Herbalism

Discussion in 'Health and Fitness' started by Tartovski, Jan 19, 2008.

  1. unfetteredmind

    unfetteredmind Valued Member

    You keep saying this but I'm not sure what you mean. If you mean it is only acupuncture if it follows the principles of TCM then you might want to check out the British Medical Acupuncture Society's website. They are an organisation whose members practise acupuncture but do not believe in Chinese Medical theory. You could start here http://www.medical-acupuncture.co.uk/patients/info.html No Qi mentioned here.
    Oh, I've just been looking back through the thread and see that it was you that quoted Felix Mann earlier so you must know this already. What do you mean by this statement then?
    Also see here for some interesting discussion on choice of control and debate about the conclusions of acupuncture trials http://www.annals.org/cgi/eletters/146/12/868#20276

    The thing about all this for me though is that even if the effect is placebo (and if it is it is quite a big one - 46% of participants with 50% reduction in frequency of headache for the trial we were discussing), does that mean it shouldn't be used? The vast majority of my patients have acupuncture alongside conventional treatment, or because conventional treatment hasn't worked or while waiting for conventional treatment. If someone needs surgery, has some acupuncture while waiting for it and (as a result of the placebo effect or not) no longer needs surgery, isn't that a good thing? Or if someone is having conventional treatment that is giving them relief but the addition of acupuncture gives them additional relief, is that so bad?
    The way I see it, the amount and quality of studies done are not sufficient to draw firm conclusions either way on acupuncture. As you said earlier:
    These things take time and I am probably more open-minded about the existence of meridians than you might think. However, practicing as I do gives practical benefit and does no harm which seems to be good medicine even if some may claim that it is not good science.
     
  2. CKava

    CKava Just one more thing... Supporter

    This is a fair question. Now as to what makes a study compelling I would say there are 4 major factors:

    1. SIZE: The amount of subjects. The bigger the better.
    2. CONTROLS: Limits the effects of variables (which ideally includes double blinding). The tighter the controls the better.
    3. REPUTATION OF GROUP CONDUCTING STUDY: The more respected the group and/or the institution the better.
    4. DURATION: The longer the subjects are observed and follow ups are performed the better.

    To put it as a dichotomy: a large scale, well controlled, well conducted and long term study is better than a small scale, poorly controlled, badly conducted and short term study. Though in reality most studies fall somewhere in between those 2 poles. The fact also remains that large scale studies often suffer from the usual problem of large scale research; more subjects, but less control and less in depth. So by no means am I saying well conducted small scale studies are useless because they certainly aren't.

    There is also a need to situate research in it's relation to the existing clinical evidence... i.e. if a research paper comes from a random Chinese medicine research center in China, displays little information about controls or knowledge of other studies and claims a 80% efficacy rate when other studies published by more established medical research groups with more detailed controls and show a small efficacy on a par with a placebo group then it's worth being skeptical. This doesn't just apply to alternative medicine either... single studies can be very convincing but before any single results become consensus there will have to be multiple studies that confirm them. A good site to look at for a real analysis of studies that make the headlines is:
    http://www.nhs.uk/News/Pages/NewsIndex.aspx

    I'd also recommend subscribing to the science-based medicine blog which is quite new but also addresses studies that make the headlines and has articles released everyday:
    http://www.sciencebasedmedicine.org/

    And again I'm out of time... hate being so busy these days.
     
  3. Tartovski

    Tartovski Valued Member

    Can I add:

    5: PEER REVIEWED?
     
  4. Late for dinner

    Late for dinner Valued Member

    This is a looong thread

    OK I haven't the patience or time to go through this whole thing but just a couple of points that might be of interest.

    There has been clinical and research evidence to show that you get physiological changes. Youcan see changes in the cerebrospiinal fluid of a rat and the chemical effects will be transferable when put into another rat. Dr. Bruce Pomeranz at the University of Toronto (and others) have shown chemical changes (not all have been identified) and also how some might be reversed (i.e. injection of Naloxone will stop a number if the effects of acupuncture)

    Onedifficulty is that while acupuncture has effects, its applications, TCM or Japanese or any other method creat a huge number of variables to test. Recent research has shown that it may be that it is less important to get an exact point for a prescription but if there is De qi produced there will be an effect. In chinese medicine they say if there is paini there will be a blockage of chhi (stagnation) and a de facto acupuncture point forms - ah shi points. In many ways there is subtle manipulation of the nervous sysem occurring

    Dont think because of the esoteric language and descriptions of what is happening that there isn't something that can be analyzed. But the problem is that often when you research things can be overly simplified, significant effect sizes might seem small but when you take out sub groups you can see trends that are important clinically.

