Posts Tagged ‘ alternative ’

TCM and You: Cupping


I have noticed that Chinese massage seems to be becoming popular, and seemingly with it Traditional Chinese Medicine (TCM1). At least browsing through two of the larger shopping centres in Hamilton (bring on the hick jokes) I saw massage centres offering these services. In particular cupping was advertised. But what exactly is cupping2?

As with many modalities in TCM Cupping appears to be based on pre-scientific notions of blood stagnation and energy blockages3. Applying cups with a slight vacuum to the skin is meant to draw out the “toxins” which then results in improved health, somehow.

The active part of cupping essentially boils down to a pressure difference. The pressure is lower on the inside of the cup and greater on the outside, this difference causes the skin to be forced up into the cup4. This process in turn causes blood to gather in the region and may cause minor damage to the area resulting in bruising.

Presumably the fact that the skin appears to be drawn up into the cup gives the impression that there is a general pulling action at work here and that toxins and other “bad stuff” are pulled out of the body in this fashion.

The trouble with this is that pressure difference is a fairly crude physical process and with regard to this biological system lacks what we in the science biz call “Specificity”5. What this means is that there is no way for the cup to restrict the “pulling action” to only harmful chemicals (the “toxins”, say) and allow everything else to be unaffected, i.e. it is not “specific” to toxins. Everything will be drawn up in the same way.

In which case you get a lovely bruise and feel like you’ve done something but that’s about it.

Ok, that’s fine for just thinking about it. What about evidence, we’re always going on about evidence here.

I attempted to find a Cochrane review on cupping but while one was listed for pain relief there did not seem to be a completed review for perusal. I did come across this review that found equivocal results for the effectiveness of cupping for pain.

The review comments on the putative mechanism of cupping:

“Assuming that cupping was beneficial for the management of pain conditions, its mechanisms of action may be of interest. The postulated modes of actions include the interruption of blood circulation and congestion as well as stopping the inflammatory extravasations (escaping of bodily fluids such as blood) from the tissues. Others have postulated that cupping could affect the autonomic nervous system and help to reduce pain . None of these theories are, however, currently established in a scientific sense.” [Emphasis added, citations removed]

The discussion of the reviews limitations is especially worth noting:

“Our review has a number of important limitations. Although strong efforts were made to retrieve all RCTs on the subject, we cannot be absolutely certain that we succeeded. Moreover, selective publishing and reporting are other major causes for bias, which have to be considered. It is conceivable that several negative RCTs remained unpublished and thus distorted the overall picture. Most of the included RCTs that reported positive results come from China, a country which has been shown to produce no negative results. Further limitations include the paucity and the often suboptimal methodological quality of the primary data. One should note, however, that design features such as placebo or blinding are difficult to incorporate in studies of cupping and that research funds are scarce. These are factors that influence both the quality and the quantity of research. In total, these factors limit the conclusiveness of this systematic review.

In conclusion, the results of our systematic review provide some suggestive evidence for the effectiveness of cupping in the management of pain conditions. However, the total number of RCTs included in the analysis and the methodological quality were too low to draw firm conclusions. Future RCTs seem warranted but must overcome the methodological shortcomings of the existing evidence.”

In conclusion then, you may see a placebo effect from this treatment – though I suspect this is over rated as a therapeutic outcome6. You may also find yourself covered in bruises (though I hear they are painless – think of them as CAM hickies). So… Dubious premise with dubious benefit, same thing – different day.

Here are a couple of images for you to keep in mind…

Mmmmm, cupping goodness.

[UPDATE 30/5/12: Islam appears to support cupping, check out this completely unbiased arabic wikipedia article]

—————————————————————————————

Footnotes:

1. Can’t get away from TLAs

2. So many jokes spring to mind, I mean come on – “cupping”?

3. See this link for some scary science illiteracy around cupping. And here’s good old Wikipedia. And “blood stagnation” really? isn’t that gangrene or septicaemia or something?

4. Keeping in mind that a vacuum does not suck, high pressure pushes.  If I may geek out a bit here; hence one of my favourite exchanges from ST:TNG:

“You were right. Somebody blew out the hatch. They were all sucked out into space.“
“Correction, sir, that’s blown out.“
“Thank you, Data.“
“A common mistake, sir.“

- Riker and Data get precise about the physics of rapid decompression into the vacuum of space

5. Yeah, I know, it sounds made up.

6. See here, here and here.

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2012
04/04
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Complexity and Health – A Rant


To shamelessly butcher a great H2G2 quote:

Biology is complicated. Really complicated. You just won’t believe how vastly hugely mindbogglingly complicated it is. I mean you may think it’s complicated to do the morning crossword, but that’s just peanuts to biology.

