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TCM Hodgepodge

acupuncture
I suspect there is more published about traditional Chinese medicine than any other SCAM. Here are some of the recent curiosities of TCM.

Burning genitals

The little girls laughed about the germs, because they didn’t believe in them; but they believed about the disease, because they’d seen that happen. Spirits caused it, everyone knew that. Spirits and bad luck. Jack had not said the right prayers.
Oryx and Crake

I long ago gave up on the idea that there are a finite number of pseudo-medical treatments. Anything a human can imagine will probably be used as a SCAM intervention. I remain amazed at the permutations that occur in the pseudo-medical world, not unlike the mix and match bioforms in Oryx and Crake.

Not everyone knows basic anatomy and physiology that allows for understanding of disease. Instead, people often rely on metaphor and magic for their understanding, especially in the world of pseudo-medicine. Sympathetic magic lies at the heart of many SCAMs.

The classic example is rhino horns for impotence. But there are other examples. What makes blood flow to a body part? Heat. What is hot? Fire. Why are you impotent? Lack of blood flow. Put it all together and it spells fire: Set your crotch alight to cure impotence. Really.

It is all about keeping blood flow moving rapidly. The warmth from the burning towels speeds the blood through the body and it makes me perform 50% better in bed.

The accompanying photo of a flaming groin is a prelude to a What’s the harm? entry or a most unpleasant admission to the burn center if it goes horribly wrong.

There is nothing on the PubMeds concerning fire therapy and little on the internet. There are several versions fire therapy. It

is much more advanced and powerful than Moxibustion.

Given the total uselessness of moxibustion, I suspect the being several times more powerful than nothing is still nothing.

While the current photographs are from China, it allegedly originated in Tibet where:

The thermotherapeutic procedure consists in the application of a herbal product with a specific formula for each disease under treatment on the area of the affected organ. The area is covered with a towel soaked in alcohol and it is then lighted [sic]. The heat produced by the burning of the alcohol is easily born by the patient. The procedure is stopped when the patient announces a disconfort [sic]. The vasodilator effect produced by the fire heat accelerates the local blood circulation and the local metabolism. Thus, the curing substances of the herbs will be carried directly to the sick organ and they will act immediately at local level.

I would not rely on any therapy that bases its endpoint upon the use a safeword. It is not a therapy for Dave Grohl, although Jerry Lee Lewis might approve.

Its alleged mechanism of action is because

All health problems relate microcirculation deficiency. At capillary level, the blood become stagnate [sic], then toxin will be cumulate [sic], using Fire Dragon Therapy can improve the microcirculation and to remove stagnate [sic] toxins.

Yep. Toxins. And:

The vasodilator effect produced by the fire heat accelerates the local blood circulation and the local metabolism. Thus, the curing substances of the herbs will be carried directly to the sick organ and they will act immediately at local level.

Like most pseudo-medicines, there is no process for which fire therapy cannot be used, including as a beauty aid.

General fire dragon therapy can help cure the following disorders: Indigestion, low metabolism, low temperature, melancholy, pain caused by stress and tension, insomnia, anxiety, fear, panic attacks, stomach distension, vertigo, hiatus hernia, benign tumors, cold bile disease, joint pains, arthritis, bone deformation, joint inflammation, superficial fever (empty fever), post-menopause syndrome and nerve inflammation (sciatic nerve, neurological disorders, etc.). In short, fire dragon therapy is good for diseases which manifest from phlegm and wind humoral disorders.

Phlegm and wind. Good for teenage boys? And are the effects? Of course

Huo Long therapy produces many side effects, but all of them are positive.

Whew.

The procedure as described is relatively safe: the towels are wet and it is the alcohol vapor above the towel, not the liquid alcohol on the towel, that is burning. As long as it doesn’t ignite the clothes or the environment, it poses little risk.

But it sure looks stupid to me.

Pop Pop

There is often the suggestion that you should consult a licensed and certified acupuncturist, not just any old needle wrangler down the street, to practice their magic on you.

