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N C C A M Research Blog

Quirky Ideas From Outside the Mainstream

August 07, 2012
Dr. Briggs
Josephine P. Briggs, M.D.

Director
National Center for Complementary and Alternative Medicine

View Dr. Briggs's biographical sketch

The July 16 issue of the Medical Journal of Australia (MJA) published an editorial addressing the debate as to whether complementary medicine courses should be taught in Australian universities. In many ways, the debate in Australia parallels debates here in the United States, and indeed debates on this blog. 

Complementary and alternative health care practices, by definition, arise from outside the mainstream, and, not surprisingly, meet much appropriate skepticism. We at NCCAM share a skeptical mindset, but, as readers of this blog know, we believe scientific inquiry has an important place in the evaluation of some non-mainstream health practices. As noted in the MJA editorial, “Science sets out to rigorously eliminate bias, not to assert it.” This is a basic tenet of the scientific method, and one that requires us to pursue our work with objectivity and neutrality, and with a dose of both open-mindedness and skepticism.

As researchers, we pursue science through the formulation and testing of hypotheses, and we should approach our studies with equipoise. As we gather and analyze our data, we need to be open to the possibility that our hypotheses may not have withstood scientific scrutiny, or that the data may be leading us in an unexpected direction. At the recent third International Research Congress on Integrative Medicine and Health, Dr. David Eisenberg reminded us in his closing remarks that “An act of inquiry is not an act of advocacy.” In other words, we conduct research to learn about the effects, safety, and/or mechanisms of a product or practice, not to promote it.

Throughout the history of medicine, there are a number of examples of “quirky” ideas that encountered resistance from mainstream medicine, but eventually, through a combination of clinical experience and scientific pursuit, led to changes in health care. For example:

  • Physical resistance training is good for people recovering from major physical trauma: Joseph Pilates, 1915
  • Relaxation and breathing techniques help with the pain of childbirth: Fernand Lamaze, 1940
  • Breastfeeding is good for babies, and mothers need help and support to establish successful breastfeeding: Edwina Froehlich, La Leche League founder, 1950s
  • Extensive palliative support and reduced medical interventions should be provided to dying patients: Saunders, Wald, Kubler-Ross, 1960s

So, sometimes good things come from challenges to mainstream orthodoxy. With that said, I do not advocate that we study every “quirky” idea that is proposed, but we must be willing to cast a critical eye over these ideas before dismissing them out-of-hand.

At NCCAM, we often encounter new ideas and unique approaches that may challenge established thinking. But we try to maintain open minds and ask tough questions to tease out whether there is scientific promise, plausibility, and amenability to rigorous scientific inquiry; potential to change health practices; and a relationship to use and practice that addresses an important public health concern. Does the idea merit an investment in research? Does it aid us in the pursuit of our strategic goals?

Ultimately, being able to bring both an open mind and a skeptical eye to the long-term challenge of evidence building is crucial, and we must be willing to do so, no matter what perspective we bring to the scientific debate.

Comments

Comments are now closed for this post.

Each of the examples Dr. Briggs mentions have a hypothesis with some degree of plausibility. But aside from perhaps some botanicals research, NCCAM does not deal in hypotheses with plausible concepts (e.g. acupuncture “meridians,” “human energy fields,” distant healing, homeopathic “memory” solutions). I think it is actually fair to claim that NCCAM has merely promoted magical thinking.

Anything that violates well-established scientific knowledge should not be considered plausible or worthy of using precious research resources. Furthermore, asking human subjects to participate in research that sets out to test extremely implausible hypotheses is unethical.

I agree that we must subject ideas to scientific evaluation prior to advocating it for use or rejecting it. I don’t agree we should teach, promote, or sell treatments not supported by good science. Unfortunatly many medical schools and journals are now teaching students to accept and promote “alternative” methods that have not prooved to be superior to placebo; as the NEJM did with acupuncture for low back pain.

I founded the first UK-serving self-help pain management organisation, in 1988, (based on Dr Chris Well’s pioneering in-house PMP programme, based at Walton Hospital, Liverpool.) His philosophy was that as orthodox medicine had nothing left to offer us concerning our chronic pain syndrome, he enlisted the mainly free help of: an acupuncturist, a healer, a dance teacher, physiotherapists and relaxation therapists therapists - along with a psychologist and a speciaist research nurse. A few years later, when our patron, Professor Patrick Wall(Gate Control Theory of Pain), kindly came to give a lecture to local physicians, one of our group members asked what he thought about Reiki Healing and acupuncture. “If it works, it works.” he replied.

