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Acupuncture Silliness
Posted: 29 October 2008 02:19 AM   [ Ignore ]   [ # 31 ]
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As an RN, I’m becoming very dismayed at the number of CEUs offered promoting various CAMs. More and more nurses I know are buying into these unproved and unscientific treatments. I can go to an accredited conference that will give me all of my CEUs required for renewal of my license that offers nothing but CAMs. I am shocked that these courses are getting more and more common. It is getting to the point where I have to be very, very careful in choosing my classes to make sure they are not mixing in unproved treatments masquerading as science.

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Posted: 29 October 2008 06:48 AM   [ Ignore ]   [ # 32 ]
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Yes, the same is true in the vet med world. I recently went to a CE conference which had all-day sessions in herbal Tx, acupuncture, etc. I am part of a new group called the Evidence-Based Veterinary Medical Association that is trying to create a board certification and journal in EBM and which will hopefully start offering some balance to the CAM perspective at such events, but it’s an u[hill effort.

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Posted: 21 January 2009 10:51 AM   [ Ignore ]   [ # 33 ]
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Acupuncture works… as placibo.

Two separate systematic reviews of data show that acupuncture is an effective treatment for prevention of headaches and migraines. But the results also suggest that faked procedures, in which needles are incorrectly inserted, can be just as effective.

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The findings, detailed in the Cochrane Database of Systematic Reviews:
• Following a course of at least eight weeks, patients treated with acupuncture suffered fewer headaches overall compared to those who were given only painkillers.
• In the migraine study, acupuncture was superior to proven prophylactic drug treatments, but faked treatments were no less effective.
• In the tension headache study, true acupuncture was actually slightly more effective than faked treatments.

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Posted: 21 January 2009 11:32 AM   [ Ignore ]   [ # 34 ]
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The key here is to be clear about what one means by “works.” As a placebo, it doesn’t affect the underlying disease process (if any, and with headaches the reality is that there may be no disease as such, just discomfort associated with stress or other psychological etiologies). I’m all for reducing discomfort, so if it a placebo does this that’s fine. BUT, the caveat I would make is that often the difference reported in such studies may be statistically significant, but it is usually minimal and not clinically noticeable. In some nausea studies, for example, acupunture reduced reported nausea but not number of vomiting episodes. In some studies on arm pain, acupuncture reduced pain but by 5 points on a 100-point scale. Statistically significant yes, but meaningful? When compared with truly effective treatments, the difference is often obvious. In studies of knee arthitis, glucosamine showed a mild improvement over placebo (when people knew they were getting glucosamine), but it was dwarfed by the improvment in pateints getting an NSAID.

The pther caveat is that the placebo effect almost always requires the patient be deceived by the provider and think they’re getting a “real” treatment. Lying to my patients for a minimal reduction in subjective discomfort and no change in their actual disease is not how I want to practice medicine.

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Posted: 21 January 2009 01:12 PM   [ Ignore ]   [ # 35 ]
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The use of placebos in medicine is very controversial. Although true placebos are not available for use outside of well controlled studies, many doctors use the placebo effect to some degree ( ie. doctors who give patients antibiotics knowing full well that the patient has a viral infection). Despite this, it is considered completely unethical to give placebos of any sort to patients as it requires the doctor to lie to the patient and undermines patient trust. Even if a placebo provides relief in the short run, in the long run it damages the credibility of the profession. When that happens and patient confidence is lost, doctors can no longer effectively alleviate pain and suffering.

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Posted: 21 January 2009 01:22 PM   [ Ignore ]   [ # 36 ]
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macgyver - 21 January 2009 01:12 PM

doctors who give patients antibiotics knowing full well that the patient has a viral infection

Are doctors actually allowed to do that? I have always wondered…

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Posted: 21 January 2009 03:03 PM   [ Ignore ]   [ # 37 ]
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I guess they could always justify giving antibiotics to a patient who has a viral infection, as a prevention against a bacterial infection that could attack the body weakened by the virus infection. No?

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Posted: 21 January 2009 03:49 PM   [ Ignore ]   [ # 38 ]
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There are lots of good rationalizations and justifications for bad medicine. Finding one is never a problem. And the reality is that the day-to-day details of doctor patient interactions aren’t closely scrutinized in my field, nor should they be most of the time. I assume the MDs are watched a bit more closely, but I’m not sure how much so The use of placebos is widespread, according to a recent article (I think in JAMA or New Eng J) if you count antibiotics and vitamins as placebos when used for things they probably don’t really treat. I’m not crazy about the practice, but I understand it.

