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New Developments in Acupuncture: Turtles and Motion-Style Treatments

Note: Lest you think that SBM is becoming “turtles all the way down,”   let me apologize for the duplication and explain that I had already written this right before I read Mark Crislip’s Turtle Agony article on Friday.   My focus is different, and turtles were only a small part of my article, so I decided to leave the turtles in. If you prefer to avoid a turtle overdose, you can just skip the Turtlepuncture section and go on to the Motion Style Acupuncture section. They are clearly labeled for your convenience.

The “science” of acupuncture trudges ever onward without really getting anywhere. New developments include a report of turtlepuncture  and a study about treating low back pain with a new kind of “motion style” acupuncture using passive or active movement while the needles are in place. I found the first amusing and the second unconvincing.

Turtlepuncture 

Turtle Acupuncture

A group of Ridley sea turtles were rescued after being stranded during a cold spell that left them hypothermic and unable to function. In addition to the usual rescue and rehabilitation efforts, two of the turtles, Dexter and Fletcher Moon, were treated with acupuncture. It was intended to  “decrease inflammation and swelling on their front flippers, restore a full range of motion on those limbs and help the animals regain their appetites.” It allegedly worked: their appetite and the use of their limbs improved. But without any controlled observations, this is only an anecdotal report and means very little. They might have recovered just as well without the treatment, for all we know.

I searched for studies on turtle acupuncture. I found studies on the miraculous turtle eight meridians method, the eight methods of intelligent turtle, turtle probing needling, green turtle searching and boring acupuncture, the extraordinary turtle flying method, and turtle probing the cave needle manipulation, and one case report of treating an American red-footed tortoise. Nothing on treating turtles.

How did they know where to put the needles? They worked with a veterinarian to find analogies between the anatomy of turtles and other animals. And acupuncture points in animals are based on analogies with humans, sometimes with amusing results: diagrams for horse acupuncture show a gall bladder meridian but horses don’t have gall bladders!

I’m glad the turtles got better, but I don’t give acupuncture the credit.

Motion Style Acupuncture

A Korean study was published in the journal Pain.  It was a multicenter, randomized, controlled, comparative effectiveness trial with a total of 58 patients with acute low back pain. It compared one session of motion style acupuncture to one injection of diclofenac. Patients in the acupuncture group improved more than those in the diclofenac group.

What Is It? The authors tell us that motion style acupuncture treatment (MSAT) is a relatively novel method that has been recently used increasingly often in South Korea, but the only reference they offer refers to two case reports. In their MSAT protocol, two assistants stood on both sides of the patient with their arms around his waist. Acupuncture needles were inserted at points selected according to Traditional Chinese Medicine and previous clinical experience. The deqi sensation was not sought, but practitioners “occasionally” manually stimulated the needle at the GV16 point. With the needles in place, the patients were asked to walk with assistance. As walking improved, less support was provided. When the patient was walking without support, the needles were removed and he was asked to continue walking for 1-2 minutes. The patients were given verbal encouragement.

Why Diclofenac? The comparison treatment was a 75 mg intramuscular injection of diclofenac sodium,  a nonsteroidal anti-inflammatory drug or NSAID. The rationale for choosing it as a comparison was unclear. NSAIDs have been proven effective for acute low back pain, but they are usually given orally. A recent view of acute low back pain treatment does not mention the IM option.  Neither does the Mayo Clinic website.   I couldn’t find any sources that recommended IM administration over the oral route. I’m guessing they chose it for this study because it was a convenient way to give one strong, rapidly acting dose for comparison with one acupuncture treatment.

Results. Pain was assessed on a scale according to subjective patient self-reports, and disability was assessed by a questionnaire at 30 min, 2 weeks, 4 weeks and 24 weeks after treatment. The outcomes were significantly better for MSAT for the earlier times but not at 24 weeks.

Does This Really Support Acupuncture?  They called this a comparative effectiveness trial. Comparative effectiveness trials are typically used to compare established interventions to see which of two effective treatments is more effective. They are not intended to explore a new, untested treatment like MSAT. There are problems with this study. The subjects were Koreans who may have been culturally predisposed to expect results from acupuncture. Endpoints were subjective. Blinding was not possible. Instead of a single treatment and an atypical control, it would have been better to compare typical MSAT treatment to standard conventional treatment of low back pain.

