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AFP Promotes Acupuncture

I subscribe to American Family Physician, the peer-reviewed journal of the American Academy of Family Physicians. It emphasizes evidence-based medicine and most articles include a table showing strength of evidence ratings for key recommendations for practice. Lately, its scientific rigor has been slipping. I have complained to the editor about several articles whose recommendations were not based on the best science, and I have been consistently ignored. 

Acupuncture for Chronic Low Back Pain 

A recent article on chronic low back pain recommended acupuncture and gave it an “A” rating corresponding to “consistent, good-quality patient-oriented evidence.” I wrote the following letter to the editor and to the author of the article:  (more…)

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The Golden State of Pseudo-Science

The state of California (CA) which is home to the most advanced education and research in biomedical sciences, computational biology, genomics and proteomics, etc, is also home to 19 institutions that have state-approved training programs in Traditional Chinese Medicine (TCM), a pseudo-medicine that is based on ideas and practices sourced by ancient cosmology, mythology, astrology, and a range of other pre-scientific beliefs that have been partially “sanitized” during the Maoist era.

Emerging out of the recent hype about complementary and alternative medicine (CAM), the educational curricula of these institutions include the study of acupuncture’s point-and-meridian system, the health and safety beliefs of ancient and medieval China, humoral pathology, herbalism, Asian massage, and a limited amount of modern biomedical sciences at a level below what is required from vocational nurses. These curricula are supposed to provide the necessary knowledge and skills for the graduates to pass a comprehensive state licensing exam and provide “primary” healthcare in CA. However, pursuant to CA Code of Regulations, Title 16, Section 1399.451(b) it is improper for these “primary” healthcare providers, “to disseminate any advertising which represents in any manner that they can cure any type of disease, condition or symptom!” Nonetheless, both the internet and the local press abound with ads by CA licensed practitioners who claim that acupuncture can cure or mitigate many diseases, ranging from allergies and infertility to stroke and paralysis.

Under the banner of CAM, a handful of these practitioners also advertise that they can communicate with spirits and heal with crystals, colors or sounds; they practice healing touch (reiki) and distance healing (via PayPal!); provide spiritual counseling and ministerial services, and make implausible medical claims such as healing a chronic condition with just one needle!

All 19 programs are approved by the CA Department Affairs’ (DCA) Board of Acupuncture, since CA law requires that the content of an acupuncture training program be assessed and approved by the State.

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Posted in: Acupuncture, Politics and Regulation, Public Health

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Oriental Medicine or Medical Orientalism?

The following is the second adapted excerpt of an upcoming article called “The Untold Story of Acupuncture.” It is scheduled to be published in December 2009 in Focus in Alternative and Complementary Therapies (FACT), a review journal that presents the evidence on alternative medicine in an analytical and impartial manner. This section argues that the current flurry of interest in acupuncture and Oriental Medicine stems predominantly out of postmodern opposition to Enlightenment rationalism, and bears witness to Orientalism and consumerism in contemporary medicine.

In five years, from 1971 to 1975, l directly experienced Est [Erhard Seminars Training], gestalt therapy, bioenergetics, rolfing, massage, jogging, health foods, tai chi, Esalen, hypnotism, modern dance, meditation, Silva Mind Control, Arica, acupuncture, sex therapy, Reichian therapy and More House — a smorgasbord course in New Consciousness.1

 Jerry Rubin (1938 – 1994)

Although acupuncture has been known in the US since the 19th Century, its therapeutic claims were dismissed or judged to be “much overrated” by the medical community.2,3 Nonetheless, the publication of a report in the New York Times by James Reston, a reporter in President Nixon’s press corps who had received acupuncture for postoperative cramps in Beijing in 1971 changed this perception, and triggered a flurry of interest amongst the American public and some in the medical community.4 Within the following months, journalists, scientists and physicians rushed to China to withness this peculiar phenomenon, which the popular press and a few scientific journals sensationalized by reporting that thousands of successful operations of all sorts were being carried out in PRC using acupuncture anesthesia; some elaborated on its widespread use for a myriad of conditions, to include paralysis and deafness!5

