Respectful Insolence

ResearchBlogging.orgAt the risk of repeating myself (but, then, since when did such concerns ever stop me before?), I’ll just start out by mentioning that, of all the non-herbal “alternative” medicine remedies out there, I used to give a bit of a pass to acupuncture. No, I never did buy any of that nonsense about how sticking thin needles into the skin at points along various “meridians” somehow “redirects the flow of qi,” that mystical life force upon which so much woo, particularly woo based on Eastern mysticism and traditional Chinese medicine depends. However, because acupuncture involves an actual physical action on the body, namely sticking needles in it, I didn’t think it entirely implausible that it might have some sort of physiological effect, such as counterirritation or the release of endorphins, that could relieve pain or induce relaxation.

Of course, back then I was still fairly early into my skeptical career of investigating “alternative” medicine claims and hadn’t read very many the studies of acupuncture. The more I read, the more I realized that acupuncture is nothing more than yet another elaborate placebo. What it took over the last couple of years for me to give up on acupuncture entirely was reading a steady stream of studies showing that “real” acupuncture is no better than “sham” acupuncture involving either using special needles that don’t break the skin, locations other than the true “meridian” points, or even toothpicks. Heck, in one case, sham acupuncture worked better than “real” acupuncture, but the study authors argued that their study was evidence that “acupuncture works”! In fact, virtually every study that shows no difference between acupuncture and sham acupuncture is still somehow spun by its authors as providing evidence that “acupuncture works” (although they usually do a bit of handwaving and represent it as “more complex” than previously thought). The more I learned, in other words, the more I asked: Can we finally just say that acupuncture is nothing more than an elaborate placebo? When I started to learn that what is represented as acupuncture today is, in fact, not really even that ancient but rather a modality resurrected by Chairman Mao to give the appearance of bringing health care to his people when he couldn’t afford modern, scientific medical modalities, that about sealed it. I saw acupuncture for what it is.

Perhaps realizing that what has been known as acupuncture is indeed no better than an elaborate placebo, acupuncturists have been trying all sorts of variations of acupuncture, the most common of which involves hooking up the acupuncture needles to a weak electrical current, a procedure that has come to be known as “electroacupuncture.” Heck, acupuncturists have even tried a variation involving lasers (because, of course, everything is better with laser beams, and, like Dr. Evil, I think that strapping lasers even to ill-tempered sea bass would be cool, although I must agree with him that it would be much cooler to have sharks with laser beams to dispatch my enemies). Here’s the problem. What acupuncturists call “electroacupuncture,” we in the medicine biz call transcutaneous electrical nerve stimulation (abbreviated TENS). What acupuncturists don’t tell you is that electroacupuncture is, in essence, TENS without science or any scientific rationale for the placement of the electrodes (which is, after all what the needles become when hooked up to an electrical source). In effect, electroacupuncture replaces science-based positioning of the electrodes with woo-based positioning. Despite that, though, it actually sometimes works, because, as TENS shows, using a weak electrical current to stimulate certain nerves can indeed relieve pain in some cases, and that’s all so-called “electroacupuncture” does. Mainly this occurs by utter coincidence, when acupuncture meridian points happen to overlie actual nerves. Indeed, I strongly suspect that the reason many of these acupuncture points are selected for various studies isn’t based on traditional Chinese medicine precepts, but because it was realized that they were close to real nerves that might do real things in the body when stimulated.

Here’s the problem. Acupuncturists take a science-based modality (TENS) and “rebrand” it as some sort of “alternative” therapy like electroacupuncture. After all, why use boring old TENS to try to relieve chronic pain when you could instead be using–ta da!–electroacupuncture. So much cooler So much more…alternative! It’s a classic bait and switch, in which woo-meisters take a modality like acupuncture, add something to it that science tells us will have a physiological effect (like electricity), find a result, and then use that to imply that the whole “alternative” medicine modality really does work after all.

That’s exactly what advocates of electroacupuncture do.

What brought this up is a post by fellow ScienceBlogger Isis. who the other day asked: Is electroacupuncture an effective treatment for hypertension? In it, Isis applied her hot scientific skills to a paper that looked at a paper examining a rat model of hypertension and whether electroacupuncture can lower blood pressure. Before I get to my take on the paper, let me just say that (1) I’m not a neuroscientist (although, whether Isis will believe it or not, I do study a glutamate receptor, in one of the more bizarre and lucky bits of serendipity between neuroscience and cancer I’ve ever come across) and (2) there’s no reason for me to delve too deeply into a discussion of the rat model because there’s no reason for me to think I can do it better than Isis, whose science hotness is indisputable. What I do bring to the discussion that Isis lacks are (1) my background as a physician and (2) my background dealing with the classic bait and switch of alternative medicine woo-meisters, which Isis clearly lacks, which allows me to cut through the woo-speak that inevitably infests papers such as this, even ones that use a well-established animal model that, unlike the infamous “reiki for rats” experiment that I had so much fun deconstructing a while back, isn’t ridiculous. However, the introduction to the paper is:

ELECTROACUPUNCTURE (EA), a potent alternative to manual acupuncture, has been suggested to be effective in treating certain cardiovascular diseases including hypertension, arrhythmias, and angina pectoris (5, 6, 41). Clinically, EA at the Neiguan- Jianshi (P5-6) acupoints has been used to treat cardiovascular diseases in Eastern and, more recently, Western countries (5, 21, 41). We and others have demonstrated that EA at P5-6 acupoints overlying the median nerve on the wrist modulate blood pressure elevation evoked by gastric distension (GD) in rats (27) or by gallbladder stimulation in cats (50) through a long-loop neural pathway, extending from the arcuate nucleus (ARC) in the hypothalamus to the ventrolateral periaqueductal gray (vlPAG) in the midbrain and, ultimately, to the rostral ventrolateral medulla (rVLM) (13, 26, 50, 58).

First off, let me make this very, very clear. these Neiguan-Jianshi acupoints have no basis in human anatomy or physiology. Really, they don’t, any more than any acupuncture point does. “Meridians” are based on a prescientific understanding of how the human body works, and the thought that sticking needles into these “meridians” redirects the flow of “qi” in order to heal is nothing more than magical thinking. These particular acupoints, probably through blind, dumb luck, happen to lie over a major nerve in the forearm, namely the median nerve. Sticking needles near the nerve would not necessarily be expected to do anything, but running electrical current near enough to stimulate the nerve might actually be expected to do something, given that the impulse thus generated would be expected to travel up the median nerve. The median nerve, by the way, is the nerve that is compressed in carpal tunnel syndrome, and its compression can, as anyone who’s ever had a bad case of carpal tunnel syndrome can tell you, can result in pain radiating up the arm to the neck and even to the head.

To make a long story short, what the investigators had found in a previous study that stimulating the median nerve with electrical current using the P5-6 acupuncture points blunted the increase in blood pressure caused by dilating the stomach in anesthetized rats. This study tried to identify the mechanism for the effect. Specifically, using stereotactic techniques, the investigators placed microdialysis probes into specific areas of the rat brain in order to take samples of the cerebrospinal fluid and infuse drugs. At this point, I’ll let Isis summarize the results:

Fu and Longhurst collected samples of cerebral spinal fluid and delivered drugs to block a receptor they thought might be mediating the response to the electroacupuncture while they stimulated the hypertensive rats at acupoints P 5-6. Electroacupuncture was effective in preventing 50% of the gastric distension-induced increase in blood pressure and caused a decline in the neurotransmitter GABA in the ventral IPAG (vIPAG), a brain region whose activation has been shown to lower blood pressure. Administration of AM251, a drug that blocks the cannabinoid type 1 receptor, to the vIPAG prevented the electroacupuncture-induced decline in GABA. AM251 did not, however, alter blood pressure and the investigators do not appear to have used it in combination with their gastric distension technique.

