Apparently well-designed low back pain AP study produces potenti

[Guest guest]

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

 

 

 

 

 

 

 

 

 

[Guest guest]

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

 

 

 

 

 

 

 

 

 

 

[Guest guest]

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

 

 

 

alonmarcus

 

 

 

 

 

 

 

 

[Guest guest]

" 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

 

 

 

alonmarcus

 

 

 

 

 

 

 

 

[Guest guest]

white as well give you lic away and hand out toothpicks

 

 

 

400 29th St. Suite 419

Oakland Ca 94609

 

 

 

alonmarcus

 

 

 

 

 

 

 

 

[Guest guest]

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

 

 

 

 

 

 

 

 

 

 

[Guest guest]

By the way do we know the background of any of the people that did the

NIH study? Who did the individualized treatments?

 

 

400 29th St. Suite 419

Oakland Ca 94609

 

 

 

alonmarcus

 

 

 

 

 

 

 

 

[Guest guest]

Hugo

while i agree medical research needs to be much less reductionist, and

we need to add to the voices that demand such studies, it is

possible. My dad has been doing longitudinal studies for many years

using complex non reductionists statistical models. At the same time,

back pain for example can be assessed on using basic measurable

outcomes. The biggest problem i see, and it is even worse with CM

folk, is that most do not understand backpain and still cling to ideas

such as most back pain is not idiopathic and therefor clump patient

groups with very different causes making analysis more difficult. The

larger the study the lower these problems play a role but they cannot

be ignored.

That said it is possible to study back pain, i have not had a chance

to actually read this study, only the press so i cant comment on these

issues. It does look like they tried to address some of our concerns

in older studies which makes it more disturbing to me.

As far as ones' own experience, i would argue that looking at it is

the least reliable way to learn about outcomes. Beside the fact that

we all see only that which we are looking for, our own personal

patient population is not a reliable witness for many reasons. And

very few of us use any true objective assessment tools with

significant followup to give us reliable information. I agree with

Angela we need to have our institution participate in high quality

research. I have found the lack of interest in such activities very

suspicious as good research is what allows for better recognition

which we all claim to want.

 

 

 

 

400 29th St. Suite 419

Oakland Ca 94609

 

 

 

alonmarcus

 

 

 

 

 

 

 

 

[Guest guest]

Hello all:

 

I posted this article originally, and I'm now back from a trip, so here

are my thoughts:

Some kinds of acupuncture may be " non-specific " for certain conditions,

including pain. For example, my own experience with using AP-school TCM

for pain was that it was hard to correlate what I did with any results

therefrom. Then I tried certain Master Tong points, as well as Richard

Tan points, and things got interesting. I also noticed that very

superficial needling could produce results, but they were very specific.

Each point would change one specific distal area of tissues, for example

a rotated vertebra, and nothing else. And this began to correlate very

highly in my practice with improved results, as well as more accurate

prognoses.

But that, of course, is my experience.

In terms of the research, it is possible though that much acupuncture,

the " average " acupuncturist, for example, or " average " TCM, could be

essentially non-specific, activating healing responses regardless of

point choice or depth or any of the other seeming parameters we worry

ourselves with. On the other hand, maybe we should stop using the word

" acupuncture " and instead use " acupunctures " as someone once suggested.

This a heterogenous group of practices, many of which might do very

different things biomedically, some specific, some non-.

 

But this research is interesting. I think it has something to tell us. I

think saying, " Oh, research and science don't have anything to do with

my qi " (as some seem to be saying) is myopic and actually constricts the

truth, instead of deepening our understanding of it.

 

-Ben Hawes, L.Ac.

 

 

 

Posted by: " Hugo Ramiro " subincor

<subincor?Subject=%20Re%3A%20Apparently%20well-designed%20low%2\

0back%20pain%20AP%20study%20produces%20potenti>

subincor <http://profiles./subincor>

 

 

Sat May 16, 2009 7:33 pm (PDT)

 

 

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

<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 <http://www.tinyurl.com/pgpfwv>

 

Special application of OCGS:

http://www.tinyurl.com/qen4yc <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://middlemedicine.wordpress.com>

http://www.chinesemedicaltherapies.org

<http://www.chinesemedicaltherapies.org>

 

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[Guest guest]

Chinese Medicine , Hugo Ramiro <subincor

wrote:

>

 

Hi Hugo, Alon, Everyone

 

jumping in here ... great post Hugo

 

TCM is:

reliable

coherent

reproducible

 

It does require hypotheses, observation, and intervention, and assessment of

those interventions.

 

Why aren't we pushing for, and participating in studies which are outcomes

based? Surely the experiences and responses of patients themselves, must carry

the weight of validity?

 

And lets get this idea of gold-standards, and grades of evidence sorted right

now. The so-called gold standard of clinical research - the meta-analysis of

many randomly controlled, double blinded trials, is never going to be more than

an exercise in comparing apples - green ones, red ones, tart ones, sweet ones,

floury ones and pulpy ones. The one you use in the pie, is not the one you use

to make apple sauce, nor is it the most appropriate one to make juice.

 

The meta-analysis is at the pointy end of the pyramid of evidence based

medicine. The pyramid base is made up of the every day experiences and

observations of health practitioners the world over, going about their disparate

and daily professional lives, doing stuff with people, little of which sees the

light of day in a journal, or even a case-study discussion group.

 

We are all scientists

 

Margi

 

http://margihealing.wordpress.com/