So your trying to explain why trials not are good for acupuncture, yet you then point to the studies which show benefits? Which is it? No, it isn't. The number one thing is how good the trial is designed. If a well designed trial consistently demonstrates a particular treatment to be effective then I generally won't have a problem with that specific treatment, however you tend to find that: a) the studies which do show positive results tend to be poorly designed. b) the best designed studies are usually negative, and more importantly, so it the medical literature as a whole. c) the few well designed studies which are positive tend to not show much of difference between established orthodox treatment and in that case I'd rather take the latter. If it was shown to be superior and safe then I'd probably use it (although I wouldn't be surpassed if it were adopted by mainstream medicine.) Of course, and I didn't. However the child had the best chance of survival on real, proven treatment and I do think removing that treatment contributed to the child's death. Never said it did and it wasn't the point. The point was to show the dangers of giving credence to unproven treatments. Well I don't feel there is enough widespread or mainstream criticism of the claims of alternative treatments and I think many people take this lack of criticism (and understanding) as somewhat of a validation. It's even worse in the UK where the NHS provides alternative mumbo jumbo like homeopathy to patients. When the National Health Service provides it it's no wonder people think it's valid. Many have the opinion that people should be able to decide and while to an extent people should to be able to decide, I think it's unrealistic to expect every individual to do there own research, I think the medical establishment should make it well known that these alternative treatments simply have no medical basis. I'm criticizing the use of unproven treatments, not declaring conventual medicine to be magic!
hmmm... Again I supsect that if you were truly interested to find if such a comparative study even exists.. you well know that you could start looking in peer review medical journals for just such a study. JAMA or Lancet would be one place to start. I'd suspect that there aren't many studies of that kind out there... primarily because so many of the forms of 'alternative medicine' can't pass muster in terms of repeatable consistent results under scientific rigour/testing methodology to even be included in such a study. Hmmm... I think if you'd bothered to actually do the reading you'd find that it's a verified account of what actually happened. Several of the case became rather clearly verified because there were lawsuits for large sums taken up. Take some time and follow up on some of the reports of such incidences and then comment. I'd be curious to see your take on it. If you haven't got time... well... that's your call too. I don't think so really. Do you? As for this: I would imagine that if you're involved in TCM you'd at least be interested what's going on where it's roots are... in China. There has been a huge amount of attention towards TCM by the Government and the media both here in Hong Kong and in Beijing. Both negative and... actually... a very large amount of it positive. I suspect that Hong Kong has some of the most proactive practitioners of TCM anywhere in the world. I would think that staying abreast of developments in TCM at it's root would be an advantage to those directly involved in it. Again - it's all fine and well to ask... but seriously... why not get a subscription to a data base... otherwise you might be stuck just reading abstracts off of sites like Lancet or JAMA or any of the other half dozen peer review sites that most likely actually have some studies of TCM and alternative med/therapies in comparison to western med. etc. That's good. The WHO generally does a good job in terms of managing public health crisis on a global scale. Did the WHO provide citations to how they actually know this? Surely that'd be a good place to start. You do realize the irony in using an organization like the WHO to back up claims about acupuncture right? Oh jeez.. 1) You couldn't be bothered to look up any of the info in the SCMP or any other news sources based in China/Hong Kong. But now they become convenient in conjunction with your Wikipedia citation. lol. 2) That there is iatrogenesis in orthodox western medicine doesn't somehow magically mean that alternative medicines have any less... or any more... or mean anything really. It would be absurd to try and draw a conclusion one way or another until one actually did the research. Obviously there is a far wider reaching system for reportage and tracking of iatrogenesis in western orthodox medicine than there is Chinese medicine I would imagine... so right there you're going to get a factor that skews results in a comparative study anyhow. If you're an alternative health practitioner... I'd seriously have to wonder about your bedside manner and how you actually deal with patients. I'm quite surprised how exasperated and defensive you come off in your posts. I cringe to think what would happen if one of your patients actually started to question you heavily on your alternative medicines and therapy. They could be in for some serious iatrogenesis.
