Acupuncture Associates

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February 2010

In Tibetan Medicine, pulse diagnosis is an important examination

YOU WON’T HAVE A DOCTOR, PART II (see the December News editorial)

2009 first year enrollment in medical school increased by 2% due to the addition of four new medical schools and increases in class size at other schools. However, 30 family medicine residency programs closed from 2003-2004 to 2007-2008, confirming the trend mentioned in the December “Is Anyone Thinking” editorial.

The trend to replacing primary care physicians with technicians will accelerate as more physicians leave the work force and ever more burdensome conditions dissuade residents from choosing a primary care career. (AAFP ).

CONSCRIPTED MEDICAL CARE IN MASSACHUSETTS

Lawmakers in Massachusetts debated a bill in November that would require physicians to accept a new State- mandated health plan or lose their medical license. The “Affordable Health Plan” is a program designed to affect businesses in the State with 50 or fewer employees. (Medical Economics Dec 18 2009 p 16).

JUST WHISTLE

The Chicago suburb of Oak Park is seeing an increase in attacks on its citizens, who are prohibited by Illinois law from protecting themselves with firearms. Instead, the police suggest citizens blow whistles. For the convenience of citizens, they have set up free distribution of whistles at bus stations.

Oak Park Police Commander Keenan Williams states that “cell phones are often taken during robberies, leaving a victim without a means to quickly call the police. But if a victim or witness to the crime blows the whistle, it is hoped someone within earshot will call 911 and report the incident immediately.” (Democratic underground and Clayton Cramer).

A HIDDEN COST OF FAST FOOD

Urologists and pediatricians have reason to believe that the high level of sodium in fast food meals is partly responsible for a vast increase of kidney stones in children. High sodium intake increased calcium excretion in the kidney, and most kidney stones are made of calcium salts.

Children’s Hospital of Philadelphia has seen an increase from 10 patients a year in 2005 to 5 a week now.

Obesity itself is associated with an increase in kidney stones, so in addition to the massive increase in cardiovascular disease and diabetes that our overweight childhood population is facing at ever earlier ages, other diseases that used to be seen mostly in adults are affecting younger patients. (Consultant January 2010; 50:1 p 19).

OBESITY DRUG FOR DOGS

A drug made by Pfizer has been approved by the FDA to treat obesity in dogs. Slentrol is a liquid that is added to a dog’s diet and reduces fat absorption and makes the dog feel full. (New Scientist, Jan 13, 2007 p 5).

ALLERGIES INCREASE

The number of American children diagnosed with food allergies increased by 18 per cent between 1997 and 2007 Allergies now affect 4 per cent of those under 17. (Pediatrics, DOI:10.1542/peds.2009.1210).

PAYING FOR PAY FOR PERFORMANCE

The “pay for performance” scam is still being promoted to credulous physicians and the public. The costs for these boondoggle programs will disproportionately burden small practices without the economy of scale available for waste and inefficiency seen with mega clinics.

Those who participate in these programs in the hopes that it will increase revenue and improve outcomes are dupes of an unproven exercise in feel-good social engineering. Unfortunately, it diverts needed resources and precious time into more bureaucratic inefficiency and away from patient care.

A study in the Annals of Family Medicine for November/December looked at eight practices in North Carolina that were participating in at least one of four quality reporting programs.

The study found that pay for performance program costs from $1,000.00 to $11,000.00 per full time physician during the implementation phase, and from $100.00 to $4,300.00 in the maintenance phase. One of the study’s authors recommends physicians consider only those quality improvement organizations willing to subsidize some of the work and costs. (American Family Physician Jan 2010 vol81, no. 1 p. 8).

ACUPRESSURE HELPS ELDERS WITH HIP FRACTURE

Elderly patients with fractured hips who were being taken by ambulance to hospital were randomly given either true or sham acupressure by paramedics who were blinded to which they were giving (they were trained in both techniques but not told which was true).

Patients in the true acupressure group reported significantly less pain and anxiety and were found to have significantly lower heart rates on admission to hospital. (Out-of-hospital Auricular Acupressure in Elder Patients with Hip Fracture: A Randomized Double-Blinded Trial. Acad Emerg Med 2006; 13: 19-23).

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LOSS OF HEIGHT AND HEART DISEASE

Men who lose more than three centimeters in height with age have a 64% increased risk of heart attack and death compared to me who lose less than one centimeter. (Height Loss in Older Men: Associations with Total Mortality and Incidence of Cardiovascular Disease. Archives of Internal Medicine 2006; 166: 2546-2552).

