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Placebo Medicine: Is It A Sham?

In the Wall Street Journal last week was a particularly bad article by Melinda Beck about acupuncture. While there was token skepticism (by Edzard Ernst, of course, who is the media’s go-to expert for CAM), the article credulously reported the marketing hype of acupuncture proponents.

Toward the end of the article Beck admits that “some critics” claim that acupuncture provides nothing more than a placebo effect, but this was followed by the usual canard:

“I don’t see any disconnect between how acupuncture works and how a placebo works,” says radiologist Vitaly Napadow at the Martinos center. “The body knows how to heal itself. That’s what a placebo does, too.”

That is a bold claim, and very common among CAM proponents, especially acupuncturists. As the data increasingly shows that acupuncture (and other implausible treatments) provides no benefit beyond placebo, we hear the special pleading that placebos work also.

But is that true? It turns out there is a literature on the placebo effect itself, and the evidence suggests that placebos generally do not work. Read more »

*This blog post was originally published at Science-Based Medicine*

Is Acupuncture Valuable In Treating Depression?

One of the basic principles of science-based medicine is that a single study rarely tells us much about any complex topic. Reliable conclusions are derived from an assessment of basic science (i.e prior probability or plausibility) and a pattern of effects across multiple clinical trials. However the mainstream media generally report each study as if it is a breakthrough or the definitive answer to the question at hand. If the many e-mails I receive asking me about such studies are representative, the general public takes a similar approach, perhaps due in part to the media coverage.

I generally do not plan to report on each study that comes out as that would be an endless and ultimately pointless exercise. But occasionally focusing on a specific study is educational, especially if that study is garnering a significant amount of media attention. And so I turn my attention this week to a recent study looking at acupuncture in major depression during pregnancy. The study concludes: Read more »

*This blog post was originally published at Science-Based Medicine*

Poor Study Design Can Show Anything You Like: Acupuncture For Hot Flashes

In the most recent issue of The Journal of clinical Oncology is a study comparing acupuncture to Effexor in the treatment of vasomotor symptoms (hot flashes) in women with breast cancer who cannot take hormone replacement therapy. The study found that the two treatments are equivalent, with longer duration and fewer side effects from acupuncture. However, the study is designed as a pilot study (very preliminary) and therefore the conclusions are highly unreliable – given prior research, this raises the question as to why the study was performed at all. Read more »

*This blog post was originally published at Science-Based Medicine*

Alternative Medicine’s Flawed Reasoning: The One True Cause of All Disease

Chiropractors, homeopaths, naturopaths, acupuncturists, and other alternative medicine practitioners constantly criticize mainstream medicine for “only treating the symptoms,” while alternative medicine allegedly treats “the underlying causes” of disease.

Nope. Not true. Exactly backwards. Think about it. When you go to a doctor with a fever, does he just treat the symptom? No, he tries to figure out what’s causing the fever and if it’s pneumonia, he identifies which microbe is responsible and gives you the right drugs to treat that particular infection. If you have abdominal pain, does the doctor just give you narcotics to treat the symptom of pain? No, he tries to figure out what’s causing the pain and if he determines you have acute appendicitis he operates to remove your appendix. Read more »

*This blog post was originally published at Science-Based Medicine*

The History Of Acupuncture: Astrology With Needles

Astrology with Needles

by Ben Kavoussi, MS, MSOM, LAc

The following is an excerpt of an upcoming article called “The Untold Story of Acupuncture.” It is scheduled to be published in December 2009 in Focus in Alternative and Complementary Therapies (FACT), a review journal that presents the evidence on alternative medicine in an analytical and impartial manner. It argues that if the effects of “real” and “sham” acupuncture do not significantly differ in well-conducted trials, it is because traditional theories for selecting points and means of stimulation are not based on an empirical rationale, but on ancient cosmology, astrology and mythology. These theories significantly resemble those that underlined European and Islamic astrological medicine and bloodletting in the Middle-Ages. In addition, the alleged predominance of acupuncture amongst the scholarly medical traditions of China is not supported by evidence, given that for most of China’s long medical history, needling, bloodletting and cautery were largely practiced by itinerant and illiterate folk-healers, and frowned upon by the learned physicians who favored the use of pharmacopoeia.

