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1083 short- or long-term benefit of acupuncture in the management of moderate to severe asthma".6 Jobst et al admit that their patients had needles stuck into different places, and sometimes also had artemisia leaves burned over some of the points. We have no information as to the placement of the needles, and their study is not reproducible. Replying to Professor Day’s criticism (Feb 14, p 387), Fung introduces the notion (well known in parapsychological circles) that scepticism may thwart results. Day’s negative study included a sceptical subject: how, Fung asks, did Day control against the "negative bias response" of this sceptic? It seems to me that anyone offering his skin to acupuncture pricks may introduce a positive response bias. How did Fung control for it? And how did Fung and Jobst, who believe in acupuncture, control for their own positive bias? Department of Community Health, University of Dublin, Trinity College, Dublin, Ireland PETR SKRABANEK 1. Fung KP, Lau SP. Acupuncture. Lancet 1984; i: 1169-71. 2. Skrabanek P. Acupuncture and the age of unreason. Lancet 1984; i: 1169-71. 3. Skrabanek P. Acupuncture: Past, present, and future. In: Stalker D, Glymour G, eds. Examining holistic medicine. New York: Prometheus Books, 1985: 181. 4. Morgan AD, Peck DF, Buchanan DR, McHardy GJR. Effect of attitudes and beliefs on exercise tolerance in chronic bronchitis. Br Med J 1983; 286: 171-73. 5. Chow OKW, So SY, Lam WK, Yu DYC, Yeung CY. Effect of acupuncture on exercise-induced asthma. Lung 1983; 161: 321-26. 6. Tashkin DP, Kroening RJ, Bresler DE, Simmons M, Coulson AH, Kerschnar H. A controlled trial of real and simulated acupuncture in the management of chronic asthma. J Allergy Clin Immunol 1985; 76: 855-64. ACUPUNCTURE TO PREVENT CISPLATIN-ASSOCIATED VOMITING SIR,-We have demonstrated the antiemetic effect of acupuncture on postoperative nausea and vomiting., Cisplatin is an effective agent in cancer treatment but the associated nausea and vomiting3 can be so severe that some patients refuse further treatment. We report here a study with electroacupuncture in patients with cisplatin-associated sickness. The study was done on 10 inpatients receiving an infusion containing cisplatin 30 mg as part of a regimen for testicular cancer. They had all had severe sickness after a previous course of treatment, despite metoclopramide. The patients gave informed consent and acupuncture was applied immediately before or soon after the start of the infusion. In random order, patients had acupuncture to the P6 (Neiguan) acupuncture point or a "dummy" point near the right elbow. Electroacupuncture was applied via a DC stimulator (frequency 10 Hz, pulse width 0-25 ms). Every patient had five or six acupuncture treatments over 3 days, only one of which was a dummy. At least 8 h elapsed between successive acupuncture treatments. Patients were unaware of whether a genuine or dummy point was being stimulated. It was not always possible for the observer, who visited the patients after 8 h, to remain unaware of the site of acupuncture since patients frequently volunteered this information. The effects over EFFECTS,* OVER 8 h, OF THREE, FOUR, OR FIVE SERIAL ACUPUNCTURE TREATMENTS IN PATIENTS WHO HAD PREVIOUSLY HAD SEVERE VOMITING AND/OR NAUSEA AFTER CISPLATIN I Grades in parentheses are for dummy treatments. *D = very good (no sickness); C = some benefit (marked reduction in sickness); B = no benefit; A = worse than before. 8 h were graded as "very good", "some benefit", "no change", or "worse" (table), relative to the sickness experienced before acupuncture was used. There was significantly less sickness when P6 acupuncture was done than when the dummy point was used (p < 0’001). There were no side-effects from acupuncture. Before this study we reviewed the sickness experienced by 54 patients who had had distressing emesis after the first chemotherapy treatment. 