First, Do No Harm

Autonomic Nervous System:Acupuncture and Low Back Pain

2012-02-11T07:37:00.000-08:00

This study evaluates the autonomic nervous system (stress response) in patients with low back pain comparing electroacupuncture (10 sessions) and an antiinflammatory medication. What they found was that both groups had pain relief, but the acupuncture group more so. There was an improvement in the stress response in the acupuncture group also. (For info on my practice please click here.)

Autonomic status and pain profile in patients of chronic low back pain and following electro acupuncture therapy: a randomized control trial.
Shankar N, Thakur M, Tandon OP, Saxena AK, Arora S, Bhattacharya N.Indian J Physiol Pharmacol. 2011 Jan-Mar;55(1):25-36.
Department of Physiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi.

Pain is a syndrome characterized by several neurophysiological changes including that of the autonomic nervous system. Chronic low back pain (LBP) is a major health problem and is a frequent reason for using unconventional therapies especially acupuncture. This study was conducted to evaluate the autonomic status and pain profile in chronic LBP patients and to observe the effect of electro acupuncture therapy. Chronic LBP patients (n=60) were recruited from the Department of Orthopaedics, GTB Hospital, Delhi. Age and sex matched healthy volunteers were selected as controls (n=30). Following a written consent, LBP patients were randomly allocated into two study groups - Group A received 10 sittings of electro acupuncture, on alternate days, at GB and UB points selected for back pain, while the Group B received a conventional drug therapy in the form of oral Valdecoxib together with supervised physiotherapy. Controls were assessed once while the patients were assessed twice, before and after completion of the treatment program (3 weeks). The autonomic status was studied with non-invasive cardiovascular autonomic function tests which included E: I ratio, 30:15 ratio, postural challenge test and sustained handgrip test. Pain intensity was measured with the visual analogue scale (VAS) and the global perceived effect (GPE). Statistical analysis was performed using repeated measure's ANOVA with Tukey's test. Pain patients showed a significantly reduced vagal tone and increased sympathetic activity as compared to the controls (P<0.05 to P<0.001 in different variables). Following treatment, both the study groups showed a reduction in vagal tone together with a decrease in the sympathetic activity. There was also a considerable relief of pain in both groups, however, the acupuncture group showed a better response (P<0.01). We conclude that there is autonomic dysfunction in chronic LBP patients. Acupuncture effectively relieves the pain and improves the autonomic status and hence can be used as an alternative/additive treatment modality in these cases.

Spinal Serotonin and Electroacupuncture: University of Maryland Group

2012-02-11T07:36:00.000-08:00

University of Maryland with another elegant study exploring the precise spinal neuro-receptors involved in electroacupuncture. They employ the model that they have used repeatedly, iwhich is to inject Freund's adjuvant into the joint space of cats hind paws. This is an irritant which mimics arthritis. They then use hind paw withdrawal latency to measure the effects of acupuncture versus control.
But don't we all know that acupuncture is just placebo??
(Information on my practice here.)

Involvement of spinal serotonin receptors in electroacupuncture anti-hyperalgesia in an inflammatory pain rat model.
Zhang Y, Li A, Xin J, Lao L, Ren K, Berman BM, Tan M, Zhang RX.
Neurochem Res. 2011 Oct;36(10):1785-92.
Center for Integrative Medicine, School of Medicine, University of Maryland, 685 W Baltimore street, MSTF Rm 8-22, Baltimore, MD 21201, USA.

We previously showed that electroacupuncture (EA) activates medulla-spinal serotonin-containing neurons. The present study investigated the effects of intrathecal 5,7-dihydroxytryptamine creatinine sulfate, a selective neurotoxin for serotonergic terminals, the 5-hydroxytryptamine 1A receptor (5-HT1AR) antagonist NAN-190 hydrobromide and the 5-HT2C receptor (5-HT2CR) antagonist SB-242,084 on EA anti-hyperalgesia. EA was given twice at acupoint GB30 after complete Freund's adjuvant (CFA) injection into hind paw. CFA-induced hyperalgesia was measured by assessing hind paw withdrawal latency (PWL) to a noxious thermal stimulus 30 min post-EA. Serotonin depletion and the 5-HT1AR antagonist blocked EA anti-hyperalgesia; the 5-HT2CR antagonist did not. Immunohistochemical staining showed that spinal 5-HT1AR was expressed and that 5-HT2CR was absent in naive and CFA-injected animals 2.5 h post-CFA. These results show a correlation between EA anti-hyperalgesia and receptor expression. Collectively, the data show that EA activates supraspinal serotonin neurons to release 5-HT, which acts on spinal 5-HT1AR to inhibit hyperalgesia.

Focus on the Cause AND the Cure

2012-02-10T06:44:00.000-08:00

The latest dust up with the Komen foundation exposed the rank partisanship in the organization. But I hope that it will also expose the bias towards finding the "cure" the magic bullet that will take away the horror that is cancer. The Komen foundation partners with business to sell products and raise money. But somehow looking for the possible cause may anger big business. I discussed the media blackout on this topic here. This issue is far from simple, and I don't want to portray it as such. Here is an excerpt from an article by Susan Love, NYTimes. Info on my practice here.

Real Race in Cancer Is Finding Its Cause
By SUSAN LOVE, M.D.

A decision by the nation’s leading breast cancer advocacy group, Susan G. Komen for the Cure, to largely cut off financing for breast cancer screenings at Planned Parenthood set off howls of outrage last week. Once again, it seemed, political gamesmanship was jeopardizing women’s health.

The widespread anger forced Komen to reverse its decision, and it has certainly reinvigorated the women’s health movement. But the furor misses an important fact: Women have been led to believe that screening is the best prevention.

In reality, we still do not know what causes breast cancer, which means we really do not know how to prevent it, either. That has pushed us to focus on looking for cancers that are already there, a practice long based on the assumption that all cancers were the same, grew at a similar rate and were visible in the breast for a period of time before spreading. It made sense: If you could find cancers earlier, you could save lives...

