accupuncture

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Actually I agree for the most part. While I strongly believe that what I do is not just d/t the placebo effect, I know that my modality is a strong "carrier" of it [edit - see Ted Kaptchuk's research on acupuncture placebo vs. pill placebo]. I also entertain the slight possiblity that acupuncture might only have non-specific and placebo effects. I doubt it, and I am not losing any sleep over it, but as a scientist I always have to be open to the possibility.


As I was discussing this thread with my fiance (also an acupuncturist), I did realize something: the effects of my acupuncture treatments has improved with experience. If the effects of acupuncture are only due to non-specific and placebo effects, then my experience should not matter. My improved ability to properly diagnose should not matter. My improved ability to develop a tailored treatment protocol should not matter. My improved needling ability should not matter.

But it does.


Granted, as a person grows with experience, their confidence rises. This would in turn be transmitted to the patient, which could improve the possiblity of a postive placebo-based outcome.

The question would be would this increased confidence / improved placebo really be sufficient enough to explain my improved patient outcomes. Personally, I doubt it.

Maybe you should involve yourself in a trial where you are the one delivering traditional acupuncture. Until you or anyone else can demonstrate an effect other than your own self-serving, unscientific claims of efficacy, I will base my views on the best available evidence. Acupuncture ~= Sham acupuncture.

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I know at least one medical anthropologist who would disagree with you...after a little wager with a senior anthropologist and his voodoo priest friend. The "event" was set up for a Monday night after the young anthropologist had gone back to the states. Mon night he was laughing as nothing happened. Thursday night, double over in extreme pain, he got a call from the senior guy saying that they couldn't do the ceremony Monday night but were doing it now..."How are you feeling" he asked, LOL! An ER visit showed nothing wrong.:scared:

I missed the punchline.

As a physician, first I am a scientist.

If the best available science does not demonstrate clinical utility, then the onus is on you, not me.
 
Actually I agree for the most part. While I strongly believe that what I do is not just d/t the placebo effect, I know that my modality is a strong "carrier" of it [edit - see Ted Kaptchuk's research on acupuncture placebo vs. pill placebo]. I also entertain the slight possiblity that acupuncture might only have non-specific and placebo effects. I doubt it, and I am not losing any sleep over it, but as a scientist I always have to be open to the possibility.


As I was discussing this thread with my fiance (also an acupuncturist), I did realize something: the effects of my acupuncture treatments has improved with experience. If the effects of acupuncture are only due to non-specific and placebo effects, then my experience should not matter. My improved ability to properly diagnose should not matter. My improved ability to develop a tailored treatment protocol should not matter. My improved needling ability should not matter.

But it does.


Granted, as a person grows with experience, their confidence rises. This would in turn be transmitted to the patient, which could improve the possiblity of a postive placebo-based outcome.

The question would be would this increased confidence / improved placebo really be sufficient enough to explain my improved patient outcomes. Personally, I doubt it.

Untill you look critically at your experience in a prospective fashion with statistical analysis of your outcome data, I don't particularly care what you doubt or what you believe. That is the difference between anecdote and science.
 
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Untill you look critically at your experience in a prospective fashion with statistical analysis of your outcome data, I don't particularly care what you doubt or what you believe. That is the difference between anecdote and science.

Actually I do critically evaluate my outcomes on a regular basis. I'm curious why you made the assumption that I didn't.
 
Actually I do critically evaluate my outcomes on a regular basis. I'm curious why you made the assumption that I didn't.

Perhaps because you haven't botherd to publish your results in a peer reviewed journal so that it can be open to the same kind of scrutiny and critique that you heap upon those who are willing to subject their data to that kind of critical review?
 
Perhaps because you haven't botherd to publish your results in a peer reviewed journal so that it can be open to the same kind of scrutiny and critique that you heap upon those who are willing to subject their data to that kind of critical review?

So we can't critique research unless we also publish research? That's completely absurd, and when combined with the tone of your last post, leads me to the conclusion that "I don't particularly care what you doubt or what you believe".
 
Untill you look critically at your experience in a prospective fashion with statistical analysis of your outcome data, I don't particularly care what you doubt or what you believe. That is the difference between anecdote and science.

Paz, of course in principle you're right...but, "those in glass houses..."

