwhelming evidence proving the mechanisms of action and efficaciousness of acupuncture, skeptics were outraged at the publication of an article supportive of acupuncture in the venerable New England Journal of Medicine. An article recently posted in the Forbes “science business” section stated that the article is “embarrassing” and that acupuncture “infiltrates” the University of Maryland Medical School. In the article, the author calls acupuncture “pseudoscience” and states that it is based on “magical thinking of non-existent life-force.” The skeptic author’s only proof of his theory is that one of the many studies cited in the article found that acupuncture was only 47.6% effective for the treatment of lower back pain and that sham acupuncture was 44.2% effective. Therefore, the author concludes that using “toothpicks” randomly on the human body will have the same pain relieving effects as acupuncture. What the author fails to mention in the Forbes attack article is that conventional western medicine therapy (a combination of drugs, physical therapy, and exercise) was only 27.4% effective in that very same study. Should we therefore abolish western medicine by MDs and call it pseudoscience? Acupuncturists have noted that the success of sham acupuncture noted in that particular study of 1,162 patients in Germany reveals that poorly placed acupuncture needles also derive benefit for the patient.

I have already blogged at length on the physiologic differences between sham and real acupuncture (http://qi-spot.com/2010/04/30/definite-proof-acupuncture-more-than-placebo/) and why it SEEMS that acupuncture is hard to validate using holy grail of western medicine studies – the double blind study (http://qi-spot.com/2010/03/30/how-to-research-acupuncture/).

What I also find interesting is the insistence of skeptics that acupuncture works by balancing Qi or something.  That is the lynchpin of their argument.  I can hear it now:

Skeptic: “They believe in some quasi mystical energy flow!  That means acupuncture MUST be quackery!”

Acupuncturist:  ”There are modern, scientifically proven phenomena that explains what we mean by qi flow.  The “needling sensation” is a result of stimulation of nerve fibers, and can be inhibited by certain drugs.  Qi can also be used to mean function, so when “qi” is deficient, one can say there may be decreased circulation to a certain area, or decreased organ function.  An excess of qi can mean a muscle is too tense… (cites more examples)”

Skeptic: (oblivious) “They believe in some quasi mystical energy flow!  That means acupuncture MUST be quackery!”

Acupuncturist:  ”Never mind.”

Seriously, I feel that way sometimes, talking to skeptics.  What’s the point?  You can treat pain in these people and they’ll assign all sorts of reasons EXCEPT the obvious – acupuncture works.

The use of the word “toothpick” also indicates a lack of even a basic awareness of how acupuncture is performed.  You don’t just “prick” people, you insert the needle and manipulate it.

Oh well…

And lastly, a list of references cited by the link I cited…

References

1. Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S. Effectiveness of acupuncture for low back pain: a systematic review. Spine 2008;33:E887-E900.

2. Wang SM, Kain ZN, White P. Acupuncture analgesia: I. The scientific basis. Anesth Analg 2008;106:602-10.

3. Han JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 2003;26:17-22.

4. Pomeranz B. Scientific research into acupuncture for the relief of pain. J Altern Complement Med 1996;2:53-60.

5. Li A, Lao L, Wang Y, et al. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalamus to alleviate edema in a rat model of inflammation. BMC Complement Altern Med 2008;8:20.

6. Dhond RP, Kettner N, Napadow V. Neuroimaging acupuncture effects in the human brain. J Altern Complement Med 2007;13:603-16.

7. Harris RE, Zubieta JK, Scott DJ, Napa- dow V, Gracely RH, Clauw DJ. Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs). Neuroimage 2009;47:1077-85.

8. Langevin HM, Churchill DL, Wu J, et al. Evidence of connective tissue involvement in acupuncture. FASEB J 2002;16:872-4.

9. Goldman N, Chen M, Fujita T, et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nat Neurosci 2010 May 30 (Epub ahead of print).

