Apparently well-designed low back pain AP study produces potenti

May 13, 2009

I stand by my comment. What it says is that allopathy is basically garbage when

it come to LBP. Somebody spent time enough with the patient to give them pills.

Don Snow DAOM, MPH

Chinese Medicine

alonmarcus

Wed, 13 May 2009 09:43:09 -0700

Re: Apparently well-designed low back pain AP study produces

potenti

Don

perhaps all the study says is that spending any time with a patient works more

then giving them a pill and sending them home

May 13, 2009

Alon,

One huge assumption that is largely overlooked, is that we think we understand

all that there is with anatomy and physiology and can therefore construct a

reliable experiment. That assumption along with the idea that acupuncture is

about pain relief is inaccurate.

The Japanese have successfully focused upon shallow or non-insertion technique

with good effects for hundreds if no thousands of years. Like the idea that a

toothpick is no better than an actual needle insertion only suggests that maybe

focal pressure can also stimulate things. Shudo Denmai happens to think

superficial technique works, and he has been in practice a lot longer then most

of us.

Let us not forget that back then there was no special-interest industry that

proclaimed to own truth such as the research wing of the medical industrial

complex.

Michael W. Bowser, DC, LAc

Chinese Medicine

alonmarcus

Wed, 13 May 2009 09:50:10 -0700

Re: Apparently well-designed low back pain AP study produces

potenti

Hugo

if you dont find it a little disturbing i think it shows a very strong positive

bias. Regardless of possible problems, and i do not know much about the details

of the individualized acup in the study, showing no diff in groups is quite

disturbing. Unless we can show differences i am afraid we will start having

trouble as a profession. Science is not going to change so that we can excuse

such failures. If we have a better way to show efficacy that still conforms to

objective assessment then we should do it. Otherwise it all sounds like excuses

in the face of evidence

May 13, 2009

It would be nice to see what the immediate results of treatment were after each

treatment, " sham " or otherwise. All we have is the final outcome. If

toothpicks work with immediate relief, we may as well quit because you don't

need a license for that.

This so-called study is somehow suspect, although I am not yet sure how or why.

Most of us have been practicing long enough to know something is suspect here.

I'd like to see the raw data and the numbers.

Dr. Don Snow, DAOM, MPH, L.Ac.

Chinese Traditional Medicine

naturaldoc1

Wed, 13 May 2009 18:16:09 +0000

RE: Re: Apparently well-designed low back pain AP study produces

potenti

Alon,

One huge assumption that is largely overlooked, is that we think we understand

all that there is with anatomy and physiology and can therefore construct a

reliable experiment. That assumption along with the idea that acupuncture is

about pain relief is inaccurate.

The Japanese have successfully focused upon shallow or non-insertion technique

with good effects for hundreds if no thousands of years. Like the idea that a

toothpick is no better than an actual needle insertion only suggests that maybe

focal pressure can also stimulate things. Shudo Denmai happens to think

superficial technique works, and he has been in practice a lot longer then most

of us.

Let us not forget that back then there was no special-interest industry that

proclaimed to own truth such as the research wing of the medical industrial

complex.

Michael W. Bowser, DC, LAc

Chinese Medicine

alonmarcus

Wed, 13 May 2009 09:50:10 -0700

Re: Apparently well-designed low back pain AP study produces

potenti

Hugo

if you dont find it a little disturbing i think it shows a very strong positive

bias. Regardless of possible problems, and i do not know much about the details

of the individualized acup in the study, showing no diff in groups is quite

disturbing. Unless we can show differences i am afraid we will start having

trouble as a profession. Science is not going to change so that we can excuse

such failures. If we have a better way to show efficacy that still conforms to

objective assessment then we should do it. Otherwise it all sounds like excuses

in the face of evidence

May 13, 2009

Hi Alon and everyone!

Alon, you raise eactly the point I was trying to bring up, and which I wrote an

aborted post on last night.

First off, I think you are right that lots of legitimate points sound like

excuses in light of this and other " evidence " .

I think you are right that we need to show efficacy otherwise we are going to

be in big trouble.

I do not find the idea of science not changing reasonable. Everything changes,

and we can enact that change. The only reason that there is so much research

into diet, herbs and " CAM " is due to a REACTION by the medical research

profession to public behaviour and non-biomedical systems of healthcare.