It's not like the practice of pain medicine in general is grounded in hard science. I find that there is a subset of patients with pain for whom acupuncture is a home-run. Generally, my primary selection criteria for acupuncture referral include: regional myofascial pain, no compensation or pending disability evaluations, and history of transient relief with other physical modabilities such as massage or manipulation. Secondary selection criteria include: female gender, possession of Birkenstock foot wear, use of only "no animal tested" cosmetics, owning a hybrid vehicle, and a strong preference for organically grown food.

If you plugged all these variables into a regression equation I am certain that you could predict a positive response to acupuncture treatment with an effect size that rivals SCS for intractable monoradicular lower extremity pain and high statistical significance! :laugh:
 
I still don't understand the point of demanding more rigorous evidence from acupuncturists. What purpose, from a practical standpoint, would this serve?

It will not reduce utilization....
It will not force acupuncturists to forego their livelihoods and perform penance in Western India for their 'sins' against humanity

patients pay out of pocket, for acupuncture and continue to do so, despite well publicized doubts and nay sayers....patients often go to acupuncturists, after seeing a physician or physicians....hence, they are willing to risk pursuing an 'alien' approach to their health care problems, in spite of living in a society that produced Osler and Flexner...

if a patient is willing to take this kind of risk and if they continue to pursue acupuncture, at their own cost....it suggests:

1. acupuncture has gained widespread acceptance
2. 'Western' medicine has consistently dissatisfied the public with Quality of Life problems (such as chronic pain).

PAZ, if you really wanted to have your opinions become a true call for action...then push for state boards to sanction practitioners that do not practice evidenced based medicine and if you start this movement, then you can draft your own criteria for EBM and present it to the state boards....this would be difficult, since most state boards have formal licensing processes for acupuncture...and some have one for physicians practicing acupuncture and also for non physicians....

however, having forums or weekly journal clubs that become spit fests about the merits of a study or another practitioner...is something that is best left for the O'Reilly factor....here today and gone tommorrow....

If your goals, however, are to reduce utilization of non-EBM practices...there is enough fodder in 'Western medicine', where the patient is utilizing someone else's money for their health care, instead of their own...

Finally, it impresses me that acupuncture is willing to subject itself to studies comparing its performance against sham operations....

...there are very few studies in interventional pain or spine surgery that compare the index procedure to sham ( ALIF is not a sham operation when compared to TDR btw)...only with a sham operation can we discern the degree of placebo contribution....

if you criticize acupuncture, then at least use one standard that can then be uniformly applied to other pain/spine procedures or for that matter, any medical procedure....be fair...

personally, it would be much easier to walk across the street from your practice and shake hands with the local acupuncturist...exchange ideas...and perhaps, manage patients jointly...

it justs seems so much harder to form a picket line, in front of the acupuncturist's practice, protesting against the use of acupuncture--Detroit style and buying Elmers glue to plaster EBM articles across the front window (I am being facetious)
 
I am in the final stages of submitting a manuscript titled: " The Sky is Blue : A Randomized Double Blind Multi-center Crossover Trial "

I used the latest in photospectrometer equipment, sampled 1000's of arcs of sky, submitted unlabelled readings to multiple centers for review, then resent those samples back to those and other centers for re-anaysis.

The data all point to the sky being blue.


PAZ: But what about when it's cloudy, and "waiting on Cochrane", "define blue", was it Photoshop or Pantone, was the photospectrometer calibration done prior to readings, etc.

There are valid scientific reasons to not recommend acupuncture, but there is no clinical downside to its use and as it is non-covered by insurance, there is no healthcare utilization downside. If a patient wants to try it, I am all for it. If it works, they will tell me. No placebo, no nocebo.
 
I am in the final stages of submitting a manuscript titled: " The Sky is Blue : A Randomized Double Blind Multi-center Crossover Trial "

I used the latest in photospectrometer equipment, sampled 1000's of arcs of sky, submitted unlabelled readings to multiple centers for review, then resent those samples back to those and other centers for re-anaysis.

The data all point to the sky being blue.


PAZ: But what about when it's cloudy, and "waiting on Cochrane", "define blue", was it Photoshop or Pantone, was the photospectrometer calibration done prior to readings, etc.

There are valid scientific reasons to not recommend acupuncture, but there is no clinical downside to its use and as it is non-covered by insurance, there is no healthcare utilization downside. If a patient wants to try it, I am all for it. If it works, they will tell me. No placebo, no nocebo.

