MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The discussion whether acupuncture is more than a placebo is as long as it is heated. Crucially, it is also quite tedious, tiresome and unproductive, not least because no resolution seems to be in sight. Whenever researchers develop an apparently credible placebo and the results of clinical trials are not what acupuncturists had hoped for, the therapists claim that the placebo is, after all, not inert and the negative findings must be due to the fact that both placebo and real acupuncture are effective.

Laser acupuncture (acupoint stimulation not with needle-insertion but with laser light) offers a possible way out of this dilemma. It is relatively easy to make a placebo laser that looks convincing to all parties concerned but is a pure and inert placebo. Many trials have been conducted following this concept, and it is therefore highly relevant to ask what the totality of this evidence suggests.

A recent systematic review did just that; specifically, it aimed to evaluate the effects of laser acupuncture on pain and functional outcomes when it is used to treat musculoskeletal disorders.

Extensive literature searches were used to identify all RCTs employing laser acupuncture. A meta-analysis was performed by calculating the standardized mean differences and 95% confidence intervals, to evaluate the effect of laser acupuncture on pain and functional outcomes. Included studies were assessed in terms of their methodological quality and appropriateness of laser parameters.

Forty-nine RCTs met the inclusion criteria. Two-thirds (31/49) of these studies reported positive effects. All of them were rated as being of high methodological quality and all of them included sufficient details about the lasers used. Negative or inconclusive studies mostly failed to demonstrate these features. For all diagnostic subgroups, positive effects for both pain and functional outcomes were more consistently seen at long-term follow-up rather than immediately after treatment.

The authors concluded that moderate-quality evidence supports the effectiveness of laser acupuncture in managing musculoskeletal pain when applied in an appropriate treatment dosage; however, the positive effects are seen only at long-term follow-up and not immediately after the cessation of treatment.

Surprised? Well, I am!

This is a meta-analysis I always wanted to conduct and never came round to doing. Using the ‘trick’ of laser acupuncture, it is possible to fully blind patients, clinicians and data evaluators. This eliminates the most obvious sources of bias in such studies. Those who are convinced that acupuncture is a pure placebo would therefore expect a negative overall result.

But the result is quite clearly positive! How can this be? I can see three options:

  • The meta-analysis could be biased and the result might therefore be false-positive. I looked hard but could not find any significant flaws.
  • The primary studies might be wrong, fraudulent etc. I did not see any obvious signs for this to be so.
  • Acupuncture might be more than a placebo after all. This notion might be unacceptable to sceptics.

I invite anyone who sufficiently understands clinical trial methodology to scrutinise the data closely and tell us which of the three possibilities is the correct one.

819 Responses to Acupuncture: new meta-analysis suggests it is effective beyond placebo

  • Fascinating, even if it is only because of the laser method, which eliminates the possibility for infections and punctures. That alone would be (almost) enough to trick me into being less critical/biased? at the start. Interesting question too, but I won’t be able to study it in any depth before next week. Nevertheless, I couldn’t help but notice this:

    Two-thirds (31/49) of these studies reported positive effects, were of high methodological quality, and reported the dosage adequately. Negative or inconclusive studies commonly failed to demonstrate these features.

    Coincidences happen, but isn’t this rather convenient?

  • None of the trials included in the meta-analysis contained a sample size of greater than 176. Isn’t it reasonable to suggest none of them are statistically sound on that basis alone?

    • No. First of all, in order to determine whether a trial is large enough, one needs to perform a power calculation. 176 will be adequate for certain comparisons and inadequate for others. You would need a biostatistician to perform the calculations to determine sample size.

      However, this is a meta-analysis. It is perfectly valid (and very common) to combine the data from under-powered trials to find strong evidence of efficacy. There’s nothing ‘statistically unsound’ about these trials. So no, that wouldn’t be a reasonable suggestion at all, but good question.

  • Forgive me: can’t resist.

    Using the ‘trick’ of laser acupuncture, it is possible to fully blind patients, clinicians and data evaluators.

    Especially if the laser is aimed at the eyes!

  • Might I suggest, admittedly without looking at the studies, that it could simply be the type of laser used that made the difference, and that acupuncture, with its bogus theories of chi and meridians, is completely irrelevent to the outcomes?

    • Hey – just so you are current on your medical research, the acupuncture meridians have been discovered. They are called “Primo Vascular Channels.”

      http://www.ncbi.nlm.nih.gov/pubmed/23852507

      Remember when they killed that guy for discovering the Earth revolved around the Sun?

      • “Primo Vascular Channels”?
        Discovered(?) over 50 years, undetectable by any modern equipment, unknown to medical science, not included in Gray’s Anatomy, yet responsible as the mechanism by which acupuncture works and, therefore, for its efficacy? Yet the discoverer somehow missed out on the Nobel Prize for Medicine?
        .
        Well, there is one thing for certain, you believe they exist;
        http://www.bethacampora.com/conditions-treated.html
        .
        You also believe you can treat an enormous range of medical conditions;
        All Back, sciatica, arthritis, injury, pre and post op prep
        Neck, shoulder, elbow (tennis, golf), wrist, carpel tunnel syndrome
        Knee (injury, arthritis) ankle, foot (heel spur, plantar fasciitis)
        Abdominal, menstural (PMS), digestive (IBS, colitis, Crohn’s), scar tissue pain
        Headache, migraine (All types)
        TMJ, dental pain, ear congestion and pain, sinus congestion pressure and pain
        .
        Apparently, you can “restore fertility” though just how is a mystery, though the claims are huge;
        “Fertility Restoration ™ has been clinical proven to:
        Increases egg quality by improving the circulation of blood and nutritious fluid around the ovaries;
        ​Reduces cysts (PCOS), dryness and stagnation in the reproductive area caused by stress, poor diet and artifical hormone management;
        ​Reduces endometriosis symptoms by stimulating tissue absorption and blood flow in and out of the Jade Palace 😉
        ​Regulates irregular or lost cycles, re-establishing a pain free, harmonious monthly cycle, very often in sync with the moon, the way it is supposed to be!
        ​Improves sperm count, motility, morphology & ph for men
        ​Balances hormones to treat and resolve PMS, bloating, acne, and fatigue.
        ​Increase feelings of relaxation to enhance sexual energy, interest, performance and enjoyment.”
        .
        You also say;
        “Research has documented that our own DNA cells become very active and communicative after needle, laser or kinetic stimulation.”
        DNA cells? Is this another medical discovery that has been totally missed by the whole medical research community across the whole world since microscopes were first used in this field?
        .
        I would like to thank Edzard for leaving your post because it gave the opportunity to see what a nonsense this is. Beth, I’m not sure whether you are a charlatan, fraud and shyster, or just a seriously deluded idiot. Maybe both to make such ridiculous statements and claims. You certainly lack an education of any worth.
        .
        As for the “guy” who was killed, which “guy” was that; the Egyptian who calculated the circumference of the Earth, with incredible accuracy given his tools, about 2,500 years ago or some other “guy”?

  • I do not consider myself to be someone who sufficiently understands clinical trial methodology, but I do think something strange is going on here. If this is such an impressive study with seemingly flawless methodology, then why on earth was it published in a fringe magazine like Journal of Acupuncture and Meridian Studies, which apparently has an impact factor of exactly 0.00 (http://www.researchgate.net/journal/2005-2901_Journal_of_Acupuncture_and_Meridian_Studies). I believe prof. Ernst still has a few cards up his sleeve.

    • Laurens said:

      I believe prof. Ernst still has a few cards up his sleeve.

      Oh, I think the dear prof is teasing us as well… 🙂

    • Google Primo Vascular Channels. It’s time to get with it dude. You sound kinda uninformed…….. here’s a link for you to get your education started.

      http://www.ncbi.nlm.nih.gov/pubmed/23852507

      • Beth

        You keep punting that paper as evidence for acupuncture or meridians or whatever, but that paper (I can only read the abstract) is titled ‘Primo Vascular System and Its Potential Role in Cancer Metastasis’ and makes no mention of acupuncture. Can you explain that discrepancy?

        • I tried Chinese foot patches claimed to remove toxins from feet based on reflexology and meridians…of the 20 possible colours I had 3 colours corresponding to my exact medical conditions ie high triglycerides,liver problems and tapeworms…why not try before waiting for studies or relying on ones that find some ingenious explanation to discredit them by clutching at straws…science is the only pillar of truth and so objective that it has no objective body to oversee its operations or disentangle it from possible corruption via various sources…it is therefore ironically as subjective as the very pseudosciences it critiques…tried it on ten friends with varying health conditions and it worked without fault

          • @Avi

            Do tell us more. I thought the only colour you got from Chinese foot patches was a brownish black, the result of reaction of moisture from your feet with substances in the pads.

            Reflexology indeed associates specific foot regions with other points in the body (something every non-comatose person should recognize as totally ridiculous!) and provides multi-coloured fantasy charts purporting to show the associations, but the charts I’ve seen have more than 20 colours, and the colours have nothing to do with Chinese foot patches.

            A reflexologist might well diagnose liver problems (a 3 sq. cm place on the sole of the right foot refers to the liver) in a sufficiently gullible subject, but there’s no part of the foot even in the fantasy world of reflexology that relates to tapeworms, and triglycerides were unknown to the ‘wisdom’ of the ancient Chinese.

            Your post makes little sense as it stands. Perhaps the good bits are in the places indicated as omissions by the use of three dots. Or do you not realize that one full stop is the widely recognized convention to end a sentence?

          • Google Bonghan Channels. That is the name of the North Korean researcher who discovered them in the 60’s. The references to acupuncture are numerous. It was because of the former “acupuncture meridian” theory that he was looking for them. In Europe, the research has been replicated, but they do not give credit to Dr. Bonghan because he would not share his formula for the nano dye used to find them. It took European researchers an additional 20 years to formulate the nano dye before they were able to reproduce his results. Because of this, they call them differently. Primo Vascular Channels, because of the simplicity of the cellular make up of the vessels. Our profession suffers from the same disease as many other industries. An acupuncture channel will have to jump out of the body carrying a neon sign that says I’m an acupuncture channel while dancing the cha cha and singing the “I’m an acupuncture channel” song in all languages before they will say, they are acupuncture channels. None the less, they ARE the channels. Every piece of research exactly correlates to the philosophy, practice and the results that we get, over and over and over. You won’t know that unless you are a trained doctor of Chinese Medicine with a progressive bent. Pretty exciting, but no tinker tape parade. With the reserves of the establishment, it’s a miracle we make any progress at all nowadays. Thanks for your interest though.

          • @Beth Hopkins

            Please see my detailed comment from March 15 that appears immediately below this series of exchanges. (You can’t have done already or you’d see I acknowledge in the first paragraph that these figments of the imagination were originally named after Bong-Han.)

            I wrote in that comment: “You’d think something as novel as an entirely new micro-vascular system might have found its way into a journal like Nature or Science somewhere over the past 55 years.” Why do you imagine Bong-Han’s ‘discovery’ remains so obscure?

            An acupuncture channel will have to jump out of the body carrying a neon sign that says I’m an acupuncture channel while dancing the cha cha and singing the “I’m an acupuncture channel” song in all languages before they will say, they are acupuncture channels.

            No, hundreds of thousands of histopathologists all over the globe who stain their sections with trypan blue (it’s not a mysterious ‘nano dye’, by the way: Bong-han did his work long before the ‘nano’ prefix became a fashionable term among pseudo-scientific ‘professions’) have missed them when they ought to have seen them.

            The description of the anatomy and molecular composition of the Bong-Han ducts/primo-vascular system means they should be bleeding obvious with all sorts of dyes used in conventional microscopy, and with electron microscopy. “In Europe, the research has been replicated”. Yes, in the same way as, historically, N-rays and Martian canals were replicated by people eager to see them.

            You plainly know very little about real science. “Dr. Bonghan … would not share his formula for the nano dye used to find them.” Scientists indeed play their cards close to their chests — until their work is published. Then they bend over backwards to reveal their methods. Indeed, it’s an unusual situation for work to be published without full disclosure of methodology: the journal(s) that published the original work has to be regarded as suspect for that reason alone. You just might think Bong-Han’s behaviour a little bit strange. Here he was in the 1960s with a potentially Nobel Prize-winning discovery and he’s being coy about trypan blue?!

            It’s more than 50 years since Bong-Han’s first publications, and still 99.9999% of the world’s histopathologists/electron microscopists haven’t seen a structure that resembles Bong-Han’s primo-vascular system. For me and most critical thinkers, that means it doesn’t exist. Like acupuncture itself, the channels are based purely on bovine faecal excrement.

      • I’ve had a quick look at the citations that come up when you use scholarly databases to search for the primo vascular system.

        Some quotes from a review here: http://www.sciencedirect.com/science/article/pii/S2005290113002082
        “In the 1960s, Professor Bong-Han Kim described a new anatomical system that corresponded to the ancient acupuncture meridians. He presented five articles describing nodes and ducts that corresponded to acupunctural points and meridians, and he called the nodes and ducts after his own name: Bonghan corpuscles and Bonghan ducts. Kim used several experimental methods such as anatomical methods, histological methods, radioautography, histochemical methods, “mysterious” blue staining methods, and radioactive dosimetry.”

        “[Kim’s] claims can be collectively known as the “Bong-Han Kim hypothesis.” The main points of the hypothesis are as follows: (1) the PVS is an independent functional morphological system; (2) the superficial PVs and the extravascular PVs are connected by superficial nodes; (3) the deep PVs are connected by intravascular PVs, deep PNs, and organ nodes; (4) the superficial PNs have a muscular layer and various cells inside, and their structure is different from the deep PNs; and (5) the PNs have different kinds of nucleic acids, primarily DNA.”

        “A liquid, called “the primo fluid”, circulates in the PVS. Its flow is slower than blood flow and lymphatic flow. The primo fluid flows in one direction, attending blood flow. The liquid flow depends on the heart beat and on the pressures of the blood and the lymph. The PVS fluid has DNA outside the cell nucleus. The biochemical components of primo fluids are DNA, RNA, nitrogen, fats, reducing sugar, hyaluronic acid, 19 free amino acids, and 16 free mononucleotides. The routes of flow are interconnected, but relatively independent. Primo fluid circulates only in a specified region, but it can also be transmitted through interconnections with other pathways.”

        I won’t go on; you can easily read this and the host of other books and articles for yourselves.

        A couple of comments. The “mysterious” blue staining methods originally used by Bong-Han Kim are seen as a reason why it took a long time for his work to gain any kind of currency. He wouldn’t disclose his histochemical stain. It later turned out to be trypan blue (though it seems alcian blue also works). Now, it’s a very strange scientist who won’t disclose something that straightforward to allow for experimental replication; even stranger that a journal should accept work without methods fully disclosed. The journal involved is the “J Jo Sun Med”, which is a Korean journal, published in the Korean language. Bong-Han Kim explicitly worked for an acupuncture institute when he first published his work.

        You will now find on the web account after account of the primo vascular system. The majority come from Korean institutes, some with titles explicitly indicating they’re centres for acupuncture or complementary medicine research. The authors of the review I quote from above acknowledge “financial support from a grant from the Traditional Korean Medicine Research and Development Project, Ministry of Health and Welfare, Republic of Korea”.

        You’d think something as novel as an entirely new micro-vascular system might have found its way into a journal like Nature or Science somewhere over the past 55 years, but everything is there either in books which, unusually in this age of the paywall, are free to download, or articles in obscure journals.

        Sorry to greet your enthusiasm with scepticism, Beth, but I fear what you’re punting just might belong with N-rays, cold fusion and the like, even though its adherents have done an impressive job of saturation web coverage. Perhaps other readers of these pages can better enlighten us?

        • Vessels within vessels strike me as odd, from what we know of the embryology of blood vessels – but not impossible. what seems really odd is the histopathologists looking at tens of millions of biopsy specimens a year have never seen these vessels either in light microscopy or at electron microscopy. The reporting team say they’re transparent and hard to see naked eye – but those arguments don’t apply to microscopy – the DNA in cell nuclei will stain with the standard H&E stain we use in most specimens, and at EM something as big as a cell will stand out like a Lego brick under your bare foot at 2am.

          I’m also intrigued by the claim that they map to meridians – if they’re inside lymphatic vessels, and lymphatic vessels don’t map to meridians, than how can that be?

          • I did wonder how such easily visible entities had been missed for decades by all the histologists in pathology and anatomy who’ve been using perfectly appropriate stains and examining these tissues routinely. Frank Collins has nailed the situation with more firmness than I dared, having never heard of primo-vascular channels during 50 years in biomedical research. What stuns me is the colossal number of people (predominantly from the one institute in Korea) prepared to put their names to this nonsense.

          • Alternologists may welcome any and all “out-there” ideas as the best thing since sliced bread, but those of us who have had some education and/or interest in reality like to wait until the enthusiasts are able to come with enough convincing evidence to become credible.

            I am joining Frank Collins and FrankO in their apprehension. What can be found on the Internet seems less than convincing, and the fact that it is so popular with the acupuncture crowd and essentially nowhere else, is a warning sign.

            I can’t understand why the acufans are so desperate to find yet another mechanism for their favourite subject. Aren’t there enough claimed mechanisms already? What about spending time and effort to learn about probability and statistics and construction of credible trials? David Colquhoun’s articles and book and YouTube video would be a good place to start, and other than the acufans, he is offering them for free.

            I think most of those who have a brain that can actually reason a bit, would be more impressed with evidence that acupuncture works to even the slightest degree than with the gazillionth explanation of how it manages to obtain its extraordinary non-results.

          • Hello Pat, your opening line intrigued me. Ever heard of vaso vasorum?

          • “Hello Pat, your opening line intrigued me. Ever heard of vaso vasorum?”

            Yes – but vaso vasorum are within the vessel wall, not the lumen.

          • Intravascular Morgellon’s ?? 😀

      • And how is this even remotely relevant, gal?

        Just because stomachs and nervous systems exist, does not prove in any way that eating peanuts will cure the common cold or any other disease.

        Even if these things are real and even if they happen to be the long sought-after meridians, which seems extremely unlikely, how would this validate acupuncture in even the slightest way? Bernie Madoff could easily prove the existence of money, the stock exchange, shares, debt certificates, bank accounts, loan sharks, and so much more, but what he could not demonstrate was profit, which just happens to be what investors are after.

      • Beth has quoted, on her website, the “acupuncture girl” who quotes yet another acupuncturist ,Lisa Rohleder, who says this about acupuncture, and its amazing ability to cure most diseases;

        *********************************************************************************************
        “Imagine what would happen if a pharmaceutical company announced that it had invented a drug which could effectively treat practically everything that could go wrong with a person. The short list would include asthma, arthritis, indigestion, PMS, sinusitis, insomnia, fibromyalgia, hot flashes, high blood pressure, infertility, constipation, the side effects of chemotherapy, and the common cold, not to mention every conceivable variety of pain. And imagine that not only can this drug address all of these problems, but all of its “side effects” are positive: it has stress-reducing and mood-elevating properties, and is fact is so relaxing that some people who have nothing really wrong with them like to use it on a regular basis, just because they enjoy it so much. And yet it isn’t addictive, and there’s no way to overdose on it. Think about the potential market for such a drug — and how it would challenge our assumptions about how medicine works.
        “Now imagine that this drug isn’t a drug, but a practice so old that it cannot be patented or claimed by anyone. A practice that requires almost no materials and potentially costs almost nothing. In a country that is not only int he midst of a health care crisis due to skyrocketing costs, but also sunk in the worse recession in memory.”
        Lisa Rohleder, “Acupuncture
        **********************************************************************************
        .
        Is there no end to the wonders of acupuncture?

        • The acupuncture girl. How cute. Maybe professor Ernst should refer to himself as the homoeoboy and professor Colquhoun as the quackeroo. That should increase their credibility!

        • Can something without a beginning strictly be said to have an end? ;D

        • Not really, because the newly found meridians, now called the Primo Vascular system contains stem cells………….chew on that one…………

          • Not really, because the newly found meridians, now called the Primo Vascular system contains stem cells………….chew on that one…………

            Repeating the same fallacies over and over without taking into account the information that shows they are indeed fallacies will not suddenly turn these fallacies into truths. A corpse remains a corpse, regardless of how many times you claim it is alive.

          • “the newly found meridians”
            For starters, they aren’t “meridians”, no matter what you define them to be, for one reason alone and which you ascribe too; they are too small to be of significance. If they are too small to be seen by the human eye (and more so beneath the skin – invisible), how could an acupuncturist possibly know where to stick the needle?
            .
            Now “chew on this one”;
            No one, apart from acupuncture believers, even believes they exist. The people who operate very high-powered and sophisticated diagnostic equipment in hospitals and diagnostic centres have not seen this apparently very obvious physiological presence. You must ask why not?
            .
            Does anyone remember the “energy” pyramids that kept razor blades sharp? Deja vu?

          • Does anyone remember the “energy” pyramids that kept razor blades sharp? Deja vu?

            The “mysterious” powers of the pyramids! Do I remember those! When I was in med school, one of my best friends slept under a pyramid, had plants under pyramids, razor blades, meat, and more I can’t even remember. And yet, in spite of all these impressive powers, people are still buying razor blades by the truckload, now 35 years later. I wonder why?

        • No response on the Primo vascular research…………..?????????????

          • Yep. It is nonsense.
            After 55 years, no on else has seen them. Is the the rest of the world so completely and utterly blind?

      • @ Beth Acampora on Monday 02 March 2015 at 21:15,

        Beth, I wrote this on Tuesday 03 March 2015 at 23:20, “I’m not sure whether you are a charlatan, fraud and shyster, or just a seriously deluded idiot.”

        Your website (http://www.healingjax.com/ under “contact physician”) reveals the latter with no uncertainty. Do you seriously regard yourself as a”physician”?

  • Or option four.

    however, the positive effects are seen only at long-term follow-up and not immediately after the cessation of treatment.

    The disease followed its normal course and the person naturally got better.
    Unless, and until, supporters of acupuncture can offer a mechanism by which (witch?) the “treatment” works, it must be treated with utmost suspicion. Poking the body and manipulating meridian energy is NOT a plausible reason. If some think it is, I ask “How much does a witch weigh?” (Monty Python’s “Holy Grail”).

    Did the study/ies ensure that no other treatments were used after treatment and in “the long-term”?

    • Whatever else is afoot with the good professor Ernst, your point is the bottom line. This study, like all others evaluating acupuncture is Tooth Fairy Science.

    • “The disease followed its normal course and the person naturally got better.”

      How does this explain the significant between group differences?

      • How does anyone explain anything about a study published in a journal that is premised on the existence of evidence for acupuncture and meridians? It wasn’t published in any respectable journal as an investigation questioning the efficacy of acupuncture, it was aimed at the target audience; believers.
        .
        Another poster has said it and I believe it is probably true; Edzard has something up his sleeve.
        .
        It reminds me of the famous paper published years ago that was complete gobbledegook but was accepted because of its use of scientific language. This one smells the same.

  • The problem with placebo is that it is commonly used with chemical injection by either a tablet or injection and only of benefit to the pharmaceutical industry. To claim that placebos are required for any testing for something that works within the psychic/ emotional body denies the fact that what cannot be seen must be false.

    There are many energy therapies that in some way are effective and even in the same modality there re highs and lows in capability.

