Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 Hi all, I'm researching the problematic issues commonly seen in Chinese medicine research. Apart from issues such as sham acupuncture, population size, acupuncturist quality, research protocol, etc, I believe that the main issue is the use of a TCM pattern analysis in the inclusion/exclusion of an RCT. I fear that as acupuncture becomes more popular and more accepted within standard health centres, that acupuncture will be used without the theories that support them. In short, RCTs will simply test the theories of western medical acupuncture or a 'cookbook' approach. This is already happening and I want to see the theories of TCM accepted into modern research. A further TCM pattern analysis should be conducted after the allopathic diagnosis to select the appropriate subjects for inclusion/exclusion into an RCT. For example, when testing for lower back pain, all patients should have the same pattern analysis, i.e. Kidney Yang deficiency. As many of you know, TCM is a subject art form and diagnosis can change from practitioner to practitioner. To take account of this, one particular style of TCM would have to be studied, i.e. Japanese or Chinese. Also, by using the 8 diagnostic principles and a panel of selected experts, would it be possible to use a mathematical formula; i.e. statistically significant, to find a correlation, and therefore a 'best of/average' pattern analysis? Anyone got any ideas on this? Warm regards, Attilio D'Alberto Doctor of (Beijing, China) B.Sc (Hons) T.C.M. M.A.T.C.M 07786198900 attiliodalberto <http://www.attiliodalberto.com/> www.attiliodalberto.com " A human being is part of the whole, called by us the Universe, a part limited in time and space. He experiences himself, his thoughts and feelings, as something separated from the rest - - a kind of optical illusion in his consciousness. " (Albert Einstein) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 I fear that as acupuncture becomes more popular and more accepted within standard health centres, that acupuncture will be used without the theories that support them. >>>>Attilio, you have to remember that acupuncture historically was never used with 8 diagnostic pattern discrimination.I do agree however that RCT must pay closer attention to traditional acup methods of diagnosis, changing protocols etc. Oakland, CA 94609 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 Attilio, I have a few ideas on this and why it should be important for us to coorelate other research findings when appropriate. I have thought that maybe we should write an article about the various physical signs and info that are known. You can contact me offline if interested. Mike W. Bowser, L Ac > " Attilio D'Alberto " <attiliodalberto >Chinese Medicine ><Chinese Medicine > > Acupuncture Research Protocols >Tue, 21 Jun 2005 13:01:54 +0100 > >Hi all, > >I'm researching the problematic issues commonly seen in Chinese medicine >research. Apart from issues such as sham acupuncture, population size, >acupuncturist quality, research protocol, etc, I believe that the main >issue >is the use of a TCM pattern analysis in the inclusion/exclusion of an RCT. >I >fear that as acupuncture becomes more popular and more accepted within >standard health centres, that acupuncture will be used without the theories >that support them. In short, RCTs will simply test the theories of western >medical acupuncture or a 'cookbook' approach. This is already happening and >I want to see the theories of TCM accepted into modern research. > >A further TCM pattern analysis should be conducted after the allopathic >diagnosis to select the appropriate subjects for inclusion/exclusion into >an >RCT. For example, when testing for lower back pain, all patients should >have >the same pattern analysis, i.e. Kidney Yang deficiency. > >As many of you know, TCM is a subject art form and diagnosis can change >from >practitioner to practitioner. To take account of this, one particular style >of TCM would have to be studied, i.e. Japanese or Chinese. Also, by using >the 8 diagnostic principles and a panel of selected experts, would it be >possible to use a mathematical formula; i.e. statistically significant, to >find a correlation, and therefore a 'best of/average' pattern analysis? > >Anyone got any ideas on this? > >Warm regards, > >Attilio D'Alberto >Doctor of (Beijing, China) >B.Sc (Hons) T.C.M. M.A.T.C.M >07786198900 >attiliodalberto > <http://www.attiliodalberto.com/> www.attiliodalberto.com > > " A human being is part of the whole, called by us the Universe, a part >limited in time and space. He experiences himself, his thoughts and >feelings, as something separated from the rest - - a kind of optical >illusion in his consciousness. " (Albert Einstein) > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 Alon, So what suggestions do you have in standardising the variability of practitioner diagnosis and treatment within a RCT setting? Warm regards, Attilio