Articles

Acupuncture Vignettes

I seem to be writing a lot about acupuncture of late. As perhaps the most popular pseudo-medicine, there seems to be more published on the topic. I have a lot of internet searches set up to automatically feed me new information on various SCAMs. Interestingly, all the chiropractic updates seem to be published on chiropractic economics sites, not from scientific sources. Go figure.

Here is a hodgepodge of articles, mostly from the scientific literature, I have read concerning acupuncture and TCM.

Tooth Fairy science and the constitution

Harriet Hall coined the term “Tooth Fairy science” which is:

to doing research on a phenomenon before establishing that the phenomenon exists…You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists.

The concept encompasses most of pseudo-medicine. Much of traditional Chinese medicine is based on concepts divorced from anatomy and physiology and are perfect for Tooth Fairy science.

An example comes from the introduction of “The Association between Yang-Deficient Constitution and Clinical Outcome of Highly Active Antiretroviral Therapy on People Living with HIV.”

Before you read further, spit take warning. If you are drinking, swallow, so liquid does not squirt out your nose and onto the computer.

…more evidence is emerging that much of the wisdom of traditional medicine can in fact be explained at genomics level (Joshi et al. and the references therein). Recently, HLA class II polymorphisms were found associated with the physiologic characteristics defined by Traditional Chinese Medicine (TCM). In TCM, constitution is believed to be a distinct characteristic of an individual. Constitution has been used to guide disease prevention, health care, and medical practice. Yang-Deficient Constitution is one of the major constitutions, which is characterized by chills, cold limbs, and also spontaneous sweating; loose tools [sic] and/or profuse clear urine; and lassitude.

So they decided to:

…systematically investigate whether there is any association between Yang-Deficient Constitution and complications incurred from HIV infection and design evidence-based treatment, we conducted a prospective observational study for evaluating the association between Yang-Deficient Constitution and clinical outcomes.

On a scale of 1 to 5 they asked HIV patients the following questions to see if they were Yang-Deficient:

  1. Do you feel cold at your limbs?
  2. Are you sensitive to cold at stomach, back, waist, or laps? Are you usually sensitive to cold weather and dress more than others?
  3. Are you more sensitive to cold air (such as outside of winter, air-conditioning, or electric fan)?
  4. Do you have flu- or cold-like symptoms more frequently or easily than others?
  5. Do you feel uncomfortable or worried for cold water or foods?
  6. Do you have pulpy bowel after having cold water or foods?

I have taken care of AIDS patients since the beginning of the epidemic and I cannot imagine how those questions could be relevant in any way to HIV, its treatment and complications.

They then collected a tonne (English measurement, it is that large) of data and ran it through the old p-value machine and found some barely significant results. They concluded:

Yang-Deficient Constitution score has a potential to be developed as a predictor for early HIV-related mortality and side effects. The interrelation and underlying mechanisms should be further investigated for evidence-based design of a more appropriate treatment strategy.

They go so far as to suggest it is the mitochondria. Medication toxicity in HIV is often due to mitochondrial toxicity. Mitochondria are important for energy. Yang deficiency syndrome patients have weak or imbalanced energy. Therefore:

Yang-Deficient Constitution is susceptible to mitochondrial toxicity is worth further investigation.

At least quantum effects are not blamed.

I keep going back to Ioannidis and there are at least three reasons, besides thinking the idea that Yang-Deficient Constitution is valid, that the conclusions of the study are false:

  • Corollary 3: The greater the number and the lesser the selection of tested relationships in a scientific field, the less likely the research findings are to be true.
  • Corollary 4: The greater the flexibility in designs, definitions, outcomes, and analytical models in a scientific field, the less likely the research findings are to be true.
  • Corollary 5: The greater the financial and other interests and prejudices in a scientific field, the less likely the research findings are to be true.

I guess they did not read the paper. Few in the pseudo-medical world seem to. Data mining garbage does not lead to diamonds. Tooth Fairy science at its more pure. Supported by the Chinese Government and Stanley Ho Centre for Emerging Infectious Diseases. Good money thrown away.

Look on my works, ye Mighty, and despair!”
Nothing beside remains. Round the decay
Of that colossal wreck, boundless and bare
The lone and level sands stretch far away.

Acupuncture beer goggles

I most studies, sham acupuncture is no better than real acupuncture for the relief of pain. The usual interpretation is that if an intervention is no different than a placebo, the intervention does not work. But there is always the issue that sham and real are better at relieving pain than doing nothing. So, goes the thinking, the efficacy of acupuncture comes from the power of placebo.

I have always referred to pseudo-medical therapies as beer goggles: they do not change reality, just the perception of reality. Changing perception of disease is an important result of an interaction with the patient. I attempt it all the time, although unlike pseudo-medical practitioners, I try do it truthfully.

Little did I realize there is a medical term for beer goggles: tactile discrimination training. It is when:

…stimulation of some form is applied to the painful area and the patient is asked to decide on the locality or type of stimulation, an approach that has been shown to be effective in the management of certain chronic pain problems.

In this study they decided to compare acupuncture to acupuncture used as tactile discrimination training in chronic low back pain. The protocol was:

After locating the points, the 14 needles were inserted. We used 15 mm needles fully inserted to ensure that the depth of needling was the same across conditions. In the experimental condition, participants participated in a sensory discrimination training task similar to that described by Moseley et al.19 A picture of a back with the position of each needle numbered (see figure 1) was positioned so that it could be comfortably viewed by the participant. The clinician then rotated a single needle in accordance with a random number sequence and the participant was required to nominate which needle was being stimulated, if the participant committed an error, they were told which point had in fact been stimulated. Each needle was stimulated for 3 s with a 10-s interval between each stimulus. This task was performed with visualization of the back via a mirror in the first 10 min and progressed to no visualisation in the last 10 min. In the control condition, participants were asked to lay comfortably and relaxed and to not attend to the needles. During the 20 min control condition the therapist manipulated needles at the same rate and using the same random sequence as they did in the experimental condition.

Of note, both were done by the same person, an acupuncturist. The only difference between the acupuncture and the tactile discrimination was:

participants responded to each needle manipulation by trying to localize the position of the needle that was being manipulated.

And the tactile discrimination acupuncture outperformed acupuncture for pain reduction.

This helps explain why sham and real acupuncture have the same effect, why acupuncture does not depend in where the needles are placed or even if needles are used. It is a form of tactile discrimination training, aka beer goggles. Perception is altered, not underlying pathology.

Blind men and the elephant in the room

There was a recent PLOS article, “Decreased Risk of Stroke in Patients with Traumatic Brain Injury Receiving Acupuncture Treatment: A Population-Based Retrospective Cohort Study.”

It was a:

a retrospective cohort study of 7409 TBI patients receiving acupuncture treatment and 29,636 propensity-score-matched TBI patients without acupuncture treatment in 2000–2008 as controls.

And it found that:

TBI patients with acupuncture treatment (4.9 per 1000 person-years) had a lower incidence of stroke compared with those without acupuncture treatment (7.5 per 1000 person-years), with a HR of 0.59 (95% CI = 0.50–0.69) after adjustment for sociodemographics, coexisting medical conditions and medications.

Interesting result. Why did they do the study? Well, in Taiwan acupuncture is a common treatment and no one had ever looked to see if it could prevent a stroke. It is a tough job, but someone had to do it.

Retrospective studies are always interesting, but not definitive, since there may be differences between the treatment and controls that would be potentially avoided in a prospective randomized trial. So were there differences in the two groups? Yep.

The acupuncture group was more likely to be on anti-coagulants, (p= 0.0003), antiplatelet drugs (p < 0.0001), and lipid lowering drugs (p < 0.0001).

Seriously. The treatment group was more likely to be on stroke preventing medications yet it was the acupuncture that was responsible for fewer stokes? Because the statistics suggested it?

To properly evaluate whether acupuncture treatment is associated with reduced stroke risk in TBI patients, we used propensity score to match the difference of age, sex, low income, and density of TCM physicians, mental disorders, hypertension, diabetes, ischemia heart disease, hyperlipidemia, migraine and epilepsy between TBI patients with and without acupuncture treatment. To accurately estimate risk of stroke after TBI for patients with and without acupuncture treatment, residual confounding effects were adjusted in the multivariable Cox proportional hazard models.
Seems so.

They had 2 possible explanations for the effects of acupuncture. The first was that acupuncture had biologic effects. I would bet against it. There is no plausible reason acupuncture could prevent stoke. The other was that patients in the acupuncture group had better care.

…patients with TBI who choose acupuncture treatment may have better knowledge, attitudes and practices regarding physical rehabilitation and disease prevention, which we believe could also contribute to reduce new-onset stroke event after TBI.

Given that the acupuncture patients were more likely to be on a medical therapy that prevents strokes, that is a more likely answer.

It wasn’t the acupuncture, it was the medications.

When I first read this article and looked at the table that demonstrated the marked difference in medications in the two groups, I could not believe it. I read it over and over, thinking “no, that couldn’t be.” I could not understand how anyone could be blind to what would appear to be a simple explanation of the difference between the two groups. The most impressive example of confirmation bias I have ever seen.

Electroacupuncture is not acupuncture

“When I use a word,’ Humpty Dumpty said in rather a scornful tone, ’it means just what I choose it to mean — neither more nor less.”
“The question is,” said Alice, “whether you can make words mean so many different things.”
“The question is,” said Humpty Dumpty, “which is to be master— that’s all.”

In my feeds I kept seeing variations of the theme: acupuncture treats sepsis. As an infectious disease doc it tweaked my interest since sepsis (a particularly severe manifestation of infection) is a disease that I routinely treat and routinely kills.

So what was this amazing study? “Dopamine mediates vagal modulation of the immune system by electroacupuncture.”

First, it was in mice.

Second, the reasoning was as follows. Many of the symptoms of sepsis are due to inflammation medicated by cytokines. Stimulating the vagus nerve decreases the inflammatory response in a variety of other diseases. It is hard to stimulate the vagus nerve directly since it is deep in the neck and check. So

We hypothesized that electroacupuncture can be an alternative strategy for vagal stimulation.

The key word is electroacupuncture.

Recently they excavated a 2000 year old tomb in China, and what they found was, in a word, incredible. First was a set of acupuncture needles. But more amazing was a set of dead AA batteries in a mechanical dragon that evidently rolled across the floor while playing cymbals. It strongly suggests that the ancient Chinese used electroacupuncture.

So they stuck a needle in the ST36 Zusanli point of mice. Which is in the leg, below the knee. Who knew that mice and humans had the same meridians and acupoints? Then they cranked in some voltage and measured various cytokines and other inflammatory mediators under various conditions to see what happens. The results were interesting. The electroacupuncture-treated mice had decreased mortality by an:

…anti-inflammatory mechanism mediated by the sciatic and vagus nerves that modulates the production of catecholamines in the adrenal glands.

But here are some key discoveries from the paper:

The anti-inflammatory effects of electroacupuncture are voltage dependent.

And:

Direct electrical stimulation of the vagus nerve mimicked the production of dopamine and norepinephrine induced by electroacupuncture.

And:

…direct electrical stimulation of the sciatic nerve mimicked the anti-inflammatory effects of electroacupuncture (Fig. 1f) in a voltage-dependent manner.

They did not use a random peripheral site to apply the voltage or another acupuncture point as a control. As best I can tell, the study actually had nothing to do with acupuncture. What they demonstrated was electrical stimulation of peripheral nerves or the vagus nerve had anti-inflammatory effects. The use of the specific acupuncture point was, well, pointless.

This is the kind of study that drives me nuts. You could remove all the references to acupuncture and the results would be just as applicable. I suppose it would then lack the sexiness that acupuncture adds. Without acupuncture as a hook, I wonder if it would have been published in Nature Medicine or get the notice it did.

And, while interesting, given all the monitors on a patient in the ICU with sepsis, I can’t see any clinical utility until some clever researcher figures out a way to give the electricity without messing up the EKG etc.

Acupuncture and erectile dysfunction

Harvard Medical School has Harvard Health Publications. Their Editor-in-Chief, Dr. Anthony Koraroff has a column called Ask Doctor. K. In the recent issues they ask him, “Is acupuncture an effective treatment for erectile dysfunction?” Dr. K’s response suggests that being from Harvard is not a preventative for getting almost everything about acupuncture wrong.

One non-drug treatment used for ED is acupuncture, the ancient Chinese practice in which a practitioner inserts hair-thin needles into specific sites along the body’s “meridians.” According to traditional beliefs, the body’s Qi (pronounced “chee”), or vital force, flows along these meridians. By stimulating specific acupoints, the practitioner aims to restore the proper flow of energy in the body.

He fails to mention that this is a pre-scientific concept with zero basis in reality. There are no meridians or acupoints or any sort of life energy. It is nonsense. And which acupuncture does he advise as the ‘real acupuncture’: Chinese, Japanese, Hand, Foot, Tongue, Ear or the German MAPS?

In treating ED, the acupuncture needles are placed in the wall of the abdomen.

Of course they are. I would be more curious why no acupuncture map ever shows meridians and acupoints in the genitals. You would think the life force would be in the life-generating organs. I know why. If you are a male making stuff up, the last thing you would do is stick needles in the genitals. Makes one think it would be useless for erectile dysfunction.

Western scientists have a different explanation.

I have always found the phase “western scientist” at best patronizing and at worst racist, but that is me. There is one science, used by humans all over the world, and to judge from output the last decade those “eastern scientists” are kicking our research butts.

They speculate that the needles stimulate the release of endorphins, the body’s natural painkillers. Other theories claim the needles release neurotransmitters, chemicals that carry messages between nerve endings.

Let’s see. You stick needles in someone and twist them and you get a pain response? And in response to a noxious stimulus neurotransmitters are made? Who’da thunk it? And water is wet. And how would that have any effect on the panoply of diseases that acupuncture is supposed to help, from ED to fertility to herniated discs? Hint. It doesn’t.

Unfortunately, there just hasn’t been enough good research to determine if acupuncture is useful for ED.

Why unfortunately? Given prior plausibility, why waste time and money on a useless therapy. But he is right. From a recent meta-analysis of acupuncture and ED:

Most investigations had methodological flaws, e.g. inadequate study design, poor reporting of results, small sample size, and publication without appropriate peer review process.