    Keep your placebo’s within the pharmaceutical industry, they need it to offer proof and in the long term that proof sometimes is found wanting.

    Develop other methods to examine the industry that has built up around those who claim to practice Energy therapy and that includes the fringe work of Acupuncture. It is actually the ability of the practitioner to be able to find the blockage within the Meridian and then remove it.

    • A common argument used by quacks. It is wrong. Just because there is no “chemical” does not mean comparative tests are not possible, or worse, irrelevant.

      Just think of transcendental meditation for example. It is supposedly “all natural”, just “mind over matter”.

      Well, it is extremely easy to test: take volunteers to the 30th or so floor of a building, let them meditate, and then invite them to step out of the window for a casual stroll/fly around the building.

      One of three things will happen: 1. the volunteers will stop being volunteers just before the test, 2. they will stroll/fly around the building and prove mind-over-matter once and for all, or 3. the city sanitation department will go on strike demanding more staff for the clean-up.

      No placebo, no chemicals, no tricks, everything perfectly natural. Wonderful test. Easy as proverbial pie.

      Question: since it is so simple a test, why hasn’t it been done? It can’t be for lack of subjects. TM still claims millions of followers all around the planet.

      • That’s the dumbest take on meditation I’ve ever heard…

        • That’s the dumbest take on meditation I’ve ever heard…

          Why? The claims are real. Just two examples:

          http://www.yogicflyingclubs.org/yogic_flying.html
          http://www.amazingabilities.com/amaze9a.html

          If you have ever read Patanjali’s Yoga Sutras, you would know it is not a modern claim either, but an ancient system of more than a thousand years old.

          The only thing that is lacking is hard evidence. While it is rather strange that the claimants have not come up with this test themselves, I think it is a very fair test. After all, isn’t that also the way we test other flying claims, such as those of mosquitoes, hawks, airplanes and helicopters?

          • Regarding meditation – I haven’t read Patanjali’s yoga sutras but I have experience with meditation and most practitioners of meditation would agree that flying out of tall buildings is the least of their concerns and it is not a goal of meditative practices. Meditation does, however, have a good track record helping things like anxiety, insomnia, and HBP, all of which conventional medicine attempts to treat pharmacologically.

          • How can you claim an interest in meditation and not have read Patanjali’s sutras, one of the seminal works on the subject?
            Just as with acupuncturists, you favour those issues that can easily be claimed without being true, because no one can verify them. That does not make it untrue, but it does not make it true either. It’s just rather convenient.

            What is your evidence for the “good track record”?

          • Not only do I “claim” to have an interest in meditation, I claim to have an active practice in meditation which allows me to have an opinion on these matters. In order to begin to understand meditation, one needs to start meditating (shocking news, I know). If someone told you they’re interested in swimming and its effects on body and mind, would you ask them how many books by famous swimmers they’ve read or would you be ok with knowing how much time they spend in the pool? While all of this doesn’t excuse my not reading Patanjali’s Yoga Sutras (a seminal work from what I hear, as you mention), it doesn’t refute my earlier argument either. Using an example of meditators jumping out of buildings to make a point about acupuncture is not only a fine example of straw man argument, it does nothing to discredit either acupuncture or meditation.
            As far as “good track record”, you’re correct, what I should’ve said: from talking to other meditators I know of cases of resolution of long standing insomnia, anxiety or hypertension through meditation practice. The most dramatic of which came from an MD who became a meditator. For evidence supported by trials, you’d have to search the web. I don’t have the references because I don’t feel like doing the search myself but I keep hearing that people are studying it more and more.

          • As far as “good track record”, you’re correct, what I should’ve said: from talking to other meditators I know of cases of resolution of long standing insomnia, anxiety or hypertension through meditation practice. The most dramatic of which came from an MD who became a meditator. For evidence supported by trials, you’d have to search the web. I don’t have the references because I don’t feel like doing the search myself but I keep hearing that people are studying it more and more.

            Well, that is that, isn’t it? Discussion over. You are not interested in evidence. Not even remotely. Which doesn’t come as a surprise. You’d not be a very firm believer in acupuncture if you did. Nor in meditation for that matter. As I’ve said elsewhere: if you enjoy these things, all the power to you. Some people climb Mount Everest, others smoke, some have needles stuck in them, some watch Star Trek, others go wafting incense at the depiction of a half-naked man on a cross. De gustibus et coloribus non disputandum as the saying goes. But don’t claim that any of this will cure any disease, because if you can’t provide the evidence, you are only providing evidence for lack of seriousness.

            And flying around a building does remain a good test of fly-by-meditation, in just the same way that drones are a good test of fly-by-wire.

          • As I said before, not only am I interested in evidence, I’m so interested in evidence of meditation’s effectiveness that I spend 1-2 hours a day doing it. I prefer to test things on myself and see how and whether they’re working rather than reading about other peoples’ experiences’ with those things.

            The reason I didn’t go looking for studies that tested meditation effects on psyche, brain function and so on was just because I’m lazy. I know they exist, I keep reading headlines about them. I’m sure if you do some simple web searching, you’ll find them

          • Sasha said:

            As I said before, not only am I interested in evidence, I’m so interested in evidence of meditation’s effectiveness that I spend 1-2 hours a day doing it. I prefer to test things on myself and see how and whether they’re working rather than reading about other peoples’ experiences’ with those things.
            The reason I didn’t go looking for studies that tested meditation effects on psyche, brain function and so on was just because I’m lazy. I know they exist, I keep reading headlines about them. I’m sure if you do some simple web searching, you’ll find them

            Then you are not in the slightest bit interested in evidence, only in confirming your own preconceived beliefs. Please try to open your mind.

          • And what evidence would that be? If you have some on mediation, bring it on, I’ll read it. But don’t ask me to go look for it so that I can disprove your beliefs about meditation.

            To repeat my earlier anology: If I’m interested in what swimming regularly will do to my health, will I go to the pool and start swimming or should I sit on my couch all day and read studies where some guy hooked up electrodes to swimmers and then wrote about it?

            I really don’t understand how I’m not opening my mind here.

          • As I said before, not only am I interested in evidence, […]

            Where?

            I don’t think you are interested. From your descriptions and your lack of interest, I can only deduce that you are not even remotely interested in evidence. I think you are confusing “seeking confirmation of your convictions” with “interest in evidence”. Someone who is interested in evidence, looks –as much as possible– at all the evidence, convenient or not, pleasant or not, desired or not… and changes her/his views accordingly.

          • Sasha’s responses to Bart are a good indication of the difficulty of educating people to comprehend what evidence consists of. I meditated, I felt good: what more do I need to know? I had a feeling I was imbued with the love of Jesus Christ: what more evidence for gods do I need? I distinctly saw a ghost in a castle window: why should I be disbelieved? A friend told me acupuncture had cured their cough: why should they be disbelieved?
             
            Sasha, our subjective feelings, thoughts and things we see are so utterly unreliable, utterly fallible, as to be near worthless. Personal testimony is often used as “evidence” in courts of law, but even lawyers are now acknowledging how much less reliable testimony is when compared with objectively obtained evidence (DNA profiling, CCTV recordings, etc.). Single personal testimony has never been scientifically acceptable. Evidence has to be reproducible.
             
            The web abounds with sites offering optical illusions and sensory delusions that entertainingly discredit the reliability of our senses. Meditating for 1–2 hours daily is definitively not a means of obtaining credible evidence; it merely gives you a sense of confidence in what you believe. The critical question is how you go about objectively proving that meditating reproducibly genuinely confers some sort of response or benefit in people who try it. I bet you can think how to go about proving that a hard blow from an axe can reproducibly sever a limb!

          • FrankO and Bart,

            If you have a point to make about meditation, you should make it and back it up with evidence. I’ll look at it.

            If you like, meditating daily is a means of gathering data for me. People have made certain claims about meditation, I’ve decided to test it on myself and see if the data I get supports these claims. And the data I’ve been getting so far is far more diverse than just “feeling good”. In fact, sometimes meditation can make you feel decidedly not good.

            There are a lot of other things I do without having obtained credible evidence that they do anything. I swim, I listen to music, I visit my father. I have no “credible evidence” that these things do anything for me but I do them because the data I’ve gathered so far tells me that those are things I should continue doing.

            There are people (or so I hear) who hook up Buddhist monks to MRI machines to see what regions of their brains light up when they meditate. If that’s the type of “credible evidence” you’re looking for, I don’t have it in a pdf that I can send you. But I’ve heard it’s out there so if someone is interested in looking for it, they can probably find it.

          • re meditation: This is like Alice Through the Looking Glass. We have a bunch of self-professed sience-based sceptics claiming x and y are not proven yet can’t be bothered to actually look at the evidence. This is the diametric opposite of scientific openness. For the record there are many pieces of research on the effects of meditation. Three major studies conducted at the University of California, Los Angeles, for example, have demonstrated how long-term meditation significantly changes brain structure, improves connectivity and gyrification, reduces brain atrophy and more. Elsewhere a meta-analysis of 47 controlled trials reported moderate evidence that meditation can improve anxiety, depression and pain. UK’s NICE have recommended mindfulness based cognitive behaviour therapy for recurrent depression since 2004. There is a lot more of this stuff. I have to say I expected a better class of argument from this cosy little bunch of deniers of anything that seems a little bit different from the meat and potatoes they’re used to.

          • It always helps to look at the evidence, before claiming it says what you would like it to say. I just picked one, and this is what it says.

            CONCLUSION AND ADDITIONAL IMPLICATIONS FOR FUTURE
            RESEARCH
            Altogether, our findings seem to add further support to the
            hypothesis that meditation is brain-protective and associated with
            a reduced age-related tissue decline. Nevertheless, it is important
            to acknowledge that the observed effects may not only be
            a consequence of meditating but also of other factors allowing
            for (or accompanying) a successful long-term practice […]
            Accumulating scientifically
            solid evidence that meditation has brain (and mind)
            altering capacities might, ultimately, allow for an effective translation
            from research to practice
            , not only in the framework of
            healthy aging, but also pathological aging, such as is evident in
            mild cognitive impairment or Alzheimer’s disease

            I’d say, we stay on our cozy couch for a while longer, studying slightly more promising and definitive stuff. Being open-minded means not to be so gullible as to jump on every snippet that just seems to confirm our prejudices. It also means to take the time and wait until strong, verifiable, replicable evidence is in. Seeing what I have seen so far, I think we can still wait for a decade or so before we become excited.

          • There are people (or so I hear) who hook up Buddhist monks to MRI machines to see what regions of their brains light up when they meditate. If that’s the type of “credible evidence” you’re looking for, I don’t have it in a pdf that I can send you. But I’ve heard it’s out there so if someone is interested in looking for it, they can probably find it.

            Hearsay is not acceptable evidence, I am afraid. Neil Armstrong and his friends really didn’t make it to the moon and back because someone at NASA had heard someone say that it was possible.

            As for the MRIs, nope. All that shows is that there is activity in the brain. Hardly remarkable. That’s what brains do. Living ones, anyway. What would be remarkable, would be *no* activity in the brain while the person is alive and well, or maybe have the activity dance around from one predetermined spot to another to another.

            MRI machines may be impressive, but we don’t need them if we want nothing more than demonstrate “activity” in a normal living and breathing person’s head. This type of thing is often done in documentaries to impress the public, but it is mostly meaningless and a waste of very expensive resources.

          • Sorry mate but why do you need so many proofs after all?
            Placebo does it’s job even with our “modern care system”, isn’t that right?
            The body is an amazing biological tool and we’re only scratching the surface when it comes to it’s true potential.. Even if acupuncture’s efficiency could be argued, is it really the point?
            Those ancient traditions bring us other views on the body and it’s capabilities (physic as well as emotionnal and mental!) and we’re stock in this 1900’s positivism paradygm :” nothing more left to discover”

          • Sorry mate but why do you need so many proofs after all?
            Placebo does it’s job even with our “modern care system”, isn’t that right?
            The body is an amazing biological tool and we’re only scratching the surface when it comes to it’s true potential.. Even if acupuncture’s efficiency could be argued, is it really the point?

            Well, I think you can answer the question yourself. Suppose you have gallstones. What treatment do you prefer? One that works or one that doesn’t? If you prefer the first, you will be happy that many of us bothered figuring out which one that is. If you prefer to be treated with something that doesn’t work, you should still be happy that many of us bothered figuring out which treatment works and which doesn’t. Otherwise, you might have to discover to your horror that you are being cured against your will.

        • @Sasha,
          The discussion about meditation is a Red Herring. Discuss it in a meditation thread.
          .
          @Peter Deadman
          “I have to say I expected a better class of argument from this cosy little bunch of deniers of anything that seems a little bit different from the meat and potatoes they’re used to.”
          Are there any more ad hominems or other wisdoms you can contribute to other than a Red Herring?

          • You are correct, of course. I only mentioned the meditation, because I wanted to give an easily understandable and unambiguous example of how trials do not have to be about drugs, something a previous poster didn’t seem to realise. The discussion about meditation detracts from that point.

            That said, I’d be interested in comparing meditation with watching Star Trek (or Walt Disney’s Snow white, or The Sword in the Stone, or whatever). How big would the differences be? Probably not very. I certainly stopped meditating once reality sank in and I started, very reluctantly, to realise it was a waste of time and effort.

      • It’s because they only just had the scientific ability to find the acupuncture meridians. They are now called Primo Vascular Channels. Here’s a link to get you started……..no more reason to wonder.

        http://www.ncbi.nlm.nih.gov/pubmed/23852507

        • It’s because they only just had the scientific ability to find the acupuncture meridians. They are now called Primo Vascular Channels. Here’s a link to get you started……..no more reason to wonder.

          Not quite. First-off, you may want to Google your Primo Vascular Channels. Google finds *3* mentions, all on the same site, all dated Mar 20, 2007, referring to *2* pages. For something that you seem to think is so important, the interest sure doesn’t seem to be there.

          Second, while scientists will always be highly interested in discovering new things and how old and new things work, these things fail miserably. Even IF they are those long sought-after meridians, that discovery does not suddenly turn the total failure of acupuncturists to provide any credible evidence that their claims are correct, into a success.

          A corpse is a corpse, no matter how its death is explained!

    • @len

      Difficult to know where to start with that load of nonsense…

    • @len
      “Keep your placebo’s within the pharmaceutical industry, they need it to offer proof and in the long term that proof sometimes is found wanting.”
      Given that nearly all of alternative “medicine” is placebo, I don’t understand.

      • Does it really matter if it is placebo or not? if it works without causing harm, then it works and why does it need debating! I add without causing harm because most modern medicine causing side affects/harm.

        • Yes, it does. A treatment either works or is a placebo. It can’t be both. When some form of alternative medicine is shown to work, it stops being considered alternative medicine and becomes an acknowledged and accepted part of medicine. If not, it is dismissed and called a placebo. A placebo does not “work”. By definition. A placebo that “works” simply isn’t a placebo.

        • Of course it matters! If we know it is only a placebo, then you are lying to patients if you tell them any different. But we do know it can cause harm, therefore, in the absence of benefit, the benefit-harm balance cannot favour it as a treatment.

          But whether conventional treatments have side effects or cause harm is entirely irrelevant to whether acupuncture is no more than a placebo.

        • if it works without causing harm, then it works and why does it need debating!

          That’s fine Sandra. And how would you like to set about proving that it works?

          • Hi FrankO, Alan and Bart,
            Could I ask if either of you have ever tried acupuncture from a fully qualified Chinese acupuncturist? Not from your GP or physiotherapist.
            I know I have tried drugs that were said to be effective but they didn’t work for me, I’ve also taken antihistamines that I was allergic to and gave me a UV rash, I’ve had antibiotics that have made every muscle swell with fluid. Every day there are people who die from side affects. Heck people don’t die from cancer they die from the their body shutting down, from the effects of the syringe driver of morphine they are given. Alan, what harm evidence would you like to put in front of me that matches the very serious side affects modern medicine causes.
            The main thing that should count is that it works there and then for that patient. Everyone is different with what they need and what works for them. The way RCT’s are usually set up; there will a pre agreed set of points used for each control group and then a sham group, but what is not taken into consideration, each person will need a different set of points according to their medical history, family history and personal circumstances. As acupuncturist we are trained to understand the subtle difference the effects someones work stress will affect their back pain or their bodies ability to recover from flu, this understanding can not be accounted for within RTC’s, nor is it accounted for within the western medical world.
            Acupuncture takes the whole person into account, recognising that an imbalance in one area affects the other area, we then find out the root cause and treat from there.
            We are not a 1 pill suits all society and it shouldn’t be the case for testing the effectiveness of treatments, Acupuncture can not and should not be judged using RTC’s the way that drugs trials use them. Acupuncturists do not slate medicine, they recognise that it has it’s place, with some things it is effective, with others acupuncture is more effective with less complications, so why don’t we all find our place and not slate the “other side” whilst we do it. We should be working together to find the most effective way to treat our patients and recognising that for some pills work and for other needles work best, isn’t that what patient care is all about?

          • Could I ask if either of you have ever tried acupuncture from a fully qualified Chinese acupuncturist? Not from your GP or physiotherapist.

            No. Since acupuncture has never been shown to be reasonably effective beyond placebo, even the most fully qualified Chinese acupuncturist is just a merchant in illusions. If I want illusion, I watch Star Trek. I do that because I enjoy it. It is also utterly harmless. On the other hand, acupuncture has risks and those risks are not outweighed by the benefits. If you actually enjoy needles being stuck in your body, all the power to you, I have no comment to make. I might ask you if you are sure you want to go ahead with this, but as long as you do not do it “because it is good for you”, it remains your choice, and only your choice.

            Now, show me beyond the reasonable doubt that acupuncture actually works and provides me with a good risk/benefit ratio, better than the alternatives, and I will be the first to go camp on that fully qualified Chinese acupuncturist’s doorstep to be sure I am the first to get in. But, as things stand now, I’ll relax and watch Star Trek.

          • Acupuncture takes the whole person into account, recognising that an imbalance in one area affects the other area, we then find out the root cause and treat from there.

            Interesting, and how do you go about “taking the whole person into account”? What is an imbalance and how do you detect it and how do you treat it and how do you know the treatment worked?

  • Off the top of my head, I would say…why call this ‘laser acupuncture’ when we already have a body of evidence that lasers can be biologically active? Why not just call it ‘laser therapy?’ The only really promising evidence i have seen with lasers in soft tissue pain is for infrared lasers at wavelengths of ~600-650nm. They stimulate fibroblasts and have some other nonspecific but potentially helpful effects like vasodilation etc. Adding the ‘acupuncture’ tag just makes discerning the actual potentially useful treatment effect more obscure and misatrributes the likely cause of any benefit observed.

  • I can’t find anywhere in the meta-analysis you’re talking about that it says it’s better than placebo. Where did you see that? The analysis is mostly comprised of studies that weren’t placebo-controlled, so I don’t see how it could determine it was better than placebo.

  • Which leads us to an obvious hypothesis: there is nothing demonstrably wrong with the study, the authors are simply lying through their teeth in their conclusion. It wouldn’t be the first time that happens. It is one of the better developed quackery arts.

  • “[studies] involving application of laser therapy to nonacupuncture points were not considered.”

    Without this comparison all that is being tested is the effect of shining lasers on people, which I believe is called low level laser therapy. It has nothing to do with acupuncture. If shining lasers at acupuncture points has specific effects that are not also the result of shining lasers on non-acupuncture points, then *that* would be interesting, but this review didn’t investigate that question.

    • However, trigger points and tender points, whose existence is said to be controversial (like acupuncture points) are treated as acupuncture points in the study.

      No justification is given. These other controversial points are simply declared to be acupuncture points.

      Without justification, I declare them not to be. Acu-laser is consequently demonstrated to be no more effective than sham.

  • I’d be interested to see what the “placebo” controls were. My (imperfect) knowledge of the area suggests two sorts of control are used in acupuncture research: “don’t do acupuncture” (either openly or patient/practitioner blinded somehow) or “do acupuncture wrong somehow” (stimulate random sites rather than traditional acupuncture sites, patient is blinded, practitioner probably isn’t).

    I would be very willing to accept (based on prior knowledge & research) that stimulating the skin via needle, laser or chemical techniques (eg Deep Heat or other agents) would affect the perception of pain but I’d require much better evidence to be convinced it would help asthma, for example.

    Perhaps simply shining lasers at people has an effect not related to acupuncture. In a way, it would be surprising if it didn’t. We know phototherapy affects people and sunlight certainly affects my skin!

  • Hi Edzard
    I’ve only had a cursory look at the meta-analysis and something stands out as being a little odd.
    If you look at the Forest plots for pain VAS at 6 to 20 weeks they report standardised mean differences – which take into account the standard deviation. They needn’t have done this because the measurements are all either 0-10 or 0-100 but never mind.

    You can see there is significant heterogeneity (I2=89%) introduced by the Rayegani 2011 study. Without it, the subtotal for effect would look somewhat different (ie. no effect).
    The reason for the huge effect size in the Rayegani study (they are looking at two comparators – sham and ultrasound) is that the study reports 0-100 pain scores but the tiniest and unlikeliest of standard deviations. For eg, pain scores of 50 with SD of 1!
    The paper is full of typos and I wonder if the authors are reporting 0-100 VAS but 0-10 SD. That would make more sense as the SD for pain scores in every trial I have seen is somewhere in the region of 1-2.
    If they have made an error of this magnitude it’s easy to see why it skews the results so.

    As I said, just a quick look but seems odd.
    Best wishes
    Stephen

  • I found this paper remarkably difficult to follow. It begins by saying that 49 studies were included for analysis. It goes on to say that 33 studies “provided sufficient data to calculate effect sizes for key outcome measures“. It splits among those 33 to differentiate between those that used placebo lasers and those that used other controls (e.g. no laser, no Rx, ultrasound or ischaemic compression). But I can’t find anywhere in these descriptions a simple indication of which 16 studies of the 49 listed in Table 1 were excluded from this analysis.
    When it comes to the Forest plot data — the part I always understood was the most important component of a meta-analysis for drawing global conclusions — only 19 studies were included. To deduce this number I had to compare by hand the full list of 49 studies in Table 1 with the list in the Forest plot figure. Of these 19 studies, four used inappropriate controls (not sham laser treatment). So the key figures for the positive global outcome in the Forest plots were generated from 15 valid and 4 invalid studies.
    We finally discover which were the 33 included and the 16 excluded studies when we arrive at Tables 3 and 4. These simply list which studies showed positive outcomes and neutral or negative outcomes for the laser acupuncture, together with doses used, and both lists are divided to detail which studies were included and which excluded. Why a similar split could not have been made at the start in the full list of studies, I have no idea.
    The bottom line seems to me that a very heterogeneous mix of studies — few of seriously high quality, as the authors themselves acknowledge — has been pooled together in a less than crystal clear presentation to demonstrate a feebly positive, but statistically significant effect several weeks after laser lights have been shone on parts of patients’ anatomy. For once, the old chestnut about “further studies are needed” seems more than apt.

  • Oh dear, is this the best that can be done after more than 60 years since Mao revived acupuncture?
    Here are a few thoughts.

