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.

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.

Best Age to Have a Baby

Here's a short summary of Huffington Post's article, What's the Best Age to Have a Baby?.

• In terms of the infant's health, the mother's best age for first-child birth is 26. In terms of the infant's mortality, the best age is 32.
• In terms of the mother's long-term health, the best age is, on average, 31. In terms of the mother's life expectancy, it's 34 or 35.

The primary research article cited by this news report is University of Texas sociologist Dr. John Mirowsky's Parenthood and Health: The Pivotal and Optimal Age at First Birth published in 2002. One other interesting bit in the article is the "positive association between health and age at first birth that is linear for men and parabolic for women". According to the full article (see Fig. 1 on p.333 and confirm with Fig. 2 on p.337), the linearity for men simply means the older, the better. That is, the older the man is at the time his wife or sex partner gives birth to their first baby, the healthier he will be in the future. Note there's an age range for this investigation. Both figures show ages starting at 15 and ending at 45.

Easier to do push-ups in a high flying airplane

A few days ago, I was in an airplane flying at an altitude of over 32,000 feet or 10,000 meters. It was a 13-hour flight. To make this journey a little more comfortable, I did some stretching and, with flight attendants' approval, took a tiny corner to do push-ups. It seems to be easier to do push-ups in this high flying airplane. I did 66 without too much effort, almost tying my record set on ground 20+ years ago.

I'm curious to see how much easier to do this exercise at this altitude. So here's my calculation. If I simplify the calculation by assuming all the mass of the earth to be at the center of the earth (as opposed to integrating the mass along the 6371 km radius), Newtonian universal gravitation between me and the earth is reduced by about 3 thousandths at 10000 meters altitude:

F0 = G (mmemearth)/(6371000)^2

F10k = G (mmemearth)/(6371000+10000)^2

where F₀ is the force between me and the earth when I'm at sea level, and F_10k the force when I'm at 10,000 meters altitude. Calculation of the percent change can omit the constant G and both masses m's:

1/(6371000)^2 - 1/(6371000+10000)^2
----------------------------------- = .00313189770433034782 i.e. 0.313%
        1/(6371000)^2

For a person weighing 70 kg or 154 pounds, that translates to 0.22 kg or about half a pound.

What's more, since the plane travels at the speed of 900 km (560 miles) per hour on this inter-continental flight, the centrifugal force [note] additionally reduces a 70 kg person by 686 newtons or 700 grams:

Fc10k = 70000 * (900000/3600)^2/(6371000+10000) = 685.62921172230057984641 newtons
 or 700 grams or 1.54 pounds

So in total, the body weight is effectively reduced by about 0.5 + 1.5 = 2 pounds in the plane traveling at 900 km/hour at 10000 meters altitude.

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[note] Centrifugal force is imaginary in Newtonian mechanics and is used as a convenient expedient. A physicist may choose to do calculation in Lagrangian mechanics.

Reverseing Alzheimer's disease

Alzheimer's disease is generally believed to be non-curable. But a recent off-purpose finding shows that a cancer treatment drug, saracatinib, can reverse the symptoms of the disease, on rats for now. Read Repurposed experimental cancer drug restores brain function in mouse models of Alzheimer’s disease. Also interesting is that "Individuals interested in participating in the trial can find more information at https://clinicaltrials.gov/ct2/show/NCT02167256?term=Alzheimer+AND+Fyn&rank=2".