Dr. Gene Bruno: The beginning of the acupuncture profession in the United States (1969–1979) — acupuncture, medical acupuncture and animal acupuncture | PDF |

Dr. Gene Bruno: The beginning of the acupuncture profession in the United States (1969–1979) — acupuncture, medical acupuncture and animal acupuncture  | PDF |


June 23, 2015 | Arthur Yin Fan, Sarah Faggert (doi: 10.1016/S2095-4964(15)60186-8)
 | PDF |

Obama and Dr. Arthur Fan, letter_105723Obama and Dr. Arthur Fan, letter 032015


Fan AY. “Obamacare” covers fifty-four million Americans for acupuncture as Essential Healthcare Benefit. J Integr Med. 2014; 12(4): 390-393

“Obamacare” is the informal and most-used term for The Patient Protection and Affordable Care Act, also known as the Affordable Care Act (ACA), and is a United States federal statute signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act, the ACA represents the most significant regulatory overhaul of the United States healthcare system since the passage of Medicare and Medicaid in 1965[1]. This healthcare reform has already begun, with the open enrollment for the first year of the ACA’s healthcare exchange marketplace ending on March 31, 2014. “Obamacare” was enacted with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government[1]. The ACA introduced a number of mechanisms, such as mandates, subsidies, and insurance exchanges that are meant to increase the coverage and affordability of healthcare. The new healthcare law also requires that insurance companies guarantee coverage for all applicants that fit within new minimum standards and offer the same rates regardless of pre-existing conditions or gender to all applicants. Additional health care reforms are aimed at reducing the cost of healthcare through additional mechanisms such as increasing competition, regulations, and incentives to streamline the delivery of healthcare and move towards a quality-based rather than quantity-based system. The Congressional Budget Office predicts that improved efficiency within the healthcare system, from the new imposed regulations, will help to lower present and future deficits as well as Medicare spending[1,2].  read more at http://www.jcimjournal.com/articles/publishArticles/pdf/S2095-4964(14)60035-2.pdf

We thank Hinman and her colleagues for their considered reply to our letter. We accept that our approach was more informal than their response, but in our defence, we were writing originally for the audience of a general journal, rather than for methodologist and statisticians.

The main point we wished to make concerns the decision to power a study without any reference to previous literature or pilot data within the setting adopted. Of course it seems superficially justified to adopt a minimum change that you wish to measure (in this case a difference over sham of 1.8 on a 10 point scale), but if this difference has never been achieved in previous research it seems odd to invest so much unless the intention was to provide evidence of a lack of effect for acupuncture and laser acupuncture. More….http://acupmed.bmjjournals.com/content/33/1/86/reply

The methodology flaws in Hinman’s acupuncture clinical trial, Part III: Sample size calculation
April 6, 2015 | Arthur Yin Fan | J Integr Med 2015; 13 (4) : 209–211
doi: 10.1016/S2095-4964(15)60184-4

Can Acupuncture Treat Knee Pain? Ge Nan, PhD, Yong Ming Li, MD, PhD.


Can Acupuncture Treat Knee Pain?

Ge Nan, PhD, Yong Ming Li, MD, PhD

Recently an article in Journal of the American Medical Association concluded that “neither laser nor needle acupuncture conferred benefit over sham for pain or function” among older chronic knee pain patients. (JAMA, 2014;312:1313)

We, the practitioners of acupuncture and more broadly Traditional Chinese Medicine (TCM), believe this conclusion is premature. There has been several thousand years of acupuncture practice in history. Acupuncturists’ observation, patients’ feedback, many previous clinical trials, as well as basic researches, all suggest that acupuncture could effectively treat knee pain.

There are several flaws in the design of this article, which we will itemize and address below. In general, the key reasons are 1) the lack of an appropriate sham needle control in the trial, 2) poorly designed protocol and insufficient power of test, and 3) exaggerated data interpretation.

This study demonstrates better effectiveness of needle acupuncture over no treatment control.
This is consistent with observations in previous clinical trials and real clinical practice. Logically, this does not argue against needle acupuncture as a potential therapy for treating chronic knee pain.
The primary goal of this trial is to determine the efficacy of laser treatment, not needle acupuncture, in treating chronic knee pain, as clearly evidenced by authors own trial protocols and publications.
A negative result is concluded from the data, that is, laser treatment was shown not to be better than sham laser treatment or needle acupuncture.
The final conclusion of this study states: both needle acupuncture and laser treatment are not better than sham laser treatment, thus acupuncture should not be recommended for patients with chronic knee pain.
This conclusion is ungrounded, and quite frankly does not make sense. Sham laser treatment is not a valid control for needle acupuncture, thus the comparison is invalid.
The acupuncture protocol in this trial is poorly designed and does not reflect real clinical practice and management of patients with knee pain.
Acupuncture point selection, acupuncture dose and frequency, time course, and evaluation points was not optimal.
Among 282 patients participated in this trial (about 70 per group), with variable health conditions, only 54 patients completed needle acupuncture treatment (less than 1 treatment per week, for 12 weeks).
This small sample of patients does not provide enough statistical power to test the difference between acupuncture and sham treatments.
Twelve months is too long a time-peirod for a second point of follow-up, considering the treatment concluded at the end of 12-week.
Moderate or severe chronic knee pain occurs naturally among older patients. A more appropriate follow up regimen would be frequent survey over a shorter time period.
The author over emphasized the strength of Zelen design and ignored its limitation.
Despite randomization in the beginning, the usage of Zelen design in this study is not appropriate. For example, different treatment groups are not equally blinded during the trial, which will exert variable placebo or even nocebo effects and eventually lead to unfair among-group comparisons. Furthermore, 19% of the patients that refused needle acupuncture were analyzed as receiving the treatment. This is not an accurate comparison by any means.
This trial includes patients older than 50 years with moderate or severe chromic knee pain and the potential benefit effect of acupuncture on younger patients or older patients with mild knee pain cannot be ruled out.
Since publication, there have been a lot of debates around the efficacy of needle acupuncture. The investigators of this trial appeared on several public interviews to promote their negative findings on acupuncture and recommend their physical therapies to the patients. However, based on above analysis, we think the conclusion of this trial is premature and editors of JAMA should re-evaluate this report.

Summary of 2014 Australian Acupuncture Trial
Figure 1: Summary of 2014 Australian Acupuncture Trial for Knee Pain: The trial was originally designed to test laser treatment using needle acupuncture as a positive control (reference treatment). However, after collecting undesired results that the needle did not work as they expected, the authors changed their research aims to test both needle and laser treatments in final report.

NIH Summary
Figure 2: A recent summary by National Center for Complementary and Integrative Health (NCCIH) of NIH states acupuncture may help to reduce pain and improve joint mobility for osteoarthritis. NCCIH analysis was based on data published prior to 2010. The quality of acupuncture trials is crucial, because flawed negative data may change this balance in the future.

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