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Showing posts tagged placebo

Failure

What happens when acupuncture fails? Up front only a little; the patient stops coming and the acupunk moves on. But there’s more happening behind the scenes. Acupuncture is constantly proving and re-proving itself since there is no conclusive, scientific proof of its treatment validity. It seems from the biomedical POV each treatment with its idiosyncrasies is a population of 1. Basically everything is so unique to that treatment (not person) that the results can’t be generalized to a larger population. So when it fails, many say “Well, since it’s not scientifically valid what more could I expect? How could those tiny needles help something that M.D.s have not been able to figure out?” And that’s it. They will dismiss acupuncture for many if not all future medical issues. But let’s consider the situation from a wider angle.

It’s common for acupunks to be the last resort for medical problems, often falling behind even chiropractors. Chiros have established more legitimacy, enough to get some of their service covered by Medicare Part B. So I and other acupunks often get people right before their surgery, after many rounds of meds that have either not worked or worked but with too many side effects, or for conditions that have drastic or no effective biomedical treatments. In these cases we are the alternative of last resort; I accept this situation because I have no control over it but also because as the last resort results are “miraculous.” The body *is* miraculous since what I input is a message with needles and the patient gets the output of improved health.

And here’s some interestingness: in some cases I only have 1 treatment to convince the person that acupuncture works. So after weeks, months, possibly years of biomedical treatments with unsatisfactory results I sometimes have 1 treatment max to change something. I once had a patient who went to a chiropractor for 2 months and gave acupuncture only 1 try. Huh. 

The first hurdle of treatment, at least as a community acupunk, is that I needle primarily or exclusively the extremities, head and neck (distal acupuncture). There are allowances, but that’s pretty much it. So when I’m dealing with musculoskeletal issues, especially back problems, the patient sounds incredulous and sometimes offended that I’m not going to insert needles into where it hurts. I think this is why I sometimes have only 1 shot. And I usually change something, but sometimes I don’t. The ones when I miss are the 1-and-dones who then dismiss acupuncture for many if not all future medical issues. The one’s I “get” become believers, even if only for their specific pain.

For more chronic issues and internal medicine type things, the person might be more willing to come in for 4-8 treatments. In these cases what may change is not the main complaint but other issues around it. That at least buys me some time to get the main complaint under some kind of control. But again, I’m under the gun. I don’t have as much time as biomedical practitioners do before the patient decides to quit.

Here’s the thing—if my treatment didn’t work for you that means that I failed, not acupuncture. That means that I have misinterpreted your situation, that I have misunderstood it’s location, that I missed. There’s no excuse for missing, only reasons. And each failure means I review, research, and go through the steps in my mind to figure out how I could possibly get a different outcome. Then I have to let go, because hanging on to too many failures messes with my head and it shows in my treatments: more needles across more places without any rhyme or reason other than “I hope I covered all my bases.” Acupuncture is enough of a shotgun without me peppering the person in the hopes that I’ve covered my bases. It’s a challenge to provide care while feeling that unless you get each move right, you have just created an anti-acupuncture ambassador that spreads the word that not only do you suck at your job but also that acupuncture everywhere doesn’t work.

So what happens when acupuncture fails? Well, most often it means I have failed, not acupuncture. Those who believe acupuncture to be an elaborate placebo will say this is a cop-out. I can’t argue against that because like I said, there’s no definitive scientific proof of its medical utility. But that’s irrelevant in light of the fact that someone has come to me for help and I have been unable to provide it. For the patient failure means loss of hope, continued suffering, and most likely a return to biomedical treatments. Not many will go deeper into alternative medicine unless they are terminal. For all people involved failure is a blow to the psyche and to the hope for something more.

 




To the bone

Certain things you know from the inside out and back. Love for husbands and wives, regardless of that BS on legal status. Love for children. Purpose in life. Justice. Things you KNOW down to the bone and that can only be taken out of you by a collision with the anti-you and annihilating each other in the quantum fury that is physics at the Creation level (been reading a lot of science and physics recently, sorry). 

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Testing my mettle

I confess to being a glutton for doubt. I love reading about medicine, physics, math, biotech, etc. What we continue to learn through the hard sciences is amazing to me. Well, some of what I read is how acupuncture is a sham/quackery/deceptive. A good summary against acupuncture as a valid form of therapy can be found here. I expose myself a lot…maybe too much…to these articles and reviews. It’s rough going carrying this doubt, so why do it?

My plans to become an MD changed in college, a story I’ll get to later. But up until that point I was a “scientist,” debunking with the latest medical or biological article the cultural remedies and thoughts on health from my Latino culture. I thought, “Who believes in aires anyways?” (“Aires” are how Latinos explain sudden and sharp musculoskeletal pains, usually on the back or ribs, but anywhere really.) I never left that “scientist” part behind.

But I changed directions in college leading me to be an acupunk. Since then I have given and received acupuncture treatments and have noted interesting and powerful results in myself and others. I have stopped my back pain with 3 needles at my elbow. I have helped a mail carrier pre- and post-surgery to lessen his often incapacitating back pain so that he could function in daily activities. I have helped a woman reduce her almost incapacitating anxiety to such low levels she says she forgets sometimes she ever was anxious. All this with 2 cent needles. I’m not cherry picking favorable results and forgetting my failures. They will be addressed in the future too.

But in light of my own successes and those of my fellow acupunks, I still doubt. I doubt when I read another study showing that “real” acupuncture is no better than “sham” acupuncture, meaning that the results of acupuncture are simply placebo effect (this one although older is one of many). I doubt when any of my patients (returning or new) don’t get the results we’re looking for. I doubt and for a while that doubt did a great job dropping my morale and making wonder if I had made the correct decision in opening up a CA office. The doubt was strong enough to lead to some adverse physical effects.

But then I see my patients and hear from them that the pain is gone within a few minutes of needle insertion or that they are able to function 10-30% better after a few treatments or that the chief complaint is no longer the chief complaint and could we work on something else. How do I tell them that according to these scientific studies that are coming out that they are faking themselves into this much pain since these 2 cent needles got rid of it? In the end I can’t do this. All I can do is celebrate their improved health alongside them.

So if the proof is in the experience, why do I insist on subjecting myself to doubts? I don’t know; I still don’t have a good answer to that. I guess I’m just testing my mettle, tempering my will. By the way, mettle is defined as: A person’s ability to cope well with difficulties or to face a demanding situation in a spirited and resilient way. Cool word; I didn’t know its exact definition until now.

 




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