Guest guest Posted December 22, 2004 Report Share Posted December 22, 2004 Todd wrote something up ripping apart this article. Here is another essay ripping apart the article from from another angle by Robert Imrie a DMV (heard of this guy Phil?) (This was posted on an American Dietetic Assoc email list (I'm a Nutritionist) and I'd love to hear some scholarly opinions as I don't know much of the history. Although I think we can all agree on some of his comments, 'googling' him shows he takes vicarious pleasures in ripping acupuncture as fraud.) From Robert Imrie DMV: Late last week, I received a phone call from Rob Stein, of the Washington Post, asking me for my views with regard to the upcoming Berman / osteoarthritis and " acupuncture " paper (and other such papers) scheduled to appear in the upcoming issue of Annals of Internal Medicine -- which he forwarded to me as PDF files. Mr. Stein chose not to include any of my thoughts or material in his Monday piece. That is, of course, " more than okay with me, " but I thought some of you might like to at least see, verbatim, the information I originally afforded him -- and that he subsequently chose to ignore. Here it is: XXXXXXXXXXXXXXXXXXXXXXXXXXXx 12/16/04 Hi, Rob (Stein), First things first. With regard to the message [press release] from Berman, et al, cited below, according to the best available scholarship, the statement that " [a]cupuncture -- the practice of inserting thin needles into specific body points to improve health and well-being -- originated in China more than 2,000 years ago, " is not only false but also absurd. In the first place, so far as I'm aware the technology required to produce such " thin needles " for " twiddling " didn't exist anywhere in the world prior to the 17th Century CE at the earliest, and it's unlikely that the requisite fine (steel) needles would have been available or used, clinically, in China prior to the 18th Century CE. Nothing even remotely resembling " modern acupuncture " shows up unequivocally in the literature prior to the 11th Century CE. Secondly, traditional Chinese medicine never recognized a diagnosis of " osteoarthritis of the knee. " Thirdly, running electrical current through tissues -- which is what was done in the trial in question -- is NOT acupuncture. Regardless of what modern proponents have arbitrarily decided to call it, acupuncture is " the manipulation of 'qi' in 'channels' by means of 'needling' (the latter referring to any intervention by means of any 'sharp or hot thing' -- including knives and branding irons as well as what we would construe as 'needles'). " The ancient Chinese had no clue what electricity was, much less how it might be used therapeutically. Defining the running of electrical current through tissues as " acupuncture " is like defining sneakers as " canvas and rubber automobiles. " Unfortunately, you may be certain that proponents of mere needle twiddling will falsely claim the study in question justifies their modality as a treatment for osteoarthritis and just about everything else. It does not. The clinical trial in question, itself, seems to display a similar lack of rigor. XXXXXXXXXXXXXXXXXXXXXXXXXXXXX [The following constitute the " first blush " notes I sent to Mr. Stein regarding the " Berman and acupuncture for osteoarthritis of the knee " late last week.] 12/16/2004 The trial design readily allowed unblinding and virtually guaranteed positive results by, among other things, " mixing apples and oranges and then comparing them to no fruit at all. " You can't apply both acupuncture and electrical stimulation to " true acupuncture " subjects in a clinical trial, only acupuncture to the " sham acupuncture " subjects, and no " hands-on " treatment at all to an " education-only " control arm, and reasonably expect that subjects won't be able to figure out which group they're in. (I suspect patients can easily tell whether they are getting current run through them, no current run through them, or no hands-on treatment at all. It's well-established that virtually ANY " hands-on " intervention will end up being more " effective " for ANY physical condition than is ANY " non-hands-on " intervention.) The trial was based on a false premise: that there are " true " and/or " false " acupuncture points and meridia. The original Chinese medical literature describes wildly varying points and conduit vessels (meridia) over the centuries. The term meridian was, in fact, first coined by the Frenchman Georges Souliét de Morant in 1939, the same man who first