From AcuMed96@aol.com Sat Jan 06 19:50:33 2001 Received: from imo-r16.mx.aol.com ([152.163.225.70] helo=imo-r16.mail.aol.com) by mailman.olympus.net with esmtp (Exim 3.20 #1) id 14F6qn-0005hL-00 for acubriefs@mailman.olympus.net; Sat, 06 Jan 2001 19:50:33 -0800 Received: from AcuMed96@aol.com by imo-r16.mx.aol.com (mail_out_v28.35.) id h.23.5bb82a9 (3926) for ; Sat, 6 Jan 2001 22:50:19 -0500 (EST) From: AcuMed96@aol.com Message-ID: <23.5bb82a9.2789417b@aol.com> Date: Sat, 6 Jan 2001 22:50:19 EST To: acubriefs@mailman.olympus.net MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="part1_23.5bb82a9.2789417b_boundary" Content-Disposition: Inline X-Mailer: 6.0 sub 171 Subject: [Acubriefs] Subscribe Sender: acubriefs-admin@mailman.olympus.net Errors-To: acubriefs-admin@mailman.olympus.net X-BeenThere: acubriefs@mailman.olympus.net X-Mailman-Version: 2.0 Precedence: bulk List-Help: List-Post: List-Subscribe: , List-Id: Acupuncture News & Information List-Unsubscribe: , List-Archive: --part1_23.5bb82a9.2789417b_boundary Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit Include me in list/ Thanks Jose Armstrong, MD acumed96@aol.com --part1_23.5bb82a9.2789417b_boundary Content-Type: text/html; charset="US-ASCII" Content-Transfer-Encoding: 7bit Include me in list/