We should continue to speak up when we think health care services are in jeopardy, but we cannot be satisfied with the status quo. We must move breast cancer advocacy to the next level, beyond screening for cancers that are already there, even beyond the cure, to finding the cause. That is true prevention.

Dr. Susan Love is president of the Dr. Susan Love Research Foundation in Santa Monica, Calif.

Acupuncture and Parasympathetic Activity and Enkephalins, Longhurst

2012-02-09T06:09:00.000-08:00

Readers of this blog are familiar with Dr. Longhurst. I've blogged about his work on acupuncture and hypertension and his recent conference here, here, and here. I also mentioned how he is convinced that electro acupuncture is necessary, indeed in this study his control is manual acupuncture. This is a study looking at electro acupuncture in cats at PC 5 and 6, showing that stimulation in the neurons of the nucleus ambiguous may be responsible for the increase in parasympathetic activity induced by acupuncture. This area of inquiry is of keen interest to me since my research concerns the autonomic nervous system and acupuncture effectiveness. More info on my practice here.

Nucleus ambiguus cholinergic neurons activated by acupuncture: Relation to enkephalin.
Brain Res. 2012 Jan 12.
Guo ZL, Li M, Longhurst JC.

Acupuncture regulates autonomic function. Our previous studies have shown that electroacupuncture (EA) at the Jianshi-Neiguan acupoints (P5-P6, underlying the median nerve) inhibits central sympathetic outflow and attenuates excitatory cardiovascular reflexes, in part, through an opioid mechanism. It is unknown if EA at these acupoints influences the parasympathetic system. Thus, using c-Fos expression, we examined activation of nucleus ambiguus (NAmb) neurons by EA, their relation to cholinergic (preganglionic parasympathetic) neurons and those containing enkephalin. To enhance detection of cell bodies containing enkephalin, colchicine (90-100μg/kg) was administered into the subarachnoid space of cats 30h prior to EA or sham-operated controls for EA. Following bilateral barodenervation and cervical vagotomy, either EA for 30min at P5-P6 acupoints or control stimulation (needle placement at P5-P6 without stimulation) was applied. While perikarya containing enkephalin were observed in some medullary nuclei (e.g., raphé), only enkephalin-containing neuronal processes were found in the NAmb. Compared to controls (n=4), more c-Fos immunoreactivity, located principally in close proximity to fibers containing enkephalin was noted in the NAmb of EA-treated cats (n=5; P<0.01). Moreover, neurons double-labeled with c-Fos and choline acetyltransferase in the NAmb were identified in EA-treated, but not control animals. These data demonstrate for the first time that EA activates preganglionic parasympathetic neurons in the NAmb. Because of their close proximity, these EA-activated neurons likely interact with nerve fibers containing enkephalin. These results suggest that EA at the P5-P6 acupoints has the potential to influence parasympathetic outflow and cardiovascular function, likely through an enkephalinergic mechanism.

Genetics of the Immune System: Dr. Medzhitov

2012-02-02T07:11:00.000-08:00

An interesting story about a Russian scientist who has studied the immune system of vertebrates. There is an innate immune system and an adaptive immune system, and he with Dr. Janeway identified the mechanism whereby the innate system triggers the adaptive one. As I've mentioned repeatedly in this blog, my hunch is that this is part of the way that acupuncture works, by triggering the body's own immune mechanisms for healing. I will excerpt some of the article here. Info on my practice here.

A Long Journey to Immune System Insights
By CLAUDIA DREIFUS

Ruslan M. Medzhitov loves scientific puzzles. And this penchant has led him to tackle some of the big questions of modern biology.

At Yale University, where he is a professor of immunology and a Howard Hughes Medical Institute investigator, Dr. Medzhitov, 45, helped make key discoveries in the workings of vertebrates’ immune systems. ..

Let’s talk about the paper by the immunologist Charles A. Janeway Jr. that changed your life. When did you learn about it?

...The only library with anything was at the Academy of Natural Sciences, and it barred nonaffiliated people from their facilities. Luckily, I had made friends with some very kind young women who worked there and who permitted me to use the library, secretly.

And it was there, one day, that I stumbled upon this three-year-old paper by Janeway, where he proposed a theory of immunity. I read it and my eyes opened up. I thought, “Now I see.”

What was in the paper?

A revolutionary idea of how the immune system worked. In vertebrates, two immune systems protect against infection. There’s the evolutionarily older system that all organisms, even plants, have — the innate immune system. There is also another system that evolved relatively recently, the adaptive immune system, which only vertebrates have. Janeway proposed that the innate system detects invading microbes, distinguishes them from everything else and signals the adaptive immune system to move against the intruder...

How did you finally prove his theory?

Our main goal was to discover the gene in the cells of the innate immune system that activates the adaptive system. That would explain how our body knows we have an infection and translates it into an immune response. It took about two years, but we found it. Today, this gene is known at the human Toll-like receptor, and it is important in immunity and in inducing inflammation.

The Brain Circuitry and Heart Rate Variability Reflections of Nausea

2012-01-30T11:18:00.000-08:00

This is a study looking at functional MRI and HRV underlying the autonomic nervous system response to nausea. This is of interest to because nausea is one of the best well studied conditions where acupuncture helps. Given my thesis that lowering sympathetic tone, (lowering the stress response) is an important aspect of acupuncture treatment, this study is pertinent. For more information on my practice, please click here.

