Episode 53: At Least Wear Gloves…

Aaron talks about the history of acupuncture and why it’s silly. Shea tells patrons about the *real* medical lingo going on…

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Welcome to Interesting If True, the podcast that really sticks it to you. I'm your host this week, Aaron, and with me are: I'm Shea, and this week I learned that in Harry Potter and the Order of the Phoenix, Dumbledore calls Voldemort by his birth name, Tom. This foreshadows the fact that J.K. Rowling does not respect people’s chosen identities.

This Week’s Beer

Simpler Times Lager from Brother-in-law

NADA: Part 1

The Point of Quackery.

This is a kick-off for what will be a multi-show run. It won't be sequential so next week we'll probably be back to our regularly scheduled silliness. This is episode 53, or, the first episode of Year Two. So, I'm going to get all serious and junk. Yep, more serious than Frank Miller. Long-time listeners to our podcasts may recall that my lovely wife, Ashley, suffers from chronic pain. As such, we're the recipients of no small amount of unwanted medical advice from friends and strangers alike, all of whom seem to think their particular brand of magic is the one to fix her up. Those same listeners may be aware that I am made up of, approximately, 60% pure, unadulterated, anxiety. Fortunately, there is no shortage of treatments for anxiety, especially for a cis/het, white man. Still, from time to time there are checkups with doctors and check-ins with therapists that can lean... woo. But let's get to the point—the needly point. In the Venn diagram of our afflictions, the center is full of unscrupulous purveyors of pseudo-medical nonsense. It's part of why I started podcasting and why many of my topics are medically oriented, albeit more often than not ye-oldie medicine. But occasionally… Chronic pain and mental health issues have a few things in common that make them fertile ground for nonsense: self-reported conditions and outcomes, lack of clear research, and societal taboo to name just a few. So, it's not uncommon for well-meaning medical professionals and amateurs alike to recommend unproven and unrealistic treatments like homeopathy, chiropractic, or in the case of this series, acupuncture. Today I want to talk about acupuncture in general. Give an overview and introduction of sorts and from there I'll do episodes on the various associated or evolutions of acupuncture. So, what is acupuncture? For the short answer, I'll quote Science Based Medicine
acupuncture is a pre-scientific superstition
The end. No? Ok. Acupuncture is, ever so briefly, an ancient or traditional form of "medicine" from ye-oldie China, or Traditional Chinese Medicine (TCM) that uses tiny, hair-thin needs to treat illnesses by blocking, redirecting, or "cleaning" chi pathways in the body. You know, magic. Still, among traditional Chinese medicines acupuncture does hold a special place in that it's actually ancient and not just another of Mao's placative measures—though it was used that way, to which we owe much of its modern popularity. It was first described in the Shi-chi text from around 90 B.C.E. This is notable because in 1970 texts from 168 B.C.E. in the Ma-wang-tui graves paint a pretty solid picture of Chinese medicine in the third century B.C.E. They don't mention acupuncture at all, so we know it was invented sometime between 168 and 90 B.C.E. Originally, from the Shi-chi text, it describes 11 mo, or vessels, the held chi. There was no mention of chi flow or interconnectivity. A hundred years later there are 12 mo and flow. It evolved somewhat over the next two millennia, from 11 OG acupuncture points, to a dozen, to dozens or hundreds now depending on who you talk to. The incredibly simplified version is that chi is the life force that flows through your body via meridians. These can become clogged with "hsieh-chi" or evil influences--depending on the century that means demons, spirits, or drinking too much, and so on. Chi was considered to float through the air, flow in the blood, even each organ had its own Chi--this organelle approach lead to people believing they could diagnose internal organs by carefully measuring one's pulse. A "diagnostic" measure still used today. People like to use the word "energy" now. It's more woo-compatible and can be marketed to low-key racists and Karens while still leaning on ancient, Asian mysticism for credibility. The idea, then, was to use tiny needles to redirect, stop, or otherwise correct the flow of Chi to get the bad stuff out at specific points in the body, often where the meridians overlap, or as the text translates to directly "caves" in the skin. These are your acupuncture points and while there is usually a common base-set, you'll play hell trying to find a consensus on how many there are or even where they all are. In the early 1900s, China became focused on the industrial revolution of the western world and began to replace TCM practices like acupuncture with contemporary medical science. The germ theory of disease, which many acupuncturists still don't accept (seriously, try finding a pic or video of a practitioner with rubber gloves on, I'll wait, no? thought not) became popular because... you know... it worked. The Chinese Communist Party all but outright rejected TCM as it was then:
Our men of learning do not understand science; thus they make use of yin-yang signs and beliefs in the five elements to confuse the world….Our doctors do not understand science: they not only know nothing of human anatomy but also know nothing of the analysis of medicines; as for bacterial poisoning and infections they have not even heard of them….We will never comprehend the ch’i even if we were to search everywhere in the universe. All of these fanciful notions and irrational beliefs can be corrected at their roots by science. 1
