Acupuncture and oriental medicine use is soaring dramatically.
The National Center for Complementary and Alternative Medicine (NCCAM) which is a part of the National Institute of Health, has reported that 3.1 million Americans used acupuncture and Oriental medicine in 2007, a 50% increase since 2002.
Part of what’s causing the increase is the frustration with the standard health care system in the U.S. In 2002 2.1 million Adults used “acupuncture care.” But in 2007 the number jumped to an estimated 3.1 million. Also the number of people who practiced yoga jumped from 10,386,000 in 2002 to 13,172,000 in 2007.
The study also gave AOM high marks for its research quality. Out of 40 systematic reviews identified by the National Library of Medicine involving acupuncture, massage therapy, naturaopathy or yoga published between 2002 and 2007, the only studies that found sufficient evidence to conclude that the given therapy was effective for a given condition all used acupuncture as a form of treatment.
http://nccam.gov/news/camstats.htm
Wednesday, September 9, 2009
Tuesday, September 8, 2009
Growing Attention to Placebo
A fascinating article from Wired magazine (http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect) addresses the curious problem that the placebo effect seems to be increasing in clinical trials and has torpedoed the launch of several new medications. Any new drug coming to market needs to demonstrate significant efficacy compared to a "dummy" pill, or placebo. Recently new "blockbuster" medications ranging from anti-depressants, to Parkinson medications, to medications for Crohn's disease have been shown to be effective, but not as effective as placebo, so have had to be pulled. Even Prozac, the work horse of mood enhancers, has not shown effectiveness compared to placebo in recent clinical studies.
The NIH and Big Pharma alike are (finally) looking into the science of placebos, though Big Pharma is reluctant to pay for the studies (natch.)
"Ironically, Big Pharma's attempt to dominate the central nervous system has ended up revealing how powerful the brain really is. The placebo response doesn't care if the catalyst for healing is a triumph of pharmacology, a compassionate therapist, or a syringe of salt water. All it requires is a reasonable expectation of getting better. That's potent medicine."
I actually had the opportunity to speak to the author of this article on a recent radio call-in talk show to discuss how the keen attention paid to placebo effect in acupuncture research is glaringly absent from surgery research. Surgeries are often compared to other surgeries or conservative treatment, but rarely are "sham" surgeries performed. see posts http://ksparrowmd.blogspot.com/2009/08/another-popular-back-procedure-found-to.html and http://ksparrowmd.blogspot.com/2009/04/believing-in-treatments-that-dont-work.html
He reminded me of the open heart procedure called Mammary Artery Ligation which had finally been debunked. But that is one of very few surgical procedures that have been subjected to any sort of even handed scrutiny. I would add that open heart surgery has to be one of the most powerful, ritualistic procedures performed in medicine and must have extremely powerful placebo properties.
My interest in this topic is because of my involvement in acupuncture research, but I also am interested in therapies that don't fit the medical model and are therefore unexplained. The Western Medical Model is phenomenally valuable, but it does have its limits and there is a tyranny of the mechanistically rational when it comes to alternatives. I also think that the placebo effect is the ultimate testament to the power of "mind-body" medicine. I think it is high time that it should be studied and hopefully harnessed, not ridiculed.
I, personally, have no interest in handing out placebos for a living, but studying what is happening physiologically interests me no end.
P.S.
I happened on another article from Wired about the effectivenes of sham acupuncture for back pain. http://www.wired.com/wiredscience/2007/09/for-back-pain-e/ Even sham acupuncture worked better than physical therapy or medications, as the NHS in Britain is now acting on.
The NIH and Big Pharma alike are (finally) looking into the science of placebos, though Big Pharma is reluctant to pay for the studies (natch.)
"Ironically, Big Pharma's attempt to dominate the central nervous system has ended up revealing how powerful the brain really is. The placebo response doesn't care if the catalyst for healing is a triumph of pharmacology, a compassionate therapist, or a syringe of salt water. All it requires is a reasonable expectation of getting better. That's potent medicine."
