Disingenuous: Adding acupuncture adds nothing.

Disingenuous:  Adding acupuncture adds nothing.

“When I use a word,’ Humpty Dumpty said in rather a scornful tone, ’it means just what I choose it to mean — neither more nor less.”

“The question is,” said Alice, “whether you can make words mean so many different things.”

“The question is,” said Humpty Dumpty, “which is to be master— that’s all.”

In my feeds I kept seeing variations of the theme: acupuncture treats sepsis. As an infectious disease doc it tweaked my interest since sepsis (a particularly severe manifestation of infection) is a disease that I routinely treat.

So what was this amazing study? Dopamine mediates vagal modulation of the immune system by electroacupuncture.  It was in mice, which may not be a good model for humans.

The reasoning for the study was as follows. Many of the symptoms of sepsis are due to inflammation mediated by cytokines. Stimulating the vagus nerve decreases the inflammatory response in a variety of other diseases. It is hard to stimulate the vagus nerve directly since it is deep in the neck and check. So

We hypothesized that electroacupuncture can be an alternative strategy for vagal stimulation.

The key word is electroacupuncture.

Recently they excavated a 2000 year old tomb in China and what they found was, in a word, incredible. First was acupuncture needles. But more amazing was a set of dead AA batteries in a mechanical dragon that evidently rolled across the floor while playing cymbals. It strongly suggests that the ancient Chinese used electroacupuncture.

So they stuck a needle in theST36 Zusanli point of mice. Which is in the leg. Who knew that mice and humans had the same meridians and acupoints. Then they cranked in some voltage and measured various cytokines and other inflammatory mediators under various conditions to see what happens. The results were interesting. The electroacupuncture treated mice had decreased mortality by an

anti-inflammatory mechanism mediated by the sciatic and vagus nerves that modulates the production of catecholamines in the adrenal glands.

But here are some key notes from the paper

The anti-inflammatory effects of electroacupuncture are voltage dependent.

and

Direct electrical stimulation of the vagus nerve mimicked the production of dopamine and norepinephrine induced by electroacupuncture.

and

direct electrical stimulation of the sciatic nerve mimicked the anti-inflammatory effects of electroacupuncture in a voltage-dependent manner.

They did not use a a random peripheral site to apply the voltage or another acupuncture point as a control. As best I can tell, the study actually had nothing to do with acupuncture. What they demonstrated was electrical stimulation of peripheral nerves or the vagus nerve had a variety of benificial anti-inflammatory effects in mice. The use of the specific the acupuncture point was, well, pointless.

This is the kind of study that drives me nuts. It was an interesting study but you could remove all the references to acupuncture and the results would be just as applicable. I suppose it would lack the sexyness that acupuncture adds. Without acupuncture as a hook, I wonder if it would have been published in Nature Medicine or get the notice it did.

And, while interesting, given all the monitors on a patient in the ICU of sepsis, I can’t see any clinical utility until some clever researcher figures out a way to give the electricity without messing up the EKG etc.

Points of Interest: 3/2/2014
Points of Interest: 3/1/2014