In fact I think that one of the things we need to do is to change science. But

that means that we, as a profession, have to start to have a much more

authoritative voice. Many people agree with us, but without a voice, that power

is squandered.

On a personal level, I find it inexcusable to believe that I have to reject my

personal experience because some massaged data spits out numbers that indicate

weak effect. Lies, darn lies and statistics. I point everyone, *again*, to the

work of Ioannidis, so that we can lose some of our stupendous naivete towards

the fantabulous accuracy of numbers. Here's the link, and the paper is called:

WHY MOST PUBLISHED RESEARCH FINDINGS ARE FALSE.

As you wait for the paper to load, please meditate on Sir Arthur Eddington's

statement about math and numbers:

" We have learnt that the exploration of the external world by the methods of

physical science leads not to a concrete reality but to a shadow world of

symbols, beneath which those methods are unadapted for penetrating. " [my

emphasis]

I have personal, direct experience of a HUGE, MONSTROUSLY COMPLEX system and my

attempts to work with it and influence it, and these studies are not up to

scratch. They have no ability to focus on true complexity or to parse the

meanings in the data.

The whole method of modern research was derived from studying small,

CONTROLLABLE samples and systems. Modern medical research is showing its age and

will, hopefully sooner rather than later, be recognised as a 21st century

example of newtonian physics. Good to a point, but in the end, missing the

point.

We are so impressed with the ability of modern science to build a jetliner, or

computers (or this great acer I'm typing on, I love this thing, it's got this

beautiful blue colour on the lid), in reliable, controlled fashions. When is

someone going to stand up and say, definitively, that the human body and the

system it interacts with is orders of magnitude more complex than these toys,

and that research methods appropriate for simplistic devices is completely

wasted on real systems?

Systems research has touched on some of these problems for several decades -

such as the field of cybernetics, which was something TCM researchers latched on

to almost from the beginning of but none of these methodologies come close

to the suppleness and fidelity of CM theory.

A relatively new discipline developed in China *as a response to the attributes

of * is termed O.C.G.S - Open Complex Giant Systems. I don't

necessarily believe that the solution is in there, but the problem is being

recognised. The field is also fluid right now, and we can impact it if we choose

to do so as a profession.

Some links on OCGS:

Check Fig 2 on page 5:

http://www.formatex.org/micte2006/pdf/746-751.pdf

(the word 'wisdom' made it on to an engineering chart)

and systems science:

http://www.tinyurl.com/pgpfwv

Special application of OCGS:

http://www.tinyurl.com/qen4yc

To finish off; it is so evident to me that the points I choose, the order and

depth of insertion, the type of manipulation, my state of mind and the patient's

state of mind, all have important, reliable, effects, that I find my gaze jaded

when it comes to what passes for " evidence " and " studies " these days. Maybe they

should be called " confoundings " instead of " studies " . The mass of complexity

present in a human interaction is not addressed in even the best of healthcare

studies. Qualitative research is gaining steam in fields other than medicine -

and their opinion is: it's very difficult and expensive to do, but it leads to a

whole new picture, and 'control' cannot be handled in the conventional

" gold-standard " sense.

In the end, *if the study cannot CONTROL the variables, then the study is

profoundly flawed*. Most, if not all, studies don't even know what the major

variables are, and believe it or not, it's not the needle. Talk about a red

herring.

Hugo

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

________________________________

Alon Marcus <alonmarcus

Chinese Medicine

Wednesday, 13 May, 2009 12:50:10

Re: Apparently well-designed low back pain AP study produces

potenti

Hugo

if you dont find it a little disturbing i think it shows a very strong positive

bias. Regardless of possible problems, and i do not know much about the details

of the individualized acup in the study, showing no diff in groups is quite

disturbing. Unless we can show differences i am afraid we will start having

trouble as a profession. Science is not going to change so that we can excuse

such failures. If we have a better way to show efficacy that still conforms to

objective assessment then we should do it. Otherwise it all sounds like excuses

in the face of evidence

www.integrativeheal thmedicine. com

May 13, 2009

Alon - why are the results a failure? It seems to me that it's saying that

stimulation of these points had an effect. Since there are styles of

acupuncture that don't insert (notably Toyahari), since there are practitioners

that do energetic work with their hands and without needles - since there was

one member of this list that suggested using a toothbrush to stimulate on

children, which I've done with surprising effect... using a toothpick with

intent could be very effective.

karen

Karen R. Adams,

Lic Ac, Dipl Ac

25 - 27 Bank Row

Greenfield, MA 01301

413-768-8333

Do or do not.