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Jose Armstrong, MD
acumed96@aol.com --part1_23.5bb82a9.2789417b_boundary-- From mfred2@leland.stanford.edu Sun Jan 07 10:46:39 2001 Received: from smtp.stanford.edu ([171.64.14.23]) by mailman.olympus.net with esmtp (Exim 3.20 #1) id 14FKpz-0007ZV-00 for acubriefs@mailman.olympus.net; Sun, 07 Jan 2001 10:46:39 -0800 Received: from smtp.stanford.edu (dialup-209.247.143.238.SanJose1.Level3.net [209.247.143.238]) by smtp.Stanford.EDU (8.11.1/8.11.1) with ESMTP id f07IkUn08529 for ; Sun, 7 Jan 2001 10:46:30 -0800 (PST) Message-Id: <4.2.0.58.20010107104337.0097e3c0@mfred2.pobox.stanford.edu> X-Sender: mfred2@mfred2.pobox.stanford.edu (Unverified) X-Mailer: QUALCOMM Windows Eudora Pro Version 4.2.0.58 Date: Sun, 07 Jan 2001 10:44:35 -0800 To: acubriefs@mailman.olympus.net From: "Dr. Michael Fredericson" In-Reply-To: Mime-Version: 1.0 Content-Type: text/plain; charset="us-ascii"; format=flowed Subject: [Acubriefs] Re: Welcome to the "Acubriefs" mailing list Sender: acubriefs-admin@mailman.olympus.net Errors-To: acubriefs-admin@mailman.olympus.net X-BeenThere: acubriefs@mailman.olympus.net X-Mailman-Version: 2.0 Precedence: bulk List-Help: List-Post: List-Subscribe: , List-Id: Acupuncture News & Information List-Unsubscribe: , List-Archive: Please subscribe me to acubriefs. Michael Fredericson, MD From kimber@olympus.net Sun Jan 07 16:14:43 2001 Received: from mail.cablespeed.com ([206.112.192.76]) by mailman.olympus.net with esmtp (Exim 3.20 #1) id 14FPxS-0007tZ-00 for acubriefs@mailman.olympus.net; Sun, 07 Jan 2001 16:14:42 -0800 Received: from laptop.olympus.net (c207-202-223-225.sea1.cablespeed.com [207.202.223.225]) by mail.cablespeed.com (8.9.3/8.9.3) with ESMTP id TAA05888 for ; Sun, 7 Jan 2001 19:18:26 -0500 Message-Id: <4.3.1.2.20010107161922.00ae0790@mail.olympus.net> X-Sender: kimber@mail.olympus.net X-Mailer: QUALCOMM Windows Eudora Version 4.3.1 Date: Sun, 07 Jan 2001 16:21:36 -0800 To: acubriefs@mailman.olympus.net From: Kimber Mime-Version: 1.0 Content-Type: multipart/alternative; boundary="=====================_10885813==_.ALT" Subject: [Acubriefs] December 2000 Acubriefs Newsletter Sender: acubriefs-admin@mailman.olympus.net Errors-To: acubriefs-admin@mailman.olympus.net X-BeenThere: acubriefs@mailman.olympus.net X-Mailman-Version: 2.0 Precedence: bulk List-Help: List-Post: List-Subscribe: , List-Id: Acupuncture News & Information List-Unsubscribe: , List-Archive: --=====================_10885813==_.ALT Content-Type: text/plain; charset="us-ascii"; format=flowed Acubriefs Newsletter Volume 1 Issue 2 To view this newsletter with your browser visit http://www.acubriefs.com December 2000 3 Recent articles reviewed in this edition: (1) ELECTROACUPUNCTURE FOR CONTROL OF MYELOABLATIVE CHEMOTHERAPY_INDUCED EMESIS: A RANDOMIZED CONTROLLED TRIAL. Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, and Shekelle PG JAMA 2000 Dec 6 284(21): p. 2755_61 http://jama.ama_assn.org/issues/v284n21/ffull/jci00080.html Reviewed by JK Rotchford, MD, MPH (2) IMMUNOMODULATORY EFFECTS OF ACUPUNCTURE IN THE TREATMENT OF ALLERGIC ASTHMA: A RANDOMIZED CONTROLLED STUDY. Joos S, Shott C, Zou H, Volker D. J Altern Complement Med 2000; 6(6):519_525. Online copy not available. Please visit http://www.catchword.com/titles/10755535.htm for more information. Reviewed by JK Rotchford, MD MPH (3) CERVICAL SPONDYLOSIS: 100 PATIENTS TREATED WITH SLIDING CUPPING. Hong Z. J Chin Med; October 2000(64):40_41. Not online but one can obtain information at http://www.jcm.co.uk/ Reviewed by JK Rotchford MD MPH 2 Oldies but Goodies reviewed: (1) OVERVIEW: ADVERSE EVENTS OF ACUPUNCTURE. Rotchford JK. Med Acup 1999; 11(2): p.32_35 http://www.medicalacupuncture.org/journal/Vol11_2/adverse.html Reviewed by Russ Erickson, MD (2) Short Articles responding to the Review of Nigel Wiseman's terminology in "A Practical Dictionary of Chinese Medicine" J Chin Medicine Feb 2000 63 (The initial Review was in The Journal of Chinese Medicine 62 Feb. 2000) http://www.jcm.co.uk/SampleArticles/terminology.html Reviewed by Russ Erickson, MD Sources for citations are the same as the Medical Acupuncture Research Foundation's (MARF) online bibliography of acupuncture at http://www.acubriefs.com. The editor for the newsletter is J.K. Rotchford MD MPH, President of the Medical Acupuncture Research Foundation. http://www.medicalacupuncture.org/marf.htm. Seirin_America along with Oriental Medical Supplies (OMS) suppliers of acupuncture needles and accessories are financial sponsors of Acubrief's Newsletter. http://www.seirinamerica.com http://www.omsmedical.com Recent articles reviewed: (1) ELECTROACUPUNCTURE FOR CONTROL OF MYELOABLATIVE CHEMOTHERAPY_INDUCED EMESIS: A RANDOMIZED CONTROLLED TRIAL. Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, and Shekelle PG JAMA Dec 6 2000 284(21): p. 2755_61. http://jama.ama_assn.org/issues/v284n21/ffull/jci00080.html Reviewed by J.K. Rotchford, MD, MPH BACKGROUND The 1997 NIH Consensus Conference on Acupuncture concluded that acupuncture was efficacious in reducing emesis associated with chemotherapy.The conference came to their conclusion based on a published randomized control trial of 10 patients, a systematic review of the literature, and the then-unpublished work of this paper's primary author.A recent meta-analysis of the use of acupuncture in the post-operative setting supports the effectiveness of acupuncture for emesis. The only other condition for which acupuncture received a definitive positive nod by the NIH Consensus Conference was its use for dental anesthesia.Most importantly, the paper was published in JAMA. Notable, however, is that this paper examines acupuncture only as adjunctive therapy to a standard pharmacological intervention for emesis.The paper fails to scientifically validate any of the principles or theories upon which traditional Oriental models of acupuncture are based. METHODS The paper reflected a well-designed, 3-arm, parallel-group, randomized controlled trial conducted at a university oncology center. Its objective was to compare the effectiveness of electroacupuncture vs minimal needling and mock electrical acupuncture, or electrical stimulation, or anti-emetic medications alone in controlling emesis among patients undergoing a highly emetogenic chemotherapy regimen. The study was comprised of 104 women; the average age, 47.Active treatment was for 5 days during concurrent triple anti-emetic pharmacotherapy and high-dose chemotherapy.The electro-acupuncture group (n=37) received low frequency electrical stimulation bilaterally at PC 6 with direct alternating polarity current with ST 36 for 20 minutes.Prior to electrical stimulation, the sensation of Qi was obtained and the patients' pulses were taken.The minimal acupuncture group was needled with special attention in not obtaining the Qi sensation at LU 7 and GB 34, and mock electrical stimulation was performed. All 3 groups received the same chemotherapy regimen (cyclophosphamide, cisplatin, and 1 day of carmustine), and anti-hemetic drugs (prochlorperazine, lorazepam, and diphenhydramine). The primary outcome evaluated was the total number of emesis episodes occurring during the 5-day study period. RESULTS The 5 median episodes of emesis for the electroacupuncture group, 10 for the minimal needling group, and 15 for the chemotherapy alone group. (P<.001).During the 9-day follow up period, the frequency of emesis was the same in all 3 groups (P=18). CONCLUSIONS Adjunct electroacupuncture for breast cancer patients was more effective in reducing the frequency of emesis than minimal needling or antiemetic pharmacotherapy alone. The observed effect had limited duration. COMMENTARY BY REVIEWER Although the study clearly needs to be duplicated at another center to permit us to generalize its findings, it is not original news.The study did not evaluate the effectiveness of electrical stimulation to other points. For this reason, it did nothing to confirm scientific legitimacy to the selection of points or theories upon which point selections arise.The fact that there was no persistence of effectiveness beyond the treatment phase leads me to believe that the effect was pharmacological, due to the known release of endorphins by electroacupuncture and their possible effect from the opiate mu receptor via its antiemetic actions. In the context of this study, the effect could be accentuated by the concurrence In clinical acupuncture practice that the effects of acupuncture are often delayed or tend to have an accumulative response (which refutes observations in this study). The study was single-blinded, which the author admits is a weakness, but difficult to avoid in studies involving surgical procedures.The practitioners involved took patient pulses prior to providing the identical treatment to every patient.I find this peculiar, though I believe in pulse diagnosis as a helpful means to obtaining a traditional Oriental medical diagnosis for it to have a possible therapeutic effect in and by itself. In this context, however, I do not understand its reflections aside from a peculiar allegiance to a traditional ritual in an otherwise excellent clinical trial.In the future, confounding variables such as pulse-taking should be avoided in studies evaluating acupuncture per se, unless they can be demonstrated to be a prequisite of acupuncture's effectiveness.It is even possible that in this context, the pulse-taking diminished the effect of the acupuncture by creating a dissonance in the practitioner (possibly communicated to the patient) - who would like to treat the patient in a "traditional" manner, but can't because of the confines of the study design. LEVEL OF EVIDENCE: II Randomized Clinical Trial CLINICAL RELEVANCY Newer pharmacological combinations including serotonin antagonists and corticosteroids agents appear to be more effective than the anti-emetic cocktail these patients received. We shall see if acupuncture is shown to have an adjunctive role with these newer protocols and/or prove to be cost effective.Nonetheless, acupuncture is safe, and clinicians can be assured of demonstrated clinical efficacy of electroacupuncture as adjunctive therapy for myeloblative chemotherapy-induced emesis. NUMBER OF REFERENCES: 30 (2) IMMUNOMODULATORY EFFECTS OF ACUPUNCTURE IN THE TREATMENT OF ALLERGIC ASTHMA: A RANDOMIZED CONTROLLED STUDY. Joos S, Shott C, Zou H, Volker D. J Altern Complement Med 2000; 6(6):519_525. Online copy not available. Please visit http://www.catchword.com/titles/10755535.htm for more information. Reviewed by J.K. Rotchford, MD MPH BACKGROUND Allergic asthma is a common problem encountered in clinical practice. Definitive scientific proof of acupuncture's effectiveness in asthma is lacking, but some recent meta_analyses by Jobst in this same journal (1995, 1996), and a plethora of case reports and expert opinion, clearly support its role as adjunctive therapy with asthma. There are scarce clinical trials examining the effects of acupuncture on serum immunological parameters. This study examined these parameters in an attempt to demonstrate acupuncture's clinical effectiveness in allergic asthma. METHODS This was a single_blind, randomized, controlled clinical trial completed in 1994 in the Department of Anaesthetics, University of Heidelberg. The objective was to determine whether acupuncture, provided in accordance with principles of TCM, was effective in allergic asthma. The study involved 38 patients: 20 in the active treatment group, and 18 in the control group. All patients received 12 acupuncture sessions of 30 minutes over a period of 4 weeks. In the control group, patients underwent a treatment at acupuncture points not specific for asthma, as determined by a skilled practitioner. This same practitioner taught 6 medical students (during a 6_month period) to provide prescribed treatments to the study participants. An initial traditional exam by the skilled practitioner, with another exam after 6 sessions, determined the prescribed treatment in the active group. Sensation of de qi was elicited in the active group; in the placebo group, only gentle superficial needling was performed. All of the patients were continued on conventional therapy; excluded from the study were patients receiving more than 7.5 mg of prednisone a day, patients with severe asthma or other serious illnesses, and patients in psychotherapy. Outcome parameters included subject feelings of improvement as determined by the clinicians; also, a host of blood immunological parameters were measured. A partial list included: Eosinophils% CD3, 4, and 8 cell concentrations, IL_2, 4, 6, 8, and 10 concentrations were measured 3 days prior to the first acupuncture session and 3 days following the last session. RESULTS General well_being was statistically different between the 2 groups following the intervention: 79% vs. 47% stated improvement. Although there was a clear difference in the amount of change in the parameters between the 2 groups, the statistical comparison revealed a significantly higher increase of the in vitro lymphocyte proliferation rate (p= 0.010) in the TCM group. For the remaining immunologic parameters, no significant differences between the 2 groups were found. CONCLUSIONS The findings imply that asthma patients benefit from acupuncture treatment given in addition to conventional therapy. The authors also conclude that acupuncture performed in accordance with the principles of TCM showed significant immune_modulating effects. COMMENTARY BY REVIEWER The design (which purportedly had medical students trained in acupuncture only 6 months) was done, supposedly, to offset the problem of single_blinded acupuncture studies. I do not believe this, and no attempt was made to document the effectiveness of blinding to the patients. For credibility, outcome measures must be valid and reliable. There was no attempt by the authors to formally address the issue of validity and reliability of outcome measures. No attempt was made to perform PFT's prior to and after treatment. There was significant difference in pre_treatment levels of the immunological parameters evaluated between the 2 groups, with the active group (TCM) having much "higher" values that lend themselves to a greater regression to the means. The groups not only differed by the TCM diagnostic parameters, but by treatment methods. Needling technique alone could explain the difference seen in the 2 groups,as well as the effect of single blinding. If one measures enough parameters, there is a statistical probability that a significant difference between 2 groups will be seen. Noted is that only 1 objective parameter showed a significant difference between the 2 groups. There were no power studies done a priori. The conclusions the authors came to are clearly unwarranted given the design and findings of the study. It does appear that needling patients effects immune parameters; however, without a control group that was not needled, this is even in question. (Regression to mean? Or other non_specific effects associated with clinical trials?) Differences between the 2 treatment groups were not statistically different, with the exception of 1 parameter in which the clinical implications are unclear. To conclude that the apparent difference between the groups is based on acupuncture according to the principles of TCM suggests a significant bias of the authors per TCM approaches. LEVEL OF EVIDENCE II Randomized Control Trial, but the study did not evaluate the effectiveness of acupuncture for asthma due to the lack of reliable and valid outcome measures for this disease. I do not believe these parameters have been demonstrated as reliable and valid for allergic asthma as well. CLINICAL RELEVANCY: Medium My interest in this study is that with some tweaking, the design might be a relatively good one for doing a large_ scale intervention looking at asthma as well as other conditions. Individualized therapy could be prescribed by a skilled practitioner, and "technicians" might provide the therapy. I would clearly include a third faction to the study to include patients who did not receive any treatment, and I would also include de qi sensation in the "sham" acupuncture group to see if this would limit differences in the 2 treatment groups. I also believe that prior to a large_scale study, there should be pilot studies observing skilled practitioners approaching asthma patients from a non_TCM acupuncture approach. My belief is that PFT's are still the gold standard with regard to asthma therapy interventions, but hospitalizations or medication amounts could also be valid outcome measures. These outcome measures need to be gleaned from the asthma literature. NUMBER OF REFERENCES: 27 (3.) CERVICAL SPONDYLOSIS: 100 PATIENTS TREATED WITH SLIDING CUPPING. Hong Z. J Chin Med 2001; October 2000(64):40_41. (Not online, but can obtain information: http://www.jcm.co.uk/) Reviewed by J. K. Rotchford, MD, MPH BACKGROUND Cervical spondylosis can be a severely disabling condition. Possible effective approaches outside of surgical interventions and standard physical therapy warrant evaluation. METHODS The author relates the findings of 100 patients treated with sliding cupping for cervical spondylosis. Describing the clinical data upon which the diagnosis was made, he details the therapeutic method which basically involved sliding a cup over the meridians involved in shoulder, upper back, and nape, using mineral oil. Sessions were once or twice a week for a month. Time was given for petechiae to resolve. The setting was the Acupuncture Department of the General Hospital of the Air Force. RESULTS The overall subjective rate of improvement was 97%, with 43% showing complete resolution of signs and symptoms after 1 month. X_ray findings confirmed that the physiological curvature of the cervical vertebrae had returned to normal in 45 cases, and the rheoencephalogram showed that the vertebral artery blood supply had also normalized in 20 cases. CONCLUSIONS The author states: " Sliding cupping therapy can promote blood circulation in the nape, relieve the tense or spastic state of the muscles, and relieve pressure on the nerves and arteries. Better therapeutic results can be obtained in cases of short duration. During treatment, any etiological factors should be eliminated, fatigue avoided, and appropriate neck exercises taught to patients." He also explains from Traditional Chinese Medicine (TCM) principles why this intervention is effective. COMMENTARY BY REVIEWER In a recent article in "Medical Acupuncture" (Spring/Summer 2000 issue), Lynnae Schwartz, MD reviewed a series of case reports providing evidence_based support of acupuncture's effectiveness. This speaks to the potential power of the case report in allowing us to provide evidence for individualized approaches to our patients. An article like this, despite not demonstrating proof of this technique as effective for cervical spondylosis (might it be the practitioner, adjunctive therapy, or setting that makes the difference?), reveals impressive findings. Clearly, the author's techniques will be used for my next patient with cervical spondylosis. I pose the question: Shouldn't we all be trying to put together a series of cases such as this? LEVEL OF EVIDENCE: IV Case Report CLINICAL RELEVANCY: High NUMBER OF REFERENCES: None Oldies but Goodies: (1) OVERVIEW: ADVERSE EVENTS OF ACUPUNCTURE. ROTCHFORD JK. Medl Acup 1999; 11(2): p.32_35. http://www.medicalacupuncture.org/journal/Vol11_2/adverse.html Reviewed by Russ Erickson, MD BACKGROUND We have a duty to ensure the greatest benefit for the least risk when using acupuncture in practice. Further and more stringent research is needed into the occurrence rate of adverse events. METHODS This article was a review of the English literature for articles related to acupuncture and adverse events. It also discusses methodological issues pertinent to evaluating adverse events. Acupuncture and adverse events are defined, and problems associated with the accurate determination of adverse acupuncture events are discussed in this article. The author believes better data can be achieved by considering acupuncture as therapy with thin, solid metal needles manipulated manually. If electroacupuncture, moxa, cupping, or other devices are used, such data should be collected separately. His definition of an adverse event is given as: "an injury or untoward event due to treatment, including failure to treat when needed." Data collection should not consider which events constitute malpractice or negligence; these are legal in nature and involvement will inhibit good data collection. Under_reporting is already a likely serious problem, as it is in non_acupuncture medical therapies. References are given and discussed to support both these statements. A problem of over_reporting is also discussed; until recently, Western medicine journals have appeared biased toward printing articles critical of acupuncture therapy as opposed to those providing positive data. Studies to collect data also need to consider comorbidity and other risk factors that act as confounding variables. Pneumothorax is given as an example. The incidence rises in smokers, those with emphysema, emaciated persons, and those on steroids. The natural history of spontaneous pneumothorax, estimated as 18 cases per 100,000 people, must also be considered. RESULTS Dr. Rotchford provides a comprehensive list of 30 types of adverse effects that have been reported for acupuncture therapy, including 5 reported deaths in the world literature. His references include 3 formal reviews of adverse acupuncture effects. The most common serious ones reported are hepatitis and pneumothorax. The author concludes that a serious event likely occurs in roughly 1 per 5,000 patients treated. It is the responsibility of practitioners to prevent adverse events, and to treat them adequately when they do occur. Approaches helpful in avoiding the more common adverse events are outlined. CONCLUSIONS Despite the likelihood of under_reporting, acupuncture is considered to be relatively safe compared to Western medication usage. This is supported both in the literature and by low malpractice premiums. Many methodological issues need to be considered when evaluating adverse events related to acupuncture. COMMENTARY BY REVIEWER This is a worthwhile article for practitioners. Unlike other articles on adverse effects in recent acupuncture literature, the author discusses the adequacy of data collection to date, as well as noting the relative safety of this medical art. Two other review articles are of interest for this subject. The first of these was from Scandinavia: "Adverse Effect of Acupuncture." Norheim, A.J. Lancet 345: 1576, 1995. (Thomso, Norway) Halvorson reported a fatal acupuncture (CV 17 perpendicular into a rare hole in the sternum, instead of needle angled properly), leading to a survey of 196 practitioners in Norway. Adverse happenings were reported by 12% of MDs and 31% of acupuncturists. Pneumothorax, fainting, local infection, and increased pain were fairly common, with other side effects rare. This was on the basis of recall, so it is likely an underestimate. There were 25 pneumothorax reports, primarily by MDs. Calculations indicate a Norwegian acupuncturist practices 4 to 5 years for each notable adverse effect seen. A list of effects reported by 1135 MDs and 197 acupuncturists is added. The second was done in the United States, concentrating on English language articles: Literature survey of "reported adverse effects associated with acupuncture treatment." Rosted, P. Amer J Acup 24(1): 27_34, 1996. This is a survey of reports from 1980 to 1995. In Denmark, Austria, France, and Germany, 10% of physicians are estimated to use acupuncture, with 1300 in England (and 3,000 non_physician acupuncturists). Major side effects are rare, especially contrasted to scores of thousands of deaths annually with conventional drug therapy. Adverse effects in 93 articles included endocarditis (4 reports), cardiac tamponade (3), pneumothorax (6), hepatitis (2 reports, 11 cases), ear perichondritis (1 report, 3 cases),neurologic problems (6), vascular problems (3), dermatitis (6), and foreign body (needle breakage) [3]. Each report is briefly discussed. Where adverse drug reactions account for 3 to 7% of hospitalizations and 0.5 to 0,9% of deaths, the incidence of adverse effects for acupuncture is very small, considering the large number of patients needled. LEVEL OF EVIDENCE: NA CLINICAL RELEVANCY: High NUMBER OF REFERENCES: 33 (2) Short Articles responding to the Review of Nigel Wiseman's terminology in "A Practical Dictionary of Chinese Medicine" J Chin Medicine Feb 2000 63 (The initial Review was in The Journal of Chinese Medicine 62 Feb. 2000) http://www.jcm.co.uk/SampleArticles/terminology.html Reviewed by Russ Erickson, MD BACKGROUND Although most practicing physicians do not become involved in academic questions such as translation and terminology issues, it is important for all practitioners to be aware of the debate on such issues, especially if one is interested in the history of Oriental medicine and the use of traditional concepts in their practice. Herein, we are essentially dealing with a series of reviews of a review. METHODS This review constitutes a series of online articles in response to a review of Nigel Wiseman's terminology in "A Practical Dictionary of Chinese Medicine" by Peter Deadman. (Reviewed in The Journal of Chinese Medicine, 62 Feb. 2000). There are experts in favor of Wiseman's terminology and others who are opposed. On Terminology, Charles Buck: The author believes there is a case for less translation, allowing terms such as Qi, Yin, Jing, etc. to stand untranslated, but teaching the Gestalt of the terms. The emphasis is shifted from scholarly translation of all terms to understanding them. The progress of CM in the West has been slowed by varied or inaccurate translations, with poor communication among translation scholars. There is often no simple congruence between Chinese and English terms, and significant meaning lies in the context. Serious errors can also rise if Western and Chinese disease categories are compared. Inaccurate concepts can destroy the credibility of CM. The translator has pride in finding the best words, but teachers and practitioners work primarily with understanding. Some examples are given of Pinyin terms, Porkert's prior attempts at translation, and commonly used translations as an example of the problems in translation. Practitioners must especially question the utility of unwieldy translated terms. In training, one has to learn exactly what terms such as Qi mean. The majority of Wiseman's terms are plain, simple, and accurate Chinese equivalents. Sometimes, however, archaic or unusual English words are used that might be misleading. Wiseman leaves Qi as Qi in his text. Perhaps this should be done more often? Some examples are given of terms this critic considers inadequate. Ideally, the linguist seeks terms that allow translation from Chinese to English to Chinese identical to the original source, but clumsy language can result. Few terms translate ideally due to both language and cultural differences. Wiseman's "Practical Dictionary" deserves a place on all practitioners' shelves, but its greatest use is as a glossary to develop understanding of Pinyin terms. Graduates of the UK Northern College of Acupuncture learn all the herb names in Pinyin without great difficulty. This allows later direct communication with their Chinese counterparts. The use of and learning the meaning of more Pinyin terms also allows better interaction with practitioners of other non_English speaking nations. In conclusion, this author quotes Flaws: "high fidelity translation is crucial in medicine". However, CM is "robust and travels well." Wiseman's work is a good compromise but imposition of some new terminology incomprehensible to many TCM practitioners might inhibit the profession's learning of Chinese, the universal CM language. China has 1 to 2 million practitioners vs. perhaps 30,000 in the West, so Pinyin should be emphasized. Other works to this effect are noted. References are given. The Right Word, Ken Rose: The publication of Mr Deadman's review of the Practical Dictionary, by Wiseman and Feng Ye, stimulated a discussion of translation standards generally. The author's Chinese mentor noted that when Americans become interested in acupuncture, practitioners must be careful. Because we are Americans, it will take years to comprehend that which we don't understand. In the 1970s, Shanghai University of TCM produced a wonderful collection of essays on many CM topics explaining the terminology used, and conveying the precise meanings of Chinese terms. The nomenclature of CM is enormously complex because of its long history and age. Chinese scholars still debate how to translate the ancient into modern CM concepts. However, the Practical Dictionary has made easier this author's work as a researcher and writer. Every age has compiled and updated the literature of CM, or "The Art of benevolence," as it has been known in China. Examples are given of terms commonly used with the Practical Dictionary translation. Those who seek to teach TCM must know and use the right words to convey proper meanings to students. This Dictionary is a noble beginning. Robert Felt, Paradigm Publications: Publicly available standards avoid coercion. The economic consequences of standards are important, and those published can be scrutinized. We still need to ask: how does our knowledge compare with that demanded of Asian practitioners? Does what we teach in our schools of CM allow survival of students in the market? Clinician's writings have not been consistent. The publishing of Chinese characters and associated English terms is helpful. The relationships found in Chinese texts are worthy of transmission _ in a mode subject to reader's ability to evaluate them objectively, with some knowledge of the author's background and abilities. No person's practice experience is adequate to overwhelm the experience carried within the Chinese literature. Some reasonable adept translation is necessary. Nigel Wiseman: He responds to the editorial criticizing his work on "The Practical Dictionary of Chinese Medicine." Some English terms given are criticized. Before publication, terminology included in the text was reviewed by experts (some names are given). The belief that Chinese medicine technical terminology is of little importance seems to be widespread among people with little access to primary Chinese texts. A foremost Chinese dictionary contains 32,000 items. A bilingual dictionary must supply a thorough translation of an adequate number to put transmission of knowledge on a firm footing. The purpose of a glossary is to provide a terminology for use of criticism. The author considers the editorial discussing his dictionary as a rare example of openly stated opinion on terminology that should be a topic for formal papers. Most journals give little space to discussion of such issues. The authors attempted to accurately reflect the Chinese concepts of the English terms given. A clinician would not be qualified to voice an opinion on such translation unless adequately linguistically trained. Examples of inadequate translations by clinical writers and teachers are given. Linguistic access plus clinical experience is necessary to evaluate Chinese medical information in any language. Each new text translated from original Chinese sources reveals richer and more complex concepts in CM. "A Practical Dictionary" singles out such concepts from many ages. "The primary need for the development of CM in the West is for everyone to gain access to China's huge mine of experience." Term choices given should not, in this Dictionary, take into account the Western reality of acupuncture. Complex reasons are given. "Appropriate adaptation can not take place until we know what we are adapting." This dictionary is a step. Over a period of decades, we can assemble a body of reliably translated literature providing a far greater understanding of CM. The author's writing of the theory of Chinese medical translation alone will be over 700 pages. The Dictionary provides and explains a bilingual list of 5,000 terms. Giovanni Macioca: Mr. Macioca believes that it is impossible to translate Chinese medicine into a Western language because of the difficulty of translating words with multiple meanings. His belief is that it is far better to give students a "feel" of Chinese terminology by explaining the term's meaning and relation to the disease in question. Even if correct English terminology is found, how does it translate to other countries? Concentrating attention to terminology distracts from proper diagnosis. Comment by Reviewer This review encompasses 22 pages of responses to an editorial commenting on and questioning a dictionary text by Wiseman and Feng Ye. It is of interest because it is easy to forget the intricacies of bilingual translation so crucial to transmitting learning from one language and culture to another. This is especially true of CM, where ancient texts and concepts foreign to Western medicine terminology and ideas exist. The Dictionary sounds like a tour de force and a text worthy of review by serious practitioners and researchers. Though Buck and especially Macioca contest the translation of some Pinyin CM terms into other languages, Wiseman and Felt defend the approach on objective and pragmatic grounds. Macioca appears certain that his ideation of all concepts he teaches is correct as he has translated and understands them. However, having a glossary to peruset can broaden the student's approach and self_evaluation. LEVEL OF EVIDENCE: NA CLINICAL RELEVANCY: Low NUMBER OF REFERENCES: 7 New references entered into acubriefs database this month: This month these references come primarily from Medline..In the future articles from non_indexed journals will be included. Effect of Acupuncture Treatment on Uterine Motility and Cyclooxygenase_2 Expression in Pregnant Rats. Kim Js, Shin KH, and Na CS Gynecol Obstet Invest 2000 Nov 50(4): p. 225_230 http://bmj.com/cgi/external_ref?access_num=0011093043&link_type=MED Complementary and alternative medicine in rheumatology. Ernst E Baillieres Best Pract Res Clin Rheumatol 2000 Dec 14(4): p. 731_749 http://bmj.com/cgi/external_ref?access_num=0011092799&link_type=MED Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness [In Process Citation] Barlas P, Robinson J, Allen J, and Baxter GD Clin Physiol 2000 Nov 20(6): p. 449_56 http://bmj.com/cgi/external_ref?access_num=0011100392&link_type=MED Restoration of propulsive peristalsis of the esophagus in achalasia [In Process Citation] Hep A, Dolina J, Dite P, Plottova Z, Valek V, Kala Z, and Prasek J Hepatogastroenterology 2000 Sep_Oct 47(35): p. 1203_4 http://bmj.com/cgi/external_ref?access_num=0011100311&link_type=MED Traditional Chinese medicine syndromes in women with frequently recurring cystitis: frequencies of syndromes and symptoms. Alraek T, Aune A, and Baerheim A Complement Ther Med 2000 Dec 8(4): p. 260_265 http://bmj.com/cgi/external_ref?access_num=0011098202&link_type=MED Normal medical practice of referring patients for complementary therapies among Australian general practitioners. Easthope G, Tranter B, and Gill G Complement Ther Med 2000 Dec 8(4): p. 226_233 http://bmj.com/cgi/external_ref?access_num=0011098197&link_type=MED Acupuncture on clinical symptoms and urodynamic measurements in spinal_cord _ injured patients with detrusor hyperreflexia [In Process Citation] Honjo H, Naya Y, Ukimura O, Kojima M, and Miki T Urol Int 2000 65(4): p. 190_5 http://bmj.com/cgi/external_ref?access_num=0011112867&link_type=MED Effect of Acupuncture_Like Stimulation on Cortical Cerebral Blood Flow in Anesthetized Rats. Uchida S, Kagitani F, Suzuki A, and Aikawa Y Jpn J Physiol 2000 Oct 50(5): p. 495_507 http://bmj.com/cgi/external_ref?access_num=0011120916&link_type=MED Cardiac Tamponade Following Acupuncture. Cheng TO Chest 2000 Dec 118(6): p. 1836_1837 http://bmj.com/cgi/external_ref?access_num=0011115486&link_type=MED Risks Associated With the Practice of Traditional Chinese Medicine: An Australian Study. Bensoussan A, Myers SP, and Carlton AL Arch Fam Med 2000 Nov 9(10): p. 1071_1078 http://bmj.com/cgi/external_ref?access_num=0011115210&link_type=MED The effect of transcutaneous electric nerve stimulation in patients with therapy_resistant hypertension. Jacobsson F, Himmelmann A, Bergbrant A, Svensson A, and Mannheimer C J Hum Hypertens 2000 Dec 14(12): p. 795_798 http://bmj.com/cgi/external_ref?access_num=0011114695&link_type=MED Acupuncture increases cell proliferation in dentate gyrus after transient global ischemia in gerbils. Kim E, Kim Y, Lee HJ, Huh Y, Chung J, Seo J, Kang J, Lee H, Yim S, and Kim C Neurosci Lett 2001 Jan 5 297(1): p. 21_24 http://bmj.com/cgi/external_ref?access_num=0011114475&link_type=MED Current topic: Complementary and alternative medicine for children: does it work? Kemper, K J Arch. Dis. Child. 2001 84: p. 6_9 http://www.archdischild.com/cgi/content/abstract/archdischild;84/1/6 Acupuncture for episodic tension_type headache: a multicentre randomized controlled trial. White AR, Resch KL, Chan JC, Norris CD, Modi SK, Patel JN, and Ernst E Cephalalgia 2000 Sep 20(7): p. 632_7 http://bmj.com/cgi/external_ref?access_num=0011128820&link_type=MED Use of acupuncture for managing chronic pelvic pain in pregnancy. A case report. Thomas CT and Napolitano PG J Reprod Med 2000 Nov 45(11): p. 944_6 http://bmj.com/cgi/external_ref?access_num=0011127110&link_type=MED More on BMA's approval of acupuncture William Asscher, David J Grant, and Mike Cummings BMJ 2001 322(7277): p. 45a http://bmj.com/cgi/content/full/322/7277/45/a End of Newsletter --=====================_10885813==_.ALT Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Acubriefs Newsletter Volume 1 Issue 2
To view this newsletter with your browser visit http://www.acubriefs.com

