Robert Imrie, David Ramey & AP in osteoarthritis of the knee

[Guest guest]

Hi All, & George,

 

Re the Berman article on AP in knee osteoarthritis [

http://tinyurl.com/6m62t ], George Mandler wrote:

> Here is another essay ripping apart the article from from another angle

> by Robert Imrie a DMV (heard of this guy Phil?) ... I think we can all

> agree on some of his comments, 'googling' him shows he takes vicarious

> pleasures in ripping acupuncture as fraud.)

 

Robert Imrie and David Ramey are veterinarians, who are very active

in Quackwatch / Quackbuster circles. In incisive and well researched

articles, they highlight the weaknesses of the entire CAM area, not

just acupuncture.

 

Drs. Imrie and Ramey are articulate and very able opponents of CAM.

Do not underestimate their abilities. IMO, anyone who tries to take

them on, attempting to cite scientific proof for most CAM therapies,

is on a hiding to nothing.

 

Many clever professionals oppose CAM. They adopt the concept of

" DIvide and Conquer " , which was so successful in the hands of the

generals of the ancient Roman armies.

 

For example, PubMed Medline has 17,518+ hits for the profile:

((acup* OR moxib* OR electro-acup* OR electroacup* OR su-jok OR koryo

OR acumoxa OR moxa OR dermojet) OR ((LLLT OR (LASER NEAR (cold OR

low)) AND (therapy OR treat* OR repair* OR heal OR health* OR

healing* OR rehab* OR regenerat* OR remodel* OR enhance* OR stimul*

OR biostim* OR efficac* OR success* OR inflamm*))) OR ((transcutan*

NEAR (electros* OR electric* OR neurostimulat*)) OR (stimulat* AND

(transcutaneous-electric* OR transcutaneous-electros*)) OR (((TENS

AND electric* OR electros*) AND stimulat*)) AND (therapy OR treat* OR

repair* OR heal OR health* OR healing* OR analges* OR rehab* OR

regenerat* OR remodel* OR enhance* OR stimul* OR biostim* OR efficac*

OR success* OR inflamm*)))

 

However, if one disalllows all keywords except (acup*), the number of

hits drops to 9802.

 

Of those, one can keep on subvividing. For example the profile (acup*

AND shoulder) has only 99 hits. One can further subdivide these into

pain, stiffness, paralysys, etc.

 

For example, (acup * AND shoulder AND paralysis) = 7 hits only

 

Then, if one uses the very high standards demanded by EBM-type

criteria to examine the individual papers in the highly fragmented

subsets, one can dismiss most of them on grounds of inadequate

design, numbers, lack of adequate controls, etc.

 

This approach leaves very few high-quality studies in any one subset

of the acup* data. Inevitably, most subsets are dismissed as not

proving the effect of acup* in THAT particular condition.

 

By eliminating each subset as " unproven " , one begins to see the

whole acup* set disappearing down the plughole.

 

Next, like the puff of smoke from the conjurer's hat, scientific

support for the efficacy of AP has disappeared. Ouch!

 

One can apply the same " divide-and-conquer principle " to any CAM

modality - herbal medicine, osteopathy, homeopathy, nutraceuticals,

etc.

is correct. We are atrociously weak as regards EBM-type

scientific validation of most of what we do as practitioners in AP /

TCM.

 

That is why CAM opponents are insisting that EBM standards be used as

the basis to assess CAM. They KNOW that we cannot defend ourselves on

that battlefield.

 

So, we have to make choices:

 

(a) Do we try to fight a battle on their (EBM) terms, KNOWING that we

MUST lose the main battle?

 

or

 

(b) Avoid THAT battle and focus instead on the political / PR battle,

in which clinical satisfaction of the PATIEBTS becomes the criterion

of success or failure of our methods?

 

Do you have other ideas on how the CAM-EBM war/battle can be fought?

 

IMO, it could take 50-100 years [assuming that research funding for

high-quality EBM studies could be found] to put EBM-type support

behind all of the the CAM cliniucal applications that we know are

useful.

 

Most of us will be dead by then.

 

Meanwhile, I expect that most of us will continue to use the methods

that work reasonably well for our patients.

 

Happy Christmas to you all,

PhilBest regards,

 

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