Acupuncture

[WisconsinWildcard]

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.

Spot on. In this thread, I use practitioner as a general term since alternative medicine is performed by physicians but much more often individuals of varying backgrounds and training.

 

[FreshFish]

Re: Acupuncture

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.

Wouldn't the "first step" be to compare diagnoses? That is more what I meant.

In the "acupuncture" context, let's suppose that there are two kinds, those who truly believe they have a "scientific" basis (analogous to my chiropractor, who has demonstrated a keen practical knowledge of how muscles, joints, tendons and ligaments interact, and prescribes very specialized exercises to strengthen areas of weakness precisely where they need strengthening), and those who are "merely" following someone else's guidelines, said guidelines which may have no "scientific" basis whatsoever (analogous to the way chiropractors in general have been described here).

So before one even starts "treatment" one first needs to diagnose what "needs to be treated", no? and yet your control group at the outset would have to present with "the same" symptoms, no?

That's more what I was trying to get at. It might not be enough to have 1,000 people with "soreness in their lower back", would it? wouldn't you have to have 1,000 people with soreness in their lower back from "the same" cause, as well?

 

[WisconsinWildcard]

Re: Acupuncture

Wouldn't the "first step" be to compare diagnoses? That is more what I meant.

Not sure what you mean by compare diagnoses. In what I described, you would shoot for specific diagnostic criteria that patients fulfill before enrolling them in the study. In truth, this makes much of alternative medicine's treatments difficult to study. For example, a pseudoscientific thing is "adrenal fatigue" that many alternative practitioners "diagnose" and "treat." I challenge anyone to look at the long list of symptoms caused by "adrenal fatigue" and not identify with one or more on a daily basis. How can you study something that you could "diagnose" literally every person who walks into your office with?

In the "acupuncture" context, let's suppose that there are two kinds, those who truly believe they have a "scientific" basis (analogous to my chiropractor, who has demonstrated a keen practical knowledge of how muscles, joints, tendons and ligaments interact, and prescribes very specialized exercises to strengthen areas of weakness precisely where they need strengthening), and those who are "merely" following someone else's guidelines, said guidelines which may have no "scientific" basis whatsoever (analogous to the way chiropractors in general have been described here).

We do not have to suppose that. Practitioner belief in a treatment affects the treatments outcome. This is why the gold standard for a clinical trial is the double blind (both practitioner and patient blinded), placebo controlled trail. This works best for pills, injections, etc. As I stated, it is difficulty to blind someone to a procedure, surgery, etc. However, I think it is reckless to say "Aw shucks. That's not possible" when looking at other treatments. Much progress has been made in blinding. I think we have decent blinding in well controlled acupuncture studies. There are several surgical techniques that have been abandoned when carefully designed trials have revealed they are no more than placebos.

Take vertebroplasty. It has largely been abandoned by the medical community. Sure, it is still being performed but it is no longer evidence based. Most of the practitioners who still do it are doing it for monitary reasons as DrD has alluded to earlier in thes thread. http://www.nytimes.com/2009/08/06/health/research/06spine.html?_r=0

So before one even starts "treatment" one first needs to diagnose what "needs to be treated", no? and yet your control group at the outset would have to present with "the same" symptoms, no? That's more what I was trying to get at. It might not be enough to have 1,000 people with "soreness in their lower back", would it? wouldn't you have to have 1,000 people with soreness in their lower back from "the same" cause, as well?

Yes. That is one reason it is reckless to see someone with minimal training. A chiropractor has little to no training in the bad outcomes. They are not trained like physicians in ruling out the other diagnoses that could be causing the symptoms. They are less capable of weeding out the warning signs of a more ominous etiology. Their diagnoses are largely based on a subluxation theory that predates most of 20th century medicine. This is why they thrive where evidence based medicine does not have very good answers and why they are usually sought after when evidence based medicine has let the patient down. They do well with vague complaints of "lower back pain." However they are campaigning to become primary care providers. In nearly every state, they would like their practice expanded and that, my friend, is where I think the real danger is.