There is no try.

Yoda, The Empire Strikes Back

________________________________

Alon Marcus <alonmarcus

Chinese Medicine

Wednesday, May 13, 2009 12:50:10 PM

Re: Apparently well-designed low back pain AP study produces

potenti

Hugo

if you dont find it a little disturbing i think it shows a very strong positive

bias. Regardless of possible problems, and i do not know much about the details

of the individualized acup in the study, showing no diff in groups is quite

disturbing. Unless we can show differences i am afraid we will start having

trouble as a profession. Science is not going to change so that we can excuse

such failures. If we have a better way to show efficacy that still conforms to

objective assessment then we should do it. Otherwise it all sounds like excuses

in the face of evidence

www.integrativeheal thmedicine. com

May 14, 2009

Just a reminder that of the six classical categories of insertion:

Superficial, Deep, Multiple, Bleeding, Follow the Channel puncturing and

Diverse puncturing,

there are four specific needling methods under the Superficial category:

Mao ci (Hair puncturing), Ban ci (Half...), Fu ci (Floating) and Zhi ci

(Straight in...)

(The Art of Acupuncture Techniques by Robert Johns pgs. 122-125 :

Six types of Insertion according to the Nei Jing)

So, it's not a Japanese invention, but has been around for over 2000 years

in China.

It's not the tool... it's the user

so, just because anyone can prick the skin with a toothpick,

it doesn't mean they know where or how to stimulate it.

Koji Ichihashi used to say that when there wasn't a needle around,

he would use a toothpick or the cap of a pen and it would be very helpful.

Of all the diverse ways that acupuncture works, stimulating the skin itself

has an effect on the underlying tissues. To what degree.. that's the

question.

Isn't this concurrent with most of the studies that are out there...

that shows that needle insertion acupuncture is more effective than

non-therapy,

but not statistically more effective than the so-called " placebo "

non-insertion needles.

K

On Wed, May 13, 2009 at 12:02 PM, Karen Adams <turusachan wrote:

>

> Alon - why are the results a failure? It seems to me that it's saying that

> stimulation of these points had an effect. Since there are styles of

> acupuncture that don't insert (notably Toyahari), since there are

> practitioners that do energetic work with their hands and without needles -

> since there was one member of this list that suggested using a toothbrush to

> stimulate on children, which I've done with surprising effect... using a

> toothpick with intent could be very effective.

> karen

>

> Karen R. Adams,

> Lic Ac, Dipl Ac

> 25 - 27 Bank Row

> Greenfield, MA 01301

> 413-768-8333

>

> Do or do not.

> There is no try.

>

> Yoda, The Empire Strikes Back

>

> ________________________________

> Alon Marcus <alonmarcus <alonmarcus%40wans.net>>

>

> To:

Chinese Medicine <Chinese Medicine%40yaho\

ogroups.com>

> Wednesday, May 13, 2009 12:50:10 PM

> Re: Apparently well-designed low back pain AP study produces

> potenti

>

> Hugo

> if you dont find it a little disturbing i think it shows a very strong

> positive bias. Regardless of possible problems, and i do not know much about

> the details of the individualized acup in the study, showing no diff in

> groups is quite disturbing. Unless we can show differences i am afraid we

> will start having trouble as a profession. Science is not going to change so

> that we can excuse such failures. If we have a better way to show efficacy

> that still conforms to objective assessment then we should do it. Otherwise

> it all sounds like excuses in the face of evidence

>

> www.integrativeheal thmedicine. com

>

May 14, 2009

Hey Alon and all:

I will take this time to reiterate that true neutrality does not exist in

humans. A strong bias is always present, including in biomedical researchers.

Hugo

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

________________________________

alon marcus <alonmarcus

Chinese Medicine

Thursday, 14 May, 2009 14:57:49

Re: Apparently well-designed low back pain AP study produces

potenti

" This so-called study is somehow suspect, although I am not yet sure

how or why. Most of us have been practicing long enough to know

something is suspect here. I'd like to see the raw data and the

numbers. "

If this statement does not show strong bias i do not what does

400 29th St. Suite 419

Oakland Ca 94609

www.integrativeheal thmedicine. com

alonmarcus (AT) wans (DOT) net

May 14, 2009

Hi Alon:

As per a longer post of mine from yesterday, I think, what do you think of the

idea that studies in acupuncture are done backwards currently - that we need to

know how to assign and control for diagnosis / assessment / slection BEFORE we

study the intervention?

