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TCM Hodgepodge

acupuncture
I suspect there is more published about traditional Chinese medicine than any other SCAM. Here are some of the recent curiosities of TCM.

Burning genitals

The little girls laughed about the germs, because they didn’t believe in them; but they believed about the disease, because they’d seen that happen. Spirits caused it, everyone knew that. Spirits and bad luck. Jack had not said the right prayers.
- Oryx and Crake

I long ago gave up on the idea that there are a finite number of pseudo-medical treatments. Anything a human can imagine will probably be used as a SCAM intervention. I remain amazed at the permutations that occur in the pseudo-medical world, not unlike the mix and match bioforms in Oryx and Crake.

Not everyone knows basic anatomy and physiology that allows for understanding of disease. Instead, people often rely on metaphor and magic for their understanding, especially in the world of pseudo-medicine. Sympathetic magic lies at the heart of many SCAMs.

The classic example is rhino horns for impotence. But there are other examples. What makes blood flow to a body part? Heat. What is hot? Fire. Why are you impotent? Lack of blood flow. Put it all together and it spells fire: Set your crotch alight to cure impotence. Really.

It is all about keeping blood flow moving rapidly. The warmth from the burning towels speeds the blood through the body and it makes me perform 50% better in bed.

The accompanying photo of a flaming groin is a prelude to a What’s the harm? entry or a most unpleasant admission to the burn center if it goes horribly wrong.

There is nothing on the PubMeds concerning fire therapy and little on the internet. There are several versions fire therapy. It

is much more advanced and powerful than Moxibustion.

Given the total uselessness of moxibustion, I suspect the being several times more powerful than nothing is still nothing.

While the current photographs are from China, it allegedly originated in Tibet where:

The thermotherapeutic procedure consists in the application of a herbal product with a specific formula for each disease under treatment on the area of the affected organ. The area is covered with a towel soaked in alcohol and it is then lighted [sic]. The heat produced by the burning of the alcohol is easily born by the patient. The procedure is stopped when the patient announces a disconfort [sic]. The vasodilator effect produced by the fire heat accelerates the local blood circulation and the local metabolism. Thus, the curing substances of the herbs will be carried directly to the sick organ and they will act immediately at local level.

I would not rely on any therapy that bases its endpoint upon the use a safeword. It is not a therapy for Dave Grohl, although Jerry Lee Lewis might approve.

Its alleged mechanism of action is because

All health problems relate microcirculation deficiency. At capillary level, the blood become stagnate [sic], then toxin will be cumulate [sic], using Fire Dragon Therapy can improve the microcirculation and to remove stagnate [sic] toxins.

Yep. Toxins. And:

The vasodilator effect produced by the fire heat accelerates the local blood circulation and the local metabolism. Thus, the curing substances of the herbs will be carried directly to the sick organ and they will act immediately at local level.

Like most pseudo-medicines, there is no process for which fire therapy cannot be used, including as a beauty aid.

General fire dragon therapy can help cure the following disorders: Indigestion, low metabolism, low temperature, melancholy, pain caused by stress and tension, insomnia, anxiety, fear, panic attacks, stomach distension, vertigo, hiatus hernia, benign tumors, cold bile disease, joint pains, arthritis, bone deformation, joint inflammation, superficial fever (empty fever), post-menopause syndrome and nerve inflammation (sciatic nerve, neurological disorders, etc.). In short, fire dragon therapy is good for diseases which manifest from phlegm and wind humoral disorders.

Phlegm and wind. Good for teenage boys? And are the effects? Of course

Huo Long therapy produces many side effects, but all of them are positive.

Whew.

The procedure as described is relatively safe: the towels are wet and it is the alcohol vapor above the towel, not the liquid alcohol on the towel, that is burning. As long as it doesn’t ignite the clothes or the environment, it poses little risk.

But it sure looks stupid to me.

Pop Pop

There is often the suggestion that you should consult a licensed and certified acupuncturist, not just any old needle wrangler down the street, to practice their magic on you.

I don’t know. I would think that licensed and certified magic is no more effective than unlicensed and uncertified magic.

Maybe they might know a bit more if certified, but the pass rates for acupuncture boards are not impressive, at least in California.

In February 2014, only 62% of first-time test takers in California passed and overall 49% passed. Gives one pause.

There are several sites on the internet with Acupuncture Board questions and flash cards. I took the tests and missed all the questions. The questions often seemed goofy to me, but then I find all of the theory and practice of acupuncture goofy.

Knowing the crossing point of the spleen meridian and the throughfare vessel or that cupping removes putrefaction and promotes granulation somehow has no relevance to what I would consider biomedical reality.