HAWTHORN SIGNIFICANTLY BENEFITS HEART FAILURE

Extract of Hawthorn fruit (shan zha) can significantly ease the symptoms of chronic heart failure when used as an adjunct to conventional treatment. A meta-analysis of the results of ten trials including 855 patients indicated that the extract increased the maximum workload that patients could endure, along with their exercise tolerance, while cardiac oxygen consumption showed a beneficial decrease.

Symptoms such as shortness of breath and fatigue improved significantly with hawthorn treatment as compared with placebo. Reported adverse events were infrequent, mild and transient. (Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD005312).

CHINESE HERBS FOR ECZEMA

A Chinese herbal formula had been found to reduce the production of inflammatory proteins linked with causing eczema. A Hong Kong team assessed the effects of the ‘Pentaherbs formulation’ (PHF, containing honeysuckle flower (jin yin hua), peppermint (bo he), peony root bark (mu dan pi), atractylodes rhizome (cang zu), and phellodendron bark (huang bai)) on immune cell cultures and patients with atopic eczema.

In the in vitro study, the researchers isolated peripheral blood mononuclear cells from randomly chosen transfusion blood samples. Cell cultures were then exposed to PHF and the effects on cell growth and production of inflammatory mediators were analyzed. PHF reduced production of four inflammatory mediators: brain-derived neurotrophic factor (BDNF), interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha and thymus and activation-regulated chemokine (TARC), following stimulation of the cells with microbial toxins.

In the second part of the experiment, 28 Chinese patients (5-21 years old) with moderate to severe eczema were treated with PHF for three months. Most continued to take steroid medication. Blood samples were taken at the beginning and end of this period. Although there was no change in the amount of steroids used by the patients, they found that levels BDNF and TARC reduced over the three months. (In vitro and clinical immunomodulatory effects of a novel Pentaherbs concoction for atopic dermatitis. Br J Dermatol. 2008 Mar 13 [Epub ahead of print]).

DOCTOR’S PAIN SKILLS INADEQUATE

The primary reason that patients seek medical care is for the symptom of pain. A report from a panel of experts convened by the Mayday fund indicates their belief that “Primary care providers often receive little training in the assessment and treatment of complex chronic pain conditions”, resulting in inadequate treatment.

The co-chair of the panel, a neurologist and chair of the department of “pain medicine and palliative care” at Beth Israel Medical Center in N.Y. states, “The fact is, patients aren’t getting competent and cost effective care that they need in chronic pain, because neither the health care system overall nor the education and training of doctors support best practices” (Mayday Pain Report).

(Ed.) Both acute and chronic pain is inadequately treated in the U.S., and will continue to be, until physicians embrace a “results based” instead of a procedure based perspective on medical practice.

One of the reasons I became interested in acupuncture during my neurosurgical rotation was this very issue. If a simple procedure such as acupuncture could work, why couldn’t this be tried in addition to all our high technology procedures? Properly applied, the risk of acupuncture is certainly minimal compared with almost any pharmaceutical or surgical treatment.

In that long ago time, “pain clinics” were becoming popular. My response then, as it is now, was that the whole hospital should be a “pain clinic”.

After more than 29 years of experience treating all kinds of painful conditions, the idea that pain treatment is separate from the treatment of the underlying condition still seems irrational.

Should we reestablish “fever clinics” or “diarrhea clinics” because these symptoms are inadequately diagnosed and treated, or should we address the poisonous conditions which have created a situation where physicians are treating disorders that don’t exist and ignoring those that do?

The same old centralist solutions are dusted off by the Mayday panel, recommending that state medical and osteopathic boards, deans of medical schools, licensing boards, and residency program directors “make sure that every trainee and health practitioner in the health professions has the skills to assess and treat pain effectively, including chronic pain.”

Having the skills doesn’t equate to being able to use them.

Doctors who prescribe narcotics risk extra scrutiny and trouble with government agencies, and practicing acupuncture when I first entered practice was considered grounds for losing a medical license. The culture of medicine will have to change for effective, if time intensive, interventions to be accepted.

In 2010, is there a single hospital system in Cleveland that provides skilled acupuncture/moxibustion to inpatients or outpatients? How many faculty members of our medical school have enough actual experience in this area to teach students?

ANTIDEPRESSANTS NO BETTER THAN PLACEBO FOR MOST PEOPLE WHO TAKE THEM

Meta-analysis of patients treated by antidepressants suggests that for patients with mild, moderate, and severe depressive symptoms, antidepressants are no more effective than placebo.

Only for very severe depression (greater than 25 on the Hamilton Depression Rating Scale) does it seem that drug therapy is better than placebo. Say the authors in their conclusion, “Prescribers, policy makers, and consumers may not be aware that the efficacy of medications largely has been established on the basis of studies that have included only those individuals with more severe forms of depression.

