Respectful Insolence

Since I’ve been on a bit of a roll with respect to acupuncture over the last week or so, I thought I’d just round out the trilogy with one more post. One myth that acupuncture apologists like to promote relentlessly is that acupuncture is completely harmless, that it almost never causes complications or problems. While it’s true that acupuncture is relatively safe, it still involves sticking needles into the skin, and, given that, it would be delusional to think that there couldn’t be injury caused by that. Rarely, however, have I seen a story like this from Canada reported in the National Post, Canadian Olympian’s ‘nightmare’ after acupuncture needle collapses her lung. It is the story of what happened to Kim Ribble-Orr, a world-class judoka who had competed in the Olympics in 2000 and harboring dreams of competing in the Olympics again, as a mixed martial artist. Those dreams were cast in doubt by a stray acupuncture needle:

When a massage therapist tried to treat the headaches she suffered after a 2006 car crash with acupuncture, however, he set off a cascade of health problems that would shatter Ms. Ribble-Orr’s sports-centred life — and raise questions about the popular needle therapy.

The therapist accidentally pierced Ms. Ribble-Orr’s left lung during acupuncture treatment that was later deemed unnecessary and ill-advised, causing the organ to collapse and leaving it permanently damaged. An Ontario court has just upheld the one-year disciplinary suspension imposed on therapist Scott Spurrell, rejecting his appeal in a case that highlights a rare but well-documented side effect of acupuncture.

Mr. Spurrell, who learned the ancient Chinese art on weekends at a local university, had no reason to stick the needle in his patient’s chest, and had wrongly advised Ms. Ribble-Orr that the chest pain and other symptoms she reported later were likely just from a muscle spasm, a discipline tribunal ruled.


Ribble-Orr had suffered many injuries due to her competition, including a dislocated elbow and shoulder, a broken hand, head injuries and repeated knee injuries. She had overcome them all to compete again, but appears unable to overcome this one. Basically, what happened is that in 2006, Ribble-Or was trying to get into mixed martial arts competition and was eying a job as a police officer. However, she was also recovering from injuries suffered in an auto collision and seeing Scott Spurrell, a massage therapist who had learned acupuncture during a weekend course at a local university. She was suffering from pounding headaches, and Spurrell convinced her that he could relieve those headaches by inserting a two inch needle, according to the disciplinary ruling, “into a muscle located between the clavicle bone and ribs.” From the description, it’s not clear to me exactly which muscle they meant, although it could conceivably have been the scalenes, the sternocleidomastoid, or perhaps even just the pectoralis major. Whatever muscle Spurrell was targeting, going between the clavicle and the ribs is basically where surgeons stick the needle when trying to place central venous catheter into the subclavian vein, and, yes, a pneumothorax is a known potential complication of placing such lines. What also puzzles me is how on earth Spurrell could have stuck the needle in deep enough to cause a pneumothorax? It would be one thing if Ribble-Orr were a fragile little old lady, but she wasn’t. She was an athlete, presumably with well-developed musculature. It would take a lot to get a needle through all of that muscle to get to the pleural cavity.

As can happen from a pneumothorax, even in a healthy person, Kibble-Orr developed pneumonia and required a thoracotomy. To be honest, it’s not clear from the account provided why she needed a thoracotomy, but it’s clear that the pneumothorax led to a cascade of complications, as described:

Shortly after leaving the clinic, Ms. Ribble-Orr began having difficulty breathing, chest pain and a “grinding” sensation. She returned to the therapist later, wondering if she had suffered a pneumothorax. He told her it was more likely a muscle spasm, but said she could go to the hospital if she felt it was more serious or if the symptoms worsened.

The next morning, she did feel worse and finally headed to the emergency department. Ms. Ribble-Orr’s lung had indeed collapsed and she spent the next two weeks in hospital, as a serious lung infection and then a blood infection followed. She was left with just 55% function in one lung.

One notes that if you do not have the knowledge to recognize symptoms and signs of potential complications resulting from your treatment, you have no business administering that treatment. It used to be that if you didn’t know how both to recognize and treat potential complications of your treatment, you shouldn’t be administering that treatment, but those days are gone. For instance, gastroenterologists do colonoscopies, even though they are not able to repair the inevitable (and thankfully uncommon) colon perforations that are a recognized risk of the procedure. But they can recognize the signs and symptoms. They know how to diagnose a potential perforation and when to call a surgeon to fix it. Spurrell was clearly utterly clueless, basically dodging responsibility by telling Kibble-Orr that she could go to the ER if she wanted to. Obviously, he didn’t think that she needed to. What should have happened, if Spurrell knew what he was doing, was a quick physical exam, which likely would have diagnosed a significant pneumothorax, through decreased breath sounds or and elevated diaphragm on the affected side, or both.

While the ruling against Spurrell is heartening, what is rather depressing is how Canadian authorities came around to it. Acupuncture is a licensed specialty. So authorities had to “prove” that Spurrell had no valid reason to insert a needle there (“valid” being defined within the system of traditional Chinese medicine undergirding acupuncture). In other words, they had to show that there was no reason under TCM to think that a needle stuck in that particular location would treat Kibble-Orr’s recurrent headaches. Moreover, it wasn’t the College of Acupuncturists who had jurisdiction, but rather the College of Massage Therapists, that had jurisdiction, and the College only requires a certain number of hours of extra training to be able to administer acupuncture, a requirement that Spurrell had met. Of course, we at SBM would argue that there’s no science-based reason at all to think that sticking a needle in a point between the clavicle and the ribs would have any effect whatsoever on recurrent chronic headaches, and that should be enough. That’s the problem with regulating quackery; to prove misconduct or malpractice, you have to do it within the system of magical thinking of the quackery that has been licensed. If, for instance, Spurrell had been able to show that there was a valid rationale under TCM for inserting the needle there, he still might have been nailed for incompetence because he stuck the needle in too deep, but quite possibly he might not have been.

Particularly depressing are the comments. For instance, one commenter named Dr. Joanny argues:

Only a bonafide doctor of Chinese medicine or acupuncture is qualified to practice Chinese medicine. The problem is not acupuncture but who is inserting the needles into your body. Only someone who has trained and studied for several years, who has passed board/state/provincial exams, is qualified to practice. All reports of puncturing lungs involve people who are people who took a little bit of training.

Yes, this acupuncturist is seriously arguing that “well-trained” TCM practitioners wouldn’t have had this complication and then goes on to cite a paper from a very acupuncture-friendly source that shows a surprising number of serious complications from acupuncture, including cardiac tamponnade, infection, various reports of needles breaking off and migrating elsewhere in the body (shades of the President of South Korea!), and even neurological injury. One remembers a recent review of the Chinese literature by Edzard Ernst describing complications of acupuncture, including pneumothorax (201 cases), spinal epidural hematoma (9 cases), subarachnoid hemorrhage (35 cases), right ventricular puncture (2 cases), intestinal perforation (5 cases), and a whole lot of other complications and infections. Indeed, Ernst found that pneumothorax was by far the most common significant complication of acupuncture, and, as we’ve discussed, acupuncture is not harmless. There are quite a few potential complications up to and including 90 deaths in the world literature.

All medicine is a risk-benefit analysis. All effective treatments have risks, and those risks have to be weighed against the potential benefits. When the benefits are significant (e.g., saving life), then greater risks are tolerable. When the potential benefits are minimal, then even minor risks might not be acceptable. When the potential benefits are none, no risk is acceptable. That is the case for acupuncture. It does not work, no matter how much acupuncturists try to prove it does.

Comments

  1. #1 Pris
    The Dark Side of the Force
    July 8, 2013

    Considering the risk of infection with many nasty diseases from improperly sterilized needles one really has to wonder why this shit is still legal.

  2. #2 The Smith of Lies
    July 8, 2013

    Oh, it is obvious that it was not acupuncturist fault. The victim… err, patient was clearly at fault for not having a positive enough attitude, thus bringing pneumothorax upon herself by thinking negative thoughts. I don’t understand how someone can think otherwise.

    And now on less sarcastic and more scary note. The fact, that legal consequences of preforming acupuncture malpractice* is to be judged by standards of an ad hoc system that is acupuncture. One has to wonder what’s next? Licensed wizards healing with magical spells? (And yes, I am well aware of licensed magicians healing with gestures and sorcerors selling their mystical remembering water/sugar; what I mean a bona fide declaration of healing through the ways of magic and incantations).

    *Well, putting asied that practice of acupuncture could be considered malpractice in and of itself.

  3. #3 AlphaGamma
    July 8, 2013

    Pris- Given that it’s something that people are allowed to do for purely aesthetic reasons (tattoos/piercings) I don’t see any reason to ban acupuncture specifically, and banning tattoos and piercings would I think be unjustifiable.

  4. #4 Ellie
    July 8, 2013

    Over the weekend I had a friend strongly urge me to look into acupuncture…to help my pain from lumbar stenosis and degenerative scoliosis. I’d rather see a wizard with magic spells! And I’m sure it would do more good than acupuncture.

  5. #5 Pris
    The Dark Side of the Force
    July 8, 2013

    @ AlphaGamma:

    Tattooing and piercing fulfill a purpose: body modification in a way that is aesthetically pleasing to the recipient.
    Where I live there are very strict health code regulations for tattoo and piercing studios with unannounced inspections. There is more regulation and checks for that then there is for acupuncture.
    There is also more education involved for tattooists and piercers. They are also required to discard all needles after each customer. If this doesn’t happen and they are caught, they will lose their business license.

    Contrast that with acupuncturists over here: Literally anyone can do it, all you need is to study some TCM, pass a test that can be resat until you pass and has nothing to do with medical knowledge and then have at it. There is no quality control of the education. There is also no requirement to dispose of the needles after each patient.

    Tattoos and piercings are reversible and only affect the surface of the body. Removing a tattoo is merely expensive. Getting a tattoo or piercing is not live threatening. Acupuncture can be.

    The risks from a properly run tattoo and piercing studio are small. There is also good quality control in place. Tattoos and piercings have a purpose.

    Contrast that with acupuncture. There is no quality control in the education. A weekend seminar is all it takes! There are less regulations concerning the practice of acupuncture. Even with a properly run acupuncture practice there is the possibility of life threatening events. It doesn’t serve a practical purpose. It’s only an elaborate placebo.

    Disclaimer: I don’t have any tattoos or piercings.

  6. #6 The Smith of Lies
    July 8, 2013

    @AlphaGamma
    Aside from points picked up by Prim, one has to consider an aspect of acupuctire legality completly unrelated with needles as such, although they were the reason first mentioned.

    With lack of demonstrated, verifiable mechanism and lack of evidence to support claims about healing properties of acupuncture one has wonder why is it legal and even regulated as far, that there are licensed acupuncturists? I’d love to get license for (quasi)medical practce of chanting in (pseudo)latin – I bet with studies of similar methodological restrictivness as those touted by acupuncuture crowd it should be possible to show efficacy of such therapy. Of course once I am licensed Wizard of High Order (title needs to be impressive in the market where one contends with Quantum* and Five Thousand Years of Tradition**) only my peers should have right to judge wheather my methods were right.

    *Homeopathy
    ** TCM

  7. #7 Eric Lund
    July 8, 2013

    To the adherents of any magical system of thinking, the system cannot fail, it can only be failed. In this case the authorities were able to show that Spurrell was the one who failed the system, not his patient. So we get the right result for the wrong reasons.

    @SoL: The logical consequence here is that alt-med becomes Calvinball. As long as you can make your justification within the system, you’re good to go. And it is quite easy, in a system full of magical thinking, to justify almost anything within the system. Direct murder of your patient is presumably out, but most things short of that are not.

  8. #8 Eric Lund
    July 8, 2013

    @AlphaGamma: One important difference between TCM and tattoos/piercing is that tattoo and piercing studios make no claims that the procedure will improve the client’s health. The people who undergo the procedure know that they are doing it for aesthetic reasons. Acupuncture is alleged to have health benefits, so it is quite reasonable to put those benefits, and the associated risks, under scrutiny.

  9. #9 AlphaGamma
    July 8, 2013

    I think acupuncture should be regulated in the same way as tattos/piercing- yes, that should include health inspections, requirements for education, and having to discard needles. I just don’t see why the fact it claims a health benefit means it should be more strictly regulated.

    Should dietary supplements be regulated more strictly than food?

  10. #10 Pris
    The Dark Side of the Force
    July 8, 2013

    AlphaGamma @9:

    Dietary supplements should be more strictly regulated than food.

    Water soluble vitamins like C are not a problem if your kidneys function properly. You just piss them out if you take high doses.

    Fat soluble vitamins are another matter entirely. Overdosing on vitamin E or A can be deadly.

    If you claim that method X has medical benefit Y, you should need evidence that it actually does what you says it does before you can perform it on people commercially.

    People eat because they are hungry. Food is regularly tested for contaminants. If used as intended, food does no harm. They take (unneeded) supplements to improve their health. This doesn’t work. At best they waste money, at worst they get sick.

    People get tattoos and piercings because they think they look nice. They might one day regret their choice, but their modification can be reversed. For a lot of money. If done properly and with the proper aftercare there are no health risks. They undergo acupuncture to treat illness. This doesn’t work. At best they wast money with no change in health, at worst they get serious complications.

    If the sole purpose of a modality is a supposed medical benefit the same rules as for ‘western’ or ‘allopathic’ medicine should apply.

    I need years of training to be allowed to practice as a doctor. Pharmaceuticals undergo years of testing to prove efficacy and study possible side effects. New non pharmaceutical treatment modalities are tested over years.

    The same standards should apply to so called ‘alternative’ treatments and ‘complementary’ medicine.

    The scare quotes are intentional.

  11. #11 JGC
    July 8, 2013

    I agree: if you make any claim that dietary supplements do more than taste good — for example, that they “boost the immune system” or “detoxify (insert favorite organ of your choice”– they should be regulated more stringently than food. They should, in fact, be held to the same standards of approval and manufacturing as any pharmaceutical.

    Acupuncture claims to be an effective medical intervention, therefore acupuncturists should be held to the same standards not of tattooists but dentists or optometrists.

  12. #12 Dangerous Bacon
    July 8, 2013

    “The problem is not acupuncture but who is inserting the needles into your body…All reports of puncturing lungs involve people who are people who took a little bit of training.”

    No _true_ acupuncturists have ever caused injury.

  13. #13 elburto
    July 8, 2013

    Welcome to AlphaGamma – basically Pris has summed up the perfect state of double standards that alternative “medicine” exists in. It’s not a bug, it’s a necessary feature.