Reiki is a perfect example of a practice that has no plausible hypothesis. We can detect radiation from distant galaxies, but not the “human energy field.” Reiki and Therapeutic Touch are based entirely on the practitioners’ claim that they can sense this “energy field” with their hands. When put to the test (in basic research that cost a mere $10) a group of these pixilated practitioners failed to be able to reliably detect this “energy field.” So why did NCCAM continue to fund clinical studies based on the notion that a “human energy field” (meridians, qi, prana, reincarnated soul, etc) exists when there isn’t a whiff of evidence for its existence? “Quirky” CAM, enabled by NCCAM, is nothing more or less than an ugly conflagration – fueled by delusion, politics, greed, and exploitation – that threatens science, science-based medicine, the health of our citizens, and hopes for a progressive society.

My experience has been that the generally assumed idea that people support is necessary for a full life and positive change is not always correct. I did a study about individuals who stopped smokint on their own. When I asked if friends,family others had helped I got a big NO. Some even said that other people sometimes had a negative role that had to be over come.

I do agree we should teach, study and promote complementary and alternative medicine in the whole world. Such therapy is proved to be effective and benefit for the patients in clinical.

Some important health information has been identified in the initial posting. I would agree that scientific studies are important. However, we must be honest and humble about the limits of RCTs. Most of these are based on a linear mechanistic model. So the modality is based on repairing, restoring or improving function or eliminating or reducing dysfunction. Hence, the majority of treatments that fit this model are based in, and often developed from a biomedical understanding of the mechanism. Then, the modality is tested in a linear approach. Many CAM approaches are based in a complex holistic model of the human organism, rather than the biomedical mechanistic model. Therefore, the modality may have non-linear pathways in which, depending on the complexity of the individual, the outcomes may be varied over time or between individuals. For example, someone may sleep better after a Reiki session and another have less pain after another. The issue of time is also relevant to a more complex view as in a complex system, there may be many feedback loops and the time for benefit may be quite varied. So the fit of using RCTs only to determine the efficacy of many CAM modalities is inadequate. Some efforts are being made to use some of the approaches from complexity science, but these are often difficult to conduct. It is very important and totally in keeping with the philosophy of science to not overstate one’s findings. So, saying that a modality doesn’t work because a specific linear, timed outcome did not reach significance is an example of hubris.

Yes, I agree with Joan’s opinion that it maybe not suitable to evaluate the efficacy of CAM using RCTs. We should pay attention to the case report based on the evidence of clinical efficacy. To my knowledge, it is not easy to quantification of diagnosis and therapeutic effect in CAM.

Can we evaluate the effect a CAM treatment has on functional abililities (and be happy with that?) In Occupational Therapy, we evaluate how a person can perform an ADL (activity of daily living such as dressing) before and after their participation in treatment. For example, “Mr. Man” can’t dress independently because of low back pain. After acupuncture, he can dress independently. Does “Mr. Man” care how the Qi flow changed during treatment? No. All he cares about is that he can reach his feet. And he will tell his neighbor to try acupuncture out because it works. Perhaps we can stress outcomes and effectiveness reasearch and backfill with basic science as we learn how to measure aspects of CAM that may not fit neatly into our usual paradigms of research. I think, in the big picture, as human beings, we could admit that we dont know all that the Universe holds and sometimes, you have to open your mind to the idea that you may not even be able to imagine, right now, the hypothesis that will lead to to an answer. Even if research can’t measure “energy fields” right now, “Mr. Man” will continue to pay for and participate in acupuncture treatment because it works, shaping the landscape of healthcare in this country.

Breastfeeding quirky??? Alternative? Definitely not! What would have been quirky, when infant formula was introduced.

Joan: If CAM cannot be studied via “linear mechanistic model” (i.e. science), then that is just another argument for NCCAM to close up shop. Anything with a plausible hypothesis can be studied with rigorous science in another branch of NIH.