D'Alberto Doctor of (Beijing, China) B.Sc. (Hons) T.C.M., M.A.T.C.M. 07786198900 attiliodalberto <http://www.attiliodalberto.com/> www.attiliodalberto.com " A human being is part of the whole, called by us the Universe, a part limited in time and space. He experiences himself, his thoughts and feelings, as something separated from the rest - - a kind of optical illusion in his consciousness. " (Albert Einstein) Chinese Medicine Chinese Medicine On Behalf Of Alon Marcus DOM 21 June 2005 18:38 Chinese Medicine Re: Acupuncture Research Protocols I fear that as acupuncture becomes more popular and more accepted within standard health centres, that acupuncture will be used without the theories that support them. >>>>Attilio, you have to remember that acupuncture historically was never used with 8 diagnostic pattern discrimination.I do agree however that RCT must pay closer attention to traditional acup methods of diagnosis, changing protocols etc. Oakland, CA 94609 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 So what suggestions do you have in standardising the variability of practitioner diagnosis and treatment within a RCT setting? >>>This is a very difficult question. I am one that thinks procedures are not best tested by RCT but with compatible groups and a blind assessor. I think this is were professions that use procedures should push for changing study design. RCTs are designed for drug studies not procedures and certainly not for CM evolving treatment protocols. The need for blinding can be achieved in two ways. First one group sees trained practitioners and these are allowed to use their art (i.e. the treatment is placed in a black box), a second group sees nontrained practitioners pretending to treat using similar procedures, and then the results of both groups are evaluated by blind evaluators. Oakland, CA 94609 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 I don't think blinding is much of an issue in recent acupuncture research literature. It's been accepted that the acupuncturist cannot be blinded but so long as the patients and assessors are, its ok. It's true that the RCT model is terrible. Even for drug trials is terrible. But nevertheless its the accepted 'gold standard'. Any dilution of this to take account of 'complementary' medicine will just weaken the view that acupuncture (and herbal medicine) actually works. Warm regards, Attilio D'Alberto Doctor of (Beijing, China) B.Sc. (Hons) T.C.M., M.A.T.C.M. 07786198900 attiliodalberto <http://www.attiliodalberto.com/> www.attiliodalberto.com " A human being is part of the whole, called by us the Universe, a part limited in time and space. He experiences himself, his thoughts and feelings, as something separated from the rest - - a kind of optical illusion in his consciousness. " (Albert Einstein) Chinese Medicine Chinese Medicine On Behalf Of Alon Marcus DOM 21 June 2005 19:54 Chinese Medicine Re: Acupuncture Research Protocols So what suggestions do you have in standardising the variability of practitioner diagnosis and treatment within a RCT setting? >>>This is a very difficult question. I am one that thinks procedures are not best tested by RCT but with compatible groups and a blind assessor. I think this is were professions that use procedures should push for changing study design. RCTs are designed for drug studies not procedures and certainly not for CM evolving treatment protocols. The need for blinding can be achieved in two ways. First one group sees trained practitioners and these are allowed to use their art (i.e. the treatment is placed in a black box), a second group sees nontrained practitioners pretending to treat using similar procedures, and then the results of both groups are evaluated by blind evaluators. Oakland, CA 94609 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 Attilio D'Alberto wrote: > Hi all, > > I'm researching the problematic issues commonly seen in Chinese medicine > research. Apart from issues such as sham acupuncture, population size, > acupuncturist quality, research protocol, etc, I believe that the main issue > is the use of a TCM pattern analysis in the inclusion/exclusion of an RCT.<snip> Hi Attilio! Not clear from this post what you mean by RCT. Maybe this is something I should already know? I have been working for ten years now on a software package to gather case studies and for the analysis of treatment outcomes, all into a large central database for empirical research. I recently recruited a real computer programmer and have arranged a way to pay him to produce the software so we may have something ready relatively soon. I wrote the package four or five times myself but it didn't run on the computer. I evidently am no programmer :-) I intend to use TCM as either primary care (without reference to allopathy) or as an adjunctive therapy (TCM doctors working with MD doctors) in the cases I will be following. Where the TCM physician is primary he/she could either use cookbook or TCM patterns as he/she