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H.R. 646, The Federal Acupuncture Coverage Act of 2009 (287 comments ↓)
H.R. 646 would amend title XVIII of the Social Security Act to provide for coverage of qualified acupuncturist services under part B of the Medicare Program, and to amend title 5, United States Code, to provide for coverage of such services under the Federal Employees Health Benefits Program.
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MATT
June 11, 2009, 12:23pm (report abuse)METHODS: Thirty patients with classic heartburn symptoms who continued to be symptomatic on standard-dose proton pump inhibitors were enrolled into the study. All participants underwent upper endoscopy while on proton pump inhibitors once daily. Subsequently, patients were randomized to either adding acupuncture to their proton pump inhibitor or doubling the proton pump inhibitor dose over a period of 4 weeks. Acupuncture was delivered twice a week by an expert.
MATT
June 11, 2009, 12:23pm (report abuse)RESULTS: The two groups did not differ in demographic parameters. The acupuncture + proton pump inhibitor group demonstrated a significant decrease in the mean daytime heartburn, night-time heartburn and acid regurgitation scores at the end of treatment when compared with baseline, while the double-dose proton pump inhibitor group did not demonstrate a significant change in their clinical endpoints. Mean general health score was only significantly improved in the acupuncture + proton pump inhibitor group. CONCLUSION: Adding acupuncture is more effective than doubling the proton pump inhibitor dose in controlling gastro-oesophageal reflux disease-related symptoms in patients who failed standard-dose proton pump inhibitors.
Jennifer Fritschy FP&BD
June 11, 2009, 1:02pm (report abuse)Acupuncture provides a solution for our current health care crisis. While it is not the only answer, numerous studies have proven its effectivness for many health problems. It is critical that we reduce health care costs while giving US citizens the time and attention they need to feel their best.
In an independent 1992 study in For example, in Scandinavia, 25% of the patients who were awaiting knee replacement surgery canceled their scheduled surgery after receiving acupuncture, saving $9,000 per patient.
C Hallstrom
June 11, 2009, 6:20pm (report abuse)Matt, you don't seem to understand what a properly blinded and controlled study entails. Please research the definition of "placebo" before commenting. Since your study is the essence of the placebo effect I really don't know what your trying to prove except that I am right. Is that your intent?
Jennifer, what on earth is FP &BD and why should I care? I think that you could use a primer on the placebo effect as well. The placebo effect is REAL and quite well documented. If you had bothered to read my evidence which I provided with direct web addresses you would at least know you need to present more coherent evidence.
Please refute my evidence if you can and if you reference a study please do so so I can at least find it and read the study myself. I will not simply take your word for it. This is like the Dick Cheney approach to science, "I know we have no evidence but we want this to be true so it is, just trust us". Ha! No way, you can't have my money!
C Hallstrom
June 11, 2009, 6:33pm (report abuse)A few facts about the placebo effect;
• Placebo surgery works better than placebo injections
• Placebo injections work better than placebo pills
• Sham acupuncture treatment works better than a placebo pill
• Capsules work better than tablets
• Big pills work better than small
• The more doses a day, the better
• The more expensive, the better
• The color of the pill makes a difference
• Telling the patient, “This will relieve your pain” works better than saying “This might help.”
Source:http://www.skeptic.com/eskeptic/09-05-20
The interesting issue in all this is not acupuncture but the placebo effect itself.
Dr. Brendan Armm
June 12, 2009, 5:22pm (report abuse)This is great. Getting acupuncture out to the people that need it. Well done.
Ted Block C.A.
June 13, 2009, 2:23pm (report abuse)I think that this is long overdue. That so many people will be able to get better quality of life with so little $ invested. It is such a shame that some such small minded people can influence so many, and seem to make the most noise.
C Hallstrom
June 13, 2009, 8:16pm (report abuse)Since you can't insult my evidence you personally insult me. That's good. You really think seeing an acupuncturist not a Medical Doctor is more important for the 47 MILLION people who are uninsured in this country? I let my evidence make my noise and all I hear is your impolite silence. You can stick your head in the sand all you wish my evidence is real. NOBODY has said a WORD about the clinical trials I presented, why is that I wonder? Could it be because they prove I am right. So to sum up, you have no evidence but I make too much noise by yelling the truth at you. I'm sorry would you check the facts for yourself if I was quieter and nicer? Would you pretty please with a cherry on top address the issues I have raised? How do you explain the placebo effect in relation to your supposed field of expertise? If you could refrain from personal insults while doing so that would be just peachy.
Ash
June 14, 2009, 12:25pm (report abuse)Modern "science" is constantly evolving. Think of how little of our bodily was understood by "scientists" 100 years ago. As our tools of discovery improve, I have little doubt that the mechanism behind acupuncture will one day be revealed. It is a system that "science" has yet to figure out a way to measure. (And I hope the mystery remains.) Placebo could not carry a system of medicine for three to four THOUSAND years. If it didn't work, it would surely have disappeared by now. The body and mind interact in ways beyond most anyone's comprehension. And if it means a patient gets better, I'll take all the placebo effect I can get.
From a professional standpoint, coverage by Medicare will likely slow down my payments and add another challenging layer to actually getting paid for the work I do. Of course, I support the bill, but I personally think it will actually have a detrimental effect to my finances. And yet, if it brings healing to more people, I'll happily stand behind it.
C Hallstrom
June 14, 2009, 6:45pm (report abuse)Ash,You are both right and wrong it seems to me. Right in that science evolves and right the placebo effect is not a negative thing in itself. Clearly it has positive effect but that effect is achieved via false pretenses (the pretense being the treatment not the psychology involved is what works) and where is the ethical line? The problem of course is that placebos do not work for everyone not even a majority and hence are not truly effective treatment. Having said that science HAS revealed the mechanism at work in acupuncture and it is the aforementioned placebo effect. Science, of course has a long history of giving us results we don't like just ask the Catholic Church. As to your thousands of years argument, first your premise itself (1000+ year history) is not without serious challenge but beyond that it is just faulty reasoning. History is rife with examples proving the fallacy of your argument. Astrology,alchemy,bleeding,etc,etc. In fact my links refute that very argument.
