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Archive for Acupuncture

“Non-pharmacological treatments for pain” ≠ CAM, no matter how much NCCIH wishes it so

NCCIH #TalkPain

I’ve had the Monday spot on this blog for quite a long time now. While there are many advantages to posting on Monday, not the least of which is having more time to put a post together (although that is also a disadvantage because it incentivizes my taking more time than I sometimes should), one distinct disadvantage is that all the Monday holidays are mine. That leaves me a choice on, for example, Memorial Day and Labor Day every year. It’s a choice with three options: The first is: Don’t post. (Do stop laughing, please. I know it’s me.) The second is: Use a guest post. I thought about this, and there are guest posts in the pipeline, but I don’t like to use a guest post just because I’m feeling lazy. It strikes me as an abuse of being the managing editor. Finally, I could post, which is what I decided to do.

I mainly decided to do a post because late last week there was something to blog about that was pretty important and interesting, courtesy of the National Center for Complementary and Integrative Health (NCCIH), which was formerly known as the National Center for Complementary and Alternative Medicine (NCCAM). Basically, on September 1, the NCCIH published a press release, “Review Examines Clinical Trial Evidence on Complementary Approaches for Five Painful Conditions.” Elsewhere, NCCIH Lead Epidemiologist and first author of the review, Richard Nahin, PhD, MPH, bragged on the NCCIH blog, “New Review Offers Providers and Researchers Evidence-Based Information on Complementary Health Approaches for Pain.” It didn’t take long for headlines to start appearing that said things like:
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Posted in: Acupuncture, Clinical Trials, Medical Academia, Politics and Regulation

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Nada for NADA: “acudetox” not effective in addiction treatment

NADA auricular acupuncture
The National Acupuncture Detoxification Association (NADA) teaches and promotes a standardized auricular acupuncture protocol, sometimes called “acudetox.” NADA claims acudetox

encourages community wellness . . . for behavioral health, including addictions, mental health, and disaster & emotional trauma.

I do not know what “community wellness” is or how one measures whether wellness has been successfully “encouraged.” In any event, in the NADA protocol, acupuncture needles are inserted bilaterally into the auricle (outer portion) of the ear at a depth of 1-3 mm at five specific points (sympathetic, shen men, lung, liver, and kidney) and left in place for 45 minutes.

And:

Beyond the actual needling treatment, a key element of the protocol specifies qualities of behavior and attitude on the part of the clinician, consistent with what is known as the Spirit of NADA.

NADA claims there is

strong evidence for the effect of the NADA protocol in improving patient outcomes [in addiction treatment] in terms of program retention, reductions in cravings, anxiety, sleep disturbance and need for pharmaceuticals.

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Posted in: Acupuncture, Clinical Trials, Legal, Politics and Regulation

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An Unexpected Miscellany of Medical Malarkey

kidcupping

 

I had originally intended a focused discussion of a single topic, but life circumstances have conspired to prevent me from doing so.  In the place of my intended post, please enjoy the following collection of hastily assembled pseudomedical odds and ends brought to my attention over the past few weeks. (more…)

Posted in: Acupuncture, Science and Medicine

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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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