Respectful Insolence

Lymphedema is a complication of breast cancer surgery that all surgeons who do breast surgery detest. Patients, of course, detest it even more. The limb swelling that is the primary symptom of lymphedema comes about because surgery on the axillary lymph nodes (the lymph nodes under the arm) that is part and parcel of surgery for breast cancer can interrupt lymph vessels and cause backup of lymph fluid in the affected arm. This backup has consequences, including skin changes, a tendency towards infections, and, in extreme cases, elephantiasis (which is, fortunately, rarely seen these days as a result of breast cancer surgery). Unfortunately, lymphedema is incurable, and the risk of developing it never goes away after breast surgery.

Lymphedema used to be much more of a problem back in the old days (say, more than 10-15 years ago), when surgery for breast cancer routinely involved an axillary dissection, or removal of most of the lymph nodes under the arm. (For surgery geeks, in breast surgery level 1 and 2 lymph nodes out of three levels, unless, of course, leven 3 nodes are grossly involved with tumor, in which case they’re taken too.) Frequently radiation therapy was needed as well, and the combination of axillary dissection and radiation therapy could produce a risk of lymphedema as high as 50%. Of course, in recent years, sentinel lymph node biopsy, which involves removing many fewer nodes (usually 1-3) has supplanted axillary dissection for most cases of breast cancer, and, consistent with fewer nodes being taken, the risk of lymphedema from sentinel lymph node biopsy is much lower. However, none of this means that lymphedema isn’t still a problem after breast surgery; it’s just less of a problem.

There are only a few basic strategies for treating lymphedema, sometimes called decongestive lymphatic therapy. For the most part, these treatments involve physical therapy, compression sleeves to “squeeze” the fluid out of the affected limb, and sometimes the use of mechanical compression stockings that “milk” the fluid back. It’s all very inconvenient and unpleasant, and there’s no doubt that this particular complication can take a major toll on a patient’s quality of life and sometimes even lead to hospitalizations for infection. It might be less of a problem than it was in years past, thanks to less invasive surgery, but it’s still a problem, and it needs better treatments.

Acupuncture is not one of them.

Not that proponents of acupuncture don’t try to convince people that acupuncture is a treatment for lymphedema. To be honest, knowing the mechanism by which lymphedema develops, I can never quite figure out why anyone would think that acupuncture would do anything for lymphedema. How, pray tell, would sticking needles into the body, often in areas of the body not involved by lymphedema, be expected to cause lymphedema to get better? Yet, acupuncturists keep claiming that acupuncture can be used to effectively treat lymphedema. Indeed, if there’s one image that causes me to cringe when I see it, it’s the image of needles being stuck into a lymphedematous arm, often with the acupuncturist not wearing gloves. In any case, just yesterday there appeared news of the publication of a study out of Memorial Sloan-Kettering Cancer Center (MSKCC) examining acupuncture as a treatment for breast cancer surgery-associated lymphedema in the ASCO Post:

Arm lymphedema affects approximately 30% of breast cancer survivors, with rates increasing with longer follow-up and cases presenting well beyond the active treatment period. Lymphedema is observed even with use of less-invasive surgical techniques for staging, and risk is further increased by such factors as radiation therapy, positive lymph node status, increased tumor burden, postoperative seroma or infection, obesity, and increased age. Current treatments for lymphedema after breast cancer treatment are expensive and require ongoing intervention. As reported by Barrie R. Cassileth, MS, PhD, of the Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center and colleagues in Cancer, acupuncture may be an effective treatment.

The study appeared in the journal Cancer and was entitled Acupuncture in the treatment of upper-limb lymphedema: Results of a pilot study. It’s as fine an example of quackademia as I’ve ever seen, its lead investigator being our old friend Barrie Cassileth, the director of the integrative medicine department at MSKCC. Just put her name in the search box of this blog, and you’ll see that, although Dr. Cassileth is very much against cancer quackery like laetrile, shark cartilage, Entelev/Cantron, various oxygen therapies (such as hyperbaric oxygen or various means of administering hydrogen peroxide), and even “energy therapies,” which Cassileth admits have no evidence to support them. Of course, acupuncture is an “energy therapy.” It does, after all, postulate that inserting fine needles into pathways in the body called “meridians” somehow alters the flow of magical, mystical life force energy known as qi, to curative intent. Yet Cassileth really loves acupuncture, so much so that she’s conducted quite a few studies on acupuncture in cancer patients. For example, there was this one on acupuncture for hot flashes a few years ago.

So this time around, it’s acupuncture for lymphedema. Truly, acupuncture is the therapy that can do anything, which is consistent with its being quackery. Certainly, no one has ever postulated a mechanism by which acupuncture can do all the things claimed for it, including (but not limited to) relieving pain, relieving hot flashes, treating infertility, improving asthma symptoms, and, of course, treating lymphedema. What’s the common unifying biological mechanism that could explain therapeutic effects in all these diseases and conditions? There is none, at least none that any acupuncturist has ever been able to explain convincingly to me, nor was any claimed in the ClinicalTrials.gov entry for this.

So what does this study purport to show? It’s a pilot study involving 33 patients with breast cancer-related lymphedema for at least six months but not longer than five years. This time period was chosen to make sure that the subjects were all out of the immediate postoperative period but not so many years out that they started to develop skin complications from chronic lymphedema. These patients all underwent twice weekly 30 minute acupuncture sessions for four weeks as follows:

Alcohol swabs were applied prior to insertion of sterile single-use filiform needles (32-36 gauge; 30-40 mm in length, Tai Chi brand, made in China and distributed by Lhasa OMS, Weymouth, MA) that penetrate 5-10 mm into the skin. A total of 14 needles were inserted: 4 in both affected and unaffected limbs, 2 in acupuncture points on both legs, and 2 in unilateral points on the torso. Selected acupuncture points (Fig. 1) were stimulated manually by gentle rotation of the needles with lift and thrust. The acupuncturists did not intentionally seek to achieve a de qi sensation.

Specific acupuncture points used in this study were determined on the basis of historical context, the published literature, and the consensus of our experienced group of MSKCC staff acupuncturists.[18-20, 34, 37] Many of these acupoints are used to treat pain, weakness, and motor impairment; others are traditionally used to drain “dampness,” a TCM concept similar to edema.

Did I just read what I thought I read? Seriously? The rationale for choosing these points was based on their being related to traditional Chinese medicine concepts to drain “dampness”? This is utter nonsense, the sort of silliness in which quackademic medicine corrupts academic medicine with concepts that have nothing to do with science. Just read about “dampness” in TCM:

In nature, dampness soaks the ground and everything that comes in contact with it, and stagnation results. Once something becomes damp, it can take a long time for it to dry out again, especially in wet weather. The yin pathogenic influence of dampness has similar qualities: It is persistent and heavy, and it can be difficult to resolve. A person who spends a lot of time in the rain, lives in a damp environment, or sleeps on the ground may be susceptible to external dampness.

Similarly, a person who eats large amounts of ice cream, cold foods and drinks, greasy foods, and sweets is prone to imbalances of internal dampness. Dampness has both tangible and intangible aspects. Tangible dampness includes phlegm, edema (fluid retention), and discharges. Intangible dampness includes a person’s subjective feelings of heaviness and dizziness. A “slippery” pulse and a greasy tongue coating usually accompany both types of dampness. In general, symptoms of dampness in the body include water retention, swelling, feelings of heaviness, coughing or vomiting phlegm, and skin rashes that ooze or are crusty (as in eczema).

As I said, none of this has anything to do with science.

So, based on a TCM concept of “dampness” being tortuously related to lymphedema, quackademics at MSKCC subjected patients to acupuncture and measured their limb circumferences. There are a few ways to measure lymphedema. One is water displacement, in which the subject puts her arm into a cylinder of water, and the volume displaced is measured. This method isn’t used much anymore because it’s messy and inconvenient to do, although it is arguably the most accurate. In most cases, lymphedema is measured by comparing the circumference of each arm at different locations defined by anatomy. Generally, this is done in four locations, the metacarpal-phalangeal joints, the wrist, 10 cm distal to the lateral epicondyles, and 15 cm proximal to the lateral epicondyles. Differences of 2 cm or more at any point compared with the contralateral arm are considered by some experts to be clinically significant. The authors used a two-point technique performed by trained research assistants 10 cm above (upper arm) and 5 cm below (lower arm) the olecranon process using nonstretch tape measures, which is said to be as sensitive and specific as any other methods. The median age of subjects was 55, and they were a mean of 3.9 years out from surgery. They were on the obese side, with a mean BMI of 30.4, which is above 30 and thus in the obese range.

