malvasia bianca

Miranda has had very bad migraines for much of this year. We’re not sure why they’ve gotten so much worse / more frequent this year, and the initial treatments her doctors prescribed were almost completely ineffective, and in some cases may have made some aspects of the situation worse. Eventually, we found a medication which led to a more noticeable improvement (though also with a more noticeable side effect), but even with that we’ve gotten pretty desparate for effective treatment options.

So Miranda wanted to try out acupuncture. I wasn’t against giving acupuncture a try, given how ineffective Western medicine had been so far, and when I mentioned the acupuncture in a couple of random conversations, I got surprisingly strong positive reactions: people saying “I had serious migraines, and acupuncture made a big difference.” So I asked my fellow Tai Chi students for recommendations (since I figured they’d be more likely to have taken acupuncture than other social groups I’m part of), and made an appointment with one of the recommended acupuncturists.

 

As somebody raised by scientists, I do not feel entirely comfortable with this. Though, as somebody with a fondness for mysticism (and as somebody who is the sort of person who would take Tai Chi classes), there’s a part of me that’s favorably inclined towards this sort of thing; but that, in turn, raises my scientist part’s alarm bells even more, because it suggests that it will be harder for me to evaluate acupuncture dispassionately.

Now, when I say that I don’t feel entirely comfortable, that doesn’t mean that I think that trying out acupuncture is an actively bad idea. As far as I can tell, acupuncture is unlikely to be harmful, and Western medicine has done a pretty bad job treating her migraines so far: so it’s not like I’m comparing acupuncture against a treatment with solid experimental evidence for its effectiveness. And I also don’t feel like I have a super strong reason to believe that acupuncture shouldn’t be effective: we’re not talking homeopathy here. But I still do want to try to figure out how I should evaluate the acupuncture treatments, what I should look for.

And, of course, what makes that evaluation particularly different/interesting is that, in a Kuhnian sense, Miranda’s acupuncturist is working in a different paradigm than Miranda’s other doctors use, or than I’m comfortable with. (I get some experience with a Traditional Chinese Medicine paradigm in my Tai Chi classes, but I don’t feel that I understand it at all well even as an outside observer, and I’m certainly not able to act natively within it.) On the one hand, that makes me inclined to treat Traditional Chinese Medicine with more respect, with an assumption that there’s something to the richness of the paradigm, even if it’s wrong in some aspects. But, on the other hand, I’m not sure that’s a justified assumption at all: I also have the belief that there’s nothing of significant value in pre-Copernican astronomy, even though it’s a paradigm that was developed over the course of centuries! At any rate, the difference in paradigms raises the question of how I’ll be able to tell things that seem wrong because they’re from a foreign paradigm apart from things that seem wrong because they don’t work; or, for that matter, things that seem right because they’re explained in terms of a rich conceptual framework apart from things that seem right because they work.

 

Question zero, then: can we see any concrete effect at all from her acupuncture treatment? There was actually a surprising effect during her first session, namely that Miranda’s hands were a lot warmer. Which is enough to disprove a null hypothesis, but not directly relevant to her therapeutic goals; so next we turn to question one, whether we see an affect on headaches. And there, too, we have an answer: she also had something of a migraine that day (not a horrible one, but definitely noticeable), and her headache decreased significantly over the course of that first treatment, beyond what Miranda was used to from chance variation.

So that was a real success. The other interesting aspect of the session was what all it entailed: I’m not sure exactly what I expected, but I’d assumed that it would basically just be needles. It wasn’t, though: the acupuncturist had some neck exercises that he wanted Miranda to do while she was getting the treatment (and he encouraged her to do those outside of treatment, too, saying they would lessen the pain even without acupuncture), and he also did some physical manipulations with her arms as well.

 

That physical therapy aspect made me actively happy to continue. Because one aspect of current Western medicine that I don’t feel entirely comfortable with is its focus on pills and similar techniques: it feels to me like the (laudable) focus on experimental evidence for techniques imposes a bias that makes doctors less likely to focus on other techniques, techniques where it is harder to gather crisp experimental evidence.

