Infertility and Acupuncture
Today I left my usual haunts in Hamilton and ventured back to my alma mater for an infertility conference given by Mount Sinai hospital in Toronto. Overall the day was interesting, although at the end of it I am left wondering what (other than the MAINPRO credits) I gained from it that I couldn’t have learned by 30 minutes of reading. Maybe I’m just too close to having done all of this in medical school / through Ob/Gyn electives… *shrug*
The part that most struck me though was the invasion of CAM into what was otherwise a very scientific and evidence-based talk. They asked Noel Wright, an acupuncturist, to give a little talk on acupuncture and how it could help with infertility.
Not to tread too far down the ad hominem path, but one comment has to be said: they could have at least found a more charismatic speaker. If you’re going to try to peddle meridians and re-balancing qi to a room full of Western-trained physicians, you should at least be able to hold their attention convincingly for more than a minute.
She started with a number of possibilities for the mechanism by which acupuncture works — yes, ‘Quantum Physics’ was on the list, without any explanation, of course. The bottom line, which was highlighted by the ‘con’ acupuncture speaker later, is that we have no idea how it works. She also seemed to be big on taking as a given the premise that acupuncture does work, which in my mind is certainly not a given.
Anyway, barely a few slides into her presentation, she had already mentioned half a dozen times that research on acupuncture and other traditional / alternative medicines was difficult to do. Finally she gave her reason — that treatment is individualized to the patient, and so using the same acupuncture points as required by western study protocols means that acupuncture won’t work (or at least, not as well). First of all — now I’m not a clinical researcher so correct me if I’m wrong — couldn’t you design a study that pitted placebo or sham acupuncture vs. ‘personalized treatment as developed by a qualified acupuncturist following such-and-such a standard’? I certainly would be happy with that, if it actually showed good results. I suspect that these are not done because a failure could then be blamed on the particular acupuncturist or system thereof…
The middle of her presentation was a crash course on traditional chinese medicine explanations for infertility (e.g. Kidney Yang/Yin Deficiency, Liver Qi stagnation, Damp-phlegm obstruction, etc.). Noel kept using phrases such as “In Chinese medicine, the Liver does the same things as in Western medicine, but it also does…”. Now as far as I know, physiology doesn’t change depending on how you think, or where you live, so I will be charitable and interpret it that she was equivocating between Liver in the Western sense (meaning the organ that lives in the RUQ of your abdomen) and the idea of “Liver” in TCM. She needs to be clearer in this distinction though, I could see she lost everybody in the audience as soon as she started this line of ‘explanation’.
Now TCM has been around for hundreds (thousands?) of years, so in all this talk they get some things right (e.g. blood deficiency symptoms approximately equal anemia), but it’s like using Ptolemeic astronomy at NASA. We have a simpler, better system that is less error prone and proven to work.
Luckily, one of the infertility Fellows did a very nice analysis of the studies done in the area of acupuncture for infertility — the conclusion was that the studies were small, not blinded, and generally unconvincing. There is still no demonstration of mechanism; the studies done used 1 or 2 acupuncture treatments when acupuncturists are running around saying the ideal course is weeks of treatment… and so on. The interesting thing that he highlighted was that in one study, the sham acupunture group had fertility rates far below acceptable — could sham acupunture (aka acupuncture done wrong) be harmful?
He also touched on the point that these are vulnerable, desperate people, who are being sold this relatively expensive treatment with no proven benefit.
In what I think is a little too much deference, the speaker belittled this point by bringing up the enormous cost of infertility treatments in general, and implying the “who am I to talk” line of thinking. But there is a key difference — IVF and other ARTs have been shown to work for most people. If you don’t use them, your chances of having a baby are miniscule. Acupuncture is nowhere near that level of evidence for success.
Where I see the need for deference is to the patient. If they want to partake in whatever woo fad is in today, I certainly won’t stop them (nor should I have the power to even if I wanted…). One thing these studies generally agree on is that there is no convincing evidence of harm from acupuncture to anything but people’s pocketbooks, so I don’t feel too bad about it. But don’t ask me to extend respect to the people who peddle — to couples desperate for any hope — moving qi energy around your body to relieve “damp heat”, without a shred of evidence for their mythology or even for the efficacy of their treatments.
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