I wonder, as an aside, what the result of board certification will be on the practice of acupuncture. There are a huge variety of styles (by country and by practitioner), acupoints, variations (bee venom or cat gut added) and techniques. There are more acupuncutures than acupuncture, perhaps as many forms as there are practitioners. I also note that some schools have high pass rates and others do not. I predict with board certification the variability of acupuncture will decline as, at least in the US, they teach to the test.

The biomedical sample questions were often simplistic and, if indicative of the knowledge base of practitioners who want to be primary care providers, scary. I was reassured to find questions concerning proper hand hygiene and sterilization of needles, although I am skeptical about their application.

What I did not find (and that doesn’t mean they were not there; it was not an exhaustive search) were questions testing whether acupuncturists had an understanding of the importance of the anatomy under their acupoints. Evidently not, for if you search acupuncture and complications on the PubMeds you will find seven pages of articles, some of which have titles that suggest needle points are going where they should not:

Some of those are impressive. It takes real effort to get deep enough to pop a stomach or heart. I would hard-pressed to accomplish such a result deliberately.

Those are the results of the first two pages of search results and does not include my all-time favorite:

Acupuncture needle found in ex-South Korea president’s lung

“I can’t figure out how the needle got into there,” Dr Sung Myung-whun was quoted as telling reporters at the hospital after the operation. “It is a mystery for me, too.”

Um, maybe because acupuncturists don’t really know what they are doing when they stick needles in people? They do not really know how deep they can safely push a needle since they have no understanding of anatomy?

There is a push to include acupuncturists as primary care physicians. Given the nature of their training and what it includes to pass their Boards (mostly magic) and excludes (reality and anatomy), I would not be skeptical of their abilities.

CIGO: Cochrane In, Garbage Out.

The Cochrane reviews. They give me pause. I understand the need and utility of systematic reviews and meta-analysis. They can give a nice overview of a topic and suggest the utility or lack thereof of a given therapy. But they are not definitive and suffer from the problem of GIGO: garbage in garbage out.

GIGO is especially pertinent when the methodologies of systematic reviews are applied to pseudo-medical interventions that are divorced from reality.

My colleagues and I have written extensively about acupuncture (we have collected many of the essays in book form available at Amzazon. Hint. Hint.).

The summary of acupuncture: it is not based in reality (there are no meridians or acupoints) and well-designed clinical trials suggest the acupuncture only works for subjective endpoints if the patient thinks they are getting acupuncture and believe it to be effective. It does not matter where needles are placed or even if needles are used at all. From a prior plausibility perspective, any positive effect from acupuncture is likely due to a combination of bias and poor study design.

But that never stops the Cochrane collaboration, who will run anything and everything through their grinder to produce a meta-analysis sausage. Unfortunately, unlike sausage, I often know what goes into the meta-analysis.

Acupuncture is the rodent hair and insect parts in the bratwurst that is “Acupuncture for treating acute ankle sprains in adults.” Can I beat a metaphor to death or what? Anything and everything that calls itself acupuncture is included; no form was ignored:

We included all types of acupuncture practices, such as needle acupuncture, electroacupuncture, laser acupuncture, pharmacoacupuncture, non-penetrating acupuncture point stimulation (e.g. acupressure and magnets) and moxibustion. Acupuncture could be compared with control (no treatment or placebo) or another standard non-surgical intervention.

Acupuncture, as is of then the case, is anything they want it to be. Insert Humpty quote here. Talk about your “heterogeneous group of acupuncture and quasi-acupuncture.” And, what surprise, they did not find any evidence that acupuncture, however defined, was effective for acute ankle sprain:

The currently available evidence from a very heterogeneous group of randomized and quasi-randomised controlled trials evaluating the effects of acupuncture for the treatment of acute ankle sprains does not provide reliable support for either the effectiveness or safety of acupuncture treatments, alone or in combination with other non-surgical interventions; or in comparison with other non-surgical interventions.

Of course, reality will never provide reliable support for either the effectiveness or safety of acupuncture treatments, because acupuncture is based on fantasy and its practitioners don’t really know what they are doing. When seen through the lens of the information provided by prior high-quality studies of acupuncture, it would suggest the following conclusion promotes a waste of time and money:

Future rigorous randomised clinical trials with larger sample sizes will be necessary to establish robust clinical evidence concerning the effectiveness and safety of acupuncture treatment for acute ankle sprains.

But for some reason the Cochrane group always suggests more studies. At least they did not suggest that it may be worthwhile for ankle sprain patients to test on an individual basis whether therapeutic acupuncture is beneficial for them.

