Orac is the nom de blog of a (not so) humble pseudonymous surgeon/scientist with an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his miscellaneous verbal meanderings, but just barely small enough to admit to himself that few will. (Continued 
At 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
Medicine & Health
Comments
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).
Posted by: daedalus2u | June 24, 2009 10:07 AM
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!
Posted by: Paul Browne | June 24, 2009 11:31 AM
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.
Posted by: Jennifer B. Phillips (aka Danio) | June 24, 2009 12:32 PM
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!
Posted by: Anthro | June 24, 2009 12:49 PM
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.
Posted by: Denice Walter | June 24, 2009 12:52 PM
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.
Posted by: Brian | June 24, 2009 1:01 PM
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?
Posted by: Karl Withakay | June 24, 2009 1:01 PM
Hey, it works for a pacemaker...
Because then they couldn't claim that the result was due to accupuncture as opposed to electrical impulses.
Posted by: Pablo | June 24, 2009 1:48 PM
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.
Posted by: David | June 24, 2009 2:11 PM
Thank you. I knew they must have been missing an obvious control. Extraordinary claims require extraordinarily stringent verification and all that jazz
Posted by: Perceval | June 24, 2009 2:32 PM
"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. :)
Posted by: Karl Withakay | June 24, 2009 2:35 PM
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.
Posted by: cannabinoid geek | June 24, 2009 3:34 PM
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.
Posted by: D. C. Sessions | June 24, 2009 3:55 PM
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." :-)
Posted by: Orac | June 24, 2009 3:58 PM
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").
Posted by: Dangerous Bacon | June 24, 2009 5:01 PM
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.
Posted by: cannabinoid geek | June 24, 2009 5:44 PM
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.
Posted by: wazza | June 24, 2009 6:07 PM
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.
Posted by: Orac | June 24, 2009 6:14 PM
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?"
Posted by: Isis the Scientist | June 24, 2009 6:52 PM
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.
Posted by: Matthew Cline | June 24, 2009 7:56 PM
Isis:
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.
Posted by: Jennifer B. Phillips (aka Danio) | June 25, 2009 12:06 AM
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.
Posted by: cannabinoid geek | June 25, 2009 2:48 AM
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.
Posted by: DLC | June 25, 2009 2:59 AM
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.
Posted by: Ian Musgrave | June 25, 2009 3:19 AM
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?
Posted by: Pseudonym | June 25, 2009 4:10 AM
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
Posted by: Rita | June 25, 2009 4:32 AM
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.
Posted by: Robert S. | June 25, 2009 4:41 AM
Pseudonym wrote:
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.
Posted by: Ian Musgrave | June 25, 2009 7:41 AM
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)
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.
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.,
Posted by: Ian Musgrave | June 25, 2009 8:08 AM
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.
Posted by: Pablo | June 25, 2009 9:43 AM
"woo-based positioning"
I love it!
Posted by: Inoculated Mind | June 25, 2009 1:15 PM
Pablo at #30 wrote:
The Journal does accept letters to the editor, so I'll fire one off.
Posted by: Ian Musgrave | June 26, 2009 4:08 AM
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.
Posted by: mark | June 29, 2009 3:42 PM
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)
Posted by: kay | June 30, 2009 3:00 PM
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.
Posted by: alternative medicine | July 5, 2009 12:01 PM
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)
Posted by: John | August 17, 2009 2:11 AM
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
Posted by: Nik | August 18, 2009 1:28 AM
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!
Posted by: Mari | September 4, 2009 3:31 PM
@ 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?
Posted by: Scientizzle | September 4, 2009 3:48 PM