Insomnia, Blue Light and the Yin of the Yin

This article in Psychology Today entitled "Blue Light and Sleepless Nights" (Insomnia is no match for the sun) by Sarah Korones reinforces a classic teaching in Chinese Medicine. The balance of Yin and Yang. We are in deepest winter, or the Yin of the Yin when it comes to seasons. So to provide balance, we need to receive the Yang of the Yang. The Yang is the day, and when the sun is at its peak, that is the Yang of the Yang. So for better sleep, it is important to get out in the sun, if possible, at midday for maximum benefit. This applies the whole year, but now it's especially important to be mindful since daylight is more limited, so you have to plan. This same principle pertains to people with S.A.D. (Seasonal Depressive Disorder) also. They need to get out in the middle of the day and take in those light rays.This article spells out the science behind this yin and yang balance. Nice.

Insomnia-a common and difficult-to-treat condition-is estimated to cost the American economy $63.2 billion each year in lost productivity. A new body of research suggests that a cure might be as simple as soaking up some sun.
Blue light, a part of the visitble spectrum in solar rays, keeps us perky during th day, by suppresing the release of melatonin, the hormone that causes sleepiness. But when we spend our time cooped up indoors, our eyes fail to take in the proper amount of light, and we never get an internal signal to sleep at night.
"If you don't have a change in melatonin levels during the wr hours of the day, your body doesn't know when to rest and when to stay awake,.."

Suggestions include
-Take your lunch outside or walk to sowrk, when the sun is at its brightes
-Read a book before bedrtime rather than watching TV. The light might turn off your melatonin and impede sleep.
-Take off your sunglasses, at least for awhile during the day to get that blue light

Complexity Science and CAM: More Mental Models

I will divide this topic into two posts since this article touches on more than one meaty subjects.
Applying Principles from Complex Systems to Studying the Efficacy of CAM Therapies
This article was published over a year ago, but I missed it. The lead author, Andrew Ahn, is a fellow I had met at the SAR (Society for Acupuncture Research) meeting in North Carolina in 2010, discussed briefly here. The article is available in its entirety. I will point out a few points that are of interest to me in particular. My research has involved HRV (Heart Rate Variability) analysis in conjunction with acupuncture. It makes sense to do this if you recognize that acupuncture cannot be explained in a linear, mechanistic fashion. I discussed some of these dilemmas here and here. So Dr. Ahn grapples with ways to study these nonlinear phenomena in this article, describing a workshop he had attended. He says,

"This discusses possible benefits and challenges associated with applying complexity science to CAM research...
Complexity theory provides a theoretical framework for evaluating and analyzing complex systems. These systems are “complex,” because they exhibit global properties not made obvious from the properties of the individual components, and they are “systems,” because they are composed of interconnected parts. Historically, complexity theory borrows concepts and tools from a range of disciplines, including chaos theory (physics), control theory (engineering), cybernetics (mathematics), and General Systems Theory (biology). More broadly, these disciplines share a common theme of nonlinearity—a concept maintaining that the size of an output is not proportional to the size of an input.
Terms such as adaptability, robustness, or health were previously considered qualitative terms and thus were quantitatively intractable. Yet, complexity science has identified analytical methods that can help assess these features... Finally, complexity science offers a conceptual framework that reflects reality better. In the real world, small inputs can have large effects, processes are dynamic, interactive effects can span across many temporal and spatial scales, and transformations from one state to another can happen gradually or precipitously...

There is a lot here. As I discussed previously in my "argument" with Dr. Longhurst over whether I was actually giving continuous stimulation with manual acupuncture, clinical outcomes attest that I get results without continuous stimulation. This requires that one sees acupuncture as setting a cascade in motion of self healing or self regulation in response to the tiny injury incurred, rather than a nerve stimulation directly to the spinal canal, brain that needs continuous input.
He also echoes one of my favorite ways of describing acupuncture's effect on the body, that it makes it sturdier, more robust, more resilient (spoke about it in this interview.) As he says "these were qualitative terms and thus were quantitatively intractable." The search for biomarkers of health, or healthy response can be seen in the testing for telomere length, HRV, galvanic skin response, or electrical impedance at acupoints. My own interest is in HRV as a measure of health and stress level or ability to respond. I will discuss this more in the next post using Dr. Ahn's article
More on the practice here.

Tragic. High Cost of Failing Artificial Hips

To be filed under "Follow the Money." This has got to be horrendous for patients since you know that the insurance company's costs will be reimbursed first since they can hire more lawyers. And to have to be dealing with these kinds of financial issues and law suits when you're not feeling well. Horrible. Some excerpts follow. I've been following this story for the 6 months and it follows the typical trajectory of the companies ignoring complaints, blaming the physicians and then finally having to cop to the problem. Not good. Not good at all. Recent blog post on topic here.
The High Cost of Failing Artificial Hips
By BARRY MEIER

The most widespread medical implant failure in decades — involving thousands of all-metal artificial hips that need to be replaced prematurely — has entered the money phase.

Medical and legal experts estimate the hip failures may cost taxpayers, insurers, employers and others billions of dollars in coming years, contributing to the soaring cost of health care. The financial fallout is expected to be unusually large and complex because the episode involves a class of products, not a single device or just one company...

The incidents have set off a financial scramble. Recently, lawsuits and complaints against makers of all-metal replacement hips passed the 5,000 mark. Insurers are alerting patients that they plan to recover their expenses from any settlement money that patients receive. Medicare is also expected to try to recover its costs...
Still, some patients are weathering some of the financial impacts on their own. While Charmin McCune, a teacher in Wylie, Tex., is recuperating well from a recent replacement operation, she said that she and her husband, also a teacher, have had more than $12,000 in expenses that have not been covered by insurance.

Information on my practice here.

Story of Stress and Disease: Robert Ader Pioneering Psychologist

This is the story of Robert Ader who first coined the term "psychoneuroimmunology" or PNI. If you're interested in stress and disease, as I am, you probably would like to read the whole article. A few excerpts here.

Robert Ader, Who Linked Stress and Illness, Dies at 79
By PAUL VITELLO

Dr. Robert Ader, an experimental psychologist who was among the first scientists to show how mental processes influence the body’s immune system, a finding that changed modern medicine, died on Tuesday in Pittsford, N.Y. He was 79...

His initial research, in the 1970s, became a touchstone for studies that have since mapped the vast communications network among immune cells, hormones and neurotransmitters. It introduced a field of research that nailed down the science behind notions once considered magical thinking: that meditation helps reduce arterial plaque; that social bonds improve cancer survival; that people under stress catch more colds; and that placebos work not only on the human mind but also on supposedly insentient cells.

At the core of Dr. Ader’s breakthrough research was an insight already obvious to any grandmother who ever said, “Stop worrying or you’ll make yourself sick.” He demonstrated scientifically that stress worsens illness — sometimes even triggering it — and that reducing stress is essential to health care...
“My father used to say, ‘I just didn’t know any better,’ ” she said, recounting how he had described his pioneering research.

He told her, she recalled, “I didn’t know the immune system wasn’t supposed to be connected to the brain.”

Information on my practice here.

New Joint Implants no Better Than Older Ones

Filed under "Follow the Money"
December 22, 2011
New Models of Implants Not Better, Study Finds
By BARRY MEIER

A new study suggests that the recent technology for artificial hips and knees did not perform any better than older, less expensive designs.

