You may not be surprised to know that I am a big fan of modern medicine. From the man in his 60s with a heart attack we resuscitate using a defibrillator, to the young man with appendicitis to the young man recovering from emergency surgery, I see every day that Western medicine not only works well, but saves lives.
I thought modern medicine was the savior of all ills, and I rejected people who claimed to benefit from alternative remedies like acupuncture.
I chuckled quietly under my breath when a patient told me how yoga could help with their stress instead of cetraline. And blame those who took vitamins or supplements for this.
Not only was alternative medicine not my bag, I thought it was a waste of money – and certainly harmful. However, I can now announce a screaming U-turn.
Because for many patients, our so accessible approach to the medical psyche clearly fails. For example, we have patients with chronic pain who have been given addictive (and often ineffective) opioid painkillers, and those with insomnia whose sleeping pills have led to long-term dependence and ill health.
There is evidence that acupuncture may be effective for gastrointestinal pain, migraines, and menopausal symptoms.
And let’s not forget patients who use multiple medications for heart problems, blood pressure, and high cholesterol to combat the side effects of an unhealthy Western lifestyle of overly processed foods and insufficient exercise.
Although necessary, many of these medications have side effects and can cause harm.
A few months ago, I treated a man after a fall that was a perfect example of the downside of our current approach.
He was in his 80s and suffering from dementia – and all the symptoms of early Parkinson’s disease. He suffers from back pain and insomnia, and is prescribed the opioid pain reliever codeine as well as zopiclone to help him sleep.
He had high blood pressure and was also on amlodipine, which lowers blood pressure but can make you dizzy if you stand up too quickly.
At 3 am he got up to go to the bathroom. His combination of drugs slowed his reflexes, and when he slipped on a rug, he failed to catch the handrail in time. He fell and suffered several broken ribs, a broken arm and significant bruising all over his face.
In a healthy person, these injuries can be easily managed, perhaps even without hospitalization. But he found it very difficult to live alone at home. After a three-week hospital stay, he was discharged to a residential home and lost his independence. The fault lay with the side effects of the drugs he was taking.
Now the argument of modern medicine is that we have to accept the side effects because there was no alternative to these drugs.
But in the last few years of my career, I began to question this orthodoxy. A healthy lifestyle can certainly account for my patient not needing his amlodipine, however, without his other medications, he would still be in pain and sleeping poorly. Or so I thought.
Last month, a study was published in the journal JAMA Network Open that showed how effective acupuncture can be in helping Parkinson’s patients sleep. (Two out of three patients suffer from insomnia.)
In the study, patients at Guangzhou University Hospital in China were given either acupuncture or sham acupuncture (using needles that do not penetrate the skin).
After four weeks of treatment, those who received real acupuncture had significantly better sleep.
The effect lasted for another four weeks. The quality of the trial was excellent and the statistical analysis showed that the risk of the results being due to chance was less than one in 1,000 (with a drug, we consider it to work if the chance of the results occurring by chance is less than one in 20) .
Despite the remarkable results, it was published without publicity – no pharmaceutical company funded the campaign, you see.
The new findings echo a 2017 trial of acupuncture in 72 insomnia patients published in the journal Sleep Medicine, which showed similar results.
I’ll be honest, I don’t know how it works. But does it matter?
Acupuncture has been practiced in China for thousands of years, and its results are now being replicated with the best kind of scientific trials—randomized controlled trials.
It doesn’t fit the medical model I was taught – and still teach – but the only conclusion we can draw is that the model I believed in was not entirely correct.
Reading about these studies led me to research other places where acupuncture might work.
There is evidence that it may be effective for gastrointestinal pain, migraines, and menopausal symptoms.
Crucially, it can treat chronic pain such as back pain, which I – like millions of others – suffer from, and for which there is little in the way of effective treatment.
The first review of studies of acupuncture for back pain was published in the journal Annals of Internal Medicine in 2005 and pooled results from seven trials. This shows that acupuncture is as effective as other treatments, such as opioid drugs, but without the side effects.
But as I read medical journals and did the continuing professional development that doctors so desperately need, what was shoved down my throat were the profit-making drug trials—and the acupuncture trials were ignored.
But I was so impressed with the results of these acupuncture studies that I booked myself in later this week to see if it might help my bad back pain.
It’s not just acupuncture. A report on a traditional Chinese medicine was presented as one of the ten most influential papers published last year at a Royal College of Emergency Medicine conference this month.
This raised eyebrows among the audience as the results were so unexpected.
Reported in JAMA, the study showed that the traditional Chinese drug tongxinluo — derived from plants and insects — taken after a heart attack led to a 36 percent reduction in outcomes such as stroke or death compared to a placebo.
Both the treatment and the placebo group also received the standard treatment, so we can conclude that there was something in the tongxinluo that caused such a beneficial effect.
Again, because we don’t understand how it worked, we can’t rule out these findings.
Of course, we must remember that an herb is a medicinal plant until it is proven to have a medicinal benefit – then it is called a medicine.
For example, digoxin and aspirin are life-saving drugs, but were originally derived from the foxglove plant and willow bark, respectively.
We need a UK based randomized controlled trial to see if the results of this Chinese treatment are replicated in the patients I treat.
Which brings me back to my U-turn: I believe in medicine — mainstream, and now alternative — that it works, and is proven by the best available evidence.
It is definitely not a randomized controlled trial – the gold standard. For example, we know the dangers of smoking and advise against it. This is not based on randomized controlled studies, but on observations of what happens to smokers and non-smokers.
But there are still some taboo areas for me: for example, homeopathy has never been shown to work in scientific studies. In fact, many experiments have shown that it does not work at all.
So for my bad back pain, I take paracetamol, do the exercises recommended by my physio – and now have my first acupuncture session.
@drrobgalloway
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