I’ve been critical of the National Center for Complementary and Integrative Health (NCCIH), which was until relatively recently known as the National Center for Complementary and Alternative Medicine (NCCAM) ever since I first discovered that it existed, lo, these many years ago. When I first discovered NCCIH, what struck me is how much pseudoscience it funded, including fellowships and educational programs in “complementary and alternative medicine” (CAM), which has rapidly morphed into “integrative medicine” (i.e., “integrating” quackery into real medicine). There were many NCCAM-funded studies to mock, including studies of homeopathy, reiki, distance healing, and worse. More recently, under the current director, Dr. Josephine Briggs, NCCIH has moved to become (or at least appear) more scientific. To this end, although not ruling out funding studies on, for example, homeopathy, it has shifted its focus to “rebranding” modalities that are not really “alternative” but really in the realm of science-based medicine” as somehow being “integrative” or “complementary.” Nowhere has NCCIH been more blatant about this than pain management, in which NCCIH has basically claimed all non-pharmacologic interventions for pain as its own.
Just before the Labor Day weekend, the NCCIH published a press release, “Review Examines Clinical Trial Evidence on Complementary Approaches for Five Painful Conditions.” Elsewhere, NCCIH Lead Epidemiologist and first author of the review, Richard Nahin, PhD, MPH, bragged on the NCCIH blog, “New Review Offers Providers and Researchers Evidence-Based Information on Complementary Health Approaches for Pain.” It didn’t take long for headlines to start appearing that said things like:
- “NIH Study Gives Primary Care Docs Needed Evidence to Complement Chronic Pain Treatments“
- “Review Suggests Safe, Effective Ways to Relieve Pain Without Meds“
- “Yoga, Acupuncture Can Help Some Pain, Studies Find“
You get the idea.
The NCCIH even held a Twitter chat on Thursday under the #talkpain hashtag to promote its new review, which had been carried by Nahin in conjunction with other investigators at the NCCIH. Co-authors included Robin Boineau, MD, MA, a medical officer at the NIH; Partap S. Khalsa, DC, PhD, a chiropractor and Deputy Director, Division of Extramural Research—yes, Deputy Director; Barbara J. Stussman, BA; and Wendy J. Weber, ND, PhD, MPH, a naturopath and Branch Chief, Clinical Research in Complementary and Integrative Health Branch, Division of Extramural Research. If you want to know why NCCIH supports so much pseudosciene, look no further than it having chiropractors and naturopaths in high ranking positions. Basically, this is a review by NCCIH for NCCIH believers.
I must admit that the Twitter chat was amusing. It was scheduled for 1 PM Thursday. Normally at that time I’m still in clinic, as I’m seldom able to finish my Thursday morning clinic before 1 PM, but I’ve noticed that my clinic is often slow on weeks before major holiday weekends, and this week was no exception. Not only was I finished before 1 PM, but I had had time to stop at the food court and get myself some grub to chow as I watched the festivities, which consisted of a whole lot of credulity, with a few skeptics interjecting some reality every now and then.
Did the review article—not an original study!—rate the promotion? Let’s find out.
Framing CAM as “non-pharmacological interventions”
The first thing I feel the need to point out here is the framing of this article, which borrows heavily from the framing used by advocates of “complementary and alternative medicine” (CAM), or, as it is now more frequently called “integrative medicine” (or, as I like to call it, integrating pseudoscience and quackery into medicine). That framing derives from a common device used by CAM advocates since the 1990s at least, in which potentially science-based interventions based on lifestyle changes, such as dietary interventions and exercise, were co-opted as being somehow “CAM,” even though there was nothing “alternative” about them. Even after CAM morphed into “complementary and integrative” approaches, there’s nothing “complementary” about these science-based methods, either, or at least there shouldn’t be. After all, what is the first science- and evidence-based intervention for type II diabetes? It’s to alter the diet, lose weight, and exercise, with the hope of reversing it, or at least preventing the need to begin pharmacological management. Ditto hypertension. I remember when I was first diagnosed with hypertension several years ago, partially likely thanks to the curse of genetics but also partially due to my sedentary lifestyle. My doctor insisted on at least three visits to see if I could bring it down without drugs, even though I thought it was too high for that. I couldn’t; so I ended up on an antihypertensive. Anecdotal evidence? Sure. However, it demonstrates that a lot of primary care doctors don’t go straight to the prescription pad, contrary to the stereotype promoted by CAM advocates.