Martin
June 14, 2009, 7:28pm (report abuse)Hallstrom, Astrology, Alchemy and bleeding may not have a "big" studies that stand behind them but they have also not been proven false. In fact, Astrology has so many coincidental results that it can't just be coincidental. The same must hold true for Acupuncture. As Ash says, it's been around for a very long time and has treated millions around the entire world. You appear to be well read and opinionated. What do you suggest? A new study? More statistical evidence? You claim that the evidence out there for acupuncture is unsubstantiated and incomplete. I do not believe Acupuncture is leaving the medical arena any time soon if at all so tell me Hallstrom, what do you suggest? What can you contribute?
Ash
June 14, 2009, 7:50pm (report abuse)I am completely confident in my reasoning. And, thank you, Martin, for your direct questioning of Hallstrom. Also, I have quite a few medical doctors, nurses and nurse practitioners that see me regularly for acupuncture and Chinese herbal medicine.
One of many studies on acupuncture, Hallstrom:
(Cost-effectiveness)
http://www.bmj.com/cgi/content/abstract/328/7442/747
I thought this would make most of you smile (and certainly frustrate at least one of you): http://www.ncbi.nlm.nih.gov/pubmed/18484250?ordinalpos=4&itool=EntrezSystem...
Ash
June 14, 2009, 7:51pm (report abuse)Trying to post this link again...It's about using a bleeding technique to treat arthritis. Using leeches, no less!
http://www.ncbi.nlm.nih.gov/pubmed/18484250?ordinalpos=4&itool=EntrezSy...
Ash
June 14, 2009, 7:52pm (report abuse)Sorry. I guess I have to post it in parts:
http://www.ncbi.nlm.nih.gov/pubmed/
18484250?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
dr.w
June 15, 2009, 4:33pm (report abuse)halstrom...
5000 years of clinical observation recorded and passed down through time by several different lineages. Also, if you don't think that we (our consciousness) affects the material world, i refer you to quantum mechanics, photon particle/wave phenomenon. To limit our exploration of the universes to reductionism is just myopic. Empiricism serves a very good purpose but it is not the only way to explain reality.
You want "proof"?
millions of people helped/cured/restored +
demand over time... THE MARKET HAS SPOKEN ;)
enough already
C Hallstrom
June 16, 2009, 1:33pm (report abuse)Actually Martin they have been proven false and you should have learned that in high school. Perhaps the real debate should be just how poorly educated our nation is. Just look at "dr.w" who seems to think that 5000 years ago we were doing "clinical observation" and that reading Deepak Chopra makes one a quantum physicist. Look, science ruins our beliefs and expectations all the time and yes it will ruin your profession by in large. I realize this is difficult to admit, the truth many times is. However the posters with evidence, even though it was bad evidence seem to have given up.
Ash if you are "completely confident in your reasoning" and you like " direct questioning" why do you refuse to address MY questions. Finally , there seems to be a core misunderstanding here about the burden of proof. You want my tax money for unproven treatment you should be proving to me and yet again and again it is I disproving you. I have refuted every study put forth and you have refuted nothing.
Dr. Marcy B. Newman
June 16, 2009, 3:28pm (report abuse)As an acupuncturist and a former public health professional, validity, validity, validity. One should look for consistency in scientific proof. Despite a very, insignificant number of medical professionals who try to discount the efficacy of Oriental Medicine (albeit - out of defensive and threatened individuals), you CANNOT discount the hundreds of studies/reviews from reputable Western institutions such as Harvard Medical School, World Health Organization, UCLA Medical school! Why would countless medical schools be teaching about acupuncture if this was not a incredibly valuable medicine that needs to be integrated into THE system!! What better way to incorporate it than to increase the access to our growing number of senior citizens on a fixed income who use Medicare!!!
***PLEASE, THE HEALTH OF OUR NATION DEPENDS ON THIS BILL!!!
Dr. Marcy B. Newman, DOM, MPH, RDH
Santa Fe, NM
C Hallstrom
June 16, 2009, 6:31pm (report abuse)Please count three of the "countless medical schools" that teach any type of "Chinese medicine". Are you sure it is actually the Medical School not some other school within the same University? Testing something and teaching something are not the same thing. So to reiterate I question the "validity" of your evidence which makes their "consistency" irrelevant. Do you question the "validity"of my evidence? There is only two pages on this thread and yet over and over the same arguments based on assumption, inference and flawed clinical trials. The health of our nation could not possibly depend on this bill, that's just absurd. Finally, I am glad to see you admit that acupuncturists are not health professionals, the health of our nation might well depend on that admission.
F Goodwin
June 17, 2009, 10:35pm (report abuse)C Hallstrom: 1. What was your negative experience with acupuncture?
2. At one point in medical history hand washing was thought foolish and many babies died in childbirth - germs could not been seen. The effects of transfats on cholesterol are now accepted. Asprin was developed from White Willow, Malaria treatments from trees. Sentinal node biopsy in breast, ovarian cancer, even the diagnosis of PTSD of returning vets. Children who are not touched do not develop or thrive. We don't have double blind trials to prove this. Acupuncture may work in a way we cannot see at this point, just as doctors did not believe in the germs they could not see. Some of your sites are not available, some are opinions, some valid studies.
3. Do you thread on other bills as avidly as this one?
Suzahne Riendeau
June 17, 2009, 10:55pm (report abuse)It is both cost-effective and beneficial to the society as a whole to cover acupuncture. This medicine treats the patient with respect, provides much needed NON-PHARMACEUTICAL treatment options and encourages patients to be more healthy and responsible in their lifestyle. Remember "health" is not merely the absence of illness.
Mercy
June 18, 2009, 5:34pm (report abuse)The Rand Corporation found that claims did not increase when acupuncture and Oriental medicine services were included in health insurance benefits (Rand Corporation, 2008). The erroneous perception that acupuncture and Oriental medicine services are an additional benefit that will increase costs has been shown to be mistaken. In fact, research has shown that acupuncture and Oriental medicine can reduce the necessity for drugs (Vas, J., Aguilar, I., Perea-Milla, E., Mendez, C., 2007), which has the added benefit of reducing potential side effects.
