Acupuncture appears to show results.

[Skeptic Ginger]

... Also, there appears to be no double blinding to control for experimenter bias. ..t.

In addition, how good was the sham acting? As Linda notes, setting up pt expectation to succeed is a critical variable in this kind of treatment and research.

All these people got drugs. None of them had acupuncture and placebo. That alone makes the results qualified.

 

[Skeptic Ginger]

Can't agree.

Nobody denies that any vaccine will have a number of adverse effects in a huge sample.

People die under anaesthesia all the time, with a death rate in USA of 5 per 1,000,000. I bet a lot more people get an anaesthetic daily than have needles shoved into their lungs!

Wouldn't some honest statistics from China on deaths from pneumothorax make interesting reading? If they did full autopsies on them all, of course.

Medicine is honest about adverse effects. Do you think your average acupuncturist doing chest needling is going to tell someone that he's about to undertake a process which could kill them?

Anesthesia is considered fairly risky compared to many medical interventions.

From a Medscape source dated 2007

A review of the literature since 1985 reveals nine case reports of acupuncture-induced pneumothorax.

Most of what I found in a quick Google of this topic were individual case reports. It's probably pretty rare. When that is the case, sometimes anecdotes are the only source of data.

 

[Skeptic Ginger]

Does the average taxi driver tell his passengers that he's about to undertake a process which could kill them?

The difference here is one taking a taxi ride is assumed to have knowledge about the everyday practice of riding in vehicles. In fact, the rider is assumed to have similar expertise on the safety of riding in vehicles as the taxi driver. You might argue the driver should disclose a bad driving record but then the surgeon isn't expected to disclose a bad track record either.

The medical disclosure of risks and alternative therapies is a standard based on the assumption the provider knows more than the patient about the risks and alternative treatments.

 

[Skeptic Ginger]

Linda - I doubt you're a Prof and I doubt about your medical qualifications. You are just arrogant!

I know the discussion is pages beyond this silliness but I am catching up here. I am certain that if Linda is not a physician she is as knowledgeable as most physicians I know. And I know a lot of docs. You probably should read a few more of people's posts before making a fool of yourself this way.

Oh, and one thing she is definitely not, it is arrogant. Funny sarcasm, yes, arrogance, no.

There, I think I'm up to speed on the thread now.

 

[BillyJoe]

All these people got drugs. None of them had acupuncture and placebo. That alone makes the results qualified.

I might have to read it again but, if my memory serves me well, the acupuncture was used as a preventative measure for migraines, and everyone got drug treatment whenever they got a migraine anyway. Did I get this wrong?

Most of what I found in a quick Google of this topic [pneumothorax form acupuncture] were individual case reports. It's probably pretty rare.

How many died?
In any case, a pneumothorax is a pretty big price to pay for a treatment with no proven benefits.

Oh, and one thing she is definitely not, it is arrogant. Funny sarcasm, yes, arrogance, no.

Unfortunately for some, they are unable to tell the difference.
(Smilies would help but, alas, Linda is allergic to them. )

 

[BillyJoe]

In the publish or perish environment, there are ways to pay more attention to the quality, rather than the quantity of the research - looking at how many times an article is cited by others, for example.

Yes, but it would also be important to know who was citing it wouldn't it?.
I imagine that altmed medical pracitioners would be busily citing each other's "research".

More journals could comply with publishing only trials that were registered before they were started (see: http://content.nejm.org/cgi/content/full/NEJMe048225). It could be made more difficult for manufacturers to provide incentives for studies whose purpose is to promote their product. (some examples)

This article was written in 2005. At that time, the registration of trials was voluntary D), but it was the intention of these 11 medical journals to accept for publication only those trials that had been registered and they were encouraging others to do the same. I wonder how far this has caught on? If all journals had this as a condition for publication, registration would become de facto compulsory. I guess this hasn't happened yet.

I was thinking mostly of myself. As I learn more and more, I discover that almost all the stuff I have figured out for myself that differs from those more knowledgeable than me turns out to be due to ignorance on my part.

I actually think that is a good starting point for all non-experts.
If your view differs from the view of experts in the field, assume for a moment that you are wrong and try to understand what the experts are saying. If you still don't get it, try again. And again. If you happen to find an expert who agrees with you, try to figure out where he went wrong.

For example, as I was learning about QM and the big deal made about the Copenhagen interpretation, my initial thought was "here's an example of how far these morons (speaking of Einstein and Bohr, of course) have their head up their ass. It's obviously just hidden variables."

Wrong thread but...
Actually, Einstein and Bohr (or was it Bohm) liked the idea of "hidden variables". Einstein because he was convinced there must be a classical interpretation of QM (god does not play dice). And Bohr because he wanted to put a quantum mechanical spin (sorry for the pun) on Einstein's classical interpretation of QM. In the end, as we know, John tolled the Bell on both of them. There are no "hidden variables".
As for Copenhagen, if I remember correctly, Schroedinger's cat ripped it to threads.

