shamupuncture success rates

[Guest guest]

Here is google's weird translation of the success rates from the german

study on sham versus real acupuncture found in the german at

http://www.medizinauskunft.de/artikel/aktuell/

28_01_04_akupunkturstudie.php

 

" Nine of ten Allergikern were also six months to the treatment still

clearly better, three from four patients with head or

Lendenwirbelsaeulenschmerzen showed likewise after this period still

improvement. Still more highly the rate was with Arthroseschmerzen (85

per cent), asthma (82 per cent) and Dysmenorrhoe (85 per cent). "

 

While I can't really tell what is being treated in all cases, I can

tell that the success rates range from 75-90% in all conditions listed.

Now perhaps we can do better with tailored treatment, but the burden

is now on us to prove it. It serves no purpose to try and cast a

positive spin on the results. As the british guardian reports, this

study could easily lead to the entire EU derecognizing acupuncture.

entire article at

http://www.guardian.co.uk/health/story/0,3605,1170061,00.html

 

" So do the German mega-studies suggest effectiveness or

ineffectiveness? Apparently, there is less room for interpretation than

one might think. One of the German investigators, Professor H J

Trampisch from Bochum University, recently provided the answer. When

asked whether these results demonstrate the success of acupuncture his

response was decisive: " No, this cannot be. In our studies, we clearly

determined that acupuncture will be deemed effective only if it is

significantly superior to sham acupuncture. If this is true, the

biggest trials in the history of acupuncture might be the beginning of

the end of this therapy. "

 

We need to either do better or prove the studies flawed when they are

finally published. If it turns out that doing certain styles of CM can

reliably give results more on the order of 95% or better for some

complaint, then we may have a case. At least if the medical

acupuncture fails, they would know where to refer.

 

But we have to reconcile to the fact that europe is a socialist union

and decisions about things like acupuncture are going to be made on a

centralized cost benefit analysis. Canada and australia and new

zealand will follow suit. Even more american insurers and workers comp

will drop acupuncture services from coverage. clock is ticking.

research or politics. We especially need herbal research as this is

where are bound to have great success and thus preserve some foothold.

 

 

 

Chinese Herbs

 

 

FAX:

[Guest guest]

clock is ticking.

research or politics. We especially need herbal research as this is

where are bound to have great success and thus preserve some foothold.

 

>>>Todd I agree. This can be the beginning of the end and if we do not get it

together it is the beginning of the end

Alon

 

 

[Guest guest]

, " Alon Marcus " <alonmarcus@w...>

wrote:

> clock is ticking.

> research or politics. We especially need herbal research as this is

> where are bound to have great success and thus preserve some foothold.

>

> >>>Todd I agree. This can be the beginning of the end and if we do not get it

together it is the beginning of the end

> Alon

 

 

basically I figure there are two groups of people. those who are waiting for

evidence before they use or refer for acupuncture (that would be the 97% of

the pop that does not currently use acu). And the other 3% who out of either

desperation or philosophy have chosen to give acupuncture a try. However, of

the latter group, only the diehard believers are likely to keep coming when the

evidence suggests the procedure is a sham. I would submit that this group of

true believers is minute. The fact is that we have been sitting with heads in

the sand again. We have assumed that our personal anecdotes and clinical

experience would be enough to prove to our patients that acupuncture worked.

We have spent a decade making arguments why we don't need to do research,

why it doesn't apply to us, why its not fair to judge us on this standard, as if

some juvenile wish fulfillment was going to make western culture disappear.

I think our patient support, such as it is, is quite flimsy in reality. I think

we

have been given the benefit of the doubt by some in the ABSENCE of evidence

to the contrary. It has been suggested that all we need to do to keep

progressing is to keep parading our happy patients in front of legislators.

 

Once upon a time a lot of happy patients and docs loved a procedure called

mammary artery ligation. It was the main procedure for angina in the fifties.

