Is acupuncture more effective than placebo, and who should you trust?
The placebo controlled acupuncture studies that are considered to be the highest level of evidence in modern medical science are designed to eliminate variables. They often use the same points on every subject, given one diagnosis, and this is simply not how acupuncture is done. There are in-depth theories behind acupuncture, none of which equate with any western diagnosis. So if a patient has fibromyalgia, (or even something as simple as low back or knee pain) there are a multitude of acupuncture diagnosis that may be associated with one western diagnosis, and every patient must be evaluated separately according to the Traditional East Asian Medicine diagnosis in order to effectively treat them with acupuncture. Then, they use placebo needles, now this is where it just gets silly... have you ever seen a placebo massage study or a placebo surgery study? Usually the answer is no. There is no place on the body you can place a needle or even a "sham" needle (that is not fully inserted or just taped on) that does not stimulate the nervous system as an acupuncture needle would. Don't get me wrong, we know that there is a difference in the effects of points used properly vs placebo, there have been many studies showing changes in the brain, chemicals released, heat changes, and electromagnetic changes associated with the proper acupuncture points. This does not mean that a placebo needle is an effective way to study any more than a placebo massage would be. Remember they are using a western diagnosis and one treatment for all the participants in most cases so they are comparing bad acupuncture to bad acupuncture and amazingly we still often get a 30% effective rate (average placebo effective rate is 20% or less) proving even bad acupuncture works ! It is also important to note that there are far more studies showing acupuncture's effectiveness for a myriad of diseases than there are studies showing it’s ineffectiveness. Even the World Health Organization has long stood behind this long list of conditions effectively treated with acupuncture. Also, many of the poorly designed studies do not even meet the criteria for clinical relevance by even western medical standards.
There are plenty of studies showing acupuncture's effectiveness beyond placebo that are well designed. As for the most recently widely publicised study about knee pain that showed acupuncture was not more effective than placebo, the study was too short (3 months) and other similar studies over longer periods (6 months) do show effectiveness for knee pain, showing us that it takes time, which was no secrete, knee pain can be a more tenacious problem to treat, not to say I have not had patients walk out pain free after their first treatment for knee pain.
Before I go on I would like you to know that I am nothing but amazed by the value of standard western medical practice and I am currently devoting part of my time to becoming a Family Nurse Practitioner so I can use this valuable modern medicine that saves and prolongs lives. However, when it comes to the actual science I have been astonished that; according to the text from my research class I took for my Nurse Practitioner degree Melnyk & Fineout (2005), an "alarming number" of health care providers do not utilize research in their daily practice and it takes an average of 17 years for new findings to reach standard medical practice. Much is being done about this as we move toward evidence based practice, as we should. Also, your doctors clinical and theoretical knowledge are vast and invaluable and should be respected and investigated with the utmost respect. Not to say that you should do what you are told with out question. Any good practitioner (if time permits) should be open to your questions and concerns and help to empower you about your health. No one person will ever have all the answers, and the answers may not yet be known to mankind either, but we do know a lot about the human body, and that knowledge is more powerful when all aspects are clearly understood. So trust your doctor, they have a lot of education behind them, but never stop questioning.
Unfortunately, even your doctor may have been unknowingly mis-lead. First, there is publication bias, where only positive studies are published readily and negative studies are held to the way side only to be discovered years later. A recent blaring example of this is the drugs used to treat depression which when all the evidence was gathered and evaluated turned out to be just as effective as placebo in most cases unless there as a severe depression (minute number of cases for the total prescribed). What is particularly alarming about this fact is that we do know that the side effects can cause suicide, worsening depression as the brain chemicals like serotonin are depleted by the drugs, and many other unnecessary uncomfortable effects (especially for children). On the same issue of publication bias, I just wrote a detailed paper on statin drugs and dementia, and found an international meta-analysis that was not available on a pub-med search that showed the massive publication bias in this field (feel free to contact me for details). Statins are much more likely to cause harm than good when it comes to long-term brain health, which would make sense because every cell in our brain and nervous system is made from cholesterol why would taking it away help?
Once again, before I go on I want to acknowledge that drugs save lives and that drug companies are responsible for the vast majority of modern medical research. However, beyond publication bias there are new alarming facts being produced about the blatant lies coming from some drug company funded studies. Avandia has been literally killing people and your doctor had no way of knowing this since a major study used to keep the drug on the market was falsified. Now, PLEASE do NOT blame your doctor ! It's not their fault that they are given false information and mislead into believing they are helping. It is, however, a good idea to ask about a treatments effective rate on health outcomes like death rates and not lab or test values. In the case of type II diabetes, it turns out that lowering your blood sugar with drugs (many drugs including insulin were included) may also be causing more harm than good. Treating the symptom like blood sugar, and not the root (insulin resistance in this case) is like taking the smoke alarm out of a burning building (thank you to Mark Hyman for the analogy).