They can only be that lunkheaded once. I hope.

TB or Not TB

As regular readers are aware, I am an Infectious Disease doctor and have been Medical Director of the infection control program my hospital system for 24 years.

It is impressive how Murphy rules in infection control. If something can cause an infection, it will cause an infection given the right circumstances.

Needles sticking the skin can drag in bacteria from the skin of the patient, from the hand of the practitioner or even from the slight aerosolization of spit from the practitioner, dragging oral bacteria into spinal fluid. It is why we wear a mask and gloves for many injections.

I have mentioned my Googlewack before. As best I can tell there is exactly one picture of an acupuncturist using gloves (actually, a physical therapist doing dry needling) on a Google image search.

Careful infection control technique is not high on the to-do list of acupuncture practitioners and a search of PubMed will result in a long list of mostly-preventable infections. As I think about it, since there is no real indication for acupuncture, they are completely preventable infections.

And now there is a report of cutaneous TB: “Analysis of 30 Patients with Acupuncture-Induced Primary Inoculation Tuberculosis

The use of Chinese acupuncture needles which are able to deeply penetrate into the tissues surrounding tendons and nerves provide an ideal route for the inoculation of tuberculosis. The patients in our outbreak underwent acupuncture twice daily for two weeks. This high degree of potential exposure may explain why there were no cases of spontaneous healing.

From an infection control perspective, it was interesting that

Despite the unsuccessful identification of the source of contamination, it is apparent that these infections were linked to acupuncture and moxibustion, because the 30 patients had the same epidemiological characteristics.

Most of the 30 patients had multiple skin infections, but the lesions were located to the sites of acupuncture and electrotherapy. Lesion severity and drug reactions in individual patient were similar, but we did not know whether these multiple lesions were independent or the result of the inoculation infections in the wounds via hemo-disseminated Mycobacterium tuberculosis.

And some patients had metastatic infections:

Although, occurrence of the three patients with meningeal and pulmonary tuberculosis and two patients with knee tuberculosis had confirmed the hemo-disseminated ability of this primary inoculation Mycobacterium tuberculosis to other tissues and the compartments.

And they finish with a little ironic humor:

Mycobacterium can easily spread without proper microbiological control of these procedures. To this end, it was recently suggested that herbal medicine and acupuncture professions should also develop a system of statutory regulation which should help prevent these issues.

Those whose world view holds that disease is due to the fanciful constructs of meridians and chi are unlikely to pay close attention to germs and their potential spread. In medicine we are fortunate that it is usually hard to infect other humans, especially if you are punctilious about applying the concepts of infection control. Too bad infection prevention is not part of their understanding.

Posted in: Acupuncture, Traditional Chinese Medicine

Leave a Comment (59) ↓

59 thoughts on “TCM Hodgepodge

  1. DevoutCatalyst says:

    My sincere condolences to all who have studied acupuncture in modern times. Nobody should be made to study nonsense to such an exacting degree and then be tested on it. This is cruelty akin to the prison rock pile. Upon passing your boards you should receive a certificate of apology from the motherf$#kers who put you up to this. Here’s a little secret: your shredded diploma makes a passable fluff for moxibustion.

  2. rork says:

    Made me wonder how astrologers are certified.

    1. Harriet Hall says:

      I don’t know about certification, but I do have some inside information about newspaper astrology columns. I met a man who had worked as a newspaper reporter. One day the editor told him the horoscope columnist had quit and assigned him that duty. He wrote the horoscope column for several months, getting ideas from old horoscopes and just making things up. Nobody complained or noticed any difference in quality.

      1. Frederick says:

        WOW, what a dream job, You can insert stupid things in there from time to time, or inside joke you have with you colleagues. Taurus : you are going to experience strange thing, because ALIENS. lol ;-)

      2. James G says:

        I have a story like that: My friend and I worked in newspaper production back when things were printed, cut and physically pasted up for layout. The horoscope text was printed and cut up daily and then the headings for the astrological signs were printed and cut up. My friend asked the person doing the work how she knew which horoscope text went with which astrological sign. The lady doing the paste up just looked at him and smiled.

      3. Seth Katzman says:

        The astrology story illuminates what’s common in SCAMS: the arbitrary nature of the claims and the supposed research backing them up. The most outrageous claims appear most arbitrary, but arbitrariness is just as present in acupuncture theory and practice. Cochrane reviews just disguise it.

  3. Windriven says:

    Every other Friday isn’t often enough.