This important feature of the evidence base is not reflected in the implicit messages present in the marketing of these medications to [doctors] and the public. There is little mention of the fact that efficacy data often come from studies that exclude precisely those patients who derive little specific pharmacological benefit from taking medications.” (Antidepressant Drug Effect and Depression Severity, JAMA Jan 6, 2010; 103:1 p 47).

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"Is Anyone Thinking?" Department

WRONG DIAGNOSIS, WRONG TREATMENT EQUALS ONE HUNDRED PER CENT CHANCE OF FAILURE

Misguided efforts will never achieve results.

The President’s wife has been sucked into the current “war” on the “obesity epidemic”.

This predictable sinkhole for resources and money will, in this latest instance, cost only ten billion dollars. On the other hand, it will ensure endless meetings of people who have already demonstrated they have too little ability and too much time on their hands.

The familiar players; “medical, business and government leaders, nutrition experts,{and} grassroots activists”, are ever ready to step up and exploit this disastrous failure of our culture to establish anything resembling a healthy lifestyle.

“At its core, the initiative has four pillars: more nutrition information, increased physical activity, easier access to healthy foods and, ultimately, personal responsibility” states the press release.

Doesn’t that sound revolutionary?

Unfortunately, all of this has been tried before, and failed utterly. If you lined up all the “wake up” calls that have been issued by taskforces, do-gooders, legislators, and medical and “scientific” panels on this subject, they would stretch from here to Pluto.

But, there are grants, tax dollars, and fellowships to be had, and endlessly repeating ineffectual attempts at a solution is the best way to ensure continued employment among the elite and the academics, and all those who beg for crumbs at their tables.

The issues begin far earlier than the politicians realize: The U.S. Preventative Task Force now suggests that “obesity management” begin at age six. Other researchers suggest that the trend to overweight is present before the age of two.

Surgery is clearly superior to all of the solutions the First Lady endorses, but somehow I doubt we will be seeing her promoting bariatric surgery.

A recent randomized trial published in the Feb 10, 2010 JAMA clearly suggests the superiority of surgery in controlling weight (known to the elite as “body mass index”, a much more intellectually satisfying term).

Two groups of obese adolescents were subjected to either gastric banding or an incredibly intensive attempt to change eating and activity behaviors. A team consisting of a general physician, a sports medicine physician, a dietitian, an exercise consultant, and a nurse were required to implement a “lifestyle” program that was designed to maximize behavioral changes.

A high cost program such as this could only be achieved inside a research institution, so real life results will be much more modest.

Yet, after two years of follow up, the lifestyle approach worked for only 12% of the children, even to obtain only a 50% improvement in “excess weight”. The surgical group obtained an 84% response.

Conclusion? “Laparoscopic adjustable gastric banding (gastric banding) has the potential to provide a safe and effective treatment.”

Despite its superiority in this study, the fact remains that no surgery is ever “safe”; 33% of surgical patients in this study required another operation to correct problems caused by the first surgery. The criteria for improvement was only a 50% reduction of excess weight, and long term nutritional and surgical complications are not considered in this study.

Any benefits will evaporate as time goes on since most weight loss is regained after surgery or intensive lifestyle changes.

Is there any benefit to a temporary 50% weight loss in obese children? No one knows.

But even if surgery is included, the latest “initiative”, with the first lady at the helm, also has a hundred percent chance of failure.

Why? Because all of the “solutions” presently proposed fail to address the cause.

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THE TRUE CAUSE OF OBESITY

The disorders underlying our dysfunctional appetites lie in the heart/brain connection, not in the digestive system.

An understanding of the function of the Heart according to traditional Chinese medicine, detailed in America the Heartless, Part I, is the first step to a realization of what can really be done to address this dangerous trend.

As I pointed out in that essay, it requires sufficient Heart qi and spirit to achieve fulfillment from food. In a person with healthy physiology, “hearty” food will contribute to the production and storage of shen or spirit in the Heart. When Heart-spirit is sufficient, food is satisfying and the person is content.

These normal mechanisms then shut down eating when energy needs are met.

In a person with damaged Heart qi and spirit, no amount of food provides this response. As a result, the individual continues to eat in a futile search for satisfaction and contentment. Obesity is the inevitable result.

WHAT DAMAGES HEART QI AND SPIRIT?

The primary factor damaging Heart qi and spirit is fear. A climate of fearfulness, as well as a culture of cowardice among the so-called “leadership” in our country has created a populace who can no longer face adversity or overcome obstacles.

A culture of entitlement has created an expectation that all of our troubles will be soothed by an all pervasive nanny-State.

