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Acupuncture CME

Some Universities have more cachet than others. On the West coast it is Stanford that has the reputation as the best. There is Oxford, Yale, MIT, and maybe Whatsamatta U. I would wager that in most people’s mind the crème de la crème is Harvard. Harvard is where you find the best of the best. If Harvard is involved, a project gains an extra gobbet of credibility. Brigham and Women’s Hospital also has a similar reputation in the US as one of the hospitals associated with only Harvard and the New England Journal of Medicine. Premier university, premier hospital, premier journal.

So if Brigham and Women’s Hospital and Harvard Medical School are offering continuing medical information (CME) for acupuncture, there must be something to it, right? A course called “Structural Acupuncture for Physicians” must have some validity.

Brigham and Women’s Hospital, which is a teaching affiliate of Harvard Medical School, includes the Oscher Clinical Center for Complementary and Integrative Medical Therapies. The Oscher center offers acupuncture, yoga, chiropractic and a variety of other modalities including craniosacral therapy.

There are few things, in a world of alternative nonsense, as nonsensical as craniosacral therapy .

A craniosacral therapy session involves the therapist placing their hands on the patient, which they say allows them to tune into what they call the craniosacral system. The practitioner gently works with the spine and the skull and its cranial sutures, diaphragms, and fascia. In this way, the restrictions of nerve passages are said to be eased, the movement of cerebrospinal fluid through the spinal cord is said to be optimized, and misaligned bones are said to be restored to their proper position.

Cranial Sacral therapists think they can improve the flow of spinal fluid flow by gently massaging the skull. Really. I can’t make this stuff up. I operate under the assumption that you can judge a person by the company they keep, although guilt by association is problematic in medical institutions. Programs are often started in hospitals for financial reasons without the benefit of scientific or medical input. It is one of the many prices we pay in the US for a for-profit medical system. But if there is a institution whose scientific standards are such that they allow craniosacral therapy, well, they lose a major chunk of credibility. As the saying goes, you lie down with pigs, you come up smellin’ like garbage.

On the other hand, it would be much easier to participate on committee work. The Pharmacy and Therapeutics committees in which I participate spends significant time evaluating the literature to decide how best to utilize new drugs and therapies. If only we offered craniosacral therapy: I would never have to justify a treatment based on science and reality again. So now I realize, sadly, that Brigham and Women’s and, by extension Harvard, has questionable scientific standards, or, if they have standards, they apply them selectively.

The brochure states

This unique course provides practical, hands-on training in acupuncture. The training program is designed to bring together Eastern and Western views of health and disease into a result-oriented acupuncture style. You will learn to evaluate and treat patients using modern Japanese acupuncture techniques that link classical Chinese theory to concrete, understandable clinical diagnostic and treatment techniques.

Whenever I hear about the Eastern views of health and disease I always think of General Westmoreland in the movie “Hearts and Minds.” I know, cheap shot. But an Eastern heart attack is different from a Western heart attack how?

What, I wonder, is a “result-oriented acupuncture style.” Since acupuncture has little, if any, efficacy, it cannot have therapeutic results. Maybe the key word is style. There is style and there is substance. I suppose they could be suggesting that the acupuncture they are teaching will only look like it is working?

Style probably refers to the type of acupuncture, as in Kiiko Style acupuncture. Like the kung fu movies I watched as a teen, there are various acupuncture styles that need to compete in a winner take alltournament, to determine once and for all whose acupuncture is strongest.

Modern Japanese acupuncture differs from Chinese acupuncture in that they use finer needles that are not placed as deeply. Japanese acupuncture does seem to share one feature with Chinese acupuncture, at least to judge from the videos of the procedure I can find searching YouTube: a complete lack of understanding of sterile technique. I you want to get the willies watch a video on acupuncture, Japanese or otherwise. Barehanded, no hand washing, the practitioner touches the area to be pierced, no alcohol wipe is used, and the junction of needle/skin is manipulated. The Kiiko style, to judge from the photographs on the website, does not include gloves. These videos should be entitled “How to transmit infectious diseases.”

I assume they will use sterile technique at the course, since “emphasis is given to “hands-on” point location and needling techniques based upon palpatory feedback” although one cannot be sanguine in regards to a hospital system that uses craniosacral therapy. Germ theory is, after all, just a theory.

The didactic portion of the course will focus on bridging the gap between acupuncture practice and science. The scientific basis of acupuncture and the methodological problems with acupuncture research is presented as part of the discussion of specific clinical conditions throughout the course.