10. Sandberg M, Lundeberg T, Lindberg LG, Gerdle B. Effects of acupuncture on skin and muscle blood flow in healthy subjects. Eur J Appl Physiol 2003;90:114-9.

11. Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med 2006;166:450-7.

12. Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, paralel-group trial with 3 groups. Arch Intern Med 2007;167:1892-8. [Erratum, Arch In- tern Med 2007;167:2072.]

13. Cherkin DC, Sherman KJ, Avins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch In- tern Med 2009;169:858-66.

14. Thomas KJ, MacPherson H, Thorpe L, et al. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ 2006; 333:623. 15. Witt CM, Jena S, Selim D, et al. Prag- matic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol 2006;164:487-96.

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I Love Mayo! (the Clinic, not the Condiment) Mayo Loves Acupuncture!

April 5th, 2010 1 comment

Why can’t more western doctors and skeptics adapt the attitude of the Mayo Clinic?

Earlier I had blogged about how a physician from the Mayo Clinic endorses acupuncture for low back pain.  Now I had chanced upon their website primer on acupuncture under the heading “Tests and Procedures”

http://www.mayoclinic.com/health/acupuncture/MY00946

Here are some notable exerpts:

Under “Definition”

Acupuncture involves the insertion of extremely thin needles in your skin at strategic points on your body. Acupuncture originated in China thousands of years ago, but over the past three decades its popularity has grown significantly within the United States.

Traditional Chinese theory explains acupuncture as a technique for balancing the flow of energy or life force — known as qi or chi (chee) — believed to flow through pathways (meridians) in your body. By inserting needles into specific points along these meridians, acupuncture practitioners believe that your energy flow will re-balance.

In contrast, many Western practitioners view the acupuncture points as places to stimulate nerves, muscles and connective tissue. This stimulation appears to boost the activity of your body’s natural painkillers and increase blood flow.

Nice to see that the website presents both theories with neither preference nor prejudice.

Now, under “Why It’s Done”, and this is a beaut.

Scientists don’t fully understand how or why acupuncture affects the amount of pain you feel. Several studies have found that acupuncture has little or no effect beyond that of the sham treatment used in some study participants — the control group — for comparison. The lack of firm results can be explained, in part, by the difficulty of devising a realistic but inactive stand-in for acupuncture. (emphasis mine)


Rob and stunt double I Love Mayo! (the Clinic, not the Condiment)  Mayo Loves Acupuncture!

A Good Stand-In is hard to find.

Difficulty in devising a realistic but inactive stand-in… isn’t that what I’ve been trying to point out for a long time?  How come THEY get it and some can’t? (or won’t?) (see http://qi-spot.com/2010/03/30/how-to-research-acupuncture/)

Now do we remember this line? (http://qi-spot.com/2010/03/20/new-bashing-technique-acupuncture-causes-disease/) Here’s what Mayo has to say:

The risks of acupuncture are low if you have a competent, certified acupuncture practitioner. Possible side effects and complications include:

  • Soreness, bleeding or bruising at the needle sites
  • Internal organ injury, particularly to the lungs, if the needles are pushed in too deeply
  • Infectious disease, such as hepatitis, contracted from reused needles

Again, balanced and fair and most of all, TRUTHFUL.

The rest of the site talks about who is eligible and who is not, how to prepare, what to expect, etc.  And it ends with a balanced note:

The effects of acupuncture are sometimes difficult to measure, but many people swear by it as a means to control a variety of painful conditions.

Several studies, however, show that simulated acupuncture appears to work just as well as real acupuncture. There also is evidence that acupuncture works best in people who expect it to work.

Since acupuncture has few side effects, it may be worth a try if you’re having trouble controlling pain with more-conventional methods.

I post this knowing skeptics will come in and say “see? placebo!” Yet I still do so because I am interested in the truth.  And the truth is any treatment will work better in people who expect it to work.  But the fact that it works in patients who also don’t expect it to work says something.