Whereas once the American spirit embraced fortitude, perseverance, bold ambition, and individual responsibility, our culture of fear has substituted wimpiness, dependence and a craven, pusillanimous expectation that someone else should solve our problems and eliminate risks.

Our mass media and political elite, themselves privileged, fearful, and cowering behind gated communities and armed guards, prescribes heavy doses of fear to manipulate and control the populace in their unceasing quest for wealth and power. Every pronouncement and communication from these institutions carries a message of fear.

What passes for entertainment and “sport” often encompasses the extremes of horror and violence. Both children and adults are corrupted by these terrifying images.

Fear can be a lifesaving gift when it is a temporary response and motivates an appropriate survival response, but when it becomes a prolonged state of being, fear destroys the Heart spirit and creates paranoia, insecurity and heartlessness.

Heartlessness in turn results in monstrous behavior, as well as an inability to love or feel empathy or compassion. The result is still more fear.

CHILDREN REQUIRE CONFIDENCE AND STABILITY

Among the last few generations, there are increasing numbers of parents who have been emotionally damaged as children themselves. As a result of the damage to their own Heart qi, they substitute food for the real love and support that nourishes children.

There are also parents who use food as a currency in an attempt to purchase good behavior from their indulged and bratty children.

It doesn’t work.

Fear and insecurity has made these parents angry, and in turn they infect their children with anger. Children need a sense of security and confidence in the capability of their parents and look to them as icons of adult behavior. A parent whose emotions are unstable and whose behavior is unpredictable will increase tendencies to fear and insecurity in their children.

Children who are drifting in a sea of insecurity and fear as a result of their emotionally crippled parents are never able to feel the contentment that good food provides to a person with a normally responsive heart.

And, although the subject of this editorial is obesity, the very same mechanisms of Heart qi and spirit disorder, when some other issues and factors are present, can also lead to the disorders of appetite known as "bulimia" and "anorexia nervosa".

As with "obesity", inadequate understanding of the issues of spririt and Heart restoration limits treatment efficacy for those who suffer from these imbalances.

ELIMINATE FAILURE AND YOU ALSO ELIMINATE SUCCESS

Our “educational” system also breeds insecurity and fear with its arbitrary and unpredictable standards for achievement and goals that have no relationship to actual academic capability.

Curriculums have been crafted to carefully avoid any acknowledgement of the value of character or morality, and certainly there is no education available on the subject of improving character or in meditational training.

Techniques that assist in achieving emotional stability are also not available in our educational system.

A false egalitarianism has been fashioned to prevent students from developing the confidence that comes from actual success and the resilience that comes from actual failure. A refusal to recognize superior achievement in some students, as well as manipulation of the definition of success so that "everyone is a hero", has created a set of standards that is so low that no one develops any motivation to excel.

With feel-good social engineering goals substituting for actual capability, students themselves are aware that they progress though their schooling with no actual ability to solve emotional or real life problems. The result has been two generations of feckless, fearful, inept, and unemployable citizens.

To solve the obesity “epidemic” we must eliminate our culture of fear and restore the factors which strengthen the Heart.

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Press Releases

Culture of Fear Series

Talk To Strangers! Doctor Challenges Common Myth

Talk To Strangers! Teach Children Confidence, Not Fear

Doctors Study Magic to Transform Fear into Confidence

Magic for Medical Professionals Press Releases

Wizards Teach Medicine to Doctors

Doctor Challenges Medical Profession to Study Magic

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Previous Acupuncture News

January 2010 newsletter
December 2009 newsletter November 2009 newsletter
October 2009 newsletter September 2009 newsletter
August 2009 newsletter July 2009 newsletter
June 2009 newsletter May 2009 newsletter
April 2009 newsletter March 2009 newsletter
February 2009 newsletter January 2009 newsletter
December 2008 newsletter November 2008 newsletter
October 2008 newsletter September 2008 newsletter
August 2008 newsletter July 2008 newsletter
June 2008 newsletter May 2008 newsletter
April 2008 newsletter March 2008 newsletter
February 2008 newsletter January 2008 newsletter
December 2007 newsletter November 2007 newsletter
October 2007 newsletter September 2007 newsletter
August 2007 newsletter July 2007 newsletter
June 2007 newsletter May 2007 newsletter
April 2007 newsletter March 2007 newsletter
February 2007 newsletter January 2007 newsletter
December 2006 newsletter November 2006 newsletter
October 2006 newsletter September 2006 newsletter
August 2006 newsletter July 2006 newsletter
June 2006 newsletter May 2006 newsletter
April 2006 newsletter March 2006 newsletter
February 2006 newsletter January 2006 newsletter
December 2005 newsletter November 2005 newsletter
October 2005 newsletter September 2005 newsletter

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