A combined HRV-fMRI approach to assess cortical control of cardiovagal modulation by motion sickness.
Conf Proc IEEE Eng Med Biol Soc. 2011 Aug;2011:2825-8.
Kim J, Napadow V, Kuo B, Barbieri R.
Abstract

Nausea is a commonly occurring symptom typified by epigastric discomfort with the urge to vomit. To date, the brain circuitry underlying the autonomic nervous system response to nausea has not been fully understood. Functional MRI (fMRI), together with a point process adaptive recursive algorithm for computation of the high-frequency (HF) index of heart rate variability (HRV) was combined to evaluate the brain circuitry underlying autonomic nervous system response to nausea. Alone, the point process analysis revealed increasing sympathetic and decreasing parasympathetic response during nausea with significant increased heart rate (HR) and decreased HF. The combined HRV-fMRI analysis demonstrated that the fMRI signal in the medial prefrontal cortex (MPFC) and pregenual anterior cingulate cortex (pgACC), regions of higher cortical functions and emotion showed a negative correlation at the baseline and a positive correlation during nausea. Overall, our findings confirm a sympathovagal shift (toward sympathetic) during nausea, which was related to brain activity in regions associated with emotion and higher cognitive function.

Post Spinal Nerve Ligation Hypersensitivity Relieved by Manual Acupuncture (in rats)

2012-01-24T13:08:00.000-08:00

This study is looking at acupuncture effectiveness for neuropathic pain. They simulate neuropathic pain by ligating a spinal nerve in the rat and then using traditional acupuncture point stimulation compared with gabapentin.

Manual acupuncture inhibits mechanical hypersensitivity induced by spinal nerve ligation in rats.
Cidral-Filho FJ, da Silva MD, Moré AO, Córdova MM, Werner MF, Santos AR.
Laboratório de Neurobiologia da Dor e Inflamação, Departamento de Ciências Fisiológicas, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil.
Abstract

Manual acupuncture (MA) has presented analgesic activity against neuropathic pain in patients and animal models, yet a series of questions remain: Is MA effectiveness dependent of acupoint selection or combination? Is it equally efficient when treatment starts on the initial (acute) or sub-chronic phase of spinal nerve ligation (SNL)-induced neuropathy? Is MA effect related to the release of endogenous opioids? Does MA produce similar effects to gabapentin? To answer these questions rats submitted to the L5/L6 SNL injury were treated with unilateral MA (ST36 (Zusanli), SP6 (Sanyingjiao) or ST36+SP6 acupoint stimulation); or with gabapentin (30 mg/kg i.p., used as positive control). Both acupoints have been demonstrated to present analgesic activity and are used in clinical practice and basic science research. In addition, we investigated the influence of naloxone (1 mg/kg i.p., a nonselective opioid receptor antagonist) on MA treatment and also the effect of unilateral ST36+SP6 MA treatment beginning acutely (5 days) or sub-chronically (14 days) after SNL. Our results demonstrate that single or combined unilateral stimulation was able to reduce mechanical hypersensitivity with treatment beginning in both acute and sub-chronic phases of SNL-induced neuropathy; MA effect was blocked by naloxone, and finally; SP6+ST36 MA presented similar effect to gabapentin (30 mg/kg). In conclusion, our results demonstrate, for the first time, that unilateral MA (ST36, SP6 or ST36+SP6) reduces hypersensitivity induced by the SNL with effect dependent of the opioid system and comparable with the one obtained with gabapentin (used as positive control).

For more information on my practice, please click here.

Johnson and Johnson Pays out in Texas Law Suit

2012-01-20T07:33:00.000-08:00

This to be tossed into the "Corruption" file, or the "Follow the Money" file. I guess they're sort of one in the same, except the "Corruption" file contains those who have been caught.

January 19, 2012
J. & J. to Pay $158 Million to End Suit Filed by Texas
By REUTERS

Johnson & Johnson said on Thursday that it would pay $158 million to settle a Texas lawsuit accusing the drug maker of improperly marketing its Risperdal antipsychotic drug to state residents on the Medicaid health program for the poor, including children.

The lawsuit accuses the company of pushing Risperdal as “appropriate and safe to treat a broad range of symptoms in populations and disease states for which it had no F.D.A.-approved indication, including in the child and adolescent population...”

“Johnson & Johnson’s scheme to profit from the Medicaid program by overstating the safety and effectiveness of an expensive drug and improperly influencing officials ended up costing taxpayers millions of dollars,” Texas’s attorney general, Greg Abbott, said in a statement...
The company is in various stages of litigation with several other states.

For more information on my practice, please click here.

Drug Cartel Forced to Report Pay Offs

2012-01-17T06:22:00.000-08:00

My title is a bit hyperbolic, but not by much. This blog post to be filed in the "It's about time" file. They are planning on extending this regulation to the medical device industry as well. Note that this law is about direct payment to doctors as well as the funding of medical research, which is also corrupted. I've touched on some of these topics here, here, here and here. Those, unfortunately, are just a few of the many posts on this type of corruption that has occurred. I'm not sure how to evaluate the penalties, $10,000 for failure to report, $100,000 for knowingly failing, for a total of $1,000,000 per year. Seems in the "slap on the wrist" range in absolute dollar amount, but the negative press may be the larger punishment. It's something, at least.(For more information about my practice, please click here.)

U.S. to Force Drug Firms to Report Money Paid to Doctors
By ROBERT PEAR

WASHINGTON — To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.

Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices...

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.

The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children...

Companies will be subject to a penalty up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty up to $100,000 for each violation, up to a total of $1 million a year...

Allan J. Coukell, a pharmacist and consumer advocate at the Pew Charitable Trusts, said: “Patients want to know they are getting treatment based on medical evidence, not a lunch or a financial relationship. They want to know if their doctor has a financial relationship with a pharmaceutical company, but they are often uncomfortable asking the doctor directly.”

Erectile Dysfunction and Anti-inflammatories

2012-01-16T08:22:00.001-08:00

To be filed in the "I Did Not Know That" file. From last year, but unknown to me.

Men taking Anti-Inflammatory Drugs more likely to develop Erectile Dysfunction
PASADENA, Calif. March 2, 2011 /PRNewswire/ -- Men who take non-steroidal anti-inflammatory drugs three times a day for more than three months are 2.4 times more likely to have erectile dysfunction compared to men who do not take those drugs regularly, according to a Kaiser Permanente study published online in The Journal of Urology.
The term "nonsteroidal" is used to distinguish these drugs from steroids, which, among a broad range of other effects, have a similar eicosanoid-depressing, anti-inflammatory action. As analgesics, NSAIDs are unusual in that they are non-narcotic.