equated qi with energy. Despite proponent claims to the contrary, all objective, scientific attempts to physically identify and characterize such points and lines have ultimately met with failure. As Dr. Felix Mann, founder of the Medical Acupuncture Society and First President of the British Medical Acupuncture Society has stated: " ...acupuncture points are no more real than the black spots that a drunkard sees in front of his eyes. " (Mann F. Reinventing Acupuncture: A New Concept of Ancient Medicine. Butterworth Heinemann, London, 1996,14.) Electrical stimulation is NOT acupuncture -- even when it's applied at points modern acupuncturists arbitrarily deem to be " true " acupoints. Defining the running of electrical current through tissues as " acupuncture " is like defining sneakers as " canvas and rubber automobiles. " Since the sham group didn't have electrical current run through them, the trial was effectively unblinded. Berman, et al, could easily have run electrical current through sham group members at " sham " acupuncture points, but they chose not to. I wonder why not. It's hard to believe that, over the years that the trial was planned and during which patients were recruited, this obvious problem/solution never occurred to any of the investigators involved. Maybe it was because they felt they wouldn't get the " right " results if they employed such an effective control. Why didn't they use " placebo acupuncture needles " -- which, while not without their own shortcomings, have at least been scientifically evaluated over the last few years? (See: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve & db=PubMed & list_uids=11799305 & dopt=Abstract) Why all the nonsense about " tapping needle guides " and " taping uninserted needles to the patients " ? The authors claim that they were using a sham acupuncture technique they had previously developed, but I suspect they never established that patients couldn't easily distinguish between sham needling and the running of electrical current run through needles that HAD been stuck through the skin! (I admit, however, that I haven't yet read the publications dealing with their " previously developed techniques. " ) Now we have some trials showing effectiveness for this intervention and some showing no effectiveness. That's exactly what one would expect from poorly designed and controlled trials for a procedure that provides only placebo, counter-irritation, and non-specific noxious stimulus effects. The " OMERACT-OARSI responder index " portion of the paper reports only a 5% difference between sham and true " responders. " As I recall that's actually less than the difference between those that could and could not distinguish " real acupuncture " from " sham " in previous trials. I suspect that it's actually less than the difference between those who can distinguish acupuncture from having electrical current run through them. The " masking effectiveness " portion of the paper makes it clear that by the end of the trial, the trial was effectively unblinded. At least 75% of the " true " group had figured out they were getting the " real " treatment, and only 58% of the " sham " group still believed they were getting the " real " treatment. That's almost a 30% difference! Note, also, that by the end of the study " unsure " respondents were substantially fewer in the " true " arm (by a factor of roughly 30%) than in the " sham " arm of the trial. In other words, a whole lot of subjects who were in the " true acupuncture " arm were able to figure that out, or were at least suspicious that they were in said arm. Were patients prohibited from, or at least admonished against, " comparing notes " after the trial began? The paper doesn't tell us. They should have been. It wouldn't take long for a patient to figure out that he/she was not getting the electrical therapy if they were to discuss their treatment experiences with someone who was getting such therapy. Were the acupuncturists prohibited from speaking or communicating with the patients during or after treatments? They should not have been, but this was not mentioned in the paper. Why weren't they immediately ushered into and out of the treatment area with observers making sure there was no overt communication between patient and acupuncturist? They should have been in order to at least minimize the possibility that they might provide an additional potential source of unblinding. The medical and scientific literature are both rife with examples of intentional and unintentional