    (1) The study is not about acupuncture at all.
    (2) The results are all over the place.
    (3) Not all studies had proper sham groups. Some comparisons were with “no-treatment”. It doesn’t seem to be stated anywhere what the “placebo” consisted of.
    (4) The average effects, even if real, are too small to benefit patients noticeably.
    (5) The studies are from “peer-reviewed journals” but many if them are alternative medicine journals where they would have been reviewed largely by acupuncturists or other alt med believers.
    (6) Subgroup analysis is done without any allowance for multiple comparisons.
    (7) The authors appear to be unaware of the idea of the false discovery rate (eg http://rsos.royalsocietypublishing.org/content/1/3/140216 )
    (8) This paper was published in a highly obscure journal that’s evidently run by people who still believe in meridians, despite abundant evidence that they are figments of the imagination.

    That’s enough for now.

    • It never ceases to amaze me that studies based on disproven and/or unfalsifiable a priori tenets get published anywhere in this 21st Century. It’s the ultimate demonstration of nincompoops clutching at not straws, but clinging for dear life onto the old ashes of their incinerated straws.

      One of the resident trolls uses the word science only in its archaic meaning “knowledge of any kind” and, as with all alt-med proponents, he/she refuses to accept that the word actually means: The systematic study of the structure and behaviour of the physical and natural world, through observation and experiment, using the rigours of the scientific method, which includes mandatory components such as measurable evidence (specifically, empirical evidence), independent replicability of empirical evidence, and the systematic review of the methods, the empirical results, and the conclusions of each study in the review.

      • @Pete, you say that science is: ‘The systematic study of the structure and behaviour of the physical and natural world, through observation and experiment, using the rigours of the scientific method, which includes mandatory components such as measurable evidence (specifically, empirical evidence), independent replicability of empirical evidence, and the systematic review of the methods, the empirical results, and the conclusions of each study in the review.’

        This is a meta-analysis of using laser light as a therapeutic intervention. When you’re done with your hissy fit about nincompoops and proverbial straws, can you explain how this systematic review is inconsistent with your offered definition of science?

        • @Ella Mentry, you have made it blindingly obvious that you have never worked in exacting fields of engineering in which spurious results are far more frequent than lunch and tea breaks.

  • Isn’t saying that “placebo and acupunctre perform the same” actually saying nothing. A placebo does not cause a physiological effect and neither does needles inserted into the skin–except for pain/discomfort.

  • I too suspect that we have more to find out about these studies and feel that DC has also nailed it.

    But I would like to point out that in the pharmacological placebo world it is known that different methods of delivery generate different sizes of effect. The most splendid pills give stronger effects.

    also we know that zeitgeist has an impact – so Radium treaments had the alt med zeitgeist in yester year, metal rods were more impressive than sticks

    so LASERS – they have the zeitgeist – the special buzz

    I bet that if we could do a meta on quantum lasers we would get a better effect yet. Or large hadron lasers. Or Higgs lasers.

    The oddest thing is that there is a lengthy treatment effect reported – if it was placebo it would be short term. So I would be looking for some skewing of natural history.

    Then could it be that effect of the p value being so low in social sciences?
    If there are 3000 odd articles relating to acupuncture trials then by chance some false positives will emerge. If a meta can successfully boundary those trials into its compass it will look artificially good.

    Seriously though, if someone knows why this meta is flawed please let me know because like a lot of folk here I am going to have to do a lot of bridge building, humble pie eating and the like if a form of ‘acu-something’ is real. Hey – I understand that this is part of the process of science – when it can be proved we change what we think – it doesn’t mean that that is easy on our feelings.
    Kind thoughts,
    Steve

    • In reality, David Colquhoun — as usual — has said it all. We’re all trying to bend over backwards to be fair.

      I have neither the time nor the inclination to read the original papers, but doing so might reveal placebo to be something other than the kind of thing Edzard describes: “a placebo laser that looks convincing to all parties concerned but is a pure and inert placebo”. As the authors themselves acknowledge: “The most common flaws were inadequate allocation concealment (78%), lack of blinded therapists (63%), and lack of intention-to-treat analysis (71%). Despite the possible bias related to these flaws, other criteria were adequately addressed to minimize the risk of bias. Almost all the studies (94%) performed adequate randomization, thereby reducing possible selection bias. In most of the studies, patients (81%) and assessors (63%) were blinded successfully”. These numbers don’t suggest a very convincing placebo laser at all.

      Ultimately, the most obvious negative feature (already pointed out by Laurens and DC) is the obscure journal in which the study is published. If laser acupuncture advocates thought their meta-analysis would revolutionize sceptical attitudes they will surely have first submitted the paper to one or more high-ranking medical journals, then lower-ranking mainstream publications, before finally ending up in this obscure, partisan publication.

      For readers tempted to suggest that the “better” journals will have bounced the study out of entrenched disbelief (the usual Galileo plea of the pseudo-scientist), I can only say that most referees of scientific papers, myself included, find the bad studies a major drain on our time, because we’re forced to spend it looking at a mass of detail to provide a robust reason for refutation. Out-of-hand rejection is the exception, not the rule, in my own experience.

  • “Acupuncture might be more than a placebo after all. This notion might be unacceptable to sceptics.”

    Not accepted, no matter what? How open and scientific minded.

    “Coincidences happen, but isn’t this rather convenient?”

    “If some think it is, I ask “How much does a witch weigh?”
    “let them meditate, and then invite them to step out of the window for a casual stroll/fly around the building.”

    “This study, like all others evaluating acupuncture is Tooth Fairy Science.”

    “there is nothing demonstrably wrong with the study, the authors are simply lying through their teeth in their conclusion”

    “It’s the ultimate demonstration of nincompoops clutching at not straws, but clinging for dear life onto the old ashes of their incinerated straws.”

    “A placebo does not cause a physiological effect and neither does needles inserted into the skin–except for pain/discomfort.”

    And the best. ” I can only say that most referees of scientific papers, myself included, find the bad studies a major drain on our time, because we’re forced to spend it looking at a mass of detail to provide a robust reason for refutation. Out-of-hand rejection is the exception, not the rule, in my own experience.”

    Such critical thinkers, following the scientific principal to the letter?

    Only one true sceptic I can see. ste5e. “Seriously though, if someone knows why this meta is flawed please let me know because like a lot of folk here I am going to have to do a lot of bridge building, humble pie eating and the like if a form of ‘acu-something’ is real. Hey – I understand that this is part of the process of science – when it can be proved we change what we think – it doesn’t mean that that is easy on our feelings.”

  • Even taking into account all the comments – especially from David Colquhoun – shouldn’t the title of the article say “Laser acupuncture”, not “Acupuncture”?

  • I don’t want to comment on this particular study but reading the tone of many of the comments I do wonder whether any evidence in favour of acupuncture efficacy would change minds. Maybe I’m being idealistic but I imagined a greater kind of openness, curiosity and humility to be key features of the scientific mind.

    • Peter Deadman said:

      I do wonder whether any evidence in favour of acupuncture efficacy would change minds.

      Why? Do you know of any?

      Maybe I’m being idealistic but I imagined a greater kind of openness, curiosity and humility to be key features of the scientific mind.

      Openness to what?

      • Many hundreds, even thousands, of studies into acupuncture are published every year in a wide range of journals, some complementary medicine journals and many not so. Just enter ‘acupuncture’ in Pubmed and spend an hour reading what comes up. I would say that the majority of these studies are positive for acupuncture. Obviously – as with all research – the quality varies but what’s confusing is how the mantra that there is no evidence for acupuncture is still trotted out.

        • the quality varies but what’s confusing is how the mantra that there is no evidence for acupuncture is still trotted out.

          That seems to be very confusing to many people. It needn’t be. It is because those pesky scientists and skeptics have a very peculiar mindset: they do not consider fantasized and just plain bad quality evidence to be evidence. At the most, they call it wish-thinking.

          Don’t feel singled out. You won’t find very many scientists and skeptics who give any credence to Jesus’ resurrection, Muhammad’s flying horse, Elvis’ still being alive, Hansel and Gretel’s gingerbread house, cold fusion and the phlogiston theory either.

          Evidence is evidently not enough to change the scientific/skeptical mind. It needs to be good evidence. There is a distinction here. An important one.

          So: come up with good, measurable, verifiable and independently replicable evidence, and you’ll find scientists and skeptics flocking to you like wasps to a dish of sugar water.

        • Peter Deadman said:

          but what’s confusing is how the mantra that there is no evidence for acupuncture is still trotted out.

          Straw man.

          But what does the best of that evidence say?

        • If there so many positive studies, where is the irrefutable evidence?
          .
          Short answer; there is none.

    • I would submit that the difference between openness and gullibility is not entirely trivial.

      Most people I know are very open to strong evidence that acupuncture has effects beyond placebo. That includes me. If acupuncture is so good, why is this evidence not forthcoming? Acupuncture is particularly special here, because it has had ample chance. Old farts like me who went to med school in the 70s will probably remember that there was a lot of talk about acupuncture in those days. I will never forget the explanations my professor of physiology gave for how acupuncture works its magic. There was just one element that didn’t seem to go away: no matter how hard they tried, they were unable to find any evidence that acupuncture actually did anything at all, besides making money for its practitioners.

      That’s openness of mind too, isn’t it? Accepting what is true, instead of klinging to fantasy?

    • I don’t understand why holistic acupuncture can’t be tested by RCT. For each patient, devise your holistic acupuncture regime. Write it down and send it, with the patient, to be given by another appropriately trained acupuncturist who is not permitted to know the patients symptoms or diagnosis. But in between the prescribing acupuncturist and the treating acupuncturist stands the experimenter. He greets the patients in pairs and half the time swaps their prescriptions. We monitor patient symptoms & satisfaction, then see whether there’s any difference in the responses of those who got “proper” acupuncture, tailored to their problems, and those who got a random selection of needlings. You could do exactly the same with homeopathy – I’ve often wondered about what would happen if you broke into a homeopathic pharmacy and swapped the labels around…

      • Hi Pat,
        It would be good if that study could be done as it seems plausible. In Uni we are currently learning which points can treat what ailment, so some treatment would treat a cold ailment such as a low BBT which could entail infertility or slow digestion, we also have points that treat hot ailments, such as raging heartburn. If a paitient with an already hot condition uses a point combination for treating a cold ailment there is a great risk the patient would feel much worse.
        I struggle to understand why the test of with or without treatment is unsatisfactory ? Why is there an issue in the paitient and practition knowing which treatment method is being used?
        I struggle to know why we have ever wanted to seek out the effects of placebos, facts are the human brain will allow the body to heal when it’s ready, I belive we owe more medical results to the placebo effects than “scientists” care to give the brain credit for!
        Ultimately the body or mind has been healed and hopefully without side affects and huge medical bills, that is what should matter!
        There should only be the cost effectiveness question hung over complimentary therapies.

        • > If a paitient with an already hot condition uses a point combination for treating a cold ailment there is a great risk the patient would feel much worse.
          That would be excellent evidence that acupuncture has a specific effect. But I can understand that you may not want to make the patient worse in the short term.

          > I struggle to understand why the test of with or without treatment is unsatisfactory ? Why is there an issue in the paitient and practition knowing which treatment method is being used?
          Here we get to the nub of the issue. The “placebo EFFECT” (there there really aren’t “placebo pills” which do good in the way the popular press believe) means that if I treat you for something which bothers you, you will feel better. If I tell your cat is depressed and treat it, you will report your cat is acting less depressed. (Both of these are on average – you don’t get improvement everytime – there is, after all, a nocebo effect too!) If I paint a room pale pink people will report that it’s warmer than if I paint it pale blue. If I put red colouring in white wine, even wine experts will report it as having red wine tannin flavour. If you know you’re getting the “real treatment” you are more likely to report a beneficial effect (and side effects!) than if you KNOW you’re getting the sugar pills. For that reason, you get more reliable data if no one knows. Obviously, you can’t alwys do this – it would be difficult to do an blinded RCT of open heart surgery vs. pills for heart disease, for example!

          We are not machines. How we FEEL (as opposed to how we ARE) is greatly influenced by everything which happens to us. I remember clearly a man who was having a heart attack and reported a great drop in pain when we X-rayed his chest – but before I’d given him any pain killers. This is 30 years ago and the standard therapy was IV morphine for the pain and IV diuretic to cause the patient to pass water, reducing the volume load on the heart. And I know that if for some reason I gave the morphine second, the fact that I’d told the patient they were going to get something for the pain, they’d feel that benefit BEFORE they got the drug.

          This is what the “placebo EFFECT” is. Every time you interact with a system, you alter it. Perhaps only a tiny amount, perhaps a lot. Perhaps for good, perhaps for ill. But even if you do something which really has no effect, it’ll be perceived as having one. As a result, it isn’t good enough to give a treatment to a group of patients and see if they feel better – you have to not treat another comparable group and see what happens to them too.

          The placebo effect is a blanket term for “everything other than the thing your trying to measure which affects the result”. It does NOT mean that the sugar pill has an action which will work in real cases. It describes a psychological short-coming of humans which tricks us into perceiving effects which are not there.

          If I’m testing a new drug and put it in coloured capsules, patients will report more benefits than if I put it in plain white capsules – unless the white ones are very large “there must be a lot of drug in this!” or really tiny “Wow! This stuff must be strong!” If I’m interested in depression, I’ll get better results from yellow pills than any other colour. And you’ll get more reports of side effects – nausea, headache, skin rashes – from blue or green pills than other colours. This is the “nocebo” effect and it doesn’t just apply to pills. If I measure your blood pressure in hospital I’m likely to get a higher reading than if I measure it at home – this is sometimes called “white coat hypertension”.

          Assessing remedies is complex beyond belief and when done badly it generates misleading information. To do it well you really need quite a large team including psychologists and statisticians to be involved right back ayt the design stage before you ever encounter your first patient.

          > I struggle to know why we have ever wanted to seek out the effects of placebos, facts are the human brain will allow the body to heal when it’s ready,
          Ultimately the body or mind has been healed and hopefully without side affects and huge medical bills, that is what should matter!

          > I belive we owe more medical results to the placebo effects than “scientists” care to give the brain credit for!
          Remember: conventional medicine also benefits from the placebo effect, just like alternative therapies!

        • You are misinformed. The placebo effect is one of the most studied phenomena known to man. Universities invest oodles of time and effort in it. Pharmaceutical companies invest gigantic amounts of money in its study, because it terrifies the hell out of them. And yes, the placebo effect is used in medicine. All the time. It is just that we prefer to add the placebo effect to our therapies, instead of rejecting therapies that work and replace them with this very tricky and dangerous effect. Just ask yourself: how many broken legs has the placebo effect repaired? How many cancers has it cured? How many people has it gotten off kidney dialysis? If you study the issue, you will find that the answer to that is “approximately none”.

  • As an acupuncturist that also uses low level laser on a daily basis on both humans & animals I consider that I have the best job in the world. The positive changes that I see in all my patients has got to be one of the most wonderful things possible. I feel so sorry for you poor skeptics who are missing out on this amazing method of health care. I may not be able to make the ‘smart’ comments on this study that the previous posts have & to be honest I dont want or need to, because I know that what I do makes a difference & that is all I and my fellow practitioners want to do.

    • Annabelle Knight said:

      As an acupuncturist that also uses low level laser on a daily basis on both humans & animals I consider that I have the best job in the world. The positive changes that I see in all my patients has got to be one of the most wonderful things possible.

      What do you believe causes those changes you see?

      I know that what I do makes a difference & that is all I and my fellow practitioners want to do.

      That one sentence nicely encapsulates your problem.

      • Indeed. I had many conversations with CAM therapists over the years and the one common feature is they all “know” their therapy works. I’ve met some who say they know it works because the patients keep coming back year after year and I’ve met some who say they know it works because the patients were cured – or at least, they walked out the door and never came back!

        This post hoc justification is seen in response too. Fo0r example, from http://www.discoverhomeopathy.com/intro.htm about what happens after you start treatment:
        “Some patients experience a period of exceptional well being and optimism. Occasionally symptoms appear to get worse for a short time. This is a good sign that the remedy is taking effect. Sometimes a cold, rash or some form of discharge may appear as a ‘spring cleaning’ effect which means your system is going through a cleaning stage. Similarly, old symptoms can reappear, usually for a short period. ”

        So – get better = evidence homeopathy is working.
        Get a new illness = evidence homeopathy is working.
        Get worse = evidence homeopathy is working

        Really?

    • I would agree with that. Acupuncturists have a wonderful job:

      No knowledge required.
      Minimal investment.
      No effort required.
      Just tell victims whatever they want to hear. They’ll be happy no matter what the outcome.
      Rake in the cash.

      Doctors have it quite a bit tougher, and they have real responsibilities and accountability on top of that. Of course, they also actually cure a substantial number of people. It seems that some of them think that is a Good Thing.

      • A university degree in TCM Acupuncture with a more in depth knowledge of A&P than nurses, that’s what is required to hold a membership with The British Acupuncture Council Bert. Where’s the “no knowledge or cost” there?
        The BAcC are working tirelessly to get the field of Acupuncture fully regulated to ensure only people with the best qualifications can practice within the UK, this woukd stop the under qualified practitioners causing harm and bring distribute to the industry.
        Although the training a Dr, nurse or physiotherapist recives to enable them to practice acupuncture does little to help the profession, the only time I’ve heard of acupuncture not working or causing harm, it has always been administered by a health professional not by a traditional trained acupunctrist.

        • The BAcC is a founder member of the Professional Standards Authority Accredited Voluntary Register (AVR). The AVR scheme is designed to recognise that an accredited organisation maintains high standards of training, safe practice and professional conduct where the operational sector is not covered by statutory regulation.
          Nobody is claiming that you are not allowed to make any investments. You are not required. There is a difference. But, why would anyone make an investment into something that has never been shown to work? Some people just might be gullible enough to do that, but if they do, doesn’t that tell us more about how gullible they are than about how effective it all is? Or maybe, as is so often the case, they are hoping that membership will give them some type of credibility with a public that generally doesn’t know much anyway?

        • Determining the criteria of what makes a good acupuncturist doesn’t bear thinking about.

          But are you aware of the Advertising Standards Authority and their rules on advertising claims about acupuncture?

      • Bart – I wanted to respond to your needlessly mean spirited and completely uninformed characterization of an Acupuncturist as someone who needs no knowledge or effort and who makes people happy by just telling them want they want to hear and then rakes in the cash and that doctors have it tougher has they have to take responsibility for their patients. Such a caricature is not only insulting to Acupuncturists (which I guess you find to be fair game) it is also insulting to our patients. You know nothing about what takes place between a qualified Acupuncturist and their patients. I have been in practice nearly 30 years and most of my patients have already been seen by several doctors and even perhaps Chiropractors and others. Most have no or very limited insurance and must pay out of pocket and so there is tremendous pressure to “take responsibility” and produce results for them in a cost effective manner – something most doctors cannot do for their patients without some third party financial assistance. For the last 7 years, I have been having patients referred to me by a few local hospitals – their Pain Management doctors. These patients have already been seen by their Primary Care doctors who have tried to help them and, if unsuccessful, refer them to Pain Management where those specialists try additional techniques. If those several approaches fail, they may then refer to an Acupuncturist. These patients do have insurance but it is a “Managed Care” insurance and that means that the Acupuncturists must submit regular (every 5 treatments or so) progress reports that includes the patient’s own evaluation of their progress and the Acupuncturist’s findings – both objective and subjective. We must measure not only the subjective intensity and frequency of the symptoms but also the patient’s medication levels and elements of their functionality as well as things (when appropriate) like range of motion findings. These progress reports are then evaluated by a reviewer and further treatments are only authorized if progress is being made. Further, an outside auditing company does an annual survey of these patients to find their level of satisfaction with how the acupuncture addressed their primary compliant (among other things). And while those surveys have never been published (I am lobbying for this), I can tell you those rates of progress on the primary complaint is far above what is usually seen in the “verum” arm of controlled acupuncture studies. This program started 7 years ago as a three year pilot program but has been extended because this insurance/hospital group was pleased with being able to get verified good results for a high percentage of these difficult cases. That is the real world of what happens when acupuncture by qualified Acupuncturists is given a chance by modern medical institutions. Despite the objections of you public skeptic types, acupuncture continues to gain acceptance by mainstream medical providers in both human and veterinarian institutions based on the positive results seen in real world practice.

        • @Matthew,
          Would you please learn to write properly? That massive block of text is hard to read.

        • Matthew, from what you wrote, it seems that you think that “to insult” is one of those irregular verbs: “I am telling the truth”, “you are insulting”.

          You say that I know nothing and am uninformed. Perhaps so. If I am, I have no qualms about this being exposed. I am fully aware of the fact that there is unnameably far more that I don’t know than that I know. I may not be particularly fond of that fact, and I am doing my utmost to remedy it at every opportunity, but I am more than realistic enough to realise I will still feel like an ignoramus who has everything to learn when he dies, something that will probably come sooner than I like and later than you like.

          So, that being said, please do tell why you wrote that:

          Acupuncture skeptics believe that there is no plausible mechanism that could explain acupuncture’s observed clinical effects and so it’s effects must be due to placebo and yet it is in the insistence of a plausible “mechanism” that the wrong question is being asked.

          To my knowledge, that is not what acupuncture skeptics believe, I definitely don’t, and unless I am sorely mistaken – which I could very well be – I have seen no such inclination from Prof. Ernst, nor from Prof. Colquhoun, nor in fact from any of the people currently active here. So, whence/why the claim? Could you elucidate your reasoning/motives for this – at least to me – erroneous claim?

          Second, if I am wrong, and I most certainly may be, it has been, after all, well over 3 decades since last I set foot on UK soil, what the requirements are to establish oneself as an acupuncturist in the UK?

          Let’s say that I am about to finish high school and that I would love to open an acupuncture practice next to my favourite book store, Foyles (if they still exist). What does UK law require me to do and, after that, what would you advise me – if anything – to do on top of that? Could you provide links to the appropriate government websites, acupuncture organisation websites, acupuncture school websites… I am sure, I am not the only one interested in learning this, and as the president of an organisation that promotes acupuncture, you are certainly in an excellent position to provide that information.

          Thank you.

    • @Annabelle,
      “As an acupuncturist that also uses low level laser on a daily basis on both humans & animals I consider that I have the best job in the world.”
      And why not? You take money from willing people and do nothing except dispense a placebo. In my understanding, I would call that theft. Your charges are high, considering the nil objective value they offer. From her website;
      “Your first acupuncture appointment will take approximately 1 hour & cost £35.00

      Your second & subsequent acupuncture appointments will be approximately 45 minutes & cost £30.00

      If you require Laser Therapy alongside acupuncture there will be an additional charge of £10.00”

      “The positive changes that I see in all my patients has got to be one of the most wonderful things possible.”
      That is what a placebo is; People “feel’ better but, in fact, nothing changes. Apart from regression to the mean, and natural progress of an illness, your contribution is giving people a warm, fuzzy feeling while lightening their wallets.

      “I feel so sorry for you poor skeptics who are missing out on this amazing method of health care.”
      Poor skeptics? Why, because we don’t see the need to throw away money on a worthless “service” that does nothing?