December 2000

3 Recent articles reviewed in this edition:

(1) ELECTROACUPUNCTURE FOR CONTROL OF MYELOABLATIVE
CHEMOTHERAPY_INDUCED EMESIS: A RANDOMIZED CONTROLLED TRIAL.
Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, and Shekelle PG JAMA 2000 Dec 6 284(21): p. 2755_61
http://jama.ama_assn.org/issues/v284n21/ffull/jci00080.h= tml
     Reviewed by JK Rotchford, MD, MPH

(2) IMMUNOMODULATORY EFFECTS OF ACUPUNCTURE IN THE TREATMENT
OF ALLERGIC ASTHMA: A RANDOMIZED CONTROLLED STUDY.  Joos S, Shott C,
Zou H, Volker D. J Altern Complement Med 2000; 6(6):519_525.
Online copy not available.  Please visit = http://www.catchword.com/titles/10755535.htm for more information.
     Reviewed by JK Rotchford, MD MPH

(3) CERVICAL SPONDYLOSIS: 100 PATIENTS TREATED WITH SLIDING
CUPPING. Hong Z. J Chin Med; October 2000(64):40_41.
Not online but one can obtain information at http://www.jcm.co.uk/
     Reviewed by JK Rotchford MD MPH

2 Oldies but Goodies reviewed:

(1) OVERVIEW: ADVERSE EVENTS OF ACUPUNCTURE. Rotchford JK.= Med Acup
1999; 11(2): p.32_35
http://www.medicalacupuncture.org/journal/Vol11_2/advers= e.html
     Reviewed by Russ Erickson, MD

(2) Short Articles responding to the Review of Nigel Wiseman's terminology= in "A Practical
Dictionary of Chinese Medicine" J Chin Medicine Feb 2000 63 (The= initial Review was in The
Journal of Chinese Medicine 62 Feb. 2000)
http://www.jcm.co.uk/SampleArticles/terminology.html=
     Reviewed by Russ Erickson, MD

Sources for citations are the same as the Medical Acupuncture Research
Foundation's (MARF) online bibliography of acupuncture at http://www.acubriefs.com. 
The editor for the newsletter is J.K. Rotchford MD MPH,  President of= the
Medical Acupuncture Research Foundation.   
http://www.medicalacupuncture.org/marf.htm.
    
     Seirin_America along with Oriental Medical Supplies= (OMS) suppliers of
acupuncture needles and accessories are financial sponsors of Acubrief's
Newsletter.
  http://www.seirinamerica.com    http://www.omsmedical.com


Recent articles reviewed:

(1)= ELECTROACUPUNCTURE FOR CONTROL OF MYELOABLATIVE
CHEMOTHERAPY_INDUCED EMESIS: A RANDOMIZED
CONTROLLED TRIAL.  Shen J, Wenger N, Glaspy J, Hays RD, Albert= PS,
Choi C, and Shekelle PG JAMA  Dec 6 2000 284(21): p. 2755_61.
http://jama.ama_assn.org/issues/v284n21/ffull/jci00080.h= tml
     Reviewed by J.K.  Rotchford, MD, MPH

BACKGROUND
The 1997 NIH Consensus Conference on Acupuncture concluded that= acupuncture was efficacious in reducing emesis associated with= chemotherapy.The conference came to their conclusion based on a published= randomized control trial of 10 patients, a systematic review of the= literature, and the then-unpublished work of this paper=92s primary= author.A recent meta-analysis of the use of acupuncture in the= post-operative setting supports the effectiveness of acupuncture for= emesis.
 The only other condition for which acupuncture received a definitive= positive nod by the NIH Consensus Conference was its use for dental= anesthesia.Most importantly, the paper was published in JAMA. Notable,= however, is that this paper examines acupuncture only as adjunctive therapy= to a standard pharmacological intervention for emesis.The paper fails to= scientifically validate any of the principles or theories upon which= traditional Oriental models of acupuncture are based.

METHODS
        The paper= reflected a well-designed, 3-arm, parallel-group, randomized controlled= trial conducted at a university oncology center. Its objective was to= compare the effectiveness of electroacupuncture vs minimal needling and= mock electrical acupuncture, or electrical stimulation, or anti-emetic= medications alone in controlling emesis among patients undergoing a highly= emetogenic chemotherapy regimen.
 The study was comprised of 104 women; the average age, 47.Active= treatment was for 5 days during concurrent triple anti-emetic= pharmacotherapy and high-dose chemotherapy.The electro-acupuncture group= (n=3D37) received low frequency electrical stimulation bilaterally at PC 6= with direct alternating polarity current with ST 36 for 20 minutes.Prior to= electrical stimulation, the sensation of Qi was obtained and the patients= =92 pulses were taken.The minimal acupuncture group was needled with special= attention in not obtaining the Qi sensation at LU 7 and GB 34, and mock= electrical stimulation was performed.
All 3 groups received the same chemotherapy regimen (cyclophosphamide,= cisplatin, and 1 day of carmustine), and anti-hemetic drugs= (prochlorperazine, lorazepam, and diphenhydramine).
The primary outcome evaluated was the total number of emesis episodes= occurring during the 5-day study period.