What bothers me the most is that the MSAT group essentially got two treatments: acupuncture and assisted mobilization. I’d like to know what would happen if they got the second without the first. Maybe the needles were superfluous.

Patients with acute back pain avoid walking because it hurts. If they avoid using the muscles due to fear of pain, they can become conditioned to expect pain. Often they have severe pain when they first start walking, but if they can keep walking the pain tends to diminish. Patients who remain active recover faster; that’s why bed rest is no longer recommended. And a recent study showed statistically and clinically significant benefit from cognitive functional therapy. This involves re-framing and confidence-building as described here.

So what if all back pain patients were encouraged to walk and were assisted with the support and cheerleading? This acupuncture study would have been a far better study if it had included a motion-style treatment control group without the acupuncture component: MST instead of MSAT.

Conclusion

Color me skeptical. I question the use of acupuncture on turtles and on non-chelonian patients with acute back pain. The evidence doesn’t support it. I’m optimistic that assisted walking with physical support and encouragement might prove to be an effective treatment for patients with acute low back pain. I hope further studies will investigate that.

 

Posted in: Acupuncture, Clinical Trials, Veterinary medicine

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33 thoughts on “New Developments in Acupuncture: Turtles and Motion-Style Treatments

  1. windriven says:

    “The subjects were Koreans who may have been culturally predisposed to expect results from acupuncture.”

    One of my best friends is a first generation Korean-American. He suffers from episodic acute lower back pain. He also extols the virtues of acupuncture. But he doesn’t use acupuncture for his back pain because the local acupuncturist is Chinese* and the Korean acupuncturist is 90 minutes away. Instead, he uses chemical hot packs and rounds of golf.

    I mention the rounds of golf because they echo Dr. Hall’s question:

    “So what if all back pain patients were encouraged to walk and were assisted with the support and cheerleading?”

    My friend would not see the irony of believing in acupuncture but choosing a palliative and exercise instead. I know because I’ve pointed it out to him. This is consistent with my experiences in China where acupuncture and TCM are honored traditions but where people run for modern medical care at the first sign of disease.

    *There is a strong undercurrent of soft bigotry in much of the Asian community. The Koreans look down on the Chinese. The Chinese look down on the Malaysians. And everyone hates the Japanese (which is OK with the Japanese because the Japanese look down on everyone).

  2. The subjects were Koreans who may have been culturally predisposed to expect results from acupuncture.

    We should also disregard all pharmaceutical trials in USA and Europe as westerners have been culturally predisposed to expect results from conventional medicine.

    No, seriously, thats just unfair to koreans.

  3. goodnightirene says:

    Why was such a poorly designed study published? It proves almost nothing, but the headline in the journal PAIN would certainly make any casual reader think otherwise.

    “Effects of motion style acupuncture treatment in acute low back pain patients with severe disability: A multicenter, randomized, controlled, comparative effectiveness trial”

    The entire exercise of continuing to test acupuncture makes a mockery of science. Unless proponents can come up with some basic rationale for this modality, they are only engaging in tooth fairy science.

  4. Harriet Hall says:

    @FastBuckArtist,

    “unfair to Koreans”

    If it was unfair, it was Koreans being unfair to Koreans. The authors were Korean, and in the paper they said:
    “Because the setting was a Korean medicine hospital, and because patients visit for the specific purpose of receiving Korean medicine, there is a fair possibility that patients would be more favorably inclined toward acupuncture, and that this propensity may have affected the results.”

    They go on to say “Also, whereas patients in the MSAT group received treatment and support from the practitioners for 20 minutes, patients in the NSAID group had only a brief encounter with the practitioners at time of injection, which may have influenced the overall level of psychological stability and satisfaction.”

    As for the idea that we should “disregard all pharmaceutical trials” of course we shouldn’t. What we should do is recognize that people expect improvement from any kind of treatment, and we should control for that. Good studies do, whether they are Korean or Canadian.

  5. goodnightirene says:

    Whether someone is “culturally predisposed to expect results” is a universal trait; what varies is the scientific validity of the treatment, not the predisposition. Conventional medicine has solid scientific evidence proving that it works–for Easterners and Westerners. When acupuncture trials are properly blinded, they show no significant result for anyone, East or West.

