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Acupuncture, Infertility, and Horrible Reporting

An article (and associated news video clip) from ClickOn in Detroit is titled “Alternative treatment helps Michigan doctor beat infertility.” This is a misleading title, and the report is an example of poor science reporting.

Was She Infertile?

The patient in question was a 33-year-old family practice doctor who believed she was infertile. By definition, infertility is failure to conceive after a year of regular intercourse without contraception. She didn’t meet that definition. She only tried for 6 months before seeing a doctor, and then for 2 more months (with some kind of unspecified medicine) and then she consulted a reproductive endocrinologist who apparently told her she was infertile because of a high FSH level. Then she “did her own research” and supposedly found that acupuncture was a key part of infertility treatment. So she sought infertility treatment from an acupuncturist.

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Posted in: Acupuncture, Obstetrics & gynecology, Science and the Media

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Informed Consent and CAM: Truth Not Optional

In three recent posts, Drs. Novella, Gorski and Atwood took the Bravewell Collaborative to task over a report on its recent survey of U.S. “integrative medicine” centers. As Dr. Novella noted,

So what is integrative medicine? When you strip away the rebranding and co-opting of features and treatments of mainstream medicine, you are left with the usual list of pseudoscientific practices that have been trying to insert themselves into mainstream medicine for decades through a series of marketing and propaganda strategies. Bravewell has positioned itself at the forefront of that effort.

Among these pseudoscientific practices listed in a chart from the report included by Dr. Gorski in his post were acupuncture, TCM, reiki, therapeutic touch, naturopathy, homeopathy and reflexology.
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Posted in: Acupuncture, Chiropractic, Energy Medicine, Homeopathy, Legal, Medical Ethics, Naturopathy, Science and Medicine

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Placebo Again.

Medicine is simultaneously both easy and hard. As an Infectious Disease doctor, my day can be summed up with the phrase “me find bug, me kill bug, me go home.” Sometimes it is just that simple. A lot of the time it isn’t. I may not be certain what the infection is, or even if the patient has an infection, or allergies and/or antibiotic resistance limit therapeutic options, the host has co-morbidities that limit effectiveness, and the patient has no financial resources for the needed treatment.

I am lucky, since most infections are acute, make people feel terrible, and require a relatively short course of therapy during which the patient feels better. I rarely have to worry about compliance with the treatment plan; it is the rare patient, usually a heroin user or a particularly irascible old man, who will not follow through with their antibiotic course. I do not have to worry about chronic or symptomless diseases like diabetes or hypertension or the complications of obesity where long term compliance often limit therapeutic success. Long term it is difficult for many people to stick with their therapeutic plan, much less their diet and exercise resolutions.
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Posted in: Acupuncture, Medical Ethics, Science and Medicine

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What Is Traditional Chinese Medicine?

One of the themes of science-based medicine is to be suspicious of any form of medicine that is not science-based. In other words, beware of dodgy qualifiers placed before “medicine,” such as: “alternative”, “integrative”, or “complementary” – those that imply that something other than science or evidence is being used to determine which treatments are safe and effective. I would also include “traditional Chinese” medicine in the dodgy category.  A recent article defending Traditional Chinese Medicine (TCM) provides, ironically, an excellent argument for the rejection of TCM as a valid form of medicine. The authors, Jingqing Hua and Baoyan Liub, engage in a number of logical fallacies that are worth exploring.

Their introduction sets the tone:

Traditional Chinese medicine (TCM) has a history of thousands of years. It is formed by summarizing the precious experience of understanding life, maintaining health, and fighting diseases accumulated in daily life, production and medical practice. It not only has systematic theories, but also has abundant preventative and therapeutic methods for disease.

It may be trivially true that TCM has a long history, but it is hard to ignore that the placement of this statement at the beginning of a scientific article implies an argument from antiquity – that TCM should be taken seriously because of this long history. I would argue that this is actually a reason to be suspicious of TCM, for it derives from a pre-scientific largely superstition-based culture, similar in this way to the pre-scientific Western culture that produced the humoral (Galenic) theory of biology.