Linda, the issue with many of the therapies, approaches and practices that NCCAM investigates is precisely that “…well-established scientific knowledge…” about them has not been established. We are still in the process of trying to establish through scientific method what exactly is happening biologically that yields the kinds of benefits Pat describes for her Mr. Man example. Those effects are what keep “alternative” options alive in the minds not only of the public (and through the word-of-mouth channel that Pat notes) but increasingly within institutional settings, whether that is at the Mayo Clinic or among US military health leaders. “If it works and its is safe,” they assert, “then we will use it.” You would not want to be in a forward combat outpost in Afghanistan and tell a company commander that his people cannot make use of acupuncture whose pain relief he has seen, if not experienced himself, first hand. This is why the value of observational research will become more pronounced as medicine becomes more “patient-centered.” Skepticism is crucial, but inquiry is the driving force that will explain to us what a meridian is or is not.

Mr. Walsh, are there to be no standards at NCCAM in determining what hypotheses are deserving of scarce research resources? That would be unfortunate, as people have no end of bizarre fad beliefs which they swear to by personal experience, e.g. killing goats by staring at them. / As for popularity – marketing and PR ploys by hospitals and the DOD are no substitute for scientific validation of safety and benefit. By “observational research,” I doubt if you are referring to serious, published case histories which can be a legitimate step towards justifying research funding. / NCCAM and DOD should realize that there is a heavy cost for pursuing phantasms: Using your example, “battlefield acupuncture” takes time away from saving lives when seconds count, and denying proven pain relief to soldiers (who have little choice in the matter) is cruel in the extreme.

Linda, I never suggested or hinted at omitting standards. I leave it to NCCAM to determine the therapies that should be investigated and the methodologies employed. They have a congressional mandate to do this work. It is up to the medical leadership at NIH, HHS and in congressional oversight committees to determine how our scarce (and growing scarcer) resources are deployed. That commitment has been maintained since the 1990s. In that time, you will observe, objections to NCCAM’s work have receded dramatically. As Dr. Briggs quoted the researcher David Eisenberg: “Inquiry is not advocacy.” (NCCAM should put that into its organizational seal!)

As for battlefield acupuncture, no one is replacing life-saving procedures in the field to see if needles are a better option. Nobody is denying proven pain relief to combat wounded. No one is coercing them to use acupuncture in place of pain meds. Why it is necessary to suggest that is beyond me.

It is an interested discussion. No matter what kind of method, we should be adopt it if clinical approved even if case reported.

As you point out, the decisions to use public funds via NCCAM on implausible hypotheses have, alas, been political, not based on sound scientific judgment. / Criticisms of NCCAM have not “receded dramatically.” If anything they have increased with NCCAM failing to produce results after two decades and *billions* of dollars later. I especially recommend “Measuring Mythology: Startling Concepts in NCCAM Grants,” by EV Mielczarek and BD Engler, 2012 Jan-Feb, Skeptical Inquirer. / “Battlefield acupuncture”: the Worst Quackery of 2011: http://www.forbes.com/sites/stevensalzberg/2011/12/30/the-worst-quackery-of-2011-battlefield-acupuncture/ “…But the real harm is in treating wounded soldiers by sticking needles in their ears, instead of offering real treatments.”

Linda, your assertions about “implausible hypotheses” do not make them so. Constantly demeaning the motives and decisions of all those working to understand the nature of CAM practices is closing in on defamation (although you and others are always careful never to place a name next to the supposed negligence you claim exists). Steve Salzburg’s Forbes’ article that you cite is more intolerance for professional, scientific inquiry that sits outside his static, limited framework for evidence. As for the political nature of budgetary decisions, that is how we do things here, as manifestly imperfect as it is. For a more serious example of undue political influence on health matters in this country I give you our current health care system. $1.3 trillion per year wasted. A population reeling in unnecessary ill-health. And you guys are nit-picking over the research into and use of acupuncture? [ Stepping off soap-box now! ]

Mr. Walsh, you seem to be avoiding the issue of implausibility. It’s not a matter of wishing or believing; plausibility requires a higher level of evidence than anecdote. CAM notions that violate well-established knowledge about the physical world have an especially low plausibility. / But you cannot deny that 20 years of NCCAM research on “quirkiness” has not provided anything useful. That’s because NCCAM has been pouring tax-payer money down the implausibility rat hole. If NCCAM was a division of the Air Force, it would be spending millions on levitation. / I recommend the following discussion to Dr. Briggs on “…making sensible estimates of the prior probabilities of hypotheses”: “Evidence and alternative medicine,” by Douglas Stalker, Mt Sinai J Med, 1995 Mar; 62(2):132-43.

