Acupuncture

[dxmnkd316]

Re: Acupuncture

D'oh.

 

[LynahFan]

Re: Acupuncture

He said bollocks. Common term used by Brits to infer the word we yanks call bullsht

Ah, the dangers of post editing! Here's another interesting Britism: "bollocks" is as you say, but if something is described as being "the dog's bollocks" that's roughly the equivalent of "the bee's knees" - i.e. the bomb. Go figure...

 

[dxmnkd316]

Re: Acupuncture

Ah, the dangers of post editing! Here's another interesting Britism: "bollocks" is as you say, but if something is described as being "the dog's bollocks" that's roughly the equivalent of "the bee's knees" - i.e. the bomb. Go figure...

Or how about "You're a pile of ****" compared to "Man, you're the sht!"

 

[Old Pio]

Re: Acupuncture

What I'm interested in is pain relief. I could go to my GP and get a script for oxycodone or I could go to a pain management clinic and get a rhizotomy. But I don't like sound of either one of those.

You're evidently wedded to your ignorance. Whether or not "Dr. Magic Fingers" provides you with relief is no excuse to bring up the subject of "never having heard of subluxations" then to dismiss doing the most rudimentary research. If you haven't heard of subluxations, it's fairly obvious by now you've got your fingers in your ears and are going "nah, nah, nah" at the top of your lungs.

 

[leswp1]

Re: Acupuncture

I've been to several chiros never heard the word subluxation until here.

Apparently we are under educated and must immediately resume having pain because relief did not happen for a scientifically legitimate reason.

If having an open mind makes me excused from the big boy table I will happily take my female version of ballocks and my open mind to the big girl table. wally you are quite welcome to join me

 

[Old Pio]

Re: Acupuncture

Apparently we are under educated and must immediately resume having pain because relief did not happen for a scientifically legitimate reason.

If having an open mind makes me excused from the big boy table I will happily take my female version of ballocks and my open mind to the big girl table. wally you are quite welcome to join me

Believe it or not, there are people for whom the phase "having an open mind" does not mean uncritical belief in every quack nostrum that comes waddling down the highway. It's clear nobody's gonna confuse you with the facts.

 

[dxmnkd316]

Re: Acupuncture

Apparently we are under educated and must immediately resume having pain because relief did not happen for a scientifically legitimate reason.

If having an open mind makes me excused from the big boy table I will happily take my female version of ballocks and my open mind to the big girl table. wally you are quite welcome to join me

Tell me then, from the big girl table, how is your tongue looking today? Scientifically speaking of course.

 

[WisconsinWildcard]

Re: Acupuncture

Apparently we are under educated and must immediately resume having pain because relief did not happen for a scientifically legitimate reason.

If having an open mind makes me excused from the big boy table I will happily take my female version of ballocks and my open mind to the big girl table. wally you are quite welcome to join me

You are fighting a strawman if you believe your relief is any less real because of lack of scientific evidence.

I feel your posts historically are quite thoughtful. I questioned arguing with you since I usually agree with you and find much of your opinions well reasoned and ethically accurate. However, I have found what you have said in this thread naive, despite well-intentioned, for reasons I have described above. I would be more than happy to elaborate on any of the evidence based issues we have disagreed upon. I have given you the opportunity to reply to my specific claims with evidence, which you have avoided. I believe I am the only person in this thread to have referenced a claim, more specifically, referenced a claim with a published paper. I think that is telling about the dedication I have to seeking truth about this issue.

I used the term "big boy table" as a well recognized term that painted a general picture instead of a way to be chauvinistic. It was a metaphor that had no sexist intent. I had hoped you would see through it based on my posting record, instead of a sexist ploy on my part.

 

[bigmrg74]

Re: Acupuncture

Apparently we are under educated and must immediately resume having pain because relief did not happen for a scientifically legitimate reason.

If having an open mind makes me excused from the big boy table I will happily take my female version of ballocks and my open mind to the big girl table. wally you are quite welcome to join me

You guys are always welcomed on my table. Old Pio, WWC, and the rest are not, they're probably wound too tight anyways with bad vibes, excessive body hair, gas, and a tenancy to run either hot or sweaty. If they don't wanna feel good for a while, more table time for those of you who do.

