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Research: Sham vs. Sham

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Hi All,

 

I intended to read and respond to the posts about the problems with

research on acupuncture, but haven't had the time to. Therefore, I am

going to go ahead and post my strongly held view without reading

them...please excuse me if I am repeating what has already been said.

 

Basically, from what I've seen, the problem with research on

acupuncture is that they study sham acupuncture vs. sham

acupuncture....they study, 1. " Sham " acupuncture points (no such

thing) vs. 2. One prescription for everyone with a given western

diagnosis with no differential diagnosis to derive the points from.

See what I mean? Sham vs. Sham. So, of course, the results come out

as about equal.

 

There was recently an article on the very popular MSN site about a

research study like this on migraines, and it really got my blood

boiling. I actually had a migraine patient stop seeing me after

reading it!

 

And why doesn't the national acupuncture organizations do more to

educate the public about these things? For instance, I'd love to see

them publish a rebuttal on MSN about the article.

 

Thoughts anyone?

 

Laura

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heylaurag wrote:

> Hi All,

>

> I intended to read and respond to the posts about the problems with

> research on acupuncture, but haven't had the time to. Therefore, I am

> going to go ahead and post my strongly held view without reading

> them...

 

Hi Laura!

 

Post first, read and reflect later. If your mechanic worked on your car

like that you'd get another mechanic! We are *doctors* remember, we

should make it a point to read on the same page.

 

Take a deep breath or several and then read what we posted - it was

fairly good, actually. If you still want to do an Emily Litella after

that, then have at it. " Never mind " .

 

<http://snltranscripts.jt.org/75/75gupdate.phtml>

 

If you had read the posts you would have seen that we were not talking

about sham acupuncture but about gathering case studies and treatment

outcomes for statistical analysis. That's very different.

 

Regards,

 

Pete

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Oops! Tee-hee-hee!! :) That was a pretty bold move on my part, eh?

Sorry, but if you'd listened to the conversation I'd been having

just 15 minutes prior to writing that post you might understand. I

needed a place to vent.

 

So how 'bout if we just consider this a completely unrelated post to

the slew of posts I was referencing and never read? When I was in TCM

school even the woman who taught us research didn't understand why the

research protocols didn't work. As a former psychology research

wanna-be (undergrad aspirations), I know a thing or two about

research. And, by the way, psychotherapy had the same problem for a

long time as we do--its very difficult to design studies that work to

validate its usefulness.

 

Gathering case studies for treatment outcomes for statistical

analysis...great idea....guess I'm a little late on this one, but

better late than never, hey?

 

:) Laura

 

 

 

Chinese Medicine , Pete Theisen

<petet@a...> wrote:

> heylaurag wrote:

> > Hi All,

> >

> > I intended to read and respond to the posts about the problems with

> > research on acupuncture, but haven't had the time to. Therefore, I am

> > going to go ahead and post my strongly held view without reading

> > them...

>

> Hi Laura!

>

> Post first, read and reflect later. If your mechanic worked on your car

> like that you'd get another mechanic! We are *doctors* remember, we

> should make it a point to read on the same page.

>

> Take a deep breath or several and then read what we posted - it was

> fairly good, actually. If you still want to do an Emily Litella after

> that, then have at it. " Never mind " .

>

> <http://snltranscripts.jt.org/75/75gupdate.phtml>

>

> If you had read the posts you would have seen that we were not talking

> about sham acupuncture but about gathering case studies and treatment

> outcomes for statistical analysis. That's very different.

>

> Regards,

>

> Pete

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Psychology is still not very well recognized as is evident by lack of care

for returning vets etc.

 

 

Mike W. Bowser, L Ac

 

 

 

> " heylaurag " <heylaurag

>Chinese Medicine

>Chinese Medicine

>Re: Research: Sham vs. Sham

>Sat, 25 Jun 2005 07:32:33 -0000

>

>Oops! Tee-hee-hee!! :) That was a pretty bold move on my part, eh?

> Sorry, but if you'd listened to the conversation I'd been having

>just 15 minutes prior to writing that post you might understand. I

>needed a place to vent.