This may seem trivially obvious, I mean we don’t compare things to brain surgery because brains are simple. But it always seems to me that the attraction of pseudo-science and altmed modalities occurs because of our yearning for easy answers. While proponents of alternative medicine affect superiority while berating conventional medicine for only treating symptoms not underlying problems it is their own philosophy that is childlike in it’s simplicity. In addition those in the altmed camp are sometimes embarrassingly binary in their approach to medicine, either vaccines work or they don’t, they are 100% safe or toxic, science is completely trustworthy or completely corrupt.

Take homeopathy*,while conventional science based medicine determines physiology, observes interactions, makes hypotheses and tests interventions and performs statistical analyses homeopathy stagnates. One of the fundamental precepts of homeopathy, the notion of “like cures like” is the most simplistic of magical thinking. Take a substance that causes a symptom in large doses and give it to a person suffering that symptom (from what ever cause, so much for treating underlying issues) in small doses and it is supposed to cure that symptom. Sympathetic magic as it has been called.

Speaking of magic, the Natural Health Expo is once again in town this month. browsing through the exhibitor list is like stepping through the looking glass. At the other end of those links are places were the rules** of the normal world do not apply, the laws of physics are suspended and anything is possible.

The breadth of inanity is so great that it’s hard to know where to start, so I just clicked on the first exhibitor and saw where it took me. African Gems and Minerals, seems solid, what could be on a firmer foundation than rocks from the earth?

Well, until you get to the page on crystals. Now I have to admit a certain fondness for crystals, the interesting variety of shapes and sizes, the symmetry and range of colours is captivating. What bugs me is the mystical properties attributed to them and the bizzare claims made for their properties, don’t trust me here’s a selection taken directly from the website:

“Kunzite Healing Stones Removes obstacles from one‘s path. It dissolves negativity automatically raising the vibrations of the area surrounding  it. Removes physical and spiritual blockages. Powerful sinus cleanser.  Use on the third eye for spiritual shift.”

Vicks has nothing on this rock, soothes the soul and clears the nose. And it sounds vaguely naughty – a must have.

“Serpentine Healing Stones. Light green is known as infinite stone… Enables one to enjoy each moment and to awaken to the inner knowledge which is so patiently  awaiting access. Excellent for easing pain. “

Opens the mind, and lets your brain fall right out. Good for aches and pains too.

“Peridot Healing Stones – Traditionally known as a stone that wards off evil. Regulates cycles of life: Physical Mental Emotional Intellectual as well as life cycles. Excellent healing stone and acts as a tonic to strengthen and regenerate the body. Birthstone for August. We have small rough stones and jewellery”

Strengthens and regenerates, well that’s vague. Will it help regenerate my dad’s hair?

“Rutile Quartz Healing Stones – Also called Angel Hair. Smokey with Rutile is a superior grounding stone that eliminates negativity promotes upliftment and joy and lifts depression. Banishes bad dreams. Strengthens the energy field. Counters electro-magnetic smog and radiation for example from computers. Rutile acts as an accelerator and speeds up the process while anchoring light into the physical being.”

Electromagnetic Smog, that sounds serious***. I’m curious exactly how this works, as electromagnetic fields are a three dimensional phenomenon how exactly does a lump of rock on your desk help you? I’m obviously over thinking it, that’s dangerous in these circles. Still “anchoring light into the physical being” sound handy, does that mean I won’t need a torch at night?

“Moldavite Healing Stones – Green Tektite found in the Molda Valley Russia. Supreme transformation stone. Activator of the third eye and heart chakra. Decodes the light body causing vibrational shift. This is sometimes experienced as the ”Moldavite Rush”. Best used in the guidance of a practitioner. A complete book was written about this stone “‘Moldavite – Star born stone of transformation‘”

Ah, the stone for professionals. Is this the one rock to rule them all perhaps?

In case you thing I looked around to the wackiest thing I could find to put up here, I assure you I didn’t. I had a clue what I was in for when the exhibitor description mentioned crystals but there was no other outward appearance of kookiness. This site displays no more and certainly less insanity than probably 80% of the other exhibitors listed****. Some further examples: Healing with cards(and reiki, and crystals), oh look a homeopath, Power Animal cards (and oddly, reiki again), not entirely sure what the heck this is.

