Friday, March 19, 2010

Acupuncture and infection

Remember how all those alternative medicine advocates like to complain about the side effects and dangers of modern medicine? Remember how they either imply or flat out claim that there are no such dangers from alternative medicine? Well, not surprisingly, it turns out that when people look at this kind of claim critically and scientifically the alties are not exactly correct.


Check out this study from the British Medical Journal I found via the BBC: Acupuncture Infection 'link'. The BMJ editorial can be found here: Acupuncture Transmitted Infections.

Now, some caution should be applied when viewing the results - sample sizes and case studies are small and relatively rare respectively, but the article does point out that the results may be the tip of the iceberg, these are only reported cases after all and acupuncture in the UK, for instance, is unregulated. And how much acucpunture treatment in China, for example, is closely followed and monitored by science based medicine and reporting?

Anyway, to throw back in the face of the "What's the harm even if it doesn't work" and the "It does work and it isn't dangerous like your western medicine" people here's some sobering quotes from the BMJ editorial:

So far, more than 50 cases have been described globally.... In localised infections, meridian specific and acupuncture point specific lesions were typical. About 70% of patients had musculoskeletal or skin infections, usually in the form of abscesses or septic arthritis, corresponding to the site of insertion of the acupuncture needles. A minority had infective endocarditis, meningitis, endophthalmitis, cervical spondylitis, retroperitoneal abscess, intra-abdominal abscess, or thoracic empyema.




As in other musculoskeletal or skin infections, Staphylococcus aureus was the most common bacterium responsible, accounting for more than half of the reported cases. Although most patients recovered, 5-10% died of the infections and at least another 10% had serious consequences such as joint destruction, paraplegia, necrotising fasciitis, and multiorgan failure.
 
The study in the BMJ also cites risks of Hepatitis B and C infection as well as the potential for infection with HIV.
 
Now I'm sure the alties will shoot back with hospital infection rates and surgery death rates and if they do they are merely reinforcing one of the points raised in the BMJ editorial. We know the rates for science based medicine because it is heavily regulated and monitored, but we don't have the same monitoring and regulation for acupuncture so they aren't comparing like with like - and what we do know suggests they really don't have much to shout about since the little information we do have suggests there is a problem, and one that isn't being monitored closely enough and might therefore be worse than it appears.
 
And yet, and here's the kicker, the alternative medicine industry doesn't want regulation, they don't want to be closely monitored, they regularly resist efforts to introduce regulation, they harp on and on about their own standards and training and how they don't need outside interference. Lo and behold, that is basically the line taken by those interviewed in the BBC article.
 
I think we begin to understand why they resist now, don't we?

4 comments:

  1. I think the alternative medicine industry wants regulation but the difficult thing is to have it apply to all the modalities. There does need to be some regulation in the UK if you can practice acupuncture without training!

    Of course there is a risk of hepatitis and HIV if an acupuncturist is reusing needles. The article does little in explaining how patients received the infections. Was it due to the acupuncturists negligence of clean needle technique?

    Some of the references do link the infection outbreaks from a single clinic that didn't keep things clean. I don't think I've met an acupuncturist who thought it was perfectly safe. Its only safe if you take care of what you're doing. Its also not pain free. Thats many different styles of acupuncture, some don't involve touching the skin, and some involve heavy stimulation. Its the reason why I don't take the acupuncture vs sham acupuncture trials seriously. I'm more interested in the effectiveness of acupuncture vs the usual treatments.

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  2. Anonymous - please choose a psuedonym to post under if you are going to post again. Any subsequent anonymous replies will be deleted. Not because you made a point I can't refute, not because you won, not because I am afraid of what you say but because it is my blog and that is my rule. Picking a nickname helps keep track of who is saying what.

    Now, I may very well write a full blog post by way of reply to this but a few things spring to mind that can be replied to in brief.

    the difficult thing is to have it apply to all the modalities

    Nonsense - evidence based medicine covers a vast range of things and yet is extremely heavily regulated. This is nothing but a pretty pathetic excuse.

    The article does little in explaining how patients received the infections.

    Of course the article says little about this. Without regulation of acupuncture, there is no way of knowing how the infections are caused. That's the point. With evidence based medicine it is extremely easy to track down the source of an infection. With made up and unregulated crap like acupuncture it is difficult, but it isn't hard to take an educated guess at likely causes then dig a little deeper.

    Its the reason why I don't take the acupuncture vs sham acupuncture trials seriously.

    What, specifically, is your problem with trials that use sham acupuncture?

    Whilst you are at it, define what you think acupuncture is because your reply seems to be setting up room for a shot at a "No True Scotsman" style bit of excuse making.

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  3. Hi I am reading this because I went to an acupuntture treatment on Friday and I have quarter sized welts at the insertion points that were used. I recognize this a problem, but wonder if you have any ideas for treating this.

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  4. Vicki, I can't give medical advice, I am not qualified to do so but you should see a doctor as soon as possible because that could be a serious reaction or infection. If you can't see one in the next 24 hours I would say go to an ER to have them look at it. I would also make sure you take pictures of the welts and think about getting a lawyer. Then don't waste money on more acupuncture.

    But you really need to go and see a real doctor, right away.

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