He continues:

There are more studies of acupuncture as a treatment for chronic pain. Some scientists point to studies that compare acupuncture to “sham acupuncture,” in which the needles are deliberately not placed properly. Such studies sometimes find that both real and sham acupuncture relieve pain. This suggests to them that acupuncture may work by causing a placebo effect.

No, this suggests that acupuncture does nothing. If real acupuncture has the same effects as twirling toothpicks, safe to say it is ineffective. Or would he use the same justification for using internal mammary artery ligation for angina? And if he is suggesting placebo medicine, well, that is usually considered unethical.

Whether this is true or not, what matters to patients is that their condition has been improved. Some of my patients have had good relief of their pain.

It doesn’t matter that the costly treatment you are suggesting is not based in reality and has no efficacy? A classic example of why I say the three most dangerous words in medicine are “in my experience.”

As for acupuncture to treat erectile dysfunction, if you’d like to give it a try, go ahead. Be sure to seek out an experienced acupuncturist. And remember that it can be time-consuming and expensive. But in experienced hands, it is safe.

No reason whatsoever in the discussion to suggest it would have any efficacy at all, but use it any way despite the cost. And those experienced hands? Yet another photo without gloves; bare fingers poking around the needle site. Acupuncture is not safe in any hands experienced or otherwise:

468 patient safety incidents were identified; 325 met our inclusion criteria for analysis. Adverse events reported include retained needles (31%), dizziness (30%), loss of consciousness/unresponsive (19%), falls (4%), Bruising or soreness at needle site (2%), Pneumothorax (1%) and other adverse reactions (12%). The majority (95%) of the incidents were categorized as low or no harm.

And this did not include the numerous reports of infection from the sloppy infection-prevention technique that defines acupuncture.

Let’s see. No reason it should be effective for ED, no clinical trials to suggest efficacy, has complications and cost, and in my experience it occasionally works for pain so try it for ED. I am not impressed with the advice. Ask Dr. K? Maybe not so much if it concerns acupuncture.

Combinations

Pseudo-medicines combine and recombine in a continual fantastical dance. Pick any two alternative medicines and someone, somewhere, has combined them into a unique treatment modality. My favorite is Tong Ren, a voodoo form of acupuncture.

I had thought, perhaps incorrectly, that no one could come up with a more ludicrous combination. Perhaps it would be dark energy homeopathy or dark matter acupuncture. I suppose it is just a matter of time before someone combines some pseudo-medical modality with the time cube and their nonsense will reign supreme.

Until then it is more mundane combinations.

There is the idea that as long as you are sticking needles in people you might as well add other substances to the needle and drag them into the dermis. It is called mesotherapy. Like much of pseudo-medicine, the concept doesn’t entail the concept of germ theory, which is just a theory after all.

There have been 35 reports of odd infections associated with mesotherapy, often atypical mycobacteria.

Evidently there is also bee venom acupuncture:

Bee venom acupuncture is growing in popularity, especially in Korea, and is used primarily for pain relief in many kinds of diseases as an alternative medical treatment.

And, in a new report, bee venom acupuncture is also associated with odd infections:

We report 3 cases of Mycobacterium chelonae infections after bee venom acupuncture. All were treated with antibiotics and surgery.

A common organism in the environment and water, Mycobacterium chelonae is not an uncommon cause of soft tissue infections where simple infection control interventions are ignored.

The authors finish with inadvertent whimsy:

Considering the increasing use of bee venom therapy and considerable morbidity of NTM infection, prevention efforts of infections are needed through strict adherence to infection control principles, including sterilization of venom extraction, purification process, injection equipment, and environment.

Strict adherence? LOL. I would be happy with gloves.

Acupuncture as gamma-hydroxybutyrate

Interesting headline: 80-Year-Old Man Paralyzes Women with Acupuncture, Molests Them.

Seo is also accused of taking off A’s panties and molesting her after paralyzing her with acupuncture needles in the foot, he got access to A after promising to treat her uterus. Another victim, a 22-year-old employee, was also molested after receiving paralyzing acupuncture from Seo.

As one commentator said:

I thought paralysis acupuncture was only possible in movies.

You are correct, Sir. There is no way acupuncture could cause paralysis. It cannot and does not do anything. But what might have happened? I lack information in this particular case, but I have seen two patients with hysterical paralysis and hysterical blindness (aka conversion disorder). Neither had a physiologic cause of their problem but neither could walk or see. I have seen patient with melanomas the size of a large button mushroom and another with an erosive tumor on his abdomen the size of a dinner plate. Both completely denied anything wrong. It was hard to believe the patients were unaware of the problem. I have been amazed over the years of what people can do given the right situations.

I wonder what kind of social expectations allowed the acupuncturists to convince his victims that they were paralyzed. Some odd combination of male dominance, conversion disorder and Stockholm syndrome? I don’t know. If indeed the event occurred as written. Given the inability of most news outlets to be even remotely accurate about pseudo-medicines, I am a touch skeptical that the events occurred as reported. It is more interesting, if true, about a milieu that allows a predator to use a worthless pseudo-medicine as a weapon for abuse.
__________________________
A gentle reminder. Check out the Society for Science-Based Medicine.

Our announcement was a month ago and it is going along nicely, if taking up a huge amount of my time.

Posted in: Acupuncture, Clinical Trials

Leave a Comment (214) ↓

214 thoughts on “Acupuncture Vignettes

  1. Iolaire says:

    I know that this is totally, utterly childish but the bit that made me spray the room with tea was the glorious typo in the first quote after the spit warning:

    “Yang-Deficient Constitution is one of the major constitutions, which is characterized by chills, cold limbs and also spontaneous sweating; loose tools ….

    Yikes.

    1. windriven says:

      ?

      I thought the authors were serious about the loose tools. I’ve always chosen my undergarments to promote loose tools. But now that I understand that loose tools beget all sorts of pains and maladies I will henceforth swaddle my tools close to my body.

      1. irenegoodnight says:

        I used to have a lot of loose tools until I finally broke down and bought a proper toolbox. To think– I could simply have got my Yang-deficiency corrected!

      2. mousethatroared says:

        Arrive late to the party and all the loose tool jokes are taken. Sad, but at least I got a chuckle out of it.

  2. tgobbi says:

    Dr. Crislip states about acupuncture: “As perhaps the most popular pseudo-medicine… ”

    Anecdote alert! I have suffered from chronic pain for more than 30 years. Over that time I’ve sought relief from neurologists, neurosurgeons, rheumatologists, physiatrists (wow, my spellcheck hates that word!), orthopedists, physical therapists – and probably other specialists I can’t even remember any more. I’d guess that 50% or more of the MDs I’ve seen have mentioned acupuncture. They may not go so far as to recommend it, but they do consistently ask if I’ve tried it or considered it. I have a stock response: I tell them that if they can show me a single valid study that demonstrates relief over and above the placebo effect, I’ll be happy to try it. Invariably they drop the subject immediately!

    1. WilliamLawrenceUtridge says:

      I see that as more of a compassion doctor attempting to do something, anything, they can to help a patient. But that’s doubtless my own medical beer goggles.

  3. Egstra says:

    Had an appointment with a new MD last week to talk about some pain issues I’ve been having. She ran through the options, from very conservative to less so. With each option, she thoroughly discussed the research, patient selection criteria, outcomes, and so forth. I was quite impressed.

    Then she mentioned acupuncture. I asked about the research and she sort of shrugged, and said that a lot of people reported improvement. I said, “Well, it does have a strong placebo effect, but there isn’t any decent literature to support its use.” She responded, “We just don’t understand everything.”

    Made me question her research skills in general.

    1. Andrey Pavlov says:

      Then she mentioned acupuncture. I asked about the research and she sort of shrugged, and said that a lot of people reported improvement. I said, “Well, it does have a strong placebo effect, but there isn’t any decent literature to support its use.” She responded, “We just don’t understand everything.”

      There are other possibilities as well. Many physicians – particularly of the older generation – truly take a “whatever helps my patient” sort of approach with “help” meaning “they say they feel better.” Peter Moran exemplifies this position and my own stepfather who is a critical care physician has said similar things when we discuss CAM. He is not as staunch about it as Peter is though.

      The point being is that it could be a way of ducking the question to try and leave you open an avenue to a placebo effect that may at least make you feel a bit better for at least a little while.

      It could also be a genuine lack of direct research on the topic. We honestly just can’t research every single thing in detail. And consequently we must rely on proxies for our information. So when a whole bunch of other physicians are doing it, including large cancer centers and whatnot, it is not entirely unreasonable to say that it might not do much but hey, it is popular and legit people are doing it. This is why I was fiercely advocating that the truth be taught in medical school (we had a few lectures on CAM and it was all credulous BS, and now that I actually have my diploma I can probably speak out a little more vociferously on the topic) because as students we are hopelessly incapable of actually researching everything. I had a classmate who basically had exactly the same attitude. All it took was me sending her two acupuncture “studies” in prominent journals and asking her to read them in full. She came back a week later and said she was blown away by how incredibly bad those studies were! In fact, that is probably a really good tack to take – find one of the egregiously bad studies and just present it to your physician, asking his/her take on it. That alone should wake them up to it.

      And there is always the “medicine is an art” group who take that to mean “since we don’t know everything we can just make stuff up and do whatever we feel seems right to us.”

      1. windriven says:

        “He is not as staunch about it as Peter is though.”

        Perhaps he just tires more easily than Peter ;-)

        1. Andrey Pavlov says:

          Perhaps he just tires more easily than Peter ;-)

          Perhaps. But we actually haven’t tussled much about it. He’s made the claims, we’ve discussed it, and he has admitted to softening his position on it and respecting my rigorous one.

          1. Do yourself a great favor that I wished was one of my options early in my career. Study alternatives! I would suggest you get Travell/Simons, Rachlin and Gunn’s books and begin to teach yourself needles. These authors started searching for alternative treatment options and to help the failures of scientific method medicine. EArly in the last century, technology was just beginning. These authors took from the best treatment options and techniques from their “modern” medical toolbox to help these patient outliers. The needle does all the work to treat the problem which is in the muscles or myofascial tissues.

            Don’t get lost in the word “Acupuncture!” It is a good therapy when used correctly. Once you understand needles then you can go back to study this ancient discipline.

            1. WilliamLawrenceUtridge says:

              Do Travell, Simons, Rachlin and Gunn exclusively focus on acupuncture as a treatment modality? Do they recommend treatments that don’t penetrate the skin, such as simple massage of trigger points? Why use acupuncture when massage seems to work reasonably well? How much evidence supports Gunn’s intramuscular stimulation approach?

              1. Harriet Hall says:

                More than that: why does he only offer information from old books rather than from recent studies, and why hasn’t the entire medical profession been convinced to follow Travell a half century after she implemented her techniques? When something obviously works and there is evidence from clinical trials, it is adopted by the entire medical profession and new evidence builds on old evidence to establish a body of knowledge. When something is not supported by credible evidence, it dies a natural death.

              2. @WilliamLawrenceUtridge

                Those are your questions to answer!

                @Harriet Hall

                I sorry for your patients who do not have a provider who understands Travell/Simons myofascial pain and dysfunction.
                I would consider this a travesty.

              3. WilliamLawrenceUtridge says:

                Again Steve – your coy answers are indistinguishable from bluff. What you think is a clever retort, to anyone else looks simply like the inability to form a cogent response.

  4. Laurens says:

    Well, the part that had me spraying coffee all over my screen was the bit about the mechanical dragon playing cymbals. An instant classic! Thank you for making my day, Dr Crislip.

  5. windriven says:

    “Then they cranked in some voltage and measured various cytokines and other inflammatory mediators under various conditions to see what happens. ”

    Did the little mice squeal, “Don’t taze me bro!”?

    That was one of the “coffee spray” lines for me as it engendered an image of adolescents with serious psychological disorders tormenting rats for … no good reason.

    “There is one science, used by humans all over the world, and to judge from output the last decade those “eastern scientists” are kicking our research butts.”

    If this bespoke the quality of work done by “eastern scientists” I’d encourage my kids to roll over and go back to sleep. But apparently this sloppiness mostly finds air in the medical literature. What up with that?

  6. I just assumed that yang deficient loose tools was TCM code for erectile dysfunction. Linguistic anthropology and all that…

  7. weing says:

    Sounds better than “shook yang”

  8. Mark Crislip says:

    that was a direct cut and paste, so I wonder where the ‘s’ went. When I “proofread” after the first draft I usually do not read the blockquotes a second time. I am not going to fix it.

    1. Calli Arcale says:

      It’s funnier this way anyway. ;-)

      Regarding EKGs:

      And, while interesting, given all the monitors on a patient in the ICU with sepsis, I can’t see any clinical utility until some clever researcher figures out a way to give the electricity without messing up the EKG etc.

      Well, in theory you could work out what signal the “therapeutic” electricity produces on the EKG and then subtract it from the EKG’s readings for as long as the “therapeutic” current is being applied — or just ignore the EKG during that particular treatment, knowing it will temporarily be incorrect. Not that this matters in the least if this tiny little study in mice isn’t replicated in humans.

  9. Mike says:

    Thanks for this Mark, especially your discussion of “electro-acupuncture.”

    Someone sent me a press release with the headline “Penn Medicine Study Demonstrates Benefit of Acupuncture for Easing Joint Pain Among Breast Cancer Patients Taking Aromatase Inhibitors”

    The study was performed by Dr. Jun Mao with funding from the NCCAM and published in the European Journal of Cancer.

    The press release states “The study participants were randomized into three groups: those receiving electro-acupuncture (EA), those receiving sham acupuncture (SA) and those in the wait-list control group (WLC).”

    And then there’s this quote “Mao noted, however, that the study size was too small to distinguish the benefits of actual EA treatment from that of the Sham group.”

    So not only does the study say nothing about acupuncture, it apparently says nothing about electro-acupuncture also!

