I can think of a reason why the recurrence rate for appendectomy is lower than for antibiotics. ;-)
Thankfully acupuncture has given me back the ability to sit/run/lift/stand. I'm so grateful I didn't get surgery in either case.
Finally somebody recommended another doctor. His advise was to make a hole in shoe insole around problematic area and see how things go. Then 9 months later she spent a month at sea and that mostly cured the problem.
As long as patients can sue their doctor, no sane doctor will do less than what the patient wants if there is a remote chance the procedure is slightly more effective. A simple but prominent example is the prescription of a generic drug versus the "original". Science tells us that there is absolute no difference. Now you tell the patient - the same patient who feels a very real, "objective" decrease in pain when being injected a saline solution instead of steroids.
And last but not least: the "best science" does not help us if doctors don't know about it. And some treatments are so weird that a doctor won't even consider it. Three anecdotes on that from my last 2 years:
1) British guy with pain in his knee. His doctor has been urging him to operate for years now. But he works in Nigeria on a oil drilling project in a good position and rather would prefer to wait the few years until he retires. The local "joujou"-man told him to rub python fat into his knee. It works for him! He told his doctor in the UK who dismissed that and told him that he might get into trouble for repeatedly rejecting sound medical advice. Shortly after I meet this guy in the Caribbean on his holiday, he tells me that story, I am skeptical and do some googling: 5 Minutes later I find a scientific study that proved that python fat is indeed a very good treatment for his condition. He mailed that to his doctor who read it and now leaves him alone. Snake oil, anyone?
2) Sahrawi ecologist with kidney stones but without the money to pay for the medical procedure to have them removed. He turns to local folk medicine, for a week he drinks a concoction that makes the stones break up and he can pass them naturally pretty much without pain. His doctor in Rabat speaks of a "miracle".
3) Business man in Casablanca was told by his doctor that he either needs surgery on his knee or he should try the traditional desert treatment: Undress, get buried in hot sand, 30 minutes later get into a tent, firmly wrapped. Repeat for 3 days. When I met him he was on his way back from his 5th treatment - he says he does it every 2 years and thereby has avoided surgery for 10 years.
There have been (unfortunately) large pharma companies over the years who manufacture generics, which are later found out to be not even close to manufacturing the real thing, or whose manufacturing processes are extremely unsafe.
Ranbaxy and GVK Biosciences are examples that spring to mind from not too long ago. There may have been others since. :(
Not my worst experiences, but two similar injuries left me with very differing experiences, as comparative examples. In the first one, the doctor wanted to get me into (arthroscopic, fortunately) surgery right away, without even doing an MRI. In the second, a different doctor said that, even if surgery were eventually warranted/needed, the condition had left me too weak to be a good surgical candidate. So, see a PT and work and strength-building, and see how I tolerated it.
The first doctor racked up a big bill and produced no positive effect. The second doctor saw me for one visit, got me to a good PT / rehab program, and helped me make a full recovery.
Anecdote, sure. But, combined with some other singular, not positive experiences: I'll go under the knife only when I have no other choice.
http://healthland.time.com/2011/08/04/under-the-knife-study-...
"People have always been afraid of general anesthesia. Many fear they won’t wake up from this “artificial sleep” — actually more of a coma, albeit drug-induced and reversible. In the 1940s, for every one million patients operated on under full anesthesia, 640 died. By the end of the 1980s, fatalities were down to four per every million, thanks to modern safety standards and better medical training. However, a recent article published in the Deutsches Ärzteblatt, the German Medical Association’s official international science journal, shows that after decades of decline, the worldwide death rate during full anesthesia is back on the rise, to about seven patients in every million. And the number of deaths within a year after a general anesthesia is frighteningly high: one in 20. In the over-65 age group, it’s one in 10."
It's worth noting that their data contains zero observed deaths in ASA Physical Status I Patients, which are basically healthy adults.
I would assume things have either stayed the same or improved: Sevoflurane was just starting to be used around the time that the data were taken for that paper.
I find it interesting that most doctors are continuing to recommend things like cardiac stenting. Maybe it's money? I wonder if they even mention diet to their patients? Or is it the patients that are the problem - even if doctors mention diet, do many patients continue to eat unhealthy?
In the case of Caldwell Esselstyn, a quick Google search took me to my favourite skeptic blog: Science Based Medicine:
https://www.sciencebasedmedicine.org/bill-clintons-diet/
Get about halfway down. I remain skeptical!
Again anecdotally, but consider the stories from people with diabetes who still won't eat well even when their foot was just amputated due to that behaviour.
What is real, who to trust.
