Hi, I’m Virginia Doran, host of To The Point, generously hosted by the American Acupuncture Council. Today, my guest is Gil Barzilay, and if you haven’t heard him speak, you’re in for a treat. He has a big following internationally, and besides a diploma in Chinese Medicine, he also has studied Chinese and Macrobiotic Nutrition, Kiiko Matsumoto-style Japanese acupuncture and he actually went to college in London at the Imperial College there at the University of London. Has a PhD in from Oxford in Cancer Research and European Medical Biology, post-doctoral fellowship at the Weitzman Institute. He’s got 11 peer-reviewed publications in leading medical journals.
He brings a special dual knowledge in the field of cancer research as well as other kinds of research. He works in Tel Aviv in Israel’s leading complimentary alternative medicine clinic, Rehovot, and he teaches acupuncture, Chinese medicine, research issues all around the world. He’s part of the International Committee of Chinese Medicine, ICCM, which holds an annual conference, which I hear is just fabulous. He also works with the Evidence-Based Acupuncture Foundation and writes regularly, reviews and newsletters.
You can see him on Facebook at DrGilTCM and/or contact him through the ICCM or Evidence-Based Acupuncture. Anyway, without further ado, I would like to introduce everyone to Gil Barzilay.
Thank you, Virginia.
What a long introduction. Yeah, that’s all right.
Well, you have a lot of credentials.
Thanks for that.
I wanted to ask you, what makes a good research study in your opinion and why? The studies that you’re going to speak about today, why are those your best of?
Okay. There’s about a thousand, I think, publications that are published on Chinese medicine every year. I get those alerts on Google twice a week. There’s a lot of information, but I think [inaudible 00:03:41] Western medicine research apply for Chinese medicine research without going into the debates, include having randomized controlled studies. So having a control, comparing a compounder to something.
There’s been a lot of debate on sham acupuncture, and I’ve seen some of the speakers that you’ve had before. I’m sure the debate of what sham acupuncture is and whether it should be controlled has been up there, so I’m not going to go into that, but there has to be a good control of some of the subs that have chosen to date had not been in any could control. They have to have a good number of patients. So of course if these Jersey studies are made in China, they sometimes can have thousands that are conducted in North America or in Europe. We’re probably talking about a hundred patient, maybe a few hundred patients.
Also, the third component of whether the study is good or not in my opinion, is having objective and [inaudible 00:04:47]. So we’ve seen a lot of placebo research that has been conducted actually in other universities around the world. One of the ways to better understand whether something works or doesn’t work is having objective and subjective measures. Because when you ask patients only, “Has your quality of life improved?” or something like that, it really depends on the data in the hospital or the clinic, so the answers can be so confusing and really not good enough for measuring the effect of an intervention.
Having a mix of both of them, these are the three that I’ve chosen have these within them.
Mm-hmm (affirmative). You know, I just wanted to interrupt for a second. I’m hearing a reverb. I don’t know, are you hearing it at your end, kind of like an echoing with the technology?
I’m fine. I can’t hear anything.
Well, hopefully the viewer won’t hear it. Okay, good. I guess there’s a little bit of one, but as long as we can still understand you. So tell us about your criteria for a good research study and why these ones are your best.
So, these are the three that I’ve chosen, but I wanted to start with putting things in little bit in a context of where we are now in terms of, not the world we live in, never talk about global warming, but I did want to share some slides. So let’s move into the slides that I’ve created. One second. Have I done something wrong?
Thank you so much for making these slides because it really helps the viewer to anchor that information.
One second. I need to put my glasses… new share.
Oh, I see the slides. Alan sees the slides.
See the slides, but they’re not moving forward.
You can’t see them.
No, I see them, but they’re not moving forward. Oh, now they are. Okay. Okay, no, something’s not working.
I see the title but not the content.
What’s up with the slide?
It says stopped sharing.
All right, good.