Rand Corporation (2008). Fact sheet. Retrieved June 17, 2008 from: http://www.rand.org/pubs/research_briefs/RB9366/index
Vas, J., Aguilar, I., Perea-Milla, E., Mendez, C., (2007). Effectiveness of acupuncture and related techniques in treating non-oncological pain in primary healthcare – an audit. Acupuncture in Medicine. 25 (1-2) 41-46.
Mercy
June 18, 2009, 5:37pm (report abuse)Another common misconception stems from the tendency to ignore distinctions among what are called Complementary and Alternative Medicines (CAM). As Dr. Edzard Ernst points out, “CAM is by no means a well-defined entity; the prevalence and reasons for using acupuncture are almost certainly different from those relating to crystal healing.” (Ernst, 2007) Discussion is more fruitful when apples and oranges are examined separately. Referring to modalities other than acupuncture and Oriental medicine in this discussion is an unnecessary distraction, as are uninformed comments about how acupuncture is practiced.
Ernst, Edzard (2007). Commentary on Bishop. Journal of Health Psychology. 12 (6). 868-870.
Mercy
June 18, 2009, 5:38pm (report abuse)Most importantly, Americans believe that health care is a personal choice. They want the freedom to choose the best medical care for their needs. With the present emphasis on prevention and healthy habits, it makes sense that acupuncture and Oriental medicine is included in those choices.
Jennifer Frtischy FP&BD
June 18, 2009, 8:08pm (report abuse)Acupuncture Found Effective for Back Pain
Study finds it superior to usual care.
By Tina Beychok, Associate Editor
There seems to be no question that Americans spend a great deal of money dealing with back pain. According to research, we spend at least $37 billion annually on medical care for back pain.1,2 Furthermore, the economy suffers another $19.8 billion in lost worker productivity due to back pain.3
In response to this, there has been extensive research on the use of acupuncture for treating back pain. A 2008 literature review concluded that there was "strong evidence" for the use of acupuncture as an adjunct to conventional therapy for lower back pain.4 Now, a new study published in the May 11, 2009 issue of Archives of Internal Medicine has added even further to the literature on the value of acupuncture in treating back pain.5
http://www.acupuncturetoday.com/mpacms/at/article.php?id=31984
C Hallstrom
June 21, 2009, 6:38pm (report abuse)Re; F Goodwin
I find it interesting you try and use evidence contrary to your own claims to prove your point. There is extensive research with regard to sanitation practices and germ theory. (That’s why it is called a theory, it has plentiful evidence to back it up like the theory of evolution or gravity). Why are the effects of trans fats now accepted? Might it be clinical data? Aspirin has had and continues to have huge amounts of clinical trials as to its uses and its efficacy. Pretty much all your evidence is backed up by extensive clinical trials, so what exactly is your point?
Questions 1 and 3 are really none of your business and have no bearing regardless. My motivations should not really matter only my evidence which you seem to say is valid so I’m not really sure where that leaves our discussion.
C Hallstrom
June 21, 2009, 6:55pm (report abuse)Re; Mercy
You probably should have read a little more instead of cherry picking your quotes. Here's mine, Ernst told this to the Guardian in 2003 "Many enthusiasts claim that the standard of evidence in CM must be different from that in mainstream health care, and they use a range of arguments to support their view: “My therapy is holistic, individualised, complex, etc; conventional outcome measures do not capture the subtle effects generated by CM; randomisation has detrimental effects that neutralise those of my treatment; and clinical trials tell us nothing about individuals”, for example. On closer inspection, these notions turn out to be pseudo-arguments, and it is tedious to argue against them (although a full discussion has been published). Suffice to say that, after years of debate, I have reached the conclusion that those who hold such views are either deliberately trying to mislead, or are not fully informed as to what a clinical trial can and cannot achieve."
C Hallstrom
June 21, 2009, 7:11pm (report abuse)Re; fp&bd;
A literature review is not considered solid evidence please present actual trials supporting your position. My trials directly refute your position for which you have no real evidence please try again. Perhaps you should actually read the review you reference as well because once again the evidence supports my position. I quote from your evidence “Interestingly, at the end of the study, there was little difference between the four acupuncture treatment groups in terms of effectiveness.”. Gosh that’s embarrassing but don’t you worry you have lots of company (see the 2 pages above). Does anyone else have evidence proving my point so well? Please by all means go right ahead it’s actually getting kinda funny. Is this the caliber of scholarship one can expect from the acupuncture community?
Mercy
June 21, 2009, 11:01pm (report abuse)C Hallstrom - Thank you for your response. I was unable to locate your quote from Edzard Ernst in the 2003 Guardian; would you mind giving a citation? The point of his comment (Journal of Health Psychology, 2007), I believe, was that much of the discussion about Complementary and Alternative Medicine is vague due to lack of understanding about the differences between therapies. You have brought up an altogether different but interesting point about clinical trials. It would be difficult to argue that clinical trials are perfect, or that they hold the answers to all of our medical questions. We are still refining the process. In your experience in medicine, you may have found that not all patients respond similarly to a given treatment. //You seem to be an avid reader. Regarding your post May 27, 2009, 12:49pm, you might enjoy reading Richard E. Nisbett, “The geography of thought: How Asians and westerners think differently…and why.” Thank you for your interest in this discussion.
Teresa Maijala
June 22, 2009, 1:49am (report abuse)I support this bill, and feel it is long over due. I have seen first hand the positive results of Acupuncture and Oriental Medicine for over 26 years. I feel as a society it is important to respect people's right to choose the type of Medical Care that they feel most comfortable with, and get the best results from. Every human being is capable of determining what brings them health and relief from illness, as well as what does not. There is a reason the use of Oriental Medicine is growing rapidly, people are getting well.
