Acupuncture

[Timothy A]

My wife has battled acid reflux and unrelated hormonal/physical peaks and valleys associated with her period for years. We've altered our nutrition (eating habits and vitamins etc) as a family to try and help her issues (as well as my son who has adhd, and my other son and daughter who are overweight). I can't say our nutritional changes have been the sliver bullet, but it certainly is not hurting our long term health. Anyway, my wife has done all the conventional stuff to deal with the acid issue and we've had no cure of it yet. Same with the hormonal stuff. She has tried different drugs for both, but the side effects suck just as much as the problem we're trying to fix. So this gets us to acupuncture. A family friend used a local acupuncturist to some pretty good results for migraines. We had some extra $ in our MSA to use, so my wife decided to give it a shot. My wife has gone 6 times (over a 3 week period) and we've really been monitoring how she feels short term and long term after each treatment. At this point the results have been a little disappointing. She is to the point where she needs to decide if we want to continue on or not. Has anyone else had any positive or negative experiences with any ailments and acupuncture as a treatment? Thanks in advance.

 

[St. Clown]

Re: Acupuncture

I had accupuncture as an almost whim when I sprained an ankle a few years back. There's a guy on the first floor of my office building who has a shop there. I went in hoping for something, but not really expecting much. I would say that it was like taking a very large ibuprofen dosage, the pain was diminished for 4-6 hours. I decided to go back there a couple more times because I didn't really have anything to lose. The second time he asked if I'd like to take a nap while he took care of my ankle. I told that I wasn't tired, but he said that he could change that, put a few needles across my brow and I was out like a light for the next half-hour.

While I've not been back there since my ankle injury, it's something I would look into again for pain like that in the future. I just wouldn't expect miracles.

 

[WisconsinWildcard]

Re: Acupuncture

My wife has battled acid reflux and unrelated hormonal/physical peaks and valleys associated with her period for years. We've altered our nutrition (eating habits and vitamins etc) as a family to try and help her issues (as well as my son who has adhd, and my other son and daughter who are overweight). I can't say our nutritional changes have been the sliver bullet, but it certainly is not hurting our long term health. Anyway, my wife has done all the conventional stuff to deal with the acid issue and we've had no cure of it yet. Same with the hormonal stuff. She has tried different drugs for both, but the side effects suck just as much as the problem we're trying to fix. So this gets us to acupuncture. A family friend used a local acupuncturist to some pretty good results for migraines. We had some extra $ in our MSA to use, so my wife decided to give it a shot. My wife has gone 6 times (over a 3 week period) and we've really been monitoring how she feels short term and long term after each treatment. At this point the results have been a little disappointing. She is to the point where she needs to decide if we want to continue on or not. Has anyone else had any positive or negative experiences with any ailments and acupuncture as a treatment? Thanks in advance.

I am very sorry your wife has had trouble controlling her reflux. It is a tough problem and something that is very difficult to live with. Simply put, the literature on acupuncture is deeply flawed and there is no convincing evidence that acupuncture would help for GERD better than a placebo. Although certain review articles and meta-analyses show modest support for acupuncture in areas such as lower back pain, there are several reasons why I personally (as well as a large, evidence based population of physicians) do not buy those conclusions. It can largely be described by a phrase of "Garbage In, Garbage Out." Most studies on acupuncture are of very questionable quality and methods. Therefore, adding a bunch of these studies together to make a broader conclusion is not too helpful as they were flawed in the first place. Something I find interesting is that there is not a single negative study on acupuncture from China. Those who appreciate statistics know that at p<.05, that is an odd phenomenon.

Anyway, here is a video that I think is a good primer into understanding acupuncture's position in evidence based medicine.
https://www.youtube.com/watch?v=pp5eiHUdwb4

One of the best books I have read on medical research is from one of the biostat guys who worked on some of the more rigorous acupuncture studies in the US.
http://www.amazon.com/Snake-Oil-Science-Complementary-Alternative/dp/0195383427

A good background on TCM
http://www.sciencebasedmedicine.org/what-is-traditional-chinese-medicine/

I am more than happy to address any specific concerns. Broadly, I would say that this quote sums up much of my feelings on alternative medicine. I would also add that although I believe many who practice alternative medicine truly have the best intentions, there are many others who are taking advantage of a vulnerable population (sick people) and are selling hope (which I find ethically dodgy). I also would like to add that I never blame a patient for seeking alternatives, but instead the practitioner who is making dubious claims.

