Conta Natura

really???? e eu que até pensava que a acunpulctura já havia sido aceite oficialmente como algo respeitável pela medicina convencial portuguesa, desde a abertura do curso no ICBAS. É muito português esta pouca abertura ao que é culturalmente diferente...se calhar estou a trair a abertura de espírito revelada pelos nossos avós quinhentistas...a comparação com a astrologia é também forte.
Para quem vive ou viveu na América deve saber como ela é aceite nos EEUU e praticada em combinação, ou não, com outras....O argumento simplista do efeito placebo é também um pouco forte e recorrente por aqui.

Sem querer fugir com o rabo à seringa (imagem apropriada), faço notar que a opinião do ciclope cínico não é propriamente a minha opinião. Só isso explica que tivesse colocado um argumento pró-vida quando escrevi a entrada sobre o aborto (sou a favor da despenalização do aborto), por exemplo. O que escrevi agora sobre a acupunctura é obviamente polémico, mas a aceitação que referes (em Portugal e nos EUA) não é pacífica. O debate continua e a discussão está claramente viciada por lobbies e complexos culturais. Por outras palavras, para o ciclope cínico o simples facto de haver dúvidas é suficiente e o discurso politicamente correcto e neutro mataria estes textos.

O comentário que fazes sobre ser muito português a pouca abertura ao que é culturalmente diferente parece-me um erro de "paralaxe cultural".

Parece-me também que explicações simples não devem ser confundidas com argumentos simplistas. Em ciência a tendência é para preferir as primeiras e evitar os segundos. Mas repara que não falei apenas do efeito placebo; mencionei ainda a falácia regressiva, isto é, a tendência para ignorarmos as flutuações naturais na nossa busca das causas.

Dito isto, não me oponho e até aprecio que as entradas do ciclope cínico despertem alguma discussão. Trazer para aqui estudos que sugerem efeitos adicionais ao efeito placebo seria pertinente. Faço apenas notar que também existem estudos com resultados contrários. (Aqui podemos encontrar uma discussão equilibrada: http://en.wikipedia.org/wiki/Acupuncture ). Sem ter estudado a literatura, creio que há suficientes dados empíricos para duvidar do alcance terapêutico e profilático da acupunctura. Mas acrescento também -e este ponto é crucial - que não percebo os fundamentos teóricos da disciplina. Ora, isto pode resultar de limitações minhas (cognitivas e culturais) e é verdade que fui cliente da TAP antes de perceber como voam os aviões mas, na prática - e, repito, nao havendo dados empíricos convincentes - se um dia tiver cancro, vou preferir a quimioterapia à acupunctura.

Prometo voltar a pensar no assunto, mas agora estou com mais dificuldades em traduzir a linguagem de um grande médico, A. Celestino da Costa, que também foi fundador e presidente do nosso research council (1929-1942). Ele gostava de utilizar metáforas científicas para justificar as suas opções estratégicas. Assim usa "endo" e "exosmose" para justificar que poderia haver ligação dos centros de investigação autónomos da faculdade que ele estava a promover na altura por razões óbvias, mas que não constam do m/vocabulário técnico inglês mais orientado para as C. Sociais, can you help me?

Reproduzo aqui um artigo recente no Guardian sobre estudos recentes da eficacia da acupuntura. Os resultados preliminares indicam que so existe um enorme efeito placebo...

Medicine man

An end to 'free' acupuncture sessions? No wonder doctors and patients got the needle

Edzard Ernst
Tuesday March 16, 2004
The Guardian

It is reported by the British Medical Journal this week that a study in the UK has indicated that acupuncture could be helpful for migraine sufferers. In Germany, however, where researchers have conducted the largest clinical trials of acupuncture ever undertaken, the results are not so clear cut. About 500,000 patients were included in these ambitious projects which are sponsored by four large health insurance companies. Previously, acupuncture research suffered from the fact that clinical studies were small, often too small to allow meaningful conclusions. A typical trial would include 50 patients and anything bigger than 100 was already seen as remarkable.

Even the background of these mega-studies is fascinating. In October 2000, the German authorities decided that the evidence for acupuncture was not sufficiently convincing for inclusion in the list of interventions qualifying for reimbursement from health insurance companies. Henceforward Germans would have to pay for acupuncture out of their own pockets, as do most people in Britain.