      “I may not be able to make the ‘smart’ comments on this study that the previous posts have & to be honest I dont want or need to, because I know that what I do makes a difference & that is all I and my fellow practitioners want to do.”
      Sorry Annabelle, you can’t make “smart” comments because, if your writing here and on your website is anything to go by, you aren’t able.

  • How to stay stuck in Beliefs

    In order to preserve a limiting belief you need to do some or all of the following:
    • Only seek confirming instances of the belief
    • Delete or even refuse to consider disconfirming instances of the belief
    • Rationalise disconfirming instances by regarding them as special cases
    • Fail to examine your own belief system
    • Distort new evidence
    • Dispute the credibility of the source of new information or evidence
    (Changing beliefs -Ian Mc Dermott)

    What essential belief are you holding on to?
    What would it take to shift that belief or is it completely immovable?
    Is ‘sceptic-scientist’ an oxymoron?

    • @Roisin Golding

      What do you believe is the most compelling evidence for acupuncture and what would change your position?

      • Dear Alan,

        Thanks for your question.

        Let me answer the second part of your question first.

        If I had less than 50% success rate such that more than half my patients each day were not significantly improving, then I would have to doubt whether acupuncture or my acupuncture was working. I have been doing acupuncture for almost thirty years now so I feel very confident in my understanding of the theory of it – so if it didn’t work for me then I would doubt acupuncture itself as a widely useful treatment.

        What type of patients do I treat? – looking at this week’s books:-
        Two vulvodynia (one onset > 12 years – 4 treatments later she was free of the pain for the first time ever – completely for a day or so, and more generally reduced to 3/10 as opposed to 7 /10. Still treating.
        The other, onset 3 years, has also had 4/5 treatments but much less frequent – with 4-6 week gaps between and not yet successful.)
        2 IVF patient, both successfully treated before and coming back for 2nd child. I don’t consider these great successes – because acupuncture was used to support IVF. In these two cases I was unsuccessful with natural fertility and there was no obvious reason why.
        One patient previously successfully treated for Bells Palsy (had for 4-5 weeks with little improvement until acupuncture.) has come back 12 years later with 6th cranial nerve palsy – diabetic.
        Assorted indigestion, irritable bowel – all successful.
        One hay fever of > 13 years duration, previously cured, back with something else.
        One atrial fibrillation – treated by elctro cardioversion – wanted to maintain sinus rhythm. As a side-effect of this acupuncture treatment his left leg, which had lacked control and coordination after a stroke, became much better controlled so that he no longer kicked into furniture etc. He came back to have this boosted after 11 months and was corrected again within 2 treatments
        One numbness and tingling in both feet – secondary to type 2 diabetes – onset 3 years – paresthesia gone within 5 treatments with almost complete regaining of sensation in sole of foot to both light and heavy touch (except large toe) after 10 treatments. Haven’t tested temp. sensation but believe it is still not normalised.
        Other fertility treatments ongoing (two now pregnant)
        colds, flues, tiredness, coughing, duration 7 – 24 weeks (all checked by GP) all variously improved within a day to a week.

        Unfortunately, none of this provides much evidence for external validation. All of the above could be co-incidental. During one particular 2 week period (not this year) I had more than half of my fertility or recurrent miscarriage patients – 12 of them – (generally 4-7 previous miscarriages unsuccessfully treated by St Mary’s at Roehampton / among other hospitals) all either became pregnant or had their 12 week (or up to six months )scan all clear, plus 14 week trisomy and Down’s testing all clear. Again, all of this could be co-incidental.

        What would not convince me of the invalidity of acupuncture are scores of negative results from RCTs – double blinded, because from what I see there is no attention paid to needle technique nor do they provide fully individualised treatment. These RCTs do not represent the acupuncture that I practice.

        I believe that there are studies which show specific physiological changes – changes in peristaltic action in response to specific points, MRI scans showing brain activity in relevant parts of the brain, changes in inflammatory markers, changes in heart rate, temperature etc. Because it is a holistic system this kind of evidence is more important to me than a verification of a specific set of points for a specific condition, e.g. pericardium 6 for nausea and vomiting (Donaldson et al – sorry I forget their names.) We work on the ‘internal milieu’. Each case with a similar Western diagnosis will have different points selected. This is important for good results.

        Best wishes,
        Roisin Golding

        • Excellent response Roisin, if it didn’t work why would these people return for other problems year later and often I bet they don’t even give medicine a chance to let them down again, they return without hesitation.

      • Hi roisin

        What is the difference between belief and science?

    • London Acupuncturist, Roisin Golding
      http://www.acupunctureworks.co.uk/roisin-golding/
      “How to stay stuck in Beliefs”
      Ms Golding, everything in your list applies to you but you won’t apply the same conditions on yourself.
      There is now an accumulation of evidence to show that the sham, revived by mass-murderer Mao Zedong as a cheap panacea for his suffering people, known as acupuncture is nothing more than a mild short-term placebo. If you really want to “examine your own belief system”, you would find that you “Distort new evidence”, fail to “credibility of the source of new information or evidence”, and you definitely “Only seek confirming instances of the belief”.

      “What essential belief are you holding on to?”
      In your case, a lucrative income.
      “What would it take to shift that belief or is it completely immovable?”
      Again, in your case, your financial and emotional investments are too great to change your beliefs.
      “Is ‘sceptic-scientist’ an oxymoron?”
      This demonstrates a lack of understanding of science and the scientific process. Far from an oxymoron, the word “sceptic” is unnecessary because it is an accepted part of science. When you come to realise that, you may cast a critical eye over your own non-sceptical world.

  • It is simplistic to apply techniques for pharmacological testing directly to understanding the science of human biiology or assessing the benefit from any form of medical treatment. These are different questions requiring different methodologies.

    This whole discussion of acupuncture, laser treatment and statistical evidence for benefit becomes so much hot air because these disparate issues are being confused.

    Clinical drug testing is based on recognition that a complex system in not understandable and is treated as a “black box” – the aim being to identify a specific outcome from a particular chemical intervention, excluding any non-chemical effects using a chemically inert placebo for comparison. Acupuncture is not a drug and is a physical intervention so there is no such thing as a placebo. Sham-acupuncture, like sham-surgery, is a far from being ideal as a placebo-equivalent. Laser therapy is not a drug and it is also not acupuncture – unless we have an idea of how it may work we cannot be confident that a sham laser will act as a placebo.

    Science seeks to understand a phenomenon by making an testing hypotheses as to how it happens. The traditional hypothesis relating to acupuncture has been disproved by the study of physiology but alternative hypotheses relating to processes in the nervous system (and possibly consequent endocrine and immune responses) have ot been disproved. Studies such as these being discussed do not address the potential scientific basis for acupuncture and tell us little about the possible physiological effects of lasers. Scientific understanding of a process does not require “black box” techniques – you don’t see many placebo-controlled studies in physics.

    Medical treatment and its benefit is quite different from pharmacology, most obviously because it is complex and includes the “placebo effect” rather than seeking to exclude it. It can only usefully be compared with no treatment or different treatment in a randomised trial. It is the absence or failure of such studies in “alternative” therapies that maintains the continuing controversy about them. It should be noted that until very recently this has also applied to much of mainstream surgery.

    • Jonathan Pitts Crick said:

      It is simplistic to apply techniques for pharmacological testing directly to understanding the science of human biiology or assessing the benefit from any form of medical treatment. These are different questions requiring different methodologies.

      So what about a methodology that’s used to evaluate complex, nuanced, social interventions such as different ways of reducing poverty or evaluating different educational interventions in schools, with the problems that trying to account for all the issues classes of kids have? Would that be better?

      • Dear Frank,

        Naturally the list applies to me and my profession as much as yours. The essential belief that I am holding onto is not, as you put it, a lucrative income. That truly would be believing in the tooth fairy.

        I suppose my essential belief (expressed in the most simple terms) is that the body is capable of self healing and self regulating and can be encouraged to do so if the internal environment is at ease. There is evidence that shows that acupuncture can reduce inflammation in the body and produce many other physiological effects. I recognise that there are also times when radical intervention, i.e. western medicine, is required.

        None of us are immune to beliefs that are ill founded, even scientific beliefs. Two recent examples spring to mind. Think for example Digoxin, the treatment of choice for heart failure and atrial fibrillation for many decades, which is now known to greatly increase cardiovascular mortality by 35% and 61% increase in death from arrhythmia!. Think also of aspirin, promoted by GPs for decades to help prevent CVA, is now causing 40% increase risk of CVA in older patients (hardly surprising.)
        These are examples of strongly held beliefs, adamantly stated as scientific fact, which subsequently were proven wrong.

        With acupuncture one must differentiate a theoretical model from the results of the practice. I admit that the theory of acupuncture with its meridian system, various qi flows etc. are not provable and these entities are likely not to exist as described! There you go. Is it a useful belief system? Absolutely, because it provides a descriptive narrative that connects up many disparate aspects of the patient’s experience and leads to a clear pathway towards holistic treatment. While it is true that almost any narrative can be used to link a series of phenomenon, the metaphors employed in acupuncture theory have proven reliably useful to guide appropriate treatment.

        Take for instance the notion of yin and yang. Professor Ernst was quoted as saying that yin and yang do not exist. I have no idea if he truly said this – I would hope not, for these are not substances but descriptors of function. It would be like saying above and below or inside and outside do not exist. They describe these positions as well as receptive or active functions in the body.

        There are currently more than 60 ongoing research projects on systems medicine in Europe. These projects are applying a truly holistic scientific approach to the question of health and illness, to understanding single medicines as well as drug interactions. They are measuring, for instance, bio-markers that have nothing to do with either the illness or the supposed action of the drugs. These biomedical scientists are taking as broad a view as possible. It’s fascinating and may well revolutionise the way that drug efficacy is assessed, (as well as the nature of health itself) and hopefully allow a more balanced approach to prescribing thereby reduce side effects and avoiding expensive waste in drug use. I would hope that in time this approach might provide an excellent framework for studying the effects of a holistic medical system such as acupuncture. I look forward to that.

        I don’t accept current RCT results simply because these studies bear little relation to what I recognise as acupuncture as is practiced by me and the majority of my colleagues. And RCTs are simply the wrong tool to understand and assess acupuncture.

        Did Professor Ernst do his PhD on the pharmacological effects of garlic? (Is this true?) RCTs are well suited to studying these effects and medicines with one or two active ingredients. Interestingly, the very few RCTs which showed positive results for acupuncture were largely on single point treatments, such as tooth pain, nausea and vomiting. This again makes sense.

        Kind Regards,
        Roisin Golding

        • THE TITLE OF MY 1) MD AND 2)PHD WERE:
          1) hypercoagulability in septic abortion (1978)
          2) the influence of physical interventions on blood rheology (1985)

          • Dear Prof. Ernst,
            Thank you for taking time to correct me. I am so glad I asked!
            Best Wishes,
            Roisin Golding

        • I would hope that in time this approach might provide an excellent framework for studying the effects of a holistic medical system such as acupuncture.

          Maybe you could enlighten us, and explain how the consistent application of a single method would be “holistic”.

          Maybe you could also explain how waffling something about Yin and Yang would change anything. When a doctor repairs a leg, and the rotting leg falls off with gangreen, that repair does not suddenly become a success story when the doctor mumbles something about calcium electrons jumping from the 3p orbital to the 4s orbital. The leg will still have rotten and will still have fallen off. If the patient feels better, so much the better, but that also does not make her leg suddenly ungangreeny and reattached.

          Skeptics and scientists want results. measurable results. The theory behind them may well be interesting and fascinating, but that does not change one iota of the results that have been or not been observed.

          Yes?

          • Dear Bart,

            no one wants results more than patients. That’s why they turn to acupuncture in the first place. That’s why they keep coming back – often many years after their first successful experience with acupuncture treatment.
            Best wishes,
            Roisin Golding

          • Roisin Golding said:

            no one wants results more than patients. That’s why they turn to acupuncture in the first place. That’s why they keep coming back – often many years after their first successful experience with acupuncture treatment.

            Does the fact that people keep going back to astrologers mean that astrology works?

          • no one wants results more than patients. That’s why they turn to acupuncture in the first place. That’s why they keep coming back – often many years after their first successful experience with acupuncture treatment.

            People keep going back to casinos as well, often many years after their first win. Does that mean customers actually make money there?

            I will reiterate my question, because the issue fascinates me:

            Can you explain how the consistent application of a single technique, acupuncture, for things as diverse and unrelated as vulvodynia, IVF (which is a medical *treatment*), Bells palsy, indigestion, irritable bowel, hay fever, atrial fibrillation, uncontrollable legs, numbness and tingling, colds, flus, tiredness, diabetes… would be “holistic”? It seems to suggest that “holistic” is used to indicate that any and all patients will be treated for any and all conditions by sticking needles in their bodies. I am merely looking for a description/definition that *you and your colleagues* would consider fair and correct.

          • jm,
            “All functions, and everything else. It’s a model of comparing things.”
            The questions remain;
            What functions?
            Everything? What, everything in the human body?
            Comparing what things?

            Do you expect to throw words out and not be asked for an explanation? Or, jm, are you doing what you seem to do, using meaningless mumbo-jumbo in the hope you won’t be challenged?

        • Roisin Golding said:

          With acupuncture one must differentiate a theoretical model from the results of the practice. I admit that the theory of acupuncture with its meridian system, various qi flows etc. are not provable and these entities are likely not to exist as described! There you go. Is it a useful belief system? Absolutely, because it provides a descriptive narrative that connects up many disparate aspects of the patient’s experience and leads to a clear pathway towards holistic treatment. While it is true that almost any narrative can be used to link a series of phenomenon, the metaphors employed in acupuncture theory have proven reliably useful to guide appropriate treatment.

          Word salad.

          Take for instance the notion of yin and yang. Professor Ernst was quoted as saying that yin and yang do not exist. I have no idea if he truly said this – I would hope not, for these are not substances but descriptors of function.

          What function?

          I don’t accept current RCT results simply because these studies bear little relation to what I recognise as acupuncture as is practiced by me and the majority of my colleagues.

          So where are the studies that test acupuncture as practised by you and others?

          And RCTs are simply the wrong tool to understand and assess acupuncture.

          Why and what do you believe would be an appropriate tool?

        • @Roisin,
          “I suppose my essential belief (expressed in the most simple terms) is that the body is capable of self healing and self regulating and can be encouraged to do so if the internal environment is at ease.”
          Do you think real medicine doesn’t recognise this characteristic of all organisms to want to resume normal function? What is meant by “internal environment is at ease” is some nebulous statement that cannot be readily defined or understood? It is something only alt-med could dream up, as if to make some fictional distinction from real medicine.

          “There is evidence that shows that acupuncture can reduce inflammation in the body and produce many other physiological effects.”
          In that case, I think Prof Ernst would know about it. Is that the case, Prof?

          “I recognise that there are also times when radical intervention, i.e. western medicine, is required.”
          Do you mean when people are really sick and require real medicine that alt-med dreams about being able to be involved, but very reluctantly acknowledges it is way out of its depth? “Curing” the worried-well is not something I would crow about as a notable achievement.

          “These are examples of strongly held beliefs, adamantly stated as scientific fact, which subsequently were proven wrong.”
          And that is what real medicine does when it is shown to be wrong; it accepts the new evidence, discards the old , and moves on in the best interests of everyone’s health. Does alt-med do this?

          “With acupuncture one must differentiate a theoretical model from the results of the practice. I admit that the theory of acupuncture with its meridian system, various qi flows etc. are not provable and these entities are likely not to exist as described! There you go. Is it a useful belief system?”
          Is it a belief system real medicine should also adopt? Let’s not worry about blood flow, the lymphatic system, endocrines, the nervous system, or orthopaedics; why not go back to phlegm and the humours? Doesn’t that provide an adequate “theoretical” model in order to practice medicine?

          “Take for instance the notion of yin and yang. Professor Ernst was quoted as saying that yin and yang do not exist. I have no idea if he truly said this – I would hope not, for these are not substances but descriptors of function. It would be like saying above and below or inside and outside do not exist. They describe these positions as well as receptive or active functions in the body.”
          This is meaningless and confused. Using flourishes of language does not elucidate on the topic.

          “I don’t accept current RCT results simply because these studies bear little relation to what I recognise as acupuncture as is practiced by me and the majority of my colleagues. And RCTs are simply the wrong tool to understand and assess acupuncture.”
          You don’t accept them because they don’t give a positive result for you? When studies show sham acupuncture gives the same result as the supposedly “real” version, any reasonable mind would accept that there is a fundamental problem with the modality. Why is this lost on the practitioners? Is their substantial emotional and financial investment, or the abject failure to see reality?

          “Interestingly, the very few RCTs which showed positive results for acupuncture were largely on single point treatments, such as tooth pain, nausea and vomiting. This again makes sense.”
          Positive results? Were they strikingly obvious or slightly above statistical noise?

          “I would hope that in time this approach might provide an excellent framework for studying the effects of a holistic medical system such as acupuncture.”
          This reference to acupuncture as being “holistic” is trotted out again and again, but never defined when questioned. What makes acupuncture “holistic” (whatever that means) and different to real medicine. Another poster referred to your use of language as “word salad”, and it would appear to be an accurate description. You, and other alt-meds, throw out words, but, under even cursory scrutiny, the prose is meaningless.

        • “With acupuncture one must differentiate a theoretical model from the results of the practice. I admit that the theory of acupuncture with its meridian system, various qi flows etc. are not provable and these entities are likely not to exist as described! ”
          I really don’t think it matters whether there’s a model of how something might work or not. In almo0st every groundbreaking case in conventional medicine, we saw an observable, measurable effect of something and then were able to derive a model of the mechanism by which it worked. Foxglove extract extended the lives of people with dropsy long before we had the concept of cardiac failure and cardiac glycosides. Back in 1785, Withering didn’t have the knowledge of chemistry to analyse what he was giving – but he could measure the effect. When I was a student we’d got as far as refining the active component, synthesising it and deriving safer variants – but we still didn’t know how it actually worked. It was still a damn useful drug. (And still is.)

          A model makes something more acceptable, but it isn’t necessary, although if existing models say something won’t work, it’ll have a hard time convincing people. For example, if water can have a memory, a large chunk of existing knowledge relating to analytical chemistry would have to be discarded. In fact, if you believe in homeopathy, I don’t see how you can believe that the water in your tap or the food in your fridge is safe to consume. The techniques used in food quality control CAN’T work if water has a memory.

        • “Take for instance the notion of yin and yang. Professor Ernst was quoted as saying that yin and yang do not exist. I have no idea if he truly said this – I would hope not, for these are not substances but descriptors of function.”
          Yin and Yang are an appeal to our tendency to see everything in opposites – heat and cold. Tall and short. Rich are poor.

          But there is no cold. There’s only less heat. You can’t build a lamp which throws out darkness. I measure how tall you are in exactly the same way I measure how short you are.

          Why does this matter? Because once you invoke the Yin then somehow you can balance it by adding Yang. This is nonsensical. If you are “poor” because your ten pieces of money are all 5p pieces, I can make you rich by adding £50 notes. But if you are “rich” because your ten pieces of money are all £50 notes, I can’t make you “poor” by giving you 5p pieces.

          • Pat, “Because once you invoke the Yin then somehow you can balance it by adding Yang. This is nonsensical.” That’s not the basis yin/yang theory.

            Using your lamp analogy, you could look at the function of the lamp. When it’s on – yang. When it’s off – yin. If there are 2 lamps, you could look at size – bigger would be yang, smaller would be yin. If you were measuring output…the brighter one would be yang, regardless of physical size.

            In terms of cold/heat, you could look at body temperature. A body temp of 99° is generally considered above normal (yang). If yesterday, the temp was 101°…today’s 99° would be yin. If someone says that yin/yang does not exist, what they are essentially saying is that you can’t compare things – like body temp of 101°, 99°, or ‘average’.

            In general, I think it’s wise to avoid medical professionals who do not believe in analysing the relationship between things (like body temp, blood pressure, TSH, etc).

            Comparative analysis seems to be a pretty important player in science itself. I would also be quite skeptical of anyone who claims to be a scientist, as says something like yin/yang theory “has no basis in science”. Either they haven’t taken the time to understand the concept (which would be bad science in and of itself, yes?) or they don’t believe in comparative analysis.

            On the other hand, maybe they mean yin/yang theory has no basis in science – science is based in yin/yang theory. Which would be much more accurate.

          • So “yin” and “yang” are whatever you define them to be today and tomorrow they can be something else?

          • Pat, precisely. If today you have water and ice, water is yang and ice is yin. If tomorrow you add heat to both to make one into vapor and the other into water, then your water becomes yin and vapor is yang (in relationship to each other).

          • jm, some of what you say is incorrect: small doesn’t mean yin and large doesn’t mean yang. the same goes for on/off

          • Nope. How did you come to that conclusion based on what I wrote?

          • “Comparative analysis seems to be a pretty important player in science itself. I would also be quite skeptical of anyone who claims to be a scientist, as says something like yin/yang theory “has no basis in science”. Either they haven’t taken the time to understand the concept (which would be bad science in and of itself, yes?) or they don’t believe in comparative analysis.”
            No, they probably haven’t taken to time to study unicorn science or young Earth creationism either, for the same reasons.

            “On the other hand, maybe they mean yin/yang theory has no basis in science – science is based in yin/yang theory. Which would be much more accurate.”
            Certainly not the latter. I hope you understand this nonsense, jm, because no one else can.

            Part of the irony of is your ability to post such nonsense on a blog is because REAL scientists discovered electricity, electromagnetism, electrical theory, electronics, computer science, new materials, et al, not because some astrologist or clairvoyant said it could be done, but this is lost on you.

          • Sasha – you’re right, small doesn’t mean yin and large doesn’t mean yang. But in comparing size, the smaller lamp would be considered yin. And the larger lamp, yang.

            Same goes for on/off. On would be yang (active) in looking at the function of the lamp. On doesn’t mean yang, but on would be the yang function of the lamp.

            Nothing is definitively yin or yang. It depends on what relationship you’re looking at. The sunny side of a hill would be yang compared to the shady side (hence the names, eh?)…but the sunny side of the same hill would be considered yin compared to the mountain next to it.

          • jm, I would be very interested to know how you arrive to classifying smaller size as yin and larger size as yang. To use your earlier example of edema – an edemous limb is by definition larger than normal limb but edema, as you yourself have said, is an yin condition in Chinese medicine.

          • Hi Sasha, yin is generally smaller/condensing/contracting, yang generally bigger/expanding type of thing. The number 20 would be considered yang compared to 13 – it would be considered yin compared to 25.

            So if you’re just looking at size (in a very simplistic, gross way,) you could consider the swollen limb the yang limb. If you’re talking about why it’s swollen, you’re looking at different things (other than just gross size).

          • ok, thanks for the explanation!

