There are two areas that I think I have a degree of expertise and knowledge. One is infectious diseases (fading rapidly in retirement). The other is SCAMs (Supplements, Complementary and Alternative Medicine). In both areas, I have long noted that those without the same understanding and experience that I have often do a less than stellar job in understanding the literature.
Practitioners of SCAMs are continually striving to map their fictitious interventions onto reality in order to justify and explain why and how their particular form on nonsense works. Difficult to do when the effects do not extend beyond a placebo effect.
You know the placebo effect: the beer goggles of medicine.
But that does not stop their trying. There are no end to papers in the Pubmeds attributing any number of radiologic, anatomic or metabolic changes to account for SCAM effects. And now we have a new explanation for acupuncture.
What is the mindset one needs to have to demonstrate the purported reality-based mechanism by which a SCAM such as acupuncture has effects? Well, you have to have just fallen off the turnip truck, leaving critical thinking behind. It helps to be vague, misrepresent studies, to repeat long discredited myths, use overwrought adjectives, and maximize your inner Humpty Dumpty:
“When I quote an alternative medicine study,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’
And to that end, the most recent attempt to put lipstick on Fengxi we have the breathless
The Astounding Discovery That Could Link Eastern and Western Medicine
The detection of another circulatory system in the human body could have enormous scientific implications.
What is this astounding structure? A third space for fluid transport, after the vascular and lymphatic systems, we have the interstitium.
What is this interstitium of which you speak? All the connective tissue in us is made of collagen and hyaluronic acid and it contains sacs of water/fluid and are connected. This was missed for years, as the structure is lost in most prepared specimens. The fact that these are all connected in a newish finding (emphasis added):
Freezing biopsy tissue before fixation preserved the anatomy of this structure, demonstrating that it is part of the submucosa and a previously unappreciated fluid-filled interstitial space, draining to lymph nodes and supported by a complex network of thick collagen bundles. These bundles are intermittently lined on one side by fibroblast-like cells that stain with endothelial markers and vimentin, although there is a highly unusual and extensive unlined interface between the matrix proteins of the bundles and the surrounding fluid. We observed similar structures in numerous tissues that are subject to intermittent or rhythmic compression, including the submucosae of the entire gastrointestinal tract and urinary bladder, the dermis, the peri-bronchial and peri-arterial soft tissues, and fascia. These anatomic structures may be important in cancer metastasis, edema, fibrosis, and mechanical functioning of many or all tissues and organs. In sum, we describe the anatomy and histology of a previously unrecognized, though widespread, macroscopic, fluid-filled space within and between tissues, a novel expansion and specification of the concept of the human interstitium.
Kind of cool. My first response was interesting, but not earth-shattering. We are filled with an interconnected microscopic water-filled bubble wrap. Not a real surprise and researchers continue to find new anatomical structures. Whether this warrants the designation of an organ, I will leave to anatomists. Seems more of a Pluto than a planet X. Or even a planet Claire. But hardly astounding.
I had fretted about the local interstitium for most of my career. Where did the fluid go in third-spacing? Where is the infection? In the cell? The interstitium? Another space? And did the antibiotics reach that space? As an inside baseball example, you should not treat pneumonia with daptomycin, as it has negligible levels in the alveoli, but for septic pulmonary emboli, an infection that is in the interstitium of the lung can respond. Sometimes. But don’t try that at home.
After describing the interstitium, the train takes the express route from Realityville to Fantasyland.
Theise, Wells and colleagues were praised by their scientific peers for their findings. “This work was really comprehensive,” says David Merrick, an assistant professor of medicine at the University of Pennsylvania. But the idea of there being a circulatory system involving the body’s connective tissues was not unfamiliar to some medical systems.
“This knowledge is actually quite ancient,” says Leah Welsh, an osteopathic physician and an assistant professor of family and community medicine at Ohio State. “It’s something that other systems of medicine have been offering for a long time, but they didn’t have microscopes.”
What? If no microscopes, what exactly were these other systems offering? How did they know about the interstitium if they had no ability to see it? A little specificity or a reference would sure be nice with such a claim. I went looking and could find nothing outside of Traditional Chinese Pseudo Medicine (TCPM). Usual vague assertions. But an assistant processor said it, so it must be so. Meh.
As Theise told an interviewer from “Radiolab” in 2023, an expert in traditional Chinese medicine approached him at a conference in China where he was speaking on the interstitium and said, “We’ve been talking about it for 4,000 years.”
