It Is Happening Again

 It Is Happening Again

A new study finds a disturbing trend in the battle against malaria. There are highly effective drugs called artemisinins — and now resistant malaria is turning up in parts of Myanmar, the reclusive country also known as Burma, where it hadn't been seen before.

The study was conducted by Dr. Charles Woodrow and his colleagues at the Mahidol-Oxford Tropical Medicine Research Unit in Bangkok.

"Particularly toward the north, resistance is certainly present as we highlight and now lies quite close to the northwest border with India," Woodrow says.

There's concern that if the resistance takes root in India, it could quickly jump to other parts of the world.

Indeed, the drug-resistant strain is already a problem on the other side of Myanmar along the frontier with Thailand. And it's widespread in Cambodia.

"In parts of Cambodia," says Woodrow, "we are really down to the last possibilities in terms of how we treat malaria. We are considering combining three drugs, extending courses from three days up to five days. So I think midterm, this is a major problem."

The great concern is that Southeast Asia has historically been a graveyard for malaria drugs. In the 1960s, malaria parasites in Thailand learned how to fend off chloroquine, a first-line malaria drug. That resistance eventually spread around the globe. In sub-Saharan Africa, the loss of chloroquine cost hundreds of thousands of lives.

In the 1990s, artemisinin-based drugs from China became the new global standard for treating falciparum malaria, but studies like this one in Myanmar show that artemisinin resistance is growing. And this is a huge problem, because malaria, according to the World Health Organization, sickens almost 200 million people a year and kills roughly 600,000.
Woodrow says the resistance is developing slowly. In combination with other drugs, artemisinins are still effective. But he's not entirely optimistic: "If the parasites were to evolve in a way that made them entirely resistant to artemisinins, this would be disastrous over a short time scale. Because you'd be left with the remnants of all the other drugs we'd tried to use in the past."
He calls this the "nightmare scenario." The world is not there yet, but in what Woodrow calls the midterm — say, the next two to five years — he predicts that artemisinin-resistant malaria is going to be causing a lot of problems in Myanmar and elsewhere.
Source of the report is here.

Some Doubt About Acupuncture

Phantom Acupuncture

There are two basic schools of thought when it comes to acupuncture, which is the practice of placing thin needles into alleged acupuncture points in order to have a therapeutic or symptomatic effect. The “traditional” interpretation is that the needles are stimulating a physiological response of some kind at the acupuncture points. Within this school there is a range of opinions as to whether this response is due to a biochemical, neurological, or another known biological response or whether it is due to the still more traditional (but actually less than a century old) belief that the needles are manipulating the life force or Qi.
The other school holds that acupuncture is essentially an elaborate placebo. (Note – this article contains all the references necessary to support my statements below, so I will not repeat them.) Any apparent response is a non-specific response to the attention of the practitioner, expectation, distraction from pain, simple regression to the mean, and other illusory effects.
Each school makes different predictions about the various lines of evidence that can be brought to bear to resolve this question. There have been in total several thousand clinical studies looking at the apparent effects of acupuncture. These have failed to convincingly reject the null hypothesis, meaning that they have not demonstrated a clear biological response to acupuncture for any indication. The better controlled studies consistently show that needle location does not matter (sham acupuncture), and that needle insertion does not matter (placebo acupuncture). You can literally have a non-acupuncturist randomly poke someone with toothpicks and get the same response as the full acupuncture treatment.
The other line of evidence regarding acupuncture are studies that look at physiological responses to having needles poked through the skin. These studies, completely unsurprisingly, show that “stuff happens” when you stick a needle through the skin. There is a local reaction to the trauma, and the brain reacts in a predictable way. I do not think these studies in any way distinguish between the two interpretations of acupuncture. Even if acupuncture is nothing but a placebo, we would still expect these types of responses to sticking needles into tissue......
To read more, click here.

A Voice on Acupuncture Research

Letters to JAMA Exposing Acupuncture Research Flaws Applauded by TCMAAA

TCMAAA calls for stricter adherence to research ethics and well-designed acupuncture studies among the integrative medicine community

TAMPA, Fla.--(BUSINESS WIRE)--In five letters to the editor published in the latest issue of JAMA, the Journal of the American Medical Association, acupuncture clinicians and researchers around the world point to key flaws that call into question the validity and research methods used in a randomized clinical trial published in JAMA in October of 2014. The Australian study, Acupuncture for chronic knee pain: a randomized clinical trial, by Hinman, et al., concluded, "In patients older than 50 years with moderate or severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function. Our findings do not support acupuncture for these patients." Many American acupuncturists were outraged when the October 2014 article was published in JAMA and have called for a review of the study's design and protocols.