TCM is on its way out, from 1927 to 1936 the Chinese Journal of Physiology has nothing to say on the topic. Acupuncture, plainly, is a theory of healing—not a medical science—based on philosophy not results, processes, or even simple observation. The foundation of acupuncture is the belief that one's chi or (Qi if you want to be correct or charge an iPhone) needs tending. Under normal, desirable conditions your chi flows through your body freely along pathways in the body called meridians. Think of this as the Force flowing through a Jedi's Force-circulatory or Force-lymphatic system. Illness, then, is caused by chi blockages or imbalances, and not the cool kind Ty Lee or the Kyoshi Warriors can inflict. The "cure" if you will, is to insert a tiny ultra-thin needle into the body where the meridians overlap to improve the flow or balance of your chi. Which is, obviously, nonsense. Despite hundreds of years and thousands of attempts, no one has ever proven the existence of, much less their ability to influence, chi by any name. And I don't want an email about electrical signals in the brain, that's just... ugh. Anywho... along comes Chairman Mao Tse-Tung and the Cultural Revolution. Tens of millions are dying from starvation and diseases, and Mao can't help everyone. Not even close. But he can placate everyone by encouraging TCM. It doesn't work, and the Communist Party knows this, but it will stop the complaints. Of course, like Trump and the Covid-19 vaccine now, Mao is reported to have rejected TCM when he was sick, instead favoring, you know, real medicine:
“even though I believe we should promote Chinese medicine, I personally do not believe in it. I don’t take Chinese medicine….”
Soon TCM became the party line and the Ministries of Health became a puppet and the aforementioned Chinese Journal of Physiology was rebranded China's Medicine, and published overtly political propaganda until 1979 when it returned to some form of normalcy. It was the early 1970's when acupuncture began taking hold in America. Dodgy studies coupled with public demonstrations that were little more than magic shows captured the west's imagination and suddenly acupuncture could do anything. And now here we are drinking beer in a basement podcast studio… So, acupuncture uses needles as tiny magic wands to make your energy feel like someone is helping. Sadly, the results don't vary: it doesn't help. Reports that it does are either another in a long line of proven plants or self-reported outcomes... often reported directly to the provider who, having just invested hours in treating you, one wouldn't want to disappoint—right? Basically, implicit and/or patient-reported bias. Or, you know, Peter Popoff-style fraud. Before we go any further I'll acknowledge that for things like chronic pain there are few ways we can gauge a condition aside from simply asking the patient. It's subjective and that makes all of this so, so much more difficult. Fortunately for us, acupuncturists often claim to be able to cure observable, measurable maladies like orthopedic injuries and diabetes. These theories often come from other philosophy-based medical theories. Western listeners might be more familiar with is the notion of a body having four "humors" which, when out of balance, cause illnesses of the body and mind. Of course, these purveyors of magic flows and vitalities lost in the court of scientific review--and reality--more than a hundred years ago. Now vitalists are relegated to "alternative" or "complementary" medicine which just so happens to be where acupuncture lives. These various theories of vitality are often at odds with each other but they all agree on one thing: illnesses are caused by bad woo, not bacteria, germs, or spontaneous runaway mitosis. As such, you'll rarely see practitioners use rubber gloves and in more cases than we've got time to cover, reusing needles often without cleaning them. Fortunately, most practitioners are now legally required to use single-use, sterile, needles... in, you know... some places. In America needles were regulated as Class II medical devices in 1996, meaning they're safe for use by a professional. The assumption being that these "professionals" know how not to give people AIDS. From what I can tell "professional acupuncturists" in America are regulated by one of three professional organizations. And if you've ever been part of a professional organization, you know damn well that they're not the FDA or the FCC. They make suggestions, not regulations. Today, acupuncture is kinda regulated in 47 of 50 states and a few bits of Europe. The rest is the wild-fucking-west. Hell, more than half of all American insurers will cover acupuncture treatments... cheaper than chemo I guess. Sadly, most people aren't wizards so redirecting chi won't help. Luckily for charlatans everywhere, we can replace "chi" with "nervous system" and suddenly it sells again. Never mind that actually sticking needles in your nerves is always a bad idea. Terms like chi and meridians are easy to replace with energy and circulatory/nervous/lymphatic/whatever system. The separation of chi pathways and modern biological systems has been lost to time. Call it what you will, chi, nerves, vitality, life-force, The Force, it doesn't matter, it's not real and tiny needles don't affect it or you. What it does is make it easier to be lax about, or outright refuse actual medical intervention. And needle-infection-based murder aside, that's how it kills people because it doesn't do anything! Which is the crux really, the mechanism of action. Acupuncturists would have us believe that harnessing spiritual energy or poking just the right spot, can somehow resolve holistic, long-term, or devastating illnesses. And as the series goes on the impossibility, indeed the absurdity of it all will become incredibly clear. No two acupuncture practitioners, like all woo-mongers, can agree on the best or