For any of these things to work large swathes of known science would have to be wrong. I just don’t see the massive amount of evidence that would be required to show that this is true. On the other hand some of the claims are just so nonsensical  it’s difficult to even know what is being asserted let alone how one might go about confirming or refuting it. Still, good for a laugh eh?*****.

—-

*Actually don’t.

**Especially rules of evidence.

*** Probably worth a post of it’s own.

****The craziness is confined to one portion of their website whereas the rest are devoted to it.

***** Just to be clear, it is the claims of the proponents that are amusing and worthy of ridicule, not the unfortunate people who are drawn into these claims. That is most definitely NOT funny.

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2010
10/14
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Is Acupuncture Worth a Punctured Lung? or Does the Risk Out Weigh the Benefit?


Friday’s issue of The New Zealand Medical Journal includes a case report of pneumothrorax in a recipient of acupuncture. For the interested layperson out there a pneumothorax in the collection of air in the space between the lung and chest wall leading in extreme cases to cardiac arrest. Acupuncture can result in pneumothorax when the needle is inserted into the lung tissue while the patient is breathing leading to the laceration of the lung and air being forced out of the lung and into the pleural cavity1. Mmm-mmm, gimmie some of that lung collapsing goodness.

Now lest I give the impression that complications from acupuncture use are common I will hasten to add that they are not. One paper estimates the rate of serious adverse events at approximately 1 per 20,ooo patients2. Though if we look at the rates of acupuncture use in the United States as an example, as of about 2007 approximately 1% of the population reported using acupuncture in the previous 12 months3. This translates to about 155 serious adverse effects per year. Another study found over 2% of patients reported adverse reactions that required treatment4, commonly for bleeding or pain. Multiply these figures by the likely worldwide numbers of people receiving acupuncture.

Lets compare this with the conventional medical field, the drug Terfenadine marketed under the trade name Seldane (Teldane here in NZ) was removed from the market in the US due to increased risk of cardiac arrhythmia when used in conjunction with certain other drugs. This expressed itself as a risk of 0.04 – 0.08 per million “defined daily doses”5. Once a replacement drug came on the market Terfenadine was taken off.

Pneumothorax as a complication from acupuncture is  rare even in this subgroup. More common is infection. As I’ve noted before6, the underlying theory of acupuncture is the manipulation of life energies (Qi or Chi), blockages or imbalances in which are the cause of disease. If such is the case then why should the treating physician7 bother with proper antiseptic technique? I suspect that most modern practitioners are however not so far down the rabbit-hole that they have thrown away germ theory completely, at least the outward practical side involved in cleaning and sterilising implements. Which is why even infections are still relatively infrequent.

I would like to point out however that given the implausibility of the treatment basis, coupled with the fact that most large well designed studies find no benefit beyond placebo does make the existence of any complications ethically troubling. If your treament is no more than an elaborate placebo, are you willing to suffer adverse effects because of it? As reported by Dr Novella of Science Based Medicine8, a recent review of acupuncture admitted that sham (placebo) acupuncture was as good a “real” acupuncture.

Lets delve into the definition of “sham” acupuncture a little more to give the proper context to this revelation. Whereas “real” acupuncture depends on the proper insertion of the needles in specific meridian points on the body sham acupuncture can be considered to be either the placement of needles into non-meridian points, or the use of implements that feel like needles to the patients but do not pierce the skin like toothpicks9. This indicates that it doesn’t matter where you stick the needles and it doesn’t even matter if you stick the needles. How then can we conclude that acupuncture works if you don’t need to perform the two defining characteristics of acupuncture?

Given this background I find it difficult to imagine why acupuncture continues to be recommended despite convincing evidence of efficacy and indisputable evidence of harm. All medical interventions carry some element of risk, this is then weighed against the potential for benefit. However when there is no benefit any amount of risk must make that equation lopsided with regard to harm. With that in mind, if you are attracted to acupuncture as a therapy let me recommend sham acupuncture as the way to go. All the placebo-y goodness of real acupuncture without the potential for the nasty drawbacks of infection, bleeding, pain or even pneumothorax.