One problem - while Dr. Steve is currently correct re MEDICARE, private payors do, indeed pay for this non-EBM based modality, and AOMNC gets more votes each year to support the Hinchey Fed Acupuncture Bill (HR818) for medicare to provide coverage. While self-pay patients are less offensive, in thsi day and age of zero sum healthcare coverage, any modality that does not ahve evidence of efficacy should go to the end of the line,a nd be covered only if there is money left after all proven modalities have been fully funded.

As well, from an ethical perspective, I do not recommend patients start modalities without evidence of efficacy. Now if they come to me convinced that they work, I don't offer opposition that they continue, the same way I don't oppose chiropractic, manipulation, PT, massaage, aquatherapy, or biofeedback. What I do say is that there is no evidence of efficacy, but if they have found it works for them, by all means, continue it.
 
So we can't critique research unless we also publish research? That's completely absurd, and when combined with the tone of your last post, leads me to the conclusion that "I don't particularly care what you doubt or what you believe".

If you'll note the sequence of posts, you were highly critical of the methodology from the German articles, and then went on to tell us extensivly about your own experience and training. You quoted your patient outcomes, but presented no data. I suggested your cause might be better served if you were to present your data in a prospective, statistically analysed format, and that what you were describing was anecdote, not science. You responded that you do - so I asked that you publish it, and subject it to the same harsh light of public critique we subjected the German articles to.

As for your comment about my "tone" please note the "tone" of all my posts - skeptical until proven using EBM. If that somehow offends your delicate sensibilities, or if you actually beleive acupuncture ought not to subject itself to the same scientific method we use to evaluate all technologies, merely because of its ancient roots, perhaps this isnt the forum for you.
 
PAZ,

I couldn't agree with you more. Acupuncturist are alternative practictioners with a foundation in eastern(more spiritual/philosophical) as opposed to western (more scientific) EBM. That being said I have never subscribed much to the whole Meridian based system. I do think acupuncture has a neurologic influence on nociceptive transmission based on Melzak and Walls pain gate theory. Acupuncture needles can stimulate cutaneous mechanoreceptors which potentiate large diameter afferents to modulate an inhibitory response at the cord level. Speaking clinically the results I have witnessed with regard to pain ratings are no more impressive than those obtained via a TENS unit. That being said, I have no double blind randomized clinical trials to base my clinical suspicions. In the future I am sure there will be more studies to validate Eastern applications in pain management but for now I feel more comfortable prescribing a TENS unit.:thumbup:
 
I missed the punchline.

As a physician, first I am a scientist.

If the best available science does not demonstrate clinical utility, then the onus is on you, not me.

No punchline...just a response to your comment about having to believe in voodoo for it to work.
 
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The data all point to the sky being blue.


Phew! You just saved your ass from being kicked by all the elementary school children in America....unlike the poor astronomer(s) who demoted Pluto.
 
If you'll note the sequence of posts, you were highly critical of the methodology from the German articles, and then went on to tell us extensivly about your own experience and training. You quoted your patient outcomes, but presented no data. I suggested your cause might be better served if you were to present your data in a prospective, statistically analysed format, and that what you were describing was anecdote, not science. You responded that you do - so I asked that you publish it, and subject it to the same harsh light of public critique we subjected the German articles to.



I wasn't highly critical - pointing out there were insignificant numbers of patients in the real and sham group, possible issues with the lack of training of the providers, and an evaluation of the treatment group should be part of a standard evaluation of ALL ACUPUNCTURE RESEARCH.

If you were reviewing clinical research that had nursing students performing diagnosis and treatment of patients, had drugs prescribed that might not be the best for the diagnosis, and those drugs were used at lower than normal dosages, would you be skeptical of the outcomes?

As for your comment about my "tone" please note the "tone" of all my posts - skeptical until proven using EBM. If that somehow offends your delicate sensibilities, or if you actually beleive acupuncture ought not to subject itself to the same scientific method we use to evaluate all technologies, merely because of its ancient roots, perhaps this isnt the forum for you.

Please. This is the tamest, most polite forum that I actually frequent. I was attempting to parallel your comments with my own. But I do like your strawman about not wanting to evaluate acupuncture because of its ancient roots...especially since the content of my posts was to evaluate current acupuncture research.
 