The most prominent members of this group of drugs are aspirin, ibuprofen, and naproxen, all of which are available over the counter in many areas.

While previous research showed a trend toward this same finding, this observational study used electronic health records, an automated pharmacy database and self-reported questionnaire data to examine NSAID use and ED in an ethnically diverse population of 80,966 men aged 45 to 69 years throughout California.

After controlling for age, race, ethnicity, smoking status, diabetes, hypertension, heart disease, high cholesterol and body mass index, the researchers found that ED was 1.4 times more likely -- a modest risk -- among regular NSAID users compared to men who did not take the drugs regularly. This association was consistent across all age groups

For more information about my practice please click here.
P.S. I sort of see this as a clash of the titans. ED is a bit of a created condition. Though there is true suffering out there, there is a heck of a lot of hype too since it's pitched at a pretty young age group. Anti-inflammatories have also been marketed very intensely even though some of the more recent ones turned out to have some serious side effects. So interesting that the two have intersected. In the article it says that they were expecting to find that anti-imflammatories improved ED. Surprise!!

NFL and Acupuncture

2012-01-16T08:03:00.000-08:00

Yay. I remember reading this article when it came out but couldn't find it, it's entitled "Big Men, Little Needles." The New York Jets use acupuncture to keep strong, healthy and pain free.
So can you!!

Needling the body forces the connective tissue aroung the pin to contract stimulating blood flow and releasing endorphins, which act as powerful pain relievers. Inserting acupuncture needles also triggers the production of dopamine a chemical in the braind that plays a part in response to pleasure and pain, which is why some patients feel high afte acupuncture therapy... Not only effective in easing pain, acupuncture can also help the body overcome one of the toughest hurles to healing, inflammation.

For more information about my practice, please click here.

Retained versus non-retained needles and Heart Rate Variability

2012-01-10T06:17:00.000-08:00

This is a study published in Chinese looking at the effects of acupuncture at P6 and P5 in healthy volunteers comparing the effects of retained needles to traditional needling. Use of P6 and P5 for cardiac purposes is a time honored prescription. These points are also used in Longhurst's protocol for for high blood pressure (hypertension.) Measuring HRV after needling P6 and P5 has precedent also.
In this study, they found a cardiac excitation initially (which I also find in practice) and then an increase in RR interval, or decrease in heart rate. They found HFR increased, which can be interpreted as an increase in parasympathetic activity. LFR was unchanged, interpreted to mean no change in sympathetic activity. Sadly, since they were healthy volunteers, there can be no clinical correlation with acupuncture effectiveness. Information on my practice here.

[Effects of retained needling and non-retained needling on regulation of the cardiac autonomic nerve].
Zhongguo Zhen Jiu. 2011 Nov;31(11):993-7.
Luo LP, Shen ZY, Yu P
Department of Physiotherapy, The Second Hospital of Sanming City, Sanming 366000, Fujian Province, China. llp77-82@163.com

To investigate the mechanism of retained needling and non-retained needling on the physiologic regulating effect of the cardiac autonomic nerve in healthy persons.
METHODS:

Sixty volunteers were randomly divided into a retained needling group and a non-retained needling group, 30 cases in each group. They were all received perpendicular needling at Neiguan (PC 6) and Jianshi (PC 5) retaining for 20 min in the retained nee dling group and without retaining in the non-retained needling group. The heart rate variability (HRV) indices, i.e., R-R interval, low frequency (LF), high frequency (HF) and LF/HF were observed.
RESULTS:
Compared with before acupuncture, the R-R interval were significant increased during the stimulation period and during the post-stimulation period in the retained needling group, especially during the stimulation period (all P < 0.01), and during the post-stimulation period of 5 min and 10 min in the non-retained needling group (P < 0.01, P < 0.05), then returned to pre-acupuncture level quickly, and the R-R interval in the retained needling group was significant ly higher than that in the non retained needling group at 10 min (P < 0.05). At 5 min, the HF were significantly higher, and the LF/HF were significantly lower than those before acupuncture (P < 0.01, P < 0.05), and there was no obvious change in LF in both groups.
CONCLUSION:
Retained needling and non-retained needling at Neiguan (PC 6) and Jianshi (PC 5) can both excite cardiac vagus nerve briefly and then the acupuncture effects reduce grad ually until disappearance, while no obvious changes can be found with cardiac sympathetic activity. Both of needling can reduce heart rate and the action time of heart rate decrease by retained needling is longer than non-retained needling.

More on Complexity

2012-01-09T16:14:00.000-08:00

Sorry for the long gap without posting! I guess I'll blame it on the holidays and getting back to work, though that certainly can't account for such a long window. I'm reworking my website, and will be giving a presentationm though that kind of activity is always going on.
But I wanted to continue a bit with the article by Andrew Ahn, discussed here. I will highlight the pertinent part, because it reflects my thinking about Heart Rate Variability and what it can tell us about the overall health of the patient. He even says that it may reflect a person's "adaptability" which is the conclusion I've come to over the years. Though effective acupuncture treatment most likely is a function of the correct acupoints, the overall state of the subjects system is probably an important factor too. Then the question becomes, how best to nurture that adaptability that will allow for self healing.

