Remembering the Barefoot Doctors

[saterraji]

Is there anyone who remembers what Mao and the Gang of Four did in the early 50's to create a community based health care program in China?

They instituted the "Barefoot Doctors" program which over 20 years trained 250 MILLION lay people from the various villages and towns throughout China, in traditional medicine to care for the public at large.

Since we are in need of a community based health-care program which supports the public at large, we might want to look at what the U.S. Department of Health did in 1974 when they ordered the translation of the "Barefoot Doctors Manual"...all 964 pages which can still be found in the Library of Congress and of course at Amazon.com

The best of all of this, since we have at our disposal instant digital information and world-wide distribution, is a simple and effective model, utilized by each and every one of us to keep us in balance and health for everyday common ailments.

The beauty of this simple, effective, inexpensive and non-toxic approach is its appeal for those who are not getting effective treatment for chronic issues such as diabetes, arthritis, irritable bowel syndrome, addiction, sleep disorders and much more.

The need for public education and training on these simple, effective therapies and how they are being applied in a community setting can be viewed at: www.barefootmedicinesociety.blogspot.com or www.womenandchildren1st.blogspot.com

I am open and willing to discuss any and all aspects of this community based health-care approach and will be teaching courses around the U.S. after the first of the year.

saterraji

[IJ]

I'm always a bit concerned when I see "nontoxic" as a buzzword for such therapies. It often keeps company with "herbal" or "natural" or "traditional" or "alternative." Looking through the page a bit, I came across a testimonial from a person who had diabetes, and his sugar was "high," and now it is "120" (these tend to vary a lot, so...) as a result of the acupuncture on his hand. He also began a program of **diet and exercise,** which I suspect was the key feature of his program. That is a lot of "alternative" in a nutshell. I bet this guy felt like he was a number in a machine, that the doctors just targeted his sugars and lipids and didn't care much about him, that his PCP was hard to get ahold of, his insurance company was a pain in the buttocks, and in the alternative clinic he met someone who seemed to care, treated him more like a person, and lo, motivated him to diet and exercise. Now, if hand accupuncture is what it takes, that's awesome--but standard Western medicine adopts, Borg-like, anything that's shown to work (provided it fits in the cost per QALY scheme and is reproducible), and I pass no judgment on intranasal butterscotch for toe cancer, provided one comes up with the data to justify it. I will always recommend what appears to be the best for the patient. Acupuncture for diabetes? Thusfar, my fear is it will detract from things we know works.

Case in point here: sugar control in diabetes has been shown to be a secondary concern, contrary to popular thought. Getting the sugar to normal (at least by medical intervention) is less important than controlling blood pressure and lipids as best we can. And I'd be curious if this guy got state-of-the-art care for those aspects of his diabetes, plus his foot exam, urine protein check, and retinal exam.

Skimming through his talk on treating the whole body through the hand.... well, interesting theory, not much to back it up. He states the front and back of the hand and body, and left and right, correspond. That's all well and good, but the hand flips. Front is now back, left is now right. So which is the proper side? He actually presumes the palms face forward, thumbs in the center, like a push--and it certainly seems that this is as reasonable as any other method, but in "anatomic position" the hands are at the sides with palms forward--thumbs out. This reverses left and right. Why does western medicine make that choice? It's based on embryologic development, and the way the arms and legs rotate during fetal life. This has real consequences in adult life for the way nerves from different spinal levels innervate bands of skin on the arms. Anatomically, he's got left and right backwards.

Maybe the chi is separate from the anatomy. But I'm waiting for stronger evidence. And I suspect that if the ancient wisdom lined up with the later-discovered embryology, we'd be hearing about how this established it's veracity.

[saterraji]

Perhaps it might be wise to expand the conversation to the quantum physics model where each part contains the whole, as is found in a hologram.

Since I have studied since 1986, with the originator of Koryo Sooji Chim, Tae Woo Yoo, PhD, who created this model in 1972, his ongoing work, and the 150K+ persons just in Korea alone who practice daily this therapy, represent a confirmation this micro-system offers value in the treatment of a variety of in the west we call "dis-ease". There happens to be another hand model which the North Koreans and Russians embrace called "Soo Jok" where the head is found on the thumb and not the middle finger which is depicted in the video link sent on the previous post.