The knowledge base of medicine has exploded over the last two decades +. We have been able to become more specific in our statements, more precise in our definitions. It used to be leukemia. Now there are numerous subtypes. We are able to target drugs better. We are able to do more with existing medication instead of needing a whole new medication. Now look for the trend in alternative medicine. They tend to target vague symptoms. They rely on things not supported by basic research. They ignore whole systems of human physiology yet claim to be "holistic." If you have a physician that is not taking into account you as a whole patient, you are either seeing an orthopedic surgeon or should find a new doctor

 

[walrus]

Re: Acupuncture

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

I had all the above mentioned treatments, PT, Drugs, massage therapy nothing worked like ART. It would never clear up on its own because as a contractor part of my business involves heavy use of my hands and arms. So I never stopped and rested. I wonder who would fund a study and why? I'm skeptical on anyone telling me its a quest for knowledge when the in real world its mostly about profit. So who would profit from the study? Only practitioners from what I see.

 

[Old Pio]

Re: Acupuncture

I had all the above mentioned treatments, PT, Drugs, massage therapy nothing worked like ART. It would never clear up on its own because as a contractor part of my business involves heavy use of my hands and arms. So I never stopped and rested. I wonder who would fund a study and why? I'm skeptical on anyone telling me its a quest for knowledge when the in real world its mostly about profit. So who would profit from the study? Only practitioners from what I see.

The other fundamental principle of quackery is: "They want to keep my therapy/treatment/drug off the market so as to maximize their profits." You shouldn't be so cavalier in dismissing scientific inquiry as being "mostly about profit." For sure, Jonas Salk would disagree.

 

[walrus]

Re: Acupuncture

The other fundamental principle of quackery is: "They want to keep my therapy/treatment/drug off the market so as to maximize their profits." You shouldn't be so cavalier in dismissing scientific inquiry as being "mostly about profit." For sure, Jonas Salk would disagree.

I never said anything about keeping it off the market, not sure where you get that. I question who is going to put the money forward for the studies to satisfy someone who needs proof it works(or doesn't) according to a dbl blind study.

 

[DrDemento]

Re: Acupuncture

The other fundamental principle of quackery is: "They want to keep my therapy/treatment/drug off the market so as to maximize their profits." You shouldn't be so cavalier in dismissing scientific inquiry as being "mostly about profit." For sure, Jonas Salk would disagree.

OP-You could not be more correct. Years ago I had a heated discussion with a patient who absolutely insisted that doctors had the cure for cancer but refused to release it so they could continue to make money off of cancer patients. First, i explained to him as best i could, there is no such thing as one cancer-each organ involved, each type of cell, each specific form of cancer is different and even case where all of the above are the same still behave differently. When he still refused to believe I simply asked him, if that was true, why do doctors die at about the same average age as non doctors and from the same gamut of diseases including cancers? And, I added, if money and power got you the best medicine, and there were hidden cures, why Did Sam Walton die of bone cancer and Ted Kennedy from brain cancer? Surely they had access to unlimited funds for unlimited and the best medical minds in the world.
There are some disease entities and some conditions that physicians just do not treat as well as we would wish we could and these are the cases that the non physician, quasi medical, witch doctor charlatans love to focus on. I have absolutely no problem with anyone who can offer a patient relief from symptoms. If they can reduce the pain in your back or the discomfort in your gut, then that is wonderful. But not at the dangerous cost of delaying or missing a diagnosis that a trained physician could have made that might save your life or prevent unrepairable damage. Once an accurate diagnosis is made, and i know that i do not have something serious that necessitates medical intervention-would i go to a chiropractor for some relief of back pain? Absolutely(but i would certainly not allow him to diagnose the condition without first consulting my orthopedic physician). Darn instead o going to that chiropractor i might even just have some cute young Chinese girl walk on my back(as long as Jen never found out about it). I have enough trouble making sure that a board certified physician is trained well enough for my satisfaction so i certainly will not trust my life or my family to an untrained provider.

 

[joecct]

Re: Acupuncture

Too many horror movies in my youth. Voodoo dolls and needles have me the willies so no acupuncture.

You know that would be a good zombie movie - acupuncturist turns patients into zombies by the application of a few/lot of needles.

 

[DrDemento]

Re: Acupuncture

Too many horror movies in my youth. Voodoo dolls and needles have me the willies so no acupuncture.

You know that would be a good zombie movie - acupuncturist turns patients into zombies by the application of a few/lot of needles.

I am beginning to think you have too much time on your hands.

