Recent rapid responses

Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on bmj.com. Although a selection of rapid responses will be included as edited readers' letters in the weekly print issue of the BMJ, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window.

Displaying 1-6 out of 6 published

16 February 2009

White and Cummings want that "Future research should define the optimum parameters and response variables for acupuncture..."

I suppose that now even the BMJ is allowing the misuse of parameter the fight to preserve its proper meanings is lost. (1,2) However, I am bound to say that I do not know which of parameter's many meanings is intended by the writers.

1 Goodman NW. Paradigm, parameter, paralysis of mind. British Medical Journal 1993; 307; 1627-1629.

2 Goodman NW, Edwards M. Medical writing: a prescription for clarity. (3rd ed) Cambridge: CUP, 2006: p 79-80.

Competing interests: None declared

Competing interests: None declared

Neville W Goodman, Retired Anaesthetist

Bristol, BS9 3LW, UK

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12 February 2009

Dear Dr Hegde,

I hope you would agree that traditional medicine should also be subjected to some kind of rigourous scintific scrutiny. If for some reason "our" methodology is not good enough to test "their" practices, then they must find an alternative way to demonstrate their effectiveness. There has to be some yardstick. Nobody is saying that it must be P value.

With regards,

Abhijit Bal

Competing interests: None declared

Competing interests: None declared

Abhijit M Bal, Consultant

Department of Medical Microbiology, Crosshouse Hospital, NHS Ayrshire and Arran, KA2 0BE

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11 February 2009

Dear Editor,

In modern medical statistical science we seem to be in a cocoon and are not able to look beyond the tip of our noses. We are like the Spanish, before Christopher Columbus discovered the new world, with their National Flag’s old insignia of “Ne Plus Ultra”- no more beyond! Time has come for us to get out of this in view of the quantum leap taken by quantum physics in the field of human biology and human consciousness. The new transcendental reality of the existence of "subtle energies" which could only be measured using newer devices has come to stay.

Professor Joie Jones of University of California in Davis has done phenomenal work in the field of acupuncture and praanic healing using fMRI validation. The results are unbelievable to conventional thinkers in medicine. The paper is in the press.

Emeritus professor William A Tiller, a physicist turned material scientist, at Stanford is the father of "subtle energy" research where he has shown, by elegant experiments, the validity of acupuncture and other modalities of treatment. (www.william tiller.com)

“Subtle Energy fields might be a fundamental manifestation of energy that underlies classical energy systems. We need to invoke current theories in physics to postulate possible scenario for SE production. It is known that what we thought of as vacuum or empty space is not really so. Quantum theory predicts this vacuum is really a container of enormous amounts of energy. Particles seem to appear and disappear out of this vacuum. Such processes are presently called Zero Point Fluctuations (ZPF), providing an infinite energetic background for the physical world,” writes Dr. TR Srinivasan, a nuclear physicist.

“Subtle energies from the universe course into the human body through the bioenergy systems, and after conversion into physical forces, aid the physical body in maintaining health. If this picture of eastern medicine (acupuncture etc.) is even partially true, Professor Tiller’s subtle energy measuring instruments provide a more detailed explanation of the possible mechanisms. Prof. Tiller has proposed that magnetic vector potentials are the means by which energy exchanges occur between subtle energy fields and the physical world of electromagnetics,” he adds.

There is more beyond-plus ultra-the new insignia of the Spanish Flag.

Yours ever, bmhegde

Competing interests: None declared

Competing interests: None declared

BM Hegde, Editor in Chief, Journal of the Sciecne of Healing Outcomes.

Mangalore, India.

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White and Cummings1 are right to suggest that further research is needed to evaluate the role of acupuncture in the management of chronic pain. However, they have not discussed the possibility of acupuncture as a method of pain relief during labour. Dissatisfaction with traditional methods is encouraging many mothers to seek acupuncture for their obstetric care and nearly 10% of patients seeking care from an acupuncture practitioner in the United Kingdom is for obstetric and gynaecological purposes2.

