More Tooth Fairy Science: Acupuncture does not improve in vitro fertilization success rates

[SidDithers]

http://scienceblogs.com/insolence/2013/07/03/more-tooth-fairy-science-acupuncture-does-not-improve-in-vitro-fertilization-success-rates-no-matter-what-acupuncturists-say/

More Tooth Fairy Science: Acupuncture does not improve in vitro fertilization success rates, no matter what acupuncturists say

Here we go again.

Oh, well. These things come in waves, and sometimes I have theme weeks. Right now, this week appears to be developing into a week of quackademic medicine involving dubious acupuncture studies. Yesterday, it was acupuncture for lymphedema after breast cancer surgery, a study coming right about what is rapidly becoming the Barad-dûr of cancer quackademia, Memorial Sloan-Kettering Cancer Center. How a hospital that is so awesome in every other way can have such a blind spot bigger than the Eye of Sauron, I don’t know, but it does, and the result is a steady stream of embarrassing forays into quackademic medicine like yesterday’s.

Of course, there is one institution that far surpasses even MSKCC in the power of its quackademic woo, and that is the University of Maryland, home to Brian Berman, king of acupuncture quackademia, and my Google Alerts did there job and, well, alerted me to a new meta-analysis published online late last week in the Journal of Human Reproduction Update. Berman is the corresponding author (of course!), and a research associate by the name of Eric Manheimer is the lead author, and together with other colleagues, they have produced yet another fine analysis of tooth fairy medicine entitled, The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis.

Now, remember all the things I said about the utter lack of prior plausibility for acupuncture for treating lymphedema? You remember, how there’s no plausible biological mechanism that would lead one even to suspect that sticking needles into parts of the body completely unrelated to the physiological mechanisms that result in lymphedema after mehanical interruption of regional lymphatics by surgery? All of that goes double—nay, triple!—for using acupuncture for infertility and improving the pregnancy rates after in vitro fertilization (IVF). I mean, seriously. Think about it. How on earth would sticking needles into the skin improve the odds of conception after this procedure? It wouldn’t, and it doesn’t. That doesn’t stop acupuncturists and acupuncture apologists from heavily selling acupuncture as somehow managing to do just that, against all physiology and reality.

So here’s how the systematic review is being sold:

Acupuncture, when used as a complementary or adjuvant therapy for in vitro fertilization (IVF), may be beneficial depending on the baseline pregnancy rates of a fertility clinic, according to research from the University of Maryland School of Medicine. The analysis from the University of Maryland Center for Integrative Medicine is published in the June 27 online edition of the journal Human Reproduction Update.

“Our systematic review of current acupuncture/IVF research found that for IVF clinics with baseline pregnancy rates higher than average (32 percent or greater) adding acupuncture had no benefit,” says Eric Manheimer, lead author and research associate at the University of Maryland Center for Integrative Medicine. “However, at IVF clinics with baseline pregnancy rates lower than average (less than 32 percent) adding acupuncture seemed to increase IVF pregnancy success rates. We saw a direct association between the baseline pregnancy success rate and the effects of adding acupuncture: the lower the baseline pregnancy rate at the clinic, the more adjuvant acupuncture seemed to increase the pregnancy rate.”

It’s hard not to be a bit snarky here and say that if your clinic is doing well with its pregnancy rate, then obviously you don’t need mumbo-jumbo. However, if you’re not doing so well, maybe some bread and circuses will help.

Always good stuff from Orac.

Sid

[SidDithers]

1. Acupuncture and breast cancer-related lymphedema: Quackademia strikes again

http://scienceblogs.com/insolence/2013/07/02/acupuncture-and-breast-cancer-related-lymphedema-quackademia-strikes-again/

Acupuncture and breast cancer-related lymphedema: Quackademia strikes again

Lymphedema is a complication of breast cancer surgery that all surgeons who do breast surgery detest. Patients, of course, detest it even more. The limb swelling that is the primary symptom of lymphedema comes about because surgery on the axillary lymph nodes (the lymph nodes under the arm) that is part and parcel of surgery for breast cancer can interrupt lymph vessels and cause backup of lymph fluid in the affected arm. This backup has consequences, including skin changes, a tendency towards infections, and, in extreme cases, elephantiasis (which is, fortunately, rarely seen these days as a result of breast cancer surgery). Unfortunately, lymphedema is incurable, and the risk of developing it never goes away after breast surgery.

Lymphedema used to be much more of a problem back in the old days (say, more than 10-15 years ago), when surgery for breast cancer routinely involved an axillary dissection, or removal of most of the lymph nodes under the arm. (For surgery geeks, in breast surgery level 1 and 2 lymph nodes out of three levels, unless, of course, leven 3 nodes are grossly involved with tumor, in which case they’re taken too.) Frequently radiation therapy was needed as well, and the combination of axillary dissection and radiation therapy could produce a risk of lymphedema as high as 50%. Of course, in recent years, sentinel lymph node biopsy, which involves removing many fewer nodes (usually 1-3) has supplanted axillary dissection for most cases of breast cancer, and, consistent with fewer nodes being taken, the risk of lymphedema from sentinel lymph node biopsy is much lower. However, none of this means that lymphedema isn’t still a problem after breast surgery; it’s just less of a problem.

There are only a few basic strategies for treating lymphedema, sometimes called decongestive lymphatic therapy. For the most part, these treatments involve physical therapy, compression sleeves to “squeeze” the fluid out of the affected limb, and sometimes the use of mechanical compression stockings that “milk” the fluid back. It’s all very inconvenient and unpleasant, and there’s no doubt that this particular complication can take a major toll on a patient’s quality of life and sometimes even lead to hospitalizations for infection. It might be less of a problem than it was in years past, thanks to less invasive surgery, but it’s still a problem, and it needs better treatments.

Acupuncture is not one of them.

This is the article from yesterday, that Orac mentions is today's post.

Sid

[cali]

2. I'm sure that's true, but that doesn't mean that

acupuncture is useless for other things.

Personally, I've found it somewhat helpful for the serious pain resulting from Complex Regional Pain Syndrome. And I've tried everything from sympathetic blocks to fentanyl patches, morphine, tens units, physical therapy, cold therapy, gabapentin, lyrica and more.

[HuckleB]

4. It is completely useless.

And like all quack nonsense, it's completely made up.

Chairman Mao: The real inventor of “traditional Chinese medicine”
http://scienceblogs.com/insolence/2013/10/25/chairman-mao-inventor-of-traditional-chinese-medicine/

I used to think it worked, too.

[hlthe2b]

3. There is a real chasm in Acupuncture--those who train in western medicine & are evidence based

and discount the totally unproven "energy channel" Eastern philosophy, versus those who focus on a largely mistranslated and thus totally misunderstood Eastern "energy meridian" type approach from ancient Chinese practices. This is not to criticize Chinese practice, but those who have promoted what now very clearly appears to be early mistranslation of Chinese writings and notions.

The former can point to good evidence for AP and e-stim/AP intervention for pain with respect to acute and chronic musculoskeletal conditions, especially osteoarthritis, suppression of nausea in some conditions and some initial evidence for a few other conditions. That acupuncture needling (and e-stim) can result in the release of endorphins and other active compounds is well documented. Thus, these indications are areas for which insurance often will pay and many European medical systems (e.g., Germany) will preferentially chose an AP course over other medical or surgical interventions.

Unfortunately, the value of AP is severely compromised by those who move from an evidence based approach to conjecture and, yes, "woo".