    And yeah, of course supplements need proper regulation, monitoring and random testing, like food, medications, cosmetics* etc. The DSHEA in the US is a disgrace, the Fox is guarding the hen house.

    @Smith – are you familiar with The Day Today, a satirical comedy from the Chris Morris stable?

    Episode 1 mocked the fact that the NHS had opened that Quack Shack homeopathy hospital. Go to the link I’ll past and ctrl+f (or ‘find in page’) the word “alternative”. It’s the full script.

    anhdesign.co.uk/smellmycheese/tv_daytoday_script_ep1.html

    *Obviously not by US standards, as cosmetics are regulated like supplements – barely. There are ingredients in American cosmetics that have been banned for decades over here. Also, all cosmetic/beauty/personal hygiene products must carry a full ingredient list here in Europe.

  14. #14 elburto
    July 8, 2013

    past=paste, sorry!

    @DB – Beat me to it. Just like how true chiroquacktors never cause lethal strokes, true herbalists weren’t selling aristolochia, and true DAN! “doctors” don’t kill kids.

  15. #15 jane
    July 8, 2013

    “When the potential benefits are minimal, then even minor risks might not be acceptable.”

    That’s a value judgement. NSAIDs can cause heart attacks, sometimes fatal; NSAIDs and aspirin increase the risk of kidney failure and probably both blindness and deafness. NSAIDs are generally not used to “save life” but ‘merely’ to relieve pain. Does that mean that they should not be used? No, because many people who are in pain are willing to accept a risk of death that, while certainly orders of magnitude higher than the risk of death from acupuncture, is still tiny. Do you think you have the wisdom to make those decisions for everyone? In our culture, each person has the right to do so based on his own experiences and values. (There are also value judgements involved in deciding how high a Number Needed to Treat an intervention may have and still be called “life-saving”, by the way.)

    “When the potential benefits are none, no risk is acceptable.” The question of what has no benefit is, again, dependent upon values. Some studies have compared acupuncture to pills and reported not just superior safety but superior efficacy. You demand that the acupuncture still be called worthless while the pills are called efficacious. However, other members of the public are free to judge those data using values other than your own. Supposing that, as your dogma says, acupuncture were indeed merely some sort of incredible super-placebo – well, if a person’s use of it still relieved his pain and increased his range of motion better than pill-popping had, would that or would it not be a benefit? You can say that it would not be a benefit to you, but if I feel that it would be a benefit to me, you have no special competence to declare that my values in that area are wrong. I think you would have to ask neither a scientist nor a preacher of Science but a philosopher for the most informed possible answer to that dispute.

  16. #16 Calli Arcale
    July 8, 2013

    Jane, when the only studies showing a therapy to be better than placebo at relieving pain are the ones with a crappy design, I don’t tend to consider that therapy proven. I tend to consider it still in the hearsay category. You’re right that it is a value judgement, though. Do you value human life more than the pride of an acupuncturist? (A pointed question, to be sure, but I have little patience today.)

  17. #17 Pris
    The Dark Side of the Force
    July 8, 2013

    jane @15:

    The question whether something has a benefit or not is absolutely not dependent on values.

    If a double blinded, randomized and placebo controlled study with a sufficient number of patient tells me that method X has no effect beyond placebo than that is an objective truth. AltMed Types would like to tell you otherwise, but that is wrong.

    It has been shown time and again that acupuncture is an elaborate placebo. It affects the subjective experience of pain.

    NSAIDs have a measurable effect beyond placebo. They are analgesic, antipyretic, antiinflamatory and anticoagulant.

    Since they have an actual effect, they have side effect. If taken in the correct dose the risk is small. Most have been in use for ages, so any potential side effects are known. Doctors know to look for them if you come to A&E with symptoms and tell them what you took.

    Actual pain relief is not a small benefit. Same goes for lowering a fever. If I have a bad cold taking paracetamol (not an NSAID, but still) lowers the fever and relieves the headache and aching joints. Combined with decongestants for the nose this means that I’m able to sleep soundly, without fever dreams and not waking up because I can’t breathe through a stuffed nose.

    If I have lower back pain and get acupuncture for it, I will get some subjective pain relieve from the placebo effect. It will not treat the underlying cause.

    Physical therapy of some sort would be a better bet of actually doing something to treat the cause.

  18. #18 JGC
    July 8, 2013

    it isn’t a value judgment, jane, since the risk assessment is driven by evidence. it’s true that prolonged high dose use of some NSAIDS can cause a small by statistically significant increase in the risk of heart attack, amounting to roughly 3 extra heart attacks per year per 1000 patients treated (http://www.ox.ac.uk/media/news_stories/2013/130530.html) and that small but significant increased risk must be considered with respect to the demonstrated benefits of treatment.

    The question of what has no benefit is, again, dependent upon values.

    No jane, againrisk assessment is not dependent on values but is driven by evidence: while risks have been demonstrated with acupuncture there is no evidence it performs any better than placebo treatments.

    If you believe otherwise I’d be interested in seeing what, in your opinion, is the single most credible and compelling piece of evidence (hopefully in the form of a well designed, appropriately blnded and controlled clinical study) demonstrating acupuncture is actually effective at treating a non-self-limiting injury or illness.

  19. #19 Todd W.
    http://www.harpocratesspeaks.com
    July 8, 2013

    @jane

    I think you misinterpret Orac. He is not trying to make judgments for all of society, but pointing out that the risk-benefit analysis must play a role in deciding what is and is not acceptable medical practice. As the benefits decline (taken in the context of the disease or condition treated), then the acceptability of risks, from an ethical perspective, also decline.

    To illustrate, if a bandaid used to cover a papercut carried with it the risk of causing (through whatever mechanism) SSPE in 1 in 50 people who used them, the risks would be too great for their ethical use by medical professionals. Yes, patients can decide for themselves what they want to use, but medical professionals must be held to a higher standard than just “whatever the patient wants”. That kind of attitude is what helped advance the development of antibiotic resistant superbugs.

    Some studies have compared acupuncture to pills and reported not just superior safety but superior efficacy.

    And have any of these studies measured objective outcomes? I.e., does acupuncture really affect the condition/disease, or does it merely make people think it does, when it isn’t doing anything at all?

    You demand that the acupuncture still be called worthless while the pills are called efficacious.

    No, he demanded no such thing.

    You seem to be arguing that acupuncture be held to a different standard than science-based medical interventions. Why do you feel that way? If you think that there is good science to support health claims for acupuncture, please provide a link to the study or at least the title, journal, date and authors so we can take a look ourselves at the evidence you find convincing.

    To date, studies that have shown some effect have either been so poorly conducted that the results are meaningless or have looked at subjective effects, rather than objective ones. When studies have been done well and looked at objective measures, acupuncture has invariably failed.

  20. #20 Todd W.
    http://www.harpocratesspeaks.com
    July 8, 2013

    On a side, yet related, tangent, I think it bears repeating that studies using sham needles (i.e., ones that do not break the skin) have exactly the same effect as real needles that do pierce the skin. Given that the effects are the same, there is no ethically justifiable reason for any acupuncturist to use real needles that pierce the skin. They should all use non-piercing needles or even just toothpicks.

  21. #21 Chris Hickie
    July 8, 2013

    She must have been in pretty good physical shape to make it through to the next morning with a pneumothorax before going to the ER.

  22. #22 palindrom
    July 8, 2013

    Calli @16 — Acupuncture is especially suited for “pointed questions”. And, no doubt, sharp criticism.

    I’ll stop now.

  23. #23 sirhcton
    July 8, 2013

    In deference to Mr. Bacon’s priority with the “no true acupuncturist” post, I submit http://www.youtube.com/watch?v=Qy7ypWCmvbg&feature=player_embedded .

  24. #24 Narad
    July 8, 2013

    Supposing that, as your dogma says, acupuncture were indeed merely some sort of incredible super-placebo

    The only “dogmas” claiming the existence of “super-placebos” are those with nothing else left to cling to.

  25. #25 The Smith of Lie
    July 8, 2013

    Palindrom @ 22

    That was indeed a sharp retort. But you make a point, there is no need to be on pins and needles when it comes to acupuncture. I daresay it is high time to puncture the bubble of that modality’s efficacy.

  26. #26 Eric Lund
    July 8, 2013

    @jane: NSAIDs are considered efficacious because they have been shown in rigorous clinical studies to be superior to placebos at pain relief. That is, by US law, a necessary condition for any prescription drug to be sold in this country. It’s not sufficient, because if the risk of side effects is severe enough the drug can be pulled off the market.

    Acupuncture is not a drug, so it is not subject to this law. (Dietary supplements are similarly treated in this country.) So people are allowed to offer acupuncture services even though in clinical studies the degree of efficacy reported seems to be anticorrelated with the rigor of the trial. This anticorrelation is a warning sign of pathological science, so we are quite right to be skeptical that acupuncture would be more effective than a placebo. If the laws were written properly, that would be enough to bar acupuncturists from making claims about improving health. That would not, by itself, prevent people from offering acupuncture services (as pointed out above, tattooing and piercing are legal in the US), but the demand for such services would be quite a bit less if nobody thought there would be a health benefit. The law still allows supplements and the like to be banned if the FDA can prove a sufficient degree of harm, but I’m not sure if that clause would apply to something like acupuncture (and even if it did, the burden of proof is on the FDA).

  27. #27 elburto
    July 8, 2013

    @Jane – you are entitled to your own values, beliefs and opinions. You are not entitled to your own facts.

    Do you have any citations that prove the superiority of acupuncture over medical approaches?

  28. #28 Bronze Dog
    July 8, 2013

    Yes, patients can decide for themselves what they want to use, but medical professionals must be held to a higher standard than just “whatever the patient wants”.

    I think the “whatever the patient wants” attitude touches on the extreme libertarian elements of altie culture. They aren’t interested in which products are actually, objectively better, they’re interested in which products sell, substituting science with market share. They naively think the invisible hand of the market will regulate quality all on its own and that no one can be fooled into buying useless or harmful medical products more than once. The reality is that health is a complex issue and we can easily misjudge our state of health as well as cause and effect.

    The whole reason we need medical claims to be tightly regulated is because most people don’t have the time and resources to research every product and service. Skeptics like me know that we can’t trust popularity since marketing departments love to manipulate the invisible hand with spin and obfuscation to make inferior products into #1 sellers. Some of us want to be able to live our lives, trusting that the products and services we buy are being objectively tested and that useless and dangerous products are being kept off the market or at least taken off the market if they slip through the cracks with their flaws undetected. We want to be able to do that instead of being told to naively trust the producers and their marketers to self-regulate. We can certainly investigate claims on our own if we want, but we’d rather not have a scientific process muddied by a culture of marketing doublespeak.

    I want the people who make medical claims to jump through necessary hoops to earn a basic level of trust, not try to badger me into lowering my standards to the point of gullibility.

  29. #29 Todd W.
    http://www.harpocratesspeaks.com
    July 8, 2013

    @Eric Lund

    The FDA’s jurisdiction over acupuncture is even more limited than most would think. They can only make determinations on the needles themselves, not the practice of acupuncture. They can mandate that the needles come with warnings and such, or shut down companies that make health claims for the needles themselves (can you imagine a syringe manufacturer claiming the syringe can cure some disease, rather than the drug it contains?), but barring evidence that the needles themselves pose an inherent, unacceptable risk, there’s not much action FDA could take.

    The problem is with the practice of acupuncture, which falls under the jurisdiction of state medical boards. And frankly, the creation of a licensing and accreditation system separate from science-based medical practice is really the thrust of Orac’s argument. It’s a double standard: real medicine is held to a higher bar, while exceptions are allowed for acupuncture simply by virtue of it’s being classed as “alternative”.

  30. #30 JGC
    July 8, 2013

    Given the studies demonstrating that retractable needles which don’t pierce the skin perform exactly as well as standard needles that do pierce the skin, would the FDA be acting within its authority to require that manufacturers only produce and acupuncturists only use retractable, non-piercing needles?

    That would dramatcally reduce the risk of a pneumothorax or infection…

  31. #31 Gray Falcon
    July 8, 2013

    Anyone who thinks that the free market is the best method of determining the best medicine clearly has no knowledge of the history of medicine. Look up “patent remedies” for but one example.

  32. #32 Graca
    July 8, 2013

    Great, I’ll be looking for your blog about the dangers of Western medicine. I’m sure you’re working on that, right?

  33. #33 Gray Falcon
    July 8, 2013

    Graca: In what way was that relevant to the topic at hand? Do you think distracting from the issue is honest?

  34. #34 elburto
    July 8, 2013

    Ah Graca there, ladies and gentlemen, rehashing the fallacious and racist trope of a dichotomous system of “eastern medicine” and “western medicine”.

    Sorry to burst your bubble Graca, but here in the real world the only split is between “medicine” (practices with proven efficacy) and “nonsense” (everything else).

    Morphine works on white British people, Han Chinese, Bengalis, and Cree Indians. Heart transplants work on Torres Strait islanders, black Scottish people of West Indian descent, Japanese people, and Greek Cypriots.

    Contrast that with:

    homeopathy- no proven effect on anyone

    acupuncture – no proven therapeutic effect on anyone

    ayurveda – no proven therapeutic effect on anyone

    moxibustion – no proven therapeutic effect on anyone

    chiropractic – no proven therapeutic effect on anyone.

    Should I continue, or do you understand?

  35. #35 lilady
    July 8, 2013

    @ Graca: Why don’t you tell us about the dangers of “Western Medicine”?

    Would your first name happen to be Sandro, Graca?

    http://www.leinsterclinic.ie/services/acupuncture/

    “Sandro Graca is a graduate of the Irish College of Traditional Chinese Medicine and of the Beijing University of Chinese Medicine.

    Originally from Portugal, Sandro moved to Ireland in 2004 and established successful acupuncture and Chinese Medicine clinics in Trim, Swords and Maynooth.

    He is a member of the Acupuncture Council of Ireland and of the Acupuncture Fertility Network, co-Founder of “TCM Ireland” and former lecturer at the Irish College of TCM.

    Having studied acupuncture in Portugal, Ireland, UK and China, Sandro is now co-Directing TCM Ireland alongside Siobhán Seville and they have studied with world leading experts such as Jani White, Debra Betts, Sarah Budd and Jane Lyttleton, making TCM Ireland a reputable and recognized entity in the field of acupuncture for fertility, IVF enhancement and pregnancy here in Ireland….”

