Adverse Events

Adverse Events

 

I sit on the Quality Councils at my hospitals and have been the Chair of the Infection Control programs since 1990. So I am well aware of the complications that can occur in medicine, but I am also aware of the work over the last 2 decades to prevent those complications. Medicine, at least in my hospitals, is remarkably safer than it was when I started.

One of the issues that separates the world of pseudo-medicines from real medicine is a recognition of the side effects of interventions and the willingness to alter practice to avoid them. Pseudo-medical providers ignore complications and, as the chiropractic response to the risk of stroke after neck manipulation demonstrates, work hard at denying that complications can occur. In real medicine we always try and side with patient safety. Not chiropractors.

"Neck manipulation is a safe, conservative treatment option for neck pain and headache. The evidence presented in the AHA paper fails to show that neck manipulation is a significant risk factor in CD.

Part of the issue is we lack good studies of the risks of various pseudo-medical interventions and there is a paucity of medical papers demonstrating quality improvement projects by pseudo-medical providers.

Hand hygiene, the simplest to study, is sorely lacking in the pseudo-medicine world. Of the 7547 Pubmed hits for Hand Hygiene, there is one for chiropractic, one on the lack of hand hygiene of naturopaths

Concerning the hygiene control visits, a concept for hygiene was lacking in 79% of 109 practices, while in 49% a concept for cleaning and disinfection was also missing. In 60% of the practices, a dispenser for hand disinfection was lacking.

and none for acupuncture, although as I have mentioned, acupuncturists do not feel that skin cleaning is necessary. At least in China, infection control is not high on the acupuncturists understanding

The current situation is that acupuncturists have understanding insufficiency in hospital infection management, lack the sterile concepts and consciousness of disinfection and isolation. Aseptic technic principles aren't strictly followed; disinfection and isolation systems are unsound; sanitary condition of hand of medical staff is unsatisfied; and there is shortness in traditional long filiform needle manipulation.

There is little reason to think the situation is any different in the US, given that a search of PubMed acupuncture and infection yields a collection of interesting and unusual infections probably due to acupuncture. Needles are dangerous.

How often there are complications from acupuncture over and above the case reports on PubMed? Quite a few according to Risk factors associated with adverse events of acupuncture: a prospective study, although how many are real complications vrs and symptoms unrelated to the acupuncture.

The incidence of any AEs per patient was 42.4% with traditional acupuncture, 40.7% with minimal acupuncture and 16.7% with non-invasive sham acupuncture. Traditional and minimal acupuncture were associated with a greater number of local AEs,

Curious. First, so many adverse reactions from non-invasive sham acupuncture, but almost none were at the acupuncture site. They were mostly symptoms like dizziness, nausea and headache.

In comparison, many of the 'real' acupuncture complications were local: pain, bleeding and bruising occurred in a third of patients as well as more systemic adverse reactions such as dizziness andheadache though the differences were not statistically significant.

Acupuncture would appear to have frequent, albeit mild, adverse reactions.

As a comparison, I looked up the side effect rates for over-the-counter ibuprofen, which I chose as it is a favorite drug for pseudo-medical providers to compare their complications against.

A total of 878 subjects received ibuprofen 200 or 400 mg, 849 acetaminophen 650 or 1000 mg, and 852 placebo. The overall frequency of side effects was comparable: ibuprofen 2.4%, acetaminophen 3.2%, and placebo 2.1%. The frequency of central nervous system symptoms was 0.8%, 2.1%, and 0.9%, respectively. Upper gastro-intestinal upset ranged from 0.8-0.9% of subjects in all groups. We conclude that single doses of nonprescription ibuprofen are well tolerated and demonstrate a side effect profile indistinguishable from that of acetaminophen and placebo.

I know, not fair, since ibuprofen actually has therapeutic benefits and in deciding on a therapy you have to weight the risks and the benefits. Ibuprofen appears to have fewer adverse reactions than acupuncture. Same with over-the-counter naproxen

Across all 48 studies, 83% of both the NAP- and placebo-treated patients reported no adverse events.

Acupuncture, besides having no proven benefit for any condition, has frequent mild adverse events, infrequent severe events and is more toxic than over the counter NSAIDS.

Points of Interest 10/24/2014
Points of Interest 10/23/14