Wednesday, 1 July 2015

Acupuncture, Shams, and Superstition

In 2012, I suffered the worst sports injury of my life. I completely traumatized the upper left quadrant of my body stopping just short of tearing my rotator cuff. I displaced the bones in my left hand and wrist. I put my elbow out of alignment. I pulled the long head of the biceps muscle out of the bicipital groove in my shoulder and I slightly herniated the C6 disc in my neck. I had two MRIs, 2 x-rays, visits to two GP’s, a neurologist, and a sports medicine specialist to diagnose this mysterious condition. I was in pain twenty-four hours a day, seven days a week for nearly five months. For ten months, I could barely move and had to be careful of how I moved for fear of causing myself more pain. I had shooting pains up and down my left arm and sometimes my right. My left hand, and occasionally my right, almost always felt tingly and sometimes went completely numb. As of this writing, three years later, my left index finger has only 75% feeling in it and still, once in a while, both hands have moments of tingling.

I do not know how I managed to survive this period of my life. It was, without a doubt, the worst health issue I have ever had. I was so desperate for relief, I told a colleague at work I would pay anybody ten thousand dollars cash, no questions asked, if they could make my pain go away. And because I was so desperate, I was willing to entertain any possible remedy. Stand on my head and spit nickels? Didn’t work.

Co-workers told me about alternative medicines: special diets, herbal supplements, balms, massage therapy, naturopathy, chiropractic medicine, and acupuncture. It all seemed farfetched, but when you’re frantic, you’ll latch onto anything. Two colleagues suggested an acupuncturist they themselves had visited, so I told myself I had nothing to lose except eight-five dollars.

Elise (name changed so I don’t get sued) was a nice enough lady, but I must point out she had no medical degree. She had been doing acupuncture for five years. We talked about my condition and the constant pain I was going through. She told me a single treatment would relieve my pain but only for twenty-four hours.

I had never done acupuncture before so it was curious to lie down on a table and have these various needles inserted in various places on my body. It’s been over three years now and my memory is a little fuzzy, but I believe there were positions on my hands, neck, forehead and feet. I didn’t have to disrobe, but obviously, I did have to take off my shoes and socks.

What were the results of this treatment? Never mind twenty-four hours, the treatment didn’t last twenty-four minutes. As soon as I stood up and put pressure back on my damaged body, all of my pain came back. Acupuncture did absolutely nothing to relieve my pain. I only did this one treatment and never went back.

However, I became curious about acupuncture and researched it. What was it? Did it work? Why were people promoting it and saying it was beneficial? I am a strong believer in the scientific method: independent scientists doing independent research independently arrive at the same results. This is what I found.

People have been questioning the effectiveness of acupuncture for a long time. Apparently the testing of this practice has not been quite scientific, that is, the testing would not pass the criteria I laid out above. I finally ran across the following investigation. (see references below for links)

Three control groups were set up.

1. normal acupuncture

2. randomly stick needles anywhere, do not follow accepted procedure

3. poke people with toothpicks; do not actually insert a needle.

All three groups reported positive results: feeling better, reduction in pain, etc. If acupuncture did, in fact, work, you would suppose the first group would be overwhelmingly positive and the other groups would show nothing. But all three groups felt better. Clearly traditional acupuncture didn’t work, however, something else was going on. The researchers concluded that the patients felt better not because of the treatment, but because of the process. They got to talk with the practitioner about their problems. Somebody made them the center of attention. And they were touched. Elsewhere it has been concluded that human touch can have therapeutic properties: a parent with a child, a nurse with a patient, or a hospice worker with the chronically or terminally ill. The conclusion was that acupuncture didn’t work, it didn’t actually do anything, but the process surrounding the treatment had psychological benefits.

For myself, it didn’t work. I went into the session clearly in pain and had no reduction in pain. I went into the session objectively, focusing on the matter at hand, and saw no physical benefits at all. I could see, however, the psychological benefits of talking with someone, going through the process, and the peacefulness of lying down on a table. My conclusion is that I concur completely with the above scientific assessment of the effectiveness of acupuncture. It doesn’t work, but the process can have a psychological effect.


