Who needs the PDR?

Only a few lines in this piece are about acupuncture, but I thought it was worth posting for the subject matter alone.  The thing they do not mention is that the PDR does not include drugs that are off patent, so it is basically a sales rep disguised as an important looking book.

8 drugs doctors wouldn't take

If your physician would skip these medicines, maybe you should, too

By Morgan Lord

With 3,480 pages of fine print, the Physicians' Desk Reference (a.k.a. PDR) is not a quick read. That's because it contains every iota of information on more than 4,000 prescription medications. Heck, the PDR is medication — a humongous sleeping pill. 

Doctors count on this compendium to help them make smart prescribing decisions — in other words, to choose drugs that will solve their patients' medical problems without creating new ones. Unfortunately, it seems some doctors rarely pull the PDR off the shelf. Or if they do crack it open, they don't stay versed on emerging research that may suddenly make a once-trusted treatment one to avoid. Worst case: You swallow something that has no business being inside your body. 

Of course, plenty of M.D.'s do know which prescription and over-the-counter drugs are duds, dangers, or both. So we asked them, "Which medications would you skip?" Their list is your second opinion. If you're on any of these meds, talk to your doctor. Maybe he or she will finally open that big red book with all the dust on it.

Celebrex 
Once nicknamed "super aspirin," Celebrex is now better known for its side effects than for its pain-relieving prowess. The drug has been linked to increased risks of stomach bleeding, kidney trouble, and liver damage. But according to a 2005 New England Journal of Medicine study, the biggest threat is to your heart: People taking 200 mg of Celebrex twice a day more than doubled their risk of dying of cardiovascular disease. Those on 400 mg twice a day more than tripled their risk, compared with people taking a placebo.

Your new strategy: What you don't want to do is stop swallowing Celebrex and begin knocking back ibuprofen, because regular use of high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to gastrointestinal bleeding. A safer swap is acupuncture. A German study found that for people suffering from chronic lower-back pain, twice-weekly acupuncture sessions were twice as effective as conventional treatments with drugs, physical therapy, and exercise. The strategic needling may stimulate central-nervous-system pathways to release the body's own painkillers, including endorphins and enkephalins, says Duke University anesthesiologist Tong-Joo Gan, M.D.

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Competition!

Well, I knew it was bound to happen.  Doctors don't need acupuncture training to add it to their service list, chiropractors just assume they are qualified to be acupuncturists with or without a "certification course,"  and now physical therapists are getting in on the act!

Needling' Becoming More Popular To Treat Pain

DENVER (CBS4) ― Some physical therapists in Colorado are offering an alternative treatment for chronic muscle pain and stiffness.

On Tuesday, CBS4 health specialist Kathy Walsh sat in on a session of the new treatment called "trigger point dry needling."

Using very thin, solid needles to penetrate deep into areas of tension, dry needling promises to stimulate, reset and relax muscles.

One satisfied dry needling patient is Sgt. First Class Lee Holloway. According to Holloway, dry needling is an effective way to relieve muscle tension.

Although similar to acupuncture, Keil says that dry needling is actually its own distinct practice. 

"It's a very Western concept of muscle anatomy," said Keil. "As compared to the Eastern concept of the meridian through acupuncture."

Some licensed acupuncturists are skeptical of this claim.

The president of the Acupuncture Association of Colorado, Nancy Bilello, says dry needling is just a dubious form of acupuncture.

"Dry needling is the same thing as acupuncture with far less training and very little regulation," said Bilello.

While licensed acupuncturists must have a minimum of 1,800 hours of training, physical therapists hoping to practice dry needling require only 46 hours of training, according to Bilello,

Despite concerns like Bilello's, in 2005 the Colorado Department of Regulatory Agencies did approve dry needling for practice by trained physical therapists.

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WARNING!

Acupuncture. Put needles in. Take needles out. All out? Yes, all out. Periodically, patients with fluffy hair or slippery clothing may have a souvenir left when they put on their hat or pull on their socks due to obstruction of the needle. However, the following is a serious example of when not having a system for insertion and withdrawal can cause a heap of trouble.

Acupunture patient left with 'forgotten' needle

May 9 2008 Media Wales

An acupuncture patient returned home from treatment with a two-inch needle stuck in her back, she said today.

Back pain sufferer Wendy Dempsey had her first acupuncture session on Wednesday at a hospital in Newport, South Wales.

The 54-year-old claims she suffered excruciating pain as she drove the five miles to her Llanmartin home and only realised what was wrong when her nephew Ieuan Edwards started screaming.

Mrs Dempsey said: “I was a bit apprehensive before the treatment, as I’d never had it done before.

“At the end, he said he’d removed the needles, and I felt fine.

“My eight-year-old nephew lives with me, and as I was driving us home I had this most tremendous pain in my back.

“I was in absolute agony. I thought I wasn’t going to get home. I kept slowing down, and every time I changed gears the pain got worse.”

When she arrived home, Mrs Dempsey said she had to wait 15 minutes before moving from the car because of the pain.

She said: “I asked my nephew to have a look at my back when we were in the house.

“He let out an ear-piercing scream. Once he had seen the needle, he was petrified.

“It’s just scared him – and it’s not done too much for me either.