Have they now. Talking about collagen bundles and hyaluronic acid and sacs of fluid? Of course not.
Once again, it looks like conventional medicine is finally catching up with Traditional Chinese Medicine. Just this past week, scientists reported that they have discovered a “new organ”, which they have named the interstitium. The Chinese have known about this organ for centuries, but they named it the san jiao.
The san jiao is responsible for the movement and transformation of various solids and fluids throughout the body, as well as for the production and circulation of nourishing energy and protective energy. It is not a single self-contained organ, but rather a functional energy system involved in regulating the activities of other organs. It is composed of three parts, known as ‘burners’, each associated with one of the body’s three main cavities: thorax, abdomen and pelvis. An ancient Chinese medical text states: ‘The Upper Burner controls intake, the Middle Burner controls transformation, the Lower Burner controls elimination.’
In Traditional Chinese Medicine, the san jiao channel is used to move energy and lift depression. The san jiao channel begins at the tip of the fourth (ring) finger and runs up along the dorsum of the hand and lower arm, to the back side of the upper arm, over the shoulder, up the neck, wraps around the ear and ends at the outer corner of the eyebrow. The san jiao channel is found bilaterally, but only one side has to be used for treatments to be effective.
What fictional TCPM and the reality-based description of the interstitium have in common is exactly zero.
And that is one explanation. Since there are as many forms of acupuncture as there are practitioners, it is no surprise that there is another link of TCPM and the interstitium that I will not quote, as it is gibberish. Read it here. But SCAM proponents so love to apply the lipstick of science to their particular pig.
One of the most intriguing areas of current research is whether there is a connection between the interstitium and the ancient Chinese practice of acupuncture.
Intriguing? Naw. Only if you believe that TCPM is not a fiction. It’s like looking to anatomy and physiology to explain the mechanism of newly discovered forms of kryptonite.
the Man of Steel discovers some never-before-seen variants of Kryptonite: purple, cobalt, speckled and rainbow. He’s determined to figure out how these new variants affect Kryptonians by experimenting on himself with the help of a very reluctant Batman.
Although I suspect kryptonite has its effects mediated by meridians and chi. Seems just as reasonable as most TCPM explanations. Just another example of trying to map BS onto reality. Never gonna happen.
Acupuncture is used to treat conditions as varied as chronic pain, migraines, seasonal allergies and nausea caused by chemotherapy, but some of its actions have never been completely explained. The discovery of the interstitium may help us understand in modern biomedical terms how acupuncture works.
Acupuncture is used to treat these ailments, but with no efficacy beyond placebo.
Chronic pain? Here is one meta-analysis
Acupuncture as an adjunct therapy may provide post-treatment pain relief lasting at least 3 months for patients with chronic neck pain, although it is not superior to sham acupuncture.
Not superior to sham, aka the placebo effect.
Migraines? In a metaanalysis of 21 studies, the best they can come up with is ‘may:-
Conclusion: The body of evidence suggests that acupuncture may be more effective than sham acupuncture in the treatment of migraine.
and you only get the may as
the certainty evidence across outcomes was low to very low
The performance bias and attrition bias are serious in most studies that were included. Selection bias may also have affected the quality of the evidence.
Conclusion: Acupuncture may have an advantage over no intervention and sham acupuncture in improving nasal symptoms and quality of life for adults with AR
Conclusion: Acupuncture in addition to usual care may increase the complete control of chemotherapy-induced acute vomiting and delayed vomiting but the certainty of evidence was very low.
Anyone see a pattern? Poorly done biased studies MAY show effects. As a rule with SCAMs, the better the study, the less the efficacy.
And, unfortunately, studies out of China are suspect as
Although many SRs of acupuncture interventions have been published in Chinese journals, the reporting quality is troubling
and there are no negative acupuncture studies out of China
No trial published in China or Russia/USSR found a test treatment to be ineffective.
80% of China’s clinical trial data are fraudulent, investigation finds
with retractions for fraud being common.
Safe to say acupuncture is a suspect literature that needs to be read with care and critical thinking, sorely lacking in this article. The NYT, not mine.
Acupuncture doesn’t work for any objective process in well-done placebo-controlled trials and only has minimal subjective effects. Ya know, placebo. But in all these kinds of papers, efficacy is presumed where none exists, and the studies are cherry-picked and are often misrepresented to provide evidence.
The principles of the practice invoke two circulating elements: chi and blood.