Just because one is a full fledged Doctor doesn't mean that they can not be a quack as well.
http://www.washingtonpost.com/news/morning-mix/wp/2014/10/01/death-doctor-who-profited-from-unnecessary-chemotherapy-for-fake-cancers-could-resume-practice-in-three-years/

Just goes to show you that you should always get a second opinion and be willing to always educate yourself about your own personal health.

 

[walrus]

Re: Acupuncture

You're evidently wedded to your ignorance. Whether or not "Dr. Magic Fingers" provides you with relief is no excuse to bring up the subject of "never having heard of subluxations" then to dismiss doing the most rudimentary research. If you haven't heard of subluxations, it's fairly obvious by now you've got your fingers in your ears and are going "nah, nah, nah" at the top of your lungs.

If the chiro I see is doing ART, which has nothing to do subluxations, why do I care about it? ART is a type of PT developed for overuse injuries. I'm not seeing a chiro to take a mole off my back by manipulating my spine into "proper alignment". For low back pain I'm seeing a chiro now who practices Cox technique. http://www.coxtechnic.com/about-us/flexion-distraction-relieves-spine-pain . He attempts to open up the passage around the nerves at L5S1 and L5L4. Its helped. He told me right from the get go, he can't cure me. I've been to an orthopedic surgeon, have had xrays and MRI. Spinal stenois, arthritis, ankylosing spondylitis. Again my options are painkillers, using radiowaves to kill nerves for temporary relief or non invasive measures such as the Cox technique, stretching and mild exercises. I do all 3 hoping to help with the pain and so I can continue to run my business.
Oh Yeah, I've had steroids shot into my back also, did nothing

 

[huskyfan]

Re: Acupuncture

interesting thread.

personally I would never let a chiropractor "crack" my spine or whatever it is they do. it sounds dangerous and I think I've read of patients being severely injured by this. or maybe it was one of those 60 minutes type specials that exposed the whole thing as quackery. then again I'm a layperson.

perhaps Chinese, Indian (how about those doshas?) and other alternative medicines have something to offer. other than placebo. but ***? why aren't we testing this stuff in trials, like we do for new drugs?? a new drug spends years coming to market, yet you can wander into a 'natural' store and buy all kinds of crap (literally) that could be harmful.

another one I would be interested in opinions on is homeopathic remedies. it sounds nonsensical. then again, does it work like vaccines? ideas?

 

[leswp1]

Re: Acupuncture

You are fighting a strawman if you believe your relief is any less real because of lack of scientific evidence.

I feel your posts historically are quite thoughtful. I questioned arguing with you since I usually agree with you and find much of your opinions well reasoned and ethically accurate. However, I have found what you have said in this thread naive, despite well-intentioned, for reasons I have described above. I would be more than happy to elaborate on any of the evidence based issues we have disagreed upon. I have given you the opportunity to reply to my specific claims with evidence, which you have avoided. I believe I am the only person in this thread to have referenced a claim, more specifically, referenced a claim with a published paper. I think that is telling about the dedication I have to seeking truth about this issue.

I used the term "big boy table" as a well recognized term that painted a general picture instead of a way to be chauvinistic. It was a metaphor that had no sexist intent. I had hoped you would see through it based on my posting record, instead of a sexist ploy on my part.

My sarcasm meter was on high.

I find your assessment that I am niave interesting. It sounds more as if you maybe have not experienced the recommendations and research change as time goes on. Things that were forcefully recommended or just as forcefully dismissed come full circle. I have been doing this long enough to have heard what was thought to be very good "research" tout and debunk all sorts of things only to see the same refuted. I haven't responded to all of your posts re 'evidence' simply because human bodies are not machines. I understand that even the most evidence based studies are done with a set number of patients and most meta-analysis studies are retrospective. I can't tell you the number of times earlier in my career I told someone to do X because the recommendations based on research are X. I no longer word it that way. I now say currently it is recommended to do X. If/until the recommendations change then this is the plan.

I had posted a number of changed recommendations before. I would add antioxidants/vitamins of all sorts, the avoidance or addition of certain foods, the use of specific classes of medication for BP (they fight on this one all the time endo vs cards), cholesterol treatment with specific meds, treatment or not of homocysteine and crp levels, preventative medication for treatment of osteoporosis/or not, treatment of ASCUS on pap or not, screening tests (pretty much every one), vaccination schedules.... All of these have had 'research' based recommendations. Many of the recommendations are issued by national specialty organizations (who at times contradict each other) who have been absolute, quoting research.

