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CFI Statement on Federal Funding for Acupuncture as a form of “Integrative Medicine”
Posted: 11 June 2010 01:40 PM   [ Ignore ]
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The CFI Office of Public Policy (OPP) has put out a position statement on acupuncture, and the larger issue of the National Center for Complementary and Alternative Medicine (NCCAM) as a haven for unscientific thinking and blatant CAM advocacy. I wholeheartedly agree with the position taken, that there is very, very little sound evidence to support most of the claims for acupuncture, that what acupuncture does do in terms of clinical benefit is largely via the placebo effect, and that the very distinction between alternative medicine and conventional medicine is a polictical and public relations distinction, not a scientific one.

IMHO, it’s fine for people to choose a placebo therapy with minimal risks, but it is not appropriate for scarce government research funds to be spent on somethig already extensively researched and found to be largely without merit. Likewise, the imprimatur of legitimacy conferred on bogus therapies by the NIH via NCCAM only harms the people the organization is supposed to help by encouraging the spread of unscientific therapies, weakening the standards of evidence in medicine, and siphoning resources away from more promising avenues of medical research.

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Posted: 11 June 2010 03:03 PM   [ Ignore ]   [ # 1 ]
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CFIs criticism of unscientific use of acupuncture is bad is valid.  However, the latent tone that all acupuncture is unscientific is about 3 weeks out of date.  A recent publication found verifiable evidence for the effect of acupuncture in mice.

Acupuncture applied by gentle manual rotation of the acupuncture needle every 5 min for a total of 30 min sharply increased the extracellular concentrations of all purines detected (Fig. 1b). Adenosine concentration increased ~24-fold (253.5 ± 81.1 nM from a baseline of 10.6 ± 6.7 nM) during the 30-min acupuncture session (Fig. 1c). The extracellular concentration of ATP returned to baseline after acupuncture, whereas adenosine, AMP and ADP remained significantly elevated (adenosine and AMP, P < 0.01; ADP, P < 0.05, paired t test compared to 0 min) at 60 min (Fig. 1c). Notably, previous studies have shown that deep brain stimulation is also associated with a severalfold increase in extracellular ATP and adenosine. Similar to electroacupuncture and transcutaneous electrical nerve stimulation, deep brain stimulation delivers electrical stimulation that triggers an increase in extracellular adenosine concentration18. [1]

As someone else paraphrases, “The investigators found adenosine levels in tissue near the needle insertion points was 24 times greater after treatment, and those mice with normal adenosine function experienced a two-thirds drop in paw pain. By contrast, mice that were genetically engineered to have no adenosine function gained no benefit from the treatment.” [2]

And I have read elsewhere that the end game for the authors of that recent study is that they hope to show that acupuncture in conjunction with specific drugs can result in more effective pain relief.  Actually they say it in their article at the very end:

Thus, acupuncture combined with pharmacological suppression of AMP deaminase activity should theoretically increase the availability of adenosine and thereby enhance the clinical benefits of acupuncture. As a proof of principle, we found that mice treated with a Food and Drug Administration approved deaminase inhibitor, deoxycoformycin, exhibited more potent increases in adenosine and benefitted from a longer-lasting suppression of chronic pain following acupuncture. In summary, we found that the anti-nociceptive action of acupuncture is mediated by activation of A1 receptors located on ascending nerves. Thus, medications that interfere with A1 receptors or adenosine metabolism may improve the clinical benefit of acupuncture.[1]

[1] http://www.nature.com/neuro/journal/vaop/ncurrent/full/nn.2562.html
[2] http://health.usnews.com/health-news/family-health/pain/articles/2010/05/30/acupuncture-may-trigger-natural-painkiller.html

[ Edited: 11 June 2010 03:14 PM by qutsemnie ]
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Posted: 11 June 2010 03:35 PM   [ Ignore ]   [ # 2 ]
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Excellent position paper, Brennen. I meant to post a link to the statement here, but forgot.

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Posted: 11 June 2010 03:41 PM   [ Ignore ]   [ # 3 ]
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qutsemnie - 11 June 2010 03:03 PM

CFIs criticism of unscientific use of acupuncture is bad is valid.  However, the latent tone that all acupuncture is unscientific is about 3 weeks out of date.  A recent publication found verifiable evidence for the effect of acupuncture in mice.