  36. #36 JGC
    July 8, 2013

    Graca, assuming that lilady has correctly identified you and that you have in fact studied acupuncture in Portugal, Ireland, etc., I’d like to extend the same question to you that I did to jane in this thread and Ingrid in a previous thread: what, in your opinion, is the single most credible and compelling piece of evidence (hopefully in the form of a well designed, appropriately blnded and controlled clinical study) demonstrating acupuncture is actually effective at treating a non-self-limiting injury or illness?

    I mean, there is some reason you believe it works as something other than a placebo, other than anecdote, confirmation bias, arguments from antiquity, etc.–isn’t there?

  37. #37 DaveH
    July 8, 2013

    @Graca #32:

    A 2 minute cursory search of some past articles:

    http://scienceblogs.com/insolence/2013/06/24/back-in-time-in-medicine-2/

    “How many complications and how the surgeon deals with them are what separate good from bad surgeons.”

    http://scienceblogs.com/insolence/2013/07/05/when-patient-expectations-battle-with-reality/

    “So, basically, we have a problem in oncology.”

    http://scienceblogs.com/insolence/2013/04/08/no-failure-to-screen-did-not-kill-your-patient/

    “It’s become increasingly apparent to me that most physicians believe that early detection is always good and that it always saves lives, having little or no conception of lead time or length bias.”

    Please come back when you have something intelligent to contribute.

  38. #38 Mike
    July 8, 2013

    @Eric in #8

    – “tattoo and piercing studios make no claims that the procedure will improve the client’s health”

    I would inject “reputable” in front of “tattoo and piercing studio.” I actually knew a local tattoo artist who would tell people that certain tats, notably of what they considered the subject’s “spirit guide,” would have beneficial affects on the recipient’s spiritual and physical health. Though, indeed, he is certainly an exception.

  39. #39 Denice Walter
    July 8, 2013

    @ palindrom:

    Don’t worrry, I won’t needle either you or your piercing insight.

  40. #40 Bronze Dog
    July 8, 2013

    Ah Graca there, ladies and gentlemen, rehashing the fallacious and racist trope of a dichotomous system of “eastern medicine” and “western medicine”.

    Racist is right, and bears repeating. It’s also disturbing that it tries to imply we subscribe to the same racist worldview, except that we’re on the other side.

    Nope.

    We reject favoritism grounded in race, nationality, or cultural heritage. “Eastern” and “Western” aren’t inherent in the treatments. They’re only labeled as such because of historical accident, and it’s sickening that alties fixate on those race-based labels instead of the treatments’ efficacy. I don’t care which hemisphere the medicine was invented in, I only care if it works.

  41. #41 The Smith of Lie
    July 8, 2013

    I may be terribly in the wrong, seeing how I never was in China, but I was led to belive that China has a healthcare system with hospitals, clinics and whatever they call their MDs . Why would they bother with all that if indeed the TCM was in all ways superior, as many of it’s proponents claim?

    By that logic Chinese people should have been perfectly healthy and in no need of SBM as we “the unwashed masses” in the West. So what’s the deal with Modern Chnese Medicine? Why does MCM exist if TCM is so great?

  42. #42 Todd W.
    http://www.harpocratesspeaks.com
    July 8, 2013

    @JGC

    would the FDA be acting within its authority to require that manufacturers only produce and acupuncturists only use retractable, non-piercing needles?

    That would probably be overstepping their bounds. They would need some very significant and substantial reason to pull their approval of standard needles, which is how you’d go about requiring production of only non-penetrating needles. I imagine that some businesses would view such action as tortious intereference (IANAL, so I may be using that term incorrectly). Suffice to say, they’d have a hard time making anything stick to curb acupuncture as far as the needles are concerned.

  43. #43 Denice Walter
    July 8, 2013

    More on woo ( and pain relief):

    just the other day, far away in a secret locale, I encountered *beaucoup de wu*:
    it seems that nature worshippers and friends of Gaia – perhaps some druids, wiccans and Tibetan Buddhists amonsgt them – were out in force, flying their respective freak flags, actualising their innermost transplendent, esoteric beings and selling their wares as well as their arcane woo-paedic ideas.

    Whilst searching for artisanal cheese in a tiny hamlet , we chanced upon a minuscule shop that offered homeopathy, aromatherapy and diverse herbal remedies fo whatever-ails-ye. My companion, who is rather expressive, complained of knee pain and thus alerted, the woo-prietors, an elderly couple, both with unencumbered, long grey locks and natural fibred, naturally-dyed flowing clothing, came rushing to his aid,
    offering him relief in the form of herbal tinctures, ointments and fragrant oils. ” You may sample our fine products,” they said. So we did.

    I was intrigued by the plethora of woo-ful skin care and soap displayed amongst the scattered river stones, lotus candle holders made of pearly shells, wind chimes and prayer flags. No acupuncture here: healing comes only from the earth and sun.

    Anyway, after about 20 minutes of sampling, we decided not to buy anything but the merchants didn’t seem to mind at all as they enjoyed our auric presence or suchlike.

    They appeared to have money from the looks of their car and general demeanor and were happily doing the goddess’ work, I suppose, distributing the healing fruits and herbs of the fertile earth to our benefit.

    These wise old souls- and those youngsters who also follow the beat of a different drummer- for some reason, always seem to like yours truly even when they aren’t trying to sell stuff to me.
    Perhaps they sense a kindred spirit., a fellow traveller.
    they have no idea…. so much for inner wisdom.

  44. #44 elburto
    July 8, 2013

    @Denice – I am blessed, in that woo-traps tend to induce bronchospasm. My cyanotic features (induced by patchouli, incense, and assorted “aromatherapeutic” gunge) and general bewheelderment* seem to frighten them. It’s a great way to avoid entanglement with the tie-dye bedecked flower-children.

    A couple of huffs of terbutaline sort it out, then something heavily caffeinated calms the racing, drug-induced heart rate. Woo-peddlers I’ve encountered here tend to be aware enough that they realise that asthma and crippledom are beyond their ken!

    *My phrase for crippledom, I am bewheeldered, I like the way it sounds, the “wheeee” is pleasing!

  45. #45 Eric Lund
    July 8, 2013

    I may be terribly in the wrong, seeing how I never was in China, but I was led to belive that China has a healthcare system with hospitals, clinics and whatever they call their MDs . Why would they bother with all that if indeed the TCM was in all ways superior, as many of it’s proponents claim?

    I have been to China, and they also make a distinction between zhong (Chinese–they call their country Zhongguo, literally “center country”) and xi (Western, i.e., science-based) when it comes to medicine. But as you say, that xi coexists with zhong is an implicit admission that zhong isn’t always the best way to go.

    Luckily, I did not require any medical services while in China. But I suspect that TCM as practiced in the West is not identical to zhong medicine in China, whereas at least in the larger cities xi medicine is the same as what you will get in a non-woo-infested Western medical practice.

  46. #46 Roadstergal
    July 8, 2013

    Adding on to the discussion of tattoo/piercing studios – I won’t go to a studio that doesn’t have fresh, autoclaved needles that are disposed of after each use, clean procedure rooms, and practitioners that wash their hands and use fresh exam gloves. I can’t imagine going to a place with less rigorous standards than that, and particularly not for having them stick a needle in any more deeply than a tattoo needle for, literally, no good reason…!

    I am awfully healthy, but I attribute that more to eating well, exercising a lot, and getting enough sleep, rather than the needles I’ve had stuck in me for various aesthetic reasons. I endured them for the outcome rather than enjoying the process itself. I have one tattoo across my back, and every time the needle passed over my spine, it would buzz my entire body – it was a unique experience, for sure…

  47. #47 Ron Edwards
    DePaul University
    July 8, 2013

    Wait – getting to this party a little late – he got the needle into her fer-frick-acking pleural cavity? And clearly not a little teeny-tiny hairlike acupuncture needle like the kind I mostly see, either – are we talking about a cardiac puncture device? Can I see a picture of this thing?

    “Your honor, the defendant did stick *this* item all the way into my client’s *chest* while claiming it was good for her.”

    And no one saw fit to charge him with ADW? Or even attempted murder?

  48. #48 Denice Walter
    July 8, 2013

    @ elburto:

    Oh they’re not frightened of me: they think me fab!
    Which is great because it gives me a front row seat to the inner workings of woo-thought.
    I often ask questions about how the effect transpires, etc.

    AS I say: they have no idea.

    @ Eric Lund:

    Funny that *xi* is SBM, not the other way around.

  49. #49 elburto
    July 8, 2013

    Oh yes, I understood that they were entranced by you, who wouldn’t be? After all, that DraconaShield spray we’ve been given by Lord D befuzzles the mere mortals!

    I need no further contact with them. It was partially due to living with a mother who had the most hilarious combination of traits – evangelical Christian (with a big ‘C’, born again, at a Billy bloody Graham revival no less!) and homeopath! She’s partially responsible for my bewheelderment, due to the decision to eschew SBM care in favour of a Jesus+Woo combination. I was only six, I didn’t really stand a chance.

    Mother has since apologised, but the damage cannot be undone. The bizarre memories of a woo-drenched childhood are alternately hilarious and horrifying. My poor Dad bears the brunt now, glucosamine instead of NSAIDs, other supplements instead of SBM. I’m just grateful that she’s encouraging my brother to take his medication. He’s newly returned to the nest following a complete breakdown, and she helped him seek proper treatment. She’s even trying to impress on him that mental illness is chronic, and that treatment can’t be stopped just because the symptoms have abated. I’m grateful for that.

  50. #50 Christine (the public servant Christine)
    July 8, 2013

    Jane: one other thing with aspirin vs acupuncture. Every box of aspirin, indeed every box of pharmaceutical pills I’ve ever seen (which is lots) has warnings of side effects either on the box or on a leaflet inside the box. Because there is no regulation of acupuncture, practitioners may not be aware there are any dangers, like the idiot in this story. And the fact that other acupuncturists supported him shows they don’t get it either.

  51. #51 Christine (the public servant Christine)
    July 8, 2013

    @elburto: never really thought about the racism inherent in the Western/Eastern medicine thing. But you are dead right.

  52. #52 Calli Arcale
    July 9, 2013

    Ron,

    I think the best that could be done would be to sue him for malpractice. If an acupuncturist has some form of medical license, then you’d have to be very careful about charging them with attempted murder for giving someone a pneumothorax. At the most, if they killed the patient, you could go after them for negligent homicide. But otherwise, well, a great many things in normal medical practice are deadly weapons, and things can go wrong there; I would think that charging this acupuncturist with attempted murder would have a grave chilling effect on the practice of medicine as a whole, because what legally would distinguish him from a gastroenterologist performing a colonoscopy and accidentally puncturing the colon? Well, the lack of a decent disclosure, but that’s all, and since the state licensing board seems not to appreciate the risks, he’s actually probably not practicing outside the scope of his field. Which is another scary thought, but not something you can solve by charging him with attempted murder.

  53. #53 Todd W.
    http://www.harpocratesspeaks.com
    July 9, 2013

    @Calli Arcale

    To add to what you said, even a medical malpractice claim would be difficult, since malpractice is based on the standards of the profession (i.e., acupuncturists). If he adhered to the standards established by acupuncturists, even if those standards are, by any scientific measure, absurd, then a charge of malpractice likely wouldn’t stick.

  54. #54 Calli Arcale
    July 9, 2013

    That’s probably true, Todd. I’ve read of cases where people tried to sue charlatans for malpractice, but failed because they were practicing within the scope of their license.

  55. #55 Ron Edwards
    July 9, 2013

    Yes, I think I can anticipate the layers of flak that would meet a claim like I’m describing. I have zero hope that it would succeed.
    But just here in the moment, people, in the glowing and sad delusion that we live in some kind of sane society … OK, the colonoscopy goes wrong, yes – a very small deviation from the proper motion yields a big problem. But that’s not what we’re talking about here! I have dissected many animals’ chests and I have also encountered many judo and other martial arts practitioners musculature in uncompromising ways. To get that thing in *there* is not a small deviation of ordinary action, and here I hold my nose and use “ordinary” even in the context of the acupuncturists’ own (I’m still holding it) “standards.” It’d be like the colonoscopy guy hitting the accelerator, zzzzzz!, and directing the instrument into the liver or something, then saying “oops.”
    And what’s this about the knife-I-mean-needle wielding maniac having some sort of relationship with the person? Are we not to investigate the possibility that he utilized the trust inherent in other, non-acupuncture-specific interactions as a way to get that thing within ten feet of her?
    Sigh. Someone’s going to bring up “intentions” now. I suppose in this nice sane world I’m pretending to inhabit, all too briefly, I’m also supposing that “intent” has not been elevated to the be-all and end-all of juridical decisions, and that impaling another person in this fashion could be looked at as the action that it is. If the dude stabs me with that because he thinks it’s good for me, and if I’m addled by regard for this person based on other factors, then he still freaking stabbed me with it, and in this world that (pop) just vanished like a soap bubble (damn it) that would still be stabbing me in the courtroom.
    Thank you for indulging me while it lasted. No need to explain the world we really live in, I know it tragically well.

  56. #56 Calli Arcale
    July 10, 2013

    Ron, that’s not the problem. The problem isn’t intent, nor is it that the whole craziness of shoving a needle deep enough into chest muscle that an accident can puncture a lung. The problem is that our legislators have created a regulatory framework wherein acupuncture is considered a legitimate medical discipline, with a licensing framework and everything. And in that context, as long as they weren’t deviating from the standard of care of their profession, they aren’t generally liable. That’s intended to protect both doctors and patients, of course, having a standard of care. But for alternative medicine, where the standard of care is often ridiculously vague and the licensing bodies take a frighteningly naive view towards evidence and side effects and risks, it becomes a loophole. We cannot close it by charging an acupuncturist with attempted murder. It has to be closed the way it was opened — by the legislature.

    BTW, I also thought the acupuncturist had a relationship with her, but then I reread it and realized I was mistaken. She’d been seeing him, but not in a romantic way — she was seeing him for massage therapy. (She’s married, BTW.)

  57. #57 jrkrideau
    July 10, 2013

    Good lord that local university has not one but two (competing?) TCM/Acupunture courses. They used to be a good and very innovative med school. I think they may have taken inovation a bit far …

  58. #58 Ron Edwards
    DePaul University
    July 10, 2013

    Calli, we’re talking past another, I think. In hopes this can be corrected, I’m posting to say I appreciate your points but do not need instruction regarding the legal and political situation. Nor do I think charges for ADW or attempted murder would be an effective activist effort. I posted in the spirit of exasperated humor. If what I posted misled you to think otherwise, then I did not post well. I’d prefer to close the book on it here.