communication between investigators and subjects that ended up defeating the blinding of clinical trials and experiments, and therefore ended up invalidating the results of same. For anyone dependent on grant money from U.S. taxpayers, surely the most important line in the paper is the one that begins: " Additional research is needed... " I have no idea how much taxpayer money was spent on this clinical trial by the NIH (or anyone else), but I'll bet a competent reporter could readily come up with a figure. :-) My best guess would be " at least several hundred thousands of dollars. " XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 12/16/2004 Hi, Rob, What follows is an excerpt from a paper Paul Buell, PhD, Dave Ramey, DVM and I published in the Scientific Review of Alternative Medicine in 2002. I thought you might find it of interest. As you can see, determining where " true " acupuncture " meridians " and points lie is more than a little problematic, since these alleged structures seem to have moved and changed in number, direction and character over the years. (You may have noticed that few " non-imaginary " human anatomical structures have changed in such manner over the last two millennia.) The Chinese seem to have only recently " decided " where " true " points and " meridia " lie. Despite proponent claims to the contrary, all objective, scientific attempts to physically identify and characterize such points and lines have ultimately met with failure. I wonder how Berman, et al, decided that their " true " points and " meridia " were " truer " than those described in previous centuries? [...] In human acupuncture, meridians have changed in number, name, character and even position through history. The Mawangdui texts describe eleven mai (vessels) which were described as containing both blood and qi. No distinction is made between vessels containing blood and those containing qi, however, the vessels did not appear to connect with each other. " Blood vessels are the obvious original referent of mai. The earliest attestation of the word is fourth century B.C., in a Zuozhuan description of a horse: 'chaotic vapor, untamed, erupts; dark blood springs forth, coursing; ridges of swollen vessels (mai) bulge.' (Zouzhuan, Xi 15,14.3a) " [ii] By the late first century B.C. (in the Huangdi neijing suwen) the number of vessels had grown to twelve, and they comprised a connected and more complex system. Moreover, blood and qi sometimes seem to flow in separate vessels, while at others they seem to flow in a mix.[iii] Vessels carrying qi are by this time referred to as 'conduits' (ching) or " conduit vessels " (ching-mai.) In later texts, the qi vessels and blood vessels are separate. " The transition from the old idea of blood vessels to physiological theory whose main purpose was to explain the movement of vapor in the body directed attention away from the blood vessels per se and towards an idealized system which meshed with correlative cosmology. " [iv] Perhaps most significantly, the twelve vessels described in the Huangdi neijing follow substantially different courses than the eleven described in the earlier Mawangdui texts. The " true " original location of human acupuncture meridians was further obscured when, in 1993, a lacquer conduit-figurine was recovered from a Western Han tomb depicting only nine mai, even though it ostensibly dates from after the Mawangdui treatises describing eleven mai. Moreover, two of the mai etched on the figurine are ones that the Mawangdui treatises fail to discuss.[v],[vi] Later, Chinese medical philosophers overtly lamented the " loss " of the original conduits.[vii] Wherever the meridians may be, they are clearly not where they started. Harper D, Early Chinese Medical Literature: The Mawangdui Medical Manuscripts, Kegan Paul International, London, 1997, 5 [ii] Harper D, ibid, 82 [iii] Paul Unschuld. Personal correspondence. [iv] Harper D, op. cit., 83-84 [v] Kuriyama, S. The Expressiveness of the Body and the Divergence of . New York, Zone Books, 1999, 43 [vi] Unschuld P. , op. cit., 35 [vii] Unschuld P. Forgotten Traditions of Ancient Chinese Medicine. Paradigm Publications, Brookline, MA, 1998, 244 On Dec 22, 2004, at 3:48 AM, wrote: > Prof. Alan Klide (Vet School Philadelphia) flagged a publication (Dec > 21, 2004) by Berman et al., who have confirmed an effect of > acupuncture (AP) in knee osteoarthritis. See details at end. What a > pity that there was not a positive western medical treatment (WM Tx) > included for comparison! The abstract