That will be an interesting discussion. Since the acupuncture literature, as discussed at length on this blog, is such that the best studies show no effect and the science is only barely applicable to acupuncture and pain treatment, it would be fun to be a fly on the wall and see how they ‘bridge the gap” for the justification of the covered uses: Pain Control, Hormonal Imbalances, OB/GYN Problems, GI Disorders, Scar Treatments, Structural and Orthopedic Problems, Cardiac and Vascular Disorders, Autoimmune and Autonomic Disorders, Mood Disorders, Myofascial and Neuroanatomic Treatment.

Not only will they be teaching Japanese acupuncture and classic Chinese acupuncture, but also auricular acupuncture and the German Microsystem approach (MAPS: Mikro-Aku-Punkt-Systeme). That last one

… is based on the Somatotopic fields comprising of specific points of correspondence in the Auricle (Ear), Scalp, Oral Cavity etc. A micro system is like a Map of the body — somatotope or a cartography of the whole organism similar to the homunculus discovered in the sensory motor cortex of the brain. Each of the Micro system points have a clearly defined correlation to and interrelation with a particular organ or function…For Example EAR Acupuncture is one such Micro-system. It was discovered by the french doctor Nogier who decoded the functional correspondences of the respective ear points. The punctual cartography of the Ear resembles an upside down embryo.

MAPS is apparently the result of the unholy mating of acupuncture and phrenology.

I am surprised they did not include Korean Hand Acupuncture, foot acupuncture and tongue acupuncture. They are leaving out three key styles of acupuncture. One wonders how six styles of acupuncture can all be valid, share similar physiology, and be supported by the same science, given their differences. I suppose it is like asking which is the valid style of astrology: Indian, Western, or Mayan. It is a trick question. They are all nonsense.

The best constructed study to date on acupuncture demonstrated that sham acupuncture by twirling toothpicks on the skin is arguably more effective and definitely has fewer side effects when compared to ‘real’ acupuncture. I can use quotes with the best of them. I wonder it they will pass out a box of toothpicks. Since twirling toothpicksgives similar results with fewer complications, one wonders how they justify teaching acupuncture styles that are less efficacious and more dangerous than toothpicks. Can you ethically offer an equivalent therapy with more side effects than a known competitor?

Let’s see, cost of the class: $6650. For that kind of cash, who needs ethics? That’s right, if you are a Harvard-affiliated hospital you can charge the cost of two loaded, top-of-the-line MacBook Pros to teach magic. I bet they get it. “Harvard-trained acupuncturist” would look great on a business card and provide instant credibility. A quick google finds practitioners whose websites mention the Harvard course for their training. Premium price for premium nonsense.

I am only disappointed they did not charge ten dollars more. $6660. Now there’s a number.

As the web page for the Oscler center says

The market for complementary and integrative medicine is vast and shows no sign of diminishing. This trend must be guided by scientific inquiry, clinical judgment, regulatory authority, and shared decision-making. – Dr. David Eisenberg.

The market. Not the need. The market. It is depressing when good institutions promote worthless nonsense.

Next time I read the NEJM and see an article from Harvard or Brigham and Women’s, I will not be as accepting of the result as I was in the past. They have lost some of their credibility with me. It is sad. Great institutions can have feet of clay. At least there are still institutions you can believe in. Mom. Apple Pie. Baseball. Go Barry Bonds.

Posted in: Medical Academia, Science and Medicine

Leave a Comment (29) ↓

29 thoughts on “Acupuncture CME

  1. windriven says:

    Harvard syllabus:

    “The didactic portion of the course will focus on bridging the gap between acupuncture practice and science. The scientific basis of acupuncture and the methodological problems with acupuncture research is presented as part of the discussion of specific clinical conditions throughout the course.”

    Translation for Delgado Community College students:

    “Science is hard and you never know, you could break a brain cell or even a nail trying to figure acupuncture out. So we’ll skip the hard stuff and go right to technique and style. All the cool kids are doing acupuncture so it must be science, right?”

    All is lost. I’m going to get my qi chonged.

  2. TsuDhoNimh says:

    the restrictions of nerve passages are said to be eased, the movement of cerebrospinal fluid through the spinal cord is said to be optimized, and misaligned bones are said to be restored to their proper position.

    OK … now that they have SAID that, what are the indications for cranio-sacral therapy?

    How do you decide whether the nerve passages are restricted or not? How do you know when they are unclogged? What is the optimal movement of CSF, and how do you know it is sub-optimal? What is the proper position of the bones? How do you know they are not aligned?

    My sarcastic side says the indication is any ill-defined condition where the patient also has a surplus of cash. The nerve passages will be unrestricted, CSF movement optimal, and bones properly aligned when the patient runs out of cash to pay for the service.

