Wednesday, August 31, 2011

Coherent Energy, Liquid Crystallinity and Acupuncture

 OK. Back to that wacky science stuff...

The Institute of Science in Society (ISIS) is a not-for-profit organization founded in 1999 by Mae-Wan Ho and Peter Saunders dedicated to providing critical and accessible scientific information to the public and to promoting social accountability and ecological sustainability in science.

Here's a link to a talk about acupuncture given by Dr. Mae-Wan Ho to the British Acupuncture Society in 1999.


Thursday, August 25, 2011

Relax, the clock is yours

One question patients often have when getting an acupuncture treatment is “How long am I supposed to have the needles in?” An important question when it comes to working on health and your own personal time. Some acupuncturists will cite classic texts that say qi circulates so many times a day in the body and therefore you need a minimum of about 30 minutes with needles to at least let the qi circulate once. Some current research indicates that it takes about 10-20 minutes to get the nervous system into gear. So generally we recommend that range of 20-30 minutes as a good minimum. 

There is a kick to the nervous system (which we'll explore in future blogs) via the prick of the acupuncture needles and the amount of time it takes to register is probably fairly consistent from person to person, but what comes after that is hard to tell (i.e., everyone has a different experience with acupuncture, and often has a different one each time they come). So we wouldn't want to disturb that process by coming in and removing the needles while you are in mid-acupuncture stream.

Many acupuncturists are restricted by table space and that oftentimes determines how long your acupuncture treatment will last. They schedule appointments every 60-90 minutes in a private room and so when that time is up and the next patient is arriving, they need to be wrapping up your time. But that space-time restriction is not normally a concern for a community acupuncture clinic, which leads even acupuncture veterans perplexed when we ask them if they are done with their acupuncture session.

But I have just seen the individual response during an acupuncture treatment vary so much that I hesitate to apply a definitive end time. Some folks can only sit still for 20 minutes and that’s it. They keep a relaxed eye on the clock and know when those 20 minutes are up. Others can stay in a chair for 2 hours and you can count the tree rings grow while they are in their recliner. Sometimes patients want to be out after 45 minutes or so just to keep time from slipping away.

Oftentimes patients are coming to de-stress or get a “tune-up” or embark upon a mystical journey of rejuvenation. Far be it from me to know exactly how long that should take. I have had acupuncture treatments that last 20 minutes, but feel like 90; and other times I have been in a chair with needles for 90 minutes and it feels like 20. That may be all in my head, but we have obviously entered a world where we realize that what happens in our heads is no longer so separate from what is happening in our bodies.

Saturday, August 20, 2011

The Story of the La-Z-Boy

Here's a link to the story of the famed La-Z-Boy reclining chair, the secret weapon of any community acupuncture clinic.

Thursday, August 18, 2011

Sacred Cows: The Long Version

This all started with my trip to MD Anderson's Integrative Oncology Conference for acupuncturists. What I experienced there was the unrelenting yet thoughtful questioning of everything. I found this to be incredibly refreshing. This is very different from how acupuncture is traditionally and commonly taught.

I was actually attempting to take on the subject of patient communication last time I wrote (after a patient asked me if I had studied acupuncture!?), but the juxtaposition of what I was presented with at a science based conference on acupuncture, and a perusal of some rather ordinary acupuncture reading materials led to something bigger. This is difficult stuff to write about and I have struggled to tie it all together. It makes people uncomfortable.

This discomfort lies in the fact that I am touching on acupuncture's sacred cows  - a 'sacred cow' being something considered (perhaps unreasonably) immune from question or criticism (for those not up on your bovine idioms).

If you look back at the articles I referenced last time, despite their entirely different perspectives, I think they both speak to a wont of some special knowledge or ability.  In the piece on research standards, the question is posed whether the usual scientific methods can even capture this knowledge, and the Master Tung piece is presented as simply knowledge beyond question.

Obviously, when you seek out a licensed professional of any kind, you do so because you seek their expertise. But what I'm talking about here is not just the knowledge of a trained professional. I'm talking about the exaltation of a body of knowledge.

At SACA we actually work hard to keep things down to earth, and to make acupuncture something more ordinary, and more accessible. As such we sometimes have to negotiate patients' preconceptions about what we do. The people I work with think I'm about half nuts as I try to articulate these concepts, as apparently do some of my patients as well, but I think what I'm writing about here is central to operating a community acupuncture clinic.


Because I think it is important to put acupuncture in some kind of perspective, and I think community acupuncture sort of builds this perspective into the model. Acupuncture doesn't have to be complicated to be effective. Community acupuncture very simply places emphasis on access to treatment and frequency of treatment over practitioner mystique. No sacred cows here. Frequency trumps cleverness. I came to practice this way because I felt that the community acupuncture model was free of the trappings that have kept acupuncture obscure and inaccessible - to both practitioners and patients. I still feel this way.

