60 Seconds of Uncritical Drivel from the Annals of Internal Medicine

I am an infectious disease specialist (ID) and as a result I have a background that allows me to have a better understanding the infectious disease literature compared to a non ID doctor. On the other hand, although I am an internist, when I see a paper on angina or stroke I have to take it face value. I have only a comparatively rudimentary understanding of cardiology and neurology.

Pseudo-medicine is also an area of expertise that most physicians lack, but it is an area where most doctors think their knowledge in medicine can be applied.

It can't.

As an example ,take a 60 second clip from the Annals of Internal Medicine Podcast. They are discussing an article in their journal Acupuncture for Chronic Severe Functional Constipation: A Randomized, Controlled Trial.

I analyzed that awful study last month. The Annals may have approved, published, and spun the article but there was a complete lack of understanding of the issues in the analysis of this pseudo-medicine.

Some have recommended the use of acupuncture for chronic constipation however the evidence for the therapeutic effects acupuncture on constipation has been limited. An article published on line first on September 13th provides some evidence on this topic Researchers randomly assigned about a 1000 patients to 28 sessions of acupuncture at traditional acupoints or sham acupuncture at non acupoints over 8 weeks. They found that patients in the treatment group had increased spontaneous bowel movements during the 8 weeks of treatment and improved quality of life. These effects persisted throughout the 12 weeks of follow up. The researchers conclude that acupuncture could be a valuable therapeutic option for patients with chronic severe functional constipation.

So much nonsense in so few words.

Some have recommended the use of acupuncture for chronic constipation

Some have recommended homeopathy and reiki for constipation as well. On basic principles of anatomy and physiology is there any reason to suspect that acupuncture, with its fantastical qi and meridians, would have any effect on any physiologic process?

evidence for the therapeutic effects acupuncture on constipation has been limited

It is not limited. There are 15 RCTs with 1256 participants andthe best a recent meta-analysis can say is acupuncture may and might work. If acupuncture were help to the standard of an angina or hypertensive medication it would have ended up in the used needle box of history long ago. Acupuncture doesn't work. For anything.

28 sessions of acupuncture

It wasn't acupuncture in the traditional Chinese pseudo-medical sense of the word of altering qi in meridians, no, it was ELECTRO acupuncture in acupoints vrs no ELECTRO in non acupoints.

They compared ELECTRIC shocks in the abdomen (which may have a therapeutic effect) with no shocks elsewhere.

Not using the word ELECTRO  makes this as misleading a 60 seconds as you can find in a medical podcast. I hope I have nothing as egregiously disingenuous in any on my podcasts.

The researchers conclude that acupuncture could be a valuable therapeutic option for patients with chronic severe functional constipation.

Only if you apply zero critical thinking to an article and have an definition of acupuncture so broad as to be meaningless can you suggest acupuncture has efficacy treating constipation.  I always tell the house-staff that precision of thought is reflected in precision of speech.

'nuff said.

Usually one has to listen to a Presidential debate to find so much wrong in so few words. Another example of why the Annals of Internal Medicine has one too many n's.

Points of Interest 10/04/2016
Points of Interest 10/03/2016

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