52 had symptoms just as severe at the subsequent treatment. We are confident that our results with acupuncture represent a genuine reduction in emetic effects of cisplatin. P6 acupuncture, though effective, is time-consuming, so we are now looking for ways to simplify the treatment-eg, by getting patients to administer it themselves, or by using acupressure.5,6 Supported by a grant from the Friends of Montgomery House, Belvoir Park Hospital, Belfast. Department of Anaesthetics, Queen’s University of Belfast, Belfast BT9 7BL; and Northern Ireland Radiotherapy Centre, Belfast J. W. DUNDEE R. G. GHALY K. T. J. FITZPATRICK G. A. LYNCH W. P. ABRAM 1. Dundee JW, Chestnutt WN, Ghaly RG, et al. Traditional Chinese acupuncture: a potentially useful antiemetic? Br Med J 1986; 293: 583-84. 2. Ghaly RG, Fitzpatrick KTJ, Dundee JW. Studies with traditional Chinese acupuncture. Anaesthesia (in press). 3. Spiegel RJ. The acute toxicities of chemotherapy. Cancer Treatment Rev 1981; 8: 197-207. 4. Dundee JW, Ghaly RG, Fitzpatrick KTJ, et al. Optimising antiemesis in cancer chemotherapy. Br Med J 1987; 294: 179. 5. Fry ENS. Acupressure and postoperative vomiting. Anaesthesia 1986; 41: 661. 6. Dianhua D, Qinglan T, Jisheng H. Observations on combatting nausea by finger pressure on the hegu point. J Trad Chinese Med 1986; 6: 111-12. EICOSAPENTAENOIC ACID SIR,-It is difficult to explain the observation of Dr Wood and colleagues (January 24, p 177) on platelet membrane eicosapentaenoic acid (EPA) content. EPA is thought to be a promising agent in the prevention of atherosclerosis. However, Wood’s group found in a large case-control study that platelets harvested soon after an acute myocardial infarction did not contain less EPA than the platelets of healthy men. If low EPA level is not a risk factor for acute myocardial infarction, further research in this direction would seem futile. EPA and arachidonic acids are competitive substrates of cyclo-oxygenase. EPA’s favourable effects are explained by the more favourable biological profile of its metabolites. 1 The EPA/arachidonic acid ratio of platelet membranes is a function of EPA consumption. In populations on a typical European diet, the ratio is under 0- (usually 0-02-0-04). In Japan, where a marine diet is more popular and cardiovascular disease is less prevalent, this ratio is about 0’5/ but in Eskimos, who have to consume mainly seafood, the ratio is above unity, going up to 70.’ Among Eskimos severe atherosclerosis is rare. In Wood’s material the ratio was 0-025 for controls and 0-024 after acute myocardial infarction. Thus the population studied consumed hardly any EPA. Just as a study among non-smokers would not identify smoking as a risk factor, without significant intake of EPA it is not appropriate to decide whether EPA has preventive potential or not. Makarenko u.4, H-1085 Budapest, Hungary KISS AKOS 1. Dyerberg J, Bang HO, Stoffersen E, Moncada S, Vane JR. Eicosapentaenoic acid and prevention of thrombosis and atherosclerosis. Lancet 1978; ii: 117-19. 2. Siess W, Roth P, Scherer B, Kurzmann I, Bohlig B, Weber PC. Platelet-membrane fatty acids, platelet aggregation, and thromboxane formation during a mackerel diet. Lancet 1980; i: 441-44. 3. Sanders TAB, Vickers M, Haines AP. Effect on blood lipids and haemostasis of a supplement of cod-liver oil, rich in eicosapentaenoic and docosahexaenoic acids, in healthy young men. Clin Sci 1981; 61: 317-24. 4. Hirai A, Hamazaki T, Terano T, Nishikawa T, Tamura Y, Kumagai A, Sajiki J. Eicosapentaenoic acid and platelet function in Japanese. Lancet 1980; ii: 1132-33. 5. Knapp HR, Reilly IAG, Alessandrini P, FitzGerald GA. In vivo indexes of platelet and vascular function during fish-oil administration in patients with atherosclerosis. N Engl J Med 1986; 314: 937-42.
