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Tai Chi versus physical therapy for osteoarthritis of the knee: How CAM “rebranding” works

Tai Chi versus physical therapy for osteoarthritis of the knee: How CAM “rebranding” works

“Complementary and alternative medicine” (CAM), now more frequently referred to as “integrative medicine” by its proponents, consists of a hodge-podge of largely unrelated treatments that range from seemingly reasonable (e.g., diet and exercise) to pure quackery (e.g., acupuncture, reiki and other “energy medicine”) that CAM proponents are trying furiously to “integrate” as coequals into science-based medicine. They do this because they have fallen under the sway of an ideology that posits a false dichotomy: To practice true “holistic” and “preventative” medicine, physicians and other health care professionals must embrace the pre-scientific, pseudoscientific, or anti-scientific ideas about medicine that underlie much of the “alternative medicine” being “integrated.”

Unfortunately, they’ve been largely successful over the last 25 years or so. From my perspective, the strategy that has been the most effective in mainstreaming quack practices as part of “integrative medicine” has been what I like to call the “rebranding” of practices that could and should be part of standard, science-based medicine. I’m referring, of course, to nutrition and dietary interventions, as well as lifestyle interventions, specifically exercise. To the extent that standard medicine might have undervalued such interventions over the past few decades, we practitioners of science-based medicine might be said, to some extent at least, to have brought this on ourselves. On the other hand, it is not as though doctors haven’t been advising our patients to quit smoking and moderate their drinking and to lose weight through altering their diet and exercising more for many decades. We do this because we know it works. For instance, when some naturopathic quack touts “curing” type II diabetes with a vegan diet plus exercise, we know that can work because we know that losing weight can normalize blood sugar values in many cases of type II diabetes. Heck, the Endocrine Society itself even says so, declaring “lifestyle optimization” as “essential for all patients with diabetes” and recommending that all patients with type II diabetes “strive to attain and maintain an optimal weight through a primarily plant-based diet high in polyunsaturated and monounsaturated fatty acids, with limited intake of saturated fatty acids and avoidance of trans fats,” that they lose weight through physical activity, and get enough rest. A vegan diet just takes that dietary advice to an unnecessary extreme, and any supplements recommended are almost always unnecessary.
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Posted in: Clinical Trials, Traditional Chinese Medicine

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

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What’s in your Traditional Chinese Medicine?

A study found 92% of Traditional Chinese Medicine was contaminated with drugs, heavy metals, or animals including cat, dog, rat and pit viper.

An analysis of 26 Traditional Chinese Medicine products found 92% were contaminated with pharmaceuticals, heavy metals, or the DNA of animals, including traces of cat, dog, rat, or pit viper.

Two weeks ago I detailed the pervasive problem of poor quality supplements. The main reason for this seems to be weak regulatory standards that prioritize the rights of manufacturers to sell supplements over the rights of consumers to buy safe, high quality, properly-labelled products. Call it “health freedom“, where the freedom belongs to producers, who in many countries are largely freed from most of the quality and safety regulations that are in place for licensed prescription and non-prescription pharmaceuticals. The result of weak regulation is that few supplements sold on the market today have been properly tested for safety or effectiveness, and there are few quality standards for the production of these products.

Not surprisingly, there are persistent signs that consumers may face real risks to their health from using these products. Now a new study from Australia confirms what past studies have already shown: adulterated and contaminated herbal remedies are the rule, rather than the exception. They often contain undeclared ingredients ranging from potential allergens to heavy metals to endangered species. (more…)

Posted in: Health Fraud, Herbs & Supplements, Naturopathy, Politics and Regulation, Public Health, Traditional Chinese Medicine

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Australian review finds no benefit to 17 natural therapies

Iridology

Health care systems around the world are being pressured to “do more and spend less”, to make healthcare more cost effective. Owing to aging populations and the growing cost of providing health services, there’s more scrutiny than ever on the value of different health treatments, with the goal of reducing the use of treatments that don’t help. The Choosing Wisely initiative was establishing expressly for this purpose. Regrettably, while well-intentioned, Choosing Wisely hasn’t had as much of an effect as you might expect. Medicine can be slow to change, as David Gorski discussed earlier this week. Unless we ruthlessly scrutinize what we do for effectiveness, and are willing to act on what we learn, self-driven change is unlikely. One way that governments (and insurers) can dramatically reduce the use of a health service or treatment is to simply stop offering it, or paying for it. Yet stopping funding is something that is relatively uncommon in health care. It seems to be much more difficult to stop a practice, possibly owing to inertia, a reluctance to change, and the sometimes-vociferous protests that can emerge from patients or physicians that may feel that their preferred therapy is effective. The formidable challenge of stopping health care funding, once it has started, is one reason why this blog has been very critical of the expanding scope of practice being granted to alternative medicine purveyors – the legislative alchemy that is the first step towards insurance coverage. Because once that’s in place, it will be far more difficult to stop it. So it’s essential to understand the evidence. (more…)

Posted in: Acupuncture, Chiropractic, Herbs & Supplements, Homeopathy, Naturopathy, Traditional Chinese Medicine

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Acupuncture/TCPM Crapfest

Acupuncture needling

Look Ma! No gloves!