Everyone thought it was highly successful. However a carefully designed

study proved that a sham operation that merely left a shallow scar without

actually opening the chest and ligating the artery was actually more effective

than the procedure itself. doctors and patients screamed bloody murder, but

in a few years, the procedure had all but disappered and was never heard from

again. Pay attention to politics. the memory of the public is short and

flawed. Put on the news that acupuncture is a sham and in a few years, most

folks who got relief from needles will be claiming it was all in their heads.

It also makes me wonder what kind of lawsuits this open for the huge number

of patients who have spent a lot of money on acupuncture without success,

especially if the px made any claims of success rates prior to treatment. for

example, many peole put the WHO conditions apporved for acupuncture on their

literature. This could easily be called a false advertising claim as none of

these claims hs any proof to back it up.

 

Alon is right. We have small window of opportunity to deal with this before

the whole thing comes crashing down. If we can't get NIH funds, maybe the

needle suppliers better cough up some cash for research and fast. I know a

student with 20 years experience writing medical research grants. We just

need cash, but if Phil is right, it will never happen as long as we are divided

on how to spend the cash.

 

[Guest guest]

, " " wrote:

We have small window of opportunity to deal with this before

> the whole thing comes crashing down.

 

it occurred to me that one of the best tactics for discrediting this german

study may be to attack on the issue of the success rates. they are way too

high. the criteria may be too lenient. in order to show TCMi is better than

sham or medical acu, we need lower success baseline rates to compete

against. if we can show the assessment of success rates was inflated, we

will discredit both the sham and medical acupuncture portions. but at least

we will be back to the status quo with some time to develop proper research.

It will be a shame to have to discredit the real acupuncture portion of the

study, but I believe that will be necessary in order to discredit the sham

results. Future studies should also focus on conditions where the assessment

criteria are objective and not based largely upon subjective pain

questionnaires (sed rates and ANA in RA, etc.).

 

[Guest guest]

I'm not sure if this is the exact study that Ted Kaptchuk cites in his book, The

Healing

Arts, but it sounds very similar. The point he made is this: Since the " sham'

procedure

was more effective than the " true " procedure BOTH had to be discedited. It would

seem rational that since the " sham " procedure was more effective than no

precedure

then the " sham " procedure should have been adopted as the true standard. It's

what

happens when you put science in front of the patient in my opinion.

doug

 

> Once upon a time a lot of happy patients and docs loved a procedure called

> mammary artery ligation. It was the main procedure for angina in the fifties.

> Everyone thought it was highly successful. However a carefully designed

> study proved that a sham operation that merely left a shallow scar without

> actually opening the chest and ligating the artery was actually more effective

> than the procedure itself. doctors and patients screamed bloody murder, but

> in a few years, the procedure had all but disappered and was never heard from

> again. Pay attention to politics. the memory of the public is short and

> flawed.

>

 

[Guest guest]

,

wrote:

> Here is google's weird translation of the success rates from the

german

> study on sham versus real acupuncture found in the german at

> http://www.medizinauskunft.de/artikel/aktuell/

> 28_01_04_akupunkturstudie.php

>

> " Nine of ten Allergikern were also six months to the treatment

still

> clearly better, three from four patients with head or

> Lendenwirbelsaeulenschmerzen showed likewise after this period

still

> improvement. Still more highly the rate was with Arthroseschmerzen

(85

> per cent), asthma (82 per cent) and Dysmenorrhoe (85 per cent). "

>

> While I can't really tell what is being treated in all cases, I

can

> tell that the success rates range from 75-90% in all conditions

listed.

> Now perhaps we can do better with tailored treatment, but the

burden

> is now on us to prove it. It serves no purpose to try and cast a

> positive spin on the results. As the british guardian reports,

this

> study could easily lead to the entire EU derecognizing

acupuncture.

> entire article at

> http://www.guardian.co.uk/health/story/0,3605,1170061,00.html

>

> " So do the German mega-studies suggest effectiveness or

> ineffectiveness? Apparently, there is less room for interpretation

than

> one might think. One of the German investigators, Professor H J

> Trampisch from Bochum University, recently provided the answer.