 

Yong Ming Li, MD, Ph.D., of New Jersey challenges that the researchers altered the aims and hypotheses of the study  after  the data was collected and the trial was closed. According to the original aims and hypotheses submitted to the official clinical trials registry in 2009 the objective of the study was not to evaluate the effectiveness of traditional needle acupuncture against sham laser acupuncture, but to evaluate laser acupuncture against sham laser acupuncture with needle acupuncture serving as a positive control for laser acupuncture. Protocols originally filed with the registry as well as the authors' baseline publication do not describe sham laser acupuncture as being a control for needle acupuncture. Dr. Li's letter furthermore debates the validity of using sham laser acupuncture as a control for needle acupuncture, as it is not generally accepted as a valid control for needle acupuncture. 

To read more, click here.
 

Local and Distal Acupuncture Points Compared for Chronic Musculoskeletal Pain

Local and Distal Acupuncture Points

Compared for Chronic Musculoskeletal Pain

One in four people suffers from chronic musculoskeletal pain (CMP). Acupuncture points stimulation is increasingly used for pain relief for CMP. Commonly, a combination of local and distant points is used. However, the difference between the effects of local and distant point stimulation is unknown. This systematic review aimed to determine if there was a difference in effects between stimulating local and distant points, and the combination of both when compared with either alone. English and Chinese electronic databases were searched to identify randomized controlled trials, where local or distant points were stimulated in adults with CMP. Pain intensity was the primary outcome measure. Nineteen were included in the qualitative analysis and 15 in the meta-analysis. Local and distant point stimulation was more effective than their respective controls in pain reduction immediately after treatment. Three studies directly compared the stimulation of local and distant points and found no significant difference between the two. No studies compared combined local and distant point stimulation with either alone. Subgroup analyses showed that, local tender point stimulation was more effective than local acupuncture points. Local and distant point stimulation induces similar degree of acupuncture analgesia. The benefit of combining local and distant point stimulation is unknown. However, subgroup analyses suggested that local tender points could be important in the treatment of CMP for short-term pain relief.

Source: Wong Lit Wan D, Wang Y, Xue CC, Wang LP, Liang FR, Zheng Z. Local and distant acupuncture points stimulation for chronic musculoskeletal pain: A systematic review on the comparative effects. Eur J Pain. 2015 Feb 17.

Acupuncture in Taiwan

Thursday, February 19

12:30 – 1:00 PM

Lunchtime Lecture Series Presents:

Acupuncture in Taiwan

Presented by Yi-Chin Fong

In China, leading Chinese medical schools and prominent Chinese medicine medical centers are all over the country. But in Taiwan, the hub of Chinese medicine and acupuncture is one institution, China Medical University which is located in Taichung. All developments of Chinese medicine and acupuncture in Taiwan are associated with China Medical University. China Medical University (CMU) was established in 1958 and is the first academic institution in Taiwan where Chinese medicine and pharmacy programs are provided. Professor Yi-Chin Fong from China Medical University is presenting Acupuncture and Chinese Medicine in Taiwan in this lunchtime seminar.

Yi-Chin Fong, M.D., Ph.D., was trained as a physician in traditional Chinese medicine and became a general surgeon. Now he is a professor in the Department of Orthopedics and Traumatology and a surgeon at China Medical University Hospital in Taiwan.

Herbs and OIT Prove an Effective Food Allergy Combo

Herbs and OIT Prove an Effective Food Allergy Combo

Dr. Xiu-Min Li, the inventor of a Chinese herbal formula to treat food allergy, is finding more success, at least in mice, with the latest iteration of her formula.

Speaking at the AAAAI 2014 meeting in early March, Li noted the concern of researchers over the widespread side effects with oral immunotherapy, in which an allergic patient in a clinical trial is fed minuscule and then increasing amounts of an allergen, with the goal of reaching desensitization to that food. Given this issue, she decided to study in mice whether pre-treatment with her formula, now called B-FAHF-2, would lessen symptoms during and following OIT.