Many of the disciplines discussed here rely on the evaluation of a whole body, not a specific condition. As there are no 2 humans who are exactly the same I conclude they would have an extremely hard time doing accurate research. It is not cookie cutter medicine and research needs a technique that is a cookie cutter approach. A homeopath might treat a particular sx with a different remedy dependent on all the other variables. Testing Pulsatilla on nasal congestion would not be accurate if it would not have been chosen for that person. I would say my opinion is not a full acceptance or a full rejection but ambivalence. There is currently no way to prove or disprove something so individualized.

In our community the super-specialists refer to both chiropractic and acupuncture therapy. There is no financial connection. Many of the patients find it helpful. In the end, when you are caring for a patient, the thing that gives them relief is important.

You guys are always welcomed on my table. Old Pio, WWC, and the rest are not, they're probably wound too tight anyways with bad vibes, excessive body hair, gas, and a tenancy to run either hot or sweaty. If they don't wanna feel good for a while, more table time for those of you who do.

Just because one is a full fledged Doctor doesn't mean that they can not be a quack as well.
http://www.washingtonpost.com/news/morning-mix/wp/2014/10/01/death-doctor-who-profited-from-unnecessary-chemotherapy-for-fake-cancers-could-resume-practice-in-three-years/

Just goes to show you that you should always get a second opinion and be willing to always educate yourself about your own personal health.

Going Tuesday. Should be sooner. Too bad you weren't closer.

 

[WisconsinWildcard]

Re: Acupuncture

My sarcasm meter was on high.

I find your assessment that I am niave interesting.

Unlike many of my word choices, I used that word specifically. I think the mentality of "If it makes you feel better it works" is naive, but well-intentioned. It does not take into account the many other variables that are crucial to this discussion including regression to the mean, the hawthorne effect, placebo and nocebo effects, resource allocation, NNT, NNH, etc.

It sounds more as if you maybe have not experienced the recommendations and research change as time goes on.

I have. I am also a student of the history of medicine and why we did things the way we did. When guidelines change, I (and most academic physicians I have worked with) do not just note the change but look to understand the reasoning behind the change. Same goes for differing guidelines from different institutions.

Things that were forcefully recommended or just as forcefully dismissed come full circle. I have been doing this long enough to have heard what was thought to be very good "research" tout and debunk all sorts of things only to see the same refuted.

You say that like it is a bad thing. Guidelines change with new research, as they should. The old research that was "very good" is still very good, it may just be expanded upon. I feel you are misrepresenting much of the changes as full 180s. Guideline revision is largely based on changing target populations for treatments and threshold for treatment. NNT (Numbers needed to treat), specificity, sensitivity are relatively fluid values and we need to adapt as new information can better guide our treatments.

I haven't responded to all of your posts re 'evidence' simply because human bodies are not machines. I understand that even the most evidence based studies are done with a set number of patients and most meta-analysis studies are retrospective. I can't tell you the number of times earlier in my career I told someone to do X because the recommendations based on research are X. I no longer word it that way. I now say currently it is recommended to do X. If/until the recommendations change then this is the plan.

It is important to note that guidelines are just that. Guidelines. They are not laws. It still comes down to the individual physician and the individual patient. You have to take into account the patients goals and wishes. A good example is that of PSA (prostate testing). Most guidelines now recommend against routine screening. However, based on patient wishes and informed consent, a physician can freely screen if he deems it necessary.

I had posted a number of changed recommendations before. I would add antioxidants/vitamins of all sorts, the avoidance or addition of certain foods, the use of specific classes of medication for BP (they fight on this one all the time endo vs cards), cholesterol treatment with specific meds, treatment or not of homocysteine and crp levels, preventative medication for treatment of osteoporosis/or not, treatment of ASCUS on pap or not, screening tests (pretty much every one), vaccination schedules.... All of these have had 'research' based recommendations. Many of the recommendations are issued by national specialty organizations (who at times contradict each other) who have been absolute, quoting research.