Hugo

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

________________________________

alon marcus <alonmarcus

Chinese Medicine

Thursday, 14 May, 2009 14:55:24

Re: Apparently well-designed low back pain AP study produces

potenti

Mike

i am more disturb by the fact that there is no diff between

individualized treatments and none. The other problem is that you cant

take this study out of context. There is a growing body of studies

that shows no diff between real treatment groups and sham regardless

of the sham used. These studies are based on self reporting and i

would hate to think what we would see if objective tests were to be

used. I just cant believe this attitude that just justifies anything

regardless of what we find. Back pain is one of the most difficult

medical problems and without extensive inclusion data beyond the usual

almost useless criteria is hard to assess, i will definitely give you

that.

400 29th St. Suite 419

Oakland Ca 94609

www.integrativeheal thmedicine. com

alonmarcus (AT) wans (DOT) net

May 15, 2009

Hi Alon, I also find the studies troubling in terms of how they are portraying

us. I personally find them laughable and amateurish. My personal viewpoint

doesn't change the immense potential damage to our credibility, however, as you

say.

I wonder if we can draw parallels between barefoot doctors and their formulaic

+ simplistic version of CM to the notions that are arising from some current

western research.

I feel that our stumbling block will not be in physiological / biochemical /

neurological research, but in clinical studies, which are adept at mangling the

clinical encounter into an absolutely incomprehensible mess. I am conclusive in

my opnion of clinical studies as being deeply naive of complexity and humanity.

This must be addressed. The whole can not be reduced. This is a law; a reality.

I, personally, believe that we need to make our true, uncompromised voice heard

at all levels of society, but primarily for our patients. They are a powerful

force of change just waiting to be activated.

I truly believe that as a profession we are in a position to grow and provide

missing and essential guidelines and viewpoints. I don't see why we should shy

away from what is an obvious call (to me!) for our profession to start showing

its true colours - which is a non-obsessive clinical dialogue tolerant of

paradox, ambiguity and diversity. It is time to call modern medicine's obsessive

compulsive monistic complex what it is.

There are inroads slowly being made in surprising places - such as in law with

intellectual property rights for indigenous peoples being successfully protected

more and mroe often, and biopiracy being recognised for what it is - the illegal

and unnacceptable co-optation ofindigenous property and knowledge.

" It is no longer debatable that human intervention by indigenous and traditional

peoples all over the world played and continues to play a crucial role in the

development and sustenance of plant species and genetic resources across the

globe. "

[...]

" Rather than being vigorously protected and genuinely respected, traditional and

indigenous peoplesâ€™ knowledge systems have been ridiculed by the dominant

epistemology

and legal culture. To add insult to injury, the products of indigenous

and traditional knowledge frameworks and cultures are continually appropriated

through legal constructs and commercial rules fashioned by the industrialized

North.

Consequently, the unauthorized appropriation of indigenous peoples bio-cultural

knowledge and resources, otherwise known as â€œbiopiracyâ€(Mgbeoji, 2005;

Dutfield,

2004), has proceeded and flourished as if it were a lawful and morally

justifiable

enterprise (RAFI, 1995a, 1999; Shiva, 1999; Villaema, 2000). "

(Mbeoji 2007)

I do not buy into this dialogue of helplessness that I so often hear in this

and other forums. If we allow it, it will happen. If we don't, it won't. That

simple.

I had a long conversation with one of the TCM bigwigs in here in Toronto /

Canada. This lady clearly believes all the above, but is tired of the fight,

which is fine; she is approaching retirement. I am wondering what the younger

generation is up to: integration or an intelligent and uncompromised dialogue

with WM?

I knwo that the above is heavily biased.

I am saying that we have to pick our bias and take our stand. WM has picked its

bias and taken its stand and is forcefully promoting its viewpoint.