This announcement created uproar - German doctors who had previously used acupuncture, and received money from health insurers for it, feared that their income would decrease. After intense lobbying it was agreed that acupuncture would be put to the test, and that German doctors experienced in acupuncture could participate in these trials. Crucially, they would be paid for doing so. So doctors were happy to take part and patients thought this was a good way of continuing to enjoy "free" acupuncture treatments.

Several "cohort studies" were started as part of the overall project. These are investigations where all patients receive treatment and the results are monitored and compared to their respective baseline values. Lacking a comparison or control group, such results have to be interpreted with the greatest of caution. But the researchers from Munich, Berlin and Bochum were also keen to embark on more rigorous tests. So they initiated four large controlled clinical trials to determine the usefulness of acupuncture for four conditions: chronic back pain; chronic arthritis of the knees; tension headache; and migraine. These trials also involved univer sity departments at Marburg, Heidelberg, Bochum and Mainz.

Patients were allocated at random to one of three treatment groups: real acupuncture plus standard medical care; sham acupuncture (needles were simply stuck into non-acupuncture points) plus standard medical care; or standard medical care alone. The trials are not yet finished - they were due to end about now, but recruitment was slow and recently it was announced that the deadline has been extended until the end of this year. Preliminary results were leaked nevertheless. They are intriguing: adjunctive acupuncture turned out to be better than standard care but sham acupuncture yields the same benefit as "real" acupuncture.

This is perplexing because it could be interpreted in two dramatically different ways. The optimist (or acupuncturist) would say that the results demonstrate the effectiveness of acupuncture - adding it to standard care improves the outcome compared to standard care alone. Hence acupuncture must be a good thing. On the other hand, the pessimist (or scientist) would insist that these results prove that acupuncture is merely a placebo therapy with no "real" effects of its own. It doesn't matter where we stick the acupuncture needle, the patient improves in any case, and this can only be due to a placebo response. Hence acupuncture has no "real" value.

So do the German mega-studies suggest effectiveness or ineffectiveness? Apparently, there is less room for interpretation than one might think. One of the German investigators, Professor H J Trampisch from Bochum University, recently provided the answer. When asked whether these results demonstrate the success of acupuncture his response was decisive: "No, this cannot be. In our studies, we clearly determined that acupuncture will be deemed effective only if it is significantly superior to sham acupuncture".

If this is true, the biggest trials in the history of acupuncture might be the beginning of the end of this therapy.

· Edzard Ernst is professor of complementary medicine at the Peninsula Medical School at the universities of Exeter and Plymouth.

Any decision you make about your health care is important--including deciding whether to use acupuncture. The National Center for Complementary and Alternative Medicine (NCCAM) has developed this fact sheet to provide you with information on acupuncture. It includes frequently asked questions, issues to consider, and a list of sources for further information. Terms that are underlined are defined at the end of this fact sheet.
Key Points
Acupuncture originated in China more than 2,000 years ago, making it one of the oldest and most commonly used medical procedures in the world.

It is important to inform all of your health care providers about any treatment that you are using or considering, including acupuncture. Ask about the treatment procedures that will be used and their likelihood of success for your condition or disease.

Be an informed consumer and find out what scientific studies have been done on the effectiveness of acupuncture for your health condition.

If you decide to use acupuncture, choose the practitioner with care. Also check with your insurer to see if the services will be covered.
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What is acupuncture?
Acupuncture is one of the oldest, most commonly used medical procedures in the world. Originating in China more than 2,000 years ago, acupuncture began to become better known in the United States in 1971, when New York Times reporter James Reston wrote about how doctors in China used needles to ease his pain after surgery.