So, what’s the point Isis? While the authors do not quite seal the deal, defining a specific causative link between the cannabinoid type 1 receptor, GABA, blood pressure, and electroacupuncture, they provide compelling evidence that electroacupuncture causes discrete biochemical changes in a region of the brain responsible for lowering blood pressure.

Actually, what the authors in reality showed (probably) is that stimulating the median nerve near the P5-6 acupuncture points with a weak electrical current blunted the increase in blood pressure caused by gastric distension and that blocking the canniboid type 1 receptor prevented the stimulation of the median nerve from lowering blood pressure. I’m a stickler for nomenclature when it comes to these things, and that’s how the results of this study should have been represented. The reason I’m a stickler for nomenclature is because, as I mentioned in the introduction, “rebranding” various science-based treatments and appropriating them as somehow “alternative” is how CAMsters operate. (Just look how they’ve appropriated diet and exercise, if you don’t believe me.) In any case, I can think of one obvious control that wasn’t done that should have been done, namely ablation of the median nerve well proximal to the P5-P6 acupuncture points. If ablation of the median nerve prevents the effect of electroacupuncture, that would nail it as far as stimulation of the median nerve being the mechanism by which the observed effect of electrical stimulation.

The thing that bothers me about this study is that it’s a lot of careful science that is corrupted by the taint of ideology. Instead of representing their results as what they were, namely that median nerve stimulation at the wrist can lower blood pressure by whatever mechanism, they fit it into the whole world view of acupuncture, which in turn depends upon the mystical world view of traditional Chinese medicine. Why on earth did they do that? The science they did was interesting enough without needing to invoke woo to sex it up. Is it because they buy into the ideology that postulates that sticking needles into the skin somehow redirects a mystical life force called qi to healing effect? Who knows? Shockingly enough, it wasn’t the National Center for Complementary and Alternative Medicine that funded this study, but rather the National Heart, Lung, and Blood Institute. Is it because the authors know that it’s much sexier to label what they are doing “electroacupuncture” than as TENS focused on the median nerve? Is it because they are believers in acupuncture who couldn’t find evidence that it does anything without the electric current? Who knows?

Of course, one other aspect of this study is the question of how durable the response is. Let’s assume for the moment that the results of the study are valid. Let’s assume even more than that. Let’s assume that the results are generalizable to humans. The question then becomes: Other than the interesting physiology, so what? Unless the response is quite durable (as in days or weeks), who on earth would want to be hooked up to electrodes once a day or once every few days rather than just take a pill? In any case, even if this study guides us to a technique of treating human hypertension by sticking needles in the wrist and stimulating the median nerve, would such a treatment be practical? Sorry, it’s the clinician in me talking, as opposed to the basic scientist. I can’t help it.

In the meantime, as much as I hate to be critical to Isis in any way, given her dedication to “hot, hot science” (although I admit, male that I am, I fail to understand her apparent obsession with shoes), her post is evidence of the insidious effect that studies such as these have. They are what Harriet Hall refers to as “Tooth Fairy science” in that they apply the methods of science to a phenomenon that is the equivalent of the Tooth Fairy. That in this case there seemed to be some science to study is the exception that proves the rule in that the results of this study are being misrepresented as evidence that there is something to acupuncture. That advocates of unscientific modalities of health care continue to call this sort of nerve stimulation “electroacupuncture” rather than the science-based modality that it is, unfortunately, works as propaganda, even among hard core purveyors of hot science like Isis.

REFERENCE:

Fu, L., & Longhurst, J. (2009). Electroacupuncture modulates vlPAG release of GABA through presynaptic cannabinoid CB1 receptors Journal of Applied Physiology, 106 (6), 1800-1809 DOI: 10.1152/japplphysiol.91648.2008

Comments

  1. #1 daedalus2u
    June 24, 2009

    Very nice discussion. This is the difference between basic research (which the paper is about), as seen from a more clinical perspective.

    You are quite right to point out that clinically this may be a much more problematic (i.e. more costly and invasive) method of regulating blood pressure than taking a pill every day. Blood pressure is something that changes all the time. Blood pressure is how the heart moves blood through blood vessels. High blood pressure is how your body responds when it needs to move more blood through the system; for example in anticipation of increased metabolic demand under stress or physical exertion.

    Hypertension as a medical condition is considered bad because there are many studies showing a correlation between hypertension and vascular damage, heart disease, kidney failure and other conditions years later. The physiology connecting hypertension with these adverse health effects is not well understood. The benefits of controlling blood pressure by various methods have been tested by seeing how the change in blood pressure (produced by different treatment modalities) correlates with changes in incidence of different diseases over time.

    It isn’t clear that every method for reducing blood pressure would be equally effective. For example, reducing blood volume reduces blood pressure. If we had a device that would in real time modulate blood volume and so regulate blood pressure, would we expect improved health? I don’t think so. Blood flow is more important than blood pressure but a lot more difficult to measure, so blood pressure is used as a surrogate marker for it. Sometimes it is the same, but sometimes not.

    I would question whether or not acute blood pressure changes from inflating a rat’s stomach with a balloon (the method they used) is an appropriate model for hypertension in humans. Preventing acute blood pressure increases from inflating the stomach may have nothing to do with preventing the adverse effects of chronic hypertension in humans. This relates to clinical endpoints in clinical trials. Surrogate endpoints (such as blood pressure) can be useful, but only when the underlying physiology is very well understood. They can’t be used as endpoints instead of the more important endpoints, which in hypertension are the long term endpoints of heart disease and kidney failure (mostly).

  2. #2 Paul Browne
    June 24, 2009

    A very nice post Orac, and I agree with daedalus2u that the rat GD model may be a good model of the blood pressure increades induced by GD in humans, but not necessarily other forms of hypertension. I’d like to see their results duplicated in spontaneously hypertensive rats before getting too excited.

    An additional worry I have with the woo-friendly focus on acupuncture rather than electrical stimulation is how it affects where they go next if this effect proves to be real. As Orac maes clear there are real problems with managing a chronic disorder such as hypertension using an invasive procedure such as acupuncture, but their focus on acupuncture suggests that the scientists involved in this study are unlikely to spend much time investigating the possibility of developing a non-invasive, more practical TENS methodology.

    That seems to me almost as much of a shame as the idea that you can get paper published in a respected scientific journal thar appears to claim that it is possible to model something that does not exist in humans (i.e. meridians) in rats!

  3. #3 Jennifer B. Phillips (aka Danio)
    June 24, 2009

    Thanks for addressing this, Orac. I was frankly pretty dismayed by credulousness with which the goddess treated the woo aspect of this study. Most unsettling was her statement within the quote you provide in this post, in which she basically takes it on faith that *electroacupuncture* is in fact responsible for the observed effects. (My comment on this very point on Isis’s blog can be found here, just in case anyone thinks I’m saying things behind her back that I wouldn’t say to her face, as it were).

    Isis’s conclusion that : “This study, done with the proper controls and published in a highly respected journal, does provide sufficiently compelling evidence to continue asking questions. It is exactly the type of methodical, introductory work that must be done to support the incorporation of “alternative” therapies into traditional medicine.”
    is also quite worrying.

    I am not a physiologist, but if something as woo-friendly as this paper appeared in one of the highly respected journals in my field, I would waste no time ripping them a new one, and I have no doubt that other scientists–hopefully much more accomplished and influential than I– would do the same. It will be interesting to see what the reaction of the physiologist community will be to this endorsement of woo in a publication that evidently carries some weight in the field. I fear that experimental and academic expertise alone is insufficient to prepare scientists/physicians in this and many other fields for the insidious inclusion of woo into their practices, especially when it’s presented with the legitimacy it received in this article.