    For those who haven’t read it, Oryx and Crake describes a dystopia examining, among several themes, genetic engineering gone wrong. Should have won a Booker, IMHO. Best novel I read in 2004. By a wide margin. And I’m not generally a big Atwood fan.

    CIGO! Bullseye!

    “But for some reason the Cochrane group always suggests more studies. At least they did suggest that it may be worthwhile for ankle sprain patients to test on an individual basis whether therapeutic acupuncture is beneficial for them.”

    Yes, and Cochrane is the Talmud of EBM; prima facie evidence of the superiority of SBM where raw sewage is never argued to be tested on an individual basis as an acceptable substitute for beef stew.

    Who knew about cutaneous TB transmission via acupuncture needles??? I can’t wait for our ever-delusional acupuncturist to wave his file of “failed surgery” photos again. I hadn’t know that TB was an issue outside the respiratory tract. The photo of the neck lesion in the PLOS citation is gripping. (Did your acupuncturist fail to clean his needles or did someone fire a shotgun into your neck?) And for those not following the thread closely, SSR recently pooh-poohed the importance of rigorous sterile technique in acupuncture.

    Anyway, thanks for another great one. I’m going to reread Oryx.

    1. irenegoodnight says:

      I could not finish Oryx and Crake and I’m a huge Atwood fan. I’ll have to give it another go.

      1. DevoutCatalyst says:

        I’m a huge fan of listening to interviews of Margaret Atwood. She never fails to correct whoever she’s talking to and she does so in engaging and enlightening ways. She’s super bright. I will listen to Oryx and Crake on audiobook, thanks both for the nudge.

    2. Renate says:

      I need more lives, to read all the books I want to read.

      1. n brownlee says:

        All the Time In the World…

      2. Chris says:

        Dear hubby mentioned last night at dinner that he wanted to see the movie “Groundhog Day” again. He explained that he had been reading a sci-fi novel where the protagonist had the power to jump back thirty years in order to make different choices. One of those is to read different books.

  4. goodnightirene says:

    For an additional $85, you can have your face read via Skype:

    Skype Chinese face map reading for health analysis

    Analyze your five organs energy, toxins and emotional balance through skype

    1. WilliamLawrenceUtridge says:

      Still beats the homeopath who would sell you a CD for your drinking water to listen to.

      1. Jon says:

        Just don’t microwave that water or it’ll make Hitler crystals.

  5. Brian Buchbinder says:

    Every time a quack uses the word “toxin” Jebus waterboards a kitten.

  6. Windriven says:

    Oh, Irene. Please do. I’ll grant you that the first 80 pages or so were a slog. I remember asking myself, ‘is this going somewhere???’ But I am so glad I pushed on.

    This is a broader, and I think more confident, Atwood than is evidenced in some of her earlier work.

    1. Jennifer Beaudry says:

      Make sure you read the additional two books in the series:

      The Year of the Flood
      MadAdam – I actually laughed out loud reading this one

      A fabulous trilogy, great fun to read

      1. Windriven says:

        They’re both on my list but echoing Renate and N Brownlee, there are so many books to read and so little time.

  7. Neil J says:

    I just passed the biomedicine portion of the acupuncture test. I’m a physicist who hasn’t taken biology since high school. This shouldn’t happen.

    1. MTDoc says:

      Congratulations! Sorry, I mean I agree with you. You will never make it in acupuncture, so you need to stick to science. :-)

      1. MTDoc says:

        Damn! I just figured out how you guys make a funny face!

        1. Windriven says:

          Well if you’d asked …

  8. ab says:

    “Set your crotch alight to cure impotence” – that’s in George Carlin’s Book Club, right?

    1. Jon says:

      I was thinking Blue Öyster Cult.

      Burn out the day
      Burn out the night
      I can’t see no reason to put up a fight
      I’m livin for givin the devil his due

      And I’m burnin, I’m burnin, I’m burnin for you
      I’m burnin, I’m burnin, I’m burnin for you

  9. Jon says:

    Of course it’s from Tibet. Mostly because Western audiences are fascinated with Tibet (which goes back to Rudolf Steiner saying Tibet was the Aryan homeland) and Western audiences have never heard of any other Chinese provinces.

  10. Lupe says:

    I was wondering if you ever considered changing the structure
    of your site? Its very well written; I love what youve got to say.
    But maybe you could a little more in the way of content so people
    could connect with it better. Youve got an awful lot of text for only having 1
    or two pictures. Maybe you could space it out better?

    1. n brownlee says:

      That’s one of the many things I appreciate about the site- no frills, and plenty of explanatory text. More pictures would mean LESS content.