Traditional Chinese medicine describes chi as flowing along one of 12 main tracks, called meridians.
Chi and meridians do not exist. Sorry. They do not. And blood? My blood and TCPM Blood are not the same.
In TCM, Blood remains a red liquid full of nutrients that flows through blood vessels; however, it possesses much wider functions not recognized in Western medicine, such as having the roles of “harboring the Mind” and “moistening the body.”
In TCM, Blood is inseparable from Qi. In fact Blood is a very dense material form of Qi. Qi gives Blood energy and life force, hence activating Blood.
Formation of blood
Blood is generated by the interaction of Grain Qi from food and drinks that enter the Stomach and Spleen and Essence from the Kidneys.
Therefore the two main important organs for the formation of Blood are Spleen and Kidneys according to TCM.
This is very much different from Western Medicine which states that formation of Blood is solely from bone marrow and hematopoietic stem cells and mention nothing about Spleen, Stomach and Kidneys.
Total nonsense. TCPM uses reverse-Jabberwocky. In the poem, Lewis Carroll uses nonsense words in place of nouns and adjectives, but we understand what vorpal or beamish likely mean in context. In TCPM, standard words like blood are used, but the definitions are nonsense. It is so mimsy.
Acupuncturists insert small needles into specific points on the body to enhance the flow of chi.
Specific? Har de har har. Different practitioners will use different points for the same disease. There were originally 365 acupoints. Hm. 365. That number seems familiar. But now there are over 2000. And there are the points for Japanese and Korean and ear and foot and hand and head acupuncture. There are many words to be used to describe acupuncture. Specific isn’t one of them. Virtually any place on the skin can be an acupoint. And, oddly, none in the eyes, under the nails, or in the genitalia. I wonder why that may be.
And just how does one know that the flow is enhanced when chi never measured, never seen, does not exist? Ah, the mysteries of TCPM.
In a 2002 study, Helene Langevin and Jason Yandow mapped the locations of acupuncture points in the arms to the fascia between and around muscles.
Oh please. Read the paper for gods sakes.
We hypothesize that the network of acupuncture points and meridians can be viewed as a representation of the network formed by interstitial connective tissue. This hypointermuscular or intramuscular connective tissue planes intermuscular or intramuscular connective tissue planes thesis is supported by ultrasound images showing connective tissue cleavage planes at acupuncture points in normal human subjects. To test this hypothesis, we mapped acupuncture points in serial gross anatomical sections through the human arm. We found an 80% correspondence between the sites of acupuncture points and the location of intermuscular or intramuscular connective tissue planes in postmortem tissue sections.
They found what they were looking for and could find it only 80% of the time. There may be occasional correspondence, but no anatomical structures that are acupoints or meridians. The lack of control is astounding and renders this mapping meaningless.
acupuncture points have since been found to lie within the same areas of connective tissue where fluid flows through the interstitium.
A 2019 paper by researchers in China, led by Dr. Hongyi Li, explains how they injected chemical tracers into acupuncture points in the hands and feet of cadavers and used chest compressions to push fluid through the bodies.
Fluorescent photography enabled them to see the tracers traveling toward the heart within interstitial spaces of the arms and legs. Li and colleagues clearly recognized, just as Wells and Theise did, that they had glimpsed evidence of an interstitial circulation system.
That is one weird ass study. As noted, they injected tracers in fresh cadaver feet and hands at acupoints and then did 2.5 hours of chest compression on the corpses to see where the tracer went. Not certain what the chest compressions did, as the blood clots quickly after death. I have done chest compression and know all too well the crunching of bones that can happen. What do 2.5 hours of chest compressions do to a corpse? I just imagine the body flopping like a fish with each compression. Kind of a mediastinal meat tenderizer. Like I said, weird ass. The authors wondered if the result had anything to do with acupuncture, as
However, the transport courses of the fibrous extravascular pathways from the thumb were significantly individual in all subjects and different from the diagrammatic drawing of Lung Meridians in Meridian Atlas. The visualized fibrous pathways were not the proof for the Meridians & Collaterals network but could be an anatomic structure for interstitial fluid transport, mediated by which acupuncture signals from an acupuncture point can be transmitted into an associated visceral structure hypothetically.
If acupuncture points seem to reside within the interstitium, could the meridians run through the interstitium as well?
If? Seem? Seems a stretch. And meridians? Naw. And what is it about these collagen bundles and sacs of fluid that result in specific structures like acupoints? What is different about the interstitum here but not there that makes it an acupoint or a meridian? Don’t think they have thought this through.