Sorry to confuse and cause misunderstanding. I was more trying to point out that there are both positive/good clinical trials and negative/good clinical trials. I think the issue here is many tote TCM as being a "magic bullet" I have never been one to do that. Yes there has been studies showing that TCM is good for headaches, while on the flip side they are not able to duplicate results. My point is that even western medicine cannot claim a great track record with some diseases (both in clinical studies and empirical evidence) yet many are ready to take what they say for gospel. I DON'T want people to think TCM is a magic bullet b/c quite frankly IT IS NOT! What some of the studies show (even the poorly designed ones) is that there is something more there, there is something tangible. Even if you do the study you set up: 1) Group 1 "authentic" TCM 2) Group 2 Sham 3) Group 3 nothing Say group 1 and 2 are close 33% each showed improvement. Well is 100% of that number Placebo? That is doubtful, even if it is in the sham acupuncture. My point being that not ALL of the results from the treatment is Placebo! To have both studies (from group 1 and group 2) show up as 100% placebo is rare. So there has to be something there, for this reason, I don't say TCM is a stand alone modality it has some things it can do better than western (imo) with less side effects. One the flip side, western is much better than TCM in other areas with none to severe side effects. What I am saying is it should be a combination of both therapies if we want to focus on the patient. After all in the end (imo) it is not whether X scientific study says it works or not, but whether or not the patient finds relief, no matter from Western Medicine or Eastern. So if you could not tell, i would NEVER recommend a patient get off a western drug or deny western treatment, unless their western MD felt it fine too
Ah, argumentum ad hominem. LOL. I won't be playing this game. In any case my patients love me because I'm good at what I do
The retractable needle sham technique was designed to address the problems with actually putting a needle into somebody's body as a control (which may have a physiological effect, therefore is not inert, therefore is not a suitable control). The idea being that a better control is to make someone think they have been needled without actually putting a needle in them, thus ensuring the control is inert. Seems reasonable to me. Yes. For a control to be "perfect" it should not have a physiological action. Sticking needles in someone does, so is not perfect. Too simplistic, which is exactly the reason that this is not the conclusion the study's authors come to. An important aspect of trial design is the control treatment and if this is flawed the study's results are not reliable. See above and post #91 for my explanation of why minimal needling is not a reliable control. There is a measurable difference in electrical resistance of the skin over points in comparison to surrounding tissue (I can't recall whether it is an increase or decrease in resistance). I don't have a source but it is great fun to get a cheap point locator and a map of the acupuncture points on the body and have a go yourself.
I couldn't get the link to work but if they found little evidence that placebo's have powerful clinical effects then what is responsible for the results of the GERAC study? I am confused as Topher and Tartovski seem to be saying that the significant clinical effects of acupuncture are placebo but you are saying that the placebo effect has now been demonstrated to be minimal.
Ah and you conveniently couldn't bother to respond to any of the points brought up either. I'm curious if you dodge like that when your patients ask you questions or raise points you're uncomfortable with?
I wasn't going for a rise. I was genuinely curious how you deal with your patients when they don't just jump on board with everything you say. From the looks of it... I can see you throwing your needles and herbs in a bag and storming out the door. I think if you actually had bothered to read what was posted in my post #102 you'd realize it wasn't all one big ad hom attack. That you only responded to the tongue in cheek part pretty much that you're being thin skinned and defensive because someone hasn't fallen all over themselves doe eyed in profuse agreement with your ideas or your beliefs about alternative medicine. Because someone responds to your post with a bit levity doesn't really equal some sort of hardcore ad hom attack. No worries though. I've seen this type of thing too many times on MAP - particularly in this forum. I expected as much... it something of a staple with many 'alternative medicine' practitioners. Thanks.