Now it is on, but okay, let’s see. Okay, so I wanted to put things in context because I wanted to say that one of those things that has been… One second. Not working, yeah, I know. Okay, so one of the things that we’ve seen this year is that of course there’s some things coming about Chinese medicine for the fact that is making it into the clinics with the World Health Organization a categorization of acupuncture as a medicine. Of course that got some good headlines, and then some nasty headlines like the integration of quackery with real medicine.
We have, of course, on the right side you can see Novak Djokovic during the tennis U.S. Open bragging about being treated with acupuncture and the moxa. You see Lady Gaga showing you off her cosmetic acupuncture, but at the same time you have some bad news like Spain planning to ban alternative medicine in health centers. You have an article here that was published the Forbes Magazine that says, “Don’t do this: 156 medical practices that are all failures,” and saying that acupuncture is quackery again. Then you have this silly photo on the bottom right hand that shows guy and says that veterans deserve better than as something that doesn’t work like acupuncture.
On one hand you have some good news, but on the other hand you have some… And some people supporting us like Novak can maybe Lady Gaga and others. On the other hand you have some bad headlines as well. At the same time though, the treatment landscape is really changing. There’s a lot of issues with the opioids, you know it very well, especially in the States, but also in Europe, very high numbers of people dying and if not at least coming to the ER.
But it’s not only the opioids, FDA has put additional box warnings and contraindications on the insomnia medications. You have Xanax, which is now the number two problem after the opioids.
Yeah, and of course the nonsteroidal antiinflammatory drugs that look like Advil or Neurophin, that look very innocent, but actually increased double and even more than double the chances of having a heart attack. Even more common drugs like Advil and others have have real health issues coming in with them.
That means that people are seeking out alternative. When we have the evidence with research, whether we are really interested in conducting research or not, it can actually support our case with the different organizations and with the health authorities. You can see that treatment guidelines all over are now embracing acupuncture as well when the evidence was solid enough.
You have here the American College of Physicians are clearly stating that acupuncture is one of the treatment options guidelines with clear recommendations on a first and second level that acupuncture should be one of the ways to treat chronic and acute pain. You have NICE, which is the British body of excellence, clinical excellence, recommending that treatment will be given prophylactically for migraines. You have ASCO, you know the American Society for Clinical Oncology in dosing, acupuncture for breast cancer patients.
We have the American College of Rheumatology embracing acupuncture, and now you also have the Adult Stroke Rehabilitation and Recovery using acupuncture. So when you have research, perhaps not all the doctors, perhaps not all the medical community’s aware of it, but when you have evidence bodies and health authorities listen to you, and then they recommend it and may even include it, and I’ve seen throughout this year that several insurance companies in insurance bodies in America have also included acupuncture now as one of the modalities of frequent, so that can only happen when you have good research.
After all of this introduction, I’m going to go into my top three for this year. So I chose top three that are not within a typical pain and migraine and other areas that we already have enough evidence that acupuncture works and there’s no point in repeating with an additional study that may demonstrate that acupuncture works for pain. We know it does.
I wanted to show some studies that perhaps not everyone is aware that exist, and are pretty solid, and I recommend that people go and read them in full. The first one is a study from Italy that looked at the effectiveness of acupuncture on pain and functional disability for people with rheumatoid arthritis. The studies from a group of medical doctors in Rome, they included 105 rheumatoid arthritis patients that were divided to get either real acupuncture or [inaudible 00:12:53] acupuncture, which I don’t usually like, but they included that. Acupuncture outside meridians or have a wait list, so not receive any acupuncture at all, while at the same time the entire group were continuing with their own treatment, whatever they had already for the RA. Either it was a nonsteroidal drug or a disease-modifying or biologics or any other analgesics that they were getting for their RA.
They received a treatment for three weeks and they were followed for additional four weeks and the points that they use there adjusting people are short of reading the study itself, it was Triple Burner five and Goldwater 39, Hartswean Keeper seven. Just to show you when I was talking about objective and subjective measures, I know this look complicated but it’s actually quite easy to read.