All this really says as I interpret it, is the body reflects itself infinitely...in infinite ways. I did an internship with Dr. Michael O. Smith, MD who began the acupuncture detox clinic at Lincoln Hospital, Bronx, NY in the early 60's and has maintained a 95% success rate since then, detoxing participants from crack, cocaine, alcohol and heroin. This NADA protocol, performed on the micro-system of the ear continues to overshadow any and all other addiction therapies in its proven effectiveness. Richard Neimtzow, MD at Bethesda Navel Hospital continues to remove "phanthom pain" from returning Iraq soldiers, who have been victims of I.E.D.'s and is now training 50 "docs" in battlefield acupuncture.

Since chi is the most basic aspect of life, moves the blood and is the determining factor, distinguishing life and death as we know it... let's take a well-rounded look at how our current medical system could benefit by incorporating this non-linear view in offering a more effective non-toxic way to "nudge" the body back into balance.

[Bill Glasheen]

You entered the den of the lions.

Since chi is the most basic aspect of life, moves the blood and is the determining factor, distinguishing life and death as we know it...

Woah there, cowboy! Let's just start right there. Peer-reviewed references, please!

- Bill

[saterraji]

Hey Bill,

Why is it that everything must exist with peer review references...I thought this is just a discussion and I am not writing a dissertation for my PhD.

Making my living in the acupuncture profession for 25 years, I will be happy to quote references since most of those reading this obviously are not schooled in this understanding of medicine.

Not sure about the "cowboy" dig...just because one's approach is different than another's, does not make them less plausible or true.

[saterraji]

Bill,

I just happens I will be in Richmond teaching the introduction to Sooji I course on Feb 20 and 21st. You are welcome to attend should your interest in this wonderful therapy interest you.

saterra

[Bill Glasheen]

Not sure about the "cowboy" dig...

It came from here.

Since chi is the most basic aspect of life...

You were rather quick in pulling that out before moving on. That's a show-stopper until you can substantiate it.

Why is it that everything must exist with peer review references...

You're now in the chat room with a practicing physician and a biomedical engineering researcher. Now and then a pharmacist or two will show up. Our standards are high - as they should be when it comes to the health of patients. Evidence-based only, please. And that means evidence that has passed the acid test of a peer review forum.

Bring up the chi word and the skeptics will come out of the woodwork on this forum. You're going to have to define it and substantiate it before continuing.

Making my living in the acupuncture profession for 25 years

Cool. Are you licensed to practice in Florida?

There is plenty of evidence for the benefits of acupuncture - for some conditions. Where there is evidence, we have a common point of discussion.

- Bill

[IJ]

Here's something to think about: when a theory explains everything, it explains nothing. For a classic example, consider Freud. He presumed that underlying conflict over sexuality could drive someone to be one way, another person to the total opposite, a third to embrace it and a fourth to reject sex and deny the possibility. ANYTHING someone did proved the theory. It was unfalsifiable and therefore useful only in that it encouraged us to consider the unconscious mind (of which there is good evidence in psychiatry and also neurology, things that people could not perceive before Freud).

For a more concrete example, consider a little project I did with a pressure point fighting text from the Dillman camp. Their claim was that knowing how chi worked could tell you what to hit in order to KO someone. Their book was full of examples of how this worked--hit this because it's also a wood point, then hit this because it's earth and wood destroy earth, etc. What did I do? I picked somewhere to start, then I looked how many other places his "rules" would permit a "logical" sequence to follow. You could attack the opposite side, or up down. You could hit in the same organ sequence or folow the cycle of destruction. And so on. Turns out ~95% of the sequences followed one of the rules. And guess what? There were also "special points" for the exceptions. In other words, you could do anything and the theory fit. It was nearly impossible not to follow one or more rules even randomly, so you couldn't disprove the theory. And because it didn't selectively drive you anywhere, it was useless. Well, it was useless at creating striking sequences; it was very useful at justifying the stated effects of any sequence they wanted to highlight. Good for the author, not so much for the reader.

Anyhoo, quantum physics has nothing to do with representations of the body on the hand. The fact that the body can reflect itself infinitely in infinite ways helps defuse any logical argument about chi and points and body representation; no matter what I say, infinity offers an exemption. Thus the representation theory is unfalsifiable. Does Dr. Kim cure diabetes on the left and Smith on the right? Well, infinite representations. Is it on the hand or on the thumb? Infinite. So both. The theory cannot be proven wrong. And it doesn't guide us. Because the options are infinite, I can pretty much stick people anywhere I want on the hand and I'm good, right? Even if it's opposite from what someone else says.