    Meanwhile, you reviewed a similar study (“Patient-Reported Outcomes in Women With Breast Cancer Enrolled in a Dual-Center, Double-Blind, Randomized Controlled Trial Assessing the Effect of Acupuncture in Reducing Aromatase Inhibitor-Induced Musculoskeletal Symptoms.”) that shows no difference between real and sham acupuncture. (half way down the article)

  10. mousethatroared says:

    I’m going to be a party pooper. “You are correct, Sir. There is no way acupuncture could cause paralysis. It cannot and does not do anything. But what might have happened? I lack information in this particular case, but I have seen two patients with hysterical paralysis and hysterical blindness (aka conversion disorder). ”

    I’d think a logical explanation would be one of two things. The assailant gave the patient a mickey, possibly in a courtesy drink or something referred to as tonic immobility. Apparently a reasonable number of sexual assault victims report freezing up or feeling immobilized/paralyzed during a sexual assault. Feel free to search tonic immobility and sexual assault for references. I’m not well versed by any means, I just remembered it mentioned in some self defense presentation years ago.

  11. Angora Rabbit says:

    “Dr. K’s response suggests that being from Harvard is not a preventative for getting almost everything about acupuncture wrong.”

    You are being kind. It means you suck up to the wealthy donor who piled $$ into your massive endowment, regardless whether the belief is rationale or even science-based. I mean, there are committees and PR science writers who figure out what goes into a newsletter, and nothing is done without a plan or purpose.

    Speaking as a cynic from C1.

    1. Andrey Pavlov says:

      This is actually sadly the case. I’m blanking on who said it but the reality is that Harvard’s (or [insert prestige institution name here]) charges 2-3 times the tuition than somewhere else, but it is ridiculous to think that you are really getting 2-3 times the education. It is all about the hobnobbery of meeting the right people and greasing the right palms that makes the cost worthwhile.

      And that doesn’t just go for Hah-vahd. My very own better half was interviewed for one of only 2 spots at Stanford for a free ride. She was flat out told, behind closed doors because the person was so infuriated by it, that because someone else was coming from a family that was better connected and had long donated to the fund she would be bumped for that person. They offered her a full fee-paying position but she couldn’t afford it.

  12. Erratic Samurai says:

    Oriental Medicine isn’t about curing diseases, it’s more about treating the symptoms of such diseases. When they talk about pattern differentiation like”Kidney Yang deficiency” its just the name of a group with a number of objective/subjective findings. With those, specific acupuncture points/herbal remedies would be beneficial for that pattern. It’s also not an “energy” medicine and Qi is not energy. It is a medicine based on observations. A lot of the acupuncture points are based on local pain also so electroacupuncture is still considered acupuncture.

    Research in acupuncture is not done well enough to represent the medicine. It can be due to frequency, points used, stimulation, needle gauge, needle depth, needle retention, patient condition over time after study, etc. It’s also not thousands of years old as Western practitioners claim. It’s changed and evolved a lot, especially after the cultural revolution. It also doesn’t help most Western practitioners are a bunch of hippies who make the medicine a joke and treat patients once a week for months for musculoloskeletal conditions that should have been treated more frequently in much less time.

    1. WilliamLawrenceUtridge says:

      so electroacupuncture is still considered acupuncture.

      Why? The only ancient battery I’ve heard about was found in Baghdad, not China. How can it be acupuncture when acupuncturists didn’t have electricity until the early 20th century at best?

      Also, as Ben Kavoussi says here, the nosology of TCM is nonsense. The one-pathogen-one-disease principles used by scientific medicine is more accurate and produces better research. Further, acupuncture point specificity has not been demonstrated bar perhaps a single point in the wrist, and herbal medicines are merely dirty drugs that are often contaminated with actual drugs (and often heavy metals).

      But I will agree that most of the research on acupuncture is terrible, and what little good research there is strongly suggests it’s not worth much.

  13. That took a lot of work and thought.

    Over the years my thought of whats and hows of Acupuncture has evolved — Acupuncture is the use of a fine filament stainless steel wire within a mythology or metaphysical framework. A more truthful factual definition based on my understanding using the tool for 17 years. Most statements and research articles (as above) are mostly related to the metaphysical or faith based aspects of the construct. This complex and imaginative construct was necessary to explain the unexplainable thousands of years ago. The ideas are taken from the laws of nature that were understood at the time; balance, opposites, alchemy, astronomy, and physics. A beautiful design that must have been perfected by the best of all the scientific methods consisting of systematic observations, measurements and experiments, and the formulations, testing, and modification of hypotheses. The Chinese mastered all the elements of the earth in amazing feats of ingenuity.

    The set of truths that lead to TCM and Acupuncture successes were simply what nature had to offer, then handed down improved for centuries:

    They used all of the universe such as the Sun, Earth, elements, wind/air, opposites, balance, society, community, wellness PLUS the predictable and reproducibility of the (physical-physics-math-geometry) laws of mother nature.

    They understood the human body and its capacity to heal and worked with that truth and power. They also used their hands, leverage, traction, scraping, brushing, hands-on tools on the flesh like dowels and subsequently needles. The needle was the revelation. This needle ignited the cascading events in such a predictable way it can be viewed as a key to healing many ailments.

    You can debate the metaphysicals until the cows come home, but the needle is where the undebatable scientific Truth is located.

  14. ian guthrie says:

    Dear Mr Crislip
    You will be dismayed to learn that acu puncture costs are some times payed for by the health insurance Groups here in Gerrmany.
    In Bremen you can not throw a brick without hitting one of their Centers.

    1. There is a truth about the actions of needles in the flesh that is reproducible. In science this is a key observation to uncover for further study. Gunn has done this but his work in being ignored and marginalized. It will not be refuted. Why we ignore this tool?? (we know why)

      Needles will save the American healthcare system — if sanity and reason prevails.

    2. Each year more and more carriers are including CAMs in the policies.

      You can not hold back the truth especially when it is cheap and effective.

      1. windriven says:

        “You can not hold back the truth especially when it is cheap and effective”

        No.

        You cannot hold back the sCAM when it is cheap and people will accept it in lieu of medical care. The only truth in your statement is the implied truth that you are delusional. The only effectiveness is your proving delusion by your continued harping on it.

        I console myself that you probably do less harm with your needles than if you were actually practicing medicine.

      2. weing says:

        “Each year more and more carriers are including CAMs in the policies.”
        Good for you. Bad for the patients and taxpayers.

      3. WilliamLawrenceUtridge says:

        Do you think perhaps the insurance carriers are responding to customer demands rather than scientific merit?

        Seriously Steve, you are grasping every single straw except the ones that matter. Customers like it! This book tells me it works! Obamacare will cover it! Insurance pays for it!

        Everything except “Well controlled trials show that it’s not just placebo!”

        Everything except what matters.

      4. WilliamLawrenceUtridge says:

        Damn, I forgot to play “Name that fallacy”!

        It’s “argumentum ad populum”. If a lot of people use it, then it must work.

        Steve, can you draw upon your impressive education and background knowledge to tell us what percentage of the world believed in bloodletting? Prayers to deities as a means of healing infectious disease? Purges?

        Please provide references.

  15. On further review and following the links, I am bewildered as to why this article was written in the first place and in this style.? Can the author elaborate?

    I would really want to separate the needle from TCM they are apples and oranges.
    TCM is Chinese medicine and will be Chinese no matter what we in the US have to say. Why bother with a tradition that is not ours.

    I am not sure if researchers and Traditional Acupuncture really understand the complexity of studying Acupuncture in that narrow paradigm.

    I would question the 15mm needles as too short to be therapeutic in Medical Acupuncture. Have you visited the American site?

    The sensationalism of Voodoo/needles and the assaults are irrelevant to science.

  16. Will we get comments from Ingraham and Hall?

    1. WilliamLawrenceUtridge says:

      When you start citing evidence rather than asserting opinion.

      1. windriven says:

        “When you start citing evidence rather than asserting opinion.”

        Ah, about the time that ferret poop turns to gold.

        1. WilliamLawrenceUtridge says:

          Steve has such a ferret. He is willing to sell you its feces for a fine price, a mere half the per-ounce cost of gold. A deal by any measure! You just have to trust him, and never open the box it comes in.

  17. Ste5e says:

    Acupuncture is felt when done on a prosthetic. Whilst under the influence of the rubber hand illusion individuals experience ‘Deqi’ when needles are placed in the rubber hand. Go figure. It is a central and descending treatment effect would be my take. It would of course be a lot safer to have needles placed in your ‘virtual’ body.

    “Twelve of 14 participants reported
    perceptual effects, characteristic of ‘Deqi’, after acupuncture
    to the rubber hand, effects that are seldom reported in
    association with the illusion alone.”
    from
    eS1226

    Research Report Poster Display
    Number: RR-PO-308-23-Wed Wednesday 22 June 12:00
    RAI: Exhibit Halls 2 & 3
    AGAINST ALL REASON—EFFECTS OF
    ACUPUNCTURE AND TENS DELIVERED TO AN
    ARTIFICIAL HAND
    Bulley A.1, Thacker M.1, Moseley L.2,3
    1King’s College London, Medicine, London, United Kingdom,
    2University of South Australia, Adelaide, Australia,
    3Neuroscience Research Australia, Sydney, Australia

    Kind thoughts,
    Steve

    1. A bizarre and unnecessary study IMO. Why on a prosthesis!!!

      This therapy will works well on phantom pain. The theory is based on referred pain patterns.

      Who in their correct mind would doubt the safety of acupuncture in the proper hands??!!

      1. WilliamLawrenceUtridge says:

        Steve to skeptic translation:

        “This is inconvenient to my beliefs about acupuncture, therefore I will belittle it without acknowledging its implications for my beliefs about acupuncture. And I will do so in a stupid way. Because my incoherent and simplistic world view doesn’t allow for change or reflections on reality.”

  18. t groan says:

    A friend of mine has had an acupuncturist knock out multiple migraines.

    She should have known better and gone to an MD that realizes acupuncture is pure bullshit and gotten some major pain killing drugs that hopefully won’t harm her, make her an addict, or cause rebound headaches when she doesn’t take them.

    That’d suit Big Pharma quite well and I’m sure make the corporate tools running this site quite happy too.

    Acupuncture like chiropractic work. That’s why people go to their practitioners and that’s why the practices remain. I realize that losing revenue is the primary reason allopathic devotees slam each and every competitor. But your arrogance, snobbishness, cold bedside manner, and devotion to toxic chemicals that can cause more harm than good really turns off a lot of people.

    1. weing says:

      “She should have known better and gone to an MD that realizes acupuncture is pure bullshit and gotten some major pain killing drugs that hopefully won’t harm her, make her an addict, or cause rebound headaches when she doesn’t take them.”
      Are those the only choices? I think that is pure bullsh!t.

      1. @weing. please you are not allowed to comment with personal views, hey moderator she or he needs reprimanding. Like to did to me. Freakin hypocrites!

        1. Harriet Hall says:

          You were not reprimanded for commenting with personal views.

          1. Oh? you got some ‘splainin’ to do!

        2. WilliamLawrenceUtridge says:

          It’s like you are incapable of even understanding the thoughts of others.

          1. “It’s like you are incapable of even understanding the thoughts of others.”

            Gee who can understand the thoughts of others, if the others have not walked in the same shoes or had a similar life? NOT logical?

            I can use the same argument with you guys who have never treated someone with needles and have never had to overcome the failures.

            1. WilliamLawrenceUtridge says:

              How many times do we have to say “personal experience can be deceptive” and “if acupuncture is so effective, why do the results of clinical trials not support this assertion” before you understand what they mean?

              Real medicine works even if the doctor hasn’t experienced the patient’s condition. Real medicine works even if the patient is in a coma.

    2. Dave says:

      FYI, here are the recommendations from UpToDate regarding the treatment of migraines with “major pain killing drugs”:

      OPIOIDS AND BARBITURATES — Opioids and barbiturates should not be used for the treatment of migraine, except as a last resort [90]:

      ●Opioids generally are not as effective as migraine-specific medications for acute migraine treatment [9,10,13]. In addition, the use of opioids is complicated by their potential for tolerance, dependence, addiction, and overdose [8].

      ●There is no high-quality evidence supporting the efficacy of barbiturates (ie, butalbital-containing compounds) for acute migraine treatment [4].

      ●The use of opioids and butalbital is associated with an increased risk for the development of chronic migraine and medication overuse headache. (See “Chronic migraine” and “Medication overuse headache: Etiology, clinical features, and diagnosis”.)

      The above are quotes from the UptoDate resource.

      . Guidelines list alternatives such as triptans, anti-emetics, ergot derivatives and dexamethasone. There are other guidelines dealing with prophylactic medication for chronic migraines. Before you rail that science based medicine pushes narcotics for migraines you should first determine what science based medicine DOES recommend ( I’m astounded how many commenters here don’t take the trouble to do that). I grant narcotics are used for migraines but that’s not necessarily the best practice.

      1. weing says:

        @Dave,
        But they have done their research. Everyone knows that research consists of reading random opinions on the internet, especially at alt med sites.

        1. Oh my goodness, such bias towards medications.

          I gave you research on myofascial pain and dysfunction as it relates to needles and Acupuncture. Did you not chose to read the data? Please keep your personal opinions and bias to yourself.

          1. Harriet Hall says:

            “Please keep your personal opinions and bias to yourself.”

            That’s rich coming from you! You’re always good for a laugh.

            1. @hall I have nothing to say to you, so please keep all of your personal and shortsighted opinions to yourself. The site is for true scientist!!

              1. oops … this site is “not” for finding the truth by using the scientific methods.

                So you can say what you like, as long as you don’t tick off the moderators. Like I almost did.

              2. Harriet Hall says:

                “@hall I have nothing to say to you, so please keep all of your personal and shortsighted opinions to yourself. The site is for true scientist!!”

                @rodrigues I have nothing to say to you, so please keep all of your personal and shortsighted opinions to yourself. The site is for true scientist!
                And in case you haven’t noticed, it is my (our) site, not yours.

              3. WilliamLawrenceUtridge says:

                Steve, you’ve ticked off the “moderators” (who only moderate first comments and those autoflagged for profanity and excessive weblinks), but you’re still posting. Your attempts at martyrdom and assumed persecution seem to be hollow.