I think there is a strawman in there. National specialty organizations quote research but do not state it in a "absolute" way. Again, you seem to be saying things in a negative light that I think are positives. I want medicine to work with the best current knowledge. I also would like them to adapt to new changes in research. I acknowledge much of the treatments we currently do will change in scope of practice. Great. Find something better, show me it is better and I will use it.

I would also use this as a spot to highlight how alternative medicine can tend to work. They (and this is a broad brush, sorry) will continue to use a treatment even after it has been shown to not be effective. Naturopaths are still using coffee enemas to treat pancreatic cancer even after the horrible failure of a large trial to deem its efficacy in pancreatic cancer. Physicians do not change their practice as well and I criticize them all the same.

Many of the disciplines discussed here rely on the evaluation of a whole body, not a specific condition. As there are no 2 humans who are exactly the same I conclude they would have an extremely hard time doing accurate research. It is not cookie cutter medicine and research needs a technique that is a cookie cutter approach. A homeopath might treat a particular sx with a different remedy dependent on all the other variables. Testing Pulsatilla on nasal congestion would not be accurate if it would not have been chosen for that person. I would say my opinion is not a full acceptance or a full rejection but ambivalence. There is currently no way to prove or disprove something so individualized.

Any physician should be evaluating the whole body as well, especially as a PCP. If not, find a new physician. It is true that acute care can trump a whole evaluation but an incomplete review of systems allows one to miss important findings.

There are millions of hours put in by some of the best and brightest around the world each year to advance medical knowledge. To say that we cannot do accurate research is a vast simplification and discounts the tremendous advances we have made in the last century using the scientific method.

I am choosing to not touch homeopathy with a 10 foot pole here because I cannot seem to articulate something without sounding extremely condescending (not that it has stopped me in the past )

In our community the super-specialists refer to both chiropractic and acupuncture therapy. There is no financial connection. Many of the patients find it helpful. In the end, when you are caring for a patient, the thing that gives them relief is important.

True, some may refer there. I think the more important question is if they think it works. I worked with a physician who performs acupuncture. He was happy to do it to anyone who wanted it, and offered it to those who did not have adequate pain control. However, when we were talking academically in private, he would freely admit it does not work. He justified it by doing a service for those who want it. I find that way of thinking a bit ethically dubious.

 

[WisconsinWildcard]

Re: Acupuncture

interesting thread.

personally I would never let a chiropractor "crack" my spine or whatever it is they do. it sounds dangerous and I think I've read of patients being severely injured by this. or maybe it was one of those 60 minutes type specials that exposed the whole thing as quackery. then again I'm a layperson.

You can be injured, hence why I never buy the "whats the harm?" argument. I have seen several patients with vertebral and carotid artery dissections from neck manipulation. Granted, I think it is a very rare complication but it is reported in the literature. I also was working at a teritary care center so we would be the ones that get all of the referrals from most of the state. I also do not believe a chiropractor has the training to recognize an acute stroke when it is happening.

perhaps Chinese, Indian (how about those doshas?) and other alternative medicines have something to offer. other than placebo. but ***? why aren't we testing this stuff in trials, like we do for new drugs?? a new drug spends years coming to market, yet you can wander into a 'natural' store and buy all kinds of crap (literally) that could be harmful.

We are testing this stuff in trials. The difference is, acupuncture will do no better than placebo (both will improve outcomes vs no treatment) and the conclusion will be "See! It works!" When a pharmaceutical does no better than placebo, it fails, is not approved and does not make it to market. It is a curious double standard that is more prevalent in the literature than one would expect.

another one I would be interested in opinions on is homeopathic remedies. it sounds nonsensical. then again, does it work like vaccines? ideas?

For homeopathy to work as they believe, the laws of physics and chemistry would not only have to be wrong but spectacularly wrong. They do not work like vaccines, that's for sure. Vaccines rely on our immune system, which I can go into further if anyone has any questions.

Read this comic. http://xkcd.com/882/ It illustrates how significant values have to be taken into context, as if you test enough variables, one would expect a false positive. There is a field of statistics http://en.wikipedia.org/wiki/Bayesian_statistics that tries to take into account the prior probability of a claim before it is tested based on the field of research as a whole.

