Questions raised by National Center for Complementary and Alternative Medicine’s new website

A few months ago the National Center for Complementary and Alternative Medicine launched a website bringing consumer health information together with easy access to their related research.  The NCCAM is a branch of the federal National Institute of Health that was created in 1998 to further scientific research of medical modalities and substances currently outside conventional mainstream medicine, such as  acupuncture, nutritional supplements, and therapeutic touch.  Their goal is to use that research to help clearly define where these modalities may integrate, or not, into more mainstream medical practice.

I applaud the website for being easy to use and for bringing so much consumer and practitioner information together.  Finding current and past research is a snap and I appreciate their focus on informing consumers.  The inclusion of a link to the Cochrane Review website is extremely helpful for finding quick, down and dirty, clear information on specific conditions and modalities based on reviews of published findings.

However, I was dismayed by what I found while searching through the acupuncture research.  The first main problem was that hundreds of research projects that were funded by the NCCAM lacked published results, many of those studies being completed well over 5 years ago.  Without being able to see the results of so many studies how can the public know basic, vital information related to NCCAM research?  Why were the studies completed but never published?  The second glaring problem is that many of the published studies were terribly designed, suffering from minimal to no blinding or controls, a serious lack of clear and reproducible materials and methods, and weak statistical analysis.  The results from such studies are at best unusable and at worst harm the status and viability of acupuncture as an integrative medical modality.  Poor science is worse than no science, and after over a decade of NCCAM funded research we are left with mountains of poor science.  While looking over the Cochrane reviews, the large majority lamented that the evidence from available studies was inconclusive due to poor study quality and that more research needs to be done.  Only a few conditions could reasonably be stated as responsive or unresponsive to acupuncture.  A quick search on PubMed reveals that only recently have researchers been really pushing for better quality acupuncture studies.  It seems incredible to me that the NCCAM would fund the poor quality studies they have for so long, and leads me to question how bad the ones that never got published were by comparison.  I am left shaking my head in wonder at the apparent lack of concern for the the quality of research funded over the past 12 years, what a sad waste of resources and time.  The serious implications of this problem include the growing movement to de-fund the NCCAM all together and to push complementary medicine out of use and back into the fringes of quackery where they think it belongs.  With more than a decade of terrible research to back them up, who can blame them at this point?

My next step is to investigate the funding approval process in the hope of finding out where the system has broken down and how it can be improved.  With so many people invested in good science and the promise of complementary modalities such as acupuncture, there must be a way to reverse the trend and start producing some high quality scientific studies.  Whatever the outcome, whether acupuncture is found to be useful or not, we need solid scientific evidence to help guide us.

Get the most out of your yoga practice: pose do’s and dont’s from the LA Times

Many years ago I gave up on yoga.  I wrenched myself doing a pose incorrectly in a class, separating the AC joint in my left shoulder and popping my first two ribs out of place on the same side.  Turns out, I have freakishly tight scalene muscles in my neck that were ripe to pull those ribs they attach to right out of place.  Months and years have gone by and my shoulder never quite reached 100% recovery.  I have been scared of yoga ever since.  Not yoga itself, but the power of my body to harm itself if I do said yoga incorrectly.

This is why I was very happy to see an article in the health section of the LA Times online today.  It contains photos and detailed descriptions of how to correctly do some of the most common, and commonly problematic, poses.  I may even give it another shot.

Enjoy the lesson!

Grumpies everywhere celebrate: it seems you are doing better than your smiley counterparts

According to this Scientific American article, people experiencing negative emotions such as fear, anger or sadness perform better on tasks, pay better attention to detail and make better decisions than compared to folks in a good mood.  The article also points to a similar article previously published in the magazine focusing on how depression may be a positive evolutionary adaptation.  If our decisions and thought processes are clearer and more detail oriented when in a bad mood, it would make sense that this trait would be passed on through evolution.  This brings to my mind a humorous picture of our hominid ancestors huddled in their caves grumpily bitching about the weather.

I am also reminded of a book a co-worker recently lent me titled “Bright-sided: How the Relentless Promotion of Positive Thinking Has Undermined America.” I have not picked it up yet, but I did hear a recent interview with the author on NPR.  Mrs. Ehrenreich calls positive thinking a “mass delusion” and advocates for realistic thinking in which we embrace how terrifying life struggles can really be.  I can’t wait to dive into the book and learn more of this “anti-Secret” theory (remember The Secret is that movie promoting intention and positive thinking to bring success and happiness).  Studies may show that being grumpy helps me do better, but I still believe I accomplish more when I’m feeling positive and inspired.  Maybe that’s part of the positivity delusion!  Let me get grumpy and think about that for a while.

In any case, the article is a good reminder that while positive thinking can make us happier, downer moods are healthy and helpful.

Stanford study shows acupuncture helps relieve major depression in pregnant women

Stanford University’s Department of Psychiatry and Behavioral Sciences published a study in the March issue of Obstetrics and Gynecology that looked at how well acupuncture could effect major depressive disorder in pregnant women.  The researchers compared a group that received acupuncture specific for their major depression with an acupuncture control group and a massage control group, both of which were not specific for depression.  The acupuncture group showed a “greater rate of decrease in symptom severity” than both the controls groups individually and combined; and there was not a significant difference between the control groups.  They noted that “The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in standard depression treatments of similar length…”  This is great news for women with major depression who can not or do not want to take pharmaceuticals for their depression while pregnant.