even consistent forms of acupuncture. Some focusing on the palm, you can cure anything with a few needles in the right part of the palm. Or the ears, nonsense like NADA—which was suggested to me and will be its own episode—which espouses the idea that with acupuncture of the ears you can cure any number of mental illnesses as well as, their focus, "curing" additions. A needle in your ear can not and will not stop your cravings for addictive substances. Ear piercings are methadone and I shouldn't have to say that out loud. The time spent with a practitioner, like any frequently visited person in a support role, may help... but not because of the fucking needles, because misery loves company, and sometimes you just need some human sympathy. Of course, there is no good evidence for acupuncture. There have been thousands of studies on the topic which can generally be lumped into two categories: scientifically rigorous, and written with a crayon. Studies that find support for acupuncture are, typically, poorly conducted or so affected by motivated reasoning as to be little more than op-eds. And, lest you think I'm catering to my own biases, I'll include a few meta-studies in the show notes for now and do a journal review in a future episode(s). The more rigorous studies generally find that acupuncture is no better than placebo. This is to say, as effective as the sugar pills medical science created intentionally and specifically to be inert. The Placebo Effect is a different topic, but no, it can't cure your diabetes, mental illness, or hysteria either--even if it's needle invoked. For something to be as good as a placebo is to say that it is as good as no intervention at all, as that is the purpose of a placebo, to have control, or no treatment, groups to rate things against. Feel free to see most episodes of Skeptics with a K if you feel like arguing that point. Still, acupuncture is touted by many. Like homeopathy or any number of other "alternative medicines," all one really has to do to put acupuncture's nonsense on full display is simply describe it. Chi blockages. Meridians… So many acupuncturists have updated their practices with "complementary science" we'll call it. These additions include things like moxibustion or burning herbs at the acupuncture site. Or using the needles to pass slight electrical currents into the body—which can actually improve symptoms... because it's called transcutaneous electrical stimulation, or TENS, and is something else entirely. TENS machines are widely available and can offer some help to chronic pain sufferers. And sure, an acupuncturist could pass a TENS-esque amount of juice through you for some benefits but because they learned to do it in a weekend for four easy payments of $19.99, you run a much higher risk of them running a fatal amount of electricity through you. Or a small amount through just the right spot to stop your heart or fry your brain. And in the end, electro-acupuncture is as responsible for pain relief as is the syringe delivering a shot of morphine. Speaking of morphine, I'm sure we've all seen the movie where Character McCharacterface has to get some kind of surgery and they use acupuncture to "numb" everything below the neck or whatever. This is one of those examples of paid testimonials and entertainment-based medical demos in the ‘60s and ‘70s. To be clear, there are no documented cases of this at all. There are plenty of records of exhibitions like this, but all have been debunked. Most patients received acupuncture in addition to painkillers by IV drop or inhalation. So, you know, anesthetics. Nearly all of the copious studies on acupuncture which were conducted with proper controls come to the conclusion that acupuncture is no better than sham acupuncture, or putting the needles in different places or not deep enough as a control. And that both sham- and real-acupuncture are as good as the no-treatment wing. Of course, blinding on these things is tricky as most people can tell if they've been stuck with something and report reduced pain in the moment. In the example I'm vaguely referencing, the result was that two times as many acupuncture patients requested additional painkillers as those who got acupuncture and painkillers, or simply painkillers in the ER. All in all, it sounds pretty open and shut. However, there's a ton of money to be made and a massive cultural dilution to overcome. So much so that even places like Johns Hopkins have pages dedicated to acupuncture that are relatively positive regarding the practice. Though they're careful to couch every claim, defense, or distraction with a suitable, legally proactive, caution. And that's where we'll have to call it today. Acupuncture is, obviously, bullshit but it's popular and has spawned enough variants that even overt nonsense doesn't seem to slow it down. We'll cover specialty acupuncture; placebo-puncture; electric, dry, burning, frozen, and wet needling, animal acupuncture, and, of course, specialties like NADA, palm, and other integrative models. Until next time remember, the only need you should be after right now is the Covid jab!
  • https://en.wikipedia.org/wiki/Regulation_of_acupuncture#United_States
  • https://quackwatch.org/acupuncture/reports/diagnosis/
  • https://quackwatch.org/acupuncture/hx/basser/
  • https://sciencebasedmedicine.org/reference/acupuncture/
  • https://www.scientificamerican.com/article/5-scientists-weigh-in-on-acupuncture/
  • http://skepdic.com/acupuncture.html
  • https://www.liebertpub.com/doi/abs/10.1089/acm.2008.0135
  • https://bjgp.org/content/40/338/379.short
  • https://www.acpjournals.org/doi/abs/10.7326/0003-4819-146-12-200706190-00008
  • https://www.sciencedirect.com/science/article/abs/pii/089543569090020P
  • https://www.acpjournals.org/doi/abs/10.7326/0003-4819-142-8-200504190-00014
  1. Kwok DW. Scientism in Chinese Thought. New Haven; 1965:135. ↩︎