RESULTS
        The 5= median episodes of emesis for the electroacupuncture group, 10 for the= minimal needling group, and 15 for the chemotherapy alone group.= (P<.001).During the 9-day follow up period, the frequency of emesis was= the same in all 3 groups (P=3D18).  CONCLUSIONS
           Adjunct= electroacupuncture for breast cancer patients was more effective in= reducing the frequency of emesis than minimal needling or antiemetic= pharmacotherapy alone. The observed effect had limited duration. = COMMENTARY BY REVIEWER
        Although= the study clearly needs to be duplicated at another center to permit us to= generalize its findings, it is not original news.The study did not evaluate= the effectiveness of electrical stimulation to other points. For this= reason, it did nothing to confirm scientific legitimacy to the selection of= points or theories upon which point selections arise.The fact that there= was no persistence of effectiveness beyond the treatment phase leads me to= believe that the effect was pharmacological, due to the known release of= endorphins by electroacupuncture and their possible effect from the opiate= mu receptor via its antiemetic actions. In the context of this study, the= effect could be accentuated by the concurrence In clinical acupuncture= practice that the effects of acupuncture are often delayed or tend to have= an accumulative response (which refutes observations in this study).
 The study was single-blinded, which the author admits is a weakness,= but difficult to avoid in studies involving surgical procedures.The= practitioners involved took patient pulses prior to providing the identical= treatment to every patient.I find this peculiar, though I believe in pulse= diagnosis as a helpful means to obtaining a traditional Oriental medical= diagnosis for it to have a possible therapeutic effect in and by itself. In= this context, however, I do not understand its reflections aside from a= peculiar allegiance to a traditional ritual in an otherwise excellent= clinical trial.In the future, confounding variables such as pulse-taking= should be avoided in studies evaluating acupuncture per se, unless they can= be demonstrated to be a prequisite of acupuncture=92s effectiveness.It is= even possible that in this context, the pulse-taking diminished the effect= of the acupuncture by creating a dissonance in the practitioner (possibly= communicated to the patient) - who would like to treat the patient in a= =93traditional=94 manner, but can=92t because of the confines of the study= design.

LEVEL OF EVIDENCE: II Randomized Clinical Trial

CLINICAL RELEVANCY
     Newer pharmacological combinations including= serotonin antagonists and corticosteroids agents appear to be more= effective than the anti-emetic cocktail these patients received. We shall= see if acupuncture is shown to have an adjunctive role with these newer= protocols and/or prove to be cost effective.Nonetheless, acupuncture is= safe, and clinicians can be assured of demonstrated clinical efficacy of= electroacupuncture as adjunctive therapy for myeloblative= chemotherapy-induced emesis.  NUMBER OF REFERENCES: 30

(2) IMMUNOMODULATORY EFFECTS OF ACUPUNCTURE IN THE  TREATMENT OF= ALLERGIC ASTHMA: A RANDOMIZED  CONTROLLED STUDY.  Joos S,= Shott C, Zou H, Volker D. J Altern  Complement Med 2000;= 6(6):519_525.  Online copy not available.  Please visit  http://www.catchword.com/titles/10755535.htm for= more information.
     Reviewed by J.K.  Rotchford, MD MPH

BACKGROUND
        Allergic asthma is a common= problem encountered in clinical practice.   Definitive scientific= proof of acupuncture's effectiveness in asthma is lacking, but  some= recent meta_analyses by Jobst in this same journal (1995, 1996), and= a  plethora of case reports and expert opinion, clearly support its= role as adjunctive  therapy with asthma.  There are scarce= clinical trials examining the effects of  acupuncture on serum= immunological parameters.  This study examined these  parameters= in an attempt to demonstrate acupuncture's clinical effectiveness in = allergic asthma.  

METHODS
        This was a single_blind,= randomized, controlled clinical trial completed in  1994 in the= Department of Anaesthetics, University of Heidelberg. The objective = was to determine whether acupuncture, provided in accordance with= principles of  TCM, was effective in allergic asthma.  The study= involved 38 patients: 20 in the  active treatment group, and 18 in the= control group.  All patients received 12  acupuncture sessions of= 30 minutes over a period of 4 weeks. In the control group,  patients= underwent a treatment at acupuncture points not specific for asthma,= as  determined by a skilled practitioner. This same practitioner= taught 6 medical  students (during a 6_month period) to provide= prescribed treatments to the study  participants.  An initial= traditional exam by the skilled practitioner, with another  exam after= 6 sessions, determined the prescribed treatment in the active= group.   Sensation of de qi was elicited in the active group; in= the placebo group, only  gentle superficial needling was= performed.  All of the patients were continued on  conventional= therapy; excluded from the study were patients receiving more than = 7.5 mg of prednisone a day, patients with severe asthma or other serious= illnesses,  and patients in psychotherapy. 
        Outcome parameters included= subject feelings of improvement as determined  by the clinicians;= also, a host of blood immunological parameters were measured.   A= partial list included: Eosinophils% CD3, 4, and 8 cell concentrations,= IL_2, 4, 6,  8, and 10 concentrations were measured 3 days prior to= the first acupuncture  session and 3 days following the last= session.

RESULTS
        General well_being was= statistically different between the 2 groups following  the= intervention: 79% vs. 47% stated improvement.  Although there was a= clear  difference in the amount of change in the parameters between= the 2 groups, the  statistical comparison revealed a significantly= higher increase of the in vitro  lymphocyte proliferation rate (p=3D= 0.010) in the TCM group.  For the remaining  immunologic= parameters, no significant differences between the 2 groups were found.

CONCLUSIONS
        The findings imply that= asthma patients benefit from acupuncture treatment  given in addition= to conventional therapy.  The authors also conclude that = acupuncture performed in accordance with the principles of TCM showed = significant immune_modulating effects.

COMMENTARY BY REVIEWER
        The design (which purportedly= had medical students trained in acupuncture  only 6 months) was done,= supposedly, to offset the problem of single_blinded  acupuncture= studies.  I do not believe this, and no attempt was made to= document  the effectiveness of blinding to the patients.  For= credibility, outcome measures  must be valid and reliable.  There= was no attempt by the authors to formally  address the issue of= validity and reliability of outcome measures.  No attempt was = made to perform PFT's prior to and after treatment. There was= significant  difference in pre_treatment levels of the immunological= parameters evaluated  between the 2 groups, with the active group= (TCM) having much "higher" values  that lend themselves to a= greater regression to the means.  The groups not only  differed= by the TCM diagnostic parameters, but by treatment methods. Needling = technique alone could explain the difference seen in the 2 groups,as well= as the  effect of single blinding.  If one measures enough= parameters, there is a statistical  probability that a significant= difference between 2 groups will be seen.  Noted is  that only 1= objective parameter showed a significant difference between the 2 = groups.  There were no power studies done a priori.
        The conclusions the authors came= to are clearly unwarranted given the design  and findings of the= study.  It does appear that needling patients effects immune = parameters; however, without a control group that was not needled, this is= even in  question. (Regression to mean? Or other non_specific effects= associated with  clinical trials?) Differences between the 2 treatment= groups were not statistically  different, with the exception of 1= parameter in which the clinical implications are  unclear. To conclude= that the apparent difference between the groups is based on = acupuncture according to the principles of TCM suggests a significant bias= of the  authors per TCM approaches.

LEVEL OF EVIDENCE
     II Randomized Control Trial, but the study did= not evaluate the  effectiveness of acupuncture for asthma due to the= lack of reliable and valid  outcome measures for this disease. I do= not believe these parameters have been  demonstrated as reliable and= valid for allergic asthma as well.
 
CLINICAL RELEVANCY:  Medium
        My interest= in this study is that with some tweaking, the design might be a = relatively good one for doing a large_ scale intervention looking at asthma= as well  as other conditions.  Individualized therapy could be= prescribed by a skilled  practitioner, and "technicians"= might provide the therapy. I would clearly include  a third faction to= the study to include patients who did not receive any treatment,  and= I would also include de qi sensation in the "sham" acupuncture= group to see if  this would limit differences in the 2 treatment= groups.  I also believe that prior to a  large_scale study, there= should be pilot studies observing skilled practitioners  approaching= asthma patients from a non_TCM acupuncture approach.  My belief= is  that  PFT's are still the gold standard with regard to asthma= therapy interventions,  but hospitalizations or medication amounts= could also  be valid outcome  measures. These outcome measures= need to be gleaned from the asthma literature.

NUMBER OF REFERENCES:  27

(3.) CERVICAL SPONDYLOSIS: 100 PATIENTS TREATED WITH
SLIDING CUPPING. Hong Z. J Chin Med 2001; October 2000(64):40_41.
(Not online, but can obtain information:
http://www.jcm.co.uk/)  
Reviewed by J. K. Rotchford, MD, MPH

BACKGROUND
        Cervical spondylosis can be a= severely disabling condition. Possible effective approaches outside of= surgical interventions and standard physical therapy warrant= evaluation.

METHODS
        The author relates the= findings of 100 patients treated with sliding cupping for cervical= spondylosis. Describing the clinical data upon which the diagnosis was= made, he details the therapeutic method which basically involved sliding a= cup over the meridians involved in shoulder, upper back, and nape, using= mineral oil. Sessions were once or twice a week for a month. Time was given= for petechiae to resolve. The setting was the Acupuncture Department of the= General Hospital of the Air Force.
       
RESULTS
       The overall subjective rate of= improvement was 97%, with 43% showing complete resolution of signs and= symptoms after 1 month.  X_ray findings confirmed that the= physiological curvature of the cervical vertebrae had returned to normal in= 45 cases, and the rheoencephalogram showed that the vertebral artery blood= supply had also normalized in 20 cases.

CONCLUSIONS
        The author states: "= Sliding cupping therapy can promote blood circulation in the nape, relieve= the tense or spastic state of the muscles, and relieve pressure on the= nerves and arteries.  Better therapeutic results can be obtained in= cases of short duration.  During treatment, any etiological factors= should be eliminated, fatigue avoided, and appropriate neck exercises= taught to patients."  He also explains from Traditional Chinese= Medicine (TCM) principles why this
intervention is effective.

COMMENTARY BY REVIEWER
        In a recent article in= "Medical Acupuncture" (Spring/Summer 2000 issue), Lynnae= Schwartz, MD reviewed a series of case reports providing evidence_based= support of acupuncture's effectiveness.  This speaks to the potential= power of the case report in allowing us to provide evidence for= individualized approaches to our= patients.         An article like= this, despite not demonstrating proof of this technique as effective for= cervical spondylosis (might it be the practitioner, adjunctive therapy, or= setting that makes the difference?), reveals impressive findings. = Clearly, the author's techniques will be used for my next patient with= cervical spondylosis.  I pose the question: Shouldn't we all be trying= to put together a series of cases such as this?
 
LEVEL OF EVIDENCE: IV Case Report

CLINICAL RELEVANCY: High

NUMBER OF REFERENCES: None



Oldies but Goodies:

(1) OVERVIEW: ADVERSE= EVENTS OF ACUPUNCTURE. ROTCHFORD JK. Medl Acup 1999; 11(2):
p.32_35.  http://www.medicalacupuncture.org/journal/Vol11_2/advers= e.html
     Reviewed by Russ Erickson, MD

BACKGROUND
        We have a duty to ensure the= greatest benefit for the least risk when using acupuncture in practice.= Further and more stringent research is needed into the occurrence rate of= adverse events.

METHODS
        This article was a review of= the English literature for articles related to acupuncture and adverse= events. It also discusses methodological issues pertinent to evaluating= adverse events.
        Acupuncture and adverse events= are defined, and problems associated with the accurate determination of= adverse acupuncture events are discussed in this article. The author= believes better data can be achieved by considering acupuncture as therapy= with thin, solid metal needles manipulated manually. If electroacupuncture,= moxa, cupping, or other devices are used, such data should be collected= separately. His definition of an adverse event is given as: "an injury= or untoward event due to treatment, including failure to treat when= needed." 
        Data collection should not= consider which events constitute malpractice or negligence; these are legal= in nature and involvement will inhibit good data collection.= Under_reporting is already a likely serious problem, as it is in= non_acupuncture medical therapies. References are given and discussed to= support both these statements.   A problem of over_reporting is= also discussed; until recently, Western medicine journals have appeared= biased toward printing articles critical of acupuncture therapy as opposed= to those providing positive data.
        Studies to collect data also need= to consider comorbidity and other risk factors that act as confounding= variables. Pneumothorax is given as an example. The incidence rises in= smokers, those with emphysema, emaciated persons, and those on steroids.= The natural history of spontaneous pneumothorax, estimated as 18 cases per= 100,000 people, must also be considered.

RESULTS
        Dr. Rotchford provides a= comprehensive list of 30 types of adverse effects that have been= reported  for acupuncture therapy, including 5 reported deaths in the= world literature. His references include 3  formal reviews of adverse= acupuncture effects. The most common serious ones reported are hepatitis= and  pneumothorax. The author concludes that a serious event likely= occurs in roughly 1 per 5,000 patients  treated. It is the= responsibility of practitioners to prevent adverse events, and to treat= them adequately  when they do occur. Approaches helpful in avoiding= the more common adverse events are outlined.
 