You have in a solid line those who receive real acupuncture, and the dash line, those who receive control acupuncture. You can see that they were doing some auger battery and arm strength as well and quality of life and pain. They were trying to assess pain. They were trying to assess the ability of people to move their hands and to feel pressure and how much pressure they can take on their hands. Of course also asking questions about quality of life. You know all these parameters acupuncture was better than a wait list or sham acupuncture. In fact, they were also looking at the number of swollen and tender joints, and there were also significantly decrease in those who received real acupuncture.
We know that acupuncture is good for lower back pain, for knee pain, whatever. This is one of the few studies that I’ve seen on rheumatoid arthritis, and it’s good also to see that it’s not only the pain but the also the functional, mobility of the patients to do things, to do normal things we do every day. That’s the first study.
Well, that’s good. I was going to ask you to explain to the audience what control acupuncture is. I haven’t heard that.
So control acupuncture, in this case it’s the sham acupuncture. They were asking if you saw on the first slide they were using acupuncture points that were not on the meridians that were relevant to RA. So that’s one of the options. One of the issues, of course, with that type of control or what is called sham acupuncture that we’ve seen in the past it doesn’t work. When you stick a needle in someone, something happens, it talks to the brain and it tells the brain, “Oh my God, you know, something has happened. React.” So just because it’s outside of the Meridian doesn’t mean there’s no reaction. That’s what we’ve seen over the years when the original studies came 30 or 20 years ago with acupuncture, we’re comparing to what they call placebo puncture.
They were comparing to needles that are at two points that are not supposed to be relevant to the disease that we’re talking, but they did actually work in a way. And so all the ones that don’t like us and think that we’re quackery or with some sort of holistic voodoo medicine, we’re saying, “You see, it doesn’t really work.” It works, even when you put needles in a place that shouldn’t work, it does work a little bit. So this whole thing, acupuncture is just not real medicine.
When they moved into doing better controls and/or comparing to people who are continuing to just take their medicine or not receiving any additional treatment, they could actually see the real effect. That’s how, in my opinion, studies should be conducted. But in this group took the double approach. They did a sham control and they did a waiting list as well. In both cases it was working better than either. So that was a good control.
Okay, so the second study, it’s actually something, and that’s why I put two studies here, but I’m not going to go through both of them, is a phenomenon that we’ve seen over the last almost 10 years. When you do acupuncture to patients who are depressed and are taking SSRIs, the results are faster, better and with less side effects. Some of the reasons from a mechanistic point of view, people have said that if you put needles then since we have seen already the effect that needles do on increasing serotonin levels in the brain, that could relate to that, don’t really understand the [inaudible 00:17:47] of why acupuncture actually helps for patients who are depressed and are already taking SSRI, but that’s effect.
This is a study that was trying to compare manual versus electro acupuncture as an add-on therapy to SSRIs. What they did, it was more than 400 patients. 156 were taking SSRIs only. 161 were receiving manual acupuncture, and 160 patients were receiving treatment with needles, with electro acupuncture. The patients were all on the usual dose of Paxil and Seroxat statin they were taking for six weeks, and the patients received treatment over six weeks with three sessions a week, and they were followed up for an additional four weeks. The points that they were using, you can see here is GV20, the Yintang, GV16, bilateral Goldwater 20, GB14 and bilateral pericardium six and spleen six. When you look at the results, they both showed that manual acupuncture together with the SSRIs or electro acupuncture were both significantly better than SSRI.
At six weeks the response rate for the SSRIs was better. There was an early onset. The level of depression that was assessed is one of the markers as well. Side effects were lower and also the number of patients that had to have their SSRI dosage increased was lower with those who received acupuncture. So acupuncture really does good for patients. I think it’s a good thing to know because I’m pretty sure that there are quite a few acupuncturists that when the patients ask them, “Do treat depression?” or “Is it going to interfere with my therapy that I’m taking now?” The answer is clearly, “No, actually probably it’s going to work better.”
Mm-hmm (affirmative). Now, would it affect the dosage they would need to be taking?