is at > http://www.annals.org/cgi/content/abstract/141/12/901 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2004 Report Share Posted December 22, 2004 Hi All, I take this opportunity to wish each one of you a happy and peaceful Christmas and a most fulfilling and productive year in 2005. Prof. Alan Klide (Vet School Philadelphia) flagged a publication (Dec 21, 2004) by Berman et al., who have confirmed an effect of acupuncture (AP) in knee osteoarthritis. See details at end. What a pity that there was not a positive western medical treatment (WM Tx) included for comparison! The abstract is at http://www.annals.org/cgi/content/abstract/141/12/901 For other Medline abstracts on AP by Dr. Berman et al., see: http://tinyurl.com/5ndf9 IMO, future AP / herbal research should forget sham or placebo Txs and compare the BEST that TCM can offer with the BEST that WM can offer, including a risks assessment AND cost-benefit analysis. Best regards, Phil PS: Alan, Many thanks for this nice Christmas present! Shalom. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Brian M. Berman, MD; Lixing Lao, PhD; Patricia Langenberg, PhD; Wen Lin Lee, PhD; Adele M.K. Gilpin, PhD; and Marc C. Hochberg, MD Effectiveness of AP as Adjunctive Therapy in Osteoarthritis of the Knee: A Randomized, Controlled Trial Annals of Internal Medicine 21 December 2004 | Volume 141 Issue 12 | Pages 901-910 Background: Evidence on the efficacy of AP for reducing the pain and dysfunction of osteoarthritis is equivocal. Objective: To determine whether AP provides greater pain relief and improved function compared with sham AP or education in patients with osteoarthritis of the knee. Design: Randomized, controlled trial. Setting: Two outpatient clinics (an integrative medicine facility and a rheumatology facility) located in academic teaching hospitals and 1 clinical trials facility. Patients: 570 patients with osteoarthritis of the knee (mean age [±SD], 65.5 ± 8.4 years). Intervention: 23 true AP sessions over 26 weeks. Controls received 6 two-hour sessions over 12 weeks or 23 sham AP sessions over 26 weeks. Measurements: Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. Secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF- 36). Results: Participants in the true AP group experienced greater improvement in WOMAC function scores than the sham AP group at 8 weeks (mean difference, –2.9 [95% CI, –5.0 to –0.8]; P = 0.01) but not in WOMAC pain score (mean difference, –0.5 [CI, –1.2 to 0.2]; P = 0.18) or the patient global assessment (mean difference, 0.16 [CI, –0.02 to 0.34]; P > 0.2). At 26 weeks, the true AP group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, –2.5 [CI, –4.7 to –0.4]; P = 0.01), WOMAC pain score (mean difference, –0.87 [CI, –1.58 to –0.16];P = 0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P = 0.02). Limitations: At 26 weeks, 43% of the participants in the education group and 25% in each of the true and sham AP groups were not available for analysis. Conclusions: AP seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham AP and education control groups. Editors' Notes: Context: Previous studies of AP for osteoarthritis have had conflicting results. This may have occurred because most studies have included small samples, a limited number of treatment sessions, or other limitations. Contribution: This randomized, controlled trial compared 24 AP sessions over 26 weeks with sham AP or arthritis education in 570 patients with osteoarthritis of the knee. AP led to greater improvements in function but not pain after 8 weeks and in both pain and function after 26 weeks. No adverse effects were associated with AP. Cautions: Many participants dropped out of the study, so readers should interpret the findings at 26 weeks with caution. –The Editors For further details and links, see: http://www.annals.org/cgi/content/abstract/141/12/901 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Best regards, Email: < WORK : Teagasc, c/o 1 Esker Lawns, Lucan, Dublin, Ireland Mobile: 353-; [in the Republic: 0] HOME : 1 Esker Lawns, Lucan, Dublin, Ireland Tel : 353-; [in the Republic: 0] WWW : http://homepage.eircom.net/~progers/searchap.htm Chinese Proverb: " Man who says it can't be done, should not interrupt man doing it " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2004 Report Share Posted December 22, 2004 Todd wrote something up ripping apart this article. Here is another essay ripping apart the article from from another angle by Robert Imrie a DMV (heard of this guy Phil?) (This was