i¿CLA MEDICINA DE "BORN-AGAIN" ESTá TOMANDO LOS
E.E.U.U. DE NUEVO A LAS EDADES MEDIAS O EN EL FUTURO?
i¿Finalmente estamos haciendo mús haber importado abierto o es
justo una cuestión de la demanda debe ser provisto?
La medicina alternativa pudo
finalmente haber roto la barrera en reinos convencionales. I did not
have the pleasure of reading the initial foray into the subject by
the prestigious Journal of the American Medical Association along
with the AMA back in 1997 when the editors selected alternative
medicine as the topic for their annual coordinated theme issues. All
ten of their Archives Journals joined in the project. However, I did
spot it the following year while perusing the JAMA November 11, 1998
Several very important concessions were made. The most important
of these was the admission that a nationwide survey had concluded
that a great many therapists are now into it, but they tempered this
with the finding that most alternative therapy is still in the hands
of practitioners or patients unsupervised by physicians or even
alternative therapy practitioners. A second somewhat scary report
stated that from 1990 to 1996 "malpractice claims against
chiropractors, massage therapists, and acupuncturist's occurred less
frequently than against physicians and the injuries were less
severe." That's scary indeed!
One of the primary rallying cries against unconventional
treatments has always been that proper scientific scrutiny, in the
form of well-run and well-supervised studies, was always missing.
Nothing, other than solicited testimonials, was consistently offered
to show that these approaches had value. In that JAMA, however, six
randomized trials were presented which addressed common clinical
conditions. In an attempt to set the record straight, an editorial
was devoted to the opinion that "alternative therapies must be
evaluated by rigorous empirical testing."
I, personally, always practiced my medicine in a conventional
manner, although I must admit that at times my approach to a
difficult problem may have occasionally strayed into the realm of
the unknown. As the malpractice issue began to rear its ugly head,
I, like so many of my more adventurous colleagues, tended to throw
caution to the wind with a great deal less abandon. It was a
stifling sensation, to say the least. So, it's refreshing to observe
the current attempt of conventional wisdom involved in trying to
capture the essence of a once verboten realm.
The topics that follow will all be devoted to this question. I
will leave it to the reader to form his or her own opinions. They
all come from the JAMA or Archives articles and letters.
Don't Worry. Having Needles Stuck in You May Sound Icky,
But It's Really Not All That Bad
The information for this portion comes from a letter about
adverse events related to acupuncture. Let's get the serious ones
out of the way first. They include such frightening things as entry
of air into the lung cavity, blood infection, and damage to the
spine. At least in Norway it seems that chest wall puncture,
fainting, local infections where the needles go in, and increased
rather than reduced pain are fairly common. The six Japanese who
cooperated in writing this letter decided to check the results of
their preceptors and interns on about 10,200 patients who had
received 55,291 treatments with acupuncture at Tsukuba College of
Technology Clinic. That should give us a pretty good idea as to what
kind of trouble a bunch of novices can get into.
Well, what were the results? I find it a bit hard to swallow that
only 64 adverse events were reported including 11 different types.
Of course, the Japanese are noted for their honesty, but I still
remain a bit skeptical that these young trainees are going to
readily reveal all their faux pas. The most common problem turned
out to be the most expected. Sixteen forgot to remove all the
needles when the job was done. Annoying? You bet; however, not
serious and obviously a good thing for students to report to show
that they're conscientious. Nothing ever happened anyway after the
errant needles were finally removed. Next came 13 with dizziness,
discomfort, or perspiration, probably due to a temporary drop in
blood pressure from the treatment. All these are good adverse events
to report since they are not the fault of the acupuncturist, but
that of the patient. Here are the rest of the events in descending
order with burns being the highest (7); bruise with pain (6); bruise
without pain (5); feeling poorly (5); minor bleeding (3); worsening
of the original complaint (3); itch and/or redness (3); pain where
the needle was placed (2); and fall from bed (1). They didn't say
whether the fall from the bed was due to writhing in agony.
The conclusion was, 'come to our clinic to learn' - couched in
the following language, "it is essential to provide acupuncturist's
the opportunity for adequate training such as internship in a
My conclusion? Maybe I'll give it a try for my sore leg.
'Listen up' Folks and Then Decide for Yourselves
Let's go through those six studies, which tested some alternative
medicine approaches, and see how they fared in the light of control
trials. Bove and Nilsson ran the first of these. The idea was to see
if patients complaining of tension-type (episodic) headaches would
benefit more from the first or second following approach:
1. A primary group receiving a combination of joint
manipulation of the spine of the neck plus friction massages of
the appropriate muscles (including trigger-point therapy, if
2. A control group receiving the same friction massages, but
instead of manipulation, low power laser light to the upper neck.
The laser was assumed to be a fake treatment of no value.
The results will surprise a lot of people who believe in
chiropractic manipulation. Although both groups improved
significantly, there was no difference between them. The
manipulation apparently had no good or bad effect.
Have you ever heard of moxibustion? Of course not, unless you
were pregnant and had a breech presentation baby at 33 weeks that
had to be rotated into a head down presentation by an acupuncturist.
Well, moxibustion is the application of heat from burning herbs to
an acupuncture point - and guess what! It worked according to
Cardini and Weixin. Head (cephalic) presentation increased
significantly by the 35th week and also at birth when compared to
patients without it. One thing though; I could find no reference to
whether any one had ever compared moxibustion to just plain moist
heat, and no explanation as to what value lay in the use of the
If you have irritable bowel syndrome you'll be happy to know that
the Chinese herbal medicine also made out better than placebo in
this study reported by Bensoussan and his group. The herbal
combination was apparently a tried and true but secret formula. A
Chinese herbalist, the patients, and a gastroenterologist evaluated
the study. Now all we have to do is find out where to get the stuff.
The next one was a flop for both acupuncture and amitriptyline (a
common standard treatment) for pain due to HIV-related peripheral
neuropathy. Shlay and his group concluded that a placebo worked just
the same as the other two approaches.
Heymsfield and his colleagues did number five. They tried
comparing weight loss and decrease in fat mass using a high-fiber,
low-energy diet plus Garcinia cambogia to just diet and placebo.
Another strikeout. There was no difference between the two.
Finally, Garfinkel's group found a definite advantage in using
yoga and relaxation techniques for carpal tunnel syndrome. They
didn't compare the method to any other approach, but they did
measure grip strength and pain reduction. There was significant
Well on the surface, it looks like a standoff; three for the
alternative approach; three against. However, that does seem unfair
if you consider that we may actually have discovered three
techniques possessing distinct value, each of which might be added
to our armentarium of therapies. Of course, more extensive
investigation is essential, but we must keep our eyes and minds open
to such ancient and time-honored practices.
Acupuncture and Reflexology,
Echinacea and Golden Seal,
Gave him faith that this curse
was forced to reinvent the wheel.
Sent him to a biofeedbacka,
Even gave him some
Twas no betta than Viagra.
A chiropractor would push and shove,
points below, above,
And did this all without a glove.
Homeopathy failed and so did yoga,
Got no where putting
He even managed to gain ten
with diet coca.
Finally found a cure without a pill,
No more going
through the mill,
Merely let him see - the size of his
Copyright Marvin Ackerman, M.D.
Copyright Marvin Ackerman, M.D.