It may affect over time. In this specific study, they actually showed that the number of patients who had to have their SSRI dosage increased over time was less when they received acupuncture, so there was no need to even go and increase your dosage. It’s only one study that actually assessed this. I wouldn’t see that as the key outcome of this study. But the fact that it’s keep on repeating yourself is quite interesting. I think that many people, we’re all very easy sometimes on treating pain because we know it works, but some of the more, life [inaudible 00:20:41] it’s good to know that if a patient or a relative asks, “Does it work with [inaudible 00:20:47] or clear with my therapy?” The answer is definitely not. It may actually even enhance it, and you may even have less side effects.
So that’s good news.
Okay, let’s go to the third study. This study made a lot of noise in the last year because it was published in JAMA internal medicine, which is a very important journal. It was looking again at acupuncture as adjunct therapy for chronic stable angina. The reason why it caught some attention is because the results were too good or there was a community to relieve. So there was some nasty headlines I’m not going to go into, but if you just Google it yourself, you’ll see some nasty headlines on WebMD and other website of people really unhappy with the results.
Antithetical to what it should be. Instead of being happy there was something for patients, they’re more concerned about the political aspects of it.
Well, the thing is that I never really understand it because if the results were choose acupuncture, don’t take drugs, I would have understood it. But actually this studies acupuncture together with the existing drugs. So there’s no competition here. Always saying is, Let’s integrate,” or “Let’s see whether acupuncture actually even improves what the drugs are doing,” because the drugs can only do up to a certain point and they don’t even work very well. [inaudible 00:22:31] we’re not taking off the presses. Don’t worry about it.
[inaudible 00:22:36] pharmaceutical. We’re just suggesting that if you add acupuncture, you can even have better results and your patients will be happier. We’re not taking their job or their sales, but that’s the way it is. Yeah. So these were again, 400 patients. It’s a nice number. They were divided into receiving acupuncture on the disease on meridian. These are [inaudible 00:23:05] bunch on the non-affected meridian sham acupuncture, which was a not real points and no simulation and wait list. In my opinion they’ve done a little bit much [inaudible 00:23:19] after all, but the [inaudible 00:23:22] we had more patients than what they chose to do.
It was four weeks, three times a week, and then six weeks follow up. So that’s a long followup as well. You can see all in all, it’s about four months. And again, no harm to the patients. All received their anti-anginal whichever day were making them ready as recommended by the doctor. So you could be a bigger block. It could have been [inaudible 00:23:57]. So I feel safe.
Now, if you look at the results, you can see here the frequency of angina attacks, and you can see here that the patients who received the real acupuncture and the reduction is significant. [inaudible 00:24:14] well, attack to less those received and none acupuncture. Meridian had also some reduction, but down to 10. Sham acupuncture down to 10, and those who were on the wait list had a reduction of one attack, one and a half attack.
Now, the interesting thing is that, remember that all the patients are continuing to take their anti-angina drugs, but they don’t work. Because you can see they started with almost 14 attacks, and they ended up with about 12. When they had acupuncture, it was halved, so the number of angina attacks you had was down by half.
Like I said, WebMD, [inaudible 00:24:59] it didn’t matter, and you don’t call [inaudible 00:25:06] top cardiologists, Americans in Europe saying that this results are too good to be true. Since this study was not done in America, you never know what happened, who conducted this study and whatever the results were, made up or something. So that’s the way it is.
That’s amazing. That’s a really dramatic one. Yeah. I like that.
Yeah, and that’s a reason perhaps they didn’t like it is that you can see that since since the patients were taking the drug and it didn’t really work, they were seeking additional options, but there are no real additional options. You can go to natural path, you can go to your homeopath or I mean, or acupuncture. That’s about a few of the alternatives. [inaudible 00:26:10] do to drugs obstacle therapies. So yeah, the results are too good to be true, but that’s the way it is.
The reverb was a just occurring a lot. Alan said to ask you if you have a cell phone maybe nearby.
Near? No, no, no, it’s two rooms away from me.