The results were as follows. A 30% or greater decrease in arm circumference was observed in 11 patients (33%) and 18 had a reduction of at least 20%, a reduction reported to be across the whole range of severity of lymphedema. One notes that 31 subjects (94%) used other standard therapies during the study, although 30 reported no change in their standard regimen. Now here’s where how you present the data makes all the difference in the word. These percentages seem huge, but you have to remember that the way they were calculated was in terms of the difference between the two arms in circumference, normalized to the pre-treatment difference. If the pre-treatment difference is small, then it doesn’t take much of a decrease in lymphedema to produce a large percentage. That’s why the really telling figure comes from Table 3, which shows that the mean difference between pre-treatment and post-treatment arm circumference was 0.9 cm (95% confidence interval 0.72 to 1.07 cm). That is spectacularly unimpressive, particularly in a population that skews obese. It sure sounds a hell of a lot more impressive.

Of course, the biggest problem with this pilot study is that it was uncontrolled. There is no control group. So we have no idea whether acupuncture had anything to do with the modest decrease in lymphedema reported. I will give Dr. Cassileth credit in that she does acknowledge this in the paper:

Whether acupuncture alone was responsible for this reduction was not evaluable in this pilot study. Our focus was on safety and potential efficacy, as current clinical practice to protect the lymphedematous arm prohibits needling.

Yet she also concludes, unfortunately:

The therapeutic and cost-reduction potential of acupuncture for lymphedema may yield an important tool in the arsenal of lymphedema management. Although randomized clinical trial results await, including our ongoing study, acupuncture can be considered to treat this distressing problem confronted by many women with no other options for sustained reduction in arm circumference.

And in a press release, she says:

“We have shown that acupuncture as a treatment for lymphedema is safe and well tolerated,” says Dr. Cassileth. “Furthermore, this study demonstrated reductions in lymphedema for the patients treated, providing strong impetus for the randomized controlled trial that is now under way to prove that the effect is real.”

Actually, no it doesn’t. This study is not good evidence that acupuncture works for lymphedema. There is no reason from a standpoint of prior plausibility informed by biology to think that acupuncture would do anything for lymphedema. On a Bayesian basis, exceedingly low prior probability plus an equivocal result (and, yes, this result is equivocal) equals a very high likelihood that the effect observed is a false positive. Even worse, the randomized clinical trial being carried out isn’t one that is likely to provide much of an answer. It’s a phase 2 clinical trial comparing immediate acupuncture to wait list for six weeks, after which wait listed subjects will cross over and receive acupuncture for six weeks. In other words, everyone in the study will receive acupuncture. I mean, really. Why are they even bothering? This study is unlikely to provide strong evidence that acupuncture works. Most likely, it will be another equivocal acupuncture trial. Of course, the ironic thing is that the crossover design was probably necessitated by the seemingly “positive” result of Cassileth’s currently reported trial. The IRB probably wouldn’t approve a no acupuncture arm in light of that, because then there wouldn’t be clinical equipoise.

Oh, the ironies of quackademic medicine, when the inevitable false positives that occur when treatments of low prior probability are tested in clinical trials complicate the next steps! It’s just infuriating how much time and resources are being wasted on studies that are so highly unlikely ever to produce useful results.

Comments

  1. #1 elburto
    July 2, 2013

    Wow. What a spectacular bloody waste of money, time, and medical education.

    Dampness and de qi sensations, really? Why not just hypothesise that the patient has dyscrasia, with phlegm holding sway over the body?

    The barber-surgeon will attach a few leeches to drain the fluid, while forcing the patient to sup wine. The control group can have little mechanical suckers attached to their skin by someone who has no haircare training, and the participants can drink tart grape juice masquerading as wine.

    Et voila!, a trial every bit as scientific as the acupuncture one. Where’s my grant?

  2. #2 Eric Lund
    July 2, 2013

    I can see how putting a hole in the right place could drain the lymph fluid, but (1) I don’t think acupuncture needles would make a big enough hole (even if it were in the right place) and (2) the risk of, shall we say, collateral damage from a big enough hole would be high. I infer point (2) from Orac’s statement that we don’t have an effective treatment for lymphedema, since if we could drain the fluid without undue risk of damaging something else that would (in principle) solve the problem.

  3. #3 elburto
    July 2, 2013

    Yep,sadly it’s not as simple as letting fluid out, as our computerised overlord says. It’s the tissue that’s suffused by fluid that’s accumulated in the lymph vessels, not actual free liquid. That’s why I said that leeches would be as good as acupuncture, no good!

    My mother’s friend developed it following surgery for breast cancer. She managed to lead a relatively normal life on RT and chemo, but it was the lymphoedema that ended up ruining her life. She’s a tiny, bird-boned little thing, so the huge swollen arms look enormous, and are agonisingly painful. She has to wear compression sleeves and have the “milking” thing done fortnightly.

  4. #4 mho
    July 2, 2013

    Can you point me toward more information on lymphedema in ovarian cancer patients?
    Can the puncture itself in acupuncture cause the lymphedema, or is the problem the danger from infection that can lead to lymphedema?

  5. #5 elburto
    July 2, 2013

    mho – Acupuncture is just thoroughly pointless, no pun intended. It’s a waste of time and energy predicated on lies and racist tropes about “the Orient”.

    It’s harmful because it deludes desperate people into believing there’s a cure, or a treatment (outside of science based medicine) that can relieve their suffering. That’s quite aside from the risks of jabbing needles into oedematous tissue, which is so irresponsible as to be unethical.

    Lymphoedema following pelvic cancers can be because of damage to the lymph nodes by surgery or treatment, or from the cancer itself. Acupuncture is just adding insult to injury.

  6. #6 elburto
    July 2, 2013

    Some useful info:

    macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Symptomssideeffects/Lymphoedema/Lymphoedema.aspx

  7. #7 Peebs
    July 2, 2013

    I want a ‘Slippery Pulse’. I have no idea what one is, but I want one ‘cos it’s slippery!

    Is it anything like mushy peas?

  8. #8 Eric Lund
    July 2, 2013

    @mho: There is obviously an infection risk if the acupuncture needles are not properly sterilized. I also assume that at least some people will experience pain from having the needles stuck in them (I have no firsthand experience of acupuncture). Apart from that, I don’t know of any studies showing direct harm from acupuncture, which, like homeopathy, tends to “work” via the placebo effect. But as elburto says, many of the people who treat their conditions with acupuncture are foregoing more efficacious treatments.

    Acupuncture is slightly less ridiculous than homeopathy, but that’s like saying the temperature outside is higher than absolute zero. You need to know a little more than high school chemistry to see that it lacks a physically plausible mechanism–but I think university level anatomy and physiology would do, and medical school level A&P certainly would.

  9. #9 elburto
    July 2, 2013

    @Eric – You may find this interesting:

    whatstheharm.net/acupuncture.html

    Hepatitis, pneumothorax and punctured hearts. Ouch!

    For any interested lurkers you can read this:

    http://www.quackwatch.org/01QuackeryRelatedTopics/acu.html

    or go to the amazingly detailed:

    http://www.sciencebasedmedicine.org/reference/acupuncture/

  10. #10 lilady
    July 2, 2013

    *Someone* needs to coordinate the information that is disseminated through the patient education page at Sloan Kettering Hospital, regarding “Common Questions About Breast Cancer Lymphedema”, under “What can I do to minimize my risk of developing lymphedema?”…and the crappy study that put post-lymph node dissection breast cancer patients at risk for infection.

    http://www2.mskcc.org/patient_education/_assets/downloads-english/20.pdf

  11. #11 Graca
    US
    July 2, 2013

    While acupuncture may not be the right treatment choice for lymphedema, calling Chinese medicine “quack” means you really don’t have any understanding of the concepts, theories, history, or conditions that it can treat very well. Just because the terminology is foreign to you, does not make it less effective. If acupuncture doesn’t work, then why do MD’s, reproductive endocrinologists, PT’s, DO’s, DC’s, the military (battlefield acupuncture) all use it and fight to have it within the scope of their practice?