Placebos can work on anyone. Even if you don't believe it. It's due to many effects such as undergoing a treatment, a conscious or unconscious expectation, etc. This link elaborates: http://www.badscience.net/?p=164 Because you give one group a real treatment and the other group a placebo with neither the patients nor the clinicians knowing which group has received which treatment. Then, we can review the results and if the real treatments has an actual effect (i.e. it actually works) then there should be a significant difference between the real treatment and the fake treatment. However if both draw similar results then it suggests there is no real effect taking place. And this is confirmed with repeat testing. For example, if a course of pills is said to send cancer in remission, two groups will receive pills with one receiving unknowingly receiving sugar pills. If the pill works we should see a major difference between the groups. If it doesn't do anything, then there will be no significant difference. However it could also be that the pills do work, but that the placebo also produced a similar effect to the real pills, however such a trial will be repeated and as your own citation suggest, the placebo effect is not constant so further tests will confirm whether pill doesn't work and both are experiencing placebos or whether the pills do work and only second group is experiencing the placebo. In any case, with regards to the acupuncture trial that has been cited in this thread, what is being discussed is not whether sticking needles into your body has any effect, it whether there is any veracity to the claims of meridian lines/chi point and that test suggests there it doesn't matter where you put the needles. Other tests suggest the same. You don't measure the placebo, you objectively measure the effect of the drug, over repeated trials or even just one large study. Don't forget that studies can include hundreds or even thousands (the one I link to below includes 1,100 patients) so a study that size will show whether a drug is having an objective effect or not. You'll unlikely get a placebo meeting the effect of the drug if the drug actually works. If it mattered where the needles were inserted and/or how deep they're inserted then the real acupuncture treatment should produce positive results, while the sham acupuncture should produce negative results, yet they produce similar results, suggesting it doesn't matter where the needles are inserted. Sorry but the idea of meridian lines/points is complete nonsense. If this 40 year old 'evidence' pointed to anything significant then real acupuncture would show a significant effect over sham acupuncture. This is a citation from the wiki acupuncture page puts it bluntly: "Felix Mann, founder and past-president of the Medical Acupuncture Society (1959–1980), the first president of the British Medical Acupuncture Society (1980), and the author of the first comprehensive English language acupuncture textbook Acupuncture: The Ancient Chinese Art of Healing' first published in 1962, has stated in his book Reinventing Acupuncture: A New Concept of Ancient Medicine: "The traditional acupuncture points are no more real than the black spots a drunkard sees in front of his eyes." (p. 14) and… "The meridians of acupuncture are no more real than the meridians of geography. If someone were to get a spade and tried to dig up the Greenwich meridian, he might end up in a lunatic asylum. Perhaps the same fate should await those doctors who believe in [acupuncture] meridians." (p. 31)[22] You're absolutely right. And as I've stated before, you tend to find that: a) the studies which do show positive results tend to be poorly designed. b) the best designed studies are usually negative, and more importantly, so it the medical literature as a whole. c) the few well designed studies which are positive tend to not show much of difference between established orthodox treatment and in that case I'd rather take the latter. If it was shown to be superior and safe then I'd probably use it (although I wouldn't be surpassed if it were adopted by mainstream medicine.) Do you want to give us examples? Even if this was true, it doesn't negate the criticism of acupuncture or alternative medicine in general. Sorry but I would think twice about using an admittedly poorly designed study as proof for anything! Not necessarily. Sticking needles into the body may have an effect beyond the placebo (although I've not seen any evidence to convince me, but it is plausible), however the point is that it doesn't matter where you stick them. As such, you cannot claim that "acupuncture works" because the evidence does not support that assertion. The evidence only supports the claim that sticking needles into the body may have an effect (placebo or otherwise), however acupuncture is not simply sticking needles into the body... it's based around a specific practice and makes very specific claims and the only way to validate them is for groups 1 to receive positive results and for groups 2 to receive negative results yet this never happens. So what. It doesn't matter. The trials still refute the claims which acupuncture is practiced on due to the similar results between real and sham acupuncture. Regarding DB acupuncture trials... here's one: http://scienceblogs.com/insolence/2007/09/yawnanother_acupuncture_study.php http://scienceblogs.com/insolence/2007/10/perception_and_reality_in_acupuncture.php www.eurekalert.org/pub_releases/2007-09/eecc-adn092607.php And this blog post goes over how you can DB a acupuncture trial which was the method used in the above cited study: http://www.theness.com/neurologicablog/index.php?p=14 This post also looks at placebos regarding that trial: http://www.badscience.net/?p=540 These links also elaborate on the points I and other in this thread have been making.