And yes, darned well worth a try.

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Mayo Clinic: Acupuncture Useful for Low Back Pain

March 13th, 2010 2 comments

Worth mentioning: Acupuncture recommended by John Bartleson, MD, of the Mayo Clinic for low back pain as evidenced on their website:

(http://www.mayoclinic.com/health/acupuncture-for-back-pain/AN02055)

From wikipedia, the Mayo Clinic  ”is a non-profit organization and an internationally renowned group of medical practice headquartered in Rochester, Minnesota. Its headquarters consist of the Mayo Medical School, the Mayo Graduate School, the Mayo School of Graduate Medical Education, and several other health science Mayo Clinic partners with a number of smaller clinics and hospitals in Minnesota, Iowa, and Wisconsin, an organization known as the “Mayo Health System.” Mayo also provides medical treatment and performs research in its facilities in Arizona and Florida.”

So what does it have to say?

“When performed properly by trained practitioners, acupuncture has proved to be an effective therapy for back pain. Several studies have found that acupuncture can help reduce chronic back pain and improve daily function.”

Very very important: when performed PROPERLY by TRAINED practitioners.  Why do I emphasize this? Time and time again I say that acupuncture is not a pill but a procedure.  It’s not just sticking a needle in, but practitioner skill is vital in the selection of acupoints and proper manipulation depending on the patient’s particular condition.  In fact, I am giving a lecture later on low back pain and will be emphasizing on several “kinds” of lumbago such as Blood Stasis (trauma), Damp-Cold, Kidney Yin Deficiency, etc etc…

The point is that not all back pains are created equal, and each must be met at their own terms.

Oh but what about the studies showing sham acupuncture also works? Doesn’t that debunk acupuncture?  And how the heck does it work anyway?

Scientists don’t fully understand how or why acupuncture affects the amount of pain you feel. Several studies have found that acupuncture causes the same effects as sham (minimal or simulated) acupuncture used in some studies for comparison. Sham acupuncture involves tapping the skin with a toothpick at the same strategic points used in acupuncture to simulate the insertion of a needle. Sham acupuncture may not be an accurate way of studying the benefits of acupuncture, however, because it’s possible that acupuncture points can be stimulated by even surface pressure. Both acupuncture and sham acupuncture showed improvement over usual medical treatments. (emphasis mine)

If only I had a penny for every time I’ve said this.

And now to complete the cycle:

Acupuncture is generally recognized as safe if done by a competent, certified acupuncture practitioner. Possible side effects and complications can occur, which include soreness, bleeding, infection or bruising at the needle sites.
Acupuncture isn’t a cure and not everyone responds to acupuncture for back pain. If your back pain doesn’t begin to improve within a few weeks, acupuncture may not be the right treatment for you. If you’re considering acupuncture for back pain, talk with your doctor, who can refer you to an acupuncturist.

Acupuncture is generally recognized as safe if done by a competent, certified acupuncture practitioner. Possible side effects and complications can occur, which include soreness, bleeding, infection or bruising at the needle sites.
Acupuncture isn’t a cure and not everyone responds to acupuncture for back pain. If your back pain doesn’t begin to improve within a few weeks, acupuncture may not be the right treatment for you. If you’re considering acupuncture for back pain, talk with your doctor, who can refer you to an acupuncturist.

There you have it folks:

a) acupuncture is a procedure, not a pill

b) sham acupuncture seems to work because it is still stimulating the acupoints, albeit less directly and less strongly

c) we may now know exactly how it works, but would that stop you from trying it if it does work?

and d) like ANY other treatment, it may not work for everyone.

This last point requires me to point out a certain bias.  If a western medicine treatment doesn’t work for a particular patient, we’ll say that it just didn’t work for a particular patient.  No one questions western medicine in general if a pill didn’t lower someone’s blood pressure.  Yet we in the so-called “alternative” field have to overcome a tendency by people to dismiss acupuncture and herbal medicine if it didn’t work for a particular person.  Know what I mean?