  12. #12 AdamG
    July 2, 2013

    conditions that it can treat very well

    What conditions are you referring to? Please make sure any claim you make is referenced with a proper study.

    As far as the history of ‘Traditional Chinese Medicine,’ I suspect that you may have been misinformed. Most of what’s known as TCM was invented in the 1920s and 30s.

  13. #13 Mephistopheles O'Brien
    July 2, 2013

    Graca,

    Please point out the well controlled, high quality studies that show that acupuncture provides a clinically significant benefit for any condition that is notably better than placebo. For extra credit, please provide links to studies that show that meridians, acupuncture points, or qi have a meaningful physical existence. One last one if possible – please provide data that suggests that the accepted acupuncture points are in some way more suitable than some random spot elsewhere on the body. Thanks in advance.

    Oh, and the reason so many people use it – it certainly looks impressive, people want it, and if you don’t pay attention to statistics or good controls in your experiments, it might look like it does something. Pain, for instance, has a significant emotional component. It also comes and goes. If you expect acupuncture to work for you and the pain changes in its normal cycles, what is more natural than saying the last thing you did helped?

  14. #14 Narad
    July 2, 2013

    I want a ‘Slippery Pulse’. I have no idea what one is, but I want one ‘cos it’s slippery!

    Unfortunately, it comes with mucus.

    This is just sad.

  15. #15 Narad
    July 2, 2013

    calling Chinese medicine “quack” means you really don’t have any understanding of the concepts, theories, history, or conditions that it can treat very well…. why do MD’s, reproductive endocrinologists, PT’s, DO’s, DC’s, the military (battlefield acupuncture) all use it

    Auricular acupuncture isn’t even Chinese, it’s French in origin.

  16. #16 mho
    July 2, 2013

    elburto: I couldn’t get the Macmillan pdf to display text, only boxes.
    And don’t worry, I do think acupuncture is pointless. Can I borrow your pun?

    eric lund: thanks for the explanation that acupuncture “works” like homeopathy “works.”

    Still wondering why OC women have a much lower rate of lymphedema than BC survivors, since so many lymph nodes are removed. Do they do sentinel node biopsies in OC?

  17. #17 herr doktor bimler
    July 2, 2013

    If acupuncture blood-letting doesn’t work, then why do […] all use it and fight to have it within the scope of their practice?

    Fixed.

  18. #18 AdamG
    July 2, 2013

    I wonder if Graca is the same Graca that runs this Irish clinc…I was particularly put off by this odious page advocating infant and child acupuncture.

  19. #19 ConspicuousCarl
    July 2, 2013

    Graca asked,
    “why do […] the military (battlefield
    acupuncture) all use it ”

    So all of those fake bomb detectors must actually work, or else why would an army have bought them?

  20. #20 elburto
    July 2, 2013

    @AdamG

    *twitch*

    That’s as deplorable as performing chiroquacktic on babies.

    @mho – I was sat with my head cocked, like an adorable Labradog, thinking “I’m sure mho is an RIer…”

    I almost sent out a PharmAlarm flare so that Lord Draconis could send out the intervention drones!

    Steal my puns and sprinkle them across the land.

  21. #21 Christine (the public servant Christine)
    July 2, 2013

    Currently in Australia the AVN is insisting vaccination is rape (and other fun activities including taping phone conversations with senators without their knowledge). Presumably this is because the skin is penetrated by the needle and there’s a little pain and blood.

    By their standards I rape myself whenever I sew, because stabbing oneself with a needle is an occupational hazard.

    Acupuncture is highly promoted by the AVN. As this also involves penetration of the skin with needles, shouldn’t they be saying it’s rape as well? (They are getting really bad press for the rape comments, because it mocks the trauma of genuine rape victims. They truly are scum.)

  22. #22 ebrillblaiddes
    July 2, 2013

    One more for the “gotta be a nut” collection. Because there’s just no reason to think that’s a good idea.

    (Other things in that collection: almost everything else involving acupuncture; thinking we should ease up on vaccination now that the diseases have gotten rare instead of vaccinating the diseases into oblivion so that more vaccines can be obsolete like the smallpox one; homeopathy in general; the idea that cancer has a known cure and no oncologist has enough attention whore tendencies to grab that Nobel; etc., etc.)

  23. #23 herr doktor bimler
    July 2, 2013

    conditions that [acupuncture] can treat very well
    What conditions are you referring to?

    Wallet Hypertrophy Syndrome.

  24. #24 Politicalguineapig
    July 2, 2013

    Eric Lund: I did acupuncture for a while; only pain I experienced was when the practitioner tried to put one in the cartilage of my ear. Made me jump.

  25. #25 Janet
    July 2, 2013

    Wow. Vaccination is rape. What does that make a mammogram?
    The mind boggles. I think I’ll take a pain pill (provided of course by Big Pharma) to help calm down the stupid broken ankle. Maybe that will help with the boggling problem.

    @Herr doktor bimler
    LOLOLOL I never met anybody with that particular hypertrophy syndrome.

  26. #26 elburto
    July 2, 2013

    @hdb – WHS is a debilitating, excruciating condition. We should set up a non-profit org that aids sufferers by relieving the load on their wallets removing harmful wallet-bloating toxins, and banning something or other… I dunno, dihydrogen monoxide.

    @Christine – I want to throw up so badly now. Double Domperidone for supper for M.D. I f*cking loathe rape apologists and people who exploit rape for their own gain/kicks. Absolute scum.

    Like you said though, they almost certainly see acupuncture needles as good. I mean these are the type of shrieking hypocrites who rage about “OMGTEHEBILTOXINSANDCHEMICALS!!!111″ out of one side of their collective mouth, while extolling the virtues of shooting bleach up the arses of autistic children out of the other side.

  27. #27 elburto
    July 2, 2013

    Erm… my new phone inserted that “for M.D.” in there, ignore it.

    Sadly, much like a naturopathic “clinic”, there are no doctors here at Casa elburto. Plenty of pharmaceuticals though, the two Mrs elburtos are devotedly loyal to our reptilian overlords.

    So with that, we will bid you goodn…ZzzzzzZzz.

  28. #28 Christine (the public servant Christine)
    July 3, 2013

    I had a spot of WHS recently… the results are sitting on my desk because when I get WHS I cure it by visiting the Book Depository. :)

    I to am devotedly loyal to our reptilian overlords for the lovely drugs.

  29. #29 Old Rockin' Dave
    No longer in the Mountains of Madness, moving into the Foothills of Foolishness...
    July 3, 2013

    Christine, if vaccination is rape, then I must be castrating my beard every morning. No wonder I hate shaving so much.
    I am starting to have my doubts about reptilian overlords. If I was a shapeshifter and could take on any human form I chose, why would I want to look like Prince Charles?

  30. #30 The Smith of Lie
    July 3, 2013

    @ Old Rocin’ Dave – I can think only of one reason – to have a form that is comfortably familiar and favorably compares to all those other scaleless, pink monkeys that I am here to conquer. Don’t judge the taste of our overlords by human standards.

    And on the acupuncture (and pre-scientific vitalism in general) note. I have a question. From what I gather all those funky modalities operate on the assumption that qi, ondic energy, life force, subtle energy or whatever else makes the body work, yes? Well, why is there no method of measuring those? We (as in humanity, assisted by Reptillians) found ways to measure and detect all kinds of improbable things. I even hear they have a giant installation in Switzerland that can detect particles so rare, small and possesed of weird properties that profane like me can’t even begin to wrap his mind around their existance. And yet, never have I heard of any methods, based on science mind you (I am looking at you dowsing based bomb detector), of detecting and/or measuring qi or force or whatever. Where is my pocket Midichlorian testing kit I ask you?

  31. #31 YOYO
    Mel
    July 3, 2013

    As someone dealing with current breast cancer and its corollaries this acupuncture crap infuriates me.

  32. #32 Militant Agnostic
    Where the Fish and Wildlife officers now carry side arms thanks to TCM
    July 3, 2013

    Graca

    calling Chinese medicine “quack” means you really don’t have any understanding of the concepts, theories, history, or conditions that it can treat very well.