      1. WilliamLawrenceUtridge says:

        Really, seriously, do not click on Lupe’s user name. It’s a penis expansion site. I don’t think that Lupe is honestly interested in the page, I think Lupe is a spambot. A pretty sophisticated one, but a spambot none the less.

        1. n brownlee says:

          Thank you. I don’t need my penis expanded.

          1. WilliamLawrenceUtridge says:

            As a man, may I speak for the gender when I say that we all need our penis expanded.

            It’s a guy thing. Penises and tumors, they’re never big enough.

            1. Windriven says:

              Speak for yourself William. Mine’s only about 38cm long, but its as big around as a can of spaghetti-o’s

              Penis reduction surgery. That’s the future!

              1. WilliamLawrenceUtridge says:

                I have a normal-sized penis and am completely comfortable with that fact. Might even be a little smaller than average, I’ve never measured. I make up for my sub-average genitals by having 36-inch biceps and regularly picking fights with drunks in bars. Does wonders for the self-esteem to bludgeon a slobbering drunk with their own shoe.

              2. Bruce says:

                Penis reduction!? I can Reiki that away for you… over Skype or you can just send me a photo. For a small fee obviously.

              3. Windriven says:

                @Bruce

                “over Skype or you can just send me a photo.”

                Let me put you in, ahem, touch with Anthony Weiner. ;-)

              4. Bruce says:

                Or if you prefer I can give you homeopathic acupuncture. It is amazing what you can do with a small prick.

              5. Windriven says:

                “It is amazing what you can do with a small prick.”

                So I’ve been told.

            2. simba says:

              As a member of the weaker sex, may I respond with ‘Hell no,’ and ‘ouch’.

              The only situation where more is invariably better is when you are talking about either bacon or vitamin C. Right? :)

  11. Calli Arcale says:

    It’s not a sophisticated spambot. It’s a run-of-the-mill spambot whose operator has realized a somewhat less obvious way of posting a form reply without any knowledge of the topic under discussion. (Less obvious than the usual vague “wow, this site is great, please write more of this topic” posts, anyway.)

    1. simba says:

      Barnum spambots.

      1. WilliamLawrenceUtridge says:

        Nice one :)

  12. SPL says:

    Sticking a needle in a sprained ankle to fix it–no hole in that logic.

  13. Why is Crislip concerned with TB in a town in China?
    Why is he attempting to link TB and Acupuncture?
    Why did the researchers in China leave out similar procedure that would break the skin; from blood draws, IVs, IM injections, minor procedures or other therapeutic injections?
    The Chinese researchers conclusions were more correlational and not causal.

    Crislip and the Chinese researchers need more evidence to answer these questions, which is probably impossible due to the the social, cultural and financial issues in that little town.

    In my experience with tens of thousand patient encounter and the use of hundred of thousands of needles, I can not relate a single puncture site injection. I have witnessed dozens of intra articular injections infections from office based knee injections in the ER. I have also recorded many accounts of articular injections from many patients in taking past medical histories.

    1. Windriven says:

      God damn it Steven, are you back already?

      “Why did the researchers in China leave out similar procedure that would break the skin; from blood draws, IVs, IM injections, minor procedures or other therapeutic injections?”

      Because phlebotomists use sterile technique.

      1. I see you did not read the article and you are still making assumptions both of which makes a poor scientist. Even an 8th grader would have picked that up.

        1. Windriven says:

          I see you’re back with your usual empty prattle.

      2. MadisonMD says:

        Why did the researchers in China leave out similar procedure that would break the skin; from blood draws, IVs, IM injections, minor procedures or other therapeutic injections?

        They don’t need blood draws, needles, etc. in China, right? They have pulse and tongue reading for diagnosis and needles for treatment.*

        —————-
        *I know the Chinese are smarter than this, but this is the logical conclusion of SSR’s idea that needles work for everything mixed with TCM diagnosis.

  14. WilliamLawrenceUtridge says:

    Why is Crislip concerned with TB in a town in China?
    Why is he attempting to link TB and Acupuncture?

    Because he’s an infectious disease doctor, and acupuncture appears to be associated with the outbreak of cutaneous tuberculosis.

    Do you still consider sterile technique to be unimportant?

    Why did the researchers in China leave out similar procedure that would break the skin; from blood draws, IVs, IM injections, minor procedures or other therapeutic injections?
    The Chinese researchers conclusions were more correlational and not causal.