C Hallstrom
June 22, 2009, 11:02am (report abuse)Re; Mercy
Defending acupuncture with a sentence that includes the phrase “crystal therapy” is probably not the best choice. As to Ernst my source is secondary but here it is; http://junkfoodscience.blogspot.com/2008/04/uk-doctor-scientist-leading-deb... /> Now, as to your other point,Richard Nisbett is a discredited scholar who went to prison for misuse of government grants. I would NOT enjoy reading “The geography of thought”. It has NOT been peer reviewed and has been widely discredited. You would know this if you had simply googled his name and avidly read the information readily available. The project (Milwaukee Project) he based his conclusions on is now believed never to have even existed. Who gives you this information? Do you just blindly believe or do you actually ask questions and do research yourself?
C Hallstrom
June 22, 2009, 11:18am (report abuse)Re; Teresa
Now your just being silly.You say"Every human being is capable of determining what brings them health and relief from illness, as well as what does not". Have you even read history? How about those who refuse proven life saving treatment in favor of prayer? For their children?It still happens today and children still die. This is what you think is best? Everyone just decides for themselves? How many assumptions can you make in 1000 characters?Something is not true just because you want it to be and I say for the umpteenth time personal experience is not considered solid evidence in science (or anywhere else for that matter). Why can't we pay for what we actually know works first for the 47 million who need it? We do have a bit of a budget crunch to worry about so we will have make some choices. I personally would like medicine and treatment actually proven to work.
C Hallstrom
June 22, 2009, 11:27am (report abuse)Mercy, sorry for the broken link here it is again; http://junkfoodscience.blogspot.com/2008/04/uk-doctor-scientist-leading-deb... /> hope it works.
C Hallstrom
June 22, 2009, 12:35pm (report abuse)Hey Mercy, I love Ernst. Here are some quotes from his recent book "Healing, Hype or Harm? A Critical Analysis of Complementary or Alternative Medicine."
“Just as reason cannot be reconciled with irrationality, so orthodox medicine cannot be integrated with alternative medicine.”
“It is also ironic that patients who reject orthodox doctors as paternalistic resort to alternative practitioners whose appeal is largely based on personal charisma and the authority of ancient texts.”
“Concepts such as the qi of Chinese traditional medicine are myths which enjoy the same status as religious faiths. Believers cling to the myth despite the evidence, reinterpret the myth to suit the evidence, or lie about the evidence to support the myth.”
“The worst medical doctor can cure diseases and save lives; the best alternative healer can only offer false hopes.”
Source; http://www.sciencebasedmedicine.org/?p=375
Thank you so much for bringing this to my attention Mercy.
Mercy
June 22, 2009, 2:32pm (report abuse)Re: Geography of Thought
Dr. Nisbett has asked that this message be conveyed on this website:
"Someone has confused me with a developmental psychologist who did do what is claimed."
Richard E. Nisbett
Theodore M. Newcomb Distinguished University Professor
Research Professor
Institute for Social Research
University of Michigan
Ann Arbor, MI
Mercy
June 22, 2009, 2:57pm (report abuse)Dear C Hallstrom Thank you for your responses, links, and quotations.
Do you agree with Dr. Ernst that medical beliefs are akin to religious beliefs?
C Hallstrom
June 22, 2009, 10:36pm (report abuse)Re; Mercy
My apologies you are right.Dr. Nisbett is not the one who went to prison. The one who went to prison ran the study Dr. Nisbett bases his conclusions upon. However Dr. Nisbett is clearly controversial and clearly not relevant to this thread regardless.
Mercy,as to your second post why do you persist in misinterpreting others remarks.Unless by "medical belief" you mean belief in "alternative therapies". Ernst clearly explains the difference between science and hocus-pocus. "Chinese medicine" falls clearly in the hocus-pocus category. Real medicine does not require belief it can only be augmented by belief. That is the point, science is decidedly not faith based. You don't have to believe antibiotics will work they work with or without belief so does heart surgery and countless more examples of real proven medicine our tax dollars should support.
C Hallstrom
June 22, 2009, 11:36pm (report abuse)Here is a rather blistering review of the Nesbitt book by Sherry Ortner (2003) for The New York Times.
http://www.nytimes.com/2003/04/20/books/east-brain-west-brain.html
She has hit the nail on the head in my opinion. While I find this conversation on cognition interesting I do not think this is the forum for such a discussion.
I continue to maintain that real medicine should be covered by our taxes for all citizens and acupuncture is not real medicine. I have proof. I await evidence proving this position is incorrect. I have yet to see any.
WWorthley
June 23, 2009, 12:25am (report abuse)If acupuncture can be considered an acceptable medical procedure, why doesn't the SG come out with strong support for the use of acupuncture as an alternative? The FDA has approved too many drugs only to pull them after they find out the true nature of the side affects. I don't like the idea of approving this for gov't employees so it can be part of their health benefits, which are paid for with my tax dollars. If acupuncture is valid it should be a medical procedure covered by all insurance companies, not just for the gov't workers. Or maybe, we should consider the gov't workers as our acupuncture test group. I would support this if it was inclusive for all, not just the gov't workers.
Christopher Reilly L.Ac.
June 23, 2009, 12:34pm (report abuse)This bill is an important part of healthcare reform. Acupuncture is cost effective, and works for many conditions which currently are not well managed by mainstream medicine. These include osteoarthritis, low back pain, migraines, IBS, chronic digestive disease including IBD, side-effects of chemo- and radiation therapy, and more. Studies published in the leading medical journals of the world have shown acupuncture to be not just effective, but superior to usual care for the management of chronic low back pain and migraines (Archives of Internal Medicine, the Lancet Neurology, the British Medical Journal, Journal of the American Medical Association). The cost of American Healthcare is spiraling out of control, and much of this cost is related to chronic health conditions such as those named above. Acupuncture offers an affordable tool that can reduce the need for more costly interventions such as surgeries and the continuous use of drug therapies.
tim green- acupuncturist
June 23, 2009, 9:10pm (report abuse)I have had a number of patients referred to an acupuncturist for treatments from Mayo-as they had the knowledge and perspective for this referral. Western medicine had nothing for these patient's ailments-they are now doing much better and frequently thank those at Mayo for their foresight.