So, while I’m happy for Miranda to keep on taking pills, I also don’t have a particular reason to believe that a chemical approach is the sole potential route to success; and if her acupuncturist is not only taking a completely foreign route (acupuncture) but pairing that with a different, less foreign route (physical adjustments), then that feels like it should increase the odds that, somewhere across all of the approaches we’re taking, we’ll find a treatment that works.

 

In that first session, Miranda’s acupuncturist was focusing on her neck, specifically on one of the vertebrae there, and that focus has continued: there’s something around one of the vertebrae that he thinks is enlarged in a way that causes problems, and he’s adopting techniques to try to shrink it. Which sounds totally plausible to me: I can easily translate vertebra problems into ideas like a nerve being pinched or blood flow being constricted, and I can imagine that that could affect migraines. (Admittedly, maybe I’m overindexing on spinal issues because of my own back problems.)

But I also just like seeing a combination of repeatedly focusing on one metric and seeing short-term pain relief actually result from the techniques that he’s using and recommending there. (Miranda reports that doing the neck exercises helps moderate the strength of headaches outside of acupuncure, too.) I like this because it gives a testable hypothesis; and I like that it gives me hope that it could provide long-term relief instead of just short-term relief, because if this vetebra hypothesis is correct and if he can shrink whatever he’s looking for there and have it stay shrunk then that should help the pain long term. (Which would give a positive answer to question two: does the treatment reduce headaches over the long term, not just the short term?)

 

The neck treatments are easiest for me to accept within my conceptual framework. But a lot of the acupuncture needles aren’t actually in her neck (in fact, I don’t think that normally any are there, though I can’t rember for sure): they’re on the top of her head, on her feet, on her back, or on her hands, and they’re in different places from week to week. When I asked about this, her acupuncturist explained it in terms of creating a path for the qi to flow, if I’m remembering correctly; I’m honestly not entirely sure what he was looking for to decide which pathways to enable which times.

And this gets back to the concept of working within different paradigms: clearly he’s working within a different one than Miranda’s western doctors. There are a few possibilities here:

• The differences in needle positioning from week to week are all for show.
• The differences are for a reason, but not a well-thought-out one.
• The differences are a manifestation of his expertise within his paradigm, but that paradigm isn’t an effective one.
• The differences are a manifestation of his expertise within his paradigm, and that paradigm is an effective one.

I could be wrong, but I’m fairly sure that the first two of these are not what’s going on: her acupuncturist does seem to me like he is an expert, I think we were probably fairly lucky to have found him.

It’s harder for me to decide between the third and fourth explanation. I would like to believe in the idea of qi; but I also have a hard time figuring out how there could be a concept like that that doesn’t map directly to some sort of standard Western medical concept (e.g. blood flow) and that we haven’t figured out how to make machines that can detect it.

So I can’t really justify that fourth explanation; we’ll see if, once I’ve done more Tai Chi, I’ll have had more experiences that cause me to believe in qi as a useful analytical concept, though.

I guess there’s a bifurcation of the third explanation, though: it could be that the paradigm is incorrect but effective? (Which, I guess, would mean that the qi explanation is wrong but he’s still doing something useful in putting the needles in different places at different times, and for deep reasons rather than just because, say, variation is effective no matter the details of that variation.) I’ll have to think about that more, though: it may be that saying “the paradigm is incorrect but effective” actually just means “the paradigm is an accurate paradigm but people outside the paradigm don’t understand it”. And that, after all, is the point of a paradigm: you need to shift into the paradigm to be able to understand it!

 

Ultimately, I just hope that the acupuncture is effective, because I really want Miranda’s migraines to become and stay manageable. Or rather, I hope that one of the treatments is effective; even if that ends up being the case, we probably won’t be able to tell which one made the difference (or if none would have made a significant difference alone and a combination was necessary). It would be nice to have a better idea of whether acupuncture works, but we’re not in a situation where we have the luxury of taking an approach designed to maximize scientific learning.