Ms. Rosa, there is little more I can say here, other than to observe, perhaps, that at one time “well-established knowledge about the physical world” included the absolute certainty that the sun revolved around the earth. The “Father of Modern Science,” Galileo of course, who challenged that orthodoxy “…was tried by the Inquisition, found ‘vehemently suspect of heresy,’ forced to recant, and spent the rest of his life under house arrest.” (thanks, Wikipedia). Let us hope the same is not in store for Dr. Briggs!

Several commenters take issue with my prior post recommending scientific evaluation of claims before teaching, promoting, or selling them to the public, questioning the applicability of randomized control trials and the scientific method while claiming that Acupuncture and other complementary therapies “work”.
When one claims that a therapy works on is making several claims: 1, that a trained practitioner can identify when a patient has a problem that can be helped, 2, that the treatment can be given that is real and different from simulated treatment, 3, that the practitioner can identify after treatment that the patient was helped.
If these claims are true, then one should be able identify skilled practitioners of the method who can identify in advance a group of patients with a particular problem who are good candidates for the treatment in question, and identify afterwards if patients are improved. If so, why not identify a group of patients, identify skilled practitioners of the method in question to provide treatment or simulated treatment (so the patient being studied will not know if he is in the treatment or control group), and other skilled practitioners to provide later evaluation, and identify other objective researchers who can randomize a group of patients who agree to be studied into the sham and treatment groups, and later be evaluated by skilled practitioners who are unaware if the patient received treatment or sham treatment? One could do such a study and learn if the patients with real treatment are more improved than patients who get sham treatment, and also compare to known effective treatments when available to see if the studied treatment is better that other treatments, compare and assess incidence of side effects.
Wouldn’t that be an honest accurate way to begin to learn the truth? Shouldn’t an effective treatment pass that type of test repeatedly? I would call that science, and don’t understand why it wouldn’t be applicable. Relying on case reports alone is so prone to bias, error, and mistaken attribution that it would be a poor way to determine which treatments to recommend; especially since there would not be a way to assess the risk of the treatment, or compare it to known effective treatments. When I read about studies of Acupuncture done that way, for example, the researchers cannot distinguish between the results of acupuncture and sham acupuncture. Unless a skilled practitioner can do better with a treatment than by pretending to provide treatment I see no reason to advocate teaching, promoting, or selling it. Don’t you agree? If not, why not?

Bone Doc: Your prescription makes complete sense to me. And I think that some one from NCCAM might step in here to provide a link to or comment on what its research has shown thus far on the methodological question you raise. In general I think that the field (research, clinical) has done a poor job responding to the assertion that “There is no evidence!” for any of these practices. So we are left too much with “Yes there is / No there isn’t,” and everyone goes their separate way. Also, I don’t think any researchers are suggesting an either / or approach; i.e.: observational trials win; RCT’s lose. Because NCCAM is charged with investigating therapies and practices that are already widespread (to say the least), the issue of “value of the outcome to the client/patient” has to be taken into consideration. It is fair to say that for the majority of other research structures, outcome value is simply non-existent since the therapies are not yet in common use. This is a huge distinction and one that obviously can put NCCAM into a difficult position in terms of public perception. So: anyone from NCCAM want to chime in here?

Bone Doc: It would be helpful if you would address the issue being discussed here: plausibility. By discussing research protocol, you have allowed Mr. Walsh to skip over the first step, the step at which NCCAM has failed from the first – i.e. deciding which hypotheses have a reasonable probability of producing useful results and are thus worthy of taxpayer-funded research. In a nutshell, by ignoring plausibility, NCCAM has guaranteed its failure. Of course, some might point out that whole *raison d’etre* of NCCAM was to ignore plausibility.

Linda, I really don’t understand. We have had literally millions of clinical encounters during which a patient has received what he or she will describe as a positive outcome from some form of integrative therapy. This outcome is eminently “plausible” for the patient, since he or she can speak to the effect. This issue of plausibility — that there is some clear potential benefit that justifies the expenditure of scarce dollars on research — sits there like a rock strata across the total CAM experience. If one considers that the patient experience has value, that is. For me it would be a grave error to ignore those experiences. Is that perhaps the underlying cause for your antagonism regarding NCCAM efforts? That the patient experience is the driver behind all this? Perhaps the problem is in the term “hypothesis,” the basis for scientific investigation? The integrative medicine research community has embodied this, I think it is far to say, by investigating “claims.” That is, the reported outcomes, on which their hypotheses are often based.