C Hallstrom
June 23, 2009, 9:32pm (report abuse)NCAHF believes:
1. Acupuncture is an unproven modality of treatment;
2. Its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge;
3. Research during the past twenty years has failed to demonstrate that acupuncture is effective against any disease;
4. Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter- irritation, operant conditioning, and other psychological mechanisms;
5. The use of acupuncture should be restricted to appropriate research settings;
6. Insurance companies should not be required by law to cover acupuncture treatment; and
7. Licensure of lay acupuncturists should be phased out.
source:http://www.ncahf.org/pp/acu.html
Man when it rains it pours. The more I look the more I find.
Shanna Cowell L.Ac.; BS Biology
June 24, 2009, 5:14pm (report abuse)C Hallstrom
The position paper you reference from the National Council Against Health Fraud was written 19 years ago. Also, just for the record, this council is not governmental but "voluntary".
Why not read a book or two about Asian Medicine theory so you can comment more intelligently on it as a system. It is basically an attempt to describe the workings of a dynamic, constantly changing system which is always interacting with and relating to itself and it's environment (kind of like weather but much more complicated.)
Assuming modern science has all the answers is flawed--many things were true before they were proven to be thus.
If one wants "studies" of acupuncture, it would probably be a good idea to study acupuncture ie Asian Medical theory first. Having begun as a science trained skeptic and converted by being exposed to treatment, I can only say the proof is in the putting and the explanations lie buried in the complex analogies which comprise the theory.
Mercy
June 24, 2009, 5:14pm (report abuse)Mayo Clinic recommends acupuncture:
* Acupuncture is safe when performed properly.
* It has few side effects.
* It can be useful as a complement to other treatment methods.
* It's becoming more available in conventional medical settings.
* It helps control certain types of pain.
* It may be an alternative if you don't respond to or don't want to take pain medications.
Retrieved June 23, 2009 from http://www.mayoclinic.com/health/acupuncture/SA00086
Mercy
June 24, 2009, 5:41pm (report abuse)Again, responding to the concern about the cost to the taxpayer, research has demonstrated that access to acupuncture services does not increase costs (Rand Corporation, 2008)
Rand Corporation, 2008. Fact sheet. Retrieved June 17, 2008 from: http://www.rand.org/pubs/research_briefs/RB9366/index
Mercy
June 24, 2009, 5:43pm (report abuse)C Hallstrom Thank you for the citation of the Sherry Ortner review of “The Geography of Thought.” It seems that she has two arguments. One, as she is an anthropologist, she would prefer that Dr. Nisbett immerse himself in a particular culture in order to describe it. She objects to psychological studies that involve isolating college students in a room for study. For better or for worse, however, this is how psychological studies are done. I would agree with her second point, that there are more than two ways to see the world. Our multi-cultural society requires some effort to reach understanding. In your post you stated that you think cognition is not important to this discussion, but I disagree. It is exactly this, reading views that we do not necessarily hold, but are willing to try to understand, that broadens our civic discourse.
C Hallstrom
June 24, 2009, 7:22pm (report abuse)Re:Shanna
So let me get this straight , I should believe in acupuncture because it is “thousands” of years old but not in something 19 years old because that is too old but not old enough? Second I never said nor did I imply that the NCAHF was in any way a “government” entity. Third, how on earth would you know what I have read or haven’t read? I would never in a million years “assume” science has all the answers that would be the antithesis of my position. No “science trained skeptic” would EVER use personal experience as an arbiter of truth as you do. So to be clear, I HAVE studied Chinese medicine at multiple schools with “grandmasters” (or charlatans if you prefer), I have read countless studies many of which I have posted here and the truth is acupuncture is a placebo and “Chinese medicine” is pseudoscience. And I have had this argument already please read the thread before posting.Please post actual evidence not unfounded opinion.
C Hallstrom
June 24, 2009, 7:32pm (report abuse)Mercy, you might have noticed that the Mayo clinic does not in ANY way say acupuncture is good for anything. They say it "may" help and "some' people find it useful. Basically they say what I say only more diplomatically, they say acupuncture is a placebo.
As to the RAND corp. study; first placebos work and are cost effective but dishonest and second careful with the RAND corp. they are a massive defense contractor. Sugar pills are cheaper than real pills and acupuncture is cheaper than real treatment. The essence of my argument that you so graciously keep proving for me. Thank you.
As to cognition what does it say about the power of placebo?
C Hallstrom
June 24, 2009, 10:15pm (report abuse)Mercy, you are misrepresenting again. That is decidedly NOT what Ortners’ article primarily argues. Are you doing this on purpose? She directly questions methodology and evidence as well as conclusions. She questions on scientific grounds which is exactly what scientists are supposed to do. It seems you take the Nesbett and cognition stuff personally which is why I would truly like to move on.
As to our civic discourse how many times does one have to argue 2+2=4 and not 5 before we can be done? Regardless, I never said anything about censoring anyone. I just prefer to address evidence otherwise it is all just opinion and opinion is like faith, hard to have a reasonable conversation about. I mean could we at least discuss the placebo effect? Is it somehow scary? It effects ALL forms of medicine and treatment (even the ones I hold to be true), I even presented abundant evidence. Why no broad civic discourse? Please apply your advice to ALL on this thread. Thanks
Jennifer Fritschy, L.Ac
June 25, 2009, 12:40am (report abuse)A recent study demonstrates how acupuncture is superior to the usual care for back pain. The US spends millions of dollars on back pain each year. Compared to usual care, acupuncture provides safe, cost-effective treatments while discouraging drug dependence and permanent disability. Learn more: http://www.acupuncturetoday.com/mpacms/at/article.php?id=31984
tim green-acupuncturist
June 25, 2009, 8:54am (report abuse)Does this D. Hallstrom work for a pharmaceutical monolith, or what? I agree with someone's comment that no more time should be wasted on his/her fearful commentary.