In 2021, a group of researchers conducted a similar experiment in China on living subjects, injecting dye into acupuncture points in the forearms of 15 volunteers.
In almost all of them, the dye slowly migrated upward along a route corresponding to the pericardium meridian, which passes through the wrist and along the inner arm. (Pericardium is the same meridian stimulated by anti-nausea wrist acupressure devices popular on cruise ships.)
Is it pressure? Or needles? If pressure works for nausea, then why use needles? Except acupressure is also ineffective:
Neither band nor placebo prevented the development of motion sickness, regardless of whether the bands were used correctly or incorrectly.
Remember how they said specific points are used in acupuncture. In this study they used
Pericardium (PC) meridian and the acupoints were identified on the forearm from the wrist to the elbow by two TCM physicians (Drs. Zhao and Hu) according to “Nomenclature and location of acupuncture points” (GB/T 12346-2006) issued by the Standardization Administration of China. Acupuncture point locations were reached by consensus and further refined or confirmed with the use of a low-electrical impedance locator device.
Yeah, they really know precisely where acupoints are. The injections were intradermal, but I thought the points were mapped to intermuscular or intramuscular connective tissue planes. So much inconsistency in the TCPM world, but that is how it should be as practitioners make it up as they go along.
“This pathway doesn’t go in the veins, it doesn’t go superficially,” says Andrew Ahn, the study’s senior author and an assistant professor at Harvard Medical School. It goes instead, he told me, into the interstitium between the muscles: “When I saw that, I said: ‘We’re onto something. This truly has to do with acupuncture.’”
Nope. It just has to do with the flow of material along the interstitium.
“I actually do think that the interstitium could be the link between Eastern and Western medicine,” Wells told me. “But you have to show scientifically that that’s the case.”
Never gonna happen, since one cannot scientifically show that a fiction is real.
It is a tale/Told by an acupuncturist, full of sound and fury,/Signifying nothing.
After this detour into nonsense, the trip down the interstitial highway veers back to reality, so I will not quote further except to note that there may be some interesting results from these findings that have nothing to do with TCPM. One of the potential applications is the spread of cancer or infections. As an aside, intra-abdominal abscesses tend to form in the right upper quadrant between the liver and diaphragm and very rarely in the left upper quadrant between the spleen and diaphragm. I was always taught it was because the RUQ has the lowest pressure, but that seemed inadequate to me. Using the interstitium flow as their highway may be a more valid explanation if that is where the flow goes. Better than saying the RUQ sucks.
Unexplained is how the semi-random placement of needles into collagen and water will treat virtually any disease, from pain to allergies to migraines, all with different anatomy and physiology. And how does the interstitium explain the near infinite varieties of acupuncture: Japanese, Korean, foot, hand, ear, head and the stupidest of the stupid, Tong Ren. Cause it can’t. Cause acupuncture is fictional.
I have to admit it flabbers my gaster that this article was written by a pulmonary and critical care physician and an associate professor of medicine. At my hospitals the critical care docs were among the most hard-ass evidence driven in the system. I cannot see where the author has ever written, studied or practiced acupuncture. He does not appear to be a true believer. I suspect this is the typical hubris of physicians who think their expertise in one area of medicine translates into another, in this case acupuncture. The author likely came across something like Is the Newly Described Interstitial Network the Anatomical Basis of Acupuncture Meridians? A Commentary and credulously ran with it. The result is the usual Dunning-Kruger superficial and gullible understanding of acupuncture that the NYT essay manifests. Safe to say he is not a regular reader of this blog.
The interstitium is the latest of many bandwagons to try and explain the unexplainable. Always remember that the diagnosis (based on examination of the tongue and pulse) and treatment of disease in TCPM is divorced from reality and, as such, will continue to try, and fail, to justify its existence with incomparable reality.
And why does this crap get into the NYT? The editor of the NYT newsletter, the Morning, said in reference to the above
Acupuncture works, of course. The studies are clear. People seek it out for treatment of all sorts of ills, from chronic pain and migraines to anxiety and insomnia.
Is it some variation of “quack magnetism” – the tendency of people and institutions who buy into one conspiracy or pseudoscience to promote many, or even all, of them? Or a new version of homeopathy: like deludes like? Birds of a feather and all that. Or maybe they used the Halupedia for research, although humans have never needed AI to hallucinate nonsense.
Whatever the reason, the result is embarrassing for the writer and the publisher.