Sunday, April 11, 2010

Pricks

What do you call a treatment modality that is effective against a gamut of human diseases including Bell's palsy, arthritis, post stroke paralysis, sciatic pain, neuralgia, migraine headaches, insomnia, dizziness, neck and shoulder and back pain, anxiety disorders, depression, mood swings, asthma, colds, flu, allergies, bronchitis, sinusitis, hypertension, angina pectoris, arteriosclerosis, anemia, acute/chronic diarrhea, constipation, indigestion, gastritis, ulcers, irregular/painful menstruation, PMS, hormonal imbalance, infertility in men and women, menopausal symptoms, UTI, prostatitis, bladder/kidney dysfunction, sexual dysfunction, fatigue, tinnitus, diabetes, immune deficiency, debilitating disorders, bed-wetting, seizures, tobacco and alcohol addiction?*

It's called a panacea. Some, including myself, would describe it as snake oil.

Now think of a tested and proved treatment, whose biological/biochemical mechanism is supported by, among others, in vitro studies, which is able to address all of the above conditions. If there is one, I'm all ears.

Let's look at some of the most common proven treatments. Because of their "wonder drug" nature antibiotics immediately spring to mind. But even they are only effective against bacterial infections not viral, and each antibiotic has its limits as to which species it can lick. Worse, antibiotics are limited by the fact that evolution favors those freaking bugs eventually outsmarting our weapon of mass decimation. The sheer number of bacteria and their extremely fast reproductive cycles means selection forces can act within years instead of millennia and longer. So as life-saving and indispensable as antibiotics are, they still cannot address anything beyond bacterial infection.

Of course there's a slew of other drugs such as statins, NSAIDs/analgesics/antipyretics, SSRIs, H2 blockers and proton pump inhibitors, beta blockers, calcium channel blockers, anticoagulant/antiplatelet drugs, insulins, ... Yet none of them claim to be able to treat the above encyclopedia of diseases. (Even SSRIs whose efficacy is controversial aren't claimed to be effective against infections, asthma, diarrhea, etc.; in fact they may have adverse side effects)

What about surgery? Well, obviously there is a whole range of surgical procedures depending on the disease/condition one is addressing. Heart surgery obviously is not going to cure a fractured tibia nor will any doctor in his right mind even suggest it. Kidney transplant does nothing if one has healthy kidneys and a brain tumor. Angioplasty certainly isn't called for if one has appendicitis or diabetes or anxiety disorders or infertility or anything in the above litany except for (certain) blockages in arteries.


Now mull over whether drugs and surgery are sensible and how plausible they are. Penicillin for instance was discovered by accident in one experiment--where a mold gate-crashed and screwed up a bacterial party. Further in vitro experiments confirmed the action of penicillin. And you can do such petri dish experiments for the current trove of antibiotics and show how they can in fact mess up the colony. Of course just having a chemical kill a dishful of bacteria tells us nothing about how it will do in the human body. Isopropyl alcohol will kill a multitude of microbial species too. But there are good reasons doctors don't prescribe isopropanol for internal use. And so you perform animal studies and clinical trials to ascertain both efficacy and, more importantly, safety at the effective dosages.


All drugs including antibiotics are chemicals. So are food, water, and air. So are hemlock, ricin, botox, and poison ivy. The body is a chemical factory. So it stands to reason that ingesting a chemical or getting it intravenously can and may have an effect on the body.

The action of a host of surgical procedures is common sense. If you place a stent in a blocked carotid artery which restores the diameter of that pipe then obviously you address the constriction and improve blood flow. You can even measure the before and after flow rate using ultrasound. Transplants are just as common sense. They're a direct analogue of parts replacement in machines. Excision of tumors also makes sense, particularly when that tumor is putting pressure on surrounding tissues. Removal of that feckless appendix specially when it's become a bloated home for a million pathogens is just as sensible.

So at least with these common treatment modalities, none of them claim to address a broad sweep of unrelated disorders. And all of them have a physical/biological/biochemical even common sensical basis for how they work and how they are suppose to treat disease.


