Sunday, February 19, 2017

Centipedes in TCM contributes to passing through blood-brain barrier

Chinese Central Television aired a video about a touching story. In 2009, a Henan-province doctor, Song Zhaopu, went to Hotan, Xinjiang, to treat young children suffering cerebral palsy, where the disease is widespread due to under-developed economy and people's lack of knowledge of health of newborn babies. In addition to massage or physical therapy and acupuncture, Dr. Song used the following TCM medicines in the treatment: 龟甲 (tortoise shell), 鳖甲 (turtle shell), 蜈蚣 (centipede), 党参 (codonopsis), 鸡内金 (membrane of chicken gizzard). The main ingredients are the first two. Codonopsis is for nourishing yin and promoting qi, and membrane of chicken gizzard is for improving digestion. What interests me is the centipede, which, according to Dr. Song, acts as the transport agent carrying the medications into the brain, because it can go through the blood-brain barrier (see the snippet near 3:10 of the third video page). This is apparently a TCM concept interpreted in the terminology of modern medical science and Dr. Song acknowledged that. If the centipede or the molecules in the blood as a result of it are literally capable of passing through the blood-brain barrier, it is a wonderful gift from mother nature because many other diseaes such as depression, dementia and Alzheimer can benefit from it. Because of the blood-brain barrier, delivering the medication to the brain is always a challenge, even though it's not the major obstacle. I did not find any research article studying the effect of dried centipedes in passing through the blood-brain barrier. But such research may be worth the effort.

Wednesday, October 12, 2016

Not quite placebo

This 2008 article, A Randomized, Controlled Pilot Study of Acupuncture Treatment for Menopausal Hot Flashes, evaluates the effect of acupuncture on menopausal hot flashes. I'm only interested in the methods used in this study. 56 women aged 44 to 55 are divided into three groups, receiving (A) "usual care" (i.e. no acupuncture or needle treatment), (B) sham acupuncture (needle points not on documented meridians), and (C) TCM (Traditional Chinese Medicine) acupuncture. The result shows that groups B and C have significantly less hot flashes than group A. In spite of a small sample size, this study can be said to show a positive effect of acupuncture. But more interesting is that both groups B and C show about the same effect, with C slightly more improvement during the early stage of the treatment. While A and B are both used as control groups, B is used as a placebo group. Therefore this study can also be said to prove that acupuncture is no better than placebo.

Alternative medicine supporters would quickly point out the difference in efficacy between groups A and C, and opponents make use of the lack of difference between B and C. But neither covers the full picture. Not all control groups are created equal, and a placebo may be designed incorrectly. This may be particularly relevant in the acupuncture study, where by convention a sham acupuncture is the same as true acupuncture except for the needle points. Unfortunately, more and more tests seem to show that such sham acupuncture is not sham enough, so to speak, although it probably also points out that the acupuncture point locations are not as important as traditionally believed.[note1]

(See also my March 27 posting of Acupuncture is removed from back pain treatment guideline in UK)

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[note1] The acupuncture points used in group C of this study are as follows: CV-4 关元, KI-3 太溪, SP-6 三阴交, BL-23 肾俞, HT-6 阴郄, KI-7 复溜. I'll leave this list to TCM experts to judge the quality of this selection in treatment of hot flashes.

Sunday, May 22, 2016

Not all cars block UV light on the side efficiently

According to a paper published on May 12, 2016 in the Journal of the American Medical Association Ophthalmology, Americans have more cataract on the left eye and skin cancer on the left face than the right eye and right face, respectively, because drivers sit on the left side, and because UV-A, the major UV component responsible for skin wrinkles among other effects, is not blocked efficiently on the side window. (The windshield blocks UV-A almost completely.)

The paper also tabulates the efficiency in UV blocking by the side windows of various automobile models. 2013 BMW is the worst, blocking only 55%, while 2011 Lexus blocks 96%, which is the best. If you drive a car with poor UV blocking efficiency on the side, drive less, use sunscreen, or install a UV blocking film on the left window.

Sunday, March 27, 2016

Acupuncture is removed from back pain treatment guideline in UK

The National Institute for Healthcare and Clinical Excellence in the U.K. recently removed acupuncture from the guideline for back pain treatment and recommended exercise as the best option. The 819-page guideline states that

Do not offer acupuncture for managing non-specific low back pain with or without sciatica

The GDG [Guideline Development Group] noted that although comparison of acupuncture with usual care demonstrated improvements in pain, function and quality of life in the short term, comparison with sham acupuncture showed no consistent clinically important effect, leading to the conclusion that the effects of acupuncture were probably the result of non-specific contextual effects...such as the attention given by the therapist or the expectation of success of an active treatment that might explain, at least in part, the observed effects to the likelihood of over-estimating the effect

The GDG considered that there was a substantial body of evidence relating to acupuncture in this review and that further research was unlikely to alter conclusions.

