In Dr. Zoe Cohen’s class we recently talked about anti-inflammatories and had a large focus on acupuncture. One of the basic articles we looked over studied the anti-inflammatory affects scupuncture had on rheumatoid arthritis (RA). The class as a whole did find several flaws and questionable portions of the paper, and we did chuckle at the fact that the scientists were performing acupuncture on a rat and how do we know if rat have similar acupoints. Furthermore, we questioned if the acupoint on a human had any anatomical basis to the nerves, cardiovascular system, etc. I did a bit of research about acupuncture on the National Oriental Medicine Accreditation Agency’s website and found that they do study the deep and superficial blood circulation as well as nerves, and so there is supposed to be some correlation between acupoints and nervous anatomy. (http://www.nomaa.org/Documents/NOMAA_Institutional_Self_Study_Guide.pdf pages 13 and 14). However I am still truly skeptical on how an acupoint in an ear can somehow pinpoint a specific internal organ to influence. Peripheral nerves lead to the central nervous system, not to specific organs.
Also in class we talked about acupuncture being a placebo effect. The issue we discussed in class was how to make an adequate placebo for acupuncture as puncturing an ear is easily felt. I mentioned that maybe some kind of local or topical anesthetic could be used so the patient wouldn’t be able to tell whether the needle pierced the skin on the ear or not. I did some lay article research on acupuncture and I found and interesting article on http://www.acupuncture.com/education/theory/placebo.htm. Apparently, using placebos in randomized clinical trials is horrible; since the placebo effect is inherent in the treatment option, we can’t use derived data from treatment group; and efficacy apparently should not be based on statistics like “the distancing and neutrality requirement of randomization, blinding and p values” but rather on a “a self-selected, biased, individual person and has nothing to do with generalizability and replicability”. Ok then….. that throws out pretty much everything we use to support that a treatment has a significant effect and throws out that there could be a general treatment for diseases. I’m not buying one bit of it. If stats don’t matter in acupuncture, then why was the stats taken to support acupuncture in the first paper that talked about acupuncture, RA, and rats? The journal it is published in is called the “Evidence-Based” Complementary and Alternative Medicine. And yes I understand that this acupuncture.com article is just a lay article. Any thoughts?
I support you in saying that the statistical evidence behind the efficacy of acupuncture is questionable. And I think we agreed that the article on acupuncture on rats was indeed quite odd.
ReplyDeleteStill, I think an interesting question to ask ourselves, and one that i'm sure many RA patients probably would consider is, "If the treatment can help me, why not try it?". I mean to say that, regardless of whats happening physiologically, whether our qi is being aligned or not, as long as we feel better, does it really matter?
I don't mean to sound obnoxious or anything, its just that I agree that its hard to accept acupuncture on a physiological or evidence based level. And because studies evaluating the benefit of acupuncture always seem to be flawed (small sample size, therapist technique, or the inherent difficulty in the use of controls such as placebo and sham acupuncture), I find it hard to believe that the scientific community will ever indefinitely accept acupuncture.
I found this website: http://www.medicalacupuncture.org/aama_marf/journal/vol15_3/article1.html
While they have some type of mechanism of how acupuncture might work, not only did it appear vague and convoluted, but it was obviously extremely bias. And I think we will always have that bias, whether its in favor or against acupuncture. Still, some of their sources we interesting, such as this one http://ashevilleacupuncture.blogspot.com/2009/06/acupuncture-for-post-surgical-dental.html, which I think you might find particularly interesting Geoff.
Anyway, like I said, the "evidence-based" research on this is definitely shaky, but hey, if I had RA or whatever, I'd be getting poked right now.
In defense of alternative therapies…
ReplyDeleteAs a physician, I demand rigorously statistically validated evidence before I will give a patient a medication. As a scientist, I am committed to the scientific method. However, I wonder if by applying scientific “reductionism” we blind ourselves to other ways of knowing. After all, our method and system of scientific knowledge creates bias. It leads us to reject phenomena that are hard to study with our quantitative methods. For instance, biomedical trials require us to create classes of patients who we believe to have similar pathophysiology. For example, investigators might conduct a trial with several thousand patients who meet specific criteria for myocardial infarction. We then generalize from the study patients to other similar patients with MI.
For many alternative therapies, patients are understood as unique – for instance, each might have a unique alignment of energy. (I should stop describing this because I really don’t know that much about these practices!!) If so, the very process of lumping a group together to be studied in a biomedical trial controverts basic tenants of the practice.
Thus, while I can’t advocate for acupuncture or other alternative therapies that lack rigorous evidence of efficacy, I also think it is important to exercise humility. Just because I can’t understand or explain alternative therapies using my heuristic does not mean that these therapies aren’t useful I try to remember that the absence of evidence does not necessarily mean evidence of absence!! So when my patients ask about benign-seeming alternative therapies, I say I just don’t know and if it seems useful to them it is worth pursuing.