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Posted in: Acupuncture, Energy Medicine, Science and Medicine

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Acupuncture, the Navy, and Faulty Thinking

A Navy neurologist, Capt. Elwood Hopkins, has posted a 3-part article on  “The Power of Acupuncture” on Navy Medicine Live, the official blog of Navy and Marine Corps Health Care. It can serve as a useful lesson in how not to think about medicine. It is a prime example of how an intelligent, educated doctor can be fooled and can fool himself into thinking that a placebo is an effective treatment.

To set the scene: acupuncture has been increasingly accepted in military circles. The Air Force is teaching its doctors “battlefield acupuncture” based on the faulty evidence of one Air Force doctor, Richard Niemtzow.  The Army is using it to treat PTSDThe Navy offers it too.

Hopkins says that after 40 years of practicing neurology, “It was only natural to begin thinking about something else.” (Why? Boredom? And why pick acupuncture?) When he got an e-mail from his Specialty Leader announcing the opportunity for Navy doctors to learn how to do acupuncture, he submitted his application that same day. He was undoubtedly impressed that this training was being offered by the Navy, lending it the imprimatur of authority. His prior impression of acupuncture was that it was a “mysterious tool” that seemed to work; and instead of asking critical questions, he says he was looking for “a fundamental scientific understanding of acupuncture” and asking to see the supporting research and data.  (more…)

Posted in: Acupuncture

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Strains, sprains and pains

What do you think would happen if you gave a bunch of “complementary and alternative medicine” practitioners access to a big pot of money — say, up to $10,000 per patient — and let them treat patients virtually without restriction, hampered only by a fee schedule. No utilization review, no refusal based on a treatment’s being “experimental” — none of the usual foils which trip up CAM practitioners in the health insurance field.

Think they’d run up the bill? Yes, they would.

In fact, that’s exactly the scenario playing out in Florida right now with the state’s no-fault auto insurance.
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Posted in: Acupuncture, Chiropractic, Legal, Politics and Regulation

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Pediatrics & “CAM” II: just wrong

In November, the journal Pediatrics published an entire supplement devoted to Pediatric Use of Complementary and Alternative Medicine: Legal, Ethical and Clinical Issues in Decision-Making. The authors purport to have “examined current legal, ethical, and clinical issues that arise when considering CAM use for children and identified where gaps remain in law and policy.” (S150) Their aim is to “illustrate the relevance and impact of identified [ethical, legal and clinical] guidelines and principles,” to recommend responses, identify issues needing further consideration, and thus “assist decision makers and act as a catalyst for policy development.” (S153)

Unfortunately, as we saw in Pediatrics & “CAM” I: the wrong solution, the authors’ solution for the “issues that arise when considering CAM use for children” consist, in the main, of placing a huge burden on the practicing physician to be knowledgeable about CAM, keep up with CAM research, educate patients about CAM, warn patients about CAM dangers, refer to CAM practitioners, ensure that CAM practitioners are properly educated, trained and credentialed, and so on.

Limit CAM? Not happening

Curiously absent are recommendations placing responsibility on those who profit from the sale of CAM products and services — the dietary supplement manufacturers, homeopaths, acupuncturists, and the like — whose actions are directly responsible for the deleterious effects on patients’ health detailed in the supplement articles and described in the earlier post.

Apparently the authors’ view is that there is no accommodation to CAM too onerous to ask the practicing physician or the patient to bear. Even though they plainly locate the problems they describe — a missed diagnosis, ineffective treatments, drug therapy interactions, poor advice — in the CAM services and products themselves, suggesting that these services and products be limited or eliminated never seems to cross their minds.

