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CARA: Integrating even more pseudoscience into veterans’ healthcare

VA logo
The pixels were barely dry on David Gorski’s lament over the expansive integration of pseudoscience into the care of veterans when President Obama signed legislation that will exacerbate this very problem. The “Comprehensive Addiction and Recovery Act of 2016” (“CARA”) contains provisions that will undoubtedly keep Tracy Gaudet, MD, and her merry band of integrative medicine aficionados at the VA busy for the next few years integrating even more quackery into veterans’ medical care.

CARA is intended to address the serious prescription drug abuse problem in the U.S. It provides grants for local communities dealing with drug abuse crises and for drug abuse programs, improves access to overdose reversal medication and medication-assisted treatment for drug addiction, and assists in training first responders, among other things. It also includes provisions related to pain management, such as development of best practices to treat pain. None of that is the problem.

Deep in the Act, almost at the end, is “Subtitle C – Complementary and Integrative Health,” which begins with “Expansion of research and education on and delivery of complementary and integrative health to veterans.” I am not sure who stuck this into the new law, but it is only tangentially related to addiction and recovery. It establishes the “Creating Options for Veterans’ Expedited Recovery” Commission or, in the acronym-rich language of government, “COVER.” (more…)

Posted in: Acupuncture, Clinical Trials, Politics and Regulation

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On the pointlessness of acupuncture in the emergency room…or anywhere else

"This patient's qi isn't flowing the way it should. Consult Acupuncture, STAT!!"

“This patient’s qi isn’t flowing the way it should. Consult Acupuncture, STAT!!”

Sometimes there is a strange confluence of events that dictate what I feel that I need to write about when my turn here at SBM rolls around each Monday. Last week, a reader sent me a rather bizarre acupuncture study, and I thought I might write about that. Then I saw Mark Crislip’s (as usual) excellent deconstruction of the frequent claim by acupuncture apologists that acupuncture “works” by releasing endorphins and thought, “Maybe another topic.” But then, over the weekend, the Friends of Science in Medicine sent me a link to their latest article, a review of acupuncture entitled “Is there any place for acupuncture in 21st century medical practice?” Not surprisingly, the FSM (Friends of Science in Medicine, not the Flying Spaghetti Monster) concludes that the answer is no. However, in stark contrast to that conclusions are studies like the one mentioned above, studies so ridiculous that, when I discuss it, you will hardly believe that anyone thought it was a good idea to utilize the money, time, and precious, precious human subjects to answer such a ridiculous question. After that discussion, I’ll come back to the FSM’s statement and discuss the evidence base (or rather, lack thereof) for acupuncture for pretty much anything.
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Posted in: Acupuncture, Clinical Trials

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Acupuncture and Endorphins: Not all that Impressive

Acupuncture needling

Pictured: A great way to get a staph infection, not a great way to get an endorphin rush.  Try jogging.  Or heroin.*

I was reading, and deconstructing, a particularly awful bit of advice for acupuncture by Consumer Reports. It was the same old same old, but it was the source that made it particularly awful. I expect more from Consumer Reports than the uncritical regurgitation of the standard mythical acupuncture narrative. The report included the quote

One possible reason for the benefits of acupuncture: Studies show that it causes us to release feel-good hormones, called endorphins, that suppress pain.

I have never bothered to go back and see what the original literature was to support endorphins as a potential mechanism for a beneficial effect of acupuncture on pain.

That endorphins are released as a result of a noxious stimulus didn’t surprise me; that is what endorphins are for. And endorphins are unlikely to be the mechanism for all the other diseases for which the WHO suggests acupuncture benefits.

To my surprise, my brief search that day came up with very little information on the endorphins and acupuncture.

What I wanted to know was the evidence behind the universal meme that acupuncture releases feel-good hormones. If Consumer Reports says it is so, it must be true, right? So I plugged ‘acupuncture endorphin’ into PubMed and went to work. (more…)

Posted in: Acupuncture, Basic Science, Clinical Trials, Traditional Chinese Medicine

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Legislative Alchemy 2016 Update: Acupuncturists win; naturopaths and chiropractors don’t (so far)

Legislative Alchemy

Legislative Alchemy

Legislative Alchemy is the process by which state legislatures transform pseudoscience and quackery into licensed health care practices. By legislative fiat, chiropractors can detect and correct non-existent subluxations, naturopaths can diagnose (with bogus tests) and treat (with useless dietary supplements and homeopathy) fabricated diseases like “adrenal fatigue” and “chronic yeast overgrowth,” and acupuncturists can unblock mythical impediments to the equally mythical “qi” by sticking people with needles. In sum, by passing chiropractic, naturopathic, acupuncture, and Traditional Chinese Medicine (TCM) practice acts, states license what are essentially fraudulent health care practices and give them an undeserved imprimatur of legitimacy.

Only 6 of the 50 state legislatures are in regular session now. Many have ended two-year (2015-2016) consecutive sessions in which legislation from one year carries over into the next. The Texas, Montana, and North Dakota legislatures didn’t meet at all in 2016.

