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Welcome to the May 2012 homepage edition of i2P-Information to Pharmacists. Rollo Manning has been having some time out having staples removed from the site of his open heart surgery.He is now at home recuperating in Darwin, having arrived home last Friday, beating a cold and hasty retreat from Canberra.We all wish him a speedy recovery and hopefully, he will be fit enough to contribute by next month.
This month, Pharmedia discusses the toll that is taken when someone complains about you to an authority without good cause. Well, the good news is that you can now take action to protect yourself if such a complaint is made, and that may even include action for defamation. Read about a recent case involving two doctors, with Mark Coleman drawing on personal experience to illustrate.

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Quackery, Skeptics and Acupuncture….

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	Chris Wright articles by this author...
Chris has spent many years in the pharmaceutical industry and is semi-retired. He has an interest in supply chain procedures, and work flows within community pharmacies, and he provides consultancies around those activities.

The reaction to the little piece about Naturopathy and my doctor (published in a June i2P update) has caused some not entirely surprising flame bursting by those who believe a remedy must be science based.
Hmmm, a good point.

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The presumed and/or questionable attributes of acupuncture seem to be the bone of contention. This is of course not unreasonable, given that i2p is a professional industry publication and does not have snake-oil sales people or witch doctors lurking behind the scenes, (to the best of my knowledge) despite the fact it often provides an alternative view of the world of pharmacy.

In defence of my doctor, (whom I will actually ask to comment in these pages herself) I should point out that she is not only a naturopath and acupuncturist but she lectures on the relationship between these skills and medicine. She works in a practice of about 15 rotating doctors and is one of only 2 in the practice skilled in acupuncture.

Placebo or not, I was introduced to acupuncture some 15 years ago at the same practice in an act of some desperation. I simply had to be able to function physically and had severely pulled a muscle in my chest, which was not only agonizing but had me shuffling around like an orangutan. Fifteen minutes and 11 needles later I thought I was an Olympian.

Placebo? Hmmm, I’d never deny the possibility but highly unlikely.

In defence of “quackery”, if you are over the age of about 50, live in Melbourne and follow football (real football, that is) you are likely to be familiar with the guy who fixed footballers ailments down at the long gone South Melbourne Footy Club.

Sadly his name escapes me now but he was legendary at the time. He was not a health professional but had an innate knowledge of bone structure and joints.

It was a simple system, walk in, queue up, take your turn and leave some money in the jar on the way out.

Was he delivering placebo to the hundreds he attended to? Of course not, he would have been well and truly exposed.

As for placebo, is it not the best of all cures, anyway.

Certainly there is an emotional difference between naturopathy and acupuncture and their acceptance professionally. Naturopathy has become a healthy source of income for many pharmacies, and rightly so……and I note the absence of snake ears, live tarantulas’ and four legged snapper on the shelves of pharmacies.

I accept that acupuncture is an unknown quantity scientifically, but does it really matter?

However there appears to be some evidence floating around and what follows is a recent research report:

The Journal of the American Board of Family Medicine 23 (3): 354-362 (2010)
DOI: 10.3122/jabfm.2010.03.080252
© 2010 American Board of Family Medicine

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Perceived Benefit of Complementary and Alternative Medicine (CAM) for Back Pain: A National Survey

Anup K. Kanodia, MD, MPH, Anna T. R. Legedza, ScD, Roger B. Davis, ScD, David M. Eisenberg, MD and Russell S. Phillips, MD

Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School Osher Research Center, Boston (AKK, RBD, DME, RSP)
Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (AKK, RBD, RSP)
Vertex Pharmaceuticals, Cambridge (ATRL)
Department of Medicine, Osher Clinical Center for Complementary and Integrative Medical Therapies, Brigham and Women's Hospital, Boston (DME), MA

Correspondence: Corresponding author: Anup Kanodia, MD, Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, 401 Park Drive, Suite 22-A West, Boston, MA 02215 (E-mail: Anup_Kanodia@hms.harvard.edu )

Background: Complementary and alternative medicine (CAM) is commonly used to treat back pain, but little is known about factors associated with improvement.

Methods: We used data from the 2002 National Health Interview Survey to examine the associations between the perceived helpfulness of various CAM therapies for back pain.

Results: Approximately 6% of the US population used CAM to treat their back pain in 2002. Sixty percent of respondents who used CAM for back pain perceived a "great deal" of benefit. Using multivariable logistic regression, the factor associated with perceived benefit from CAM modalities was reporting that a reason for using CAM was that "conventional medical treatment would not help" (odds ratio [OR], 1.46; 95% CI, 1.14–1.86). The 2 factors associated with less perceived benefit from CAM modalities were fair to poor self-reported health status (OR, 0.58; 95% CI, 0.41–0.82) and referral by a conventional medical practitioner for CAM (OR, 0.7; 95% CI, 0.54–0.92). Using chiropractic as a reference, massage (OR, 0.62; 95% CI, 0.46–0.83), relaxation techniques (OR, 0.25; 95% CI, 0.14–0.45), and herbal therapy (OR, 0.3; 95% CI, 0.19–0.46) were all associated with less perceived benefit whereas those with similar perceived benefit included yoga/tai chi/qi gong (OR, 0.71; 95% CI, 0.41–1.22) and acupuncture (OR, 0.71; 95% CI, 0.37–1.38).

Conclusions: The majority of respondents who used CAM for back pain perceived benefit. Specific factors and therapies associated with perceived benefit warrant further investigation.

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