Wednesday, March 15, 2006

Adventures in Acupuncture

I've always been a good placebo responder. Give me a sugar pill, tell me that it has side effects and I can produce them on command.

So I am playing with acupuncture needles - I ordered them from China via Ebay.

Placing a few needles in fairly random places, I've found that I can make my entire hand go totally numb. I was quite surprised, as I wasn't expecting that to happen - not consciously at least. I'm going to test it later and see if Ican do the same with an entire leg and, if successful, then do it without the needles.

I must confess that I'm quite a coward when it comes to needles - I was never very good at sticking them into other people either - I always loathed giving injection to patients. So the acupuncture needles I've put into my hand hardly even break the skin. Now, I'm not so sure about chi and meridians and stuff as these aren't things I've ever really studied. So I've either struck it lucky or I'll have to put my numbness down to my skills at producing a decent placebo response.

I used to see it a lot of placebo response (and its inverse, "nocebo") in my brief time as a research assistant on drug trials. The trials were "double-blind" which meant neither we, nor the human guinea-pigs, knew what they were receiving - i.e. they could get the real drug or a dummy pill and none of us would be any wiser.

As part of "informed consent" we'd have to list out to the guinea pig the expected and known side effects of the drug. Only if there was some serious adverse reaction could we open the sealed plastic thing that had a code on it and then call through to the research H.Q. to find out what exactly we'd given the unfortunate patient.

Expectation is a powerful thing and it was amazing to see just how many patients suffered insomnia, dry mouths, urinary incontinence and skin rashes from what turned out to be a sugar pill.

I found it strange that we only ever told them what negative effects the drug might have on them; we rarely mentioned the beneficial effects that might happen.

On the peanut anaphylaxis trials, we'd open a packet of "peanut extract" - it could either be a placebo or the real thing and see what happened.

It was the "smell test" to see if it was the smell of the nuts or the particles in the smell of the nuts that caused the problem for a fortunately tiny few.

Remember that thing you learned at school about farts and the reason why they smell? It's because of the natural smell of the gasses themselves and also because of the countless micro-particles of brown matter that end up lining your nasal membranes.

A hideous thought indeed yet I distinctly remember how after learning about this, producing farts at school somehow became even funnier than before.

We had the "silent but deadly" variety that were always amusing ("he who smelt it, dealt it" which was always countered with, "he who denied it, supplied it") and the "thundercrackers" that would usually trigger a brief farting competition - much to the teacher's disgust.

It is strange, but people do tend to laugh at some bad smells.

Bad smells fall into two categories: there are funny bad smells and there are bad smells that make you feel ill.

Go to a joke shop and buy some stink bombs - these are always good for alaugh - Go into town and drop a couple in the shopping mall. Hang around and watch how people respond.

People just love a good smell like that and they'll talk about it to their friends later in the day.

Meanwhile, the smell of children's vomit is a smell to make you ill. I had to handle a lot of vomit during my time spent as a hospital nurse and children's vomit has that special quality to it that tends to promote vomiting in everyone else.

It promotes weird reactions in people - such as when a kid is sick in school, rather than clearing it up, some adult always comes along and covers it in sawdust.

I've never been quite sure why they do that.

Nor was I entirely sure why, knowing that the human guinea pig was seriously allergic to peanuts, we would open a packet (or pretend packet) of peanuts just inches from their nose. But that is what the research criteria stated we must do, so that is what us faithful researchers did.

Just following orders, guv'nor.

Thankfully, I was only on that particular trial for one day (I was helping out to cover sickness). The unfortunate subject in my trial, having successfully survived all our previous allergy tests that day, took one brief gasp and immediately fainted. The heart monitor showed asystole (the "flat line" you see on the hospital TV dramas that comes with that beeeeeeeeeeeeeeeeeeeeeeeeeep sound) for about 15 seconds. Whilst the subjects heart had ceased operating at any great speed, mine accelerated to about a gazillion beats per minute.

Naturally our actions were heroic and the patient was saved and went home later that day.

"They often do that," said my medical colleague, "and those packets have never turned out to be real yet."

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Addendum: News story in the news today - clinical trial subjects admitted to intensive care following adverse reaction: http://news.bbc.co.uk/1/hi/england/london/4808836.stm

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