The study, which draws on data from Australia’s orthopedic registry, covered implants introduced from 2003 to 2007 and was published this week. The findings are significant for patients in the United States because many of the new designs, like so-called metal-on-metal hips, are widely used here. Those implants, which have both a ball and cup made of metal, are expected to fail prematurely in tens of thousands of patients rather than lasting 15 years or more as artificial joints are supposed to do.
The Australian study showed that not a single new artificial hip or knee introduced over a recent five-year period was any more durable than older ones. In fact, 30 percent of them fared worse...


“Not only has the introduction of this technology been potentially detrimental to patient care, but the current approach may be an important driver of increased health care costs,” the review concluded...

That review, by researchers in Austria (mistake, should be Australia), found that surgeons involved in the original published reports are often involved in its development and may have a financial stake in them. In addition, such reviews tend to be short term...
This month, bipartisan legislation was introduced in the Senate that could force manufacturers to track the performance of implants like artificial hips after they have been approved for sale. Proponents of the bill acknowledge that the measure faces an uphill fight.
Both device producers and their allies in Congress have maintained that any additional F.D.A. regulations would slow the development and marketing of innovative products that benefit patients. For his part, Dr. Graves, the Australian official, said he believed that such arguments were misleading.

Where have we heard that before?? That regulation will somehow damage innovation, or hurt business and job creation? Just about every time any sort of regulation is proposed, that's when.
Info on my practice here.

Getting Rid of Mercury, Good News for Once

Tremendous health news. EPA will regulate mercury from coal plants. This is to be filed in the "First Do No Harm" file, but is a tremendous victory for regulation and standing up to moneyed interests. I will link you to Paul Krugmans' blog post on the subject. But I especially like that he says "This is actually a much bigger issue, when it comes to saving American lives, than terrorism." I always look at the numbers and there are a lot preventable causes of death and disability that are more dangerous than terrorism, yet it is terrorism that gets all the attention, and, of course, money. No money in prevention, lets face it. I've cut down the post, so feel free to link to the full one.

The Meaning of Mercury

Let me repeat part of that: it will save tens of thousands of lives every year and prevent birth defects, learning disabilities, and respiratory diseases. This is actually a much bigger issue, when it comes to saving American lives, than terrorism.

As Roberts explains, we’ve known about these costs of mercury pollution for decades, yet it took until now to get something done. The reason is, of course, obvious: special interests, hiding behind claims of immense economic damage if anything was done, were able to block action.

It’s worth noting that these claims of economic harm from pollution regulation have always been proved wrong when the regulation finally came. Ozone regulation was supposed to cripple the economy; so was acid rain regulation; neither did.

Oh, and if we’re going to have to scrap some power plants and replace them, it’s hard to think of a better time to do it than now, when the workers and resources needed to do the replacing would largely have been unemployed otherwise...

Info on the practice here.

Placebo and Acupuncture vs Acupuncture for Dogs

Compare and contrast.
A study looking AGAIN at acupuncture for osteoarthritis after the biggest study ever done on acupuncture put the placebo issue to rest. Why don't we see this scrutiny with anti-depressant studies? Or stents? There can actually be some hazards with either of those...
Meanwhile other groups are moving on and using acupuncture in dogs for post operative pain. Because it's all about the placebo effect...

Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture.
White P, Bishop FL, Prescott P, Scott C, Little P, Lewith G
Faculty of Health Sciences, University of Southampton, Highfield, Southampton, UK.
Abstract
The individual practitioner and the patient's belief had a significant effect on outcome. The 2 placebos were equally as effective and credible as acupuncture. Needle and nonneedle placebos are equivalent. An unknown characteristic of the treating practitioner predicts outcome, as does the patient's belief (independently). Beliefs about treatment veracity shape how patients self-report outcome, complicating and confounding study interpretation.

Electroanalgesia for the postoperative control pain in dogs.
Cassu RN, Silva DA, Genari Filho T, Stevanin H.Acta Cir Bras. 2012 Jan;27(1):43-8.
Unoeste, Presidente Prudente, SP, Brazil.
To evaluate the analgesic and neuroendocrine effects of electroanalgesia in dogs undergoing ovariohysterectomy.
RESULTS: EA and EAD- treated dogs had lower pain scores than DER treated dogs one hour postoperatively. Fewer EA and EAD-treated dogs required rescue analgesia. Serum cortisol did not differ among treatments.
CONCLUSION:Preoperative application of electrical stimuli to acupuncture points isolated or in combination with peri-incisional dermatomes provides a reduced postoperative opioid requirement and promotes an effective analgesia in dogs undergoing ovariohyterectomy.

So do dogs' beliefs influence outcomes too?

Info on my practice here.

Acetaminophen and Asthma

To be filed in the "I did not know that" file. I have my Pediatric Boards, but apparently have not kept up in a meaningful way. I certainly remember the shunning of aspirin because of Reye's syndrome. So odd that we might have caused a problem of a different sort. There are so many interesting aspects to this article, I will highlight a few, please link on the title for the whole article. I read (somewhere) that acetaminophen was a significant contributor to renal failure also. Yikes. Just shows, even the most benign of pharmaceuticals can have unpredictable side effects. Info on my practice here.

Studies Suggest an Acetaminophen-Asthma Link

By CHRISTIE ASCHWANDEN

THE HYPOTHESIS

Acetaminophen increases the risk of childhood asthma.

THE INVESTIGATOR Dr. John T. McBride, Akron Children’s Hospital.

The sharp worldwide increase in childhood asthma over the past 30 years has long perplexed researchers, who have considered explanations as varied as improved hygiene and immunizations. Over the last decade, however, a new idea has emerged.

The asthma epidemic accelerated in the 1980s, some researchers have noted, about the same time that aspirin was linked to Reye’s syndrome in children. Doctors stopped giving aspirin to children with fevers, opting instead for acetaminophen. In a paper published in The Annals of Allergy and Asthma Immunology in 1998, Dr. Arthur Varner, then a fellow in the immunology training program at the University of Wisconsin School of Medicine, argued that the switch to acetaminophen might have fueled the increase in asthma.

Since then, more than 20 studies have produced results in support of his theory, including a large analysis of data on more than 200,000 children that found an increased risk of asthma among children who had taken acetaminophen. In November, Dr. John T. McBride, a pediatrician at Akron Children’s Hospital in Ohio, published a paper in the journal Pediatrics arguing that the evidence for a link between acetaminophen and asthma is now strong enough for doctors to recommend that infants and children who have asthma (or are at risk for the disease) avoid acetaminophen.

Dr. McBride based his assertion on several lines of evidence. In addition to the timing of the asthma epidemic, he said, there is now a plausible explanation for how acetaminophen might provoke or worsen asthma, a chronic inflammatory condition of the lungs. Even a single dose of acetaminophen can reduce the body’s levels of glutathione, an enzyme that helps repair oxidative damage that can drive inflammation in the airways, researchers have found....

For instance, a study published in The Lancet in 2008 examined information collected on more than 205,000 children from 31 countries as part of the International Study of Asthma and Allergies in Childhood, known as the Isaac study. The 2008 analysis found that children who had taken acetaminophen for a fever during the first year of life had a 50 percent greater risk of developing asthma symptoms, compared with children who had not taken the drug. The risk rose with increasing use — children who had taken acetaminophen at least once a month had a threefold increase in the risk of asthma symptoms.

A study published by British researchers in 2000 using data from the Isaac study found that the prevalence of asthma increased in lock step with sales of acetaminophen in the 36 countries examined. The more acetaminophen used in a country, the greater that country’s prevalence of asthma.