Have some of you ever questioned whether the scientific method is flawed? Whether RCTs have limitations? Whether EBM is better for patient care or better for the control of insurance companies over the minds of physicians?

If you have questioned these things and you have an answer, that's great. Otherwise I would urge you to think about it.
 
Insults are so quickly delivered here. Why can't we be more professional?

Have some of you ever questioned whether the scientific method is flawed? QUOTE]

You are being a doofus.

The rest of the post is fine. EBM has limitations. RCT's list the limitations in the study.
 
Here's one study that came out in the Annals of Internal Medicine in Dec, 2004 that made lots of noise, as it is perhaps the largest RCT using a very effective sham acupuncture technique (via surveys filled out by patients in both the control and sham group...greater than 85% in both groups believed they were in the true acupuncture group, or were not sure which group they were in):

Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial.

Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC.

University of Maryland School of Medicine, Baltimore, Maryland 21207, USA.

BACKGROUND: Evidence on the efficacy of acupuncture for reducing the pain and dysfunction of osteoarthritis is equivocal.

OBJECTIVE: To determine whether acupuncture provides greater pain relief and improved function compared with sham acupuncture or education in patients with osteoarthritis of the knee.

DESIGN: Randomized, controlled trial.

SETTING: Two outpatient clinics (an integrative medicine facility and a rheumatology facility) located in academic teaching hospitals and 1 clinical trials facility. PATIENTS: 570 patients with osteoarthritis of the knee (mean age [+/-SD], 65.5 +/- 8.4 years).

INTERVENTION: 23 true acupuncture sessions over 26 weeks. Controls received 6 two-hour sessions over 12 weeks or 23 sham acupuncture sessions over 26 weeks.

MEASUREMENTS: Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. Secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF-36). RESULTS: Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks (mean difference, -2.9 [95% CI, -5.0 to -0.8]; P = 0.01) but not in WOMAC pain score (mean difference, -0.5 [CI, -1.2 to 0.2]; P = 0.18) or the patient global assessment (mean difference, 0.16 [CI, -0.02 to 0.34]; P > 0.2). At 26 weeks, the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, -2.5 [CI, -4.7 to -0.4]; P = 0.01), WOMAC pain score (mean difference, -0.87 [CI, -1.58 to -0.16];P = 0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P = 0.02).

LIMITATIONS: At 26 weeks, 43% of the participants in the education group and 25% in each of the true and sham acupuncture groups were not available for analysis.

CONCLUSIONS: Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.
 
Here's a link to the full article for any of you interested in the details:

http://www.redorbit.com/news/health..._adjunctive_therapy_in_osteoarthritis_of_the/

RESULTS

Pain

While pain among participants who were receiving true acupuncture decreased more than in the sham group at all of the postbaseline assessments, this difference was not statistically significant at week 8. By week 14, the mean WOMAC pain score had decreased by 3.6 units in the acupuncture group (a 40% decrease from baseline) compared with -2.7 in the sham group (P = 0.02). These differences remained at week 26 (P = 0.003).

Function

The true acupuncture group's improvement in function from baseline was significantly greater than that of the sham control group at weeks 8 (P = 0.01), 14 (P = 0.04), and 26 (P = 0.009). A change of more than 12 units by 14 weeks is an almost 40% improvement from baseline.

Patient Global Assessment

Consisting of 1 item that asked participants how their knee osteoarthritis was affecting them, the patient global assessment showed no statistically significant difference in true versus sham acupuncture improvement until the final 26-week assessment (Table 2). At the conclusion of the trial, participants' changes from baseline were significantly greater (es = 0.26; P = 0.02) for those receiving true acupuncture (15%) than their sham counterparts (6%). However, the difference between groups was somewhat less and not significant in the imputed analysis (P = 0.11).

SF-36 Physical Function

The SF-36 was administered to trial participants only at baseline, week 8, and week 26. While the overall pattern of improvement mirrored that of the other outcome variables, changes in overall physical component score did not statistically significantly differ between the true versus sham acupuncture groups (Table 2).

Six-Minute Walk

We observed no statistically significant differences at any time point.

OMERACT-OARSI Responder Index

The proportion of participants who were classified as responders at 26 weeks was 98 of 186 (52%) in the true acupuncture group, 86 of 183 (47%) in the sham group (P > 0.2 compared with true), and 52 of 174 (30%) in the education group. These between-group differences were not significant for the true versus sham comparison, but the proportion of responders was significantly greater (P < 0.001) in both the true and sham acupuncture groups than in the education control group.
 
