The Clinical Application of Chi 1

EoR has been reading the January/February 2006 edition of the Journal of Complementary Medicine. It's like a porn magazine for the woo brigade.

The JCM provides the latest news and research in CM, evidence-based reviews on CM treatments for conditions commonly presenting in primary care; expert commentary on topical issues; regular sections on relevant therapies, education, routes to referral, further education and training.

The method employed in this journal consists of a large number of brief reports of studies that may indicate some potential benefit in various natural substances (which is fine by EoR - if the studies are confirmed the active ingredient is usually isolated and it becomes part of mainstream medicine), much good advice (if lacking a little in detail and depth), and then the knife which has been oh-so-surreptitiously inserted is suddenly twisted and you're down on the floor screaming in agony but there's no release.

For example, "CM: what pharmacists should do" discusses issues of ethics, registration of products, assessing customer needs, monitoring adverse events and so on. Towards the end pharmacists are advised

Proactive consumers most commonly took CMs and had the best health outcomes.

EoR wonders, in passing, what the difference between an 'active' consumer and a 'proactive' consumer is. Note how that little conjunction 'and' has suddenly become a causal link rather than a grammatical tool? It could equally be argued that "proactive" consumers are better informed generally, and specifically about conventional treatment and are probably more likely to see a doctor. There may be many more factors involved, but we are only told about two. A bit later we are told

However, most enquiries about CM were rarely direct, and the real query had to be discerned with prompts such as 'What are you trying to find out?'

This is clearly about pushing a product, not providing the best solution about a consumer's needs. EoR imagines a Monty Python type sketch taking place in your local pharmacy:

Proactive Consumer: I'm a bit concerned about my heart/lungs/legs/smoking/overactive bowel/underactive bowel/brain exploding [delete where appropriate - however, the more conditions the merrier].
Hyperactive Pharmacist: We have just the thing for you: Magic Aura Detoxing Ayurvedic Herbal Homeopathic Drops!
Proactive Consumer (in a daze): Oooooooh.... I feel better already.

The so-called evidence-based approach of the journal is also clearly shown in the lead article on Irritable Bowel Syndrome. This is an eight page article which goes into pathophysiology, conventional treatment, diet, allergies, food intolerances, the placebo effect, probiotics (getting a bit left field here), "Botanical medicine" (getting more left field here - all these are supported by numerous studies being mentioned - in fact, so many studies that they often only get a couple of lines of attention which is insufficient to assess the validity and rigour of the study - obviously, most GPs are not going to have the time or inclination to search out and go through all these studies), and then we go way out into left field where we find Chinese and Ayurvedic Medicine. In the same authoritative tone, we are informed about

chi stagnation and blood stasis [...] damp heat in the Middle Burner meridian [...] deficiency of spleen and kidney yang [...] spleen and liver disharmony [...] spleen yang deficiency [...] an imbalanced increase in the Vata dosha.

This is supported by a double-blind, placebo controlled trial into herbs, incidentally conducted by a JCM Editorial Board Member, even though

The efficacy of many Chinese and Ayurvedic herbs has yet to be established.

Another article goes on at length about Liver Detox Programs. In between "Which toxin is that?" and "Rationale" we are told

There is little direct scientific evidence to suggest that LDPs improve prognostic outcomes for patients with specific chronic diseases. There is, however, some evidence to suggest that a simple general detox program over two to several weeks may assist in reducing general symptoms of poor health in various patient populations.

Note the clutching at straws about very vague responses in indeterminate cases. Wherever there is "some" evidence, proclaim it loudly. EoR wonders about the quality of these trials.

There's a regular column on medical acupuncture, this month on the Puppet Master Points, which EoR will ignore except for the boggling view of anatomy inspired by

Langevin has postulated that the connective tissue (CT) enfolding every muscle and continuous from head to toe is part of the acupuncture signalling system.

Hang on, that seems to presume the evidence already of an "acupuncture signalling system". Did EoR miss something? Oh, it's only a "postulated" hypothesis.

When a needle penetrates the CT and is twirled, the CT fibres wrap around the needle, are stretched and produce a piezoelectric signal that is propagated along specific tissue planes.

Don't you just love the scientific authority of all that jargon? Since a piezoelectric effect is caused by very high pressures applied to crystals, EoR wonders how a little twisting needle can cause such a reaction (he's happy about the crystal part - we all know about woo crystals in the body and which migrate to the feet in the magical world of reflexology). How is this (imaginary) signal propagated? More importantly, how is it transmitted to the brain rather than just to surrounding tissue? And even if it was transmitted successfully to the brain, how does the brain know where it's coming from and what it's saying? EoR could go on, but such questions are not the point of the article. The point is to engender a feeling amongst GPs and others that acupuncture is scientifically proven and well known to be effective.

There's more (including one article EoR will address separately), but you get the idea.