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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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Knee Osteoarthritis: Thumbs Down for Acupuncture and Glucosamine

Osteoarthritis is the “wear and tear” kind of arthritis that many of us develop as we get older.  Cartilage becomes less resilient with age, collagen can degenerate, and inflammation and new bone outgrowths (osteophytes) can occur.  This leads to pain, crepitus (Rice Krispie type crackling noises with movement), swelling and fluid accumulation in the joints (effusion), and can severely limit activity for some patients. Patellofemoral pain is one of the most common of the repetitive strain injuries and is like an early onset of arthritis.

Since knee osteoarthritis is such a ubiquitous annoyance, home remedies and CAM offerings abound.  Previously we have covered a number of CAM options on this blog, including glucosamine, acupuncture, and several others. The American Academy of Orthopaedic Surgeons (AAOS) has just issued a 1200 page report evaluating the evidence for various treatments for knee osteoarthritis short of total knee replacement surgery. A 13 page summary is available online. They have done the heavy lifting for us, reviewing all the available scientific studies for evidence of effectiveness. Here’s what the science says: (I’ve highlighted the ones where the evidence is strong.)  (more…)

Posted in: Acupuncture, Herbs & Supplements, Surgical Procedures

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