BBC Programme to show acupuncture deactivates brain

[Lothian]

It appears that we have a problem with mathematics as well as science. And I thought we British were unfallible

· 44% said creationism should be included
· 41% intelligent design
· 69% wanted evolution as part of the science curriculum
Possibly
41% wanted all three
3% wanted only creationism
28% wanted only evolution and
28% wanted none.

 

[richardm]

Possibly

Curse you and your reasonable explanations

 

[Lothian]

Curse you and your reasonable explanations

No, just more evidence of the infallibility of the British (well the infallibility of 48% of us )

 

[John A]

Would a needle in a 3Tesla field be pulled onto the magnet?

I guess if it was ferromagnetic. If you hold a key on a keyring near a 3T scanner even when it is not scanning the key will stand horizontal, pointing towards the scanner. People who have done a lot of metalwork, are usually advised not to be scanned (at least not for non-medical purposes) presumably because of the risk of small scraps of metal being in their eyes. Oh and tatoos with metallic inks can be problematic...

 

[John A]

One of them was the ubiquitous George Lewith from Southampton [snip]. There is nothing on PubMed resembling this study within the last 2 years.

The names can be found at http://www.bris.ac.uk/news/2006/889.html (replace xxx with www). No study comes up under these names on pubmed. It seems safe to conclude that it has not published.

 

[John A]

I mean an an analgesic effect. Not proves it, but strongly suggests it. I mean it seems as if does relieve pain. The question is whether it is merely a placebo, and the research seems to strongly suggest that it's not merely a placebo.

This is my point - what exactly do you mean by "it" in the context of this experiment? Does it test acupuncture or just deep insertion of needles? Why is it not the placebo effect? Because there is a neural response? Could subjects distinguish between the "control" shallow insertion and the "acupunture" deep insertion? Were they prompted during the deep insertions to report whether they had a de chi experience? Maybe the deep insertions just hurt more so they tried to block the pain. Perhaps they would have got the same inactivation if the patients were given either a light pinch or a hard pinch. You see my point - there is sufficient vagueness in the information we have so as to render any conclusion highly speculative. I struggle to find any conclusion based on the evidence as presented. This is my problem with the program - lack of crucial detail with only lip service paid to the scientific method. The experiment itself sounds interesting but I will reserve judgement until I can read the paper.

On a different point, to correct a misconception that the program appeared to perpetuate, just because there is a neurophysiological response it does not necessarily follow that acupuncture has a physiological (i.e. non-placebo) effect. Anything psychological is ultimately neurophysiological. The inactivation could have simply resulted from the subject exerting control over the ammount of pain they percieve. Not that the neurophysiological underpinnings of the placebo effect aren't an exciting area for research. For an interesting read on this front I recommend:
Colloca L, Benedetti F. Placebos and painkillers: is mind as real as matter? Nature Reviews Neuroscience 6:545.

John.

 

[John A]

Here's an interesting paper courtesy of RS on badscience.net (apologies if you are on this forum):

Longe et al 2001

Counter-stimulatory effects on pain perception and processing are significantly altered by attention: an fMRI study.

Counter-stimulation reduces pain perception; however, the role of attention during this process is rarely discussed despite attention itself being a well known modulator of pain perception. This study investigated the effect of attentional modulation on pain perception during counter-stimulation using fMRI. Subjects received a noxious thermal stimulus together with an innocuous vibratory counter-stimulus. Subjects directed their attention towards either pain, vibration, or a neutral visual stimulus. During painful and counter-stimulation all subjects reported a reduction in pain perception when attending to counter-stimulation compared with attending to pain. Imaging data supported this behavioural finding showing reduced activity in pain processing areas (anterior cingulate, insula, thalamus). These results suggest attention plays an important part in the pain relief experienced from counter-stimulation.

 

[Deetee]

Interesting.
This may explain some of the findings in the Sykes MRI study.
I wonder why the people thinking up the trial and defining aims and methodology didn't do a review of the literature on the subject they wished to investigate. I guess they thought they knew it all already.


PS - re the programme:

The open university site features a lot of woo stuff and details what we will see in the next 2 programmes from the series. Not encouraging from the sound of it.....

 

[BobW]

Oh and tatoos with metallic inks can be problematic...