    This is a grim reality check, indeed.

  4. #4 Anthro
    June 24, 2009

    I had acupuncture about 25 years ago from a chinese medical doctor (insurance in Oregon will–or would 25 years ago–cover acupuncture from a medical doctor). It had been suggested by my orthopedist (with a bit of a wink) for tennis elbow. Well, the tennis elbow disappeared after three visits (could be coincidence), but at each visit, the doc put the needles in my earlobes (he was very straightforward, spoke only passable english, and did not engage in any mumbo-jumbo) which he said would “release endorphins” when I winced. Well, I am a runner and know what “runner’s high” is and after these treatments, I had a feeling of euphoria that greatly exceeded my runner’s high (I’ve never done drugs so can’t use that for a comparison). I could barely make it to my car and would just sit there for a while because I really couldn’t drive!

    I have never indulged in any other woo and I read this blog because I am so disturbed by its prevalence today. I would not do acupuncture today for all the reasons you go into here and previously, but what about those earlobes? Any possibility of endorphins being triggered? If what I experienced was a placebo, it is a powerful effect indeed!

  5. #5 Denice Walter
    June 24, 2009

    Orac asks why people would entertain this complicated,unwieldy nonsense when they could “just take a pill”? To those entranced by woo,pills are anathema, being as they are products of Big Pharma,as is TENS.I also suspect that procedures that are intricate,somewhat difficult, and seemingly arcane, appeal to their “esoteric,romantic” leanings. An ancient medical art is so much more attractive than are, uh, toothpicks.

  6. #6 Brian
    June 24, 2009

    Acupuncturists take a science-based modality (TENS) and “rebrand” it as some sort of “alternative” therapy like electroacupuncture.”

    And then gullible doctors on the faculty of my medical school use this as “evidence” that acupunture, and all sorts of woo as a natural extension, is effective.

  7. #7 Karl Withakay
    June 24, 2009

    So, the abstract doesn’t make it crystal clear, but in regards to durability, it sounds like the effects taper off in as little as 35 minutes after stimulation, which wouldn’t be a particularly practical therapy unless you permanently embedded electrodes that automatically applied periodic stimulation throughout the day.

    Why no control that applied current via any method other than needles (embedded electrodes) to rule out the null hypothesis that the needling itself is irrelevant?

  8. #8 Pablo
    June 24, 2009

    So, the abstract doesn’t make it crystal clear, but in regards to durability, it sounds like the effects taper off in as little as 35 minutes after stimulation, which wouldn’t be a particularly practical therapy unless you permanently embedded electrodes that automatically applied periodic stimulation throughout the day.

    Hey, it works for a pacemaker…

    Why no control that applied current via any method other than needles (embedded electrodes) to rule out the null hypothesis that the needling itself is irrelevant?

    Because then they couldn’t claim that the result was due to accupuncture as opposed to electrical impulses.

  9. #9 David
    June 24, 2009

    Thank you for an excellent analysis, Orac. My viewpoint is a little different but I reach the same conclusion:

    Hypertension is a disease state while transient elevated blood pressure is a normal physiologic response to an acute pain stimulus. The acute BP elevation is mediated by the sympathetic nervous system, with increases in cardiac output and also increases in systemic vascular resistance. Is it a surprise that stimulating a peripheral nerve with electricity leads to a change in how the central nervous system responds to the gastric pain signal? What this paper showed isn’t that “electroacupuncture” treats pain but that the physiologic response to pain is modified by nerve stimulation. D’oh.

  10. #10 Perceval
    June 24, 2009

    Thank you. I knew they must have been missing an obvious control. Extraordinary claims require extraordinarily stringent verification and all that jazz

  11. #11 Karl Withakay
    June 24, 2009

    “Hey, it works for a pacemaker…”
    It is an intriguing possibility down the road.

    “Because then they couldn’t claim that the result was due to accupuncture as opposed to electrical impulses.”

    But that implies that they had an underlying agenda to validate acupuncture (in any form possible) rather than do honest research into the effectiveness of using electrical stimulation for BP modulation; that can’t be true. :)

  12. #12 cannabinoid geek
    June 24, 2009

    i disagree that proper controls were done. while i am not an expert in the physiology of blood pressure, i am very well versed in the neuronal endocannabinoid signaling system. as such, when i saw it was proposed as a cannabinoid-mediated process, i HAD to read it. i did include my critique of the AM251 experiment in Isis’ comment section. (in short, by not doing the experiment in sham controls, they really proved nothing other than inhibition of CB1 receptors removes inhibition of GABA release, a finding so entirely NOT novel that it irritated me to have wasted my time reading it.)

    i was also dismayed that she presented this as a well-controlled study. to me it seemed to be some science and a whole lot of handwaving.

  13. #13 D. C. Sessions
    June 24, 2009

    In any case, even if this study guides us to a technique of treating human hypertension by sticking needles in the wrist and stimulating the median nerve, would such a treatment be practical?

    Well, that gets to the other control: application of the electrical current without piercing the skin. What would happen if the same current were applied via an adhesive electrode?

    If the adhesive electrode worked, it could actually turn out to be a viable long-term treatment.

  14. #14 Orac
    June 24, 2009

    I told you I wasn’t a neuroscientist. I’m also not an expert in cannaboids. But I am a scientist, and I did find one control that seemed rather blindingly obvious to me, while readers pointed out another one. Now you’ve pointed out the most sophisticated control, that only a neuroscientist would know to suggest.

    So what I’m getting is that maybe the science in this paper wasn’t “hot, hot science” (as Isis would put it) after all, in addition to the misuse and abuse of nomenclature to appropriate TENS as “electroacupuncture.” :-)

  15. #15 Dangerous Bacon
    June 24, 2009

    Instead of “bait and switch”, isn’t electroacupuncture more properly termed “bait and shock”?

    “I’m also not an expert in cannaboids*.”

    That’s not what I heard (snerk).

    *(avoids the wrath of Orac by not pointing out, uh, what I’m not going to point out regarding “cannaboids”).

  16. #16 cannabinoid geek
    June 24, 2009

    i know you’re not a neuroscientist, Orac. that’s ok, not everyone is perfect. ;)

    in all seriousness though, there’s nothing more effective than attacking from all relevant fronts of expertise. i hadn’t seen anyone else pop in with that control critique, and knew you’d find it useful in driving your already-strong point home.

  17. #17 wazza
    June 24, 2009

    Well, 1. they probably couldn’t find any other point on the nerve that wasn’t also an acupuncture point (ever seen one of those charts? They’re everywhere!) and 2. people often don’t want to take pills because drugs are seen as unhealthy, so if we can get TENS out there doing things it could do a lot of good for these people.

  18. #18 Orac
    June 24, 2009

    Actually, another thing occurred to me. The investigators stuck the needles in 3 mm. In a rat, that’s probably more than half the diameter of the wrist. It’s the equivalent of sticking a needle into a human wrist halfway through. Scale up the diameter of the needle, and it’s actually probably more like driving a nail halfway through the risk.

  19. #19 Isis the Scientist
    June 24, 2009

    Ouch! That last paragraph almost stung my ego. Almost ;)

    Alright, Brother Orac. I’ll get on board with the framing of woo. I agreed with our cannabanoid friend that the link to CB1 in the brain with blood pressure was weak in the original post, but I still think their gastric distension model is interesting and the GABA changes in the brain are worth stopping to look at…..