A meta-analysis published in 2009 calculated that children who had taken acetaminophen in the past year had nearly double the risk of wheezing compared with those who had not taken the drug. “We know that acetaminophen can cause increased bronchial constriction and wheezing,” said Mahyar Etminan, a pharmacoepidemiologist at the University of British Columbia and lead author of the study....

So far, only one randomized controlled trial has investigated the link. Researchers at Boston University School of Medicine randomly assigned 1,879 children with asthma to take either acetaminophen or ibuprofen if they developed a fever. The results, published in 2002, showed that children who took acetaminophen to treat a fever were more than twice as likely to seek a doctor’s care later for asthma symptoms as those who took ibuprofen...”..

Acetaminophen has been shown to reduce the antibody response to immunizations, so the drug should not be given to children in advance of a vaccination, Dr. Beasley also noted...

De Qi versus Psychological Factors and Acupuncture Efficacy

I have cut this description of the study. Please click on the title for the full abstract.

De-qi, not psychological factors, determines the therapeutic efficacy of acupuncture treatment for primary dysmenorrhea.
Xiong J, Liu F, Zhang MM, Wang W, Huang GY. Chin J Integr Med. 2011 Oct 12. [Epub ahead of print] Institute of Integrated Traditional and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
OBJECTIVE:
To study the impact of De-qi (, obtaining qi) and psychological factors on the efficacy of acupuncture treatment for primary dysmenorrhea, with an attempt to explore the relationship among De-qi, psychological factors, and clinical efficacy.
RESULTS:
Complete data were obtained from 120 patients, 60 patients in each group. There were statistically significant differences in pain intensity (W=2410.0, P<0.01) and pain duration (W=3181.0, P<0.01) between the two groups. The number of De-qi acupoints (W=1150.5, P<0.01) and the average intensity of De-qi (W=1141.0, P<0.01) were significantly higher in the manipulation group as compared with their non-manipulation counterparts. The correlation coefficients between De-qi and therapeutic efficacy of acupuncture were greater than those between psychological factors and therapeutic efficacy.
CONCLUSIONS:
Compared with the psychological factors, De-qi contributed more to the pain-relieving effect of acupuncture in subjects with primary dysmenorrhea. Moreover, manual manipulation is a prerequisite for eliciting and enhancing the De-qi sensations, and De-qi is critical for achieving therapeutic effects.

If we try to figure out why a De Qi sensation would be key to effectiveness (my teachers from Shanghai insisted that it wasn't, btw) maybe it's because acupuncture mimics an insect bite or some other insult encountered in nature that would start a healing cascade. Just thinking, thinking... Trying to come up with a mental model.
More on the practice here.

Acupuncture Saves Money for Low Back Pain Treatment in Canada

This might seem obvious, Great Britain prioritizes acupuncture for the same reason, to save money and spend on treatments that work. It's all about incentives... I've cut it down, so please click on title for full abstract.
Reduced health resource use after acupuncture for low-back pain.
Moritz S, Liu MF, Rickhi B, Xu TJ, Paccagnan P, Quan H.
J Altern Complement Med. 2011 Nov;17(11):1015-9. Epub 2011 Nov 9.
1 Canadian Institute of Natural and Integrative Medicine , Calgary, Alberta, Canada .
Abstract Objectives: Acupuncture is commonly used to treat low-back pain (LBP) and clinical trials have demonstrated its efficacy. However, less is known about how the utilization of acupuncture impacts public health service utilization in the real world. This study investigates the association between acupuncture utilization for LBP and health care utilization by assessing whether patients who undergo acupuncture subsequently use fewer health care resources and whether those patients differ in their health care use from the general population with LBP. Results: For the 201 cases and 804 controls, the mean age was 48 years and 54% were female. The number of physician visits for the 1-year period postacupuncture decreased 49% for the acupuncture group (p<0.01) compared to the 1-year period preacupuncture. For the comparison there was a decrease of 2% in physician visits (p=0.59) for the same time periods. Corresponding to the decrease, physician services cost declined 37% for the case group (p=0.01) and 1% for the comparison (p=0.86). Conclusions: Results suggest that patients with LBP were less likely to visit physicians for LBP after acupuncture treatment. This led to reduced health services spending on LBP.

Info on my practice here.

HIV Peripheral Neuropathy, Acupuncture and Amitrypiline

This was actually a re-evaluation of a previous study on HIV neuropathy and acupuncture. I've cut it down, please link on the title for the full source.

Effects of acupuncture in reducing attrition and mortality in HIV-infected men with peripheral neuropathy.
Shiflett SC, Schwartz GE.
Laboratory for Advances in Consciousness and Health, Department of Psychology, University of Arizona, Tucson, USA. shiflett@email.arizona.edu
Abstract
A clinical trial reported in JAMA (Shay et al, 1998), involving acupuncture and amitriptyline in HIV-infected patients, concluded that there was no effect for either acupuncture or amitriptyline on neuropathic pain. However, a recent reassessment of this study showed that there were really three different and independent clinical trials, each with a different research design, which had been combined into a single database and consequently analyzed with a relatively insensitive statistics. When only the first substudy, factorially crossed design involving acupuncture and amitriptyline, was reanalyzed by itself using more powerful statistics, it was found that acupuncture and amitriptyline both worked independently to reduce pain, but also that acupuncture worked best in the absence of amitriptyline, and that there may have been adverse events associated with the combination of the two treatments. ..
RESULTS:
Whereas the results were inconclusive for the pain measures, acupuncture had a strong and positive effect on attrition and mortality...
CONCLUSIONS:
Acupuncture was clearly effective in reducing attrition and mortality in this sample, especially when health status was taken into account, but results for pain relief were mixed...The combined results of these two studies strongly support the importance of recognizing that interactions involving acupuncture and other treatments, may positively as well as negatively modify main effect results in clinical trials, and thus must be recognized and systematically explored...

Lots of interesting results in this study. First is that they took the time to re-evaluate a previous study. Two, that they were able to distinguish an actual difference in mortality rates. Three, that the combination of amitryptiline and acupuncture were not as effective. The only drug commonly stated to interfere with acupuncture is Prednisone. But I've privately wondered if Neurontin (Gabapentin) doesn't interfere with acupuncture also. Now questions about amitryptiline.
This is an important question, not only clinically, but because it may help us to understand the mechanism of action. For example, taking Prednisone may down regulate, or muck up the hypothalamic/pituitary axis response to acupuncture. Gabapentin is thought to reduce calcium currents in the brain, so perhaps that's part of the mechanism of action of acupuncture. Amitryptiline is a serotonin-norepinephrine reuptake inhibitor, so may, again, somehow interfere with acupuncture's effect.
more on my practice here

Anti-inflammatory effects of Electro Acupuncture: Part 3

And just a quick case study concerning the same topic of electro acupuncture and lung function. I started treating a patient with moderately severe asthma and exczema 2 weeks ago. He has had both conditions since grade school, and now is in his early 40's. He had never tried acupuncture but was desperate, since he was using his inhaler 10 times a day. I gave him two sided acupuncture beginning prone, with standard points for the lungs and asthma adding electro acupuncture at 23 Bladder for immune function. Then supine, again, with standard points.(Write to me if you'd like the point prescription.)
He was a profound responder. After one treatment he didn't need to use his inhaler and was able to play soccer again after months of having to avoid activity,
Asthma has always had the triad of bronchoconstriction, inflammation and mucous production. More recently (15 years maybe) inflammation is considered the most predominant component. And asthma treatment has changed accordingly.
In light of the previous posts on the anti-inflammatory effects of acupuncture, my patients' course makes much more sense. If the main mechanism of acupuncture's action was bronchodilation, you would not expect the effect to be so long lasting after a single treatment. Most likely the electro acupuncture on Bladder 23 decreased pro-inflammatory agents,( or other points as well.)
Practice info here.

