How I can do what I do

In googling for studies and interpretations on the flu vaccines, I came across Science-Based Medicine. A little snarky at times, they seemed like my sort of people. Then I read what they think about acupuncture. Apparently, I am unethical, irresponsible, and practicing tooth-fairy science. Much of this has to do with the lack of well designed scientific studies. Hi, there, Pot! You can call me Kettle!

I pause to link in this context, I really do. Because I don’t want to be giving the antivaxers anything that can be construed as support. But I conclude flu vaccination is beneficial, given vaccination’s history, even if the current studies aren’t all well designed with great numbers. I conclude that acupuncture is worth doing, and I can’t conceive of a well designed study. There are just too many variables. Needling placement. (I can think of five schools of theory that will come up with different places to put the needles to treat the same thing.) Style. (Tonify or sedate, in school we talked about at least 9 ways to do both. I don’t think modern science even accepts the concepts of tonify or sedate.) Depth. Gauge. How in the world to make it truly double-blind. What’s being treated, and how severe it is. Even if I could think of an acceptable study, here’s the thing. Acupuncturists who are successful enough to fund a study tend to have enough of a reputation for results that they don’t need scientific papers on the field. Acupuncturists who don’t have that sort of clout don’t have any money. So the studies are left to the scientific establishment, people who aren’t particularly interested in acupuncture theory and leave out so much that anyone who does employ acupuncture theory finds the study to be quite flawed.

It’s also commonly said that acupuncture is unsafe, carrying large risk of disease transmission, pneumothorax, and makes patients delay seeking effective treatment. Common to the point that pneumothorax is standard on a consent to treatment form. It has made a potential patient leave at least once. Thing is, I am licensed in acupuncture. I’ve taken my anatomy classes. And been certified in clean needle technique. We who have had the education are held to the double standard where we have to take exams and pay considerable fees to maintain licensure, but we’re painted with the broad idiot-brush for the mistakes of those who have not. I’ll admit it’s not that hard for a patient to get a minor hematoma. Sometimes I stick a blood vessel. It happens. Maybe a couple times a year. But to do serious damage like puncturing a lung, you’d either have to have no idea where the lungs are, or be careless to the point of almost trying to cause damage. In Texas, if not for chronic pain or substance dependency, my patient needs to have been seen by an MD or DC first. And we acupuncturists have a time/treatment limit we need to meet. Progress, or send them to an MD. I’m okay with that. As I’ve said before, I am not the ultimate authority on anything. I don’t want to be, either. (Malpractice insurance fees, anyone? My current premium is ugly enough as is.)

I’m an engineer’s daughter, my sister and her husband are both MDs, and pretty much everyone I socialized with in undergrad went on to medical school. My undergrad degrees are in computer science and math. Trust me when I say I never imagined I’d be doing this when I grew up. I tried it, acupuncture helped me, and I studied it. I have since helped others. So, I think I’ve covered tooth-fairy science (it is, what’s your point?), responsibility (regulation by the Texas Medical Board is pretty good about making sure I do no harm), and now we get into ethics. How can I live with myself, practicing an unproven modality? Isn’t it wrong of me to sell the placebo effect for my own personal gain? Aren’t I no better than an antivaxer making a fortune on immunotonics?

What I see most is chronic pain. Probably any acupuncturist would say that. Those patients don’t have to have seen a doctor, but usually they have, and usually it didn’t help, or didn’t help enough. Maybe it’s not the needles. Maybe it’s the personal attention I give them. Maybe it’s the relaxation of lying down on a padded table with quiet music and the aromatherapy diffuser I usually forget to put oil in. They usually leave feeling better. (I wouldn’t be able to make a living, or if I could, wouldn’t be able to stomach making a living like that if my results were mostly bad.) Does how really matter? I would never tell someone to go off their meds. In fact, I’ve used acupuncture to help patients stay on chemotherapy. But sometimes they don’t want to be on meds, want to be on fewer meds, are on meds that aren’t effective enough, or they are going to avoid or delay surgery anyway and would like to be more comfortable. Is it more ethical to deny them care because it hasn’t been sufficiently statistically proven in a published paper, or is it more ethical to say, “I think I can help you with that” and at least provide temporary relief with few side effects?

AntiCAMers, I used to be one of you. Why use primitive healing when you have modern medicine? Modern medicine is great; I was sure glad to have access to it when I had appendicitis. On several of my patients’ back pains, not so much. That’s okay. I don’t think there’s any one right way. If you don’t like the idea of acupuncture, don’t get it. You might try it if you’re hurting badly enough. If you’re incensed about safety, you don’t have to be an acupuncturist to get on the board and draft the rules. But it’s been around (evolving, BTW, like any other academic field of worth, since there is also the argument that it is NOT an ancient practice, so longevity is NOT a rational argument) for several millenia, and I don’t think it’s going away.

2 Replies to “How I can do what I do”

  1. I am a physician. Having practiced primary care in Texas for 26 years, I know that ‘placebo treatment’ is often superior to no treatment. My placebo treatment is often an adjunct to more proven modalities, and would be extremely difficult to quantify in a double blind study. You see, I only use ‘placebo’ when I believe it will work. If I believe it will work, then the patient will believe it will work. As long as you’re not hurting the patient, you will likely see a superior result.

    Besides, there’s much we (the experts) don’t know about medicine and the world, in general.

  2. I seem to remember the tooth-fairy associated with pain. Speaking of it, are there any studies about pain that can truly be called evidence-based (science-based)? How about the objective sampling device? I’ve seen acupuncture help people. I don’t mean the kind of help that turns them into a legal drug addict. I mean they become one of the rarest of all patients- the chronic pain patient that says he/she doesn’t need a refill of their hydrocodone. I’m a physician too. Almost every time I have to write a prescription for such a case because someone thought there was no other option to bring the pain under control except to prescribe narcotics for the remainder of a patient’s life, thereby a creating a “legal” drug addict that will suffer much worse from withdrawal if I don’t prescribe another 30-day supply of narcotics and the regulators remind me I am obligated to do, I have to live with myself for an unproven modality. As far as I know, all pain is subjective. True objective evidence doesn’t exist. Yes, it is the needles. It’s also the personal attention, the relaxation, the music, and the aromatherapy (perhaps related to Ayurvedic medicinal therapy that has benefitted humankind as long as acupuncture has). Can you imagine the problems I’d have everyday if I was to have soothing music in the exam room and suggested to someone they relax and breathe deeply? The scientists, True Pot and Real Kettle, who made such ignorant remarks need to spend their time doing something beneficial like use their great intelligence to find a way to do some objective studies or at least help them pull their heads out of the darkness while thse of us who are so skilled find some content in observing that the effort we put forth actually makes someone’s day a little better.

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