thought best for the case. I am going to ask the programmer to give the practitioner a lot of leeway in reporting as long as essential data is acquired. I will also ask that a way be included to add patterns, protocols and treatments to the software from the field on-the-fly as it were. The software will keep the clinic record on the local computer where it can be printed or used in other applications. There will be a deluxe version that will keep an accounting file as well so the day after the end of your tax period you can file your tax return, if you have the deluxe version. If everyone in the acupuncture community uses this software we will rather soon have a population of cases large enough to answer any question. I hope you all will help me by peer reviewing the design and contributing cases through the program. Regards, Pete Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 Hi Pete, Yes, if I remember correctly, it was you who asked me what RCT stands for some time back RCT is the universal term for Randomised Controlled Trial, the gold standard for research in healthcare. I'm interested in seeing your software program, how and if it would work. In your software program, will you include research trials in the format or will it be practitioner cases only? Will every practitioners case then be uploaded to a main server for others to download and review? I'll gladly look over it for you when its ready. Warm regards, Attilio D'Alberto Doctor of (Beijing, China) B.Sc. (Hons) T.C.M., M.A.T.C.M. 07786198900 attiliodalberto <http://www.attiliodalberto.com/> www.attiliodalberto.com " A human being is part of the whole, called by us the Universe, a part limited in time and space. He experiences himself, his thoughts and feelings, as something separated from the rest - - a kind of optical illusion in his consciousness. " (Albert Einstein) Chinese Medicine Chinese Medicine On Behalf Of Pete Theisen 21 June 2005 20:36 Chinese Medicine Re: Acupuncture Research Protocols Attilio D'Alberto wrote: > Hi all, > > I'm researching the problematic issues commonly seen in Chinese medicine > research. Apart from issues such as sham acupuncture, population size, > acupuncturist quality, research protocol, etc, I believe that the main issue > is the use of a TCM pattern analysis in the inclusion/exclusion of an RCT.<snip> Hi Attilio! Not clear from this post what you mean by RCT. Maybe this is something I should already know? I have been working for ten years now on a software package to gather case studies and for the analysis of treatment outcomes, all into a large central database for empirical research. I recently recruited a real computer programmer and have arranged a way to pay him to produce the software so we may have something ready relatively soon. I wrote the package four or five times myself but it didn't run on the computer. I evidently am no programmer :-) I intend to use TCM as either primary care (without reference to allopathy) or as an adjunctive therapy (TCM doctors working with MD doctors) in the cases I will be following. Where the TCM physician is primary he/she could either use cookbook or TCM patterns as he/she thought best for the case. I am going to ask the programmer to give the practitioner a lot of leeway in reporting as long as essential data is acquired. I will also ask that a way be included to add patterns, protocols and treatments to the software from the field on-the-fly as it were. The software will keep the clinic record on the local computer where it can be printed or used in other applications. There will be a deluxe version that will keep an accounting file as well so the day after the end of your tax period you can file your tax return, if you have the deluxe version. If everyone in the acupuncture community uses this software we will rather soon have a population of cases large enough to answer any question. I hope you all will help me by peer reviewing the design and contributing cases through the program. Regards, Pete http://babel.altavista.com/ and adjust accordingly. _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 Attilio D'Alberto wrote: > I don't think blinding is much of an issue in recent acupuncture research > literature. It's been accepted that the acupuncturist cannot be blinded but > so long as the patients and assessors are, its ok. > > It's true that the RCT model is terrible. Hi Attilio! RCT? <http://rctinc.tycoonplanet.com/index.shtml> <http://www.rctech.com/> <http://www.answers.com/topic/rct-1?method=6> Acronyms are confusing. Whenever you post an acronym, *please* try to spell it out at least one time, preferably in the first paragraph. If it is randomized controlled trials, you need at least 100 million to play in that sandbox in the US, maybe cheaper in the UK? If it is terrible, why go there, especially why go there for 100 mil that none of us have? Regards, Pete Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 It's true that the RCT model is terrible. Even for drug trials