Patients with heartburn are often diagnosed with GERD (gastroesophageal reflux disease) and treated with a drug called a proton pump inhibitor (PPI) to reduce stomach acid production. It is pretty effective, but it doesn’t always work. When it doesn’t, standard practice has been to double the dose of PPI. Doubling the dose only improves symptoms in 20-25%. Most patients who fail the single dose turn out to have normal esophageal acid exposure, or “functional” heartburn. In other words, the symptoms appear to be due to something other than excess acid – so it really may not make much sense to double the PPI dose. What else could doctors try?
Archive for Energy Medicine
Hype over science: Does acupuncture really improve the chances of success for in vitro fertilization?
There it was on Friday greeting me on the ABC News website: “Study: Acupuncture May Boost Pregnancy” in bold blue letters, with the title of the webpage being “Needles Help You Become Pregnant.” The story began:
It sounds far-fetched sticking needles in women to help them become pregnant but a scientific review suggests that acupuncture might improve the odds of conceiving if done right before or after embryos are placed in the womb.
The surprising finding is far from proven, and there are only theories for how and why acupuncture might work. However, some fertility specialists say they are hopeful that this relatively inexpensive and simple treatment might ultimately prove to be a useful add-on to traditional methods.
By the end of the day, the story was all over the media, including radio, TV, news websites, the blogosphere, and various other outlets, all trumpeting the message that a scientific study says that acupuncture can help infertile couples conceive. Nary a skeptical word seemed to be found. Knowing very well just how far parents will go to conceive, I was curious: Did this study actually say what the media says it said? What was so new and radical about this study that it rated a press release and a lot of promotion? Do we here at SBM (particularly Steve) need to rethink our extreme skepticism about acupuncture, given the poor quality evidence and lack of even a glimmer of a convincing physiologic mechanism to explain its supposed activities?
News bulletin on BBC NEWS International version, 8 Feruary 2008:“Acupuncture ‘boosts IVF chances.’ Acupuncture may increase the success rates of fertility treatment, according to a study. “
(Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, Bouter LM. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ. 2008 Feb 7)
First off, how plausible is the claim? The press release states that acupuncture had been used in China fior thousands of years for infertility. Has it? No medical historian writing I have seen made such an interpretation of ancient texts. Maybe I missed something…possible. But acupuncture was not used for specific disorders or purposes, but was used as a sort of panacea to cause balance of either the Yin and Yang or of the relationship of the individual with the 5 elements and the cosmos and the earth. There is nothing specific in claims of acupuncture in traditional Chinese Medicine history. Who gave the news people that misleading lead-in?
Second, what is the plausibility that acupuncture could possibly affect a laboratory procedure on tissue removed from the subject, regardless of timing? Negligible to none. There is no consistent and credible information that acupuncture is effective for anything, except as a conditiong agent for perception of symptoms.
So, does acupuncture increase the success of IVF?
The infiltration of complementary and alternative medicine (CAM) and “integrative medicine” into academia
A few years back, my co-blogger Wally Sampson wrote a now infamous editorial entitled Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded. When I first read it, I must admit, I found it to be a bit harsh and–dare I say?–even close-minded. After all, plausibility aside, I believed at the time that the only way to demonstrate once and for all in a way that everyone would have to accept that many of these “alternative” therapies were no more effective than a placebo would be to do high-quality randomized clinical trials to test whether they worked, and NCCAM seemed to be the perfect funding agency to see that this occurred. Yes, this attitude in retrospect was quite naïve, as I have since learned the hard lesson over several years that no amount of studies will convince advocates of complimentary and alternative medicine (CAM) that their favored therapy doesn’t work, be it chelation therapy for autism or cardiovascular disease, homeopathy, reiki, or various other “energy” therapies that invoke manipulation of qi as a means of “healing,” such as acupuncture, but that is what I believed at the time.
Belief in the healing power of magnets and magnetic fields has existed since the discovery of magnets several thousand years ago. In the late 18th century, Franz Anton Mesmer, an infamous charlatan, promoted the notion that he could heal with “animal magnetism.” In the 19th century magnetic healers were common – D.D. Palmer was a magnetic healer prior to founding chiropractic. Magnetic devices for everyday aches and pains have been increasingly popular recently, and today they are a multi-billion dollar industry.
Yet the scientific evidence does not, generally, support the use of magnets for specific indications, and the vast majority (if not totality) of claims made for magnetic devices in marketing are either false or unsupported and highly implausible. The media attention given to a recent study of static magnetic fields (SMF) in the treatment of inflammation brings up many important points regarding this disconnect.
A sciencedaily.com headline from January 7th proclaims: “Healing Value Of Magnets Demonstrated In Biomedical Engineering Study.” This headline is extremely misleading, especially the use of the word “healing.” The article is referring to a study by CE Morris and Thomas Skalak(1) published two months ago in the American Journal of Physiology – Acute Exposure to a Moderate Strength Magnetic Field Reduces Edema Formation in Rats. In the sciencedaily article Skalak is quoted as saying:
“We now hope to implement a series of steps, including private investment partners and eventually a major corporate partner, to realize these very widespread applications that will make a positive difference for human health.”
This optimism, however, is premature, and represents a significant problem with many popular therapies, the extrapolation from preliminary pre-clinical studies to clinical applications in humans. But before I look at this new study in more detail I will review some basic concepts for background.
Note: I think the following post is perfect in terms of spelling and grammar. It isn’t. I am starting to think I have a language processing problem given the typo’s that seem to slip in to each post. Be that as it may, there is a subset of readers who get their underoo’s in a twist at missing articles and apostrophes. If you are one of those readers, come back in a day. This post will be proofread and corrected, at which time this note will be missing and you can read the text without the pain of my poor grammar skills.
In the last post on acupuncture, I noted that the University of Maryland offered, among other supplements, complementary and alternative medicine (SCAMs), reflexology. I was uncertain as to the particulars of this SCAM, and this post is a result of those investigations. (more…)