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Tue Jul 9, 2013, 09:50 AM

Acupuncture: Small risks versus no benefit

http://scienceblogs.com/insolence/2013/07/08/acupuncture-small-risks-versus-no-benefit/

Since I’ve been on a bit of a roll with respect to acupuncture over the last week or so, I thought I’d just round out the trilogy with one more post. One myth that acupuncture apologists like to promote relentlessly is that acupuncture is completely harmless, that it almost never causes complications or problems. While it’s true that acupuncture is relatively safe, it still involves sticking needles into the skin, and, given that, it would be delusional to think that there couldn’t be injury caused by that. Rarely, however, have I seen a story like this from Canada reported in the National Post, Canadian Olympian’s ‘nightmare’ after acupuncture needle collapses her lung. It is the story of what happened to Kim Ribble-Orr, a world-class judoka who had competed in the Olympics in 2000 and harboring dreams of competing in the Olympics again, as a mixed martial artist. Those dreams were cast in doubt by a stray acupuncture needle:

When a massage therapist tried to treat the headaches she suffered after a 2006 car crash with acupuncture, however, he set off a cascade of health problems that would shatter Ms. Ribble-Orr’s sports-centred life — and raise questions about the popular needle therapy.

The therapist accidentally pierced Ms. Ribble-Orr’s left lung during acupuncture treatment that was later deemed unnecessary and ill-advised, causing the organ to collapse and leaving it permanently damaged. An Ontario court has just upheld the one-year disciplinary suspension imposed on therapist Scott Spurrell, rejecting his appeal in a case that highlights a rare but well-documented side effect of acupuncture.

Mr. Spurrell, who learned the ancient Chinese art on weekends at a local university, had no reason to stick the needle in his patient’s chest, and had wrongly advised Ms. Ribble-Orr that the chest pain and other symptoms she reported later were likely just from a muscle spasm, a discipline tribunal ruled.


Ribble-Orr had suffered many injuries due to her competition, including a dislocated elbow and shoulder, a broken hand, head injuries and repeated knee injuries. She had overcome them all to compete again, but appears unable to overcome this one. Basically, what happened is that in 2006, Ribble-Or was trying to get into mixed martial arts competition and was eying a job as a police officer. However, she was also recovering from injuries suffered in an auto collision and seeing Scott Spurrell, a massage therapist who had learned acupuncture during a weekend course at a local university. She was suffering from pounding headaches, and Spurrell convinced her that he could relieve those headaches by inserting a two inch needle, according to the disciplinary ruling, “into a muscle located between the clavicle bone and ribs.” From the description, it’s not clear to me exactly which muscle they meant, although it could conceivably have been the scalenes, the sternocleidomastoid, or perhaps even just the pectoralis major. Whatever muscle Spurrell was targeting, going between the clavicle and the ribs is basically where surgeons stick the needle when trying to place central venous catheter into the subclavian vein, and, yes, a pneumothorax is a known potential complication of placing such lines. What also puzzles me is how on earth Spurrell could have stuck the needle in deep enough to cause a pneumothorax? It would be one thing if Ribble-Orr were a fragile little old lady, but she wasn’t. She was an athlete, presumably with well-developed musculature. It would take a lot to get a needle through all of that muscle to get to the pleural cavity.

snip

All medicine is a risk-benefit analysis. All effective treatments have risks, and those risks have to be weighed against the potential benefits. When the benefits are significant (e.g., saving life), then greater risks are tolerable. When the potential benefits are minimal, then even minor risks might not be acceptable. When the potential benefits are none, no risk is acceptable. That is the case for acupuncture. It does not work, no matter how much acupuncturists try to prove it does.


How the fuck could someone believe that sticking a needle into the chest could relieve headaches?

Sid

39 replies, 7268 views

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Arrow 39 replies Author Time Post
Reply Acupuncture: Small risks versus no benefit (Original post)
SidDithers Jul 2013 OP
NV Whino Jul 2013 #1
SidDithers Jul 2013 #3
NV Whino Jul 2013 #18
snooper2 Jul 2013 #20
hlthe2b Jul 2013 #2
SidDithers Jul 2013 #5
hlthe2b Jul 2013 #8
pscot Jul 2013 #4
Hell Hath No Fury Jul 2013 #15
JaneyVee Jul 2013 #6
SCantiGOP Jul 2013 #9
pscot Jul 2013 #13
kysrsoze Jul 2013 #31
G_j Jul 2013 #7
1-Old-Man Jul 2013 #12
G_j Jul 2013 #16
Hell Hath No Fury Jul 2013 #10
longship Jul 2013 #11
SidDithers Jul 2013 #14
Bluenorthwest Jul 2013 #17
Iggo Jul 2013 #30
hlthe2b Jul 2013 #19
SidDithers Jul 2013 #23
hlthe2b Jul 2013 #26
grantcart Jul 2013 #33
cali Jul 2013 #34
zipplewrath Jul 2013 #35
Thinkingabout Jul 2013 #21
ananda Jul 2013 #22
Thinkingabout Jul 2013 #24
Bluenorthwest Jul 2013 #27
uppityperson Jul 2013 #25
agent46 Jul 2013 #28
HuckleB Oct 2013 #38
agent46 Oct 2013 #39
Archae Jul 2013 #29
HuckleB Oct 2013 #36
LiberalEsto Jul 2013 #32
HuckleB Oct 2013 #37

Response to SidDithers (Original post)

Tue Jul 9, 2013, 10:01 AM

1. I find it difficult to believe that an accupunture needle could pierce the lung

The needles are ultra thin and, in fact, go in only about 1/8 of an inch, if that. Maybe he was using an ice pick.

I think her lung collapsed due to some of her other, pre existing injuries. Like maybe the car accident.

Please note, this is not a promotion for accupunture. It is simply a statement of fact about accupunture needles.

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Response to NV Whino (Reply #1)

Tue Jul 9, 2013, 10:03 AM

3. That wasn't the finding of the Ontario Court...

The court found that the collapsed lung was caused by the use of a 2" accupuncture needle.

Sid

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Response to SidDithers (Reply #3)

Tue Jul 9, 2013, 10:47 AM

18. The needles are 2" long

But they don't go in that far. They are flexible and it would be really hard to push it up to the "hilt," so to speak.

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Response to NV Whino (Reply #1)

Tue Jul 9, 2013, 10:50 AM

20. Watch this video, (Warning, not for the weak stomach types)

 

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Response to SidDithers (Original post)

Tue Jul 9, 2013, 10:01 AM

2. This is why most states regulate to those physicians (and veterinarians) who go on to receive

additional certification in acupuncture. If you go to someone who knows nothing about human anatomy (or animal anatomy in the case of veterinary care) this is a risk.

But, Sid, you really do need to read some reputable peer review articles on the appropriate use of acupuncture and the science behind it (not the bastardized interpretations of Chinese philosophy behind it). You seem only to read the woo--which exists to one degree or another for every aspect and every domain of medicine.

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Response to hlthe2b (Reply #2)

Tue Jul 9, 2013, 10:05 AM

5. So what's the science that tells an accupuncturist...

that the treatment for headaches is to put a needle into the chest?

How does one affect the other?

Sid

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Response to SidDithers (Reply #5)

Tue Jul 9, 2013, 10:07 AM

8. I won't be insulted, Sid.. I indicated this person didn't know basic anatomy.

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Response to SidDithers (Original post)

Tue Jul 9, 2013, 10:05 AM

4. I read a study that determined

placement of the needles is pretty much random from one practitioner to the next.

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Response to pscot (Reply #4)

Tue Jul 9, 2013, 10:17 AM

15. Not really "random".

 

There are 100s of treatment points all over the body and different practitioners can use different point combinations to achieve a goal. A point in the chest could impact headaches via a certain central meridian, but a more commonly used treatment point is in the hand. What looks random still has theory behind it.

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Response to SidDithers (Original post)

Tue Jul 9, 2013, 10:05 AM

6. I have no idea how it works but I know 4 people who quit smoking from acupuncture.

 

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Response to JaneyVee (Reply #6)

Tue Jul 9, 2013, 10:08 AM

9. and I know a guy who finally quit smoking after hypnosis

He said the only reason it worked is he felt like a damned fool for spending several hundred dollars on something that didn't work, and he would have felt worse had he not quit smoking.

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Response to SCantiGOP (Reply #9)

Tue Jul 9, 2013, 10:12 AM

13. The cashectomy effect

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Response to JaneyVee (Reply #6)

Tue Jul 9, 2013, 12:46 PM

31. I, my wife and 6 other friends quit after laser treatment

It's supposed to be related to acupressure points. Maybe it's all in our minds, but not one of us has gone back to smoking after 6 years.

I think there are a lot of psychological impacts on health which we don't really understand.

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Response to SidDithers (Original post)

Tue Jul 9, 2013, 10:06 AM

7. lost track of how many times

I've seen this one story repeated...

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Response to G_j (Reply #7)

Tue Jul 9, 2013, 10:10 AM

12. True, but idiots still have the needles stuck in them so the cause continues.

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Response to 1-Old-Man (Reply #12)

Tue Jul 9, 2013, 10:27 AM

16. one story

If it was so dangerous, wouldn't there be more than one story?

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Response to SidDithers (Original post)

Tue Jul 9, 2013, 10:09 AM

10. That massage therapist had -

 

no business treating his client with needles unsupervised until he had become fully accredited. Acupuncture wasn't the problem, HE was.

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Response to SidDithers (Original post)

Tue Jul 9, 2013, 10:10 AM

11. The Science-Based Medicine Blog is a great resource as well.

These quack modalities have plenty of research which demonstrate lack of efficacy. This Blog does a great job of analyzing this research.

Science-Based Medicine

For Google fans, "SBM" in the search usually gets to entries in this Blog.

E.G., Google: acupuncture research SBM

R&K

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Response to longship (Reply #11)

Tue Jul 9, 2013, 10:15 AM

14. Yup...

Orac, the author of this piece, is actually David Gorski, who uses his real name at SBM. Both sites are on my regular reading list, and I've decided to make an effort to bring interesting, science-based articles from both sites to DU.

DU looks like woo central sometimes, with crap from naturalnews, mercola and whale.to posted as credible information. Gotta get some actual science-based information up here to combat the nonsense.

Sid

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Response to SidDithers (Reply #14)

Tue Jul 9, 2013, 10:30 AM

17. And yet your story is about a massage threapist practicing medicine illegally, or it would be here

 

One would assume it is also a bad idea to get surgery or prescriptions from a massage therapist or a barber, not because antibiotics are bad but because a massage therapist does not know what they are doing. 'This guy I know, he had his appendix removed at the nail salon and got an infection, so never let a surgeon touch your appendix' is not logic that flies with me.
A 2 inch needle? A massage therapist? Good lord, the crazy tales some will tell.

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Response to longship (Reply #11)

Tue Jul 9, 2013, 11:55 AM

30. Thanks for the link.

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Response to SidDithers (Original post)

Tue Jul 9, 2013, 10:47 AM

19. The Nationl Institutes of Health (NIH) concludes differently:



Meta-Analysis

A recent NCCAM-funded study, employing individual patient data meta-analyses and published in the Archives of Internal Medicine, provides the most rigorous evidence to date that acupuncture may be helpful for chronic pain. 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.

Although millions of Americans use acupuncture each year, often for chronic pain, there has been considerable controversy surrounding its value as a therapy and whether it is anything more than an elaborate placebo. Research exploring a number of possible mechanisms for acupuncture’s pain-relieving effects is ongoing.

Researchers from the Acupuncture Trialists’ Collaboration, a group that was established to synthesize data from high-quality randomized trials on acupuncture for chronic pain, conducted an analysis of individual patient data from 29 high-quality randomized controlled trials, including a total of 17,922 people. These trials investigated the use of acupuncture for back and neck pain, osteoarthritis, shoulder pain, or chronic headache.

For all pain types studied, the researchers found modest but statistically significant differences between acupuncture versus simulated acupuncture approaches (i.e., specific effects), and larger differences between acupuncture versus a no-acupuncture controls (i.e., non-specific effects). (In traditional acupuncture, needles are inserted at specific points on the body. Simulated acupuncture includes a variety of approaches which mimic this procedure; some approaches do not pierce the skin or use specific points on the body.) The sizes of the effects were generally similar across all pain conditions studied.

The authors noted that these findings suggest that the total effects of acupuncture, as experienced by patients in clinical practice, are clinically relevant. They also noted that their study provides the most robust evidence to date that acupuncture is more than just placebo and a reasonable referral option for patients with chronic pain.
Reference

Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Archives of Internal Medicine. September 10, 2012; Epub ahead of print.


Edited to add NIH direct link:
http://nccam.nih.gov/research/results/spotlight/091012


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Response to hlthe2b (Reply #19)

Tue Jul 9, 2013, 11:03 AM

23. Well NCCAM concludes differently...

but then again, NCCAM is a great example of politics over science.

Sid

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Response to SidDithers (Reply #23)

Tue Jul 9, 2013, 11:15 AM

26. NCCAM is one of the Insitutes of NIH... Educate yourself, SID, please

I don't promote woo, but neither do I promote disproven dogma. Both are harmful.

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Response to SidDithers (Reply #23)

Wed Jul 10, 2013, 09:15 AM

33. And what about the Journal for the AMA

Here is a peer review article about a study that indicates that Acupuncture is effective with chronic pain:

http://archinte.jamanetwork.com/article.aspx?articleid=1357513



Background Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.

Methods We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients analyzed.

Results In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias.

Conclusions Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.



So is Science a process of peer review double blind studies or simply "whatever Sid thinks?"

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Response to grantcart (Reply #33)

Wed Jul 10, 2013, 09:31 AM

34. I have type II CRPS

 

CRPS RSD is ranked as the most painful form of chronic pain that exists today by the McGill Pain Index.

Complex Regional Pain Syndrome, or CRPS, formerly known as RSD or Reflex Sympathetic Dystrophy is a progressive disease of the Autonomic Nervous System, and more specifically, the Sympathetic Nervous System. The pain is characterized as constant, extremely intense, and out of proportion to the original injury. The pain is typically accompanied by swelling, skin changes, extreme sensitivity, and can often be debilitating. It usually affects one or more of the four limbs but can occur in any part of the body and in over 70% of the victims it spreads to additional areas.

http://www.rsdhope.org/

(I don't know about out of proportion to the original injury; I still have nightmare about pull myself up the dirt road with my tibia having ruptured the skin, to get help)

In any case, I've tried an enormous array of therapies from sympathetic nerve blocks in the spinal column, to fentanyl patches, morphine, lyrica, gabapentin, percocet, physical therapy, etc. And I have found acupuncture to help some. No, it's not a cure, but it does provide me with some relief- more than the nerve blocks and it's not painful and intrusive.

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Response to hlthe2b (Reply #19)

Wed Jul 10, 2013, 10:40 AM

35. The most important sentence

"The larger component includes factors such as the patient’s belief that treatment will be effective, as well as placebo and other context effects."

Everything follows from that.

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Response to SidDithers (Original post)

Tue Jul 9, 2013, 10:59 AM

21. I am a very satisfied person using acupuncture on several occasions and would continue with the

right therapist. It is not always about believing and it helps acupuncture to work since I also used acupuncture on my dog and I don't think she believed it was going to work and this is what helped her. She had a pinched nerve in her neck and after three treatments I had my old pup back again. I have also used acupuncture to treat back pain and after a rear end collision used acupuncture to treat and again was successful. It may not help all but for me the pain went away immediately.

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Response to Thinkingabout (Reply #21)

Tue Jul 9, 2013, 11:01 AM

22. Acupuncture helped my brain and energy flow.

Can't complain really.

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Response to ananda (Reply #22)

Tue Jul 9, 2013, 11:07 AM

24. You might fool people but it does not work that way with little pups.

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Response to Thinkingabout (Reply #21)

Tue Jul 9, 2013, 11:30 AM

27. I get acupuncture because it was recommened to me by a friend who is not just an MD

 

but one of nation's leading chronic pain specialists. Sid read a blog, plus he's in Canada which has very different rules about such things, this link offers the Oregon State licensing rules
http://www.oregon.gov/omb/LAcApplicationPacket/AcLicensureOverview.pdf

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Response to SidDithers (Original post)

Tue Jul 9, 2013, 11:10 AM

25. Problem is that requirements are not adequate for MTs to do acupuncture. Malpractice is bad, but

happens with every profession.

While the ruling against Spurrell is heartening, what is rather depressing is how Canadian authorities came around to it. Acupuncture is a licensed specialty. So authorities had to “prove” that Spurrell had no valid reason to insert a needle there (“valid” being defined within the system of traditional Chinese medicine undergirding acupuncture). In other words, they had to show that there was no reason under TCM to think that a needle stuck in that particular location would treat Kibble-Orr’s recurrent headaches. Moreover, it wasn’t the College of Acupuncturists who had jurisdiction, but rather the College of Massage Therapists, that had jurisdiction, and the College only requires a certain number of hours of extra training to be able to administer acupuncture, a requirement that Spurrell had met. Of course, we at SBM would argue that there’s no science-based reason at all to think that sticking a needle in a point between the clavicle and the ribs would have any effect whatsoever on recurrent chronic headaches, and that should be enough. That’s the problem with regulating quackery; to prove misconduct or malpractice, you have to do it within the system of magical thinking of the quackery that has been licensed. If, for instance, Spurrell had been able to show that there was a valid rationale under TCM for inserting the needle there, he still might have been nailed for incompetence because he stuck the needle in too deep, but quite possibly he might not have been.


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Response to SidDithers (Original post)

Tue Jul 9, 2013, 11:37 AM

28. My wife is a Tradition Chinese Medicine practitioner

My wife is a Tradition Chinese Medicine practitioner from a family line of TCM doctors. The theory behind the application of the needles is time tested and rather complex. Normally, the use of needles is combined with herbal treatments and powerful massage techniques from a system called Tui Na.

Since TCM is not a uniform field of study and has developed over centuries by families and handed down from teacher to student, there exist many variations of treatment for any particular health problem. Over thousands of years of practice, treatments that fail fall into disuse while effective methods gain traction, spread and endure.

A great deal of research is now being done in modern Universities in China and elsewhere in order to establish the science behind the tradition. If the story above is accurate, I'd say the therapist was blindingly incompetent and this cautionary tale is being trotted out for use as propaganda.



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Response to agent46 (Reply #28)

Sat Oct 26, 2013, 11:08 AM

38. It hasn't developed over the centuries.

And if it had, that would only speak to its prescientific origins. In other words, to the fact that they just made stuff up, for the most part.

Chairman Mao: The real inventor of “traditional Chinese medicine”
http://scienceblogs.com/insolence/2013/10/25/chairman-mao-inventor-of-traditional-chinese-medicine/

I used to think it worked, too.

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Response to HuckleB (Reply #38)

Sat Oct 26, 2013, 08:30 PM

39. Thanks for this link

I'll read it. Looks interesting.

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Response to SidDithers (Original post)

Tue Jul 9, 2013, 11:46 AM

29. I gripe about homeopathy I see in drugstores, Sid, you gripe about acupuncture.

A lot of "traditional medicine" is still woo.

Chriropractic is based on an outdated belief that the brain sends "energy" to the body.

Homeopathy is based on an outdated belief that water retains some kind of magic.

Acupuncture is based on the same blind belief chiropractic came from.

http://www.skepdic.com/acupuncture.html

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Response to Archae (Reply #29)

Sat Oct 26, 2013, 11:03 AM

36. None of them work. That's the bottom line.

Why do we allow them to be foisted upon the ignorant?

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Response to SidDithers (Original post)

Tue Jul 9, 2013, 08:04 PM

32. On the other hand acupuncture helped me lose 23 pounds

 

and I've managed to keep almost all of it off for several years.

What happened to that poor woman sounds awful. It sounds like she had acupuncture from someone with inadequate training. I believe that well-trained, experienced acupuncturists can treat a variety of conditions.

Acupuncture helped my lower back considerably. I used to need at least two cortisone injections in my lower spine every year. The orthopedist said he didn't recommend surgery because it could cause additional problems.

I found a reputable acupuncturist through my health insurance company -- it wasn't covered but she gave discounts to those who had this insurance. She worked on me for a couple of weeks, two to three sessions a week, and it genuinely helped. I have not needed a single cortisone injection in the five years since the treatment.

She also encouraged me to try weight loss treatment with acupuncture since it would help my back. It worked very well, and I wasn't even dieting. The weight came off at the rate of 1 to 2 pounds a week. I was very much impressed with how well it worked.

From what I've been told or have read, acupuncture relies on knowing the lines or meridians in the body where energy flows. restricted. Placing needles on the correct points helps release blocked energy and restore well-being. There are points on the body that can release blocked energy in a seemingly unrelated part of the body.

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Response to LiberalEsto (Reply #32)

Sat Oct 26, 2013, 11:07 AM

37. It's all a big placebo.

Chairman Mao: The real inventor of “traditional Chinese medicine”
http://scienceblogs.com/insolence/2013/10/25/chairman-mao-inventor-of-traditional-chinese-medicine/

I used to think it worked, too.

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