As I get older I get more grumpy. Issues that at one time I was rather sanguine about, now irritate the hell out of me. It is not like it was when I started practice. Information was hard to come by. Going through the Index Medicus, with the world’s tiniest font, wandering the stacks looking for papers, sending off for reprints, getting a precious Xerox (or even a mimeograph) of a classic paper from an attending.

You understood the value of eminence-based medicine, as it took a career to acquire and master the literature. You relied on the wisdom of old geezers like me who had decades of experience and reading.

That was then. Now? The world’s information is available almost instantaneously. You may not be able to master a new topic spending a day on Google and Pubmed, but you can acquire a reasonable understanding, especially of you have some background.

Because of Google and Pubmed, the only reasons for ignorance of your area of expertise in medicine are time, laziness, or stupidity. As a specialist, only time is an excuse. It is my job to keep up with infectious diseases, although with over 10,000 articles a year in ID, it is impossible to read everything. But if I have a question concerning patient care, I need to look it up. I have another blog whose raison d’être is looking up answers to the daily questions that arise in practice.

On the characteristics of a useful clinical trial

So the characteristics of a useful clinical trial are not hard to determine: Randomized, double blind, placebo controlled, adequately powered. Because you want to avoid spending time and money on a study only to end up with no useful conclusions. This is especially important with acupuncture where it not does matter what kind of acupuncture is used, if needles are used, where the needles are placed or even if you mime acupuncture or perform acupuncture on a rubber hand. The key features for success in acupuncture are belief that the patient is receiving acupuncture and that the patient believes the acupuncture will be effective. And the stronger the belief, the better the subjective response. (more…)

Posted in: Acupuncture, Clinical Trials, Traditional Chinese Medicine

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How To Listen to Chi

My Chi says my puppy is bad for me and I should get rid of it.  I'm keeping the puppy, and getting rid of my Chi instead.

My Chi says my puppy is bad for me and I should get rid of it. I’m keeping the puppy, and getting rid of my Chi instead.

You will need flat shoes and a bottle of vitamins, herbal formula, or prescription medicine.

Step 1: Hold the bottle with both hands, touching your chest

Step 2: Stand up straight and get your balance

Step 3: Close your eyes and feel what is happening to your body.

Results:

If your body moves forward or stays neutral – going side to side – then whatever you are holding near your chest is okay for you. Your Chi matches.

If your body moves backwards – whatever you are holding is not good for you. Your body is repelling it. Chi is saying it doesn’t want that.

You can do this test on just about anything – a bottle of wine, foods, clothing. It’s easy to test and see if these things bring positive or negative energy to your body.

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Posted in: Energy Medicine, Traditional Chinese Medicine

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“America’s Quack” strikes back

Wile E. Coyote or Dr. Henry Miller? You be the judge!

Wile E. Coyote or Dr. Henry Miller? You be the judge!

Those of you who read my not-so-super-secret other blog (or who follow the news) familiar with this, but I feel that what happened over the last couple of weeks with respect to a man to whom I like to refer as “America’s Quack” is worth posting right here, in modified form.

Last week, a group of ten doctors led by Dr. Henry Miller, most of whom were affiliated either with the Hoover Institution or the American Council on Science and Health (ACSH)—or both—wrote a letter to Lee Goldman, MD, the Dean of the Faculties of Health Sciences and Medicine at Columbia University complaining that Dr. Mehmet Oz shouldn’t be faculty at Columbia University because of his “disdain for science and for evidence-based medicine, as well as baseless and relentless opposition to the genetic engineering of food crops” and “an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.” The letter produced a fair amount of media attention a week ago. I originally mildly approved of it, but over the course of a few days after the letter was released, my opinion on it soured. The reasons were several and included a profound distaste for threatening letters sent to a person’s employers, admittedly based in part on my own experiences having been at the receiving end of such intimidation tactics, as well as a concern that the letter had been written with no clear purpose behind it other than as a publicity stunt to embarrass Dr. Oz and Columbia. When I learned that Dr. Oz was planning to answer the letter on his show this week, there were predictions that this particularly bone-headed publicity stunt would backfire spectacularly. And it did.
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Posted in: Herbs & Supplements, Homeopathy, Science and the Media, Traditional Chinese Medicine

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Pseudoscience North: What’s happening to the University of Toronto?