So here’s where the framing gets more sophisticated, as it does in this review article. After co-opting sensible and potentially science-based lifestyle interventions as being “complementary” or “integrative,” CAM advocates, such as Nahin et al, divide interventions into two categories, “pharmacological” and “non-pharmacological.” Naturally, CAM claims all the non-pharmacological interventions for its own, furthering the stereotype that science- and evidence-based medicine is about nothing more than drug therapy:
Back pain, joint pain, neck pain, and headaches are among the most common types of pain experienced by US adults (Table 1).3, 4, 5, 6 The prevalence rates for these conditions have remained relatively stable over time. Among the many pharmacological and nonpharmacological approaches that have been incorporated into pain management strategies are complementary health approaches. This broad category of care includes procedures by licensed practitioners such as acupuncturists, chiropractors, and massage therapists, as well as self-care approaches such as relaxation techniques (eg, meditation) and meditative movement-based approaches (eg, yoga and tai chi) and natural products such a glucosamine and herbal medicines. National surveys going back more than 25 years have consistently found that these complementary approaches are used by about 30% to 40% of the US public in a given year,7, 8, 9, 10, 11 although use of a given approach may wax and wane over time (Table 2).
There is no doubt that chronic pain has become a major public health problem. Flowing from this public health problem has been an epidemic of abuse of prescription opioids, an issue that has recently been prominently covered in the press and recognized by the CDC as a massive public health problem, causing a record number of deaths in 2014. So there’s no doubt that finding science-based non-opioid strategies for patients with chronic pain to obtain relief is very important, arguably one of the top three or five priorities for public health in the US. Naturally, whenever there’s a public health problem, CAM advocates see an opportunity to promote pseudoscience, such as acupuncture. Of course, the CAM modalities examined range from quackery (acupuncture) to potentially helpful and science-based but co-opted by CAM (various exercise approaches like tai chi and yoga) to supplements, which, when they work, are basically pharmacological interventions disguised as nonpharmacological interventions.
The evidence base for CAM interventions for pain: Methods
In their review, Nahin et al examined existing evidence addressing the efficacy, effectiveness, and safety of seven common CAM approaches: acupuncture; spinal manipulation or osteopathic manipulation; massage therapy; tai chi; yoga; relaxation techniques including meditation; and selected natural product supplements, including chondroitin, glucosamine, methylsulfonylmethane (MSM), S-adenosyl-L-methionine (SAMe), and omega-3 fatty acids. They examined these interventions in five common painful conditions: back pain, osteoarthritis, neck pain, severe headaches and migraine, and fibromyalgia. Their methodology is described thusly:
The randomized, controlled clinical trial (RCT) is considered the strongest study design for investigating the efficacy and safety of pharmacological, behavioral, and physical interventions. To identify examples of RCTs for each complementary approach, we performed searches of the MEDLINE database for articles published from January 1, 1966, through March 31, 2016, using the search strategy outlined in Supplemental Appendix 2 (available online at http://www.mayoclinicproceedings.org). In order to make this review as relevant as possible to primary care physicians in the United States, we limited this review to RCTs either proformed [sic] in the United States or that included participants from the United States. This decision was based on 2 factors. First, the unique health care system in the United States vs other countries means that the standard care or usual care control groups used in the United States and other countries may vary substantially. Thus, whether a given complementary approach performs better than usual care in another country may not reflect how the approach would perform in US trials. Another factor is that the training and licensure of acupuncturists, chiropractors, and naturopathic doctors vary substantially among countries, as does the marketing, regulation, and use of dietary supplements. For instance, in Germany, the location of some of the largest acupuncture trials, acupuncture is only practiced by medical doctors, whereas the vast majority of acupuncture treatment in the United States is provided by licensed acupuncturists. Thus, the findings from German trials may not be directly comparable to acupuncture as practiced in the United States.
