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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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Acupuncture does not work for menopause: A tale of two acupuncture studies

Women looking for relief from hot flashes will be disappointed if they think acupuncture will help them.

Women looking for relief from hot flashes will be disappointed if they think acupuncture will help them.

Arguably, one of the most popular forms of so-called “complementary and alternative medicine” (CAM) being “integrated” with real medicine by those who label their specialty “integrative medicine” is acupuncture. It’s particularly popular in academic medical centers as a subject of what I like to refer to as “quackademic medicine“; that is, the study of pseudoscience and quackery as though it were real medicine. Consider this. It’s very difficult to find academic medical centers that will proclaim that they offer, for example, The One Quackery To Rule Them All (homeopathy). True, a lot of integrative medicine programs at academic medical centers do offer homeopathy. They just don’t do it directly or mention it on their websites. Instead, they offer naturopathy, and, as I’ve discussed several times, homeopathy is an integral—nay, required—part of naturopathy. (After graduation from naturopathy school, freshly minted naturopaths are even tested on homeopathy when they take the NPLEX, the naturopathic licensing examination.) Personally, I find this unwillingness of academic medical centers that offer naturopathy to admit to offering homeopathy somewhat promising, as it tells me that even at quackademic medical centers there are still CAM modalities too quacky for them to want to be openly associated with. That optimism rapidly fades when I contemplate what a hodge-podge of quackery naturopathy is and how many academic integrative medicine programs offer it.

If you believe acupuncturists, acupuncture can be used to treat almost anything. Anyone with a reasonable grasp of critical thinking should recognize that a claim that an intervention, whatever it is, can treat many unrelated disorders is a huge red flag that that intervention is almost certainly not science-based and is probably quackery. So it is with acupuncture; yet, that hasn’t stopped the doyens of integrative medicine at the most respected medical schools from being seduced by the mysticism of acupuncture and studying it. I can’t entirely blame them. I must admit, there was a time when even I thought that there might be something to acupuncture. After all, unlike so many other CAM interventions, acupuncture involved doing something physical, inserting actual needles into the body. However, as I critically examined more and more acupuncture studies, I eventually came to agree with David Colquhoun and Steve Novella that acupuncture is nothing more than a “theatrical placebo.”
(more…)

Posted in: Acupuncture, Cancer, Clinical Trials, Traditional Chinese Medicine

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Academic Consortium plan: force medical residents to practice integrative medicine

The Integrative Medicine Wheel

The Integrative Medicine Wheel

“Integrative medicine” (IM) is an ideological movement within medicine driven in large part by those whose livelihoods depend on its continued existence. This includes both those with positions in academic medicine and individual practitioners who use the IM brand to attract patients.

Despite IM and its antecedents (alternative, complementary, alternative and complementary, complementary and integrative) having been around for about a quarter century, we still do not have a working definition of integrative medicine or have any idea whether it positively affects patient outcomes. And, despite the lip service given to IM being evidence-based, or “evidence-informed” or incorporating “appropriate” services into conventional medicine, there does not seem to be any standard for determining which modalities are appropriate for inclusion. We can infer, however, that evidence of effectiveness is not a criterion, as reiki, cranial sacral “therapy”, and homeopathy are standard fare.

In fact, the prospect for actually improving patient outcomes by importing CAM treatments (such as acupuncture) into medical practice would seem to be decreasing over time, as more and more fail to hold up under the scrutiny of well-designed and conducted clinical trials. Perhaps the dearth of evidence for “alternative” treatments is the impetus behind the importation of conventional modalities, such as nutrition and exercise, into the IM fold, treatments that were never viewed as CAM when the whole enterprise started. It has also led to special pleading demanding that research standards be loosened, most recently by the NCCIH, its director’s promise to ensure “rigorous science” notwithstanding.

There is no standard delivery model for integrative medicine or, importantly, an agreed-upon role for the various practitioners who bring the “integrative” to integrative medicine, such as chiropractors, naturopaths and acupuncturists. For example, should they be allowed to practice independently or should the medical doctor have final say on patient care? And, if they differ in their proposed diagnoses and treatments, how are those issues to be resolved? (more…)

Posted in: Acupuncture, Chiropractic, Ethics, Medical Academia, Medical Ethics, Naturopathy

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April Fool Cannot Surpass SCAM

Stick some coffee up the tailpipe and you've got yourself some complementary and alternative auto care!

Stick some coffee up the tailpipe and you’ve got yourself some complementary and alternative auto care!

It’s April Fools’ day in the US of A. One of the internet traditions is to come up with a story that is weird or unlikely, but not so weird or unlikely that it is not believable, in order to fool people that the story is real.

I gave it the old SBM try, I really did, but I couldn’t do it. I wanted to come up with a SCAM therapy so weird, so unlikely, that I could not find an example of it actually being practiced.