  59. [...] Small risks versus no benefit. Also A Trilogy of (Acupuncture) [...]

  60. #60 ChinaMyte
    August 8, 2013

    Wow–this blog is a joke. First, your logic is astoundingly ridiculous. You point out that a licensed acupuncturist gained his/her license over the course of a weekend–meaning the individual was obviously poorly trained and woefully inexperienced. Then, when this mockery of an acupuncturist makes a severe mistake, you claim the entire system is a joke and potentially “dangerous.” I’m fairly certain that’s called an “informal fallacy.”

    Most doctors of Chinese Medicine are exceptionally well-educated and experienced, with degrees in biology and/or physics, and have advanced degrees (Graduate and PhD) in Oriental Medicine. Some traditional practitioners in China have merely inherited their practice from family, but they actually tend to be quite talented and have lifelong experience. Acupuncture by a well-trained doctor of Chinese Medicine is quite safe and has been proven so over the course of two millennia.

    And what’s even more laughable is that you claim that, potentially, a whole “90 people worldwide” may have died at the hands of acupuncturists, without mentioning that the study cited shows that many of the mistakes were performed by poorly-trained acupuncturists and experimental procedures, then attempt to use that as “evidence” of the potential danger of acupuncture, and that the “risk-benefit analysis” weighs against acupuncture.

    You also conveniently ignore that, in the US alone, between 100,000 to 180,000 people die from western medical error every year making it the 6th most preventable cause of death in the United States. In other words: when compared to western medicine, Chinese medicine is considerably less likely to cause damage of any kind–especially death.

    In addition, I’ve read several of your other posts with your opinion about Chinese Medicine and it’s inherently clear that you know little about it–despite your pretense to the opposite. It’s unfortunate that a person would have so little knowledge about a subject and then pontificate about its supposed inefficacy, and that people would use your commentary to justify their prejudiced ignorance.

    Perhaps when you speak, read and write Chinese and have thoroughly studied the remarkable amount of data regarding efficacy of Chinese Medicine that has been gathered over the course of 3500 years (that’s including the years preceding the written works of the Huangdi Neijing) you can get back to us about your belief–and yes I say “belief” because that’s all it is–that Chinese Medicine is ineffective “quackery.”

  61. #61 LW
    August 8, 2013

    “the remarkable amount of data regarding efficacy of Chinese Medicine”

    Perhaps you could provide some of that?

  62. #62 Christine (the public servant Christine)
    August 8, 2013

    ChinaMyte: Yes, this person was poorly trained… That is why acupuncture is a joke, there is NO formal certification required to call yourself an acupuncturist. I could train at the university of Google and set myself up as an acupuncturist. Try setting yourself up as a breast cancer specialist like Orac with GoogleU training and see how far it gets you. Heck, most professions don’t allow GoogleU qualifications as a basis for practice.

  63. #63 elburto
    August 8, 2013

    Acupuncture by a well-trained doctor of Chinese Medicine is quite safe and has been proven so over the course of two millennia.

    Then why did it die out at the one of the Song Dynasty? Even one thousand years ago people had the sense to realise that stabbing needles into the skin as a cure for anything was on a par with shamanism and alchemy.

    It was banned outright in the 19th century, and after that, it was mocked as the superstitious nonsense that it is. It was only revived when Mao Zedong declaring he wanted a “traditional” alternative to what he saw as the elitist practice of science-based medicine. In reality, it was a ruse to deflect attention away from the growing dearth of qualified doctors, especially in rural areas.

    Your “ancient” practice is actually newer than a fair chunk of SBM:

    Under Mao’s leadership, in response to the lack of modern medical practitioners, acupuncture was revived and its theory rewritten to adhere to the political, economic and logistic necessities of providing for the medical needs of China’s population. Despite Mao proclaiming the practice of Chinese medicine to be “scientific”, the practice was based more on the materialist assumptions of Marxism in opposition to superstition rather than the Western practice of empirical investigation of nature. Later the 1950s TCM’s theory was again rewritten at Mao’s insistence as a political response to the lack of unity between scientific and traditional Chinese medicine, and to correct the supposed “bourgeois thought of Western doctors of medicine”

    One last point, now that I’ve finished the hysterical laughing fit brought on by your insistence that only someone fluent in Chinese has the right to criticise quackupuncture. The trope of ‘Eastern’ medicine’s alleged superiority over ‘Western’ medicine is both nonsensical, and racist.

    Not only are you othering and exoticising billions of people, you’re also propping up (inadvertently or deliberately, intent is irrelevant) the disgusting delusion that there are inherent, race-based differences in the body that affect how people react to illness. Guess what? It’s nonsense.

    Morphine has the same mechanism of action in me (white, British) as it does in a Han Chinese woman, a Sinti man, or a Maori child. Removing the gall bladder will have the same effects on a Black British woman of Trinidadian origin as it would on a Metis man, or a Bengali teenager. There is no “Eastern medicine” or “Western medicine. All that exists is ‘medicine’ (stuff that works) and not-medicine, like quackupuncture.

  64. #64 elburto
    August 8, 2013

    Oh and BTW – I think you’ll find that the vast majority of Chinese people go to doctors and hospitals when they’re ill or injured. Acupuncture is used by those too poor to afford medical care, and by the worried-well. Much the same situation as here in the ‘West’.

  65. #65 JGC
    Where is this evidence of which you speak?
    August 8, 2013

    Perhaps when you speak, read and write Chinese and have thoroughly studied the remarkable amount of data regarding efficacy of Chinese Medicine that has been gathered over the course of 3500 years

    ChinaMyte, let’s address the premise that acupuncture is safe and efective (i.e., that it actually works) in as simple and direct a way as possible:

    What in your opinion is the single most compelling piece of evidence indicating that acupuncture is more effective at treating non-self-limiting illnesses or injuries than are placebo controls?

  66. #66 Leigh Jackson
    August 8, 2013

    However reliable the knowledge base underlying TCM may be, here is one Chinese medical historian who says that knowledge base can not be compared with the anatomical knowledge gained from the experimental methods of the Roman physician Galen and his Renaissance successors.

    http://www.nzasia.org.nz/downloads/NZJAS-Dec01/Jingbao.pdf

    Acupuncture may have some psycho-therapeutic value for some people, but little if any clinical value is evident to scientific investigation. And no reason for thinking clinical benefit would be evident – just the opposite.

  67. #67 ChinaMyte
    August 8, 2013

    I’ve attempted to address all questions, even if I did not address some of them individually for the sake of time and brevity.

    First, let’s address what Chinese Medicine is: Chinese Medicine is the ancient Chinese approach to the diagnosis and treatment of illness. Treatments include acupuncture, herbal formularies, diet, tui na, moxibustion, and other treatments. The diagnostic criterion and accompanying treatments are explained in the Huangdi Neiing, which is the core text of Chinese Medicine and dates back to approximately 400 BCE, in addition to numerous treatises provided by practitioners of Chinese Medicine over the 2400 years following the publication of the Huangdi Neijing.

    Therefore, when addressing acupuncture, it should be included within the realms of Chinese Medicine. It was never meant to be practiced separately from Chinese Medicine due to the preceding requirement for a diagnosis based on Chinese medicinal theory. Allowing people to gain acupuncture licenses without having a license to practice Chinese Medicine is the equivalent of allowing a person to write prescriptions without having a medical degree. Yet if that occurred, ineffective treatments or medical errors would not render western pharmaceuticals ineffective. Similarly, claiming acupuncture is ineffective or a “joke” simply because states allow people to become licensed acupuncturists without the proper training, is also untrue.

    In other words: If you don’t understand Chinese Medicine, you lack the knowledge you need to understand acupuncture. That goes for anyone practicing it, as well as anyone claiming it is ineffective.

    Second, if you are interested in researching the efficacy of Chinese Medicine, yes–it is required that a person be able to, at the very least, have a near-fluent understanding of written Chinese given that the majority of Chinese Medicine texts have yet to be translated. This is not to say that a person needs to read Chinese to understand Chinese Medicine, which is something I never claimed. However, if you are looking for data regarding the efficacy of Chinese Medicine that has been proven over the course of several millennia, you’ll need an exceptional understanding of Chinese. For any of you that happen to read Chinese, there is an excellent database of ancient Chinese Medicine texts, many of which carry the efficacy data I previously mentioned. I believe there is a fee; however, there is also a free trial period in case you were merely interested in perusing the database instead of doing genuine research. The database is simply called “The Chinese Medicine Database” and the link is here: http://www.cm-db.com/

    Despite this large amount of data regarding Chinese Medicine, the common claim by western scientists and physicians is that there is “no proof or data” that supports its efficacy. But clearly it’s not that the data doesn’t exist, it’s that those making the claims lack the knowledge required to study it.

    [quote]Then why did it die out at the one of the Song Dynasty? Even one thousand years ago people had the sense to realise that stabbing needles into the skin as a cure for anything was on a par with shamanism and alchemy.[/quote]

    I’m not sure where you’re getting your information, but this is entirely incorrect. It’s quite well-known that the emperors of the Song Dynasty were enamored with Chinese Medicine, and dozens of prominent medicinal texts were written during that time period. In fact, the Song Dynasty probably paid more attention to the proliferation of Chinese Medicine than any other dynasty. Chinese Medicine texts were published by the Song government’s printing press, “Medical Books Press,” that widely printed and distributed the ‘Huangdi Neijing’ (The Yellow Emperor’s Internal Canon), ‘The Classic of Acupunture and Moxibustion,’ ‘The Treatises on Cold-Induced and Miscellaneous Diseases,’ ‘The Pulse Classic,’ and numerous others.

    [quote]It was banned outright in the 19th century, and after that, it was mocked as the superstitious nonsense that it is.[/quote]

    Again, I’m not sure where you’re getting your information, but it’s phenomenally inaccurate. Chinese Medicine was never banned, let alone during the end of the Qing Dynasty, during which prominent doctors, such as Wang Yengming, added exceptional treatises on Chinese Medicine. The introduction of western medicine during the invasion of China by the British and Europe added debate, surely, but it was certainly never banned and was still embraced by most Chinese.

    As for the claim of “superstitious nonsense”–exactly what is superstitious about Chinese Medicine, including acupuncture? Superstition would infer belief, yet the entirety of Chinese Medicine developed using basic scientific method of hypotheses, predictions and testing. An acupuncture “point,” for instance, is not derived from a belief, nor is it considered religious in nature, nor is it associated with fear. The point was selected after the formulation of hypotheses, and subsequent testing, retesting and analysis over the period of several thousand years.

    The claim that it is “superstitious nonsense” only shows a lack of understanding, and the clear indication that some individuals would likely deem anything that uses esoteric descriptions to describe natural or biological phenomena as inherently “unscientific” and therefore “superstitious.” However, the use of philosophy and esoteric terminology doesn’t necessarily mean there is no scientific explanation for it. Natural philosophy, the predecessor to modern science (particularly physics) used similar terminology. Given its proven effectiveness, it is logical to conclude that eventually, there will be a scientific explanation for Chinese Medicine–but that such scientific proof will require studies that approach it using a broad understanding of eastern philosophy, biology and physics.

    [quote]Your “ancient” practice is actually newer than a fair chunk of SBM:
    It was only revived when Mao Zedong declaring he wanted a “traditional” alternative to what he saw as the elitist practice of science-based medicine. In reality, it was a ruse to deflect attention away from the growing dearth of qualified doctors, especially in rural areas.[/quote]

    Wherever you’re acquiring your information, I highly recommend that you seek alternative sources. Your information is so laughably wrong, I can only assume that you merely seek out information that confirms your bias, rather than approaching the subject rationally, and thoroughly studying it so as to acquire genuine knowledge. Mao Zedong wholeheartedly embraced western medicine, and many of the medical hospitals established under his rule are still in use today. His answer to the shortage of qualified physicians wasn’t Chinese Medicine, but what later became known as the “barefoot doctors” which were minimally-trained citizens that would travel to rural areas and provide basic medical care based on western medical practices.

    As for the claim that Mao Zedong “rewrote” Chinese Medicine, whomever made such a ridiculous claim would then have to explain how current practices and instruction still use ancient texts and theories. Prior to his interference, Chinese Medicine was taught and practiced similarly to other Chinese classical arts, in which an instructor carefully chose his students. In addition, Chinese Medicine had, and still has, numerous schools of thought. This is proved in its wide proliferation throughout Asia, and the various schools of Chinese Medicine in China, Japan, Taiwan and Korea. Mao certainly didn’t have any power over medicine in Japan and Korea.

    However, Mao’s belief was in line with his communist ideals, and that was his belief that Chinese Medicine belonged to the people of China. Mao wanted to standardize Chinese Medicine so that it could be taught in schools and therefore become freely available to anyone who wanted to learn. He created a quorum of Chinese Medicine practitioners who analyzed all schools of thought, gathered their commonality, and established standardized Chinese Medicine.

    In other words: Traditional Chinese Medicine is still based on ancient practices and literature, it is merely standardized. Further, many of the other schools of Chinese Medicine are still in wide practice. Only a person totally unfamiliar with Chinese Medicine would believe that it is new.

    [quote]I think you’ll find that the vast majority of Chinese people go to doctors and hospitals when they’re ill or injured. Acupuncture is used by those too poor to afford medical care, and by the worried-well. Much the same situation as here in the ‘West’.[/quote]

    I have lived in China (rural and urban), sought medical treatment in China, studied medicine in China, and I can, with complete confidence, tell you that this is entirely untrue. Culturally-speaking, many of the Chinese who seek western medical assistance over Chinese Medicine do so purely because there is an underlying–albeit misguided–belief among the Chinese that if it is expensive, it is better. This belief is far more reflective of opinions about social status than perspectives on medicine. Chinese Medicine is readily embraced in both rural and urban areas. In fact, there are several significant hospitals in China’s largest cities, such as Beijing, Shanghai and Xi’An, that combine both western and Chinese Medicine. Western physicians that practice at these hospitals examine their patients and determine whether or not their condition can be treated with Chinese Medicine. Likewise, Chinese Medicine practitioners will determine whether or not their patient would benefit from western medicine. Only in the west is this considered a radical idea. In Asia, it is the best approach to medicine.

    [quote]The trope of ‘Eastern’ medicine’s alleged superiority over ‘Western’ medicine is both nonsensical, and racist.[/quote]

    Fascinating. You speak of racism and then have the audacity to speak about nonsense. I’ve never claimed superiority of Chinese Medicine. My only allusion to such an idea was in defense of its safety by comparison. Given the ridiculous, illogical attack on the safety of acupuncture, I of course took the time to rebut the idea with facts. I have no problem, whatsoever, recognizing the limits of Chinese Medicine. Western medicine tends to be superior in regards to surgical procedures and acute conditions, like emergency treatment and aggressive disease.