    I appreciate the context that you provide as a physician, and I will certainly never, ever, ever claim that these data are applicable to humans at this stage. As a physiologist I would question whether this technique is effective in chronic animal models of hypertension like the salt sensitive or the Goldblatt two kidney one clip model. I’d also still like to see some human data, cause that’s how I roll. I don’t feel like I have fallen captive to woo because it’s not going to make me change how treat my own health or the recommendations I make to scientific boards of major medical organizations. But seeing biochemical changes in my very favorite brain region is still enough to make me say, “hm?”

  20. #20 Matthew Cline
    June 24, 2009

    What it took over the last couple of years for me to give up on acupuncture entirely was reading a steady stream of studies showing that “real” acupuncture is no better than “sham” acupuncture involving either using special needles that don’t break the skin, locations other than the true “meridian” points, or even toothpicks.

    Darn, I wish I could remember exactly where I read this (badscience.net, maybe), but some woo-meisters have come up with a hand-wave for this: you see, the verum (non-placebo) group is getting a benefit from the treatment, and is then transmitting that benefit along to the control group, which is why they show the same results. They even proposed a way of testing this: like normal, simultaneously give the treatment and placebo to the verum and control groups, and once that’s finished pick a third group and give them the placebo. If their theory is correct, the third group will show less improvement than the first two groups.

  21. #21 Jennifer B. Phillips (aka Danio)
    June 25, 2009

    Isis:

    I don’t feel like I have fallen captive to woo because it’s not going to make me change how treat my own health or the recommendations I make to scientific boards of major medical organizations. But seeing biochemical changes in my very favorite brain region is still enough to make me say, “hm?”

    The point is (setting aside all discussion of proper controls for a moment) that there’s zero evidence that these biochemical changes have anything to do with the “EA at P5-6 acupoints”, which was, in fact, the conclusion of this paper. If you accept this explanation, as the content of your original blog post and your comment here would seem to indicate, then I would argue that you have, in fact, fallen captive to woo.

  22. #22 cannabinoid geek
    June 25, 2009

    alright, this bugs me just enough to fire up the laptop one last time for the evening (morning? whatever time it is)

    i really don’t mean to pile on, Isis. it’s not about you, it’s about this paper that just continues to irk me. i’m just up to my neck in ANOVAs of varying intensities tonight… and this is brewing in the back of my mind.

    the evidence for a CB1-based mechanism of action was not just weak, it was nonexistent. not only did they observe a massive supra-baseline rescue (over 300% of pre-EA GABA levels! which immediately sounded sirens in my mind about their claim that it was “blocking” an effect of EA), but they only gave the AM251 after the EA in the active GD cohort.

    [for the record, i am ALWAYS suspicious when y-axes for matched datasets do not match...]

    ideally, they should have set up an experiment where they tested interaction of drug x EA (or sham) x GD (or sham). that way, if AM251 really blocked the effect of EA, there would have been a drug x EA interaction. and if it were related to the induction of increased bp via GD, there would be the 3-way interaction.

    it looks to me like they threw that in there to suggest a link between nonexistent things like qi, and actual receptors in the brain. well, we KNOW that’s a big part of why this got published. i’m just surprised it got published in a respected journal.

    ok, i have spoken my peace. and a good night to all.

  23. #23 DLC
    June 25, 2009

    Why is it we keep wasting money on testing this stuff when everything to date has suggested it doesn’t work ?
    It’s as if the scientific community were Sisyphus, pushing the rock up the hill every day.

  24. #24 Ian Musgrave
    June 25, 2009

    I am a neuroscientist, and many moons ago, before I was seduced by the intricacies of signal transduction and neurodegeneration, I worked on neuronal control of hypertension.

    My first thought was that the most appropriate control would be a little local anaesthetic in the median nerve, up from the electro acupuncture (EA) site, then I read their earlier paper, showing that their EA stimulation parameters starts the median nerve firing (specifically the A-delta and C-fiber somatic afferents ie the pain communication nerves). Since stimulating A and C fibers causes bradycardia (eg see here) and vasodilation, it is no surprise that stimulation of the median nerve A and C fibres (and the peroneal nerve and the ulnar nerve A and C fibres) would cause reflex falls in blood pressure.

    No acupuncture to see here folks, this is plain old nerve electrophysiology (indeed, the peroneal nerve was on a non-cardiovascular meridian, an the finding that electrically stimulating this nerve caused a fall in blood pressure is at odds with the “acupuncture” hypothesis).

    Why they used gastric distension, when a much better model would be Spontaneously Hypertensive rats, or even DOCA salt rats (give that all animal models of hypertension have shortcommings), was not clear (yeah postprandial hypertension may be an issue, but are you going to rush to an acupuncturist after every meal?). Also, the fact that the blood pressure fall is transient after stimulation is an issue. Do you really think continous stimulation of your pain sensing nerves is a good idea, when we have a whole range of effective drugs with minimal side effects?

    It’s a marginally interesting study of the effect of activating pain afferents on blood pressure reflexes of marginal interest to treating blood pressure, and provides no support for acupuncture at all.

  25. #25 Pseudonym
    June 25, 2009

    I don’t understand the second paragraph.

    Let’s propose the hypothesis that acupuncture is really just a method for releasing endorphins or counter-irritation. If that’s the hypothesis, then it follows that sham acupuncture should have the same effectiveness as “real” acupuncture. Studies which show that sham acupuncture does just as well don’t contradict the hypothesis. The same may go for the toothpick study, but I don’t know enough about it to comment.

    What do people think of this?

  26. #26 Rita
    June 25, 2009

    No-one else is going to, so can I put in a word for the poor bloody rats? Must they be messed about with for woo as well as for conventional studies?
    Rita

  27. #27 Robert S.
    June 25, 2009

    Someone up thread mentioned that a pacemaker wouldn’t be that big of a deal. IIRC there is an implantable product that helps control blood pressure in certain high risk patients. After a quick google it seems to be called Rheos, marketed by CVRx. Seems like an interesting solution to drug resistant hypertension but wow, quite invasive. In any case, the correct waveform at the correct place can lower blood pressure, that at least is clear.

  28. #28 Ian Musgrave
    June 25, 2009

    Pseudonym wrote:

    What do people think of this?

    This being Lancet. 1980 Nov 1;2(8201):946-9. Increased beta-endorphin but not met-enkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain. Clement-Jones V, McLoughlin L, Tomlin S, Besser GM, Rees LH, Wen HL. Electro acupuncture again. All that is happening is that you are electrically stimulating nerves which interfere with pain perception (look up the gate theory of pain). Transcutaneous electrical stimulation for pain relief is well known, all electroacupuncture is is a less safe version of the transcutaneous electrodes.

    Again, no acupuncture effect, just normal nerve physiology upon electrical stimulation.

  29. #29 Ian Musgrave
    June 25, 2009

    Well, well, well, look what I found.
    Clin Physiol. 1991 Mar;11(2):161-8.Low-frequency transcutaneous nerve stimulation in mild/moderate hypertension. Kaada B, Flatheim E, Woie L. (full abstract)

    In a short-term experiment TNS produced a significant lowering of systolic, mean arterial, and diastolic pressures amounting to 8 mmHg (P less than 0.01), 6 mmHg (P less than 0.01), and 4 mmHg (P less than 0.02), respectively.

    So it turns out that transcutaenous nerve stimulation is known to cause falls in blood pressure (there is a small but substantial literature on this). So, simple electrical stimulation of nerves at low frequency will cause modest falls in blood pressure. The results of Fu and Longhurst (and the earlier Longhurst paper, Zhou et al 2005) are not due to acupuncture, but to the electrical stimulation of the median nerve. As they would have realised if they had done a simple literature search.