    I’d rather have a shampoo, comb out and blow dry from a hairdresser. There’s no HIPAA to restrict the flow of gossip, and it’s only $15+tip at the local cheap salon.

  3. Jann Bellamy says:

    I think TsuDhoNimh is onto something. I’ll bet in a trial of salon shampoo/blow dry v. acupuncture, the salon treatment would beat out acupuncture every time, for any problem, at least for women. If you added highlights to the salon treatment, no contest! Same results predicted for manicure/pedicure v. acupuncture.

  4. wales says:

    The “willies”? C’mon MC, regarding supposed “non-sterile” technique in acupuncture. We already went through this in one of your other posts. Did you not see that the demonstration technique for your youtube link used an acupuncture needle equipped with a plastic insertion tube which prevented the fingers from contacting the insertion point and which slipped off upon insertion? Put on your glasses, watch again, closely.

    This is a PR demo piece. I have seen plenty of medical PR pieces that do not show physicians/nurses washing their hands prior to touching and treating the patient. Presumably the practitioner washed her hands prior to the demo. Under your assumptions, we should assume when we see filmed surgery techniques demonstrated that the surgeon did not wash his/her hands unless we actually see the hands being washed. Cheap shot.

  5. AlexisT says:

    My antenatal teacher told us several times that craniosacral therapy (or cranial osteopathy as it’s called in Britain) was a miracle cure for fussy babies. It didn’t take much for me to see that a light head massage, while undoubtedly soothing, probably did nothing for most babies. My enthusiasm dropped into the negatives once I saw what they charged for that massage.

    Here’s what they claim CST can do for babies:
    http://www.cranial.org.uk/page3.html

  6. Mark Crislip says:

    My vision is fine

    1:43 into the video

    the acupuncturist touches both areas to be inserted with the bare finger with no prep of one hand before inserting the needle with the other, so what use is the tube?

    Would you want your IV inserted under similar technique?

  7. MKirschMD says:

    Medical care is being driven by maniacal marketers who want a piece of the billions of dollars being spent on ‘alternative’ medicine. The public believes this stuff. Snake oil has always sold well. Its pitchmen today are hospital executives.

  8. DevoutCatalyst says:

    And here’s an infant death by craniosacral therapy:

    http://anaximperator.wordpress.com/2009/05/07/infant-dies-after-craniosacral-therapy/

  9. Harriet Hall says:

    Harvard produced people like Andrew Weil and John Mack (psychiatrist who studied alien abductions). Its reputation had already dropped in my book, and now it’s even lower.

    Just one question: is using alcohol wipes before every needle stick evidence-based? I thought the evidence didn’t show any benefit for SQ, intradermal, or IM injections as long as the skin was reasonably clean. (Of course IVs are another matter.)

    Not to say acupuncture doesn’t cause infections. I just reviewed a manuscript for a paper that will be coming out in the journal Pain that compiled a substantial list of published reports of serious infectious complications of acupuncture treatments.

  10. Mark Crislip says:

    I have looked at a ton of acupucnture videos on the net.

    In every one the practitioner touches the area to be needled barehanded and then placed the needle with no skin prep.

    The tube gives the illusion of safe technique, not the reality.

    The prep depends on what you are trying to prevent. Infection of the site or transmission of infection. If the practitoner had hep B, that would be enough,with a little bad luck, to pass it on.

    There is practice you can get away with and best practice. Most of the time time you can get away with a remarkable ammount of sloppy practice and not get an infection. But as the recent JAMA article demonstrated re: surgical bundles, when you do everything right all the time, infections decrease.

  11. khan says:

    They didn’t include the different schools of haruspicy? So closed-minded.

  12. Lawrence C. says:

    Harvard has been rusting on its laurels for a long time. This isn’t news or very worrisome. There are plenty of fine people who can see what they’re doing well or not doing well and make a sound judgment regarding whatever it is that currently bears the Harvard name. The worshiping of “the market” in all areas of American life, including medicine, is part of our society. No reason to expect doctors to be immune to this part of our national cult and odd to think they should except themselves from such a vital part of American living.

    What is potentially worrisome is that an MD seems to think watching a “ton” of videos on YouTube constitutes legitimate research (or is the foundation for anything except eye strain.) Where did that passive methodology come from, an online CME course from Harvard? ;-)

  13. windriven says:

    @ Lawrence C

    “What is potentially worrisome is that an MD seems to think watching a “ton” of videos on YouTube constitutes legitimate research”

    I’ve been reading for a lot of years but I must not have mastered it yet. I missed the part where Crislip claimed that YouTube videos constituted a careful review of aseptic technique among acupuncturists.