It can’t be done. Like a Trump utterance*, you can’t invent a SCAM (Supplements, Complementary and Alternative Medicine) that someone, somewhere, has already pulled out of, er, well, thin air and are using it on patients.

Of course, what would you expect given that many SCAMs were in fact, pulled out of, er, well thin air. Think chiropractic and DD Palmer, iridology by August von Peczely, and reiki by Mikao Usui. Making up fantastical stuff is what they do.

But even within the spectrum of pseudo-medicine there are those are practices and papers that are so bizarro they should be an April Fools’ joke. But are not. It may be a matter of taste, what one person considers wack-a-loon another would find imminently reasonable. There are certainly assigned delegates that prove that assertion. But even within the wack-a-loon world of SCAM, there are those practices and papers that are more wack-a-loon than others and should be April Fools’ jokes. Maybe it is like more unique. Unique is one of a kind, so something can’t be more one of a kind. More wack-a-loon? Such is the world of SCAM. (more…)

Posted in: Acupuncture, Energy Medicine, Homeopathy, Medical devices, Naturopathy, Politics and Regulation, Science and Medicine

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Oregon Health & Science University SCAM Day

From the Wikimedia Commons, originally posted by Flickr user Alex E. Proimos (link)

From the Wikimedia Commons, originally posted by Flickr user Alex E. Proimos (link).  Oy.

I was looking over a recent class catalog from my alma mater, University of Oregon. I see the Astronomy Department is having a day devoted to astrology, inviting astrologers to talk about their profession. And the Chemistry department is having alchemists give an overview on how to change base metals into gold. And, to green our energy, the Physics Department, where I acquired my undergraduate degree, is having a symposium on perpetual motion machines. I am so proud.

I kid.

But not when it comes to SCAM (Supplements, Complementary and Alternative Medicine). Medicine is strange in that has no issues embracing pseudo-science. My medical school, OHSU, had an afternoon devoted to Integrative Medicine for the third year medical students, with lectures by a chiropractor, a traditional Chinese pseudomedicine practitioner, a naturopath and an integrative medicine practitioner. They also had a small group discussion of a case of irritable bowel syndrome where one of the discussion leaders was a……Qi……….Gong………..master. Really. I would be so pissed if I was going $166,000 in medical school debt and I was being taught about the approach to ANYTHING by a Qi Gong Master. It was a day to ignore that whole ‘science’ thing in the name of the school. (more…)

Posted in: Acupuncture, Chiropractic, Homeopathy, Medical Academia, Naturopathy, Science and Medicine

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Acupuncture for Coronary Artery Disease

Pictured: Really, really bad idea, on all levels.

Pictured: Really, really bad idea, on all levels; literal, metaphorical, pedagogical, tautological, hemodynamic, pathological, basically all the -ics, -cals, and -als.

I have spent the last 35 years mostly in acute care medicine. Spending my day in the hospital gives me the bias that we are fragile creatures who can die unexpectedly and easily. Much of the time we pull patients through, but I have a great respect for acute diseases. Over the years I have seen too many people wake up feeling good and dead by dinner time

There is a reason the phrase is “as serious as a heart attack”. Heart attacks and heart arrhythmias can kill. About 5% of patients admitted to the hospital with a heart attack die. And 250,000 have sudden death each year, never making it to the hospital, succumbing to their ventricular fibrillation precipitated by acute coronary ischemia. Ted Cruz notwithstanding, you need a functioning heart to live.

Scary stuff. So when I read Pubmed articles like “Effects of Acupuncture at the Yintang and the Chengjiang Acupoints on Cardiac Arrhythmias and Neurocardiogenic Syncope in Emergency First Aid“, I wonder what is going on in the minds of some people. (more…)

Posted in: Acupuncture, Clinical Trials

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Curse Removal from the Annals. More Acupuncture Nonsense.

Pictured: Joshua Tree. Not pictured: My bleached bones.

Pictured: Joshua Tree. Not pictured: My bleached bones.  I hope.

A short post this week. Last weekend was a busy call weekend and as I type this I am heading for Palm Springs for a long weekend of hiking in the desert. If there is no entry in 14 days, look for my bleached bones somewhere in Joshua Tree.

Some observations about a recent article in the once-respected Annals of Internal Medicine, whose recent articles on acupuncture suggest their motto should be “The Annals: we have one too many ns.”

First there was, “Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial,” and now “Acupuncture for Menopausal Hot Flashes: A Randomized Trial.”

Spinning yin deficiency

Why do the study? Why do any acupuncture study? Negative studies will not change practice. There are no reality-based reasons to think that acupuncture would be effective for any process. All the high quality studies show no efficacy. (more…)

Posted in: Acupuncture, Clinical Trials, Science and Medicine

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