For centuries both patients and their barbers believed in that blood-letting was effective treatment for all sorts of maladies. Thank goodness science put an end to that. Nonsensical and ineffective practices, however, linger on, demanding attention from NCCAM. And why not? Anything goes at NCCAM. How about a NCCAM-funded study on the beneficial effect of sacrificing chickens before surgery? Lots of people in Brazil think animal sacrifice is effective, and frankly it’s more plausible than homeopathy or acupuncture since presumably someone gets to eat the chicken. / So far, I haven’t heard any mention by you or NCCAM of Bayesian analysis. Has NCCAM ever used a Bayesian approach to selecting subjects for research? If so, where can I find it? If not, why is a CAM popularity contest preferable?

“Throughout the history of medicine, there are a number of examples of “quirky” ideas that encountered resistance from mainstream medicine, but eventually, through a combination of clinical experience and scientific pursuit, led to changes in health care. For example:”

“Physical resistance training is good for people recovering from major physical trauma: Joseph Pilates, 1915”

True, but additional, more recent studies under the direction of licensed medical doctors (orthopedists and physiatrists) with the collaboration of licensed physical therapists, have shown that specific interventions such as splinting, orthotics and braces for congenital/acquired disabilities and following corrective surgeries, as well as specific exercises are far more effective. These newer treatments required no grants from NCCAM. Aside from a study of chiropractic practices, funded by NCCAM, that showed temporary improvement for lower back pain, what other studies of chiropractic practices prove that any other problem is ameliorated or cured by chiropractors?

“Relaxation and breathing techniques help with the pain of childbirth: Fernand Lamaze, 1940”

Was this study funded by NCCAM? Have any other studies been funded by NCCAM using CAM interventions, such as those practiced by CAM practitioners, proven to be more effective?

“Breastfeeding is good for babies, and mothers need help and support to establish successful breastfeeding: Edwina Froehlich, La Leche League founder, 1950s”

That’s a brilliant observation. Researchers, not CAM practitioners, have measured the temporary immunities transferred to newborns through breastfeeding. Researchers, physicians and licensed nurse midwifes, not CAM practitioners, have reported on the positive benefits for women (quick involution of the uterus), when the infant is held and suckled in the delivery suite.

“Extensive palliative support and reduced medical interventions should be provided to dying patients: Saunders, Wald, Kubler-Ross, 1960s”

Extensive palliative support means “comfort measures”, which include adequate pain relief during the process of dying, including the use of opiates and other drugs. Which “comfort measures” used by CAM practitioners provide sustained and measurable pain relief (?)…certainly not chiropractic, reikki, acupuncture or other such nonsensical and noneffective CAM measures.

I believe a rereading of Dr. Briggs’ statement regarding the criteria NCCAM staff uses to determine whether a particular CAM modality is suitable for study…taking particular note of the word PLAUSIBILITY:

“At NCCAM, we often encounter new ideas and unique approaches that may challenge established thinking. But we try to maintain open minds and ask tough questions to tease out whether there is scientific promise, plausibility, and amenability to rigorous scientific inquiry; potential to change health practices; and a relationship to use and practice that addresses an important public health concern. Does the idea merit an investment in research? Does it aid us in the pursuit of our strategic goals?”

It is NOT the CAM practitioner and it is NOT any of the practitioner’s “patients” who determine the PLAUSIBILITY of a particular “treatment”….based solely on their prejudices about a CAM modality. Plausibility, as determined by actual physicians, chemists and biologists who are employed at the NCCAM determine plausibility.