I remember this being 'busted' on Mythbusters - at least for the case of a piece of pork tattooed with ink containing lots of iron oxide.

I just tried putting some stainless steel objects near to a very strong neodymium magnet and there was no attraction that I could observe.

 

[Zendal Darkman]

The open university site features a lot of woo stuff and details what we will see in the next 2 programmes from the series. Not encouraging from the sound of it.....

The whole section on "alternative medicine" was simply awful. The open university appear to have done the same thing that many respectable organisations have done (BBC, NHS direct etc). They have given the job of producing a "balanced" article to an "expert" in AM, someone who is obviously a practioner in it. Out of several pages of pro AM text, I think there was just one paragraph addressing the "controversial" aspect of AM, and even then this was spun by several more paragraphs explaining in a matter of fact way, why the scientists had difficulty measuring the obvious benefits of it.

 

[Asolepius]

Here is my rapid response to John Garrow's review article on the series. I saw his draft, and it was brutally edited by the BMJ, but maybe he will be allowed to add some more after episode 2.

 

[loose cannon]

I have read this forum for several months and have always been impressed by the depth of knowledge that many posters bring to these pages. This thread however has galvanised me into finally pressing the keyboard into action. Members of this forum are (with a few obvious exceptions!) believers in the scientific method, i.e. we explain the world in all its aspects by a near infinate number of theories. These theories stand until proven wrong, when a fresh theory takes it's place. The longer a theory has been in place, the more likely it is to be true, but history has taught us that this rule of thumb can only be used with caution. Theories compete with each other and can stand or fall on the basis of scientific experiment or observation. Experiments are also subject to the scientific method and so have proper controls, clear aims, good statistical back up and are repeatable by other researchers and so are peer reviewed. This programme fails to do any of this. The open heart surgery and the arguments about positive pressure ventilation and mediastinal strength are an irrelevant diversion, just get an acupuncture believer to have a hip replacement or even an in growing toenail op without the aid of hypnosis or any western/modern aid eg local anaesthetic in this country with a watching panel of impartial observers. The Chinese have always promoted their eastern methods, but mainly only as part of Mao's efforts to promote the country as a whole. The Chinese are by all account no healthier than us now that they are falling victim to the carbohydrate overload and general pollution learnt from the west. Mao himself used western medicine. Eastern therapies ironically often have western proponants who have championed or even rewritten them in the past.
As stated by previous posters, this so called experiment just shows that by inserting needles in different ways, you can get different responces to pain. Wow.
Acupuncture may work. We must not be seen to just dismiss it out of hand, but just ask for it to be proven, otherwise we are just a bunch of loud mouthed religeous zealots who do not realise it!
This web site and forum with a few other good sites have been a breath of fresh air for me, when all round there is a rising tide of religeous loonacy and new age drivel. All free thinking people of science must with one voice shout ******** to accupuncture on the NHS, Homeopathical rubbish on the NHS, spoonbending idiots claiming inner powers, dowsers, crystal healers. reiki rubbish etc etc ad nauseum. But at the same time be able to say our religeon does not require faith ( ie belief with no proof) we can prove all we say or refute, can you.
Thanks for reading this, I'm gone for another beer
p.s. I know father Christmas exists, and can prove it!

 

[Asolepius]

loose cannon - a very warm welcome, and thanks for your kind words about posters here. Since joining the JREF forums, I have experienced a new vibrancy to life, and indeed a new sense of purpose, which I never had when I was religious. It's heartwarming to see that rubbing off on someone new. I'm looking forward to reading more of your posts.

 

[John A]

I remember being 'busted' on Mythbusters - at least for the case of a piece of pork tattooed with ink containing lots of iron oxide.

I seem to remember having been asked about it before being allowed in the scanner (I do not have any). As for using a piece of pork, I don't know if that would reveal very localised burning and there obviously wouldn't be any resultant inflamation. A quick pubmed search for "tattoo MRI" reveals a few cases of burns although this seems rare - it may depend on the exact ink used. It certainly doesn't appear to be problem enough to stop you having an MRI for medical purposes.