        • Roisin, you list two examples of “recent” scientific beliefs that are ill-founded. The digoxin/atrial fibrillation story probably is a good example of slow learning by cardiologists. The aspirin use, however, is less straightforward. The meta-analysis that lies behind the newspaper “aspirin scare” stories (JAMA. 1998;280(22):1930-1935) showed that aspirin use “was associated with an absolute risk reduction in myocardial infarction of 137 events per 10,000 persons… and in ischemic stroke, a reduction of 39 events per 10,000 persons. However, aspirin treatment was also associated with an absolute risk increase in hemorrhagic stroke of 12 events per 10,000 persons. (12 events per 100,000 was a 40% increase, but the absolute numbers are very small.) So aspirin reduced heart attack and stroke risk in 176 people out of 100,000 while increasing risk of cerebral bleeds in 12 out of 100,000. I’d say those data favour aspiring use. Nothing is perfect in this world.
          You might have gone on to add things like the decades of misunderstanding that peptic ulcer was an infectious disease, the 19th century discovery that many conditions thought to be the result of “miasmas” and “humours” (concepts akin to the dear old nonsense of yin and yang) were caused by bacterial infection.
          The point is that medical practice changes once good, well designed and thoroughly executed experiments (in clinics and laboratories) show that long-accepted dogmas were wrong. What do you change about your acupuncture practice when it is shown pretty conclusively that acupuncture is no better than yet another form of patient-comforting theatre?

          • FrankO, regarding aspiring – reductions that you cite are compared to what? In other words what’s the NNT for aspirin use and what population are you citing – high risk, low risk, etc?

            Regarding yin/yang – they’re nothing like miasmas or humours, that’s a misunderstanding of an old Chinese concept and it just shows that the person has no idea of what they’re talking about.

            Regarding ulcers – modern microbiological research now shows that H.pylori may offer protection against developing asthma, so, in this case at least, cost/benefit isn’t that clear

          • Hello Frank,

            Thanks for that. I appreciate it.
            Could you clarify something for me please, because I don’t have the figures and don’t know fully how it is calculated? And it would help me to understand this in relation to other preventative treatments as well.
            So – there is a risk reduction of 176 out of 100,000 people for ischemic stroke/ heart attack, and as you say, a smaller increased risk of bleeds – 12 per 100,000 (you say 10,000 and then 100,000?). But, with aspirin, like other preventative treatments, millions of people who are not at risk of ischemic stroke but who are, especially elderly folk, at high risk of hemorrhagic stroke now take this preventative. So in calculating the absolute risk, it isn’t just a matter of an increase of 12 per 100,000 of the already at risk group (which has a limited number), but a much larger number of people outside that group are now put at risk. On top of that, a bleed is much more devastating than a clot – death rates are higher and overall recovery poor. Does the risk reduction then still add up?
            That’s just a straight up question.

            best wishes,
            Roisin Golding

          • To Sasha and Roisin, the study populations were mixed. They comprised 12 whose patients had a prior history of cardiac disease, 2 based on patients with prior cerebral disease and 2 with healthy subjects. I gave you the reference: why not read the paper for yourselves? (You can go to it directly at http://jama.jamanetwork.com/article.aspx?articleid=188245.)

            Miasmas, humours, yin and yang, qui (however you wish to spell it) are all medico-philosophical concepts that don’t stand up to any serious scrutiny. We’ve come a long way since we believed all matter was made of earth, fire, air and water. It would be nice to think we might equally grow out of other, simplistic beliefs that offer zilch to the world of reality. Day vs. night is often held up as a good example of yin and yang (struth!). Excess yang results in fever; excess ying leads to accumulation of fluids in the body. For crying out loud!

            Roisin, you state correctly that elderly folk now often take aspirin routinely. But they should be doing so at low dose (75-85 mg/day), depending on their age, health history and sex. In 14 of the 16 studies in the meta-analysis I cited, the subjects were taking doses bigger than this. If you want to see the complexity of risk-benefit calculation for aspirin, try this: http://www.ahrq.gov/professionals/clinicians-providers/resources/aspprovider.html.

            Sasha, the fascinating and strong possibility that H. pylori may protect against development of asthma in childhood is not exactly a simple medical cost-benefit problem. (See Blaser et al, 2008 for a nice review of the situation; http://www.med.nyu.edu/medicine/labs/blaserlab/PDFs/Blaser%20Gut%2057%20561%2008.pdf) If you’re suggesting we should leave adult peptic ulcers untreated to ensure the bacterium gets passed to as many youngsters as possible it seems to me we’re trying to balance two alternative miseries. As the evidence for a specific inverse relation between H. pylori and asthma grows, the simple answer will probably turn out, ultimately, to be a vaccine. We observe, we experiment, we learn.

            All this is a heck of a long way from the notion that shining a laser on the bodies of people with pain leads to a (very small) reduction in that pain weeks later. That concept remains equivalent to the idea there’s a unicorn in my garage: it’s an extraordinary claim that requires evidence a darn sight more extraordinary than the meta-analysis cited in the OP.

          • FrankO, thanks for the aspirin article link. I’ll read it.

            Your understanding of yinyang theory is incomplete. It isn’t a medico-philosophical concept, it’s a philosophical concept that Chinese culture later applied to many areas, including medicine, politics, and so on. Edema and fever can’t just be classified as yin or yang even though yinyang theory encompasses it. And old notions of earth, water, fire and so on aren’t what Chinese medicine calls Five phases. There are many anologies used to understand yinyang theory and how it applies to medicine. If you’re interested in it, you can google the mechanism of wind formation (and I mean it as a meteorological event) and see how it applies. In trying to understand it, would be helpful to know that the characters for yin and yang in Chinese literally mean shady side of the hill and sunny side of the hill.

            As far as H. pylori, from what I’ve heard being said on the subject – H. pylori is a good thing in the small intestine but becomes a bad thing when it gets into the stomach because of the weakness in the pyloric sphincter. The reasons for the weakness are too long to list here but I doubt vaccinating will solve the problem.

          • Frank,
            thanks for the links. I’ll read later.

            Roisin Golding

          • Franko,

            If you translate the terms that you’re using, here’s what you just said:
            —-

            “”We’ve come a long way since we believed all matter was made of earth, fire, air and water. It would be nice to think we might equally grow out of other, simplistic beliefs that offer zilch to the world of reality.”

            We no longer believe that structure, cohesiveness, change and movement are part of reality.
            —-

            “Day vs. night is often held up as a good example of yin and yang (struth!).”

            Day and night are observably different (struth!).
            —-

            “Excess yang results in fever; excess ying leads to accumulation of fluids in the body. For crying out loud!”

            Excess heat in the body results in fever; sluggish fluid movement leads to accumulation of fluids in the body. For crying out loud!

          • jm, your ability to comprehend what we know of our cosmos, our planet and our bodies is truly hopeless.
            We no longer believe that structure, cohesiveness, change and movement are part of reality.
            Which of these is earth, fire, air or water?
            Day and night are observably different.
            Yes, and well understood. And absolutely nothing whatsoever to do with senseless concepts like yin and yang.
            Excess heat in the body results in fever; sluggish fluid movement leads to accumulation of fluids in the body.
            If that’s a precis of your understanding of physiology you need to get some education.
            You seem to live in a curious world where everything tangible, measurable and capable of investigation is waved off with abstract words and concepts. I your car runs out of petrol do you find some to top it up, or just stand scratching your head wondering whether the car’s yin or yang needs attention?

          • Franko, you’re using terms that particular meanings when used in this context (earth/water/fire/wind, yin/yang, etc). So rather than personal attacks, you should find out what they mean. I gave you a rather polite and generous translation of how your comment translates.

            I could have just said, as you so eloquently did: your ability to comprehend what we know of our cosmos, our planet and our bodies is truly hopeless.

      • That’s further across the spectrum of kinds of subject which we can try to investigate and it’s arguable that in the social sciences we are fooling ourselves to imagine they are analysable at all. But in medicine there are enough people with more-or-less similar conditions to allow a reasonably reproducible statistical description of the outcomes of diferent treatments – e.g., as I said, randomise to treatment or no treatment (by intention). If the enthusiasts for “alternative” treatments cannot show any benefit in this way they should seriously question why they are doing it. OTOH if a simple treat/don’t trial does show a beefit then the mainstream medical scientists should take the result seriously and not reject it because they can’t think of a mechanism nor quibble about how much is a psychological effect, which is not necessarily distinct from any other mechanism. Sure, understanding the mechanism is important in developing the methods further but even if it remains obscure the treatment is still valid and should be used.

    • Laser therapy is not a drug and it is also not acupuncture – unless we have an idea of how it may work we cannot be confident that a sham laser will act as a placebo.

      Excellent point. In other words, if sham laser/acupuncture/whatever does not act as a placebo and is, as a result, indistinguishible from the genuine therapy, there is no reason to use expensive acupuncturists, any clown will do. I think that is wonderful news, since non-acupuncturists tend to be a lot cheaper than acupuncturists. It seems this would be a win-win situation. The acupuncturists would be out of work, but since they tend to claim that making money is not a consideration, they would still be getting what they always wanted, only without that annoying money.

  • Does it really matter if it is placebo or not? if it works without causing harm, then it works and why does it need debating! I add without causing harm because most modern medicine causing side affects/harm.
    I have seen long standing eczema vanish after 2 acupuncture treatments, a patient who has had PMS migraines for 10 years, they stopped within 1 treatment and back pain disappear straight after the 1st treatment….None of these people have had to take chemicals, they haven’t had adverse side affects…. Acupuncture along with any other drug, works for some and not for others, the fact is it works for some and if done safely and correctly by a registered and fully qualified acupuncturist they there will be no harm!

    If Acupuncture doesn’t work, why do we have certain points that are contraindicated during pregnancy as they induce labour….How do they use Acupuncture to block pain within open heart surgery in China? Take a look at the first 30secs of this film from the BBC https://www.youtube.com/watch?v=41vm87qq1KU

    • Sandra

      If you look a bit further, you’ll soon find that “acupuncture anaesthesia for open heart surgery” is a well known fraud. It first surfaced in the 70s and resurfaced in a BBC2/OU programme about alternative medicine in 2006. In both cases it turned out that the patient had regular general and local anaesthetics. The needles were merely decorative. The fact that this was not mentioned in the programme led to a complaint to the BBC Trust, which was eventually upheld.
      You can find more about this at
      http://www.dcscience.net/2006/02/27/bbc2-and-the-open-university-on-alternative-medicine/

      It’s important to realise that traditional Chinese medicine in China is strongly influenced by nationalism and it is now very big business. Like most big business, it has a tendency to be economical with the truth.

      • Hi David,
        I was waiting for 1 of you to notice my mistake with that, I did some extra digging after I’d done the post and found the general reporter had mentioned she had no general (otherwise the patient would have been asleep) but local and sedative meds. So please excuse that reference, I am just about to enter the research part of my acupuncture degree course and this will be a very interesting subject to bring up.
        So you mention the fact that when something is big business there tends to be an angle of miss truth surrounding the possible results….. Just like in the medical industry then? I have a friend who is a medical writer so I know who pays them to write the report, I also know my friend won’t touch drugs and chooses complimentary health science these days!
        I notice you failed to comment on some of the patients I have observed 1st hand improve when the medical industry has failed them for many years previously. What’s your take on these results?

        • Yes, Sandra, exactly like in the medical industry – with the difference that the medical industry is scientifically controlled big business with scientifically proven results and huge investments in truly scientific research, whereas CM is just big business without the science, without the control systems, without the proven results and without investments. That’s why the medical industry is a serious big business and CM is just plain big business.

          • @K.H
            For more on how “truly scientific” this research is in the medical industry, I recommend the following books:

            The Emperor’s New Drugs
            Our Daily Meds
            Side Effects
            The Truth About the Drug Companies
            Bad Pharma
            Hippocrates’ Shadow

            All are written by either MDs with impressive credentials or researchers or investigative journalists

          • For more on how “truly scientific” this research is in the medical industry,

            No sane person would claim that there is no fraud in the field. Fraud is everywhere, assuming there is none here, would be naive.

            I would also say that acupuncture is, in this respect, more trustworthy than medicine: when an acupuncturist tells you something, you can trust that information to be wrong with almost complete certainty. You can’t do that in medicine, since it stands a very good chance of being right.

    • How do they use Acupuncture to block pain within open heart surgery in China? Take a look at the first 30secs of this film from the BBC https://www.youtube.com/watch?v=41vm87qq1KU

      Easy as proverbial pie: they don’t, and they say so clearly in the documentary at about 8m101s:

      “Although sedated by drugs and her chest numbed, she’ll be conscious throughout the whole procedure”.

      Patients very often have the choice between general anaesthetics and local ones, *without* acupuncture. Acupuncture is just an *addition* here, in the same way that patients are given music to listen to or even a movie to watch and keep their mind of things. i.ow.: acupuncture is just a form of entertainment here, nothing more.

    • A complaint against the BBC was upheld by them after investigation because this segment may “mislead the public” into believing that acupuncture was being used as the anaesthetic. It’s bunk.

  • My same response and question goes to Tim and Bart.
    Again I am asking to have my poor choice of reference excused, I did attempt to delete after I’d seen a few reports concerning the misleading information. It’s a good start to the researching health and diseases unit that actually starts next week.

    • @Sandra,
      “So you mention the fact that when something is big business there tends to be an angle of miss truth surrounding the possible results….. Just like in the medical industry then? I have a friend who is a medical writer so I know who pays them to write the report, I also know my friend won’t touch drugs and chooses complimentary health science these days!”

      My experience with conspiracy theorists is that they have a screw loose and are blinkered to any information that may disturb their world view. The paragraph above shows you suffer from this condition and, as a result, will invoke logical fallacy after fallacy to rationalise the unsustainable. The fact that you were prepared to accept that acupuncture was the only anaesthesia without question demonstrates this.

      While you may regard this as an ad hominem, I believe it needs to be said; your view is unsound and you do not have the capacity, or willingness, to self-challenge and examine your own thought processes. You are a “True Believer”, for whom no evidence will ever be good enough.

      “I am just about to enter the research part of my acupuncture degree course”
      This is a sad indictment of any university that they would devalue the rest of their academic standing by offering a degree in the mass-murderer’s new alt-med.

      • @Frank Collins

        Not only do you engage in ad hominem, you’re also adept at “poisoning the well” in bringing up Mao to opine on acupuncture

        • “Not only do you engage in ad hominem”
          It wasn’t an ad hominem, it is an observation on the state of your mind and your clear incapacity to engage in anything approaching critical thinking.
          “you’re also adept at “poisoning the well” in bringing up Mao to opine on acupuncture”
          Acupuncture was discredited in China and though Mao would not use it himself, reviving the superstition was a cunning and Machiavellian political, economic and nationalistic measure by the despot. All you’ve done is to buy into a devious and deadly ploy perpetuated by a mass-murderer, as if it is some mystical Eastern “medicine” wrongly misunderstood by the “West”. The Chinese had the sense to ditch it but you don’t.
          http://rheumatology.oxfordjournals.org/content/43/5/662.long

          • @Frank Collins, once again, whatever you read in a magazine doesn’t correspond to reality. There were multiple attempts to outlaw acupuncture in China, many of them long before Mao, and they all failed because people continued to practice it. Mao “industrialized” the practice of acupuncture in China and it’s continuing to grow there as well as in other countries. India, for example, has recently began sponsoring acupuncture education with the full support of the government, placing TCM physicians on the same level of support as allopaths, homeopaths, and Auyrvedic physicians. I suggest you go and check out how acupuncture is doing there or in China to see for yourself. Of course, in your case, it would mean leaving your mother’s basement.

          • It wasn’t an ad hominem, it is an observation on the state of your mind and your clear incapacity to engage in anything approaching critical thinking.

            I can’t help but wonder if our hammered-in “respect” for religion has anything to do with this. Homoeopathy, acupuncture, much of herbalism, many ‘old wives tales’ are essentially baseless nonsense. I think we know that by now to a very high degree of certainty. So is religion.

            Many people won’t touch religion, but it seems to me that if we agree that leave it be, we are sawing off the branch on which we sit. Either we think that evidence has value, and the astonishing progress we have made in the past few centuries would seem to indicate beyond the reasonable doubt that it does, or we think it does not. But how can we justify that religion should be “left alone” or “respected”?

            I can at least accept the possibility that people are confused when they hear one type of superstition vehemently attacked for the nonsense it is, while the same skeptic/scientist will leave the other type unchallenged.
            Robert Winston, who gives clearly the impression of someone with a good general background, good education and adequate intelligence, says in one of his documentaries (The Story of God, Part 3 “God of the Gaps” at approx. 5 minutes), talking about the miracles in Lourdes:

            Coming to Lourdes clearly is very important for a lot of people and one must not try and undermine that. That seems to me to be something which is essential to them and should be respected.

            When I heard that, he lost – in my view – his credibility as a skeptic and a scientist. The recent hoopla around the optical illusion of the blue/black gold/white dress left an uneducated girl like Taylor Swift “confused and scared”. Is it then not, at least possible or even plausible, that our double standard for religion on the one hand and quackery on the other hand will confuse the hell out of people like this?

            It seems to me that people who go into alternology, or worse, quackery, are not usually the most educated ones where science is concerned. Would it not seem to them that if we ‘respect’ religion as our society does, that we are viciously attacking alternology and quackery because of a hidden motive to protect some establishment interests, rather than simply because of what science is showing us to be true (in the sense of “the most probable hypothesis”).

            How can we protect the idea that Jesus spat in someone’s eyes and cured blindness, while rejecting the idea of ancient wisdom about sticking needles into people and curing infertility? The first is at least as ridiculous as the second. A double standard is being applied, and it seems to me that we must be very clear that both are to be treated with the utmost skepticism, for the very same reasons.

            I don’t know. I am merely trying to understand how people who are obviously intelligent enough to have language skills and to learn how to use a computer can allow obvious liars to so completely pull the wool over their eyes. I don’t think many people would still go to Bernie Madoff for financial advice. Why then, would they believe the claims of an acupuncturist-promoter who posits something verifiably nonsensical as: “Acupuncture skeptics believe that there is no plausible mechanism that could explain acupuncture’s observed clinical effects and so it’s effects must be due to placebo”? We don’t know the exact mechanism of how Ibuprofen works either, but we don’t reject Ibuprofen, because we know it works.

            I don’t get it. Maybe I am just too stupid and lack the necessary insight.

          • @Frank Collins, once again, whatever you read in a magazine doesn’t correspond to reality

            Well, you are the right address, since Professor Ernst is one of the authors of that “magazine” article. It is entitled A brief history of acupuncture. You see, some of us actually verify references, a time-consuming but very enlightening exercice.

          • Oh wow, so first you read Professor Ernst’s article and then you opine on it on Professor Ernst’s blog? What an enlightening exercise, indeed!

            I can offer you another frame of reference – how about hopping on a plane and coming to the US to see the explosion of acupuncture clinics all over the country? And PTs and chiros are pulling all the stops to circumvent existing educational laws and add acupuncture to their scope of practice. While you’re here, visit some military hospitals, it seems US military began to hire acupuncturists to treat pain, PTSD, and whatever else vets are coming home with.

            If you get bored in the US, go to South America where acupuncture is all the rage. Don’t forget Brazil, there MDs like it so much, they won’t anybody else do it, no matter how well trained.

            And then, hop over to Australia, these guys are even crazier – they are incorporating acupuncture into their national healthcare system and acupuncturists are now working in hospitals.

            You can then go to India which passed a law around 2005 regulating acupuncture education in the country and establishing acupuncture and TCM as another modality that gets full support of the Indian government, along allopathy, homeopathy, and Auyrveda. Given the amount of people in India and how poor health coverage is, it won’t be long before tens of thousands are treated there with acupuncture daily!

            And then you can visit China. Oh, China. Now you came to see the Big Boys. Those godless commies. Don’t like our pills. Using acupuncture left and right, having it in hospitals, outpatient clinics, private clinics, homes, and anywhere else you can find someone with a needle.

            I wonder what all those people are thinking? They must have not read Prof. Ernst’s article “History of Acupuncture in China”. They should do it immediately, that will show them! And Prof. Ernst can list you guys as references for more gravitas.

          • This “magazine” is known as a medical journal, but that would be of no importance to you, since fantasy and wish thinking are just as valid to you. Fine. Your choice. I strongly object to schools who are teaching nonsense to defenseless children, but as an adult, if that is what you are, it is your fundamental right to do your utmost to be as ignorant as you possibly can be. Be happy with it. What I don’t know, is why you would waste your time on a blog, written by someone for whom evidence is the foundation of what he does, but again, that is your right.

            For the rest, I am flabbergasted. What are you doing in the US? If you really believe what you are saying, you should hop on a plane right now and go to Syria. People from all over the planet are coming together there to worship, celebrate and submit to the One True God.

          • I assure you that I know what medical journals are, that’s why, in response to your another non-sensical argument (this time about Star Trek) I quoted you an article from JAMA. You’ve heard about them? It stands for Journal of American Medical Association, you may want to look it up.

            I went on this blog because someone on the acupuncture forum mentioned an article on meta-analysis of acupuncture studies. Reading the comments was not a complete waste of time, some of the sceptics provide useful links that I intend to read up on. Besides, it’s always good to challenge your own assumptions and see how they hold up under scrutiny. That’s one of the things meditation teaches you, by the way.

            However, when it comes to your and some other peoples’ comments, I wonder if you guys have any capacity for rational thought. From you, for example, we’ve heard such jewels as: flying meditators, prayer and watching Star Trek as an alternative to acupuncture, and now going to Syria. Syria, really? That, by the way, is called a “red herring argument”, you may want to look it up too.

            Whenever any of these “arguments” (I am not even sure they deserve the title) are refuted, you guys just move on to a next logical fallacy. So far, I’ve seen red herrings, straw men, and poisoning the well. All in the name of science and EBM.

            I suggest you take some time off from EBM blogs and read up on logical fallacies, as you yourself have said, it could be an “enlightening” experience.

          • @sasha,
            “Of course, in your case, it would mean leaving your mother’s basement.”
            Given I wasn’t ever there, and I left home 42 years ago, your vitriol is not missed.
            ~
            Since you hold yourself out as a guru on Logical Fallacies, I suggest you research the Fallacy Fallacy, then look in a mirror.

    • Perhaps now you understand why the QUALITY of the study is important. Badly designed studies are (unintentionally) as misleading as deliberately fraudulent claims, such as the open-heart surgery one. Sadly, very few people have the training to design a trial well – and I include conventional medicine in that, which is why conventional scientists put a lot of effort into tearing other people’s research apart looking for flaws. This is interpreted by alt-med as bias against alternative therapies – but we do EXACTLY the same thing to claims for conventional therapy.

      • I do feel that we are constantly striving for a 1 shoe fits all option.
        Instead of spending money on studies to prove the effectiveness for a large majority over a perceived placebo, why can’t we put that money in to finding preventions and cures without side effects. These will be cures that work for some and not for all but they won’t cause a big list of side effects.

        • ” why can’t we put that money in to finding preventions and cures without side effects. ”
          I think you’ll find that we are doing just that. Or do you think researchers set out to find treatments with side effects? The first members of new classes of drugs may well have side effects – and then the race is on to find ones which either work better or work just as well but with fewer side effects. Both make a drug more marketable in a competitive industry.

          But there’s no point in creating interventions which don’t have side effects – but don’t cure or prevent either.

          • Hello everyone 🙂

            It seem like these topics are endlessly debated with no resolution. This is because we have our own bias and are much more comfortable with world view that of our own. Scientists try to look at things objectively by first identify their own bias.