    One doesn’t conduct a blood draw from the neck. Further, all patients recieved acupuncture twice daily for several weeks (this was a uniting characteristic) and numerous cases were at the site of needling. One might ask – did the authors of the paper discuss possible confounds or how they eliminated non-acupuncture or moxibustion sources of infection? Did you read the source article? And while yes, the results are correlational, not causal, that doesn’t mean no lessons can be learned form this – to whit, the importance of sterile technique, sterile needles and that acupuncture is far from a risk-free treatment.

    Crislip and the Chinese researchers need more evidence to answer these questions, which is probably impossible due to the the social, cultural and financial issues in that little town.

    It sounds like you just want to discount the results because they are personally and financially inconvenient to you.

    In my experience with tens of thousand patient encounter and the use of hundred of thousands of needles, I can not relate a single puncture site injection. I have witnessed dozens of intra articular injections infections from office based knee injections in the ER. I have also recorded many accounts of articular injections from many patients in taking past medical histories.

    Well, in the experience with these researchers and what, 30-odd patients, acupuncture resulted in a disfiguring and dangerous cutaneous infection, which is most easily and readily explained through the germ theory of disease combined with inappropriate sterile technique. As Dr. Crislip says, “If something can cause an infection, it will cause an infection given the right circumstances.” Well, in this case it appears that the infection found the right circumstances – improperly sterilized needles and skin combined with repeated daily penetration of said skin with said needles.

    Few here would argue that this is characteristic of acupuncture, that it is a common outcome. Merely that it is a potential outcome and yet another reason to not employ acupuncture given it’s lack of evidence of efficacy.

    We know you aren’t going to change your mind, but despite your narcissistic belief to the contrary – this blog really isn’t aimed at you personally. Nobody really cares about you beyond the momentary entertainment you provide.

    1. ===
      [In most patients the electrotherapy lasted 10–30 min. All injection materials were disposable. A total of four electrotherapeutic pads were used, without disinfection.
      Therefore, it was speculated that the occurrence of tuberculosis infection might have resulted from the introduction of tubercle bacilli from the electrotherapeutic pads, into soft tissues via small skin wounds. However, culture of samples from the four electrotherapeutic pads appeared negative. Accordingly, it was impossible to determine the source of contamination.] http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0100377

      “Therefore, it was speculated that the occurrence of tuberculosis infection might have resulted from the introduction of tubercle bacilli from the electrotherapeutic pads, “
      This means nothing to you guys?

      “Most patients linked the lesion sites to electrotherapy.”
      Electrotherapy is not Acupuncture or electroacupuncture, so this link is weak.

      “All injection materials were disposable. “ meaning single use (i would hope).
      “4 pad were not disinfected” — How does this factor into the case?
      “Accordingly, it was impossible to determine the source of contamination.”
      I would say impossible too and irrelevant to the practice of medicine in the US!

      “Well, in the experience with these researchers and what, 30-odd patients, acupuncture resulted in a disfiguring and dangerous cutaneous infection,”
      That was not their conclusion. This must be your extrapolation, which is invalid.

      “which is most easily and readily explained through the germ theory of disease combined with inappropriate sterile technique.”
      Where did this come from??? This is a theory based on an assumption.

      As Dr. Crislip says, “If something can cause an infection, it will cause an infection given the right circumstances.”
      True, we see this in hospitals all over the US.

      “improperly sterilized needles and skin combined with repeated daily penetration of said skin with said needles.”
      Where did you get this from? The needles were sterile and the pads were not.

      “Few here would argue that this is characteristic of acupuncture, that it is a common outcome.”
      This article is in no way linking the tb and needle use. If you all think this is a characteristic of acupuncture, please keep your options to yourselves and make it clear that they are your opinions. I would hope that you would not want your opinions to do harm by negatively influencing a potential miserable pain patient.

      “Merely that it is a potential outcome and yet another reason to not employ acupuncture given it’s lack of evidence of efficacy.”
      Yes we know your and this gang are cynical and biased towards ALL alternative.

      We know you aren’t going to change your mind”
      Actually I have changed my mind from Acupuncture ignorance which is where you are to enlightenment of what is reasonably true in medicine? Needles are indispensable to my practice and many other providers who are enlightened. How else would I even began to help these patient, another failed back case. I get a few per month.
      https://www.dropbox.com/s/8yhk6nnwc51ef1f/failed%20back%20female%20late%2060s.%202014-07-08%2010.15.04.jpg

      “this blog really isn’t aimed at you personally. “Nobody really cares”
      This I find sad and a waste, that you do not care to know or grow.

      “entertainment” you provide.
      This is all this site is all about, Crislip post an article and the rest of you feed off of the consenscious without the appropriate investigatory analysis.