So again, the ultimate motivation for my getting into all this was patient perception and expectation - which is pretty fascinating, and only occasionally concerning. What I'm learning is that the occasional interactions of concern all seem to arise out of patients coming in with some kind of preconceived notions about what acupuncture is about. Interestingly, these are typically people who have never had acupuncture yet strangely want to hold us to our sacred cows. Sorry if I've burst any bubbles.

I'm a pretty straight forward and not particularly mystically inclined person. I practice a form of medicine that is largely historically based rather than evidence based, and I am intrigued by the intersection of these two worlds. If my training and experience tells me acupuncture will not solve a problem this doesn't mean I don't "believe" in acupuncture. I strive to discern reality clearly, not merely impose my beliefs on it. It's OK for acupuncture to not be everything.

Ultimately any authority I possess is born of direct experience. And my direct experience of acupuncture is that I've been told a lot about acupuncture, but in fact very little of what I have been told do I actually know to be true by my direct experience. I'm not doubting acupuncture or my own abilities when I say this. I am questioning if it works in quite the way we are taught. I have always questioned this.

Nick Kurtz, a community acupuncturist from Kansas recently gave a report on the CAN website about the 2011 NADA conference. 'Dr. Michael Smith had some choice words for acupuncturists: He talked about how the acupuncture books ignore current research in favor of thousand year old texts and that that is completely unacceptable for health care providers. If we accepted the research then the books would get real thin real fast, and training would be simpler and cheaper, and more people would be helped. He talked about how the research shows that point location does not matter and that different styles of acupuncture and sham acupuncture are all effective - and if all that is true then most acupuncturists don't understand how acupuncture works.  He said acupuncture right now is more like a religion then medicine, and acupuncture books are more like the bible than a medical textbook'

Those sacred cows again.

Now I gotta tell you, writing stuff like I'm writing has been cause for great debate around here. Concern has been expressed that what I'm saying will be construed as an acupuncturist expressing skepticism about acupuncture. That's not the case at all. I have no doubt as to the profundity of this medicine. And my intention in no way is to disparage the rich historical body of knowledge on which it is based. I'm friends with Will Morris, and I use some Master Tung stuff in my practice. However, that what I'm saying is so challenging is to me indicative of how hard it is for the acupuncture profession to question itself - and that needs to change.

More on the wacky world of science later....

Thursday, August 11, 2011

No Better than a Placebo

There was a study recently reported that compared St. John's Wort and Citalopram (Celexa) to a placebo. Now, the study only looked at “minor depression” so we cannot interpret anything for other classifications of depression. But congratulations to St. John's Wort for being of equal effectiveness as an FDA approved, laboratory-derived pharmaceutical. However, as new (and older) books have been highlighting, this type of finding is pretty common.

Chinese herbal medicine also has various remedies with similar usage histories as St. John's Wort. We choose from one of several base formulas, based upon the symptom information a patient provides and some subtler pieces of information—this is what we're taking into account when we check a patient's tongue and pulses. In China they've conducted lots of studies on many of these classic formulas, but oftentimes it's really hard to trust the few findings we get wind of. In so many you get this “80% of patients reported some improvement in their condition so this formula is obviously awesome” result. But hopefully there is going to be a trend towards conducting more studies of Chinese herbs (and acupuncture, Wally) here in the U.S. For example, another recent study looked at using an herbal formula to treat hot flashes in post-menopausal women. While the study showed that they did not produce a statistically significant advantage over a placebo, it is encouraging to see this investigative process happening and hopefully see it be refined to take into account better prescribing methods for Chinese herbal formulas.

So someday, someone will get around to looking at some of the herbal formulas Chinese herbal medicine uses to address “diseases” such as minor depression. Those studies may also find that they are no better than a placebo. But that will probably mean that the Chinese herbs are also as effective as St. John's Wort or whatever antidepressant medication they go up against. And perhaps in that hopefully-not-too-distant “someday” acupuncture and Chinese herbs will find at least a minimal amount of funding that will save us from having to work mainly in this direction.

Monday, August 8, 2011

A Worldview Informed by Positivism?

Communicating about acupuncture is no simple thing.

I think in part this is a result of how we acupuncturists are trained to think (or perhaps not think) about acupuncture, and in part, patient perception and expectation about something that most know little about- but that's another blog.

First, about acupuncturists…Let me give a couple of examples of contemporary acupuncture thinking.

