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Acupuncture CME

Some Universities have more cachet than others. On the West coast it is Stanford that has the reputation as the best. There is Oxford, Yale, MIT, and maybe Whatsamatta U. I would wager that in most people’s mind the crème de la crème is Harvard. Harvard is where you find the best of the best. If Harvard is involved, a project gains an extra gobbet of credibility. Brigham and Women’s Hospital also has a similar reputation in the US as one of the hospitals associated with only Harvard and the New England Journal of Medicine. Premier university, premier hospital, premier journal.

So if Brigham and Women’s Hospital and Harvard Medical School are offering continuing medical information (CME) for acupuncture, there must be something to it, right? A course called “Structural Acupuncture for Physicians” must have some validity.

Brigham and Women’s Hospital, which is a teaching affiliate of Harvard Medical School, includes the Oscher Clinical Center for Complementary and Integrative Medical Therapies. The Oscher center offers acupuncture, yoga, chiropractic and a variety of other modalities including craniosacral therapy.

There are few things, in a world of alternative nonsense, as nonsensical as craniosacral therapy .

A craniosacral therapy session involves the therapist placing their hands on the patient, which they say allows them to tune into what they call the craniosacral system. The practitioner gently works with the spine and the skull and its cranial sutures, diaphragms, and fascia. In this way, the restrictions of nerve passages are said to be eased, the movement of cerebrospinal fluid through the spinal cord is said to be optimized, and misaligned bones are said to be restored to their proper position.

Cranial Sacral therapists think they can improve the flow of spinal fluid flow by gently massaging the skull. Really. I can’t make this stuff up. I operate under the assumption that you can judge a person by the company they keep, although guilt by association is problematic in medical institutions. Programs are often started in hospitals for financial reasons without the benefit of scientific or medical input. It is one of the many prices we pay in the US for a for-profit medical system. But if there is a institution whose scientific standards are such that they allow craniosacral therapy, well, they lose a major chunk of credibility. As the saying goes, you lie down with pigs, you come up smellin’ like garbage.

On the other hand, it would be much easier to participate on committee work. The Pharmacy and Therapeutics committees in which I participate spends significant time evaluating the literature to decide how best to utilize new drugs and therapies. If only we offered craniosacral therapy: I would never have to justify a treatment based on science and reality again. So now I realize, sadly, that Brigham and Women’s and, by extension Harvard, has questionable scientific standards, or, if they have standards, they apply them selectively.

The brochure states

This unique course provides practical, hands-on training in acupuncture. The training program is designed to bring together Eastern and Western views of health and disease into a result-oriented acupuncture style. You will learn to evaluate and treat patients using modern Japanese acupuncture techniques that link classical Chinese theory to concrete, understandable clinical diagnostic and treatment techniques.

Whenever I hear about the Eastern views of health and disease I always think of General Westmoreland in the movie “Hearts and Minds.” I know, cheap shot. But an Eastern heart attack is different from a Western heart attack how?

What, I wonder, is a “result-oriented acupuncture style.” Since acupuncture has little, if any, efficacy, it cannot have therapeutic results. Maybe the key word is style. There is style and there is substance. I suppose they could be suggesting that the acupuncture they are teaching will only look like it is working?

Style probably refers to the type of acupuncture, as in Kiiko Style acupuncture. Like the kung fu movies I watched as a teen, there are various acupuncture styles that need to compete in a winner take alltournament, to determine once and for all whose acupuncture is strongest.

Modern Japanese acupuncture differs from Chinese acupuncture in that they use finer needles that are not placed as deeply. Japanese acupuncture does seem to share one feature with Chinese acupuncture, at least to judge from the videos of the procedure I can find searching YouTube: a complete lack of understanding of sterile technique. I you want to get the willies watch a video on acupuncture, Japanese or otherwise. Barehanded, no hand washing, the practitioner touches the area to be pierced, no alcohol wipe is used, and the junction of needle/skin is manipulated. The Kiiko style, to judge from the photographs on the website, does not include gloves. These videos should be entitled “How to transmit infectious diseases.”