But there is (at least) one modality that boasts of actually being able treat that long roster of conditions above. And that's acupuncture. A short introduction to the theory behind acupuncture:
In TCM (traditional Chinese medicine), the body is seen as a delicate balance of two opposing and inseparable forces: yin and yang. The concept of two opposing yet complementary forces described in traditional Chinese medicine. Yin represents cold, slow, or passive aspects of the person, while yang represents hot, excited, or active aspects. A major theory is that health is achieved through balancing yin and yang and disease is caused by an imbalance leading to a blockage in the flow of qi. Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle. According to TCM, health is achieved by maintaining the body in a "balanced state"; disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qi. In traditional Chinese medicine, the vital energy or life force proposed to regulate a person's spiritual, emotional, mental, and physical health and to be influenced by the opposing forces of yin and yang. (vital energy) along pathways known as meridians. Qi can be unblocked, according to TCM, by using acupuncture at certain points on the body that connect with these meridians. Sources vary on the number of meridians, with numbers ranging from 14 to 20. One commonly cited source describes meridians as 14 main channels "connecting the body in a weblike interconnecting matrix" of at least 2,000 acupuncture points.

For illustrations of these meridians go here, here and here among others.

Could "meridians" be just a fancy name for the network of blood/lymph vessels or the nervous system or muscle groups or some other system within the body? Apparently not. Meridians are a completely different phenomenon from anything we currently know of human anatomy. Thus, if we dissect a cadaver and look for meridians, we can mince the whole corpse, but neither we nor acupuncturists will be able to find these channels. You can take a microscope or any other instrument and examine every square micron of the body internally and externally and you won't see these meridians nor will you discover what they're made of. They're not made of nerves, vessels, muscles, or any tissue. We can't see them via dissection or fMRI, X-ray, ultrasound, CAT scan, PET scan, etc.

Dissecting human cadavers was taboo in ancient China [Shapiro p.50, Ernst & Singh p.52]. Needless to say back then they didn't have anything remotely close to any of our imaging technology. So how did the Chinese "know" of the existence of meridians thousands of years ago? They didn't. They merely came up with the idea of a network of energy or vital force conduits and happily took it for granted and passed on the "therapeutic" tradition and its supposed mechanism of operation down the generations.

And what about the vaunted energy form called qi? What kind of energy is this: chemical, mechanical, thermal, electromagnetic, nuclear? Or is it some new form which the ancients knew about but which scientists have been unable to discover? How do you measure this energy? What instruments can be used to detect it? Energy has to come from somewhere. What produces qi? And since energy dissipates where does qi go? We know human biochemistry pretty well. Our energy comes from chemical reactions made possible through the food, water and oxygen we take in. What metabolic processes are involved? It seems these questions can't be answered. Qi is some "energy" that can't be detected, or perhaps can be detected but only subjectively--not unlike the "human energy field" which touch therapists claim to be able to detect. But then 9-yr old Emily Rosa's study--published in the prestigious Journal of the American Medical Association--effectively debunked the claim of practitioners--mostly nurses--that they can sense this energy field. So is qi yet another imagined phenomenon which would be equally debunked if subjected to a blinded test of detection? Will another 9-year old to put an end to thousands of years of nonsense?

There are meridians which can't be seen, qi which can't be objectively detected or quantified. And then there are postulated mechanisms of cure which make little sense: Disease is said to be caused by blocked or unbalanced qi, and acupuncture is the method by which the flow of qi is unblocked or rebalanced. What does unblocking and rebalancing qi mean biologically, physiologically, etc.? What are the physical, physiological, biochemical processes involved? What happens at the cellular level? Can this unblocking, rebalancing of the undetectable qi be detected and measured?

