Confessions of a Sydney surgeon: why your operation may not work (opens in new tab)

Sorry but I trust a surgeon's opinion, especially one who is willing to step forward publicly and challenge the status quo at risk of their reputation, far more than some random internet user.

This is a pretty stupid example imo, it isn't really workable in practice. You can die from a ruptured appendix and the surgery isn't terribly involved. Whereas people come in constantly with elevated WBCs; it'd require a high index of suspicion to treat for appendicitis with antibiotics in every circumstance. You would probably end up doing more harm than good that way because antibiotics are not benign drugs.

Yes, but the recurrence rate will be lower if you get an appendectomy.

As part of a study? No. This is how studies are done. Give one set of people the real medicine and another people the fake one and see what happens. They are told before hand that they could receive the fake medicine/treatment and they must agree to the study.

Not if they agreed to be part of a study. Otherwise, no one could use a placebo.

In a study, patients aren't lied to exactly; they're told their either going to receive a real treatment or a phony one, but they won't know which.

You can look at sites like the Cochrane Collaboration or NICE.

Cochrane provide meta-analysis of various treatments. The meta review include a good summary of the paper. Here's their list of stuff about acupuncture: http://www.cochrane.org/search/site/acupuncture

NICE reviews evidence of safety and efficacy to try to decide if the English NHS should offer (and thus pay for) a treatment. Nice will sometimes say "do this", sometimes they'll say "we don't have enough evidence to say either way", and sometimes they'll say "do not do". If they recommend to not do something it's because they have plenty of evidence of harm. Here's their list of stuff about acupuncture (a lot of which is of the "do not do" recommendation): http://www.nice.org.uk/search?q=acupucture

England is also introducing "personal health budgets" for people with long term conditions. This is a small pot of money that the patient can spend pretty much how they wish (not on debt, gambling, alcohol, tobacco, or anything illegal) so long as they can persuade a panel. This could include homeopathy or acupuncture. For example: Imagine a person who is frequently and severely self-harming. (They attend emergency department every week, and they're usually admitted from ED into hospital for surgery.) This person may feel that a joining a 5-a-side soccer club and getting acupuncture would help reduce either the frequency or severity of their self harm. http://www.nhs.uk/choiceintheNHS/Yourchoices/personal-health... https://www.england.nhs.uk/healthbudgets/

Acupuncture is a very effective placebo (because you can really feel it working). There's a whole complex theory about points all over the body which affect ailments in different parts of the body, also based on personality type, but (of course!) none of it matters. Carefully poke someone with needles anywhere (and pretend there's some meaning behind the placement) and the effect is the same.

The big give-away that a treatment is just a convincing placebo is that it claims to help with everything.

I tried accupuncture last, I should have tried it first. I love how western medicine calls any mechanism it doesn't understand "placebo" (reference to child comment) or "psychosomatic". Acupuncture worked for me after I exhausted everything western medicine had to offer (short of surgery). I had serious injuries (MRI showed this). I had verified radiating nerve pain, tests showed the nerves were innervated (activated) by these injuries to the spine. Acupuncture did what steroids, gabba blockers, physical therapy, et.al. could not.

Western medicine has some amazing things to offer for serious conditions. Its really silly how most other ailments are covered by crap in the drug store. I say crap because after my wife started treating the family with essential oils, and my acupuncturist's herbal remedies I'm sick less often and recover faster. I even avoided having to have my gallbladder removed. On fucking herbs ¯\_(ツ)_/¯ Do I know why all these organic compounds and odd treatments work? Does that mean they don't? Does it mean it's all psychosomatic? sigh Maybe, just maybe people in the east figured out a system for treating many ailments. Maybe western medicine needs to zoom out from the molecule and start looking at the whole patient.

You want a lesson in the limits of western medicine? Watch your child die slowly of cancer. Losing my daughter disabused me of any fantasies of cures just around the corner. Meanwhile top doctors kept saying "we've never seen this before". Western medicine doesn't have answers for half of what people think it does. This isn't CSI. Humble out. If some herbs and acupuncture can heal people then deal with it.