            Professor Ernst has just given you one systemic review above. He gave 3 possible choices which he eliminated 2. so the last option would be true that acupuncture works. 🙂

            Please review theses high quality studies for more evidences:

            http://www.ncbi.nlm.nih.gov/pubmed/22965186
            http://www.ncbi.nlm.nih.gov/pubmed/25661270
            http://www.ncbi.nlm.nih.gov/pubmed/19160193

            In the USA, acupuncture is regulated and licensed acupuncturists hold at least master-level education.
            It seem like more and more research are coming out to support the referral for acupuncture as a complementary treatment modality to conventional treatments.

            disclosure: i am an acupuncturist 🙂

          • @Thang,
            Well, let’s see what these “high quality studies” have to say;
            ************************************************************************
            http://www.ncbi.nlm.nih.gov/pubmed/22965186
            CONCLUSIONS:
            Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.
            ~
            http://www.ncbi.nlm.nih.gov/pubmed/25661270
            CONCLUSIONS:
            Acupuncture, in addition to conventional analgesic treatment, is an effective treatment for posttonsillectomy pain. Acupuncture is safe and well received by children and their parents.
            ~
            http://www.ncbi.nlm.nih.gov/pubmed/19160193
            AUTHORS’ CONCLUSIONS:
            In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of ‘true’ acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.
            ************************************************************
            ~
            Putting aside the “quality” of the studies, the conclusions are certainly underwhelming. If that is the best artillery acupuncture has, it isn’t very impressive.
            ~
            I’m pleased you advised of your financial interest in the discussion, however, there isn’t any evidence to suggest this conclusion; “It seem like more and more research are coming out to support the referral for acupuncture as a complementary treatment modality to conventional treatments.”
            ~
            What’s more, if acupuncture is believed to be only “complementary” to conventional treatments and its effects are not significant, what is the point of it?

          • Dear Frank,

            medical practitioners use evidence-informed to guide their clinical decisions. This means that we use not only the available researches, but also taking account our clinical experiences and patients’s experiences. for example, certain population of the patients won’t response to just medication alone for migraine headache. this is when complementary modalities such as acupuncture, herbal medicine such as butterbur might be useful in lower the recurrence frequency and intensity. sometimes migraine headache is disabling. and patients deserve every bit of help they can get. I think the patients should be informed about available options and let them decide what works best for them.

            “Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.”

            considering adding acupuncture to the treatment plan for those children and able to lower the dosage of analgesic drug to minimize the side effects would be a noble idea.

            “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.”

            I interpret this as acupuncture might be an option for chronic pain for certain population (minimize opiod dependency?). that acupuncture is better than placebo. and we still don’t know how it works 🙂

            best regards

          • @Thang,
            “medical practitioners use evidence-informed to guide their clinical decisions. This means that we use not only the available researches, but also taking account our clinical experiences and patients’s experiences. for example, certain population of the patients won’t response to just medication alone for migraine headache. this is when complementary modalities such as acupuncture, herbal medicine such as butterbur might be useful in lower the recurrence frequency and intensity. sometimes migraine headache is disabling. and patients deserve every bit of help they can get. I think the patients should be informed about available options and let them decide what works best for them.”
            Are you a medical doctor or an acupuncturist? If the latter, you are NOT a medical practitioner and are not in any position to give medical advice, particularly not this kind of advice “patients should be informed about available options and let them decide what works best for them”.
            ~
            Your interpretation of the conclusions is too optimistic and does not display a realistic grasp of how thin any evidence as to the efficacy of acupuncture. Your bias is evident, since you have a substantial financial stake in a positive outcome.

          • In the USA where I live, some states qualified acupuncturists as primary care physicians. we work under the supervision of the medical boards because we are medical practitioners. We know our limit and our scope of practice and make referrals to other medical practitioners when it is medically necessary. 🙂

            best regards

          • Thang on Wednesday 15 April 2015 at 22:48
            In the USA where I live, some states qualified acupuncturists as primary care physicians. we work under the supervision of the medical boards because we are medical practitioners. We know our limit and our scope of practice and make referrals to other medical practitioners when it is medically necessary.

            Americans also have life expectancies at birth that are over 2 years lower than neighbouring Canada. Coincidence?

          • @Thang,
            ‘In the USA where I live, some states qualified acupuncturists as primary care physicians. we work under the supervision of the medical boards because we are medical practitioners. We know our limit and our scope of practice and make referrals to other medical practitioners when it is medically necessary. :)”
            That is a worry. You just aren’t well trained enough, or smart enough to be a primary care physician.
            ~
            How do you know your “limits” without the training equivalent to a real doctor? When you kill someone?

          • Thang said:

            In the USA where I live, some states qualified acupuncturists as primary care physicians.

            Please list those states so we all know which ones to avoid.

          • Dear Bart,

            There are many factors contributing to one’s life expectancy. These include health systems, individual behaviors, how much time we spend on this blog, social economical disparities, education, environmental factors, public policies… This research paper actually suggesting “much of the US health disadvantage is due to variations in non-medical determinants of health, some of which result from dramatic differences in public policies across the US and other OECD countries.”

            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112220/

            It has nothing to do with adding acupuncturists to the medical team.

            Dear Frank,

            Our limit is defined in our scope of practice. what is your bias? what do you know about our training? what qualified you to make such statement? I fully understand what pharmacology is because it was part of the course work to become an acupuncturist. The point is the scientist who was able to make life-saving medication for malaria because she understood biomedicine, studied those “ancient wisdom” from Traditional Chinese Medicine classics, and tweaked those wisdom to make it better.

            Dear Alan,

            There is no need to. Your bias and prejudice is against acupuncture anyway. Hopefully by commenting here you will get a few more clicks to your less popular website. 🙂

            What is medicine?
            med·i·cine
            ˈmedəsən/
            noun
            1.
            the science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery).
            2.
            a compound or preparation used for the treatment or prevention of disease, especially a drug or drugs taken by mouth.

            what is science?

            sci·ence
            ˈsīəns/Submit
            noun
            the intellectual and practical activity encompassing the systematic study of the structure and behavior of the physical and natural world through observation and experiment.

            from these definitions, there is no such thing as “alternative” medicine. There is just plain medicine.

          • @Thang,
            I’ll give you an “A” for persistence but a “F” for comprehension.

            I said this, in relation to the studies you cited;
            “Putting aside the “quality” of the studies, the conclusions are certainly underwhelming. If that is the best artillery acupuncture has, it isn’t very impressive.”
            ~
            “Our limit is defined in our scope of practice. what is your bias? what do you know about our training? what qualified you to make such statement?”
            If you don’t have a full medical training, how do you know the limit of your training?
            ~
            “I fully understand what pharmacology is because it was part of the course work to become an acupuncturist. The point is the scientist who was able to make life-saving medication for malaria because she understood biomedicine, studied those “ancient wisdom” from Traditional Chinese Medicine classics, and tweaked those wisdom to make it better.”
            If you understood pharmacology, you wouldn’t have posted what you did. There is no ancient wisdom associated with medicine. No one did autopsies.

          • Frank-

            “There is no ancient wisdom associated with medicine. No one did autopsies.”

            You’ve reset the bar with that one. That’s awesome.

          • @jm,
            “Frank-
            “There is no ancient wisdom associated with medicine. No one did autopsies.”
            You’ve reset the bar with that one. That’s awesome.”
            Putting aside the pointless hyperbole, please tell me what “ancient wisdom” of which you are aware?
            ~
            I’d also like to know the branch of alternative medicine in which you dabble?

          • @Thang

            I don’t know why your opinions of me pre-empt you from providing the list and backing up your claim. Perhaps you just can’t?

          • Dear Frank,

            If you didn’t learn Chinese, does that mean you don’t know your limit regarding your ability to speak Chinese? If a GP didn’t have as much training as a surgeon, does it mean he doesn’t know his limit regarding surgery and able to make referral? Scope of practice is there to set the limit of what one can and cannot do. again, all you do is wrongly assume base on your bias.

            if you mean autopsy as in forensic autopsy, actually our ancestors had started autopsy as early as 206BC.

            I am here to clear out misconceptions. what are you here for Frank? if you are so concern about public safety and try to educate the public, then you failed miserably because acupuncture is even more popular. If you are trying to educate other medical providers, then you also failed miserably because even when Dr. Ernst has written a chapter in the Text Book of Pain as well as many scholarly articles criticizing alternative medicine. Yet, alternative medicine is gaining more popularity among medical students.

            to ensure public safety in my opinion, don’t waste time here. one can do something more meaningful by ensuring that acupuncture is done by a properly trained and licensed acupuncturists.

            I am no longer wasting my breath because ancient wisdom tells me that it will be like water dropping on ducks’ heads. I have a life to live. 🙂

            best regards and good luck!

          • @Thang,
            “If you didn’t learn Chinese, does that mean you don’t know your limit regarding your ability to speak Chinese? If a GP didn’t have as much training as a surgeon, does it mean he doesn’t know his limit regarding surgery and able to make referral? Scope of practice is there to set the limit of what one can and cannot do. again, all you do is wrongly assume base on your bias.”
            Very good analogy. I take it to mean that if I didn’t learn Chinese, I wouldn’t pretend to speak the language to a Chinese speaker. It would only be pretending, in the same way acupuncturists pretend to know about medicine.
            ~
            “if you mean autopsy as in forensic autopsy, actually our ancestors had started autopsy as early as 206BC.”
            Oh, so the Chinese fully understood germ theory, had microscopes and understood pathology? I didn’t know that.
            ~
            “I am here to clear out misconceptions. what are you here for Frank? if you are so concern about public safety and try to educate the public, then you failed miserably because acupuncture is even more popular. If you are trying to educate other medical providers, then you also failed miserably because even when Dr. Ernst has written a chapter in the Text Book of Pain as well as many scholarly articles criticizing alternative medicine. Yet, alternative medicine is gaining more popularity among medical students.”
            My interest is in the absurdities that human reason (or lack of it) will take in the rationalisation of a nonsense. The rest of your paragraph is a couple of Logical Fallacies; Sweeping Generalisation, and Argument from Popularity (no surprise).
            ~
            “to ensure public safety in my opinion, don’t waste time here. one can do something more meaningful by ensuring that acupuncture is done by a properly trained and licensed acupuncturists.”
            Someone like you who practices something which is baseless?
            ~
            “I am no longer wasting my breath because ancient wisdom tells me that it will be like water dropping on ducks’ heads. I have a life to live. :)”
            If you are going to use a simile, at least don’t stuff it up. You may be able to convince some people that your witchcraft is efficacious but not here.
            Please don’t kill, paralyse, or in some way injure some poor, stupid person who seeks your “treatment”.
            ~
            Einstein was right; human stupidity is infinite.

          • @Thang
            According to Eberhard’s History of China the first autopsy in the country was made in 1145 in the Sung period. “…before the Sung, Chinese doctors did not know how organs which were called ‘liver’, ‘heart’, etc. looked and where they were located in the body.” [page 221]. But I guess you’ll tell us he’s wrong.

          • Frank – According to the illustrious Wikipedia,

            “In China, instruments resembling surgical tools have also been found in the archaeological sites of Bronze Age dating from the Shang Dynasty, along with seeds likely used for herbalism.

            Hua Tuo was a famous Chinese physician during the Eastern Han and Three Kingdoms era. He was the first person to perform surgery with the aid of anesthesia, some 1600 years before the practice was adopted by Europeans. Bian Que (Pien Ch’iao) was a “miracle doctor” described by the Chinese historian Qima Nan in Shi Ji who was credited with many skills. Another book, Liezi (Lieh Tzu) describes that Bian Que conducted a two way exchange of hearts between people. This account also credited Bian Que with using general anaesthesia which would place it far before Hua Tuo, but the source in Liezi is questioned and the author may have been compiling stories from other works. Nonetheless, it establishes the concept of heart transplantation back to around 300 CE.”

            Who knew, eh? The drawings of organs from that time period are pretty cool, too.

          • @jm,
            “Another book, Liezi (Lieh Tzu) describes that Bian Que conducted a two way exchange of hearts between people. This account also credited Bian Que with using general anaesthesia which would place it far before Hua Tuo, but the source in Liezi is questioned and the author may have been compiling stories from other works. Nonetheless, it establishes the concept of heart transplantation back to around 300 CE.”
            ~
            That is fascinating, though it does lack credibility (a little understatement).
            ~
            “two way exchange of hearts between people”
            I thought about a serious comment but read it again and laughed. Really, a “two way exchange”? There are too many questions; were they alive to start with, were they alive afterwards, why would anyone consent to such a thing, what was the purpose, the list goes on?
            ~
            “general anaesthesia”?
            What, the ancient Chinese kept this gem to themselves for 1,600 years?
            ~
            Here are some links, including Wikipedia, that may help you;
            http://philosophy.hku.hk/think/critical/ct.php
            http://en.wikipedia.org/wiki/Critical_thinking
            ~
            When are you going to tell me which branch of alt-med in which you are involved? I’ve asked a few times but you have not answered.

          • Frank,

            “That is fascinating, though it does lack credibility (a little understatement).”

            Quite the understatement, since “…Chinese doctors did not know how organs which were called ‘liver’, ‘heart’, etc. looked and where they were located in the body. [page 221].”

            Kinda makes the drawings pretty unbelievable, too. Maybe they used witchcraft to fake them. It’s probably a conspiracy.

            “What, the ancient Chinese kept this gem to themselves for 1,600 years?”

            Obviously another conspiracy. With some petty politics and court drama thrown in for good measure.

            “Here are some links, including Wikipedia, that may help you;
            http://philosophy.hku.hk/think/critical/ct.php
            http://en.wikipedia.org/wiki/Critical_thinking

            You should read those. Seriously. Then re-read your comments. And then again, I sometimes wonder if you’re a character created by Edzard for comic relief.

          • @jm,
            The lengths to which you will go to avoid a simple question;
            What is the alt-med you practise?
            ~
            As for your other comments, I’ll let those people who don’t believe in fairies judge.
            ~
            “Quite the understatement, since “…Chinese doctors did not know how organs which were called ‘liver’, ‘heart’, etc. looked and where they were located in the body. [page 221].””
            That wasn’t me.

          • @jm

            Hi JM,
            If you are interested in history of medicine (you seem well versed from the Chinese medicine view, which I found intriguing) you may find Mr Roy Porter’s book “Blood and Guts” an interesting read.

            Regards

            George

          • @jm,
            I repeat as I will ad nauseum,
            “The lengths to which you will go to avoid a simple question;
            What is the alt-med you practise?

          • Thanks George – and, love the title!

            Cheers

          • @jm,
            What is the alt-med you practise?“
            Are you too embarrassed to disclose?

          • Frank, maybe jm is waiting for your response to A N Others repeated question to you (sometime ago now i admit), on where you found the literature to support thoracic manipulation?

          • “Frank, maybe jm is waiting for your response to A N Others repeated question to you (sometime ago now i admit), on where you found the literature to support thoracic manipulation?”
            An Other asked a question of me and, later, answered it him/herself. Maybe you weren’t paying attention?
            ~
            after that pointless distraction, I ask;
            jm,
            What alt-med do you practise?
            Are you too ashamed to answer?
            You are normally very quick to respond, so please tell me (and everyone else), what brand of alt-med do you do?

        • I do feel that we are constantly striving for a 1 shoe fits all option.

          As far as acupuncture is concerned, you are almost certainly almost completely correct. Acupuncture treats any and all conditions with one single “therapy” consisting of sticking needles into people. The word acupuncturists use for this is “holistic”.

      • Frank I see your many many years of experience has left you with very little open mindedness towards insights from people learning the field. I’m sure before you took your course and even to date, you had belived something to be true that turned out to not be, did that mean that everything you ever thought previously was also untrue?
        Are you saying that my friend has lied to me about the reports and who commissions them to write the reports?
        Have you ever tried an acupuncture treatment?

        • Sandra said:

          Frank I see your many many years of experience has left you with very little open mindedness towards insights from people learning the field.

          Should we continue to be ‘open minded’ regardless of the overwhelming evidence that acupuncture is unlikely to be little more than a theatrical placebo? At what point should we start concluding that there is not a jot of good evidence, or should we be ‘open minded’ for ever?

          I’m sure before you took your course and even to date, you had belived something to be true that turned out to not be, did that mean that everything you ever thought previously was also untrue?

          Irrelevant. We are discussing acupuncture here.

          Are you saying that my friend has lied to me about the reports and who commissions them to write the reports?

          No one is saying that, but your bifurcation fallacy exposes your inability to think critically.

          Have you ever tried an acupuncture treatment?

          Again, you expose your lack of critical thinking skills: the evidence for acupuncture does not rely on whether or not Frank or I has tried it.

        • Frank I see your many many years of experience has left you with very little open mindedness towards insights from people learning the field.

          It is called ‘experience’.

    • Again I am asking to have my poor choice of reference excused, I did attempt to delete after I’d seen a few reports concerning the misleading information. It’s a good start to the researching health and diseases unit that actually starts next week.

      It should teach you that television is first and foremost a medium of entertainment and that accuracy and truth are not necessarily goals the makers of a programme are striving for. It should also teach you not to stop and scream victory after the first sound bite that seemingly confirms what you are thinking. Even a programme as shoddily made as this documentary, sometimes contains the elements that allow the attentive viewer to understand what is actually going on. Although the BBC is highly respected, its documentaries are certainly not by definition free of misrepresentations or outright fantasy.

      In this very case, ‘reports concerning the misleading information’ are not needed. If you are human, understand English at a basic level and are sufficiently intelligent to make it through elementary school, you should be able to figure out by yourself that there is something wrong with the claims made in this programme. All it takes, is to watch the whole programme and not stop after the first claim.

      It should teach you that just because someone makes a claim that confirms your ideas, does not mean that claim reflects the truth.

      You should be warned though: if you start using your brains and stop being gullible, you may never get your acupuncture diploma. Despite loud claims to the contrary, most acupuncturists seem to be far more interested in selling their hocus pocus to their gullible customers than they are in providing these customers with good healthcare. If they were, they would not be practicing a technique that has never been reliably shown to be effective beyond placebo.

      Ask yourself how it is possible that longevity of the Chinese only really started to increase when they adopted “Evil Western Medicine”. Look it up. The Chinese did not have stellar life spans before western medicine. If Western medicine is so awful and is killing us off in droves, how is it possible that we live longer than ever? Is it really outside of the realm of possibilities that TCM is not all that fantastic after all?

  • Bart wrote “I will reiterate my question, because the issue fascinates me:

    Can you explain how the consistent application of a single technique, acupuncture, for things as diverse and unrelated as vulvodynia, IVF (which is a medical *treatment*), Bells palsy, indigestion, irritable bowel, hay fever, atrial fibrillation, uncontrollable legs, numbness and tingling, colds, flus, tiredness, diabetes… would be “holistic”? It seems to suggest that “holistic” is used to indicate that any and all patients will be treated for any and all conditions by sticking needles in their bodies. I am merely looking for a description/definition that *you and your colleagues* would consider fair and correct.”
    Dear Bart,

    Thanks for re-phrasing the question, which is now clear to me.

    It turns out it is a very useful question. Through listening to many seminars on such things as chronic pain, I have come to realise that holistic means something entirely different to Western medics than it does to alternative practitioners, including acupuncturists.

    For example, take bladder pain syndrome (formerly known as cystitis – even though not caused by inflammation. Usually treated by repeat antibiotic prescriptions, even though bacterial infection is rarely found.) So, when this condition becomes chronic, a ‘holistic’ approach, by WM standards, is employed. This means, for the patient, visits to
    1. Pain medicine specialists
    2. physiotherapists
    3. pelvic floor specialists (other than physios)
    4. urogynaecologists/ uro-neurologists
    5. clinical health psychologists
    6. CBT practitioners
    7. and of course pharmacologists/chemist
    8. and finally for some – urological surgeons

    In other words a holistic approach, in western medicine, means getting lots of specialists on board to treat different aspects of the same patient.

    It might surprise you to know that the patient does not experience this as a ‘holistic’ approach, but rather that they feel fragmented into different parts, and that somewhere in amongst that they, as a person, are not seen at all.

    Upshot of all this – 11 patients needed to be treated for one to be treated effectively. Cure is not a realistic goal for BPS in this setting (according to the specialists speaking). For some it is an inexorable journey to radical surgery. Pharmacological treatments have little evidence to back them up (chronic BPS specialist’s words, not mine. )

    In amongst this group of over 50 specialists in this field, the majority pessimistic about prospects for patients despite the recent re-classification of the disease (which at least helps clarify the diagnosis), there was one urologist who piped up that she was very hopeful with the way things were going and had great results. She too used a holistic approach at the hospital where she worked. (She was largely asking about the neuro-modulation techniques, plus discussing some pharma, without explaining how her team treated this.)

    At the break I asked her how she was getting such good results while others were so pessimistic. What was she doing differently?

    Her answer – she was using an acupuncturist! (She didn’t know that I was one.) I asked how many acupuncture treatments were required. She said about 20. She didn’t know specifically how the acupuncturist treated this. I thought this was quite a high number of treatments but then I realised that the severity of the patients she saw was much greater than the patients I see, which usually takes 6 – 10 treatments. She said that the treatment was very cheap and cost effective and that she and her patients were very pleased with the results.

    So – our version of holistic? The patient’s seemingly disconnected symptoms can all be taken into account. For example, BPS:- We ask, is this person generally chilly, do they have other symptoms such as low back pain, what else is going on? Or, on the other hand, does this person have cloudy urine, dark urine, heaviness or achy limbs (17% of PBS also have fibromyalgia). Or, is this person anxious, nervous, sleepless. Is it largely experienced or made worse after sex? Are they thirsty, feel warm or hot much of the time . etc. So, we individualise the treatment accordingly. It is a holistic treatment in that other aspects of their experience, and not only symptoms, are incorporated and formed into a pattern of illness and treated accordingly. We don’t consider that using a small selection of points from the literally millions of possible combinations of acupuncture points is tantamount to treating everyone the same way.

    Best wishes,

    Roisin Golding

    • That is a very interesting explanation, Roisin. In other words, as is the case in homoeopathy, acupuncturists only look at symptoms, the causes don’t interest them. The former just mumble something about an ignorant vital force that has lost its way and must be led back to the path it is supposed to follow, and the latter waffle something equally vague about meridians and chi and yin and yang, and leave it at that.

      According to what you write here, acupuncturists are dismissing the original concept of holism, and replacing it with one of their own that reduces the patient to a collection of superficial symptoms. That would certainly go a long way in explaining why they use the same treatment for everything and why they do not need the multidiscplinary teams we use in medicine.

      Whether this total disregard of the realities of biology and medicine is a Good Thing, remains to be seen. I am not convinced that shutting out most everything of our demonstrable knowledge would be good. But that’s just me. Many people seem to think that ignorance is bliss and do everything to be as ignorant as they possibly can. Apparently, that includes acupuncturists. They prefer fantasy to reality. All the power to them, but is that really a good basis for treating actual people with genuine illnesses?

      If what you wrote here is what you tell your customers, you are doing them a serious disservice. In medicine, we are not so arrogant. Instead, we humbly recognise that we are only at the beginning, that there is massively more to learn than we have already learned. We also recognise that it is not reasonably possible for any human being who has at least normal intelligence and memory capabilities to know all there is to know.