At this point, we begin to hear about user testimonials. Many many asian people do this, and they have since ancient times. Ok! They also eat a high salt pickled food diet and while they are satisfied, the practice is widespread, and it's ancient, they also get high rates of gastric cancer from it. So where does that leave us?

Regarding the last paragraph, I would suggest providing, or at elast starting from, specific definitions. What does it mean to be nonlinear here? That it doesn't make sense from pathophysiology to therapy to outcome? More effective... than what? You're referencing a comparative trial--between what and what? Chi moves the blood? What does the heart do? Chi distinguishes life and death? I pronounce death, and I'm able to do this without a chi meter. In fact, I understand there is no such thing. As far as incorporation goes, I am happy to incorporate all that is established by the weight of evidence.

[IJ]

The mention of drug detox provided an opportunity for verification and specific discussion. I went to pubmed and searched "Smith MO addiction" and found nothing--"Smith M addiction" brought up one relevant reference:

J Subst Abuse Treat. 1994 May-Jun;11(3):205-15.
Acupuncture for crack-cocaine detoxification: experimental evaluation of efficacy.
Lipton DS, Brewington V, Smith M.
National Development and Research Institutes, Inc., New York, New York.

Anecdotal studies have reported acupuncture alleviating the severity of withdrawal symptoms associated with cocaine abuse. The efficacy of auricular (ear) acupuncture in reducing cocaine/crack craving and consumption was examined via a single-blind, placebo experiment. One hundred and fifty individuals seeking treatment for cocaine/crack abuse were randomly assigned to receive either experimental or placebo acupuncture treatments. Treatments were provided in an outpatient setting for a one-month period. Placebo treatments involved acupuncture at ear locations not used for drug treatment. Subjects provided urine specimens for drug content analysis after each acupuncture session. Urinalysis results over the one-month study period favored the experimental group. Experimental subjects in treatment over 2 weeks had significantly lower cocaine metabolite levels relative to placebo subjects in treatment for a comparable period. Treatment retention with both groups was similar. Relative to pretreatment usage, a significant decrease in cocaine consumption was reported by both groups. Self-report outcomes did not indicate significant between-groups differences.

I happened to have access to the full article. In it, they claim 10,000 patients were treated for detox and Lincoln hospital. Their claim is actually that 40% showed "substantial improvement." Other findings of note: the procedure had to be only single blind, but they tried to minimize accidental proceduralist to recipient communication to limit unblinding. 42 of 152 did not complete the study. The researchers found: no difference in percent urine positivity for cocaine metabolites, retention, or self reported outcomes. They report a large number of additional analyses based on subgroups with and without heroin, etc etc. They state that differences in cocaine content in the positive specimens favored the experimental group (with effect beginning halfway thru therapy and vanishing by end of therapy) suggesting less cocaine during that time (or more water intake, etc). These positive results reflect only 15 patients in each group due to attrition.

Several similar articles popped up as related during the search. Haven't read these. All were in complementary medicine or JSAT as above. Did review two reviews.

One commented on addiction science thusly:


Qual Saf Health Care. 2002 Mar;11(1):92-7. Acupuncture.
Vickers A, Wilson P, Kleijnen J. Memorial Sloan-Kettering Cancer Center, New York, USA.

Acupuncture is widely promoted as an aid to smoking cessation.
A systematic review of 21 trials suggested that, at best,
acupuncture may have a small benefit over a sham acupuncture
procedure for short term abstinence rates.72 Acupuncture
is not more effective than placebo techniques for long term
abstinence.72 Quit rates for acupuncture appear slightly lower
than those for nicotine replacement.73
Acupuncture has been used to treat cocaine addiction in
several hundred drug treatment programmes in the United
States.74 Several RCTs have been conducted75–79 but these have
not been subjected to systematic review. Acupuncture is
favoured in some analyses, but some RCTs were complicated
by multiple statistical comparisons: this increases the likelihood
of a false positive result. The most rigorous RCT reported
that patients assigned to acupuncture were significantly more
likely to provide cocaine negative urine samples, the prespecified
primary outcome measure, than those in both the control
and sham acupuncture groups.79
No systematic reviews evaluating the use of acupuncture to
treat alcoholism or opiate addiction were identified. The
number, size, quality, and strength of findings of RCTs studying
acupuncture for alcoholism and opiate addiction is insufficient
to guide clinical decisions.80–86

I will try to track down the best reviewed article:

79 Avants SK, Margolin A, Holford TR, et al. A randomized controlled trial
of auricular acupuncture for cocaine dependence. Arch Intern Med
2000;160:2305–12.