    Could you explain the concepts and theories behind the use of ground up Rhinoceros horn to treat ED or bear bile to treat whatever it is used for. Those of us who are concerned about extinction of endangered species and and tormenting animals based on whimsy would like to know .

  33. #33 Marc Stephens Is Insane
    July 3, 2013

    Wow. Vaccination is rape. What does that make a mammogram?

    Janet, it’s so coincidental you wrote this. Just the other day Natural News ran a ludicrous piece comparing mammogram parties to “medical date rape” because women typically consume a glass or two of wine at these parties before the procedure. The implication is that doctors lure women to clinics, get them drunk and then subject the women to mammograms that they would not consent to if sober. The piece completely ignored the fact that women plan and attend these parties voluntarily to make the procedure a little less stressful and a bit more “social.”

  34. #34 Jergen
    July 3, 2013

    Just yesterday my Dana Farber oncologist suggested acupuncture for Tamoxifen induced hot flashes. I nearly fell off the exam table. No thanks. While going through radiation I was offered Reiki. My world class cancer center is embracing woo. How depressing!

  35. #35 The Smith of Lie
    July 3, 2013

    Jergen – I sympathize, while I have no health problesm nearly as serious as cancer, I’d probably freak out if I were in your shoes.

    However the malicious part of me can’t help but see this as an occasion for some snappy retort. For example, if they again offer reiki or acupucture you could politely thank them, but stipulate you’d prefer a sacrifice of a goat to Baal Zəvûv. It has the same chances of working and mechanisms are similarly plausible, so maybe they’ll go for it.

  36. #36 Mephistopheles O'Brien
    July 3, 2013

    Not only that, but a goat properly sacrificed and barbecued is darned tasty.

  37. #37 Teresa L
    July 3, 2013

    Here’s a research article on the effects of acupuncture in the brain as measured by fMRI scans, which show modulation of the limbic system. http://www.nmr.mgh.harvard.edu/~vitaly/PDF/hui_JoVE_2010.pdf

    Also, the BBC did aired a documentary on acupuncture a few months ago. http://youtu.be/41vm87qq1KU

    The majority of Chinese medicines are comprised of plant and minerals, not animal products. If you want to know how they work, just look at the chemical compounds. A pharmacist in the U.S. has written an extensive book on it. http://books.google.com/books/about/Chinese_Medical_Herbology_and_Pharmacolo.html?id=w-b3PAAACAAJ

    As for the rhino horn, it is not prescribed to treat ED. The only people who even make that specific claim are the skeptics. http://www.pbs.org/wnet/nature/episodes/rhinoceros/rhino-horn-use-fact-vs-fiction/1178/

  38. #38 Old Rockin' Dave
    July 3, 2013

    The Smith:
    If you were a shapeshifter who was here to push for our Big Pharma overlords, why would you promote woo, like Prince Chuckles? Why pick that face, when you could be handsome and charismatic? And given the shapeshifting power, why would you have to wish to be your lady love’s tampon, when you could just transform yourself into it any time you please? Nope, the vitiated genes of the Royal Family don’t pass muster. And they don’t pass the smell test – corgis and horses are probably pretty damn good at sniffing out carnivorous lizards.

  39. #39 Krebiozen
    July 3, 2013

    Teresa L,

    Also, the BBC did aired a documentary on acupuncture a few months ago.

    A few months ago? That documentary is 7 years old, and a number of shortcomings were pointed out at the time. not least that the patient having surgery using only acupuncture as anesthesia was in fact under the influence of powerful sedatives and large doses of local anesthetic. Here’s Simon Singh’s take on the program.

    Most TSM herbal remedies are ineffective, though a few show some promise. Since it isn’t effective for anything I don’t much care what pseudomedical purpose rhino horn is used for, it’s the fact that the species is at the point of extinction because of it that bothers me.

  40. #40 Krebiozen
    July 3, 2013

    In a hurry – TCM, not TSM, and sorry about the unclosed link, it still works.

  41. #41 herr doktor bimler
    July 3, 2013

    As for the rhino horn, it is not prescribed to treat ED. The only people who even make that specific claim are the skeptics. http://www.pbs.org/wnet/nature/episodes/rhinoceros/rhino-horn-use-fact-vs-fiction/1178/

    Is this academic link to a PBS promotion intended to prove something? We are told that

    “Overall there isn’t much evidence to support the plethora of claims about the healing properties of the horns. In 1990, researchers at Chinese University in Hong Kong found that large doses of rhino horn extract could slightly lower fever in rats (as could extracts from Saiga antelope and water buffalo horn)”

    Notice the absence of any disclaimer about rhinoceros horn and ED.

    OTOH, we do learn from the vacuous boofhead who wrote it that “…there may be some truth behind the rhino horn’s ability to detect poisons which is linked to the composition of the horn. […] Many poisons are strongly alkaline (or basic), and may have reacted chemically with the keratin.” O RLY.

    The majority of Chinese medicines are comprised of plant and minerals, not animal products.

    Apparently Teresa L expects us to forget and forgive the dependence of TCM upon animal torture and animal extinction, just because TCM also draws upon plant materials?
    I am lost for appropriate insults here. Perhaps Elburto can help.

  42. #42 herr doktor bimler
    July 3, 2013

    Here’s a research article on the effects of acupuncture in the brain as measured by fMRI scans, which show modulation of the limbic system.

    Yes, pain stimulation causes activity in the limbic system. Which can be detected with fMRI. I think we knew that.
    I had never come across this “Journal of Visualized Experiments” before. It appears to be a form of Youtube.

  43. #43 janet
    July 3, 2013

    @Marc Stephens Is Insane
    Personally, I prefer a couple of stiff shots of high-end single malt Scotch to deal with a mammogram–damn things HURT! (I know, I know, they hurt less than breast cancer, but they still hurt.)

  44. #44 herr doktor bimler
    July 3, 2013

    damn things HURT
    That is why the operators keep them ice-cold — to numb sensation.

  45. #45 elburto
    July 3, 2013

    MSII@33 Oh now I have the real, red, elburto rage. These people are lucky I’ve been rendered immobile because AAAARGH.

    One thing is like rape, and that’s rape. Easy. These people need sit down, shut the fvck up, and stop throwing the word about like some… disgusting confetti.

    @hdb – the bloody qi-k of the woomongers, insulting us by providing poor quality “evidence” to distract us from the vile cruelty visited upon our animal friends in the name of “tradition”.

    They are stoma-bags, guano sandwiches, pus-wallowing enema nozzles on legs. As higher mammals we should be carefully guarding and treasuring the other creatures on Earth, not exploiting them to prove some pathetic, racist trope about the “superiority” of ~~traditional eastern medicine~~.

    Amusing side-note I type on my phone using t9 predictive text on a number pad layout. As I started to type ‘eastern’ my phone suggested ‘fraud’. Considering I’ve
    had it for less for a week it knows me really well!

  46. #46 Jergen
    July 3, 2013

    A goat sacrifice….that would have been a good one. I was so stunned I instead said, while raising my eyebrows, “this is Dana Farber, right?”. I don’t think they will be offering me that nonsense again. Although I must admit that I did take them up on the free massage. ;)

  47. #47 Christine (the public servant Christine)
    July 4, 2013

    Our local cancer treatment centre takes an “if you can’t beat ‘em…” approach to cancer patients who want alternative treatments as well as real ones. The staff dont push alternative treatments; if someone asks about it, they’ll point out there’s no agreement about whether the treatments work. If the patients insist. they’ll be directed to an alternative practitioner “who specialises in working with cancer patients” (read: won’t tell you to stop your chemo or radiation).

    I asked my mother’s oncologist about it when my mother had endometrial cancer. The oncologist (also a woman) told me they worked out a while ago that discounting alternative treatments all together just gets some peoples’ backs up, so even though she thinks it’s crap, she’d rather have them working with a practitioner who sees the merits of chemo etc. And if they believe it’s going to help them get better, she isn’t going to try and stop them.

    I can understand the appeal of woo (if sticking needles into my skin would get rid of this damn migraine I’ve had for a week I’d say turn me into a pincushion, and be quick about it!). But it’s damn frustrating that healthcare workers have to come up with strategies like this to deal with it.

  48. #48 elburto
    July 4, 2013

    @Christine – I’d stick needles in my eyes to kill migraine. Whereas I can remain upbeat about not being able to walk, migraines (especially the long ones) make me want to die. You have my every sympathy.