Transcript of EICOSAPENTAENOIC ACID
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short- or long-term benefit of acupuncture in the management ofmoderate to severe asthma".6
Jobst et al admit that their patients had needles stuck intodifferent places, and sometimes also had artemisia leaves burnedover some of the points. We have no information as to the placementof the needles, and their study is not reproducible.Replying to Professor Day’s criticism (Feb 14, p 387), Fung
introduces the notion (well known in parapsychological circles) thatscepticism may thwart results. Day’s negative study included asceptical subject: how, Fung asks, did Day control against the"negative bias response" of this sceptic? It seems to me that anyoneoffering his skin to acupuncture pricks may introduce a positiveresponse bias. How did Fung control for it? And how did Fung andJobst, who believe in acupuncture, control for their own positivebias?
Department of Community Health,University of Dublin,Trinity College,Dublin, Ireland PETR SKRABANEK
1. Fung KP, Lau SP. Acupuncture. Lancet 1984; i: 1169-71.2. Skrabanek P. Acupuncture and the age of unreason. Lancet 1984; i: 1169-71.3. Skrabanek P. Acupuncture: Past, present, and future. In: Stalker D, Glymour G, eds.
Examining holistic medicine. New York: Prometheus Books, 1985: 181.4. Morgan AD, Peck DF, Buchanan DR, McHardy GJR. Effect of attitudes and beliefs
on exercise tolerance in chronic bronchitis. Br Med J 1983; 286: 171-73.5. Chow OKW, So SY, Lam WK, Yu DYC, Yeung CY. Effect of acupuncture on
exercise-induced asthma. Lung 1983; 161: 321-26.6. Tashkin DP, Kroening RJ, Bresler DE, Simmons M, Coulson AH, Kerschnar H.
A controlled trial of real and simulated acupuncture in the management of chronic
asthma. J Allergy Clin Immunol 1985; 76: 855-64.
ACUPUNCTURE TO PREVENTCISPLATIN-ASSOCIATED VOMITING
SIR,-We have demonstrated the antiemetic effect of
acupuncture on postoperative nausea and vomiting., Cisplatin isan effective agent in cancer treatment but the associated nausea and
vomiting3 can be so severe that some patients refuse furthertreatment. We report here a study with electroacupuncture inpatients with cisplatin-associated sickness.The study was done on 10 inpatients receiving an infusion
containing cisplatin 30 mg as part of a regimen for testicular cancer.They had all had severe sickness after a previous course oftreatment, despite metoclopramide. The patients gave informedconsent and acupuncture was applied immediately before or soonafter the start of the infusion.
In random order, patients had acupuncture to the P6 (Neiguan)acupuncture point or a "dummy" point near the right elbow.Electroacupuncture was applied via a DC stimulator (frequency10 Hz, pulse width 0-25 ms). Every patient had five or six
acupuncture treatments over 3 days, only one of which was adummy. At least 8 h elapsed between successive acupuncturetreatments. Patients were unaware of whether a genuine or dummypoint was being stimulated.
It was not always possible for the observer, who visited thepatients after 8 h, to remain unaware of the site of acupuncture sincepatients frequently volunteered this information. The effects over
EFFECTS,* OVER 8 h, OF THREE, FOUR, OR FIVE SERIALACUPUNCTURE TREATMENTS IN PATIENTS WHO HAD PREVIOUSLY
HAD SEVERE VOMITING AND/OR NAUSEA AFTER CISPLATINI
Grades in parentheses are for dummy treatments.*D = very good (no sickness); C = some benefit (marked reduction in sickness); B = nobenefit; A = worse than before.
8 h were graded as "very good", "some benefit", "no change", or"worse" (table), relative to the sickness experienced beforeacupuncture was used.There was significantly less sickness when P6 acupuncture was
done than when the dummy point was used (p < 0’001). There wereno side-effects from acupuncture.
Before this study we reviewed the sickness experienced by 54patients who had had distressing emesis after the first chemotherapytreatment. 52 had symptoms just as severe at the subsequenttreatment. We are confident that our results with acupuncturerepresent a genuine reduction in emetic effects of cisplatin. P6acupuncture, though effective, is time-consuming, so we are nowlooking for ways to simplify the treatment-eg, by getting patientsto administer it themselves, or by using acupressure.5,6
Supported by a grant from the Friends of Montgomery House, BelvoirPark Hospital, Belfast.
