Rant

A couple of issues or so back, the New England Journal of Medicine published a clinical vignette on acupuncture and the treatment of chronic back pain. They also reviewed the literature and mentioned the German studies where so called "sham" acupuncture worked nearly as well as so called "real" acupuncture. Both the real and the sham involved the insertion of needles into the body.

The conclusion: real acupuncture has not been demonstrated to be more effective than sham acupuncture, and so might just be placebo.

This blows my mind just a little bit. I propose that the question raised by such a study is not whether or not acupuncture is placebo, but what is "real" acupuncture? To my mind they are drawing a conclusion before even beginning to study the problem. There is a bias towards assuming what you do not understand must be placebo. I find that to be just a little bit ridiculous. It seems to me before you can study real acupuncture vs. sham acupuncture, you might first need to understand what real acupuncture is....

Almost as striking were the comments sent in by readers. One was from several Chinese doctors saying basically if you're going to study this stuff, you have to put it in the context of Traditional Chinese Medicine. Another was from a reader who questioned the ethics of recommending a course of treatment that could well be placebo. He makes the point that a course of 10-12 treatments as proposed in the vignette could cost $1000-$1500.

I think these two comments frame nicely the problems this medicine faces in our country, and how community acupuncture potentially offers sensible solutions.

First of all, I don't buy the notion that acupuncture must be performed strictly adhering to the principles of Traditional Chinese Medicine to work, or to be studied effectively. There are too many ways of doing acupuncture that are all effective to some degree or another, and they are not all TCM. In fact, too much of what is taught in acupuncture schools is taught without question, and much of what is taught probably should probably be framed in more of an anthropological perspective. I'm not dismissing TCM, it's just it's hard to see how we will ever arrive at clear inquiry if it is ever necessary to be self referential in order to be valid. To attempt to scientifically study acupuncture through the lens of TCM is to distort the picture from the beginning. There are too many cultural assumptions of validity. Just because it's agreed upon doesn't make it science.

Now to be fair, there is more to Chinese medicine than acupuncture. If I were treating someone's low back pain, chances are I would use cupping, and chances are I'd use herbs. Chances are too, I wouldn't even put a needle in their back! None the less, we've got to start cutting through the exoticism that surrounds this medicine if we truly want it to be widely used. As it stands, most recent surveys indicate about 1% of the population using acupuncture in a given year.

Essentially you've got the white folk saying we don't understand it so it must be placebo, and the Chinese saying you don't understand it because you're doing it wrong and so you'll never understand it.
I think everyone is demonstrating a lack of perspective, but I am none the less hopeful that over time meaningful inquiry will emerge.

Theory and philosophy are one thing, clinical practice another, and scientific inquiry another thing still.

The second comment, about sending someone off for $1000-$1500 worth of treatment indeed raises some questions, and they are obvious ones: At that rate, these would be $100 to $150 per session treatments.  Seriously, who can afford to do that? This is precisely where acupuncturists so often get in a bind. Unless the patient is wealthy, what likely will happen is the patient will likely have expectations around treatment that probably aren't realistic - in part because they can't afford a course of treatment, and in part because they are going to assume you have some special powers if you're charging those rates. The whole thing fosters unrealistic perceptions and expectations about what acupuncture is, and how it works both on the part of the patient and the practitioner.

Acupuncture is either going to help, or it's not. And if it doesn't, it's not because the patient was a non-believer, and it's probably not because the practitioner failed to make the correct TCM zang fu diagnosis either...zang who?

Onward

Busy week

Busy week last week giving free treatments for Acupuncture and Oriental Medicine Day, which we celebrated all week.

It went well...

Mostly it seemed folks were genuinely interested in checking out acupuncture and the clinic, and were supportive of the work we're doing here. 
  
Also did a health fair Thursday at the Texas Workforce Commission. Nice folks, and great hospitality.

Honestly, people are kind of funny about acupuncture, but again, it seemed there were a few who were genuinely interested in what we're doing here at South Austin Community Acupuncture.
 
I also saw some people at the TWC health fair I hadn't seen in a while, like the Jonci Jensen, a naturopath in town I respect greatly, and Antoinette from Texas Seniors' Guides - an invaluable resource for the elderly, or those who have aging family members or friends.

Weekend spent cleaning up the website for hours and days...

work

Que Sera Sera

On Friday, Oct 1st, we got a 6am call from my mom's assisted living in Austin saying they thought she was having a heart attack. Georgia is 92 years old. We met her at the emergency room at Seton Southwest, and there were definitely moments where we thought we were losing her. After a weekend in the hospital, she prevailed however, and we moved her back to her hometown of Richmond, Texas to a skilled nursing facility. Here's a couple of pics of G, in her new digs...still smiling, still singing 'Que Sera Sera'.

Mother and daughters

SACA in Austin Monthly

Well...thanks Austin Monthly.
You almost got it.

Tobacco, Alcohol, Recreational Drugs, and Acupuncture... Seriously?

Acupuncture is a process...

Just as there is a slow food movement, what community acupuncture clinics are doing is a movement towards slow medicine. Acupuncture is gentle, safe, and effective for a wide range of disorders - but generally speaking it takes some doing. As in, you have to actually get acupuncture to benefit from it...it is very much a process.

It's not like we just put the needles in 'just so' and you are magically fixed (well...sometimes). More often than not some kind of course of treatment is required.

One of THE central ideas behind the sliding scale fee structure of South Austin Community Acupuncture is to price treatment such that ordinary people can afford to get acupuncture as often or for as long as they need to get great results.

Why am I saying this - again?

Because: I have had the experience of patients who seemingly understand that their course of treatment is going to be a process - they tell me they are not looking for a quick fix, and that they are ready to do whatever it takes to solve their problem that has been plaguing them for years. Then they come three or four times and disappear...

Mostly, people show up when they have an acute something going on, or when they just feel like getting acupuncture. Then there's a handful that come long term - some for years.

But I'm not writing this for the folks who have already figured out how to best use acupuncture for themselves. I  am writing this to give some perspective specifically to those who maybe are not familiar with acupuncture, or those who tried it once or twice and decided it didn't work...

Many acupuncturists charge $70 or more for a single treatment. At South Austin Community Acupuncture you could get four treatments for that amount of money - or literally a months worth of treatments for the cost of one single treatment at other clinics. Put yet another way, you could come for 6 MONTHS for what it would cost you to go 6 WEEKS elsewhere...By doing this we are making it possible for you to get acupuncture over a period of time and really help you with your problem.

This is huge! In fact it is the elephant in the treatment room.

The community acupuncture people are the only people I've seen have the courage, and honesty, and common sense to point out that maybe the most important thing about acupuncture is not the prowess of the practitioner, but rather the most important thing is simply getting acupuncture.

Getting acupuncture...

Sure, some have more experience or training than others - but at the end of the day acupuncture is at heart a simple yet profound folk medicine. It is not magic! Chance's are it's not gonna work any better if your acupuncturist studied with a Daoist priest who traces his lineage back to 2AD...It's gonna work better if you get it - often enough, and/or long enough.

So, I encourage folks with chronic, stubborn problems to stay with it. You have a unique opportunity with community acupuncture to actually use acupuncture to your best advantage. Things that took a lifetime, or years to develop are not going to be fixed with two or three treatments. Give it some time, and enjoy the process....