I actually had the opportunity to speak to the author of this article on a recent radio call-in talk show to discuss how the keen attention paid to placebo effect in acupuncture research is glaringly absent from surgery research. Surgeries are often compared to other surgeries or conservative treatment, but rarely are "sham" surgeries performed. see posts http://ksparrowmd.blogspot.com/2009/08/another-popular-back-procedure-found-to.html and http://ksparrowmd.blogspot.com/2009/04/believing-in-treatments-that-dont-work.html
He reminded me of the open heart procedure called Mammary Artery Ligation which had finally been debunked. But that is one of very few surgical procedures that have been subjected to any sort of even handed scrutiny. I would add that open heart surgery has to be one of the most powerful, ritualistic procedures performed in medicine and must have extremely powerful placebo properties.
My interest in this topic is because of my involvement in acupuncture research, but I also am interested in therapies that don't fit the medical model and are therefore unexplained. The Western Medical Model is phenomenally valuable, but it does have its limits and there is a tyranny of the mechanistically rational when it comes to alternatives. I also think that the placebo effect is the ultimate testament to the power of "mind-body" medicine. I think it is high time that it should be studied and hopefully harnessed, not ridiculed.
I, personally, have no interest in handing out placebos for a living, but studying what is happening physiologically interests me no end.
P.S.
I happened on another article from Wired about the effectivenes of sham acupuncture for back pain. http://www.wired.com/wiredscience/2007/09/for-back-pain-e/ Even sham acupuncture worked better than physical therapy or medications, as the NHS in Britain is now acting on.
Monday, August 24, 2009
Another Popular Back Procedure found to be ineffective
The Mayo clinic has found that using medical cement to fix cracks in the brittle vertebrae of elderly people is no better than placebo. The reason that this article is of interest to me is that it fits in the category of things that make sense from a Western Medicine point of view, and so are enthusiastically performed even though there is no evidence for efficacy. Or as my blog post of 4.2.09 was titled, "Believing in Treatments that Don't Work." Given the rigorous standards for acupuncture research, the use of sham needles, sham placement or even (ridiculously) trying to control for the practitioner interaction, it is nice to see the Mayo clinic applying the same rigor to a "logical," popular, western medical procedure.
They go on to say at the end of article that the "miraculous" recoveries seen could be due to the anesthesia, placebo, or the fractures healed on their own. The anesthesia in this case was local anesthesia, so it is possible that the needling helped.
I am the first to admit that there are mysteries in the healing process and that placebo can play a large roll in any therapy, including acupuncture. But Western Medical procedures should be treated with the same level of skepticism as acupuncture is, if not more, since they are often more dangerous and almost always much more expensive. A quick search to determine how much the back cement treatment costs shows that it it runs $526-558 for the first level and then $236 for each level after that. That doesn't include the anesthesia or recovery room fees etc... In addition, particularly with the drama of surgical procedures the placebo effect has the potential to be quite powerful indeed.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/08/06/MNN9194H2O.DTL
Cement for backs ineffective from San Francisco Chronicle,
Stephanie Nano, Associated Press
Thursday, August 6, 2009
A common treatment that uses medical cement to fix cracks in the spinal bones of elderly people worked no better than a sham treatment, the first rigorous studies of the popular procedure reveal.
Pain and disability were virtually the same up to six months later, whether patients had a real treatment or a fake one.
Tens of thousands of Americans each year are treated with bone cement, especially older women with osteoporosis, some of them stooped and unable to stand up straight. The treatment is so widely believed to work that the researchers had a hard time getting patients to take part when it was explained that half of them would not get the real thing...
"All of us who do the procedure have seen apparently miraculous cures," said Dr. David F. Kallmes, a radiologist at the Mayo Clinic who led one of the studies. But he said there were also "miraculous cures" among those who got the fake treatments.
Bone cement has long been approved for many medical uses, but this particular use had not been tested.
The findings, published in today's New England Journal of Medicine, mean patients and doctors need to review the options together, wrote Dr. James N. Weinstein of Dartmouth Medical School in an accompanying editorial. "When best evidence suggests a tossup between treatment options and no benefit, informed patient choice is essential," he said.
The researchers do not know why people felt better, but suggest it could be due to the anesthesia, the placebo effect or that the fractures healed on their own over time.