    When I “expect results” from an antibiotic, it’s because they exist, unlike acupuncture points. The antibiotic will work on anyone, regardless of geography, acupuncture only works for the predisposed, regardless of geography.

  6. @Harriet

    whereas patients in the MSAT group received treatment and support from the practitioners for 20 minutes, patients in the NSAID group had only a brief encounter with the practitioners at time of injection

    Acupuncture takes more time than injections thats just the nature of the treatment. The nature of the treatment also makes it hard to blind the patient to what treatment he’s receiving.

    “Koreans are predisposed” is unfair and paints them as uneducated, which is untrue. South Korea has one of the most rigorous science school curriculums in the world. They understand what anti-inflammatory drugs do no worse than a western patient.

  7. windriven says:

    @irene and Dr. Hall

    “We should also disregard all pharmaceutical trials in USA and Europe as westerners have been culturally predisposed to expect results from conventional medicine.”

    Nobody is actually that stupid. FBA is a classic troll, stirring the pot for a reaction. He knows perfectly well that well-designed RCTs are blinded to obviate that sort of bias. Clearly, the Shin study didn’t even pretend to be blinded.

    @All

    When you feed trolls you get comment sections that veer far off into the tall weeds and detract from the issues at hand. It is one thing to engage in debate, quite another to respond to an unending stream of banalities from a small inane clown posse.

  8. WilliamLawrenceUtridge says:

    The nice thing about surgery, pharmaceuticals, blood tests and objective interventions with objective measures is that bacteria don’t blush – they just die in the face of effective antibiotics irrespective the person they’re living on or in. Acupuncture has failed every objective test it has faced, it offerns no advantage for any disease or disability it has been tested for. The sole exceptions are pain and nausea, two symptoms, not diseases, which are incredibly liable to placebo effects. The body can essentially mute the pain response if necessary, limbs can be avulsed from their sockets with no noticeable effects beyond the absence of pain.

    Meanwhile, heart attacks don’t really respond to placebos. Blood tests come back positive or negative irrespective the population involved – or the reference values are changed based on the relevant evidence.

    I predict you will revert to making vague criticisms and not bother trying to make any positive statements about what you believe is good practice. That’s how denialists work.

  9. ConspicuousCarl says:

    FastBuckArtist on 04 Jun 2013 at 9:03 am
    westerners have been culturally predisposed to expect results from conventional medicine.

    That’s why we use placebo pills in drug trials. You really should look into this science stuff some day, it’s absolutely fascinating.

  10. ConspicuousCarl says:

    This blog needs more animal pictures. This blog is so lacking in animal pictures that on most days it would be hard to tell that we are even on the Internet if not for the CAM trolls. And Gorski’s porn.

  11. I don’t really need to get as far as considering the potential cultural bias involved:

    “Endpoints were subjective. Blinding was not possible.”

    Game over.

  12. ABS says:

    In several European countries IM diclofenac 75 mg is standard treatment for acute low back pain. And no, it doesn’t seem to be because it is “one strong, rapidly acting dose”, since oral diclofenac will elicit pretty much the same pharmacological effect. However, patients do seem to believe it is “stronger and faster” acting. That’s probably the same kind of placebo effect as the one obtained with acupuncture.

  13. WilliamLawrenceUtridge says:

    Injection might actually be a better control than otherwise realized, since injections have a stronger placebo effect than pills in general. Was this a deliberate choice? Unlikely.

  14. Narad says:

    South Korea has one of the most rigorous science school curriculums in the world.

    I guess that settles that.

  15. @Narad

    I guess that settles that.

    Ah the killer fan :) .. well keep in mind Korea has some of the hardest-soaked alcoholics in asia. Drinking into unconsciousness is a common social event. I am sure that has something to do with the fear of killer fans.

  16. norrisL says:

    Recently I decided to stir up the quacks, so I posted comments on quite a few you tube videos about the impossibility of effect from acupuncture. I did the same with homeopaths and iridologists.

    What did I find?

    1. Many of these people have prevented anyone from commenting or have comments that may be subject to moderation. Why is it so? because they don’t want dissenting opinion expressed on their video?