 

[WisconsinWildcard]

Re: Acupuncture

You guys are always welcomed on my table. Old Pio, WWC, and the rest are not, they're probably wound too tight anyways with bad vibes, excessive body hair, gas, and a tenancy to run either hot or sweaty. If they don't wanna feel good for a while, more table time for those of you who do.

Just because one is a full fledged Doctor doesn't mean that they can not be a quack as well.
http://www.washingtonpost.com/news/morning-mix/wp/2014/10/01/death-doctor-who-profited-from-unnecessary-chemotherapy-for-fake-cancers-could-resume-practice-in-three-years/

Just goes to show you that you should always get a second opinion and be willing to always educate yourself about your own personal health.

Excessive body hair? I can't even grow a ****ing beard It is no coincidence that some of my patients have referred to me as Doogie Howser

The very people who are the most outspoken critics of alternative medicine are also the ones who are most outspoken about cancer quackery. Same team man.

http://www.sciencebasedmedicine.org...tors-betray-science-based-medicine-for-money/

That article is from Dr. David Gorski, a surgical oncologist in the Detroit area. Read it please and let me know if you think he held any punches.

 

[leswp1]

Re: Acupuncture

Unlike many of my word choices, I used that word specifically. I think the mentality of "If it makes you feel better it works" is naive, but well-intentioned. It does not take into account the many other variables that are crucial to this discussion including regression to the mean, the hawthorne effect, placebo and nocebo effects, resource allocation, NNT, NNH, etc.



I have. I am also a student of the history of medicine and why we did things the way we did. When guidelines change, I (and most academic physicians I have worked with) do not just note the change but look to understand the reasoning behind the change. Same goes for differing guidelines from different institutions.



You say that like it is a bad thing. Guidelines change with new research, as they should. The old research that was "very good" is still very good, it may just be expanded upon. I feel you are misrepresenting much of the changes as full 180s. Guideline revision is largely based on changing target populations for treatments and threshold for treatment. NNT (Numbers needed to treat), specificity, sensitivity are relatively fluid values and we need to adapt as new information can better guide our treatments.



It is important to note that guidelines are just that. Guidelines. They are not laws. It still comes down to the individual physician and the individual patient. You have to take into account the patients goals and wishes. A good example is that of PSA (prostate testing). Most guidelines now recommend against routine screening. However, based on patient wishes and informed consent, a physician can freely screen if he deems it necessary.



I think there is a strawman in there. National specialty organizations quote research but do not state it in a "absolute" way. Again, you seem to be saying things in a negative light that I think are positives. I want medicine to work with the best current knowledge. I also would like them to adapt to new changes in research. I acknowledge much of the treatments we currently do will change in scope of practice. Great. Find something better, show me it is better and I will use it.

I would also use this as a spot to highlight how alternative medicine can tend to work. They (and this is a broad brush, sorry) will continue to use a treatment even after it has been shown to not be effective. Naturopaths are still using coffee enemas to treat pancreatic cancer even after the horrible failure of a large trial to deem its efficacy in pancreatic cancer. Physicians do not change their practice as well and I criticize them all the same.



Any physician should be evaluating the whole body as well, especially as a PCP. If not, find a new physician. It is true that acute care can trump a whole evaluation but an incomplete review of systems allows one to miss important findings.

There are millions of hours put in by some of the best and brightest around the world each year to advance medical knowledge. To say that we cannot do accurate research is a vast simplification and discounts the tremendous advances we have made in the last century using the scientific method.

I am choosing to not touch homeopathy with a 10 foot pole here because I cannot seem to articulate something without sounding extremely condescending (not that it has stopped me in the past )

True, some may refer there. I think the more important question is if they think it works. I worked with a physician who performs acupuncture. He was happy to do it to anyone who wanted it, and offered it to those who did not have adequate pain control. However, when we were talking academically in private, he would freely admit it does not work. He justified it by doing a service for those who want it. I find that way of thinking a bit ethically dubious.