      So, instead of putting on the blinkers and rejecting the evidence outright, we accept our weaknesses and do the best we can: we learn about biology and medicine in general and then we specialise. No brain surgeon will be expected to diagnose and treat type II diabetes, no pulmonary specialist will be asked to remove a brain tumour and so on. But these specialists all speak the same language, the language of biology and medicine.

      And instead of reducing medical knowledge to whatever can fit into a single human head, we bring all those heads together in multidisciplinary teams to treat the patient. In doing so, these specialists can look at causes as well as symptoms and they discuss within the group what the consequences of certain decisions may be and they make the best, or at times, the least bad decision they can make, whether that means treating the patient a certain way, or another way, or not treating the patient at all.

      Let’s just forget about the anecdote, shall we? We already know how reliable and useful those are.

      The acupuncturists, on the other hand, smile, perform some hocus pocus, the customer goes away, has no benefits except for some short-lived illusion, but if and when the symptoms disappear (as they do for very many conditions) they step up and claim the credit, if not, they blame medicine.

      Interesting. I am not sure I could live with myself doing that. I prefer honesty and integrity.

  • Hmmmm! reading quickly through all this, as a lowly student, I look forward to the day that I have the time for this verbal tit for tatting! I must also remember that should I write something in the future, the best way to draw attention to my meaty article is to throw it to the wolves! Who it would seem are out there slinking around in the undergrowth, ready to pounce and rip said meaty article apart just for the fun of it, and then tell everyone how awful it tasted! Well, better get back to it, trying to learn how not to be narrow minded and respect other peoples views, hey ho!

    • “trying to learn how … to … respect other peoples views, hey ho!”

      You don’t have to respect other peoples views. You have to acknowledge that they have views – and then you are quite entitled to rip those views to shreds if you can show that they are wrong. If you are, as you say, a student, then I suggest you make that your first lesson.

    • Well, better get back to it, trying to learn how not to be narrow minded and respect other peoples views, hey ho!

      Question: do you really disrespect people so much that you think that misrepresentations, errors and outright lies should go unadressed? What an appalling morality!

      • Is that a snake in the grass?

        • No, but there is someone wet behind the ears.

          “Hmmmm! reading quickly through all this, as a lowly student, I look forward to the day that I have the time for this verbal tit for tatting!”
          Seeking to demean a discussion does you no credit.

          “I must also remember that should I write something in the future, the best way to draw attention to my meaty article is to throw it to the wolves! Who it would seem are out there slinking around in the undergrowth, ready to pounce and rip said meaty article apart just for the fun of it, and then tell everyone how awful it tasted!”
          From your inability to write properly and think critically, I have grave doubts anything like a “meaty article” will ever eventuate.
          “Well, better get back to it, trying to learn how not to be narrow minded and respect other peoples views, hey ho!”
          Narrow-mindedness is the very trait you are showing by this post. As Pat and Bart said above, respecting any and all opinions is philosophical relativism, and has been described by some philosophers as dangerous and stupid. A person may be entitled to an opinion, however, they are not entitled to have that opinion unquestioned or unchallenged. I was talking to a retired secondary school teacher recently and this whole business of “respect at all costs” in schools drove her nuts. It stifled critical assessment and made students think that just because they had an “opinion”, it was as valid as anyone else’s. Wrong, stupid and dangerous.

  • Professor Ernst deserves credit for having the integrity to state here that “acupuncture might be more than a placebo after all.” Admitting that a study suggests that this is possible demonstrates that healthy skepticism does not have to equate to closed mindedness. In light of this ray of hope for constructive discord, I would like to offer a reason why most skeptics have been wrong about acupuncture and why much of the research done on acupuncture has been asking the wrong questions and using the wrong methodologies. Acupuncture skeptics believe that there is no plausible mechanism that could explain acupuncture’s observed clinical effects and so it’s effects must be due to placebo and yet it is in the insistence of a plausible “mechanism” that the wrong question is being asked. Please consider the following two hypotheses: 1. Although biological organisms have evolved elaborate self-regulatory/self-healing systems that respond spontaneously to any perceived threat to homeostasis, that does not mean they automatically get every benefit possible out of those systems. 2. Acupuncture has the potential to facilitate the better use of an organism’s self-regulatory/self-healing resources.

    If, for the sake of argument, one were to accept that these two hypotheses could be possible, it should change the manner in which acupuncture is viewed and studied. Modern medical “mechanisms” research has been focused on testing if a specific intervention causes a specific effect in an organism – a sort of “mechanical fix” of a problem. We are a long way from knowing everything about how a complex organism uses its vast resources to respond to threats to homeostasis and so, if acupuncture works by “greasing the wheels” of those responses and improving their efficiency, we could not appropriately test this with the current mechanical based cause and effect methods.

    It seems those involved with acupuncture research when it first began to be studied in the West either did not understand that it worked by facilitating the better usage of the body’s own resources or they were so eager to win approval from the “mainstream” that they ignored the pitfalls of using methods designed to test an altogether different type of medical intervention. And acupuncture IS an altogether different type of medical intervention than what we are accustomed to in modern medicine. This difference is somewhat like the difference between using a modern chemical pesticide to kill aphids in one’s garden versus planting dill or caraway plants to attract ladybugs that, in turn, eat the aphids. The basic goal is the same but the science behind these two approaches is different and best methods for testing their effectiveness would need to be different.

    Some of us who work in the acupuncture field are just now getting a better grip on what has gone wrong with acupuncture research and how to address it. No one who knows this field could deny that acupuncture is helping many people and animals the world over to ease suffering and often doing so with a better safety factor than mainstream medicine. In light of this, I would ask those skeptics out there who are so certain acupuncture is nothing more than placebo to follow Professors Ernst’s lead and not close your minds to the possibility that “acupuncture might be more than a placebo after all”. The research done thus far has not been a fair test of acupuncture’s true potential but with more time we hope to address those problems and better show what acupuncture can and cannot do. Thank you. Matthew Bauer, President, The Acupuncture Now Foundation.

    • Acupuncture skeptics believe that there is no plausible mechanism that could explain acupuncture’s observed clinical effects and so it’s effects must be due to placebo and yet it is in the insistence of a plausible “mechanism” that the wrong question is being asked.

      This is why I am always prepared to accept evidence that acupuncture works, but not prepared to accept an acupuncturist’ss word. The only talent I have ever seen in acupuncturists is the talent to misrepresent or lie outright. The above claim is so embarassingly wrong, that the author should apologise for it and scurry back to whatever he came from to repent. I went to med school in the 70s and there were absolutely very credible and plausible mechanisms being proposed. What was not forthcoming was demonstrable evidence that it has any effectiveness in the treatment of any disease to even the smallest detectable level.

      We do not “not believe in acupuncture” because we find no plausible mechanism, we do not believe in acupuncture because we have no reasons to. Nothing more. Lying is not an acceptable form of evidence.

      • “We do not “not believe in acupuncture” because we find no plausible mechanism, we do not believe in acupuncture because we have no reasons to.”

        Bart, no one cares what you believe or disbelieve in. Least of all tens if not hundreds of thousands of people who go for acupuncture every day. You keep bringing up “going to school in the 70’s” as some sort of crystal ball that allows you to opine on all things medical. I know enough MDs to fill a small medical school, including most members of my immediate family. And plenty of them not only “believe” in acupuncture, they refer patients for it and some practice it themselves.

        • Bart, no one cares what you believe or disbelieve in.

          You are misrepresenting what I wrote. It is not about what I *believe* or don’t *believe*. It is about making demonstrably erroneous claims. The claim by Matthew Bauer is *wrong* and demonstrably so. All you have to do to know that, is read what professor Ernst wrote. You do not need my opinion to figure out that Matthew Bauer’s claim is wrong.

          What *I* am interested in, is in understanding why anyone would be even tempted to believe the claims by someone who is demonstrably wrong.

          • Ok, let’s address “not clinically significant” and “sticking needles through the skin doesn’t do anything”. This one is from Linde, K. 2005. Acupuncture for patients with migraine. A randomized controlled trial. JAMA 293 (17): 2118-25.

            In that study acupuncture reduced migraines for 51 percent of patients while sham acupuncture reduced migraines for 53 percent. The third group was “control” – patients were put on the waiting list to receive acupuncture, in that group 15 percent improved. Thus, there was 36-38% improvement among those seen by an acupuncturist (sham or real) compared to those placed on a waiting list.

            And now to quote the MD writing about this study: “That’s an NNT of less than three, indicating that the rituals of acupuncture have more impact than some of the most effective ACTIVE ingredients that modern medicine has ever devised, including aspirin, heart surgery, and some chemotherapies”.

            IMO, the good doctor is mistaken regarding “the rituals” of acupuncture – but they could always do a study comparing a “ritual” of acupuncture vs a ritual of beating a shamanic drum, for example, and see what it does for a patient’s headache.

            Of course, at this point acupuncture sceptics promptly forget their earlier arguments of “sticking needles through the skin doesn’t do anything” and you might as well go home and watch Star Trek. They seize upon no difference of sham vs real to say: “See we told you so, acupuncture is placebo”. It is then a job of acupuncturists to look at the study methodology to see what kind of sham and real acupuncture researchers used.

            I also wonder what would happen if the researches in the study took advice of some on this thread and devised a fourth group, those who were told: “Go home, we’ll pray for you and you can watch Star Trek while we’re doing it”. After all the very act of placing patients on acupuncture wait list seems to be a low-level therapeutic encounter – 15% improved. My guess, the fourth group of Star Trek watchers would report 0% improvement which would give acupuncture the NNT of 2 placing it among some of the most powerful therapies ever devised.

          • I am not misrepresenting anything, I just cut and pasted what you wrote: ” we don’t believe in acupuncture because we have no reasons to. Lying is not an acceptable form of evidence”.

            So, to that I once again am saying – no one gives a crap what you “believe” in. Speaking of religion. Thousands of people administer acupuncture every day and that list is growing. Hundreds of thousands of patients are receiving acupuncture every day and that list is growing too. Do you think all these people care about what a few people on Edzard Ernst blog think about acupuncture? They’re just happy to be out of pain and misery and that’s good enough.

          • Your quote is not in question, but you did misrepresent or misunderstand what I wrote, and my reply was a reply to that, but that reply wasn’t entirely up to snuff either. So, let’s backtrack a bit and make it clear:

            What you wrote is a mistake that very many people make, almost always because they do not understand the difference between “not believing” and “disbelieving”. A scientist/skeptic will not disbelieve anything. For good reasons. It is next to impossible for many negatives to be proven. It is clear that I do not “believe” that unicorns exist, but I do not disbelieve them either because I am all too aware that there is always the possibility that unicorns are running around in some forest and have simply not been discovered yet.

            The same is true for acupuncture, homeopathy, whatever your preferred deity happens to be…

            All we can say is that the best available evidence shows that it is highly unlikely that acupuncture has any specific effects.

            In other words, I do not “believe” that acupuncture works, I also do not “disbelieve” that acupuncture works. There is no belief here, but there is a practice: namely I act “as if” acupuncture does not work. Because there are no reasons to believe it does. That may change, but given the extreme unlikelihood of that proposal, I will be just as happy to not use acupuncture as I am not checking behind every tree if there is a unicorn hiding behind it. That is a task for acupuncture believers and unicorn believers.

            To paraphrase my own blog: A-acupuncturists do not believe acupuncture does not work, they simply do not believe it does work.

            I hope that makes it clear.

          • Yes it does, actually. It makes it more clear

      • Bart – Your (unnecessarily bitter) post highlights the very problem I was alluding to. The research on acupuncture in the 1970s was dominated by researching acupuncture analgesia especially as it related to what was (wrongly) called Acupuncture Anesthesia or AA. This was the worst possible introduction for acupuncture in the West for two reasons. First was political. AA was used as a propaganda tool by elements of Mao’s regime. They touted it as an example of Mao’s forward thinking ideology – taking an ancient Chinese practice –acupuncture- and “improving” it for modern use thus making it superior to anything in the West. This “We have something better than you” was the wrong message to introduce acupuncture with and caused a backlash mentality that still resonates today. More problematic than the propaganda however, was the fact that AA was a hybrid form of acupuncture not at all representative of how it had been successfully used for more than 2000 years. AA attempts to force the body to do something it is not naturally inclined to do – to allow itself to be cut open without pain. Traditional acupuncture was always used to help the body to better heal itself– something the body should be doing but for any number of reasons is not getting the job done. The combination of these two factors caused acupuncture to get off on the wrong foot in the West. Many who tried to objectively evaluate acupuncture at that time formed an opinion that it was not legitimate and many of those have held that opinion ever since as one’s first impression tends to hold sway. Not only did this unfortunate set of circumstances cause Western researchers and skeptics to look at any research coming out of China with suspicion, it also caused even open-minded researches to look at acupuncture as something that could make the body do something it may not be inclined to do naturally rather than as a therapy that seeks to facilitate what the body should do if meeting its full potential.

        I did not have time to respond to your post yesterday as I was treating 24 patients, several of those sent to me by pain management specialists from a few local hospitals. If you should have any interest in how acupuncture is being applied in the real-world, please read my post in response to your uniformed “rake in the cash” post above.

        • I am not an acupuncturist and I clearly do not have the mind-reading abilities you seem to think you have, so I won’t claim that your reactions or you are bitter or mean-spirited.

          Acupuncture skeptics believe that there is no plausible mechanism that could explain acupuncture’s observed clinical effects and so it’s effects must be due to placebo and yet it is in the insistence of a plausible “mechanism” that the wrong question is being asked.

          I simply repeat your claim, Matthew. You may accuse me of whatever you want, but that does not change that what you wrote is wrong. You are misrepresenting what “acupuncture skeptics” say. You may not like that reaction, but you made the claim, I am merely responding to it.

          That is not bitter, that is not mean-spirited, and even if it were, it would be irrelevant. It is simply the statement of an objective fact. You can ask Professor Ernst himself whether it is really true that he and his colleagues are declaring the clinical effects of acupuncture to be due to the placebo effect because there is no plausible mechanism. If he says you are correct, I will post an apology on my blog, and clearly say that I was wrong. I do not want to win this debate. I want the truth to come out of it, and I do not care who this truth is most convenient to.

          The reason the clinical effects of acupuncture are ascribed to the placebo effect, is because they are indistinguishable from the placebo effect, and just as strong (or weak). The “mechanism” has nothing to do with this. Sure, we would *love* to have a mechanism, but only if there is a measurable effect. That’s the whole point. In fact, acupuncture is somewhat exceptional in this sense. We already have plausible mechanisms, we have had them for decades. We just can’t study them properly, because there is no convincing effect to connect to those mechanisms.

          Before I explain to my teacher how I managed to obtain a good score on a test, should I not obtain that good score first? What is the point of explaining how I managed to get a good score, if my score is bad?

          What makes acupuncture so special that it deserves researchers to spend their time and resources to explain its good results before it has any to show?

          • Bart – in a post on this thread Frank Collins wrote “Unless, and until, supporters of acupuncture can offer a mechanism by which (witch?) the “treatment” works, it must be treated with utmost suspicion.” This is a position I have read by many skeptic bloggers over the years; that the lack of a credible mechanism to explain acupuncture means that is has a higher bar to clear in research than other therapies that do have clear and plausible mechanisms. Are you saying you do not share this view and that the mechanism issue is not an issue at all so all that is needed is good outcome studies that show verum acupuncture outperforming so-called sham or placebo acupuncture? If that is your personal view I stand corrected as far as you personally go but I still say that this is the view and has been for decades of other self-proclaimed skeptics. And when someone tells me to “scurry back to wherever I came from” – yes, I take that as mean spirited and all to typical of the type of discourse anyone can expect who ties to have a constructive discussion with a pseudo-skeptic on a topic they have closed their minds to.

          • Matthew,

            Utmost suspicion? Of course. That’s what skeptics and scientists do. For everything. English is not my mother tongue, so I may be mistaken, but to me, “treated with utmost suspicion” is not quite the same thing as:

            Acupuncture skeptics believe that there is no plausible mechanism that could explain acupuncture’s observed clinical effects and so it’s effects must be due to placebo and yet it is in the insistence of a plausible “mechanism” that the wrong question is being asked.

            I submit that those who believe what you say they believe, simply belong in the same basket as the flat earthers and the moon hoaxers. I happen to have a very good friend who is a moon hoaxer. I think people like that need compassion and, if available, treatment. I am, I freely admit, not the right person to provide it.

          • Matthew,

            I clicked on Post Comment a little too soon, an unfortunate habit of mine.

            Are you saying you do not share this view and that the mechanism issue is not an issue at all so all that is needed is good outcome studies that show verum acupuncture outperforming so-called sham or placebo acupuncture? If that is your personal view I stand corrected as far as you personally go

            That is essentially correct. I have always thought that a level playing field is required. In medicine, we like to be able to explain everything, but we are more than realistic enough to know that what we would like is often not attainable, at least not yet.

            Whether or not I know the mechanism through which Ibuprofen works is irrelevant if good quality studies, replicable by completely independent teams on a consistent basis show that it works. That will not stop me from *desiring* an explanation, and from searching for a mechanism, but if the evidence is there that it works and that it is reasonably safe (and not as in “the headache is over, and the patient is now a corpse”) then I *will* advise other people to use it, and –perhaps more importantly– I will use it on myself.

            Acupuncture and any other “system” deserve the same treatment. That is the only problem I have with acupuncture: very lofty claims by acupuncturists… and no demonstrable results. As a consequence, I live my life and I reason as though acupuncture is a hoax, and I ignore it. But I *will* change that attitude if/when the evidence is there, in just the same way that biologists have had to accept that the platypus was real and not a hoax.

            It can be done. Vitamin C was accepted, sunlight was accepted, anaesthetics have been accepted, a gazillion other things have been accepted. All for one simple reason: they work and the tests and trials show that they do. All acupuncture has to do, is follow the same path. If it succeeds, it will be accepted. If not, not. It’s that simple.

            I will not waste my time on it, however. In my book, the hundreds of trials that have been conducted are conclusive enough. It is also not my role. Let the believers do the work. That’s how it is done, and should be done. They should convince us, not the other way. Reality has its rights, after all.

          • Bart wrote “ It can be done. Vitamin C was accepted, sunlight was accepted, anaesthetics have been accepted, a gazillion other things have been accepted. All for one simple reason: they work and the tests and trials show that they do. All acupuncture has to do, is follow the same path. If it succeeds, it will be accepted. If not, not. It’s that simple.”

            I suppose you will be happy then to note that acupuncture is doing as you suggest and just last month the American Academy of Otolaryngology—Head and Neck Surgery Foundation published its most recent Clinical Practice Guidelines and has included acupuncture stating “Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with AR who are interested in nonpharmacologic therapy.” http://www.ncbi.nlm.nih.gov/pubmed/25644617

            I am confident this is just the one of the several mainstream medical specialty organizations that will be accepting acupuncture based on the best evidence. I hope you will join me in congratulating acupuncture for successfully following the path you said it needed to follow and I look forward to reading your blog post encouraging people with allergic rhinitis who are interested in nonpharmacologic therapy to seek out acupuncture by a fully qualified acupuncture specialist.

          • Yes, Matthew, good luck. This guy has his head so far up his ass, I wonder if he’s breathing.

          • What a glowing recommendation! Phew!

            Aggregate evidence quality: Grade B, based on randomized
            controlled trials with limitations, observational
            studies with consistent effects
            •• Level of confidence in evidence: Low; the randomized
            trials did not show comparison to traditional medical
            therapy for AR and had methodological flaws.

            I think I’ll follow Prof Colquhoun’s recommendation and try to avoid making a fool of myself. The recommendation will have to wait.

      • Dear Bart,

        “The only talent I have ever seen in acupuncturists is the talent to misrepresent or lie outright.”

        I think this is full of assumptions about what an acupuncturist is and what he/she can contribute. Please read this article to see that acupuncturists could possibly contribute greatly to the science of medicine.

        http://www.mmv.org/newsroom/news/chinese-scientist-wins-award-life-saving-discovery-artemisinin

        and yes, most acupuncturists do practice herbology.
        To assume all acupuncturists lie and misrepresent is nothing but lie and misrepresenting. maybe you have a bad experience with one UK acupuncturist. maybe you have never seen a licensed acupuncturist in practice. but to generalize and stereotype all acupuncturists this way is just beyond reasonable and rational skepticism.

        you probably have another assumption about what we acupuncturists think as being holistic. being holistic to me means considering the body as a whole integrated system. We consider they way patients sleep, eat, bowel patterns, live their life, forming habits, spiritual preferences, bias, their relationships, and environmental factors such as housing condition, the weather where they live, the wind direction, the water they drink… might all be factors contributing to their disease process. I hope this will clear up some of the assumptions that you have about an acupuncturist.

        Best regards,

        • @Thang,
          I think you find out what pharmacology is;
          http://en.wikipedia.org/wiki/Pharmacology
          Pharmaceutical companies are doing it constantly and looking at situations in which naturally occurring compounds have been used before. These same companies also tests poisons, such as from the sea animals, which your “ancient wisdom” didn’t consider.
          ~
          “and yes, most acupuncturists do practice herbology.”
          another brand of witchcraft for which no RCTs have been done.
          ~
          Why do you think so-called “holistic” treatment is the realm of alt-med? Whenever I go to the doctor, he or she asks me about other factors in my life. It is just that she or she does fawn all over me or pander to my ego to make me feel “special” (for two reasons, it isn’t necessary and I don’t have a fragile personality).
          ~
          I’ve said it before and you confirm it; alt-meds just aren’t that smart.

        • @Thang
          “We consider they way patients sleep, eat, bowel patterns, live their life, forming habits, spiritual preferences, bias, their relationships, and environmental factors such as housing condition, the weather where they live, the wind direction, the water they drink… might all be factors contributing to their disease process.”
          Indeed, these might all be factors. Now please design experiments to determine which of these factors really does contribute to the disease in question, That way we will get some evidence to support your contentions, rather than hand waving and arguing from guesswork.

    • Thank you Pat Harkin for putting me in my place! That really told me! (not) I will carry on respecting what others have to say even when what they sounds a tad condescending. And as for ‘ripping up’ well that is a very ‘wolf’y’ thing to say, proves my point.
      Mr Bauer, that’s what a student likes to hear! common sense! informative! helpful! forward thinking and positive. I have printed this off to show my peers! even if acupuncture is not your bag what you say is logical and your attitude is to be applauded, it makes a nice change from all the snarling.

    • @Matthew Bauer,
      “It seems those involved with acupuncture research when it first began to be studied in the West either did not understand that it worked by facilitating the better usage of the body’s own resources or they were so eager to win approval from the “mainstream” that they ignored the pitfalls of using methods designed to test an altogether different type of medical intervention.”
      I’ll say it because I think others may want to but have more reserve than me; this is an absolute crock. The Chinese were smart enough to discard acupuncture because it was viewed as backwards and superstitious.
      “And acupuncture IS an altogether different type of medical intervention than what we are accustomed to in modern medicine.”
      At least you got that right; one works and the other is a nonsense, premised on long debunked primitive views of the world.
      “acupuncture might be more than a placebo after all”
      I assume the subtlety of this statement went straight over your head.