Because heart rate is dynamically balanced through many elements, including the autonomic nervous system, respiration, hormones, and other physiologic systems, the heart theoretically should be responsive to, and exhibit increased complexity across, multiple time scales in concert with fluctuations in these elements. The temporal changes of a variable therefore may contain hidden information that is useful for describing the overall system. This capacity to capture the global state of a system or an individual suggests these complexity-based measures may act as surrogates for concepts that were traditionally difficult to measure but considered important for CAM research (e.g., “health” and “adaptability”). Does a homeopathy prescription or massage treatment affect complexity measures of HRV?...
means to understand CAM better, CAM therapies themselves can be thought of as exemplars for how complexity theory can be applied to clinical medicine. Historically, conventional medicine has evolved and developed under a reductionist Cartesian framework. Complex problems such as chronic diseases were typically divided into smaller, simpler, and thus tractable, units. This approach has affected the way practitioners diagnose, treat, and prevent illnesses. Importantly, it has also shaped the practitioner's worldview and heuristic approach to medicine. To incorporate a distinct philosophical framework such as complexity theory to medicine may therefore challenge pervasive entrenched beliefs and perspectives....
In this regard, CAM is uniquely poised to provide the needed perspective and experience. Many CAM therapies are rooted in a worldview most consistent with complexity and systems theory. The human body is viewed holistically and considered dynamic and complex; the mind, body, and spirit are inextricably linked; and the interactions among the organs and individuals are as important as the components themselves... fractal patterns within the body (e.g., reflexology, auricular acupuncture), and the use of minimal interventions to affect the larger system (e.g., acupuncture and homeopathy).

I didn't realize that the traditional medical model was a "reductionist Cartesian model." I've always thought that the limiting perpective of traditional medicine, was that it was mainly developed after the industrial revolution, and so the body is seen as a machine rather than a living, adapting, organism.

More on my practice here.

Acupuncture for Eczema, the role of Basophils

2012-01-09T12:06:00.000-08:00

Nice study, but small, looking at acupuncture's effect on the "itch" of eczema and the correlation with basophils. Post on an acupuncture study on eczema here from Napadow. Info on my practice here.

J Altern Complement Med. 2011 Apr;17(4):309-14. Epub 2011 Mar 28.
Effect of acupuncture on allergen-induced basophil activation in patients with atopic eczema:a pilot trial.
Pfab F, Athanasiadis GI, Huss-Marp J, Fuqin J, Heuser B, Cifuentes L, Brockow K, Schober W, Konstantinow A, Irnich D, Behrendt H, Ring J, Ollert
Department of Dermatology and Allergy, Technische Universität München, Biedersteiner Straße 29, Munich, Germany. florian.pfab@lrz.tum.de
Abstract
OBJECTIVE AND METHODS:

The crucial symptom of atopic eczema is itch. Acupuncture has been shown to exhibit a significant effect on experimental itch; however, studies focusing on clinical itch in atopic eczema and corresponding mechanisms are lacking. The study design was a unicenter, single-blinded (observer), prospective, randomized clinical pilot trial with an additional experimental part. In 10 patients with atopic eczema, we investigated the effect of acupuncture treatment (n = 5) compared to no treatment (n = 5) on itch intensity and in vitro basophil CD63 expression upon allergen stimulation (house dust mite and timothy grass pollen) in a pilot trial.
RESULTS:
Mean itch intensity in a visual analog scale was rated significantly lower in the acupuncture group (-25% ± 26% [day 15-day 0]; -24% ± 31% [day 33-day 0]) than in the control group (15% ± 6% [day 15-day 0]; 29% ± 9% [day 33-day 0]). From day 0 (before treatment) to day 15 (after 5 acupuncture treatments) as well as day 33 (after 10 acupuncture treatments), the acupuncture group showed less CD63 positive basophils than the control group regarding stimulation with house dust mite and grass pollen allergen at various concentrations (5 ng/mL, 1 ng/mL, 0.5 ng/mL, or 0.25 ng/mL).
CONCLUSIONS:
Our results show a reduction of itch intensity and of in vitro allergen-induced basophil activation in patients with atopic eczema after acupuncture treatment. Reducing basophil activation can be a further tool in investigating the mechanisms of action of acupuncture in immunoglobulin E-mediated allergy. Due to the limited number of patients included in our pilot trial, further studies are needed to strengthen the hypothesis.

Prostrate Screening Update: First, Do No Harm

2012-01-09T11:25:00.000-08:00

On Jan 6th there was an update to the prostate cancer screening study showing that even with a longer follow up time, the screening is of extremely limited benefit. Given the nasty side effects of treatment, (outined below) the recommendation is not to screen with PSA. I've discussed this topic previously here, here, here

Prostate Cancer Screening Shows No Benefit
By TARA PARKER-POPE
Updated findings from one of the largest studies of prostate cancer screening show that the commonly used P.S.A. blood test did not save lives, although questions remain about whether younger men or those at very high risk for the disease might benefit.
Last fall, the United States Preventive Services Task Force concluded that healthy men should no longer be routinely screened for prostate cancer using the prostate-specific antigen, or P.S.A., blood test. That decision was based on findings from five well-controlled clinical trials, including a major American study called the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial, which studied P.S.A. testing in nearly 77,000 men ages 55 to 74...
Because prostate cancer can take several years to develop, the investigators continued to collect data after reporting the initial findings.
In a new paper published today in The Journal of the National Cancer Institute, the scientists report that the additional follow-up time didn’t change the overall conclusion: that regular P.S.A. testing does not save lives and can lead to aggressive treatments that leave men impotent, incontinent or both..
The findings suggest that the type of cancer typically detected by screening is so slow-growing that it often is unlikely to cause harm before the man dies of another cause...
“I think it supports the recommendation that for the average man in the United States, mass screening is probably not beneficial at all,’’ Dr. Andriole said. “It also will keep the discussion open about whether there are indeed subsets of men who do potentially stand to benefit from P.S.A. screening.”

What's old is new again. "The findings suggest that the type of cancer typically detected by screening is so slow-growing that it often is unlikely to cause harm before the man dies of another cause... This is what we were taught in medical centuries ago when I was a medical student.
For more on my practice, please click here.

Insomnia, Blue Light and the Yin of the Yin

2011-12-30T09:40:00.000-08:00

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

2011-12-29T08:46:00.000-08:00

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

2011-12-28T06:03:00.000-08:00

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

2011-12-26T08:40:00.000-08:00

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

2011-12-23T11:03:00.000-08:00

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

2011-12-22T07:31:00.000-08:00

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

2011-12-21T08:58:00.000-08:00

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

2011-12-20T08:21:00.000-08:00

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

2011-12-18T19:33:00.000-08:00

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

2011-12-18T11:34:00.000-08:00

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

2011-12-18T11:12:00.000-08:00

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

2011-12-17T11:50:00.000-08:00

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

2011-12-17T11:35:00.000-08:00

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

2011-12-17T11:17:00.000-08:00

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

2011-12-16T20:11:00.000-08:00

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

2011-12-16T20:02:00.000-08:00

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

2011-12-16T19:52:00.000-08:00

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.