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Posted in: Acupuncture, Chiropractic, Herbs & Supplements, Homeopathy, Legal, Medical Ethics, Politics and Regulation, Vaccines

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Acupuncture for Amblyopia

An recent article in the journal Ophthalmology reported the results of a clinical trial that evaluated acupuncture as an adjunctive treatment for anisometropic amblyopia. In the abstract, the authors conclude:

Acupuncture is a potentially useful complementary treatment modality that may provide sustainable adjunctive effect to refractive correction for anisometropic amblyopia in young children. Further large-scale studies seem warranted.

A little background information is in order.

In a healthy visual system the various structures in the eye focus light ambient light to form a sharp image on the retina. The retina functions like the CCD in a digital camera. Light energy is transduced to electrical signals, which are transmitted through the optic nerve. The signals from the optic nerve are relayed to the occipital cortex (at the very back of the brain) where they are interpreted into the experience of vision.

Amblyopia is often called “lazy eye”. If during childhood the brain is deprived of quality visual information it does not mature properly and loses the potential for good vision. Any opacity within the eye which significantly degrades the quality of the image forming on the retina (such as congenital cataract) can cause amblyopia. Strabismus (misalignment of the 2 eyes) can also cause amblyopia. If the eyes are not aligned, the brain has difficulty reconciling the disparate images from the 2 eyes. In order to avoid double vision the brain may “ignore” the input from one eye, and corresponding part of the visual cortex will not develop properly. Extreme, uncorrected, refractive errors (nearsightedness, farsightedness or astigmatism) can cause amblyopia. Patients with different refractive errors in their 2 eyes, a condition known as anisometropia, can also develop amblyopia in one eye.
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Posted in: Acupuncture, Ophthalmology, Science and Medicine

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November Hodgepodge

There have not been a lot of topics of late that warrant extensive analysis and discussion.  But there are a number of little topics of interest, each worthy of a few paragraphs of discussion, archetypes of issues in medicine, science based and otherwise.

Xigirs. No, it is not whale vomit, but close.

Last month Xigris  was pulled from the market by Lilly.  Yes, I understand the shock. Xigris, we hardly knew ye.   Xigris is the brand name for drotrecogin alfa, or activated protein C.  It is an enzyme in the clotting cascade that is/was given for the treatment of sepsis. (more…)

Posted in: Acupuncture, Energy Medicine, Pharmaceuticals, Science and Medicine

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Pediatrics & “CAM” I: the wrong solution

Oh no!  Not again! The venerable medical journal Pediatrics devotes an entire supplement this month to Pediatric Use of Complementary and Alternative Medicine: Legal, Ethical, and Clinical Issues in Decision-Making.

We sense from the very first sentence that we are in familiar territory:

Rapid increases the use of complementary and alternative medicine (CAM) raise important legal, ethical, clinical, and policy issues. (S150)

“Rapid increases”? And evidence of these “rapid increases?” None cited.

We do, however, see the same shopworn reference to popularity deconstructed elsewhere on SBM. What we learned by actually examining “the large 2007 US survey” which purportedly “revealed that ~4 in 10 adults and 1 in 9 children and youth used CAM products or therapies within the previous year”(S150) is that

…most hard-core CAM modalities are used by a very small percentage of the population. Most are less than five percent. Only massage and manipulation are greater than 10 percent. These numbers are also not significantly different from 10 or 20 years ago — belying the claim that CAM use is increasing.

We also find this definition of “CAM”:

a broad domain of healing resources …other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. (S150)

I’m not sure what it takes to become “intrinsic” to the “politically dominant” healthcare system. If it includes being legal, licensed or covered by public and/or private insurance, that would appear to disqualify dietary supplements, chiropractic, acupuncture, homeopathy, homeopathic products and naturopathy as “CAM” in some, or in some cases all, of the American states.

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Posted in: Acupuncture, Chiropractic, Herbs & Supplements, Homeopathy, Legal, Medical Ethics, Naturopathy, Politics and Regulation, Science and Medicine, Vaccines

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