Anti-inflammatory effects of Electro Acupuncture: Part 2

The antioxidative effect of electro-acupuncture in a mouse model of Parkinson's disease.

Neuroscience Research Institute, Peking University, Beijing, People's Republic of China.

Abstract

Accumulating evidence indicates that oxidative stress plays a critical role in Parkinson's disease (PD). Our previous work has shown that 100 Hz electro-acupuncture (EA) stimulation at ZUSANLI (ST36) and SANYINJIAO (SP6) protects neurons in the substantia nigra pars compacta from 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) toxicity in male C57BL/6 mice, a model of PD. In the present study we administered 100 Hz EA stimulation at the two acupoints to MPTP-lesioned mice for 12 sessions starting from the day prior to the first MPTP injection. We found that in the striatum of MPTP treated mice 100 Hz EA stimulation effectively inhibited the production of hydrogen peroxide and malonaldehyde, and increased glutathione concentration and total superoxide dismutase activity through biochemical methods. However, it decreased glutathione peroxidase activity via biochemical analysis and did not affect the level of 1-methyl-4-phenylpyridinium in the striatum revealed by high performance liquid chromatography with ultraviolet detection. These data suggest that 100 Hz EA stimulation at ST36 and SP6 has antioxidative effects in the MPTP model of PD. This data, along with our previous work, indicates that 100 Hz EA stimulation at ST36 and SP6 protects the nigrostriatal system by multiple mechanisms including antioxidation and antiapoptosis, and suggests that EA stimulation is a promising therapy for treating PD.

As in the previous post, application of electro acupuncture remote from the site of the damage, can be effective. This has changed the way I practice acupuncture. Info on the practice here.

Anti-inflammatory effects of Electro Acupuncture: Part 1

Anti-inflammatory effects of electroacupuncture in the respiratory system of a symptomatic amyotrophic lateral sclerosis animal model.

Department of Standard Research, Korea Institute of Oriental Medicine, Daejeon, Korea.Jiang JH, Yang EJ, Baek MG, Kim SH, Lee SM,

Abstract

BACKGROUND:

Because amyotrophic lateral sclerosis (ALS) is a progressive inflammatory disease, treatment of the pulmonary system plays a key role in ALS patients' care. Previous studies have mainly examined the pathological mechanism of ALS in the central nervous system; however, there has been relatively little research regarding the pulmonary system in ALS animal models. In inflammatory diseases, including asthma and arthritis, electroacupuncture (EA) is commonly used for its anti-inflammatory effects. The goal of this study was to determine whether EA treatment affects inflammation in the pulmonary system in an ALS animal model.

METHODS:

EA treatment at ST36 (Zusanli) acupoint was performed with 14-week-old hSOD1(G93A) transgenic mice. (details were then given of the Western blot for certain biomarkers, please go to the abstract for details.)

RESULTS:

EA treatment decreased the expression of the proinflammatory proteins such as TNF-α and IL-6, pNF-κB, and Iba-1 and increased the level of activated pAKT and pERK compared to control hSOD1(G93A) mice.

CONCLUSIONS:

Our findings suggest that EA could be an effective anti-inflammatory treatment for the respiratory impairment that occurs in ALS animal models.

I reported in an earlier post about Dr. Hiramitsu's study at the ISAMS conference on electroacupuncture at Ming Men in arthritic mice showing decreased inflammation. This was remarkable to me because of the fact that the electroacupuncture was not at the joint itself. Now in this study, we see the same phenomenon, of electroacupuncture at Stomach 36 causing decreased levels of proinflammatory biomarkers.

Information on my practice here.

Hot Flashes, Acupuncture and the Adrenal Pituitary Axis

I really like this study because it identifies the mechanism of action as being the pituitary/adrenal axis. That's what my research is all about.

Menopause. 2011 Sep 30.
A pilot randomized, single-blind, placebo-controlled trial of traditional acupuncture for vasomotor symptoms and mechanistic pathways of menopause.
Painovich JM, Shufelt CL, Azziz R, Yang Y, Goodarzi MO, Braunstein GD, Karlan BY, Stewart PM, Merz CN.
The aim of this study was to conduct a pilot study for the feasibility of planning a definitive clinical trial comparing traditional acupuncture (TA) with sham acupuncture (SA) and waiting control (WC) on menopause-related vasomotor symptoms (VMS), quality of life, and the hypothalamic-pituitary-adrenal axis in perimenopausal and postmenopausal women.
METHODS:
Thirty-three perimenopausal and postmenopausal women with at least seven VMS daily were randomized to TA, SA, or WC. The TA and SA groups were given three treatments per week for 12 weeks. Outcomes included the number and severity of VMS, Menopause-Specific Quality of Life Questionnaire, Beck Depression Inventory, Spielberg State-Trait Anxiety Instrument, Pittsburgh Quality Sleep Index, 24-hour urine cortisol and metabolites, and adrenocorticotropic hormone stimulation testing.
RESULTS:
Both the TA and SA groups demonstrated improved VMS trends compared with the WC group (? -3.5 ± 3.00 vs -4.1 ± 3.79 vs -1.2 ± 2.4, respectively; P = 20) and significantly improved Menopause-Specific Quality of Life Questionnaire vasomotor scores (? -1.5 ± 2.02 vs -1.8 ± 1.52 vs -0.3 ± 0.64, respectively; P = 0.04). There were no psychosocial group differences. Exit 24-hour urinary measures were lower in the TA versus the SA or WC group in total cortisol metabolites (4,658.9 ± 1,670.9 vs 7,735.8 ± 3,747.9 vs 5,166.0 ± 2,234.5, P = 0.03; respectively) and dehydroepiandrosterone (41.4 ± 27.46, 161.2 ± 222.77, and 252.4 ± 385.40, respectively; P = 0.05). The response data on adrenocorticotropic hormone stimulation cortisol also trended in the hypothesized direction (P = 0.17).
CONCLUSIONS:
Both TA and SA reduce VMS frequency and severity and improve VMS-related quality of life compared with WC; however, TA alone may impact the hypothalamic-pituitary-adrenal axis. This association is viewed as preliminary and hypothesis generating and should be explored in a large clinical trial.

Nice.
More on the practice here.