Trojan Rabbit

 

Today’s post is a reluctant challenge. I’m nominating my own alma mater, the University of Toronto, as the new pseudoscience leader among large universities – not just in Canada, but all of North America. If you can identify a large university promoting or embracing more scientifically questionable activities, I’ll happily buy you a coffee. Yes, it’s personal to me, as I have two degrees from U of T. But I’m more concerned about the precedent. If Canada’s largest university is making decisions that appear to lack a careful consideration of the scientific evidence, then what does that suggest about the scientific standards for universities in Canada? (more…)

Posted in: Chiropractic, Homeopathy, Medical Academia, Medical Ethics, Naturopathy, Traditional Chinese Medicine, Vaccines

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Traditional Chinese Pseudo-Medicine Hodgepodge

Qing Dynasty (1662-1722) painting, traditional Chinese medical view of the human viscera from the back.  Image L0039962 from the Wellcome Trust image library, via the Wikimedia Commons.

Qing Dynasty (1662-1722) painting, traditional Chinese medical view of the human viscera from the back. Image L0039962 from the Wellcome Trust image library, via the Wikimedia Commons.

As I have noted before, more is published on acupuncture and traditional Chinese pseudo-medicine than the other SCAM. Here are some of the articles that drew my attention.

Captain Hook and acupuncture

Here is one of the more curious articles on acupuncture I have yet to find, “Psychophysical and neurophysiological responses to acupuncture stimulation to incorporated rubber hand.”

I did not know this, but you can fool a person into thinking that a rubber hand is their own.

The synchronous tactile stimulation of the real hand of an individual and rubber hand leads to the feeling that the rubber hand is incorporated with the body of that individual. This is referred to as the rubber hand illusion (RHI), and it occurs because the brain is attempting to interpret the interaction of the visual, tactile, and proprioceptive systems of the body, which in turn, leads to a re-calibration of the touch and the felt position of the hand. The multimodal visuotactile stimulation inherent in the RHI induces the brain to temporarily incorporate external objects into its body image. In addition, when the experimenter threatens the rubber hand with a needle during this illusion, it generally elicits an enhanced sympathetic response and a measurable cortical anxiety response, which indicates that the bodily ownership of the rubber hand causes changes in the interoceptive system of the brain.

Cool. Check out this video to see how it is done. So what happens when you do acupuncture on a rubber hand that the brain thinks is its own?

The findings of the present study clearly demonstrate that acupuncture stimulation to a rubber hand resulted in the experience of the DeQi sensation when the rubber hand was fully incorporated into the body.

As judged by fMRI findings (always taken with a grain of salt substitute) and patient reports. DeQi is what dey feel when de needle is twirled in de skin. (more…)

Posted in: Acupuncture, Science and Medicine, Traditional Chinese Medicine

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2015 NHIS Report on Complementary Health Approaches (whatever that means)

Formerly known as "relaxing," now known as a "complementary health approach." Gustav Courbet, "Young ladies on the banks of the Seine," 1857.

Formerly known as “relaxing,” now known as a “complementary health approach.” Gustav Courbet, “Young ladies on the banks of the Seine,” 1857. Public domain, via Wikimedia Commons.

Back in 2004, data from the 2002 National Health Interview Survey (NHIS) appeared in a report titled “Complementary and Alternative Medicine Use Among Adults: United States, 2002.” It showed a whopping 62% of adults had used CAM in the past 12 months, but only if prayer for health reasons was included. With prayer excluded, the percentage was substantially lower, at 35%.

“CAM” was defined as:

a group of diverse medical and health care systems, therapies, and products that are not presently considered to be part of conventional medicine.

The authors noted that, in earlier surveys of CAM use, “CAM has been operationally defined in a variety of ways” and the lists of CAM interventions/therapies included “varied considerably among the surveys.”

The most commonly used CAM therapies (excluding prayer) were non-vitamin, non-mineral natural products (18.9%), deep breathing exercises (11.6%), chiropractic care (7.5%), yoga (5.1%), massage (5.0%) and diet-based therapies (3.5%). CAM was most often used to treat back pain or problems, head or chest colds, neck pain or problems, joint pain or stiffness, and anxiety or depression. Most CAM use was self-prescribed. Rebranding things like exercise (yoga) as “CAM” was in the mix from the get-go.

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Posted in: Acupuncture, Chiropractic, Clinical Trials, Energy Medicine, Herbs & Supplements, Homeopathy, Naturopathy, Traditional Chinese Medicine

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