Notice something here? One sentence stood out: “Thus, whether a given complementary approach performs better than usual care in another country may not reflect how the approach would perform in US trials.” I can’t recall how many times I have pointed out that a given intervention will nearly always perform better than usual care. In acupuncture trials, for instance, acupuncture virtually always produces better results than “usual care.” What matters is whether an intervention performs better than a sham control. In the case of acupuncture, the evidence is very clear. Acupuncture does not perform better than sham acupuncture using the “wrong” acupuncture points or retractable needles that disguise to both practitioner and patient whether the needles actually enter the skin. As I like to say, it doesn’t matter where you stick the acupuncture needles. It doesn’t even matter if you stick the needles in, my favorite example being a German study that used toothpicks twirled against the skin as its sham control and found no difference between “true” or “verum” acupuncture over sham. That’s because acupuncture is nothing more than theatrical placebo.
Be that as it may, basically a trial result on efficacy or effectiveness was termed “positive” if the CAM approach led to statistically significant improvements in pain severity, pain-related disability, and/or function, compared to the control group. A negative result meant that there was no difference between the intervention and control groups.
The evidence base for CAM interventions for pain: Results
The first thing I noticed reading this review is that, contrary to the headlines about the review, the actual results of the review were far more measured and—dare I say it?—wishy-washy. Of course, it is always thus for CAM, where the requirements of publishing in the peer-reviewed literature demand discussing all the caveats and weaknesses of a finding. Keeping that in mind, here are the conditions and CAM treatments for which Nahin et al reported “positive” results:
- Acupuncture and yoga for back pain
- Acupuncture and tai chi for osteoarthritis of the knee
- Massage therapy for neck pain—with adequate doses and for short-term benefit
- Relaxation techniques for severe headaches and migraine.
Let’s take a look at acupuncture for back pain, as reported by Nahin et al:
We found 4 RCTs (total participants, 1092)15, 16, 17, 18 that assessed the clinical benefit of acupuncture for treatment of low back pain (LBP) (age range, 28-60 years; most participants were white) and used primary study outcomes of self-report of pain intensity (numeric rating scale or visual analog scale [VAS]) and/or functional disability (Roland-Morris Disability Questionnaire, Oswestry Disability Index [ODI], or Disability Rating Index). Cherkin et al15, 16 reported modest improvement in pain intensity and function compared with usual care. In pregnant women using auricular acupuncture, Wang et al17 found a significant reduction in pain intensity and improved functional status compared with no treatment. Comparison of verum to sham acupuncture had mixed results, with 2 RCTS16, 18 finding no significant difference and 1 RCT17 finding a slight but significant difference. No significant adverse events were reported.
This is the very definition of a negative review. The only clearly positive results were found in studies that compared acupuncture versus usual care or no treatment and only one study comparing “verum” acupuncture to sham showed a positive result, that result being “slight but significant.” To me, “slight but significant” means small and statistically significant but almost certainly not clinically significant. This sort of result is very common in studies of treatments that are no better than placebo controls, and the proper way to report this would have been that there is no good evidence that acupuncture does better than sham/placebo for low back pain. Worse, nowhere in the review is there any rigorous formal assessment of the quality of the studies that were used to do the review.
We see the same dance with phrasing with yoga and back pain:
We identified 6 RCTs of yoga for cLBP57, 58, 59, 60, 61, 62 (total participants, 596; all adults, predominantly female). Three named forms of yoga were studied: hatha,57, 58 viniyoga,59, 60 and iyengar61, 62; all were performed in group settings, with class durations from 60 to 90 minutes and the number of sessions ranging from 12 to 24, either once or twice per week, with recommendations for home practice. Compared with usual care, 2 studies59, 60 found that yoga provided improvements in pain and function, but the results were mixed when compared with exercise/stretching. A dose-response study57 compared once-weekly to twice-weekly classes and found that they produced equivalent improvements in pain intensity and function. Three smaller studies compared yoga with wait list58, 61 or education control62 and reported significant modest reductions in pain intensity and function/disability. No RCTs reported significant adverse events.