I assume they will use sterile technique at the course, since “emphasis is given to “hands-on” point location and needling techniques based upon palpatory feedback” although one cannot be sanguine in regards to a hospital system that uses craniosacral therapy. Germ theory is, after all, just a theory.

The didactic portion of the course will focus on bridging the gap between acupuncture practice and science. The scientific basis of acupuncture and the methodological problems with acupuncture research is presented as part of the discussion of specific clinical conditions throughout the course.

That will be an interesting discussion. Since the acupuncture literature, as discussed at length on this blog, is such that the best studies show no effect and the science is only barely applicable to acupuncture and pain treatment, it would be fun to be a fly on the wall and see how they ‘bridge the gap” for the justification of the covered uses: Pain Control, Hormonal Imbalances, OB/GYN Problems, GI Disorders, Scar Treatments, Structural and Orthopedic Problems, Cardiac and Vascular Disorders, Autoimmune and Autonomic Disorders, Mood Disorders, Myofascial and Neuroanatomic Treatment.

Not only will they be teaching Japanese acupuncture and classic Chinese acupuncture, but also auricular acupuncture and the German Microsystem approach (MAPS: Mikro-Aku-Punkt-Systeme). That last one

… is based on the Somatotopic fields comprising of specific points of correspondence in the Auricle (Ear), Scalp, Oral Cavity etc. A micro system is like a Map of the body — somatotope or a cartography of the whole organism similar to the homunculus discovered in the sensory motor cortex of the brain. Each of the Micro system points have a clearly defined correlation to and interrelation with a particular organ or function…For Example EAR Acupuncture is one such Micro-system. It was discovered by the french doctor Nogier who decoded the functional correspondences of the respective ear points. The punctual cartography of the Ear resembles an upside down embryo.

MAPS is apparently the result of the unholy mating of acupuncture and phrenology.

I am surprised they did not include Korean Hand Acupuncture, foot acupuncture and tongue acupuncture. They are leaving out three key styles of acupuncture. One wonders how six styles of acupuncture can all be valid, share similar physiology, and be supported by the same science, given their differences. I suppose it is like asking which is the valid style of astrology: Indian, Western, or Mayan. It is a trick question. They are all nonsense.

The best constructed study to date on acupuncture demonstrated that sham acupuncture by twirling toothpicks on the skin is arguably more effective and definitely has fewer side effects when compared to ‘real’ acupuncture. I can use quotes with the best of them. I wonder it they will pass out a box of toothpicks. Since twirling toothpicksgives similar results with fewer complications, one wonders how they justify teaching acupuncture styles that are less efficacious and more dangerous than toothpicks. Can you ethically offer an equivalent therapy with more side effects than a known competitor?

Let’s see, cost of the class: $6650. For that kind of cash, who needs ethics? That’s right, if you are a Harvard-affiliated hospital you can charge the cost of two loaded, top-of-the-line MacBook Pros to teach magic. I bet they get it. “Harvard-trained acupuncturist” would look great on a business card and provide instant credibility. A quick google finds practitioners whose websites mention the Harvard course for their training. Premium price for premium nonsense.

I am only disappointed they did not charge ten dollars more. $6660. Now there’s a number.

As the web page for the Oscler center says

The market for complementary and integrative medicine is vast and shows no sign of diminishing. This trend must be guided by scientific inquiry, clinical judgment, regulatory authority, and shared decision-making. – Dr. David Eisenberg.

The market. Not the need. The market. It is depressing when good institutions promote worthless nonsense.

Next time I read the NEJM and see an article from Harvard or Brigham and Women’s, I will not be as accepting of the result as I was in the past. They have lost some of their credibility with me. It is sad. Great institutions can have feet of clay. At least there are still institutions you can believe in. Mom. Apple Pie. Baseball. Go Barry Bonds.

Posted in: Medical Academia, Science and Medicine

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