Through careful observation and experimentation, I have come to the realization that this applies to others as well, although I continue to look for disconfirming evidence.

There's no getting away from it, is there? To a great degree, we are all dependent upon the opinion of experts in the field. Most of us can never hope to ever be an expert. And even the expert has to be careful!

I see. I think that under those circumstances you are mostly reading the abstracts for yourself? To confirm that you aren't missing some important and valid information that would lend weight to their opinions? I think that if you knew what screening questions to ask when reading the abstract, you could at least satisfy yourself as to whether valid conclusions could be drawn from the study and whether those conlcusions would support their opinions. If the answer is "no" it would save you some work.

http://www.cche.net/usersguides/start.asp#T1
from this:
[URL]http://www.cche.net/usersguides/start.asp#Deciding[/URL]

Thanks, if I get a chance, I will have a look at this over the weekend.

No, but it may be similar to the general culture of 20 years ago in North America/Australia/UK.

Australia?
Oh, wait, you must be referring to the far north (like your deep south!)


regards,
BillyJoe

 

[fls]

Yes, but it would also be important to know who was citing it wouldn't it?.
I imagine that altmed medical pracitioners would be busily citing each other's "research".

Yes, there are other considerations - for example, the impact factor of the journal in which the research is published (which effectively eliminates the altmed researchers).

This article was written in 2005. At that time, the registration of trials was voluntary D), but it was the intention of these 11 medical journals to accept for publication only those trials that had been registered and they were encouraging others to do the same. I wonder how far this has caught on? If all journals had this as a condition for publication, registration would become de facto compulsory. I guess this hasn't happened yet.

I'm not sure what the follow-up shows. I have noticed progress, but I haven't looked for something that shows the extent of compliance.

I actually think that is a good starting point for all non-experts.
If your view differs from the view of experts in the field, assume for a moment that you are wrong and try to understand what the experts are saying. If you still don't get it, try again. And again. If you happen to find an expert who agrees with you, try to figure out where he went wrong.

This advice should not be confined to non-experts.

Wrong thread but...
Actually, Einstein and Bohr (or was it Bohm) liked the idea of "hidden variables". Einstein because he was convinced there must be a classical interpretation of QM (god does not play dice).

I realized that. Einstein was included because he gave serious consideration to the issue when it should have so obviously () been dismissed out of hand.

(I think it was Bohm. By using Einstein and Bohr, I thought I had someone (recognizable) from both sides.)

Linda

 

[JJM]

{snip} On the other hand, no other so called complementary or alternative discipline has been (and never will) awarded such a status ( Homeopathy, Chiropractic, Osteopathy etc.).

{snip}

Will never be awarded ... ? Hmm.

"[SIZE=-1]ITALY STRAIGHTENS UP, LEGALIZES CHIROPRACTIC"
[/SIZE][SIZE=-1]http://www.chiroweb.com/world/italy.html[/SIZE][SIZE=-1][/SIZE][SIZE=-1]
Are the chiros mistaken?

[/SIZE]

 

[jli]

I might have to read it again but, if my memory serves me well, the acupuncture was used as a preventative measure for migraines, and everyone got drug treatment whenever they got a migraine anyway. Did I get this wrong?

That is my understanding as well. The authors used the amount of drug intake as another measure (besides changes in MIDAS scores) for the effect of treatment. I don´t think the use of drugs in attack treatment is a problem in this study. But it is probably true that acupuncture given by someone who believes acupunture works will have stronger effect than sham acupuncture given by someone who really doesn´t believe sham acupuncture works.

 

[Skeptic Ginger]

I might have to read it again but, if my memory serves me well, the acupuncture was used as a preventative measure for migraines, and everyone got drug treatment whenever they got a migraine anyway. Did I get this wrong?

I haven't read the whole paper yet, but it's coming.

How many died?
In any case, a pneumothorax is a pretty big price to pay for a treatment with no proven benefits.

I didn't review the case studies but at a glance none of them were autopsies. It's a pretty survivable injury unless you get further complications in addition.

As far as the risk vs benefit, this same thing comes up with Chiropractic interventions which carry the more frequent risk of vertebral artery rupture and subsequent quadriplegia (which I have personally seen one case of, making it not as rare as you think). But the counter argument is that for some pain interventions, the alternative therapy, drug intervention, doesn't have much better outcomes than placebo either which is surprising but depending on the type of pain being treated, is what the research shows. And drug treatments have many known hazards. Seems kind of weird weighing the risks of alternative placebos, but that may be what we have here.

As for migraine, I believe we do have effective alternative treatments though I have not reviewed the therapies recently. But if acupuncture helps other kinds of pain, in particular, chronic pain, then (sigh) along with Chiropractic interventions, I have to consider these to be viable options. I continue to assess the data in the meantime.

Unfortunately for some, they are unable to tell the difference.
(Smilies would help but, alas, Linda is allergic to them. )

But smiles would ruin the mood that one needs to enjoy good sarcasm.