"By definition, alternative medicine has either not been proved to work, or been proved not to work. You know what they call alternative medicine that’s been proved to work? Medicine."--Tim Minchin

 

[Old Pio]

Re: Acupuncture

I am very sorry your wife has had trouble controlling her reflux. It is a tough problem and something that is very difficult to live with. Simply put, the literature on acupuncture is deeply flawed and there is no convincing evidence that acupuncture would help for GERD better than a placebo. Although certain review articles and meta-analyses show modest support for acupuncture in areas such as lower back pain, there are several reasons why I personally (as well as a large, evidence based population of physicians) do not buy those conclusions. It can largely be described by a phrase of "Garbage In, Garbage Out." Most studies on acupuncture are of very questionable quality and methods. Therefore, adding a bunch of these studies together to make a broader conclusion is not too helpful as they were flawed in the first place. Something I find interesting is that there is not a single negative study on acupuncture from China. Those who appreciate statistics know that at p<.05, that is an odd phenomenon.

Anyway, here is a video that I think is a good primer into understanding acupuncture's position in evidence based medicine.
https://www.youtube.com/watch?v=pp5eiHUdwb4

One of the best books I have read on medical research is from one of the biostat guys who worked on some of the more rigorous acupuncture studies in the US.
http://www.amazon.com/Snake-Oil-Science-Complementary-Alternative/dp/0195383427

A good background on TCM
http://www.sciencebasedmedicine.org/what-is-traditional-chinese-medicine/

I am more than happy to address any specific concerns. Broadly, I would say that this quote sums up much of my feelings on alternative medicine. I would also add that although I believe many who practice alternative medicine truly have the best intentions, there are many others who are taking advantage of a vulnerable population (sick people) and are selling hope (which I find ethically dodgy). I also would like to add that I never blame a patient for seeking alternatives, but instead the practitioner who is making dubious claims.

"By definition, alternative medicine has either not been proved to work, or been proved not to work. You know what they call alternative medicine that’s been proved to work? Medicine."--Tim Minchin

The classic assertion of all quackery: one cause, one cure. As in: human ailments are caused by spinal "subluxations" and spinal manipulation therapy can "cure" those ailments. The mind is a powerful instrument. In controlled studies of new drugs, people getting the placebo frequently complain of side effects.

Cancer quackery is among the most cruel. Please recall poor Steve McQueen, dying of mesothelioma, heading down to Mexico for coffee enemas. The landscape is littered with phony cancer "cures" and the quacks who offer them. Perhaps the worst was Harry Hoxsey, whose nutritional cancer quackery is still practiced in (wait for it) Mexico.

Years ago Dr. Pio helped the feds get the goods on the Durovic brothers, who were peddling a useless cancer drug call Krebiozen. The guy fronting their operation was Dr. Andrew Ivy, president of the University of Illinois medical school. As a graduate of that school, Dr. Pio was intensely embarrassed and wanted to get that senile old fool stopped. He described for me once in great disgust watching Ivy "scrub" before giving an injection of this "wonder drug."

The beauty of cancer "cures" is that some people don't have cancer. Some of those who do go into remission. Some of those who appear to respond to the quack drug are actually responding to ordinary treatments. And the rest are dead. So all that's left are the sincere "survivors" of cancer, telling the world how apricot pits or horse blood or coffee enemas "cured" them of their cancers.

 

[walrus]

Re: Acupuncture

I'd look further into diet if I were you. I agree with St Cloud, I've had acupuncture for low back pain, it helped for a few hours

 

[DrDemento]

Re: Acupuncture

The classic assertion of all quackery: one cause, one cure. As in: human ailments are caused by spinal "subluxations" and spinal manipulation therapy can "cure" those ailments. The mind is a powerful instrument. In controlled studies of new drugs, people getting the placebo frequently complain of side effects.

Cancer quackery is among the most cruel. Please recall poor Steve McQueen, dying of mesothelioma, heading down to Mexico for coffee enemas. The landscape is littered with phony cancer "cures" and the quacks who offer them. Perhaps the worst was Harry Hoxsey, whose nutritional cancer quackery is still practiced in (wait for it) Mexico.

Years ago Dr. Pio helped the feds get the goods on the Durovic brothers, who were peddling a useless cancer drug call Krebiozen. The guy fronting their operation was Dr. Andrew Ivy, president of the University of Illinois medical school. As a graduate of that school, Dr. Pio was intensely embarrassed and wanted to get that senile old fool stopped. He described for me once in great disgust watching Ivy "scrub" before giving an injection of this "wonder drug."

