terça-feira, 3 de agosto de 2010

Acumpultura para dor Cronica no New England - A polêmica

Um artigo publicado no New Englando Journal of Medicine de 29 de Julho já causou bastante polêmica pelo tema. A medicina clássica não reconhece o valor da acumpultura pois as evidências científicas dessas técnica são muito escassas. Por outro lado pacientes referem alivio da dor.

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Free Abstract

This article has no abstract; the first 100 words appear below.


This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the authors' clinical recommendations.


A 45-year-old construction worker with a 7-year history of intermittent low back pain is seen by his family physician. The pain has gradually increased over the past 4 months, despite pain medications, physical therapy, and two epidural corticosteroid injections. The pain is described as a dull ache in the lumbosacral area with episodic aching in the posterior aspect of both thighs; it worsens with prolonged standing and sitting. He is concerned about losing his job, while at the same time worried that continuing to work could cause further pain. The results of a neurologic examination and a straight-leg–raising test . . .

Source Information

From the Center for Integrative Medicine, University of Maryland School of Medicine (B.M.B.), and the University of Maryland Dental School (R.D.) — both in Baltimore; the Department of Neurology and the Program in Integrative Health, University of Vermont College of Medicine, Burlington (H.H.L.); and the Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin (C.M.W.). Address reprint requests to Dr. Berman at the University of Maryland School of Medicine, 2200 Kernan Dr., Baltimore, MD 21207, or at .

Media in This Article

Figure 1

Figure 1. Acupuncture Meridians.

Twelve of the major acupuncture meridians are associated with a specific internal organ (e.g., heart, lung, or spleen), and an additional eight meridians are considered to be vessels or reservoirs of energy (qi) not associated with internal organs. Shown are the governing vessel (GV) meridian (black), the urinary bladder (UB) meridian (green), and the gallbladder (GB) meridian (blue).

Figure 2

Figure 2. Acupuncture Points Used in the Treatment of Chronic Low Back Pain.

Shown are the locations of acupuncture points that are commonly used in the treatment of chronic low back pain, including UB 23 (shenshu), UB 25 (dachangshu), GV 3 (yaoyangguan), UB 40 (weizhong), and GB 30 (huantiao). GB denotes gallbladder, G

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Quackademic medicine infiltrates the New England Journal of Medicine [Respectful Insolence]
3 de agosto de 2010 10:00

One of the things that disturbs me the most about where medicine is going is the infiltration of quackery into academic medicine. So prevalent is this unfortunate phenomenon that Doctor RW even coined a truly apt term for it: Quackademic medicine. In essence, pseudoscientific and even prescientific ideas are rapidly being "integrated" with science-based medicine, or, as I tend to view it, quackery is being "integrated" with scientific medicine, to the gradual erosion of scientific standards in medicine. No quackery is too quacky, it seems. Even homeopathy and naturopathy can seemingly find their way into academic medical centers.

By far the most common form of pseudoscience to wend its way into what should be bastions of scientific medicine is acupuncture. Harvard, Stanford, Yale, M. D. Anderson, and many others, they've all fallen under the sway of the idea that somehow sticking thin little needles into points that bear no relationship to any known anatomic structure and that supposedly "unblock" the flow of some sort of "life energy" that can't be detected by any means that science has. Most recently, as I described, studies that seek to "prove that acupuncture works" have found their way into high quality, high impact journals whose editors should know better but apparently can't recognize that the evidence in the study doesn't actually show what the authors claim it shows. Even so, there are some journals that I didn't expect to see this sort of infiltration of quackademic medicine. Granted, I never expected it to show itself in one of the Nature journals, as it did in the study I just mentioned. I also never expected it to show up in that flagship of clinical journals, a journal that is one of the highest impact and most read medical journals that exists. I'm talking the New England Journal of Medicine, and, unfortunately, I'm also talking an unfortunately credulous article from Dr. Brian M. Berman, who is the founder of the Center for Integrative Medicine, University of Maryland School of Medicine and the holder of multiple NCCAM center grants, and other institutions, entitled Acupuncture for Chronic Low Back Pain.

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