    The last person who tried to force $CAM remedies down my throat (for migraine) was subjected to a rant so severe that he was visibly shaken. After he tried to convince his partner* to abandon his HAART regimen in favour of various quack modalities, I never spoke to him again, mainly for his own protection because I was (and still am, five years later) so furious.

    I hope your migraine vanishes soon. The only thing that really blitzes mine is cold. I have these brilliant gel-filled cooling pads that don’t even require refrigeration, I think they work by magic! Anyway, they’re soft squishy mats that are about 40cm x 30cm, and I rest my head and neck on one, and lie the other one over my forehead and eyes, usually over my light-blocking eye mask.

    It tends to knock me flat out into dreamland, but can massively shorten the duration of an attack of head menace.

    Hope yours is gone ASAP.

    *One of our best friends, J, who actually was Other Mrs elburto’s wingman on our second date, the one where she asked me out.

    We were friends with both guys, and stunned when J became seriously ill overnight after a dental procedure. After a week of fruitless tests a doctor on the ICU asked his partner for permission to perform an HIV test, which was positive.

    The dental infection had landed in a body with a T-cell count so low that it was in single figures, with devastating results. It took months of impatient treatment before J could even come home, and that was when his partner, the walking colostomy bag, tried to persuade him to use “natural treatments”. His reasoning was that he had dodged the HIV bullet because he didn’t “abuse [his] body with mainstream medications”, and that this was a warning to J about the dangers of Big Pharma.

    We’re still friends with J but I haven’t spoken to the other arsewipe ever since.

  49. #49 Narad
    July 4, 2013

    If you want to know how they work, just look at the chemical compounds.

    Not so fast. Here, one Dr. Shen informs us as follows:

    “When used to treat psychosis, anchoring herbs are usually combined with herbs that Dissolve Phlegm, because in these cases, phlegm has become an additional disease factor.

    “Now phlegm is a concept that is a little hard to grasp, but worth the effort, because it is phlegm that can turn a mild depression into a full blown psychotic episode. Actually, it’s pretty simple. We already understand phlegm as a synonym for mucous, a viscous bodily fluid. According to TCM, heat causes fluids and gases to shed water and become thick, and phlegm can be a thickening of any fluid or of any vapor. Thickened fluids can obviously impede flow, and thickened vapors can do so as well.

    “Psychosis happens when heat thickened vapor (hot phlegm) has obstructed the portals of consciousness, clouding it, obscuring the Shen, and causing the mind to lose contact with its spiritual connection. Phlegm-Fire in the Heart, as this psychotic condition is known, requires medicines to Extinguish Fire and Dissolve Phlegm.”

    See, I wouldn’t have inferred this particular mechanism by “just look[ing] at the chemical compounds.”

  50. #50 Christine (the public servant Christine)
    July 4, 2013

    @elburto: Our weather patterns are nuts at the moment, always makes everythng whacky. And my re-enactor group is hosting a big event this weekend, and the autocrat is stressing everyone out worrying about things she doesn’t need to and ignoring things she does.

    We can get these awesome little cooling gel pads for migraines, if I sleep with one of these it alleviates them somewhat. another thing that helps is Tiger Balm on the neck. All hail Tiger Balm.

    I used to subscribe to a few fibromyalgia mailing lists, but stopped because fibromyalgia is a HUGE woo magnet. The mailing lists tend to get over-run by people promoting raw food, macrobiotic diets, crystals, mineral baths… The minute you suggest these things might not be so useful you get jumped on.

  51. #51 mho
    July 4, 2013

    ok, now which one of you wrote the wikipedia entry on tiger balm? Its too good to be true…

  52. #52 Narad
    July 4, 2013

    ok, now which one of you wrote the wikipedia entry on tiger balm? Its too good to be true…

    It would be better if it appropriated the phrase “DO NOT PUT ON KNOB AND BOLLOCKS.”

  53. #53 Christine (the public servant Christine)
    July 4, 2013

    I suspect the “secret formulation” thing is a bit of a woo marker, true. However, putting the white Tiger Balm on my neck means I can move it.

  54. #54 Ingrid Marsten C.L.T.
    Los Angeles, CA 90291
    July 5, 2013

    I’ve taught TCM for about 18 years, including at UCLA (even though I am NOT a licensed acupuncturist).
    LE is a mechanical problem, and as much as I applaud Dr.. Cassileth and MSKCC’s efforts to explore alternative and complementary medicine, I doubt that LE can be alleviated through acupuncture. Acupuncture can help with dampness (which can cause fluid retention), but you cannot cure a structural issue like non-functional l.n. after surgical or radiation tx.

    Besides the limited amount of participants and the way the study was conducted (as we know, any study can be skewed), it will NOT save the patient any money. Acupuncture is usually not covered by insurance – or mostly only in cases of pain, unless one has really good insurance. I fear that Dr. Cassileth’s statement sends out a potentially harmful message to patients. I have a post-surgical patient who already, after 10 days, shows signs of LE. And I am treating patients who haven’t had any MLD/CDT and are fibrotic.

    That said, I am a big believer in acupuncture for pain and chin. herbs (provided they are “clean”) for many ailments.
    Thank you for bringing this to our attention.
    Best,
    Ingrid

  55. #55 Ingrid Marsten C.L.T.
    Los Angeles, CA 90291
    July 5, 2013

    I’ve read some of the comments , after posting my comment.
    OK, here is the deal: TCM is over 5,000 years old. Whilst we, the Europeans, were reading bird entrails and “bleeding” patients to death, the Chinese developed/evolved a form of medicine, which was based originally on Ayurvedic medicine and their own , locally different, folk medicine. Eventually, and after HUGE (5,000 years is pretty long) more or less clinical studies, they found that certain acupuncture/acupressure points alleviated certain complaints. Large Intestine 4 = Hegu, for example, is a known anesthesia point.

    Especially combined with nutrition, based on the condition and constitution of the patient, plus herbs (pharmacology), acupuncture may be quite helpful for many health issues. That said, if I had appendicitis, I would get myself to the ER pronto, rather than taking “cold” herbs (=antibiotics to douse the heat= infection).

    And yes, like everywhere, there are some Acupuncturists who will make false promises and statements for a quick buck – I know some Chiropractors who are absolute Quacks too, but many are very conscientious and knowledgeable.
    BTW: The California State Board for Acupuncture is one of the toughest in the USA; it includes tons of western medicine.
    So, it’s not all bad…..like everywhere, you have to find the right practitioner. I’m sorry for the bad experiences some people had with acupuncture (and I also don’t believe it will help LE)
    Lastly, animals tend to not react in terms of placebo, but they do respond to acupuncture/acupressure; again depending on condition, but arthritis, digestive issues, etc. can often be manged by TCM.
    The best way is probably an integrative approach, provided it is based on more extensive studies.

  56. #56 herr doktor bimler
    July 5, 2013

    Now phlegm is a concept that is a little hard to grasp

    Indeed. You get it all over your fingers if you try. Ack! Thbbft!

  57. #57 herr doktor bimler
    July 5, 2013

    “DO NOT PUT ON KNOB AND BOLLOCKS.”

    Or nipples. Or so I hear from a friend.

  58. #58 The Smith of Lie
    July 5, 2013

    @Ingrid Marsten C.L.T.
    Ciaim that TCM is 5000 years old is pretty impressive. Especially in context of treating those 5000 years as clinical studies. So I guess it won’t be a problem to provide some materials that doccument methodology behind the meridians? I would gladly read some well documented explanation of how one point is chosen over another for certain applications.

    Oh, and I do not mean “after stabbing people for 5000 years at random it turns out that…”, I very much could do the same myself, but as fun as stabbing people sonds, I want to know rationale behind chosing one point on the body over another.

    Also, I belive that since you have 18 years of practice, you will be able to finally explain me the mechanism behind the acupuncture, since so far the material I saw refers to pretty vague concepts, like qi. Of course, maybe it is qi, but in that case I’d love to hear what it is and how exactly does it work. Possibly, how can it measured.

    And yes, while I am part of unbeliving crowd, those are honest questions, that I’d love to hear convincing answers to.