The term acupuncture describes a family of procedures involving stimulation of anatomical points on the body by a variety of techniques. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries. The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

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How widely is acupuncture used in the United States
In the past two decades, acupuncture has grown in popularity in the United States. The report from a Consensus Development Conference on Acupuncture held at the National Institutes of Health (NIH) in 1997 stated that acupuncture is being "widely" practiced--by thousands of physicians, dentists, acupuncturists, and other practitioners--for relief or prevention of pain and for various other health conditions.1 According to the 2002 National Health Interview Survey--the largest and most comprehensive survey of complementary and alternative medicine (CAM) use by American adults to date--an estimated 8.2 million U.S. adults had ever used acupuncture, and an estimated 2.1 million U.S. adults had used acupuncture in the previous year.2

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What does acupuncture feel like?
Acupuncture needles are metallic, solid, and hair-thin. People experience acupuncture differently, but most feel no or minimal pain as the needles are inserted. Some people are energized by treatment, while others feel relaxed.3 Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment.4 This is why it is important to seek treatment from a qualified acupuncture practitioner.

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from
http://nccam.nih.gov/health/acupuncture/

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News release
From The University of Southampton

Ref: 05/71
01 May 2005
ACUPUNCTURE: BEYOND THE PLACEBO EFFECT

Researchers at the University of Southampton and University College London have shown for the first time that the impact of acupuncture goes beyond the acknowledged placebo effect caused by the patient's own expectation of feeling benefit from the treatment.

The scientists from Southampton, Dr George Lewith and Dr Peter White of the University's Complementary Medicine Research Unit, have distinguished between the placebo effects produced by a patient's expectation and the real effects of treatment in a group of patients with painful osteo-arthritis, by monitoring specific responses in the brain during treatment.

Working with the Functional Imaging Unit at University College London, Dr Peter White of Southampton and Dr Jérémie Pariente of UCL used sophisticated Positron Emission Tomography (PET) scans to find out what happened in the brains of patients receiving acupuncture-related treatment.

In one intervention patients were touched with blunt needles but were aware that the needle would not pierce the skin and that it did not have any therapeutic value. Scans showed that only the areas associated with the sensation of touch were activated in their brains.

Another intervention involved being treated using specially developed needles that give the impression of skin penetration without actually piercing the skin. The needles work like stage daggers, with the tip disappearing into the body of the needle when pressure is applied. These patients believed that the treatment was real and scans showed an area of the brain associated with the production of natural opiates - substances that act in a non-specific way to relieve pain - was activated in these patients.

Finally, the third intervention was real acupuncture. As well as the opiate centre, another region of the brain, the ipsilateral insular, was also activated during the treatment. This is a pathway known to be associated with acupuncture treatment and thought to be involved in pain modulation.

The brain activity in the third group of patients shows that real acupuncture elicits a demonstrable physiological effect over and above a simple skin prick. In addition, the response of the second group of patients who received the sham acupuncture treatment, indicates that the expectation of and belief in the treatment also has a physiological effect on the brain. The expectation appears to mediate a potentially powerful although non-specific clinical response to acupuncture.

Dr George Lewith comments: "By indicating a very specific neuronal pathway for acupuncture treatment, this research is an important step forward for understanding the basic mechanisms involved in acupuncture and placebo".

The findings are published in the 1 May edition of the journal NeuroImage. Dr Lewith and Dr White hope to continue their work with a more detailed programme of research, in conjunction with their colleagues.

The paper 'Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture' appears in the Vol 25 Issue 4 of NeuroImage published on 1 May 2005 (pp 1161 - 1167). The authors are Jérémie Pariente, Peter White, Richard S.J. Frackowiak, and George Lewith.

Fonte: http://www.soton.ac.uk/mediacentre/news/2005/may/05_71.shtml

"...Ignorante não é aquele que não sabe , mas aquele que se recusa a aprender..." É mesmo preciso identificar o idiota que terá feito tal afirmação? O que é um facto é que o vosso pensamento envergonha a vossa classe (The So called Science Men ) ... Tristes e pequenas mentes, atulhadas de referancias, nomes pensamentos de outrem, mais carneiros, enfim mais um Tuga...Tadinhos e Tadinhas dos que morreram na fogueira porque se lembraram ser possivel visitar a lua... Pena que o nosso unico Nobel não esteja ainda vivo , assim em prol da ciencia sempre poderia continuar a fazer umas lobotomiazitas , dava jeito, melhor dava igual... Talvez um dia se algum de vocês tiver um qq carcinomazito... AHHH e escreve-se acupunctura e já agora quanto ao sadomasoquismo... mas isso é outra conversa...

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