Pictured: Joshua Tree. Not pictured: My bleached bones.

Pictured: Joshua Tree. Not pictured: My bleached bones.  I hope.

A short post this week. Last weekend was a busy call weekend and as I type this I am heading for Palm Springs for a long weekend of hiking in the desert. If there is no entry in 14 days, look for my bleached bones somewhere in Joshua Tree.

Some observations about a recent article in the once-respected Annals of Internal Medicine, whose recent articles on acupuncture suggest their motto should be “The Annals: we have one too many ns.”

First there was, “Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial,” and now “Acupuncture for Menopausal Hot Flashes: A Randomized Trial.”

Spinning yin deficiency

Why do the study? Why do any acupuncture study? Negative studies will not change practice. There are no reality-based reasons to think that acupuncture would be effective for any process. All the high quality studies show no efficacy.

As of the last Cochrane review of acupuncture for hot flashes, the data suggested:

When acupuncture was compared with sham acupuncture, there was no evidence of any difference in their effect on hot flushes. When acupuncture was compared with no treatment, there appeared to be a benefit from acupuncture, but acupuncture appeared to be less effective than [hormone therapy].

Treatment is no different than placebo, so for any real therapy it would be concluded that the intervention is not effective.

And the results continue in this new study:

Chinese medicine acupuncture was not superior to noninsertive sham acupuncture for women with moderately severe menopausal [hot flashes].

Nicely said. Expressing the proper and rigorous interpretation of the study, acupuncture is not effective. For once the take on the web was correct: acupuncture doesn’t work for hot flashes. This probably suggests the authors of the study never learned to spin their results. So often when acupuncture is equal to placebo, acupuncture is declared effective since it has the “power of the placebo”. You probably do not remember, but two years ago there was a similar study where acupuncture and sham acupuncture were equal for reducing hot flashes. Then the spin was “Acupuncture may reduce severity and frequency of menopausal hot flashes.”

The lead author needs to get her SCAM speak down better, instead saying:

“Acupuncture has been shown to be more effective than placebo for a number of conditions, specifically chronic pain,” said the lead author, Dr. Carolyn Ee, a family physician trained in both Western and Chinese medicine. “To say that it doesn’t work for hot flashes is not the same as saying it doesn’t work.”

Chronic pain is singular, so I guess the number of conditions specifically is one. The loneliest number as I remember. And while I agree it isn’t the same, acupuncture still doesn’t work.

It would be an interesting sociological study. Do a test of acupuncture vs sham acupuncture vs wait list. Doesn’t matter the symptom as long as there is a subjective endpoint. Real and sham will be equal in symptom relief and superior to doing nothing. Then send out two identical press releases except one that concludes acupuncture does nothing and one concludes it is effective.

It would be interesting to see if anyone actually cognates on the releases.

And why would the Annals publish an article that says the study was using:

Chinese medicine needle acupuncture designed to treat kidney yin deficiency

My first google hit using “kidney yin deficiency” as a search term suggests kidney yin deficiency

usually presents as lumbar soreness

And

follows the rules of yang vacuity internal cold; therefore it usually presents cold symptoms, e.g. cold and pain in the lumbar area and cold limbs. Kidney qi deficiency is a common clinical diagnosis and does not usually present with cold symptoms. When the kidney’s astringent or storage functions are poor with a kidney qi deficiency, associated symptoms appear, e.g. frequent urination, copious amounts of clear urine, incontinence, enuresis, seminal emission, abortion, or miscarriage

Nowhere on the search result do they mention hot flashes.

Next hit. Menopause hot flashes? Nope

The next? Nope.

So I searched for menopause and kidney yin deficiency and found it.

When hot flashes or sweating are the major complaints, TCM regards these as internal damage problems due to such things as blood and qi deficiency, kidney yin deficiency, spleen and heart deficiency, phlegm stagnation, heat or phlegm irritating heart.

It goes to the heart of Traditional Chinese Pseudo-Medicine. They have zero standards and basically make stuff up as they go along.

When I see kidney yin deficiency as a rationale for a clinical intervention, I wonder if the Annals would have published a similar trial using the Traditional European Pseudo Medicine of four humors as the basis of a study and bleeding as the treatment. It would have the same result. It is a hoax that needs to be played.

The ethics of cursing

One last thought about acupuncture. I like the concept of acupuncture as a complex therapeutic ritual. But the longer I am in the SCAM world, the more I think this gives acupuncture, and other pseudo-medicines, too much benefit of the doubt.

Occasionally there is an article about the arrest of a fortune teller. The fortune teller has convinced someone that they or their material goods are cursed and the curse is the source of problems or discontent in the household. In modern times the curse is sometimes referred to as negative energy.

The fortune teller then helps lift the curse. It may be money to help perform a ritual to lift the curse or remove the negative energy. Sometimes the valuables are cleansed and then disappear. Magic? In the legal system this behavior is considered fraud and theft and the fortune teller, if caught, often goes to jail.

I cannot find if the victims of the curse scam feel better after their curse has been lifted or the negative energy banished. There are no studies I could locate on the topic. At least I could find no studies outside of the literature for pseudo-medicines.

Is the practice of acupuncture, reiki, homeopathy, chiropractic and the other pseudo-medicines any different from the practice of curse removal? Not that I can see. They have the same basic principles, just different language. Barely.

Acupuncture is a ritual; it is a curse removal ritual. At its center, so is most of CAM.

Do the ends justify the means? It depends on the ends and the means. But in medicine there are those who consider it OK to do the equivalent of the curse removal, fraud and theft, as long as the patient reports benefit.

There is little information on curses as a cause of illness outside of Biblical references, so it would appear to be an area with the potential for growth.

It would be simple enough to do. Get an online pseudo-medical degree like ND, DC or Lac. Then you can do virtually anything and call it therapy. Then set up a clinic to remove the negative energies and curses for medical purposes. The authorities will never look twice. And in a year or two you will probably be hired by the local University Medical Center’s Integrative Medical Clinic. I bet the Cleveland Clinic will be the first.

Now my seat back needs to be in the upright and locked position and my computer stowed under the seat in front of me. Later.

 

 

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His growing multi-media empire can be found at edgydoc.com.

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