NOLAGAS, thanks for highlighting some important points, but you are clearly biased, as you have not highlighted those results noted to be "significant" in the study.

If I were to do the same, I would post as such:

"Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. Secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF-36).

RESULTS: Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks (mean difference, -2.9 [95% CI, -5.0 to -0.8]; P = 0.01) but not in WOMAC pain score (mean difference, -0.5 [CI, -1.2 to 0.2]; P = 0.18) or the patient global assessment (mean difference, 0.16 [CI, -0.02 to 0.34]; P > 0.2). At 26 weeks, the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, -2.5 [CI, -4.7 to -0.4]; P = 0.01), WOMAC pain score (mean difference, -0.87 [CI, -1.58 to -0.16];P = 0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P = 0.02)."

It is hard to be free of one's self biases. We are all guilty of this. Identifying if you have a bias is a start, and to be able to figure out what is fueling one's bias is much tougher.

Respectfully, if one is to scrutinize this study, please remove your filtered glasses prior to doing so.
 
Have some of you ever questioned whether the scientific method is flawed? Whether RCTs have limitations? Whether EBM is better for patient care or better for the control of insurance companies over the minds of physicians?

If you have questioned these things and you have an answer, that's great. Otherwise I would urge you to think about it.

Churchill's famous dictum: "Democracy is the worst form of government, except for all those other forms that have been tried from time to time." (from a House of Commons speech on Nov. 11, 1947)

One might suggest viewing EBM the same way - until you have a better system, that's what we have to work with
 
Actually I do critically evaluate my outcomes on a regular basis. I'm curious why you made the assumption that I didn't.
paz5559 said:
Perhaps because you haven't botherd to publish your results in a peer reviewed journal so that it can be open to the same kind of scrutiny and critique that you heap upon those who are willing to subject their data to that kind of critical review?

In future, you might want to borrow one of my favorite tricks speakers who go up to the microphone at meetings use when they speak of evaluating their work in the same off the cuff fashion you allude to:

If you have done one case: "in my experience"

If you have done two cases: "in my series"

If you have done three cases: "case after case demonstrates."
 
In future, you might want to borrow one of my favorite tricks speakers who go up to the microphone at meetings use when they speak of evaluating their work in the same off the cuff fashion you allude to:

If you have done one case: "in my experience"

If you have done two cases: "in my series"

If you have done three cases: "case after case demonstrates."

Actually that is funny. Here is one of my favorites:

"I've come to the conclusion that... / From what I have learned... / Experience has taught me ..."

- Famous intro's when a person is about to pass off something they heard in class, read in a book, or found online [gasp!] as something original.
 
I was just pointing out that even your example of a study favorable to accupuncture vs sham failed to show a difference in several outcome measurements.

You left the results out all together and just posted the biased conclusions. Biased in that they only summarized the positive and not the negative results.
 
I was just pointing out that even your example of a study favorable to accupuncture vs sham failed to show a difference in several outcome measurements.

You left the results out all together and just posted the biased conclusions. Biased in that they only summarized the positive and not the negative results.

NOLAGAS:

The post I made was a direct copy of the abstract as published in the Annals of Internal Medicine. I have not doctored it in any way to present it in a biased fashion. :rolleyes:
 
NOLAGAS, thanks for highlighting some important points, but you are clearly biased, as you have not highlighted those results noted to be "significant" in the study.

If I were to do the same, I would post as such:

"Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. Secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF-36).

RESULTS: Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks (mean difference, -2.9 [95% CI, -5.0 to -0.8]; P = 0.01) but not in WOMAC pain score (mean difference, -0.5 [CI, -1.2 to 0.2]; P = 0.18) or the patient global assessment (mean difference, 0.16 [CI, -0.02 to 0.34]; P > 0.2). At 26 weeks, the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, -2.5 [CI, -4.7 to -0.4]; P = 0.01), WOMAC pain score (mean difference, -0.87 [CI, -1.58 to -0.16];P = 0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P = 0.02)."

It is hard to be free of one's self biases. We are all guilty of this. Identifying if you have a bias is a start, and to be able to figure out what is fueling one's bias is much tougher.

Respectfully, if one is to scrutinize this study, please remove your filtered glasses prior to doing so.