We need more good direct science to base our health care on, and until then please make careful decisions and rely on what we do know with absolute certainty, your life style, including diet and exercise matter immensely and are often more important factors than what drug you are on. Diet and exercise can alter your genes so you have no reason to blame things like your weight solely on genetics. You can get to better health more readily with the time tested methods that may not be as easy as a pill but with all this information you should now know there is sometimes no other answer. Of couse, the individual always matters and I mean the individual drug and the individual person. Drugs do save lives but it may be less often than we would like and every one is different. The FDA is currently trying to ban the chemo drug Avastin as it has been shown not to increase life when looked at broadly, this does not mean it has not saved individual lives but it does mean it is being over-prescribed to the wrong people. Avastin was shown to change test results and x-rays for the positive but LiFe is what matters and you can have a nice x-ray and lab report but if you are dead in 3 months what does that matter? We now know that the Epo drugs were probably hastening death in many chemo patients and they were handed out like water to cancer patients for many years while the drug companies that studied them made billions of dollars. It is important to get new treatments out there as soon as possible but we must use caution and reason in doing so.
So, is acupuncture more effective than placebo? Yes it is. Its effects are subtly profound but it's safety is undeniable and its history shows us that it may be one of the safest effective treatments for many conditions that do not have any other option. As for the western doctors (which will include me in a few years) you should trust your doctor, but know that you are the master of your health and no pill or quick fix can have the same benefit as prevention in the first place. So please, take care and let me or your trusted provider know if you have any questions about how to best solve your heath problems !
References in links and
Melnyk, B. M. & Fineout-Overholt, E. (2005). Evidence-Based Practice. Philadelphia, PA: Lippincott Williams & Wilkins.
The Risk of Using Sunscreen
Wearing sunscreen to prevent skin cancer seems like a no-brainer. Unfortunately when I put my mind to it I found out this statement is more literal than I thought. It turns out that there is more epidemiological evidence that shows an INCREASE in skin cancer with regular sunscreen use.1 While there are some complexions, like those with freckles that may benefit from sunscreen use, the safe way to go seems to be using clothing, hats, and shade to reduce sun exposure without the risk of harmful chemicals.2,4,5 In a quantitative review of the literature from 1966-2003 Dennis, Freeman, & VanBeek found that “no association was seen between melanoma and sunscreen use.”6 The authors also note that the long-term effects of new sunscreens may take decades to determine.6 Green, et al. found “no significant differences in the incidence of first new skin cancers between groups randomly assigned daily sunscreen and no daily sunscreen” particularly not with basal-cell carcinoma.7 Routine sunscreen use for 4.5 years does show some effect for cutaneous squamous-cell carcinoma prevention.7
The Environmental Working Group just released an excellent sunscreen guide (updated link for 2011). After they reviewed 500 sunscreens they could only recommend 38 of them (in 2010). I highly recommend using those, or others that are comparable, especially since seemingly healthy ingredients like vitamin A have been recently shown to increase skin tumor growth and lesions.5 Just be sure that you do not increase your sun exposure because you are wearing sunscreen.
It is also very important to note that what state of health your body is in is more important than what you put on it, or how well you shield your self from the sun’s also beneficial rays.1,2,5 Eating a diet full of a wide variety of fresh fruits, vegetables, nuts and grains (that includes 7-9 servings of vegetables & fruits and plenty of properly preserved good fats) is an excellent way to start. Controlling stress through meditation, Qi Gong, Yoga, and exercise is also a very important component in preventing all types of cancer and disease. Cancer is a complex process that starts with an energy deficiency that gets the body’s complex dance of natural mechanisms out of balance, usually because of multiple compounding factors and including many external influences. Do what you can to reduce negative influences like stress, toxins and poor diet. Another 2011 update: Sulforaphane used topically is showing great promise for skin cancer prevention as an after sun exposure lotion (the only lotion I found with this so far has antifreeze in it also... be careful). You can also get sulforaphane in a pill. I am not sure if this can be used topically, but I am looking into it!
Responsible exposure to the sun is vital to our health! Most people are aware that vitamin D is needed for the absorption of calcium in the gut, but did you know that a deficiency can increase: muscle weakness, cancer, type 1 diabetes in children, congestive heart failure, hypertension, schizophrenia, depression, and wheezing?3 In fact, “93% of persons 10 to 65 years of age who were admitted to a hospital emergency department with muscle aches and bone pain and who had a wide variety of diagnoses, including fibromyalgia, chronic fatigue syndrome, and depression, were deficient in vitamin D.”3 To get enough D you need to expose your bare skin to sun that is unencumbered by buildings during the peak hours of the day. Holick (2007) recommends that “exposure of arms and legs for 5 to 30 minutes (depending on time of day, season, latitude, and skin pigmentation) between the hours of 10 a.m. and 3 p.m. twice a week is often adequate. “3
Methods: I searched Pub Med using the MeSH terms "Sunscreening Agents"[Mesh] AND "Skin Neoplasms"[Mesh] and limited the search to Clinical Trials, Meta-Analysis, Randomized Controlled Trials, in humans, in English, in the Core clinical journals. I received 16 results, a shockingly low number. However, considering the difficulty of time factors epidemiological data seems to be the best source of information as shown in the Meta-Analysis and quantitative review. All relevant articles were reviewed and represented in this article.