The other review wrote:

Harm Reduct J. 2005 Mar 17;2(1):4.
Efficacy of acupuncture for cocaine dependence: a systematic review & meta-analysis. Mills EJ, Wu P, Gagnier J, Ebbert JO.

BACKGROUND: Acupuncture is a commonly used treatment option for the treatment of addictions such as alcohol, nicotine and drug dependence. We systematically reviewed and meta-analyzed the randomized controlled trials of acupuncture for the treatment of cocaine addiction. METHODS: Two reviewers independently searched 10 databases. Unpublished studies were sought using Clinicaltrials.gov, the UK National Research Register and contacting content experts. Eligible studies enrolled patients with the diagnosis of cocaine dependence of any duration or severity randomly allocated to either acupuncture or sham or other control. We excluded studies of acupuncture methods and trials enrolling patients with polysubstance use or dependence. We abstracted data on study methodology and outcomes. We pooled the studies providing biochemical confirmation of cocaine abstinence. RESULTS: Nine studies enrolling 1747 participants met inclusion criteria; 7 provided details for biochemical confirmation of cocaine abstinence. On average, trials lost 50% of enrolled participants (range 0-63%). The pooled odds ratio estimating the effect of acupuncture on cocaine abstinence at the last reported time-point was 0.76 (95% CI, 0.45 to 1.27, P = 0.30, I2 = 30%, Heterogeneity P = 0.19). CONCLUSION: This systematic review and meta-analysis does not support the use of acupuncture for the treatment of cocaine dependence. However, most trials were hampered by large loss to follow up and the strength of the inference is consequently weakened.

[IJ]

Some of the best evidence summaries in medicine come from Cochrane. Here's their work on acupuncure and cocaine:

Cochrane Database Syst Rev. 2006 Jan 25;(1):CD005192.

Auricular acupuncture for cocaine dependence.
Gates S, Smith LA, Foxcroft DR.

Warwick Medical School, University of Warwick, Warwick Emergency Care and Rehabilitation, Coventry CV4 7AL, Coventry, UK, CV4 7AL. s.gates@warwick.ac.uk

BACKGROUND: Auricular acupuncture (insertion of acupuncture into a number, usually five, of specific points in the ear) is a widely-used treatment for cocaine dependence. OBJECTIVES: To determine whether auricular acupuncture is an effective treatment for cocaine dependence, and to investigate whether its effectiveness is influenced by the treatment regimen. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (January 1966 to October 2004) , EMBASE (January 1988 to October 2004); PsycInfo (1985 to October 2004); CINAHL (1982 to October 2004); SIGLE (1980 to October 2004) and reference lists of articles. SELECTION CRITERIA: Randomised controlled trials comparing a therapeutic regimen of auricular acupuncture with sham acupuncture or no treatment for reduction of cocaine use in cocaine dependents. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data from published reports and assessed study quality using the Drug and Alcohol CRG checklist. All authors were contacted for additional information; two provided data. Separate meta-analyses were conducted for studies comparing auricular acupuncture with sham acupuncture, and with no treatment. For the main cocaine use outcomes, analyses were conducted by intention to treat, assuming that missing data were treatment failures. Available case analyses, using only individuals who provided data, were also conducted. MAIN RESULTS: Seven studies with a total of 1,433 participants were included. All were of generally low methodological quality. No differences between acupuncture and sham acupuncture were found for attition RR 1.05 (95% CI 0.89 to 1.23) or acupuncture and no acupuncture: RR 1.06 (95% CI 0.90 to 1.26) neither for any measure of cocaine or other drug use. However, the number of participants included in meta-analyses was low, and power was limited. Moderate benefit or harm is not ruled out by these results. Methodological limitations of the included studies may have also made the results open to bias. AUTHORS' CONCLUSIONS: There is currently no evidence that auricular acupuncture is effective for the treatment of cocaine dependence. The evidence is not of high quality and is inconclusive. Further randomised trials of auricular acupuncture may be justified.

And on IBS:

Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005111.

Acupuncture for treatment of irritable bowel syndrome.
Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B.

AUTHORS' CONCLUSIONS: Most of the trials included in this review were of poor quality and were heterogeneous in terms of interventions, controls, and outcomes measured. With the exception of one outcome in common between two trials, data were not combined. Therefore, it is still inconclusive whether acupuncture is more effective than sham acupuncture or other interventions for treating IBS.

And insomnia:

Cochrane Database Syst Rev. 2007 Jul 18;(3):CD005472.