Cochrane provide meta-analysis of various treatments. The meta review include a good summary of the paper. Here's their list of stuff about acupuncture: http://www.cochrane.org/search/site/acupuncture
NICE reviews evidence of safety and efficacy to try to decide if the English NHS should offer (and thus pay for) a treatment. Nice will sometimes say "do this", sometimes they'll say "we don't have enough evidence to say either way", and sometimes they'll say "do not do". If they recommend to not do something it's because they have plenty of evidence of harm. Here's their list of stuff about acupuncture (a lot of which is of the "do not do" recommendation): http://www.nice.org.uk/search?q=acupucture
England is also introducing "personal health budgets" for people with long term conditions. This is a small pot of money that the patient can spend pretty much how they wish (not on debt, gambling, alcohol, tobacco, or anything illegal) so long as they can persuade a panel. This could include homeopathy or acupuncture. For example: Imagine a person who is frequently and severely self-harming. (They attend emergency department every week, and they're usually admitted from ED into hospital for surgery.) This person may feel that a joining a 5-a-side soccer club and getting acupuncture would help reduce either the frequency or severity of their self harm. http://www.nhs.uk/choiceintheNHS/Yourchoices/personal-health... https://www.england.nhs.uk/healthbudgets/
The big give-away that a treatment is just a convincing placebo is that it claims to help with everything.
Western medicine has some amazing things to offer for serious conditions. Its really silly how most other ailments are covered by crap in the drug store. I say crap because after my wife started treating the family with essential oils, and my acupuncturist's herbal remedies I'm sick less often and recover faster. I even avoided having to have my gallbladder removed. On fucking herbs ¯\_(ツ)_/¯ Do I know why all these organic compounds and odd treatments work? Does that mean they don't? Does it mean it's all psychosomatic? sigh Maybe, just maybe people in the east figured out a system for treating many ailments. Maybe western medicine needs to zoom out from the molecule and start looking at the whole patient.
You want a lesson in the limits of western medicine? Watch your child die slowly of cancer. Losing my daughter disabused me of any fantasies of cures just around the corner. Meanwhile top doctors kept saying "we've never seen this before". Western medicine doesn't have answers for half of what people think it does. This isn't CSI. Humble out. If some herbs and acupuncture can heal people then deal with it.
The control treatment is typically use of acupuncture needles in areas not specifically specified by codified acupuncture standards (it is a thing... you can go to school for this stuff remember), or the use of sham needles, which still penetrate by like half a inch or something.
All most of the studies you will find that both arms (control and 'real' acupuncture) both show similar improvements in outcome. A valid (and I think the right one) conclusion to draw from these studies is that while the internal logic of acupuncture doesn't do anything, the mechanical action of poking needles into the body has non-trivial benefits.
If you can't get acupuncture covered by insurance, you can look into dry needling (its mechanically the same thing...). A quick google search tells me that some states will allow chiropractors and physiotherapists to perform dry needling and may fall under different insurance buckets.
edit: sorry, I forgot to add this in. obviously poking needles into muscles won't do anything for stuff that isn't rooted in muscles/other connective tissue. Won't do shit for your asthma or allergies for example...
You can talk your way out of some problems; but not all problems. Some things require physical changes driven by external (alien to the self) forces.
One benefits from anything that at worst can bring very little harm if it keeps the person from a surgery with a small upside at best but that can potentially bring a lot of harm through post-operational complications.
I've tried to analyse what the therapist did, but couldn't explain it. The only - off the chart - explanation is that everything is energy, and that we have energy outside our body boundaries that can influence our well being. I'm pretty down to earth. I've met enough people who worship these alternative methods, and I don't. But if it works, it works, and I will use it.
So maybe this is not promoting acupuncture, but I'm just saying that these alternative methods can do stuff to me - but maybe not to you - and modern medicine cannot explain it. Acupuncture may work like this in another situation and for other persons.
Then there is another big thing regarding acupuncture, and that is holism, which makes the acupuncturist look at the whole picture, all your problems, qualities, strenghts and weaknesses.
I imagine there are some people for whom surgery isn't an option. I'm not sure what that condition might be given the routine nature of the procedure, but they might be out there.
Basically my point is that most people where you could diagnose appendicitis from elevated WBCs followed by ultrasound will probably not be in the hospital or clinic or ED in the first place. The reason this is a surgical emergency is because the symptoms are of rapid onset. Thus, elevated WBCs are of limited utility. Furthermore, because appendicitis is an emergency, ultrasound is not the preferred imaging modality–CT scans are used instead, which are relatively more expensive and expose patients to ionizing radiation.
You can choose to treat patients with antibiotics (and they've done studies), but generally over 50% of patients managed initially with antibiotics will ultimately require surgery anyway within 48 hours, and of the <50% that don't, there is a relatively high recurrence rate that will ultimately also require surgery. Given that appendectomy has a very low morbidity and mortality, this is one of the surgeries that are harder to argue against in my opinion.
From my reading of Uptodate, experts in the field feel similarly; after performing a cost/benefit analysis, initial management with antibiotics is indicated only for patients who cannot undergo surgery.
"Do not use acupuncture to treat hyperbilirubinaemia", "Do not offer acupuncture for treating lower urinary tract symptoms (LUTS) in men.", "Acupuncture is not recommended for the management of otitis media with effusion (OME)."
But it is an option for low back pain https://www.nice.org.uk/guidance/cg88/chapter/1-guidance
Citation needed.
"Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials"
It is one of the most "technically true" facts I have ever seen.