 

[Camillus]

I'm still puzzled by this. Now it's been mentioned, I do know that in man the mediastinum is a much more robust structure than in any of the species I deal with - I was always astonished that inducing a unilateral pneumothorax as a treatment for tuberculous granuloma was feasible. (In the species I deal with, the mediastinum is so delicate that you simply couldn't rely on it to stay intact under any interference at all, let alone be robust enough to maintain the integrity of the pleural space.) So, I can't discount the possibility that one might be able to do what was apparently seen in that programme, that is expose the heart in an open chest while retaining the patient's ability to breathe by relying on keeping the mediastinum intact. Though my mind is still boggling at the idea.

What I really can't get my head around is the idea that anyone would want to, or that the procedure could be regarded as acceptably safe. Yes, keyhole surgery, absolutely, right from the beginning of this thread we were speculating that the advertised "open-heart surgery" might simply be a keyhole procedure, which would simple be a very big "so what". But the idea that any surgeon would be comfortable sawing through the sternum of a non-intubated, non-ventilated patient, and rummaging around within the chest long enough and deep enough and with enough sharp implements to set up a heart-lung bypass, relying only on the integrity of the mediastinal tissues to allow the patient to continue breathing spontaneously, I find very very hard to believe. That anyone would consider this to be preferred prodedure, simply to avoid a general anaesthetic, boggles my mind to the point of complete flat spin.

If that is indeed the case, then of course I defer to what the experts say, but are we really sure about the facts of this? The information on another list I'm discussing this on is very much to the effect that splitting the sternum wide open is not something which would normally be considered without anaesthesia and ventilation.

Rolfe.

It's common enough for cardiothoracic surgeons to carry out research on different techniques for getting into the chest:

"Reversed-J inferior versus full median sternotomy: which is better for awake coronary bypass surgery." Journal of cardiac surgery, {J-Card-Surg}, Sep-Oct 2005, vol. 20, no. 5, p. 463-8, ISSN: 0886-0440.

Kirali-Kaan Kayalar-Nihan Ozen-Yücel Sareyyüpoglu-Basar, Güzelmeriç-Füsun, Koçak-Tuncer, Yakut-Cevat.

Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey. imkkirali@yahoo.com.

BACKGROUND: The aim of this study was to ascertain whether the approach with a less invasive reversed-J inferior sternotomy could improve intraoperative patient compliance and postoperative recovery than the standard median sternotomy. METHODS: Seventeen patients underwent elective single coronary artery bypass graft operation under high thoracic epidural anesthesia without endotracheal intubation. The reversed-J sternotomy was performed in 10 patients (Group A) and full sternotomy in 7 patients (Group B). The technical and surgical difficulties, pulmonary functions (by spirometric tests) and hospital stay were assessed. RESULTS: Through the reversed-J sternotomy coronary revascularization was accomplished without any additional technical difficulties and with a good exposure of both the left anterior descending artery and the left internal thoracic artery. No conversion to standard sternotomy and no intubation were observed. Additional doses of local anesthetic at jugular notch was not required in Group A. Pleura was opened more in Group B (57% vs. 20%; p = 0.14). Oxygen saturation was better in Group A during the surgical procedure (98.8 +/- 0.7% vs. 97.1 +/- 2.1%; p = 0.033), however, intraoperative PaCO2 was similar in both the groups. The patients in Group A were discharged from the hospital earlier (3.2 +/- 1.5 vs. 7.3 +/- 3.5 days; p = 0.004). CONCLUSIONS: Less invasive approach to coronary artery bypass graft operations is possible through combination of the high thoracic epidural anesthesia and a reversed-J sternotomy. This technique is less traumatic for patient and provides practical better oxygenation and shorter hospital stay.

From what I can ascertain the anaethesia is a high epidural. Given at the right dose it will produce numbness from the block down and make it very difficult to move.

I think it's chosen as a technique for patients who are too high risk for conventional anaesthesia. It may also be part of the CT surgeons attempts to hold back the tide of invasive cardiology, but that would just be wild speculation on my part.

 

[Rolfe]

Now THAT is FASCINATING!! Thank you. It still boggles my mind, but not in quite the same way. So, what at first seems to be impossible, becomes possible with sufficient expertise (and some rather co-operative anatomy).

Now, it seems a fair bet to me that a few people with enough knowledge to know that there was a problem there, but nevertheless unaware of this very specialist research, would question what they were seeing. So, would it have killed the presenter to take a few seconds to mention just how this lady was actually being sawn in half? Oops, might it have been that mentioning the details of the technique would get the "high epidural anaesthesia" part too close for comfort?