I haven’t read the papers yet, but were the double-blinded to see if just the process of putting the needles anywhere in the body caused increases in this response? I doubt it. The majority of the acupuncture studies done by the industry have been poorly done and none double blinded.

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Posted: 11 June 2010 04:24 PM   [ Ignore ]   [ # 4 ]
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That experiment is on mice with objectively measurable response variables, it isn’t standard practice to blind those evaluators in those cases.

But, more then that they had an observable phenomenon in response to acupuncture, that is repeatable and explains the scientific basis for acupuncture (basically what the CFI position paper said is nearly never offered).  They performed acupuncture on a mice and measured a 24 fold increase in levels of a natural chemical with known analgesic property from before and after.  That claim if repeatable immediately destroys the essence CFI position paper. It doesn’t take an experiment to reevaluate this fact because of the responses involved.  It only takes someone going out getting a mouse poking it for thirty minutes and checking to see if this chemical increased anywhere near 24 folds.  If the levels were lower and anywhere close to moment to moment variation then we would need a well designed statistical experiment.

Following that, they offered a way to consider pain in a mouse, and here is where the experiment begins.  Or as they say

Having established that adenosine is released during acupuncture, we next asked whether adenosine is critical for the anti-nociceptive effects of acupuncture.

  Essentially I consider this “low hanging fruit” based on their first observation. The important thing to realize though is no matter what you think of this part of the experiment, the first observation is crushing to the CFI position paper.

The core of their experiment is two types of mice, and individuals from two types of mice were randomized to two levels of an acupuncture factor (presence/absence).  The two types of mice are one genetically engineered to be unresponsive to the known analgesic agent that increases 24 times with acupuncture and the other type of mouse is a standard strain.  All mice receive an injection of an inflammatory agent that causes pain.  To construct a response variable, they used existing research that found a specific area of the brain had specific electrical response to pain.  They shocked mice feet to verify the pain response was observable to known painful stimulus.  Also they are using existing literature. What they find is that the mice with acupuncture have much less electrical stimulation associated with pain (and they have already showed you that a analgesic agent increased 24 times so they have explained why).  But the icing on the cake is that mice genetically engineered to not be able to respond to this chemical had no particular reduction in the response variable.  These are all statistically significant differences.

If the core of the CFI position is that there should be no further public funding for research into acupuncture, the center would do well to note that everything about this paper screams further research is merited.

[ Edited: 11 June 2010 04:33 PM by qutsemnie ]
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Posted: 11 June 2010 05:15 PM   [ Ignore ]   [ # 5 ]
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Oh geez, after 50 years, I’m wrong.  In the mid 1950s a friend persuaded (conned) me into attending a lecture by Adell Davis at the Lindburg health food store on Wilshire Blvd. in West Los Angeles.  She spoke of the value of acupuncture on horses.  That was just too much for me, and I stalked out.  I told my friend that was the dumbest thing I’d heard in quite a while.  Now I find that there may have been some merit in what she said.  Don’t tell me that I have to re-evaluate all of my disbeliefs in alternative medicine.  red face

Occam

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Posted: 11 June 2010 05:45 PM   [ Ignore ]   [ # 6 ]
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questsemnie,

The study you mention is an interesting one, but it most definitively does not indicate that “acupuncture works” as the media reports it. It indicates that if you stick needles into mice this has some effect on adenosine which modulates pain perception. An interesting finding, to be sure, and one that suggests it may be possible that needle insertion of some kind could truly reduce pain through physiologic, rather than expectancy or other psychological, mechanisms. But there is a big gap to be bridged between such a lab phenomenon and clinical medicine. And as I said above, if this is the most convincing bit of evidence to date, after 40 years of extensive study, the government’s research money would probably be better spent elsewhere.

For a thorough discussion of what that study means, and what it doesn’t, see David Gorski’s post on Science-Based Medicine or Ed Yong’s post at Discover Magazine

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Posted: 11 June 2010 05:49 PM   [ Ignore ]   [ # 7 ]
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You know, this gives me an idea.  I think I’ll open Crazy Monky’s Drive-Thru Acupuncture.  People will drive up to one of my many, conveniently placed establishments, pull up to the drive-thru window, pay me, then I’ll hit them in the face with a porcupine tied to a stick.  I’ll be rich!  Rich as a king!