posted on an American Dietetic Assoc email list (I'm a Nutritionist) and I'd love to hear some scholarly opinions as I don't know much of the history. Although I think we can all agree on some of his comments, 'googling' him shows he takes vicarious pleasures in ripping acupuncture as fraud.) From Robert Imrie DMV: Late last week, I received a phone call from Rob Stein, of the Washington Post, asking me for my views with regard to the upcoming Berman / osteoarthritis and " acupuncture " paper (and other such papers) scheduled to appear in the upcoming issue of Annals of Internal Medicine -- which he forwarded to me as PDF files. Mr. Stein chose not to include any of my thoughts or material in his Monday piece. That is, of course, " more than okay with me, " but I thought some of you might like to at least see, verbatim, the information I originally afforded him -- and that he subsequently chose to ignore. Here it is: XXXXXXXXXXXXXXXXXXXXXXXXXXXx 12/16/04 Hi, Rob (Stein), First things first. With regard to the message [press release] from Berman, et al, cited below, according to the best available scholarship, the statement that " [a]cupuncture -- the practice of inserting thin needles into specific body points to improve health and well-being -- originated in China more than 2,000 years ago, " is not only false but also absurd. In the first place, so far as I'm aware the technology required to produce such " thin needles " for " twiddling " didn't exist anywhere in the world prior to the 17th Century CE at the earliest, and it's unlikely that the requisite fine (steel) needles would have been available or used, clinically, in China prior to the 18th Century CE. Nothing even remotely resembling " modern acupuncture " shows up unequivocally in the literature prior to the 11th Century CE. Secondly, traditional Chinese medicine never recognized a diagnosis of " osteoarthritis of the knee. " Thirdly, running electrical current through tissues -- which is what was done in the trial in question -- is NOT acupuncture. Regardless of what modern proponents have arbitrarily decided to call it, acupuncture is " the manipulation of 'qi' in 'channels' by means of 'needling' (the latter referring to any intervention by means of any 'sharp or hot thing' -- including knives and branding irons as well as what we would construe as 'needles'). " The ancient Chinese had no clue what electricity was, much less how it might be used therapeutically. Defining the running of electrical current through tissues as " acupuncture " is like defining sneakers as " canvas and rubber automobiles. " Unfortunately, you may be certain that proponents of mere needle twiddling will falsely claim the study in question justifies their modality as a treatment for osteoarthritis and just about everything else. It does not. The clinical trial in question, itself, seems to display a similar lack of rigor. XXXXXXXXXXXXXXXXXXXXXXXXXXXXX [The following constitute the " first blush " notes I sent to Mr. Stein regarding the " Berman and acupuncture for osteoarthritis of the knee " late last week.] 12/16/2004 The trial design readily allowed unblinding and virtually guaranteed positive results by, among other things, " mixing apples and oranges and then comparing them to no fruit at all. " You can't apply both acupuncture and electrical stimulation to " true acupuncture " subjects in a clinical trial, only acupuncture to the " sham acupuncture " subjects, and no " hands-on " treatment at all to an " education-only " control arm, and reasonably expect that subjects won't be able to figure out which group they're in. (I suspect patients can easily tell whether they are getting current run through them, no current run through them, or no hands-on treatment at all. It's well-established that virtually ANY " hands-on " intervention will end up being more " effective " for ANY physical condition than is ANY " non-hands-on " intervention.) The trial was based on a false premise: that there are " true " and/or " false " acupuncture points and meridia. The original Chinese medical literature describes wildly varying points and conduit vessels (meridia) over the centuries. The term meridian was, in fact, first coined by the Frenchman Georges Souliét de Morant in 1939, the same man who first equated qi with energy. Despite proponent claims to the contrary, all objective, scientific attempts to physically identify and characterize such points and lines have ultimately met with failure. As Dr. Felix Mann, founder of the Medical Acupuncture Society