CONCLUSIONS
      Despite the likelihood of= under_reporting, acupuncture is considered to be relatively safe compared= to  Western medication usage. This is supported both in the literature= and by low malpractice premiums.   Many methodological issues= need to be considered when evaluating adverse events related to= acupuncture.
 
COMMENTARY BY REVIEWER
       This is a worthwhile article for= practitioners. Unlike other articles on adverse effects in recent = acupuncture literature, the author discusses the adequacy of data= collection to date, as well as noting the  relative safety of this= medical art. Two other review articles are of interest for this subject.= The first of these  was from Scandinavia:   = "Adverse Effect of Acupuncture." Norheim, A.J. Lancet 345: 1576,= 1995. (Thomso, Norway)        = Halvorson reported a fatal acupuncture (CV 17 perpendicular into a rare= hole in the sternum, instead of  needle angled properly), leading to a= survey of 196 practitioners in Norway.  Adverse happenings were = reported by 12% of MDs and 31% of acupuncturists. Pneumothorax, fainting,= local infection, and  increased pain were fairly common, with other= side effects rare.  This was on the basis of recall, so it is = likely an underestimate. There were 25 pneumothorax reports, primarily by= MDs. Calculations indicate a  Norwegian acupuncturist practices 4 to 5= years for each notable adverse effect seen.  A list of effects = reported by 1135 MDs and 197 acupuncturists is added. 
The second was done in the United States, concentrating on English language= articles:

Literature survey of "reported adverse effects associated with= acupuncture treatment." Rosted, P. Amer J  Acup 24(1): 27_34,= 1996.       This is a survey of reports from= 1980 to 1995. In Denmark, Austria, France, and Germany, 10% of = physicians are estimated to use acupuncture, with 1300 in England (and= 3,000 non_physician  acupuncturists). Major side effects are rare,= especially contrasted to scores of thousands of deaths  annually with= conventional drug therapy.  Adverse effects in 93 articles included= endocarditis (4 reports),  cardiac tamponade (3), pneumothorax (6),= hepatitis (2 reports, 11 cases), ear perichondritis (1 report, 3 = cases),neurologic problems (6), vascular problems (3), dermatitis (6), and= foreign body (needle breakage)  [3]. Each report is briefly= discussed.  Where adverse drug reactions account for 3 to 7% of= hospitalizations  and 0.5 to 0,9% of deaths, the incidence of adverse= effects for acupuncture is very small, considering the  large number= of patients needled.
 
LEVEL OF EVIDENCE: NA

CLINICAL RELEVANCY:  High

NUMBER OF REFERENCES: 33

(2) Short Articles responding to the Review of Nigel Wiseman's terminology= in "A
Practical Dictionary of Chinese Medicine" J Chin Medicine Feb 2000= 63 (The initial Review
was in The Journal of Chinese Medicine 62 Feb. 2000)
http://www.jcm.co.uk/SampleArticles/terminology.html=
Reviewed by Russ Erickson, MD

BACKGROUND
        Although most practicing= physicians do not become involved in academic questions such as
translation and terminology issues, it is important for all practitioners to= be aware of the debate on such issues, especially if one is interested in= the history of Oriental medicine and the use of traditional concepts = in their practice.  Herein, we are essentially dealing with a series= of reviews of a review.

METHODS
          This review= constitutes a series of online articles in response to a review of Nigel= Wiseman's  terminology in "A Practical Dictionary of Chinese= Medicine" by Peter Deadman. (Reviewed in The Journal  of Chinese= Medicine, 62 Feb. 2000).   There are experts in favor of= Wiseman's terminology and others who are opposed.

On Terminology, Charles Buck:
     The author believes there is a case for less= translation, allowing terms such as Qi, Yin, Jing, etc. to stand= untranslated, but teaching the Gestalt of the terms. The emphasis is= shifted from scholarly translation of all terms to understanding them. The= progress of CM in the West has been slowed by varied or inaccurate= translations, with poor communication among translation scholars. There is= often no simple congruence between Chinese and English terms, and= significant meaning lies in the context. Serious errors can also rise if= Western and Chinese disease categories are compared. Inaccurate concepts= can destroy the credibility of CM. The translator has pride in finding the= best words, but teachers and practitioners work primarily with= understanding. Some examples are given of Pinyin terms, Porkert's prior= attempts at translation, and commonly used translations as an example of= the problems in translation. Practitioners must especially question the= utility of unwieldy translated terms. In training, one has to learn exactly= what terms such as Qi mean. The majority of Wiseman's terms are plain,= simple, and accurate Chinese equivalents. Sometimes, however, archaic or= unusual English words are used that might be misleading. Wiseman leaves Qi= as Qi in his text.  Perhaps this should be done more often? Some= examples are given of terms this critic considers inadequate. Ideally, the= linguist seeks terms that allow translation from Chinese to English to= Chinese identical to the original source, but clumsy language can result.= Few terms translate ideally due to both language and cultural differences.= Wiseman's "Practical Dictionary" deserves a place on all= practitioners' shelves, but its greatest use is as a glossary to develop= understanding of Pinyin terms. Graduates of the UK Northern College of= Acupuncture learn all the herb names in Pinyin without great difficulty.= This allows later direct communication with their Chinese counterparts. The= use of and learning the meaning of more Pinyin terms also allows better= interaction with practitioners of other non_English speaking nations.
     In conclusion, this author quotes Flaws: "high= fidelity translation is crucial in medicine". However, CM is= "robust and travels well." Wiseman's work is a good compromise= but imposition of some new terminology incomprehensible to many TCM= practitioners might inhibit the profession's learning of Chinese, the= universal CM language. China has 1 to 2 million practitioners vs. perhaps= 30,000 in the West, so Pinyin should be emphasized. Other works to this= effect are noted. References are given.

The Right Word, Ken Rose:
     The publication of Mr Deadman's review of the= Practical Dictionary, by Wiseman and Feng Ye, stimulated a discussion of= translation standards generally. The author's Chinese mentor noted that= when Americans become interested in acupuncture, practitioners must be= careful. Because we are Americans, it will take years to comprehend that= which we don't understand. In the 1970s, Shanghai University of TCM= produced a wonderful collection of essays on many CM topics explaining the= terminology used, and conveying the precise meanings of Chinese terms. The= nomenclature of CM is enormously complex because of its long history and= age. Chinese scholars still debate how to translate the ancient into modern= CM concepts. However, the Practical Dictionary has made easier this= author's work as a researcher and writer. Every age has compiled and= updated the literature of CM, or "The Art of benevolence," as it= has been known in China. Examples are given of terms commonly used with the= Practical Dictionary translation. Those who seek to teach TCM must know and= use the right words to convey proper meanings to students. This Dictionary= is a noble beginning.

Robert Felt, Paradigm Publications:
     Publicly available standards avoid coercion. The= economic consequences of standards are important, and those published can= be scrutinized. We still need to ask: how does our knowledge compare with= that demanded of Asian practitioners? Does what we teach in our schools of= CM allow survival of students in the market? Clinician's writings have not= been consistent. The publishing of Chinese characters and associated= English terms is helpful. The relationships found in Chinese texts are= worthy of transmission _ in a mode subject to reader's ability to evaluate= them objectively, with some knowledge of the author's background and= abilities. No person's practice experience is adequate to overwhelm the= experience carried within the Chinese literature. Some reasonable adept= translation is necessary.

Nigel Wiseman:
     He responds to the editorial criticizing his work= on "The Practical Dictionary of Chinese Medicine."  Some= English terms given are criticized. Before publication, terminology= included in the text was reviewed by experts (some names are given). The= belief that Chinese medicine technical terminology is of little importance= seems to be widespread among people with little access to primary Chinese= texts. A foremost Chinese dictionary contains 32,000 items. A bilingual= dictionary must supply a thorough translation of an adequate number to put= transmission of knowledge on a firm footing. The purpose of a glossary is= to provide a terminology for use of criticism. The author considers the= editorial discussing his dictionary as a rare example of openly stated= opinion on terminology that should be a topic for formal papers. Most= journals give little space to discussion of such issues. The authors= attempted to accurately reflect the Chinese concepts of the English terms= given. A clinician would not be qualified to voice an opinion on such= translation unless adequately linguistically trained. Examples of= inadequate translations by clinical writers and teachers are given.= Linguistic access plus clinical experience is necessary to evaluate Chinese= medical information in any language. Each new text translated from original= Chinese sources reveals richer and more complex concepts in CM. "A= Practical Dictionary" singles out such concepts from many ages.= "The primary need for the development of CM in the West is for= everyone to gain access to China's huge mine of experience." Term= choices given should not, in this Dictionary, take into account the Western= reality of acupuncture. Complex reasons are given. "Appropriate= adaptation can not take place until we know what we are adapting."= This dictionary is a step. Over a period of decades, we can assemble a body= of reliably translated literature providing a far greater understanding of= CM. The author's writing of the theory of Chinese medical translation alone= will be over 700 pages. The Dictionary provides and explains a bilingual= list of 5,000 terms.

Giovanni Macioca:
     Mr. Macioca believes that it is impossible to= translate Chinese medicine into a Western language because of the= difficulty of translating words with multiple meanings. His belief is that= it is far better to give students a "feel" of Chinese terminology= by explaining the term's meaning and relation to the disease in question.= Even if correct English terminology is found, how does it translate to= other countries? Concentrating attention to terminology distracts from= proper diagnosis.

Comment by Reviewer
        This review encompasses 22= pages of responses to an editorial commenting on and questioning a= dictionary text by Wiseman and Feng Ye. It is of interest because it is= easy to forget the intricacies of bilingual translation so crucial to= transmitting learning from one language and culture to another. This is= especially true of CM, where ancient texts and concepts foreign to Western= medicine terminology and ideas exist. The Dictionary sounds like a tour de= force and a text worthy of review by serious practitioners and researchers.= Though Buck and especially Macioca contest the translation of some Pinyin= CM terms into other languages, Wiseman and Felt defend the approach on= objective and pragmatic grounds.  Macioca appears certain that his= ideation of all concepts he teaches is correct as he has translated and= understands them. However, having a glossary to peruset can broaden the= student's approach and self_evaluation.

LEVEL OF EVIDENCE: NA

CLINICAL RELEVANCY: Low
NUMBER OF REFERENCES: 7


New references entered into= acubriefs database this month:

This month these= references come primarily from Medline..In the future articles= from       
     non_indexed journals will be included.


Effect of Acupuncture Treatment on Uterine Motility and Cyclooxygenase_2=
Expression in Pregnant Rats.
Kim Js, Shin KH, and Na CS
Gynecol Obstet Invest 2000 Nov 50(4): p. 225_230
http://bmj.com/cgi/external_ref?access_num=3D0011093043&= amp;link_type=3DMED

Complementary and alternative medicine in rheumatology.
Ernst E Baillieres Best Pract Res Clin Rheumatol 2000 Dec 14(4): p. 731_749=
http://bmj.com/cgi/external_ref?access_num=3D0011092799&= amp;link_type=3DMED

Lack of effect of acupuncture upon signs and symptoms of delayed onset=
muscle soreness [In Process Citation]
Barlas P, Robinson J, Allen J, and Baxter GD
Clin Physiol 2000 Nov 20(6): p. 449_56
http://bmj.com/cgi/external_ref?access_num=3D0011100392&= amp;link_type=3DMED

Restoration of propulsive peristalsis of the esophagus in achalasia= [In
Process Citation]
Hep A, Dolina J, Dite P, Plottova Z, Valek V, Kala Z, and Prasek J
Hepatogastroenterology 2000 Sep_Oct 47(35): p. 1203_4
http://bmj.com/cgi/external_ref?access_num=3D0011100311&= amp;link_type=3DMED

Traditional Chinese medicine syndromes in women with frequently recurring=
cystitis: frequencies of syndromes and symptoms.
Alraek T, Aune A, and Baerheim A
Complement Ther Med 2000 Dec 8(4): p. 260_265
http://bmj.com/cgi/external_ref?access_num=3D0011098202&= amp;link_type=3DMED

Normal medical practice of referring patients for complementary therapies=
among Australian general practitioners.
Easthope G, Tranter B, and Gill G Complement Ther Med 2000 Dec 8(4): p.= 226_233
http://bmj.com/cgi/external_ref?access_num=3D0011098197&= amp;link_type=3DMED
 
Acupuncture on clinical symptoms and urodynamic measurements in= spinal_cord
  _ injured patients with detrusor hyperreflexia [In Process= Citation]
Honjo H, Naya Y, Ukimura O, Kojima M, and Miki T Urol Int 2000 65(4): p.= 190_5
http://bmj.com/cgi/external_ref?access_num=3D0011112867&= amp;link_type=3DMED

Effect of Acupuncture_Like Stimulation on Cortical Cerebral Blood Flow in=
Anesthetized Rats. Uchida S, Kagitani F, Suzuki A, and Aikawa Y
Jpn J Physiol 2000 Oct 50(5): p. 495_507
http://bmj.com/cgi/external_ref?access_num=3D0011120916&= amp;link_type=3DMED

Cardiac Tamponade Following Acupuncture. Cheng TO   Chest= 2000 Dec 118(6): p. 1836_1837
  http://bmj.com/cgi/external_ref?access_num=3D0011115486&= amp;link_type=3DMED

  Risks Associated With the Practice of Traditional Chinese= Medicine: An
  Australian Study.   Bensoussan A, Myers SP, and Carlton= AL
  Arch Fam Med 2000 Nov 9(10): p. 1071_1078
  http://bmj.com/cgi/external_ref?access_num=3D0011115210&= amp;link_type=3DMED