Note again that the only unequivocal differences were between yoga and usual care and that even then there was no detectable “dose-response” effect. Even then, the effects were modest, completely consistent with placebo effects. Like acupuncture, when a sham intervention (non-yoga stretching) was compared with acupuncture, the results were “mixed.” They’re always “mixed” with placebo medicine. Again, the correct way to report this result would have been that stretching exercises appear to help compared to doing nothing (although placebo effects can’t be ruled out) and that there’s no good evidence that yoga is any better than any other form of stretching exercises for low back pain.
Tai chi also falls into this category as a form of low impact exercise designed to emphasize body awareness and control; there is no good evidence that it is significantly better than other forms of low impact exercise for pretty much anything, including pain. That doesn’t stop actual high profile CAM advocates from somehow differentiating it from exercise. No less a figure than Dr. Brent Bauer at the Mayo Clinic even tries to separate tai chi from other forms of exercise:
I have many chronic pain patients who aren’t able to exercise – I often have them try tai chi, as gentle way to get moving again #talkpain
— Brent Bauer (@babmd) September 1, 2016
A certain “friend” of this blog would have none of it:
Tai chi is a form of exercise! #talkpain https://t.co/4E6fh9a623
— David Gorski (@gorskon) September 1, 2016
Seriously, one more time: What is tai chi but a form of slow, gentle exercise?
Then there’s acupuncture and osteoarthritis:
Four RCTs examined whether acupuncture could relieve symptoms associated with OA of the knee.87, 88, 89, 90 These studies used similar definitions of knee OA. Participants were predominantly female, had mean ages between 60 and 65 years, and had knee pain for an average of 9 to 11 years. All studies incorporated either the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score or the WOMAC pain subscore as the primary outcomes. In 2 of the trials,89, 90 no difference was seen between verum acupuncture and sham acupuncture for either the primary or secondary outcome measure. The third trial,87 which used a sham control, found significantly better improvement in both the WOMAC pain subscale and function subscale after 14 weeks of treatment. For the 3 trials that also incorporated either an attention control87 or standard care controls,88, 90 verum acupuncture produced significantly better improvement in primary and secondary outcomes than that observed in the control group.
I could just cut and paste the paragraph I wrote after the section on acupuncture for low back pain, substitute the word “osteoarthritis” for “low back pain,” and adjust the numbers to match the paragraph above, and it would fit just as well. This is the very definition of a negative review, just like the one for acupuncture and low back pain. Acupuncture, being the theatrical placebo it is, does better compared to no treatment, education, or wait list controls. Compared to sham acupuncture, the results are “mixed” with only one study being “positive,” as in statistically significantly positive, even though it’s almost certainly not clinically significant.
And so it goes with the other comparisons. It’s OK, though, for CAM aficionados, because they know that the popular press will strip their findings of all those pesky ambiguities and make it sound as though the results were far more positive than they were. Meanwhile, the quack press takes the reports and gives them headlines like Alternative Treatments Reduce Pain Safely, something this NCCIH review definitely does not demonstrate.
The selling of “integrative medicine” by NCCIH
I’ve sometimes noted that NCCIH is not as bad when it comes to ran pseudoscience as it was a decade ago, when it was still NCCAM. Since Dr. Josephine Briggs took over several years ago, there have been fewer blatantly pseudoscientific “studies” funded, such as homeopathy, distance healing, and the like, and a shift towards varieties of CAM that seem less quacky on the surface. Indeed, I have not been able to find a study of homeopathy for which NCCIH provided grant support since 2008.
However, this shift towards co-opting sensible and potentially science-based modalities such as diet and exercise, because of its insidiousness, is no less harmful, particularly given the presence of outright quacks like chiropractors and naturopaths in high-ranking positions within NCCIH. Basically, reeling from all the negative studies it funded of truly “alternative” treatments, NCCIH has seen an opportunity to seem relevant by more tightly co-opting “nonpharmacologic treatments for pain,” rebranding them as somehow “integrative” or “complementary,” and then lumping them together with the remaining pseudoscience that has enough seemingly-positive studies combined with enough popularity among naturopaths and other quacks that help oversee NCCIH, to imply that the whole “integrative package” is the answer to our opioid abuse crisis.