They go on to say at the end of article that the "miraculous" recoveries seen could be due to the anesthesia, placebo, or the fractures healed on their own. The anesthesia in this case was local anesthesia, so it is possible that the needling helped.
I am the first to admit that there are mysteries in the healing process and that placebo can play a large roll in any therapy, including acupuncture. But Western Medical procedures should be treated with the same level of skepticism as acupuncture is, if not more, since they are often more dangerous and almost always much more expensive. A quick search to determine how much the back cement treatment costs shows that it it runs $526-558 for the first level and then $236 for each level after that. That doesn't include the anesthesia or recovery room fees etc... In addition, particularly with the drama of surgical procedures the placebo effect has the potential to be quite powerful indeed.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/08/06/MNN9194H2O.DTL
Cement for backs ineffective from San Francisco Chronicle,
Stephanie Nano, Associated Press
Thursday, August 6, 2009
A common treatment that uses medical cement to fix cracks in the spinal bones of elderly people worked no better than a sham treatment, the first rigorous studies of the popular procedure reveal.
Pain and disability were virtually the same up to six months later, whether patients had a real treatment or a fake one.
Tens of thousands of Americans each year are treated with bone cement, especially older women with osteoporosis, some of them stooped and unable to stand up straight. The treatment is so widely believed to work that the researchers had a hard time getting patients to take part when it was explained that half of them would not get the real thing...
"All of us who do the procedure have seen apparently miraculous cures," said Dr. David F. Kallmes, a radiologist at the Mayo Clinic who led one of the studies. But he said there were also "miraculous cures" among those who got the fake treatments.
Bone cement has long been approved for many medical uses, but this particular use had not been tested.
The findings, published in today's New England Journal of Medicine, mean patients and doctors need to review the options together, wrote Dr. James N. Weinstein of Dartmouth Medical School in an accompanying editorial. "When best evidence suggests a tossup between treatment options and no benefit, informed patient choice is essential," he said.
The researchers do not know why people felt better, but suggest it could be due to the anesthesia, the placebo effect or that the fractures healed on their own over time.
Thursday, June 18, 2009
Britain's National Health Service Prioritizes Acupuncture for Back Pain
(I'm not sure how I missed this study which came out in May. This is great news for the practice of acupuncture and great news for patients in Britain. )
"NHS pins its hopes for treating back pain on acupuncture"
"Unprecedented approval for alternative therapies from health service watchdog"
"Tens of millions of pounds are being wasted by the NHS(National Health Service) on useless treatments for back pain, money that should be diverted to alternative therapies such as acupuncture and spinal manipulation, a health service watchdog says today.
From among 200 treatments and devices claimed to help a bad back, the National Institute for Clinical Excellence (Nice) has passed judgement on what works and what doesn't. X-rays, ultrasound and steroid injections are out and osteopathy, chiropractic and "needling" (i.e. acupuncture) are in, it says.
The new guidelines mark a watershed in the treatment of the condition and for Nice itself. It is the first time that the institute has issued a positive recommendation that the NHS provide, and pay for, alternative therapies.
But Nice says a careful review of the evidence shows that acupuncture and spinal manipulation work."
The article goes on to say that Back pain is among the most common reasons for visits to family doctors (after colds and flu.) The NHS spends 1.5 billion pounds (about 2 billion dollars) treating 2.5 million patients. The study found that most of the money was wasted. The new guidelines pertain to patients whose back pain has persisted more than 6 weeks. The new guidelines say that these patients should be offered three options: an exercise programme, a course of manual therapy including manipulation or a course of acupuncture. If one treatment option does not work, patients may be offered a second.
The panel that drew up the guidelines expects acupuncture to be the most popular option, with an estimated annual cost of over £24m in England and Wales.
"To pay for the new treatments, the panel estimates that ending the use of steroid and other injections into the back will save more than £33m, stopping MRI scans will save £12m, and a further £1m can be diverted from funds for X-rays. Evidence shows that ordering X-rays can make patients worse, by confirming their invalid status. The overall net cost to the NHS of implementing the guidelines is estimated at just £77,000."
"Professor Peter Littlejohns, the clinical and public health director at Nice, said: "Most people will be affected by low back pain at some stage in their lives. The NHS now has evidence-based guidance on how to treat the condition effectively."...""In this case, the evidence was robust enough to make a positive recommendation," he said."
