I had a cabdriver tell me the other day that he only drove to pay the bills while he got his business up and running. I said cool, I'm always impressed when people take the plunge and become their own boss, what are you doing? His response? Accupuncture.

All I could think was "Oh shit, And now this whackjob has my home address in his garmin." so I smiled and wished him luck and made nice til I got home.

There are three types of medicine.

1. Conventional medicine. Stuff that has been shown to work, most of the time (no, we don't always understand why). Sometimes derived from natural sources (e.g. salicylic acid or aspirin from willowbark) or from direct synthesis, or techniques that can be shown to have a beneficial effect, under circumstances that we understand reasonably well. Chiropractic springs to mind.

2. Alternative medicines that work sometimes but we have no idea how or why, and where the practitioners treat it as voodoo science according to the wisdom of the ancients. Acupuncture falls into this category. It almost certainly works by feedback in the nervous system, but we don't understand it well enough to know when it will or will not work, or how to apply it. Herbal remedies are like this too - if St John's Wort was as good as people claim, I'm sure a pharmaceutical chemist would have isolated the active ingredient by now and improved it. Anti-depressant drugs are a big market. This category survives on "we couldn't make it into 'conventional medicine' on the evidence but it's natural so it must be better". They work sometimes - but as well as the more accepted stuff?

3. Total garbage. Can't work and never will. Homeopathy, reflexology, reiki. This category survives by conning complete idiots.

Why isn't this malpractice? I haven't figured that out yet.

Sigh, neither have I. Here, vitamin supplements and the herbal remedies can be marketed with outrageous claims without having to prove efficacy - and yet prescription drug advertising is illegal. I've just been tested and found to be severely deficient in Vitamin D, so I'm taking supplements. That makes sense. Spending money on multivitamins all the time just gives you the most expensive urine in the world.

I should clarify - my father (an obstetrician and gynaecologist) did resort to acupuncture for severe arthritic pain in his hands and feet (He also later had surgery to remove cartilage, etc - his thumbs won't bend). Only after everything else failed, and he was lucky and it did give him some relief. I'd probably attempt hypnotherapy for my addiction issues too if I wasn't such a stubborn pain the ass, and, well, not such a good subject for that sort of thing. It's important to distinguish between the not-well-understood practices that might work sometimes and the voodoo science.

None of which is a defense of teaching it to medical students. If anything, they should be taught which are possible (and the chances of it working) vs which are ridiculous. I *hope* that's what they're doing.

I'm not sure acupuncture falls into the same category as these other things. There seems to be some scientific evidence supporting it. For instance, here's a statement by the NIH:

http://consensus.nih.gov/1997/1997Acupuncture107html.htm

promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program

However, there are no double-blind tests that show that acupuncture works. The placebo effect can be powerful..

If the objective of a treatment is subjective, then a placebo effect can be used to prove effectiveness. If the objective of treatment is objective, then the placebo effect cannot be used to prove effectiveness.

For example, perceived pain is subjective. If the objective is to reduce perceived pain, and the placebo effect creates a subjective feeling of reduced pain, then the treatment was effective.

It's different when we examine the curative effects of a treatment. Then, we are examining an objective, physical change in a diseased structure. In this case, the placebo effect cannot be curative or even effective.

Learn more about these "alternative and complementary medicine" modalities at Science-Based Medcine, a blog.

-Steve

The only reason I can think of to teach this nonsense at a medical school is to make physicians aware of what it entails so they can discuss it with their patients. Many people seek this stuff out in addition to going to regular doctors and doctors should be able to tell them why it's at best harmless (except to their wallets) and at worst very dangerous.

> However, there are no double-blind tests that
> show that acupuncture works. The placebo effect
> can be powerful..

I'm no expert, but from what I'm reading a double-blind test for acupuncture isn't really possible. It's not like giving someone a sugar pill and saying its a medicine.

Did you hear about the homeopath who died? He missed taking his medicine, and the overdose killed him!

...and don't forget Dara O'Briaian!

So what's going on at Maryland's medical school? UMM is home to one of the nation's premier "integrative medicine" programs, which promotes a wide range of questionable practices.

The only reason I can think of to teach this nonsense at a medical school is to make physicians aware of what it entails so they can discuss it with their patients. Many people seek this stuff out in addition to going to regular doctors and doctors should be able to tell them why it's at best harmless (except to their wallets) and at worst very dangerous.

Most likely, the University of Maryland Medical School was forced to include these curricula by a legislative act.

A chiropractor who was elected to the Florida legislature introduced a bill to establish a homeopathic medicine degree progam at Florida State University. The university fought the idea, feeling it would bring derision on the university and make fund-raising difficult for the university's real science programs.

Last I heard, the bill went down in flames.

I told the witchdoctor I was in love with you! I told the witchdoctor I was in love with you!

I'm no expert, but from what I'm reading a double-blind test for acupuncture isn't really possible. It's not like giving someone a sugar pill and saying its a medicine.

According to the NIH summary that was linked earlier, they tried tests in which the needles were placed in the "wrong" locations, leading to inconclusive results. I could see designing a test to treat a specific, diagnosable ailment with multiple methods including acupuncture. It would be hard to make double-blind, unless those administering the needles and those interpreting the results were separate groups.

"(Why isn't this malpractice? I haven't figured that out yet.)"

For the same reason that the alternative-medicine industry can get away with violating truth-in-advertising laws just by putting a disclaimer in their ads, when no other industry can do so. Alternative medicine is an aspect of leftism, and most government officials are leftists or leftist sympathizers.

I did see somewhere else where a doctor give a good reason for taking alternative-medicine courses. He said that patients will take herbs and stuff whether doctors recommend it or not, and doctors need to be aware of how they interact with conventional treatments.

The problem with conventional medicine is that it always looks at feedback which is not necessarily patients word of mouth but at some measurable parameters like the blood sugar or bile or something else. This is fine for acute and pathological problems which can be measured in a lab, but when it comes to chronic non pathological problems which never show up in any test and where doses which are of the level required to actually measure a change in a lab are actually fatal, this fails miserably. Also because most conventional medicine treatments have some animal testing stage before even going to a clinical trial with humans, nothing really gets developed for chronic non pathological ailments because these things cannot be measured in a lab rat, but instead require human feedback which is probably not even allowed because it will be classified as speculation and playing with the lives of people.

The approach earlier was not to replace the symptoms, but to actually achieve an overall balance in the body to prevent the symptoms from recurring. While conventional medicine works well for pathological stuff, it does not work well for things that are non pathological like diabetes or migraine or vertigo or some hormonal imbalances which people are not able to figure out and alternative medicine actually shows more promise in these areas probably because of the fact that it was developed directly with human feedback and did not depend on lab measurements. If the approach of experimenting directly on humans for chronic issues which cannot be lab measured is actually followed, conventional medicine would probably work as well for these non pathological chronic disorders.