 

[Skeptic Ginger]

That is my understanding as well. The authors used the amount of drug intake as another measure (besides changes in MIDAS scores) for the effect of treatment. I don´t think the use of drugs in attack treatment is a problem in this study. But it is probably true that acupuncture given by someone who believes acupunture works will have stronger effect than sham acupuncture given by someone who really doesn´t believe sham acupuncture works.

But what I said was it makes the results, 'qualified', which means there are still confounding variables in this case. I didn't not say the outcome was suspect, though until the study result is consistently found in repeated studies, the outcome does remain unconfirmed.

Re the medical journals and 'alternative (to evidence) medicine', there was a shift to include research in these therapies in peer reviewed medical journals at least a decade or more ago. It has been accompanied by an equal shift of researchers actually studying the 'alternative (to evidence) medicine' therapies.

IE, do a proper study and it isn't likely to be rejected for publication on the sole basis the intervention studied isn't orthodox. So I'm unclear what you are saying Linda, did I misunderstand?

Alternative Medicine Meets Science
Phil B. Fontanarosa, MD; George D. Lundberg, MD
JAMA. 1998;280:1618-1619.

 

[JJM]

{snip} As for migraine, I believe we do have effective alternative treatments though I have not reviewed the therapies recently. But if acupuncture helps other kinds of pain, in particular, chronic pain, then (sigh) along with Chiropractic interventions, I have to consider these to be viable options. I continue to assess the data in the meantime. {snip}

On the other hand, we could study placebos to determine what it is about them that seems to work. Then, apply those factors without the magical thinking http://www.sciencebasedmedicine.org/?p=90 One could hope to get the benefit without the risk.

As for "chiro" interventions for pain, those that work (mostly, spinal manipulation) are not chiropractic. Massagers and health care professionals get good results, that way, as well. "Chiropractic" is identification and "adjustment" of (imaginary) subluxations.

This (40 minute) video explains why it is safer to get neck manipulation from a health professional. [FONT=&quot]http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv[/FONT]
In short, professionals are more selective concerning who needs it, and better in their technique.

 

[BillyJoe]

Linda,

One early thought while reading bits of those EBV guidelines you linked to earlier:

It seems to me they are trying - with great difficulty - to close the barn door as the horses are actually bolting through it. If only those horses had been properly bedded down in their stalls in the first place....

Surely it's time for a massive effort to kill off the flawed clinical trial.

 

[BillyJoe]

....and a bit of irony:

There is no evidence that evidence based medicine improves patient outcomes.

 

[Ivor the Engineer]

<snip>

Surely it's time for a massive effort to kill off the flawed clinical trial.

What would fill the pages of medical journals?

 

[JJM]

....and a bit of irony:

There is no evidence that evidence based medicine improves patient outcomes.

... And a bit of irony: I would not wish to be accused of quoting you out of context- so there it is.

In the 1960s a friend of mine got the fatal diagnosis of Hodgkins lymphoma. In the 1970s, my cousin had that diagnosis, and he is (today, thirty years later) a healthy, robust, volunteer firefighter in his town. Evidence-based medicine has defanged many killers. Could you be any more ignorant, or was that a ham-handed attempt at comedy?

 

[BillyJoe]

... And a bit of irony: I would not wish to be accused of quoting you out of context- so there it is.

In the 1960s a friend of mine got the fatal diagnosis of Hodgkins lymphoma. In the 1970s, my cousin had that diagnosis, and he is (today, thirty years later) a healthy, robust, volunteer firefighter in his town. Evidence-based medicine has defanged many killers. Could you be any more ignorant, or was that a ham-handed attempt at comedy?

Yes, I was laughing at myself because, to add a little more irony, I intuitively believe in Evidence Based Medicine.

My post was actually a paraphrase of something I read in the EBM guidelines linked to by Linda. They were published in 2001, so it may no longer be the case that "there is no evidence that Evidence Based Medicine works".

In reference to your particular case of Hodgkins Disease, there is probably not much dispute about how it should be treated. The EBV approach (in those guidelines) seems to be directed more at treatments that have been conventionally used based on intuition, experience, and knowledge of the pathophysiology of disease rather than on the results of clinical trials. Such treatments are likely to vary between individual clinicians, sometimes significantly. The EBM approach is an attempt to find out objectively what works in these cases.

(Seems smilies don't always work )

BJ

 

[BillyJoe]

Surely it's time for a massive effort to kill off the flawed clinical trial.

What would fill the pages of medical journals?

The results of reliable clinical trials.

 

[JJM]

{snip}
(Seems smilies don't always work )

BJ

I understand.

 

[jli]

But what I said was it makes the results, 'qualified', which means there are still confounding variables in this case. I didn't not say the outcome was suspect, though until the study result is consistently found in repeated studies, the outcome does remain unconfirmed.

I´m not sure that I understand what you mean by qualified. Is it to be understood as though you mean that the results of this particular study indicate a beneficial effect of acupuncture as a preventive measure of migraine attacks? If so, how does the use of drugs make it qualified?