    What I take issue with is the erroneous idea that Chinese Medicine is not only inferior, but entirely ineffective. And I have a serious problem with the fact that such conclusions arise, not out of a thorough study and understanding of Chinese Medicine, but out of pure arrogance and bias. To disregard Chinese Medicine in such a manner is not only intellectually dishonest, but hinders advancements in science and medicine; and the primary victims of this disregard are millions of people afflicted with illness and disease. Any doctor of western medicine that totally disregards complementary medicine, while having little understanding of it, is a poor physician to both his patients and the medical community at large.

  68. #68 JGC
    Cut to the chase
    August 9, 2013

    ChinaMyte just answer the question asked.

    What in your opinion is the single most compelling piece of evidence indicating that acupuncture is more effective at treating non-self-limiting illnesses or injuries than are placebo controls?

  69. #69 ChinaMyte
    August 9, 2013

    @JGC: I was sure I answered the question when I discussed the several thousand years of evidence. In most scientific data, it’s rare to have a single piece of evidence that proves efficacy or fact of any kind, so I’m unsure why you are demanding it. With at least 2500 years proof of efficacy through studies, experiments and the broad proliferation of Chinese Medicine, I’d say that’s quite sufficient.

  70. #70 Chris,
    August 9, 2013

    So, ChinaMyte, you have no evidence that acupuncture works from the absolute lack of verifiable references in your comments.

    Good to know.

  71. #71 Chris,
    August 9, 2013

    By the way if you go by geography and include Japan as “Eastern”, then the DTaP and most statins are okay dokay.

    Also homeopathy is bad because that originated in Germany, which apparently is “Western.” Funny how geography works.

    Who knew that those on the western edge of the Pacific Ocean practiced science based medicine, while others in old Europe stuck to old myths?

    I can comment because a string on a globe that stretched to my town to Japan would be equal to a string stretched to Germany. Your “eastern” versus “western” is lost on me.

  72. #72 ChinaMyte
    August 9, 2013

    @Chris: I gave you an entire website with hundreds of historical texts that show the efficacy of Chinese Medicine through studies conducted by numerous practitioners and researchers of Chinese Medicine. If you believe that they only “verifiable” studies are conducted by western scientists in the 21st century with conclusions written in English, then you have more issues that I can help you with.

    As for the rest of your comment about east vs. west, I’m sure if you actually went back and read my commentary, you’ll notice I said nothing about homeopathy, and that I never once mentioned “eastern medicine.” I always referred to it as “Chinese Medicine.”

  73. #73 Bill Price
    August 9, 2013

    Ah, yes. ChinaMyte gives the classic Courtier’s Response: “You just don’t have the education, sophistication, and background to fully appreciate The Emperor’s New Clothes.”

  74. #74 elburto
    August 9, 2013

    Bloviating about the history of your chosen woo and invoking fallacies* hand over fist does not constitute proof of efficacy. Scientific research studies prove and disprove theories, so provide some citations.

    Like I said earlier, medical science is binary. There is no ‘alternative medicine’, ‘complementary medicine’, or ‘[insert nationality] medicine’. There’s ‘medicine’ – anything with proven efficacy, and ‘not-medicine’ – everything else.

    Folk remedies (involving biological material) that appear to have an effect beyond placebo fall under the domain of pharmacognosy. Herbal remedies with actual medicinal effects are. refined or synthesised so that only the active ingredients remain, and so that dosages are standardised. In the type of ‘herbal medicine’ practised in Chinese medicine all that happens is that folklore and superstition combine to drive demand for products that have no proven efficacy, unknown quantities of bioactive material, and potential for great harm.

    Scientific study of the medicinal properties of remedies containing biological material has given us drugs like quinine, aspirin, Taxol, digitalis, and many more. The use of certain spurious “remedies” based on superstition and myth lead to the virtual extinction of plants and animals, and death and damaged lives due to promotion of substances such as aristolochia.

    So once more, offer up proof that “traditional Chinese medicine” works. Real science can be translated and replicated in any language, Any claim that only someone proficient in certain languages can understand certain practices is a giant red flag. It falls into the fallacious realm of “other ways of knowing”.

    Also, if any of it works, or ever has, then it should be testable here and now, by scientific researchers.** It should be easy to prove that ‘Qi’ and ‘meridians’ exist. Chinese “medicines” and “therapies” will, if efficacious, stand up to rigorous scientific analysis. However, we already know that acupuncture, moxibustion, and cupping have no benefit beyond placebo, and evidence that they can cause harm. In science, a researcher or practitioner’s ethnicity is irrelevant. Why should proponents of Chinese medicine get to make ridiculous claims about how the Chinese are just so ~different~, that only someone immersed in Chinese language and culture can understand why burning stuff and making human pin-cushions is “medicine”? More racism.

    So stop dodging the question and supply citations proving that Chinese medicine is anything but superstition and woo. Admit to yourself that a broken arm would have you running for the nearest emergency dept, not to a Chinese herbalist, or someone who inherited their trade in acupuncture the way most people inherit money or property.

    *So many, argument to antiquity is in there, argument to authority, it’s like fallacy bingo.

    ** SPOILER ALERT!

    A metric $hitload of scientists are Chinese. Problem solved, we’ll only allow them to bust your myths wide open!

  75. #75 Chris,
    August 9, 2013

    ChinaMyte:

    I gave you an entire website with hundreds of historical texts that show the efficacy of Chinese Medicine through studies conducted by numerous practitioners and researchers of Chinese Medicine.

    Anyone can make a website. So what?

    Where is the PubMed indexed study by a qualified researcher? Just post the PMID.

    But before you do, try reading this book. One part includes the evaluation of papers, especially from China.

    Also remember format rules for a forum are not html. First thing you must do is substitute square brackets for angle brackets, and instead just “quote” you need to use “blockquote.” See the following:
    How to use a blockquote: <blockquote>Put paragraph of person you are quoting in here.</blockquote>

  76. #76 ChinaMyte
    August 9, 2013

    Thank you for the information about quotations–I merely happened upon this forum and was not aware that html didn’t work until I after I posted my second comment. Hopefully it will work this time.

    Like I said earlier, medical science is binary. There is no ‘alternative medicine’, ‘complementary medicine’, or ‘[insert nationality] medicine’. There’s ‘medicine’ – anything with proven efficacy, and ‘not-medicine’ – everything else.

    Of course. So, in the future, I’ll merely refer to Chinese Medicine and western medicine as “medicine” and “medicine” and you can sort out what I mean.

    Or, we can avoid stupidity and recognize that arguments over semantics are ridiculous, and that clarity is required for communication.

    In the type of ‘herbal medicine’ practised in Chinese medicine all that happens is that folklore and superstition combine to drive demand for products that have no proven efficacy, unknown quantities of bioactive material, and potential for great harm.

    Chinese formularies are extraordinarily similar to modern pharmacology. They are not mere folk remedies. They are specifically designed according to Chinese medicinal theory, and their efficacy has been well-proven–though it is quite evident that you will not accept any source other than those in modern English.

    You speak of “no proven efficacy,” yet if I were to talk about inactive ingredients such as starch, carnauba wax or hypromellose, wouldn’t you be forced to say the same thing? Chinese formularies contain similar ingredients–they are herbs that bind and balance each formula that have no specific medicinal purpose.

    Any claim that only someone proficient in certain languages can understand certain practices is a giant red flag. It falls into the fallacious realm of “other ways of knowing”.

    It’s not about saying you are not educated enough to understand Chinese Medicine, or that it is some “mystical” information that only a select few could comprehend. It’s about pointing out that non-Chinese scientific studies of Chinese Medicine have only just begun, and the bulk of information still remains untranslated. The data exists–even if you don’t believe it does.

    However, we already know that acupuncture, moxibustion, and cupping have no benefit beyond placebo, and evidence that they can cause harm.

    You do? That’s news. You might want to do a little more research and get back to me.

    In science, a researcher or practitioner’s ethnicity is irrelevant. Why should proponents of Chinese medicine get to make ridiculous claims about how the Chinese are just so ~different~, that only someone immersed in Chinese language and culture can understand why burning stuff and making human pin-cushions is “medicine”? More racism.

    It’s not about being Chinese, it’s about a medicinal theory and practice that was created and developed in China over the period of several millennia. It has had a significant amount of time to be honed and perfected. You speak of science, but you entirely forget its predecessor–natural philosophy. Like I said: given the age of Chinese Medicine its theory is explained through philosophy; however, that doesn’t mean it is not scientifically explainable. If you don’t understand natural philosophy, you won’t be able to understand Chinese Medicine.

    I was sure that it was well accepted among scientists that to understand nature requires a multidisciplinary approach, yet you appear to be under the impression that the only approach to the understanding of natural phenomena is through biology. And I can only assume that it is because you study biology, but not physics or philosophy.

    Admit to yourself that a broken arm would have you running for the nearest emergency dept, not to a Chinese herbalist,

    Funny, I was sure I already said that I would seek western medical services in emergencies, and I was also certain that I never said western medicine was ineffective or inferior. However, for other issues, such as depression, I’d seek Chinese Medicine, which has been proven to cure depression–as opposed to western medicine, which merely treats symptoms with lifelong medication.

    It’s probably time to give up the hurt bunny routine. Saying that Chinese Medicine is effective does not suddenly render western medicine ineffective.

    Anyone can make a website. So what?

    But not everyone can make a website that contains scanned copies of ancient medicinal texts. Either those texts exist, or they’ve done a phenomenal job at creating faux texts.

    In addition, if it is too difficult for you to search “acupuncture” on PubMed and you require that others do it for you, I’m not sure I can be of assistance. However, if you decide to take the time to look through the numerous studies that prove the efficacy of acupuncture for various ailments, I congratulate you for doing more than I expected.

    As for the rest of the comments I can only say this: I did not, for one second, come on here to “prove” that Chinese Medicine is effective. It would be impossible to include every study, every piece of information, describe Chinese Medicine in thorough detail, and force open closed minds while writing in a tiny little box on someone’s blog.

    My entire purpose is merely a quest for a little humility. Is it really that difficult to say “I do not understand Chinese Medicine well enough to speak with any authority regarding its efficacy, and will therefore remain skeptical and focus on what I do know, until a time comes that I decide to seek genuine answers.”

    And why would I expect this? Because that’s what GOOD scientists do. A good scientist studies, recognizes the limits of his understanding, and possesses a healthy balance of curiosity, skepticism and humility. A poor scientist claims knowledge he doesn’t have, speaks with finality on subjects he is ignorant of, and never, ever questions or challenges the status quo.

    If it is too difficult for you to admit you haven’t done the homework required to thoroughly understand Chinese Medicine to speak with authority regarding its theory or efficacy, then congratulations: you have reached your full, yet incredibly limited potential as scientists.

  77. #77 elburto
    August 9, 2013

    Philosophy =/= medicine.

    Traditional Chinese “medicine” =/= medicine.

    Medicine needs no qualifiers. It works, or it doesn’t. You also dodged the part about superstitious bunk “remedies” rendering plants and animals to near extinction. You also failed to explain ‘Qi’ and ‘meridians’, and how processes with no plausible mechanism of action can work. Most of your “Chinese medicine” is impossible per the laws of physics, chemistry and biology. How do you explain the fact that research proves that sham acupuncture, and even twirling toothpick points on the skin, produces the same results as “real” acupuncture?

    PMID/study from high-impact journal proving existence of Qi or meridians.

    Ditto for proof that acupuncture, moxibustion and cupping are a) effective and b) not potentially risky.

    Acupuncture for patients with migraine: a randomized controlled trial.
    JAMA 2005;293:2118–25

    Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ 2005;331:376–82

    German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups.
    Arch Intern Med 2007;167:1892–8

    Acupuncture in patients with osteoarthritis of the knee: a randomised trial.
    Lancet 2005;366:136–43

    A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.
    Arch Intern Med 2009;169:858–66

    Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups.
    BMJ 2009;338:a3115

    Acupuncture for chronic pain: individual patient data meta-analysis.
    Arch Intern Med 2012;172:1444–53

    Acupuncture for ‘frequent attenders’ with medically unexplained symptoms: a randomised controlled trial (CACTUS study).
    Br J Gen Pract 2011;61:e295–e305

    Net result? Acupuncture has no effect beyond placebo.

    Research/reference article of note:

    Acupuncturists show that acupuncture doesn’t work, but conclude the opposite: journal fails. 2011.
    Available at: hdcscience.net/?p=4439

  78. #78 Krebiozen
    August 9, 2013

    ChinaMyte,

    An acupuncture “point,” for instance, is not derived from a belief, nor is it considered religious in nature, nor is it associated with fear. The point was selected after the formulation of hypotheses, and subsequent testing, retesting and analysis over the period of several thousand years.

    As I understand it these points were originally places where blood vessels came close to the surface, and that acupuncture was indistinguishable from medieval European lancing and bloodletting which is why taking the pulse is still so important – even the implements used were almost identical. It was only in the 1930s that a Chinese pediatrician called Cheng Dan’an repositioned the points away from away from blood vessels and towards nerves. He also replaced the larger lancets previously used with the fine needles used today. This has all been well documented by Ben Kavoussi, MS, MSOM, LAc and others, here for example.

    The “retesting and analysis over the period of several thousand years” that you describe was subject to the same cognitive biases that misled European physicians for thousands of years, right up until randomized clinical trials were developed. This is why bloodletting, along with other dangerous practices, was considered to be effective despite “retesting and analysis over the period of several thousand years”.

    By the way, I’m curious to know your explanation for how “retesting and analysis over the period of several thousand years” missed the toxic effects of Aristolochia, a herb often used in TCM that causes renal failure and cancer (PDF).

  79. #79 Krebiozen
    August 9, 2013

    ChinaMyte,

    However, for other issues, such as depression, I’d seek Chinese Medicine, which has been proven to cure depression–as opposed to western medicine, which merely treats symptoms with lifelong medication.