>

>So how 'bout if we just consider this a completely unrelated post to

>the slew of posts I was referencing and never read? When I was in TCM

>school even the woman who taught us research didn't understand why the

>research protocols didn't work. As a former psychology research

>wanna-be (undergrad aspirations), I know a thing or two about

>research. And, by the way, psychotherapy had the same problem for a

>long time as we do--its very difficult to design studies that work to

>validate its usefulness.

>

>Gathering case studies for treatment outcomes for statistical

>analysis...great idea....guess I'm a little late on this one, but

>better late than never, hey?

>

>:) Laura

>

>

>

>Chinese Medicine , Pete Theisen

><petet@a...> wrote:

> > heylaurag wrote:

> > > Hi All,

> > >

> > > I intended to read and respond to the posts about the problems with

> > > research on acupuncture, but haven't had the time to. Therefore, I am

> > > going to go ahead and post my strongly held view without reading

> > > them...

> >

> > Hi Laura!

> >

> > Post first, read and reflect later. If your mechanic worked on your car

> > like that you'd get another mechanic! We are *doctors* remember, we

> > should make it a point to read on the same page.

> >

> > Take a deep breath or several and then read what we posted - it was

> > fairly good, actually. If you still want to do an Emily Litella after

> > that, then have at it. " Never mind " .

> >

> > <http://snltranscripts.jt.org/75/75gupdate.phtml>

> >

> > If you had read the posts you would have seen that we were not talking

> > about sham acupuncture but about gathering case studies and treatment

> > outcomes for statistical analysis. That's very different.

> >

> > Regards,

> >

> > Pete

>

>

>

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heylaurag wrote:

> Oops! Tee-hee-hee!! :) That was a pretty bold move on my part, eh?

> Sorry, but if you'd listened to the conversation I'd been having

> just 15 minutes prior to writing that post you might understand. I

> needed a place to vent.

 

Hi Laura!

 

Just remember while you are venting, anyone with a login can read

our posts, it doesn't help if we look like we want to skip steps in

things like research.

 

The statistical idea is to apply the study to a huge population, in the

millions. The size of the study alone will lend it validity. We can do

it if everyone gets behind it. Several programmers are working on the

interface. It will take a little money but not all that much for

hosting, paying the programmers and whatever.

 

The hosting will have to be on Linux or Unix servers (security issues

preclude using Windows), but the application will work with any browser

so all of us *can* participate. If there are 10,000 acupuncturists using

the application every hundred patient treatments from each would add a

million case records so it won't even take that long once it is up and

everyone starts using it.

 

Will 10,000 acupuncturists use this application? Well, if your patient

record is done, the patient's bill is printed and your accounting entry

is already made by the time you leave the room, yes, maybe you would

like to use the application.

 

The main thing to do now is to get into the habit of asking returning

patients about their feelings immediately after the treatment and how

long the effect lasted. You can even ask immediately after the treatment

as well. This is what we want to document for each syndrome/protocol,

results.

 

I have seen doctors who didn't look back, just would ask how the patient

felt today and treat those symptoms and signs. This has a validity, but

it doesn't help gather data.

 

Regards,

 

Pete

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Wow Pete, it is really very encouraging to hear that this is already

in the works. I'm thrilled!

 

But jeez, Pete, I wasn't trying to skip any steps, I was merely trying

to write a post commenting on my thoughts about current research

without having time to read previous posts on the subject, that's all.

I'm a busy and opinionated girl I guess. But at least I admitted

to it in the post. :)

 

By the way, I always ask my patients how they were after their last

treatment because I am trying to get better and better at my craft, so

I want details. I even encourage them to email me before the next

visit. The downside is that I think it sets some of them up for

misconceptions, such as the idea that the only effect of acupuncture

is right after the treatment and that if they are not symptom-free

after any given treatment it didn't help them at all (as opposed to

the idea that it was a step in the process). I've had patients tell

me that they didn't feel that well right after the treatment but then

2 days later their symptoms went away...and they don't " get it " that

the acupuncture is quite possibly the reason why. But its worth it to

be able to learn and grow as a practitioner.

 

Psychtherapy research still has a long way to go, but it has gotten

better. One of the problems with studying either one is that there is

such a variability in the talent and skill of the person delivering

the service. There is no way to compare that to studying whether a

certain pill works.

 

I would think that physical therapy would have the same challenges in

being studied. I wonder how did they gained such acceptance into the

medical field?