      1. WilliamLawrenceUtridge says:

        “Therefore, it was speculated that the occurrence of tuberculosis infection might have resulted from the introduction of tubercle bacilli from the electrotherapeutic pads, “
        This means nothing to you guys?

        To me it means “the patients probably got tuberculosis from the electrotherapeutic pads”, what with the bold part of the sentence.

        “All injection materials were disposable. “ meaning single use (i would hope).
        “4 pad were not disinfected” — How does this factor into the case?

        Um… it doesn’t sound like it. It sounds like the patients spread tuberculosis from the pads, got horrible, ulcerating skin infections, then the pads got disinfected.

        “Accordingly, it was impossible to determine the source of contamination.”
        I would say impossible too and irrelevant to the practice of medicine in the US!

        Not the way you do it – a patient has tuberculosis on their skin, you don’t sanitize the skin surface before needling, and boom – subcutaneous tuberculosis. Seriously, just a little alcohol on the needling site before you undertake your useless therapy. What’s the harm?

        “Well, in the experience with these researchers and what, 30-odd patients, acupuncture resulted in a disfiguring and dangerous cutaneous infection,”
        That was not their conclusion. This must be your extrapolation, which is invalid

        Actually, it’s really in the experience of these 30 patients, who all got acupuncture, then got massive, oozing wounds right in the area where they were needled. You keep saying clinical experience is a valid source of information – well, in the authors’ of the paper’s clinical experience, these patients got fist-sized holes infected into them because of acupuncture. So nyah.

        Where did this come from??? This is a theory based on an assumption.

        Yeah, and my assumptions about where subcutaneous tuberculosis immediately deep to the site of acupuncture needling makes a lot of sense within the context of anatomy, physiology, infectious disease and sterile technique – your assumption that acupuncture can magically heal nigh-everything, does not.

        As Dr. Crislip says, “If something can cause an infection, it will cause an infection given the right circumstances.”
        True, we see this in hospitals all over the US.

        Yes, and apparently in China. The difference being, in most hospitals the infections come from having surgery or other skin-penetrating circumstances that actually have proof of efficacy. Unlike acupuncture, which is a placebo.

        This article is in no way linking the tb and needle use.

        What was the title of the article again? Oh yeah – “Analysis of 30 Patients with Acupuncture-Induced Primary Inoculation Tuberculosis“. But no, it’s totally not about how acupuncture caused TB.

        If you all think this is a characteristic of acupuncture, please keep your options to yourselves and make it clear that they are your opinions. I would hope that you would not want your opinions to do harm by negatively influencing a potential miserable pain patient.

        I’d rather you didn’t give your customers subcutaneous TB that leaves them with massive disfiguring scars, but I guess you can’t always get what you want.

        Yes we know your and this gang are cynical and biased towards ALL alternative.

        Yes, that’s because assholes sell alternative medicine directly to the public without disclosing its potential harms, and without proof of efficacy. There’s a reason why I and others here are cynical about alternative medicine – nearly all of it directly contradicts what is known of anatomy, physiology and biology, and in the rare case where a CAM proponent actually does research on it, they generally do it so badly it’s a complete waste of time.

        Actually I have changed my mind from Acupuncture ignorance which is where you are to enlightenment of what is reasonably true in medicine? Needles are indispensable to my practice and many other providers who are enlightened. How else would I even began to help these patient, another failed back case. I get a few per month.

        1) What research base supports your intervention?

        2) How many come back weeks or months later with unresolved back pain?

        3) How many don’t come back because your therapy didn’t help them at all?

        This I find sad and a waste, that you do not care to know or grow.

        All I want is reasonable evidence that your claims of efficacy are based on an empirical foundation other than clinical experience and anecdotes. Why do you find this so offensive? Is it because you can’t prove anything beyond anecdotes?

        This is all this site is all about, Crislip post an article and the rest of you feed off of the consenscious without the appropriate investigatory analysis.

        Yeah…I keep asking for the evidence for me to investigate. On a good day you’ll drop in a single shoddy review article, on a bad day you’ll dump several dozen irrelevant articles, and most days you just repeat yourself.

        It was unconvincing the first time, it’s not going to be convincing the second or thirty-second. Get some new material.

        1. The original article is correlational at best and Crislip’s article is more sensational or entertainment than scientific.

          Just remember Acupuncture is the use of a stainless steel surgical instrument within established protocols. The protocols can be from ancient Chinese, French Energetic, GunnIMS, Travell/Simons or Prolo.

          You will come the same conclusions as millions of others who have used and are using this instrument once you review ALL the data, not just the bits and pieces Crislip or INgraham gives you.