PCOS and Acupuncture: Sham versus True

Bottom line, no difference. Both help the LH to FSH ratio

True and sham acupuncture produced similar frequency of ovulation and improved LH to FSH ratios in women with polycystic ovary syndrome.
Pastore LM, Williams CD, Jenkins J, Patrie JT.J Clin Endocrinol Metab. 2011 Oct;96(10):3143-50. Epub 2011 Aug 3.
Source

Department of Obstetrics/Gynecology, University of Virginia, Charlottesville, Virginia 22908, USA. lpastore@virginia.edu
Acupuncture may represent a nonpharmaceutical treatment for women with polycystic ovary syndrome (PCOS), based on four studies.
OBJECTIVE:

The objective of the study was to determine whether true, as compared with sham, acupuncture normalizes pituitary gonadotropin hormones and increases ovulatory frequency in women with PCOS.
DESIGN:
This was a randomized, double-blind, sham-controlled clinical trial (5 month protocol).
Intervention included 12 sessions of true or sham acupuncture (Park sham device) for 8 wk.
MAIN OUTCOME MEASURES:
Serum LH and FSH at baseline, after intervention, and 3 months later were measured. Ovulation was measured with weekly urine or blood samples.
RESULTS:Both arms demonstrated a similar mean ovulation rate over the 5 months (0.37/month among n = 40 true acupuncture and 0.40/month among n = 44 sham participants, P = 0.6), similar LH to FSH ratio improvement (-0.5 and -0.8 true and sham, respectively, P < 0.04 after intervention vs. baseline) and a similar decline in LH over the 5-month protocol (P < 0.05). Neither arm experienced a change in FSH. There were seven pregnancies (no difference by intervention, P = 0.7). Lower fasting insulin and free testosterone were highly correlated with a higher ovulation rate within the true acupuncture group only (P = 0.03), controlling for prestudy menstrual frequency and body mass index.
CONCLUSION:
We were unable to discern a difference between the true and sham acupuncture protocols for these women with PCOS, and both groups had a similar improvement in their LH/FSH ratio.

Again, depends on your model whether it was a real sham or not.
more on my practice here

Acupuncture and Nerve Pain from Cancer

Science News

Acupuncture May Ease Severe Nerve Pain Associated With Cancer Treatment, Study Suggests

Cancer patients treated with taxanes, vinca alkaloids, or platinum compounds can develop a condition known as chemotherapy induced peripheral neuropathy, or CIPN for short, as a by-product of their treatment. These powerful drugs can damage peripheral nerves, particularly in the calves and feet, which can result in severe nerve pain and/or difficulty walking. As yet, there is no effective antidote.

Out of a total of 192 patients with peripheral neuropathy eligible for inclusion in the study, 11 had developed their symptoms during a course of chemotherapy for various types of cancer. Six of these patients agreed to undergo acupuncture; the other five served as a comparison group.

Twenty needles were inserted at prescribed points and depths and left in place for 20 minutes during each of the 10 sessions. These were delivered over a period of three months by a senior doctor, who had been fully trained in acupuncture and had used the technique for 20 years.

Nerve conduction studies, to assess the signalling speed and intensity of two nerves in the same calf were carried out before acupuncture and again six months after chemotherapy in the six volunteers. The same studies on patients in the comparison group were carried out after they had completed their chemotherapy and then again six months later.

In those given acupuncture, both the speed and the intensity of the nerve signalling improved in five out of the six patients. And these same patients said their condition had improved. Among those in the comparison group, speed remained the same in three, fell in one, and improved in one. Intensity remained the same in one, improved in two, and decreased in two.

The authors point to previous research, which suggests that acupuncture may boost blood flow in the legs, which may in turn aid the repair of nerve damage.

I had seen the abstract of this study, but not the article. Nice write up if you want to read the whole thing.

More on my practice here.

Max Planck and Stephen Gould:Hard and Soft Science

I lamented in a previous post about the fact that many fine minds will avoid the softer and more complicated world of medicine.
In John Sarno's book "The Divided Mind," he quotes Stephen J. Gould who has the same complaint in Natural History. "An unfortunate but regrettable common stereotype about science divides the profession into two domains of different status. We have, on the one hand, the 'hard' or physical sciences that deal in numerical precision, prediction and experimentation. On the other hand, the 'soft' sciences that treat the complex objects of history in all their richness must trade these virtues for 'mere' description without firm numbers in a confusing world where, at best, we can hope to explain what we cannot predict. The history of life embodies all the messiness of this second and undervalued, style of science."
Granted, he's talking about history and not medicine. But some of the same problems are in both. No rock solid predictability. Many and messy variables.
info on the practice here.

Adler and the Autonomic Nervous System via Sarno

I've been reading "The Divided Mind" by John Sarno. He is a physician rehab specialist who has made a name for himself identifying psychological causes of musculoskeletal pain. (See this previous post.) Alfred Adler joined Freud in 1902, but then split off because of differences in "models"(my term.) According to Sarno, "he was the first to recognize that the psyche could induce physical symptoms by initiating physiological pathology." Adler wrote " The mind is able to activate the physical conditions. The emotions and their physical expressions tell us how the mind is wcting and reacting in a situation it interprets as favorable or unfavorable." "A mental tension affects both the ectral nervous system and the autonomic nervous system." The body through the autonomic nervsou system, the vagus nerve and the endocrine vatiations, is set into movement which can manifest itself in alterations of the blood circulation, of the secretions, of the muscle tonus, and of almost all the organs."

I like this because of what I've seen in my own clinic and research, i.e. the role of stress and "tension" in illness and disease. And also because the Chinese ancients saw the pivotal role of emotions in illness. In Chinese Medicine each organ and entrail has it's own role in the psyche. The emotions, or passions were one of the seven "perversive energies." It's actually sort of a "duh" tell me something I don't know.
Just last week I saw a patient who had gone to an alternative diagnostician who had said that she had fire in her liver. The patient couldn't understand that at all since she's Windex healthy and active and I suggested that it was because of her nasty divorce and she burst into tears, and felt so much better having seen the connection. It's all related. What do you think?
info on my practice here

Acupuncture Vs Topamax for Chronic Migraine Prophylaxis

Cephalalgia. 2011 Nov;31(15):1510-21. Epub 2011 Oct 21.
Acupuncture versus topiramate in chronic migraine prophylaxis: A randomized clinical trial.
Yang CP, Chang MH, Liu PE, Li TC, Hsieh CL, Hwang KL, Chang HH.
Source

Kuang Tien General Hospital, Taiwan.
Abstract

Background: The aim of this study was to investigate the efficacy and tolerability of acupuncture compared with topiramate treatment in chronic migraine (CM) prophylaxis. Methods: A total of 66 consecutive and prospective CM patients were randomly divided into two treatment arms: 1) acupuncture group: acupuncture administered in 24 sessions over 12 weeks (n?=?33); and 2) topiramate group: a 4-week titration, initiated at 25?mg/day and increased by 25?mg/day weekly to a maximum of 100 mg/day followed by an 8-week maintenance period (n=?33). Results: A significantly larger decrease in the mean monthly number of moderate/severe headache days (primary end point) from 20.2±1.5 days to 9.8±?2.8 days was observed in the acupuncture group compared with 19.8?±?1.7 days to 4.1 days in the topiramate group Significant differences favoring acupuncture were also observed for all secondary efficacy variables. These significant differences still existed when we focused on those patients who were overusing acute medication. Adverse events occurred in 6% of acupuncture group and 66% of topiramate group. Conclusion: We suggest that acupuncture could be considered a treatment option for CM patients willing to undergo this prophylactic treatment, even for those patients with medication overuse.

Again, lots of treatments in this study. But, wow, that's a lot of side effects from Topamax!! I mean, 66%??
Do you treat patients this many times in your practice? I usually don't feel comfortable requiring this intensity of treatment.
Info on my practice here. More on acupuncture and migraine here.

More Longevity Tips

I like both of these, from Dr. Mao Shing Ni's book. Squats and self foot massage.

"Youth Hormone" Factory: Your Body
Imagine a rush of rejuvenating growth hormones in your body without expensive injections or pills. Studies show that just doing squats and leg presses will boost your natural production of "youth hormone to several times the normal output. Increased growth hormone means increased muscle mass and strength, decreased fat deposits, more mental alertness, better sexual enjoyment, and elevated moods...