 

[Timothy A]

Re: Acupuncture

Thanks for the replies. We met with David last week to review his findings. He did a full oriental exam, meaning they analyze your tongue as well, which gives him insights as to what is going on with the body. (The color and texture supposedly say a lot about your body's internal functions.) He thinks a 12 treatment program with an oriental herb program (where they custom mix up herbal capsules per what they think you need) would pretty much clear up the pre and post PMS issues and the acid re-flux. We're just not convinced it will work based on the results of the 6 treatment test run (and the feedback on this site).

Interestingly, in his office there is a chart showing all the acupuncture spots, which are on all the extremities plus the torso. He only treated my wife on her extremities and not on the torso at all, which I found very uneasily questionable.

 

[joecct]

I am beginning to think you have too much time on your hands.

Retired and minding grandson #2 during the day with grandma.

 

[Old Pio]

Re: Acupuncture

OP-You could not be more correct. Years ago I had a heated discussion with a patient who absolutely insisted that doctors had the cure for cancer but refused to release it so they could continue to make money off of cancer patients. First, i explained to him as best i could, there is no such thing as one cancer-each organ involved, each type of cell, each specific form of cancer is different and even case where all of the above are the same still behave differently. When he still refused to believe I simply asked him, if that was true, why do doctors die at about the same average age as non doctors and from the same gamut of diseases including cancers? And, I added, if money and power got you the best medicine, and there were hidden cures, why Did Sam Walton die of bone cancer and Ted Kennedy from brain cancer? Surely they had access to unlimited funds for unlimited and the best medical minds in the world.
There are some disease entities and some conditions that physicians just do not treat as well as we would wish we could and these are the cases that the non physician, quasi medical, witch doctor charlatans love to focus on. I have absolutely no problem with anyone who can offer a patient relief from symptoms. If they can reduce the pain in your back or the discomfort in your gut, then that is wonderful. But not at the dangerous cost of delaying or missing a diagnosis that a trained physician could have made that might save your life or prevent unrepairable damage. Once an accurate diagnosis is made, and i know that i do not have something serious that necessitates medical intervention-would i go to a chiropractor for some relief of back pain? Absolutely(but i would certainly not allow him to diagnose the condition without first consulting my orthopedic physician). Darn instead o going to that chiropractor i might even just have some cute young Chinese girl walk on my back(as long as Jen never found out about it). I have enough trouble making sure that a board certified physician is trained well enough for my satisfaction so i certainly will not trust my life or my family to an untrained provider.

Dr. Pio used to say if it were true that they were keeping life saving therapies off the market to guard their profits, then we would never have seen penicillin. He estimated about two out of three of us wouldn't be here without it. If, someday, a vaccine against all of the various cancers were created, it would cost tens of thousands of dollars per injection. And every insurance company and medical payer would jump at providing those injections. A fixed cost. Perfect.

Some chiropractors and other quacks expend a great deal of effort to convince their patients to make them their primary care givers. These "one cause, one cure" types make poor PCPs because of their limited training and knowledge. Dr. Pio used to refer to an "index of suspicion," which is underdeveloped or missing entirely with these people. Under the circumstances you just discussed, where you've got a Type M condition, well diagnosed, then a chiropractor with appropriate limits on his scope of practice could provide you with some pain relief.

 

[Old Pio]

Re: Acupuncture

I never said anything about keeping it off the market, not sure where you get that. I question who is going to put the money forward for the studies to satisfy someone who needs proof it works(or doesn't) according to a dbl blind study.

In most cases the much hated "big pharma" will be paying for the research. Some avenues of inquiry turn out to be dead ends. Others not. And in many cases, a drug created for one purpose winds up having more than one application. We have a Food and Drug Administration which "protects" us and establishes standards for the introduction of new drugs in the market place. Extremely complicated and difficult regulations. Some would argue the FDA can frequently be too protective, by keeping drugs off the market the efficacy of which have been demonstrated.

One of the requirements of scientific inquiry is that experiments and studies can be replicated by others following the same protocols. In the case of chiropractic, the central premise, that so-called "subluxations" are responsible for human suffering has never been proven. Nor, in fact, the existence of "subluxations" in the first place. Yet, in over a century, organizaed chiropractic has been unable to prove even the existence of subluxations, let alone their role, if any, in human illness. And it has shown very little interest in inquiring.

Think about the advances in scientific medicine over the past 100 years. And during that same period chiroprators have stubbornly clung to their core beliefs, practicing today essentially the same way they did a century ago in the Iowa cornfields.