...Usually I am fairly articulate and understandable. I appear not to be so today. I will try again. in less conceptual/more concrete terms. Short, sweet and to the point-
-I believe in evidence based medicine.
-I believe evolving guidelines are better than static ones.
-I understand why the guidelines changed and am up on the reasoning behind them.
-It is because I have seen the evolution that I withhold passing judgment on things I do not think are fully understood.
-Many of the guidelines were changed because we now have a better understanding of what is happening in the body. Sometimes it is not what we first thought.
-I was not implying the people practicing medicine do not take the whole body into account.
-I was referring to the variables in the context of research. If humans were a machine, built to spec, then research would be easy.
-Integrative medicine considers those variables differently when choosing the components of a treatment. Some of these variables Standard medicine does not take into account.
-I did not disparage the researchers or their methods.
-I was stating my belief there is no way to control for all the variables taken into consideration when Integrative medicine choses a treatment
-...therefore I believe it makes it difficult to conduct research on the method accurately. Unless you are working with clones finding a control group that matches all of the variables would be exceedingly difficult.
-There are many things that humans did not conceive of in the past and have figured out.
-I will continue to withhold judgment rather than dismiss or actively embrace most of the things offered because I do not think we completely understand the human body.
-Grey is a very hard color to tolerate but I do not think anything to do with a human body is black and white, completely understandable or predictable.

 

[dxmnkd316]

Re: Acupuncture

This

-I believe in evidence based medicine.

And this

It is because I have seen the evolution that I withhold passing judgment on things I do not think are fully understood.

Cannot be reconciled.

This

I was stating my belief there is no way to control for all the variables taken into consideration when Integrative medicine choses a treatment
-...therefore I believe it makes it difficult to conduct research on the method accurately. Unless you are working with clones finding a control group that matches all of the variables would be exceedingly difficult.

Is why we have very carefully controlled clinical trials. If acupuncture and chiropractors can't pass muster, they should be shunned.

 

[WisconsinWildcard]

Re: Acupuncture

-I believe in evidence based medicine.

This statement is in direct opposition to this.

Personally I don't care if something is placebo or has a bunch of studies supporting it. If it works then it is good.

I used homeopathic stuff to start my labor. The midwife said nothing was happening when I was checked. I took something and was in labor with in the hour. Was it placebo? don't know and don't care. It worked and I wasn't induced. Had back pain so severe I couldn't breathe without my knees buckling. Saw the chiropractor and had significant relief immediately. Again- I don't care if it was placebo.

More convincing to me was giving my 9 month old a homeopathic remedy and seeing him respond with drastic change in sx. Placebo by proxy? Have seen a c5-6 quadriplegic get acupuncture and function at c7-8 level within days. No one on the medical team had an explanation as there was no other intervention happening and the injury/level was well documented. Placebo or not I am pretty sure that guy was happy with the result.

Main point- if it works and does no harm- good.

-It is because I have seen the evolution that I withhold passing judgment on things I do not think are fully understood.

All knowledge is provisional. Nothing is fully understood. Everything is subject to revision. Given the time, I could tell you exactly what would be needed to change my mind about every single thing I believe in.

-Integrative medicine considers those variables differently when choosing the components of a treatment. Some of these variables Standard medicine does not take into account.

Not sure what "Standard medicine" is. It is either supported by evidence or it is not (there is room for discussion, and shades of grey). Why not state it like that? Why make arbitrary divisions like this?

Also, if you mix cow pie with apple pie, it does not make the apple pie taste better.

-I was stating my belief there is no way to control for all the variables taken into consideration when Integrative medicine choses a treatment
-...therefore I believe it makes it difficult to conduct research on the method accurately. Unless you are working with clones finding a control group that matches all of the variables would be exceedingly difficult.

Why can we study certain things that are nuanced but not others? This is where the power of a study is important. See women's health study.

-There are many things that humans did not conceive of in the past and have figured out.

Every mystery ever solved throughout history has turned out to be not magic.

-I will continue to withhold judgment rather than dismiss or actively embrace most of the things offered because I do not think we completely understand the human body.

We never will. All scientific knowledge, by design, is provisional.

-Grey is a very hard color to tolerate but I do not think anything to do with a human body is black and white, completely understandable or predictable.

I live in a world of grey and love it.

 

[dxmnkd316]

Re: Acupuncture

This
And this

Cannot be reconciled

This statement is in direct opposition to this.

Hey, that's what I said.

 

[WisconsinWildcard]

Re: Acupuncture

Hey, that's what I said.

And beat me on the timestamp. Well done