Acupuncture no better than sham in hypertension - SHARP Trial

May 4, 2007

shocking. in 13 years of practice, I never saw any sustained decrease in BP from

the typical regimen of any form of acupuncture plus patent meds that could not

be explained by other concurrent changes such as diet and exercise. Not just

talking about myself, but also the patients seen by dozens of others supposedly

skilled px in school clinics. Even high does herbs are not very effective and I

was always dismayed to learn how many senior herbalists from China took BP meds

as they aged as a result. sadly, I predict controlled evidence will ultimately

show that acupuncture is good for some musculoskeletal problems and herbs for a

wide range of minor complaints. But this medicine is not going to turn out to be

the salvation of the world. If you really could cure things like hepatitis or

lupus with TCM, the chinese would be making hay out of it instead of racing

headlong into their embrace of modern science and cutting edge therapies like

stem cells. Chinese med is a nice safe alternat

ive to the drugstore for many of the minor things that ail people. no miracle

cures hiding anywhere.

-------------- Original message ----------------------

" " <

> Hi All,

>

> Bad news: the SHARP trial reported no benefit from AP over sham AP in

> treating hypertension (BP: systolic 140-179mm Hg; diastolic 90-109mm Hg).

>

> I have not been able to access the full text but the abstract is below:

>

> Hypertension. 2006;48:838.) ï¿½ 2006 American Heart Association, Inc.

> Original Articles Stop Hypertension With the Acupuncture Research

> Program (SHARP) Results of a Randomized, Controlled Clinical Trial Eric A.

> Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James

> Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens;

> Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M. Zusman

> From the New England Research Institutes (E.A.M., L.A.K., S.S.),

> Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.),

> Watertown, Mass; Childrenï¿½s Hospital Boston (L.A.K.), Boston, Mass;

> Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B., R.M.Z.),

> Harvard Medical School, Boston, Mass; Samueli Institute (C.G.), Alexandria,

> Va; and the School of Medicine (R.J.P.), Wake Forest University, Winston-

> Salem, NC. Correspondence to Eric A. Macklin, New England Research

> Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail

> EMacklin Case studies and small trials suggest that

> acupuncture may effectively treat hypertension, but no large randomized

> trials have been reported. The Stop Hypertension with the Acupuncture

> Research Program pilot trial enrolled 192 participants with untreated blood

> pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design of the

> trial combined rigorous methodology and adherence to principles of

> traditional Chinese medicine. Participants were weaned off

> antihypertensives before enrollment and were then randomly assigned to 3

> treatments: individualized traditional Chinese acupuncture, standardized

> acupuncture at preselected points, or invasive sham acupuncture.

> Participants received 12 acupuncture treatments over 6 to 8 weeks. During

> the first 10 weeks after random assignment, BP was monitored every 14

> days, and antihypertensives were prescribed if BP exceeded 180/110 mm

> Hg. The mean BP decrease from baseline to 10 weeks, the primary end

> point, did not differ significantly between participants randomly assigned to

> active (individualized and standardized) versus sham acupuncture (systolic

> BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the difference: -4.0

> to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95% CI for

> the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing participants by

> age, race, gender, baseline BP, history of antihypertensive use, obesity, or

> primary traditional Chinese medicine diagnosis did not reveal any subgroups

> for which the benefits of active acupuncture differed significantly from sham

> acupuncture. Active acupuncture provided no greater benefit than invasive

> sham acupuncture in reducing systolic or diastolic BP. Key Words:

> acupuncture o blood pressure o hypertension o randomized clinical trial o

> traditional Chinese medicine

>

> Best regards,

>

May 4, 2007

Ah, that's too bad, I guess I'll have to tell my patients I've helped

with hypertension over the years that it didn't really work. Also,

I'll have to tell all the patients I've treated over twenty-five

years with menstrual disorders, insomnia, digestive problems, and

other conditions that acupuncture only treats musculoskeletal disorders.

On May 4, 2007, at 2:28 PM, wrote:

> shocking. in 13 years of practice, I never saw any sustained

> decrease in BP from the typical regimen of any form of acupuncture

> plus patent meds that could not be explained by other concurrent

> changes such as diet and exercise. Not just talking about myself,

> but also the patients seen by dozens of others supposedly skilled

> px in school clinics. Even high does herbs are not very effective

> and I was always dismayed to learn how many senior herbalists from

> China took BP meds as they aged as a result. sadly, I predict

> controlled evidence will ultimately show that acupuncture is good

> for some musculoskeletal problems and herbs for a wide range of

> minor complaints. But this medicine is not going to turn out to be

> the salvation of the world. If you really could cure things like

> hepatitis or lupus with TCM, the chinese would be making hay out of

> it instead of racing headlong into their embrace of modern science

> and cutting edge therapies like stem cells. Chinese med is a nice

> safe alternat

> ive to the drugstore for many of the minor things that ail people.