is terrible. But nevertheless its the accepted 'gold standard'. Any dilution of this to take account of 'complementary' medicine will just weaken the view that acupuncture (and herbal medicine) actually works. >>>I do not agree. There is pressure from mainstream medicine to change this process regarding surgery and many other procedures.I have been reading discussions on this issue in mainstream journals.What we need it to educate and research community about oriental ways of practicing acupu.Not all " acceptable " studies must have fixed treatment protocols. By the way I think RCT work well for drugs and are the only way to get accurate information Oakland, CA 94609 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 Attilio D'Alberto wrote: > Hi Pete, > > Yes, if I remember correctly, it was you who asked me what RCT stands for > some time back Hi Attilio! I hope I live until *you* get old, then I will send you smileys about *your* memory. I am developing the software partly for those who don't remember *everything* from day to day! The main function of the software is to collect case studies for empirical research. As the program is used in acupuncture clinics throughout the English-speaking world it will accumulate more and more case studies to a central server. As the patients return for follow up treatment the results of the previous treatments will be recorded. I would be happy to put in anything the community wishes to have into the software, as long as you have the patience to explain it to me! I may not grasp it on the first message. Regards, Pete Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 This is getting out of the scope of this group, but RCTs using the statically significant model do not reflect the individual human race. We are all unique and you cannot use a standard medication for everyone. Even the head of Glaxo-Welcome stated that their medicine doesn't work on half the people its suppose to. It's the only way to get 'accurate' information, because its the only way things are done right now. I'm sure the RCT model will change in the near future as its being constantly broken down by those investigating the efficacy of TCM. Warm regards, Attilio D'Alberto Doctor of (Beijing, China) B.Sc. (Hons) T.C.M., M.A.T.C.M. 07786198900 attiliodalberto <http://www.attiliodalberto.com/> www.attiliodalberto.com " A human being is part of the whole, called by us the Universe, a part limited in time and space. He experiences himself, his thoughts and feelings, as something separated from the rest - - a kind of optical illusion in his consciousness. " (Albert Einstein) Chinese Medicine Chinese Medicine On Behalf Of Alon Marcus DOM 21 June 2005 21:58 Chinese Medicine Re: Acupuncture Research Protocols It's true that the RCT model is terrible. Even for drug trials is terrible. But nevertheless its the accepted 'gold standard'. Any dilution of this to take account of 'complementary' medicine will just weaken the view that acupuncture (and herbal medicine) actually works. >>>I do not agree. There is pressure from mainstream medicine to change this process regarding surgery and many other procedures.I have been reading discussions on this issue in mainstream journals.What we need it to educate and research community about oriental ways of practicing acupu.Not all " acceptable " studies must have fixed treatment protocols. By the way I think RCT work well for drugs and are the only way to get accurate information Oakland, CA 94609 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2005 Report Share Posted June 21, 2005 Don't take it personally Pete, I have a terrible memory and I'm relatively young. Warm regards, Attilio D'Alberto Doctor of (Beijing, China) B.Sc. (Hons) T.C.M., M.A.T.C.M. 07786198900 attiliodalberto <http://www.attiliodalberto.com/> www.attiliodalberto.com " A human being is part of the whole, called by us the Universe, a part limited in time and space. He experiences himself, his thoughts and feelings, as something separated from the rest - - a kind of optical illusion in his consciousness. " (Albert Einstein) Chinese Medicine Chinese Medicine On Behalf Of Pete Theisen 21 June 2005 22:03 Chinese Medicine Re: Acupuncture Research Protocols Attilio D'Alberto wrote: > Hi Pete, > > Yes, if I remember correctly, it was you who asked me what RCT stands for > some time back Hi Attilio! I hope I live until *you* get old, then I will send you smileys about *your* memory. I am developing the software partly for those who don't remember *everything* from day to day! The main function of the software is to collect case studies for empirical research. As the program is used in acupuncture clinics throughout the English-speaking world it will accumulate more and more case studies to a central server. As the patients return for follow up treatment the results of the previous treatments will be recorded. I would be happy to put in anything the community wishes to have into the software, as long as you have the patience