I have been doing Bar Method for 8 years. It incorporates core strengthening, weight training, push ups, stretching and lots of thigh strengthening exercises. Maybe part of its benefits are the increased growth hormone levels!

Chinese Methuselah's Longevity Secret
Pengzu, the Chnese Methuselah who reputedly lived 800 years, s said to have invented daoin, a gentle stretching and meditative exercise that some consider to be the predecessor to yoga. One of the first moves of daoin is to take one of your heels and it against the sole of your other foot until you feel heat in the massaged foot, then reverse the feet and repeat with the other heel. Besides stimulation blood flow into the lower extremities, rubbing the bottoms of the feet activates an important acupuncture point for energy and vitality called Gushing Spring. Modern research shows that stimulating the points as a balancing action on the hormonal and nervous systems.

Info on my practice here.

Dr. Oz: Acupuncture Facelift

In my practice, I call this procedure "Facial Rejuvenation."
I advise most of my facial rejuvenation patients to use the MTS skin roller. It has many tiny needles on a roller, and you can use it daily, and then a more robust version weekly. I advise getting the dermal integrity brand, because you need to use it frequently and I worry that the cheaper versions will deteriorate much too quickly. You can use with any safe exfoliative product or just moisturizer, and it helps with collagen production, evenness of skin tone, reduced wrinkles, and reduced acne scars. I've used it for a few years and think it's a good, natural skin aid. My patients who have bought it are fans too.
My main complaint about this segment on Dr. Oz, is that facial rejuvenation, if correctly done requires many, many more needles than shown in the video. The photo below, from Dr. Oz' website, shows how the tone of the face is more even, and the face "fresher."


More info on my practice here.

Ounce of prevention: Junk Food

One more story ripped from the headlines, another chapter in "an ounce of prevention.s'
Article in the SF Chron

Food giants fight proposed nutrition guidelines

An effort by four federal agencies to limit marketing of junk food to children has provoked a fight between the packaged food industry and public health groups as intense as the cigarette wars of the 1980s.

The agency guidelines, ordered by Congress in 2009, are due this month after a 1 1/2-year delay. They will be scaled back after a ferocious lobbying campaign by food manufacturers who fear that Twinkies are fast becoming the next tobacco.

The stakes are high, both for the $1 trillion food industry and for public health groups alarmed by Americans' growing girth. Whether a child develops a taste for fruit or Froot Loops can establish lifelong eating patterns that translate to billions of dollars in sales of packaged foods and potentially devastating consequences for public health.

We know that childhood obesity has reached epidemic proportions. A third of poor preschoolers are now obese by age 5. Obese children are more likely to become obese adults with all the resulting health problems.
Michele Simon author of "Appetite for Profit" says "Industry knows they have to get the kids while they're young because they want them hooked on their products..."
The Center for Disease Control and Prevention, The FDA, and the Department of Agriculture have issued "voluntary guidelines."
Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity, said obesity is now about as costly to public health as smoking and said that the food industry behavior is "remarkably parallel" to that of the tobacco companies years ago.

"That means, he said, "considering children prey, doing whatever they can do to circumvent parental awareness, and marketing in ways that develop strong brand loyalties at very early ages for junk food."...
"Most moms would agree that Kool-Aid and Cocoa Puffs are not healthy," Wootan said. "Certainly nutritionists would. The only ones who think those foods are healthy is the food industry itself."

Lots of money to made in the junk food, er, "packaged food" industry. The public health costs of diabetes, heart disease, etc... will be on us. No incentives for prevention in our society.

Info on my practice here.

Coffe Consumption Lowers Endometrial Cancer Risk

A Prospective Cohort Study of Coffee Consumption and Risk of Endometrial Cancer over a 26-Year Follow-Up.
Je Y, Hankinson SE, Tworoger SS, Devivo I, Giovannucci E.
Cancer Epidemiol Biomarkers Prev. 2011 Nov 22. [Epub ahead of print]

Authors' Affiliations: Departments of 1Nutrition and 2Epidemiology, Harvard School of Public Health; and 3Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
METHODS:
We prospectively assessed coffee consumption in relation to endometrial cancer risk in the Nurses' Health Study (NHS) with 67,470 female participants aged 34 to 59 in 1980. Cumulative average coffee intake was calculated with all available questionnaires to assess long-term effects..
RESULTS:
Fewer than 4 cups of coffee per day were not associated with endometrial cancer risk. However, women who consumed 4 or more cups of coffee had 25% lower risk of endometrial cancer than those who consumed less than 1 cup per day... For decaffeinated coffee consumption, a suggestive inverse association was found among women who consumed 2 or more cups per day versus <1 cup/mo. Tea consumption was not associated with endometrial cancer risk.
CONCLUSIONS:
These prospective data suggest that four or more cups of coffee per day are associated with a lower risk of endometrial cancer.Impact: Drinking of coffee, given its widespread consumption, might be an additional strategy to reduce endometrial cancer risk. However, addition of substantial sugar and cream to coffee could offset any potential benefits.

So, yay! Something I like turns out to be okay. Especially combined with the lowered Parkinson's, and diabetes risk. It's hard to imagine drinking 4 cups of caffeinated coffee a day, but maybe I should try...

Garlic and Soup: More Longevity Tips from Dr. Mao

Here is what Dr. Mao(1) says about Garlic

A Garlic Clove every day
The delicious ingredient that spices up Italian food does a lot more than whet your appetite. Studies indicate that allicin, the active ingredient in garlic, can prevent atherosclerosis and coronary blockage, lower cholesterol, reduce blood clot formation, stimulate the pituitary, regulate blood sugar, and prevent cancer. As an antibacterial, it is often used to treat minor infections. To balance out its pungency, eat some breath-freshening parsley.

(I always love it when something I like anyway turns out to be so good for you!)
I like this tip about soup, too.

To Slim Down, Fill up with Soup
(excerpt)
One simple dietary change can cut your risk of being counted in the premature death statistics--eat soup at least once a day. ..Bottom line: people who eat one or more bowls of soup each day lose more weight than those who eat the same number of calories but don't eat soup. Homemade is best...

Dr. Mao Shing Ni " Secrets of Longevity"
More on my practice here.

Max Planck and the Immutable Laws of Physics

Charlie Munger discusses Max Planck a number of times in the book, Poor Charlie's Almanack(1).
Max Planck was a physicist who developed Planck's constant, earned a doctorate at the age of 21, worked on energy emissions which lead to the "Quantum Theory," and received the Nobel Prize in 1918. He tried once to do economics and gave it up. So why would one of the smartest people to have ever lived give up economics? "It's to hard. The best solution you can get is messy and uncertain." It didn't have enough order to it so he gave it up.
What does this have to do with Health Matters? It made me think about the fact that medicine is a messy science too. Though our models are those of the hard sciences, physics, biochemisty, cellular biology, anatomy, results in medicine are not orderly. Outcomes are multifactorial. In my own career, I've gone from perhaps the only branch of medicine that has the most reliable outcomes, Anesthesiology, to one that has the least, Acupuncture (though I would say Psychiatry is on a par with Acupuncture.) But in contrast to Economics, where we're only talking about money (cough), the stakes in Medicine are so much higher. We need to convince people of Max Plancks' exceptional ability to wrestle with difficult, multifactorial, untidy outcomes because the need is so great. We need new and better models and methods.
Info on my practice here.

