American Board of Oriental Reproductive Medicine/Press Release Rebuttal to Copenhagen Study

Lots of media buzzing around quoting the Danish study which the ABORM (www.aborm.org) has sent a rebuutal.

I spoke with a PR contact and this is her advice to us as a profession and as individual practitioners if asked about by the media for a comment.
It uis easy to take it personally and get emotional about it. I like her advice and suggest we follow it, especially the last point about the media.

Key messages
Study inconclusive and difficult to interpret due to study design
Study shows no causal link between alternative treatment and IVF outcomes
Acupuncture has RTC and clinical trials that demonstrate robust 12-15 % improvement in IVF outcomes
Acupuncture is safe, noninvasive and inexpensive
Patients should find a qualified, experienced acupuncture practitioner with specialized training in fertility treatment and IVF.

Media advice for practitioners
Do not comment on study to media—refer questions to ABORM spokesperson

Lorne

Wanting to Grow*Share*Connect with like minded TCMers

It is quite obvious after having read many studies that give both positive and negative results on the very same thing that science is fallible, plain and simple.

Aside from outcomes, it should matter that women who do not succeed with IVF cope better with the feelings associated with this.

How can we collect stats on how the women undergoing acupuncture 'felt' during the cycle as opposed to women who did not? Can we ask the IVF clinic staff to report changes or differences in women who do acupuncture?

Is it common sense that if these results are favorable toward acupuncture then this is all the proof we need that integration is important?

Stepping outside the scientific arena is important and something the ABORM may consider putting some energy into, in my opinion. Quantifying 'feelings' and impact on 'spirit' or mental health proves to be difficult with the scientific model of study used today, yet this is very important to our patients.

My question to the ABORM is, 'How can we study the subjective testimonies of our patients?'

Spence (webdoktor)

I second Spences comment.

I think the rebutal letter speaks to the fact that the latest study was poorly done and lacks quantifiable data about the specific relationship between IVF and acupuncture.

Many RCT's and clinical studies already exist prooving acupuncture is helpful for IVF, so I don't think we need to worry there.

As Spence pointed out, the issue that remains is to find ways to measure and appreciate the overall emotional well being that clients experience while going through an IVF cycle, whether the embryo implants or not.

Trevor

This thread is also related to the rebuttal. I think this is how it began....http://www.chinesemedicinetools.com/article- sharing/infertility/alternative-medicine-hurt

Lorne

Wanting to Grow*Share*Connect with like minded TCMers

Okay, so here's my response/thoughts...sorry if I'm ranting a bit....

I agree that it's important we don't take this personally. The medical climate is going through a big transition right now as people are choosing to access so many different modalities, it's almost like a new form of ethnomedicine is evolving as different modalities are converging into one medical culture. I guess it's inevitable that this process will involve some dissent as people simply don't know enough about 'alternatives' and as a result are threatened by them and thus moved to question.

Ultimately, I think it's really important to support a vision of a medical community that has the patients' best interests in mind, where we learn to use the strengths of each modality based on clinical success, and not worry too much about understanding how it works. Each modality stems from such a unique paradigm, it's really challenging to find a universal perspective that they can all be seen through mechanistically. Spence, I know you touched on the ABORM shifting away from the western scientific arena in the context of un-quantifiability of emotion and spirit. I want to expand on this.....and this is a pretty big paradigm shift but I feel like somehow we need to facilitate this shift to realize that western science is a function of anthropology. It is completely subject to its own method of interpreting patterns in reality and not as purely objective as it's made out to be. So it's unrealistic to try to observe and 'prove' the validity of other modalities through this one particular lens.

The first thing I learned in my biostats class at UBC, basically the course that teaches 'scientists' how to design studies and interpret the data to inform and create official statistics: is that you can never ever prove a theory (because the observation of reality is subjective). you can only disprove one. so the whole process starts with a 'null hypothesis' which is basically the opposite of what you want to prove and then you go about disproving it. This is the foundation of 'scientific proof'. This is not meant to disrespect western science, but to acknowledge its ontological limits and recognize that western medicine is an 'ethnomedicine', a function of western cultural beliefs and perspectives, and not the be all and end all / ultimate truth / pure fact. It is equal to all other modalities.