During 2015-2016, over a dozen naturopathic licensing or registration bills and at least 15 naturopathic practice expansion bills were introduced. (In some states, companion bills were introduced in each house. These were counted as one bill.) At least 19 chiropractic practice expansion bills were introduced in the same period. Four acupuncture/TCM practice acts were introduced, as were 14 practice expansion bills. This count does not include bills trying to force public and private insurers to cover CAM practitioner services.

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Posted in: Acupuncture, Chiropractic, Legal, Naturopathy, Politics and Regulation

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“Complementary and Integrative Health” at the VA: Integrating pseudoscience into the care of veterans

BattlefieldAcupuncture

I was originally going to write this post for the 4th of July, given the subject matter. However, as regular readers know, I am not unlike Dug the Dog in the movie Up, with new topics that float past me in my social media and blog reading rounds serving as the squirrel. Then I got a copy of the movie VAXXED to review last week, and before I knew it this post had been delayed two weeks. Never let it be said, though, that I don’t circle back to topics that interest med. (Wait, strike that. Sometimes, that actually does happen. It just didn’t happen this time.) This time around, I will be using documents forwarded to me by a reader as a means of revisiting a discussion that dates back to the early days of this blog, before discussing the broader problem, which is the infiltration of pseudoscientific “complementary and alternative medicine” (CAM) into VA medical centers.

The return of the revenge of “battlefield acupuncture”

Today’s topic is the Veterans Health Administration (VHA) and its embrace of pseudoscience. VA Medical Centers (VAMCs) provide care for over 8 million veterans, ranging from the dwindling number of World War II and Korean War veterans to soldiers coming home now from our wars in Iraq and Afghanistan. Although there have been problems over the years with VAMCs and the quality of care they provide, including a recent scandal over hiding veterans’ inability to get timely doctor’s appointments at VAMCs, a concerted effort to improve that quality of care over the last couple of decades has yielded fruit so that today the quality of care in VA facilities compares favorably to the private sector. Unfortunately, like the private sector, the VA is also embracing alternative medicine in the form of CAM, or, as its proponents like to call it these days, “integrative medicine,” in order to put a happy label on the “integration” of pseudoscience and quackery with conventional medicine.
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Posted in: Acupuncture, Naturopathy, Politics and Regulation, Traditional Chinese Medicine

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Robotically-Assisted Acupuncture Brings Ancient Healing Technique Into the 21st Century

An acupuncturist and acupuncture anesthetist perform robotically-assisted acupuncture on a patient who has been feeling kind of tired lately

An acupuncturist and acupuncture anesthetist perform robotically-assisted acupuncture on a patient who has been feeling kind of tired lately

Developed over many thousands of years (or maybe a little less), what has come to be known as traditional Chinese acupuncture has proven capable of curing or at least ameliorating the symptoms of a variety of medical conditions. But one of its greatest strengths, the intimate connection between the practitioner and the acupuncture needle, is also one of its most significant weaknesses. Taking advantage of the robotic technology being used by surgeons to perform an increasing number of minimally-invasive procedures, cutting edge acupuncture providers are now able to provide relief for patients that were once felt to be either poor candidates or had failed to improve despite treatments with traditional acupuncture by hand. (more…)

Posted in: Acupuncture, Humor

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About Herbs: an app to avoid

Pictured: A better source of health information than "About Herbs".

Pictured: A better source of health information than “About Herbs”.

Medicine has an intellectual hierarchy. Supposedly the best and the brightest are in the academic medical centers and are the thought leaders in their field.

Those of us lower in the hierarchy are well aware of some of the warts present on our betters, but I would expect those at the top would adhere to the highest intellectual and ethical standards. People being, well, people, expecting exceptional standards is admittedly an unrealistic expectation.

It would appear that many academic centers are doing their best to avoid meeting my expectations, attempting to abandon all standards.

I mentioned over at SfSBM that Dana-Farber is spending 2 million dollars on a renovation to, in part, offer the unmitigated steer manure that is reiki and reflexology to their cancer patients. Yes. Reiki. Reflexology.

Those are not fracking earthquakes in Kentucky, those tremors are the result of the tremendous kinetic energy of Flexner spinning in his grave as his life’s work becomes a farce.

Dana-Farber is just one of many academic medical centers who are putting their imprimatur on nonsense.

Memorial Sloan Kettering Cancer Integrative has released “About Herbs”, an iPad/iPhone guide to Botanicals, Supplements, Complementary Therapies and More. Spoiler alert: the ‘More’ does not include critical thinking. This guide is not anywhere as ludicrous as offering reeky, sorry, reiki, but at times it comes close. (more…)

Posted in: Acupuncture, Commentary, Critical Thinking, Herbs & Supplements, Homeopathy, Traditional Chinese Medicine

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Bye Bye Bravewell

Bravewell Collaborative

Exactly one year ago tomorrow, The Bravewell Collaborative shut down, an event so momentous that few seem to have noticed. It’s been a while since we at SBM devoted much attention to Bravewell, although, at one time, its doings were a regular feature of SBM posts.