Further reading:

Type “Acupuncture” and “Infection” or “Pneumothorax” into Pubmed as key words and you will find a variety of papers, a selection of which are below:

Acupuncture induced pneumothorax:a case report (not the report mentioned in the post)

Editorial:Acupuncture transmitted infections

Cutaneous Mycobacterium haemophilum infection in a kidney transplant recipient after acupuncture treatment.

Acupuncture needle-associated prosthetic knee infection after total knee arthroplasty

Footnotes:

1. Clinical analysis on 38 cases of pneumothorax induced by acupuncture or acupoint injection

2. A cumulative review of the range and incidence of significant adverse events associated with acupuncture

3. http://nccam.nih.gov/health/acupuncture/introduction.htm

4. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form.

5. Detection and reporting of drug-induced proarrhythmias: room for improvement

6. Scepticon: Acupuncture

7. And here I use the term loosely.

8.Acupuncture Pseudoscience in the New England Journal of Medicine

9. I kid you not, here are a couple of the studies:
Description and Validation of a Noninvasive Placebo Acupuncture Procedure
A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain

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2010
08/16
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World Homeopathy Awareness


Just when I thought I wouldn’t have to worry about Homeopathy again any-time soon I discover that next week (April 10-16) is World Homeopathy Awareness Week. In theory I am right behind an initiative such as this as homeopaths do a surprisingly poor job of educating the public about what homeopathy actually is.

I suspect though that highlighting the fact that there is no active ingredient in most homeopathic preparations and that huge swathes of established science would have to be wrong for it to work will not feature prominently in the promotional materials.

For those not in the know homeopathy is based on two principles not found anywhere in science, like cures like, known as the “Law of Similars” and less is more or the “Law of Infinitesimals”. In a nutshell these two “Laws” state that a substance that causes similar symptoms to a disease will cure it and the more you dilute the substance the more powerful it becomes. In practice this means that homeopathic preparations can have some unusual starting ingredients (like duck liver) and are diluted to the point that no active ingredient is left in the final product.

A common dilution for preparations is 30C, or 30 consecutive 100 fold dilutions. At this level not only are the no molecules of active ingredient left there aren’t even any molecules of water left from the last dilution that contained any active ingredient.

Due to this fact homeopaths have been reduced to very fanciful explanations of how it might work, most involves invoking some sort of water “memory” effect. This isn’t impossible but neglects to mentions that if it is the case, then the water also remembers every poison it has come into contact with as well. How does it know which effect it should have? Should it kill or cure?

A study performed in 2008 and published in the New Zealand Medical Journal showed that while 85% of respondents believed they knew what homeopathy was less than 5% knew that there is no active ingredient in most preparations. I don’t expect this statistic to change due to any efforts on the part of homeopaths or those that sell generic remedies.

Here’s a pithy website dedicated to How Homeopathy Works.

For those with a high tolerance to brain melting gibberish here’s a video with one of the more confusing explanations of homeopathy:
Youtube Page direct

[UPDATE: Thanks to commenter Lizditz on Dr Steven Novella's blog about this I have been alerted to this great philosophy paper on Homeopathy; "Evidence and simplicity: Why we should reject homeopathy", go read it now.]

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2010
04/09
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What is the Harm of Alternative Medicine?


Yesterday fellow Sciblogger Grant posted about homeopathic medications in pharmacies and questioned the legitimacy of reputable organisations selling such patent snake oil. The comments to this entry reveal one of the most frustrating aspects of speaking out against unscientific medicine and can be summarised thusly: “I’m far too sophisticated to be taken in by this stuff myself but other people seem to like it and if it doesn’t work then what’s the harm?”.

This attitude is ever present and comes from a reasonable starting point i.e. everyone is entitled to their own opinion and it’s not my job to save them from themselves. I can totally get behind that, usually. When it comes to ineffective medications of the alternative variety however this impulse though understandable is misguided and I’d like to put down a few reasons why I think so, some are speculative but I think the possibility of harm is great enough that they deserve to be considered.

For a start there may well be direct harm caused by using alternative remedies. As there is little to no regulation of these medications then no proof of safety or efficacy is required for sale. Witness the Zicam debacle last year regarding a “homeopathic” cold medication.

Further more the possibility for indirect harm (as multiply alluded to by Grant) may be significant. In case your imagination is not up to the task I will outline a few ways this may be the case. For instance the underlying principles of something like homeopathy are no only unscientific they are in direct contradiction of the last 200 years of scientific understanding. If they are used as the basis of reasoning about health then the results can be more dire than someone getting a bad nights sleep (in the case of the homeopathic sleep aid Grant used as an example).