Huh, okay. All right. I have one nearby, but I don’t know that that’s it. I can’t read what… Okay. So you know, with a little bit of time that we have left, can you talk about acupuncture and the research that’s relevant for the opioid crisis that we have. I mean it’s really an epidemic here. It’s so unfortunate and the politics don’t really support the real regulation of the drug companies with the pharmaceuticals that have… Not that that’s the whole root of the problem, but that’s a big portion of it, how it became so big. Can you speak about that from your knowledge?
Yeah, Alan has written something that is important. Cell phones should be off no matter where it is. Okay. It’s off. It really is off. I was a good boy before.
Yeah, so I’m just curious, is there much research for that? Things that we can give to doctors or patients? I mean, there is for pain, but what about addiction?
There is some research on addiction as well, especially the one that was done with veterans in the U.S. with the veterans’ associations and several of them. I think there isn’t enough research that has been done. That’s perhaps part of the problem, because I think in the first few years after the opiod crisis has become such a crisis that the people, you know, the American Physicians Association and others had to react to that and seek alternatives.
The first instance was for an alternative and so acupuncture would be an alternative for treating pain. And that’s correct, and that’s worked. The American ACP and also the American Medical Association, all the other associations, including a bunch of also one of the ways, one of the modalities people will notice. Then only since about 2016 or ’17 you start seeing research being developed and done now on whether [inaudible 00:29:16] in addiction.
We begin to see the results now. The results are interesting and positive, but I think the studies that I’ve seen to date are quite small, and so [inaudible 00:29:32] happy with with. It’s interesting and it’s going in the right direction and perhaps it’s even not even surprising but I don’t think there isn’t enough publications to wave and say, you know, we can also help with coming off addiction.
We can definitely do that and we know we do that, but the research is still, I think, [inaudible 00:30:00] to available. Talked about it.
Is there anything else you wanted to say in conclusion? We’ll have to have you back at another time to talk about things and get that sorted out.
I would just recommend for people to once in a while, I mean if you’re not interested in looking for research or if you don’t know where to look for it or read it, look at for example, the summaries that we are doing the evidence-based acupuncture website, because that has a lot of resources for people who don’t have the time to read or really not interested in research, it’s too complicated. [inaudible 00:30:47] and all of it is okay.
We summarized the highlight and we tried to make it accessible so that every therapist, wherever they are in the world can actually discuss it also with their patients, because we know that when patients sit in our office or lie on the bed with needles, they start asking questions for their brother, sister, mother, son, neighbor, and sometimes it’s beyond what they themselves came for. But there’s a lot of evidence out there and so if you can’t be bothered and that’s totally okay, go for example the DBA website and have a look at that, or look for research courses.
I’m sure there are in America, there’s some online as well and there’s plenty of research around that we can use and convince people. Local hospitals, local clinics. [inaudible 00:31:47] integration. No one is saying that acupuncture is better than drugs or that drugs are better that well. pharmaceutical companies are saying that drugs are better than [inaudible 00:31:58], but I think that if we integrate, it going to work really well. This is where we have integration in all hospitals, it’s really amazing, in oncology, in pain, in orthopedics and some psychiatric.
It’s working quite well. It took 10 or 15 years of fighting with the evidence. So you need to know the evidence for that.
But you know, we owe people like you and Mel Hopper Koppelman and John [inaudible 00:32:31], so many people, I can’t even name them all, but it’s really a gift, what they’re doing for the field, and we need to support that. It’s a really great organization and it’s for the sake of all of us.
So, anyway, thank you so much for coming, even though you’re in Tel Aviv and I’m in Connecticut, but thanks for taking your time to share your knowledge and we’ll hope to have you back again sometime.
Thanks so much for having me.
Yeah, I’ll just say goodbye to everyone. Again, I’m Virginia Duran, your host and my website’s LuminousBeauty.com and Gil Barzilay. You can see by his Facebook, DrGilBarzilay is it?
No, DrGilTCM is the easiest way to find it.
DrGilTCM on Facebook, and of course the Evidence-Based Acupuncture site. So thanks again, and we’ll see you after the New Year. Okay.
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