Mid-Show Bumper

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Forbidden Diagnosis

Interested in what we have to say about this story? Good news, it’s available right now to subscribers at Patreon.com/iit! Since Aaron decided to go all medical on you I think I’ll follow suit. Instead of doing some woo or whatnot I am going to learn you some hidden medical terms doctors use. If you work in IT you have probably heard of a PEBCAK error, for you uninitiated PEBCAK in an acronym for Problem Exists Between Chair And Keyboard and is often used to describe a problem brought on by the user, it is a softer term if you don’t know the meaning but between IT professionals they all know what happened. Well it makes sense that doctors and nurses would use similar shorthand speech in their fields, so today we take a look at forbidden diagnosis! If you end up in the hospital and hear you have a positive John Thomas sign, you will now know two things; That you have a penis and you got an x-ray of your pelvis. The John Thomas, JT or Throckmorton‘s sign is a slang used by physicians to refer to the position of the penis in the X-ray scans of a man’s pelvis. A patient has a positive John Thomas sign if his penis points in the direction of the injured body part and a negative John Thomas sign if it points in the opposite direction.Some physicians believe the position of the penis in x-ray scans is not always coincidental. For instance, men with hip fractures are likelier to have positive John Thomas signs. Physicians believe this is because patients with hip injuries often rest at an angle to avoid pain and discomfort, causing the penis to point towards the injured hip. Logical . . . but weird. The Daughter from California, Karen from Cali more like, (or Son from California in the case of men) is a medical term for a person who suddenly arrives at a hospital and demands physicians perform some medical procedures to save the life of a dying relative. Some Physicians sometimes swap California with New York. The Daughter from California is usually angry and pisses the medical staff off. They refuse treatment suggestions, even from fellow relatives, and will continue to force their suggestions on everyone. Physicians consider their actions a syndrome they call Daughter from California syndrome. The Daughter from California is often a distant relative that has not seen the dying relative in a while. So they are often surprised by how bad the situation has deteriorated. Physicians believe the guilt feelings of being away from the sick relative is often responsible for the behavior of the Daughter from California We've all seen those new families who just recently had a child and are quite inexperienced. There's nothing wrong with this until it becomes a recurring issue that the healthcare industry and healthcare professionals have to deal with. NPS stands for New Parent Syndrome and occurs when a parent or set of parents repeatedly bring in their baby or children to deal with minor issues because they freak out whenever something appears to be going wrong. There's nothing wrong with this, as they just want to make sure their baby is fully healthy, but it does become an issue over time as healthcare facilities have to free up resources to deal with something that isn't serious. From Grey’s Anatomy or ER, you may be familiar with Code Blue—an emergency code indicating that someone needs immediate resuscitation. But sometimes doctors might realize there’s no way to save the patient. In that case, they may call a “Hollywood Code,” also known as “Show Code,” “Light Blue Code,” or “Slow Code.” Rather than dropping everything and sprinting to the patient’s bed, they stroll to the scene, slowly check for a pulse, and begin their intervention, Goldman explains. “It’s a play for time until it’s acceptable to pronounce the patient dead,” he writes. The slow code is often the fallout of the difficulties in explaining the condition of the patient to their relatives. So the physicians perform the ruse to trick the relatives of the patient into thinking they are really trying to save the dying. The slow code is a very controversial process, even among nurses and physicians. While some suggest it should only be used as an option of last resort, others insist it is never an option. While a beemer might refer to the ride sitting in a surgeon’s driveway, it’s also slang for an obese patient. Beemer comes from BMI, or body mass index, a measure of body fat based on height and weight. Beemer Code refers to an extra fee a doctor might charge for treating an obese patient. I’ll have to go through my charges at my last surgery… The "Clinic Unit" is used to indicate weight, where one clinic unit equals 200 pounds. ‘Three clinic units' is a sneaky way of saying the patient weighs 600 pounds. This might come from the idea that a clinic is equal to an entire facility in a hospital, which, one assumes, weighs a lot. As we can