Medical

About a year ago the editors of Anesthesia & Analgesia solicited a written debate on whether or not acupuncture is effective or simply an elaborate placebo. Four experienced acupuncture researchers agreed to write the pro-acupuncture article, Wang, Harris, Lin and Gan . They asked David Colquhoun to write the con position, and David asked me to write it with him (which, of course, I enthusiastically agreed to do). The article is fortunately published in open access, and so I can reprint it here (full article is below). What I think David and I convincingly demonstrated is that, according to the usual standards of medicine, acupuncture does not work. Let me explain what I mean by that. Clinical research can never prove that an intervention has an effect size of zero. Rather, clinical research assumes the null hypothesis, that the treatment does not work, and the burden of proof lies with demonstrating adequate evidence to reject the null hypothesis. So, when being technical, researchers will conclude that a negative study “fails to reject the null hypothesis.” Further, negative studies do not demonstrate an effect size of zero, but rather that any possible effect is likely to be smaller than the power of existing research to detect. The greater the number and power of such studies, however, the closer this remaining possible effect size gets to zero. At some point the remaining possible effect becomes clinically insignificant. In other words, clinical research may not be able to detect the difference between zero effect and a tiny effect, but at some point it becomes irrelevant. What David and I have convincingly argued, in my opinion, is that after decades of research and more than 3000 trials, acupuncture researchers have failed to reject the null hypothesis, and any remaining possible specific effect from acupuncture is so tiny as to be clinically insignificant. In layman’s terms, acupuncture does not work – for anything. This has profound clinical, ethical, scientific, and practical implications. In my opinion humanity should not waste another penny, another moment, another patient – any further resources on this dead end. We should consider this a lesson learned, cut our losses, and move on. I suspect, however, human nature being what it is, that this will not happen anytime soon. ________________ Full article reprinted from Anesthesia & Analgesia Acupuncture Is Theatrical Placebo David Colquhoun, PhD* and Steven P. Novella, MD† Introduction Pain is a big problem. If you read about pain management centers, you might think it had been solved. It has not. And when no effective treatment exists for a medical problem, it leads to a tendency to clutch at straws. Research has shown that acupuncture is little more than such a straw. Although it is commonly claimed that acupuncture has been around for thousands of years, it has not always been popular, even in China. For almost 1000 years, it was in decline, and in 1822, Emperor Dao Guang issued an imperial edict stating that acupuncture and moxibustion should be banned forever from the Imperial Medical Academy.1 Acupuncture continued as a minor fringe activity in the 1950s. After the Chinese Civil War, the Chinese Communist Party ridiculed Traditional Chinese Medicine, including acupuncture, as superstitious. Chairman Mao Zedong later revived Traditional Chinese Medicine as part of the Great Proletarian Cultural Revolution of 1966.2 The revival was a convenient response to the dearth of medically trained people in postwar China and a useful way to increase Chinese nationalism. It is said that Chairman Mao himself preferred Western medicine. His personal physician quotes him as saying “Even though I believe we should promote Chinese medicine, I personally do not believe in it. I do not take Chinese medicine.”3 The political, or perhaps commercial, bias seems to still exist. It has been reported (by authors who are sympathetic to alternative medic

Taming our diabetes monsters may seem like only a metaphor for what we try to do every day, but now there’s a fun new app for that. Just launched in the U.S. for the first time on June 4, the…The post ‘Diabetes Monster’ App Actually Motivates! appeared first on DiabetesMine: the all things diabetes blog.

Like hand hygiene, getting workers to stay home when sick is an example of a horizontal infection prevention strategy. Horizontal strategies are multipotent (not aimed at a single pathogen), generally simple methods. While most humans inherently know that it’s not a good idea to come to work with fever or diarrhea, many either can’t or won’t stay home and risk infecting co-workers, customers, or patients. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

Brought to you by MedPage Today. 1. Organ Donors Will Sign Up on Facebook. Despite years of media and public service campaigns appealing for organ donations, donor rates remained static while demand increased — until Facebook. 2. MRI May Spot Meningitis from Tainted Steroids. A screening MRI may provide early warning of spinal or paraspinal meningitis in patients who received contaminated steroid injections. 3. Red Meat Hikes Diabetes Risk. Eating more beef, pork, and lamb may raise diabetes risk, whereas reducing intake appears to trim risk. Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

Sometimes, between blogging, a demanding day (and night) job doing surgery and science, and everything else, I embarrass myself. Sure, sometimes I embarrass myself by saying something that, in retrospect, I wish I hadn’t. More often, I embarrass myself by letting things slide that I shouldn’t. For instance, when friends send me a prepublication copy of their books, I should damned well read them, don’t you think? So it was that Paul Offit sent me a copy of his latest book, which just hit the bookstores and online outlets this week, Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine, and I haven’t finished it. Oh, I’ve read a good chunk of it, but it’s not a huge book (around 335 pages); so I should have finished it by now, particularly since it’s quite good. My failure to properly read and plug the book aside, I’m glad to see that the book’s getting attention in a large media outlet, namely USA Today, in an article by Liz Szabo Book raises alarms about alternative medicine. There’s also a companion piece How to guard against a quack. I figure that the least I can do is to plug Dr. Offit’s book and the USA Today story in which he is featured, just as Harriet plugged his recent speaking appearance. It’s also nice that Steve Novella and I were both interviewed. Now, excuse me while I get back to doing what I really should have had finished a month or two ago: Reading Dr. Offit’s excellent book.

