Dr. Harriet Hall, M.D., editor of the website Science-Based Medicine, highlighted the use of acupuncture to treat age-related macular degeneration (AMD) last month. She mentioned that Stephen S. Rodrigues, an acupuncturist from Dallas, Texas, had referred to her a website that advertised an acupuncture treatment known as the Santa Fe protocol that promised to “reverse vision loss from macular degeneration in 4 days or your money back.” The article was written by Alston C. Lundgren, once a family physician who turned to the practice of acupuncture. While such a claim can make some people believe that acupuncture can treat AMD, a major cause of blindness in older adults, Dr. Hall casts her doubts upon the claim and the study used to back up the promise that appears on the Santa Fe protocol website. The criteria used by Dr. Hall to evaluate the claim that acupuncture can treat certain kinds of blindness is useful in spotting which reported medical “miracles” are also unproven and ineffective.
AMD comes in two types: wet and dry. According to Dr. Hall, dry macular degeneration constitutes about 90 percent of AMD patients, while the wet version makes up the remaining 10 percent. According to the Mayo Clinic, dry AMD is the gradual loss of sight in the center field of vision and is caused by deterioration of the macula, which is the center of the retina. Wet AMD is the leaking of blood and other fluids in the blood vessels that are beneath the retina in the back of the eye. While current medicine cannot cure dry AMD, wet AMD can be treated with anti-VEGF, which slows the disease’s progress.
Dr. Lundgren claims that the Santa Fe protocol treats both wet and dry AMD, using acupuncture to reverse the process. His website proposes three components to his treatment, which includes inserting small steel studs into certain nerve endings in the ear that correspond with specific regions of the brain. Doing so will bring more oxygen-rich blood and cortisone to the retina. He also claims that he has perform over 10,000 treatments on 1,500 patients with an 85 percent success rate. Patients are given five sessions over five consecutive days. Other than a study published in Medical Acupuncture in 2005 by Dr. Lundgren and a couple of PowerPoint presentations, Dr. Hall could not find any other resources to support his claim – not even on PubMed.
Dr. Hall was skeptical about the study because it lacked a control group, blinding and consistent reporting. Also, the study did not involve an ophthalmologist and was not approved by the Institution Review Board (IRB), which protects the human rights of test subjects to guard against physical and psychological harm. Thus, the study was considered unethical. Dr. Hall pointed out that even though the obscure journal was peer-reviewed, it would mostly be read by other acupuncturists who are “inherently biased in favor of their discipline.”
“This could have been good science,” Dr. Hall wrote. Dr. Lundgren could have recruited a retinal specialist, used an “acceptable control group,” blinded the visual acuity testing, and documented detectable changes of the disease itself. “He could have gotten IRB approval and been published in a PubMed-listed mainstream medical journal so others could have checked his work.” Unfortunately, about half of the published research is littered with such poor-quality studies, which can confuse or mislead both professionals and patients alike.
Currently, PubMed yields very little results about acupuncture treatments on AMD. The only publication available is from a Chinese-language study published in Zhongguo Zhen Jiu in 2011 that showed those who had AMD and were treated with acupuncture had an 88.3 percent effective rate versus the “medication group” that was treated with oral intake of vitamins C and E and an Entodon injection, which had a 60 percent effective rate. About 84 cases (with 90 affected eyes) were randomly selected to an acupuncture treatment (56 cases, 60 eyes) or a conventional medical treatment (28 cases, 30 eyes).
Professionals and patients alike can protect themselves from false medical “miracles” by learning to question and identify these claims. Who conducted the study, and where was it conducted and published? Was the claim supported by randomized, controlled trials and double-blinded studies or a bunch of testimonials and anecdotes? How big was the sample population and the dropout rate? Does the claim make sense? As the late Barry L Beyerstein, Ph.D., who was a professor of psychology at Simon Fraser University in Burnaby, British Columbia, mentioned, if a practitioner is “ignorant of or openly hostile to mainstream science” or cannot provide a “reasonable scientific rationale for his or her methods or claims,” then there is a high probability that one is dealing with a “quack.”
Despite the claims that acupuncture can treat blindness, Charles M. Zacks, M.D., chairman of the Academy’s Ethics Committee, told Eye Net magazine, a publication by the American Academy of Ophthalmology, that ophthalmologists should use “current established therapies” while bringing in cutting-edge treatments carefully into clinical practice. If such therapies do not work, techniques and therapies that are “investigative and experimentally promising” should be the next options. He cautioned “speculative or unproven” therapies, which include many modalities of complementary alternative medicine.
By Nick Ng
Zhongguo Zhen Jiu (Chinese acupuncture and moxibustion)
Community Eye Health Journal
The Community of Skeptical Inquiry
American Academy of Ophthalmology