I don’t know. I would think that licensed and certified magic is no more effective than unlicensed and uncertified magic.

Maybe they might know a bit more if certified, but the pass rates for acupuncture boards are not impressive, at least in California.

In February 2014, only 62% of first-time test takers in California passed and overall 49% passed. Gives one pause.

There are several sites on the internet with Acupuncture Board questions and flash cards. I took the tests and missed all the questions. The questions often seemed goofy to me, but then I find all of the theory and practice of acupuncture goofy.

Knowing the crossing point of the spleen meridian and the throughfare vessel or that cupping removes putrefaction and promotes granulation somehow has no relevance to what I would consider biomedical reality.

I wonder, as an aside, what the result of board certification will be on the practice of acupuncture. There are a huge variety of styles (by country and by practitioner), acupoints, variations (bee venom or cat gut added) and techniques. There are more acupuncutures than acupuncture, perhaps as many forms as there are practitioners. I also note that some schools have high pass rates and others do not. I predict with board certification the variability of acupuncture will decline as, at least in the US, they teach to the test.

The biomedical sample questions were often simplistic and, if indicative of the knowledge base of practitioners who want to be primary care providers, scary. I was reassured to find questions concerning proper hand hygiene and sterilization of needles, although I am skeptical about their application.

What I did not find (and that doesn’t mean they were not there; it was not an exhaustive search) were questions testing whether acupuncturists had an understanding of the importance of the anatomy under their acupoints. Evidently not, for if you search acupuncture and complications on the PubMeds you will find seven pages of articles, some of which have titles that suggest needle points are going where they should not:

Some of those are impressive. It takes real effort to get deep enough to pop a stomach or heart. I would hard-pressed to accomplish such a result deliberately.

Those are the results of the first two pages of search results and does not include my all-time favorite:

Acupuncture needle found in ex-South Korea president’s lung

“I can’t figure out how the needle got into there,” Dr Sung Myung-whun was quoted as telling reporters at the hospital after the operation. “It is a mystery for me, too.”

Um, maybe because acupuncturists don’t really know what they are doing when they stick needles in people? They do not really know how deep they can safely push a needle since they have no understanding of anatomy?

There is a push to include acupuncturists as primary care physicians. Given the nature of their training and what it includes to pass their Boards (mostly magic) and excludes (reality and anatomy), I would not be skeptical of their abilities.

CIGO: Cochrane In, Garbage Out.

The Cochrane reviews. They give me pause. I understand the need and utility of systematic reviews and meta-analysis. They can give a nice overview of a topic and suggest the utility or lack thereof of a given therapy. But they are not definitive and suffer from the problem of GIGO: garbage in garbage out.

GIGO is especially pertinent when the methodologies of systematic reviews are applied to pseudo-medical interventions that are divorced from reality.

My colleagues and I have written extensively about acupuncture (we have collected many of the essays in book form available at Amzazon. Hint. Hint.).

The summary of acupuncture: it is not based in reality (there are no meridians or acupoints) and well-designed clinical trials suggest the acupuncture only works for subjective endpoints if the patient thinks they are getting acupuncture and believe it to be effective. It does not matter where needles are placed or even if needles are used at all. From a prior plausibility perspective, any positive effect from acupuncture is likely due to a combination of bias and poor study design.

But that never stops the Cochrane collaboration, who will run anything and everything through their grinder to produce a meta-analysis sausage. Unfortunately, unlike sausage, I often know what goes into the meta-analysis.

Acupuncture is the rodent hair and insect parts in the bratwurst that is “Acupuncture for treating acute ankle sprains in adults.” Can I beat a metaphor to death or what? Anything and everything that calls itself acupuncture is included; no form was ignored:

We included all types of acupuncture practices, such as needle acupuncture, electroacupuncture, laser acupuncture, pharmacoacupuncture, non-penetrating acupuncture point stimulation (e.g. acupressure and magnets) and moxibustion. Acupuncture could be compared with control (no treatment or placebo) or another standard non-surgical intervention.