Department of Anaesthetics,Queen’s University of Belfast,Belfast BT9 7BL;and Northern Ireland Radiotherapy
Centre, Belfast
J. W. DUNDEER. G. GHALYK. T. J. FITZPATRICKG. A. LYNCHW. P. ABRAM
1. Dundee JW, Chestnutt WN, Ghaly RG, et al. Traditional Chinese acupuncture: apotentially useful antiemetic? Br Med J 1986; 293: 583-84.
2. Ghaly RG, Fitzpatrick KTJ, Dundee JW. Studies with traditional Chinese
acupuncture. Anaesthesia (in press).3. Spiegel RJ. The acute toxicities of chemotherapy. Cancer Treatment Rev 1981; 8:
197-207.4. Dundee JW, Ghaly RG, Fitzpatrick KTJ, et al. Optimising antiemesis in cancer
chemotherapy. Br Med J 1987; 294: 179.5. Fry ENS. Acupressure and postoperative vomiting. Anaesthesia 1986; 41: 661.6. Dianhua D, Qinglan T, Jisheng H. Observations on combatting nausea by finger
pressure on the hegu point. J Trad Chinese Med 1986; 6: 111-12.
EICOSAPENTAENOIC ACID
SIR,-It is difficult to explain the observation of Dr Wood andcolleagues (January 24, p 177) on platelet membrane
eicosapentaenoic acid (EPA) content. EPA is thought to be apromising agent in the prevention of atherosclerosis. However,Wood’s group found in a large case-control study that plateletsharvested soon after an acute myocardial infarction did not containless EPA than the platelets of healthy men. If low EPA level is not arisk factor for acute myocardial infarction, further research in thisdirection would seem futile. EPA and arachidonic acids are
competitive substrates of cyclo-oxygenase. EPA’s favourable effectsare explained by the more favourable biological profile of itsmetabolites. 1 The EPA/arachidonic acid ratio of plateletmembranes is a function of EPA consumption. In populations on atypical European diet, the ratio is under 0- (usually 0-02-0-04). InJapan, where a marine diet is more popular and cardiovasculardisease is less prevalent, this ratio is about 0’5/ but in Eskimos, whohave to consume mainly seafood, the ratio is above unity, going upto 70.’ Among Eskimos severe atherosclerosis is rare.
In Wood’s material the ratio was 0-025 for controls and 0-024after acute myocardial infarction. Thus the population studiedconsumed hardly any EPA. Just as a study among non-smokerswould not identify smoking as a risk factor, without significantintake of EPA it is not appropriate to decide whether EPA haspreventive potential or not.
Makarenko u.4,H-1085 Budapest,Hungary KISS AKOS
1. Dyerberg J, Bang HO, Stoffersen E, Moncada S, Vane JR. Eicosapentaenoic acid andprevention of thrombosis and atherosclerosis. Lancet 1978; ii: 117-19.
2. Siess W, Roth P, Scherer B, Kurzmann I, Bohlig B, Weber PC. Platelet-membranefatty acids, platelet aggregation, and thromboxane formation during a mackereldiet. Lancet 1980; i: 441-44.
3. Sanders TAB, Vickers M, Haines AP. Effect on blood lipids and haemostasis of asupplement of cod-liver oil, rich in eicosapentaenoic and docosahexaenoic acids, inhealthy young men. Clin Sci 1981; 61: 317-24.
4. Hirai A, Hamazaki T, Terano T, Nishikawa T, Tamura Y, Kumagai A, Sajiki J.Eicosapentaenoic acid and platelet function in Japanese. Lancet 1980; ii: 1132-33.
5. Knapp HR, Reilly IAG, Alessandrini P, FitzGerald GA. In vivo indexes of plateletand vascular function during fish-oil administration in patients withatherosclerosis. N Engl J Med 1986; 314: 937-42.
