Monday, June 14, 2010

My Acupuncture Experience

As I'd threatened a while back, I went and got acupuncture. This was very easy for me to set up if only because my medical school has a free clinic that's run by medical students. We see uninsured patients and it's a win-win - the patients get care, and we get to improve our clinical skills instead of memorizing more hormone signaling pathways. To my surprise, one of the attached services offered at the clinic is acupuncture, although this is done by students from an acupuncture institute (not by the med school).

In setting up the appointment with the acupuncture clinic, I was quite open with them that I was a skeptic and this was their chance to convert me. In fairness, let's be clear now that a) my own pre-existing bias is that acupuncture doesn't work, and b) that one person getting one acupuncture treatment can't be expected to provide evidence for or against efficacy. To be clear, I would love to be proven wrong and find out that there is some efficacy to acupuncture - not only would the reproducible science of such a finding no doubt open up new avenues into neurology and biochemistry, it would also be a super-cheap way for lots of people to get pain relief. To be honest I was mostly interested in the experience itself.

And here's how that experience went: I made the appointment by email, at which point the acupuncturist didn't yet ask what I wanted to be treated for (okay, at a regular check-up with an MD they don't ask you what you want to be treated for.) Then I came to the clinic early before my shift for my treatment. I was asked what I would like to be treated for, and among other things I said that I'd recently had trouble with an on-again off-again sore right ankle, which is what they decided to treat me for. The acupuncturist and the student that actually worked on me took a great deal of care in measuring my pulse at both wrists and inspected my tongue. They asked me several times whether I had problems with low energy, and I replied that's one problem I don't think I've ever really had, although I experience the same occasional sleep-deprivation that you might expect a medical student would, and I do consume an unholy amount of caffeine. They thought that was evidence though I (and most people who know me) would disagree. As far as I know, this didn't affect the treatment anyway.

As for the treatment itself - the needles were placed with a quick tap and I was laying there with my eyes closed so I didn't even realize the first few had gone in because I didn't feel them at all. At one point the head acupuncturist cautioned me not to look at my needles, although it was okay to look at other people's. (Can't figure out why that would be.) After 15 minutes they removed them.

The next morning? My ankle was sore, although no worse than it it ever is when it comes and goes on its own. The acupuncturist had warned me that it might get worse before it gets better. Charitably, you might say he predicted what happened; uncharitably, you might say he was covering all his options. Objectively, again - given the nature of the condition, this one case can provide no evidence either way. The nature of the condition and the chance of spontaneous remission have a huge impact on statistics, which is why trials of new cancer drugs usually have fewer patients than other types of diseases. Cancer usually doesn't go away on its own, but ankles do. But if you don't have those statistically robust numbers - which in this case, we don't - and you have to make a decision about whether it works based on limited information - and when you make a decision, you always are - then you go with peer-reviewed papers and meta-analyses, like the one Steven Novella references here for acupuncture and in vitro fertilization. (If you find anything about joint pain please share in the comments!) Note that you have to ask these questions with regard to specific causes and effects - a study of ibuprofen as an antibiotic would no doubt show no efficacy relative to placebo, but from this you can't generalize that NSAIDs or drugs in general are ineffective. Then again, if you'd looked at studies of ibuprofen in the diverse therapeutic areas where its practitioners used it and they all showed no effect, increased skepticism about ibuprofen would be warranted.

You may have noticed that I've shied away in this post from naming people or institutions, and here we get into the political complications of translating skepticism into action. First and foremost, the acupuncture people were nothing but accommodating to me in terms of fitting me in for a session and pleasant during the session itself, and of course I'm appreciative of that. But I'm actually feeling bad writing this post. As Daniel Dennett has said, there's just no polite way of telling someone that their beliefs are all superstition, and that they're wasting their time and making the world worse by spreading misinformation. I also have to admit, given the evidence, that I'm puzzled an academic medical establishment would want to associate with an acupuncture clinic - and I'm holding back here too since it was made very clear to me by people at my own institution that the acupuncturists were valued members of the team. First year medical students like your blogger have the political power of a dead gnat, and if I decided to take up the skeptical cause at the med school in favor of ending this association, not only would I not succeed, I would earn myself some influential enemies in the process. To be honest I'm far more nervous writing this post than I was about participating in Draw Mohammed Day.


vjack said...

I may be completely wrong about this, but I tend to view the acceptance of acupuncture in the medical community as more about public relations than anything else. Admittedly, I have not read methodologically rigorous randomized clinical trials on the efficacy of acupuncture. There may be solid evidence that it works - I haven't looked into it. But my guess is that what the medical community doing here is more about wanting to appear receptive to Eastern medicine than evidence.

TGP said...

I bet acupuncture is really great when you fear needles more than you dislike pain.

Michael Caton said...

I hadn't thought about acupuncture for the needlephobic before. It would be interesting to see if there are people who can do acupuncture but can't tolerate blood draws or injections.

Vjack, I think your idea is probably right. It's one thing when a private managed care group reimburses for acupuncture because they want to appeal to customers (and I believe Kaiser does) but it's another when the PR/marketing angle extends to academic institutions.

TGP said...

Injection baste a turkey? Fuck that.

Inflate a basketball? Cold sweat.

I don't even like to be in the room while my wife is knitting!

I can take a shot if I look away and try to tell jokes. Drawing blood pretty much means I do a stand-up routine and pretend I don't have one arm.

If somebody suggested sticking a whole bunch of needles in me and leaving them there for a while on what amounts to a hunch that it might do something, I'd be out of the room, leaving a me-shaped hole in the wall.

Michael Caton said...

I can tell you that the acupuncture needles were certainly less uncomfortable than a standard blood draw or injection. Wasn't clear that they went in very far since they don't really stand straight up. You put most pins in 5 mm and they stand up - try it on dead skin in your hand or heel. There, did you faint?