    2. Many of the replies I received were quite rude and aggressive. That didn’t hurt, as I was expecting such responses.

    3. Just as many suggested that I must have had a bad experience with acupuncture/homeopathy etc and that I should find a better practitioner.

    4. Not a single commenter was able to provide any credible eveidence for their particular form of quackery.

  17. goodnightirene says:

    @norrisL

    You have to understand that believers don’t care about or require proof of any of their beliefs. Anecdotes and “experience” are all that matter to them. Dissenters are just so much “negative energy” and need to be avoided.

    Half way through a rundown of logic errors with a former friend brought this: “Irene, I’m just not a science person, that’s just not the way I relate to the world”. I really had no comeback for that that would be in keeping with respecting the constitutional religious rights of others. I could only think this was a fine example of being so open-minded that one’s brain falls out.

    Now I have found out that a good friend in Portland, who has a PhD, voted against fluoridation in the recent referendum. Sigh. I shall no doubt die friendless at this rate.

  18. windriven says:

    @irene

    “Irene, I’m just not a science person, that’s just not the way I relate to the world”.

    Perhaps, dear friend, but that is demonstrably the way the world relates to you.

    :-)

    It probably wouldn’t have helped. But it is true and might give 1 in 1000 woolies pause.

  19. goodnightirene says:

    @windriven

    Good suggestion, but she wouldn’t have “got it”–trust me. The scary thing is that this woman was an RN, but having “lost her faith in allopathic medicine”, became…..a teacher! She suddenly “retired early” and I can only think she was forced out as she is completely unhinged. It all started with aromatherapy.

    I will commit your response to memory as it may come in handy for those a bit less unhinged. I’ve also been trying to refine a short and snappy reply to “too much, too soon”–that’s one I get even from the fairly mainstream sorts.

  20. stanmrak says:

    CAM promoters have their anecdotes and experience; scientists seem to base all their beliefs on studies – without knowing for sure whether the studies are legitimate or not. History demonstrates clearly that there’s really no way of telling.

  21. goodnightirene says:

    “… without knowing for sure whether the studies are legitimate or not.”

    No, stanmrak, you have misstated the premise. You have also isolated a single study out of the context of the larger medical literature and the scientific method–but you knew that, didn’t you?

    History demonstates only that some people refuse to learn its lessons.

  22. windriven says:

    @stanmrak

    “without knowing for sure whether the studies are legitimate or not”

    It is easy enough to judge the merits of a given study. Even so, science does not hinge on the result of one experiment or one study. Evidence must be replicable, methodology must be examinable. “Hey Bubba, lookit this…” may suffice in the world of woo but science doesn’t work that way.

    You should go have a beer or two with Fast RipOff Artist and Th1Th2. The three of you would comprise a triumvirate of twits. With a few beers you might at least be amusing.

  23. WilliamLawrenceUtridge says:

    CAM promoters have their anecdotes and experience; scientists seem to base all their beliefs on studies – without knowing for sure whether the studies are legitimate or not. History demonstrates clearly that there’s really no way of telling.

    Scientists base their beliefs on evidence, most of which comes from controlled studies. If you understood anything about controlled studies you would understand why this is superior to any other method we have found to date (witness its success in engineering, medicine, longevity, health, transportation, technology and in fact any field that relies on empirical research). And scientists base their beliefs on a synthesis of evidence that is then tested via falsification (ideally). Science has three other advantages:

    1) It is public – results are freely shared (or should be)

    2) It is iterative – science builds on previous work.

    3) It is self-critical – it discards what doesn’t work, and improves upon what does, to dramatic effect. It is explicitly Lamarckian.

    It is also imperfect (I’m reading Bad Pharma now, and certainly it has opened up the rabbit hole in terms of the flaws in medicine). However, in response to point 3, it will get better. Probably not right away, probably not quickly, but clever researchers will work away at the issue and visible improvements will be noted. Even Bad Pharma‘s discussion of flawed trial results are not in terms of “it’s all wrong”, they are in terms of “results are exaggerated”. Fortunately science is not limited solely to what passed before, it can try to improve (regulators on the other hand, are a significant part of the problem because of a resistance to change – you can help with this by pushing for more openness in data sharing and decision making, contact your congressperson).