and First President of the British Medical Acupuncture Society has stated: " ...acupuncture points are no more real than the black spots that a drunkard sees in front of his eyes. " (Mann F. Reinventing Acupuncture: A New Concept of Ancient Medicine. Butterworth Heinemann, London, 1996,14.) Electrical stimulation is NOT acupuncture -- even when it's applied at points modern acupuncturists arbitrarily deem to be " true " acupoints. Defining the running of electrical current through tissues as " acupuncture " is like defining sneakers as " canvas and rubber automobiles. " Since the sham group didn't have electrical current run through them, the trial was effectively unblinded. Berman, et al, could easily have run electrical current through sham group members at " sham " acupuncture points, but they chose not to. I wonder why not. It's hard to believe that, over the years that the trial was planned and during which patients were recruited, this obvious problem/solution never occurred to any of the investigators involved. Maybe it was because they felt they wouldn't get the " right " results if they employed such an effective control. Why didn't they use " placebo acupuncture needles " -- which, while not without their own shortcomings, have at least been scientifically evaluated over the last few years? (See: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve & db=PubMed & list_uids=11799305 & dopt=Abstract) Why all the nonsense about " tapping needle guides " and " taping uninserted needles to the patients " ? The authors claim that they were using a sham acupuncture technique they had previously developed, but I suspect they never established that patients couldn't easily distinguish between sham needling and the running of electrical current run through needles that HAD been stuck through the skin! (I admit, however, that I haven't yet read the publications dealing with their " previously developed techniques. " ) Now we have some trials showing effectiveness for this intervention and some showing no effectiveness. That's exactly what one would expect from poorly designed and controlled trials for a procedure that provides only placebo, counter-irritation, and non-specific noxious stimulus effects. The " OMERACT-OARSI responder index " portion of the paper reports only a 5% difference between sham and true " responders. " As I recall that's actually less than the difference between those that could and could not distinguish " real acupuncture " from " sham " in previous trials. I suspect that it's actually less than the difference between those who can distinguish acupuncture from having electrical current run through them. The " masking effectiveness " portion of the paper makes it clear that by the end of the trial, the trial was effectively unblinded. At least 75% of the " true " group had figured out they were getting the " real " treatment, and only 58% of the " sham " group still believed they were getting the " real " treatment. That's almost a 30% difference! Note, also, that by the end of the study " unsure " respondents were substantially fewer in the " true " arm (by a factor of roughly 30%) than in the " sham " arm of the trial. In other words, a whole lot of subjects who were in the " true acupuncture " arm were able to figure that out, or were at least suspicious that they were in said arm. Were patients prohibited from, or at least admonished against, " comparing notes " after the trial began? The paper doesn't tell us. They should have been. It wouldn't take long for a patient to figure out that he/she was not getting the electrical therapy if they were to discuss their treatment experiences with someone who was getting such therapy. Were the acupuncturists prohibited from speaking or communicating with the patients during or after treatments? They should not have been, but this was not mentioned in the paper. Why weren't they immediately ushered into and out of the treatment area with observers making sure there was no overt communication between patient and acupuncturist? They should have been in order to at least minimize the possibility that they might provide an additional potential source of unblinding. The medical and scientific literature are both rife with examples of intentional and unintentional communication between investigators and subjects that ended up defeating the blinding of clinical trials and experiments, and therefore ended up invalidating the results of same. For anyone dependent on grant money from U.S. taxpayers, surely the most