These unconfirmed claims in the heady social and intellectual climate of the 1970s–meaning the American Counterculture; the rejection of mainstream values, beliefs and ideals; the youth movement, nonconformism and the hippie subculture, the belief in a “New” and  “Cosmic” consciousness and the cult phenomenon; revolutionary ideas mixed with environmentalism; organic farming and the avoidance of pollution, agrochemicals and pharmaceuticals; nonconformism and alternative lifestyles; a syncretistic mix of psychedelic drugs, Eastern religions and Native American spiritualities; the resurgence of the taste for mystic, occult, and magical phenomena;6,7 and the belief in the existence of a separate and non-ordinary reality, as upheld by one of the fathers of the New Age movement, Carlos Castaneda8–gave the justification to view acupuncture as a “heal all” therapy based on alternate perceptions of health and disease.  This amalgamation happened precisely when a whole generation of disenchanted Westerners were eager to find novel solutions for their existential predicaments; one that would be free from the constraints of the so-called “repressive rationality” of modern science in “overdeveloped” societies.9,10. Most Western publications on acupuncture therefore fostered the belief that Eastern healing arts have crucial characteristics directly and unequivocally opposite to the repressive rationalism of the West.
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Posted in: Acupuncture, History, Science and Medicine

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James Reston’s Tooth of Gold

One of the fathers of critical thinking and skeptical inquiry, the French philosopher Bernard le Bovier de Fontenelle (1657–1757) recounts in 1687 in his Histoire des oracles–a debunking book on popular beliefs, myths and superstitions that caused tremendous stir in theological and philosophical circles of his time–a colorful story that could very well illustrate the flurry of interest and research in acupuncture that followed a 1971 anecdotal account of its use in China, and the plethora of verbiage and publications that ensued. If the story of the Tooth of Gold is comical, colorful and amusing, its applicability to acupuncture is not.

In 1593, the rumor ran that a seven year old in Silesia grew a tooth of gold in place of one of the cheek tooth he lost. Horatius, professor of medicine at the University of Helmstad, wrote a history of this tooth in 1595 and alleged that it was partially natural, partially miraculous, and that it was sent by God to this child to console the Christians that were oppressed by the Turks. Just imagine what consolation and what concern this tooth might bring to the Christians or to the Turks. For this tooth not to lack historians, Rullandus rewrote its history in the same year. Two years later, Ingolsteterus, another learned man, wrote against the views of Rullandus on the tooth of gold; to which Rullandus immediately wrote a fine and wise reply. Another great man named Libavius gathered all that had been written on this tooth and added his own views. Nothing lacked to these many fine books, other than the tooth were truly of gold. When the goldsmith examined it, he found that it was made of a leaf of gold skillfully applied to the tooth; but they began by writing books and then they consulted the goldsmith.1

Translated from French by the author

Besides the glut of popular publications on Chinese acupuncture and medicine by wishful authors without any training in biomedical sciences and healthcare, the NIH, the NCCAM, and some of our most prodigious medical universities also have official and academic publications on the subject that too well resemble the fine and wise publications of Horatius and his contemporaries. They also began by writing books and articles on the theories that could explain the purported indications of acupuncture, and then they assessed the veracity these indications in clinical trials and according to the principles of evidence-based medicine.
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Posted in: Acupuncture, History, Science and the Media

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Needles in the skin cause changes in the brain, but acupuncture still doesn’t work

ResearchBlogging.orgI don’t recall if I’ve mentioned it on SBM before, but I went to the University of Michigan. In fact, I didn’t go there just for undergraduate studies or medical school, but rather for both, graduating with a B.S. in Chemistry with Honors in 1984 and from medical school in 1988. In my eight years in Ann Arbor, I came to love the place, and I still have an affinity for it, even though it’s been over 20 years since I last walked about the campus as a student, although I have been back from time to time for various functions, most recently to see Brian Deer speak last winter. True, I’m not fanatical about it, as some of my contemporaries and friends who attened U. of M. with me back in the 1980s (and, sadly, the string of losses to Ohio State and the definitively mediocre last season Michigan had last year make it very hard to be a Michigan football fan these days). However, I do have considerable affection for the place. It molded me, trained me in science, taught me medicine, and provided me the basis for everything I do professionally today.
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Posted in: Acupuncture, Clinical Trials, Medical Academia, Science and the Media

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Risks Associated With Complementary And Alternative Medicine (CAM): A Brief Overview

Having grown up on a dairy farm, I am one of the least likely people to object to the deification of yogurt. However, as a critical thinker, I cannot help but resist the idea (promoted by some health sites) that probiotics are a reasonable alternative to chemotherapy in the treatment of colon cancer. And there are many other equally unhelpful claims being made all the time. Fish oil for ALS anyone?

What amazes me about the “cherry yoga” camp (as my friend Bob Stern likes to call it), is that they aggressively market CAM as “harmless” and “natural.” They point to the warning labels and informed consents associated with science-based medicines as evidence that the alternative must be safer. In reality, many alternative practices are less effective, and can carry serious risks (usually undisclosed to the patient). For your interest, I’ve gathered some examples of risks associated with common alternative practices that have been described by the CDC and in the medical literature:
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Posted in: Acupuncture, Chiropractic, Herbs & Supplements, Homeopathy

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Acupuncture for IVF Revisited – More Tooth Fairy Science?