    Crislip said:
    “Japanese acupuncture does seem to share one feature with Chinese acupuncture, at least to judge from the videos of the procedure I can find searching YouTube: a complete lack of understanding of sterile technique.”

    This is hardly an assertion of rigorous research.

    When you set out to nit pick, the first task is to find a nit.

  14. Lawrence C. says:

    When you set out to nit pick, the first task is to find a nit.

    What you lack in humor you certainly make up for in overserious comments. As your name suggests, you are indeed torn apart by the winds, and sadly enough don’t seem to know from whence they come.

    I found no nit, hence the smiley face, that bright visual clue that one should find at least a salt grain, but I seem to have attracted a nitwit. It must be me, the particular poor quality of my writing, that makes such things flock. Thus to be gracious I am not going to read or comment any longer on this blog. While some of the articles are of occasional utility most of the comments are not even utilitarian and, to paraphrase Heraclitus, reading things here is like a day of wine revealing far, far too much about the prejudices and ignorance that one supposedly rails against. I’ll stick to my silent vices and leave this ostentatious virtue to you good folks. Adieu.

  15. windriven says:

    Hmmm. I just love those little smiley faces, I wish I knew how to insert them in my comments. If I did, I’d be sure to insert them where they are appropriate to my intent. A smiley face after the first sentence of your last paragraph one would indeed read as a clue that the the objection was made tongue in cheek. After the second it reads as a self-congratulatory exclamation, having just hoisted Crislip on his own petard.

  16. squirrelelite says:

    @windriven,
    It’s a lot easier to insert smiley’s and other little graphics here than it is over at ScienceBlogs, which seems to ignore them.

    For a simple smiley, try
    :
    )

    i.e. :)

    or for tongue in cheek,
    ;
    )

    i.e. ;)

    etc.

  17. rmgw says:

    “I would wager that in most people’s mind the crème de la crème is Harvard….”

    In a list that includes Oxford? puh-leeze!

    That acupuncture stuff is a clincher, too, wouldn’t you say?

  18. pmoran says:

    squirrelelite, how do you italicise? Where is such information kept?

    PM

  19. Chris says:

    Dr. Moran, here is a page of basic html tags:
    http://www.lagcc.cuny.edu/ctl/resources/pdfs/html.pdf

    The ones that are useful here are italics, bold and how to imbed links. One thing that is missing is “blockquote.” Which would put quoted texts in its own paragraph instead of quotation marks.

  20. Thanks, Mark. I’ve been meaning to write about this course for some time (it’s been around for several years) but now I won’t have to. The only thing I would add is a snide comment about misleading language: “structural” acupuncture. What, exactly, is meant by that? I dunno, but I can guess: it seems to lend an air of legitimacy to an otherwise illegitimate course. Kinda like “medical” acupuncture, the title of a similar course at UCLA and Stanford.

    KA

  21. nitpicking says:

    Fine article, but did you have to print the entire text twice?

  22. Mark Crislip says:

    All All good good things things are are worth worth repeating repeating.

    Fixed. I think it is a wordpress issue.

  23. David Gorski says:

    Sorry I disappeared completely from SBM for three or four days. I wanted to comment here, but working on a grant application let me to staying up nearly all night Wednesday and Thursday and then crashing hard last night.

    In any case, I’d agree, Kim. If you want to write about this course, please write about this course. There’s nothing that says that two SBM bloggers can’t take on the same topic. Your different perspective would be welcome.

  24. Dr Benway says:

    Dr. Crislip,

    For the sake of the Googles, please change “Oscher” and “Oscler” to “Osher.”

    Bernard and Barbro Osher have donated nearly a billion dollars to various programs in the arts, education, and medicine.

    I would very much like for the Oshers, who seem like nice people, to read Science Based Medicine.

  25. cloudskimmer says:

    In my one experience watching an acupuncturist at work, the tube seemed to prevent the flimsy needle from bending during initial insertion–just a tap to get it started. Then the tube was removed and the fingers of one hand held the end of the needle next to the skin, while the other hand pinched the needle farther up and pushed it further into the victim. (oops, I mean patient.) It was a horrible demonstration of non-sterile technique; luckily there was no infection in this case; since the “treatment” was completely ineffective, there was no motivation to go back. Despite reporting this to the state licensing board, they found no deviation from proper technique.
    Unhappily a nurse in a convalescent hospital happily injected my mother without first using an alcohol swab on the skin, and when I questioned this procedure, she claimed that there were no longer infections from needles because they are used only once. Another nurse (not at that facility) said this is not the case, and I should’ve insisted on sterile technique. Any comments? Do some nurses routinely inject patients without swabbing the skin first? Does it matter? I’m going to refuse any shots in the future if no alcohol swab is applied first.