The beauty of cancer "cures" is that some people don't have cancer. Some of those who do go into remission. Some of those who appear to respond to the quack drug are actually responding to ordinary treatments. And the rest are dead. So all that's left are the sincere "survivors" of cancer, telling the world how apricot pits or horse blood or coffee enemas "cured" them of their cancers.

Totally agree with this post. I have always been honest with my patients. i tell them that about 75% of what i do is science and I know what i am doing. 20% of what i do is the Art of Medicine just based purely on experience, trial and error and sometimes off label use of medications. And 5% is just pure luck. Anecdotal evidence of cures and improvements are just that, anecdotal. I have patients with stage 4 metastatic melanoma who should not be able to live for 6 months still be around and totally in remission 6-10 years later (without treatment of any sort). And i have seen some with non-invasive in situ lesions that were totally excised and carefully followed and monitored with he best of all medical/surgical treatments who die within a year from their disease spreading out of control. Because of the unpredictability of some of these diseases and afflictions, the possibility always exists for someone to claim a miracle cure or treatment.
Ask yourself one question-if any one single works so well and cures or improves so many patients, why would we see all sorts of other treatments proposed for the same disease? Walk into any pharmacy and look at the aisle containing acne medications-if there was one single great treatment, then why are there hundreds of different kinds there? Same thing for gastric upset, arthritic pain, cold symptoms, etc. 60 years ago they started treating syphilis with a shot of that new fangled antibiotic penicillin. And it worked. Worked so well that nobody needed to treat the disease with anything else. Even after all these years, it is still one of the most effective treatments and there are only a few alternatives ever needed.
Cancers, back pain, headaches, cold symptoms, insomnia, irritable bowel and reflux-everyone claims to have a wonder treatment for these but if any of them were really that good at treating all patients, why do so many patients still suffer so much and keep looking for alternatives. These diseases lend themselves to all sorts of phony baloney people claiming to be able to treat them.
I am a great believer in any form of treatment that works. If acupuncture makes you feel better, and it is not harming you in any way or delaying your seeking a more effective treatment, then by all means get poked to your heart's content. Is there a scientific basis for this? Unlikely, but maybe it falls into the 20% of treatment that is art or the 5% that is pure luck.

 

[FreshFish]

Re: Acupuncture

I am a great believer in any form of treatment that works.

While I bit off-topic, I have had excellent results working with a chiropractor for all sorts of various joint pain, not merely "spinal realignments." He typically finds an imbalance in muscle strength between one side of the joint and the other, and then prescribes a set of exercises intended to restore balance. They do work in alleviating the joint pain (neck, shoulder, elbow, hip, knee at various times over the past eight years). I also had some lower back issues which have cleared up, partly from treatment, more from the exercises he prescribed for that.

Sorry this doesn't help your wife at all, but not every practitioner of every "alternative" medicine is ineffective, in my experience. My only "problem" has been that sometimes the number of exercises he would have me do take up more time than I'd normally have available in which to do them.

 

[WisconsinWildcard]

Re: Acupuncture

The classic assertion of all quackery: one cause, one cure. As in: human ailments are caused by spinal "subluxations" and spinal manipulation therapy can "cure" those ailments. The mind is a powerful instrument. In controlled studies of new drugs, people getting the placebo frequently complain of side effects.

Cancer quackery is among the most cruel. Please recall poor Steve McQueen, dying of mesothelioma, heading down to Mexico for coffee enemas. The landscape is littered with phony cancer "cures" and the quacks who offer them. Perhaps the worst was Harry Hoxsey, whose nutritional cancer quackery is still practiced in (wait for it) Mexico.

Years ago Dr. Pio helped the feds get the goods on the Durovic brothers, who were peddling a useless cancer drug call Krebiozen. The guy fronting their operation was Dr. Andrew Ivy, president of the University of Illinois medical school. As a graduate of that school, Dr. Pio was intensely embarrassed and wanted to get that senile old fool stopped. He described for me once in great disgust watching Ivy "scrub" before giving an injection of this "wonder drug."

The beauty of cancer "cures" is that some people don't have cancer. Some of those who do go into remission. Some of those who appear to respond to the quack drug are actually responding to ordinary treatments. And the rest are dead. So all that's left are the sincere "survivors" of cancer, telling the world how apricot pits or horse blood or coffee enemas "cured" them of their cancers.