  59. #59 herr doktor bimler
    July 5, 2013

    after HUGE (5,000 years is pretty long) more or less clinical studies

    Why stop at 5000 years? When you’re fantasising unsubstantiated ahistorical bumfluff, why not go for 15000 or 25000 years?
    I am disappointed by Ingrid’s lack of vision.

  60. #60 The Smith of Lie
    July 5, 2013

    @HMB
    Oh c’mon. It couldn’t be more than 6000 years old, since that’s how old the Earth is.

    But then again, it could mean that Chinese are descendents of aliens that came to Earth 1000 years after its creation by God. Seems legit.

  61. #61 Krebiozen
    July 5, 2013

    Ingrid Marsten C.L.T.,

    OK, here is the deal: TCM is over 5,000 years old.

    Some of it might be, but acupuncture as we know it was invented in the 1930s. Before that acupuncture was indistinguishable from medieval European bloodletting (that’s why acupuncturists take your pulse), the needles used were almost identical to medieval European bloodletting implements, and only itinerant folk-healers carried it out. In any case, the antiquity of a type of medicine is no guarantee of efficacy.

    Whilst we, the Europeans, were reading bird entrails and “bleeding” patients to death, the Chinese

    .. were reading yarrow stalks and using astrology and bleeding patients to death. The Chinese concepts of chi, meridians, dampness, heat, yin, yang etc. are just as pre-scientific and inaccurate as European concepts of humors.

    developed/evolved a form of medicine, which was based originally on Ayurvedic medicine and their own , locally different, folk medicine.

    Neither of which were very effective – check the life expectancy at birth in India and China before (15-20) and after (60-70) the introduction of modern scientific medicine. If TCM is so effective, why was life expectancy so low?

    Eventually, and after HUGE (5,000 years is pretty long) more or less clinical studies,

    “More or less” clinical studies in ancient China? Do you have any evidence for this? I thought it was all based on the sort of trial and error that led people in Europe and America to erroneously believe, for centuries, that bloodletting was effective.

    they found that certain acupuncture/acupressure points alleviated certain complaints.

    To quote Felix Mann, “…acupuncture points are no more real than the black spots that a drunkard sees in front of his eyes.” Do you have any evidence that they alleviate any conditions that are not self-limiting and/or especially susceptible to placebo effects?

    Large Intestine 4 = Hegu, for example, is a known anesthesia point.

    If that is true, why is it that large doses of local anesthetics and sedatives are required for surgery in addition to acupuncture?

    Especially combined with nutrition, based on the condition and constitution of the patient, plus herbs (pharmacology), acupuncture may be quite helpful for many health issues.

    Which health issues, which herbs precisely, and what evidence is there that these are safe and effective? There are some poor quality Chinese studies that show efficacy, but the reviews and meta-analyses I have looked at are almost all inconclusive, barely statistically significant and/or clinically insignificant, with occasional possible benefits but no conclusive evidence. From Cochrane (which is often accused of bias towards alternative treatments):

    Chinese medicinal herbs… have not been conclusively shown to have curative effects on gallstones.
    Epilepsy …the current evidence is insufficient to support its use as a treatment for epilepsy.
    Mumps …did not find any randomised controlled trials which provided reliable evidence for the effectiveness and safety of Chinese medicinal herbs for mumps.
    Influenza …studies were of poor quality, the evidence does not support or reject the use of any Chinese herbal preparations for influenza.
    Hyperthyroidism… we were unable to find reliable evidence to recommend a specific herbal preparation from 103 investigated formulations.
    Hypertriglyceridemia… no definite conclusion is possible especially because of the unclear risk of bias in the included studies and lack of reporting on patient-important long-term outcomes.
    Schizophrenia… using Chinese herbs alone for psychotic symptoms may not be indicated, but if used in conjunction with Western antipsychotic drugs, they may be beneficial in terms of mental state, global functioning and decrease of adverse effects. However, further trials are needed before the effects of TCM for people with schizophrenia can be evaluated with any real confidence.

    And so it goes on and on. Some are clearly dangerous – one wonders how 5,000 years of “more or less clinical studies” failed to notice the carcinogenic effects of Aristolochia for example.

    That said, if I had appendicitis, I would get myself to the ER pronto, rather than taking “cold” herbs (=antibiotics to douse the heat= infection).

    That seems very sensible. I haven’t seen anything that convinces me that the effects of acupuncture and the great majority of TCM are anything more than placebo.

    Acupuncture can help with dampness

    I find talc or antiperspirant work much better.

  62. #62 elburto
    July 5, 2013

    I wonder if Ingrid is coming back.

  63. #63 Mephistopheles O'Brien
    July 5, 2013

    Krebiozen – for extreme dampness, a good dehumidifier or canisters of silica gel may be indicated. Or you could take a more philosophical view, as did Inspector Clouseau.

  64. #64 herr doktor bimler
    July 5, 2013

    Chinese are descendents of aliens that came to Earth
    No, no, that’s the Hungarians.

  65. #65 Narad
    July 5, 2013

    No, no, that’s the Hungarians.

    Long ago, when I wound up sharing a previously solitary lab space with a Hungarian, he introduced himself by telling a bestiality joke, the punchline of which was merely making a strange noise repeatedly.

  66. #66 herr doktor bimler
    July 5, 2013

    Whilst we, the Europeans, were reading bird entrails and “bleeding” patients to death, the Chinese developed/evolved a form of medicine, which was based originally on Ayurvedic medicine and their own , locally different, folk medicine.

    Ah. So handing down a time-honoured tradition is evidence of primitive barbarity in the case of European culture, but of refined advancement when China is involved.

    That is a weird way to think.

  67. #67 Ingrid Marsten C.L.T.
    July 6, 2013

    Hi All,

    I will be coming back, “armed” with some clinical studies you actually might accept and respect.

    Of course, you are not wrong when you say that they way we run clinical studies nowadays is not applicable to ancient TCM. Although, I particularly like the many modern clinical studies of ca 75 patients, which are then applied as truth, given that pharmaceutical companies do NOT have to disclose everything to the FDA; just the aspects that support their claims (and, of course their financial goals). And yes, I know there are some very good and life-saving pharmaceuticals out there, amongst some who have so many side effects that taking one requires another (the average 60-year old US patient is on ca 6 to 10 meds daily)

    I am also not claiming that acupuncture and TCM is panacea, however, the NIH has conducted numerous studies into a variety of health issues and the efficacy of acupuncture.

    BTW: Dampness in TCM does not apply to perspiration, please people, stop the condescending attitude. Unless it’s the four humors that are ruling you – see this link for your amusement and possible enlightenment, depending how much you want to take the “blinders/blinkers” off. :)
    http://www.nlm.nih.gov/exhibition/shakespeare/fourhumors.html

    I am busy doing other things (LE – MLD related) right now, however, I will try to open your minds just a little bit…..
    Respectfully yours,
    Ingrid

  68. #68 JGC
    July 6, 2013

    Ingrid, there’s no need to open our minds. Just the need to provide actual scientific evidence that your claims re: the efficacy of acupuncture are accurate.

    Let’s make this as simple as possible: in your opinion, what is the single most compelling p acupuncture is effective at treating a non-self limiting injury or illness?

  69. #69 JGC
    July 6, 2013

    Should read single most compelling piece of evidence

  70. #70 Narad
    July 6, 2013

    Of course, you are not wrong when you say that they way we run clinical studies nowadays is not applicable to ancient TCM.

    Or when it’s pointed out that acupuncture isn’t “ancient” in the first place.

    I am busy doing other things (LE – MLD related) right now

    At, perhaps, $120+ an hour for “specialized rhythmic pumping techniques”?

  71. #71 lo_mcg
    July 6, 2013

    After my breast cancer surgery, which included removal of all axillary lymph nodes, advice on preventing lymphoedema included keeping needles THE HELL AWAY from the affected arm.

    Surprising how many medical professionals don’t know that women who’ve had lymph node removal shouldn’t have injections, blood tests, blood pressure etc to the affected arm; I’ve had some scoff at the advice I was given and insist it would be ok. My arm, my risk – I stuck to my guns.

    I’m no scientist; my understanding was that not only was the risk of infection a concern, but that the very fact of a needle piercing the arm meant lymphatic fluid will rush in to help the arm as it perceives it to be under attack and the fluid may then have difficulty getting out – which is why injections to that arm, though they are bound to be sterile, are a no-no.