(1)Poor Charlie's Almanack: The Wit and Wisdom of Charles T. Munger, Peter Kaufman 2006

An Ounce of Prevention: Parallel Stories in the Newspaper

This article was a plea from a computer scientist at UCB for more computer experts to get involved in the "war on cancer." And, indeed, in such a multifactorial, huge medical health issue, the more help the better. In the last week there was also this article outlining an online website to raise funds for cancer research: a highly laudable effort, also.

In the same bout of newspaper reading, there is this article exploring the increasing dust in the American west and its effect on snow melt (it increases it.) Some of the reasons posited for the increase in dust (which has lead to high asthma rates) is global warming and off road vehicle use.
And this article looking at the risky but lucrative practice of deep sea drilling off the coast of Brazil. ""We see big slicks of oil, fish that have changed colors," he said."
And this article examining the ground water pollution resulting from the controversial practice of hydraulic fracturing, or fracking. ""Fracking poses serious threats to safe drinking water... Last year, Wyoming became one of the first states to require oil and gas companies to publicly disclose the chemicals used in fracking. Colorado regulators are considering doing the same."

And this article describing the dangerous lack of regulation, ie "self regulation" in the natural gas pipelines in Pennsylvania.

The point being, that there is a cavalier, reckless attitude toward the potential health risks in all of these practices mentioned above from carbon emissions, to off road vehicles, deep oil drilling, fracking, and natural gas production. And then scrambling on the other end to try to combat cancer, asthma and other health risks that are increasing by the day. It is glaringly obvious that it is all about incentives, and that is where the conversation needs to go.

Info on my practice

Update:
And then there is this story about the nuclear regulatory commission members, all pro-industry fighting tooth an nail to relax regulations. It never ends.

Heart Rate Variability Monitoring (HRV) and Mental Models

More Models: How Models inform Heart Rate Variability (HRV) analysis and acupuncture
What I noticed years ago in doing HRV monitoring in the clinic, is that in patients who are likely to respond to acupuncture, one sees a decrease in their LFR/HFR ratio during the session. My latest study suggests that more sensitive yet is the Sample Entropy increase during the session. This is counter intuitive since most studies have looked at HRV before and then after the session.
But why a "responder" will respond to the needles immediately after placement with a decrease in the stress response within the first 10 to 15 minutes is because you've perturbed their system with the "nudge" of the needles and they respond with a relaxation response. This model is a sort of "stress test" on the system akin to a Valsalva or tilt test and then we watch to see what happens.
In other studies, researchers have looked at HRV before and after treatment, which makes utter sense according to their models that acupuncture decreases stress over time.
In my model I'm looking at the reaction, in theirs, they're looking at the outcome.
More on my practice here. Research here

Precautionary Principle and Genetically Modified Food

Over the last few days, I've been discussing Munger's model of avoiding that which is bad for healthier or more successful outcomes. I've made the point that in Medicine, also, that is part of the way to be healthy, to avoid the unhealthy. Simplistic, but in a way profound.
When it comes to cancer, the Emperor of All Maladies, how do we avoid what is negative? We know the obvious, tobacco and asbestos, nuclear fall out, maybe full body scans at the airport. But what else? What else to we avoid? I was bedside a few times a week with a friend in her final months of battling thyroid cancer, and it inspired me to become a vegan, since there is some data to suggest a plant based diet can improve your immunity and help your own system to fight cancer. But what else can we avoid?
Cue this Op-Ed by Eric Schlosser and Gary Hirshberg. You might want to read the whole thing, but I'll feature a few highlights.
More on my practice here.

The right to know what you are eating

Gary Hirshberg,Eric Schlosser

An unprecedented agricultural experiment is being conducted at America's dinner tables. While none of the processed food we ate 20 years ago contained genetically engineered ingredients, now 75 percent of it does - even though the long-term human health and environmental impacts are unknown. The Food and Drug Administration doesn't require labeling of genetically engineered foods. But as the current drive to get labeling on the ballot in California confirms, consumers want to know whether our food contains these revolutionary new things...

Biotech companies have fought labeling, claiming genetically engineered crops are "substantially the same" and produce larger yields - both unproven claims. But genetically engineered crops have led to the increased use of pesticides, often sold by the same companies that make genetically engineered seeds...Almost all the research on the safety of genetically engineered foods has been conducted by the companies that sell them. ..A study of pregnant women found genetically engineered corn toxins in 93 percent of the women and 80 percent of their unborn children. All of their umbilical cords had glyphosate residues. Biotech companies say genetically engineered crops aren't different - but defend their patent rights by arguing they're unique and that anybody who grows them without permission should be prosecuted. These companies want it both ways...

A recent poll found 93 percent of Americans think genetically engineered foods should be labeled. This month, 384,000 people signed a Just Label It ( www.justlabelit.org) petition urging the FDA to mandate genetically engineered food labeling nationally. ..
The FDA doesn't let pharmaceutical companies test new drugs on people without their informed consent...

So, in a nutshell, the companies that produce the Genetically Modified Food, run their own studies, tell us not to worry, all is well and they're exactly the same as all the other foods, but no, you can't know if you're eating them or not. What if they turn out to be implicated in cancer rates? Those of us who are not so trusting of these big conglomerates and their in-house studies ought to have the right to know what we're eating, so we can at least "first do no harm."

Eczema Triggers

I have a number of patients suffering from eczema, and came across this handy list in Acupuncture Today of the possible triggers. In Chinese Medicine, eczema can present with many different patterns and one treats accordingly.
milk
eggs
peanuts
soybeans
fish
wheat
dust mite allergies
pollen allergies
over-washing hands
frequent bathing
pregnancy
menstruation
thyroid imbalances
infections (staph, strep, or herpes simplexa0
Dry, cold weather (decreased humidity)
sweating
wool clothing or blankets
emotional stress (a trigger, not a cause)

Info on my practice here.

More on Munger's Mental Models and Acupuncture

My post yesterday was a riff on Charlie Munger and his use of mental models. Why is this of interest? I am searching for workable models to use for acupuncture and thereby improve its efficacy. I also think that the models for Western Medicine are breaking down in various ways and to varying degrees. They are still the best we have, but they are inadequate and have been corrupted by moneyed interests to boot.
Example:
At the ISAMS conference, I presented a poster on Heart Rate Variability and its correlation with clinical outcomes in my private practice clinic. Professor Longhurst was interested in the poster in so much as he came over a number of times to argue with me. He has done yeoman's work on hypertension and cardiac health and acupuncture. His argument was that since I used manual and not electroacupuncture, I was not getting a sustained stimulation so I couldn't draw any conclusions. His argument makes sense according to his mental model; i.e that acupuncture works by stimulating nerves under the meridian. My models say that that's part of it, but after reading a textbook on Immunology and the Skin describing what happens when one gets a sunburn, I would posit that there are cascades of immunological healing effects that happen with the tiny injury of placing of a needle. (This is the model that could account for the non-specific needling effects seen with acupuncture.) Also, as I've written about repeatedly on this blog and in my research I think that the decrease in the stress response can account for the variety of conditions treated by acupuncture from panic attacks to allergy to sciatica.
Models are extremely important, because without them how can we improve outcomes? When it comes to Longhurst's model it worked in this study on hypertension, but to use electroacupuncture routinely in the clinic, especially for musculoskeletal pain can lead to severe aggravation of symptoms, which, naturally enrages the patients. Not good clinically nor for business... Electroacupuncture is used on lab animals all the time and they don't seem to be enraged, but maybe they have a stronger placebo effect?? I kid.
The mental models used in Traditional Chinese Medicine, also do their best to make sense of health and healing in their own ingenious way and have structured their models completely differently than the models of Western Medicine. It is a struggle to use models that don't fit with our models, but on the other hand there is a constraint of thinking in only using the traditional models again and again if they are failing. For failing models you need look no further than Avastin, temporal artery surgery for stroke prevention, or stents to name a few.
More on my practice here.