 

Laura

 

 

 

Chinese Medicine , Pete Theisen

<petet@a...> wrote:

> heylaurag wrote:

> > Oops! Tee-hee-hee!! :) That was a pretty bold move on my part, eh?

> > Sorry, but if you'd listened to the conversation I'd been having

> > just 15 minutes prior to writing that post you might understand. I

> > needed a place to vent.

>

> Hi Laura!

>

> Just remember while you are venting, anyone with a login can read

> our posts, it doesn't help if we look like we want to skip steps in

> things like research.

>

> The statistical idea is to apply the study to a huge population, in the

> millions. The size of the study alone will lend it validity. We can do

> it if everyone gets behind it. Several programmers are working on the

> interface. It will take a little money but not all that much for

> hosting, paying the programmers and whatever.

>

> The hosting will have to be on Linux or Unix servers (security issues

> preclude using Windows), but the application will work with any browser

> so all of us *can* participate. If there are 10,000 acupuncturists using

> the application every hundred patient treatments from each would add a

> million case records so it won't even take that long once it is up and

> everyone starts using it.

>

> Will 10,000 acupuncturists use this application? Well, if your patient

> record is done, the patient's bill is printed and your accounting entry

> is already made by the time you leave the room, yes, maybe you would

> like to use the application.

>

> The main thing to do now is to get into the habit of asking returning

> patients about their feelings immediately after the treatment and how

> long the effect lasted. You can even ask immediately after the treatment

> as well. This is what we want to document for each syndrome/protocol,

> results.

>

> I have seen doctors who didn't look back, just would ask how the patient

> felt today and treat those symptoms and signs. This has a validity, but

> it doesn't help gather data.

>

> Regards,

>

> Pete

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heylaurag wrote:

> Wow Pete, it is really very encouraging to hear that this is already

> in the works. I'm thrilled!

 

Hi Laura!

 

Busy and opinionated serve research poorly, more appropriate to a barber

or a cabbie! :-) Reading the material before commenting is a " step " , I

think. Try to reserve expression of " venting " opinions to that which you

know you can prove, it would help us all.

 

You might tell people out front that sometimes the effect of the

treatment is instantaneous and sometimes it takes a while. You might

even put language like that into your informed consent document. If a

lawyer writes your IC you will probably never be sued, but you may never

treat either - trade off!

 

If the patient says they feel better after the treatment try to tell

them it might be temporary, you want them to try to remember how long

they felt good and tell you next time. Then if they gradually suffer the

return of a symptom it won't be a surprise and they will tell you about

it rather than canceling the next appointment without explanation.

 

If we have millions of records, the individual skill of any one doctor

will be less of a factor, I hope. The Psyches and the PT folks face a

similar challenge as you point out. I think a lot of PTs work *for* MDs

or at least do a lot of ingratiating free services for them.

 

Regards,

 

Pete

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Hi Pete--I wrote in comments down below:

 

 

Chinese Medicine , Pete Theisen

<petet@a...> wrote:

> heylaurag wrote:

> > Wow Pete, it is really very encouraging to hear that this is already

> > in the works. I'm thrilled!

>

> Hi Laura!

>

> Busy and opinionated serve research poorly, more appropriate to a barber

> or a cabbie! :-) Reading the material before commenting is a " step " , I

> think. Try to reserve expression of " venting " opinions to that which you

> know you can prove, it would help us all.

 

 

 

Jeez, Pete, doncha think you're being a little hard on me? All I was

doing was talking about something that I would still say was a valid

point about how research has been conducted on acupuncture so far.

Give a girl a break. I wasn't commenting on the material in the

posts, I was commenting on research itself---which is something that I

have read a lot about. Actually you could almost say that I am an

expert on the topic of research, considering my undergraduate degree

was aimed toward becoming a researcher, I've worked on research

projects, and all three of my masters degrees involved classes on

research and statistics.

 

 

 

>

> You might tell people out front that sometimes the effect of the

> treatment is instantaneous and sometimes it takes a while. You might

> even put language like that into your informed consent document. If a

> lawyer writes your IC you will probably never be sued, but you may never

> treat either - trade off!

>

> If the patient says they feel better after the treatment try to tell

> them it might be temporary, you want them to try to remember how long

> they felt good and tell you next time. Then if they gradually suffer the

> return of a symptom it won't be a surprise and they will tell you about

> it rather than canceling the next appointment without explanation.