"NHS pins its hopes for treating back pain on acupuncture"
"Unprecedented approval for alternative therapies from health service watchdog"
"Tens of millions of pounds are being wasted by the NHS(National Health Service) on useless treatments for back pain, money that should be diverted to alternative therapies such as acupuncture and spinal manipulation, a health service watchdog says today.
From among 200 treatments and devices claimed to help a bad back, the National Institute for Clinical Excellence (Nice) has passed judgement on what works and what doesn't. X-rays, ultrasound and steroid injections are out and osteopathy, chiropractic and "needling" (i.e. acupuncture) are in, it says.
The new guidelines mark a watershed in the treatment of the condition and for Nice itself. It is the first time that the institute has issued a positive recommendation that the NHS provide, and pay for, alternative therapies.
But Nice says a careful review of the evidence shows that acupuncture and spinal manipulation work."
The article goes on to say that Back pain is among the most common reasons for visits to family doctors (after colds and flu.) The NHS spends 1.5 billion pounds (about 2 billion dollars) treating 2.5 million patients. The study found that most of the money was wasted. The new guidelines pertain to patients whose back pain has persisted more than 6 weeks. The new guidelines say that these patients should be offered three options: an exercise programme, a course of manual therapy including manipulation or a course of acupuncture. If one treatment option does not work, patients may be offered a second.
The panel that drew up the guidelines expects acupuncture to be the most popular option, with an estimated annual cost of over £24m in England and Wales.
"To pay for the new treatments, the panel estimates that ending the use of steroid and other injections into the back will save more than £33m, stopping MRI scans will save £12m, and a further £1m can be diverted from funds for X-rays. Evidence shows that ordering X-rays can make patients worse, by confirming their invalid status. The overall net cost to the NHS of implementing the guidelines is estimated at just £77,000."
"Professor Peter Littlejohns, the clinical and public health director at Nice, said: "Most people will be affected by low back pain at some stage in their lives. The NHS now has evidence-based guidance on how to treat the condition effectively."...""In this case, the evidence was robust enough to make a positive recommendation," he said."
Wednesday, June 3, 2009
Acupuncture and Stress, in Rats?
This is a study looking at biochemical markers of stress in rats using a very common acupuncture point Pericardium 6. (Pericardium 6 is the point often used for motion sickness or nausea in pregnancy.)
They gave the animals mild stressors for 8 weeks and compared acupuncture at Pericardium 6 to Triple Heater 5 (another common point on the other side of the arm.)
Their conclusion was
"The present results demonstrated that acupuncture was effective in restoring CMS-related biochemical and behavioral impairments such as anxiety and anhedonia and that acupuncture point was more effective than non-acupuncture point. These results suggest that acupuncture has a therapeutic effect on chronic stress-related diseases such as depression and anxiety.
The effects of acupuncture stimulation at PC6 (Neiguan) on chronic mild stress-induced biochemical and behavioral responses."
Neurosci Lett. 2009 May 7.
Division of Brain Disease, Center for Biomedical Science, National Institute of Health, Seoul, 122-701 Republic of Korea.
Kim H, Park HJ, Han SM, Hahm DH, Lee HJ, Kim KS, Shim I.
They gave the animals mild stressors for 8 weeks and compared acupuncture at Pericardium 6 to Triple Heater 5 (another common point on the other side of the arm.)
Their conclusion was
"The present results demonstrated that acupuncture was effective in restoring CMS-related biochemical and behavioral impairments such as anxiety and anhedonia and that acupuncture point was more effective than non-acupuncture point. These results suggest that acupuncture has a therapeutic effect on chronic stress-related diseases such as depression and anxiety.
The effects of acupuncture stimulation at PC6 (Neiguan) on chronic mild stress-induced biochemical and behavioral responses."
Neurosci Lett. 2009 May 7.
Division of Brain Disease, Center for Biomedical Science, National Institute of Health, Seoul, 122-701 Republic of Korea.
Kim H, Park HJ, Han SM, Hahm DH, Lee HJ, Kim KS, Shim I.
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