Max Planck and Stephen Gould:Hard and Soft Science

2011-12-16T19:35:00.000-08:00

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

2011-12-16T19:12:00.000-08:00

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

2011-12-16T10:23:00.000-08:00

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

2011-12-15T09:47:00.000-08:00

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

2011-12-14T13:21:00.000-08:00

In my practice, I call this procedure "Facial Rejuvenation."
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.
More info on my practice here.

Ounce of prevention: Junk Food

2011-12-13T10:57:00.000-08:00

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

2011-12-12T08:57:00.000-08:00

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

2011-12-12T07:52:00.001-08:00

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

2011-12-11T11:16:00.000-08:00

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

2011-12-11T10:37:00.001-08:00

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 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

2011-12-08T10:11:00.000-08:00

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

2011-12-07T16:46:00.000-08:00

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

2011-12-07T07:12:00.000-08:00

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

2011-12-06T09:09:00.000-08:00

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

2011-12-05T15:42:00.000-08:00

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

2011-12-05T08:38:00.000-08:00

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

2011-12-04T08:50:00.001-08:00

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

2011-12-04T08:22:00.000-08:00

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

2011-12-02T16:33:00.000-08:00

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...

What's in a name? Time to rename "cancer?"

2011-11-22T10:53:00.000-08:00

I was speaking to one of my Medical School classmates at my recent reunion about this very topic. (I went to Tulane Medical School and was speaking to Dr. Oliver Sartor, a specialist and expert in Prostate Cancer.) We were discussing this because his area of expertise is prostate cancer, and there have been such dramatic and controversial developments in that field discussed here and here. that part of the problem is the terminology. Some cancers are quite indolent, most prostate cancers are for example. It would help patients make treatment decisions if those more benign cancers were not described as cancer since that term is so loaded. Often once patients get that diagnosis their reaction is to "get rid of it." But in the case of prostate cancer, the cure can be worse than the disease.

‘Cancer’ or ‘Weird Cells’: Which Sounds Deadlier?
By GINA KOLATA

My friend’s mother got terrifying news after she had a mammogram. She had Stage 0 breast cancer. Cancer. That dreadful word. Of course she had to have surgery to get it out of her breast, followed by hormonal therapy.

Or did she?

Though it is impossible to say whether the treatment was necessary in this case, one thing is growing increasingly clear to many researchers: The word “cancer” is out of date, and all too often it can be unnecessarily frightening.

“Cancer” is used, these experts say, for far too many conditions that are very different in their prognoses — from “Stage 0 breast cancer,” which may be harmless if left alone, to glioblastomas, brain tumors with a dismal prognosis no matter what treatment is tried...
Now, some medical experts have recommended getting rid of the word “cancer” altogether for certain conditions that may or may not be potentially fatal...
Many medical investigators now speak in terms of the probability that a tumor is deadly. And they talk of a newly recognized risk of cancer screening — overdiagnosis. Screening can find what are actually harmless, if abnormal-looking, clusters of cells.

But since it is not known for sure whether they will develop into fatal cancers, doctors tend to treat them with the same methods that they use to treat clearly invasive cancers. Screening is finding “cancers” that did not need to be found. So maybe “cancer” is not always the right word for them.
That happened recently with Stage 0 breast cancer, also known as ductal carcinoma in situ, or D.C.I.S. It is a small accumulation of abnormal-looking cells inside the milk ducts of the breast. There’s no lump, nothing to be felt. In fact, Stage 0 was almost never detected before the advent of mammography screening.
Now, with widespread screening, this particular diagnosis accounts for about 20 percent of all breast cancers. That is, if it actually is cancer.

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Interview with ME! in the Examiner

2011-11-21T16:15:00.000-08:00

Here's a link to the interview. I wish I hadn't been so wordy and wonkish. But if the shoe fits...

Info on my practice here.

Approval for Avastin for Breast Cancer Revoked by FDA

2011-11-21T08:31:00.000-08:00

I've been putting off posting about this latest article about Avastin for breast cancer. I find the way that these very loaded controversies are settled very depressing. In the case of Avastin, it looks like in the best case scenario it extends life for 5-6 months at a cost of $88,000 per year. Recent studies show that the life span extension is more like 1-2 months. It also comes with many nasty and dangerous side effects. To lobby against the FDA ruling, Genentech and Roche mount a defense including the impassioned pleas of patients themselves. I get queasy even writing about this. Medicine needs to have studies to evaluate treatments, not anecdotes from desperate patients. It brings up the horrors of cancer and how we want to do anything in reason to help fight it. But we have to balance the evidence with the emotion and it's so incredibly difficult. If patients have been harmed, and their lives shortened, those voices should be out there also or should they? Should we really be deciding drug efficacy issues in the court of public opinion? We have always needed to studies to weed out anecdotal results. It is a sad day when questions in medicine are decided much as in politics, that those with the money have an outsized voice. Science is getting sidelined because money speaks loudest. But those heart breaking voices of cancer patients are so compelling, we all get that...
November 18, 2011

F.D.A. Revokes Approval of Avastin for Use as Breast Cancer Drug
By ANDREW POLLACK

The commissioner of the Food and Drug Administration on Friday revoked the approval of the drug Avastin as a treatment for breast cancer, ruling on an emotional issue that pitted the hopes of some desperate patients against the statistics of clinical trials. The commissioner, Dr. Margaret A. Hamburg, said that clinical trials had shown that the drug was not helping breast cancer
patients to live longer or to meaningfully control their tumors, but did expose them to potentially serious side effects like severe high blood pressure and hemorrhaging.

