Case Studies vrs. Experiments and Acupuncture

contentimage4Chinese medical literature has been based on case-studies collected by experienced physicians over the millennia. While the research standard of our modern era is the ‘RCT’ (randomized controlled trial), Western medicine also uses case studies to illustrate how a diagnosis is made ( NEJM for years had a pathology case featured that  was like reading a good ‘who done it’)  Every physician has a few incredible stories that have molded their particular practice choices.  

One story I heard from a seasoned general practitioner was of a cardio-version from atrial fibrillation that occurred with acupuncture.  She had traveled with a group of physicians to China to learn acupuncture in the ’40’s, and was using it regularly in her practice. One of her patients developed atrial fibrillation and was in the hospital on telemetry.  At that time, only two drugs existed to treat this rapid heart rate, digoxin and propanolol.  Both had been given, but the patient’s heart rate was still racing and irregular.  She asked the cardiologist if she could try some acupuncture, and then proceeded to place needles at Nei Guan, or P6. With the heart monitor recording every beat, after the second needle was placed, there was a brief pause in rhythm followed by a perfect regular sinus pattern. This is usually seen in any defibrillator cardio-version. The cardiologist came into the room, wondering what had occurred. She explained the treatment briefly, but he thought it was the effect of the drugs, albeit very delayed. For another interesting case-study in a-fib cardio-version see:  ( http://www.medicalacupuncture.org/aama_marf/journal/vol1_1/fibrillation.html )

Would a RCT of such patients with acupuncture show statistical significance? It might, but if you were one of the, lets say 40%, who did convert to a normal rhythm, without having to undergo repeated electrical defibrillation, would you care? Those people who would respond to this cheap, alternative therapy, would save some money, time, worry, and related complications, like strokes! With the increase in our older population, this could be a good thing. 

Back in the old days, in China, without the internet and mass publications, interesting case studies were written down.  The older doctor had enough experience that he was his own statistical trial for good results, and he was allowed to ‘blog’ on his experience. The better docs had generations of ancestors that came before them, handing down their clinical pearls to their sons and apprentices. I still like a good story. A remarkable one, while perhaps not a statistical study, can lead to ideas for effective treatment. It is also my hope to share some interesting case studies through this blog. 

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