see some physicians are not exactly delicate when it comes to describing overweight and obese patients. A surgeon might use the euphemism “excessive soft tissue” to refer to the layers of fat she needs to cut through before reaching the muscle, or she might say the patient is “fluffy.” OB-GYNs might talk among themselves about “harpooning the whale,” or inserting an epidural catheter, which provides pain-relief medication, into an obese woman’s spinal canal during the late stages of labor. Since it can be tough to locate the insertion point through fat, one hospital even created a “Prince of Whales Award” for the resident who placed epidurals “in the most tonnage in one shift,” quoting an anesthesiologist. Some doctors may say they charge a “beemer code, maybe one who’s “two clinic units,” or 400 pounds. You've probably had to deal with someone who just frustrates you every single time they interact with you. Well, the healthcare industry is no different. Healthcare professionals have to deal with a wide variety of patients on a daily basis, and there are those patients who seem to be a nuisance every single time they come back around or whenever someone has to deal with them. For those particular patients, healthcare professionals use a funny acronym that consists of four letters: PITB. This acronym stands for Pain in the Butt and fits those difficult patients perfectly. GOMER seems to have a couple of different meanings and a few different theories regarding its origin. Some say the acronym stands for “get out of my emergency room” and refers to old and sometimes demented patients with several complicated conditions. Others say it actually means “grand old man of the emergency room.” The word was popularized by Samuel Shem, the pen name of physician Stephen Bergman, in his 1978 novel House of God. Here, it's used to refer to patients who visit the hospital frequently with "complicated but uninspiring and incurable conditions." However, the Oxford English Dictionary’s earliest citation is from a July 1972 issue of National Lampoon: “Gomer, a senile, messy, or highly unpleasant patient.” This might come from the earlier military slang for someone inept or stupid, perhaps named for the bumbling Gomer Pyle of The Andy Griffith Show. The funny-looking kid (FLK) is used to refer to a child with some unknown growth or mental condition. The funny-looking kid often has a strange face. This could be evident in their flat nose bridges, sloppy foreheads, abnormal-looking lips among others. Sometimes, their faces are normal but blank and without expression. To be clear, doctors do not use funny to mean funny in the amusing sense. They use funny to mean odd. Nevertheless, the slang is considered derogatory. The term is only used for children with abnormal faces caused by unidentified medical conditions. I actually heard of this one from a retired nurse I work with, she said it wasn’t done to be mean but often was written to make sure follow-up with the child was done to make sure they were healthy. I hope you have learned a bit today, if anything maybe you’ll keep your ears open next time you visit the hospital. Before I let you go, it wouldn’t be one of my stories unless it involved some juvenile humor so our last secret medical term, also a call back to previous shows, is a social injury of the rectum. Sometimes people stick weird things up their anus. And some of these items get so deep they reach the rectum and become irremovable, prompting a visit to the emergency room. Physicians call these sorts of incidents “social injury of the rectum. ”Patients with social injury of the rectum often require surgery to remove whatever got stuck up there. Physicians have operated on patients with pens, beer bottles, bowling pins, baseballs, electrical tapes, wine corks, flashlights, cucumbers, fruits, and light bulbs stuck in their rectums. Physicians have also removed larger items like wooden rods, ice picks, a soy sauce bottle, a peanut butter jar, the head of a Barbie doll, and a bedpost from the rectum of patients. For understandable reasons, most patients only complain of abdominal pain and refuse to reveal the real issue whenever they get admitted. They only partly confess after x-rays reveal they have got some other weird stuff up there. We say partly because they sometimes deny putting anything in their anus and provide hilarious suggestions to explain how those items ended up there.

Outro

I’m Aaron, and I’d like to thank all our listeners, supporters, and co-hosts. Find out more about the show, social links, and contact information at InterestingIfTrue.com. Music for this episode was created by Wayne Jones and was used with permission. The opinions, views, and nonsense expressed in this show are those of the hosts only and do not represent any other people, organizations, or lifeforms. All rights reserved, Interesting If True 2020.

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