I largely agree with everything you have said (here ). Regarding the coffee enema, the infamous Gonzalez Regimen which has been a black eye on the NCCAM branch of the NIH. Basically, coffee enemas caused people with the already bad prognosis of pancreatic cancer to die even quicker.
http://www.sciencebasedmedicine.org/the-ethics-of-cam-trials-gonzo-part-i/

Ask yourself one question-if any one single works so well and cures or improves so many patients, why would we see all sorts of other treatments proposed for the same disease? Walk into any pharmacy and look at the aisle containing acne medications-if there was one single great treatment, then why are there hundreds of different kinds there? Same thing for gastric upset, arthritic pain, cold symptoms, etc. 60 years ago they started treating syphilis with a shot of that new fangled antibiotic penicillin. And it worked. Worked so well that nobody needed to treat the disease with anything else. Even after all these years, it is still one of the most effective treatments and there are only a few alternatives ever needed.
Cancers, back pain, headaches, cold symptoms, insomnia, irritable bowel and reflux-everyone claims to have a wonder treatment for these but if any of them were really that good at treating all patients, why do so many patients still suffer so much and keep looking for alternatives. These diseases lend themselves to all sorts of phony baloney people claiming to be able to treat them.
I am a great believer in any form of treatment that works. If acupuncture makes you feel better, and it is not harming you in any way or delaying your seeking a more effective treatment, then by all means get poked to your heart's content. Is there a scientific basis for this? Unlikely, but maybe it falls into the 20% of treatment that is art or the 5% that is pure luck.

I agree with much of what you say except for the part about being a believer if it "works." There are just too many factors that go unnoticed by an individual patient or practitioner for that to be the be-all-end-all. This is why I think it is more important to look at well controlled studies to try better understand if there is an effect. And I have to say I am not a big believer in "Placebo Medicine." I freely grant that every practitioner of any training benefits from the placebo effect. However, the way we determine is something is an effective treatment is if it performs better than placebo, not at the level of a placebo.

Take the better acupuncture studies that have come out for the last 5-10 years. When adequately controlled, it does not matter where the needle is placed, who is doing it, or if the needle even punctures the skin. Acupuncture and sham (placebo) arms perform the same, both better than no-treatment, and they say "it works!" If you were using that data for a pharmaceutical there is no way it would gain traction. I would also point out that acupuncture is not zero risk. Set aside the financial costs (both to individual and overall healthcare dollars), there is an abundance of case reports of finding needles broken off, organ puncture, pneumothorax, etc.

Additionally, most people who try alternative medicine are at the most desperate stage. The largest amount of pain, discomfort, etc. End of their rope. It makes it very susceptible to regression toward the mean. http://en.wikipedia.org/wiki/Regression_toward_the_mean No matter what was done, they would have gotten better. The result is whatever alternative therapy they are currently using "works." And if it doesn't work, then the alternative practictioner will never see that patient again, further confirming their biases.

 

[WisconsinWildcard]

Re: Acupuncture

While I bit off-topic, I have had excellent results working with a chiropractor for all sorts of various joint pain, not merely "spinal realignments." He typically finds an imbalance in muscle strength between one side of the joint and the other, and then prescribes a set of exercises intended to restore balance. They do work in alleviating the joint pain (neck, shoulder, elbow, hip, knee at various times over the past eight years). I also had some lower back issues which have cleared up, partly from treatment, more from the exercises he prescribed for that.

Sorry this doesn't help your wife at all, but not every practitioner of every "alternative" medicine is ineffective, in my experience. My only "problem" has been that sometimes the number of exercises he would have me do take up more time than I'd normally have available in which to do them.

The best line I have heard about chiropractors is that they are physical therapists with delusions of grandeur. I think they can function well in the role of a evidence based physical therapist. However, they are very dangerous when they overstep their expertise. http://www.sciencebasedmedicine.org/chiropractors-as-family-doctors-no-way/ The chiropractic professional groups claim to be able to treat asthma, diabetes, etc and I think that is grossly inappropriate. I would also strongly advise against any neck manipulation. Artery dissections and stroke are very serious side effects that are rarely talked about.

I think it would be hard to find a doc who advises against exercise (if you find one, leave). In fact, I struggle to think of a condition it would not help. However, we may not be able to teach effective exercises and that may be where physical therapists and chiropractors have their most beneficial role.

 

[busterman62]

Re: Acupuncture

I agree with much of what you say except for the part about being a believer if it "works."

You will, Grasshopper, You will.