 

 

I appreciate the ideas, but oh my gosh, I do tell them all of this and

more. I personally find that I practically exert more energy

explaining things like this than I want to. At the of the work day I

am more tired from all my explaining than anything (perhaps dt a

propensity toward lung qi xu). Anyone else feel that way? Maybe I

explain too much, actually.

 

 

 

>

> If we have millions of records, the individual skill of any one doctor

> will be less of a factor, I hope.

 

 

Again, I was not commenting on the type of research that you are

talking about when I said that. I was commenting on how research has

been done in the past. See?

 

 

 

The Psyches and the PT folks face a

> similar challenge as you point out. I think a lot of PTs work *for* MDs

> or at least do a lot of ingratiating free services for them.

 

 

Yep, I think you are right. Its something for us to think about as a

profession--whether or not we are willing to be in the role of

" working under the doctor " so that they feel less threatened by us and

accept us more. I really don't know my opinion on that because I can

see a good argument either way. I will say that many of the doctors

that I have worked with actually see through that nonsense when they

are suppose to be " the final word " for a discipline that they know

very little about. I experienced that as an MSW working in

hospitals--they would sign off on my charts and make it clear to me

that they trusted me and realized that I knew more about what I was

doing than they do. But of course, there are some doctors who would

go to town with " attitude " about that. Its tough to say whether or

not it would be worth it, but it certainly would put us in a position

to help more people.

 

>

> Regards,

>

> Pete

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heylaurag wrote:

<snip>

> Jeez, Pete, doncha think you're being a little hard on me?

 

Hi Laura!

 

Hard? You can see the smiley face, I think you are being hard on me. Was

Chevy Chase hard on Gilda Radner? " Miss Litella, the editorial was about

saving endangered *species*, not saving endangered *feces*. " " Oh, that's

very different. Never mind. "

 

Three master's degrees one of which is an MSW? (non social workers

reading this understand that getting an MSW is difficult for difficult's

sake - as in if they make the course really hard no one will notice that

the whole sw profession is political correct nonsense <g> - yes, I was a

social worker for 7 years)

 

So I thought I was a professional student? I'm sure you get my point

about not skipping steps, given your background. Smiley face or not you

certainly know what I mean.

 

Regards,

 

Pete

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Hi Pete--I think this is definitely a case of intention obscured by

the written word. Its happened before, it'll happen again. I'm

still confused, actually, quite possibly because I haven't a clue

about the Miss Litella reference...anyway, sorry for the confusion,

and sorry to everyone for filling your inbox with my confusion. I

shall now slink away into the shadows...

 

:) Laura

 

 

 

Chinese Medicine , Pete Theisen

<petet@a...> wrote:

> heylaurag wrote:

> <snip>

> > Jeez, Pete, doncha think you're being a little hard on me?

>

> Hi Laura!

>

> Hard? You can see the smiley face, I think you are being hard on

me. Was

> Chevy Chase hard on Gilda Radner? " Miss Litella, the editorial was

about

> saving endangered *species*, not saving endangered *feces*. " " Oh,

that's

> very different. Never mind. "

>

> Three master's degrees one of which is an MSW? (non social workers

> reading this understand that getting an MSW is difficult for

difficult's

> sake - as in if they make the course really hard no one will notice

that

> the whole sw profession is political correct nonsense <g> - yes, I

was a

> social worker for 7 years)

>

> So I thought I was a professional student? I'm sure you get my point

> about not skipping steps, given your background. Smiley face or not

you

> certainly know what I mean.

>

> Regards,

>

> Pete

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heylaurag wrote:

> I haven't a clue about the Miss Litella reference

 

Hi Laura!

 

It's a *joke* from 70s era Saturday Night Live. The first season, if

memory serves. " Emily Litella " was a Gilda Radner character who would

" vent " deliver a " viewer feedback " speech on Chevy Chase's " Weekend

Update " segment which was a news program spoof.

 

" Emily " *always* misunderstood some essential part of the editorial she

was *heatedly* responding to, Chevy *always* pointed out the error and

then she would say in the sweetest voice " Oh, that's very different.

Never mind. " Gilda and Chevy probably did a dozen or more of these, back

in the day when SNL was actually funny.