The effect of transcutaneous electric nerve stimulation in patients with=
therapy_resistant hypertension. Jacobsson F, Himmelmann A, Bergbrant A,= Svensson A, and Mannheimer C   J Hum Hypertens 2000 Dec 14(12):= p. 795_798
http://bmj.com/cgi/external_ref?access_num=3D0011114695&= amp;link_type=3DMED

Acupuncture increases cell proliferation in dentate gyrus after transient=
global ischemia in gerbils. Kim E, Kim Y, Lee HJ, Huh Y, Chung J, Seo J,= Kang J, Lee H, Yim S, and Kim C  Neurosci Lett 2001 Jan 5 297(1): p.= 21_24
http://bmj.com/cgi/external_ref?access_num=3D0011114475&= amp;link_type=3DMED
 
Current topic: Complementary and alternative medicine for children: does= it
work?  Kemper, K J   Arch. Dis. Child. 2001 84: p. 6_9=
  http://www.archdischild.com/cgi/content/abstract/archdis= child;84/1/6
 
Acupuncture for episodic tension_type headache: a multicentre randomized=
controlled trial. White AR, Resch KL, Chan JC, Norris CD, Modi SK, Patel= JN, and Ernst E   Cephalalgia 2000 Sep 20(7): p. 632_7
http://bmj.com/cgi/external_ref?access_num=3D0011128820&= amp;link_type=3DMED

Use of acupuncture for managing chronic pelvic pain in pregnancy. A case=
report. Thomas CT and Napolitano PG J Reprod Med 2000 Nov 45(11): p.= 944_6
http://bmj.com/cgi/external_ref?access_num=3D0011127110&= amp;link_type=3DMED

More on BMA's approval of acupuncture William Asscher, David J Grant,= and Mike Cummings BMJ 2001 322(7277): p. 45a
http://bmj.com/cgi/content/full/322/7277/45/a