The evidence to support acupuncture for pain relief in labour is limited but a small number of studies seem to indicate that there is less need for epidural analgesia or other analgesics in patients who have received acupuncture through needles3,4. It is generally observed that administration of acupuncture techniques during labour is time consuming and may indeed interfere with routine monitoring of mother and baby5.

The expectations of pregnant women are changing and significant numbers are seeking non-traditional methods to help with the delivery of their baby. There is limited evidence to suggest that acupuncture has a role to play in the whole process of labour and this needs to be researched further.

References:

1. White A, Cummings M. Does Acupuncture Relieve Pain? British Medical Journal 2009, 338, p303-0

2. MacPherson H, Sinclair-Lian N, Thomas K. Patients’ Seeking Care from Acupuncture Practitioners in the UK: A National Survey. Complementary Therapy Medicine 2006, 14(1), p20-30

3. Ramnero A, Hanson U, Kihlgren M. Acupuncture Treatment during Labour – A Randomised Controlled Trial. British Journal of Obstetrics and Gynaecology 2002, 109(6), p637-44

4. Nesheim B, Kinge R, Berg B et al. Acupuncture During Labour can Reduce the Use of Meperidine: A Controlled Clinical Study Clinical Journal of Pain 2003, 19(3) p187-191

5. Abouleish E, Depp R. Acupuncture in Obstetrics. Anaesthesia and Analgesia 1975, 54(1), p83-88

Competing interests: None declared

Competing interests: None declared

India Ramaiah, 2nd Yr Medical Student

Liverpool L3 5NX

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5 February 2009

Everyone remembers the climber(A Ralston 26 April 2003) in the USA, who on slipping in a rock crevasse had his right hand jammed by a 300 pound boulder,and on the third day cut his own hand off with his penknife. This can be achieved by massive activation of the efferent dorsolateral funiculus thus suppressing perception of pain, to be able to survive.

Many people had done similar things to survive. Even a 7 yo boy in Australia in 2004, who had a fractured clavicle, # ribs, and # humerus plus a pneumothorax but was able to walk 2 kilometers to get help for his dad...who had collapsed near the quad bike.

So why not Acupuncture anaesthesia by similar activation? Hypnosis to stop pain perception may also work this way?

Competing interests: None declared

Competing interests: None declared

A. Breck McKay, Musculoskeletal/Pain Physician

Victoria Piont QLD Australia

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Dear Editor

I read with interest your editorial and the review paper on the effectiveness of acupuncture. Many authors have suggested that acupuncture exerts a placebo effect. While I am not familiar with this topic, I would like to share with your readers an incident over 35 years ago, while my classmates and I witnessed acupuncture anaesthesia as junior medical students on our visit to a university hospital in Guangzhou. In response to our request to learn more about this very popular technique in the '70s, the Sun Yat sen University Medical College arrranged an operation for us to observe. We were given an opportunity to physically examine the patient, a middle-aged woman with a thyroid nodule. We then witnessed the entire operation in the observation tower. Two needles were inserted, one on each hand, in the 'He gu' acupoints (situated on the dorsal webspace between the thumb and the index finger). Both needles were connected to an electrical pulse generating machine. No anaesthestic gas was given and no i.v. medications / i.v. line were seen, and the patient was wide awake.

From her facial expression, we could see no signs of pain or discomfort. After the surgery was finished, she waved at us while still on the table. We examined her again after she left the operating theatre, and the surgeon brought us the resected nodule as well. While I cannot rule out the administration of analgesics during the interval between our physical examination and her appearance on the operating table, I strongly doubt whether placebo effect, or even a shot of analgesics, can sedate a patient so much that she could endure a neck operation without distress. I might add that she was fully conscious and did not appear to be sedated immediately after the surgery, when we examined her again.

TW Wong

Competing interests: None declared

Competing interests: None declared

Tze Wai Wong, professor

Dept. of Community & Family Medicine, School of Public Health, The Chinese University of Hong Kong,

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