As Linda Rosa has stated in her posts, there should be good science (such as proof that energy fields surround the human body) to ever contemplate studies of Reikki being funded by public tax dollars through grants through the NCCAM

My major concern is jumping too quickly to RCTs. The notion of plausibility is interesting, but could have an element of perception in it. I refer back to the analogy of Galileo. At that time the idea of the earth circling the sun was implausible to many. RCTs require a hypothesis and many of these hypotheses are based on a physiologic mechanism. It is possible that the hypothesis in some of the RCTs may be inappropriate. My point was that there are other types of studies that may generate hypotheses. Many observational, mixed methods, etc. Additionally, complexity science may be very applicable to some types of healing modality. These approaches may generate data that may then be tested in an RCT. It would be good to support some of these approaches before jumping into RCTs prematurely and then assuming that you have the final scientific absolute truth.

Lilady: When you write: “It is NOT the CAM practitioner and it is NOT any of the practitioner’s ‘patients’ who determine the PLAUSIBILITY of a particular ‘treatment’….based solely on their prejudices about a CAM modality.” // Do you consider a positive outcome a matter of “prejudice?” // When a person experiences relief from pain, as a friend of mine did after using acupuncture for a debilitating sinus condition, what should be the response of medical science to such an outcome?

My major concern is still the issue of “Plausibility” which is what Dr. Briggs’ stated above is what the staff at the NCCAM is *supposed* to consider, before they fund a study with tax dollars.

We should expect that scientists at NCCAM are not impressed with *practitioners* of CAM or their *patients* belief in treatments/cures, nor how non-scientists have mislabeled these *beliefs* as Plausibility…but rather the degree of Plausibility that a given treatment modality is worth further scientific inquiry and worthy of funding to test a modality.

How many hundreds of thousands of taxpayer money went into each of these studies which when first proposed showed no prior possibility and no prior plausibility of ever proving to yield positive results? These are just a few of the studies that the NCCAM has funded: “Inhaling Lemons and Lavender Aids in Wound Healing” “Using Magnets to Treat Arthritis” “Testing of Prayer to Cure AIDS” “Testing Prayer To Hasten Healing of Breast Cancer Reconstruction Surgery” and…the infamous “Testing of Homeopathy *Medicine* for Treatment of a Variety of Self-Limiting Ailments”.

If only the scientists at NCCAM had used “Plausibility”….

BTW, the Galileo Gambit and all its permutations is a fairy tale. He was persecuted only by the Catholic Church because his findings destroyed the Catholic established dogma of the earth being the center of the universe.

Taylor Walsh: Your friends claims to have experienced pain relief due to sinusitis. That is a patient’s anecdote…which again is not the PLAUSIBILITY factor that Dr. Briggs and her colleagues are supposed to be using to make decisions to fund research. Remember anecdotes are not data. Did your friend also tell you about the theory of using acupuncture to relieve sinus pain? According to acupuncturists the basis of their treatment is based on the flow of Qi (or Chi) through “energy ducts” or “meridians” throughout the human body. The placement of needles, sometimes at the site of the problem on the human body, but often far removed from the site of the problem, enable the Qi/Chi to flow through the energy ducts/meridians. Show us any scientist who has analyzed what the Qi/Chi substance is and show us any scientists who has located these “energy ducts/meridians” in any human body.//

On the other hand, every human has facial sinuses which are air-filled pockets…we can visualize them on X-Rays, CT Scans and MRI Scans. We can also visualize on these same scans when they are inflamed and have mucus in them, that causes sinus pain. When medicine is taken to decrease the inflammation, we see the results on these same scans. When antibiotics are prescribed for a bacterial sinusitis, we see the results on these scans and the patient is relieved of the sinus pain caused by the inflammatory pressure and the mucus that has caused sinus pain.//

Your friends anecdote has no more “scientific” proof and does not meet PLAUSIBILITY factors that scientists should be using, than the anecdote from a person who claims walking around a craps gambling table three times counterclockwise relieved his gambling debt.

Lilady: I didn’t suggest that my friend’s outcome was scientific proof. She took on the acupuncture after the standard medications, and everything else her doctor prescribed, failed to address the problem. I did ask, however: “What should be the response of medical science to such an outcome?” // What should it be?

Your friends anecdotal story of relief is just that…an anecdote. Thanks for adding some details to your friend’s anecdotal story of acupuncture relieving sinusitis pain.// “She took on the acupuncture after the standard medications, and everything else her doctor prescribed, failed to address the problem.” Doctors whose education and whose practice of medicine are based in science, don’t prescribe acupuncture. They prescribe the “standard medications” which DO NOT instantaneously cure a case of sinusitis, but which work because of their proven anti-inflammatory action and their proven effectiveness to cure with antibiotics, sinusitis caused by bacterial infection.// You and your friend have assumed that a course of *treatments* with acupuncture that permits the flow of “Qi” through “meridians”, effected a cure of a self-limiting sinusitis.