 

[DrDemento]

Re: Acupuncture

WWC: We are not in disagreement at all. In my post I indicated if it works(relieves symptoms) by all means try it as long as it does not delay seeking a proper diagnosis and is in no other way harmful to you. If someone has their pain relieved without any harmful effects, by all means go ahead and try it even if it is not scientifically proven in a double blind study. Sometimes as scientific as we physicians try to be, we are forced to relieve suffering for which we have no real answer. Your other post is also spot on. I have had patients with severe acne who were allegedly being treated for the condition by chiropractors with spinal manipulation (after almost 50 years in medicine i am still having difficulty understanding what a subluxation of the spine really is and how it can cause cystic acne vulgaris). We even had one young lady that a chiropractor wanted to treat for severe headaches (and some spinal symptoms) with neck manipulation. Turns out she was leaking from a Berry aneurysm and he could have perhaps killed her with a quick snap of the neck. 16 hours of neurosurgery was far more helpful in this case.

 

[WisconsinWildcard]

Re: Acupuncture

WWC: We are not in disagreement at all. In my post I indicated if it works(relieves symptoms) by all means try it as long as it does not delay seeking a proper diagnosis and is in no other way harmful to you. If someone has their pain relieved without any harmful effects, by all means go ahead and try it even if it is not scientifically proven in a double blind study. Sometimes as scientific as we physicians try to be, we are forced to relieve suffering for which we have no real answer. Your other post is also spot on. I have had patients with severe acne who were allegedly being treated for the condition by chiropractors with spinal manipulation (after almost 50 years in medicine i am still having difficulty understanding what a subluxation of the spine really is and how it can cause cystic acne vulgaris). We even had one young lady that a chiropractor wanted to treat for severe headaches (and some spinal symptoms) with neck manipulation. Turns out she was leaking from a Berry aneurysm and he could have perhaps killed her with a quick snap of the neck. 16 hours of neurosurgery was far more helpful in this case.

Point taken. I was trying to show (albeit poorly) that "works" is a very nuanced and complicated term that has a very different meaning to people of varying medical expertise or background.

Subluxations are a tricky business. We had a 30 something patient that had a dissection in his vertebral artery worthy of a head-on car collision. The only thing significant in his history was seeing a chiropractor for headache. Turns out, working in a tertiary referral center you see 1-2 of these cases a month and the attending (an interventional neurologist) did not have many kind words to say about neck manipulations. Case reports only of rare complications, I know, but it would be basically impossible to do a prospective study (I feel the chiropractors would frown on participating in something like that and the population size needed for study would be immense.)

 

[Old Pio]

Re: Acupuncture

WWC: We are not in disagreement at all. In my post I indicated if it works(relieves symptoms) by all means try it as long as it does not delay seeking a proper diagnosis and is in no other way harmful to you. If someone has their pain relieved without any harmful effects, by all means go ahead and try it even if it is not scientifically proven in a double blind study. Sometimes as scientific as we physicians try to be, we are forced to relieve suffering for which we have no real answer. Your other post is also spot on. I have had patients with severe acne who were allegedly being treated for the condition by chiropractors with spinal manipulation (after almost 50 years in medicine i am still having difficulty understanding what a subluxation of the spine really is and how it can cause cystic acne vulgaris). We even had one young lady that a chiropractor wanted to treat for severe headaches (and some spinal symptoms) with neck manipulation. Turns out she was leaking from a Berry aneurysm and he could have perhaps killed her with a quick snap of the neck. 16 hours of neurosurgery was far more helpful in this case.

My problem with chiropractic is scope of practice. Chiropractic holds itself out as a separate and superior form of medicine. Certainly superior to what they contemptuously refer to as "allopathic" medicine. D. D. Palmer essentially invented chiropractic in 19th century Iowa. And created the concept of spinal "subluxations" which are responsible for a host of conditions. And if these "subluxations" are treated chiropractically, these conditions will diminish or even disappear.

There are a couple of problems here. For one thing, no one has been able to demonstrate what a "subluxation" is or even that "subluxations" exist. And no one has been able to establish the connection between treatment of "subluxations" and the relief of human illness.

Howard Jarvis, PhD, then president of the National Council Against Health Fraud, described chiropractic to me as the largest non scientific health system extant. Add to this that many (most?) chiropractors are relentlessly entrepreneurial and you have huge potential for abuse. Many chiros still use parlor tricks (weak arm, strong arm, and one leg shorter than the other, etc) to convince the gullible. I've seen segments on TV where chiropractors encourage and pretend to be "adjusting" the spines of infants. It's just slight of hand, of course. One gifted quack several years ago came up with something called Neural Organizational Therapy which held that squeezing the skulls of children would "cure" learning disabilities. And he got at least one California school district to go along with the nonsense. Many chrios rely on unnecessary and dangerous full spine x-rays. There are divisions within chiropractic. Some are called "straights" and practice the old time Palmer razz-a-matazz. Some are called "mixers," who incorporate "nutritional" and other hocus pocus in their ministering.