    In a long-term study, after 2 weeks of daily stimulation, a similar depression was recorded with no stimulation on the day of examination. An eventual clinical use of the depressor effect of TNS demands further clinical research.

    You don’t need to stuck needles in people, you can just use stick on electrodes. But why bother with the range of simple antihypertensive medications we have. A couple of pills with almost no side effects vs clumping around with an electrical stimulator attached to you. Although there is some preliminary evidence that TNS may be of some help in drug resistant cases of high blood pressure. See

    J Hum Hypertens. 2000 Dec;14(12):795-8.The effect of transcutaneous electric nerve stimulation in patients with therapy-resistant hypertension. Jacobsson F, et al.,

  30. #30 Pablo
    June 25, 2009

    Ian – that’s a good find. Nice sleuthing (the literature can be a tricky thicket). I think it warrants a letter to the editor of the journal. It doesn’t have to be nasty, just a quick little comment making the authors aware that their results are consistent with previously reported studies, and that there is no indication that it has anything to do with accupuncture.

  31. #31 Inoculated Mind
    June 25, 2009

    “woo-based positioning”
    I love it!

  32. #32 Ian Musgrave
    June 26, 2009

    Pablo at #30 wrote:

    I think it warrants a letter to the editor of the journal.

    The Journal does accept letters to the editor, so I’ll fire one off.

  33. #33 mark
    June 29, 2009

    I hypothesize that TENS is nothing less than the homeopathic form of Electro-Acupuncture, wherein it is the size of the needles, rather than concentration of active ingredient, that is infinitely reduced.

  34. #34 kay
    June 30, 2009

    Hello,

    Do you know where to find different chinese medecine as Snake wine ? I already bought this one:
    http://www.asiansnakewine.com

    But I am now looking for different types of natural medecine (for example with LIZARD inside the bottle).
    Thanks for help.

    (by the way I found your website on Google when looking for Snake wine bottles)

  35. #35 alternative medicine
    July 5, 2009

    I would question whether or not acute blood pressure changes from inflating a rat’s stomach with a balloon (the method they used) is an appropriate model for hypertension in humans.

  36. #36 John
    August 17, 2009

    Well I guess that Western Medicine will have a problem with anything they can not control or make a buck out of. In Australia we are now seeing the Western Doctors saying of course acupuncture works we need to regulate that profession.(Thats code of how can we stop them competing for our dollars)

    When Western Medeicine can find a way to make a buck out of it and not feel insecure because they don’t know how it works, then and only then will it get the green light.
    Drug companies own Doctors and their education. When they can remember that science was meant to be observing and testing then you can call yourself a Doctor.(well not a real Phd but a MD)

  37. #37 Nik
    August 18, 2009

    Let me please to get it straight. The articles on acupuncture indeed report no difference on sham and acupuncture group.Well other articles saying exactly same about use of tens. My explanation – acupuncturist in acupuncture studies are not always practitioners with experience. My guess (forgive me if I am wrong)is that acupuncturist are folks from close circles to researchers. Practitioners with good name and successful practice not prone to studies because it is a waste of time and money usually. The other reason is that acupuncture falls rather under art when experience and knowledge make a good combination. To make it shorter it is difficult to run a randomized trial based on assumption that there is no difference between acupuncturist. Applying the same approach for painting I would say it sucks because majority of painters do not produce anything good and majority of people do not need it.

    Acupuncture is effective but different way for different conditions. Assuming that you talking about muscle pain I would say that just needling of the sore spot will improve the condition if it is not a chronic pain. It is called a-shi technique which is very simple and very effective. No knowledge of acupoints (or qi energy)is required

    If we want to compare electro acupuncure with something I would name Al-TENS (acupuncture like TENS) and PENS (Percutaneous electrical nerve stimulation) Many articles reporting positive result on use of PENS. The trouble is again with the research idea. Percutaneous stimulation of nerve? are you sure? How do you archive it? I understand TENS may stimulate the nerve’s endings because of the electrode size but PENS?. I doubt that anybody tried to needle a nerve’s ending and stimulate it with electrical current and prove it.
    When it is discussion about benefits of acupuncture I would like to remind you that anti-inflammatories have not much difference compared to sham group in subjects with chronic pain either. Almost same groups where acupuncture were tested.
    The discussion is not about acupuncture but about frustration of conventional medicine to deal with chronic pain.
    The reasons of chronic pain is not really a pain mut reduced muscle performance muscle strength. The restoration of it does produce a long term result

  38. #38 Mari
    September 4, 2009

    Ooops! Your blog just came up when I was searching for something else. But it has given me cause to scroll down and leave a comment. This may be well off topic (as it refers to the real acupunture and not the electric woos) but it could help someone somewhere if nothing else (eg a hospital) can. I was paralysed by a YF vaccination (I was in tip-top shape just before the vax – and after: could hardly breathe and was completely drenched and collapsing – plus I got YF symptoms 5 days later and nearly died of spleen/liver failure so even the vaccine centre had to admit it was vaccine linked). Anyway, after pill popping (or rather dodgy syringes) and a whole lot of other unthinkables I gave up hope and turned to (well at least in mind as body could not)… acupunture needles for the first time in my life – and thank God I did – along with homeopathy it was the only thing that got my neck and limbs moving again, got rid of the terrible nerve pain, the feeling back in my limbs. Of course I don’t expect any of you to believe this – but just please if you ever find yourself or another in this agonising state and you feel like you in you have nothing more to lose (and you don’t even have to admit you did) try it!

  39. #39 Scientizzle
    September 4, 2009

    @ John #36: Western Medicine will have a problem with anything they can not control or make a buck out of

    So…acupuncturists only needle people pro bono? There’s zero money to be made with these modalities? Medical institutions around the world haven’t tried to cash in on altmed/integrative med at all?

    Your insinuation that “Western Medicine” is only cynically profit-motivated (and, by non-sequitur extention, “Eastern” is apparently not) is a laughably out of touch with reality. Don’t deny a profit motive on either side.

    science [is] meant to be observing and testing
    …and acupuncture has repeatedly failed to show an effect above placebo in rigorous testing. Isn’t that right?

  40. #40 JenJohnson
    November 29, 2009

    I agree, but not with the “why not just take a pill?” question. Try any of these reasons:
    1) side effects, known, minimized, yet to be known and those that will never be known because the effect is delayed or unquanitified (like a preference change began in childhood)
    2) hair loss from the types of drugs that lower blood pressure. For those whose hair is already weak, these pills may make them bald, permanently.
    3) Drug interactions, known and unknown
    4) unknown risks during pregnancy
    5) unknown risks during breastfeeding
    and, at the risk of repeating myself — all those side effects!!

  41. #41 Antaeus Feldspar
    November 29, 2009

    … side effects, known, minimized, yet to be known and those that will never be known

    Drug interactions, known and unknown

    unknown risks during pregnancy…

    unknown risks during breastfeeding…

    Uh, Jen, you do realize that “argument from ignorance” is a fallacy, right?

    I think it was someone on this blog who recently put it elegantly, and since it’s from memory, I must paraphrase: “It’s not that science has all the answers; it doesn’t. It’s that science’s would-be competitors don’t have any.”

  42. #42 Brendan
    May 18, 2010

    Your dismissive claim that acupuncture is “woo” seems more emotionally motivated than scientifically motivated. Why don’t you all relax and just look at the physiology of what is happening in the body, so we can move medicine forward.

    By the way, do you really want to make the claim that most orthopedists place TENS pads “scientifically”? Grow up. Both acupuncturists and orthopedists do the same thing. Place it where it hurts or on motor points. Its not rocket science.