The Skeptic’s Dictionary – May 7/2015
Acupuncture by Robert Todd Carroll
Some stories are unquestionably true, but they probably do not justify the conclusion that the treatment was effective. For example, we know that many people seek relief for their pain from a physician, chiropractor, or acupuncturist only when the pain becomes severe. We also know that many types of pain follow cycles: periods of relative freedom from pain are followed by periods of gradual increase in severity; and periods of severe pain are followed by gradual reduction in pain. The natural regression of pain and other disorders often leads both medical practitioners and patients to erroneously conclude that the treatment was effective when in fact the patient would have improved even if he or she hadn't sought any treatment. In short, most pains and illnesses go away on their own, but some of them go away shortly after seeking treatment and this leads us to think erroneously that there is a causal connection between the treatment and the relief. We know for a fact, for example, that many patients who are given antibiotics by their physicians erroneously attribute their recovery from a viral infection to the medicine. The patients really feel relief. They really show physiological changes. They really get better. Yet, we know that none of this has anything to do with the antibiotic because antibiotics don't act on viruses; they act only on bacteria.

Wikipedia: Acupuncture: Sham acupuncture and research
A 2014 Nature Reviews Cancer review article found that "contrary to the claimed mechanism of redirecting the flow of qi through meridians, researchers usually find that it generally does not matter where the needles are inserted, how often (that is, no dose-response effect is observed), or even if needles are actually inserted. In other words, ‘sham’ or ‘placebo’ acupuncture generally produces the same effects as ‘real’ acupuncture and, in some cases, does better."

A Curious Addition
During my session with Elise, she suggested I needed an “emotional cleansing”. She told me that it would be hard to believe, but 80% of the pain I was feeling was emotional, not physical. Astonished, I listened to her explanation of how an hour-long session for $120 would relieve me of my agony. I half-seriously, half-jokingly asked if this was going to leave me curled up in the corner of the room sobbing like a baby.

I’m sure Elise is a nice lady and meant well, but I was a tad outraged at this obvious quackery. A person with no medical qualifications, with no psychiatric credentials, was trying to convince me she had the magic formula for all my ills. Was she bulls**ttin’ me to get my money or did she honestly believe that what she was doing would, in fact, achieve all that she was claiming? What’s worse, a deliberate fraud or a sincere one?

Back at my office, I spoke to the two colleagues who had recommended visiting Elise. One of them admitted they had done the emotional cleansing. What did they get out of it? They were unclear. Perhaps they were embarrassed to go into any personal details, but I remained sceptical that a one hour session for $120 was going to be a life-transforming experience. However, over my lifetime, I have personally witnessed a number of odd events, situations where an individual has undergone a radical change in their thinking: a non-believer becoming a born again Christian, an alcoholic becoming sober, your average person being bitten by the bug and turning into an artist or musician. Nevertheless, with my pain right off the dial, I felt Elise was preying on my desperation. I don’t believe she was doing so deliberately or maliciously; I think she actually felt she was helping people. And in referring back to the above test of acupuncture, if there are psychological benefits to something, even if there is no actual physical cure, can we qualify this thing as worthless?

My Blog: Health: Pascal's Wager and Desperation - Jul 11/2012
The 17th century French philosopher and mathematician Blaise Pascal argued that there was more to be gained by believing in God than not... If you have an injury, is it better to believe in a remedy than not? Is there more to be gained by trying a supplement, a new diet, or an exercise then by not trying it? Whether it works or not remains to be seen but like Pascal with his wager, if you don't place a bet you can't win?

I see the biggest danger here that you stop seeking legitimate treatment because you think you’ve found “a” treatment.

Alternative Medicines and the Right Answer
During the course of my quest for the right answer, I tried a number of different things. In researching these various remedies, I discovered a whole world of hocus-pocus unproven by the scientific method and merely supported by hope and faith. In many ways, I was startled to discover what goes on in our world and what the collective we through our government, laws, and regulations permits to go on. We haven’t yet gotten around to proving that X is actually snake oil, so we’ll let it out on the market. Buyer beware. Fad miracle cure indeed.

I went to a massage therapist. She gave me a therapeutic massage. It did nothing to help me. I went to a chiropractor. He cracked my neck. No effect. I tried some herbal supplements. I saw no results.

What was going on?

I investigated and turned up more and more evidence that alternative medicines do not work, but like the study of acupuncture above, the process could potentially have a psychological effect for people even if there was no remedial effect. In other words, people were buying snake oil. They were buying hope.