    CAM on the other hand, is deceptive (it adopts the trappings of science without the meaningful parts) and fossilized (that acupuncture is 2,000 years old is held up as praise, as if it were a good thing), resists change, and bases it’s practices on, hell I don’t know, whatever is profitable? There’s no standard for competent practice and no incentive or mechanism to discard what doesn’t work. This is why CAM promonents like you and FBA consistently spend so much time criticizing mainstream medicine, because you can’t honestly engage with any sort of meaningful criticism and improvement. CAM simply can’t stand up to honest scrutiny, so it resorts to dishonest false dilemmas and other fallacies – just like all the pseudoscience. Creationism, climate change denial, pseudohistory, cryptozoology, perpetual motion machines, all are based on fallacies and lies rather than an honest look at evidence.

  24. mousethatroared says:

    Conspicuious Carl “This blog needs more animal pictures. This blog is so lacking in animal pictures that on most days it would be hard to tell that we are even on the Internet if not for the CAM trolls. And Gorski’s porn.”

    I agree – I find pictures of adorable puppies and kitties allow me to think more critically.

  25. norrisL says:

    @ goodnightirene

    You have to understand that believers don’t care about or require proof of any of their beliefs. Anecdotes and “experience” are all that matter to them. Dissenters are just so much “negative energy” and need to be avoided.

    Indeed Irene, you are correct. many of the youtube replies fell into that category.

    Have a look at these

    Follies_and_Fallacies_in_Medicine.pdf

    The_death_of_Human_Medicine.pdf

    They are both a long spiel but they worth reading

    norrisL

  26. norrisL says:

    @ mousethatroared

    As a veterinarian I can only agree with your desire for more animal pictures. After all, animals are a lot more intelligent than woo type people.

    norrisL :)

  27. pseudoscience says:

    Hi

    Yes South Korea does have rigorous science school curriculum

    but it also have a oriental medical degree where you major in a pseudoscience for 6 years(just like a med school)

    after sitting the pseudoscience national exam these so call oriental doctors are able to practice their pseudoscience just like a normal MD in South Korea

    also it’s not surprising to see tv dramas promoting oriental practitioners of Korean history,
    as if they made some sort of contribution to modern medicine what so ever

  28. pseudoscience says:

    also South Korea is plagued with pseudoscience

    although it’s one of the most high tech countries in the world

    many many people(more than you expect) believe in things such as

    Chinese astrology(it’s not hard to find a so called Chinese astrology expert on tv)
    Feng Shui
    hand palms
    Chinese Physiognomy(it’s similar to Chinese astrology that it determines your fate)
    Sasang typology(this pseudoscience idea made by a Korean in the 1800s which is also part of traditional Korean ‘medicine’)
    the notion that your Chinese characters in your name affects your fate(another Chinese pseudoscience)

    the pseudoscience idea that your blood type affects your personality

    there was this guy in Korea called ‘Huh Jun’(1537/1539–1615), basically he didn’t make any contribution to modern science/medicine what so ever

    but most people in Korea thinks he was a great doctor or something and to this they traditional Korean practitioners read the same book he wrote 500 years ago

    Korea is plagued with pseudoscience beliefs, just turn on the tv and it won’t take long to see or hear it

  29. windriven says:

    @pseudoscience

    “the notion that your Chinese characters in your name affects your fate(another Chinese pseudoscience)”

    ???

    Korean characters are different than Chinese characters.

  30. pseudoscience says:

    Hi windriven

    Most Korean words and names are derived from Chinese characters

    Yes Korea has its own alphabet system nowadays but 99% of Korean names are made using Chinese characters(I guess its similar to English derived from Latin and French thing)

    Just wiki a famous Korean name(how about Kim Jong-un?) and you will see his name written in ‘Hanja’

    Hopefully you understand what I mean

  31. windriven says:

    @pseudoscience

    Interesting. I’ll discuss this with my Korean friends. Thanks for the information.

  32. Heather says:

    I adore science based medicine and please let me share my position regarding acupuncture done to animals: it’s cruel. That said, there is one part of this article that still rankles now almost a month later after first reading it. Salt water on a wound is not the same as salt in a wound! Now, are the puncture wounds putting those turtles more at risk for infection? Absolutely. Do I think salt water at a concentration which is essentially saline will feel like salt being poured into a wound? No, not so much.

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