              4. David Gorski says:

                Dr. Hall is an editor of this site. She can comment as she pleases, when she pleases, how she pleases. The same does not apply to Mr. Rodrigues. You’re skating on very thin ice once again.

                Oh, and your claiming that this site is only for “true scientists,” with the implication that you are a “true scientist,” just fried my irony meter. The poor thing is crackling and quivering, reduced to a pool of molten plastic and sizzling wires.

              5. David Gorski says:

                So you can say what you like, as long as you don’t tick off the moderators. Like I almost did.

                Not “almost did.”

                “Did.”

                And ticking off the moderators is hard to do on this site because there is minimal moderation and we generally have very thick skins and a high tolerance for nonsense from the occasional troll.

            2. @hall “The site is for true scientist! And in case you haven’t noticed, it is my (our) site, not yours.”

              I actually have noticed it’s your site and that is at the core of my concern. You use the word “science” in such a narrow view that the “broad” description in your policy is not true and concise. I wish you would update you title to fit this narrow view so the public will not be duped into a direction that may be harmful to their health and wellbeing.

              1. Harriet Hall says:

                You are the one who is using the word “science” in an idiosyncratic sense that does not correspond to the way scientists define it. You are essentially rejecting the core principle of science, the need to formally test claims, and you are replacing it with “experience,” which science has found to be unreliable. You have a lot of nerve insulting us and telling us to change the title of our blog and to tell me not to express my opinions on my own blog. You would have been banned long ago on any other blog, and your continued presence here is a tribute to our tolerance. You were warned, but not because you expressed your opinions. Everyone expresses opinions in these comments, and only a handful have been banned or even warned in the 6-plus years of our existence. Look back and re-read the warning and try to understand it.

              2. So define your definition of science, where you get acquire the data, how it is analysed, tested, update, debated and clarified.

                Where are the valid sources?

                I am attacking the science and you all want to get in the way and make it personal.

                Example, I find it erroneous for a site to state Acupuncture does not work, when I have been using it for a decade and can see an experience that it works. How am I to believe you are being fair, honest and truthful?

                If you do not believe me why should anyone believe you or the editors of this site.

              3. Windriven says:

                @Rodrigues

                “So define your definition of science, where you get acquire the data, how it is analysed, tested, update, debated and clarified.”

                No. I think first you should explain why anyone here should waste another nanosecond on you, your studied ignorance, or your delusional beliefs.

              4. Harriet Hall says:

                His definition of science is clear: his experience of observing something = science. (“I saw patients get better with acupuncture, therefore it works.”)

                Everyone else’s definition of science is: observations verified by formal testing to minimize the possibility that either the observations or the interpretation of what they mean might be faulty. (“I thought I saw patients get better with acupuncture, so let’s do a controlled study to find out if my observations are correct and if more patients get better with acupuncture than with a placebo or with no treatment at all. Let’s rule out all possible confounders that might have misled me.”)

                The height of hubris is to imagine that your own powers of observation and interpretation are so infallible that your beliefs need not be tested like everyone’s else’s.

              5. MadisonMD says:

                @SSR
                If you understand what science is, if you call yourself a scientist, then perhaps at least you could define ‘control’ and concisely state its purpose?

              6. Sawyer says:

                Your timing is impeccable SSR. I was just listening to the latest SGU episode while browsing through your comments, and was struck by the prescience of something Dr. Novella mentioned. He pointed out how the skeptical community bends over backwards to accommodate pseudoscientists and offer them a real opportunity to join the discussion about science and medicine, something that “mainstream” scientists wouldn’t even bother with. This website has one of the most liberal moderation policies I have ever seen. The contributors and commenters here have literally spent hundreds of hours reading and responding to your posts, yet in your Bizarro World of alternative medicine, you think that you are being treated unfairly. It’s the opposite. You have been given a soapbox a thousand times larger than you deserve, and you still have the arrogance to insist it’s too small.

                For those of us not living in the Bizarro World, the latest Skeptic’s Guide podcast has an interview with Dr. Gorski that’s worth checking out.

              7. WilliamLawrenceUtridge says:

                I wish you would update you title to fit this narrow view so the public will not be duped into a direction that may be harmful to their health and wellbeing.

                Coming from the guy who thinks his opinion is superior to clinical trials, that’s rich.

                So define your definition of science, where you get acquire the data, how it is analysed, tested, update, debated and clarified.

                Um…no, that’s nobody’s definition of science. Seriously, what school did you go to? Science isn’t merely about having data, it’s about how you get it, how you compare it, how you use it to test ideas, how you try to gather data that disproves your hypothesis.

                Jebus, you don’t know a damned thing, do you?

                Example, I find it erroneous for a site to state Acupuncture does not work, when I have been using it for a decade and can see an experience that it works. How am I to believe you are being fair, honest and truthful?

                Again I must point out – mere clinical experience and personal are inadequate. You damn surgeons for fusing spines and replacing knees when their clinical experience says it is worthwhile, meanwhile carefully controlled scientific research says it is worthless. So why do you rag on the scientists and believe the science here, but ignore it when it comes to acupuncture?

                I don’t expect you to answer this question, you never have – because it would totally undercut your point about personal clinical judgement over-riding science and make you an obvious hypocrite.

                I also think it’s pathetic that you claim persecution merely because we ask you to justify your claims, then point out when your evidence is substandard.

                You know what a real scientist would do? Admit uncertainty and hypothesize novel ways of testing the idea. Not sit on their ass claiming they are being unfairly targeted. Real scientists have to defend their ideas against other scientists, and those other scientists know what the fuck they are talking about and exactly what the weak points in your theories are.

          2. WilliamLawrenceUtridge says:

            Steve, you gave your research. It was analyzed. Old books published by questionable press, based on case studies. You did provide what, five journal articles? Four were irrelevant or of terrible quality, enabling no conclusions. One was a decent starting point for research on trigger point needling (IIRC), with a minor clinical difference between control and treatment groups.

            What you gave us was evidence that would be at best phase I clinical trials if this were a drug. All you demonstrated was your willingness to cite shoddy research to reinforce your existing beliefs, and your willingness to ignore dissenting information.

              1. WilliamLawrenceUtridge says:

                Did you notice the title of that page? “Fibromyalgia (FM) and Chronic Myofascial Pain (CMP) For Doctors and Other Health Care Providers”. Did you notice the age of many of the references? Did you notice the large volume of case reports?

                Would you prescribe a drug to most of your customers solely on the basis of 20 year old case reports and 14 year old clinical trials conducted on patients with nearly-unrelated conditions?

              2. @WilliamLawrenceUtridge
                I was trained in the 80s, most what worked them still works now., even after 30 yrs and I would wager they will still work in a thousand years. In a thousand yr, we may have a better options but for the next decade, I will use what is vetted in the real world.

                Trying a new me-too med today is tantamount to truly using people as guinea pigs.

    3. WilliamLawrenceUtridge says:

      Hm…I sense sarcasm.

      Did the acupuncturist also recommend supplements?

      Did your friend have to go back for multiple appointments?

      Were the appointments free?

      You think acupuncturists don’t have revenue to worry about?

      Did the needles penetrate the skin?

      Was the skin cleaned before being needled?

      Were the needles fresh from the package, or could they have been reused?

      Was your friend needled anywhere in the torso? Because collapsed lungs are a recognized side effect of acupuncture. Did the acupuncturist mention this to your friend?

      Did the acupuncturist spend any time badmouthing or discouraging real medical care?

      Did the acupuncturist try to convince your friend that acupuncture was good for anything beyond pain and nausea?

      1. @WilliamLawrenceUtridge
        Did you read what you said?? You have lost your mind — literally!!

        You have a misguided personal or paid mission to disparage alternatives?
        If you are paid, you are doing a great job! Who is paying you? Must be a good amount.

        If it is Personal, you need to see a therapist.

        You can say the same about traditional providers as they disparage alternatives.

        1. WilliamLawrenceUtridge says:

          So, since you can’t actually respond to my points, you’re going to claim the problem is that I am crazy.

          To put it another way – I am biased and paid by Big Pharma, because you can’t refute my points.

          Yeah, I think the problem is you. I think you have a lot of money, pride and time wrapped up in unproven modalities, and you can’t handle the loss of revenue and pride that acknowledging their weakness would inflict upon you.

          1. Remember most of the weight in an arguement goes to the one who has the most experience, ME, who has a decade to study.

            Minimal to an outside observer.

            So … If it is Personal, you need to see a therapist.

            1. WilliamLawrenceUtridge says:

              Ha! Really? OK then – how many knee replacements have you done? How many spinal fusion surgeries have you done?

              What’s that? Zero? Well then, looks like you should ignore all the research to the contrary and believe the surgeons who have done hundreds of each, that knee replacements and spinal fusions are the best thing ever!

              And let’s not forget the millions of homeopaths convinced they can cure everything from headaches to cancer! Bloodletters practiced and were convinced by millennia of bloodletting that what they were doing worked! Traditional Chinese medicine practitioners prescribed tiger penis according to the phases of the moon and astrology for centuries, to great effect! So let’s bring all of them back too!

              Personal experience is not the best guide to treatment, it’s your misplaced delusion that it is. Well-controlled research with proper randomization, blinding and convincing placebo treatments is a far better guide. How you consistently fail to appreciate this is beyond me, but apparently it’s beyond you as well.

              1. I’m very close to completely realizing that knee replacement and spinal fusions do not work for the “weak” indications of pain and what is seen on radiologic studies. Why? I have seen hundreds of failed cases with that model. One would be enough to question the validity and look for preventive options.

                Your argument about failed therapy from the past is valid but you fail not to recognized the theories that have weathered the test of time, like Acupuncture and bloodletting.

                You do actually need personal experience to understand, practice and understand the nuances of clinical medicine, this is where the art come in. The mastery of medicine takes decades to develop and these masterminds have the greatest insights and wisdom.

                “And let’s not forget the millions of homeopaths convinced they can cure everything from headaches to cancer!”

                Hey guy!!!! Is that not what medicine is doing today is attempting to convinced us that they can cure but are only perpetrating a cure and profiting. A better way to spend time would be to study everything, find the best, safest and most economical and deject the wasteful and harmful.

                “Would you prescribe a drug to most of your customers solely on the basis of 20 year old case reports and 14 year old clinical trials conducted on patients with nearly-unrelated conditions?”
                Yes I have just because of those studies. Now I will stick to the ones that have not killed so many. Remember troglitazone, trovafloxacin or valdecoxib.

              2. MadisonMD says:

                It seems that bloodletting and homeopathy have stood the test of time and thus are truly convincing to this delusional acupuncturist.

                It seems that someone stuck a caduceus in and now the gall is spilling out. Stay tuned, he may get better if the Greeks were right about the humors.

              3. WilliamLawrenceUtridge says:

                So…you’ve seen hundreds of failed cases. What about the successful cases? How many of those do you see?

                How has bloodletting survived the test of time again?

                Hey guy!!!! Is that not what medicine is doing today is attempting to convinced us that they can cure but are only perpetrating a cure and profiting.

                The failings of modern medicine (even if you identified them correctly) do not justify your shitty medical practices.

                Also, do you charge for your services? If so, doesn’t that make you a hypocrite for criticizing others for charging for their services? At least with validated medicine, the doctors aren’t just charging for placebos.

                A better way to spend time would be to study everything, find the best, safest and most economical and deject the wasteful and harmful.

                Brilliant idea. Why don’t you study all possible treatments, every single surgical, pharmaceutical and lifestyle technique out there, then figure out what works?

                The rest of us will rely on clinical trials, meta-analyses, consensus statements and the slow, validated findings of science.

              4. MadisonMD says:

                “Study everything”
                What an utterly stupid thing to write. So we need to study how toenail clipping on a monthly versus weekly basis might operate to prevent Alzheimer’s, how yodeling on low hills may cure cancer, how voodoo dolls can relieve arthritis, how a perpetual motion machine might solve the world’s energy problems, and how a pill with nothing in it might cure the common cold (which cures itself).

                In SSR’s conception of how science should operate, there would be no prioritization, no fundamental understanding of mechanism, no knowledge biology/chemistry/physics from which to derive probable hypotheses, no appreciation of the false positive and negative rate of clinical trials or limitations of other research. His ‘science’ would operate without coherence, wherein things considered ‘facts’ would exist in isolation, perhaps completely at odds with other ‘facts.’ Instead of ‘standing on the shoulders of giants’ to see more, we would ignore all prior knowledge and just test random stuff. (How convenient for the ignorant!)

                There could be no advance in knowledge whatsoever if scientists followed such precepts. SSR, your ideas are rejected, and this may leave you dejected (use a dictionary if you require it).

              5. Blood Letting 101:
                https://online.epocrates.com/u/2942134/Hemochromatosis
                By removing blood, the patient’s bone marrow is stimulated to make new red cells using the iron they have in storage.

                Each 1 mL of packed red cells contains approximately 1 mg of iron, so removing 500 mL of blood with a hematocrit of 40% removes approximately 200 mg of iron.

                Each unit of phlebotomized blood should decrease the ferritin by approximately 30 micrograms/L.

                :)

              6. “In SSR’s conception … be no prioritization, no fundamental understanding of mechanism, no knowledge biology/chemistry/physics…hypotheses, no appreciation of the false positive and negative rate of clinical trials or limitations of other research.”

                A sane scientists would not make assumptions as to what another believes or their experiences. That is plan sophomoric! Dang … get your heads out of your stratospheres, all the rest of us are not complete stupid.

  19. Windriven says:

    “Remember most of the weight in an arguement goes to the one who has the most experience…”

    No. Most of the weight in a debate goes to the one with the best argument supported by the most compelling evidence. You don’t even have half a tuna sandwich.

    1. Acupuncture is highly effective for a lot of problems and is not as effective in others. Do you really want to know which, find the truth or are just disavow all of Acupuncture?

      All of the evidence should be consider before you publish a conclusion on the web to make it public which could interfere with a person’s medical decisions. If you cherry pick the evidence that supports your personal arguments, that is a personal opinion and not scientific or practical. In some cases of chronic pain any delays will further seed the pain disease deeper into the myofascial tissues and make it more difficult to treat.