Longevity, Jing, Dr. Mao, and Munger's Models

This is another quote from Dr. Mao Shing Ni's book "Secrets of Longevity." It concerns one of the key concepts in Chinese Medicine, jing. The topic of jing is a Chinese Medicine mental model that, in part, echoes the Munger model of "inverting" or avoiding what you don't want to get what you want.

Ancient Formula Strengthens Your Essence
According to Chinese longevity philosophy, jing, or essence is the basic substance of life. Innate essence is inherited from parentage and can be refined through practices such as tai chi, qigong, and meditation, while a second kind of jing acquired during your life can be replenished through diet, nutrition and longevity herbs. A formula for enduring youth passed down in our family medical tradition contains such essence-building herbs as Chinese wild yam, ligustri fruit, schizandra berry, sesame seed, eucommia bark, he shou wu root and cistanches root. Studies of all these plants confirm their positive effects on the hormonal, immune and metabolic systems.

What he doesn't mention are the things that can harm your jing, childbirth without sufficient rest, drugs, excessive alcohol, illness. So avoiding these are over half the battle against aging. The crucial aspect of jing is that it can be supported throughout life with wise and balanced living, but once destroyed is extremely difficult to replace. This fits nicely with the Munger model, that in avoiding destructive habits or avoiding "where you are going to die so you don't go there" is a key concept in Chinese Medicine.
The formula I recommend for longevity and an overall health tonic is Astra Essence from Health Concerns. The "Astra" in "Astra Essence" is for astragalus an herb that nourishes the lung function and, indeed, can keep you from getting ill, especially with respiratory illnesses, colds, flu etc... It has been studied in conjunction with telomeres and has been shown to decrease cellular aging also.
For info on my practice please click here.

Monday Morning Philosophizing: Charlie Munger

This may seem off the topic of medicine, but I think if you stay with me, you'll see the relevance. Over the weekend I was reading a book about and by Charlie Munger[i], a famous and successful investor and partner of Warren Buffett. I was interested in the various "mental models"he's derived from multiple disciplines (mathematics, physics, psychology, engineering) and wanted to read more about them.
One quip that he uses over and over again is the quote from an old "rustic" who says "I wish I knew where I was going to die, and then I'd never go there." Which is funny, of course, but it echoes the great algebraist Jacobi, who said "Invert, always invert." Munger's point in investing and in life, is that in avoiding what is negative, you are much more likely to be successful. Avoid losing, spend less than you make, and save.

So what does this have to do with acupuncture and alternative medicine? I realized that the "First Do No Harm" part of acupuncture and alternative medicine, though hardly a ringing call to action is an important part of the mission. In keeping people off medications whenever possible is not a small thing. Some studies show that the side effects of pharmaceutical drugs kill some 140,000 people in the U.S. a year and cost the country over $136 billion annually. As always, it's hard to prove a negative, but the wisdom of billionaires, Chinese ancients, genius mathematicians, and "rustics" concur that by avoiding the negative, you're much more likely to flourish. Once back pain, IBS, or migraines occur if the standard was to use acupuncture first who knows how much medication, cost and work would be saved. I've discussed these issues frequently in this blog, for eg here, here, and here.

Info on my practice here.

---

[i] “Poor Charlie’s Almanac: Wit and Wisdom of Charlie Munger” Kaufman 2006

Medicare Expert Testifies and Decries Waste

This describes the testimony of an Obama official in charge of Medicare, and he targets the bureaucracy, but it makes a very interesting read. He clearly is totally apolitical and just trying to improve Medicare, but gets attacked by Republicans, of course. I won't try to comment on the whole article, of you're interested the link is here. But this is the money quote at the end of the article. (For info on my practice, please click here.)

Dr. Berwick said most of the criticism by Republicans, who warn of a government takeover of health care, was “purely political, a world of sound bites.” In the interview, he lashed out at Republicans who depict him as an advocate of rationing health care.

In 2009, he told a biotechnology journal, “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

Dr. Berwick said Republicans had “completed distorted” his meaning. “My point,” he said, “is that someone, like your health insurance company, is going to limit what you can get. That’s the way it’s set up. The government, unlike many private health insurance plans, is working in the daylight. That’s a strength.”

Word.

Longevity: Live Long Without Arthritis

I've been meaning to incorporate some of my reading into the blog for awhile, so here's my first attempt. This is from a book called "Secrets of Longevity" by Dr. Mao Shin Ni.

More than 40 million Americans, one out of six, have some form of arthritis- but you don't have to be one of them. Recent studies show that osteoarthritis is not an inevitable part of the aging process. Here's your program: maintain an ideal wight; get regular low-impact exercise; eat a diet rick in antioxidants such as viatamins C, A, and E; get some sun for vitamin D; eat lots of enzyme-rick foods containing bromelain, like papaya and pineapples; take supplements such as glucosamine and chrondroitin that support joing and cartilage health. and use the herbs ginger, turmeric, and cinnamon, all of wihich can help reduce inflammation and increase circulation. Additionally, some people may find it helful to avoid foods from the night shade family , which contain a plant alkaloid called solanine. These include tomatoes, potatoes, eggplants, and bell peppers.

I don't necessarily endorse all of these suggestions (I was planning on making "escalivada" for dinner with roasted potatoes...) I haven't been convinced by the studies on glucosamine and chontroitin. I was at a conference where a rheumatologist quipped, "Eating glucosamine and chondroitin for your joints is like eating brains to get smart." But studies don't always tell the full story.
I would also add that Meir Schneider, a movement specialist in San Francisco says that where there is flexibility, there is no arthritis, submitted for your consideration.
Info on my practice here.

Most Hospitalizations in Elders due to Four Drugs

In the "First Do No Harm" file we have this article outlining the dangers inherent in certain medications. All of these meds have been around a long time, and all are "tried and true." Is it maybe time to review their safety or risk benefit ratio? I would take issue with them lumping aspiring with other anti-platelet medications, but that's just my hunch, not based on data. Information on my practice here.

Four Drugs Cause Most Hospitalizations in Older Adults
By ANAHAD O'CONNOR

Blood thinners and diabetes drugs cause most emergency hospital visits for drug reactions among people over 65 in the United States, a new study shows.

Just four medications or medication groups — used alone or together — were responsible for two-thirds of emergency hospitalizations among older Americans, according to the report. At the top of the list was warfarin, also known as Coumadin, a blood thinner. It accounted for 33 percent of emergency hospital visits. Insulin injections were next on the list, accounting for 14 percent of emergency visits.

Aspirin, clopidogrel and other antiplatelet drugs that help prevent blood clotting were involved in 13 percent of emergency visits. And just behind them were diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations.

All these drugs are commonly prescribed to older adults, and they can be hard to use correctly. One problem they share is a narrow therapeutic index, meaning the line between an effective dose and a hazardous one is thin. The sheer extent to which they are involved in hospitalizations among older people, though, was not expected, said Dr. Dan Budnitz, an author of the study and director of the Medication Safety Program at the Centers for Disease Control and Prevention...