 

You posted a few days ago that you hadn't read the posts on the topic

but you were going to comment (*vent*, you later said) on the topic

anyway. It made me think of that " Emily Litella " series. " Emily's "

venting was always based on a misunderstanding, very similar to your

expanding on something you haven't read. That and my other thought about

at least appearing to do our homework.

 

Regards,

 

Pete

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Don't you mean Rosanne Rosanna Dana.

 

 

Mike W. Bowser, L Ac

 

 

 

>Pete Theisen <petet

>Chinese Medicine

>Chinese Medicine

>Re: Research: Sham vs. Sham

>Mon, 27 Jun 2005 15:30:05 -0400

>

>heylaurag wrote:

> > I haven't a clue about the Miss Litella reference

>

>Hi Laura!

>

>It's a *joke* from 70s era Saturday Night Live. The first season, if

>memory serves. " Emily Litella " was a Gilda Radner character who would

> " vent " deliver a " viewer feedback " speech on Chevy Chase's " Weekend

>Update " segment which was a news program spoof.

>

> " Emily " *always* misunderstood some essential part of the editorial she

>was *heatedly* responding to, Chevy *always* pointed out the error and

>then she would say in the sweetest voice " Oh, that's very different.

>Never mind. " Gilda and Chevy probably did a dozen or more of these, back

>in the day when SNL was actually funny.

>

>You posted a few days ago that you hadn't read the posts on the topic

>but you were going to comment (*vent*, you later said) on the topic

>anyway. It made me think of that " Emily Litella " series. " Emily's "

>venting was always based on a misunderstanding, very similar to your

>expanding on something you haven't read. That and my other thought about

>at least appearing to do our homework.

>

>Regards,

>

>Pete

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mike Bowser wrote:

> Don't you mean Rosanne Rosanna Dana.

 

Hi Mike!

 

No. She was the one who was going to *die* and said it was *always*

*something*. Same actress/comedienne, though, Gilda Radner. She also

did Baba Wawa.

 

" I got up this morning and was still a little groggy and as I was waking

up I realized I had those teeny tiny itty bitty eye crystals in the

corners of my eyes. You know the ones that you put your finger there and

you can feel them crunching around all mashing in and around your

eyeball. Well I had a whole mass of em in the corner of my right eye so

I'm rubbing and rubbing trying to get em out and they just stay there

mashing around in my eye driving me nuts! I thought I was gonna *die*!

So eventually I'm rubbing and rubbing and get em all out so I wanna go

outside to clean the snow off my car when before you know it I bust

though the screen door window just trying to get outside. I shoved my

whole elbow into that glass and was standing there all shocked cause I

was sure I was bleeding and you know that just the sight of blood makes

me wanna puke! Like this one time I was opening a Christmas card when I

sliced my thumb open with a letter opener. There was blood everywhere -

on the envelope, on the card, on the picture of the little baby Jesus in

the manger. I thought I was gonna *die*! Well what I'm getting at is -

It just goes to show you, its *always*something*; if it's not one thing,

it's another. Either you got eye crystals mashing your eye - or your

slicing your thumb open. Either your car is covered with snow and ice -

or you bust out a window trying to get out of your house in the morning. "

 

<http://koomaster.diaryland.com/021205_5.html>

 

Regards,

 

Pete

 

>>heylaurag wrote:

>>

>>>I haven't a clue about the Miss Litella reference

>>

>>Hi Laura!

>>

>>It's a *joke* from 70s era Saturday Night Live. The first season, if

>>memory serves. " Emily Litella " was a Gilda Radner character who would

>> " vent " deliver a " viewer feedback " speech on Chevy Chase's " Weekend

>>Update " segment which was a news program spoof.

>>

>> " Emily " *always* misunderstood some essential part of the editorial she

>>was *heatedly* responding to, Chevy *always* pointed out the error and

>>then she would say in the sweetest voice " Oh, that's very different.

>>Never mind. " Gilda and Chevy probably did a dozen or more of these, back

>>in the day when SNL was actually funny.

>>

>>You posted a few days ago that you hadn't read the posts on the topic

>>but you were going to comment (*vent*, you later said) on the topic

>>anyway. It made me think of that " Emily Litella " series. " Emily's "

>>venting was always based on a misunderstanding, very similar to your

>>expanding on something you haven't read. That and my other thought about

>>at least appearing to do our homework.

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