For instance, here, co-author and naturopath Wendy Weber claims that this reviews does address whether these therapies work, neglecting to point out that it shows that they almost certainly don’t:
She also basically admits, with a whole lot of hand waving, that we don’t know the mechanisms by which “complementary” therapies “work” for pain. Of course, that’s because the ones reviewed almost certainly do not, hoping that “future research” will answer those questions. Oh, and, Congress, keep funding us to do studies like the ones chiropractor and co-author Partap Khalsa wants to see:
In other words, let’s do more tooth fairy science and study differences in effects in different populations, mechanism, dosage, and the like without actually having conclusively demonstrated beforehand that the treatments under study actually do work.
As I noted before, NCCIH is now emphasizing as its key scientific priority pain and difficult-to-control symptoms, in particular nonpharmacologic methods of relieving pain. This review clearly is a result of that priority. Unfortunately, this review also demonstrates just how little promise there is in the specific “nonpharmacological approaches” rebranded as CAM examined. Basically, this review is most consistent with none of them working for chronic pain. However, NCCIH can’t admit that, which is why the NCCIH has discussed how to do “innovative clinical trials” by using “pragmatic clinical trials to address questions about the integration of complementary health approaches into health care systems, or to study the effectiveness of complementary or integrative approaches in comparison to standard care.” Unfortunately, pragmatic trials are trials that are done only after more rigorous trials actually show that an intervention works, with the intent to see how it works in the “real world.” Doing pragmatic trials of treatments not yet shown to work is putting the cart before the horse.
That’s pretty much CAM in a nutshell, at least CAM that doesn’t have infinitesimally small prior probability, like homeopathy. Basically, NCCIH is proposing to study how these CAM modalities work without having established that they work, as it rebrands plausible potential “nonpharmacologic” treatments as CAM. Why does it do this? Because it has to. To steal a phrase from Harriet Hall about naturopathy: What CAM offers that is helpful is not unique, and what it offers that is unique is not good. As Steve Novella put it, this review and #talkpain were basically a scam.
33 replies on “NCCIH: Co-opting “nonpharmacologic” treatments for pain as being “alternative” or “complementary””
Laughable is, the acupuncturists will discuss meridians and energy flow, an energy that is immeasurable, in an era when we can measure what’s going on in a single nucleus of an ion and even in a single electron.
Making this, osteopathic and chiropractic manipulation all medicines better taught at Hogwarts.
Which has an equal statistical distribution with their alleged, likely cherry picked findings.
Where a report of improvement of 0.1% is observed, with a 0.5% margin for error…
Plain PT&OT can perform far better than the nonsense that was quoted! With real, peer reviewed studies.
This is the core deceit of integrative medicine,as you and others have identified many times. Alternative medicine is really alternatives to proven medicine, and in order to try to confer legitimacy they co-opt valid therapies that were never remotely alternative, pretending that these are in their realm and then claiming that in order to get the benefits of these therapies you also have to let Dr. Bullshit in the door.
Meditation for pain like headaches is biofeedback by another name. You can measure biofeedback, somewhat, by looking at vital signs. I’ve used biofeedback successfully for mild to moderate migraines . . . but it only lasts as long as I’m doing the biofeedback. As soon as I stop, the pain returns. I’ve found it to be useless as a general rule, since I need to be able to break the migraine so I can return to activities that require a certain level of concentration, like working. I don’t know anyone who has migraines who successfully uses meditation or biofeedback.
Calling biofeedback meditation is indeed letting Dr. Bullshit in the door, as Guy says. There’s nothing mystical or mysterious about meditation, but the quacks want you to buy the whole enchilada if even one piece looks like it might work.
@ Panacea #3
It may depend on severity, but I find some of the biofeedback techniques for migraines (as well as some CBT techniques) can help me be functional through the pain of my migraines (enough I can stay at work).