    Most MD’s do not practice in a “scientific” manner at all. You do what you’re told to do (often by people who profit from your choices) and you get bent out of shape when anyone else gets results.

  43. #43 Eric
    August 12, 2010

    As a practicing acupuncturist I can only say that my sham techniques have frequently and often created such a powerful placebo effect that many patients coming to my office having exhausted “allopathic” cures find quick and lasting relief.

    Some doctors, having been impressed by my results have actually started referring patients to me.

    The real sham is the belief that Western Medicine has pure scientific roots that back up every treatment. If only it were the case (for example) that drug studies were conducted in a scientifically neutral (instead of pure profit driven) methodology perhaps this would be true. It seems that mostly only studies that show what the manufacturer wishes to show ever get published (or is that just my faulty observation?)

    I read recently that a physician accused of faking multiple research studies claimed it was due to Bipolar Disorder? Thank god he had the ability to fall back upon the proven science of psychology and the DSM manual to provide cause for lying for years.

    It is a shame that my “sham” practice has helped many patients who continued to suffer after seeing their Western Physician, however they continue referring their friends so who are we to complain?

    I have no doubt that further studies (via Western research methods) will continue to validate many of the techniques of Chinese Medicine. However, with thousands of years of knowledge and millions of patients treated, I am confident that acupuncture can be very effective even without these forthcoming studies.

  44. #44 Phoenix Woman
    August 15, 2010

    Let me annotate that last comment with the English translation:

    “As a practicing acupuncturist I can only say that my sham techniques have frequently and often created such a powerful placebo effect that many patients coming to my office having exhausted ‘allopathic’ cures find quick and lasting relief.”

    Oooh, the unsupported word from some guy on the internet! Truly powerful evidence. Not.

    “Some doctors, having been impressed by my results have actually started referring patients to me.”

    See above.

    “The real sham is the belief that Western Medicine has pure scientific roots that back up every treatment. If only it were the case (for example) that drug studies were conducted in a scientifically neutral (instead of pure profit driven) methodology perhaps this would be true. It seems that mostly only studies that show what the manufacturer wishes to show ever get published (or is that just my faulty observation?)”

    Lots of handwaving and aspersions-casting, but again, nothing beyond the unsupported word of some guy on the internet.

    “I read recently that a physician accused of faking multiple research studies claimed it was due to Bipolar Disorder? Thank god he had the ability to fall back upon the proven science of psychology and the DSM manual to provide cause for lying for years.”

    Because of course if one physician is caught doing this, it obviously means that they all must be, right?

    Okay, gang, name the fallacies of logic Eric has herewith deployed. That’s right, he’s using both the Hasty Generalization and Cherry-Picking fallacies to imply without evidencehttp://en.wikipedia.org/wiki/Cherry_picking that because one person in a group does something, every person in that group must also do it.

    “It is a shame that my ‘sham’ practice has helped many patients who continued to suffer after seeing their Western Physician, however they continue referring their friends so who are we to complain?”

    Once again we’re back to the unsupported word of some guy on the internet. And that’s before we even examine the whole question of the placebo effect.

    “I have no doubt that further studies (via Western research methods) will continue to validate many of the techniques of Chinese Medicine.”

    But wait! He just spent a third of his piece telling us that all “allopathic” doctors and researchers (that is, users of “Western research methods”) are frauds who are only in it for the money given them by Big Pharma to fake studies. If this is the case, then wouldn’t Big Pharma ensure that no such studies ever see the light of day? Or is he just trying to attempt a not-very-adroit straddle of the worlds of woo and reality?

    “However, with thousands of years of knowledge and millions of patients treated, I am confident that acupuncture can be very effective even without these forthcoming studies.”

    In a word, bullshit:

    The earliest accounts of Chinese medicine reached the West in the 13th century: they didn’t mention acupuncture at all. The first Westerner to write about acupuncture, Wilhelm Ten Rhijn, in 1680, didn’t describe acupuncture as we know it today: he didn’t mention specific points or “qi;” he spoke of large gold needles that were implanted deep into the skull or “womb” and left in place for 30 respirations.

    Acupuncture was tried off and on in Europe after that. It was first tried in America in 1826 as a possible means of resuscitating drowning victims. They couldn’t get it to work and “gave up in disgust.” I imagine sticking needles in soggy dead bodies was pretty disgusting.

    Through the early 20th century, no Western account of acupuncture referred to acupuncture points: needles were simply inserted near the point of pain. Qi was originally vapor arising from food, and meridians were channels or vessels. A Frenchman, Georges Soulie de Morant, was the first to use the term “meridian” and to equate qi with energy – in 1939. Auricular (ear) acupuncture was invented by a Frenchman in 1957.

    The Chinese government tried to ban acupuncture several times between 1822 and WWII, when the Chinese Nationalist government tried to suppress it. Mao revived it in the “barefoot doctor” campaign in the 1960s as a cheap way of providing care to the masses; he did not use it himself and he did not believe it worked. It was Mao’s government that coined the term “traditional Chinese medicine” or TCM, to include acupuncture, herbal medicine, moxibustion, and other traditional practices.

    In 1972 James Reston accompanied Nixon to China and returned to tell about his appendectomy. It was widely believed that his appendix was removed under acupuncture anesthesia. In reality, acupuncture was used only as an adjunct for pain relief the day after surgery, and the relief was probably coincident with the expected return of normal bowel motility. A widely circulated picture of a patient allegedly undergoing open heart surgery with acupuncture anesthesia was shown to be bogus. If acupuncture is used in surgery today, it is used along with conventional anesthesia and/or pre-operative meds, and it is selected only for patients who believe in it and are likely to have a placebo response.

    In other words, bullshit.

  45. #45 Robert
    November 29, 2010

    Interesting read. I have to say I though electroacupuncture was a gimmick, but it resolved my issues post-shoulder surgery x 2. I have had cuff surgery twice and developed a lot of scar tissue that trigger point and deep tissue massage just couldn’t get rid of in addition to a ton of mobility still missing. 8 treatments with the Pointer Plus and all the locked up rhomboid and cuff musles released….after a long saga of 3 years, 2 surgical interventions, months of rehab and a lot of massage.

    Worked for me and that’s all I care about….back in the pool and put in 16,000 meters last week!

  46. #46 Chris
    November 29, 2010

    There seems to be a necromancer epidemic today. Robert why did you feel the need to share your story on an article that is almost one and a half years old?

    Some basic rules before commenting on a blog or forum:

    1) If you find an article through Google, before commenting go to the first page and see what is under discussion.

    2) Get to know the place, lurk for a while.

    3) Become familiar with the writing style, especially in how issues are discussed. Anecdotes are not considered data.

    4) Actually read the article and comments before commenting.

    5) Try to proof read your comments (okay, we don’t all do that).

    6) If you think you want to bring a subject up to the participants’ attention, please use the search box on the upper left side of this page to see if it has been discussed before.

    7) If you get an error when posting a comment, before posting again… open another window to see if it was actually posted.

  47. #47 T. Bruce McNeely
    November 29, 2010

    “Robert” sounds an awful lot like this guy: http://scienceblogs.com/insolence/2009/09/a_religious_loon_cant_even_wait_until_he.php – comment 111

    Do we have a morphing necromancer on our hands? Let the exorcism begin!

  48. #48 Jahahreeh Finley
    December 1, 2010

    What do you guys think about the following article on low-frequency electroacupunture and how the researchers showed it improved insulin sensitivity by activating SIRT1/PGC1alpha in skeletal muscle? Thanks.