When

> asked whether these results demonstrate the success of acupuncture

his

> response was decisive: " No, this cannot be. In our studies, we

clearly

> determined that acupuncture will be deemed effective only if it is

> significantly superior to sham acupuncture. If this is true, the

> biggest trials in the history of acupuncture might be the beginning

of

> the end of this therapy. "

 

A D.Ryan wote an article in the American journal of acupuncture

arguing against the validity of sham acupuncure as a control. I

haven't read the article, but it is referenced in Kendall's book. He

points out that the effects of sham acupuncture are unknown. How can

a control have such a loose foundation?

matt

 

 

 

 

>

> We need to either do better or prove the studies flawed when they

are

> finally published. If it turns out that doing certain styles of CM

can

> reliably give results more on the order of 95% or better for some

> complaint, then we may have a case. At least if the medical

> acupuncture fails, they would know where to refer.

>

> But we have to reconcile to the fact that europe is a socialist

union

> and decisions about things like acupuncture are going to be made on

a

> centralized cost benefit analysis. Canada and australia and new

> zealand will follow suit. Even more american insurers and workers

comp

> will drop acupuncture services from coverage. clock is ticking.

> research or politics. We especially need herbal research as this

is

> where are bound to have great success and thus preserve some

foothold.

>

>

>

> Chinese Herbs

>

>

> FAX:

[Guest guest]

they are way too

high.

>>>I was thinking the same thing. Something is not right.

Alon

 

 

[Guest guest]

Future studies should also focus on conditions where the assessment

criteria are objective and not based largely upon subjective pain

questionnaires (sed rates and ANA in RA, etc.).

 

>>>This a must if we want to get real data. I has to leave the how do you feel

arena

a

 

 

[Guest guest]

, " Alon Marcus "

<alonmarcus@w...> wrote:

> Future studies should also focus on conditions where the assessment

> criteria are objective and not based largely upon subjective pain

> questionnaires (sed rates and ANA in RA, etc.).

>

> >>>This a must if we want to get real data. I has to leave the how

do you feel arena

> a

>

>

[Guest guest]

Do you believe that if objective markers indicate that someone's pain

should be cured, then they are cured, even if they still feel immense

pain?

>>>>By the way that is a meaningless statement. How do you think objective

markers are used to study pain? You will not have such a situation such as you

state. Even with musculoskeletal problems were you still have idiots in WM

stating such things as 80% of low back pain is idiopathic and therefore can not

be documented, a well trained and up to date educated practitioner can document

the majority of the sources of the pain and document a more objective levels of

function and pain. So you can not just have somebody in immense pain without

showing some time of objective findings. You can even measure who is faking and

who is not.

Alon

 

 

[Guest guest]

He

points out that the effects of sham acupuncture are unknown. How can

a control have such a loose foundation?

 

>>>Regardless of effects sham is the only comparison that compares the need for

training in acupuncture. If we are not better than sham than we do not need

training. A set of needles can be given to any medical professional to be used.

That would be much more cost effective than creating a whole new profession. And

reminds me of the argument in detox ear acupu with many drug rehab consolers

insisting that one does not need to know acup and can just do the NADA protocol.

Perhaps they are right

Alon

 

 

[Guest guest]

, " Alon Marcus "

<alonmarcus@w...> wrote:

> Do you believe that if objective markers indicate that someone's pain

> should be cured, then they are cured, even if they still feel immense

> pain?

> >>>>By the way that is a meaningless statement. How do you think

objective markers are used to study pain? You will not have such a

situation such as you state. Even with musculoskeletal problems were

you still have idiots in WM stating such things as 80% of low back

pain is idiopathic and therefore can not be documented, a well trained

and up to date educated practitioner can document the majority of the

sources of the pain and document a more objective levels of function

and pain. So you can not just have somebody in immense pain without

showing some time of objective findings. You can even measure who is

faking and who is not.

> Alon

 

Pain, if nothing else, is a perception, existing only in the mind.