    I developed lymphoedema more than 2 years after surgery – just looked down one day and noticed my right hand was significantly bigger than the left.

    @lilady: I may have misunderstood you; is there something wrong with the advice in the “What can I do to minimize my risk of developing lymphedema” link?

    @ Marc Stephens Is Insane (he is indeed): I always have at least two drinks before a cervical smear. Natural News would have a field day…

  72. #72 Militant Agnostic
    Where it is "Tormenting Farm Animals for Entertainment" Week
    July 6, 2013

    Ingrid, as a Professor at Emperor’s College of Traditional Oriental Medicine in Santa Monica, perhaps you could briefly explain the concept of “dampness” in TCM so that our minds might be opened.

  73. #73 Krebiozen
    July 6, 2013

    Ingrid,

    Although, I particularly like the many modern clinical studies of ca 75 patients, which are then applied as truth, given that pharmaceutical companies do NOT have to disclose everything to the FDA; just the aspects that support their claims (and, of course their financial goals).

    Do you have an example of a drug that was brought to market after clinical trials on only 75 patients? Or any treatment that was adopted after trials on such a small number? Phase I trials perhaps, but Phase III trials usually include thousands of subjects. We need better oversight of drug companies, I agree.

    And yes, I know there are some very good and life-saving pharmaceuticals out there, amongst some who have so many side effects that taking one requires another (the average 60-year old US patient is on ca 6 to 10 meds daily)

    The average 60-year old Chinese patient depending on TCM alone was dead. Just saying.

    I am also not claiming that acupuncture and TCM is panacea, however, the NIH has conducted numerous studies into a variety of health issues and the efficacy of acupuncture.

    They have indeed, at least NCCAM has, and the only conditions that acupuncture has been found to be possibly helpful for are self-limiting or placebo-susceptible conditions. All the studies I have seen suggest that acupuncture is a particularly effective placebo, that may make people feel better, but doesn’t objectively improve their condition.

    I am busy doing other things (LE – MLD related) right now, however, I will try to open your minds just a little bit…..

    You can try, but I think you will find that most people commenting here are well-educated about acupuncture and its evidence base. I used to be a lot more open-minded about acupuncture, and even paid for it a couple of times some years ago, but the more I read about it, especially clinical trials, the more skeptical I get.

  74. #74 Narad
    July 6, 2013

    I should probably note that the reference to “specialized rhythmic pumping techniques” does not refer to anything that I’ve seen proffered by Ingrid, but to this. No, it’s not a high-impact journal. Then again, neither does “CLT” seem to be a rigorous certification, either.

  75. #75 Militant Agnostic
    Where it is "Tormenting Farm Animals for Entertainment" Week
    July 7, 2013

    Ingrid – What do they teach about Rhino Horn, and the ethics of using parts of endangered species, the ethics of creating a financial incentive for poaching and the ethics of confining bears in small cages to extract there bile through a perpetually open wound at Emperor’s College of Traditional Oriental Medicine?

    Perhaps some day the Rhino’s will have their revenge

    http://www.farleftside.com/2013/7-1-13-rhinos-revenge.html

  76. #76 Delurked Lurker
    On a gas covered planet whizzing around a nuclear fireball
    July 7, 2013

    Today i saw a documentary on another species of animal that is under threat due to traditional Chinese medicine, Manta rays.

    These magnificent and intelligent animals are slaughtered for one thing, their gills. The rest of the animal is discarded and the gills are shipped to Asia for use in that BS Chinese medicine. I find this truly disgusting and anyone who shills for this archaic cruel and useless practice is beneath my contempt,

  77. #77 Ingrid Marsten C.L.T.
    July 7, 2013

    American TCM practitioners and especially Emperor’s College/ Yo-San do NOT ever use pulverized Rhino horn or bear gallbladder or for that matter any endangered species. Mostly, our formulas are plant-based, and we try our best to make sure the herbs are “clean” = no heavy metals, pesticides, herbicides, etc…..
    Occasionally, we might use crushed shells of clam type animals. English is not my native language and I am momentarily “blanking” on the exact name.
    My point is that in the US, a TCM practitioner would not treat ED with pulverizes rhino horn or bear gallbladder, but try to strengthen the patient’s constitution through other means (nutrition, life style changes, Qi Gong – which BTW is paid for by German health insurances for a plethora of health issues, though not ED of course – AND/OR send them to an MD for further testing and a prescription for Viagra or Cialis ;)
    I too find torturing or chasing animals for any purposes appalling. But then I find vivisection disgusting too.
    And, being a typical California “kook”, I don’t eat mammals, though I will eat free-range, organic chicken and sustainably fished animals. I grow a lot of my own veggies too. Of course I realize that not everybody can do that.

    As a scuba diver, I admire the grace of mantas )and sharks) – to kill them for some BS medicine…I agree is awful and should absolutely be forbidden! There are plant-based formulas that could be substituted. There is a big cultural component at work here too I doubt, we, in the western world, would. even consider this.
    But then, I find fur coats made of baby seals appalling too; right along with so-called hunting from helicopters.

    I’d like you to know that I am not defending ALL practices in TCM , just that TCM can have its place.

    When I moved from Germany to the US, I started getting a respiratory infection. In Germany, I would have gone to the pharmacy (University degree in Germany), and asked for herbs. Here, I walked into a CVS, asked the pharmacist, who looked at me as if I was crazy and said to me: “You need to go get antibiotics”. I was NOT at that point yet, however, as I didn’t have a natural/herbal way back then to deal with it, I eventually ended up in an MD’s office, got antibiotics at $12 a pop……What does that tell you? I was neither impressed nor amused at all

  78. #78 Ingrid Marsten C.L.T.
    July 7, 2013

    @lo_mcg
    You were right to run!
    I would NEVER tell anybody to puncture the affected limb — EVER, nor take BP on that side, etc…..
    Most healthcare practitioners, including physicians (oncologists exempted), have very limited knowledge of LE.
    I have a client whose cardiologist asked him WHEN his lymphedema would be cured……..Thankfully, my client is educated about LE and knows not to have anything done to his arm. He is also very diligent about wearing his compression sleeve and exercise.
    FYI: Another client got a paraffin bath at a manicure place = huge flare-up of her LE.
    I wish more people knew about LE….and that is one of my regular projects
    Be well,
    Ingrid

  79. #79 Mephistopheles O'Brien
    July 7, 2013

    Ingrid Marsten C.L.T. – It is well recognized that some plants produce chemicals that are medically useful. Is there something about traditional Chinese medicine that is useful in applying or categorizing these? If so, how do you know?

  80. #80 Christine (the public servant Christine)
    July 7, 2013

    Ingrid: private health insurance in Australia tends to cover things like acupunture and homeopathy too. This does not mean it’s effective – it means the insurance company thinks it can sign more people to policies (and therefore make more profit) if they provide some cover for these treatments. As someone who pays private health insurance I’m really annoyed that my premiums cover treatments with no validity.

    The public health system (which is paid for by taxes) does not pay for any alternative treatments. Because the health budget is shrinking all the time, only treatments with a proven benefit to a large number of people are paid for out of the public purse. The alt-meddlers have tried to get government funding, but never been able to demonstrate their efficiacy.

  81. #81 Krebiozen
    July 8, 2013

    Ingrid,

    You claimed that 5,000 years of “more or less clinical studies” means that TCM treatments are safe and effective. You didn’t respond to my comment about Aristolochia, a traditional Chinese remedy for female ailments, particularly pregnant women. How did 5,000 years of “more or less clinical studies” fail to notice Aristolochia’s damaging effects on the urinary tract and carcinogenic properties? Its use in Taiwan appears to be responsible for the rate of urinary tract and renal cancer in Taiwan being about four times higher than in Western countries.

    Given this, how can we have any confidence in other TCM treatments?

  82. #82 JGC
    Still waiting for a response
    July 8, 2013

    Ingrid, what in your opinion is the single most credible, most compelling piece of evidence (hopefully in the form of a well-designed, properly controlled and blinded clinical study) demonstrating acupuncture is successful at treating non-self-limiting injuries or illnesses?

  83. #83 Mephistopheles O'Brien
    July 16, 2013

    @Ingrid Marsten C.L.T. – I, possibly not alone, am still very interested to hear if you’ve got some form of credible, compelling evidence for the value of TCM, particularly acupuncture. Thanks.