The thing here is that the conditions/diseases that western medicine doesn't have a good track record are ones that NO form of medicine can cure: AIDS, Cancer, Mental illness, complicated genetic disorders and so on. However, progress is being made slowly and surely over time so that we are slowly improving quality of life for patients. You only have to compare the fate of a HIV positive patient at the start of the 80's to today to see that. If you can point to a condition where alt. medicine has a better track record than conventional medicine i'll be surprised. Ben Goldacre makes a very good point that alot of things western medicine "can't fix" are things which have become medicalised (ie people asign a simplistic medical cause to them) even though they shouldn't be, for example back pain. Anyway, shouldn't we split this thread when it wandered off into needle land?
I don't duck the hard questions as my contribution to this thread shows. It's just yours that I haven't answered. But maybe that's because you ask the really tough ones, eh? The truth of the matter is that I have limited time here so restrict myself to discussion that I find stimulating and meaningful. Whatever your other points your ad hom simply suggests to me that we have different goals here. And the fact that you continue with references to me having tantrums etc just suggests that it is actually you throwing your toys out of the pram because I won't play. You know, it's actually quite a transparent strategy to have a dig at someone with a smile on your face then when they call you on it say that you were only joking and accuse them of defensiveness. I see it all the time in the playground at my daughter's school
Firstly, the trials are not necessarily to test whether inserting needles has an effect rather it is to test whether the claims of inserting needles into specific parts of the body does anything significant vs. inserting them randomly, so that control is fine. In fact it's necessary. Since acupuncture is based on the claim that the needles must be inserted into specific parts of the body, the consistent negative results are enough to demonstrate that those claims are false. Secondly you would not be able to double blind you're suggestion. And see my comments above as to why not only it is a sufficient control, it is a necessary one! If you want to test whether the needles must be inserted in specific places or random places, you must have two groups with one having the needles inserted randomly and the other with them inserted into specific areas. Even if this is true it doesn't speak of the veracity of acupuncture since the trials constantly show it doesn't matter where the needles are inserted!
How exactly does one define what should or should not be "medicalized"? Even your example of back pain is woefully inadiquate. Studies have constistantly shown that untreated chronic pain is associated with increased morbitity. Basically, living with chronic pain is debilitating to the body as well as to the mind. It increases BP, heart rate, blood glucose- all of which can lead to other diseases such as hypertension and diabetes. So why would you not treat chronic pain as a medical condition? Further, what other conditions are you refering to that have become "medicalized". It seems to me that you are just pulling things out of your hat to support a mediocre argument. Now as to research- some modalities of T/ACM are indeed questionable. Some are starting to acumulate decent research. Due to the fact that America is slower then the rest of the world, most of the research is coming out of the UK and Germany. Aromatherapy and many herbal suppliments are starting to develope a good research base and acupuncture is starting to be better researched- though with mixed results as of yet. And yes, it is the patients job to learn about their conditions on their own- just as it is my job (partially) to make sure that patients have the resources they need to do so. I would NOT recommend going back to the modality of treatment in which the doctor is never questioned.
Nice. Passive aggressive behavior will get you everywhere with me. Awww... are you that delicate that a bit of tongue in cheek posting on a forum ruffles your feathers to the extent? Reality check time. You were coming off well defensive before I ever entered the conversation. Your first posts to me reeked of it. So really... you don't have to keep explaining... I think I'm rather clear on what angle you coming from now. Like I said I wasn't really all that surprised.
I don't think he is referring to chronic pain especially pain that can be detected as having clear physiological effects. I think he is more thinking about the various 'back pains' with no detectable physiological cause which proliferate in modern society but are often suspiciously absent in say rural communities and the like.
So basically, you want to dismiss "back pains" from the urban setting? Do you have any idea how highly unethical it is to dismiss pain merely because you think it shouldn't be there? And how much of these back pains are due to lifestyle and environmental issues that can easily be addressed and taken care of? You are right that back pain is more common in the urban environment, but rather then dismissing it out of hand as you seem to be suggesting we do, why would you not address the source? Hunching over a computor in the typically sedentary jobs of the urban population can precipitate back pain as can stress, poor posture and any number of things. So again I ask, exactly how do you wish to define "medicalization", how do you propose to ignore reported symptoms and at what point do you cross the line of ethics?