    Low-Frequency Electroacupuncture Improves Insulin Sensitivity in Obese Diabetic Mice through Activation of SIRT1/PGC-1α in Skeletal Muscle

    Liang F, et al. (2011). Evidence-Based Complementary and Alternative Medicine, Article ID 735297 doi:10.1155/2011/735297

  49. #49 Scottynuke
    December 1, 2010

    I tend to think electrical stimulation of the body isn’t acupunture.

    But that’s just me.

  50. #50 Paul
    February 11, 2011

    Hi, I hope this comes accross in the good spirit that is intended. Have you ever heard of the intelligence trap? well it appears to me that you are well and truly in it. Can we get back to basics for a moment or two, eg have you or anyone you know ever seen an atom? If we are made up of atoms which are 99.9% electric fields (with no measurable boundaries)Then what is the “substance that we are made of”.Indeed when you start “homing in” on some scientific “facts” they frequenly have no substance. As Eistein said reality is “a stubonly persistent illusion”.

    Btw the reason i came accross this post is because I have had Parkison’s disease for the last ten years and I have had “real” acupuncture by a top Chinese Doctor, and iam just experimenting with electroacupuncture. best wishes and a very interesting blog.

  51. #51 Antaeus Feldspar
    February 11, 2011

    Have you ever heard of the intelligence trap? well it appears to me that you are well and truly in it.

    Of course, if you are the one caught in the intelligence trap, it would naturally appear to you that it would be everyone else “well and truly in it.”

    Can we get back to basics for a moment or two, eg have you or anyone you know ever seen an atom?

    Have you ever seen air? Of course you have not. Does this make you doubt its existence? I doubt it.

    Observation of the visible spectrum of light is only one of many ways we gain evidence about the world around us. Because evolution gave us sophisticated natural instruments for such observation (i.e., eyes) does not mean that all other means of observing the world are secondary.

    If we are made up of atoms which are 99.9% electric fields (with no measurable boundaries)Then what is the “substance that we are made of”.

    Have you ever heard the expression “missing the forest for the trees”? You are bringing it to life. The fact that atoms are composed of subatomic particles and that subatomic particles are subject to electromagnetic interactions (which I believe is a more accurate phrasing than “99.9% electric fields (with no measurable boundaries”) doesn’t negate the fact that they are still atoms.

    Indeed when you start “homing in” on some scientific “facts” they frequenly have no substance.

    It would be more accurate to say that when a deluded individual does not want to believe in some scientific fact, he very rarely has trouble pushing his investigation past his point of competence, to the point where he can no longer comprehend what he observes, and at this point he feels himself free to jump to the mistaken conclusion that “it’s so mysterious, no one really knows what’s going on, and if no one really knows what’s going on, I can believe whatever I want to!”

    It doesn’t work that way, however. The person who believes that the Earth is a perfectly round sphere and the person who believes it is a flat disc are both mistaken, but they are not equally mistaken.

  52. #52 Beamup
    February 11, 2011

    If we are made up of atoms which are 99.9% electric fields (with no measurable boundaries)Then what is the “substance that we are made of”.

    If you’re going to make a sciencey argument, please at least try to get your facts correct. This is a highly inaccurate description. In particular, it comes from a CLASSICAL picture, where nuclei and electrons are point particles, which is grossly inadequate to deal with phenomena at atomic scales.

  53. #53 Evidence-based Technology
    March 21, 2011

    The Swiss and German technology in bioelectric medicine developed over the last fifty years and is effective in a specific range of diagnostic and therapeutic applications. This is based upon research conducted by the Russians, Japanese, Swiss, Germans, French, and now the Americans. Research and technological development continues and the subject requires some study, objective (scientific) observation and reasoning, education in physics and engineering and mathematics, and the understanding that the EEG, EKG, and Transcan 2000 are based on the same bioelectric technology. These bioelectric technologies are now used worldwide and investigated at Stanford University, the National Institute of Health, the University of San Francisco, and UCLA to name a few and these bioelectric technologies being discussed in this article are FDA and ISO approved.

  54. #54 Jacob
    April 20, 2011

    Hmm, yet another uneducated critique of acupuncture. You counter the theory of qi and “meridians” without knowing anything about it…interesting debate tactic. If you took the time to research the subject, you would find that the word “meridian” is an inaccurate translation of the Chinese word Jing-Mai which means “transporting vessel”. You would also learn that acupuncture is based on a very detailed and accurate understanding of cardiovascular circulation. The linees drawn on acupuncture charts are only a mnemonic device by which we organize the acupuncture points. Acupuncture points, by the way, are only locations on the surface of the body. Nowhere in acupuncture theory is it claimed that an acupuncture point is anything other than a location. There are, no-doubt, idiots out there talking about ideas that have nothing to do with acupuncture theory. When you try to criticize something you don’t understand, you become one of them.

    As far as research goes, any scientist knows that any single is unimpressive. There are countless studies showing acupuncture is useless and countless studies showing it works. All of these studies are small and not without problems. Studies for modern medicine are usually larger, but are also fraught with error, not to mention dead-wrong. The studies supporting many pharmaceuticals are dubious at best. It is only after years of death and ADR’s that the truth comes out. Studies can be manipulated in many ways. If you actually read most of the studies done on acupuncture (pro or con), you can only say that they are inconclusive as far as answering the question, “does acupuncture work?”

    If you wish to educate yourself, if for no other reason than to make better arguments against acupuncture, I recommend “Dao of Chinese Medicine” by Kendall. Kendall explains the problems with translating acupuncture into modern terms (i.e. use of the word meridian), and discusses acupuncture in modern terms.

    Sincerely,
    Perfectly sane and intelligent person using a perfectly rational procedure to successfully treat and cure many problems for which MD’s have failed.

    PS: nerve ablation studies have been done confirming acupuncture point effects…Kendall’s book cites them.

  55. #55 Orac
    April 20, 2011

    Then provide the peer reviewed scientific studies that “confirm acupuncture point effects” and support your claim that acupuncture points are based on a very detailed and accurate understanding of cardiovascular circulation.

  56. #56 Treebeard
    July 12, 2011

    Hi, when money is the issue one side would rather down the other. I guess that TENS therapy and Acupuncture (even electroacupuncture) can be used. They both have the same scientific basis. I find pathetic the fact that acupuncturists seem to look at themselves as the saving last resort after western medicine is used, I also totally disagree with the yin yen philosophy heyy…. thats not science it is a philosophy just like medieval theories of the humor – wouldnt be surprised if that energy yiin yen thing and the humor thing have common philosophical origins. What I can add here to the discussion is that according to a certain physicist the electric signals passing through nerves are not electron driven – but are vortices carrying the same charge as the electron – this is physics – I would also add that traditional acupuncture is not the same as electroacupuncture – the benefits received from traditional acupuncture is different than the TENS like effects of electroacupuncture – ie the electric current induced into the body is electron driven and not biological. Traditional acupuncture probably also has a scientific basis (which is not yin yan balancing energy thingie) but actually the needles might act as a positive electrode open to the atmosphere open to a biological kind of electricity which is non-electron carrying charge. The patient though must be earthed by standing or touching the ground. Only in this way can I think of a form of energy balancing – but heyy this is not a new age junk crack pot philosophy but real science.

  57. #57 Mj
    December 24, 2011

    I guess you didn’t do your research too well. Acupuncture itself has been proven effective in numerous research cases by many well respected organizations, including the AMA. I find it interesting that you never mentioned the research by Pomeranz & Stux (German Medical doctors researching Acupuncture Analgesia) who proved that endorphins and enkephalins are released during electroacupuncture.
    Another interesting fact that you got incorrect is that electroacupuncture does not mimic TENS, rather the opposite. TENS units were patented in 1974 where electroacupunture stimulation on record dates back to 63 AD.
    To say that electroacupuncture is primarily an extravagant placebo demonstrates your I’ll knowledge of the topic. You also fail to mention that all “medical” or alternative treatments have a certain degree of placebo effect, including aspirin ( which by the way can be classified as alternative in nature since aspirin comes from the bark of the Willow tree).
    Interesting article, but you really need to do more research.