The results are highly encouraging. Li said the combination of the two therapies “resulted in significantly fewer adverse reactions related to OIT.” But further, she and her colleagues even found that B-FAHF-2 “enhanced the OIT desensitization, and it induced more persistent protection and greater immunomodulating effects.”

For the study, mice were made allergic to peanut, cashew and walnut, and 16 of the rodents were given twice daily doses of B-FAHF-2 for three weeks, while 16 others had a placebo. Both groups then underwent OIT treatment for three weeks with a peanut-nut mixture. After completing the therapy, the mice had oral food challenges (just as humans are given) to test their ability to consume the individual foods they had been allergic to. Mice in the Chinese formula group had fewer and milder reactions, lower IgE antibody levels and lower histamine.

In the OIT-only group, seven of 16 had moderate to severe reactions during the challenges compared to two mice in the herb-OIT group having only mild reactions.

Li looks forward to moving the research forward on the new formula. One drawback to the Chinese herb formula had been the large numbers of pills it required taking a day. But Li explained to her allergist colleagues – and large number came for this session – that this new version of the formula is more potent and concentrated.

She says the required daily dose has been reduced by 80 percent – down to six to eight pills in adults (and fewer in children) from the older FAHF formula which required an adult to take more than 30 pills a day.

Source of the report is here.

Acupuncture back pain success determined by psychological factors

Acupuncture back pain success determined by psychological factors

According to new research, people being treated for lower back pain with acupuncture are likely to gain less benefit from the treatment if they have low expectations of how effective it is.

The study, published in The Journal of Clinical Pain, also suggests that patients who are positive about their back pain and feel in control of their symptoms go on to experience less back-related disability while receiving acupuncture.

"The analysis showed that psychological factors were consistently associated with back-related disability," says study author Dr. Felicity Bishop. "People who started out with very low expectations of acupuncture - who thought it probably would not help them - were more likely to report less benefit as treatment went on."

Well established as a form of complementary therapy, acupuncture is commonly used to treat a wide range of health problems. The World Health Organization (WHO) has stated that acupuncture is an effective form of treatment for 28 conditions, including lower back pain and the following:

Evidence also suggests that acupuncture could be beneficial in the treatment of many other diseases, symptoms and conditions, although the WHO believe further proof is needed.

However, previous research has also found that factors other than the insertion of needles into specific areas of the skin play a part in how effective acupuncture is. These factors include the patient's belief in the therapy and the relationship between the patient and acupuncturist.

For the study, 485 people receiving acupuncture for lower back pain were recruited, being seen by a total of 83 acupuncturists. The participants completed questionnaires prior to the commencement of their treatment, and then again after 2 weeks, 3 months and 6 months.

The questionnaires measured demographic characteristics and lower back disability, as well as variables from four different psychological theories for predicting lower back pain outcomes: the fear-avoidance model, the common sense model, expectancy theory and social-cognitive theory.

'Processing of different emotions in relation to treatment can influence outcomes'

As hypothesized by the authors, psychological variables were associated with changes in disability among the participants and were accountable for two thirds of the variance in disability.

Dr. Bishop explains that when individual patients were able to see their pain in a more positive light they would go on to experience less back-related disability:

"In particular, they experienced less disability over the course of treatment when they came to see their back pain as more controllable, when they felt they had better understanding of their back pain, when they felt better able to cope with it, were less emotional about it, and when they felt their back pain was going to have less of an impact on their lives."

The authors acknowledge that it is difficult to assess how representative the sample of patients in the study is. Compared with a British survey of acupuncture users, the participants were similar in age and sex but fewer had previous acupuncture experience.

Dr. Stephen Simpson, director of research at Arthritis Research UK, says that the study emphasizes how the placebo effect influences pain. "The process whereby the brain's processing of different emotions in relation to their treatment can influence outcome is a really important area for research," he adds.

The authors of the study suggest future research should test whether integrating acupuncture with psychological interventions targeting illness and self-perceptions can improve patient outcomes.

"Factors such as the relationship between practitioner and the patient can inform this and we should be able to understand the biological pathways by which this happens," concludes Dr. Simpson. "This understanding could lead in the future to better targeting of acupuncture and related therapies in order to maximize patient benefit." 

The source of the report is here.