> no miracle cures hiding anywhere.

>

> -------------- Original message ----------------------

> " " <

>> Hi All,

>>

>> Bad news: the SHARP trial reported no benefit from AP over sham AP in

>> treating hypertension (BP: systolic 140-179mm Hg; diastolic

>> 90-109mm Hg).

>>

>> I have not been able to access the full text but the abstract is

>> below:

>>

>> Hypertension. 2006;48:838.) ï¿½ 2006 American Heart Association, Inc.

>> Original Articles Stop Hypertension With the Acupuncture Research

>> Program (SHARP) Results of a Randomized, Controlled Clinical Trial

>> Eric A.

>> Macklin; Peter M. Wayne; Leslie A. Kalish; Peter Valaskatgis; James

>> Thompson; May C.M. Pian-Smith; Qunhao Zhang; Stephanie Stevens;

>> Christine Goertz; Ronald J. Prineas; Beverly Buczynski; Randall M.

>> Zusman

>> From the New England Research Institutes (E.A.M., L.A.K., S.S.),

>> Watertown, Mass; New England School of Acupuncture (P.M.W., P.V.),

>> Watertown, Mass; Childrenï¿½s Hospital Boston (L.A.K.), Boston, Mass;

>> Massachusetts General Hospital (J.T., M.C.M.P.-S., Q.Z., B.B.,

>> R.M.Z.),

>> Harvard Medical School, Boston, Mass; Samueli Institute (C.G.),

>> Alexandria,

>> Va; and the School of Medicine (R.J.P.), Wake Forest University,

>> Winston-

>> Salem, NC. Correspondence to Eric A. Macklin, New England Research

>> Institutes, Inc, 9 Galen St, Watertown, MA 02472. E-mail

>> EMacklin Case studies and small trials suggest that

>> acupuncture may effectively treat hypertension, but no large

>> randomized

>> trials have been reported. The Stop Hypertension with the Acupuncture

>> Research Program pilot trial enrolled 192 participants with

>> untreated blood

>> pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design

>> of the

>> trial combined rigorous methodology and adherence to principles of

>> traditional Chinese medicine. Participants were weaned off

>> antihypertensives before enrollment and were then randomly

>> assigned to 3

>> treatments: individualized traditional Chinese acupuncture,

>> standardized

>> acupuncture at preselected points, or invasive sham acupuncture.

>> Participants received 12 acupuncture treatments over 6 to 8 weeks.

>> During

>> the first 10 weeks after random assignment, BP was monitored every 14

>> days, and antihypertensives were prescribed if BP exceeded 180/110 mm

>> Hg. The mean BP decrease from baseline to 10 weeks, the primary end

>> point, did not differ significantly between participants randomly

>> assigned to

>> active (individualized and standardized) versus sham acupuncture

>> (systolic

>> BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI for the

>> difference: -4.0

>> to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -2.81 mm Hg, 95%

>> CI for

>> the difference: -3.6 to 0.6 mm Hg; P=0.16). Categorizing

>> participants by

>> age, race, gender, baseline BP, history of antihypertensive use,

>> obesity, or

>> primary traditional Chinese medicine diagnosis did not reveal any

>> subgroups

>> for which the benefits of active acupuncture differed

>> significantly from sham

>> acupuncture. Active acupuncture provided no greater benefit than

>> invasive

>> sham acupuncture in reducing systolic or diastolic BP. Key Words:

>> acupuncture o blood pressure o hypertension o randomized clinical

>> trial o

>> traditional Chinese medicine

>>

>> Best regards,

>>

May 4, 2007

I agree with Zâ€™ev here 100%. There is no doubt CM has the ability to work (for

HBP and many other conditions). Just because a modern cookbook style TCM

approach may be found ineffective in some research, does not mean that CM cannot

treat that disease. Do you know how many approaches one could find for any given

complaint / condition. This is just with herbs. But in regard to acupuncture,

just putting a needle in IMO is far from â€œrealâ€ acupuncture, therefore any

standardized point (or herbal) prescription is a crap shoot either way (if it

will work or not). We love to jump up and down when it does work and laugh (or

cry) when it doesnâ€™t. But clearly no one practices this way, or at least the

practitioners that I respect and the ones that I see get bomber results. So why

perform research in a way that the medicine is not practiced? IMO there is only

one way to research CM, the way it is practiced (with placebos and all) â€“ Put

it as a whole, straight up against what ever your testing.