So I think it's all about recognizing each modality equally and knowing the strength of each one in order to use them complementarily, where each seems to work best clinically. Also advocating more well designed clinical studies (as opposed to 'mechanistic' ones), and remembering to embody our role in an interdependent medical climate that is respectful to its 'counterparts' or partners.

In terms of the down on earth practical dealings....thanks Lorne, I agree with the key points being:
the study was inconclusive because of how it was designed
re-directing to studies that were better designed
not be emotional
no comments to media
re-direct to ABORM

I just got an email from someone asking me to support a letter to Acupuncture Today condemning the formation of a "self-appointed board" of Chinese reproductive medicine as well as specialty boards in general. The person who emailed me this request said that they were trying to get as many names on this letter as possible by well-know individuals, teachers, practitioners, etc. Just a heads up.

This same kind of whining was heard when the NCCAOM was originally formed and when I tried to form a CM gyn specialty board. However, we now have osteopathic acupuncture, sports medicine, and internal medicine specialty boards. So let them pound sand.

Bob Flaws
Blue Poppy

After reading things like this:

http://www.chinesemedicinetools.com/research/ infertility/fertility-method-linked-to-low- testosterone-in-boy

The door swings both ways. Here is an example of "science" showing that ART can be "bad" as well. Im sorry, but we see enough disease as is without adding more knowingly. Are we so desprite to have childern, that we will have childern even if we know we are bringing them into this world already ill?

Perhaps the women in the re-buttal study were not ready to have childern? Maybe they should count themselves lucky.

I personally loved "Practical Fertility Treatment in Todays World" by Heather Bruce. This in my opinion is the best of her work on DVD. No BS, here it is lifestyle kind of stuff. She contuniously brings up the great point of quality over quantity. We want healthy well balanced childern, not just a "pregnancy" which may or may not carry to term with what quality of Jing for that child?

We are still "Health Care Providers" not baby making machines. And I think once patients understand this idea of quality over quantity, poor studys like this will be less persausive. I believe deep down, people want heathy happy kids over just "a kid".

I think it goes great hand in hand with Jane Lyttletons CD lectures and Bob Flaws Gyno for a base of information. All are TCM based. But Practical Fertility = Lifestyle, Jane = Infertility/ TCM look at Western Sciences, Bob = Foundations....

Can anyone reccomend a good WM book/ DVD for a foundation in Intertility/ TX?

We can probably find at least 1,000 or more medical studies from the '70's and '80s trumpeting the miracle benefits of estrogen replacement therapy for peri and post-menopausal women. Look where those "scientific" studies ended up based on their faulty assumptions...

There was a recent study in a medical journal about increased mortality rates among people who took antioxidants. Once again, a small little drop in an ocean of studies that contradict it.

I think it is best not to overreact. I'm glad Ray at ABORM took the time to write the rebuttal. It's important to re-emphasize that there are studies that show a significant increase in success while using acupuncture. I also think it's important to note that the study in question was much broader in its scope in terms of the types of alternative treatments used. So, without the focused and systematic approach that acupuncture can provide, with its complete system of diagnosis and treatment, it very well could be that hodge-podge alternative therapies with no clear strategy or foundation would not produce much in terms of better results.

Regardless, I for one am confident that this will not scare fertility patients away from acupuncturists. The cat is already out of the bag as far as a critical mass of people understanding that acupuncture is a great way to relieve stress, balance the body, and maintain wellness. Regardless of any "scare tactic" promulgated by the medical elite, a large number people will make up their own minds and continue to use acupuncture and other modalities to get lasting relief from conditions that conventional medicine only temporarily solves or can't solve at all. Additionally, there are a good number of independent-minded RE's who have been integrating acupuncture into their clinics (either via referral or in-house) who know that their acupuncture patients in many cases handle the whole procedure with much less stress and complications than their non-acupuncture counterparts. So, I don't think this one study will sway them. And, those who already think what we do is not legitimate, well, they will finally have a little feather in their cap. But, they were probably never going to be convinced anyway, so what does it matter?

This too shall pass....

Chris Axelrad, M.S.O.M., L. Ac., M.M.Q.
Houston, TX