Well, the fun part about acupuncture is this that all the studies that 'disprove' acupuncture are disproving very specific things. Specifically, they show that 'traditional chinese acupencture' with the whole crap about chi and meridians and whatever are not significantly different from the control treatment.

The control treatment is typically use of acupuncture needles in areas not specifically specified by codified acupuncture standards (it is a thing... you can go to school for this stuff remember), or the use of sham needles, which still penetrate by like half a inch or something.

All most of the studies you will find that both arms (control and 'real' acupuncture) both show similar improvements in outcome. A valid (and I think the right one) conclusion to draw from these studies is that while the internal logic of acupuncture doesn't do anything, the mechanical action of poking needles into the body has non-trivial benefits.

If you can't get acupuncture covered by insurance, you can look into dry needling (its mechanically the same thing...). A quick google search tells me that some states will allow chiropractors and physiotherapists to perform dry needling and may fall under different insurance buckets.

edit: sorry, I forgot to add this in. obviously poking needles into muscles won't do anything for stuff that isn't rooted in muscles/other connective tissue. Won't do shit for your asthma or allergies for example...

Trust results. For some people the best medicine is guided by some change from within. I believe that as far as positive outcomes are concerned (ruling out helpful communities and other factors) the actual reason that placebos and that any organized system of belief work for some people is the same. They want to, and believe that they will, get better; thus they do, or at least they learn to cope. It's pretty much a psychological solution.

You can talk your way out of some problems; but not all problems. Some things require physical changes driven by external (alien to the self) forces.

Acupuncture does not need even to have an effect of placebo to be helpful.

One benefits from anything that at worst can bring very little harm if it keeps the person from a surgery with a small upside at best but that can potentially bring a lot of harm through post-operational complications.

I had a herniated disc - incredibly painful and it had terrible affects on my mood and my weight as well. I found that most of the effective treatments were ones that put me in a better mental state even if they had no effect on the pain. As someone else said; trust results!

The problem is that due to the placebo effect you will never know what is real or not. That said I would suspect that a lot of alternative medicines have therepeutic benefits. We just don't know why or how.

Don't trust it, try it. If it works for you, it works. If not, try somewhere else. I've tried ayurveda, which even doesn't use needles, just some weird hippie waving with hands above me, not even touching me, and nothing else has give me so much energy back in a period when my energy was really low. I've tried acupuncture then as well, and various other alternative techniques. Most of them were very relaxing, like a day in a spa, and a day later the effect was gone.

I've tried to analyse what the therapist did, but couldn't explain it. The only - off the chart - explanation is that everything is energy, and that we have energy outside our body boundaries that can influence our well being. I'm pretty down to earth. I've met enough people who worship these alternative methods, and I don't. But if it works, it works, and I will use it.

So maybe this is not promoting acupuncture, but I'm just saying that these alternative methods can do stuff to me - but maybe not to you - and modern medicine cannot explain it. Acupuncture may work like this in another situation and for other persons.

Then there is another big thing regarding acupuncture, and that is holism, which makes the acupuncturist look at the whole picture, all your problems, qualities, strenghts and weaknesses.

It is much lower.

http://healthland.time.com/2011/08/04/under-the-knife-study-...

"People have always been afraid of general anesthesia. Many fear they won’t wake up from this “artificial sleep” — actually more of a coma, albeit drug-induced and reversible. In the 1940s, for every one million patients operated on under full anesthesia, 640 died. By the end of the 1980s, fatalities were down to four per every million, thanks to modern safety standards and better medical training. However, a recent article published in the Deutsches Ärzteblatt, the German Medical Association’s official international science journal, shows that after decades of decline, the worldwide death rate during full anesthesia is back on the rise, to about seven patients in every million. And the number of deaths within a year after a general anesthesia is frighteningly high: one in 20. In the over-65 age group, it’s one in 10."

It is absolutely way too high. Here's a paper that puts it at about 1 per 13,000: Lagasse (2002): http://student.purduecal.edu/~jbojczuk/Research/Anesthesia%2...

It's worth noting that their data contains zero observed deaths in ASA Physical Status I Patients, which are basically healthy adults.

I would assume things have either stayed the same or improved: Sevoflurane was just starting to be used around the time that the data were taken for that paper.