Thursday, October 11, 2012

Acupuncture


One kind of neat thing I got to do in residency was acupuncture. There was an acupuncture clinic once a week and an attending would supervise us in performing acupuncture on patients.

As far as procedures went, it was pretty easy. The attending would point to a spot and we’d stick a needle there. Even if we were doing it “wrong,” we had no idea. And the patients all liked it and were very grateful.

Here’s how you do acupuncture as a resident:

1) Stick needles where attending tells you

2) Turn out lights in room and set timer for fifteen minutes

3) Go back and take out needles

4) Wipe needle sites with gauze “to keep the chi from escaping” and simultaneously roll eyes

At some point, I thought it might be nice to learn acupuncture for real and incorporate it into my practice someday. When I mentioned this to my father, he said, “So you want to be a quack then?” But I don’t believe acupuncture is quackery. At least, not entirely. If it’s done right, I don’t think it is. I have to wonder how many people in this country do it right.

I located a physician in my area who did primarily acupuncture, to learn more about it. She told me about a course for physicians who want to learn acupuncture, which involves several training sessions as well as hours of self-study. She recommended a book to me called The Web That Has No Weaver, about Chinese medicine.

She also told me that acupuncture isn’t “worth it” financially. That the only reason to do acupuncture is because you love it.

I finally decided that I didn’t love it enough or believe in it enough. That’s why I lost interest in acupuncture.

The only way I currently use acupuncture is when I’m doing EMGs. Apparently, the place where you put the needle to assess the first dorsal interosseous muscle is “a powerful acupuncture point” according to one of my former attendings. So I always tell that to patients, although I recognize that any effect my sticking a needle in there has is purely placebo.

17 comments:

  1. I had the opportunity to follow a physician trained in acupuncture from a well known university who performed it every couple of months on a patient with macular degeneration. The patient stated before the session she could not read words and her husband's face was a large blur to her. During the session, she commented on her vision improving enough to see the lines in the ceiling. Afterwards she was walking around reading everything aloud she could see. It may have been a placebo effect, but it was a very powerful one for that patient. I wouldn't mind a placebo that improved my vision.

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  2. Someone did a study a few years back on chronic pain patients, with some receiving "real" acupuncture and some "fake." Both groups reported significant pain relief.

    A lot of people read that as "acupuncture is bullshit because it isn't any better than placebo." I read it as "holy shit, placebo works really well for pain, let's do more of that."

    I suspect that works in two ways, apart from whether you believe in traditional Chinese medicine or not: one, the satisfaction of undergoing a procedure (hooray! we're doing something!) and two, the good feeling of receiving care and attention.

    Along similar lines, I read that some chronic pain patients see less relief than expected from non-narcotic pain killers because they've learned, subconsciously, to associate narcotic side effects with pain relief. When they don't feel woozy, their brains decide the drug isn't working, and it doesn't. I guess that's the reverse placebo effect?

    I'm with the first commenter: I don't care if it's the placebo effect if it works. You hear about the power of mind over body all the time, but most people can't turn that on and off at will. If those little needles will give me the boost I need to use my own brainpower, I'm all for it.

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    1. It is unlikely that "sham" acupuncture is truly a sham (a.k.a. "fake") treatment as even light touch has been shown by functional MRI to activate areas of the brain's limbic system. This raises the possibility that the sham acupuncture works, at least in part, by stimulating nerves that have some reliable clinical effect. If that's the case, we can't conclude much from any of the previous blinded acupuncture clinical trials.

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    2. If I remember correctly, in those studies they still stuck needles in people, just not in the "special acupuncture spots". So either it truly is a placebo, or needles randomly stuck in the skin have special healing powers.

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  3. I think we need more research to show us how to harness the awesome power of PLACEBO.

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  4. There's also spillover effects from this though. Does the fact that doctors are willing to recommend and perform alternative treatments like acupuncture for the placebo effect have any effect on the willingness of people going out and seeing, say, a homeopath instead of a real physician?

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  5. If you agree to treat someone who is not (physically) sick, you are validating their (fictional) disease.

    You as a DOCTOR are doing the opposite of giving a placebo, you are giving them a disease. Only a doctor, the power of a doctor can diagnose disease.

    In treating a patient you are confirming that the patient is ill.

    Have the strength to say "You are not sick".

    If you don't, the patient will look for the rest of their lives for a cure that doesn't exist.

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    1. That's really interesting, though I wonder how well it really works, particularly with people who either a) don't believe the doctor, or b) really are sick and the doctor is wrong.

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    2. And you don't have to be physically sick to legitimately need help/healing. Sometimes just acknowledging that something is difficult/painful is helpful. "you are not sick" can be alienating. "you are not suffering from any serious disease that I can see at this time, but I realize you are hurting and you may benefit from XYZ" can actually help.

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    3. "What if the patient IS sick?" you ask. Science can see "sick" on an Xray or blood test or some scientific test. Doctors are supposed to use science to heal people, not religion.
      The placebo effect is the power of religion. People believe in something so completely , they make it come true. http://mindhacks.com/2009/04/23/reverse-psychology-in-a-pill-anti-placebo/

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    4. This comment has been removed by the author.

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    5. Not true, Mark. Science is much more gray than black and white. One xray or CT scan (or even a cut-and-dry lab result) may look very different from one practitioner to the next. And that's not even addressing false-positives and negatives, when "science" is just plain wrong. It's the the total wholeness of the human being that makes both medicine and religion amazing (and effective) when used together.

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    6. You are a vampire, if you are lying to your patient to make them happy and selling some (addictive)drug or treatment(placebo).
      Religion is supposed to be a voluntary decision. If I don't worship you doctor , do I still have my freedom?

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  6. “Seeing my acupuncturist is not just about needling. She does so much more. She listens. When I go in, we spend the first few minutes just talking.” - I commend your acupuncturist for being conversational, Fizzy. It builds a personal connection between you and your doctor, you know. Also, it contributes in alleviating one’s condition in one way or another. Anyway, you’re right, a person is not meant to stay in his/her comfort zone for too long.

    Erik Denmon

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  7. I am ashamed at my ancestors for coming up with this cockamamie bullshit called acupuncture

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