Well, off to University to enlighten some minds.

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

January 16th, 2010 3 comments

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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Lend Me Your Ears! Ear Acupuncture for Back Pain in Pregnant Women

October 17th, 2009 1 comment
ChineseEarAcupuncture 300x257 Lend Me Your Ears! Ear Acupuncture for Back Pain in Pregnant Women

Ear Acupuncture Chart (image courtesy http://www.acupunctureproducts.com

Afraid of having needles stuck in you?

The American Journal of Obstetrics and Gynecology noted that  “ear acupuncture” works better than sham acupuncture at “fake” points and control in relieving low back and pelvic pain.

Excerpts from the text (“Ear Acupuncture Curbs Back Pain in Pregnant Women” courtesy of Reuters Health), which again is “news” to some people who don’t know that this technique has been around for hundreds of years.

In a study, women who had pressure needles held in place with tape at three acupuncture points in their ears for one week, were more likely to experience significant reductions in lower back and pelvic pain than those who had the needles placed at three “sham” points or women in a control group who didn’t get real or fake acupuncture.

Some “skeptics” justify their position about acupuncture by citing studies claiming that fake acupuncture  – real needles inserted in non acupuncture points – work seemingly just as well as those inserted into real points.  They often claim this means points are useless.  They also forget that inserting needles is better than not inserting.

Actually this proves the meridian theory is real, since Qi flows through the meridians, thus putting needles along the meridians WILL have some effect, albeit not the ideal one.  So what did the researchers do here?

They randomly assigned 159 women in the 25th to 38th week of pregnancy to receive real acupuncture, acupuncture delivered to points that would theoretically not affect pain in the pelvic or lower back area, and a control group.

For ear acupuncture, the points are more specific and there are no “lines” connecting the dots.  Therefore, you have to use the points properly or have no effect at all, even if you put stimulation in other parts of the ear.

The results:

A 30 percent or greater reduction in pain was reported by 81 percent of women in the acupuncture group, 59 percent of women in the sham acupuncture group and 47 percent of women in the control group. The difference between the sham and control groups wasn’t statistically significant.

Thirty-seven percent of women in the acupuncture group were pain-free after a week of acupuncture, compared to 22 percent in the sham group and 9 percent of the control group. Improvements in function were significantly greater among women who had real acupuncture compared to those who got the fake version or received no treatment.

So, real acupuncture works better than fake or ordinary painkillers, etc…  Okay… maybe NOW the skeptics will believe us. (I wish.)

But the pain relief didn’t persist for some; a week after the end of acupuncture treatment, 68 percent of those who received the real thing still had a 30 percent or greater reduction in pain compared to the beginning of treatment, while 32 percent in the sham acupuncture group and 18 percent of the control group sustained this level of pain reduction. There was no significant difference among the groups in the percentage remaining free of pain two weeks into the study.

So one week of real acupuncture produced more lasting relief than fake acupuncture.  Imagine if we actually continued the treatment.

The original study: <http://www.ajog.org/article/S0002-9378(09)00424-4/fulltext>

Sources:

Reuters Health.  “Ear Acupuncture Curbs Back Pain in Pregnant Women” abcnews.go.com 16 October 2009.  17 October 2009 <http://abcnews.go.com/Health/WireStory?id=8847011&page=1>
Shu-Ming Wang, Peggy DeZinno, Eric C. Lin, Haiqun Lin, James J. Yue, Michael R. Berman, Ferne Braveman, Zeev N. Kain.  “Auricular acupuncture as a treatment for pregnant women who have low back and posterior pelvic pain: a pilot study” American Journal of Obstetrics & Gynecology September 2009 (Vol. 201, Issue 3, Pages 271.e1-271.e9) Online June 29, 2009.  17 October 2009 <http://www.ajog.org/article/S0002-9378(09)00424-4/fulltext>

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