And there are reformist chiropractors who work with MDs, and limit their scope of practice to Type M (musculo-skeletal) conditions. Since most MDs receive no training in spinal manipulation therapy, and chiropractors do, they can be useful in ameliorating the pain people experience following traffic accidents, sports injures, etc. Dr. Pio used to refer patients recovering from crushed chest automobile accidents to chiropractors for relief of pain. But not for treatment of diabetes, TB or acne. One advantage that chiropractors have is they "lay on hands." And regardless of the efficacy of the manipulation, that human touch can have a significant impact on patients who are in pain.

 

[WisconsinWildcard]

Re: Acupuncture

My problem with chiropractic is scope of practice. Chiropractic holds itself out as a separate and superior form of medicine. Certainly superior to what they contemptuously refer to as "allopathic" medicine. D. D. Palmer essentially invented chiropractic in 19th century Iowa. And created the concept of spinal "subluxations" which are responsible for a host of conditions. And if these "subluxations" are treated chiropractically, these conditions will diminish or even disappear.

There are a couple of problems here. For one thing, no one has been able to demonstrate what a "subluxation" is or even that "subluxations" exist. And no one has been able to establish the connection between treatment of "subluxations" and the relief of human illness.

Howard Jarvis, PhD, then president of the National Council Against Health Fraud, described chiropractic to me as the largest non scientific health system extant. Add to this that many (most?) chiropractors are relentlessly entrepreneurial and you have huge potential for abuse. Many chiros still use parlor tricks (weak arm, strong arm, and one leg shorter than the other, etc) to convince the gullible. I've seen segments on TV where chiropractors encourage and pretend to be "adjusting" the spines of infants. It's just slight of hand, of course. One gifted quack several years ago came up with something called Neural Organizational Therapy which held that squeezing the skulls of children would "cure" learning disabilities. And he got at least one California school district to go along with the nonsense. Many chrios rely on unnecessary and dangerous full spine x-rays. There are divisions within chiropractic. Some are called "straights" and practice the old time Palmer razz-a-matazz. Some are called "mixers," who incorporate "nutritional" and other hocus pocus in their ministering.

And there are reformist chiropractors who work with MDs, and limit their scope of practice to Type M (musculo-skeletal) conditions. Since most MDs receive no training in spinal manipulation therapy, and chiropractors do, they can be useful in ameliorating the pain people experience following traffic accidents, sports injures, etc. Dr. Pio used to refer patients recovering from crushed chest automobile accidents to chiropractors for relief of pain. But not for treatment of diabetes, TB or acne. One advantage that chiropractors have is they "lay on hands." And regardless of the efficacy of the manipulation, that human touch can have a significant impact on patients who are in pain.

Very good summation. The term allopathic medicine was coined by the inventor of homeopathy (http://en.wikipedia.org/wiki/Allopathic_medicine) and co-opted by many outside mainstream evidence based medicine. I have informed many of my colleagues when they mindlessly use allopathic to describe MDs

Now homeopathy...quackery in its truest form.
https://www.youtube.com/watch?v=BWE1tH93G9U

 

[walrus]

Re: Acupuncture

I've seen a chiro many times, especially one trained in ART, active release technique, it most of been an illusion that the tendinitis in my arms disappeared after treatment.

 

[WisconsinWildcard]

Re: Acupuncture

I've seen a chiro many times, especially one trained in ART, active release technique, it most of been an illusion that the tendinitis in my arms disappeared after treatment.

I am happy that you made this comment because it is inevitable that a personal anecdote or two enters this discussion. I have not found a good way to continue the discussion because I am already at a significant disadvantage. You have a personal experience of it working, something I am pretty sure I cannot dissuade you from. You may know other people that it has worked for. An educated person (or several) in a position of expertise had told you it worked. Given that framework, I am almost left to prove that it does not work, which I cannot.

However, I will say this for your consideration. When people try a treatment, any treatment, they are often very desperate. They have often tried many other things to no avail. This is where the concept of "regression toward the mean" I mentioned earlier comes in. Often, doing absolutely nothing at all will have the same result since pain does not increase forever. Eventually, you adapt, your body heals, or you die.

Additionally, there are a whole host of other factors in play. The placebo effect is powerful (at times) but complicated and not well understood. Wearing a white coat improves outcomes. Larger pills work better than smaller. Certain colors of pills have different side effects. Every area of medicine benefits from this, but we also try to determine if what we are doing works outside of these effects. This is why the sacred cow of medicine has become the double-blind placebo controlled study. Granted, there are many problems with this, some known, some unknown but it has proved to be a powerful way of knowing. And, as Ben Goldacre states: Just because there are problems with aircraft design does not mean that magic carpets exist.