LOL, Sorry topher but your whole argument against my "40 year old evidence" is a quote that is 30 years old? Gosh that makes it all the better One the other hand I do like your links, one was way toooooo long and seemed to be citing the same point over and over (many science types seem to do that ) the others I read and do enjoy the background of the study you presented a few points your own article states this: 1) “It has proven efficacy in pain related to, for example, osteoarthritis, but the evidence for its effect in cancer patients is lacking,” Enblom said. “In this study, the question of whether invasive acupuncture is more effective than non-penetrating placebo needles for the reduction of radiotherapy-related nausea is answered.” I have never seen any acupuncture claim to have a "Cure for cancer!" I have seen it used in conjunction with (even in mainland china they combine the therapies). 2) While your article does make some interesting point and interesting numbers it never states the exp. of the practitioners? Were they actually TCM or were they just people using needles? I ask b/c (I don't know how it is in the UK) but in the US our MDs and Chiros can use acupuncture (MDs with absolutely ZERO hours of training and Chiros with 100) showing that they are not even traditionally trained in the acupuncture points and all their functions. The other condition it brings up is it is not at all thorough (what points were used? Why? What is the TCM diagnosis? What specifically were they trying to treat?) These are all points a TCM practitioner would ask as EVERY condition within TCM is different. In the west you say you have a headache, in TCM we have 10+ different kinds all requiring different treatments (everything ranging from different points, different herbs, different stim etc.) This article posts NONE of that! Of course this article is just the flip side of the article that the one link spoke out about the back study. If you are actually using TCM (and not just acupuncture) you should actually publish the study and provide the results so we know what it means. Otherwise this study misleads the public, for example are we as TCM practitioners publishing studies about Western medicine and just using numbers and chinese terms, showing them ineffective? This article just shows that "Acupuncture" did not work but makes NO mention that it was done by a true TCM doctor. For us in the US to be considered a TCM doctor we currently follow the Shanghai TCM school model which includes: 1) 3000+ hours of study (4 years masters degree program) with looking into doing another 2000+ PhD (which in some cases includes hospital intern hours) 2) This program does NOT only work on Chinese medicine we also do: a) Pharamcology b) Biology c) Chemistry d) Microbiology e) Biochemistry f) Anatomy and physiology g) Western surface anatomy h) Western medical pathology All resulting in about half the program being western medicine. 3) Our national exam is written by both professionals in our industry as well as Nurses and MDs. This national exam MUST be passed to be considered a "Licensed Acupuncturist" So when these studies speak out against acupuncture when the persons performing it may only have 100+ hours of needling (or none at all) I see a problem with that. Many assume we have just spent a "weekend crash course" in Chinese medicine when we have given 4+ years of our lives to study Western AND Eastern medicine (at least in the US). We have TCM teachers at our school that have PhDs in Western Medicine AND Eastern. Heck my mentor had 2 PhDs and started numerous medical organizations that are still thriving today. Yet many think we are "new agers" promoting alternative therapies, nothing could be further from the truth. One thing my other teacher mentions is (if you can speak/read japanese) look at many of the studies published by them. One of the most technologically advanced societies is still using Acupuncture and Herbal medicine showing many great studies. But currently unfortunately many are not translated, (my teacher was kind enough to point some out). So please understand I am not one to "throw out" the scientific model, I am one to question it. How can you not? How often do you hear about something that is NOW bad for you, but was good for you a year ago? And now a new "study" shows it is not as bad as it is once thought. How about the simple headache? Most OTCs help somewhat, but not on a consistent basis and they still don't work for everyone (even though clinical studies show it should work for a larger majority) Not all do. Fibromyalgia: This has been a medical "dumping ground" where they are doing clinical trials/studies for drugs that work in clinical setting but are NOT working in RL. This disease alone has been thrown back and forth between and actualy disease and a psychosomatic illness. Nausea: why don't all the medications out there work for everyone? Even though once again it should work for the majority not all work, yet they are still on the market. Tremors/epilepsy: Same thing, clinical trials for drugs and procedures show they work well, but many suffer relapses a few