For those of you not familiar with Bravewell, a brief history. The main mover and shaker behind The Bravewell Collaborative was Christy Mack, wife of former Morgan Stanley head John Mack and a financier of sorts in her own right. She and the widow of another Morgan Stanley bigwig, Susan Karches, neither of whom had any particular expertise in finance, managed to get about $220 million in bailout funds from the Federal Reserve, a boondoggle recounted in Matt Taibbi’s 2011 hilarious Rolling Stone article, “The Real Housewives of Wall St.” Ms. Mack had established the Bravewell Collaborative a few years earlier, with her own contributions and that of other philanthropists, as a private operating foundation, a further opportunity to benefit from government largesse in the form of tax deductions.

Here’s Bravewell’s definition of “integrative medicine”:

Integrative medicine is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s health. Employing a personalized strategy that considers the patient’s unique conditions, needs and circumstances, integrative medicine uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimal health.

(more…)

Posted in: Acupuncture, Chiropractic, Energy Medicine, Homeopathy, Medical Academia, Naturopathy

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The Primo Vascular System: The N-rays of Acupuncture?

Is this a PVS structure or something else?

Is this a PVS structure or something else?

Acupuncture meridians and acupoints are imaginary until proven otherwise. Anatomists have never been able to detect them by microscopy or autopsy, and they are not mentioned in anatomy textbooks. For decades, acupuncturists have been trying to prove that their pre-scientific belief system is grounded in scientific reality. Now they are telling us that acupuncture meridians and acupoints have been discovered in the form of the Primo vascular system (PVS). A typical website trumpets “Science Finally Proves Meridians Exist.”

The available information is confusing.

Primo vessels were supposedly missed by anatomists because they are so small. They are reported to only be visible by electron microscopy, yet researchers have used dye to show them under a regular microscope. There has been speculation about their involvement in cancer metastasis: one paper provides images of a putative PVS cancer metastasis thread afloat in a lymph duct.  PVS vessels are said to be too tiny to study by the usual methods of science, but some researchers say they have somehow learned that they are characterized by high resistance and low capacitance. They are allegedly studded with electrically charged nodes that attract nutrients, oxygen, and regulatory hormones. They allegedly transmit energy to organs and integrate the features of the cardiovascular, nervous, immune, and hormonal systems and serve as the physical substrate for acupuncture points and meridians. (more…)

Posted in: Acupuncture, Basic Science

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Dry Needling

Pictured: The difference between the acupunctures and dry needling.

Pictured: The difference between the acupunctures and dry needling.

War, huh, yeah
What is it good for
Absolutely nothing
Uh-huh huh
War, huh, yeah
What is it good for
Absolutely nothing
Say it again, y’all
War, huh,
What is it good for
Absolutely nothing
Listen to me
Ohhh, war, I despise
Cause it means destruction
Of innocent lives
War means tears
To thousands of mothers eyes
When their sons go to fight
And lose their lives
Ooh, war, huh
Good God, y’all
What is it good for
Absolutely nothing
Say it again
War, whoa,
What is it good for
Absolutely nothing
Listen to me
War, it ain’t nothing
But a heartbreaker
Friends only to the undertaker
Ooooh, war
It’s an enemy to all mankind
The point of war blows my mind
War has caused unrest
Within the younger generation
Induction then destruction
Who wants to die
Aaaaah, war-huh
Good God y’all
What is it good for
Absolutely nothing
Say it again
War, huh
What is it good for
Absolutely nothing
Listen to me
War, huh, yeah
What is it good for
Absolutely nothing
Come on, let me hear ya
War, it ain’t nothing but a heartbreaker
It’s got one friend
That’s the undertaker
War has shattered
Many a young man’s dreams
Made him disabled, bitter and mean
Life is much to short and precious
To spend fighting wars these days
War can’t give life
It can only take it away
Ooooh, war, huh
Ooh yeah
What is it good for
Absolutely nothing
Say it again, y’all
War, whoa,
What is it good for
Absolutely nothing
Come on, sing it
War, whoa,
Come on and shout it, y’all
What is it good for
Absolutely nothing
Come on, come on now
It ain’t nothing but a heartbreaker
Friends only to the undertaker
Peace, love and understanding
Is there no place for them today
They say we must fight to keep our freedom
But Lord knows there’s got to be a better way
Ooooooh, war, huh
Good God y’all
What is it good for
absolutely nothing
Say it again, y’all
War, huh
What is it good for
Absolutely nothing
Say it again, y’all
What is it good for
Absolutely nothing

Edwin Starr

I’m convinced. War is bad. But I have a solution. To the 54 current armed conflicts in the world: forget about it. Then no shots will be fired and no one will be injured or killed. It’s that easy. Problem identified, problem sol-ved. Go Science and Big ‘S’ Skepticism. Any complaints about my solution aren’t worth responding to.

Now that the problem of war is settled, let’s move on to dry needling. (more…)

Posted in: Acupuncture

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