  84. #84 Apoliticaly
    Universe
    July 26, 2013

    I was looking for some scientific studies to prove knee surgery works, but they had no controls…bummer

    Is acupuncture a medicine or a procedure?

  85. #85 JGC
    July 26, 2013

    I’d go with ‘neither’.

    With respect to lacking false analogy, for two reason: first, it isn’t ethical in many surgical procedures to include a true placebo or sham surgery control but that doesn’t prevent the design of studies than yield accurate determinations of efficacy.

    And second, with respect to acupuncture the problem isn’t an ethical barrier to including appropriate controls but the fact that studies performed with adequate controls demonntrate it’s no more effective than placebo treatments.

  86. #86 JGC
    July 26, 2013

    sigh. should read “With respect to lacking appropriate controls you’re offering a false analogy:
    .

  87. #87 Shannon
    July 28, 2013

    I had acupuncture for the first time about a month ago. I had a Fissure which the Colon doctor said could only be fixed with surgery. I truly know acupuncture works I have had 4 treatments and now have no pain. She also stopped my night sweating. Believe me it is worth a try before surgery. People have to open there mind to healing. The military uses ear acupressure points for severe injuries on the field. Try it for yourself and then judge.

  88. #88 Chris,
    July 28, 2013

    Okay, Shannon, that is one anecdote. Now go and find a thousand more with the same result for the exact disorder and then you will have the data to publish a paper.

  89. #89 lilady
    July 29, 2013

    Did the acupuncturist insert the needle in your ear, Shannon?

    Could you describe how opening the Qi channels works to remove the pain from a fistula?

    http://medical-dictionary.thefreedictionary.com/fistula

  90. […] Specific acupuncture points used in this study were determined on the basis of historical context, the published literature, and the consensus of our experienced group of MSKCC staff acupuncturists.[18-20, 34, 37] Many of these acupoints are used to treat pain, weakness, and motor impairment; others are traditionally used to drain dampness, a TCM concept similar to edema. Did I just read what I thought I read? Seriously? The rationale for choosing these points was based on their being related to traditional Chinese medicine concepts to drain dampness? This is utter nonsense, the sort of silliness in which quackademic medicine corrupts academic medicine with concepts that have nothing to do with science. Just read about dampness in TCM : In nature, dampness soaks the ground and everything that comes in contact with it, and stagnation results. Once something becomes damp, it can take a long time for it to dry out again, especially in wet weather. The yin pathogenic influence of dampness has similar qualities: It is persistent and heavy, and it can be difficult to resolve. A person who spends a lot of time in the rain, lives in a damp environment, or sleeps on the ground may be susceptible to external dampness. Similarly, a person who eats large amounts of ice cream, cold foods and drinks, greasy foods, and sweets is prone to imbalances of internal dampness. Dampness has both tangible and intangible aspects. Tangible dampness includes phlegm, edema (fluid retention), and discharges. Intangible dampness includes a persons subjective feelings of heaviness and dizziness. For the original version including any supplementary images or video, visit http://scienceblogs.com/insolence/2013/07/02/acupuncture-and-breast-cancer-related-lymphedema-quacka… […]

  91. #91 Nancy Grossman
    August 1, 2013

    Oh for goodness sake, just because you don’t happen to understand how acupuncture works doesn’t mean it doesn’t work. There happen to be perfectly decent studies showing that acupuncture is helpful for lymphoedema, among many, many other things. Just because you haven’t read them and choose not to believe them doesn’t mean it is all hooey. (Full disclosure: I have been earning a living practicing this so-called quackery for decades, and my patients are pretty happy.) There are those among us who will call anything they don’t understand or don’t want to understand some kind of quackery.

    Even when the military, not known for its touchy-feely tendencies, started using acupuncture successfully for pain, PTSD, and traumatic brain injury, it was derided as falling victim to the quacks. Which, frankly, is rather insulting to our injured servicemen and -women–to suggest that they are incapable of differentiating whether their 10/10 pain is actually now 1/10 or whether their TBI headaches are improving with treatment or not.

    And yes, if you read an acupuncture text, it may not sound understandable–just like if a non-physician with no background in western medical terminology read a western medical text. “Drain Dampness” is a treatment strategy, and, if you happen to be “Damp”, you happen to feel much better when the Dampness is drained–i.e., if you have “edema” (anyone recognize that term?), you feel better when it is not there. Why make fun of different terminologies (except making fun is such a sport for some)? Acupuncture is getting more and more attention from western medicine and the general public because it, um, happens to work much of the time.

  92. #92 Orac
    August 1, 2013

    Nancy: You wouldn’t happen to have any, oh…you know…science to define what “drain dampness” means and to demonstrate that sticking thin needles into nonexistent anatomic “meridians” does anything to actually “drain dampness.”

  93. #93 AdamG
    August 1, 2013

    There happen to be perfectly decent studies showing that acupuncture is helpful for lymphoedema,

    So show them to us.

  94. #94 lilady
    August 1, 2013

    Gee Nancy, I seem to recall “hearing about edema”…somewhere. Is it similar to axillary node dissection lymphedema? Where do you insert those needles to treat lymphedema? Do you know some basic human anatomy or are you relying on those acupuncture points to insert needles to encourage the flow of the Chi or Qi life forces?

    @ Adam G: Would “testimonials” satisfy you?

    http://rivervalleyacupuncture.com/testimonials/

  95. #95 novalox
    August 1, 2013

    @nancy

    [citation needed]

  96. #96 Marc Stephens Is Insane
    August 1, 2013

    Nancy Groissman also seems to believe acupuncture can “detox”drug addicts and alcoholics, and she believes in things like reiki, Chinese herbal medicine and tuning forks. I doubt we’ll be getting anything scientific from her.

    From her website/advertising:

    In the early 1990′s, she and several colleagues organized and staffed the first acupuncture-detoxification clinic for alcoholics and drug addicts in western Massachusetts, at Gandara Center in Springfield. She has also lectured and taught extensively on the subject of Chinese medicine.

    Nancy has additional training and certification (when available) in acupressure, Chinese herbal medicine, pediatric medical massage (pediatric tuina), AcuQuitSM for smoking cessation, Toyo Hari Japanese-acupuncture techniques, hands-on energy healing techniques of Reiki (level 2 certification) and Reconnective Healing (level 3 certification), acupuncture facial rejuvenation, and Acutonics® (the use of tuning forks on acupuncture points). She has worked closely with the sports-medicine departments at Mt. Holyoke College in South Hadley, MA, and the University of Massachusetts at Amherst, as well as maintaining her private practice at…

  97. #97 AdamG
    August 1, 2013

    Grossman’s just another quack eager to take your money to ‘treat’ your children with her nonsense:

    Pediatric health concerns
    Nancy uses pediatric tuina (a style of acupressure) and acupuncture as well as suggestions for home care to treat a wide variety of children’s health concerns, including cough, indigestion, night crying, failure-to-thrive, fever, asthma, and earache, as well as to provide general preventive care. Chinese medicine has also shown promise as a treatment to improve developmental and behavioral issues in children with autism and Asperger’s syndrome.

  98. #98 Krebiozen
    August 1, 2013

    Oh for goodness sake, just because you have some ridiculous explanations of how acupuncture works doesn’t mean it does work.
    FTFY

  99. […] Papayas are often claimed to be part of Aboriginal Australian traditional medicine, but free [read] radicals, a waste product given off by mitochondira processing food 13 . Drinking milk not only […]

  100. #100 Stephanie
    California
    September 27, 2013

    I had a deposition yesterday because I’m suing the hospital that disabled me by giving me nerve damage, a prolapsed wrist for a month, dislocating shoulder and pain ever since 12/20/11. 15 lymph nodes removed for early DCIS in a lymph node, I have painful lymphedema in both arms as well as the nerve pain. The other sides lawyer hammered me because I refused acupuncture and further nerve tests that are painful. I love you Alburto and Ingrid and all the rest of you for even caring.

  101. #101 Stephanie
    September 27, 2013

    I would like to add that there is one thing that helped the horrible nerve pain and coldness in my hand and wrist. I paid a woman to teach me to do acupressure on my neck, shoulder arm and hand. Immediately my hand became warm and I could move my wrist. I do it on both arms and hands twice daily. It is better from acupressure.

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