The Limits of Modern Medical Science
While I appreciate hope as much as the next person, I didn’t want bulls**t, I wanted a cure, a real cure. The outcome of my quest over many months was that it is very very difficult finding the “right answer”. In the beginning, I thought I would go to my family doctor, get an assessment, and get a course of action. Take two aspirins and call me in the morning. Instead, my faith in the medical profession as the be all and end all resulted in me seeing the limits of modern medical knowledge. My doctor tested me and concluded I had not torn my rotator cuff. I went to emergency at a local hospital and another doctor told me the same thing. Okay, in this, medical science was one hundred percent correct. However, both doctors failed to detect my displaced bones, the long head of the biceps tendon out of the bicipital groove, and the herniated C6 disc. In puzzling over this months later, I joked that I walk into my doctor with a knife sticking out of my shoulder and he tells me I don’t have the flu. Technically he’s correct, but he’s missed my problem.

X-rays and MRIs of both my neck and shoulder failed to conclusively prove the herniated C6 disc. However, a neurologist, in hooking up various electrodes and sending shocks up and down my left arm, pointed to something amiss in my nervous system. The supposition was that something was “probably” wrong with my C6 disc. This would explain my “referred pain” (https://en.wikipedia.org/wiki/Referred_pain). In a nutshell, referred pain is when damage in one part of the body causes pain to be felt elsewhere. The C6 vertebrae in the neck is where nerves split off to run down both arms. The shooting pains in my arms, the tingling in the hands and the occasional numbing was supposedly due to an impingement in the C6 nerve trunk. Any herniation of a disc in the neck can cause the disc to press against the nerve causing either pain or cutting off feeling.

I know what I know
In looking back at the extent of my problems, knowing what I know now and filling in the blanks the best I can with further research, I look at my various visits, acupuncturist, chiropractor, and massage therapist, as people who were sincere in their desire to help, but could only offer me what they knew. But what did I need? It humorously dawned on me that if I had visited Joe the Plumber and told him about my problem, he would have come over and repaired my kitchen sink. Why? Because that’s what plumbers do. Obviously that’s not what I needed but Joe can only give me what he knows.

And because these people only know what they know, they do not know if what they’re offering is even effective or is snake oil.

Landon the Kinesiologist
Kinesiology is defined as the scientific study of human movement. Oddly enough, my benefits package at work does not cover this treatment. In other words, kinesiology is not (yet) recognised by the insurance company for reimbursement. What does that mean?

A colleague at work recommended visiting Landon. I have spoken to a few people who have studied kinesiology and I’ve concluded that Landon’s expertise is broader and more practical. While others talk the talk, Landon walks the walk. His approach to a problem is to find the underlying cause and as he explains it, the body is a machine, a self-repairing machine. However, from time to time, moving parts get out of alignment and the body can’t self-repair so it adapts. He realigns what the body can’t and let’s the body heal itself in the correct position.

Working with this gentleman has been a startling and puzzling experience, but out of all the people I’ve worked with, he is the only one who can demonstrate immediate and visible results. Instead of going through everything, let me tell you about one specific example: the long head of the biceps muscle.

The biceps muscle in your upper arm is connected in one spot to the forearm. The upper part of the muscle is connected to a tendon which splits into two parts, the short head and the long head. The short head comes across the front of the shoulder while the long head goes up over the end of the humerus, the bone in your upper arm, through the bicipital groove and attaches to the shoulder. The traverse humeral ligament covers the bicipital groove to maintain the long head in the groove.

Straining the biceps muscle can cause the long head to jump out of the groove. Apparently this is common in sports. Baseball pitchers have this happen to them. When this happens, the upper part of the biceps muscle is no longer properly anchored and there is a loss of strength in the arm. Oddly enough, I have discovered that in day-to-day living, such an issue does not necessarily present itself in such a dramatic way that anybody would think there’s a problem. You may experience some discomfort, possibly a pain in a certain position, and you don’t think anything of it; you merely adjust what you’re doing and carry on with your life. The question comes to mind of how many people are walking around with this problem? Instead of being one hundred percent okay, it seems that we can live a normal life with our bodies only at 95% capacity, or 90%. Yes, we have various aches and pains, but it’s not enough to stop us. We switch position and carry on.