important line in the paper is the one that begins: " Additional research is needed... " I have no idea how much taxpayer money was spent on this clinical trial by the NIH (or anyone else), but I'll bet a competent reporter could readily come up with a figure. :-) My best guess would be " at least several hundred thousands of dollars. " XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 12/16/2004 Hi, Rob, What follows is an excerpt from a paper Paul Buell, PhD, Dave Ramey, DVM and I published in the Scientific Review of Alternative Medicine in 2002. I thought you might find it of interest. As you can see, determining where " true " acupuncture " meridians " and points lie is more than a little problematic, since these alleged structures seem to have moved and changed in number, direction and character over the years. (You may have noticed that few " non-imaginary " human anatomical structures have changed in such manner over the last two millennia.) The Chinese seem to have only recently " decided " where " true " points and " meridia " lie. Despite proponent claims to the contrary, all objective, scientific attempts to physically identify and characterize such points and lines have ultimately met with failure. I wonder how Berman, et al, decided that their " true " points and " meridia " were " truer " than those described in previous centuries? [...] In human acupuncture, meridians have changed in number, name, character and even position through history. The Mawangdui texts describe eleven mai (vessels) which were described as containing both blood and qi. No distinction is made between vessels containing blood and those containing qi, however, the vessels did not appear to connect with each other. " Blood vessels are the obvious original referent of mai. The earliest attestation of the word is fourth century B.C., in a Zuozhuan description of a horse: 'chaotic vapor, untamed, erupts; dark blood springs forth, coursing; ridges of swollen vessels (mai) bulge.' (Zouzhuan, Xi 15,14.3a) " [ii] By the late first century B.C. (in the Huangdi neijing suwen) the number of vessels had grown to twelve, and they comprised a connected and more complex system. Moreover, blood and qi sometimes seem to flow in separate vessels, while at others they seem to flow in a mix.[iii] Vessels carrying qi are by this time referred to as 'conduits' (ching) or " conduit vessels " (ching-mai.) In later texts, the qi vessels and blood vessels are separate. " The transition from the old idea of blood vessels to physiological theory whose main purpose was to explain the movement of vapor in the body directed attention away from the blood vessels per se and towards an idealized system which meshed with correlative cosmology. " [iv] Perhaps most significantly, the twelve vessels described in the Huangdi neijing follow substantially different courses than the eleven described in the earlier Mawangdui texts. The " true " original location of human acupuncture meridians was further obscured when, in 1993, a lacquer conduit-figurine was recovered from a Western Han tomb depicting only nine mai, even though it ostensibly dates from after the Mawangdui treatises describing eleven mai. Moreover, two of the mai etched on the figurine are ones that the Mawangdui treatises fail to discuss.[v],[vi] Later, Chinese medical philosophers overtly lamented the " loss " of the original conduits.[vii] Wherever the meridians may be, they are clearly not where they started. Harper D, Early Chinese Medical Literature: The Mawangdui Medical Manuscripts, Kegan Paul International, London, 1997, 5 [ii] Harper D, ibid, 82 [iii] Paul Unschuld. Personal correspondence. [iv] Harper D, op. cit., 83-84 [v] Kuriyama, S. The Expressiveness of the Body and the Divergence of . New York, Zone Books, 1999, 43 [vi] Unschuld P. , op. cit., 35 [vii] Unschuld P. Forgotten Traditions of Ancient Chinese Medicine. Paradigm Publications, Brookline, MA, 1998, 244 On Dec 22, 2004, at 3:48 AM, wrote: > Prof. Alan Klide (Vet School Philadelphia) flagged a publication (Dec > 21, 2004) by Berman et al., who have confirmed an effect of > acupuncture (AP) in knee osteoarthritis. See details at end. What a > pity that there was not a positive western medical treatment (WM Tx) > included for comparison! The abstract is at > http://www.annals.org/cgi/content/abstract/141/12/901 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2004 Report Share Posted December 22, 2004 Great report especially in light of the Celebrex and Vioxx info. My only question - what was the training of the acupuncturists? 