          BTW, Why are you speaking and defending Crislip anyway, it is his article?

          1. WilliamLawrenceUtridge says:

            The original article is correlational at best and Crislip’s article is more sensational or entertainment than scientific.

            I’m sure Dr. Crislip will be happy to hear that he struck the appropriate note. The article may be correlational, but do you seriously deny that deeply penetrating unsanitized skin with needles that are twisted and manipulated can’t spread cutaneous tuberculosis? On what basis do you make this claim? To what would you attribute this cluster of an extremely rare condition? What’s your alternative explanation? Because it seems like when the study summary is “all these people who all got acupuncture from the same place then all developed the same condition”, it’s pretty reasonable to concede that acupuncture might have something to do with it.

            Just remember Acupuncture is the use of a stainless steel surgical instrument within established protocols. The protocols can be from ancient Chinese, French Energetic, GunnIMS, Travell/Simons or Prolo.

            Just remember, stainless steel needles couldn’t be manufactured until the 17th century, and the Chinese didn’t use them. Just remember, French “Energetic” acupuncture is based on one guy making up a homunculous, projecting it over the ear, and then failing to test his theory. Just remember, Gunn, Travell, Simons and prolotherapy are all unproven approaches aimed at musculoskeletal conditions, which has zero in common with the original and French beliefs that acupuncture was a disease-modifying treatment not intended merely to relieve muscle pain. Just remember that all of these protocols are mutually-contradictory, unproven, and it doesn’t matter where you put the needles.

            You will come the same conclusions as millions of others who have used and are using this instrument once you review ALL the data, not just the bits and pieces Crislip or INgraham gives you.

            Actually, Dr. Crislip and Paul would probably defer to comprehensive systematic reviews, or failing that – large, well-controlled trials. These reviews find that acupuncture does not work for anything but pain and nausea, and even in these modalities, there is no evidence it works better than placebo.

            BTW, Why are you speaking and defending Crislip anyway, it is his article?

            I enjoy shooting people down on the internet. I can’t speak for Dr. Crislip, but I would assume he is extremely busy with his growing multi-media empire as well as his day job as the head of an infectious disease department. In addition, despite your pretensions of fearsome majesty and taut, rippling, manly argumentative stylings, you’re actually pretty boring and repetitive, with no real exposure beyond blog comments. I would venture a guess that you’re beneath his notice.

            1. Windriven says:

              ” I would venture a guess that you’re beneath his notice.”

              To say nothing of his contempt.

          2. Windriven says:

            “Just remember Acupuncture is the use of a stainless steel surgical instrument within established protocols.”

            So what? Absent the (oooooohhhhh) stainless steel pretend surgical instruments (since when is acupuncture surgery, dumbass? And apparently sterile technique is not even part of the acupuncture “protocol”. Very surgical, if you’re playing with the Hasbro toy. ) the “protocol” is make believe – like masturbating while looking at a Christina Aguillera poster. And the likelihood of acupuncture accomplishing anything clinically useful is only slightly more probable than you scoring a night with the aforementioned babe.

            “You will come the same conclusions as millions of others who have used and are using this instrument”

            Oh bullcrap. There are 27,835 licensed acupuncturists in the US as of 2013. Even if you imagine 10 times more in the rest of the world that is about 307,000. That isn’t even 1/3 of a million.

            You want anyone here to come to the same conclusion, offer up some meaningful scientific evidence. Your constant drone of idiotic, meaningless, repetitive anecdotes don’t mean squat and they won’t mean squat if you repeat them “millions” of times.

            “BTW, Why are you speaking and defending Crislip anyway”

            Because Crislip has a history of well thought out and well presented arguments – including this one. You, on the other hand, have a record similar to that of Mr. Ed.

            1. Windriven says:

              BTW, as an indirect measure of the American mind I’ll note that Mr. Ed ran for 5 1/2 years and 143 episodes were made. That is one long run for a one trick pony ;-)

            2. WilliamLawrenceUtridge says:

              like masturbating while looking at a Christina Aguillera poster

              Um…you can actually masturbate while looking at a Christina Aguillera poster. I have a friend…who told me about it. Really awkward conversation. Flogging the dolphin to Xtina is far more real than acupuncture.

              1. Windriven says:

                I was going for the difference between fantasizing about boning someone with actually doing the deed.

                I suppose one could masturbate to a poster of Olive Oyl – and that would still make more sense than anything I’ve heard from Steve.

              2. WilliamLawrenceUtridge says:

                Rule 34, one could easily masturbate to a poster of Olive Oyl.

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