good morning

[Guest guest]

> Ken wrote (excerpts)

 

" kenrose2008 " <kenrose2008

Re: Science and Rhinos

 

Your mention of the placebo effect as

being thought of as the effective agent

or essence of acupuncture is both a poignant

and highly pertinent reminder of the presence

of this danger in our midst.

 

...........

I came to see his research

concerning the placebo effect as an effort

to prove in terms that scientists can accept

that acupuncture is a placebo.

............. I tend to see the whole

effort at Harvard as an attempt on the

part of an important agency of " the

medical establishment " to coopt the

marketing momentum of acupuncture

and bring it into alignment with the

interests of mainstream medical

personnel. Integration, in other words.

 

> Z'ev told me that harvard research is about to begin that will attempt

> to prove

> just that. acupuncture is a placebo. if so, then little has actually

> changed.

>

 

 

I don't know if this is a reference to Kaptchuk's work.

 

Ken, I think he is doing exactly the opposite in using acupuncture to

show the shamanistic and subjective realities of all medicine. He

clearly has stopped being an acupuncturist but instead is investigating

how much of Western medicine is " placebo " and that the western

scientific needs to acknowledge its own biases. I think he has stopped

" proving " acupuncture because he accepts it. (read quote below) In that

way, I see the ultimate outcome of his research is to bring back the

mystical, magical to all healing arts. For example, one story that

stuck with me from his book after the Web (name?) was about a trial

where they did actual heart surgery and " placebo " cuts in the sternum.

The cuts (Ren mai?) actually did better. The punch line is that the

" doctors " then stopped doing BOTH procedures because the placebo was

well.. the placebo. It is this type of tunnel vision of Western

research methods that he is attacking.

 

 

http://www.annals.org/cgi/content/full/136/5/374

Numerous randomized, controlled trials and more than 25 systematic

reviews and meta-analyses have evaluated the clinical efficacy of

acupuncture. Evidence from these trials indicates that acupuncture is

effective for emesis developing after surgery or chemotherapy in adults

and for nausea associated with pregnancy. Good evidence exists that

acupuncture is also effective for relieving dental pain. For such

conditions as chronic pain, back pain, and headache, the data are

equivocal or contradictory. Clinical research on acupuncture poses

unique methodologic challenges. Properly performed acupuncture seems to

be a safe procedure. Basic-science research provides evidence that

begins to offer plausible mechanisms for the presumed physiologic

effects of acupuncture. Multiple research approaches have shown that

acupuncture activates endogenous opioid mechanisms. Recent data,

obtained by using functional magnetic resonance imaging, suggest that

acupuncture has regionally specific, quantifiable effects on relevant

brain structures. Acupuncture may stimulate gene expression of

neuropeptides. The training and provision of acupuncture care in the

United States are rapidly expanding.

 

 

 

 

http://www.annals.org/cgi/content/full/136/11/817

Besides clinical and scientific value, the question of enhanced placebo

effects raises complex ethical questions concerning what is

" legitimate " healing. What should determine appropriate healing, a

patient¡Çs improvement from his or her own baseline (clinical

significance) or relative improvement compared with a placebo

(fastidious efficacy)? As one philosopher of medicine has asked, are

results less important than method (3) ? Both performative and

fastidious efficacy can be measured. Which measurement represents

universal science? Which measurement embodies cultural judgment on what

is " correct " healing? Are the concerns of the physician identical to

those of the patient? Is denying patients with nonspecific back pain

treatment with a sham machine an ethical judgment or a scientific

judgment? Should a patient with chronic neck pain who cannot take

diazepam because of unacceptable side effects be denied acupuncture

that may have an " enhanced placebo effect " because such an effect is

" bogus " ? Who should decide?

 

The practitioner-healer must expertly play the role of heroic rescuer

to facilitate a placebo effect (32) . Numerous RCTs have compared

optimistic or enthusiastic physician attitudes toward drug or placebo

with neutral or doubtful physician attitudes. Practitioners have had

significant impact on such clinical conditions as pain (33-36) ,

psychiatric illness (37-41) , hypertension (42, 43) ,obesity (44) , and

perimenopause symptoms (45) . Although some studies have shown no

effect of physicians¡Ç expectations on clinical end points (46-48) , a

systematic review of 85 studies found that although more research is

needed, provider-induced " expectancies are a mechanism for placebo

effects, [which have] received support across a range of clinical areas

in a variety of studies " (49) . A second review, which used more

stringent entry criteria, found 25 RCTs that examined the impact of

randomly assigning patients with physical illnesses to different levels

of expectancy and emotional support. Although researchers found

inconsistent effects and determined that further research was needed,

they also found that " enhancing patients¡Ç expectations through positive

information about the treatment or illness, while providing support or

reassurance, [seemed to] significantly influence health outcomes " (50) .

 

compare with Bensky's SIOM article (excerpt)

 

Purpose »Ö,Elation ´î,and the Pancreas ç£

 

by Dan Bensky , D.O.

Our aim is to see the world of acupuncture clearly. If we look at it

through the lenses of biomedicine we are going to miss much of

importance. While the technology and constructs of modern biomedicine

can be helpful, using them in acupuncture requires translation into the

framework of traditional Oriental medicine. It has been said that

acupuncture is the practice of medicine. Of course this is true if what

you mean by medicine is the science and art of dealing with the

maintenance of health and the treatment of disease. It is even more

obvious that this statement is untrue if by ¡Èmedicine¡É you mean

conventional Western medicine. Acupuncture requires different

knowledge, uses different thinking processes, and calls upon different

talents. To state that a knowledge of conventional Western medicine

uniquely qualifies one to do acupuncture is ethnocentric at best. This

is like saying you need to know American English before you can speak

Chinese or that one must be able to barbecue before learning how to

cook Peking duck.

 

On Wednesday, October 22, 2003, at 08:47 AM,

wrote:

 

>

> , yehuda l frischman <

> @j...> wrote:

> I happened to pick up a book written in the

>> 80s by a popular western MD today, and just 15 years ago, the accepted

>> belief was that acupuncture efficacy was due to placebo. Few MDs

>> believe

>> that today.

>

>

>