    That simply isn’t true; there is no good evidence that acupuncture is effective for depression. Even Cochrane disagrees with you. A meta-analysis of 30 trials with 2,812 participants concluded:

    There was a high risk of bias in the majority of trials. There was insufficient evidence of a consistent beneficial effect from acupuncture compared with a wait list control or sham acupuncture control. Two trials found acupuncture may have an additive benefit when combined with medication compared with medication alone. A subgroup of participants with depression as a co-morbidity experienced a reduction in depression with manual acupuncture compared with SSRIs (RR 1.66, 95%CI 1.03, 2.68) (three trials, 94 participants). The majority of trials compared manual and electro acupuncture with medication and found no effect between groups. [...] We found insufficient evidence to recommend the use of acupuncture for people with depression. The results are limited by the high risk of bias in the majority of trials meeting inclusion criteria.

  80. #80 elburto
    August 9, 2013

    @Krebiozen – (S)he ignored my mention of aristolochia too, and the issue of plants and animals being driven toward extinction.

  81. #81 LW
    August 9, 2013

    It’s not about being Chinese, it’s about a medicinal theory and practice that was created and developed in China over the period of several millennia. It has had a significant amount of time to be honed and perfected.

    China was not isolated from the rest of the world during those millennia. There were trade routes all the way to Europe, and useful knowledge flowed along with the tangible goods. But Traditional Chinese Medicine did not. Why not?

    If there is a treasure trove of valuable medical knowledge in those ancient Chinese documents, obviously anybody who is fluent in both Chinese and English — which is tens of millions of people — could make a fortune by translating them into English. Why hasn’t that been done?

  82. #82 Krebiozen
    August 9, 2013

    elburto,

    (S)he ignored my mention of aristolochia too, and the issue of plants and animals being driven toward extinction.

    I noticed. I’m just wondering how this “retesting and analysis over the period of several thousand years” managed to miss such a major deleterious effect of this plant. If it didn’t pick that up, I don’t have much faith in its abilities to detect beneficial effects of anything.

  83. #83 JGC
    August 9, 2013

    I was sure I answered the question when I discussed the several thousand years of evidence.

    No, you didn’t:–you’ve asserted that evidence exists without actually providing any of it..

    Please identify what in your opinion is the single most compelling piece of evidence indicating that acupuncture is more effective at treating non-self-limiting illnesses or injuries than are placebo controls?

    Again, I’m asking for

  84. #84 JGC
    August 9, 2013

    They are specifically designed according to Chinese medicinal theory, and their efficacy has been well-proven–though it is quite evident that you will not accept any source other than those in modern English.

    It’s not that we’re unwilling to accept anything that isn’t written in modern English but that we aren’t willing to accept anything that isn’t actual evidence of efficacy.

    That traditional Chinese medicine has been in use for two millenia isn’t evidence it works. That traditional Chinese doctors are considered well educated or have advanced degrees Oriental Medicine isn’t evidence it works. That practicioners who have inherited their practice from families have lifelong experience administering Chinese medicine isn’t evidence it works.

    If you’re going to convince us it works, you’ll have to show us real evidence it’s effective.

  85. #85 Edith Prickly
    August 9, 2013

    However, for other issues, such as depression, I’d seek Chinese Medicine, which has been proven to cure depression

    Citation please? I am certain “western” doctors would be very interested in a cure for depression.

    as opposed to western medicine, which merely treats symptoms with lifelong medication.

    What is the mechanism of action for the TCM treatment that allegedly cures depression? Modern antidepressants adjust the levels of certain neurotransmitters in the brain and are most effective in treating severe depression. If you are claiming TCM is “curing” mild to moderate depression, it is just as likely that therapy would have had the same effect, or the depression might resolve on its own without any intervention.

  86. #86 ChinaMyte
    August 9, 2013

    Medicine needs no qualifiers. It works, or it doesn’t.

    Yes. Chinese Medicine works, therefore it is medicine.

    You also dodged the part about superstitious bunk “remedies” rendering plants and animals to near extinction.

    No, I answered it plainly. However, because you believe that folk remedies and the formularies used in Chinese Medicine are the same, you think I have avoided the question. Again, another example of how you do not understand Chinese Medicine and are unwilling to admit it.

    You also failed to explain ‘Qi’ and ‘meridians’, and how processes with no plausible mechanism of action can work. Most of your “Chinese medicine” is impossible per the laws of physics,

    Before I’m even willing to spend my time discussing the nature of Qi and its comparison to physics and biochemistry, please explain to me what Qi is according to Chinese medicinal theory. If it’s clear you understand it, I’ll take the time to discuss it. If you don’t understand it, I’ll not bother wasting my time.

    As I understand it these points were originally places where blood vessels came close to the surface,

    Your understanding would be incorrect. Most of the points and methods used today are contained within the 2400 year-old Huangdi Neijing, particularly the Lingshu Jing.

    But Traditional Chinese Medicine did not. Why not?

    It didn’t? Then how did it manage to reach the Koreas and Japan? How did it manage to influence India’s Ayurveda?

    If you’re going to convince us it works, you’ll have to show us real evidence it’s effective.

    Again, I’m not here to convince you it works. I’m only here to ask that you admit you do not know enough about it to claim one way or the other. I’ve given you the resources that avail you to 2500 years of studies conducted by Chinese Medicine practitioners. Yet because you can’t read it, you believe it doesn’t exist.

    Someone said that PubMed was an acceptable resource on this blog, so for your satisfaction I have included a few of the numerous studies regarding the efficacy of Chinese Medicine using it. This isn’t meant to convince you, but is a mere encouragement to do your own research instead of expecting others to do it for you before you will open your mind:

    Women who received depression-specific acupuncture were more likely to respond to treatment compared with those receiving non-specific acupuncture.
    http://www.ncbi.nlm.nih.gov/pubmed/23904069

    Acupuncture for chronic functional constipation is safe and may improve weekly spontaneous bowel movements, quality of life, and relevant symptoms.
    http://www.ncbi.nlm.nih.gov/pubmed/23895148

    Acupuncture treatment improves nerve conduction in peripheral neuropathy.
    http://www.ncbi.nlm.nih.gov/pubmed/17355547

    Efficacy observation on acupuncture and moxibustion combined with hot compress of TCM herbs for scleroderma.
    http://www.ncbi.nlm.nih.gov/pubmed/23885611

    Acupuncture at key points combined with rehabilitation therapy effectively relieves the spasmodic condition of the patients with post-stroke spasmodic hemiplegia, improves the limb function and the life activity of the patients.
    http://www.ncbi.nlm.nih.gov/pubmed/23885610

    Acupuncture at the twelve meridians points achieves the superior and quick effect on general anxiety disorder as compared with clonazepam and the efficacy mechanism is related to the improvements of brain waves in the patients.
    http://www.ncbi.nlm.nih.gov/pubmed/23885609

    Efficacy controlled observation on acupuncture and western medicine for gastrointestinal dysmotility in liver cirrhosis.
    http://www.ncbi.nlm.nih.gov/pubmed/23885607

    Evidence was found for the use of acupuncture for cancer treatment-related nausea and vomiting. Benefit was reported for other cancer-related symptoms, including pain, fatigue, hot flushes, xerostomia, dyspnoea and anxiety.
    http://www.ncbi.nlm.nih.gov/pubmed/23868190

    Acupuncture-evoked response in somatosensory and prefrontal cortices predicts immediate pain reduction in carpal tunnel syndrome.
    http://www.ncbi.nlm.nih.gov/pubmed/23843881

    Low-intensity laser acupuncture can be safe and effective treatment in asthmatic children.
    http://www.ncbi.nlm.nih.gov/pubmed/23843569

    Active acupuncture results in lateralisation of functional cerebral response to the contralateral unaffected hemisphere in patients with unilateral stroke.
    http://www.ncbi.nlm.nih.gov/pubmed/23822904

    Moxibustion at Baihui (GV 20) reduces significantly the levels of IgA, IgG and IgM for the patients with intractable facial paralysis.
    http://www.ncbi.nlm.nih.gov/pubmed/23819228

    This study suggests a potential role for acupuncture in the treatment of the sexual side-effects of SSRIs and SNRIs as well for a potential benefit of integrating medical and complementary and alternative practitioners.
    http://www.ncbi.nlm.nih.gov/pubmed/23790229

    A study which demonstrates that acupuncture may be an effective approach for improving symptoms-in particular, pain and well-being-in lung cancer patients.
    http://www.ncbi.nlm.nih.gov/pubmed/23737683

    A study that concludes acupuncture should be in the hypertension treatment guidelines and widely used for blood pressure regulation.
    http://www.ncbi.nlm.nih.gov/pubmed/23724695

    A study that shows acupuncture is effective in the treatment in pain management during postoperative care following heart surgery, and suggests it is superior to opioids.
    http://www.ncbi.nlm.nih.gov/pubmed/23573118

    Acupuncture improves sleep in postmenopause in a randomized, double-blind, placebo-controlled study.
    http://www.ncbi.nlm.nih.gov/pubmed/22943846

    Acupuncture significantly improves motor function in hemiplegic patients.
    http://www.ncbi.nlm.nih.gov/pubmed/23713736

    Effect of direct moxibustion at Sihua points on cytokine of chemotherapy patients with lung cancer.
    http://www.ncbi.nlm.nih.gov/pubmed/23713299

    Acupuncture in the treatment of upper-limb lymphedema after breast cancer treatment.
    http://www.ncbi.nlm.nih.gov/pubmed/23576267

    Acupuncture for the treatment of hot flashes in patients with breast cancer receiving antiestrogen therapy.
    http://www.ncbi.nlm.nih.gov/pubmed/23383974

    Acupuncture as a treatment for subclinical hypothyroidism.
    http://www.ncbi.nlm.nih.gov/pubmed/22165143

    Moxibustion successful in increasing immunity after heavy load training in athletes.
    http://www.ncbi.nlm.nih.gov/pubmed/23885614

  87. #87 ChinaMyte
    August 9, 2013

    missed the toxic effects of Aristolochia, a herb often used in TCM that causes renal failure and cancer.

    To satisfy every question is impossible, though yes–I missed this comment. First, Chinese Medicine has been honed over a few thousand years within its own spectrum, as I said–but such advances can only occur within its limits of technology and understanding. It still possesses the ability for improvement as scientific knowledge advances–much like western medicine.

    Second, because we are comparing Chinese and western medicine, it would be dishonest to focus on a single pharmacological side effect of herbs used in Chinese Medicine without mentioning the 100,000 people that die from western pharmaceuticals every year, or their countless, serious side effects, including paralysis, organ damage and failure, heart attack and enlargement, gastrointestinal disturbances, hallucinations, suicidal thoughts, etc.

    My point is: A single side effect, whether severe or minor, doesn’t disprove the efficacy of Chinese Medicine (which, as I said, is the Chinese approach to the diagnosis and treatment of illness–not mere remedies or single herbs.) If it does, then you must also conclude that western medicine is ineffective due to the overwhelming number of side effects of phamacueticals, including death, and the immense number of drugs that have been removed from the market either due to dangerous side effects or inefficacy.

  88. #88 Chris,
    August 9, 2013

    ChinaMyte:

    But not everyone can make a website that contains scanned copies of ancient medicinal texts.

    Appeal to antiquity. Also, a false premise considering the existence of this site (includes Islamic texts going back over a thousand years):
    http://www.nlm.nih.gov/hmd/

    If you read the book I suggested you will understand why we are underwhelmed.

    Again you say: “Yes. Chinese Medicine works, therefore it is medicine.”

    Prove that it works for a non-self-limiting condition with a cure, not symptom relief (which is what that Gish Gallop list is mostly about). Examples would include type 1 diabetes, tuberculosis, rabies, syphilis, strep infections, etc. And to repeat: cure, not symptom relief. Though no one can cure an type 1 diabetes, with that, just show they can live without insulin.

  89. #89 Chris,
    Distractions abound...
    August 9, 2013

    I needed to finish my sentence: why we are underwhelmed by your Gish Gallop list of papers.

  90. #90 Chemmomo
    Under what will hopefully remain a clear sky
    August 9, 2013

    ChinaMyte, I’m going to repeat JGC’s request.

    Would you be willing to pick the one study in your list (or even a different one; either way just make sure you include a link in the new comment) which you think provides the most compelling evidence that “Chinese Medicine” is effective, then summarize why that study shows you this is true?

  91. #91 ChinaMyte
    August 9, 2013

    So, let me see if I understand this correctly: The initial blog claimed that acupuncture was totally ineffective. Subsequent comments called it “superstitious nonsense” and that any success in acupuncture is the result of placebo effect. There were also comments to that Chinese Medicine, including acupuncture, is dangerous, and the risk/benefit ratio is not in favor of Chinese Medicine because it is ineffective. In addition, there were highly inaccurate claims of the definition of Chinese Medicine, its history, theory and application.

    Not only I was I able to overwhelmingly prove that not a single one of you actually understands Chinese Medicine well enough to speak with any kind of authority on the subject (especially regarding the ridiculous claims about the Song Dynasty, Mao Zedong, and the lack of understanding of herbal formularies vs. folk remedies) but I acquiesced to the request to:

    Where is the PubMed indexed study by a qualified researcher? Just post the PMID.

    I didn’t post a single study, I posted over 20. However, despite a list from a requested source that includes studies conducted by qualified researchers and easily concludes that Chinese Medicine is efficacious and certainly not “superstitious nonsense,” my list (albeit a small list in comparison to the amount of information available) is now a list of lies and half-truths, and I’m expected to prove that Chinese Medicine is entirely superior to all other forms of medicine.

    In other words, it doesn’t matter how many medical studies I provide, how logical my arguments are, or how much evidence exists, you are so convinced you are right that you won’t accept anything other than information that suits your bias.

    Poor science indeed.

  92. #92 ChinaMyte
    August 9, 2013

    If you read the book I suggested you will understand why we are underwhelmed.

    Anyone who gets their information from a single source will never find fact, only bias.

  93. #93 Chris,
    August 10, 2013

    Even more proof that you have nothing. Just show us that “Chinese medicine”,, especially acupuncture, is effective with a non-self-limiting disease like type 1 diabetes, tuberculosis, or rabies.

    And, really, until you read the suggested book you will not understand why we are underwhelmed by your “evidence.” Because, you just don’t understand that you really have not provided any kind of valid “medical study.” Most of those results are subjective (“I think I feel better”), not objective (“the bacterial cultures are now negative” or “the blood sugar is normal” or “the patient has not died from rabies”).

  94. #94 ChinaMyte
    August 10, 2013

    Most of those results are subjective (“I think I feel better”), not objective (“the bacterial cultures are now negative” or “the blood sugar is normal” or “the patient has not died from rabies”).

    Many of these studies prove physiological changes through examination and were considerably more than subjective interpretation. Did you not actually read them? You only asked for one and I provided several.