Acupuncture for insomnia.
Cheuk DK, Yeung WF, Chung KF, Wong V.

AUTHORS' CONCLUSIONS: The small number of randomised controlled trials, together with the poor methodological quality and significant clinical heterogeneity, means that the current evidence is not sufficiently extensive or rigorous to support the use of any form of acupuncture for the treatment of insomnia. Larger high quality clinical trials employing appropriate randomisation concealment and blinding with longer follow-up are needed to further investigate the efficacy and safety of acupuncture for the treatment of insomnia.

And epilepsy:

Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005062.
Acupuncture for epilepsy.
Cheuk DK, Wong V.

AUTHORS' CONCLUSIONS: The current evidence does not support acupuncture as a treatment for epilepsy. Much larger high quality clinical trials employing appropriate controls are needed.

Here's something on alcohol withdrawal:

Alcohol Clin Exp Res. 2007 Mar;31(3):436-42.

Ear acupuncture for alcohol withdrawal in comparison with aromatherapy: a randomized-controlled trial.
Kunz S, Schulz M, Lewitzky M, Driessen M, Rau H.
CONCLUSION: The results do not support the assumption of a superiority of acupuncture over the control therapy in its specific effects on alcohol withdrawal symptoms.

And another:

Alcohol Alcohol. 2003 Jul-Aug;38(4):369-75.
Acupuncture for alcohol withdrawal: a randomized controlled trial.

CONCLUSIONS: The data from this pilot trial do not suggest a relevant benefit of auricular laser acupuncture for alcohol withdrawal. A larger trial including adequate sham interventions is needed, however, to reliably determine the effectiveness of any type of auricular acupuncture in this condition.

Opiate withdrawal:

J Subst Abuse Treat. 2009 Apr;36(3):345-9. Epub 2008 Nov 12.
Auricular acupuncture as an adjunct to opiate detoxification treatment: effects on withdrawal symptoms.
Bearn J, Swami A, Stewart D, Atnas C, Giotto L, Gossop M.

Auricular acupuncture had no effect upon withdrawal severity or craving when provided as an adjunct to a standard methadone detoxification treatment. The results are consistent with the findings of other studies that failed to find any effect of acupuncture in the treatment of drug dependence. The failure to find any clinical gains from the adjunctive use of auricular acupuncture during detoxification from opiates raises concerns about the widespread acceptance of this intervention.

At this point, fingers become sore from searching and the desire for a reason to keep looking for efficacy becomes more pointed. Enthusiasts, guide me to the positive data? Or can we tentatively conclude the therapy in question is nontoxic because it is nonactive?

[IJ]

So here is that trial from Archives:

Arch Intern Med. 2000 Aug 14-28;160(15):2305-12.
A randomized controlled trial of auricular acupuncture for cocaine dependence.
Avants SK, Margolin A, Holford TR, Kosten TR.


http://archinte.ama-assn.org/cgi/conten ... 60/15/2305
Comment in:

Arch Intern Med. 2001 Mar 26;161(6):894-5; author reply 895.
Arch Intern Med. 2001 Mar 26;161(6):894; author reply 895.

BACKGROUND: Partly because of a lack of a conventional, effective treatment for cocaine addiction, auricular acupuncture is used to treat this disorder in numerous drug treatment facilities across the country for both primary cocaine-dependent and opiate-dependent populations. OBJECTIVE: To evaluate the effectiveness of auricular acupuncture for the treatment of cocaine addiction. METHODS: Eighty-two cocaine-dependent, methadone-maintained patients were randomly assigned to 1 of 3 conditions: auricular acupuncture, a needle-insertion control condition, or a no-needle relaxation control. Treatment sessions were provided 5 times weekly for 8 weeks. The primary outcome was cocaine use assessed by 3-times-weekly urine toxicology screens. RESULTS: Longitudinal analysis of the urine data for the intent-to-treat sample showed that patients assigned to acupuncture were significantly more likely to provide cocaine-negative urine samples relative to both the relaxation control (odds ratio, 3.41; 95% confidence interval, 1.33-8.72; P =. 01) and the needle-insertion control (odds ratio, 2.40; 95% confidence interval, 1.00-5.75; P =.05). CONCLUSIONS: Findings from the current study suggest that acupuncture shows promise for the treatment of cocaine dependence. Further investigation of this treatment modality appears to be warranted.