 

[leswp1]

Re: Acupuncture

Chiming in late and trying to ignore some of the things posted because my reply would be pages long. Yrs ago I worked in a large teaching hospital in Boston. They had some pts on my floor who were part of an acupuncture study. The results were incredible. The medical staff, including the attending, residents and PT were all in agreement that for the thing they were studying the results were amazing. Anecdotally I have seen some improbable results with acupuncture treatment, some of my patients have had great relief from treatment after failing other methods. Many of the patients I see who have had acupuncture do not think they are 'cured'. They do feel better overall and more able to handle the sx they are experiencing.

Of course the studies I have read over the yrs may have been 'greatly flawed' but it is my understanding they have found increase levels of endorphins and cortisol when the person is treated correctly. They have found that correct placement of needles causes the micro-electric currents in the fascia to alter. This last bit of info was imparted at a MEDICAL conference by a medical Dr. who was not pushing acupuncture at all.

I have never told a patient they will be cured. The acupuncturists in our community are very careful to tell patients they can't cure everything and have the list generated by the WHO regarding when acupuncture would be appropriate. They also will tell people they are not a replacement for medical care.

I have a hard time giving blanket dismissal of 'alternative' medicine practices. In every discipline you are going to have charlatans and great practitioners. Anyone that says they are going to cure you, no problem, should be scary what ever their title.

 

[Old Pio]

Re: Acupuncture

Chiming in late and trying to ignore some of the things posted because my reply would be pages long. Yrs ago I worked in a large teaching hospital in Boston. They had some pts on my floor who were part of an acupuncture study. The results were incredible. The medical staff, including the attending, residents and PT were all in agreement that for the thing they were studying the results were amazing. Anecdotally I have seen some improbable results with acupuncture treatment, some of my patients have had great relief from treatment after failing other methods. Many of the patients I see who have had acupuncture do not think they are 'cured'. They do feel better overall and more able to handle the sx they are experiencing.

Of course the studies I have read over the yrs may have been 'greatly flawed' but it is my understanding they have found increase levels of endorphins and cortisol when the person is treated correctly. They have found that correct placement of needles causes the micro-electric currents in the fascia to alter. This last bit of info was imparted at a MEDICAL conference by a medical Dr. who was not pushing acupuncture at all.

I have never told a patient they will be cured. The acupuncturists in our community are very careful to tell patients they can't cure everything and have the list generated by the WHO regarding when acupuncture would be appropriate. They also will tell people they are not a replacement for medical care.

I have a hard time giving blanket dismissal of 'alternative' medicine practices. In every discipline you are going to have charlatans and great practitioners. Anyone that says they are going to cure you, no problem, should be scary what ever their title.

Whatever works. The power of the mind to alleviate symptoms (at least temporarily) is well known. Every faith healing quack knows and relies on this.

 

[walrus]

Re: Acupuncture

Whatever works. The power of the mind to alleviate symptoms (at least temporarily) is well known. Every faith healing quack knows and relies on this.

Don't Drs rely on that also?
Probably poorly worded, but a good attitude certainly helps healing

 

[walrus]

Re: Acupuncture

In most cases the much hated "big pharma" will be paying for the research. .

Whats in it for Big pharma, why would they care about ART?

 

[Old Pio]

Re: Acupuncture

Whats in it for Big pharma, why would they care about ART?

They don't. They wouldn't. I was describing what happens with scientific medicine. Chiropractic operates under no such constraints. Whatever they dream up and can sell to the credulous and gullible becomes the flavor of the month (like squeezing the skulls of children to "cure" learning disabilities, for instance). Proving that what they're selling is safe and effective is an annoyance. Thus, they never, ever make the effort. Perhaps chiropractors could take some of the money they spend on various get rich quick schemes and do the research themselves. 'Course they've had a century and more to prove the existence of "subluxations" and have so far taken a pass. After all, they are trying to prevent this superior form of medicine from fulfilling its Iowa destiny.

 

[Old Pio]

Re: Acupuncture

Don't Drs rely on that also?
Probably poorly worded, but a good attitude certainly helps healing

Sure. Under the right circumstances. They also rely on science. Something which sends the average chiropractor running from the room because their nonsense is non scientific and has never been proven to be safe and effective.

 

[huskyfan]

"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

this. however ... a few times when I've been suffering from insomnia, I have scheduled late night acupuncture sessions, went home and slept like a baby. coincidence? I'll take it.