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Posted: 21 January 2009 05:15 PM   [ Ignore ]   [ # 39 ]
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George - 21 January 2009 01:22 PM
macgyver - 21 January 2009 01:12 PM

doctors who give patients antibiotics knowing full well that the patient has a viral infection

Are doctors actually allowed to do that? I have always wondered…

The fact is that it is difficult to know for certain whether an individual has a viral infection, so having some government watch dog looking over the doctors shoulder would not only be impractical but it would ultimately be one doctor’s opinion against another’s.  Unfortunately even when physicians are pretty certain they are dealing with a viral infection some give antibiotics because patients pressure them for it and in the modern managed care environment they don’t have the time to educate the patient about the difference between viral and bacterial infections and the dangers of misusing antibiotics. These doctors know many patients will feel better and have a better opinion of their doctor if they receive antibiotics. The antibiotics don’t really do anything but the patient gets better because antibiotics have such a powerful placebo affect and because the patient is going to get better anyway.

[ Edited: 21 January 2009 06:06 PM by macgyver ]
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Posted: 21 January 2009 06:35 PM   [ Ignore ]   [ # 40 ]
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Hey, I just thought of something.  When parents reject antibiotics for the sick child because they don’t believe in standard medication, the doctor can just tell them that the needle is for acupuncture.  smile

Reminds me of a conversation with my internist last year when I had a cold.  “I was hoping to get a prescriptio . . .” (he cut me off) “No, people don’t realize that viral infections don’t respond to antibiotics.”  “I know that.  I wasn’t going to ask for an antibiotic.  Rather, the dumb dextromethorphan is useless for controlling my cough and keeping me awake.  Could I get a prescription for cough medicine with codeine in it?”  “Oh, OK.”  [Postscript -  it worked like a dream.]

Occam

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Posted: 21 January 2009 06:47 PM   [ Ignore ]   [ # 41 ]
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Isn’t cough working in our favour when we have a cold? Why suppress it? Aren’t you increasing your chances of developing a pneumonia this way?

(Beware! A graphic designer playing a doctor.)

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Posted: 21 January 2009 06:53 PM   [ Ignore ]   [ # 42 ]
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It contains guaiacol, too, which causes the mucus to be much thinner.  That way, the cilia can move it up, out of the lungs, and then it goes down the esophagus to be digested.  (Now, we’ll let Brennen and Mcgyver tear my explanation apart.  LOL  )

Occam

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Posted: 21 January 2009 07:38 PM   [ Ignore ]   [ # 43 ]
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George - 21 January 2009 06:47 PM

Isn’t cough working in our favour when we have a cold? Why suppress it? Aren’t you increasing your chances of developing a pneumonia this way?

(Beware! A graphic designer playing a doctor.)

If I’ve learned anything over the past two decades in medicine it’s that you can’t have too much confidence in the power of common sense. What I mean is that things don’t always work the way you think they should. Common sense would tell us that the cough reflex must be an adaptation that has survival benefits, and that to suppress it when we are ill would therefor have negative side effects. The truth is that there is no evidence that cough suppressants have a negative effect on the outcome of respiratory illnesses, although that could be because the majority of cough suppressants including codeine don’t really work very well. The same is true of fever, which is presumably a survival adaptation since it is brought on by cytokines manufactured by our immune system when confronted with an infection. Yet suppressing fever doesn’t seem to have a negative affect on the outcome of the underlying illness.

The reason common sense is not as useful as one would think is because we don’t understand the physiology of our bodies as well as we would like.

[ Edited: 21 January 2009 07:55 PM by macgyver ]
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Posted: 21 January 2009 07:51 PM   [ Ignore ]   [ # 44 ]
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Occam - 21 January 2009 06:53 PM

It contains guaiacol, too, which causes the mucus to be much thinner.  That way, the cilia can move it up, out of the lungs, and then it goes down the esophagus to be digested.  (Now, we’ll let Brennen and Mcgyver tear my explanation apart.  LOL  )

Occam

Sorry. My role isn’t to “tear your explanation apart”. Your explanation is in line with what is commonly taught about this drug. Guiaicolate is often used in cough remedies but like many old time treatments it was never subject to the rigorous placebo controlled trials that meds today have to go through. More recently it has been studied and results have been conflicting. It may help or may not. Any theories about it’s mechanism of action ( if it has one) are conjecture at this point.

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Posted: 21 January 2009 09:25 PM   [ Ignore ]   [ # 45 ]
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The cough reflex is, as I recall, triggered by stimulation of nerves in the oropharynx or larynx. Primary adaptive purpose of this seems to be preventing aspiration. Inflammation reduces the stimulus threshold of these nerves, so cough is more easily triggered. I don’t think it has any adaptive value under these circumstances. Now, there is conventional wisdom that with lower respiratory infections, such as pneumonia, coughing helps to clear mucus and debris out of the lungs, which is beneficial. So in my field we tend to freely suppress cough if we can in upper respiratory infections (such as infectious tracheobronchitis or “kennel cough”) using narcotics or anti-inflammatories (or lately fashionable antibiotics with anti-inflammatory effects, such as doxycycline), whereas we tend to avoid cough suppressants and encourage coughing (with nebulization and coupage) for pneumonias. Not sure how science-based that is or if it resembles what MDs do for humans.

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