Christopher R. Reilly
June 25, 2009, 1:13pm (report abuse)Speaking of evidence-based...
(the following journals are not only peer-reviewed, but are among the very top medical journals in the world)
"Evidence-Based Recommendations for Cancer Nausea and Vomiting." Journal of Clinical Oncology. Aug 10, 2008. 26(23). 3903-10
I quote "In summary, evidence supports electro acupuncture by clinicians competent in its administration for chemotherapy-induced nausea."
"Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society." Annals of Internal Medicine. Oct 2, 2007. 147(7): 478-491.
"For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits...for chronic or subacute back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture..."
Christopher Reilly
June 25, 2009, 1:48pm (report abuse)In case you missed it, the American College of Physicians backs acupuncture as a therapy with "proven benefits"
To continue
"A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain." Archives of Internal Medicine. May 11, 2009. 169(9): 858-66.
Ten sessions of acupuncture over the first seven weeks compared with continuous usual care over a year. At one year acupuncture group reports superior improvements in pain and symptoms. Not many placebo's last for a year. Usual care includes medications, exercise and physical therapy already proven superior to placebo.
"German Acupuncture Trials for Low Back Pain" Archives of Internal Medicine. Sept 24, 2007. 167(17): 1892-98.
10 to 15 acupuncture sessions compared to six months continuous usual care. At six months acupuncture group responder rate for pain and function is 47.6% versus 27.4% for usual care.
C Hallstrom
June 25, 2009, 2:11pm (report abuse)Jennifer, I already addressed your study. Here it is again
"Interestingly, at the end of the study, there was little difference between the four acupuncture treatment groups in terms of effectiveness." . As in a toothpick(used in study) was as effective as acupuncture.
Mercy, where are you? Tim Green is trying to censor our public discourse. I have said and say again I make no money on any side of this issue. My interest is both intellectual and as a concerned citizen nothing more. What's your interest?This is America Sir, do not attempt to silence me.My commentary is not "fearful" you just happen to be afraid of what I say not how I say anything.That of course is the essence of free speech and is why you try to silence me.Not bloody likely.
Christopher Reilly
June 25, 2009, 2:33pm (report abuse)Migraines and Headaches...
"Effectiveness and Tolerability of Acupuncture Compared to Metoprolol in Migraine Prophylaxis." Headache. 2006. 46(10): 1492-1502.
Twelve weeks acupuncture compared to twelve weeks metoprolol for migraine prevention. 61% responder rate for acupuncture compared to 49% for metoprolol. Both physicians and patients reporting far fewer adverse effects with acupuncture.
"Efficacy of Acupuncture for Prophylaxis of Migraine: a Multicentre Randomized Controlled Clinical Trial." The Lancet Neurology. April 2006. 5(4): 310-316.
Ten sessions of acupuncture in the first 6 weeks compared to continuous standard care (mostly meds). At 26 weeks, acupuncture group responder rate of 47% compared to 40% in standard care group.
"Acupuncture for Patients with Migraines." Journal of the American Medical Association. May 4, 2005. 293(17): 2118-2125.
Twelve sessions acupuncture in eight weeks. At twenty-four weeks acupuncture had a 51% responder rate.
C Hallstrom
June 25, 2009, 2:37pm (report abuse)Reilly,
Your first two sources are not clinical trials and have no evidence so what’s your point? However the studies you do reference support me and not you and have both been referenced already.Your first study concludes and I quote“Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects.”
Your second study proves my point again quite well and I quote
“Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy.” That means placebo acupuncture works as well as “real” acupuncture just as your other study proves.You are proving my point yet again
Christopher R Reilly
June 25, 2009, 2:44pm (report abuse)"Acupuncture for Chronic Headache in Primary Care: Large Pragmatic, Randomized Trial." British Medical Journal. March 7, 2004. 328(7442): 744.
12 acupuncture sessions mostly within the first three months plus usual care, compared to continuous usual care over 12 months. Acupuncture group has 22 fewer headache days per year and 22% more responders than usual care alone. In addition, acupuncture group uses 15% fewer meds, had 25% fewer visits to general practitioner and missed 15% fewer days of work.
"Acupuncture in the Prophylactic Treatment of Migraine Without Aura: A Comparison with Flunarizine." Headache. Oct 25, 2002. 42(9): 855-861.
Six months of acupuncture compared to six months treatment with flunarizine. At 2,4 and 6 months acupuncture equal to or better than flunarizine to reduce migraine attacks and use of pain relievers. Acupuncture alone shown to reduce pain of attacks, and had significantly fewer adverse side effects.
Christopher Reilly
June 25, 2009, 2:52pm (report abuse)It should be pretty obvious what the point of the first two citations were. The folks at the Journal for Clinical Oncology (one of the top oncology journals in the world) feel that there is enough proven benefit to support acupuncture. The American Pain Society and the American College of Physicians both feel that there is adequate evidence to support acupuncture for low back pain. The clear point is this: Why, when some of the most prestigious institutions in their respective fields feel there is adequate evidence for acupuncture, should we listen to you? Institutions like these don't just put out treatment recommendations on a whim. Do you believe you know better than the experts in the field? You quoted a clearly biased source (the NCAHF) as if it had some meaning, can you seriously question me quoting the established sources that I have as if they have no meaning?
C Hallstrom
June 25, 2009, 2:52pm (report abuse)Reilly, I am having trouble finding your references could you provide web links?. They are clearly footnotes are they yours? If they are not you should source that as well. What I can find of your sources says exactly what I said above acupuncture and sham acupuncture have the same effect.Hello placebo. Can you show me how they say anything else?
Christopher Reilly
June 25, 2009, 2:58pm (report abuse)In addition, your quoting the NCHAF from nineteen years ago is relevant because the statement is now severly out of date. It's referene to research is out of date. There are no such thing as lay acupuncturists having licenses today.
C Hallstrom
June 25, 2009, 3:07pm (report abuse)Really Reilly? the State no longer licenses acupuncturists? Really? What on earth is a "licensed acupuncturist" then? Please read carefully, your studies by in large support my position and I never said the NCHAF position was irrelevant(though it does seem somewhat extreme) and beyond that take it up with them.