Now what I do for topics I do not know much about is first do a search on pubmed. I am peripherally familiar with ART but from what I can find on pubmed, ART is a patented technique that has an evidence base is largely anecdotal. I could not find any studies with a control group and the studies involved small groups of studies with varied conditions.

So that brings me to where this sits in the evidence pyramid. Case reports and pilot studies are good for developing a hypothesis but not testing it. So at this point, ART has not been tested. From a medical standpoint, we do not know if it "works."

That brings us back to a point DrDemento was making earlier. If it seems to help you, fine. ART does not seem to have any easily discernible risk. However (this is the most important part), there is no evidence that improvement of tendinitis is inherent to anything exclusive to ART. It could be due to the "hands on" approach. Maybe a massage would work. It could be due to a compassionate individual spending time on your issue. Maybe a longer visit with your primary care provider would work. It could be due to learning exercises, stretching, and knowledge about your injury. Maybe a physical therapist not trained in ART would work.

That is the reason we spend billions of dollars on medical research. To advance knowledge. To allow us to have some insight into if a process "works" or if something actually has a measurable effect free from bias or confounders. ART appears to have been around since 1985 and from what I could tell, there has been no sincere attempt to study this in a way that would be significantly persuasive to those trying to practice evidence based medicine.


GEORGE, J.W, TEPE, R.E, BUSOLD, D., KEUSS, S., PRATHER, H., SKAGGS, C.D., ‘The effects of active release technique on carpal tunnel patients: a pilot study’, Journal of chiropractic medicine, 2006, pp. 119-122
DROVER, J.M, FORAND, D.R., HERZOG, W., ‘Influence of active release technique on quadriceps inhibition and strength: a pilot study’, Journal of Manipulative and Physiological Therapeutics, 2004, volume 27, num. 6, pp. 408-413
HOWITT, S., JUNG, S., HAMMONDS, N., ‘Conservative treatment of a tibialis posterior strain in a novice triathlete: a case report’, The Journal of the Canadian Chiropractic Association, 2009 March, volume 53, num. 1, pp. 23 – 31
HOWITT, S., ‘Lateral epicondylosis: a case study of conservative care utilizing ART and rehabilitation’, Journal of the Canadian Chiropractic Association, 2006 September, volume 50, num. 3, pp. 182 – 189

 

[Old Pio]

Re: Acupuncture

Very good summation. The term allopathic medicine was coined by the inventor of homeopathy (http://en.wikipedia.org/wiki/Allopathic_medicine) and co-opted by many outside mainstream evidence based medicine. I have informed many of my colleagues when they mindlessly use allopathic to describe MDs

Now homeopathy...quackery in its truest form.
https://www.youtube.com/watch?v=BWE1tH93G9U

Hahnemann surely belongs in the quack Hall of Fame. "Water memory" and all of the rest of that tripe.

James Randi is a national treasure and a true MacArthur Genius. We haven't talked about faith healers, but Randy destroyed Peter Popoff on the Carson show.

As a young physician practicing in the country (before moving to Chicago) Dr. Pio used to tell me about the farm wife who suffered fainting spells, but only when she was arguing with her husband. So on one occasion he showed up (yes, a house call) and the lady was splayed out on the kitchen floor. Dr. Pio administered a couple of drops of household ammonia in her nose--which got her up immediately and miraculously cured those fainting spells permanently!

 

[DrDemento]

Re: Acupuncture

WWC and OP: The three of us seem to all be on the same page. But let me digress for a moment. The general public, however, is bombarded by media coverage that seems to revel in the anecdotes that we have been discussing. It seems that everyone wants to have a piece of the financial medical pie. The government and the insurers who now control much of the medical pocket book is really only interested in the bottom line. if it costs less, than it acceptable. And they could care less who provides whatever service they are willing to pay for.(unless of course it affects these esteemed lawmakers personally) Years ago they began to lump all of those who provide any sort of medical care with the term Provider. I am not a provider and have never been one. I am a physician with all the education, training, certifications and experience to prove it. The general public is being led down a very treacherous path in that the kind of medical care they are receiving is being determined by their insurer or the government. They are in essence practicing medicine, but without a medical license. Nurse practitioners, physician assistants, and others can perhaps provide some valuable services under limited conditions and under medical supervision. Lumping chiropractic and acupuncture into this equation is adding oranges to apples. But using the general term of medical provider for all is doing a great disservice as not all medical care provided is equal. Medical care provided by different hospitals and different physicians is not even equal. Some physicians are well trained having graduated near the top of their class from a top notch medical school and then training in a respected residency program and then have more experience than others. For simple medical care needs, perhaps it makes little difference. But for any true diagnostic difficulty or a condition of any real seriousness, the difference can be and often is one of life or death. I am pretty sure that the general public is either unaware or just plain uninformed that the decisions of such importance about their lives are often made by some totally untrained and unqualified young person who answers the phone for a major insurer.