End of Newsletter
    --=====================_10885813==_.ALT-- From Mistiko12@email.msn.com Sun Feb 04 07:55:42 2001 Received: from cpimssmtpu03.email.msn.com ([207.46.181.19]) by mailman.olympus.net with esmtp (Exim 3.20 #1) id 14PRVu-00014Z-00 for acubriefs@mailman.olympus.net; Sun, 04 Feb 2001 07:55:42 -0800 Received: from compaq ([63.57.49.57] unverified) by cpimssmtpu03.email.msn.com with Microsoft SMTPSVC(5.0.2195.1600); Sun, 4 Feb 2001 07:56:52 -0800 Message-ID: <00c301c08ed4$aa4a9780$3931393f@compaq> From: "Jesus" To: Date: Sun, 4 Feb 2001 12:02:36 -0600 Organization: Microsoft Corporation X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 5.00.2919.6600 X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2919.6600 X-OriginalArrivalTime: 04 Feb 2001 15:56:52.0806 (UTC) FILETIME=[175C3660:01C08EC3] Subject: [Acubriefs] (no subject) Sender: acubriefs-admin@mailman.olympus.net Errors-To: acubriefs-admin@mailman.olympus.net X-BeenThere: acubriefs@mailman.olympus.net X-Mailman-Version: 2.0 Precedence: bulk List-Help: List-Post: List-Subscribe: , List-Id: Acupuncture News & Information List-Unsubscribe: , List-Archive: pleaseinclude me in your list. Jesus A. Maldonado MD From kimber@olympus.net Tue Feb 06 17:50:40 2001 Received: from mail.cablespeed.com ([206.112.192.76]) by mailman.olympus.net with esmtp (Exim 3.20 #1) id 14QJkl-0003g1-00 for acubriefs@mailman.olympus.net; Tue, 06 Feb 2001 17:50:39 -0800 Received: from laptop.olympus.net (c207-202-223-225.sea1.cablespeed.com [207.202.223.225]) by mail.cablespeed.com (8.9.3/8.9.3) with ESMTP id RAA25591 for ; Tue, 6 Feb 2001 17:51:53 -0800 Message-Id: <4.3.1.2.20010206175823.00c25480@mail.olympus.net> X-Sender: kimber@mail.olympus.net X-Mailer: QUALCOMM Windows Eudora Version 4.3.1 Date: Tue, 06 Feb 2001 17:59:46 -0800 To: acubriefs@mailman.olympus.net From: Kimber Mime-Version: 1.0 Content-Type: multipart/alternative; boundary="=====================_35026111==_.ALT" Subject: [Acubriefs] January 2001 Edition of Acubriefs Newsletter Sender: acubriefs-admin@mailman.olympus.net Errors-To: acubriefs-admin@mailman.olympus.net X-BeenThere: acubriefs@mailman.olympus.net X-Mailman-Version: 2.0 Precedence: bulk List-Help: List-Post: List-Subscribe: , List-Id: Acupuncture News & Information List-Unsubscribe: , List-Archive: --=====================_35026111==_.ALT Content-Type: text/plain; charset="iso-8859-1"; format=flowed Content-Transfer-Encoding: quoted-printable Acubriefs Newsletter (Volume 2/Issue 1) To view this newsletter with your browser, visit http://www.acubriefs.com January 2001 The January 2001 edition of the newsletter will depart from its=20 usual format. Rather than review recent citations, the Cochrane Library=20 (Issue Jan 2001) is reviewed with regard to acupuncture research. For=20 those of you unfamiliar with the Cochrane Collaboration, the following=20 introduction is lifted from their home page:=20 http://www.update_software.com/cochrane/help/ =93The Cochrane Collaboration is an international organization that= =20 began in 1993 as a response to Archie Cochrane's call for systematic,=20 up-to-date reviews in health care. Cochrane was an epidemiologist who=20 observed that: Health care practice is not always based on good evidence. There is too= =20 much information for any individual to access and use. Resources are always limited, so it is all the more important to know=20 which interventions work. The Collaboration now comprises centers in 15 countries, 50=20 topic-based Review groups, and about 6,000 members. The collaboration=20 members hand-search journals in 19 countries, produce Cochrane reviews,=20 moderate the feedback system, and ensure that methodology, statistics, and= =20 software used in the writing of reviews is state-of-the-art and that consumer and other groups are represented. The main output of The Cochrane Collaboration is systematic=20 reviews of the effects of health care interventions. These systematic=20 reviews are published electronically in successive issues of The Cochrane=20 Library.=94 Editor=92s Note: This edition of =93Acubriefs=94 reflects the=20 importance I place on our readers being familiar with the Cochrane Library,= =20 and particularly their reviews pertinent to acupuncture. The Cochrane=20 Library approaches acupuncture from an analytical/objective/statistical=20 viewpoint. With the clear emphasis on evidence-based recommendations, it=20 has been hailed by academicians and governmental agencies as the standard=20 approach upon which to base all recommendations. An issue with many=20 practitioners, and even some researchers, is that by using standard=20 evidence-based approaches, one can never fully and fairly evaluate=20 acupuncture; certainly, as practiced from an Oriental medical=20 perspective. The subjective nature of Oriental medical diagnoses alone=20 limits the value of objectively evaluating outcomes based on Oriental=20 medical models. In simple words: if we cannot fully agree on what the=20 problem is, can we ever objectively determine which treatment is=20 best? There are also such mundane problems as clearly defining=20 acupuncture, and determining appropriate acupuncture interventions for a=20 particular Western diagnosis. Almost inevitably, the reviews of=20 interventions skirt these important but relevant issues. In my opinion, the case series approach to evaluating=20 interventions from an evidence-based format demonstrates the greatest hope= =20 of evaluating acupuncture from a Western perspective. The only other=20 viable alternative is outcome studies evaluating interventions from a=20 context rather than a Western diagnostic standpoint. Otherwise, we will=20 continue to see studies designed to meet Western criteria for properly=20 randomized controlled trials that fail miserably to reflect the reality of= =20 clinical acupuncture practice. Seirin-America, along with Oriental Medical Supplies (OMS),=20 suppliers of acupuncture needles and accessories, are financial sponsors of= =20 Acubrief=92s Newsletter. (www.seirinamerica.com and www.omsmedical.com) The Cochrane Library has several categories. The first and most=20 important is =93The Cochrane Database of Systematic Reviews.=94 (Total of= 59=20 hits using =93acupuncture=94 as the search item.) This section is divided= into=20 Complete Reviews (38 hits) and Protocols (21). The most pertinent=20 reviews, along with their findings, are briefly discussed herein by James=20 K. Rotchford, MD, MPH, editor. 1. Acupuncture for Chronic Asthma. Linde K, Jobst K, Panton J. Acupuncture for chronic asthma (Cochrane=20 Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software. Note: Last update November 2000: Authors noted that they could only=20 identify 7 small studies that were of variable quality, and had=20 inconsistent results. As a result, they concluded that there is presently= =20 insufficient evidence to make recommendations about the value of=20 acupuncture in asthma treatment. 2.Acupuncture for Idiopathic Headache. Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G.=20 Acupuncture for idiopathic headache (Cochrane Review). In: The Cochrane=20 Library, Issue 1, 2001. Oxford: Update Software. Note: (The last significant amendment was Nov 2000.) There is enough data= =20 suggestive of acupuncture=92s help so that patients should not be= discouraged=20 from trying acupuncture from a risk/benefit standpoint. Many helpful=20 suggestions including study size and design are given for further research. 3.Acupuncture for Induction of Labor. Smith CA, Crowther CA. Acupuncture for induction of labor (Cochrane=20 Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software. Note: (The last significant amendment was Nov 2000.) Although an ongoing=20 RCT is underway, no RCT as yet has evaluated acupuncture for this=20 indication. They do note that 1 study documents the effectiveness of TENS= =20 to stimulate uterine contractions. 4. Acupuncture for Low Back Pain. Tulder MW van, Cherkin DC, Berman B, Lao L, Koes BW. Acupuncture for low=20 back pain (Cochrane Review). In: The Cochrane Library, Issue 1, 2001.=20 Oxford: Update Software. Note: (The last significant amendment was Feb 1999.) This review failed to= =20 demonstrate the effectiveness of acupuncture for low back pain. Hence, the= =20 reviewers fail to recommend acupuncture for low back pain. They also=20 state, =93Due to the poor quality of the studies, the effectiveness of=20 acupuncture for low back pain remains unclear.=94 It is incumbent on me to= =20 remind the reader (and perhaps, some of the reviewers) that a failure to=20 demonstrate effectiveness does not mean that the intervention is=20 ineffective. 5. Acupuncture for Smoking Cessation. This review should be cited as: White AR, Rampes H, Ernst E. Acupuncture=20 for smoking cessation (Cochrane Review). In: The Cochrane Library, Issue 1,= =20 2001. Oxford: Update Software. Note: (The last significant amendment was June 1999.) No evidence is=20 available for the specific effectiveness of acupuncture in smoking=20 cessation any greater than a placebo effect. Studies should be looked at=20 to evaluate acupuncture=92s effect in reducing craving. Since the placebo= =20 effect is so powerful, I do not think that these findings preclude the=20 rationality of offering acupuncture for smoking cessation. Again, a=20 failure to demonstrate effectiveness does not mean that the intervention is= =20 ineffective. 6. Transcutaneous Electrical Nerve Stimulation for Knee Osteoarthritis. This review should be cited as: Osiri M, Welch V, Brosseau L, Shea B,=20 McGowan J, Tugwell P, Wells G. Transcutaneous electrical nerve stimulation= =20 for knee osteoarthritis (Cochrane Review). In: The Cochrane Library, Issue= =20 1, 2001. Oxford: Update Software. Note: (The last significant amendment was June 1999.) If treatment=20 persisted for 6 weeks, there was clear evidence that TENS was more=20 effective than placebo in controlling the pain associated with=20 osteoarthritis of the knee. The following are pertinent Protocols which have been developed for future= =20 systematic reviews: 1. He L, Zhou D, Wu B, Li N. Acupuncture for Bell's palsy (Protocol for a=20 Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update=20 Software. 2. Richardson MA, Allen C, Ezzo J, Lao L, Ramirez G, Ramirez T, Zhang G.=20 Acupuncture for chemotherapy-induced nausea or vomiting among cancer=20 patients (Protocol for a Cochrane Review). In: The Cochrane Library, Issue= =20 1, 2001. Oxford: Update Software. 3.Green S, Buchbinder R, Hall S, Barnsley L, Forbes A, Smidt N, Assendelft= =20 W. Acupuncture for lateral elbow pain in adults (Protocol for a Cochrane=20 Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software. 4. Ezzo J, Hadhazy V, Berman B, Birch S, Kaplan G, Hochberg M. Acupuncture= =20 for osteoarthritis (Protocol for a Cochrane Review). In: The Cochrane=20 Library, Issue 1, 2001. Oxford: Update Software. 5. Wilson M, Farquhar C, Kennedy S, Jin X. Transcutaneous electrical nerve= =20 stimulation and acupuncture for primary dysmenorrhoea (Protocol for a=20 Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update=20 Software. The next major section of the Cochrane Library is: Database of Abstracts of Review of Effectiveness (35 hits with search term =93acupuncture=94; 9 major ones herein reviewed.) Quality Assessed Systematic Reviews: 1. A Meta_Analysis of the Effectiveness of Acupuncture in Smoking= Cessation. Ashenden R, Silagy C A, Lodge M, Fowler G. A meta-analysis of the=20 effectiveness of acupuncture in smoking cessation. Drug and Alcohol Review,= =20 1997; 16, 33-40. Note: The authors=92 conclusions and those echoed by the CRD reviewer are=20 that while acupuncture appears promising, there is insufficient evidence at= =20 present to recommend it as an effective form of therapy. More direct=20 comparative trials with larger numbers of subjects are required before the= =20 effectiveness of acupuncture can be reliably compared against other= therapies. 2. A Review of Randomized Clinical Trials in Tinnitus. Dobie R A. A review of randomized clinical trials in tinnitus. Laryngoscope= =20 1999, 109(8), 1202-1211. Note: 6 RCT=92s for acupuncture showed no statistically significant=20 difference; however, there is no discussion of size of studies or the=20 possibility of sham acupuncture being used as comparison. Only database=20 searched was MEDLINE up to 1998. 3. A Systematic Review of Randomized Controlled Trials of Acupuncture for=20 Neck Pain. White A R, Ernst E. A systematic review of randomized controlled trials of= =20 acupuncture for neck pain. Rheumatology, 1999; 83(2); 143-147. Note: The authors believe that better designed trials of acupuncture are=20 required before its place in the management of neck pain can be defined. 4.Acupuncture and Addiction Treatment. Moner S E. Acupuncture and addiction treatment. Journal of Addictive=20 Diseases, 1996; 15(3); 79-100. Note: Although the author concluded that the evidence is very encouraging=20 for the use of acupuncture in addictive disorders, the CRD reviewer=92s=20 belief is that there was inadequate evidence to support a pro or con= position. 5. Acupuncture as a Symptomatic Treatment of Osteoarthritis: A Systematic=20 Review. Ernst E. Acupuncture as a symptomatic treatment of osteoarthritis: a=20 systematic review. Scandinavian Journal of Rheumatology, 1997; 26(6);= 444-447. Note: The author, well-respected in the area of evidence-based evaluation of acupuncture, concluded that the evidence does= =20 not support the position that acupuncture is superior to sham needling in=20 alleviating pain of axial and peripheral joint osteoarthritis. CRD=20 commentary was supportive of this conclusion, but noted that inclusion of=20 all pertinent studies was perhaps limited because certain databases were=20 not included. 6. Acupuncture as a Treatment for Temporomandibular Joint Dysfunction: A=20 Systematic Review of Randomized Trials. Ernst E, White A R. Acupuncture as a treatment for temporomandibular joint= =20 dysfunction: a systematic review of randomized trials. Archives of=20 Otolaryngology Head and Neck Surgery, 1999; 125(3); 269-272. Note: Basically, all studies were supportive of acupuncture=92s= effectiveness=20 in TMJ, but the quality of the studies was such, it was felt that more=20 rigorous studies involving other locations besides Scandinavian sites were= =20 necessary before concluding that the evidence supported acupuncture=92s use= =20 in TMJ. 7. Acupuncture as an Adjuvant Therapy in Stroke Rehabilitation? Ernst E, White A R. Acupuncture as an adjuvant therapy in stroke=20 rehabilitation? Wiener Medizinische Wochenschrift 1996; 146, 556-558. Note: Similar to the last review, the author concludes that several trials= =20 suggest that acupuncture is a useful adjunct for stroke rehabilitation;=20 however, methodological flaws in the studies indicate that current data is= =20 not conclusive and that further trials should be initiated. 8. Acupuncture/Acupressure for Weight Reduction? A Systematic Review. Ernst E. Acupuncture/acupressure for weight reduction? a systematic review.= =20 Wiener Klinische Wochenschrift 1997; 109(2); 60-62. Note: Again, the author concludes that no clear picture emerged and that=20 further well-designed clinical trials are required. 9.The Use of Acupuncture in Dentistry: A Systematic Review. Rosted P. The use of acupuncture in dentistry: a systematic review.=20 Acupuncture in Medicine 1998, 16(1), 43-48. Note: The author found that 11 out of 15 papers were in favor of standard=20 (traditional) acupuncture, having been shown to be more effective than=20 non-standard (sham) acupuncture, or to have a similar effect to=20 conventional treatments. The value as an analgesic for surgery is=20 questioned, but the beneficial effect in treatments involving TMJ=20 dysfunction and facial pain appears real; in this area, acupuncture could= =20 be a valuable alternative to orthodox treatment. However, the number of=20 good quality randomized trials are few and more studies are required. CRD= =20 commentary basically felt the above conclusions were justifiable. The next major section of the Cochrane Library is: The Cochrane Controlled Trials Register: (1,189 hits for the term =93acupuncture;=94 only year 2000 references are=20 listed below.) 1. A prospective randomized study comparing acupuncture with physiotherapy= =20 for low-back and pelvic pain in pregnancy. AU:Wedenberg K; Moen B; Norling A SO:Acta Obstetricia et Gynecologica Scandinavia; May 2000; Vol 79; Pp 331-5. 2.A randomized controlled trial of auricular acupuncture for cocaine=20 dependence. AU: Avants SK; Margolin A; Holford TR; Kosten TR SO: Archives of Internal Medicine; Aug 2000,14-28; Vol 160; Pp 2305-12. 3. Acupressure for nausea: results of a pilot study. AU:Dibble SL; Chapman J; Mack KA; Shih AS. SO:Oncology Nursing Forum,Jan-Feb 2000; Vol 27; Pp 41-7. 4. Acupuncture for symptom relief in HIV-positive adults: lessons learned=20 from a pilot study. AU:Beal MW; Nield_Anderson L. SO: Alternative Therapies in Health & Medicine; Sep 2000; Vol 6; Pp 33-42. 5. Acupuncture treatment of bulbar palsy: a report of 54 cases. AU: Liu L. SO: Journal of Traditional Chinese Medicine; Mar 2000; Vol 20; Pp 30-2. 6. Effect of acupuncture on pain management in patients before and after=20 lumbar disc protrusion surgery: a randomized control study. AU:Wang RR; Tronnier V. SO: American Journal of Chinese Medicine; Yr 2000;= =20 Vol 28; Pp 25-33. 7. Effect of sensory stimulation (acupuncture) on sympathetic and=20 parasympathetic activities in healthy subjects. AU:Haker E; Egekvist H; Bjerring P. SO: Journal of the Autonomic Nervous=20 System; Feb 14 2000; Vol 79; Pp 52-9. 8. Effects of electro_acupuncture on anovulation in women with polycystic=20 ovary syndrome. AU: Stener_Victorin, E., Waldenstrom, U., Tagnfors, U., Lundeberg, T.,=20 Lindstedt, G., and Janson, P. O. SO: Acta Obstetricia et Gynecologica Scandinavica; Yr 2000; Pp 180-8. 9. Korean hand acupressure reduces postoperative vomiting in children after= =20 strabismus surgery. AU:Schlager A; Boehler M; Puhringer F. SO: British Journal of Anaesthesia;= =20 Aug 2000; Vol 85; Pp 267-70. 10. The benefit from whole body acupuncture in major depression. AU: Roschke J; Wolf C; Muller MJ; Wagner P; Mann K; Grozinger M; Bech S.=20 SO: Journal of Affective Disorders; Jan-Mar 2000; Vol 57. 11.Treatment of 86 cases of facial spasm by acupuncture and pressure on=20 otopoints. AU: Li Y; Peng C. SO: Journal of Traditional Chinese Medicine; Mar 2000;=20 Vol 20; Pp 33-5. Acupuncture in patients with minor depressive episodes and generalized=20 anxiety. Results of an experimental study. (German) AU: Eich H; Agelink MW; Lehmann E; Lemmer W; Klieser E . SO: Fortschritte der Neurologie_Psychiatrie; Mar 2000; Vol 68; Pp 137-44. 13. Effect of needle acupuncture on pain perception and functional=20 impairment of patients with coxarthrosis. (German) AU: Fink MG; Kunsebeck HW; Wippermann B. SO: Zeitschrift fur Rheumatologie;= =20 Jun 2000; 59(3):191-9; Jun 2000; Vol 59; Pp 191-9. 14. The use of low_frequency magnetotherapy and EHF puncture in the=20 combined treatment of arterial hypertension in vibration_induced disease.=20 (Russian) AU: Drobyshev VA, Filippova GN, Loseva M, Shpagina LA, Shelepova NV,=20 Zhelezniak MS. SO: Voprosy Kurortologii, Fizioterapii i Lechebnoi=20 Fizicheskoi Kultury; May-Jun 2000; Pp 9-11. The next section follows with pertinent references: Health Technology Assessment Database (5 hits, 1999 total) 1. Acupuncture for migraine and headache in primary care: a pragmatic,=20 randomized trial: primary research (project). Acupuncture for migraine and headache in primary care: a pragmatic,=20 randomized trial/primary research (project). UK NHS National Coordinating=20 Centre for Health Technology Assessment (NCCHTA). 2. Longer term clinical and economic benefits of offering acupuncture to=20 patients with chronic low back pain: primary research (project). Longer term clinical and economic benefits of offering acupuncture to=20 patients with chronic low back pain: primary research (project). UK NHS=20 National Coordinating Centre for Health Technology Assessment(NCCHTA). NHS Economic Evaluation Database (2 hits, 6113 total) 1. Addition of acupuncture and self-care education in the treatment of=20 patients with severe angina pectoris may be cost beneficial: an open,=20 prospective study. Ballegaard M D, Johannessen A, Karpatschof B, Nyboe J. Addition of=20 acupuncture and self-care education in the treatment of patients with=20 severe angina pectoris may be cost beneficial: an open, prospective study.= =20 Journal of Alternative and Complementary Medicine, 1999, 5(5), 405-413. 2.Cost-benefit of combined use of acupuncture, shiatsu, and lifestyle=20 adjustment for treatment of patients with severe angina pectoris. Ballegaard S, Norrelund S, Smith D F. Cost-benefit of combined use of=20 acupuncture, shiatsu, and lifestyle adjustment for treatment of patients=20 with severe angina pectoris. Acupuncture & Electro-Therapeutics Research,=20 1996; 21(3-4), 187-197. Following are some of the references which have been added to Acubriefs=20 database since the December edition which are not Cochrane references: Research into complementary and alternative medicines: problems and=20 potential Richard L. Nahin and Stephen E. Straus BMJ 2001 322(7279): p.=20 161-164http://bmj.com/cgi/content/full/322/7279/161=20 Can doctors respond to patient=92s increasing interest in complementary and= =20 alternative medicine? Commentary: special study modules and complementary=20 and alternative medicine{=97} The Glasgow experience Owen,D.K.; Lewith,G.;= =20 Stephens,C.R.; Bryden,Helen http://bmj.com/cgi/content/full/322/7279/154 Lessons on integration from the developing world=92s experience Commentary:= =20 Challenges in using traditional systems of medicine Gerard Boddeker and=20 Ranjit Roy Chaudhry BMJ 2001 322(7279): p. 164-167 http://bmj.com/cgi/content/full/322/7279/164 Regulation in complementary and alternative medicine Simon Y. Mills BMJ=20 2001 322(7279): p.158-160 http://bmj.com/cgi/citmgr?gca=3Dbmj;322/7279/158 Is electrodermal testing as effective as skin prick tests for diagnosing=20 allergies? A double blind, randomised block design study George T. Lewith;= =20 Julian N. Kenyon; Jackie Broomfield; Philip Prescott; Jonathan Goddard;=20 Stephen T. Holgate BMJ 2001 322(7279): p 131-134 http://bmj.com/cgi/content/abstract/322/7279/131 Electrodermal testing for allergies is unreliable BMJ 2001 322(7279) p.0b http://bmj.com/cgi/content/full/322/7279/0/b Integrated medicine: orthodox meets alternative Opher Caspi:Tony Woolfson;= =20 Peter Morrell BMJ 2001 322(7279) p.168 http://bmj.com/cgi/content/full/322/7279/168 Briefing BMJ 2001 322(7279) p.3 http://bmj.com/cgi/content/full/322/7279/S3_7279 Netlines Rhonda MacDonald BMJ 2001 322(7279) p. 179b http://bmj.com/cgi/content/full/322/7279/179/b Enhancing human healing David Reilly BMJ 2001 322(7279) p. 120-121 http://bmj.com/cgi/content/full/322/7279/120 Acupuncture Massage vs Swedish Massage and Individual Exercises vs Group=20 Exercises in Low Back Pain Sufferers - a Randomised Controlled Clinical=20 Trial in a 2x2 factorial Design Franke, A.; Gebauer, S.; Franke, K.; and Brockow, T. Forsch Komplementarmed= =20 Klass Natureilkd 2000 7(6) p. 286-293 http://www.ncbi.nlm.nih.gov/htbin_post/Entrez/query?db=3Dm&form=3D6&uid=3D00= 11155022&dopt=3Dr Acupuncture for adolescent smokers=96a randomized double-blind controlled=20 trial. [In Process Citation] Yiming,C.; Changxin, Z.; Ung, W.S.; Lei, Z.;=20 and Kean, L.S. Am J Chin Medd 2000 28(3-4): p. 443-449 http://www.ncbi.nlm.nih.gov/htbin_post/Entrez/query?db=3Dm&form=3D6&uid=3D00= 11154059&dopt=3Dr Chronotherapy in traditional Chinese medicine [In Process Citation]=20 Samuels, N. Am J Chin Med 2000 28(3-4): p. 419-423 http://www.ncbi.nlm.nih.gov/htbin_post/Entrez/query?db=3Dm&form=3D6&uid=3D00= 11154056&dopt=3Dr Acupuncture in headache: a critical review [In Process Citation] Manias,=20 P.; Tagaris, G.; Karageorgiou, K. Clin J Pain 200 Dec 16(4): p. 334-339 http://www.ncbi.nlm.nih.gov/htbin_post/Entrez/query?db=3Dm&form=3D6&uid=3D00= 11153790&dopt=3Dr Profile: The Human League Rhonda MacDonald BMJ 2001: 322:178 http://bmj.com/cgi/content/full/322/7279/178 Editorials: Integrated Medicine Lesley Rees and Andrew Weil BMJ 2001:=20 322:119-120 http://bmj.com/cgi/content/full/322/7279/119 BMJ approves acupuncture BMJ 2001 322(7278): p.90e http://bmj.com/cgi/content/full/321/7270/1220/a Effectiveness of Ginkgo biloba in treating tinnitus:double blind, placebo=20 controlled trial Shelley Drew and Ewart Davies BMJ 2001 322(7278): p.73 http://bmj.com/cgi/content/abstract/322/7278/7 Acupuncture can work, and it=92s not just wishful thinking.[In Process=20 Citation] Schultz, S. US News World Rep 2000 Dec 18 129(24): p. 58-60 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3Dretrieve&db=3Dpubmed&lis= t_uids=3D0011144228&dopt=3DAbstract Acupuncture in general practice [In Process Citation] Traum, D. Aust Fam=20 Physician 2000 Dec 29(12): p. 1139-1143 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3Dretrieve&db=3Dpubmed&lis= t_uids=3D0011140218&dopt=3DAbstract [Treatment of tension headache] Schoenen, J. Rev Neurol (Paris) 2000 Dec=20 156 suppl 4(): P.4S87-4S92 http://www.e2med.com/register.asp?Return=3Ddisplay_pdf&Population=3Dn&Journa= l=3Drn&Volume=3D156&Issue=3DSup4&ID=3D&View=3D&Abstract=3D&Page=3D4S87 {Prophylactic treatments of migraine] Massiou, H Rev Neurol (Paris) 2000=20 Dec 156 suppl 4(): p.4S79-4S86 http://www.e2med.com/register.asp?Return=3Ddisplay_pdf&Population=3Dn&Journa= l=3Drn&Volume=3D156&Issue=3DSup4&ID=3D&View=3D&Abstract=3D&Page=3D4S79 The use of alternative therapies in the support of breastfeeding [In=20 Process Citation] Ayers, J.F. J Hum Lact 2000 Feb 16(1): p. 52-56 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3Dretrieve&db=3Dpubmed&lis= t_uids=3D0011138225&dopt=3DAbstract Lack of effect of acupuncture upon signs and symptoms of delayed onset=20 muscle soreness [In Process Citation] Barlas, P.; Robinson, J.; Allen, J.;= =20 Baxter, G.D. Clin Physiol 2000 Nov 20(6): p. 449-456 http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=3Dm&form=3D6&uid=3D00= 11100392&dopt=3Dr Restoration of propulsive peristalsis of the esophagus in achalasia [In=20 Process Citation] Hep, A.; Dolina, J.; Dite, P.; Plottova, Z.; Valek, V.;=20 Kala, Z.; Prasek, V. Hepatogastroenterology 2000 Sept-Oct 47(35): p.= 1203-1204 http://www.ncbi.nlm.nih.gov/htbin_post/Entrez/query?db=3Dm&form=3D6&uid=3D00= 11100311&dopt=3Dr Traditional Chinese medicine syndromes in women with frequently recurring=20 cystitis: freequencies of syndromes and symptoms Alraek, T.; Aune, A.;=20 Baerheim, A. Complement Ther Med 2000 Dec 8(4): p. 260-265 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&db=3DPubMed&lis= t_uids=3D11098202&dopt=3DAbstract Normal medical practice of referring patients for complementary therapies=20 among Australian general practitioners. Easthope, G.; Tranter, B. and Gill,= =20 G Complement Ther Med 2000 Dec 8(4): p. 226-233 The end of January 2001 newsletter James K. Rotchford, MD, MPH 1334 Lawrence Street Port Townsend, WA 98368 360-385-4843 360-379-1441 Fax kimber@olympus.net --=====================_35026111==_.ALT Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Acubriefs Newsletter (Volume 2/Issue 1)