I don’t see the scientific proof that the person had self-limiting sinusitis. This seems as hypothetical as the acupuncture improved the pain. There have been some studies on the efficacy of acupuncture. Just because we can’t find a material meridian, doesn’t mean acupuncture may not be effective in certain situations. One study did document that manipulating the needle on an acupuncture point was traced to pulling fascia strands connected to the related organ. Also, absolute rigid belief in selected scientific studies is a type of dogma as well.

Lilady: I respect your opinions regarding CAM practices and NCCAM funding. I would like to hear your opinion of what NCAMM’S role is by bringing up a similiar experience to the situation Taylor Walsh described. If we don’t take into account real situations people encounter and the role NCCAM might play in them, then what are we all doing here? I have a family member who also had Sinusitis. Chronic sinusitis treated heavily with rounds and rounds of antibiotics with no effect. Finally, the specialist in this field told her “I have nothing else for you”.
It seems NCAMM is charged with trying to make some sense out of what happens next. Many people will leave the realm of Western medicine and seek help from other cultures of healing. If we want someone to investigate what happens in this space, it seems NCCAM is on track. If we want NCCAM to measure only previously defined (by science) physical measurements of say bloodwork or how much mucous is in there, it seems that any reasearch facility could do so. Lets allow NCCAM room to be of some guidance in this world that is filled with many choices. If straight science is what you are after, maybe a University or reasearch facility is a better choice than NCCAM. NCCAM is boldly stepping out into the unknown and attempting to help the public make some sense of it. It can be a messy place.

For every anecdote there is an equal and opposite anecdote. I tried a course of acupuncture for sinusitis and it did nothing whatsoever. I also took the ephedra the ancient and non-English-speaking Chinese doctor (who very convincingly fitted all my preconceptions) prescribed, but found that pseudoephedrine and ibuprofen worked better. Homeopathy didn’t do anything either, neither did a host of other extremely unlikely and in some cases probably dangerous things I tried when truly desperate. I still get flare-ups of sinusitis, that sometimes last for weeks and sometimes go away for no apparent reason without treatment. If I was trying some wacky alternative remedy when this happened it would be easy to think the relied was caused by the remedy when it would have gone away on its own. Antibiotics usually help, but I use them as a last resort, not wishing to mess up my gut flora.

There is a reason why I brought up acupuncture on this blog…because the latest “study” funded by NCCAM is a meta-analysis of supposedly *good* studies of acupuncture treatment for pain relief. The authors of the meta-analysis located 27 studies that purportedly found positive results for the relief of pain. Here is what the NCCAM press release states about this study://

“…In addition, results from the study provide robust evidence that the effects of acupuncture on pain are attributable to two components. The larger component includes factors such as the patient’s belief that treatment will be effective, as well as placebo and other context effects. A smaller acupuncture-specific component involves such issues as the locations of specific needling points or depth of needling…” See the larger component (“patient’s belief that treatment will be effective, as well as placebo and other context effects.”)?//

Just a *quicky* press release and articles appearing in the popular media about this meta-analysis of 27 *good* studies does NOT reflect the growing body of evidence derived from studies that use “sham acupuncture needles” that clearly show that patients’ belief system plus the placebo effect are the only determinate for the small, statistically insignificant, patient anecdotes of effectiveness of acupuncture.//

It is insulting to differentiate between *Western Medicine* and *Eastern Medicine*…there is only one medicine which is science and evidenced-based.//

Again, I question why we need to waste taxpayer money on this separate NCCAM Institute, when the staff resources and funding could be used in other NIH institutes? The proposal for this study was supposed to meet the NCCAM’s “Prior Plausibility” criteria…I’d love to see a comment here from Dr. Briggs why staff believed that acupuncture needles inserted into a person following *meridians* to enable the Qi substance to flow throughout the body, meets the “Prior Plausibility” criteria.//

Also see my posts above about other nonsensical studies funded by the NCCAM such as “Inhaling Lemons and Lavender Aids in Wound Healing” “Using Magnets to Treat Arthritis” “Testing of Prayer to Cure AIDS” “Testing Prayer To Hasten Healing of Breast Cancer Reconstruction Surgery” and…the infamous “Testing of Homeopathy *Medicine* for Treatment of a Variety of Self-Limiting Ailments”.//