Unfortunately the pain meds that do anything for the headaches that have been tried to date either don’t do much, or make me less functional than just periodically relaxing the muscles that tense up while I have the headache and using distraction to moderate my experience of the pain. One reason sometimes I do better at work than at home with a migraine is I usually have some task that requires enough attention to detail at work that can block my awareness of the pain.
Although it is going to depend on symptoms. Some pain is too great to be distracted from, and sometimes blurry vision or other visual issues make it difficult to do some of the work that will distract me enough to blunt the pain.
Now should the migraines get severe enough we may have to try some other medications, but so far things haven’t been bad enough to do additional trial and error to see if this drug or that drug will break/block the pain and leave me capable of working rather than have to lay down until the drug wears off.
I used to get some heavy migraines. I found that Imitrex and Zomig (the only two I tried) worked quite well. I’ve literally been back to work within the hour with a single IM injection (they’re in tablet form as well, as I recall).
The migraines have since changed in character, I’ll still get the aura, but no pain. Just this:
Lasts between 20 minutes and a hour, which is a *lot* less time than a migraine used to last, if untreated.
My migraines stopped when I was diagnosed coeliac and changed my diet, but when I got them I found sumatriptan worked well.
So, how is this better than good old fashioned physical therapy?
I have pretty severe back pain and PT has been a miracle for me.
Migraines – Imitrex also comes in a nasal spray. I could never take the pills when I had migraines because of severe nausea. The spray helped. Fortunately, I only get the occasional optical migraine these days. I’m sorry that all of you are suffering with them. It can be pretty terrible.
Migraines suck eggs to put it mildly. I get terrible migraines and have since childhood, including the occasionally ocular migraine (temporary blindness, scary and it happened at work once).
Triptans were a miracle drug to me. Other drugs worked but not well. The good news is, they worked every time. I could predict how I would feel one hour later. Other drugs worked as well, but took longer to get rid of the migraine completely, or got me to rebound more quickly, or had problems with alertness (opioids).
Biofeedback only worked while I was doing it which isn’t helpful when you need to earn a living. “Natural” remedies simply did not work at all.
I did try chiropracty for awhile. But before he adjusted my neck, I either had a session with a massage therapist or he used what is essentially a TENS unit on me . . . which makes me wonder why I needed the chiropractor; did the adjustment actually do anything for the migraine at all?
See it’s stuff like this that made me give up on “natural” or CAM therapies. They either just steal from regular medicine or it’s a load of expensive but useless crap therapies.
Anecdote alert: in seeking help for chronic pain for an elderly person, my conclusion was that everything worked… For two to three months. Then the treatment stopped working. More likely the placebo effect ended and hope that the promises were real died. My point is that any study that doesn’t last for at least six months, preferably longer, isn’t worth the paper it’s printed on nor the electrons consumed. It’s just another example of how we fool ourselves. Many of the interventions were real medical options offered by real doctors. Their only commonality was that they all failed over the long term.
I’m not being critical of the doctors, except the ones who, when they ran out of their pet options, recommended quackery. This is a very difficult, perhaps intractable problem. Deluding ourselves with quack treatments will only delay us in our search for a solution, if one exists.
It would be interesting to run a study where all the participants do the same exercises, but for half of them the exercises have fancy yoga-y names, and for the other half they have dull descriptive names. (Ex: Volcano pose vs hands-over-head standing stretch)
# 7 Taysha
So, how is this better than good old fashioned physical therapy?
I have pretty severe back pain and PT has been a miracle for me.
I have has low-grade neck pain for many years and managed to compound this with a rotator cuff injury.
Four or five sessions of physical therapy combined with continued use of the exercises the physiotherapist gave me did wonders. Neck pain almost completely gone as long as I remember to do the daily exercises.
There are lots of nonpharnacologic interventions that can help people in pain. I have used some, and every practitioner that I knowuses them too. Of course, each one has to be chosen to fit the patient, meaning of course, that it is individualized treatment, one of the holy grails of woo–based medicine.
Everybody knows the value of heat/cold , rest, and immobilization. For some weight reduction or other lifestyle changes will help. Physical and occupational therapy almost go without saying.