The numbers may be statistically significant, but are they clinically significant. Is a difference of 0.87 in WOMAC Pain clinically different, or just enough of a difference among two groups to be mathematically different? I believe the WOMAC to be a 20 point Likert scale, thus a difference of 0.87 carries little clinical weight. For VAS (0-10) we consider a change in 2 to be significant (despite the percentage fluctuating at the ends of the scale). I would hold the WOMAC to same or similar criteria making a clinically significant endpoint of a change between 3-5.
 
PAZ,

I couldn't agree with you more. Acupuncturist are alternative practictioners with a foundation in eastern(more spiritual/philosophical) as opposed to western (more scientific) EBM. That being said I have never subscribed much to the whole Meridian based system. I do think acupuncture has a neurologic influence on nociceptive transmission based on Melzak and Walls pain gate theory. Acupuncture needles can stimulate cutaneous mechanoreceptors which potentiate large diameter afferents to modulate an inhibitory response at the cord level. Speaking clinically the results I have witnessed with regard to pain ratings are no more impressive than those obtained via a TENS unit. That being said, I have no double blind randomized clinical trials to base my clinical suspicions. In the future I am sure there will be more studies to validate Eastern applications in pain management but for now I feel more comfortable prescribing a TENS unit.:thumbup:

First, what makes acupuncturists "alternative" practitioners? Alternative to what? Clearly this is a disparaging remark. They aren't westerners? How much do you know about the science of acupuncture. If you went to acupuncture school you would also see that you are dead wrong if you think that acupuncture is just based on "spiritual/philosophical principles." this is getting back to old scientific/rational/western vs. eastern divisive argument. How much do you know about complex herbal prescriptions?

I think the majority of pain practitioners know very little about acupuncture. How many have spent time w/ a certified L.Ac, talked to their patients, shared patients or read the acupuncture literature.

What happened to due respect, to at a minimum considering our colleagues as offering "complementary" medicine.

Why don't you subscribe to the meridian theory? Have you read about it? By the way, the gate theory is pretty basic these days, we know alot more than we used to. Remarkable insight ,, but just part of the picture of pain ttransmission. It did not address central sensitization, etc.

What I know about TENS units is that based on EBM data they are basically useless, I don't think that is a straightforward or just comparison.
 
What I know about TENS units is that based on EBM data they are basically useless, I don't think that is a straightforward or just comparison.

Wait, so we apply EBM principles to TENS, but not to accupuncture?
 
Wait, so we apply EBM principles to TENS, but not to accupuncture?


touche.... but testing a TENs unit as a therapeutic intervention appear to me to be much less complex and testing "acupuncture" as an entire field of medicine.
 
touche.... but testing a TENs unit as a therapeutic intervention appear to me to be much less complex and testing "acupuncture" as an entire field of medicine.

Ah, silly me ... so apparently accupuncture is too complex to be subjected to the same principles we readily apply to all other aspects of patient care.

My bad ;)
 
Yes, I agree. but only for "excellent chinese medicine practitioner".
Accupuncture is based on Chinese culture.
In fact, in China, Accupuncture can treat many, the most important one is the sequela of neural illness, other cases such as pain, reducing weight, even cold. but in US, maybe it is usually used to treat pain.
I TOTALLY agree with this sentiment. Also, if you can't read chinese I don't know if you can be an excellent chinese medicine practitioner. Do you know any great allopathic medical doctors that can't read english?
 
So we can't critique research unless we also publish research? That's completely absurd, and when combined with the tone of your last post, leads me to the conclusion that "I don't particularly care what you doubt or what you believe".

NOPE...

Rule #1 amongst all scientists (not just physicians)

If It Ain't Published... It Ain't True Yet.

I am dead serious....It took forever to disprove so many misconception in medicine.. we don't need more 'conventional misconceptions'.... otherwise we would still be bleeding people to cure many diseases.
 
NOPE...

Rule #1 amongst all scientists (not just physicians)

If It Ain't Published... It Ain't True Yet.

I am dead serious....It took forever to disprove so many misconception in medicine.. we don't need more 'conventional misconceptions'.... otherwise we would still be bleeding people to cure many diseases.

I think you misinterpreted my post. I was responding to the suggestion that I cannot analyze a study unless I publish research.



Oh, and about the TENS, most acupuncturists don't use them. We use electro-acupuncture instead. Big difference.
 
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