Before anyone gets too too excited.... their followup work:

J Altern Complement Med. 2002 Apr;8(2):111-21.
Interpreting conflicting findings from clinical trials of auricular acupuncture for cocaine addiction: does treatment context influence outcome?
Margolin A, Avants SK, Holford TR.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA. arthur.margolin@yale.edu

Comment in:
J Altern Complement Med. 2002 Apr;8(2):123-5.

OBJECTIVE: To compare findings from two consecutive clinical trials of auricular acupuncture for cocaine addiction conducted at the same site in order to explore consistency of treatment effects. SUBJECTS: One hundred and sixty-five (165) cocaine-dependent, methadone-maintained patients (study 1, n = 82; study 2, n = 83). INTERVENTIONS: Subjects in both studies were randomly assigned to auricular acupuncture, a needle insertion control condition, or a no-needle relaxation control. Treatment sessions were offered five times weekly for 8 weeks. The two studies were equivalent in design, except that unlike study 1, study 2 offered subject payments for attendance and did not include weekly group counseling. OUTCOME MEASURES: Cocaine use assessed by three times weekly urine screens constituted the primary outcome. Secondary measures included retention in treatment, treatment attendance, treatment credibility, therapeutic alliance, and acute effects of treatments. RESULTS: Intent-to-treat analysis showed that patients assigned to acupuncture in study 1, but not in study 2, were significantly more likely to provide cocaine-negative urine samples relative to the two control conditions. CONCLUSIONS: The positive effect for acupuncture found in study 1 was not found in study 2. Even though the two studies were similar, reasons for this inconsistency cannot be determined definitively, but may be because of differences in psychosocial context and payment contingencies between the two studies, or the lack of effectiveness of acupuncture in this application. The need to critically consider the influence of treatment context and other potential moderating variables on outcome in order to draw conclusions regarding treatment effectiveness is discussed.

Also recall that the Cochrane analysis was done in 2006 and included this work.

[f.Channell]

I looked quickly at one of those reports and is was too small a sample to be valid.

Why are you discounting a treatment method with thousands of years of history of success?

One hundred years ago western scientists and doctors thought phrenology worked.

I often wonder why acupuncture and other asian methods are thought of as new and different when historically they have been around centuries longer.

Lets not forget the founder of our system was a chinese medicine expert of some extent.

F.

[Bill Glasheen]

Why are you discounting a treatment method with thousands of years of history of success?

MISSOURI!!!! Just because you said it is so doesn't mean it is so.

Acupuncture works in some situations. Where it does work, it should be used.

Sometimes it doesn't do better than placebo. In other words, sometimes it's a mind-body treatment. That's no different than giving someone great bedside manner and a sugar pill.

- Bill

[f.Channell]

Personally I don't think either method work on drug users.
A matter for the shrinks as far as I'm concerned.

But as far as my moms dauschund goes who couldn't walk or get out of bed goes and was neither influenced by the suggestion of a sugar pill or bedside manner and was cured by a holistic Vet with acupuncture goes......

Yep Hilda walked for 5 more years,

In answer to "Missouri" she would respond "woof".

If all else failed I would give acupuncture a try.

F.

[IJ]

"Why are you discounting a treatment method with thousands of years of history of success?"

If by discounting, you mean, believing it has not yet proven itself for the indications studied, that's because there isn't good quality data supporting it yet. Just look at the reviews. Might it work? Sure. But the effect size is likely to be small, and the more negative studies for a given condition, the closer to negligible it becomes. It's much like that empty force study. The force guy felt he just had an off day. Well, if the effect was real, Bill shoulda measured SOMETHING.

Now, I'm a pragmatist. There were recently two big studies on kyphoplasty--filling compression fractures with cement which we thought worked well for pain. These were are well done as they could be, with a sham procedure and good blinding. NO BENEFIT. In an editorial, someone suggested we DISCUSS THE RISKS AND BENEFITS AND LET PATIENTS DECIDE. Whaaaat?? I don't pay taxes into medicare so we can do invasive expensive placebotomies on patients. That's absurd! But if acupuncture yields a great effect (equal placebo) at low cost and low risk? Fine, allow it, save money, save procedures, save risk, and reduce cost over western approaches that are also failures. BUT don't ask me to believe that its better than placebo (until data shows it is). If you want to try it on a dog?

And I don't think acupuncture is new. It's WELL STUDIED phase is relatively young. If we coulda done kyphoplasties for 2000 years, I bet they'd be viewed as traditional, great track record, all that. But the data changes everything. The procedure simply should never be done!