I read this Reuters Health article on MedlinePlus, and then I read the study the article referred to (The impact of acupuncture on in vitro fertilization) and now my head hurts. The study found that acupuncture was not effective in increasing the pregnancy rate (PR) during in vitro fertilization (IVF). As quoted on MedlinePlus, the lead author, Alice Domar, seems to blame her patients (the presumably poor quality of their embryos) rather than acupuncture for the lack of success, and then she recommends using acupuncture even if it doesn’t work. That was bad enough, but “poor quality embryos” is a hypothesis that was actually tested and rejected in the study itself. Has Domar forgotten?

The headline of the MedlinePlus article says “acupuncture doesn’t boost IVF success for all” – suggesting that it boosts success for some? Then the first sentence says the study suggested that acupuncture doesn’t work, period. But wait…

The lead researcher says acupuncture may not have worked in her study because, unlike past research, her investigation wasn’t limited to women who had good quality embryos available for transfer. “I’m wondering if my sample was just not a good sample, in that most of the patients in my study were probably not the best-prognosis patients,”
Domar and her team say the most likely explanation for the lack of an acupuncture effect in their study was the fact that they included many women who didn’t have good quality embryos available for transfer. While acupuncture may help a woman become pregnant after the transfer of a healthy embryo, the researcher noted in an interview, it can’t repair an embryo with chromosomal defects or other abnormalities.

Hold the boat!! In the Discussion section of the paper itself, Domar et al point out that previous research has included mostly patients with good quality embryos. They ask if perhaps acupuncture only works for good quality embryos? They test that hypothesis by separately analyzing the subjects in this study who had good quality embryos. There was no increase in PR with acupuncture in this sub-group; the results were the same as for the entire sample. (more…)

Posted in: Acupuncture, Clinical Trials

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Bad Books

In the interests of fairness and intellectual honesty, I’ve forced myself to read a lot of really bad books. The True Believer tells me his guru’s book is the Real Stuff. He tells me I have a closed mind and won’t look at anything outside establishment dogma, and if I only read the book and understood Dr. Quack’s evidence and arguments, I would be a True Believer too. I have tried, really I have. I’ve given the Dr. Quacks every chance to convert me, and I’ve hoped to learn something new, but I’m always disappointed. I’ve come to the point that I feel like I’m reading the same book over and over: it is always a mixture of real science, pseudoscience, and speculation, based on cherry-picked evidence and argued with the same logical fallacies.

I recently got hooked into reading another one by a correspondent who had called me an “ignorant relic” for writing a “grossly ignorant article” about alternative medicine. I suggested he read R. Barker Bausell’s book Snake Oil Science and a couple of others, which he promised to do. Then he said, “If I am willing to buy three books that you have suggested and read them and you are not willing to read what I have suggested, then that pretty much says all that needs to be said.”

I was willing, even though the very title of the book suggested that its message was incompatible with the scientific evidence as I know it: How to Prevent and Treat Cancer with Natural Medicine. The authors are big names in naturopathic and herbal medicine: Michael Murray, Tim Birdsall, Joseph Pizzorno, and Paul Riley. It’s nowhere near as bad as some of the bad books I’ve read, but it is a good example of the genre and I’ll use it to illustrate why I call them bad.

It offers “an arsenal of disease-fighting tools for prevention, treatment, and coping with side effects” (Yes, it offers tools; but do those tools work?) And it promises to “change your internal environment so cancer can’t survive.” (Wow! If it could really do that, every oncologist in the world would enthusiastically adopt these methods and the authors would be eligible for a Nobel prize.)
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Posted in: Book & movie reviews, Herbs & Supplements, Science and Medicine

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How Is Alternative Medicine Like Earmark Spending?

I recently watched a special news report about John McCain leading the charge towards making legislative earmarks illegal. The Economist defines earmarks this way:

Earmarks, for the uninitiated, are spending projects that are directly requested by individual members of Congress and are not subject to competitive bidding.

Most Americans are rightly upset about the practice of slipping pet projects into larger, well-vetted, and consensus-built legislative initiatives. They know instinctively that it’s morally wrong to sneak in personal favors and appropriate tax payer dollars to special interest groups without allowing others to weigh in. I certainly hope that McCain and his peers will succeed in discontinuing this corrupt practice.