 

[FreshFish]

Re: Acupuncture

Now what I do for topics I do not know much about is first do a search on pubmed. I am peripherally familiar with ART but from what I can find on pubmed, ART is a patented technique that has an evidence base is largely anecdotal. I could not find any studies with a control group and the studies involved small groups of studies with varied conditions.

So that brings me to where this sits in the evidence pyramid. Case reports and pilot studies are good for developing a hypothesis but not testing it. So at this point, ART has not been tested. From a medical standpoint, we do not know if it "works."

It is hard for me to envision how one might even design a "controlled experiment" in the first place. I bend over and twist sideways and hear a "pop" in my knee, and subsequently have pain and soreness there. I visit "my" chiropractor (who from all accounts posted here is very much an anomaly), and he explains to me how the ligaments and tendons in the knee are connected, how they operate, and he pokes and prods for a minute or two and then prescribes some exercises. He also has an ultrasound treatment (which "anecdotally" seems to help) and an electro-stimulation machine of some sort (which "anecdotally" seems mostly a placebo).

How could you gather a "control group" for such a condition, and what would be the "accepted" existing medical "procedure" against which to test it?

 

[WisconsinWildcard]

Re: Acupuncture

It is hard for me to envision how one might even design a "controlled experiment" in the first place. I bend over and twist sideways and hear a "pop" in my knee, and subsequently have pain and soreness there. I visit "my" chiropractor (who from all accounts posted here is very much an anomaly), and he explains to me how the ligaments and tendons in the knee are connected, how they operate, and he pokes and prods for a minute or two and then prescribes some exercises. He also has an ultrasound treatment (which "anecdotally" seems to help) and an electro-stimulation machine of some sort (which "anecdotally" seems mostly a placebo).

How could you gather a "control group" for such a condition, and what would be the "accepted" existing medical "procedure" against which to test it?

From the described experience, it would not be too hard to design a control group. First you would have to isolate a variable. Let's say the ultrasound. Have two groups of similar people, one treated by a real ultrasound and one from a "sham" (or fake group). If you really wanted a "good" experiment, also blind the chiropractor to whether they are using a real ultrasound or fake. Then compare outcomes.

Some problems I can already identify with this study (among many) are if the patient or chiropractor could tell the difference between the real and sham ultrasound. I admittedly do not know much about this procedure so I am kind of winging it. Additionally, outcomes would be a sticky point. Pain is notoriously difficult to quantify. You could follow up with pain scales, length of resolution of symptoms, ability to participate in normal activities, over the counter analgesic use, etc. None are perfect but it would be a good start to legitimizing a treatment. Given time, I could likely design a better experiment.

Since this is a thread about acupuncture, I can talk a bit about the difficulties in studying the process. First off, as you identified, it is important to have an adequate control or something to compare it to. It is near obvious that acupuncture vs nothing will help people in most cases. However, it is difficult to blind both the practitioner and the patient. They can usually blind the patient but the practitioner is more difficult. They have used "sheaths" that encase the needle so the practitioner does not know if it fully enters the patient (normal treatment) or just sits on the surface (sham).

Long story short, looking at the whole field of acupuncture research, the better you control and blind, the less effect acupuncture has. In fact, the video I posted in an earlier post describes a study where tooth picks had a better outcome than needling. Additionally, in the vast majority of studies, location of the needles is irrelevant. Outcomes are the same whether you follow "the lines" or just pick a random spot on the body.

Additionally, the improvement is usually never objective. Here is a study in NEJM where acupuncture was used for asthma. The acupuncture arm (both sham and normal) showed improvements in subjective asthma symptoms. However, they did not show improvement in objective findings like lung function tests. This can falsely give reassurance in a dangerous condition like asthma. It highlights the point that placebo effects are tricky and can unexpectidly be nocebo. http://en.wikipedia.org/wiki/Nocebo

http://www.nejm.org/doi/full/10.1056/NEJMoa1103319#t=article