“Sometimes, despite the hopes of investigators, patients, industry and even the F.D.A. itself, the results of rigorous testing can be disappointing,” Dr. Hamburg told reporters Friday. “This is the case with Avastin when used for the treatment of metastatic breast cancer.”

Avastin will remain on the market as a treatment for other types of cancers, so doctors can use it off-label for breast cancer. But insurers might no longer pay for the drug, which would put it out of reach of many women because it costs about 88,000 a year...

Please go to the link to read the whole article.
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Acupuncture for Xerostomia (Dry Mouth) in Cancer Patients

2011-11-18T11:23:00.000-08:00

Much of the literature I've seen on acupuncture for xerostomia has been on treating the xerostomia once is develops. This sounds like a practical way to prevent, namely give acupuncture at the time of the radiation.

Cancer. 2011 Nov 9. doi: 10.1002/cncr.26550.
Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma.
Meng Z, Garcia MK, Hu C, Chiang J, Chambers M, Rosenthal DI, Peng H, Zhang Y, Zhao Q, Zhao G, Liu L, Spelman A, Palmer JL, Wei Q, Cohen L.

Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Abstract
BACKGROUND:

Xerostomia (dry mouth) after head/neck radiation is a common problem among cancer patients, and available treatments are of little benefit. The objective of this trial was to determine whether acupuncture can prevent xerostomia among head/neck patients undergoing radiotherapy.
METHODS:

A randomized, controlled trial among patients with nasopharyngeal carcinoma was conducted comparing acupuncture to standard care. Participants were treated at Fudan University Shanghai Cancer Center, Shanghai, China. Forty patients were randomized to acupuncture treatment and 46 to standard care. Patients were treated 3×/wk on the same days they received radiotherapy. Subjective measures included the Xerostomia Questionnaire and MD Anderson Symptom Inventory-Head and Neck (MDASI-HN). Objective measures were unstimulated and stimulated whole salivary flow rates. Patients were followed for 6 months after the end of radiotherapy.
RESULTS:

Xerostomia Questionnaire scores for acupuncture were statistically significantly lower than for controls starting in week 3 through the 6 months (P = .003 at week3, all other P < .0001), with clinically significant differences as follows: week 11, relative risk (RR) 0.63 (95% confidence interval [CI], 0.45-0.87); 6 months, RR 0.38 (95% CI, 0.19-0.76). Similar findings were seen for MDASI-HN scores. Group differences emerged as early as 3 weeks into treatment for saliva (unstimulated whole salivary flow rate, P = .0004), with greater saliva flow in the acupuncture group at week 7 (unstimulated whole salivary flow rate, P < .0001; stimulated whole salivary flow rate, P = .002) and 11 (unstimulated whole salivary flow rate, P < .02; stimulated whole salivary flow rate, P < .03) and at 6 months (stimulated whole salivary flow rate, P < .003).

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"Broken Hearts" in Women After a Shock

2011-11-18T07:07:00.001-08:00

I wanted to cite this article because of the implications in Traditional Chinese Medicine (TCM). In TCM, the heart is the home of the spirit or Shen. So in treating disturbances of the Shen, the practitioner will treat the heart through the heart meridian and through the pericardium meridian. Interestingly, both of these meridians have been found to have a direct effect on the vagus nerve and the autonomic nervous system. So in this article when it explains how a "shock" can affect the heart through adrenaline etc..., TCM has had a way to treat that for millenia.
I've discussed these sort of overlaps before in this blog, here, for example. Of course, data on acupuncture and the autonomic nervous system can be found here, here, and here to name a few. I'd have to think about this further from a TCM standpoint why women would be more susceptible. The fact that women over 55 are more susceptible would suggest a yin/yang issue, but that's speculative...

'Broken heart syndrome' hits women harder

Marilynn Marchione, Associated Press

Thursday, November 17, 2011

Orlando --

A woman's heart breaks more easily than a man's.

Women are seven to nine times more likely to suffer "broken heart syndrome," when sudden or prolonged stress such as an emotional breakup or death causes overwhelming heart failure or heart attack-like symptoms, the first nationwide study of this finds. Patients usually recover with no lasting damage.

Japanese doctors first recognized this syndrome around 1990 and named it Takotsubo cardiomyopathy - tako tsubo are octopus traps that resemble the shape of the stricken heart.

It happens when a big shock triggers a rush of adrenaline and other stress hormones that cause the heart's main chamber to balloon suddenly. Tests show dramatic changes in rhythm and blood substances typical of a heart attack, but no artery blockages that typically cause one. ..

"I was very curious why only women were having this," said Dr. Abhishek Deshmukh of the University of Arkansas, who did the first large study of the problem and reported results Wednesday at an American Heart Association conference in Florida.

Using a federal database with 1,000 hospitals, Deshmukh found 6,229 cases in 2007. Only 671 involved men. After adjusting for high blood pressure, smoking and other factors that can affect heart problems, women were 7.5 times more likely to suffer the syndrome than men.

It was three times more common in women over 55 than in younger women.

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High Resolution CT scans lead to higher costs

2011-11-16T16:35:00.001-08:00

I became aware of these high resolution CT scans at Dr. Rita Redberg's talk last year at a UCSF conference called eontroversies in Women's Health" and wrote about it here. This article refers to a new paper released today in JAMA questioning the benefits of all the additional tests, as well as the costs. First do no harm except when there's money to be made...

High-resolution CT scans having costly follow-ups

Victoria Colliver, Chronicle Staff Writer

Wednesday, November 16, 2011

Patients who had high-resolution CT scans to check for heart disease ended up having far more invasive tests and follow-up procedures for a cost of $4,000 more per patient than those who underwent basic stress tests, according a study by Stanford researchers.

What the study, published in today's Journal of the American Medical Association, didn't determine was whether those extra tests and surgeries translated into healthier outcomes.

CT angiography uses high-resolution computed tomography technology to take pictures of the heart to help doctors see blockages. Researchers questioned whether the high-quality images might reduce the need for additional tests, particularly when they ruled out disease.