Heaven is covered with constellations, Earth with waterways, and man with channels.

Yellow Emperor’s Canon of Medicine (黄帝内, huang di nei jing)1

Acupuncture is presumed to have its origins in blood ritual, magic tattooing and body piercing associated with Neolithic healing practices.2,3 The Neolithic origin hypothesis is supported by the presence of nonfigurative tattoos on the Tyrolean Ice Man–an inhabitant of the Oetztal Alps in Europe–whose naturally preserved 5,200-year-old body displays a set of small cross-shaped tattoos that are located significantly proximal to classical acupuncture points. Medical imaging shows that the middle-aged man suffered from lumbar arthrosis and the cross-shaped tattoos are located at points traditionally indicated for this condition.4,5 Similar nonfigurative tattoos and evidence of therapeutic tattooing, lancing and blood ritual have been found throughout the Ancient world, including the Americas.6,7,8 Health-related tattoos are still prevalent in Tibet, where specific points on the body are needled with a blend of medicinal herbs in the dyes. These practices appear to be largely intended to maintain balance with the natural and spiritual worlds, and also to protect against demonic infestation and malevolence. Seemingly, this Neolithic and Bronze Age lancing heritage, which was intertwined with magic and animism has evolved in various cultures into codified systems of lancing and venesection for assuring good health and longevity. In addition to treating the impurity or superabundance of blood, in various cultures lancing was also believed to affect the flow of a numinous life-force that is, for instance, called qi (or chi, 氣, pronounced “chee”) in Chinese, prāna (प्राण) in Sanskrit, pneuma (πνεύμα) in Greek, etc.9 In many instances, elements of metaphysics, mythology, mysticism, magic, shamanism, exorcism, astrology and empirical medicine intimately intertwined, making it difficult for modern scholars to interpret them as mutually exclusive categories.

In China, for instance, the numinous force was believed to mirror the Sun’s annual journey through the Ecliptic-meaning its apparent path on the celestial sphere–and to circulate in a network of 12 primary jing luo (經络) known in English as the chinglo channels or simply channels or meridians (a term coined in 1939 by George Soulié de Morant, a French diplomat). These imaginary pathways run from head to toes and interconnect around 360 primary points on the skin.10 There is a strong possibility that the web of these channels was a rudimentary model of the vascular system that was conceptualized according to an episteme­-meaning a set of fundamental beliefs-that was based on astrological principles and solar mythology. This episteme­ also indicated that a person’s health and destiny are determined by the position of the Sun, the Moon, the 5 Planets and the apparition of comets, along with the person’s time of birth.11 In this worldview, each body segment corresponds to one of the 12 Houses of the Chinese zodiac system di zhi (地支) known in English as the Earthly Branches, and which consists of 12 two-hour (30°) divisions of the Ecliptic. The channels are therefore named according to their degree of yin (阴) and yang (阳), from tai yang (太阳) to jue yin (厥阴), which are terms that describe the phases and the positions of the Sun and the Moon.12 Each has five special points designated by the characters 水 (Water), 木 (Wood), 火 (Fire), 土 (Earth) and 金 (Metal) which are also the Chinese terms for Mercury, Jupiter, Mars, Saturn and Venus13, and seem to correspond to the transit positions of these Planets in the matching House. Each point is also associated with a color, which comes from the visual appearance of the matching Planet in the night sky. Venus is white, Jupiter blue-green, Saturn golden-yellow, Mars red, and Mercury “black,” for it appears to be the dimmest of the five. Each of these points has also an occult connection with a direction, a segment of time, a season, a number set, a taste, a musical note, an internal organ, a body region, etc, in an ancient Chinese metaphysical cosmology often referred to as “correlative cosmology”14 and reminiscent of the esoteric and mystical beliefs held by Pythagoras of Samos (c. 580-c. 490 BC) and his followers, the Pythagoreans.15 In his occult and magico-mystical worldview, the nature of the life-force qi is often described in such terms16:

The major premise of Chinese medical theory is that all the forms of life in the universe are animated by an essential life-force or vital energy called qi. Qi also means “breath” and air and is similar to the Hindu concept of prāna. Invisible, tasteless, odorless, and formless, qi nevertheless permeates the entire cosmos. Qi is transferable and transmutable; digestion extracts qi from food and drink and transfers it to the body, breathing extracts qi from air and transfers it to the lungs. When these two forms of qi meet in the blood-stream, they transmute to form human-qi, which then circulates throughout the body as vital energy. It is the quality and balance of your qi that determines your state of health and span of life.

Other texts refer to qi as a “cosmic spirit that pervades and enlivens all things”17 and “from which the world was created.”18 For instance, the alchemist Ko Hung (葛洪, 2nd – 3rd Century AD) writes that “Man is in qi and qi is in each human being. Heaven and Earth and the ten thousand things all require qi to stay alive. A person that knows how to allow qi to circulate will preserve himself and banish illness that might cause him harm.”19, 20 The belief in a “cosmological correlation” between its pathways in the body and the Houses of the Chinese zodiac seems to be based on health and safety beliefs in geocentric cosmology and the related doctrine of “as above, so below” which stipulated that everything in the Heavens has its counterpart on Earth and also in man.

The episteme of “as above, so below” and correlative cosmology were prevalent throughout the ancient world, from the Eastern Mediterranean cultures to Northern Europe. It is notably found in the relics of a collection of occult writings called the Corpus Hermetica which are believed to be compiled in Hellenistic Egypt during the 1st or 3rd century AD and are attributed to Hermes Trismegistus (”Thrice-great Hermes”), the Greek equivalent of the Egyptian god of wisdom, Thoth. The original text was presumably lost or destroyed during the systematic annihilation of non-Christian literature between the 4th and 6th centuries AD. Nonetheless, a section of it known as the Emerald Tablet survived and was translated into Arabic by the Muslim conquerors and later into Latin by John of Seville c. 1140 AD and by Philip of Tripoli c. 1243 AD. An Arabic version of the Tablet by the Muslim polymath and alchemist Abu Musa Jābir ibn Hayyān (أبو موسى جابر بن حيان , c. 721-c. 815 AD) states “That which is above is from that which is below, and that which is below is from that which is above, working the miracles of One.”21 Given the prevalence of this set of fundamental beliefs throughout the ancient world, it seems that the natural philosophy that has given rise to the underlying theories of acupuncture in China stems from the same set of beliefs in that were also prevalent along the Silk Road in Persia, Mesopotamia, Egypt and in Greece and that have influenced the health and safety beliefs of pre-Christian Europe, such as the Eastern Mediterranean mystery cults22, or the early Gnostic Christianity.23 This hypothesis is supported by a statement by Gregor (Gregorius) Reisch (c. 1467-1525) in Margarita Philosophica (Pearl of Wisdom), first published in 150324:

The pagans believed that the zodiac formed the body of the Grand Man of the Universe. This body, which they called the Macrocosm (the Great World), was divided into twelve major parts, one of which was under the control of the celestial powers reposing in each of the zodiacal constellations. Believing that the entire universal system was epitomized in man’s body, which they called the Microcosm (the Little World), they evolved that now familiar figure of “the cut-up man in the almanac” by allotting a sign of the zodiac to each of twelve major parts of the human body.

Figure1

Figure 1: European medieval Zodiac Man form John de Foxton’s Liber Cosmographiae, published in 1408. It indicated the repartition of astrological influences on the body which physicians used to determine the auspicious time to let blood. Images courtesy of The Master and Fellows of Trinity College, Cambridge, UK.

Given this fundamental belief, European physicians Read more »

*This blog post was originally published at Science-Based Medicine*

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