Coincidentally, just after I watched this news report about earmarks, I went online to catch up on my blog reading. The first post I encountered made reference to an opinion piece written by Deepak Chopra, Andrew Weil, Dean Ornish, and Rustum Roy in the Wall Street Journal. Chopra et al. were asking Americans to redouble their efforts to adopt healthy lifestyles (including wholesome diets and regular physical activity) as a means to promote good health and avoid disease. At the end of the article they slipped in a plea for President-elect Obama to consider integrating alternative medicine practices (which included everything from healthy diet to meditation and acupuncture) into a government-sponsored approach to health.
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Posted in: Nutrition, Politics and Regulation, Science and Medicine, Science and the Media

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“Battlefield acupuncture”?

THE SCENE: Iraq, Afghanistan, or anywhere where U.S. troops are risking life and limb.

THE TIME: The not-too-distant-future. Maybe even 2009.

Joe is on patrol.

It’s the middle of summer in the desert town. The air hangs heavy, hot, dry and dusty, like a blast furnace firing steel. The heat penetrates Joe’s 80 lb pack in much the same way the heat from boiling water penetrates the shell of an unfortunate lobster. Joe’s heart races. His squad is on edge; their eyes dart furiously to and fro, looking for the deadly threat that might lurk in the shadows. Every shadow is a potential source of death, every alley a refuge from which the enemy can attack and kill him or his buddies, every rooftop a fortress from which the enemy can rain death upon the squad. The area is known to be thick with terrorists and insurgents. Joe pictured them waiting unseen from every nook and cranny for the opportunity to attack. The skin on Joe’s back is all prickly. He distinctly feels as though he has a huge bullseye pointed on his back. He feels a bead of sweat dripping down his forehead and onto his eyelid, all slimy and salty. Joe desperately wants to wipe it away, but that would necessitate removing one of his hands from his weapon. The split second it would take for him to put it back might mean the difference between life and death for him or one of his buddies.

A loud roar fills Joe’s ears, and suddenly he feels as though he has no weight. The scene unfolds in slow motion, just like in the movies. Dazed, Joe hears a tumult as though from a great distance, but can see nothing. Yelling and gunfire all around, he becomes conscious enough to realize that he’s lying flat on his back. He feels searing pain in his legs and a hot liquid oozing around them. It occurs to Joe that it must be his own blood or even perhaps his own urine, but he’s just too dazed to care.

“Medic!” Joe hears someone scream. He feels someone pull his helmet from his head and realizes that the sound of gunfire and yelling is receding. His unit must be driving away the ambushers. Good! He thinks. Give those assholes hell, guys! He opens his eyes, and realizes that his buddy’s got his back, and turns to see another man, a medic, drop to his knees at his side. His uniform is stained a disturbing red. Joe feels the medic wrapping something around his thigh. It’s a tourniquet, and Joe cries out in pain as he feels it constricting around his upper thigh.

“Bleeding’s better!” Joe hears the medic say to his buddy. “I’ll take it from here.” Joe’s buddy runs off to join the rest of his unit, and the medic moves his face close to Joe’s. He feels himself being moved from side to side and then his legs being moved. More pain. Joe cries out.

The medic leans in to talk to Joe, “I think we’ve got the bleeding under control for now. I put a tourniquet on your leg. Let’s get you out of here. The docs’ll patch you up in no time.” Joe is vaguely aware of another corpsmen with a stretcher nearby. The medic leans in again, “Are you in pain, soldier?”

“What do you think? My leg hurts like a sonofabitch! I could really use something for the pain,” Joe hears himself yelling, again as if from a distance. Pain is shooting through his leg, setting every nerve on fire, and the tourniquet is biting into raw muscle through the edge of a wound that comes all the way up to his groin. The flayed edges of his skin shoot fire to his brain, and he can feel his broken bones grinding against each other every time he moves in spite of the splint.

“I’ve got something better that’ll help,” the medic screams over the din.

Better? Joe thinks. I’m in agony here. I need something! Anything!

The medic pulls a small box out of his pack. Joe sees that it’s a small case. He opens it. Its contents look something like this:

acupuncturekit

Joe is puzzled. Where’s the morphine? He wonders. “What are those needles?” Joe asks. “What are you doing? I’ve never seen syringes that look like that before!”

“Acupuncture,” replies the medic. “I’ll take care of you.”

“What are you going to do with them?” Joe replies.

“Stick them into your earlobe. It’ll take the pain away really fast.”

“Are you shittin’ me?” Joe screeches, trying to get up to grab the medic by the front of his uniform. “My leg’s a bloody mess, I’m in agony, and you’re tellin’ me you’re gonna stick little needles in my ear and make it all better? Like that‘s going to do anything! I need real pain medicine! Give me morphine! NOW!
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Posted in: Acupuncture, Medical Ethics, Politics and Regulation

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