I don't honestly know what a "reversed-J sternotomy" is exactly, but it seems that they were able to get away with a full sternotomy too, so it sounds as if that refinement isn't entirely essential. So, I'm happy to climb down and agree that this might indeed be exactly what the cameras were showing, with no trickery.

However, we also seem to have solved the problem of the imprecise language used in relation to "numbing the chest". High epidural. OK. Very impressive. All those other little needles were doing just what, exactly?

Asolepius, was this the nature of the "other" trickery you said you thought was involved, when you were explaining that what we saw might indeed be what she got?

Well, that was a big puzzle to me, but it didn't actually have any relevance to the acupuncture itself. Now it's solved, at least to my satisfaction, what were you saying about the MRI again?

Rolfe.

 

[Badly Shaved Monkey]

Oops, might it have been that mentioning the details of the technique would get the "high epidural anaesthesia" part too close for comfort?

I didn't know you could do an epidural at that level, but this was the guess I made during the programme. Of, course it completely invalidates every claim for the benefit of acupuncture that was made around the heart surgery item. Physicist commenting on medicine...rant...moan

It just goes to show that you can be quite bright, but if you are actually an outsider from the field in question you may utterly fail to grasp what is going on. Surely someone should have mentioned to her that when the chinese medics said, "Oh, yes she has had a bit of sedation and a little local anaesthetic" this was not a trivial statement.

 

[Thing]

Here is my rapid response to John Garrow's review article on the series.

And an excellent response too. Just one point regarding: "While respecting Professor Sykes' eminence within her field, it was a mistake to put a physicist in the anchor position for this series." Understandable politeness but she has no eminence in the field---she has a PhD in the field and zero publications. It's hard to be less eminent and still count as a physicist.

 

[Rolfe]

I didn't know you could do an epidural at that level, but this was the guess I made during the programme. Of, course it completely invalidates every claim for the benefit of acupuncture that was made around the heart surgery item. Physicist commenting on medicine...rant...moan.

To be honest, it didn't occur to me at the time. And neither did the possibility that the mediastinum might be robust enough to maintain the integrity of the pleural cavity, although I did know that the human mediastinum is a remarkably tough nut. I was so puzzled by what the hell was going on that the acupuncture itself became a secondary consideration for me during the programme. I would have thought that a bit of basic explanation of what was going on might have been appropriate.

However, it seems to me that Kathy Sykes might not have realised that there was anything to explain. If the Chinese team had their routine quite pat, then without anyone questioning how they could maintain respiration without ventilation during a thoracotomy, the fact that a proportion of the audience might be asking exactly that may not have occurred to anyone.

Rereading that fascinating abstract Camillus posted, I see that it's not such a big procedure that's being described. As far as I know, you don't need to stop the heart for a coronary artery bypass graft, and it's not open-heart surgery. No heart-lung machine would be required, presumably, and I don't see any mention of that in the abstract. So, we have the sternotomy and the exposed heart without intubation or ventilation, but we do not have the fitting of heart-lung bypass equipment, or the stopping and opening of the heart. I wonder if the regular surgeons would be prepared to go that far?

Nevertheless, it does most certainly demonstrate that what was shown in the programme is possible, if not necessarily desirable, safe or best practice.

I suppose that for Kathy Sykes to have explained that awake, non-intubated thoracotomy is practised by mainstream surgeons, would pretty much have exploded the whole thing. Duh, so if this is unremarkable, then what are the acupuncture needles adding to the exercise? What I'm not sure about is whether she realised this, and decided just not to touch on the subject, or whether she just didn't know enough to ask, "how is the patient breathing?", and so was completely taken in by the whole performance.

Surely someone should have mentioned to her that when the chinese medics said, "Oh, yes she has had a bit of sedation and a little local anaesthetic" this was not a trivial statement.

Er, uh-huh.

Rolfe.

 

[Badly Shaved Monkey]

One of them was the ubiquitous George Lewith from Southampton.

Oh, yes. Hilariously subtitled "The Academic" when he walked self-importantly into the buidling where they were meeting. I didn't recognise his at that point but wondered who it could be that would be given such a vague descriptor, in contrast to "The Neuroscientist" etc.

Perhaps, "The Man Who's Made a Good Living from Homeopathy" was too long.