References:
1. Huncharek, M., & Kupelnick, B. (2002). Use of Topical Sunscreens and the Risk of Malignant Melanoma: A Meta-Analysis of 9067 Patients From 11 Case-Control Studies. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12084704
2. Gallagher, R., Rivers, J., Lee, T., Bajdik, C., McLean, D. & Coldman, A. (2000). Broad-spectrum sunscreen use and the development of new nevi in white children: A randomized controlled trial. JAMA 14;283(22), 2955-60. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10865273
3. Holick, M. (2007). The New England Journal of Medicine, 357, 266-81. Retrieved from http://www.vitamindhealth.org/?page_id=48
4. Glanz, K., Schoenfeld, E., & Steffen, A. (2010). A Randomized Trial of Tailored Skin Cancer Prevention Messages for Adults: Project SCAPE. American Journal of Public Health, 100(4), 745-741. Doi: 10.2105/AJPH.2008.155705
5. EWG’s Sunscreen Guide. In Environmental Working Group (ewg.org) Retrieved from http://www.ewg.org/2010sunscreen/?inlist=Y&utm_source=sunscreen&utm_medium=email&utm_content=first-link&utm_campaign=toxics
6. Dennis, L., Freeman, B., VanBeek, M. (2003). Sunscreen use and the risk for melanoma: a quantitative review. Ann Intern Med., 16:139(12), 966-78. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14678916
7. Green, A., et al. (1999). Daily sunscreen application and beta-carotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomized controlled trial. Lancet 354(9180), 723-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10475183
The Language of Acupuncture
In this language the seasons are associated with elements that in turn are associated with organs; Spring (Wood, Liver), Summer (Fire, Heart), Late Summer (Earth, Spleen), Fall (Metal, Lung), and Winter (Water, Kidney). This spring I have been observing liver wind patterns arise out of a slightly yin deficient winter, making eczema, allergies, headaches, menstrual irregularity, pain that moves around, spasms, dizziness and even frustration and anger arise as our energy makes its way from deep in our bones out to the surface. This complex language is not easily understood, so don't get caught up in the details but observe the flowing patterns of the generating sequence (metal, to water, to wood, to fire, to earth); this is what we as practitoners use to balance the body, and why we suggest certain foods or habits that can help your body stay in harmony. I look forward to helping you understand your body in any way that I can because I believe you hold the power to your own health and well being. I also sincerly hope that our culture can successfully foster this invaluable medicine through correct understanding and not lose what took centuries to discover by dissecting past the knowledge (we may have just discovered that acupuncture channels are tiny physical structures that have been missed previously because when you cut the skin they are obscured by clotting factors). Please come to class where we experience these connections while I explain the patterns; come in for a treatment so I can go over your diagnosis for you, and always feel free to contact me with any questions.
New scope of practice for East Asian Medical Providers !
New definitions include: breathing, relaxation, and East Asian exercise techniques; Qi gong; health education; East Asian massage and Tui na; superficial heat and cold therapies; and recommendations and selling of herbs, vitamins, minerals, and dietary and nutritional supplements.
Thank you Washington State Acupuncture and Oriental Medicine Association!
Exciting News for WA State East Asian Medical Providers!
As of last night the Senate Passed SB6280 to further the scope of LAc's (Licensed Acupuncturists) to clearly include and represent what we do, East Asian Medicine. This bill also introduces this term and allows Acupuncturists to now call them selves East Asian Medicine Providers (EAMP). I hope that this brings further clarity to our state and beyond about what an East Asian Medical practitioner has to offer, as what we practice is a total system of medicine developed continually over thousands of years of history.
Nurse Practitioner on the way
I have decided to further my education and licensure and become a Family Nurse Practitioner (ARNP in WA State). I will be taking classes slowly so as not to interupt my regular practice. In a year or two I expect to start clinical internship at a fine local facility. This will not be changing my work schedule as I will be utilizing one of my extra days off for this purpose. I feel that with such a strong degree so close at hand (given my previous education and experience as an RN) that it would be silly not to integrate fully with this primary care license. I was accepted into a masters program this week and expect to start classes in May.
Subscribe to:
Posts (Atom)
Posts