While sticking needles into meridian points is *usually* harmless, there are documented reports of acupuncture *practitioners* not using sterile techniques and infecting their *patients* with the hepatitis B virus. Other documented reports of acupuncture needles piercing arteries…and the chest surgery that the former president of Korea underwent to remove an acupuncture needle from his lung.//

The major harm IMO, is funding NCCAM staff who are poor stewards of taxpayer money and who do not use “Prior Plausibility” criteria to make decisions about funding studies.

Lilady: Would love to hear your opinion on what you believe is the best course of action when a medical doctor tells you ” I have nothing else for you”. That is after “traditional” drugs, multiple doctors and treatment is not effective in relieving suffering. Where does one put thier trust? Does NCCAM have a role? This is a reality for many.

“Where does one put thier trust? Does NCCAM have a role? This is a reality for many.”// How about looking at a science-based blog? Try sciencebasedmedicine.org…look for the two separate posts, by two different physicians, “An Acupuncture Meta-Analysis” and “Can we finally just say that acupuncture is nothing more than an elaborate placebo?”//This is NOT a new study, but rather a meta-analysis of existing studies, which the authors sifted through to find “the best” studies of acupuncture, that were NOT double-blinded, that used a “0-100 pain scale” to pump up the the findings which, when analyzed, are statistically and clinically insignificant.

Interesting that some of these previous medical discoveries were so quirky and argued against.  They do seem like no brainers to me but that could just be because of my experience.  I would like to see what currently is thought of as quircky but is going to be implemented in the future in regards to dealing with back pain.  I use a cybertech medical brace from braceability to currently handle my back pain but would love to see some new advances in the medical field!

what is the definition of quirky?  is it that the speaker doesn’t understand it or it is different from what the speaker is accustomed to .  Quirky seems a very subjective and opioniated descriptor.

I was diagnosed with a nechrotic hip which could not be diagnosed until with an MRI. i stayed in touch with a surgeon who said until I decided surgery I could do anything that didn’t hurt but I read it was better to give it as much rest and I did so going to a gym where i only did sitting exercises. After several years I had another MRI  and things were the same. I finally pleaded for another MRI after another few years (the poor MD was not supossed to do it because MRI’s cost too much) but finally gave in and although my hip was not great it was not nechrotic any more and not subject to collapse. So the last MRI saved me from a surgery that would have cost much more than the MRI. So with the cost saving (ha) I was lucky that I followed my own judgement and although MD’s certainly try to do their  best often the patient knows best.

Evidence-based medicine (EBM) has an increasing importance in this generation. It’s more important or more relevant if there are scientific evidences regarding certain issues.Being able to go against the norm or the mainstream is sometimes more fruitful than just relying on the ‘usual’ and there’s nothing wrong with having an open mind and a different perspective. It just adds a little something to the table.Cheers!

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Evidence-based medicine (EBM) is a move in the right direction, but I would like to put in a plug for science-based medicine (SBM) which includes prior plausibility in an assessment of the potential efficacy of a treatment modality. It seems increasingly clear that false positives are much more likely than false negatives in clinical trials, and that much of the evidence that is claimed to support the efficacy of various CAM treatments is actually noise, not a signal.  Quirky ideas may lead to innovation, but quirky ideas that fly in the face of large amounts of established science (i.e. have zero to low prior plausibility) have never yet led to any medical breakthroughs, despite the billions of dollars NCCAM and OCCAM have spent on researching them.  The hypothesis that homeopathy, acupuncture and therapeutic touch, for example, have any benefits beyond placebo, is extremely implausible, and in my view any money spent on researching them is simply wasted. The only disorders that appear to show even a small response to these treatments are those that we know have a large psychological component, that are assessed subjectively, and that we know respond to placebos e.g. pain, anxiety, depression. I think we should look at developing a science-based placebo, that can complement science-based treatments that address objective disorders by making the patient feel subjectively better as well. We know that a sympathetic ear, suggestion, massage and gentle exercise have these effects, without introducing any supernatural concepts. Perhaps a combination of these might lure patients away from the proliferation of irrational treatments so many pursue these days.