years after the procedures/drugs. Ultimately having to take stronger medications. Carpal tunnel/Rheumatoid Arthitis: One of the western methods for carpal tunnel is surgery to cut the impending ligament that constricts the median nerve of the hand. This brings about relief for a short time, cause often after the impending ligament was cut the patient now has the SAME pain as before! What good is the surgery? but it should work in theory.... With Rheumatoid Arthritis it is close to the same take OTC drugs till the pain gets so bad you need prescribed meds. Then we will get you something stronger, something stronger, something stronger. I am sorry, but this should show something wrong with this way of thinking, if pain does NOT get better with Meds do you keep giving stronger meds? A patient should not HAVE to get USED to taking pain and medications the rest of their lives. Gynecological issues: Many things western considers "normal" are not considered normal in the Chinese Medicine model. Cramps, PMS, etc are not considered something "normal" in the eastern framework of medicine. In this mindset ANY kind of pain is the bodies way of saying "something is wrong". Which brings me to Pain, Chronic/acute: ANY kind of pain is a firing of the neurons in the body to tell the brain something is WRONG! But what do pain relievers do? They block this message plain and simple. The difficulty with these meds is they block ALL pain messages (they are not localized, unless given in the hospital) So if you get pain anywhere else from a disease the body cannot tell the brain about it. I have seen some suggestions as to this could be a possible link why some Cancers, Heart conditions, Severe digestive issues go unnoticed for so long, because the bodies pain receptors are being blocked by pain medicines. When is it ever good to cut off the communication from the body to the mind? These are just some points, but interesting ones. Again, as I stated many take Western Medicine as Gospel, but don't even question the medicine. Why not question the medicine? Maybe it would also be good for others (patients) to do as much research on Western Medicine as they do on alternative therapies. The difficulty is the reasearch is not always out there, many times it is not even done to its fullest capacity. I have already provided this link once but here it is again: http://www.medicinenet.com/script/main/art.asp?articlekey=80473 The FDA that is supposed to "protect" americans from dangerous drugs, has the drug companies paying nearly 42% of their profit. Seems odd that a governing body is paid by the companies that want their drugs on the market...This quote alone is scary.... "FDA has dramatically insufficient resources to perform or commission post-approval safety studies," Hennessy said. "As a result of this, the American people rely almost exclusively on pharmaceutical companies to fund the research to identify the risks associated with their own products." This includes study for both alternative and modern therapies. But what do you think will happen if a Drug company is able to "identify the risks associated with their own products"? In the US there are many lawsuits out now against drug companies b/c drugs have been put on the market that have killed people, permanently crippled them etc. When the drugs were not thoroughly given Clinical trials! This is from the FDA's own website: "No regulated product is totally risk-free, so these judgments are important. FDA will allow a product to present more of a risk when its potential benefit is great — especially for products used to treat serious, life-threatening conditions. FDA reviews the results of laboratory, animal and human clinical testing done by companies to determine if the product they want to put on the market is safe and effective. FDA does not develop or test products itself. The Agency does this pre-market review for new human drugs and biologics (such as vaccines, blood products, biotechnology products and gene therapy), complex medical devices, food and color additives, infant formulas, and animal drugs." http://www.fda.gov/opacom/7approvl.html also: "For example, the average review time for an innovative new drug is now only 6 months, and some have been approved even faster. " Seems pretty fast for drugs that could "present more of a risk, for the greater good." Even the FDA admits to some of their staff reviews not being scientists: "The board is a panel of scientists and non-scientists in hospitals and research institutions that oversees clinical research." Finally Phase 3 trials of a drug range from volunteers of (from their own words) "The number of subjects usually ranges from several hundred to about 3,000 people." http://www.fda.gov/fdac/special/testtubetopatient/drugreview.html The current US population....300,000,000 The maximum amount of people a new drug is tested on....3000 So what .003% of the population. (sorry my math is horrid ) You asked for proof and numbers, as I mentioned I don't know what it is like it the UK, but we are truly in a healthcare crisis in the US. There are more reasons than I stated but you get the idea.