Interestingly, when the British news media Daily Mail reports NHS's decision, readers' comments are almost exclusively in favor of acupuncture as a treatment option for back pain. The first page of the news report web page displays the most liked comments, such as

"What works for one person, doesn't necessarily work for another, I swear by acupuncture, and have never had success with physiotherapy, it seems a bit short sighted to just remove it as an option.

"Experts should try it for themselves. Acupuncture was the only effective treatment that I had for chronic back and neck pain following a car accident in which I was a passenger."

"I have spent a fortune on all the conventional methods of pain relief for my back and nothing was permanent but acupuncture seems to have worked. Don't take it away."

This is interesting because NHS's decision apparently contradicts a large number of ordinary people's personal experience. NHS definitely has followed the scientific methodology with strict adherence to the universally accepted medical research standard. But it's not wise to dismiss all users' anecdotal evidence as false, sham, or even "contextual". Unless there is bias in users' comments (e.g., only those with positive results care to post), there appears to be a statistical disconnect between the research and personal evidence-based public opinion. Multiple explanations may be offered. I suspect that the definition of sham acupuncture, commonly used in double- or single-blind trials may need to be reviewed. Unlike other types of placebo such as in medication, "sham" acupuncture may actually not be completely sham; due to complex interconnections between the meridians and hundreds of acupuncture points, acupuncture at a random or sham needle point may partially contribute to the treatment effect as a real treatment does albeit at a lesser degree. Sham acupuncture may need to be "improved" to be more or completely sham without compromising the blindness in medical trials. If no better alternative is found, putting the people participating in the trial in sleep may be an option.

Even more interestingly, when a Chinese microblogger posted a brief message to Weibo, the Chinese equivalent of Twitter, with no link to any news report or the NHS Web site, it generated mostly sneering comments on acupuncture. Since the posting page requires login to be read and is in Chinese, here is my literal English translation of the beginning part of the message, which is relevant to the topic.

#Acupuncture has no effect# Big (news)! NHS news: Acupuncture has already been removed from the list of treatments in the back pain treatment guideline newly published in the U.K., because research concludes that there is no evidence to prove its effectiveness.

Note the hash-marked title, sensational and without mention of its applicability (for back pain only), and readers' comments (not shown here) ignore the "back pain only" part and reject acupuncture categorically. It is ironic that acupuncture is held in contempt by Chinese netizens but regarded favorably by non-Chinese, at least according to their anecdotes, considering the fact that the technique originated in ancient China (except for ear acupuncture, which originated in France in the 1950s). It is so true that "Acupuncture grew and diminished in popularity in China repeatedly, depending on the country's political leadership and the favor of rationalism or Western medicine", according to Wikipedia, citing A. White and E. Ernst's 2004 book A Brief History of Acupuncture. Chinese Internet users are generally young and cynical. Acupuncture or the whole traditional Chinese medicine system often becomes the victim of indiscriminate satire, just as it happened in the early 1900's when China woke up to face the powerful and fearful western world.

On the U.S. side, both a 2013 and a 2015 systematic review on the NIH web site find relatively low quality of research but nevertheless benefit of acupuncture on low back pain. It's unlikely that NIH will take a drastic measure as NHS did.

Friday, December 18, 2015

Comments on a research article on toxicity of TCM medincines

Nature Scientific Reports published an article "Combined DNA, toxicological and heavy metal analyses provides an auditing toolkit to improve pharmacovigilance of traditional Chinese medicine (TCM)". This research is valuable because it raises the concern over the unregulated TCM market and the safety of TCM medicines. The toxicity due to heavy metals is particularly alarming and warrants systematic investigation, because unlike biological toxicity, chemical toxicity cannot be reduced at an elevated temperature under which TCM medicines are typically prepared.

What is not obvious, however, in reading this article is that this type of research has one common idiosyncrasy: disproportionally picking somewhat poisonous and toxic TCM medicines, and non-plant-based medicines. In actual TCM practice, plant-based medicines (herbs) are used very much more frequently than animal- and mineral-based ones, and a professional TCM doctor is well aware of toxicity of commonly used medicines, such as Asarum, one of those researchers' favorite victims. Naturally, a "surprise" in finding toxicity in these medicines can only come from less-informed lay persons or non-practitioners.

In future studies, the researchers should select medicines based on their usage or prescription frequency. If there's no aggregate or frequency statistics on the prescribed medicine names, one way to create an approximate frequency list is mine, created about ten years ago based on herb name occurrence on the Internet. See http://yong321.freeshell.org/misc/HerbFrequency.html with its result at http://yong321.freeshell.org/misc/HerbFrequencyG.txt.