4 years, or 100 hrs?? Happy Holidays \\\ Kayte Chinese Medicine , " " <@e...> wrote: > Hi All, > > I take this opportunity to wish each one of you a happy and peaceful > Christmas and a most fulfilling and productive year in 2005. > > Prof. Alan Klide (Vet School Philadelphia) flagged a publication (Dec > 21, 2004) by Berman et al., who have confirmed an effect of > acupuncture (AP) in knee osteoarthritis. See details at end. What a > pity that there was not a positive western medical treatment (WM Tx) > included for comparison! The abstract is at > http://www.annals.org/cgi/content/abstract/141/12/901 > > For other Medline abstracts on AP by Dr. Berman et al., see: > http://tinyurl.com/5ndf9 > > IMO, future AP / herbal research should forget sham or placebo Txs > and compare the BEST that TCM can offer with the BEST that WM can > offer, including a risks assessment AND cost-benefit analysis. > > Best regards, > Phil > > PS: Alan, Many thanks for this nice Christmas present! Shalom. > > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > Brian M. Berman, MD; Lixing Lao, PhD; Patricia Langenberg, PhD; Wen > Lin Lee, PhD; Adele M.K. Gilpin, PhD; and Marc C. Hochberg, MD > Effectiveness of AP as Adjunctive Therapy in Osteoarthritis of the > Knee: A Randomized, Controlled Trial Annals of Internal Medicine 21 > December 2004 | Volume 141 Issue 12 | Pages 901-910 Background: > Evidence on the efficacy of AP for reducing the pain and dysfunction > of osteoarthritis is equivocal. Objective: To determine whether AP > provides greater pain relief and improved function compared with sham > AP or education in patients with osteoarthritis of the knee. Design: > Randomized, controlled trial. Setting: Two outpatient clinics (an > integrative medicine facility and a rheumatology facility) located in > academic teaching hospitals and 1 clinical trials facility. Patients: > 570 patients with osteoarthritis of the knee (mean age [±SD], 65.5 ± > 8.4 years). Intervention: 23 true AP sessions over 26 weeks. Controls > received 6 two-hour sessions over 12 weeks or 23 sham AP sessions > over 26 weeks. Measurements: Primary outcomes were changes in the > Western Ontario and McMaster Universities Osteoarthritis Index > (WOMAC) pain and function scores at 8 and 26 weeks. Secondary > outcomes were patient global assessment, 6-minute walk distance, and > physical health scores of the 36-Item Short-Form Health Survey (SF- > 36). Results: Participants in the true AP group experienced greater > improvement in WOMAC function scores than the sham AP group at 8 > weeks (mean difference, –2.9 [95% CI, –5.0 to –0.8]; P = 0.01) but > not in WOMAC pain score (mean difference, –0.5 [CI, –1.2 to 0.2]; P = > 0.18) or the patient global assessment (mean difference, 0.16 [CI, > –0.02 to 0.34]; P > 0.2). At 26 weeks, the true AP group experienced > significantly greater improvement than the sham group in the WOMAC > function score (mean difference, –2.5 [CI, –4.7 to –0.4]; P = 0.01), > WOMAC pain score (mean difference, –0.87 [CI, –1.58 to –0.16];P = > 0.003), and patient global assessment (mean difference, 0.26 [CI, > 0.07 to 0.45]; P = 0.02). Limitations: At 26 weeks, 43% of the > participants in the education group and 25% in each of the true and > sham AP groups were not available for analysis. Conclusions: AP seems > to provide improvement in function and pain relief as an adjunctive > therapy for osteoarthritis of the knee when compared with credible > sham AP and education control groups. > > Editors' Notes: Context: Previous studies of AP for osteoarthritis > have had conflicting results. This may have occurred because most > studies have included small samples, a limited number of treatment > sessions, or other limitations. > > Contribution: This randomized, controlled trial compared 24 AP > sessions over 26 weeks with sham AP or arthritis education in 570 > patients with osteoarthritis of the knee. AP led to greater > improvements in function but not pain after 8 weeks and in both pain > and function after 26 weeks. No adverse effects were associated with > AP. > > Cautions: Many participants dropped out of the study, so readers > should interpret the findings at 26 weeks with caution. –The Editors > For further details and links, see: > http://www.annals.org/cgi/content/abstract/141/12/901 > > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > Best regards, > Quote Link to comment Share on other sites More sharing options...
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