How did Landon detect this phenomenon? While my research shows medical science relying on MRIs, Landon has a very simple test. I put my arm straight out in front of me, bend it at ninety degrees up, tilt the upper part out slightly, and he pushes down on my arm close to the elbow. When the long head of the biceps tendon is out of the groove, I can’t hold my arm up. I am weak as a kitten. Landon takes his fingers, digs into my shoulder feeling around the long head, and pulls it back into the groove. This doesn’t hurt, by the way. When he performs the test a second time, I can feel my strength shoot up a thousand percent. I feel as though he could hang off my arm and I could hold him up.

In telling you this, it even seems to me like hocus-pocus, but I have experienced this and it’s extraordinary. This is an example of what Landon does and how I have immediate results from his treatments.

Now, how important is this? As I said, in my day-to-day life, I carry on unaware of the long head being out of the bicipital groove. If I experience discomfort, I switch position. If I am weak in lifting something, I will use my right arm to assist. However, I joined a gym two years ago and in pushing myself, I certainly notice the problem. Discomfort and aches, sometimes pain, indicate I am trying to get the body machine to work when its moving parts are not properly aligned and as Landon has told me, the body for the most part is a resilient machine, self-repairing. But sometimes, it can’t self-repair and as a consequence it attempts to adapt which can lead to other problems.

A member of my family
Gary fell down. Hard. Four months of massage therapy and chiropractic sessions had not improved his condition. He suffered from on-going pain, numbing in one leg, and limited movement. Thinking of my own experience, I got him to see Landon: one session with a follow-up a month later. Several adjustments to the body, some taping over several weeks to hold things together while the body healed, and a number of isometric exercises to get the muscles properly firing again. Gary also had the long head of the biceps tendon out of the bicipital groove. Obviously people have no idea they are suffering from this condition.

Within a short period of time, Gary was back in tip-top condition. In other words, his other treatments were ineffective. The other treatments did not address the underlying causes of his problems: long head out of the groove, displaced bones, misfiring muscles due to alignment problems. If Gary had not visited Landon, he would have spent months, possibly years, doing ineffectual treatments over and over again with little or no results.

I’ve told Gary to not go back to massage therapy, do not go back to the chiropractor, and for God’s sake, do not do acupuncture.

FYI: Gary told me his chiropractor cracked his neck. This article could also be about chiropractic medicine. I’m sorry; it’s “alternative medicine” and it doesn’t work. Maybe some chiropractors have knowledge like Landon which would make them effective to an extent, but cracking bones is not a treatment unto itself. I, for one, will never go again.

Final Word
I never went back to the acupuncturist. I certainly never did an emotional cleansing. As I said, while Elise was a nice enough lady, she had no idea of what she was talking about. Carpe diem. It was completely up to me to make such a determination.

Elsewhere on my blog, I’ve talked about correlation versus causation. So often we see thing #1 happen then notice thing #2. We conclude that thing #2 caused thing #1 when in reality, the two things merely happened at the same time. The two things are correlated, but thing #2 did not cause thing #1.

If people report they feel better after acupuncture, it is perfectly reasonable to assume acupuncture does something beneficial. However, the above experiment shows that acupuncture itself does nothing. It is something else. It is human interaction, human touch which actually provides the relief. One could argue that’s good enough, unfortunately if the patient does have a very real problem, acupuncture is not curing anything. In fact, it could be delaying the person from seeking proper medical care.

During the course of the treatment of my injury, I recognised the humour of correlation versus causation. If I had started to eat a peanut butter and jelly sandwich every day for lunch, one could assume that sometime, after six months or after a year, I would eventually feel better. I could conclude it was the peanut butter and jelly sandwich that cured me. Ridiculous, I know. But for those who proselytise various practises like chromotherapy, cupping therapy, or sound therapy, they are promoting ideas which relate back to the above scientific assessment of acupuncture: correlation versus causation; psychological benefit versus a real benefit.

In my particular case, I kept looking for a solution to my problem and eventually found help with a kinesiologist. He put the long head of the biceps tendon back in the bicipital groove. He put the displaced bones of my wrist and my elbow back in alignment. He got me started on a series of isometric exercises which seem to have helped in getting my body back to moving properly again.

However, in retrospect, I recognise that the greatest part of the healing process was my body healing itself. The kinesiologist provided the best, practical assistance in my recovery, but most of the credit goes to my body itself. A doctor fits me with a splint, puts my leg in a cast. This is an important part of the healing process. But it is my body itself that mends the bone. My peanut butter and jelly sandwich didn’t have anything to do with it.