to explain it to me! I may not grasp it on the first message. Regards, Pete http://babel.altavista.com/ and adjust accordingly. _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2005 Report Share Posted June 22, 2005 Attilio D'Alberto wrote: > Don't take it personally Pete, I have a terrible memory and I'm relatively > young. > > Warm regards, Hi Attilio! All in good fun, today I'm " it " , tomorrow you are <s> Regards, Pete Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2005 Report Share Posted June 22, 2005 Attilio had contacted me offline about an article he was preparing for publication along this line of thought. I was making an offer of collaberation on such an endeavor but with a slight twist. While most of us have heard of this or that research that shows something of acupuncture interest no one has yet attempted to pool this info to show that there is an event that is created by such an experiment. Attilio let me know. Later Mike W. Bowser, L Ac >Pete Theisen <petet >Chinese Medicine >Chinese Medicine >Re: Acupuncture Research Protocols >Tue, 21 Jun 2005 15:47:41 -0400 > >mike Bowser wrote: > > Attilio, > > I have a few ideas on this and why it should be important for us to > > coorelate other research findings when appropriate. I have thought that > > maybe we should write an article about the various physical signs and >info > > that are known. You can contact me offline if interested. > >Hi Mike! > >Keep it on line, a number of us are interested :-) > >Regards, > >Pete Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2005 Report Share Posted June 22, 2005 Hi Gabriele & All, wrote: > ... I recalled those old (about sixties) experiments done on (poor) > dogs, who received electrostimating acup. (like in analgesy, low > freqency, 5Hz); just after one hour, while analgesy was effective, was > injected nalorphine (Naloxone) the same drug used in patients in > overdose due to Heroin or Morphine; Nalorphine works on the same sites > of opium derivates, inhibiting them. In the dogs' experiment after the > injection, the analgesic effect of electroacupncture suddenly > disappeared, such demonstrating the same drug mechanism in acupuncture, > as in a drug opioid analgesic treatment. Of course, this is only a > western sight of acupuncture, but it could be useful -in my opinion- to > execute an RCT vs placebo, assuming as a placebo treatement the > injection or not of nalorphine (placebo acupuncture) vs another kind of > " naked " injection, like a watery salt solution (Physiologic solution) > after an acupuncture treatement. Hoping to be understood, because of my > terrible english (reading an english artcle is a thing, while > writing...) I wish to ask you all about this idea and how to do it, > maybe in two nations, why not? Best regards and thanks to all of you. > , Italy As far as I know, Bruce Pomeranz was the first author to prove a role for the the pituitary and the endogenous opiate system in AP: Pomeranz B, Cheng R, Law P. AP reduces electrophysiological and behavioral responses to noxious stimuli: pituitary is implicated. Exp Neurol. 1977 Jan;54(1):172-8. PMID: 832694 [PubMed - indexed for MEDLINE] Pomeranz B, Chiu D. Naloxone blockade of AP analgesia: endorphin implicated. Life Sci. 1976 Dec 1;19(11):1757-62. No abstract available. PMID: 187888 [PubMed - indexed for MEDLINE] However, NON-OPIATE mechanisms, involving serotonin, substance P and other neurotransmitters, also modulate AP responses. Therefore, to use ONLY opiate antagonists in a control group may fail to block some effects of real AP. In RTCs to examine the effects of AP, I prefer a design that compares real AP versus real Western Tx (state-of-the-art conventional therapy), and excludes a placebo or " sham " AP group. If necessary, a third UNTREATED group could act as the neghative control. Best regards, Tel: (H): +353-(0) or (M): +353-(0) Ireland. Tel: (W): +353-(0) or (M): +353-(0) " Man who says it can't be done should not interrupt man doing it " - Chinese Proverb Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2005 Report Share Posted June 22, 2005 Hi All, there's an article on the usefulness of RCT's for acupuncturists at http://www.medicalacupuncture.org/aama_marf/journal/vol16_1/article1.html One of the proposed solutions is another acronym, namely PCT's! Pragmatic controlled trials. References to PCT's are: # Hammerschlag R. Acupuncture: on what should its evidence base be based? Altern Ther Health Med. 2003;9:34. # Thomas KJ, Fitter M, Brazier J, et al. Longer term clinical and economic benefits of offering acupuncture to patients with chronic low back pain assessed as suitable for primary care management. Complement Ther Med. 1999;7:91-100. # MacPherson H. Out of the laboratory and into the clinic: acupuncture research in the real world. Clin Acup Oriental Med. 2000;1:97-100. Has anyone read these articles? Tom. Quote Link to comment Share on other sites More sharing options...
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