This particular study had a methods that helped establish more credibility for the results.  First, the study involved a fairly large number of subjects, 150 women.  Second, the researchers worked hard to establish good controls by having junior acupuncturists performing acupuncture protocols prescribed by senior acupuncturist so that the juniors did not know which group they were giving acupuncture to.  Additionally, the treatments were given in 12 sessions over 8 weeks which is consistent with typical clinical practice.  Altogether these methods make for a seemingly solid acupuncture study, as well as another example of how acupuncture can be a safe and effective treatment option.

Health Care Reform

I found this link to a handy New York Times breakdown of how the health care legislation would effect folks.  It is broken down by category so it is easy to find out how it will effect you; and written clearly thank goodness!

I meant to post it as soon as I found it, I’m sorry for the delay.

Acupuncture wins vs. Effexor

Last month a study was published in the Journal of Clinical Oncology comparing acupuncture and Effexor (brand name of venlafaxine) for treating hot flashes in breast cancer patients undergoing antiestrogen treatment.  Effexor is a pharmaceutical used for major depression that can also treat hot flashes.  It is used to treat hot flashes in breast cancer patients undergoing antiestrogen therapy because the typical hot flash treatment of hormone replacement therapy is contraindicated.

The study showed that acupuncture was just as effective as the Effexor and produced no negative side effects.  By contrast, the Effexor patients reported 18 undesired effects including nausea, dizziness, anxiety, etc…  Additionally, the acupuncture group was still symptom free after two weeks where the Effexor group had an increase in hot flashes.  Last, and very important, the acupuncture group reported positive side effects such as improved mental clarity and well-being.

This study is a wonderful endorsement of how effective acupuncture can be to treat the side effects of cancer treatments.  Patients and doctors will hopefully grow more aware of acupuncture as an option to help reduce suffering and improve quality of life during cancer treatment.  It is also my hope that more studies such as this will prove the need for acupuncture as an integrated part of standard medical care.

Spreading mental health around the world, American style.

This NY Times article is lengthy but well worth the read.

After reading it I was reminded that how we perceive the world, ourselves, and the relationship between the two is largely dependent on our own culture.  The article points out one key failing of exporting mental health diagnoses and treatments.  Mental illnesses are not specific entities such as a viral or bacterial illness and must be looked at in the context of culture; with norms differing era to era, by gender and by society.  For example, normal behavior in a society that prizes communal harmony will see selfish behavior differently than societies that put higher value on individualist expression.

By promoting one culture’s diagnostic standards for mental illness, the other culture’s inherent standards are easily looked over.  This has been the case with the promotion of the DSM (the standard mental illness diagnostic manual used here in the US) defined illnesses in countries where traditional views become “quaint” and/or “un-scientific” in comparison.  I personally see this problem when Traditional Chinese Medicine ideas are compared to modern western medicine ideas.  My own bias, in fact, makes it difficult for me to take terms like “blood deficiency” or the idea that wind in the body creates limb tremors or muscle spasms seriously.  However, I consistently see how beautifully this ancient system works in diagnosing and treating disease and predicting disease outcomes.  There is a movement among TCM practitioners to both hold onto these key ideas and translate them into concepts and language useful to western medicine so that we may better interface with those practitioners to the benefit of our patients.

Back to mental illness.  According to the article, different societies will manifest different symptoms of mental illnesses based on culturally accepted behaviors.  As pointed out in the article: “We might think of the culture as possessing a ‘symptom repertoire’ — a range of physical symptoms available to the unconscious mind for the physical expression of psychological conflict” says Edward Shorter, a medical historian at the University of Toronto.”  The article mentions the recent prevalence of anorexia in Hong Kong as an example.  Dr. Sing Lee, from the Chinese University of Hong Kong, states: “When there is a cultural atmosphere in which professionals, the media, schools, doctors, psychologists all recognize and endorse and talk about and publicize eating disorders, then people can be triggered to consciously or unconsciously pick eating-disorder pathology as a way to express that conflict.”

While some folks may believe that promoting the DSM definitions of mental illness in other countries is leading to increased awareness and treatment of mental disorders along with decreased stigma associated with mental illnesses, the opposite is showing to be true.  Juli McGruder from the University of Puget Sound found in her research during her stay in Zanzibar that families and communities took better care of their schizophrenic patients than in more “westernized” or “modern” countries.  The population believed that mental illness was a sign of spirit possession and would take good care of the afflicted member of their group by trying to appease angry or evil spirits with food, drink and comforts.  When the person was well enough to interact with and be productive in the society they were welcomed.   Not surprisingly, the incidence of relapse in these types of communities was extremely low compared to here in the US where schizophrenics are sequestered from the rest of society.  Furthermore, Prof. Sheila Mehta from Auburn University in Montgomery, Alabama has shown through her research that when people view mental illness as a “brain disease” rather than the effect of earlier life circumstances, they were inclined to treat the “brain diseased” people more harshly.  She speculates that perhaps when we view mental illness simply as physical damage in the brain, we then see the ill person as more completely broken, with less hope of help or recovery.

The article was both thought provoking and enlightening and I encourage you to take the time to read through it.  It is a real mind opener; and a reminder that there is no one right answer when it comes to questions of society and culture.

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