C Hallstrom
June 25, 2009, 3:17pm (report abuse)You mean severely out of date just like "Chinese medicine" whose reference to science is beyond out of date? Can we apply the same standards please? You can't have it both ways.
Chrisotpher Reilly
June 25, 2009, 3:23pm (report abuse)Your point, as I understand so far seems to be that acupuncture is innefective, does not have clinical value and is a poor area to invest resources in. What I have cited does not prove any of those points. What it proves (and not in each study- in many acupuncture is proven superior to sham acupuncture) is not only is acupuncture effective, but superior to usual care. Now lets include that many studies are showing that both "true" acupuncture and "sham" acupuncture are superior to usual care.
You reason that since acupuncture is not significantly higher in effect than "sham" acupuncture in some studies, it's merely placebo and should not be used. The only logical extension of your reasoning is that usual care is likewise no better than a placebo and should not be used. This includes FDA approved medications already proven to be superior to placebo. Why are you stopping short of this? Does it not fit your agenda, or is it too obviously incorrect that all usual care is bonk?
Christopher Reilly
June 25, 2009, 3:25pm (report abuse)Excuse me, but if you'll check my citations, no a single one of them dates back further than 2000. Please stick to the facts of my statements, as I have not once referenced the age of Chinese Medicine as a source of authority or proof. I've only cited the top medical journals of the world, and recent articles only.
Christopher Reilly
June 25, 2009, 3:35pm (report abuse)The studies in which true and sham acupuncture are seen nearly equally effective (but still, remember, superior to many commonly prescribed medications and therapies) must be looked at more closely in order to be understood.
In the ones I have quoted, two main methods of sham acupuncture are used. One is stimulating points without actual insertion, and two is insertion, but at area's that are not traditional points.
There are many indications that point to "sham" acupuncture as not being a good placebo control. One is that it is virtually unheard of for any true, inert placebo to have such amazingly high success rates. Second is that the effects of acupuncture are seen to last ten months and more beyond the last treatment, true inert placebo effects are virtually never that durable. Third, as I've stated repeatedly, acupuncture is proven to be superior to therapies that already passed the placebo test. Can you seriously ignore that acupuncture is shown superior to usual care?
C Hallstrom
June 25, 2009, 3:39pm (report abuse)I never said it had "no clinical value". I say and have always said "Chinese medicine" is meaningless and acupuncture is a placebo. Placebo's DO have clinical value but are based on deception. And yes I believe deception is a poor place to invest resources. As to your other accusations I'll just quote myself about said placebo effect"It effects ALL forms of medicine and treatment (even the ones I hold to be true), I even presented abundant evidence. Why no broad civic discourse?
So, while I do appreciate the discourse you seem to agree there is good evidence that acupuncture acts as a placebo. Please stick to extending your own reasoning your not doing a very good job extending mine. I NEVER said placebo was the same as usual care if it was it wouldn't be a placebo.Placebos have clinical value by definition. Come on now I've already been through this with other posts.
Christopher Reilly
June 25, 2009, 3:54pm (report abuse)There is strong discussion in the field concerning the use of "sham" acupuncture as a placebo control, and how to design it more effectively.
How likely is it that something proving superior to usual care and widely practiced, established, therapies that have already proven themselves to be more effective than other placebo is itself a merely inert placebo? Not likely.
Is it possible that both sham and true acupuncture both activate therapeutic physiological processes in a similar way? Absolutely.
Would that refute the traditional claims as to how and why acupuncture works? Very possibly yes.
Would that refute the clinical and economic value of acupuncture? No.
Two questions:
How can you claim acupuncture has no clinical relevance when I have just listed numerous research articles showing it to be MORE effective than established methods of care?
How, if you claim acupuncture is mere inert placebo, can you stop short of saying the same for all usual care?
Christopher Reilly
June 25, 2009, 3:58pm (report abuse)Nice try at a smokescreen, but I don't think we're quite that easily thrown of the track.
I said nothing about whether placebo effects all forms of medicine or not. The question put quite clearly again is:
1) You claim that Chinese medicine is meaningless and placebo
2) Acupuncture has been proven superior to usual care'
3) How can you not also claim that usual care is meaningless?
Sounds pretty clear to me...
C Hallstrom
June 25, 2009, 4:10pm (report abuse)Best discourse yet. I said in an earlier post that placebos were what interested me most. They are not however all "inert". Acupuncture is a great example of this very phenomena. I posted a hierarchy of placebos earlier and the more active the intervention the more powerful the placebo. And again I don't no where you get the "no clinical relevance" placebos have clinical relevance. Again should healthcare be based on deception? Even if it works? I still so no as a general principle but do not deny the necessity to use placebos when proven alternatives may not exist. I do not in any way support the teaching of psuedoscience(Chinese medicine) to support whatever clinical relevance acupuncture may have.As to usual care absolutely the placebo effect is at play as well. Again that I think is worth exploring.However real medicine works without the placebo effect that is just a fact.No faith required.
Thanks for the honest interchange it is most refreshing.
C Hallstrom
June 25, 2009, 4:19pm (report abuse)I don't think you truly understand placebos. No smokescreen intended none needed. Because using a toothpick at random points works as well as acupuncture what does that say? The reason I reference all healthcare and placebos is to demonstrate how widespread their presence and effect can be. Penicillin is not a placebo and so on. Gee I think I've said this before oh wait I have. Your reference to the problems with properly controlled studies is apt for it calls into question all the "positive" studies out there. Again thank you.You never know a few more posts we may agree. But what fun would that be huh?
C Hallstrom
June 25, 2009, 4:29pm (report abuse)Sorry let me finish my penicillin argument. Penicillin and "proven" medications work whether we believe or not. Placebos work on our perception and beliefs. Real medicine can be enhanced by this effect and phony medicine can seem to have an clinical effect. But it is not the placebo(the actual thing or treatment) causing the effect rather it is something else entirely. Again that I think is interesting. How do our bodies use that belief/perception to heal itself since we know it is not the medicine/treatment doing the healing?