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         =           &= nbsp;         &n= bsp;         &nb= sp;         January 2001

        The January 2001 edition of the newsletter will depart from its usual format. Rather than review recent citations, the Cochrane Library (Issue Jan 2001) is reviewed with regard to acupuncture research.   For those of you unfamiliar with the Cochrane Collaboration, the following introduction is lifted from their home page: http://www.update_software.com/cochrane/help/
  

        =93The Cochrane Collaboration is an international organization that began in 1993 as a response to Archie Cochrane's call for systematic, up-to-date reviews in health care. Cochrane was an epidemiologist who observed that:

   Health care practice is not always based on good evidence. There is too much information for any individual to    access and use.
  Resources are always limited, so it is all the more important to know which interventions work.

 
       The Collaboration now comprises centers in 15 countries, 50 topic-based Review groups, and about 6,000 members. The collaboration members hand-search journals in 19 countries, produce Cochrane reviews, moderate the feedback system, and ensure that methodology, statistics, and software used in the writing of reviews is
state-of-the-art and that consumer and other groups are represented.

        The main output of The Cochrane Collaboration is systematic reviews of the effects of health care interventions. These systematic reviews are published electronically in successive issues of The Cochrane Library.=94  

        Editor=92s Note:  This edition of =93Acubriefs=94 reflects the importance I place on our readers being familiar with the Cochrane Library, and particularly their reviews pertinent to acupuncture.   The Cochrane Library approaches acupuncture from an analytical/objective/statistical viewpoint. With the clear emphasis on evidence-based recommendations, it has been hailed by academicians and governmental agencies as the standard approach upon which to base all recommendations.  An issue with many practitioners, and even some researchers, is that by using standard evidence-based approaches, one can never fully and fairly evaluate acupuncture; certainly, as practiced from an Oriental medical perspective.   The subjective nature of Oriental medical diagnoses alone limits the value of objectively evaluating outcomes based on Oriental medical models.   In simple words:  if we cannot fully agree on what the problem is, can we ever objectively determine which treatment is best?   There are also such mundane problems as clearly defining acupuncture, and determining appropriate acupuncture interventions for a particular Western diagnosis.   Almost inevitably, the reviews of interventions skirt these important but relevant issues.
        In my opinion, the case series approach to evaluating interventions from an evidence-based format demonstrates the greatest hope of evaluating acupuncture from a Western perspective.   The only other viable alternative is outcome studies evaluating interventions from a context rather than a Western diagnostic standpoint.   Otherwise, we will continue to see studies designed to meet Western criteria for properly randomized controlled trials that fail miserably to reflect the reality of clinical acupuncture practice.
 
        Seirin-Ame= rica, along with Oriental Medical Supplies (OMS), suppliers of acupuncture needles and accessories, are financial sponsors of Acubrief=92s Newsletter.  (www.seirinamerica.com and  www.omsmedical.com)

       The Cochrane Library has several categories. The first and most important is =93The Cochrane Database of Systematic Reviews.=94  (Total of 59 hits using =93acupuncture=94 a= s the search item.) This section is divided into Complete Reviews (38 hits) and Protocols (21).   The most pertinent reviews, along with their findings, are briefly discussed herein by James K. Rotchford, MD, MPH, editor.

1. Acupuncture for Chronic Asthma.
Linde K, Jobst K, Panton J. Acupuncture for chronic asthma (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

Note: Last update November 2000: Authors noted that they could only identify 7 small studies that were of variable quality, and had inconsistent results.   As a result, they concluded that there is presently insufficient evidence to make recommendations about the value of acupuncture in
asthma treatment.

2.Acupuncture for Idiopathic Headache.
Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G. Acupuncture for idiopathic headache (Cochrane Review). In: The Cochrane Library, Issue 1, 2001.
Oxford: Update Software.

Note: (The last significant amendment was Nov 2000.)  There is enough data suggestive of acupuncture=92s help so that patients should not be discouraged from trying acupuncture from a risk/benefit standpoint.  Many helpful suggestions including study size and design are given for further research.

3.Acupuncture for Induction of Labor.
Smith CA, Crowther CA. Acupuncture for induction of labor (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

Note: (The last significant amendment was Nov 2000.) Although an ongoing RCT is underway, no RCT as yet has evaluated acupuncture for this indication.  They do note that 1 study documents the effectiveness of TENS to stimulate uterine contractions.

4. Acupuncture for Low Back Pain.
Tulder MW van, Cherkin DC, Berman B, Lao L, Koes BW. Acupuncture for low back pain (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.
Note: (The last significant amendment was Feb 1999.) This review failed to demonstrate the effectiveness of acupuncture for low back pain.  Hence, the reviewers fail to recommend acupuncture for low back pain.  They also state, =93Due to the poor quality of the studies, the effectiveness of acupuncture for low back pain remains unclear.=94  It is incumbent on me to remind the reader (and perhaps, some of the reviewers) that a failure to demonstrate effectiveness does not mean that the intervention is ineffective.  

5. Acupuncture for Smoking Cessation.
This review should be cited as: White AR, Rampes H, Ernst E. Acupuncture for smoking cessation (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

Note: (The last significant amendment was June 1999.)  No evidence is available for the specific effectiveness of acupuncture in smoking cessation any greater than a placebo effect.  Studies should be looked at to evaluate acupuncture=92s effect in reducing craving.    Since the placebo effect is so powerful, I do not think that these findings preclude the rationality of offering acupuncture for smoking cessation.   Again, a failure to demonstrate effectiveness does not mean that the intervention is ineffective.  
         =        
6. Transcutaneous Electrical Nerve Stimulation for Knee Osteoarthritis.
This review should be cited as: Osiri M, Welch V, Brosseau L, Shea B, McGowan J, Tugwell P, Wells G.  Transcutaneous electrical nerve stimulation for knee osteoarthritis (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

Note: (The last significant amendment was June 1999.) If treatment persisted for 6 weeks, there was clear evidence that TENS was more effective than placebo in controlling the pain associated with osteoarthritis of the knee.

The following are pertinent Protocols which have been developed for future systematic reviews:

1. He L, Zhou D, Wu B, Li N. Acupuncture for Bell's palsy (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

2. Richardson MA, Allen C, Ezzo J, Lao L, Ramirez G, Ramirez T, Zhang G. Acupuncture for chemotherapy-induced nausea or vomiting among cancer patients (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

3.Green S, Buchbinder R, Hall S, Barnsley L, Forbes A, Smidt N, Assendelft W. Acupuncture for lateral elbow pain in adults (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

4. Ezzo J, Hadhazy V, Berman B, Birch S, Kaplan G, Hochberg M. Acupuncture for osteoarthritis (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

5. Wilson M, Farquhar C, Kennedy S, Jin X. Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

The next major section of the Cochrane Library is:

Database of Abstracts of Review of Effectiveness
(35 hits with search term =93acupuncture=94; 9 major ones herein reviewed.)

Quality Assessed Systematic Reviews:

1.  A Meta_Analysis of the Effectiveness of Acupuncture in Smoking Cessation.
Ashenden R, Silagy C A, Lodge M, Fowler G. A meta-analysis of the effectiveness of acupuncture in smoking cessation. Drug and Alcohol Review, 1997; 16, 33-40.

Note: The authors=92 conclusions and those echoed by the CRD reviewer are that while acupuncture appears promising, there is insufficient evidence at present to recommend it as an effective form of therapy. More direct comparative trials with larger numbers of subjects are required before the effectiveness of acupuncture can be reliably compared against other therapies.

2.  A Review of Randomized Clinical Trials in Tinnitus.
Dobie R A. A review of randomized clinical trials in tinnitus. Laryngoscope 1999, 109(8), 1202-1211.

Note: 6 RCT=92s for acupuncture showed no statistically significant difference; however, there is no discussion of size of studies or the possibility of sham acupuncture being used as comparison. Only database searched was MEDLINE up to 1998.

3. A Systematic Review of Randomized Controlled Trials of Acupuncture for Neck Pain.
White A R, Ernst E. A systematic review of randomized controlled trials of acupuncture for neck pain. Rheumatology, 1999; 83(2); 143-147.

Note: The authors believe that better designed trials of acupuncture are required before its place in the management of neck pain can be defined.

4.Acupuncture and Addiction Treatment.
Moner S E. Acupuncture and addiction treatment. Journal of Addictive Diseases, 1996; 15(3); 79-100.
Note: Although the author concluded that the evidence is very encouraging for the use of acupuncture in addictive disorders, the CRD reviewer=92s belief is that there was inadequate evidence to support a pro or con position.

5. Acupuncture as a Symptomatic Treatment of Osteoarthritis: A Systematic Review.
Ernst E. Acupuncture as a symptomatic treatment of osteoarthritis: a systematic review. Scandinavian Journal of Rheumatology, 1997; 26(6); 444-447.

Note: The author, well-respected in the area of
evidence-based evaluation of acupuncture, concluded that the evidence does not support the position that acupuncture is superior to sham needling in alleviating pain of axial and peripheral joint osteoarthritis.  CRD commentary was supportive of this conclusion, but noted that inclusion of all pertinent studies was perhaps limited because certain databases were not included.

6. Acupuncture as a Treatment for Temporomandibular Joint Dysfunction: A Systematic Review of Randomized Trials.
Ernst E, White A R. Acupuncture as a treatment for temporomandibular joint dysfunction: a systematic review of randomized trials. Archives of Otolaryngology Head and Neck Surgery, 1999; 125(3); 269-272.

Note: Basically, all studies were supportive of acupuncture=92s effectiveness in TMJ, but the quality of the studies was such, it was felt that more rigorous studies involving other locations besides Scandinavian sites were necessary before concluding that the evidence supported acupuncture=92s use in TMJ.

7.  Acupuncture as an Adjuvant Therapy in Stroke Rehabilitation?
Ernst E, White A R. Acupuncture as an adjuvant therap