      1. MadisonMD says:

        Acupuncture is highly effective for a lot of problems and is not as effective in others.

        Obviously nobody simply takes your word for it. Prove it. Show the data.

        1. Windriven says:

          ” In some cases of chronic pain any delays will further seed the pain disease deeper into the myofascial tissues and make it more difficult to treat.”

          @Madison – I haven’t been to doctor skool like our friend here so could you explain to me what the chronic pain disease is and the mechanism by which it is seeded into the myofascial tissues? Is it just me or do those words constitute something less than incoherent babble?

          1. MadisonMD says:

            Incoherent babble emerging from an endless font.

            1. Windriven says:

              Steve, I really hate to break this to you but that isn’t evidence. The fact that there are like-minded squirrels out there does not prove squirrelology to be useful.

              There are still people who believe in all sorts of silliness. Scraping them all into a pile doesn’t make their silliness profound.

              In the case of the Pakasi paper – self published to the Scribners reader rather than a peer-reviewed publication – his argument would suggest prescribing a muscle relaxant rather than poking around with pointy objects. This presuming that his argument has any basis in reality. It struck me as high school level biology sprinkled with a few impressive words. But I am a physicist, not a biologist.

              1. The links was to insight thought and imagination so you could be inspired to do your own research. SSS is discounted and does not have a formal code and needs further study.

                Dogmatist of science are go busy proving where they stand is flat that they refuse to look up to realize the world could be round.

              2. WilliamLawrenceUtridge says:

                Steve, there are lots of insights and imaginations about the world that turn out to be wrong. Lamarckianism makes great sense and is superficially convincing – but wrong. For that matter, beliefs about bulging disks causing back pain are also very convincing in the abstract, but wrong.

                “Dogma” is insisting on a belief in the face of contradictory evidence. You are the dogmatist. It is not dogma to point out that the evidence doesn’t support your claims, it is merely common sense.

                Further, you are simultaneously stating “this needs further study” and “this works and is awesome.” This proves that you are only interested in science if it supports what you already believe. You have faith in science when it is convenient to you, the rest of the time you don’t care. You’re a hypocrite who is only interested in avoiding changing your mind.

      2. WilliamLawrenceUtridge says:

        Acupuncture is highly effective for a lot of problems and is not as effective in others. Do you really want to know which, find the truth or are just disavow all of Acupuncture?

        If that is the case – why do clinical trials consistently fail to find any results beyond placebo? So far your replies have been “nyah, they weren’t experts”. It’s amazing how nobody else is an expert, and nobody else’s experience matters except yours.

        All of the evidence should be consider before you publish a conclusion on the web to make it public which could interfere with a person’s medical decisions. If you cherry pick the evidence that supports your personal arguments, that is a personal opinion and not scientific or practical. In some cases of chronic pain any delays will further seed the pain disease deeper into the myofascial tissues and make it more difficult to treat.

        Jebus, that takes some balls. And some startling lack of insight.

        1. The proof is everywhere to anyone with common sense, an unbiased open and flexible intent and the ability to use logic. I’m just a single messenger, but there are thousands who have figured out this puzzle. I still consider your definition of science is too shortsighted and mechanical and does not take into account the long term ramifications that I witness in the office.
          Real people, flesh and blood who have failed this method, and under the present paradigm will have to suffer for at least another decade before something positive happens. Hopefully we all won’t drive over the cliff.

          You will find paltry disproof of this discipline. What you will find is that the stainless steel filament needle is the perfect tool to treat many pain and myofascial problems when used with experienced hands. (as with all tools and operations)

          I don’t think I have stated anything that is not factual and definitely not an intentional lie or false irresponsible edict. You have all of my favorite references so every aspect can be researched.
          It’s lazy to ask to be fed this information (it is everywhere) and even if presented on this site, easy to argue and discount because of groupthink and fear of being ridiculed by your friends.

          I have to apologize for having to yelling personal disparaging words like a child would have to deal with bullies on the playground. I have my beliefs and I will defend them until better concepts are discovered.

          1. weing says:

            “I don’t think I have stated anything that is not factual and definitely not an intentional lie or false irresponsible edict.”

            Except it’s not science. Don’t try to say it is. Just acknowledge that you are using unscientific methods and tell your patients that. That would be telling them the whole truth.

          2. Windriven says:

            ” I have my beliefs and I will defend them until better concepts are discovered.”

            This bit of self referential idiocy brings to mind something that I read from, as I recall, Neil deGrasse Tyson: “the beauty of science is that it works whether you believe in it or not.”

            We all know that you believe in, among other things, acupuncture. Why then does every decent study reveal no benefit beyond placebo? You can believe the earth is flat. But the weight of evidence is an oblate sphere.

            1. weing says:

              “You can believe the earth is flat.”
              Except Htrea is a cube.
              http://www.spacebooger.com/2011/11/26/super-science-saturday-bizzarro-physics/

              1. Windriven says:

                Too ad. Sailing the waters of a cubic planet would be awesome!

          3. WilliamLawrenceUtridge says:

            See, you say “flexible”, but you act the exact opposite. You’re inflexible. You wrap, torture and force any evidence you can scrape together to fit around your core dogma. That never changes, your core beliefs are not flexible or amenable to change, they are fixed. You’re a hypocrite who is unwilling to engage with any evidence that contradicts what you already believe.

            I don’t think I have stated anything that is not factual and definitely not an intentional lie or false irresponsible edict.

            Yeah, but you can only manage this by never reading or thinking about any dissenting information. You may be a pious fraud, but you’re still a fraud, who maintains his beliefs only by never, ever considering alternatives.

            I have to apologize for having to yelling personal disparaging words like a child would have to deal with bullies on the playground. I have my beliefs and I will defend them until better concepts are discovered.

            How will you ever know if better concepts have been discovered? You don’t even know how to assess what evidence exists, let alone what evidence will be uncovered in the future.

            I mean Jebus, even your apology is assholish, you’re basically saying “I’m sorry everyone else is so mean”. Maybe if you weren’t such a dogmatic idiot, people wouldn’t be “mean” ( by which I mean, of course “willing to point out when you’re wrong).

            1. “Yeah, but you can only manage this by never reading or thinking about any dissenting information.”

              Actually I have read tons and I have the honor of actually practicing ALL of those concepts in the real world. Some are profoundly beneficial and others are profoundly worthless. You can not see this data from your inexperienced vantage point, so you will have to trust me. :)

              “assess what evidence exists”
              Bizarre biased statement. If a patient states that the “all sinus infection symptomatology has abated.” How is that not evidence, OHHHH your evidence is based on how you define the information! What the patient states and what I observe is not valid for your precise, absolutely perfect scientific methods, that you do not oversee and have 100% trust. That is a personal and very selective; not in anyway scientific.

              Hey the name calling is really unnecessary. “dogmatic contradicting, pious, fraud, asshole and hypocrite”
              I have offered alternatives and lots of data, books and articles but you have chosen not to incorporate into your thought processes and methods, you will not budge on the idea that Acupuncture and needles are worthless tools and should be dumped, ignore all the work by the age old medical predecessors, hope the present capitalist system being enriched by this fraud will save us from collapse and be judge and jury of the new commenters. —- When you wish for something that can not happen, force and punish those who don’t hold your beliefs, suppress alternative therapies, suppress others without your beliefs just for the sake of those beliefs is that not a form of Witch Craft???!!!

              1. MadisonMD says:

                If a patient states that the “all sinus infection symptomatology has abated. How is that not evidence[?]”

                You still fail to understand that a control is needed to determine whether the symptom abated due to the intervention or would have abated anyway? Is it scarcely possible that you could be so, er, thick?

              2. Windriven says:

                You also ignore the difference between actual and apparent results. You should read the Wechsler for a wonderful example.

                People are easy to fool. Easy for others to fool. Easier still to fool themselves.

              3. RCT will save us from healthcare disaster??!! Ok, I see your point now.

              4. Windriven says:

                @SSR

                “RCT will save us from healthcare disaster??!!”

                Now which healthcare disaster are you arching your eyebrows over? And how is your comment not a non sequitur? What does it have to do either Madison’s or my response to you?

                RCTs will save us from a lot of wasted motion and wasted money and wasted time. Even negative studies help point the way to the future. Sitting in the echo chamber or your own experience – not so much.

                Really Steve, you should develop a basic understanding of of the cognitive traps that befall all of us. It will make you a better doctor.

  20. weing says:

    Sorry for misspelling Htrae. My lysdexia is showing.

  21. Dr. Quinn says:

    For supposedly being an objective, science-based “.org”, some articles are very subjective and opinionated. That certainly takes away from the legitimacy of the articles. I certainly do not believe in Chi, meridians, or energy flow. Does inserting a needle cause a physiologic response? It probably has some mechanical, chemical, and neurologic effects which, if better studied, may be of some use for certain conditions. Less obvious personal opinion would make this site more valuable.

    1. Sawyer says:

      Less obvious personal opinion would make this site more valuable

      This is the strategy that almost every university, hospital, and government institution has taken for the last 30 years. It has not worked. Instead of encouraging good research and real medical progress, we have created a perpetual funding cycle for crappy research that never demonstrates anything we didn’t already know.

      If you don’t think acupuncture has been sufficiently studied, then you should be far more upset with the thousands of scientists that have wasted their careers producing terrible research on the subject.

    2. Andrey Pavlov says:

      Does inserting a needle cause a physiologic response? It probably has some mechanical, chemical, and neurologic effects which, if better studied, may be of some use for certain conditions.

      You should actually read the posts right here about those exact questions. There is data. And the data shows that those ideas don’t pan out either. At this point, we can be quite certain that acupuncture is nothing more than an elaborate placebo. All other potential mechanisms have been explored and show no good evidence for and at least some evidence against, plus very low prior plausibility down to almost zero depending on the specific putative mechanism claimed.

      Less obvious personal Your scientific opinion would make[i] this site more valuable.

      FTFY.

    3. WilliamLawrenceUtridge says:

      If you search in the search box, you will find dozens, possibly even hundreds of articles. Here is a recent example. It may also be of interest for you to know that in addition to the long-discredited idea that the individual points matter (they don’t, you can needle anywhere for the same results; may I suggest avoiding the lungs as one of the major iatrogenic harms of acupuncture is lung collapse?) the actual skin penetration appears to be irrelevant (retracting needles and toothpics held in place by guide tubes work just as well, provided the patient thinks they are getting real acupuncture) but highly, highly relevant is the degree to which the practitioner is enthusiastic or not. The latter, in fact, washes out nearly all other aspects of acupuncture “treatment”.

      So yes, there are definitely chemical, neurological and mechanical effects – as one would expect, you are penetrating the skin! They just appear to be irrelevant to acupuncture’s intrapsychic effects – that is its use as a placebo to treat pain and nausea, the only symptoms for which it has proven “effective”.

      Of course, it has zero effects for any objective complaints and it cannot treat any actual medical conditions. Merely two symptoms, and from everything we can tell, only through placebo.

      1. Andrey Pavlov says:

        So yes, there are definitely chemical, neurological and mechanical effects – as one would expect, you are penetrating the skin!

        I suppose in a very pedantically useless sense that is true. But the reality is that those needles are so thin and sharp and the technique intentionally done to diminish sensation, that the mechanical effects are essentially nonexistent. The chemical and neurogical changes are purely placebo – the same as if you had your back turnend and someone played the sound of a bear roaring, if you believed there really was a bear, would have chemical and neurological effects.

        Occasionally one does feel the needles, sometimes rather sharply painfully but really running the whole gamut. This is an accidental and unintended effect however.

        1. WilliamLawrenceUtridge says:

          Oh, I meant it in the pedantically useless sense :)

    4. Harriet Hall says:

      @ Dr. Quinn.

      You accuse us of being subjective and opinionated, and all you offer is your subjective and opinionated criticism. Every article on SBM links to evidence from scientific studies; you offer nothing of the sort. If you think you can do better and write a “legitimate” article that is objective and not opinionated, to show us what you think we should be doing, please do. We welcome worthy guest articles.

    5. Hello, Dr Quinn. Thanks for chiming in.
      You are correct in that this site is very opinionated and narrow. I have posted many references to Acupuncture and all related topics, but to no avail, there is a type of group-think syndrome, so no one (i don’t think) has done any reading or further research outside of the sources used. They just seem to write an article and solely debate the article.

      For the explanation of “energy” you have to think 5000 yrs ago and apply the human body to nature, which is a wise metaphor. So simple that it can not be refuted.

      The mechanical, chemical, and neurological effects are basically what a prick from a wire or nail will inflict into the flesh. The healing cascade is innate. The question is why does flesh need to be pricked or stimulated or poked with a needle? Myofascial diseases that have been studied or 100 years. Myofascial pain and dysfunction is causing a vast amount of pain, confusion and misery of all diseases.

      So you have a simple safe tool (in modern times) and a reason to stimulate the flesh or myofascial tissue with this tool. Irrefutable to a reasonable person.

      1. WilliamLawrenceUtridge says:

        Your opinions lacked avail because you could not cite any evidence supporting them bar your own opinion. Meanwhile, much evidence can be found saying it doesn’t matter if you break the skin, it doesn’t matter if you needle at random, but it does matter if you are happy and smiley while doing it. Hence, research shows that acupuncture is placebo.

        Steve, do you know who Kim Ribble-Orr is? You should look her up, and ask her about the safety of acupuncture.

        1. Gee poor lady!

          Here are a few more that were not accidental but failures of care.

          https://www.dropbox.com/sh/01ohpwiu97dxhk8/atKtdoPoJ2

  22. weing says:

    “Does inserting a needle cause a physiologic response? It probably has some mechanical, chemical, and neurologic effects which, if better studied, may be of some use for certain conditions.”
    Where are the studies showing this? I will not accept the claims of these practitioners without them showing adequate studies to back their practice up. But that’s just me.

    1. @weing. I some how feel that something is wrong. Are you just an Avatar? I don’t think you actually are here to believe anything. What is your intent here? Why are you here? What is your background? What experiences can you draw on to construct your data base?

      1. WilliamLawrenceUtridge says:

        Let me translate:

        “I can’t think of why or how you are wrong, so you must be paid by Big Pharma. The problem definitely isn’t that I’m wrong and a poor critical thinker, the problem is you are being paid off”.