  58. #58 LW
    December 24, 2011

    [Citation needed]

    I’d especially like a citation for this: “electroacupunture stimulation on record dates back to 63 AD.”. how do you know that precise date?

  59. #59 Lawrence
    December 24, 2011

    “alternative” to stuff that actually works. Time and time again it has to be explained that treatments that work aren’t considered alternative, they are just considered medicine.

  60. #60 Krebiozen
    December 24, 2011

    Mj,
    Ooh a comment on a two year old thread to play with.

    I guess you didn’t do your research too well.

    Oh the irony…

    Acupuncture itself has been proven effective in numerous research cases by many well respected organizations, including the AMA.

    If you take a long hard look at the evidence overall, there is little to suggest that acupuncture is more than an elaborate placebo, especially since effective sham acupuncture placebos have been developed. Even the studies that do show an effect over placebo show a very small one. Check out some review studies, Cochrane has done a few that some think are too kind to acupuncture and even those find little to get excited about. You find comments like, “acupuncture may be better than doing nothing, at least in the short term”, “a small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias”.

    I find it interesting that you never mentioned the research by Pomeranz & Stux (German Medical doctors researching Acupuncture Analgesia) who proved that endorphins and enkephalins are released during electroacupuncture.

    Endorphins and enkephalins are also released if someone stomps on your foot, which also works as a marvelous distraction from pain elsewhere in the body.

    Another interesting fact that you got incorrect is that electroacupuncture does not mimic TENS, rather the opposite. TENS units were patented in 1974 where electroacupunture stimulation on record dates back to 63 AD.

    Standing on an electric fish in ancient Greece does not count as acupuncture. Modern acupuncture, including the meridian system, was developed in China in the 1930s and popularized in Europe by a fraudulent Frenchman. Before that it was almost identical to medieval bloodletting.

    To say that electroacupuncture is primarily an extravagant placebo demonstrates your I’ll knowledge of the topic.

    Any evidence to show that it isn’t?

    You also fail to mention that all “medical” or alternative treatments have a certain degree of placebo effect,

    Perhaps that’s because it is so obvious and has been discussed here many times before. The whole point of placebo controlled clinical trials is to determine the effect of a treatment over and above placebo.

    including aspirin ( which by the way can be classified as alternative in nature since aspirin comes from the bark of the Willow tree).

    Are you serious? So anything that is based on natural substances is alternative? Like statins (red rice yeast), digoxin (foxglove), taxol (yew), vincristine (Madagascar periwinkle), most antibiotics and a whole host of other drugs? Anyway, willow bark does not contain aspirin, it contains salicylic acid salts, which have similar effects to aspirin, acetylsalicylic acid, but more side effects. Aspirin is a safer version of the natural substance, with a known dose.

    Interesting article, but you really need to do more research.

    As I say, the irony…

  61. #61 W. Kevin Vicklund
    December 24, 2011

    Another interesting fact that you got incorrect is that electroacupuncture does not mimic TENS, rather the opposite. TENS units were patented in 1974 where electroacupunture stimulation on record dates back to 63 AD.

    Bzzzt. The first documented use of TENS was in 63 AD, when Scribonius Largus (no really, that was his real name) used electric eels (direct placement or sticking feet in a pool of said fish) to relive pain. No needles were used – this was definitely not electroacupuncture. Electroacupuncture wasn’t used until the early 19th century, by French physicians merging Chinese acupuncture with TENS devices that had been under development since the 16th century and popularized by Ben Franklin.

    The first use of electroacupuncture in China wasn’t until 1934, well after the 1913 patent of a device similar to the modern patient-wearable TENS device that was patented in 1974.

  62. #62 TruthSeeker
    March 14, 2012

    Although I imagine I am speaking to a wall, I will try anyways.

    The body is surely a chemical machine. All that happens within it can, in some way, be described by chemical reactions.
    Any decent chemist knows that charge can greatly effect or even change the outcome of any chemical reaction and that just about any molecule can have one of several different charge qualities, neutral, positive and negative usually being the least.
    Any decent physicist understands that given an emf with the correct qualities of power and frequency one can easily move charges.
    Any decent scientist knows we don’t know squat about the exact conditions under which molecules form or crystals grow; we don’t know the exact frequency or power of an emf which will cause a reaction to proceed one way or another.

    I therefore conclude that based upon the qualities of the electricity applied and manner in which the needles are used, electroacupunture has the potential to affect a person positively, negatively or neutrally and can certainly have a placebo affect in any of those three directions as well.

    My point being you can argue your citations all day long but you are no closer to the truth.
    Should you let someone stick needles in you and send electricity through those needles? probably not unless they can explain it to you in physical detail (with nomenclature and all.)

    But you should not wholly condemn the idea. It is possible and for all we know (ego and bias aside) some old asian man somewhere may understand a way of effectively using it.

    I stumbled upon this website because my sister, who is diligently working towards her phd in chemistry, has suffered from a rare ms-like disease for the past four years (quite likely longer, dormant.) She had taken the mainstream western approach to her illness for the first three years and continues to occasionally (and she always says regrettably) use various migraine abortion medicines along with whatever regulars her neurologist may have her on.
    For the last year I have encouraged her to drastically change her diet, going to entirely raw fruits and vegetables. This has massively reduced her need for her medications and has improved her overall health such that she can continue to work in the lab.
    Recently she has also found significant relief from deep tissue massage and most recently acupunture, which produced physical feelings in her body and caused reactions; incidentally, at the end she was accidentally shocked (too much carpeting) through one of the needles.
    She presents her work in a week or so earning her her masters as well as phd candidacy. So far the acupunture seems to have some positive effect. We know that the massage provides relief which can last several days.
    Her neurologist has admitted she has exhausted most of what he can offer her and she now understands that the temporary relief any medicine comes at a detrimental cost to her health. He supports her trying alternative options but I imagine would never recommend it himself.

    I am write computer software and have some higher education in most sciences though only one degree. I don’t well understand what I talk about (sorry for the bad grammar too) but I do understand and refuse to dismiss the possibilities. Did you forgot how to dream?

    Reality doesn’t live in citations, otherwise we would never make headway.

  63. #63 AdamG
    March 14, 2012

    My point being you can argue your citations all day long but you are no closer to the truth.

    Wrong. ‘Arguing citations all day’ brings us no closer to your ‘truth,’ but the fact of the matter is that asserting that something may be true does not make it true. ‘Arguing citations all day’ is precisely how we decide when something is true and something is false. The null hypothesis is that acupuncture has no effect greater than placebo on any measurable trait. So far, despite numerous attempts, no study has been able to statistically reject this null hypothesis. Go ahead, see if you can find one.

    Reality doesn’t live in citations, otherwise we would never make headway.

    Wrong again. Citations provide evidence for or against hypotheses to explain the world around us and its various phenomena. What method do you propose to distinguish between two competing hypotheses both explaining the same phenomenon? Without citations, we’d never make headway on any problem. For someone with ‘some higher education in most sciences,’ you should really understand this concept.

  64. #64 Narad
    March 15, 2012

    Any decent scientist knows we don’t know squat about the exact conditions under which molecules form or crystals grow; we don’t know the exact frequency or power of an emf which will cause a reaction to proceed one way or another.

    Sorry, there’s no reason to proceed past this point in the game of Find the Faulty Syllogism in the Bloviation Stack.

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