Some pain sufferers hold on to their pain for a secondary benefit, such as avoiding unpleasant situations. Substituting a better secondary benefit can help. Other non-physical interventions include anxiety reduction, distraction, and a demonstration that the pain is taken seriously; as one nurse I knew from a 3rd-world country put it, “So many problems can be solved with a cup of tea and a little chat.”
I wonder how long it will be until the Wonderful World of Woo either co-opts or denounces them.
I am an Acupuncturist, and a damn good one at that. I see patients come in because the “science based PILL POPPING PROFIT machine” has failed them over and over again! Why don’t YOU tell these people the relief they FINALLY got from ACUPUNCTURE is quackery! I dare ya…
OK, your customers were taken for a ride, they received care equal to that of a placebo.
Could you be more specific about this evaluation scale?
“Could you be more specific about this evaluation scale?”
Why don’t YOU tell these people the relief they FINALLY got from ACUPUNCTURE is quackery! I dare ya…
Dear imaginary customers, you’re the victims of quackery.
To the clients of Lizette Mullen:
The relief you are feeling from acupuncture is the by-product of quackery. What is making you feel better is not the alignment of your qi by the stimulation of acupoints on your meridians, since neither acupoints or meridians exist in the physical reality of your body. Rather, your relief comes from your expectations, attitudes, interactions with Ms. Mullen, and the ritual of the procedure. Research studies have repeatedly shown that, all other things being equal, you would experience the same relief if a ‘sham acupuncturist’ poked at random spots on your skin with toothpicks as long as you thought you were receiving ‘acupuncture’ . Acupuncture is quackery because it’s claims are manifestly false, but yes you may nevertheless feel some relief after visiting Ms.Mullen. You may experience more relief from a session with Ms. Mullen than you would with other acupuncturists, other quacks, or other sorts of therapists. You might be able to get as much or more benefit from other less costly activities that offer some departure from your daily routine. If you decide the relief you feel from visiting Ms. Mullen is worth it to you, you must understand that this is symptomatic relief only. Acupuncture will have no effect whatsoever on whatever underlying disease or injury is the source of your discomfort. If you are in enough distress to seek relief from acupuncture, you should without question have your condition diagnosed, monitored and treated by a competent MD. Also, know that acupuncturists have no diagnostic skills for real conditions, and any explanation Ms. Mullen gives you for the source of your distress will be nothing but twaddle, or, at best, a layperson’s guess.
I hereby double-dog dare Mullen to indeed tell her clients the above. Hand-outs to each arriving customer would be nice, but a large poster in the waiting room would do.
@sadmar #20, thanks for the reminder.
I had forgotten, after wife “helped me” by misfiling the referral, to schedule my PT for my shoulder.
First order of business on Monday!
It might have been simpler to suggest linking to the original comment. There seems to be some confusion on the part of the degree-granting institution, though.
Whatever sells, I guess.
Ah, nowhere as good as my alma mater, Wossamotta U. 😉
Yes, it’d be nice to see evidence on how outcome differs between the ministrations of a “damn good” acupuncturist and one who is just so-so.
I have to think Ms. Mullen is one of the “damn good” ones though, since she’s affiliated with the Midwest College of Oriental Medicine, which offers such dynamic courses as:
“A302 Chinese Medical Pathology 2 – This course further studies the eight principle theory as it applies to the pathology of the five phases, the Zang Fu organs and the triple burner.”
“A312 Accessory Techniques – Students will attend lectures, demonstrate and practice in the traditional and modern accessory techniques of Oriental Medicine: moxibustion, magnets, guasha, cupping and auricular techniques.”
Indeed, the judicious use of magnets simultaneously with cupping has been known to draw offending organs completely out of the body, so they can be disposed of without further interrupting the flow of vital Qi.