IMO, â€œTrueâ€ CM in practice literally relies on its ability to see the

individual and customize treatments. This is not some clichÃ© holistic mumbo

jumbo, but clearly demonstrated in the CM literature by anyone who has spent

time reading pre-modern or modern case studies. Clearly it is my experience, and

doctors that I have followed, that it can effectively treat the very difficult

diseases. Not just musculoskeletal. To judge CM with some base sample

prescription (with some mods) is just not how the great doctors (that I have

observed or read about) practice. It is comparing apples and oranges.

Over simplification? Just because the current trend in China is to modernize and

simplify the medicine with standardize protocols etc does not mean that

practicing in an (opposite) individualized fashion doesnâ€™t work, X does not

negate Y. Quite frankly it is very hard to practice at the level that really

makes use of all information (past and present) and writes individualized

formulas, essentially practicing CM the way it is designed to. So why is China

doing what they are doing? This is a complicated question and answer. But China

is currently teaching to the masses, never before done like this. One school I

recently visited (ZheJiang) had over 10,000 students enrolled. (BTW- only around

33% of them end up practicing, most looked like they for 18-20 years old, oh,

they were).

This western modernization has little to do with effectiveness, there are many

factors, including economics (as always). Why are McDonalds popping up all over

China? Training in China has many problems like we do.

To put thing in perspective, one has to look where much of the research, that

for example Bob has extensively published, comes from. For example, for a PHD

thesis many students decide to do some easy research project, taking some base

prescription with mods etc and putting it to the test for a given disease. Just

like what we commonly read in the journals. When I was talking with the students

they said, yes it is easy, you can be done in a few months. This is great for

the many who just want there PHD and be out. The alternative is doing some

classical literature research (or whatever) which can take years. Granted this

(former) type of research can result in the newest and greatest patent for

disease X, which does happen, but come on, this is not the in the trenches

medicine. Granted there are all levels of doctors, there are those that just

give xiao yao san over and over, but again let the results speak for themselves.

Judging the medicine on its lowest common denominator makes little sense to me.

Not to toally bash the Chinese, because they have 1 distinct advantage. The

student who does want to break out of the box has almost unlimited resources

compared to us. There are old doctors to study with, TCM libraries that I

estimate are over 1000x bigger than the average school US TCM library to access

material. There are young doctors that are totally rebelling against this modern

trend and are very vocal about it!

Addressing Toddâ€™s 15 year observations: Do you think it is fair to gauge how

well the medicine performs by years of watching students in a western school

clinic? I have much respect for Todd and his herbal abilities, but in the three

school clinics I have been in, I can only laugh at the level of medicine. I am

not saying I am any better and I was at one time one of those fumbling students.

But putting a 75 year old Chinese doctor to the test makes much more sense then

concluding that CM doesnâ€™t work from meager observations, especially with the

relatively poor level of practice that goes on in the states (at least herbal

medicine). Even supervisors prescriptions in the school clinic are not a fair

judge, they rarely spend much time with patients and rely many times of the

students observations and perspectives.

There are many levels and CM has a black hole of knowledge if one desires to

access it. It is not easy, but testing simflied approaches (the way that is

happening) is just Western medicine testing CMâ€™s tools, not CMâ€™s thinking!

Finally, because of all of this, I think standardization is a double edged

sword, and the many Chinese I have spoke with agree. It is a complex arena and

many differing opinions. There are many ideas and articles on the subject.

-

_____

On Behalf Of

Friday, May 04, 2007 5:31 PM

Re: Acupuncture no better than sham in hypertension - SHARP Trial

Ah, that's too bad, I guess I'll have to tell my patients I've helped

with hypertension over the years that it didn't really work. Also,

I'll have to tell all the patients I've treated over twenty-five

years with menstrual disorders, insomnia, digestive problems, and

other conditions that acupuncture only treats musculoskeletal disorders.

On May 4, 2007, at 2:28 PM, (AT) comcast (DOT) <%40comcast.net> net

wrote: