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Acupuncture
 

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A look at the evidence for acupuncture in pain, infertility, and asthma treatment by the Science Based Medicine Club.

A look at the evidence for acupuncture in pain, infertility, and asthma treatment by the Science Based Medicine Club.

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  • Science hasn’t found any anything that corrseponds to QI/meridiansSome scientists think Qi is a real and useful way to understand the human body. Others think that it’s just old medicine and no longer relevant.In China, some scientists think Qi is a useful abstraction in modeling bodily processes, while others dismiss it as philosophy with no relationship to modern physiology/medicine (1)TRANSITION. NOW YOU’VE COVERED THE BASICS, LET’S LOOK AT APPLICATION.
  • Reviews of reviews are better than individual studiesUsing systematic reviews, we can get a broader picture of the evidence.Make an animation for the top of pyramids.
  • Emphasize the More Babies
  • Layify more.
  • `This is the only thing I’m talking about in which people die.IT’S INCREDIBLY IMPORTANT THAT WHATEVER TREATMENT CLAIMS TO TREAT ASTHMA HAS SOLID EVIDENCE BEHIND IT BECAUSE YOU CAN DIE
  • GET RID OF EVERYTHING EXCEPT THE MAIN CONCLUSION QUOTE FROM COCHRANE (BUT DON’T’ SAY OR WRITE COCHRANE)
  • EXPLAIN IN DETAILALBUTEROL = PUFFERWHITE OUT ALL DETAILS EXCEPT NAMES. CHANGE AXES TO FEEL BETTER AND GET BETTER

Acupuncture Acupuncture Presentation Transcript

  • AcupunctureUBC Students for Science Based Medicine UBC SBM
  • UBC SBM What I’ll Cover• Acupuncture – History, Definition, and Basis in Traditional Chinese Medicine• What does the research say about acupuncture for … – Nausea? – Pain? – Infertility? – Asthma?
  • UBC SBMHistory: Unclear
  • UBC SBM History 1800 CE • Connection1000 CE between electricity and nerves made• Professionalized 1600 CE • Circulatory system fully described • Reproduction not understood.
  • What is acupuncture?BC Health Professions Act:Traditional Chinese Medicine Practitionersand Acupuncturists RegulationAcupuncture is an act of stimulation, by means of needles, of specific sites on the skin, to promote, maintain, restore or improve health, to prevent a disorder, disease or to alleviate pain and includes A. Needles: mechanical, thermal, electrical B. Lasers & magnets C. Burning dried leaves (moxibustion) UBC SBM
  • UBC SBM What is Acupuncture?College of TCM Practitioners and Acupuncturistsof BC• Acupuncture is a procedure in Traditional Chinese Medicine.• TCM grows out of Daoism (religion/philosophy): – Yin/Yang (bright/dark) – Five Elements
  • UBC SBMWhat is Acupuncture?
  • UBC SBM Acupuncture Basics • Scientists in China divided on whether meridian system is relevant • Current research does not strongly support the idea that there is something unique about acupuncture points or that meridians exist1) Sampson, WI (September/October 1996). "Traditional Medicine and Pseudoscience in China: A Report of the Second CSICOP Delegation (Part 2)". Skeptical Inquirer 20 (5).1) Langevin, H. M., & Yandow, J. A. (2002). Relationship of acupuncture points and meridians to connective tissue planes. THE ANATOMICAL RECORD (NEW ANAT.), 269, 257-265. Retrieved from http://www.uvm.edu/annb/faculty/PDFs/257.pdf
  • UBC SBM Research• There’s a lot of research out there
  • Levels of Research UBC SBM
  • UBC SBMWhy reviews have different results• Reasons why reviews come up with different conclusions: – No one likes publishing negative studies, so positive studies are overrepresented – Different statistical formulas – Different studies
  • UBC SBM Nausea 2008 2009 (10 studies) (40 studies) AcupunctureAbraham, J. (2008). "Acupressure and acupuncture in preventing and managing postoperative nausea andvomiting in adults". Journal of perioperative practice 18 (12): 543–551.Lee A, Fan, LTY (2009). Lee, Anna. ed. "Stimulation of the wrist acupuncture point P6 for preventing postoperativenausea and vomiting". Cochrane Database of Systematic Reviews (Online) (2): CD003281.
  • UBC SBM Nausea: Conclusion• Acupuncture at wrist helps with nausea after surgery• But – No difference between needles and pressure – Not better than present medication – Only tested nausea after surgery • Not food poisoning or motion sickness
  • UBC SBM PainSomewhat unclearConflicting Evidence
  • UBC SBM Pain Review of reviewsReview 1 Review 2 Review 3 Review 4 Review 5 Individual StudiesErnst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A reviewof reviews." Pain 152 (4): 755–764.
  • UBC SBM Pain: Review of reviews • Migraines • Tension Headaches • Rheumatoid Arthritis • Cancer Pain • Fibromyalgia (long term body wide pain) • Muscular-skeletal Pain • Shoulder Pain • During Surgery Pain • After Surgery Pain • Jaw Joint Pain • Sciatica (leg pain) • Neck Pain • Low Back Pain • OsteoarthritisErnst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A reviewof reviews." Pain 152 (4): 755–764.
  • UBC SBM Pain: Chronic Low-Back Pain People who experienced pain reduction 40 30 20 10 0 Acupuncture Fake No Acupuncture Treatment• But – Short term only (3 months) – Not better than conventional therapiesFurlan, Andrea D; Van Tulder, Maurits W; Cherkin, Dan; Tsukayama, Hiroshi; Lao, Lixing; Koes, Bart W; Berman,Brian M (2005). Furlan, Andrea D. ed. "Acupuncture and dry-needling for low back pain" (PDF). CochraneDatabase Syst Rev (1): CD001351.
  • UBC SBM Pain: Review of reviews • Migraines • Tension Headaches • Rheumatoid Arthritis • Cancer Pain • Fibromyalgia (long term body wide pain) • Muscular-skeletal Pain • Shoulder Pain • During Surgery Pain • After Surgery Pain • Jaw Joint Pain • Sciatica (leg pain) • Neck Pain • Low Back Pain • OsteoarthritisErnst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A reviewof reviews." Pain 152 (4): 755–764.
  • UBC SBM Pain: Conclusion1. Small pain reduction in some types of pain, no reduction in most other types1. Little or no difference between acupuncture and fake acupuncture
  • UBC SBMInfertility
  • UBC SBM Infertility Review 1 Review 2 Review 3 Review 4 (2008) (2008) (2009) (2011)MorePregnanciesMoreBabies
  • UBC SBM Infertility: Conclusion• Conclusion: – There is conflicting evidence about whether acupuncture treats infertility – Most reviews suggest acupuncture does not increase odds of giving birth
  • UBC SBM Asthma• Long term lung disease.• Reversible breathing difficulty.• Often, but not always, caused by allergies.• 250,000 deaths/year worldwide (GINA, 2009)"Global Strategy for Asthma Management and Prevention 2010(update)" (PDF). Global Initiative for Asthma. 2010.
  • UBC SBM Asthma• Review 1 (2002): – “The current analysis did not find evidence of the efficacy of acupuncture in the treatment of patients with asthma”• Review 2 (2002): – “There is not enough evidence to make recommendations about the value of acupuncture in asthma treatment.” Linde K, Jobst K, Panton J. Acupuncture for chronicasthma (Cochrane Review). The Cochrane Library, Issue 2. Oxford, Update Software, 2002. Martin J, Donaldson AN, Villarroel R, Parmar MKB, Ernst E, Higginson IJ. Efficacy of acupuncture in asthma: systematic review and meta-analysis of published data from 11 randomised controlled trials. The European Respiratory Journal. 2002;20(4):846–852.
  • Placebo Effect: Does it really help? Feeling Better Getting BetterWechsler ME, Kelley JM, Boyd IO, Dutile S, Marigowda G, et al. (2011) Active albuterol or placebo, sham acupuncture, or nointervention in asthma. N Engl J Med 365: 119–126.
  • Acupuncture Conclusion: UBC SBM Benefits Subjective ObjectiveAfter Surgery Nausea Infertility – Acupuncture at wrist seems to – Latest review says fertility does help not increase chance of having a – No difference between needles baby and pressure AsthmaPain Weak - - – Best evidence does not Evidence is weak - – Comparable to conventional Both fake acupuncture and real – support it’s use Existing therapies prevent death therapies acupuncture have small effect - Conventional therapies - – Those therapies aren’ttypes of Mostly equal for most great much better (Asthma) to begin with pain - No competing therapy (IVF) – For some types of pain real - Except IVF is a therapy acupuncture seems to be better itself that does help than fake acupuncture but with infertility there’s conflicting evidence
  • UBC SBM Acupuncture Conclusion: Risks and side effects – Bacterial and viral infections • Non sterile needling • Small risk, but still real – Trauma • Not bleeding (surprisingly) • Pain, headache, numbness • Pneumothorax • DeathErnst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A review ofreviews" (pdf). Pain 152 (4): 755–764.
  • Concluding Statements• Acupuncture: – minor benefits, evidence generally weak – minor to major risks – has been studied for decades and still no clear effect – If acupuncture were a drug it would not make it to market and would be abandoned• Alternative Medicine• Controversial to recommend UBC SBM
  • Works Cited1. Manheimer, E., Zhang, G., Udoff, L., et al., 2008. Effects ofacupuncture on rates of pregnancy and live birth among womenundergoing in vitro fertilization: systematic review andmeta-analysis. British Medical Journal 336, 545–549.2. El-Toukhy, T., Sunkara, S.K., Khairy, M., et al., 2008. A systematicreview and meta-analysis of acupuncture in in vitro fertilization.British Journal of Obstetrics and Gynaecology 10, 1203–1213.3. Sunkara, S.K., Coomarasamy, A., Khalaf, Y., El-Toukhy, T., 2009.Acupuncture and in vitro fertilization: updated meta-analysis.Human Reproduction 24, 2047–2048.4. Moy I, Milad MP, Barnes R, Confino E, Kazer RR, Zhang X. Randomized controlled trial: effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization. Fertil Steril. 2011;95:583–7. doi: 10.1016/j.fertnstert.2010.05.024
  • Acupuncture By Ratib IslamUBC Students for Science Based Medicine UBC SBM