Acupuncture, as is of then the case, is anything they want it to be. Insert Humpty quote here. Talk about your “heterogeneous group of acupuncture and quasi-acupuncture.” And, what surprise, they did not find any evidence that acupuncture, however defined, was effective for acute ankle sprain:

The currently available evidence from a very heterogeneous group of randomized and quasi-randomised controlled trials evaluating the effects of acupuncture for the treatment of acute ankle sprains does not provide reliable support for either the effectiveness or safety of acupuncture treatments, alone or in combination with other non-surgical interventions; or in comparison with other non-surgical interventions.

Of course, reality will never provide reliable support for either the effectiveness or safety of acupuncture treatments, because acupuncture is based on fantasy and its practitioners don’t really know what they are doing. When seen through the lens of the information provided by prior high-quality studies of acupuncture, it would suggest the following conclusion promotes a waste of time and money:

Future rigorous randomised clinical trials with larger sample sizes will be necessary to establish robust clinical evidence concerning the effectiveness and safety of acupuncture treatment for acute ankle sprains.

But for some reason the Cochrane group always suggests more studies. At least they did not suggest that it may be worthwhile for ankle sprain patients to test on an individual basis whether therapeutic acupuncture is beneficial for them.

They can only be that lunkheaded once. I hope.

TB or Not TB

As regular readers are aware, I am an Infectious Disease doctor and have been Medical Director of the infection control program my hospital system for 24 years.

It is impressive how Murphy rules in infection control. If something can cause an infection, it will cause an infection given the right circumstances.

Needles sticking the skin can drag in bacteria from the skin of the patient, from the hand of the practitioner or even from the slight aerosolization of spit from the practitioner, dragging oral bacteria into spinal fluid. It is why we wear a mask and gloves for many injections.

I have mentioned my Googlewack before. As best I can tell there is exactly one picture of an acupuncturist using gloves (actually, a physical therapist doing dry needling) on a Google image search.

Careful infection control technique is not high on the to-do list of acupuncture practitioners and a search of PubMed will result in a long list of mostly-preventable infections. As I think about it, since there is no real indication for acupuncture, they are completely preventable infections.

And now there is a report of cutaneous TB: “Analysis of 30 Patients with Acupuncture-Induced Primary Inoculation Tuberculosis

The use of Chinese acupuncture needles which are able to deeply penetrate into the tissues surrounding tendons and nerves provide an ideal route for the inoculation of tuberculosis. The patients in our outbreak underwent acupuncture twice daily for two weeks. This high degree of potential exposure may explain why there were no cases of spontaneous healing.

From an infection control perspective, it was interesting that

Despite the unsuccessful identification of the source of contamination, it is apparent that these infections were linked to acupuncture and moxibustion, because the 30 patients had the same epidemiological characteristics.

Most of the 30 patients had multiple skin infections, but the lesions were located to the sites of acupuncture and electrotherapy. Lesion severity and drug reactions in individual patient were similar, but we did not know whether these multiple lesions were independent or the result of the inoculation infections in the wounds via hemo-disseminated Mycobacterium tuberculosis.

And some patients had metastatic infections:

Although, occurrence of the three patients with meningeal and pulmonary tuberculosis and two patients with knee tuberculosis had confirmed the hemo-disseminated ability of this primary inoculation Mycobacterium tuberculosis to other tissues and the compartments.

And they finish with a little ironic humor:

Mycobacterium can easily spread without proper microbiological control of these procedures. To this end, it was recently suggested that herbal medicine and acupuncture professions should also develop a system of statutory regulation which should help prevent these issues.

Those whose world view holds that disease is due to the fanciful constructs of meridians and chi are unlikely to pay close attention to germs and their potential spread. In medicine we are fortunate that it is usually hard to infect other humans, especially if you are punctilious about applying the concepts of infection control. Too bad infection prevention is not part of their understanding.

Posted in: Acupuncture, Traditional Chinese Medicine

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