    This one shows an increase in immunity through measurable erythrocyte and T-lymphocyte subsets function:

    Moxibustion successful in increasing immunity after heavy load training in athletes.
    http://www.ncbi.nlm.nih.gov/pubmed/23885614

    This one shows a difference in arm circumference after a reduction in edema:

    http://www.ncbi.nlm.nih.gov/pubmed/23576267

    This study shows that moxibustion positively affects serum CSF and IL-2 levels, as well as tumor necrosis factor:

    http://www.ncbi.nlm.nih.gov/pubmed/23713299

    This one has shown that acupuncture can regulate blood pressure:

    A study that concludes acupuncture should be in the hypertension treatment guidelines and widely used for blood pressure regulation.
    http://www.ncbi.nlm.nih.gov/pubmed/23724695

    This one showed that acupuncture can significantly affect autoimmunity:

    Moxibustion at Baihui (GV 20) reduces significantly the levels of IgA, IgG and IgM for the patients with intractable facial paralysis.
    http://www.ncbi.nlm.nih.gov/pubmed/23819228

    This study shows lateralization of brain function in patients with unilateral stroke while acupuncture was performed during brain scans:

    Active acupuncture results in lateralisation of functional cerebral response to the contralateral unaffected hemisphere in patients with unilateral stroke.
    http://www.ncbi.nlm.nih.gov/pubmed/23822904

    This study shows a measurable improvement in liver function if patients with cirrhosis:

    Efficacy controlled observation on acupuncture and western medicine for gastrointestinal dysmotility in liver cirrhosis.
    http://www.ncbi.nlm.nih.gov/pubmed/23885607

    And those are merely from the group of studies I provided, which, as I said previously, are only a small portion of the studies available–which for whatever reason, you refuse to research yourself.

    As for your book–you clearly assume that I’ve never been the skeptic and must therefore be ignorant of dissenting opinion. However, prior to my move to China, my opinion of Chinese Medicine was similar to those expressed here. I thought it was complete nonsense, and I was highly skeptical of holistic medicine in general. It wasn’t until after I observed it, experienced it, and thoroughly studied it, that I was forced (and I mean forced–my mind was quite closed) to conclude over a period of years that my initial opinion was based on a combination of arrogance, ignorance and prejudice. It was extraordinarily humbling and changed my approach to science in general.

    I highly recommend that you do your own research–though I must admit I am beginning to believe that any information that doesn’t confirm your bias will be disregarded.

  95. #95 Chemmomo
    Clarifying my earlier comment
    August 10, 2013

    ChinaMyte,

    not a single one of you actually understands Chinese Medicine well enough to speak with any kind of authority

    I freely admit I’m not an authority. I’m lay person with a background in science who has done some reading on the subject, but not a lot. None of the reading I’ve done so far suggests that “Chinese Medicine” (quotation marks only since I’m borrowing your term) is more effective than a modern scientific approach which includes controlled studies.

    If you wish to change my mind about that, could you explain – with more detail – a little more to me? You’ve already given us a lot of sweeping generalizations and a long list of citations that obviously most of us don’t have time to read for the sake of an internet discussion. Neither of those approaches are particularly convincing. I’d like to hear about a specific, documented (i.e., a link anyone can read – in English) example of something from “Chinese Medicine,” and I’d like you to explain why you think that report means that example works. In your own words.

    I’m not looking for an Orac-length dissertation worthy of its own blog post. Just a link to study I can read for myself, and a paragraph or two that spells out why it tells you that what you’re calling “Chinese Medicine” is effective.

  96. #96 Bill Price
    In no mood to be tolerant of BS
    August 10, 2013

    ChinaMyte, August 9, 2013

    To satisfy every question is impossible,

    If it is ever to be the case that Ancient Chinese Witchdoctory is to be considered as Medicine, there are many, many questions that must be answered. As a very small sample, not even an appetizer’s worth:
    • In this multitude of “studies” of which you speak, how many of them define the protocol and results well enough to be validated, analyzed and replicated?
    • ACW apparently predates the development of the discipline of statistics. In lieu of statistics, how do these studies, and their protocols, characterize the confidence level and trustworthiness of whatever results they present?
    • What care is taken to address – eliminate, or otherwise account for – known confounders in these protocols? Do the ACW protocols identify other confounders that are not considered in Medicine?
    • We have been told here, recently, about “dampness” as a significant concept in “the Chinese approach to the diagnosis and treatment of illness”. It is characterized the same as a humour from Ancient Western Witchdoctory. There seem to be other concepts of the same general character in the ACW approach. Do these concepts represent anything having actual, objective existence? If so, for each such concept, what?
    Questions like this must be addressed and answered before any of your multitude of ACW studies can be considered to have any meaning.

  97. #97 ChinaMyte
    August 10, 2013

    Note–there is a comment of mine that is awaiting moderation due to my inclusion of several web links.

    None of the reading I’ve done so far suggests that “Chinese Medicine” (quotation marks only since I’m borrowing your term) is more effective than a modern scientific approach which includes controlled studies.

    Several of the studies I’ve listed include measurable physiological changes, meaning they are not placebo effect but are genuine results. Also, I’ve never insisted that Chinese Medicine was more effective; this entire discussion was about the efficacy of Chinese Medicine. I believe I’ve shown enough evidence that would, at the very least, lead a skeptic to admit that Chinese Medicine is worth researching.

    I’d like to hear about a specific, documented (i.e., a link anyone can read – in English) example of something from “Chinese Medicine,” and I’d like you to explain why you think that report means that example works. In your own words.

    You’ll have to pardon me, but it’s difficult for me to be sympathetic to the idea that people want answers, but are unwilling to do the work required to find them. I’ve provided the resources, you are welcome to look through them should you be interested in understanding Chinese Medicine.

    Like I said–several of the studies I’ve listed show measurable physiological changes, which should be enough to prove that it is more than placebo. And those studies only include acupuncture, which is only one treatment among many in Chinese Medicine. They do not include the entire scope of Chinese Medicine or what it is fully capable of.

    However, there is no single study, nor should there ever be, that proves efficacy of anything, including Chinese Medicine. My “belief” in the efficacy of Chinese Medicine came over a period of many years of study and experience, not a single study or observation.

    If it is ever to be the case that Ancient Chinese Witchdoctory is to be considered as Medicine, there are many, many questions that must be answered.

    I agree. However, my comment was obviously about this discussion. I am one against ten. I have a life.

    In this multitude of “studies” of which you speak, how many of them define the protocol and results well enough to be validated, analyzed and replicated?

    Regarding the ancient Chinese data, it would take quite a bit of time for me to gather that information and I’m not interested in doing so, given that you are unlikely to accept the answer anyway.

    As for the recent medical studies from PubMed that I posted earlier, presumably all of them would meet your criteria. Because they are freely available, perhaps you should take the time to read them yourself. There are many others from the same source.

    ACW apparently predates the development of the discipline of statistics. In lieu of statistics, how do these studies, and their protocols, characterize the confidence level and trustworthiness of whatever results they present?

    • What care is taken to address – eliminate, or otherwise account for – known confounders in these protocols? Do the ACW protocols identify other confounders that are not considered in Medicine?

    Define statistics. Perhaps the discipline of statistics is younger, but statistical methods are quite a bit older, and at least the same age of Chinese Medicine. But like I said–even if you entirely disregard ancient texts and evidence, there is enough modern evidence that points to efficacy. Modern studies of Chinese Medicine take the same considerations as studies of western medicine. If you accept western medical studies conducted under similar conditions as studies of Chinese Medicine, what prevents you from accepting the latter?

    We have been told here, recently, about “dampness” as a significant concept in “the Chinese approach to the diagnosis and treatment of illness”. It is characterized the same as a humour from Ancient Western Witchdoctory. There seem to be other concepts of the same general character in the ACW approach. Do these concepts represent anything having actual, objective existence? If so, for each such concept, what?

    I always find it fascinating when skeptics try to support their bias through intellectual dishonesty by painting Chinese Medicine as irrational as possible through the use of terms like “witchdoctory” or “superstitious.” I’ve explained this earlier, but both terms would imply religious, shamanistic, or mythical connotations–yet Chinese Medicine was founded on the basic scientific methods of hypotheses, predictions and experimentation. You can continue to use such terms if you wish, but it only shows your bias against Chinese Medicine, rather than pointing to actual knowledge.

    Because of its age, Chinese medicinal theory is a type of natural philosophy, which explains natural phenomena through the study of elements, the infinite, natural qualities and the relationship between physical entities, both within the human body and without. Natural philosophy is the predecessor to the natural sciences. The term “dampness” is not, in and of itself, inherently significant, but is a “natural quality” or description of an overall condition such as a cough that produces phlegm. I learned a long time ago that minds cannot be open through argument, regardless of how logical. Therefore, I am not here to prove or convince you of anything, but merely hoping for the humility required to admit that no one here has enough knowledge about Chinese Medicine to make the claims that have been produced about its efficacy. So far, only one person has been able to accomplish that. Therefore, I will not explain each natural quality because it would require explaining a great deal more about Chinese Medicine that I have time for; and because the information is freely available, you are clearly able to do the research yourself if you would genuinely like to learn about Chinese Medicine.

    Yet it’s a shame, given that I’m almost certain that my unwillingness to cradle your intellectual laziness will almost certainly, in your mind, infer I have no acceptable answers.

  98. #98 al kimeea
    www.quackademiology.com
    August 10, 2013

    Because of its age, Chinese medicinal theory is a type of natural philosophy, which explains natural phenomena through the study of elements, the infinite, natural qualities and the relationship between physical entities, both within the human body and without. Natural philosophy is the predecessor to the natural sciences.

    Ah, now the idea that chronic lower back pain is caused by the liver processing gamma rays in the skull as explained by Traditional Chinese Acupuncturists in Hogtown makes prefect sense. Thanks.

  99. #99 Krebiozen
    August 10, 2013

    ChinaMyte,

    As I understand it these points were originally places where blood vessels came close to the surface,

    Your understanding would be incorrect. Most of the points and methods used today are contained within the 2400 year-old Huangdi Neijing, particularly the Lingshu Jing.

    At the time the Huangdi Neijing was written China was steeped in superstitious shamanism that used talismans, spells and incantations to combat disease, and the five phases; water, wood, fire, earth and metal were supernatural concepts. The sophisticated medical system built up through centuries of careful study and observation you describe is a myth.

    Did you read Ben Kavoussi’s article about acupuncture? Or are you “so convinced you are right that you won’t accept anything other than information that suits your bias”?

  100. #100 Bill Price
    August 10, 2013

    #96, ChinaMyte, August 10, 2013

    Define statistics. Perhaps the discipline of statistics is younger, but statistical methods are quite a bit older, and at least the same age of Chinese Medicine.

    Wikipedia can tell you more than you need to know, at this level, about statistics — but as much as one would need to know to for a basic understanding of scientific research (including medical studies). A particular question, though, would address the nearly universal use of the p characteristic of study results, roughly the probability that the study result does not actually reflect reality. The usual criterion in Medicine is that a study is useful iff p < .05; that is, there’s less than 5% probability that the result is wrong, based on the study population, protocol, the specific results, etc. A subset of the question from my list then amounts to “what quality measures, such as the p characteristic, does ACW use, and how well do those measures characterize the quality of the results?”

    We have been told here, recently, about “dampness” as a significant concept in “the Chinese approach to the diagnosis and treatment of illness”. It is characterized the same as a humour from Ancient Western Witchdoctory. There seem to be other concepts of the same general character in the ACW approach. Do these concepts represent anything having actual, objective existence? If so, for each such concept, what?

    I always find it fascinating when skeptics try to support their bias through intellectual dishonesty by painting Chinese Medicine as irrational as possible through the use of terms like “witchdoctory” or “superstitious.” … You can continue to use such terms if you wish, but it only shows your bias against Chinese Medicine, rather than pointing to actual knowledge.

    Aaaaannnnd, you fail the test that I had hidden in the paragraph you quoted. If you wish to do an exercise in self-awareness, you may (a) find the test and (b) see where you failed. Hint: how did I refer to pre-1800 European practices? Further hint: why did you change the subject instead of addressing the question you quoted?

    yet Chinese Medicine was founded on the basic scientific methods of hypotheses, predictions and experimentation. …Because of its age, Chinese medicinal theory is a type of natural philosophy, which explains natural phenomena through the study of elements, the infinite, natural qualities and the relationship between physical entities, both within the human body and without. Natural philosophy is the predecessor to the natural sciences.

    Science emerged from “Natural Philosophy,” and Medicine emerged from Witchdoctory, by recognizing and addressing the weaknesses inherent in “Natural Philosophy.” They were addressed by inter alia
    (a) taking measures to reduce (or at least account for) experimenter and subject bias and other error sources;
    (b) developing analysis techniques for quality control;
    (c) designing experiments to be replicable, actually replicating them, and understanding what happened when replication failed;
    (d) developing a mindset (if you will) of humility about our ability to accurately deal with reality; and
    (e) learning to frame conjectures, hypotheses, and predictions so experiments can be conducted to falsify them, rather than trying to use experiments to confirm purported statements of fact.
    Science then proceeded to identify the ‘elements’ that really exist (92 of them, to begin with), and dropping the ones that don’t (e.g., the humours, the earth-air-fire-water quadrimivirate, the æther); recognize that the universe is finite, not ‘infinite'; identify the ‘natural qualities’ that nature actually has; and understand the “the relationship between physical entities” and that the human body is really nothing special with respect to other “physical entities” (there’s that humility, again).

    Yet it’s a shame, given that I’m almost certain that my unwillingness to cradle your intellectual laziness will almost certainly, in your mind, infer[sic] I have no acceptable answers.

    Your failure to support your claims only implies unwillingness, not necessarily inability (although lack of answers is not precluded).

    you are clearly able to do the research yourself if you would genuinely like to learn about Chinese Medicine.

    Were I fifty years younger, it might be feasible to develop enough fluency in ancient Chinese languages to be able develop expertise in ACW. If family precedent is meaningful, however, I likely have only about 15 to 20 years, of declining vigor, left. That hardly seems sufficient to do the job you challenge me to do, just so that you don’t need to do any more than making unsupported assertions. You may conclude from the above that I don’t see how it could be worth it.
    ============================
    The questions I posed earlier are just a sample of the questions that ACW must address before it can be considered as Medicine. They were not given to you for answer, but I appreciate your attempts at addressing them. They reflect the process AEW has gone through on its journey from “Natural Philosophy” to Medicine — a process that ACW would need to go through to become part of Medicine.