The onus of proof is of course upon those who make the claim for the existence of new postulated phenomena. But no evidence has been provided. On the other hand, we've been looking inside the human body for centuries. And since the last century we've been scanning it too.We've also measured signals coming from it. But meridians and qi are nowhere to be found. Which naturally leads to the question: How then do today's acupuncture proponents know that meridians and qi are not just human constructs, that they in fact have empirical reality? What's the difference, for instance, between unseen channels that conduct some force or energy (poorly and vaguely defined as they are) and unblocking and rebalancing that energy and the claim that all human disorders are caused by undetectable gremlins in the brain and that realigning gremlin aura in a particular way cures the person of their disease? Neither meridians nor gremlins can be found, neither qi nor auras are detectable much less measurable, neither unblocking/rebalancing qi nor realigning auras have been shown to actually occur. These phenomena have no existence beyond the crania of their proponents. Acupuncture (as is our gremlin theory of disease) is pseudoscientific from the git go.

Even some acupuncturists have already given up providing tangibility to these concepts. A brochure by the China Acupuncture Health Center in Westford, Massachusetts, for instance, admits, "you can't look at [qi] under a microscope, you can't detect it with any scientific instrument. You cannot isolate it in any form or substrate" [Shapiro, p.48]. Just like invisible gremlins and their aura. Felix Mann, founder and president from 1959 to 1980 of the (British) Medical Acupuncture Society, is most explicit and forceful about the nature of these ancient concepts:
Acupuncture points, in the traditional sense, do not exist.... Meridians, in the traditional sense, likewise do not exist. [Mann p.3-4]

Some [researchers] have tried to find acupuncture points or meridians by measurement of the electrical skin resistance. Those with a microscope have tried to find specialised structures in the skin or subjacent tissue. Those who have the use of infra-red photography, Kirlian photography or ultrasound have all diligently searched for the elusive acupuncture point. Some have been "successful" and have described their findings in journals.

If only these researchers had realised that the traditional acupuncture point does not exist! [Mann, p.5]

The meridians of acupuncture are no more real than the meridians of geography. If someone were to get a spade and tried to dig up the Greenwich meridian, he might end up in a lunatic asylum. Perhaps the same fate should await those doctors who believe in meridians. [Mann p.31]

Given how 1. there is not a shred of evidence for the existence of meridians and qi, 2. there is hardly any scientific rationale for how needling the skin can produce the plethora of claimed therapeutic effects, and 3. acupuncture is claimed to be a panacea, with the ability of treat infectious diseases, psychiatric, reproductive,  gastroenterological, musculo-skeletal, respiratory, ... disorders, the prior probability that it is an efficacious therapy is extremely low. Even prior to testing and conducting trials there is no good reason to believe that acupuncture should work, anymore than chiropractic manipulation of the spine or pinching various points on the butt will cure the said litany of diseases.

In fact acupuncture can be likened to that other pseudoscience--chiropractic. It postulates a phenomenon of subluxation or misalignment of the spine. As with blocked qi, subluxations are said to be the cause of diseases. And while needling can unblock and rebalance qi, spinal manipulation can correct subluxations and cure the patient of his ailment. Just a needling is a panacea, realignment of the backbone is touted to be a cure-all.

So can pin pricks treat the host of disorders mentioned above? We should be most skeptical that they can. 


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* This list of diseases comes from a pamphlet by Shenrong Liu, an acupuncturist who has a master's degree in Traditional Chinese Medicine from the Academy of Chinese Culture & Health Sciences in Oakland, California. She is (or was) a Chinese Medicine Physician in China and has been in practice for 20 years. She's currently practising TCM in the Philippines. In her pamphlet she writes, "According to the United Nation's World Health Organization, over seventy diseases can be treated effectively with acupuncture, including the following:" The above list of diseases then follows.


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References:

Edzard Ernst & Simon Singh. Trick or Treatment: Alternative Medicine on Trial. Bantam, 2008.
Felix Mann. Reinventing Acupuncture: A New Concept of Ancient Medicine, 2ed., Butterworth-Heinemann, 2000.
Rose Shapiro. Suckers: How Alternative Medicine Makes Fools of Us All. Harvill Secker, 2008.

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