    I personally know that there are many different types of research and levels of evidence. Much of western medicine suffers from the same problems that you will find when trying to research chinese medicine... you just aren't as aware of it. I knowt that in grad school I thought that soooooo much of the evidence inwestern studies were weak in their design, employed poor statistical methods and asked questions in a way that had no relevance to clinical practice.

    Nothing survives that isn't useful in some way...martial arts or medicine

    Acupuncture has been used in the medical community here in the UK for something close to 200 + years and of course much longer in the oriental community. If you want more information on where you might look for stuff that will help your exploration of research, acupuncture or relatedyou can pm me and I will give you a couple of to look.

    Cheers, powchoy
     
  5. Tartovski

    Tartovski Valued Member

    Very true, they can always serve as a bad example. ;)

    (this trite response is because I really can't be arsed going into why popularity of an idea or it's age is in any way related to how valid it is)
     
  6. Taoquan

    Taoquan Valued Member

    Thank you all for your insightful replies,

    I am very busy atm, so will try to get back to some great points soon.

    One question for CK and Tart?

    Is there a certain organization that might matter as well that lends to credibility of studies (this is a huge exaggeration but for example a major university and some self employed scientist?)
     
  7. Tartovski

    Tartovski Valued Member

    Not really. If you base whether a study is good or not based on who did it, you are falling under the fallacy of appeal to authority ie: Prof. brainbox said it, therefore it must be true!

    What Ckava and I mean is that if a well respected institution has carried out a study, it's more likely to be a good study because well respect institution by definition do good research - that's why they are respected.
     
  8. Taoquan

    Taoquan Valued Member

    Topher,
    I thank you for you input, however, it seems like you are right and we are just going in circles and not really understanding each other. Your points are noted and I thank you for your insight.

    CK and Tart,

    Can you two possilby also elminate more of the "Myths/Facts" of the placebo effect as well (and where possible provide sources)? I.e

    1) Animals CANNOT be subjects of the Placebo effect. I have heard this from numerous people (including vets and seen it in other science journals) but am not sure this is still the case.

    2) Can placebo effect provide immediate physical results? What I mean by this is I have seen acupuncture techs. that are meant to manipulate the persons structure (the tech. I speak of is a tech to realign posterior/anterior/horizontal hip tilt, similar to what a Physical therapist checks for) within 20 minutes the alignment is perfect...Is this possible with the placebo effect? (honestly wondering)

    3) Somewhat in line with the above question, do we know how strong the placebo effect is? In TCM/acupuncture we do treat the CC (Chief complaint) but often there is a Root problem in addition to the branch problem (the basic idea in TCM that the whole body is connected). So patients will also find other issues going away (i.e. come in for low back pain and even though we don't treat it the knees and sometimes urination issues may clear up). Is this also possible with the placebo effect if the patient is not aware it is?

    Thanks for your time all :D
     
  9. CKava

    CKava Just one more thing... Supporter

    Taoquan I am intending to reply to all your points at some point soon just a bit busy like you at the minute! Haven't forgotten about your questions though!
     
  10. Topher

    Topher allo!

    I mean that simply sticking needles into the skin isn't acupuncture. Acupuncture is based around a specific philosophy with specific claims. Acupuncture is not just randomly sticking needles into the body.

    Here's some points also worth noting regarding medical studies:

    I emphasised number six since that seems like an obvious one to look out for.

    I'd guess the Royal Society (UK) or the National Academy of Sciences (US) are two respected science organisation, which is made up of the most elite scientists.
     
  11. Taoquan

    Taoquan Valued Member

    Topher,
    Thanks for all the great links I will give them a once over atm, and a more thorough going through when I have more time.

    CK,
    No worries I understand :D
     
  12. Taoquan

    Taoquan Valued Member

Share This Page