Christopher Reilly
June 25, 2009, 5:12pm (report abuse)I looked it up, and my understandeing of placebo is quite on.
First, acupuncture does have direct physiological effects. Not all of them are known, but some are. A proper placebo is inert.
(As a side note, there is a big difference between knowing how something works, and whether it works. Many medications were established long before we knew exactly how they work biochemically in the body.)
Second, "placebo effect" is the effect brought about by the expectation of outcome and/or relief as opposed to relief provided by the direct physical effects of a non-placebo.
Do you honestly expect us to buy that acupuncture alone was proved superior to all usual care COMBINED because patients believed that it would. As you mentioned, placebo exists in all therapies, so why didn't therapies as complex and hands on as physical therapy provide an equally powerful placebo effect as acupuncture's, if that's what you say it was?
Christopher Reilly
June 25, 2009, 5:19pm (report abuse)I have done my best to address your points directly, and you have yet to answer any of my more pressing questions.
1) If acupuncture is meaningless, and acupuncture proved superior to usual care, how can you not also denounce usual care as meaningless?
2) If acupuncture is merely due to placebo effect, why does it prove more effective than established therapies that have already been proven to be superior to placebo.
3) Given the similarity between contact and other variables, why doesn't the placebo effect at play with a therapy like physical therapy come even close to the effects of acupuncture?
4) Why do you consistintly ignore the most likely explanation, that "sham" acupuncture is not inert, adn therefore is not a good placebo?
5)The Journal of Clinical Oncology, the American Pain Society, and the American College of Physicians all support acupuncture, why should we listen to you?
Christopher Reilly
June 25, 2009, 5:28pm (report abuse)The purpose of this post is to decide on whether covering acupuncture is appropriate. Acupuncture has been shown to have superior clinical effectiveness to usual care, and with fewer adverse events. It's a no brainer.
As to the other issues of debate, I have done my best to be direct in answering the challenges directly, but have yet to see a direct answer to a single question I have posed.
I'll pose one more to CH and others: if you or a loved one sufferd from back pain, and you were aware of something that works better than anything you've done so far, and has fewer side effects, would you skip it? The clinical relevance of acupuncture is overwhelming. Wouldn't you expect your insurance to cover a therapy more effective than the ones it already covers?
Christopher Reilly
June 25, 2009, 7:50pm (report abuse)I've got a stack of charting to do before I fly out of town for the weekend. I think I've stated my position clearly, and I think the facts speak for themselves.
I'll check back next week to see if any of my questions have actually been addressed directly.
Have a great weekend, including you CH ;)
C Hallstrom
June 26, 2009, 10:11am (report abuse)Try to make less assumptions you'll feel better. And for the FIFTH time placebos do NOT have to be inert. To quote myself quoting someone else again,
• Placebo surgery works better than placebo injections
• Placebo injections work better than placebo pills
• Sham acupuncture treatment works better than a placebo pill
• Capsules work better than tablets
• Big pills work better than small
• The more doses a day, the better
• The more expensive, the better
• The color of the pill makes a difference
• Telling the patient, “This will relieve your pain” works better than saying “This might help.”
Source:http://www.skeptic.com/eskeptic/09-05-20
For the fourth time if placebo acupuncture(sham) gets the same results as acupuncture acupuncture is a placebo. That is NOT a debatable point. Finally acupuncture has fewer side effects because it doesn't actually do anything. Have a nice weekend as well. Take a placebo you'll feel better.
luke643
June 27, 2009, 1:24am (report abuse)hallstrom
I am an acupuncture student, -so you know what team I play for
In a meta-analysis published in the Journal of Internal Medicine (259:2) in 2006, the author determined that, according to the best available clinical trials, Acu is effective in treating 10 common conditions. the author went on to discuss the POTENTIAL faults with the data of these trials due to "inadequate control of placebo effects".
The author concluded however, that with or without understanding the role of placebo - the therapeutic effect exists and should be accepted as useful treatment.
Acu. is not science. It is an empirical medical modality based on systematic correspondences of the human organism and its surrounding environment. I would never suggest it is science.
Is the criteria for public medical care science? or is it efficacious medicine? Science is not efficacy, efficacy is efficacy. sometimes we don't need to know why it works, just that it does is sufficient.
luke643
June 27, 2009, 9:57am (report abuse)hallstrom 2
this may make you uncomfortable, but engaging the patient in the treatment (engaging placebo?) is a necessary part of acupuncture. Acupuncturists facilitate self healing. this is a-scientific. You keep trying to get everyone to fit the square peg into the round hole.
again, medical care does not have to be based on science to be effective care. Science can help to understand why certain aspects of care work, but it is most effective in working with reductionist methods, rather then those that deal with complex systems. This is why systems oriented theories in physics and ecological sciences are so difficult to qunatify and rarely leave the theoretical plane.
Tim
June 29, 2009, 7:47am (report abuse)to quote-"if placebo acupuncture(sham) gets the same results as acupuncture, acupuncture is a placebo"////or////if a chicken has feathers and a feather duster has feathers, a chicken is a feather duster-thank goodness the Socratic method is usually context dependent
C Hallstrom
June 29, 2009, 10:45am (report abuse)Luke & Tim you guys are hysterical. Is this a comedy routine?
Luke you defend acupuncture by saying it is not science but that is OK because science doesn't matter. What matters is the word efficacy because efficacy is efficacy. Now that's funny. Medical care does not have to be based on science? That is your argument? Really?
Tim all I can say is ?????
Who do you think your kidding? Do you understand the way clinical trials work? Your analogy isn't worth a feather let alone a feather duster. I provide evidence and you provide silly word games. Good for you.
p.s. Socratic Method-I donta think thata word(s) mean whatta you think it mean.(try asking a question next time you'll seem more Socratic) Inconceivable!
tim
June 29, 2009, 11:22am (report abuse)Hellstrom-Vicente-I bow to your Princess Bride reference-and graciously bow out-tim