"We show pretty clearly, especially in the Medicare population, it actually leads to more testing," said Dr. Mark Hlatky, senior author of the study and professor of medicine and health research and policy at the Stanford University School of Medicine. "What we don't know is out of all those extra procedures and all extra angioplasties and all those surgeries, did they do good for the patients?"

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Autonomic and subjective responses to real and sham acupuncture stimulation.

2011-11-13T11:57:00.000-08:00

Skin conductance and heart rate are evaluated in this study as a measure of autonomic response to verum versus sham acupuncture. It is confusing in this abstract whether the pain experienced was experimentally imposed or if the patients were being treated for pain. The conductance increased and heart rate decreased during acupuncture. It's difficult to tell from this abstract, what happened from there, however. In my own exploration of skin conductance, it often increases during treatment, but unlike HRV did not correlate with positive outcomes. (For info on my practice, click here.)

Autonomic and subjective responses to real and sham acupuncture stimulation.
Kang OS, Chang DS, Lee MH, Lee H, Park HJ, Chae Y.

Acupuncture and Meridian Science Research Center, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-701, Republic of Korea.
Auton Neurosci. 2011 Jan 20;159(1-2):127-30. Epub 2010 Aug 21.

This study compared verum acupuncture (VA) and sham acupuncture (SA) stimulation by assessing autonomic and subjective responses. Autonomic responses such as skin conductance response (SCR) and heart rate (HR) were measured. Subjective pain ratings were collected and evaluated. A correlation analysis was performed for SCR and HR changes and subjective pain ratings. In both VA and SA sessions, SCR increased, and HR decreased. Subjective responses were different for VA and SA. The SCR changes correlated with subjective responses for VA, but not SA. The present results suggest that VA and SA do not fundamentally differ in their autonomic response patterns.

Study Debunks Operation to Prevent Strokes

2011-11-11T10:50:00.000-08:00

I'm sorry to see that this attempt also failed. I discussed the failed use of stents to prevent strokes here. But I just want to emphasize that $20 million is quite a bit of money that could have gone to health clinics to avail patients of exercise machinery, or subsidies to provide better nutrition, education, or even improved drug compliance. $20 million is not nothing. And it was used to subsidize the study of a very expensive procedure that made logical sense, but turned out to be bust. I commented on the persistence of the medical establishment to use treatments that don't work here. There is a tyranny of "logic," or "what makes sense" even though it turns out to be dangerous. Maybe we need to rethink our models. Just sayin'.
info on my practice here. Excerpts from the article follow, emphases mine.
November 8, 2011

Study Debunks Operation to Prevent Strokes
By DENISE GRADY

An operation that doctors hoped would prevent strokes in people with poor circulation to the brain does not work, researchers are reporting. A $20 million study, paid for by the government, was cut short when it became apparent that the surgery was not helping patients who had complete blockages in one of their two carotid arteries, which run up either side of the neck and feed 80 percent of the brain.

The surgery was a bypass that connected a scalp artery to a deeper vessel to improve blood flow to the brain.

The new study, published on Wednesday in The Journal of the American Medical Association, is the second in recent months to find that a costly treatment, one that doctors had high hopes for, did not prevent strokes. In September, researchers reported that stents being used to prop open blocked arteries deep in the brain were actually causing strokes. That study was also cut short.

Both the stents and the bypass operation seemed to make sense medically, and doctors thought they should work. Their failure highlights the peril of assuming that an apparent improvement on a lab test or X-ray, like better blood flow or a wider artery, will translate into something that actually helps patients, warned an editorial that accompanied the new findings. Only rigorous studies can tell for sure.

The editorial writer, Dr. Joseph P. Broderick, chairman of neurology at the University of Cincinnati College of Medicine, also cautioned that other stroke treatments were being used without sufficient study, particularly devices to remove clots. Dr. Broderick said doctors liked new technology, were paid well to use it and tended to believe in what they were doing, even without data.

The bypass operations were performed at 49 hospitals in the United States and Canada. All the patients given the surgery had had a stroke or transient ischemic attack (sometimes called a mini-stroke) during the previous 120 days, and were at high risk for another stroke. About 24,000 people a year in the United States were thought to be candidates for the operation.

...

The surgery costs about $40,000, probably 10 times the price of a year’s worth of medicine to reduce the risk of stroke, according to Dr. William J. Powers, the lead author of the study and chairman of neurology at the University of North Carolina in Chapel Hill...

Dr. David Langer, a brain surgeon and associate professor at the Hofstra North Shore-Long Island Jewish School of Medicine, said the study was well done and important.

“Surgeons don’t want to be doing bad operations,” Dr. Langer said. “Whenever you have a paper like this, we’re all disappointed, because we like to operate. But in the end it’s a good thing...”

More ISAMS: Dr. S.C. Tjen-A-Looi Cardiovascular Acupuncture Mechanisms

2011-11-07T07:46:00.000-08:00

I will leave you with the conclusions. The more specific aspects of the talk were deep into the physiology of the brain and spinal cord. These are the points that you can share with your patients if they ask "How does acupuncture work?"

Clinical Relevance of Point Specificity and Prolonged Action with Acupuncture Treatment
Stephanie C. Tjen-A-Looi, M.S., Ph.D.
School of Medicine
Susan Samueli Center for
Integrative Medicine
University of California, Irvine
Collaborators: Peng Li, John C. Longhurst, Liang-Wu Fu, Zhi-Ling Guo, Min Li
Goal To determine the biological effects of point specificity.
Conclusion
• Acupoint specificity does exist.
• Stimulation at acupoints over deep somatic nerves exert greatest inhibitory cardiovascular electroacupuncture influences.
• Stimulation of acupoints located on meridians activates underlying nerves to induce acupuncture inhibition.

Conclusion Long lasting effect of acupuncture
•Long-loop pathway
•Neural circuitry
•Neurotransmitter specific
•mRNA expressions

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