Sticking needles in me is going to realign my energy with my meridians? I need somebody to put the moving parts of my body machine back in alignment. I don’t need hocus-pocus; I need practical solutions. However, I have certainly learned that getting a practical solution is not as easy as I would have thought. Modern medical science can be wonderful but even it has its limitations. Unfortunately, due to those limitations, people turn to self-diagnosis and self-treatment. Alternative medicines like homeopathy, naturopathy, chiropractic, energy medicine, various forms of acupuncture, etc. do not pass the scientific test, but do have a placebo effect: we think we’re feeling better. There can be a psychological benefit. And I would add that in desperation, we are willing to try anything. I certainly was that desperate.

In retrospect, I wish somebody had told me right up front this is the course of action and it would take ten months to right itself. I could have psychologically prepared myself. I could have gritted my teeth and weathered the storm. Instead, I carried on from one treatment to another in the vague hope of finding something, anything, to help me. I have to count my blessings, however, in that I got better. I have run into a number of people with stories that don’t have such a happy ending: life-changing health issues, on-going treatment costs, reduced and limited mobility, and years of chronic pain with no hope in sight. I have experienced all of that but got better. Some people don’t.

Health is everything. At the height of my issue, I could barely walk. I had to steel myself to shuffle four blocks to the grocery store as it hurt to move. (I live alone.) I would exit my apartment building and look across the street at a park. Children were playing. Adults were walking their dogs. Joggers would go by. My entire life had been up-ended. The freedom of a fully-functioning body had been taken away from me and I was condemned to my apartment, to a day of moving as little as possible, to a constant vigil of never-ending pain management. It was hell. It was truly hell on Earth. While I wanted hope as much as the next person, I didn’t want false hope. I was lucky enough to find it. Others are wasting a fortune.


References

My apologies to Houston Methodist Orthopedics & Sports Medicine for "borrowing" their image of the shoulder. It was the best I could find.

Wikipedia: Superstition
Superstition is the belief in supernatural causality—that one event causes another without any natural process linking the two events—such as astrology, religion, omens, witchcraft, prophecies, etc., that contradicts natural science.

Wikipedia: Alternative medicine
Alternative medicine is any practice that is put forward as having the healing effects of medicine, but is not founded on evidence gathered using the scientific method. It consists of a wide range of health care practices, products and therapies. Examples include new and traditional medicine practices such as homeopathy, naturopathy, chiropractic, energy medicine, various forms of acupuncture, traditional Chinese medicine, Ayurvedic medicine, and Christian faith healing. The treatments are those that are not part of the science-based healthcare system.

Wikipedia: Acupuncture
Acupuncture is a form of alternative medicine and a key component of traditional Chinese medicine (TCM) involving inserting thin needles into the body at acupuncture points.

PainScience – Jan 25/2015
Does Acupuncture Work for Pain? by Paul Ingraham
In early 2009, the British Medical Journal published a new analysis of acupuncture for pain … with discouraging results. Again. Not the first time, not the last. More recently and dramatically, the journal Pain did it again — one of the top ten journals for pain and injury science. In early 2011, Pain published a thorough and rather harsh scientific smack down of acupuncture, concluding that there is “little truly convincing evidence that acupuncture is effective in reducing pain.”

Wikipedia: Trick or Treatment
Trick or Treatment? Alternative Medicine on Trial (North American title: Trick or Treatment: The Undeniable Facts about Alternative Medicine) is a 2008 book about alternative medicine by Simon Singh and Edzard Ernst. Singh is a physicist and the writer of several popular science books. Ernst is a professor of complementary medicine.

International Anesthesia Research Society - June 2013
Acupuncture Is Theatrical Placebo by David Colquhoun, PhD and Steven P. Novella, MD
The best controlled studies show a clear pattern, with acupuncture the outcome does not depend on needle location or even needle insertion. Since these variables are those that define acupuncture, the only sensible conclusion is that acupuncture does not work.

The Guardian – July 26/2013
Why acupuncture is giving sceptics the needle by David Derbyshire
Last month, in the journal Anesthesia and Analgesia, two leading medical rationalists, pharmacologist David Colquhoun and neurologist Steven Novella, stuck in the knife: "the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance," they wrote. "It seems that acupuncture is little or no more than a theatrical placebo."



2015-07-01

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