        No Steve, you are wrong because you have no evidence, and we’re not paid. We’re just critical and know what evidence is.

        1. References:
          Gunn Approach to the Treatment of Chronic Pain: Intramuscular Stimulation for Myofascial Pain of Radiculopathic Origin [Hardcover] C. Chan Gunn MD OBC CM DSc(hon) PhD (Author) http://www.amazon.com/Gunn-Approach-Treatment-Chronic-Pain/dp/0443054223/ref=sr_1_1?ie=UTF8&qid=1355779325&sr=8-1&keywords=chan+gunn
          Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual (2-Volume Set) [Hardcover] David G. Simons (Author), Janet G. Travell (Author), Lois S. Simons (Author), Barbara D. Cummings (Author) http://www.amazon.com/Travell-Simons-Myofascial-Pain-Dysfunction/dp/0683307711/ref=sr_1_1?s=books&ie=UTF8&qid=1355779391&sr=1-1&keywords=travell%2C+md+vol+1
          Myofascial Pain and Fibromyalgia: Trigger Point Management [Hardcover]
          Edward S. Rachlin MD FACS (Author), Isabel Rachlin PT (Author), Isabel Rachlin (Author) http://www.amazon.com/Myofascial-Pain-Fibromyalgia-Trigger-Management/dp/0323011551/ref=sr_1_2?s=books&ie=UTF8&qid=1355779432&sr=1-2&keywords=rachlin%2C+md
          Ligament and Tendon Relaxation (Skeletal Disability : Treated By Prolotherapy) [Hardcover] George S. Hackett (Author)
          http://www.amazon.com/Ligament-Tendon-Relaxation-Skeletal-Disability/dp/039805066X/ref=sr_1_1?ie=UTF8&qid=1355958020&sr=8-1&keywords=ligament+and+tendon+relaxation
          Pain Procedures in Clinical Practice, 2e by Ted A. Lennard MD, David G Vivian MM BS FAFMM, Stevan DOW Walkowski and Aneesh K. Singla MD MPH (Mar 15, 2000)
          Backache from Occiput to Coccyx Hardcover – January 1, 1964, by Gerald L. Burke (Author)
          Intraneural Injections for Rheumatoid Arthritis and Osteoarthritis & Control of Pain in Arthritis of the Knee by DiFabio and Pybus http://arthritistrust.org/books-and-pamphlets/
          Acupuncture Energetics: A Clinical Approach for Physicians Hardcover, by Joseph M. Helms
          Healing through Trigger Point Therapy: A Guide to Fibromyalgia, Myofascial Pain and Dysfunction by Devin J. Starlanyl, John Sharkey and Amanda Williams (Aug 27, 2013)
          Myofascial Pain and Fibromyalgia Syndromes: A Clinical Guide to Diagnosis and Management, 1e by Peter E. Baldry MB FRCP (May 4, 2001)
          Travell J. Office hours: day and night. The autobiography of Janet Travell, M.D. New York: World Publishing Co.; 1968.
          Kellgren JH. A preliminary account of referred pains arising from muscle. Br Med J 1938;1:325–7.
          Gutstein M. Diagnosis and treatment of muscular rheumatism. Br J Phys Med 1938;1:302–21.
          Kelly M. The treatment of fibrositis and allied disorders by local anaesthesia. Med J Aust 1941;1:294–8.
          Simons DG, Travell JG, Simons LS. Travell and Simons Myofascial pain and dysfunction. The trigger point manual, upper half of body. Vol 1. 2nd ed. Baltimore: Williams & Wilkins; 1999.
          Travell W, Travell J. Modifications and effects of the static surge of the static wire-brush discharge. Arch Phys Ther 1941;22:486–9.
          Travell J, Rinzler S, Herman M. Pain and disability of the shoulder and arm: treatment by intramuscular infiltration with procaine hydrochloride. J Am Med Assoc 1942;120:417–22.
          Travell J, Rinzler SH. The myofascial genesis of pain. Postgrad Med 1952;11:425–34. [PubMed]
          Bates T. Myofascial pain. In: Green M, Haggerty RJ, eds. Ambulatory pediatrics II: Personal health care of children in the office. WB Saunders: Philadelphia; 1977. p. 147–8.
          Bates T, Grunwaldt E. Myofascial pain in childhood. J Pediatr 1958;53:198–209. [PubMed]
          Sorensen TC. Kennedy. New York: Harper & Row; 1965. p. 40.
          McCloskey E. Her spirit and work live on. Int J Appl Kinesiol Kinesiology Med 2002;13:11.
          Davies C. The trigger point therapy workbook. Oakland (CA): New Harbinger Publications, Inc.; 2001. p. 15.

  23. Mark Stewart says:

    I am a big believer in prescription medicine; but I’ve seen my wife, who suffers from cervical dystonia, go from having to have close to the maximum dosage of Botox® every 90 days to none after being treated with acupuncture. How could needles in the neck and back improve a movement disorder that originates in the basal ganglia? I don’t know, but I do know it did.

    I had symptoms of a frozen shoulder a while ago, and 3 treatments to free up my rotator cuff did the trick; no need for 6 months of physical therapy.

    1. Harriet Hall says:

      @Mark Stewart,

      “How could needles in the neck and back improve a movement disorder that originates in the basal ganglia? I don’t know, but I do know it did.”

      Sorry, but you don’t know for sure that it did. All you know is that her symptoms improved “after” the treatment. To find out whether dystonia improves “because” of acupuncture would require scientific studies. This systematic review of studies of treatments for dystonia found no evidence for acupuncture: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275299/

      As for your frozen shoulder, there is no evidence that acupuncture can free up the rotator cuff, and symptoms like yours can sometimes resolve spontaneously. I know because I had similar symptoms that resolved with no treatment at all.

      Experiences like yours and your wife’s can be very persuasive, but we have had to learn this lesson over and over throughout the history of medicine: we can’t rely on experience alone; we need evidence from controlled studies.

      1. “To find out whether dystonia improves “because” of acupuncture would require scientific studies.”

        There are no studies to prove that cholesterol meds allows for a longer more productive and active life, but we still use it.

        5000 yrs and needles will be with us until we perish off this planet.

        1. Windriven says:

          “5000 yrs and needles will be with us until we perish off this planet.”

          Probably. Knitting needles, sewing needles, hypodermic needles, needle bearings, needles on coniferous trees. Acupuncture needles? They won’t make it to the 22nd century outside of a few anachronistic cults.

        2. Harriet Hall says:

          “There are no studies to prove that cholesterol meds allows for a longer more productive and active life, but we still use it.”

          There are lots of studies showing that statins allow for a longer life.
          There are no studies showing that acupuncture allows for a longer life.

      2. The guy just made a statement for his personal experience.

        Why would a reasonable provider NOT just acquiesce and say “Great, in your case it worked!”

        The way you stated your remark was to blame him like he was tricked into thinking his shoulder was NOT treated with the therapy and that it was going to get well anyway.

        Dang blame and shame tactic, poor argumentative stance to an outsider like me. The groupthinker love to chew up outsiders of any stripe. :(

        1. Windriven says:

          “Why would a reasonable provider NOT just acquiesce and say “Great, in your case it worked!””

          Because you have no evidence that it is true. Now it would be perfectly reasonable to say, “Great, I’m glad you’re feeling better.”

          To use the infectious disease example, sometimes antibiotics are given to treat what is thought to be an infection because of pyrexia, rubor, etc. But the infectious agent is never identified. Did the patient respond to the drug? Did the patient recover spontanteously? Did the patient recover because the overhead fluorescent lamps were on for precisely 13 hours and 12 minutes on the day the patient improved? Who knows?

        2. Harriet Hall says:

          “Why would a reasonable provider NOT just acquiesce and say “Great, in your case it worked!””

          Because a reasonable provider would know that it might have been a case of post hoc ergo proper hoc error. A reasonable provider would say “I’m glad you’re better” not “it worked.” I respected the commenter enough to talk to him as an equal rather than “acquiescing.”

        3. n brownlee says:

          Because it’s NOT REASONABLE. It’s credulous, ignorant, and dim witted. And if you don’t know why by now, so are you.

          1. Windriven says:

            When I mix my drink tonight, I’ll toast to mother goddam too ;-)

            1. n brownlee says:

              I may change my user name…

        4. MadisonMD says:

          Wow, just wow. SJR just can’t get beyond that propter hoc, ergo hoc issue of his. Time and time again, we have talked about the importance of controls to address this issue. How can we possibly help? How..how?

          Perhaps we could provide a few mundane examples of where this fails.
          Does waving lighted sticks at the airport cause planes to land?
          Does turning the radio on cause cars to move?
          Does a rooster call cause the sun to rise?
          Did Haley’s comet cause Samuel Clemens’ death?

          …yet I suspect he is beyond remediation.

      3. Mark Stewart says:

        Yes, I can’t be 100% positive it did, but I do know dystonia doesn’t automatically get better. I’ve read a medical textbook on movement disorders so I am knowledgeable about it. She had been getting Botox® for several years. I agree that double-blind studies are the gold standard and should be done before making recommendations to the general public. But I also feel that doctors and scientists should take note of anecdotal evidence presented by patients.

        Fortunately, some doctor listened to a patient battling cocaine addiction when the patient mentioned that when he was taking Baclofen said that the Baclofen reduced his craving dramatically. See http://www.nature.com/npp/journal/v28/n3/full/1300088a.html for a journal article on it. Good thing that doctor didn’t ignore that.

        1. Harriet Hall says:

          Doctors very much DO take note of anecdotal evidence presented by patients. The case you mention is a good example of how they take note and then verify with scientific testing. Anecdotal evidence provides valuable clues to potentially productive areas of study; it does not provide a reason to offer the anecdotal treatment to other patients before testing.

          1. Hmmm, that actually does not makes sense???!!

            We use these anecdotes as clues but are not allowed to utilized the same treatment to benefit others?
            Where does the art of medicine come into play?
            Do we just leave those failed cases to suffer?

            1. Simba says:

              ‘Clues to productive areas of study’ seems pretty self-explanatory, not ‘clues as to how to treat people with no other evidence. So yes, it does make sense.

              I’ve said it before and I’ll say it again- if I was a patient of yours I wouldn’t like to be recommended treatments that don’t lack evidence. We’re not your guinea pigs, not without explicit consent to be a treatment subject.

              1. simba says:

                Apologies if that sounded overly confrontational, it was just the easiest way to phrase it. It applies to all doctors who will reccomend treatments which lack evidence, without making that lack explicit.

            2. @simba
              Apologies to you, but have you ever tried to care for someone who has status headaches or status migrainosus??

              If you are worth your salt you will pull all the rabbits out to your hat that you have. If you have none the patient will suffer!

              Would you try a lidocaine 1% .05/.05 cc NS spray in the nostril to break these headaches?

              Would you try a craniosacral session to break these headaches?

              High dose steroids?

              Lithium?

              or would you tell them that their problem is now out of the standard of care protocols and you don’t believe in any of the studies of alternatives. Sorry?

              Do you believe a provider who uses a treatment “off label” and does no harm is liable or just?
              Do you really care?
              Are you just a pawn to these SBM dogmatist.
              Who put you up to this?

              1. simba says:

                Who put me up to this? No-one. Just looking around online to see if dry needling’s useful or not. Studies might have convinced me, but I figure once people start resorting to conspiracy theories there’s usually not much substance.

                I would not attend a doctor who told me craniosacral therapy would help my migranes, or who told me green jello would cure my acne, because that seems like a doctor who doesn’t know what he’s talking about. I wouldn’t attend a doctor who’s that paternalistic, dishonest/incompetent, or who wasn’t willing to look up and honestly tell me about the evidence base of the treatments they suggest.

                You’re trying to change the subject to my trying something myself- but we’re talking about doctors advising patients.

                Offer me a possibly ineffective off-label treatment, fine, just don’t sell me a pig in a poke. My interest as a patient is in not being lied to. That seems pretty universal, no?

              2. @simba
                I have absolutely no idea who people are around here, so I just assumed you were told to bug me and my idea of alternatives.

                Free speech without bounds, intent, civility, creditably, credentials, an open mind, inquisitiveness or responsibility will get you this site. It’s a cesspool of loose ended thoughts.
                If you want valid, vetted and viable ideas on how to care for Migraines go to HealthTap. https://www.healthtap.com/

                Be careful of what you have been told or what you think or what you understand today as time goes by your logic will change. I once thought Acupuncture was hokey, now I understand what it IS and what it’s NOT.

                Migraine pain requires a recipe of options all together in a package. Separate in to the parts they are less effective and maybe a waste of time. In a package with wellness the power is magnified and will get you the results you are looking for.

                Magnesium has to be a part of the package or the healing will be very very slow.

                Acupuncture can be traditional or myofascial as in dry needling. Dry needling is uncomfortable and 30% of people find it to painful so wet needling is the next step. I mix and match all needling in my office because I’ve learned from many failures.

                Find my website if you like

  24. Andrey Pavlov says:

    Does a rooster call cause the sun to rise?

    Wait… they don’t? You’ve turned my world upside down.

    1. simba says:

      This is why foxes must be controlled, lest they end the world. Hence the red-jacketed symbolic ritual of the chase: red for the blood the fox lusts for, on ‘blood horses’. Previously ‘bloodhounds’ were used, but the foxhound is the derivative of those older dogs.

      That’s why the illuminati’s trying to ban it in several countries. When the foxes kill all the roosters, the sun doesn’t rise, and Cthulhu awakens.

  25. simba says:

    What’s the evidence for the existence specifically of myofascial trigger points? I’ve been at a few conferences with very excited people jumping up and down about them, but I can’t seem to find good studies or systematic reviews- just books.

    I thought there might be something to them, but Dr Rodrigues’s points have made me doubt that.

    1. The fault is that a lot of pain academics are attempting to cloak over all the work that has been done in the past century to establish new paradigms. They are actually attempting to gloss over all that work.

      Prime example is on Ingrahams site he has a weak section disavowing Trps. Weak, biased and IMO unethical, disrespectful to all those icons of medicine!