  101. #101 Leigh Jackson
    August 10, 2013

    You say of TCM that “there is enough modern evidence that points to efficacy”.

    So we do not all have to become proficient in Chinese and study oodles of ancient texts as you originally claimed was necessary.

    We can therefore concentrate on modern studies. Of these, the most reliable are systematic reviews. Of these, Cochrane Reviews are widely held in high regard.

    The 2010 Cochrane Review of acupuncture for treatment of depression searched for all published and unpublished randomised studies of acupuncture for depression – as defined by all of the primary medical classificatory systems including CCMD-3-R (China’s system) – and found no good evidence of the effectiveness of acupuncture for this condition.

    For which TCM modality is there a Cochrane Review or study of equivalent quality proving the effectiveness of TCM for depression?

    Or do I have to learn Chinese and study oodles of ancient texts after all in order to find such evidence? Frankly, I don’t lay much faith in that direction considering the demolition of the myth that TCM knew about the circulation of the blood thousands of years before Harvey – given in the link of my prvious comment.

  102. #102 Krebiozen
    August 10, 2013

    I started working my way through ChinaMyte’s list of PubMed references, but it’s the usual poor quality evidence I have seen many times before and I gave up in disgust.

    These are tiny studies, often with no mention of blinding, in some cases no control groups, with small effects and results that are barely statistically significant.

    Also these are mostly subjectively assessed or functional conditions that are susceptible to placebo effects such as regression to the mean (improvements in some studies are compared to baseline). There is nothing there that suggests to me that there is anything more than placebo effects.

    Some examples of what I mean:

    PMID 23885611 ChinaMyte says:

    Efficacy observation on acupuncture and moxibustion combined with hot compress of TCM herbs for scleroderma.

    Not particularly surprisingly hot compresses improve symptoms of scleroderma as compared to sodium heparin cream (why sodium heparin?). Did the additional acupuncture and moxibustion have any effect? Would a hot compress without herbs work as well? The study doesn’t tell us.

    PMID 23843569 ChinaMyte says:

    Low-intensity laser acupuncture can be safe and effective treatment in asthmatic children.

    This is a study with no control group, that found an improvement in symptoms in children on steroidal inhalers who were also receiving acupuncture:

    Inhaled steroids dose decreased from 200-450 to 0-200 μg/day and all patients stopped short acting B2 agonist (SABA) rescue (p < 0.01, 0.001).

    I would conclude that inhaled steroids are very useful for controlling childhood asthma. There is no reason at all to assume that the acupuncture had anything to do with it. Yet the study concludes:

    low-intensity laser acupuncture can be safe and effective treatment in asthmatic children.

    How can anyone conclude any such thing from a study with no control group? My own experience with asthma is that inhaled steroids have completely eliminated my need for albuterol, and I have cut my inhaled steroid dose by 75% since diagnosis. I had no acupuncture.

  103. #103 AdamG
    August 10, 2013

    I doubt ChinaMyte has even read the studies it Gish Galloped. From the abstract of the very first one (a meta-analysis):

    The evidence is inconclusive to allow us to make any recommendations for depression-specific acupuncture, maternal massage, bright light therapy, and omega-3 fatty acids for the treatment of antenatal depression. The included trials were too small with non-generalisable samples, to make any recommendations.

    from the second (note ‘might’ and ‘could’ in lieu of actual statistics):

    Meta-analysis indicated that acupuncture for chronic functional constipation was probably as effective as conventional medical therapy in the change of bowel movements. For the colonic transit activity, acupuncture might be the same as conventional medical therapy and could be better than sham acupuncture

    Articles 3,4, and 5 all failed to include a sham acupuncture control group. I stopped there.

    Is this really the best there is for acupuncture?

  104. #104 Khani
    August 10, 2013

    #99 “Science then proceeded to identify the ‘elements’ that really exist (92 of them, to begin with), and dropping the ones that don’t (e.g., the humours, the earth-air-fire-water quadrimivirate, the æther)”

    I still miss phlogiston.

  105. #105 Narad
    August 10, 2013

    Scientific study of the medicinal properties of remedies containing biological material has given us drugs like quinine, aspirin, Taxol, digitalis, and many more.

    Nitpick: The Pacific yew had no folk medicinal use; paclitaxel was discovered at random.

  106. #106 Narad
    August 10, 2013

    And I can only assume that it is because you study biology, but not physics or philosophy.

    Oh, this should be good. I can assure you, ChinaMyte, that you will find every bit as much competence here in the latter two subjects as you will in the former.

  107. #107 Denice Walter
    August 10, 2013

    To pique my interest, first of all, I’d like to see convincing evidence that points, meridians, “vessels” and xi exist outside of the imagination.

    If your explanatory system relies upon concepts that can’t be shown to exist physically, your system is in trouble.

  108. #108 Krebiozen
    August 10, 2013

    Khani,

    I still miss phlogiston.

    Think of it as the opposite of oxygen, and it’s still with us.

  109. #109 Bronze Dog
    August 10, 2013

    ChinaMyte:

    In other words: when compared to western medicine…

    You might want to read the comments before yours, ChinaMyte. Some of us consider that phrase to be inherently racist, sometimes against both easterners and westerners. We’re into science-based medicine.

    The reason why science-based medicine tends to have negative effects is because it actually does something. The human body is a complex entity with all sorts of things that can go wrong. It’s a matter of risk/benefit ratio, and the problem we have with acupuncture is right in the title of the OP.

    Homeopathy, a big name quackery, was developed in the west and fares no better than acupuncture, aside from being even less risky, since it’s usually a sugar or lactose pill that touched their diluted water or alcohol. It’s free of negative effects because it doesn’t do anything.

    Real medicine is about taking calculated risks for the necessary benefits. You have to compare the risks and benefits of the treatment against the risks of inaction, and sometimes you have different treatments with different levels and types of risks and benefits. You also have to deal with human mortality. You can’t know in advance which individual treatments will succeed or fail because there are no guarantees in life. All you can do is play the best odds from available evidence to stay in the game. No matter how skilled we are, we all eventually lose.

  110. #110 Chemmomo
    Land Without Preview
    August 10, 2013

    ChinaMyte, perhaps some of this will become moot after your comment leaves moderation (I’m assuming your reference to a moderated comment is not #86 which was already there when I commented last night).
    #96 (my emphasis)

    I’ve never insisted that Chinese Medicine was more effective

    Fine – let’s rephrase that as “as least as effective”; I don’t want to be putting words in your mouth. I was assuming you are advocating for something better than what I already have.

    people want answers, but are unwilling to do the work required to find them

    It’s not that I am not willing to do the work – I want to hear you explain your work.

    Several of the studies I’ve listed include measurable physiological changes, meaning they are not placebo effect but are genuine results

    Which ones? Your list is too long for me to be able to pick those out from the titles.

    there is no single study, nor should there ever be, that proves efficacy of anything, including Chinese Medicine. My “belief” in the efficacy of Chinese Medicine came over a period of many years of study and experience, not a single study or observation.

    No kidding. That much is obvious from everything else you’ve posted so far, and it is the way that science is supposed to work. I’d just like an example of something that you think works, and an explanation in your own words why you think that. Just one example which I can then examine for myself, and find out if I agree with your conclusions.

  111. #111 Orac
    August 10, 2013

    I’m locked out of the back end and can’t moderate comments. Whenever I try to log in I get an error message. So, unfortunately, I can’t release comments that get caught in the moderation queue until the powers that be fix whatever the problem is. I just hope they fix it before Monday, so that I can have some fresh Insolence ready for my readers. In the meantime, remember, more than two links in a comment will cause that comment to be caught in the moderation/spam filter.

  112. #112 Leigh Jackson
    August 10, 2013

    A recent review from China confirms the result of Cochrane finding lack of good evidence for efficacy of acupuncture for depression.

    Wang J. et al. 2013 searched Chinese sources for systematic reviews of TCM and also the Cochrane Database of Systematic Reviews, PubMed and Embase.
    http://www.ncbi.nlm.nih.gov/pubmed/23789210

    Out of 606 systematic reviews meeting their inclusion criteria they only identified 6 “high quality” references showing efficacy; one purportedly for depression: Wang H. et al. 2008.

    Unfortunately, this is not entirely accurate. Wang H. found the quality of the 8 studies included in their review to be of low quality and suggested that more full-scale trials with reliable designs were needed to determine the effectiveness of acupuncture.

    This high quality meta-analysis does not itself provide a strong warrant for the effectiveness of acupuncture.

    The Cochrane meta-analysis had nearly six times more subjects than Wang H. drawn from 30 studies.

    It is surprising that Wang J. identified the Wang H. meta-analysis but not the larger Cochrane meta-analysis. Both reviews reached identical conclusions: poor quality studies exist which do not warrant firm conclusions regarding efficacy of acupuncture for depression; there exists a need for higher powered, higher quality studies.

    We can properly say that the all the evidence we have at present, from all around the world, is consistent with acupuncture being no more effective than placebo for depression.

  113. #113 Agashem
    Chion on lap
    August 10, 2013

    ChinaMyte: since there are so many acupuncture points and meridians that have increased quite a lot from the original 365 points, doesn’t that show how silly this is? How do you explain ear points for organs and hand points for organs and foot points for organs? Do you believe the body is wired that way? Melzack has done repeated studies on acupuncture and his results show that TENS is as effective (placebo grade). Why do you persist on puncturing the skin when an electrode on the surface is as effective? What about moxibustion? Is it needed to make acupuncture more effective or is it effective on its own? How can you advocate burning anything on anyone’s skin in this day and age when there are much safer options out there? Show me how acupuncture is advancing and changing in the face of new medical discoveries of how the body works.

  114. #114 Krebiozen
    August 10, 2013

    I’m locked out of the back end

    I think there’s an ointment that can help with that.
    Seriously, I hope you get it fixed soon.

  115. #115 Krebiozen
    August 10, 2013

    When I look at the bloodletting that some TCM practitioners still use i.e. wet cupping, Islamic bloodletting that still exists, and the pulses that TCM practitioners take so seriously, it seems obvious to me that TCM generally is functionally identical to medieval medicine based on humors. I honestly don’t understand why anyone bothers with it.

  116. #116 JGC
    August 12, 2013

    However, there is no single study, nor should there ever be, that proves efficacy of anything, including Chinese Medicine

    I haven’t asked for a single study which proves the efficacy of acupuncture but instead which study you believe provides the most compelling evidence that “Chinese Medicine” is effective at treating non-self-limiting injury or illness.

    Pick the best study from the Gish Gallop list you posted, or pick an entirely different study, and let’s discuss that evidence.

  117. #117 JGC
    August 12, 2013

    sorry–should read “but instead which study you believe provides the most compelling evidence that acupuncture is effective at treating non-self-limiting injury or illness, as I think it’s best we focus on a specific treatment modality.

  118. #118 Bronze Dog
    August 12, 2013

    We’re asking for one good study that provides compelling evidence that one acupuncture treatment works on one non-self-limiting condition. We don’t expect the whole shebang at once and it should be understandable that we’d want evidence behind one acupuncture claim as a starting point.

  119. #119 Jing
    Toronto
    August 29, 2013

    Scott Spurrell is not a licensed acupuncturist under TCM Acupuncture College ;Scott Spurrell is a licensed registered massage therapist -RMT. under massage therapy College .In Ontario ( or Canada ),RMT got gov permission to do Acupuncture. It is not illegal for RMT do Acupuncture.

  120. #120 Jing
    Toronto
    August 29, 2013

    S Scott Spurrell is not a licensed acupuncturist under TCM Acupuncture College ;Scott Spurrell is a licensed registered massage therapist -RMT. under massage therapy College .In Ontario ( or Canada ),RMT got gov permission to do Acupuncture. It is not illegal for RMT do Acupuncture.

  121. [...] However, she was also recovering from injuries suffered in an auto collision and seeing Scott Spurrell, a massage therapist who had learned acupuncture during a weekend course at a local university. She was suffering from pounding headaches, and Spurrell convinced her that he could relieve those headaches by inserting a two inch needle, according to the disciplinary ruling, into a muscle located between the clavicle bone and ribs. From the description, its not clear to me exactly which muscle they meant, although it could conceivably have been the scalenes, the sternocleidomastoid, or perhaps even just the pectoralis major. Whatever muscle Spurrell was targeting, going between the clavicle and the ribs is basically where surgeons stick the needle when trying to place central venous catheter into the subclavian vein, and, yes, a pneumothorax is a known potential complication of placing such lines. What also puzzles me is how on earth Spurrell could have stuck the needle in deep enough to cause a pneumothorax? It would be one thing if Ribble-Orr were a fragile little old lady, but she wasnt. She was an athlete, presumably with well-developed musculature. It would take a lot to get a needle through all of that muscle to get to the pleural cavity. As can happen from a pneumothorax, even in a healthy person, Kibble-Orr developed pneumonia and required a thoracotomy. To be honest, its not clear from the account provided why she needed a thoracotomy, but its clear that the pneumothorax led to a cascade of complications, as described: Shortly after leaving the clinic, Ms. Ribble-Orr began having difficulty breathing, chest pain and a grinding sensation. She returned to the therapist later, wondering if she had suffered a pneumothorax. He told her it was more likely a muscle spasm, but said she could go to the hospital if she felt it was more serious or if the symptoms worsened. The next morning, she did feel worse and finally headed to the emergency department. Ms. Ribble-Orrs lung had indeed collapsed and she spent the next two weeks in hospital, as a serious lung infection and then a blood infection followed. She was left with just 55% function in one lung. One notes that if you do not have the knowledge to recognize symptoms and signs of potential complications resulting from your treatment, you have no business administering that treatment. It used to be that if you didnt know how both to recognize and treat potential complications of your treatment, you shouldnt be administering that treatment, but those days are gone. For instance, gastroenterologists do colonoscopies, even though they are not able to repair the inevitable (and thankfully uncommon) colon perforations that are a recognized risk of the procedure. But they can recognize the signs and symptoms. They know how to diagnose a potential perforation and when to call a surgeon to fix it. Spurrell was clearly utterly clueless, basically dodging responsibility by telling Kibble-Orr that she could go to the ER if she wanted to. Obviously, he didnt think that she needed to. What should have happened, if Spurrell knew what he was doing, was a quick physical exam, which likely would have diagnosed a significant pneumothorax, through decreased breath sounds or and elevated diaphragm on the affected side, or both. For the original version including any supplementary images or video, visit http://scienceblogs.com/insolence/2013/07/08/acupuncture-small-risks-versus-no-benefit/ [...]

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