I read an article recently in Acupuncture Today. It was titled ‘Master Tung’s Five Zang Channel System and Clinical Applications’. In truth, the piece was pretty lacking in substantive content. There were some themes running through the piece though. It spoke of a system based on wisdom inherited from ancestors, the “secret” memorized – passed down by family oral tradition; the effectiveness of which was “confirmed completely” by a large number of undocumented clinical cases; the importance of this work demonstrated clearly by a few anecdotal stories of cases and a couple of self published books by students of the master; and some indication that the true meaning is inevitably to some degree lost in translation to English. Not a lot to go on there…

Another is a piece published in The American Acupuncturist by William Morris, president of AOMA Graduate School of Integrative Medicine – located here in Austin. It is titled ‘Standards for Reporting Acupuncture Research’. In this piece the author outlines current research standards, but the gist really seems to be the author's take on “positivism as a worldview and how it informs the practice of evidence based medicine”. The author states, “While Chinese medicine adopts principles that can be constructed as laws, theories such as 5 Phases and yin-yang do not comport with a contemporary scientific construction of laws.” He concludes with the statement, “There may be a question whether the worldview informed by positivism is a point of view which captures the knowledges of acupuncture and East Asian medicine best.”  


Positivism (I had to look it up) refers to "a theory that theology and metaphysics are earlier imperfect modes of knowledge and that positive knowledge is based on natural phenomena and their properties and relations as verified by the empirical sciences" (Websters).  So a worldview informed by positivism is essentially a worldview informed by scientific inquiry.

So I sort of don’t get it. On the one hand the author outlines standards developed thus far so that acupuncture may be studied more effectively, and on the other he essentially questions whether the scientific method can capture the knowledge of the medicine.

One of these articles reports on a traditional lineage approach to learning, the other a modern scientific approach. Both are more than just a little obscure, and both exemplify the challenges acupuncturists face in moving the field forward, and the challenge of communicating meaningfully about what we do as acupuncturists.

Somehow the field of acupuncture has got to reconcile the disparities between Chinese traditional culture and the modern world. This is a problem not unique to traditional medicine. It is also an acknowledged problem for modern science as China comes to the fore as a global leader. 

I’m not saying everything we do as clinicians needs to be 100% science based or communicated in scientific language, but I do think it is high time we begin to more broadly question the body of knowledge on which acupuncture practice is based. We at least need to come to terms with what we are talking about. Are we talking about philosophy or science? Are we talking about something we know or what we believe? Fundamentally it’s hard to talk about acupuncture because in large part  - if we’re honest with ourselves - we really don't know very much about it at all despite a historical record spanning centuries. Simply claiming metaphysical superiority to reductionist bourgeois methods ain't gonna cut it.

There, I said it.

Thursday, August 4, 2011

Sleep on it

We treat a lot of patients for insomnia at South Austin Community Acupuncture. Most people have dealt with it at some point. Sometimes it pales in comparison to all the other events in one's life while at other times it is the axis of all our other problems.

In nosing around I came across something in the Harvard Mental Health Letter, which basically seemed like the biomedical protocol for dealing with insomnia. It ran over the use of cognitive behavioral therapy and of course medications. There are caveats of using therapy first and drugs second and if drugs then low doses and for short duration. But I wonder what the reality of that is. There was some reference to relaxation and reconditioning.

The whole reason I looked up insomnia in the first place was because I came across another different article in the American Journal of Public Health: “The Medicalization of Sleeplessness: A Public Health Concern”. The abstract states: “ sleeplessness complaints and insomnia diagnoses increased over time and were far outpaced by prescriptions for sedative hypnotics” (italics mine). The article is an overview of the author's dissertation and reflects that “[p]hysicians were cognizant and critical of medicalization. They conceptualized insomnia as a symptom, part of the aging process, or a reaction to stress - not a disease.”

Maybe we should have a few more steps in between the statement: “I can't sleep” and the prescription pad. A “public health concern” that is “not a disease” doesn't need to be attacked with pharmaceuticals as often as it is. I would like to see the “Relaxation Techniques” and “Reconditioning” (really poor choice of words, that) sections from Harvard's protocol explode as treatment options: get some exercise, meditate, take a tai chi or yoga class, learn to dance, learn to paint. Try some acupuncture. Learn what sleeping with strangers is about and how it often leads to better sleep on your own. And if you already know, tell a friend that it can probably help them, too.

Tuesday, August 2, 2011

Introducing Mike Sobin: super-blogger

Many of you already know Mike from his years working at the clinic as a student, and now as a Licensed acupuncturist. we're turning him loose, keyboard a-blazing, right here, right now, in the blogoshpere. Enjoy!