      The proof of a therapy lies in the outcomes and the outcomes can only be assessed reliably in the clinical setting. I have lobbied NIH, Agency for Healthcare Research and Quality (AHRQ), AAMA, Texas Family Practice Associations to study this downstream data … all are distracted by upstream issues.

      If anyone here has access to those epidemiologist or interested researcher, let them know.

      1. Simba says:

        But where are the well-designed blinded placebo-controlled studies? You can’t gloss over those, and they are the best way to assess outcomes in the clinical setting.

        Anything will work on some people if the practitioner believes it does- at least well enough to confirm the belief of the practitioner. I’m looking for solid evidence.

        1. “Anything will work on some people”
          Yes you are correct, Groupthink is working on you all to well!

          If we double blinded every therapy and confirmed the results with long term followups, we would very few therapeutic options in clinical practice.

          1. PMoran says:

            SS: “If we double blinded every therapy and confirmed the results with long term followups, we would very few therapeutic options in clinical practice.”

            Intriguing comment. Is this an admission that much of what you observe is from spontaneous remission and non-specific influences, including placebo-related? I mean, that is what double-blind RCTs reveal, separating out those which have additional physiological activity. .

            1. I’m a witness to the failures of SBM and the success of Alternatives — I know the difference as does my patients!!! Yall are dumb or aware of the flaws in the science methods used my many on this site. Y’all are blissfully ignoring these issues.

              The study of inanimate objects and number fall under the traditional scientific models. The study of biologic entities has to be on a different metrics and paradigms.

              The unethical business of medicine loves to twist the two in an attempt to disavow what we see in the office.

              Thanks to all of you for helping to cloak over the medical carnage witnessed by some of us on the front lines. You chose not to want to know or you are being rewarded in the form of power, money or prestige. Good job at dehumanizing people!

              1. WilliamLawrenceUtridge says:

                I’m a witness to the failures of SBM and the success of Alternatives — I know the difference as does my patients!!!

                How do you know the difference? How do you know you aren’t merely seeing those patients with unusually long recovery times, and you were merely the last person to see them before they would have gotten better without any further treatment? How do you know you aren’t merely a tax on the lives of people who are slow to heal?

                The study of biologic entities has to be on a different metrics and paradigms.

                Why? Sure, you wouldn’t test a pain response the same way you test concrete hardness or the melting point of steel, but the conceptual basics (control groups, careful record-keeping, matched numbers and measures as objective as they can be made) should work irrespective the subject matter. Is there any reason why testing acupuncture outcomes, for instance, should fail merely becuase you use a well-controlled intervention and randomization?

                You chose not to want to know or you are being rewarded in the form of power, money or prestige.

                So what you’re saying is, because you can’t come up with any good rebuttals to the points made, we must be paid shills for Big Pharma? My interpretation would be that you simply don’t have any good points to make, and are unaware of how flawed and lacking the medical literature is to support the use of acupuncture.

                Good job at dehumanizing people!

                How does lying and failing to reveal the problems with the medical literature on acupuncture “humanize” people? It would seem to infantilize them in my opinion. Should we return to the “good ol’ days” of paternalistic medicine, where women weren’t told they have cancer and doctors prescribed saline injections to make patients feel better? Because that strikes me as unethical.

              2. Dave says:

                I fail to see how advising someone that there is no good proof that accupuncture works better than sham accupuncture or placebo gains anyone any money, prestige or power.

                It is evident that actually doing said accupuncture DOES gain money, for the person doing it, namely you. I also know people who state they have been helped by accupuncture, but I don’t know if accupuncture was the reason they got better. This had been discussed endlessly in responses to your posts. There was an interesting segment on NPR yesterday about the effects of the mind on personal responses. If you give a person cheap wine but pour it from an expensive bottle, the pleasure they get from the wine is much greater than if you pour it from the original bottle. A person may get great pleasure form a piece of artwork, to be replaced by depression when they find the work is a forgery. As I believe Penn and Teller said, “qi is the flow of money from the patient to the practitioner”

              3. PMoran says:

                You haven’t answered my question. How sure can you be that the results you are seeing are not due to the psychological impact of your confidence, personality, reputation and the variety of non-specific influences (distraction, counterirritation, repeated psychosocial interactions, etc) that some of your more aggressive physical programs your methods entail?

                I am prepared to argue that so far as we can know for sure some of the benefits that you observe derive from these factors (the rest due to the way conditions can sometimes dramatically resolve spontaneously and various innate biases and illusions within medical practice) , but not that you results are from the exertion of otherwise unsupported medical theories.

                And that is the main sticking point with most the audience you have chosen to engage with here. For example, clarify where you stand on Chinese medical theory in relation to such matters as the significance of acupuncture points and flows of chi, and you may receive a better hearing. While you seem to be giving an credence to implausible and otherwise unsupported medical theories such as those of TCM you will continue to be dismissed.

  26. simba says:

    It’s an intervention that would be fairly easy to test, though? Heck, you could do it, after ethical approval, and publish it.

    I want this to work. I just don’t want to presume it works without good evidence.

    An interest in medical history will teach you fairly quickly that ‘it works in my experience’ means very little.

    For example, intelligent, experienced doctors during cholera epidemics found the most effective treatments to be (take your pick): turpentine internally and externally, friction of the spine, acetate of lead, calomel, hot mustard foot baths (seriously), mustard poultices, peppermint, laudanum, flannel undergarments… Nowadays we have much fewer therapeutic options for cholera. But at least we know which ones work.

    Are you saying that most of the things currently used don’t work? Wouldn’t it be better to find that out?

    I agree, for certain conditions there aren’t many evidence-based options. What’s wrong with telling the patient that truthfully?

  27. PMoran says:

    “Perception is altered, not underlying pathology.”

    So — what, Mark? Do we eschew all symptomatic treatment because it doesn’t correct pathology? I know you can’t mean that, since perhaps fifty per cent or more of all treatment episodes are to relieve symptoms and that is all that a lot of drugs do.

    Treatments probably often “work” mainly through us paying less attention to symptoms, once having taken action regarding them and getting on with life and its many distractions. ANY treatment can do that much with moderate discomfort. This is just one of many ways in which human psychology/neurology can influence subjective or psychosomatic complaints but by requiring some kind of treatment ritual to be brought into play.

    Now why is this to be regarded from the get-go as a bad thing, as the demeaning “beer goggles” analogy implies when combined with the above statement?

    To do so implies somewhat off-kilter priorities when discussing a medical outcome, hinting at a value judgement that science alone cannot make and which should be being kept at a distance when trying to get a handle on the actual facts. It suggests bias — that you have an angle.

    That you do is amplified by the fact that you describe trying to elicit the same phenomena in your own patients, but that you regard that as somehow more “truthful”.

    Surely it would be equally “truthful” and even more informative regarding certain aspects of CAM to allow that true believers such as SS are able to elicit the same responses.

  28. @Dave
    You can NOT truly sham acupuncture!!! Why would you to???
    Would you sham an appendectomy for infection, tonsillectomy for recurrant sorttheroates, cholecystectomy for indigenstion or colectomy for cancer?

    I have already stated what Acupuncture is and what it is not! if you like to educate yourself you can follow my threads.

    “It is evident that actually doing said acupuncture DOES gain money, for the person doing it, namely you.”
    Same can be said of our entire healthcare system too!! Why pick on this discipline. I’m certain that knees joints do not need to be lopped off. There is no outrage for this procedure??!! Bias, dogma favoritism and cronyism.

    1. Windriven says:

      “You can NOT truly sham acupuncture!!! Why would you”

      To determine if it has effect beyond placebo.

      “Would you sham an appendectomy for infection…”

      There is no need. The result of untreated appendicitis is well known. There is a long record of full recovery following appendectomy. What is the question that this research would answer?

      If you suffered a bout of acute appendicitis, what would you prescribe for yourself? Appendectomy? Acupuncture? Chiropractic manipulation?

      1. You obviously think you are the greatest clinician of all times and everyone else is just plain old stupid without any common sense.

        Who is his right mind would even consider acupuncture or manipulation for an acute abdomen?? !!! You apparently think so!!??

        This show your stupidity as it relates to medicine.

        And you do not understand the word placebo or the placebo effect or innate healing. Who are you anyway again?

        1. Windriven says:

          “Who is his right mind would even consider acupuncture or manipulation for an acute abdomen?? !!! You apparently think so!!??”

          Have a shower, Steve. Cold. Long. Do you understand irony? I don’t mean this disrespectfully, but if English is not your native language, tell me and I’ll stop using irony, metaphor, sarcasm and satire in our all-too-frequent exchanges.

          Who brought up appendicitis in this thread? Steve Rodrigues. Scroll back and see for yourself. You seem to believe that an RCT is required to demonstrate the usefulness of appendectomy in treating acute appendicitis. That is … bizarre. I simply folded it back around on you.

          “And you do not understand the word placebo or the placebo effect or innate healing. ”

          Oh, I certainly do understand placebo and placebo effect. I appreciate “innate healing” as regression to the mean but whatevs.

          “Who are you anyway again?”

          You should be careful asking that question as you may get an answer that you really don’t want to hear. For the moment I’ll leave it at this: I’m a scientist who, while once impressed by your passion for your patients, is deeply disturbed by your loose attachment to the mainstream of clinical thought and practice and more disturbed still by your obvious and refractory ignorance of basic cognitive flaws that we all share and must work diligently to contain. It is one thing to be myopic Steve, quite another to refuse glasses.

          1. LOL, you and I apparently view clinical medicine differently. We do see differently. You being a scientist and me being a well … you know … a physician.

            My view with a little more clinical experience is a little more inclusive and a little more valid. You really should allow a clinician to comment on clinical medicine.

            Gee even you clinical medicine bloggers have not read the text or articles so even their insights would be limited.

            1. Windriven says:

              “We do see differently. You being a scientist and me being a well … you know …”

              A quack?

              “My view with a little more clinical experience is a little more inclusive and a little more valid.”

              I’ve no idea what you mean by “inclusive” but your assertion that it is more valid is demonstrably, laughably, incorrect.

              “Gee even you clinical medicine bloggers have not read the text or articles ”

              No, Steve. Should they also read “The Organon of Medicine?” “The Cure for All Diseases?” “The Original Reiki Handbook of Dr. Mikao Usui?” Serious people doing serious medicine don’t have time for fantasies.

              Reflect on the difference in medical care during your grandmother’s time and your own. Reflect on it carefully and thoughtfully. None of those monumental advances have a single frigging thing to do with acupuncture needles. NONE of them.

              1. Apples and Oranges.

                I do not know Reiki, but I am sure it has some therapeutic value if used wisely. You can not compare this to Acupuncture, dry needling or some CAMs. CAMs are valid when used wisely. Traditional medicine is malpractice with used as a vending machine.

                If you have not practiced CAMs you really are not in a position to suggest to patients all of their options.

              2. Windriven says:

                “If you have not practiced CAMs you really are not in a position to suggest to patients all of their options.”

                I have not practiced auto-asphyxia but I’m confident I have standing to comment on it.

    2. PMoran says:

      “I have already stated what Acupuncture is and what it is not! if you like to educate yourself you can follow my threads.”

      In our parallel dialogue I am asking for the same, briefly, and in your own words.

      You surely cannot expect us to us to go back through your hundreds of posts in which I have the impression that you have always been vague on this point..

      Reference to other sources is a cop-out, if you are not prepared to own up to your own beliefs, or alternatively, admit that you cannot be sure why your methods seem to work, you are merely very sure that they do.

      1. You really should allow a clinician to comment on clinical medicine. Gee even you clinical medicine bloggers have not read the text or articles so even their insights would be limited.

        1. Windriven says:

          “You really should allow a clinician to comment on clinical medicine.”

          Ummm, Dr. Moran is. Dr. Hickie is. MtDoc is. Dr. Gorski is. Dr. Novella is. Dr. Jones is. Dr. Pavlov is. weing is. Dr. Crislip is. I know and am ashamed that I am failing to remember many more who grace these pages.

          You are the lone voice shrieking in the desert, Steve. Do you have some kind of messianic thing going on? You’re right and all of science is full of sh!t?

          I lived in the deep south for 20 years. A common bumper sticker there held: The Bible Said It, I Believe It, That Settles It.

          You’re kind of like that, Steve. You believe it. But buddy, that doesn’t settle it. Not nearly.

    3. MadisonMD says:

      Why would you sham X?
      Well, SSR, would you sham mammary artery ligation for angina?
      Why, yes you would.
      Would you sham arthroscopic knee surgery?
      Why, yes you would do that to.
      Why, you ask? To determine if there is intrinsic efficacy of the intervention. These findings change clinical practice. Have you ever heard of mammary artery ligation being done on patients? Of course not. It doesn’t work. Similarly arthroscopic partial meniscectomy should be discontinued. It doesn’t work. This is how science is employed to improve medicine.

      I cannot fathom why you would have it any other way.

      1. “To determine if there is intrinsic efficacy of the intervention.”
        So if you do not believe that Acupuncture has no validity, than you need to do some more study. I can get you the references or just go to Am Acad of Medical Acupuncture website and review the data.

        1. MadisonMD says:

          So if you do not believe that Acupuncture has no validity, than you need to do some more study.

          I don’t think this is what you meant to say. Anyway, if I remove the ‘no,’ I get your point.

          I would be more than happy to review your citations. In fact, please post the citation that provides the strongest evidence of the intrinsic efficacy of acupuncture. I expect you will not just link to a book or website that simply asserts it does do something, but that you will link to actual evidence.

          1. Windriven says:

            ” I expect you will not just link to a book or website…”

            I expect that Charles Dickens will invite you to lunch before Dr. Rodrigues links to a meaningful, positive, peer-reviewed study. But hope springs eternal!

          2. A scientist job is to do their own research.

            Pseudo-scientist only read and consider what is presented to them.

            Perpetrating-scientist only read and consider what is spoon fed to them.

            Medical Practitioners should try, see and error from all aspects of the discipline to find what actually works in the real world in a particular case.

            1. WilliamLawrenceUtridge says:

              A scientist job is to do their own research.