[…] medicine,” even though they are simply part of medicine. I pointed this out a mere two weeks ago when I discussed the National Center for Complementary and Integrative Health (NCCIH) review of non-pharmacological […]
… including chondroitin, glucosamine, methylsulfonylmethane (MSM), S-adenosyl-L-methionine (SAMe), and omega-3 fatty acids. They examined these interventions in five common painful conditions: back pain
Our cumulative family experience is that missing components or inadequate doses can render this list ineffective. This list misses (mega)vitamin C and D as important possible components for rapid effect. Tested doses in the studies are inadequate for us too, we usually need higher loading doses.
Some people require vitamin D intake (far) above even the new “upper limit” of 4000 iu to have minimally adequate blood levels and will suffer arthritic pains until repleted. The old RDA of 200 iu vitamin D and the slow change, show the unscientific threads that dominate(d) over mainstream medicine and nutrition. (hint: unmonitored deficiencies in magnesium and vitamin K2 will probably be allowed to sabotage progress in vitamin D)
[…] little over a month ago, I wrote about how proponents of “complementary and alternative medicine” (CAM), now more frequently […]
[…] little over a month ago, I wrote about how proponents of “complementary and alternative medicine” (CAM), now more frequently called […]
I’m a long-time reader-love your blog. Thanks for discussing this! I have Ehlers-Danlos Syndrome Type 3/Hypermobility type as well as several compressed discs in my spine from a car accident. I need surgery and narcotic pain meds not WOO. This entire article is fulled with the stupid tripe of woo I keep getting pushed toward EVERYTIME I SEE ANY DR. This BS is exactly what chronic pain sufferers endure when we try to seek treatment and management from: the scientific medical community. Really? YES. I want science-based medicine to treat my back injury and pain issues from my disorder yet every Dr suggests this “alternative” woo nonsense. Trying to refer me to chiros-groan-I dislocate and I don’t want to have a stroke or otherwise, and/or get more disc compression and pain. Trying to sell me “health IVs” of multi-vitamins that aren’t covered by insurance. I don’t need that. I’m not a celeb w/ a hangover, I’m an actual sick person. Even our EDS and Marfan conferences for any updates on new treatments for connective-tissue disorders shovel this at us. I want REAL medicine to help me. Instead, I’m told I need surgery but I can’t be prescribed pain meds from a PAIN MANAGEMENT DR and then, (insert any form of woo) is suggested. I understand the DEA laws, but not treating patients w/ meds when they need them doesn’t make sense. I wish more Drs would stand up and stop promoting this alternative BS to me and everyone at our conferences. The only way to kill quackery is to help patients w/ REAL medicine. Hopefully, your blog can continue fighting the power.
I find it odd that many to most pain management doctors that you’re referred to are pushing woo over evidence based medicine, that they’re apparently claiming DEA regulations is, well frankly, BS.
My wife was prescribed, with no difficulty, narcotics for her pain by our primary, while the specialists fight over who will get to care for us (because, when one neurosurgeon refused to fill out the insurance company questionnaire in order to have an MRI authorized, he suggested we find another doctor, which we promptly did. Once our primary filled out the form properly, the MRI was performed and suddenly that physician wants her back, sorry Charlie, we follow doctors orders). She’s up to morphine ER bid and hydromorphone qid prn breakthrough pain.
When my wife started to take a fall, I caught her and am showing every sign consistent with disc herniation, complete with spasms in both calves with sciatica. I have my hydrocodone sitting in front of me right now, currently at 5 mg q 6 hrs.
So, I’d suggest you investigate your referring physician’s referral habits and how many are suggesting woo, then see what your primary thinks of that woo.
It might be time to find a new primary.
[…] as “nonpharmacological” approaches to chronic pain. Indeed, a couple of months ago, NCCIH even published a rather poor quality systematic review that purported to show that some forms of CAM were effective against chronic pain and represented […]
[…] Health (NCCIH) in particular (such as Edzard Ernst, Steve Novella, Michael Vagg, and, of course, yours truly), in which he compared critics of the NCCIH review to Donald Trump. This was, of course, before the […]
[…] We don’t even have a working definition of “integrative medicine,” although experience tells us that incorporating diagnoses and treatments with insufficient evidence of safety and effectiveness is an acceptable element of integrative practice, as is rebranding “conventional” practices as “integrative.” […]