This perception may be based on " real " trauma, such as a knee injury,

or may have no basis in reality outside of the mind. Much in the same

way a person may experience tactile hallucinations while on drugs, or

in the way a person experiences sensations (including pain) while

dreaming, a person while awake can experience pain that is just in the

mind. This pain is no less real than any other pain because pain is a

perception.

 

Alon, you have dodged my question above by trying to make me seem

wrong, when clearly I am not. Please answer the question: Do you

believe that if objective markers indicate that someone's pain should

be cured, then they are cured, even if they still feel immense pain?

 

Brian C. Allen

[Guest guest]

, " bcataiji " <bcaom@c...> wrote:

 

>

> Leaving the " how do you feel arena " is a useless extreme. Patient

> subjectivity is very important, as are objective markers.

>

> BCA

 

Brian

 

no one is denying that, especially Alon who has probably treated more pain

patients than just about anyone on this list. the problem is that subjective

questionnaires tend to skew results upward. We cannot dispute the results of

the german study becuase there is no room to do better. the point alon and I

are arguing is a strategic one. clinically, I find the pain questionnaires

accurate. However the natural skewing of subjectivity plus the lack of

acceptance of such methods of assessment should not make them our primary

strategy. People have also argued for years that outcome studies are the best

way to study TCM. I agree. However such studies will not make a dent in the

armor of western medical hegemony. I will say it a million times till it

sinks in. Paradigms change when normal science is challenged on its own

terms.

 

As long as we take the tactic that we need cutting age outcomes research that

incorporates ideas about complexity and chaos, we willmake no social

progress. We get to explore those ideas after we prove or disprove some more

basic things such as whether monkeys can perfom acupuncture as good as

humans. Some may argue we will never prove such things with current study

design. Well, that's too bad (and dead wrong, IMO), because no one who makes

decisions about healthcare could care less about so-called cutting edge

science. Maybe this debate just comes down to idealists and pragmatists. It

is not that pragmatists don't have ideals or understand the positions of

idealists. Its just that history shows the idealists always lose.

[Guest guest]

Alon,

 

, " Alon Marcus " So you can

not just have somebody in immense pain without showing some time of

objective findings. You can even measure who is faking and who is not.

 

 

I agree with the above. Years ago I worked with an MD and most

patients were PIP and WC. Often there were cases in court and large

amounts of money at risk.

 

Patients would often come back claiming to be in pain. However, I

could feel the difference in the way the tissue felt under my hands.

I could see the change in their facial expressions, their gait, etc.

 

The body does not lie!

 

Fernando

[Guest guest]

, " Alon Marcus " And reminds

me of the argument in detox ear acupu with many drug rehab consolers

insisting that one does not need to know acup and can just do the

NADA protocol. Perhaps they are right

 

------------------------------

They are right!

 

I spent time at Lincoln Detox in the South Bronx, NY.

 

I developed a holistic protocol at Net Counseling Center in

Wilmington, DE., where I trained nurses to do the NADA protocol. I

can tell you that they are right. The clients responded very well to

the nurses' treatments.

 

 

 

Fernando

[Guest guest]

Brian if you are talking about non-physiologic pain than you are correct. One's

mind can feel anything. However, you will not find any insurance company willing

to pay for the treatment of such pain as usually it is considered a psychiatric

condition. When we get to that area we are in a territory that is very difficult

to study and definitely is not were we need to put our energies when dealing

which such basic questions as is acupuncture all a sham. We need to study

things that are measurable

Alon

 

 

[Guest guest]

clinically, I find the pain questionnaires

accurate.

>>>They have been also shown to correlate to more objective criteria, however,

then you need to use the more sophisticated ones. They should always be used

with other measurements such as endurance for example. If you show the patient

functional capacity greatly increased that is considered much more significant

Alon

 

 

[Guest guest]

I developed a holistic protocol at Net Counseling Center in

Wilmington, DE., where I trained nurses to do the NADA protocol. I

can tell you that they are right. The clients responded very well to

the nurses' treatments.

 

 

<<<<Fernando if it is all a sham that the better the personal communication the

practitioner has the more he/she will do and all they need is to be safe

Alon