Use of these therapies for minor ailments by the “worried and wonky well” may increase the possibility they they will be used for more serious health issues where the results could be deadly.

Look no further than the position statement of the WHO regarding the use of homeopathy in the treatment of Malaria and AIDs (among other things). The consequences of such thinking could be incalculable in terms of human suffering and spread of disease. But what’s the harm, right?

Additionally it is one thing for adults to make an informed choice for themselves based on available evidence filter through their particular world view but what about when this choice id forced on their children? The recent case of parents being found guilty of manslaughter over giving homeopathic remedies to their sick daughter is a terrible reminder that sometimes it is innocent children that pay the price for people’s gullibility. But, you know, what’s the harm?

When ostensibly professional medical providers such as pharmacists sell demonstrably irrational treatments they lend credibility to them that the average person uses to base decisions on. I mean the wouldn’t sell it if it didn’t work, right?

So while I understand the commitment to individual autonomy and freedom of choice that leads to the “What’s the Harm?” question, I fail to see how this means that fraudulent therapies must be let off the hook simply because there is a demand for them.

This has been a more vitriolic post than I normally write but what’s the point of a blog if you can’t vent once in a while?

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2010
01/26
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Herbal Medicines


It certainly seems that in recent years herbal style medicines have grown more popular and more widely available. I’m certainly not going to espouse the view that these medicines are a waste of time, that they do nothing or that they have no plausibility. However neither do I think that simply because they are seen as “natural” (whatever that means) that they are necessarily superior to drugs produced by pharmaceutical companies. The problem with herbal/natural remedies isn’t that there isn’t a plausible mechanism of action, (as in Homeopathy for instance) but that there is usually not enough good quality data to support their use for a particular indication. In addition, while drugs developed for the pharmaceutical industry must pass stringent safety and efficacy tests those that are labeled herbal supplements often get a free pass. So not only may there not be evidence that they work but no evidence that they are not harmful.

There also seems to be a disturbing corollary to promoting remedies despite lack of evidence and that is the continued use in the face of dis-confirming evidence. Recently good studies have been published refuting claims for benefits to taking either Ginkgo Biloba extract for cognitive function or Echinacea for colds. Though I expect this information to have zero impact on sales even if the results of the studies gain wide distribution.

Remedies that consist of preparations made from the raw plant also suffer from inherent variation between plants, both between individual plants and in the same individual over time. So even if there is an efficacious active ingredient the dose would not be controlled. If herbal remedies have an effect on the body then they are drugs, by definition, they should be treated as such. In other words they should be evaluated for safety and effectiveness, considered when taking other medications for potential interactions and dispensed by those who are trained to appreciate the risks/benefits and science based medicine.

Resources

http://www.theness.com/neurologicablog/?p=424

http://www.sciencebasedmedicine.org/?p=293

2008
12/08
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Radionics


Radionics appears to be a sort of umbrella term that refers to the healing of tissues from a distance using some sort of electronic device. Researching this concept can give you the feeling that everyone is just making it up as the go along, curiously. It appears to have all started with Albert Abrams, M.D. (1864-1924). Abrams made all sorts of claims from diagnosis by proxy to diagnosis via autographs, finally coming up with an electronic device he claimed could diagnose from a distance.

Various imitators have cropped up since Abrams with their own versions of his “BlackBox” with different variations of diagnosis methods and outputs of the device, ranging from wires connected to the patient and vials of blood to Polaroids on the diagnosis side and the feeling of stickiness or friction on a plastic or rubber pad for the output reading. If the practice was limited to merely diagnosis of medical maladies then that would be bad enough, however the promoters of these devices also claim to be able to heal the disorders uncovered and this is where the real tragedy is.

Pseudo-scientific methods such as this appeal to those who are disillusioned with current medical progress in treatment of the more pernicious forms of disease that still plague our world, especially cancer. If these alternative medicines are the last hope of the terminally ill then who are we to take that away? But the proliferation of acceptance means that some people will turn to the alternative first, leading to unnecessary pain, suffering and death. That is the answer to the question “What’s the harm?”.

Resources:

http://www.quackwatch.org/04ConsumerEducation/News/rife.html

http://www.skepdic.com/radionics.html

http://home.pacbell.net/lotus999/radionics1.htm -Would be funny if they weren’t serious, ok it’s still funny.

http://www.dowsingnewzealand.org/ -Look, our very own.

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