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Posted: 11 June 2010 06:08 PM   [ Ignore ]   [ # 8 ]
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Dead Monky - 11 June 2010 05:49 PM

You know, this gives me an idea.  I think I’ll open Crazy Monky’s Drive-Thru Acupuncture.  People will drive up to one of my many, conveniently placed establishments, pull up to the drive-thru window, pay me, then I’ll hit them in the face with a porcupine tied to a stick.  I’ll be rich!  Rich as a king!

Yes, I really don’t think it will matter how or where you hit them, just as long as they get hit with needles!

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Posted: 12 June 2010 04:11 PM   [ Ignore ]   [ # 9 ]
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Brennan and qutsemmie thanks for links.  It sounds like the Nature article is getting a lot of downloads.

The Nature paper doesn’t support the acupuncture hogwash, does it?
OB-HX736_acupun_D_20100322202919.jpg

[ Edited: 12 June 2010 04:14 PM by Jackson ]
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Posted: 12 June 2010 04:15 PM   [ Ignore ]   [ # 10 ]
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Jackson - 12 June 2010 04:11 PM

Brennan and qutsemmie thanks for links.  It sounds like the Nature article is getting a lot of downloads.

The Nature paper doesn’t support the acupuncture hogwash.

The only high quality research I have seen regarding acupuncture, has suggested that it works no better than a placebo, with more morbidity (primarily infection of the puncture sites).

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Posted: 12 June 2010 04:16 PM   [ Ignore ]   [ # 11 ]
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asanta - 12 June 2010 04:15 PM
Jackson - 12 June 2010 04:11 PM

Brennan and qutsemmie thanks for links.  It sounds like the Nature article is getting a lot of downloads.

The Nature paper doesn’t support the acupuncture hogwash.

The only high quality research I have seen regarding acupuncture, has suggested that it works no better than a placebo, with more morbidity (primarily infection of the puncture sites).

Thanks to you too Asanta!

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Posted: 22 June 2010 09:52 AM   [ Ignore ]   [ # 12 ]
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mckenzievmd - 11 June 2010 01:40 PM

The CFI Office of Public Policy (OPP) has put out a position statement on acupuncture, and the larger issue of the National Center for Complementary and Alternative Medicine (NCCAM) as a haven for unscientific thinking and blatant CAM advocacy. I wholeheartedly agree with the position taken, that there is very, very little sound evidence to support most of the claims for acupuncture, that what acupuncture does do in terms of clinical benefit is largely via the placebo effect, and that the very distinction between alternative medicine and conventional medicine is a polictical and public relations distinction, not a scientific one.

IMHO, it’s fine for people to choose a placebo therapy with minimal risks, but it is not appropriate for scarce government research funds to be spent on somethig already extensively researched and found to be largely without merit. Likewise, the imprimatur of legitimacy conferred on bogus therapies by the NIH via NCCAM only harms the people the organization is supposed to help by encouraging the spread of unscientific therapies, weakening the standards of evidence in medicine, and siphoning resources away from more promising avenues of medical research.

You might know that the major support for establishing the Center came from an Iowa Senator, Harkin, some 25 or so years ago.

Another career politician ... er, that is, “public servant ... with nothing to offer but his biases.

[ Edited: 04 July 2010 06:20 AM by Analytic ]
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Posted: 22 June 2010 01:44 PM   [ Ignore ]   [ # 13 ]
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Just for clarity’s sake, I assume by “the Center” you mean the NCCAM. Not CFI.

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Posted: 22 June 2010 01:53 PM   [ Ignore ]   [ # 14 ]
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Please see previous Post for clarity’s sake.

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Posted: 22 June 2010 01:58 PM   [ Ignore ]   [ # 15 ]
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The acupuncture needles created some sort of pain in the mice which had already had paw pain induced. How, the one source didn’t say, but I wouldn’t be surprised if they claim it was hemostat pressure.

The secretion of adenosine - an analgesic - was supposedly involved in the mice pain relief.

if it were suggested to work in humans, adensine at the needle site could also easily be measured.

In the meantime, we have a number of relatively, to significantly, potent analgesics.

Has it been shown that high levels of adenosine are produced in humans in response to acupuncture? The authors, apparently, didn’t say.

[ Edited: 22 June 2010 02:06 PM by Analytic ]
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