You won’t be surprised to learn that I’m a big fan of modern medicine. From the 60-year-old man who suffered a cardiac arrest and was brought back to life with a defibrillator to the teenager with appendicitis who was helped by emergency surgery, every day I see Western medicine not only working well, but saving lives.
I used to think that modern medicine was the salvation from all ills and looked down on people who claimed to have benefited from alternative remedies like acupuncture.
I would chuckle when a patient told me that yoga, rather than sertraline, was more helpful for their stress, and I would make fun of those who took vitamins or supplements for this or that.
Alternative medicine was not only not for me, but at best it seemed like a waste of money and almost certainly harmful. But now I can announce a radical change.
Because for many patients, the approach that is so ingrained in our medical psyche is clearly failing. We have chronic pain patients taking excessive doses of addictive (and often ineffective) opioid painkillers, for example, and others with insomnia whose sleeping pills have led to long-term dependence and health problems.
There is evidence that acupuncture may be effective in treating gastrointestinal pain, migraine, and menopausal symptoms.
Let’s also not forget patients who take multiple medications for heart failure, blood pressure and high cholesterol, to combat the side effects of unhealthy Western lifestyles filled with too much processed food and not enough exercise.
Although necessary, many of these medications have side effects and can cause harm.
A few months ago I treated a man who suffered a fall and was a perfect example of the drawbacks of our current approach.
He was in his 80s and suffered from dementia, as well as all the hallmarks of early Parkinson’s disease. He had also been suffering from back pain and insomnia, and had been prescribed codeine, an opioid painkiller, as well as zopiclone to help him sleep.
She had high blood pressure and was also taking amlodipine, which lowers blood pressure but can make you dizzy if you stand up quickly.
At 3 a.m., she got up to go to the bathroom. The combination of her medications made her reflexes slower, and when she slipped on a rug, she couldn’t grab the handrail in time. She fell, broke some ribs, fractured her arm, and suffered significant bruising all over her face.
For a healthy person, these injuries would be easily manageable, possibly even without the need for hospitalisation. But for him, living alone at home was very difficult. After a three-week stay in hospital, he was discharged and moved to a residential care home, where he lost his independence. The side effects of the medication he was taking are to blame.
Now, the argument of modern medicine is that there were no alternatives to these drugs, so we must accept the side effects.
But in the last few years of my career, I have begun to question this orthodoxy. A healthier lifestyle might have meant my patient did not need amlodipine, yet without his other medications, he would still have been in pain and sleeping poorly. Or so I thought.
Last month, a study was published in the prestigious journal JAMA Network Open showing 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 received acupuncture or sham acupuncture (using needles that do not penetrate the skin).
After four weeks of treatment, those who received real acupuncture slept significantly better.
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 (we consider that a drug works if the results due to chance are less than one in 20).
Despite the remarkable results, the paper was published without fanfare (no pharmaceutical company funded the advertising).
The new findings echoed an acupuncture trial in 72 insomnia patients published in 2017 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 have been replicated using the best form of scientific experimentation: randomized controlled trials.
It doesn’t fit the medical model I was taught—and I teach—but the only conclusion we can draw is that the model I believed in is not entirely correct.
Reading about these studies made me look into where else acupuncture might work.
There is evidence that it may be effective in treating gastrointestinal pain, migraine, and menopausal symptoms.
Crucially, it could also treat chronic pain, such as back pain, which I — like millions of others — suffer from, and for which there are few effective treatments available.
The first review of studies on acupuncture for back pain was published in 2005 in the Annals of Internal Medicine and pooled the results of seven trials. It showed that acupuncture was as effective as other treatments, such as opioid medications, but without the side effects.
But when I read the medical journals and undertook the continuing professional development that physicians are required to do, it was the for-profit drug trials that were shoved down my throat, while the results of the “non-profit” acupuncture trials were ignored.
But I am so impressed with the results of these acupuncture studies that I have booked an appointment later this week to see if it can help me with my back pain.
It’s not just acupuncture. At a Royal College of Emergency Medicine conference this month, a report on a type of traditional Chinese medicine was featured as one of the ten most influential papers published last year.
This surprised the audience because the results were so unexpected.
The study, published in JAMA, showed that the traditional Chinese medicine 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 with a placebo.
Both the treatment group and the placebo group also received the standard treatment, so we can only conclude that there was something about the tongxinluo that had such a beneficial effect.
Again, even if we don’t understand how it worked, we can’t dismiss these findings.
Of course, we have to remember that an herb is an herb until it is proven to have a medical benefit, and then it is called a drug.
For example, digoxin and aspirin are life-saving drugs, but they were originally derived from the foxglove plant and willow bark, respectively.
We need a randomised controlled trial in the UK to see if the results of this Chinese treatment can be reproduced in the patients I treat.
This brings me back to my change of heart: I believe in medicine (conventional and now alternative) that works, as demonstrated by the best available evidence.
This is not necessarily a randomized controlled trial, which is the gold standard. For example, we know the dangers of smoking and we advise against it. This is not based on randomized controlled trials, but on observations of what happens to smokers and non-smokers.
But there are still some areas that I am not interested in: homeopathy, for example, has never been shown in scientific studies to work. In fact, many trials have shown that it does not work at all.
So for my back pain I am taking paracetamol, doing the exercises my physiotherapist recommended and now I am also having my first acupuncture session.
@drrobgalloway