Magical Thinking and My Shoulder Pain

I've had this shoulder pain for about 10 years and haven't done anything about it, but it's worsened during this joke of a winter. (God to Global Warming Worriers: "You want winter back?  I'll give you winter back!")  I'm losing function, but, like many people, I avoid doctors.  This is of course a personal irony because I have spent 40 years working with, talking to, and interviewing physicians, and I really like them as a tribe and many as humans. 

Some of them are my heroes, in fact, for instance George Lundberg,  my ex-boss at Medscape and former editor of JAMA.  George spent a portion of his considerable intelligence and energy in fighting the false promises of complementary and alternative medicine (CAM for short), which he perceives as wracked with inadequate studies and insubstantial evidence. 

As one of his acolytes and having followed the literature on CAM for years, I'm a strong supporter of this view.  The evidence on any benefits for most herbs, CAM procedures (eg. acupuncture. chiropractic), supplements, and other so-called natural substances, is weak at best.  Very few rigorous studies have been conducted on these so-called natural therapies, particularly randomized trials that pit them against placebos or FDA approved treatments.  Some reasons for this:

1. You can't usually patent CAM agents because they're natural, so drug companies have no incentive for spending the big bucks required for conducting clinical trials. 
2. CAM manufacturers sometimes publish their own studies, but these are even more suspect than those run by that popular villain, Big Pharma, whose trials and drugs are FDA reviewed and regulated, which CAM's aren't. (FDA, however, can go after false claims and contamination of natural agents.)
3. CAM has no standards, at least in the US, so let's say you want to study Echinacea purpurea, one of nine cornflower species, to see if it cures the common cold. You throw its leaves in a pot, boil them up, strain them, and bottle the results. You and your sniffling friends swallow a tablespoon or two, and hurrah, it cures your colds (maybe).  You publish the results in a tiny journal. Someone else using roots, a different species, or different dosages, does their own tiny study and says Echinacea is useless for the cold. A cornflower by the same name wouldn't smell just as sweet. 
4. The Fed has a CAM center (NCCAM) that funds research on natural treatments, but because big clinical trials are so expensive, most of its money goes to very small ones, basic research (not human relevant), or analyses of existing published CAM trials. The latter typically can't tell if there are any benefits with the CAM agent in question because the trials analyzed were too weak to support any evidence (Go to point 1 and use this list as an infinite loop

Another point, natural stuff is not always safe.  (In fact, really, think about nature for even a nanosecond -- tooth and f-ing claw).  Some observations on CAM's safety:

• It would follow that CAM treatments powerful enough to be effective would also have side effects and interactions, just as our regulated drugs do. St. John's wort, for instance, actually may relieve some depression, but then it becomes no different from any other approved anti-depressant. It can cause problems. 
• Using CAM as a substitute to tested treatments for serious illnesses can kill you.  Farewell Steve Jobs. 
• Taking too much of anything, even nice natural things, can be bad.  Beta-carotein and smokers -- good example. 
• Regarding traditional Chinese medicine (TCM), the darling of New Ageists, a guy who runs the biggest physician social media company in China told me that by Chinese law TCM isn't allowed to be studied.  Everything in the big fat TCM Book was written about a zillion years ago, so I suppose it would be embarrassing to find out that practices done for centuries might be useless or worse. Furthermore, Chinese doctors are now injecting TCM potions, even though the Great Book only talks about oral remedies, and no one knows whether spurting herbs into the blood stream may be lethal, because THEY CAN'T STUDY THEM.  (We can study them here if we want, but see previous numbered list for why we won't.)

But, given this pious rant, here's the humiliating truth.  I am a CAM junkie. I've taken glucosamine to prevent arthritis for 15 years based on a couple faulty optimistic studies (so far so good).  I'm a major user of probiotics, coenzyme Q10, vitamin D3, and B complex -- all based on inadequate positive studies that I chose to believe over the equally inadequate negative ones.  I house apple cider vinegar and raw honey for cold emergencies, and I have a secret recipe for elderberry syrup that I plan to bottle this summer for curing everything. I meditate every day and I took yoga for ten years, until some power-hungry instructor bellowed me into straining my shoulder during chaturanga.

So, full circle and long story long.  My shoulder was injured practicing some hyperactive version of an Eastern practice, so what did I do this week?  I went to an acupuncturist in Hudson.  A very smart and pleasant young woman, who studied in Seattle and lived in China for a while, pinned me up, electrified me, and gave me hickies on my back with vacuum cups. I lay on my side for an hour and dozed, came home, and slept that night without waking up from shoulder pain for the first time in months. 

I can't imagine acupuncture will cure whatever is wrong with my shoulder, and I have little faith that the relief will last.  But, what seems to be clear from pretty good evidence is that stress and its sidekick, an over enthusiastic immune system, are making a lot of us sick. And many CAM treatments target these bad friends.  Furthermore, even if the benefits are only a placebo effect, we know from studies that this can be pretty substantial, with placebos sometimes even beating the drugs they're up against.  So, I say, what the hell.  I'll keep going to the very comforting lady with the needles and put off the burly orthopedist with his scary knives as long as I can, and I won't tell Dr. Lundberg.