Hugo

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

________________________________

Alon Marcus <alonmarcus

Chinese Medicine

Friday, 15 May, 2009 14:56:44

Re: Apparently well-designed low back pain AP study produces

potenti

Hugo

I agree that is much that needs to be understood when studying acup. There are

many needs that are not common in other studies. Regardless, the fact that the

bigger the study the less specific effect, and now just using toothpicks, is

quite troubling. It definitely questions the need for a profession. We are

sounding like a group that is completely blind to evidence, truly reminds me of

the anti global warming crowd. If it only take is toothpick why pay for our

education? why pay a professional for treatment? why not just give cookbook

handout to people and hand them toothpicks? that would be a lot cheeper

www.integrativeheal thmedicine. com

May 15, 2009

I think one of the main problems is that we don't get to design the studies.

That is one of the main problems with not having a doctoral requirement. If you

want to be a licensed psychologist, you carry out some piece of research AND you

get a very good grounding in research designs, potential biases in studies,

statistical interpretation, etc. And as a result all psychological research is

being done BY psychologists, not by the medical community. Right now the Ac

schools don't see preparation for research as part of their mission, and we are

not at the table included in the discussion because we essentially don't have

the skills.,.

Regards,

Angela Pfaffenberger, Ph.D.

angelapfa

www.InnerhealthSalem.com

Phone: 503 364 3022

-

Hugo Ramiro

Chinese Medicine

Friday, May 15, 2009 12:41 PM

Re: Re: Apparently well-designed low back pain AP study

produces potenti

Hi Alon, I also find the studies troubling in terms of how they are portraying

us. I personally find them laughable and amateurish. My personal viewpoint

doesn't change the immense potential damage to our credibility, however, as you

say.

I wonder if we can draw parallels between barefoot doctors and their formulaic

+ simplistic version of CM to the notions that are arising from some current

western research.

I feel that our stumbling block will not be in physiological / biochemical /

neurological research, but in clinical studies, which are adept at mangling the

clinical encounter into an absolutely incomprehensible mess. I am conclusive in

my opnion of clinical studies as being deeply naive of complexity and humanity.

This must be addressed. The whole can not be reduced. This is a law; a reality.

I, personally, believe that we need to make our true, uncompromised voice

heard at all levels of society, but primarily for our patients. They are a

powerful force of change just waiting to be activated.

I truly believe that as a profession we are in a position to grow and provide

missing and essential guidelines and viewpoints. I don't see why we should shy

away from what is an obvious call (to me!) for our profession to start showing

its true colours - which is a non-obsessive clinical dialogue tolerant of

paradox, ambiguity and diversity. It is time to call modern medicine's obsessive

compulsive monistic complex what it is.

There are inroads slowly being made in surprising places - such as in law with

intellectual property rights for indigenous peoples being successfully protected

more and mroe often, and biopiracy being recognised for what it is - the illegal

and unnacceptable co-optation ofindigenous property and knowledge.

" It is no longer debatable that human intervention by indigenous and

traditional

peoples all over the world played and continues to play a crucial role in the

development and sustenance of plant species and genetic resources across the

globe. "

[...]

" Rather than being vigorously protected and genuinely respected, traditional

and

indigenous peoplesâ€™ knowledge systems have been ridiculed by the dominant

epistemology

and legal culture. To add insult to injury, the products of indigenous

and traditional knowledge frameworks and cultures are continually appropriated

through legal constructs and commercial rules fashioned by the industrialized

North.

Consequently, the unauthorized appropriation of indigenous peoples

bio-cultural

knowledge and resources, otherwise known as â€œbiopiracyâ€(Mgbeoji, 2005;

Dutfield,

2004), has proceeded and flourished as if it were a lawful and morally

justifiable

enterprise (RAFI, 1995a, 1999; Shiva, 1999; Villaema, 2000). "

(Mbeoji 2007)

I do not buy into this dialogue of helplessness that I so often hear in this

and other forums. If we allow it, it will happen. If we don't, it won't. That

simple.

I had a long conversation with one of the TCM bigwigs in here in Toronto /

Canada. This lady clearly believes all the above, but is tired of the fight,

which is fine; she is approaching retirement. I am wondering what the younger

generation is up to: integration or an intelligent and uncompromised dialogue

with WM?

I knwo that the above is heavily biased.

I am saying that we have to pick our bias and take our stand. WM has picked

its bias and taken its stand and is forcefully promoting its viewpoint.