“By driving home, I think I’d pushed it in further.”

Mrs Dempsey was driven to the Royal Gwent Hospital, Newport, by a neighbour, where the needle was removed from near the bottom of her back.

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Military Service (for them)

In an effort to prevent the situation many of our veterans faced following Vietnam, the VA has made wonderful progress in helping our military personnel re-acclimate to their lives before war. Yet in some areas, the services are spectacular, while in others it is sub-par or non-existent. This is why folks like the ones below are a wonderful boon to our soldiers, especially those returning home with PTSD.

Acupuncturists serving the troops

May 4, 2008
Margaret Gargarian respects the fact that her son's high school in Belmont has a community service requirement. "I think it should be part of life," she said.

To do her part, Gargarian - an anesthesiologist at Massachusetts General Hospital who has training in acupuncture - recently joined an offshoot of Acupuncturists Without Borders.

Gargarian and licensed acupuncturists Margaret Ryding, Bill Kellar, and Patricia Burkhart, all of Arlington, offer free, weekly acupuncture treatments for US military personnel who have served in Iraq and Afghanistan.

Gargarian said she believes alternative therapies are valuable because they offer another tool to cure or manage health problems.

Benefits of acupuncture, she said, may include reduced anxiety and irritability; improved sleep, energy, and mental clarity; and the alleviation of flashbacks and nightmares.

Although a client may feel a "quick pinch" as the thin acupuncture needles are inserted,

Gargarian said the treatment is relaxing. Sessions typical last a half hour.

"Every time we treat someone," she said, "it makes us feel good, too."

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Ahhh, Research!

Finding a research study involving acupuncture that has any statistical significance or reproducible design is not an easy task. This one involving hot flashes and tamoxifen is decent, despite the argument that it is not reproducible because there is no pill involved (?!) and the results are subjective (um, last time I checked there was no lab value for pain or discomfort). An objector does bring up a reluctance to send one of his patients to an acupuncturist he is not familiar with, and that should make any practitioner realize that MDs can be an important component to a successful practice. From my standpoint, I would have liked to have known what treatment protocol was used, but with a little digging I am sure it is not difficult to find.

Acupuncture Can Relieve Hot Flushes Caused by Tamoxifen
Monday, 21 April 2008 20:53 Zosia Chustecka

Acupuncture reduced by half the hot flushes caused by tamoxifen in a small clinical trial involving 59 breast cancer patients after surgery. Relief was experienced both day and night, and the reduction in hot flushes was seen 3 months after the last acupuncture treatment.

The study involved a 10-week course of treatment (with sessions twice a week for 5 weeks, and then once a week for 5 weeks). A control group received sham acupuncture, with needles inserted shallowly (to a depth of 3 mm; in real acupuncture, needles are inserted to a depth of 3 cm), and in places far away from known acupuncture points. Ms. Hervik said that in both cases she aimed for a neutral atmosphere, with no soft music and minimal time spent talking to the patient, to reduce the placebo effect of the treatment.

Women treated with real acupuncture reported a 50% reduction in hot flushes, both day and night, and reported a further reduction in hot flushes when assessed 3 months after the last acupuncture treatment. The women in the sham group reported no changes in hot flushes during the day, and a slight reduction in hot flushes at night while the treatment was ongoing, but they increased once the treatment stopped.

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Fellowship Opportunity

If you like the cold and the security of working within the Western Medical setting, this sounds like a winning experience. I had not visited MCAOMs website before (http://www.nwhealth.edu/index.html) but the programs look impressive. This was actually from a chiropractic newsletter.

Northwestern Health Sciences begins acupuncture fellowship program

The Minnesota College of Acupuncture and Oriental Medicine (MCAOM) at Northwestern Health Sciences University now offers a post-graduate fellowship opportunity in collaboration with the Woodwinds Health Campus in Woodbury, Minn.

The one-year fellowship, launched in November 2006, provides a licensed acupuncturist with post-graduate experience in a hospital setting. Mark McKenzie, LAc, MOm, dean of MCAOM, said he believes there are no other acupuncture and Oriental medicine schools in the United States partnering with hospitals to offer such a paid fellowship.

The fellowship is partially funded by HealthEast Care System. Ian Johnson, LAc, MOm, a 2006 graduate of MCAOM, has been selected to carry out the year-long fellowship. He will be working under the guidance of Wei Liu, BMed, LAc, a professor at Northwestern.

According to McKenzie, the fellowship program would not have happened in the Midwest 10 years ago due to lack of understanding about the field.

MIA Message

The news in the acupuncture world has been dismally uninteresting of late. Lots of private practice press releases and "did you know acupuncture was good for" types of news are the bulk of what I have been receiving. I have not felt compelled to pass along things I have already covered, but I also lost total track of time ans I see it has been over two months since my last post! I have not attend any more CEU seminars to report back on either, shame on me, and I am in a quandary as to weather I am going to go see Richard Tan or Mary Elizabeth Wakefield this summer.

However, the other reason for the delay is general life. I started nurse practitioner school this semester and just moved into a new house a few days ago (we had been looking and planning for nearly a year). My practice is continuing to grow and I am hoping to change my office in the next few months.

It somehow seems like a lot more when you live it as opposed to when you write it.