The ED is a hectic place. Sore throats. Heart attacks. Dog bites. Broken bones. Strokes. Major trauma. If you work in an ED, you see it all. And then some. Is it any wonder then, with the potential for literally thousands of medical and surgical problems to stumble through the doors of an ED, that hospitals and the bodies that accredit them demand strict, regimented, standard, reproducible emergency assessments and the forms that document them? Of course not. This insures that all the basic questions are asked, that decision trees are followed, that diagnostic criteria are carefully applied, that correct diagnoses are made, and that treatment decisions are made based on evidenced based standards of care, both local and national. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

Researchers at Stanford have created a solar-powered retinal implant capable of transmitting visual signals to the brains of rats. A Medical Daily story offers more details about the study (subscription required), which appears today in Nature Communications: To address [the] shortcomings of bionic implants, [Daniel Palanker, PhD, an associate professor ophthalmology at Stanford, and his colleagues developed a solar-powered microchip that could be inserted into the sub-retinal layers of the eye. This device was placed adjacent to the neurons that send visual information to the brain, which should stimulate a more “natural” pattern of neural activity. Their retinal prosthetic is wireless, so its special set of video eyeglasses beams images directly into the microchip. In this study, Palanker’s team from the Hansen Experimental Physics Laboratory placed these second-generation implants into the retinas of rats with or without macular degeneration. The researchers found that the new bionic retinas could transmit images into the minds of rats, which was observed by measuring brain activity in the visual centers of the rodents’ brains. Brain activity returned to normal in rats with eye disease that were given these retinal implants. Previously: Australian scientists implant early prototype of a “bionic eye” into a patient, Stanford-developed retinal prosthesis uses near-infrared light to transmit images and Developing a prosthetic eye to treat blindness

There’s an interesting post today on Shots about a family with an autistic son visiting the Please Touch Museum in Philadelphia. The museum is one of more than 30 centers for learning and preservation that are taking steps (.pdf) to increase health awareness, including responding to the special needs of visitors with conditions such as autism or Alzheimer’s. Jessica Naudziunas writes: … it’s not always easy to take a kid with autism out into the world, especially a museum. A recent tally found that 1 in 88 children in the U.S. is somewhere on the autism spectrum. For these youngsters, if a place doesn’t have appropriate accommodations, museum-going is a no-go for much of their childhood. That’s because so often, what seems like a fun diversion ends up causing feelings of anxiety and sometimes panic. That’s why some museums have made special accommodations. “During those hours the museum looks different,” said Leslie Walker, Please Touch Museum’s vice president for community learning. Flashing lights are dimmed, and booming music is turned down. Kids who want a sense of security about their visit are encouraged to create custom schedules and maps beforehand. And museum employees who will teach kids about the exhibits go through sensitivity training to learn what needs a child with autism might have to interact like their peers. Previously: Stanford study reveals why human voices are less rewarding for kids with autism, Director of Stanford Autism Center responds to your questions on research and treatment and A mother’s story on what she learned from her autistic son Photo by Jim, the Photographer

Why do we never consider unintended consequences? Whether we are thinking of legislation or physician led guideline panels, or governing bodies (like ACGME), the lack of consideration of unintended consequences remains mind numbing. Let me provide some examples. Please read this articles about how the war on drugs has fueled the hepatitis C epidemic. One could also argue that this war damages more young people than the drugs themselves. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

Drug discovery is time-consuming and expensive, and failure is a strong possibility. To accelerate the therapeutic development process, the National Institutes of Health recently launched a program pairing researchers with a selection of pharmaceutical industry compounds, which proved to be ineffective for the specific use they were developed for, to determine if the drugs are useful in treating other conditions. Today, the NIH awarded $12.7 million to nine academic research groups to reexamine pharmaceutical industry compounds to treat eight disease areas, including Alzheimer’s disease, Duchenne muscular dystrophy and schizophrenia. Francis Collins, MD, PhD, director of the NIH, wrote on his blog: With this approach, we are hopeful that we can give these compounds a second chance, while making important discoveries for several diseases. I am very excited about this pilot program for several reasons. As part of the design of the program, NIH developed template agreements to streamline the legal and administrative process for academic-industry collaboration—and already it’s clear that that strategy is saving months if not years of negotiations. In addition, this is our first experiment with “crowdsourcing” of therapeutic opportunities—giving the entire biomedical community access to highly active compounds and related data, and enabling anyone to make new connections to disease. I expect this model to yield some great science, and I’m optimistic it will also speed the development of new drugs to patients. Previously: Why drug development is time consuming and expensive (hint: it’s hard) Photo by Ano Lobb