              Pseudo-scientist only read and consider what is presented to them

              See, this is hilarious coming from you – you not only show little understanding of, or even awareness of, the critical literature, you don’t even understand basic science. For instance, why do actual scientists try to disprove theories?

              Medical Practitioners should try, see and error from all aspects of the discipline to find what actually works in the real world in a particular case.

              You know who used this approach for centuries? Bloodletters and priests.

              Do you give your patients medicine and reset bones, or do you cut open their veins and take out a cup or two? Because bloodletters were absolutely convinced they were healing rather than killing their patients.

              1. Windriven says:

                Jesus, William. You have more patience than I. Some of his ramblings give me a headache as I try to make sense of them. WTF is a perpetrating scientist anyway?

                Wait! If you know, don’t tell me. I think I’m happier not knowing.

              2. WilliamLawrenceUtridge says:

                Always remember – Steve is never going to change his mind. My goal is to show lurkers and fence-sitters that his points are empty and stupid.

                My guess would be a “perpetuating scientist” is someone who fails to adjust their practice, research and publications on the basis of Steve’s brilliant and unsubstantiated ideas. That or he’s a Turing engine that needs a kick.

              3. I live and in a reality state and seeing and treating real people.

                I have not idea what Yall do??!! Except do do on common sense. :)

              4. WilliamLawrenceUtridge says:

                The problem with common sense is that it is often wrong. Common sense says the earth is flat. Common sense says that the earth is the centre of the solar system. Common sense says that humans could never affect anything so huge as the atmosphere. Common sense says that plants and animals are designed to occupy their niches.

                Common sense says that people will change their minds in the face of evidence.

            2. If the evidence is overwhelming, I will change my mind! Just telling me that the techniques I used in the office are hocus pocus and to stop is not practical.

              Only the patient can tell me if something is ineffective.

              Besides I believe in innate “God-Given” healing. Yall only believe each other.

              1. Windriven says:

                “If the evidence is overwhelming, I will change my mind!”

                We have linked innumerable studies that demonstrate that acupuncture has no effect beyond placebo. How much more overwhelming can it get? Yet you supply no studies showing profound effect, only anecdotes.

                ‘Besides I believe in innate “God-Given” healing.”

                Believe in what you want. But don’t bet your patients’ lives on innate anything, god-given or not.

    4. Dave says:

      Knee replacement for my wife, who could barely get to the mailbox, has enabled her to walk without knee pain.

      Appendectomies and colectomies are scientifically valid forms of treatment.

      YOU have accused those here who question the value of accupuncture of doing so for financial reasons, whereas you are the one making money from this questionable procedure. I have no problem with a surgeon getting paid for an appendectomy, a procedure with known efficacy. I do have a problem with scamming people. I’m still waiting for you to show that accupuncture works better than placebo or sham accupuncture (which CAN be done) in a randomized trial. So far all you’ve given is anecdotal evidence and the fact that it has been done for ages, as have numerous worthless procedures. You on’t win an argument here by accusing your detractors of finiancial interests, you win it with facts about the PROCEDURE IN QUESTION

      1. MadisonMD says:

        I have no problem with a surgeon getting paid for an appendectomy, a procedure with known efficacy.

        I think SSR is asking why these procedures are accepted without RCT versus sham. A valid point, although he has purposefully selected a set of standard care procedures for very dangerous medical conditions for which it would be unethical to randomize patients to control.

        He has brought up the point that SBM accepts these interventions without controlled RCTs. A valid point that, nevertheless, has been addressed here before. Yes there are SBM interventions that are accepted without RCT like vaccination to prevent measles, antibiotics for endocarditis, or surgery to remove primary cancer in non-metastatic disease (though randomized trials do exist when the disease is already metastasized– see here and here). In fact, this is in part why SBM rejects a purely EBM approach that devalues all evidence outside RCT.

        Where SSR blunders is in that there is no ethics or danger to patients entailed by RCT of sham acupuncture versus acupuncture, except, perhaps, the small risk of penetrating the skin with a needle if you actually get acupuncture. Moreover, non-specific effects of acupuncture on subjective outcomes are expected. This is exactly where RCT can reveal the specific effect of the intervention. One could argue that, in the SBM paradigm, you wouldn’t actually even do the acupuncture study because of the low prior plausibility and lack of mechanism.

        1. Dave says:

          Good point. We are all aware that sometimes randomized controlled trials are not necessary as the outcome without the intervention is so obvious.

          SSR has continual refrains. One is that the posters objecting to his treatments are somehow being paid, which they are not (but even if they were, that has no bearing on whether accupuncture works). The other is that certain medical interventions do not work very well, such as arthroscopic knee surgery (which has been discussed in detail here – the point has been made that this surgery for certain conditions indeed does work, but only as well as a sham surgery and therefore the effect is that of a placebo) as if that makes his treatments more valid. It’s like saying that 2 plus 2 equals 4 because 5 plus three does not equal 10. Even a school child knows the flaws in these arguments and I just get sick of seeing them brought up here multiple times every day.

          1. MadisonMD says:

            Dave: Agreed. Perhaps his repetitive arguments are useful as a foil. Its the lurkers who we reach by engaging.

            1. Great!

              So please, if complementary medicine and alternatives are the topic then allow the person with the most clinical experience to answer those questions.

              1. Windriven says:

                The most clinical experience??? You flatter yourself.

              2. Not flattery — just true.

      2. You have no problem with a surgeon amputating your wife’s God’s given knee?

        You are correct I can not convince you so you really do not have to comment on this matter ever again.

        I am sure there are others who wish to know how best to use this valuable discipline.

        1. Windriven says:

          1. You don’t amputate a knee. You might amputate a leg above or below or at the knee. You might replace the knee. But you don’t amputate the knee.

          2. God has nothing to do with my – or anyone else’s – wife’s knee.

          3. This is a site dedicated to SCIENCE based medicine. Dave has standing to comment here. Madison has standing to comment here. You are a guest who adds nothing but a bit of comic relief.

          4. Acupuncture is not a valuable discipline and, while I share your certainty that there are others who wish to use it, thankfully their number is small.

          As an aside Steve, I looked you up on HealthGrades.com. You have a 3/5 star rating. There are a bunch of board certified family medicine physicians in your immediate area with more reviews and much higher (5/5) ratings. Ambareen Salam. Nazish Islahi. Sara Trachina. Vance Niemann. Stephanie McCann. Of course it doesn’t look like any of them do acupuncture. So… what’s that about?

          1. If this is a SBM site why are all of you default to personal attacks? Do the SBM clan leader tell you what to read? Have you even looked at any of the references?

            The beauty of having many different providers in a location is choice! With our choice then you have to tolerate a narrow spectrum of SBM dogma and fallacy.

            If a surgeon removes a joint it’s amputated gone, adios, hasta lavista and incinerated. Amputations leaves you permanently disabled.

            1. Windriven says:

              “Do the SBM clan leader tell you what to read?”

              Of course! Don’t you get Dr. Gorski’s daily memo. Each of us are told what to read and what to think and who to comment on. I would be lost without it.

            2. weing says:

              “If a surgeon removes a joint it’s amputated gone, adios, hasta lavista and incinerated. Amputations leaves you permanently disabled.”

              I wonder how you feel about cataract extractions and IOLs?

            3. MadisonMD says:

              Do the SBM clan leader tell you what to read?

              No, the authors put out daily blog posts which many of us read. You are free to do so as well.

            4. Windriven says:

              “If a surgeon removes a joint it’s amputated gone, adios, hasta lavista and incinerated. Amputations leaves you permanently disabled.”

              Yeah, huh? My sainted aunt Pat had a total hip that transformed her life, banishing pain and disability, and allowing her to resume her many passions in the outdoors- including mowing her 3 acre lawn with a non-riding mower (insisted it kept her in shape). A week before she died of anaplastic thyroid carcinoma her journal entry was consumed with pulling damnable weeds from her front lawn.

              Now this is one simple anecdote – though I could give several more – but her surgery left her newly reabled. I personally know people whose lives have been positively transformed by joint replacements including shoulders (!), hips, and more knees than a hive of bees.

              This is prima facie evidence that your blanket assertion that “amputation leaves you permanently disabled” is just plain wrong.

              1. n brownlee says:

                Me, too. I had one hip replacement before I was 50; the second before I was 60. Those prostheses have made my life livable again. Before the first, I couldn’t walk, much less dig my garden, or dance like a maniac to ‘sixties music – now I can.

              2. “Main article: Physical disability
                Any impairment which limits the physical function of limbs, fine bones, or gross motor ability is a physical impairment, not necessarily a physical disability.”

                A natural joint is alive, auto-repairing and can restore to a relatively “normal” state of function. If that joint is removed for and replaced with a hunk of metal, you are permanently disabled. This means be careful if you step off of a curb, run and jump, step off a >2 foot porch, slip or fall, hard twisting or pivoting.

        2. Dave says:

          My wife has pretty severe rheumatoid arthritis. Her “God-given” knees were a mess – bone-on-bone, causing constant pain and preventing her from walking without severe discomfort. The knee replacements are great. She also has had cervical spine surgery (if you went to medical school I am sure you are aware of some cord-threatening cervical spine problems people with this contition have) to prevent her from becoming quadriplegic, We’ve been extremely happy with her surgeries. I wish I could say the same about her medications.

          1. mouse says:

            If the previous knees were god given, then I guess the replacement knees are a god send. ;)

            This is a joke my mom used to be fond of http://jokes.cc.com/funny-god-jokes/79gtkv/flood-shmud

            1. Windriven says:

              An oldie but a goodie.

              And consider your god-given/godsend paraprosdokianism stolen!

            2. Exactly!!!!

              Who would you want to help you with the aches, pain and stiffness in your hip?

              An experienced surgeon with a metallic fake joint?
              or
              Someone who has experience with a set of needles to perform myofascial needling?

              If you chose the first, I will forever think of you as a paid operative.

              1. n brownlee says:

                Some crip out there got two checks- because I never got ANY, and paid for the new hip, too.

              2. That this the beauty of the present system, they can replace your hip and if it fails, they will replace it again and again until you give up or you die.

                Yes we all pay for this present chaotic “ruse” system that you guys want to keep in place.

                Completely barbaric.
                Completely true.

            3. So in an elated state you will yell, “OH MY Crislip!” or OH my scientific holy genius”

              God is locked into the human existence! So who do you worship?

              1. Windriven says:

                “So who do you worship?”

                Speaking only for myself: I don’t. What would you have me worship? And why?

          2. Google bone-on-bone and try to understand the concept. It is a myth.

            1. Dave says:

              SSR, arthritis can cause joint destruction – rheumatology 101. When that occurs the result can be disabling, as it was for my wife. A joint replacement can reduce pain and increase function, as it has for her. I’m not going to add semantic differences and bone on bone is easier to say than describing the joint space narrowing and other things seen on x-ray.

              Tell me, how do YOU treat a patient with aseptic necrosis of the femoral head? With magic needles?

              1. “arthritis can cause joint destruction – rheumatology 101″

                This concept is incomplete and thus a lie, farce, ruse, deception- you get the idea.

                What is arthritis?
                What is destruction?
                Can something be destroyed (to death) within the human body?
                What happens when the disease burns out or the stress is resolved?

              2. Dave says:

                It’s probably a waste of time but if you don’t care to read about joint destruction and damage from rheumatoid arthritis here are some citations.

                http://www.ncbi.nlm.nih.gov/...
                ard.bmj.com/content/71/6/793
                or maybe better for you, from the article in wikipedia:

                “As the pathology progresses the inflammatory activity leads to tendon tethering and erosion and destruction of the joint surface, which impairs range of movement and leads to deformity. The fingers may suffer from almost any deformity depending on which joints are most involved. Specific deformities, which also occur in osteoarthritis, include ulnar deviation, boutonniere deformity, swan neck deformity and “Z-thumb.” “Z-thumb” or “Z-deformity” consists of hyperextension of the interphalangeal joint, fixed flexion and subluxation of the metacarpophalangeal joint and gives a “Z” appearance to the thumb.[9] :1089 The hammer toe deformity may be seen. In the worst case, joints are known as arthritis mutilans due to the mutilating nature of the deformities.”

  29. DrMoran says:

    Re appendicitis and why no RCTs have been done.

    Early last century its mortality rate was 26%. In a series published by Hale et Al (Ann Surg 225:252-261, 1997) involving 4950 patients the mortality rate was 0.08%!

    Surgeons cannot claim the credit; our forebears did much the same kinds of operations. Modern anaesthesiology, antibiotics, intensive care, better medical management of the very young and the very old, and investigative techniques have all contributed.

    Earlier diagnosis may play some part, but the same source stated that perforation of the appendix is still found in 20-30%, as was the case all those years ago. We still encounter generalised peritonitis, abscesses, septicaemia etc, but can deal with these and other complications with more confidence nowadays.

      1. Windriven says:

        “About 20% of those treated with antibiotics had a return of pain or other symptoms and needed to go back the hospital; some of these had serious infections brewing.”

        What’s your point, Steve?

          1. Infections, tumors, cancer, aneurysm have a standard of care that seems practical.

            Pain in a joint should have more options than 2.

            1. WilliamLawrenceUtridge says:

              Any options that are offered should be shown to work better than placebo. It’s unethical for drug companies to sell sugar pills under the guise of medicine, it should be unethical for you to charge patients for needles that show only inconsistent, short-term results that are indistinguishable from nonpenetrative sham needling.

              All that people are asking for is proof that something works consistently and safely, and a single standard of care rather than a double-standard that favours unproven and unlikely treatments.

              1. Options are what we all really want, even though you may want a perfect solution to an illness.

                It’s pie in the sky to think that a scientist working in a controlled environment will solve all cases of neuropathy. or a single pill will cure or a scientifically controlled set of standards. NOPE, the human body does not allow for such a situation.

                The “proof” that you are searching for does not exist in reality.

              2. WilliamLawrenceUtridge says:

                Again, options are only good if the options themselves are good. The option of death by poisoning or strangulation – not good options. The option of your money or your life? Not good options.

                It’s also funny that you object to single solutions for complex problems, when you so strongly advocate for acupuncture, which you claim can address most, if not all, musculoskeletal complaints. Hypocrite.

Comments are closed.