  26. juliany8s says:

    I took a course in this style of acupuncture last year and I must say that it is a really bizarre mash up of eastern woo, modern medicine and accidents waiting to happen. I also spent some time at the instructors clinic; another eye opening experience. The technique is less than standard (for acupuncture, which is not sterile anyway) no alcohol was used, points were palpated for ‘accuracy’ with bare fingers, and needles were handled at the point of contact with the skin. Needles were also routinely withdrawn and reinserted elsewhere. There was often boasting by the instructor about how ‘the master’ in Japan would use one needle per patient, withdrawing it and reinserting where ‘needed’!

    The tone of the theory was such that the authors (Kiiko Matsumoto & David Euler) were drawing comparisons between information about the human body gleaned from old Chinese medical manuals and modern anatomy and physiology. Like some sort of retrofit of ancient ideas into the modern understanding. It sounded nice to me until I grew a few more skeptical brain cells and realised that it is all just very imaginative wishful thinking based on confirmation bias wrapped in modern medical language and doused with eastern romanticism.

    Claims like using points on the back of the legs to open up the basilar artery; a point on the foot to reduce pressure pain in the abdomen that stems from a clogged portal vein then leads to a ‘backed-up’ liver. I could go on and on…

    My skepticism really blew up when I read about a treatment for polyuria. The ‘master’ claimed that the small intestine 13 point (qu yuan) is used for urinary problems, especially hormone related, as it regulates the secretion of vasopressin by the pituitary. Wow. I thought this was pretty specific for a point on the shoulder so I looked for the reference, and found none…in fact there were no references at all in the entire 400 odd (really odd) pages of the text. At least, not to anything that would remotely constitute evidence for such claims.

    I won’t even get started on the ‘ion pumping cords’…

  27. davideuler1 says:

    I am always so sorry and saddened to read opinions such as the one Published by Mark Crislip. For a representative of a very young kind of medicine, that changes it’s truths, facts, and standards of care many times after being responsible for so many deaths of correctly prescribed medication and surgery, to criticize types of medicine he has absolutely no knowledge of is, for the lack of a polite way of saying it, sad. He educates himself from youtube…? Modern, Allopathic medicine has proven itself very useful and courageous in emergency situations, saving un-countable number of lives. Unfortunately the scale then is tipped back with chronic disorders. One should be humbled by the fact that we do not know the actual reason why most diseases and syndromes occur, leave alone how many medications work! We are using many techniques to try and help patients, often without the knowledge why and more often under wrong assumptions that are corrected every couple of years or so in updated Merck manuals, internal disease text books etc (just compare the change of knowledge about the hormonal system between now and 20 years ago – you think we know it all now?). Just visit your local pain clinic.
    Acupuncture was around for about 2500 years, at least one should respect the fact that this kind of medicine with its very smart ways of understanding the human body existed in the East when westerners had no real medicine to speak of. This comment is not about providing proof that acupuncture works, it does and it is a well published and researched fact. Many tens of thousands of reputable physicians around the world practice acupuncture side by side (or exclusively) with Allopathic medicine. So all these thousands of very well educated physicians are misguided? Well, coming from a person who obviously does not know the first thing about acupuncture I find his article distasteful, shallow, arrogant, and mainly wrong.
    Why don’t we walk a little in a path before we criticize and bash every one on it? Yes?

    1. Harriet Hall says:

      I am always so sorry and saddened to read opinions such as the comments by davideuler1. It’s quite a collection of logical fallacies, from ancient wisdom to the argument from popularity. He baldly asserts that “acupuncture works,” disregarding all the evidence to the contrary that has been presented on this blog, without even presenting any evidence of his own. His comment about Dr. Crislip having no knowledge of acupuncture is untrue and is an unwarranted ad hominem. I could go on to explain all the other flaws in davideuler1′s thinking, but I don’t think he would understand me, and I think most of the readers of this blog can spot them without my assistance. I can only hope that he will continue to read this blog and will gradually learn what science-based medicine means.

  28. davideuler1 says:

    Has any one thought of the difference between hollow and filliform needles? Hmm I guess not since some of the distinguished authors and learned member of the medical association are so concerned about sterility. I can point to numerous problems in hospitals where, naturally only scientific methods are used. Anyone into microbiology and the healthy skin barrier? guess not. I love it when people speak off and trumpet with no knowledge. I would love to see the numeric comparison between sterile incidents in medical facilities vs. acupuncture. Now that would be interesting.

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