      • Obviously you know nothing about acupuncture. First of all, the anatomical channels have been discovered. They are now called Primo Vascular Channels. If you do not have enough interest to even google that, then you have no business even commenting on the issue. Second, The Chinese did not discard it, they use it together with western methods. They have developed the most interesting blend of the best of both. They have pharmaceutical drugs mixed together with herbs in the same pill. The drug alleviates the symptom and the herbs treat the underlying problem that caused it. They perform acupuncture and surgery in the same hospital. If you are going to try and prove some archaic point, at least get your facts straight. Jeez……….

        • Beth Acampora said:

          Obviously you know nothing about acupuncture. First of all, the anatomical channels have been discovered. They are now called Primo Vascular Channels.

          You keep repeating that yet have provided not a jot of evidence that these Primo Vascular Channels have anything to do with acupuncture. Why’s that?

          • How do you think things get discovered…………? Your obvious bias would block any ability for your brain to comprehend new information…..no amount of evidence would convince you because you already made up your mind. You are not interested in the truth……only in supporting your own opinion. And if you have NO knowledge of acupuncture philosophy or theory or reality of practice then you would not be able to comprehend it anyway. Shovel down your drugs and waste away in a nursing home. I find it hilarious that anyone with such a closed mind considers themselves “scientific”…….what a joke.

          • Beth Acampora said:

            How do you think things get discovered…………? Your obvious bias would block any ability for your brain to comprehend new information…..no amount of evidence would convince you because you already made up your mind. You are not interested in the truth……only in supporting your own opinion. And if you have NO knowledge of acupuncture philosophy or theory or reality of practice then you would not be able to comprehend it anyway. Shovel down your drugs and waste away in a nursing home. I find it hilarious that anyone with such a closed mind considers themselves “scientific”…….what a joke.

            ROFL!

            Please put aside the vitriol and unfounded assumptions and accusations and please have a go at answering the question I asked.

          • Please put aside the vitriol and unfounded assumptions and accusations and please have a go at answering the question I asked.

            I totally second that!

        • Obviously you know nothing about acupuncture. First of all, the anatomical channels have been discovered. They are now called Primo Vascular Channels. If you do not have enough interest to even google that, then you have no business even commenting on the issue.

          I did. These are the impressive results:

          3 results (0.39 seconds)
          Search Results
          The Science Behind Medical Acupuncture – SteadyHealth
          http://www.steadyhealth.com › … › Alternative medicine & healing therapies
          Mar 20, 2007 – The primo vascular channels, which previously were termed the Bonghan corpuscles and ducts, are a physical structure that has been …
          The Science Behind Medical Acupuncture – SteadyHealth
          http://www.steadyhealth.com › … › Alternative medicine & healing therapies
          Mar 20, 2007 – The primo vascular channels, which previously were termed the Bonghan corpuscles and ducts, are a physical structure that has been …
          How Does Acupuncture Really Work? – SteadyHealth
          http://www.steadyhealth.com › … › Alternative medicine & healing therapies
          Mar 20, 2007 – But the primo vascular channels may be at work in these applications of acupuncture, too, waiting to be discovered by research. Sources & …

          Link:
          https://www.google.ca/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=%22primo%20vascular%20channels%22

          • Beth

            I – and others – have been asking you for good evidence that these primo vascular channels have anything to do with acupuncture. I’ve not seen you do that yet. Why?

          • You are not looking for evidence that it may be valid………you are looking to prove your bias against it. If you actually read the first 6 or six links about the Primo Vascular system, you would have read the correlations to the acupuncture system. The links are in English. Can you not read? Why would I read it for you and spoon feed it to you like a baby………….? BTW……….you can not hold a closed mind and call yourself “scientific”………..Don’t you understand the true meaning and process that goes into the word “discovery”………………? With your mentality, we’d never advance. This is just a page for REGRESSIVES………..

          • If you actually read the first 6 or six links about the Primo Vascular system, you would have read the correlations to the acupuncture system.

            Correlations? Sure. It reminds me of the ancient Greeks who are often claimed to have “discovered the atom”. They did nothing of the sort. There were just a few among them who speculated that one would not be able to split matter into smaller particles indefinitely. Others speculated something else. Just because a few of these people hypothesised something vaguely compatible with the theory of the atom, does not show in any way that they had some deep insight others lacked. Worse, Samuel Hahnemann, when he dreamed up homoeopathy, completely ignored the atomic theory. If he had taken it seriously, he would never have started his homoeopathy, for he would have realised how impressively wrong it is.
            Correlations are, at the most, an indication that something merits further study. As the saying goes: don’t confuse correlation with causation.

            But, once again, assuming for the sake of argument that they are real, why are acupuncturists so fascinated by these channels? As David Colquhoun has written: over 3,000 tests have failed to show any convincing clinical effect. Why would one want to waste her/his time to explain a phenomenon that has not been shown to exist in the first place? I don’t get it. There are so many other things of which we *do* know that they exist and cannot explain. It seems such a waste of effort and time.

          • Bart,
            Very interesting. This website (http://www.steadyhealth.com/articles/the-science-behind-medical-acupuncture-a2830.html) has this as its heading.
            “Western-trained doctors have reluctantly come to agree over the past 30 to 40 years that acupuncture really works, but scientists are only now beginning to understand why.”
            .
            There are some other claims that deserve a mention;
            “Tiny threads that are only visible under an electron microscope, the primo vascular vessels are studded with electrically charged nodes that attract nutrients, oxygen, and regulatory hormones.”
            “The primo vascular vessels are characterized by high resistance and low capacitance.”
            “Since 2010, a series of researchers in South Korea have noted the usefulness of Bong-Han’s discovery in explaining acupuncture:
            Vessels transmit energy to organs.
            The organs use the energy to become more responsive to oxygen, glucose, and hormones.
            Changes in electrical charge at nodes on the primo vascular vessels can attract or repel white blood cells.”
            .
            It seems these vessels are so tiny that an electron microscope is necessary to see them, BUT they are large enough for their electrical characteristics to be measured. Although sounding very technical, the significance of their resistance (as distinct from their impedance which incorporates any inductance, a frequency dependent resistance) and capacitance is not explained, nor how it could possibly be measured.
            .
            This is pseudo-scientific gobbledygook at its best (worst); impressive sounding but complete crap. Sadly, people like Beth, who have no idea what the words and concepts mean, swallow this nonsense because they want to believe.

          • Truly impressive, isn’t Frank? These primo thingies are really something.

            The article you are linking to:
            The primo vascular channels, which previously were termed the Bonghan corpuscles and ducts, are a physical structure that has been identified on the surfaces of human and animal organs. Tiny threads that are only visible under an electron microscope, the primo vascular vessels are studded with electrically charged nodes that attract nutrients, oxygen, and regulatory hormones.

            And here is a picture http://en.wikipedia.org/wiki/Primo-vascular_system#mediaviewer/File:Primo_vessel.jpg

            So, apparently, you don’t even need a magnifying glass to take pictures of these primo thingies that are only visible under an electron microscope.

            I learn new things every day, but this is really exceptional. I must be brain damaged for still not believing in the extreme effectiveness of acupuncture!

          • Beth Acampora said:

            You are not looking for evidence that it may be valid………you are looking to prove your bias against it. If you actually read the first 6 or six links about the Primo Vascular system, you would have read the correlations to the acupuncture system. The links are in English. Can you not read? Why would I read it for you and spoon feed it to you like a baby………….? BTW……….you can not hold a closed mind and call yourself “scientific”………..Don’t you understand the true meaning and process that goes into the word “discovery”………………? With your mentality, we’d never advance. This is just a page for REGRESSIVES………..

            You’re doing it again. Please put aside your vitriol and try to answer the questions you have not even come close to answering.

            Do you have any good evidence that these primo vascular channels have anything to do with acupuncture?

          • This thread is getting way too long: it’s showing up all the problems with the WordPress tiered reply system.
             
            The “primo vascular channels” are discussed at length in several posts towards the top of the thread. They are claimed to be visible by light microscopy with the appropriate (trypan blue) stain. From my previous post, citing a review article:”The biochemical components of primo fluids are DNA, RNA, nitrogen, fats, reducing sugar, hyaluronic acid, 19 free amino acids, and 16 free mononucleotides.“, which sounds like something from a Ladybird book of biochemistry.
             
            Remarkably, over the 50+ years since they were first described, these channels remain visible only to people working in a particular Korean acupuncture institute. Somehow they have eluded the light and electron microscopes of the histologists who study tissues daily. Look about 16 posts down from the start of the comments to read more about these miraculous new channels, which seem to have escaped the notice of the Nobel Committee and the major biomedical journals.

  • Thank you, Mathew.

  • To Linda Young
    I’m impressed that you, as a student, want facts. I think that mechanism is almost irrelevant. There is no point in investigating mechanisms until you are sure that there is an effect to be explained. I say “almost irrelevant” because, if there is good reason to think that the treatment is implausible, that makes it more likely that a positive result is a false positive. There are good statistical reasons for this and they are explained in http://rsos.royalsocietypublishing.org/content/1/3/140216 (if you don’t like mathematics, there is a simpler version of the argument on Youtube, at https://www.youtube.com/watch?v=tRZMD1cYX_c )

    But even without invoking that statistical argument, it is surely suspicious that, after over 3000 trials, we are still saying “more research is needed”. You might be interested in my own review of the facts. If there were any substantial effect surely it should have been obvious after 3 or 4 well-designed trials?

    You might be interested in my own take on the evidence. It’s had over 40,000 views on my blog alone. I’d be interested to hear your opinion about it.
    http://www.dcscience.net/2013/05/30/acupuncture-is-a-theatrical-placebo-the-end-of-a-myth/

    • Thank you Mr Colquhoun I will most certainly look on your site, all views whatever they are deserve respect and consideration. If only other people would have the attitude you have, showing a novice such a reasonable approach to the discussion in question! respect is a two way thing, one day the student may well be the master, I look forward to reading your point of view, once again thank you.

  • Now this is very interesting: NeuroLogica Blog » Phantom Acupuncture

    Conclusion

    The totality of evidence strongly indicates that there is nothing specific to acupuncture. Acupuncture points don’t exist, Qi does not exist, and the elaborate details of acupuncture treatment do not matter. In other words – acupuncture is an elaborate (and unnecessarily so) placebo.

    We can now add phantom acupuncture to sham and placebo acupuncture as lines of evidence demonstrating that acupuncture is no more than a placebo. The researchers indicate their desire to take the next step – to see if there is a clinical response to phantom acupuncture. The placebo hypothesis predicts that there should be, at least to some extent, depending on proper blinding (if possible).

    What all of this means is that the very concept of acupuncture adds nothing to our understanding of the universe, and biology and medicine specifically. It is a failed concept. We lose nothing by discarding it. Any part of acupuncture that “works” is mere placebo and therefore not specific to acupuncture. Anything specific to acupuncture does not work.

    Any non-specific symptomatic benefits to acupuncture (which do not appear to be clinically significant, by the way) can be achieved without sticking needles through the skin (which entails some risk), does not require special training, and does not require an expensive elaborate procedure. Further, persisting in the myth of acupuncture fosters misunderstanding of science, biology, and medicine which has insidiously negative effects.

    Acupuncture itself is a phantom phenomenon and should go the way of the ether and N-rays.

    • Here are my questions about the last paragraph, specifically about benefits of acupuncture not being clinically significant and that they can be achieved without sticking needles through the skin:

      1) Not clinically significant compared to what?
      2) What other therapy do you propose to achieve the same result as “sticking needles through the skin”.

      • Sasha said:

        Here are my questions about the last paragraph, specifically about benefits of acupuncture not being clinically significant and that they can be achieved without sticking needles through the skin:
        1) Not clinically significant compared to what?

        ‘Not clinically significant’ isn’t relative. It is saying that studies show that while some do show some small effects, those effects are small and have little or no relevance to patients.

        2) What other therapy do you propose to achieve the same result as “sticking needles through the skin”.

        I’m not proposing any. But the evidence shows that not sticking pins in or sticking pins in the ‘wrong’ places is equally ineffective.

      • 1) Not clinically significant compared to what?

        To the condition we are attempting to treat. When you have a broken leg, and someone repairs it, that is clinically significant. If you have diabetes and go into hypo/hyperglycemia regularly, it is is clinically significant if these are reduced or eliminated.

        2) What other therapy do you propose to achieve the same result as “sticking needles through the skin”.

        Prayer, watching Star Trek, homoeopathy, reiki, anything that has not been shown to improve any condition. And all of these would already be superior from the start, since they are less harmful.

        • Ok, let’s address “not clinically significant” and “sticking needles through the skin doesn’t do anything”. This one is from Linde, K. 2005. Acupuncture for patients with migraine. A randomized controlled trial. JAMA 293 (17): 2118-25.
          In that study acupuncture reduced migraines for 51 percent of patients while sham acupuncture reduced migraines for 53 percent. The third group was “control” – patients were put on the waiting list to receive acupuncture, in that group 15 percent improved. Thus, there was 36-38% improvement among those seen by an acupuncturist (sham or real) compared to those placed on a waiting list.
          And now to quote the MD writing about this study: “That’s an NNT of less than three, indicating that the rituals of acupuncture have more impact than some of the most effective ACTIVE ingredients that modern medicine has ever devised, including aspirin, heart surgery, and some chemotherapies”.
          IMO, the good doctor is mistaken regarding “the rituals” of acupuncture – but they could always do a study comparing a “ritual” of acupuncture vs a ritual of beating a shamanic drum, for example, and see what it does for a patient’s headache.
          Of course, at this point acupuncture sceptics promptly forget their earlier arguments of “sticking needles through the skin doesn’t do anything” and you might as well go home and watch Star Trek. They seize upon no difference of sham vs real to say: “See we told you so, acupuncture is placebo”. It is then a job of acupuncturists to look at the study methodology to see what kind of sham and real acupuncture researchers used.
          I also wonder what would happen if the researches in the study took advice of some on this thread and devised a fourth group, those who were told: “Go home, we’ll pray for you and you can watch Star Trek while we’re doing it”. After all the very act of placing patients on acupuncture wait list seems to be a low-level therapeutic encounter – 15% improved. My guess, the fourth group of Star Trek watchers would report 0% improvement which would give acupuncture the NNT of 2.

          • Very nice. And let’s now see what the authors say:

            CONCLUSION:
            Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control.

            That’s the placebo effect for you.

          • And what happened to the earlier arguments: 1) sticking needles through the skin does nothing and 2) going home to pray and wach star trek would have the same effect as acupuncture?

            Are we now moving on to the next logical fallacy, namely “raising the bar”?

          • @Sasha

            And Linde’s conclusion?

            Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control.

            It shows there are no specific effects for acupuncture.

          • Sasha

            The numbers that you quote support strongly the view that acupuncture is a placebo. Give that that’s the case then there is no need for “trained” acupuncturists. Anyone with a toothpick would do just as well.

            The argument that placebo effects are real, while true, lost its force when it was discovered that placebo effects are usually too small for a patient to notice them (roughly 10 points on a 100 point pain scale). You can find references in my paper http://www.dcscience.net/2013/05/30/acupuncture-is-a-theatrical-placebo-the-end-of-a-myth/

            The stories of miracle results that are being promoted by acupuncturists on this blog are not primarily s result of placebo effects. They are just a manifestation of the “get-better-anyway” effect. You get treated when you are at your worst and the next day you feel better, and would have felt better without the treatment too. Check the literature about “regression to the mean”. It’s perhaps the most important reason why people think that things work when they don’t.

            It’s true that an NNT if 3 is as good as most analgesic drugs. I fear that all that that means is that neither does much good. While it’s true that NNT is useful as an easy-to-understand measure of efficacy. it’s also a rather crude one. “Improvement” can have any value. and the NNT depends on which amount of improvement you define as the, entirely arbitrary, cut off point between “worked” and “didn’t work”.

          • David, I will follow up the link you give and will get back with a response a bit later (I just have some things to do today). As a short note, however, I’d love to see a study where there are 4 groups:
            1) real acupuncture
            2) sham acupuncture
            3) whatever drug is now being used the most in migraine treatment (either triptans or antiemetics)
            4) an ACTIVE placebo

            Also, that study would need to involve experienced acupuncturists to design real and sham protocols. The reason for this – Chinese Medicine doesn’t treat diseases, it treats patterns. So, asthma, for example, is treated in conventional medicine with steroids and bronchodilators for everybody. In Chinese Medicine you could have Lung Heat, Lung Cold, Phlegm Accumulation, Spleen Qi Deficiency, Ki Qi Deficiency and so on. Or any combination of those, and these are just some of the major patterns. Identifying them is very important because it changes the treatment protocol. Thus you can’t have the same treatment protocol for your real acupuncture group and would have to individualize depending on a pattern.

            The same applies to headaches.

          • David

            The JAMA study that I cite only proves that in that particular study sham acupuncture performed as well as verum. I’d have to see the study’s methodology to know more. TCM doesn’t treat conditions (like migraine), it treats patterns. There are a number of patterns within TCM that fall under the heading of “headache”. If patients’ treatments in the verum group weren’t individualized to reflect their patterns, the comparison with sham group has no meaning.

            If you want to make a claim that people with toothpicks can do as well as trained acupuncturists in the treatment of migraines, you’d need to back it up with evidence. You can do a study where one group gets pocked with toothpicks and another gets acupuncture and see how they compare.

            It’s true that “improvement” is a fuzzy metric but so is pain. Pain is a very fuzzy phenomenon. The NNT of 3 is still good, there are a lot of conventional medical interventions that are built on much less than that. SSRIs, for example, barely outperform placebos (most of the time they don’t, actually). And when they do, the improvement is about 1.8 on Hamilton scale which is nothing.

            I’ll read up more on “regression to the mean” as well as your paper but “get better anyway” theory doesn’t explain what happens with acupuncture. Every good acupuncturist’s practice is filled with stories of people getting better or completely getting rid of conditions that no one else could do anything about. That is the reason for the explosion of its popularity around the world that we’re seeing.

            Probably the same reason for people wanting to study it more and more. Is there any other “alternative” therapy that’s getting so many studies done? There’s just too much anectodal evidence to ignore it. We have MDs referring their patients to our clinic and I’ve never even met them or solicited their referrals.

          • David

            I’ve read your article that you linked and here are my thoughts:

            Bringing up Mao or a Chinese emperor to support your point of view is a red herring argument. What they believed or didn’t believe about acupuncture is irrelevant. Maybe, if you asked five other emperors before Dao Guang, they would have all told you that acupuncture is the greatest thing in the world. Maybe, outside of Mao, 11 out of other 12 members of Politburo loved acupuncture. Who knows and who cares? Apparently, Mao didn’t like to brush his teeth either. Are you planning to let dentists know about this exciting new development?

            Inconsistency as a prominent characteristic of acupuncture research has a lot to do with low quality of research itself. In a recent study on acupuncture for knee OA patients got 8 weekly acupuncture treatments and were asked 12 months later if their knees improved. Apparently they didn’t. I’m surprised that people manage to get funding for this sort of stuff.

            “Holistic” nature of acupuncture and TCM in general has nothing to do with empathy. It has to do with the depth of differential diagnosis that’s needed to practice it effectively. TCM doesn’t treat conditions, it treats patterns that a patient exhibits. Thus, 12 migraine sufferers could theoretically exhibit 12 different patterns: Liver Yang rising, Liver Fire, Blood stagnation, Stomach Heat, Qi deficiency and so on. All of them will be treated differently even though they have the same main complaint. An asthmatic and a patient with migraine will be treated with the same protocol if they exhibit the same pattern. Thus, one of the most fundamental statements in Chinese Medicine: “Same disease, different treatments; different diseases, same treatment”.

            Any worthwile research on acupuncture would have to take this into account. No verum acupuncture group can have the same protocol for all of its patients. They have to be individualized to reflect a pattern each patient exhibits.

            Looking for acupuncture meridians is pointless, they are not physical structures. Going into it here would be pointless but you can let me know if you’re interested.

            Your assertion that patients didn’t get useful degree of relief in the studies probably has a lot to do with the quality of the studies themselves. In the real world most acupuncturists practice outside of insurance structure and run cash practices. If patients didn’t get relief that they can’t get anywhere else, they wouldn’t come back and all acupuncturists would be out of business. It’s that simple.

            The “unanimity” between acupuncturists and non-acupuncturists that any benefits that exist are too small once again doesn’t play out in the real world. If anything there’s more and more unanimity among various health professions that there are benefits. That’s why in all developed countries adjunct health professions (PTs, chiros) are pushing to add acupuncture to their scope of practice.

            As far as specific conditions and how acupuncture treats them, it varies. Autoimmune conditions like RA are harder to treat. Pain is easier but it depends on etiology. Spinal stenosis is much harder to treat that back pain from muscle spasm or herniated disc and so on.

            Finally, in trying to emulate Dao Guang and banish acupuncture from clinical practice, it’s useful to remember the example of Dao Guang himself. He wasn’t able to do it and he was an emperor.

          • Go home, we’ll pray for you and you can watch Star Trek while we’re doing it”. After all the very act of placing patients on acupuncture wait list seems to be a low-level therapeutic encounter – 15% improved. My guess, the fourth group of Star Trek watchers would report 0% improvement which would give acupuncture the NNT of 2.

            I missed that one. In fact, because I am a Star Trek fan, I would love to see such a trial. There is, even after a lot of thinking, no the slightest indication that this would have any curative results. However, given how diverse placebos can be, I am afraid that predicting a result of 0 is unrealistic. My guess would be somewhere in between the waiting list and acupuncture, depending on how it is presented.

            Don’t forget that even waiting lists (or something similar) can be very powerful. It is one of the issues dentists have to deal with: patients go to the dentist with a throbbing, searing toothache that would make them scream if they were not afraid of people’s reactions, they get a seat in the waiting room, and then they leave because the pain is gone.

            Is a chair in a dentist’s room really so powerful? Of course not. All it shows is that it is the brain that creates the pain and that this brain can also annihilate it. The effect is very well known. Unfortunately, so far, it is essentially useless, because it is largely uncontrollable and unpredictable. So, we use analgesics. They may not be ideal, but they are far far more reliable. It is why the supposedly spectacular demonstrations of surgery-under-acupuncture make ample use of analgesics. They are the cause of the absence of pain, not acupuncture.

            And regardless of what people may think of doctors and surgeons, they are human beings, and with the exception of Hannibal Lecter there aren’t very many of them who rejoice in seeing their patients suffer.

            In fact, when the readers of the New England Journal of Medicine were asked to vote for the most important article in the 200 year history of the journal, they voted overwhelmingly for a report by Boston surgeon Henry Jacob Bigelow, “Insensibility during Surgical Operations Produced by Inhalation”. Doctors are not the insensitive conspiring monsters many acupuncturists and other alternologists like to claim. You see, doctors are human too, they don’t like to suffer either. There is also a practical element here: a squirming and screaming patient is quite hard to operate on. It is just better for everyone if the patient does not suffer.

          • And I think that watching Star Trek for migraines will give a result somewhere between waiting list for acupuncture and zero, probably closer to zero. But as I’ve said, I’d like to see a study, without placebo wash-out period with 5 groups:
            1) verum acupuncture (protocols designed by acupuncturists)
            2) sham acupuncture (non-acupuncturists can design it)
            3) whatever is the drug of choice
            4) inactive placebo
            5) active placebo (a drug that can produce side effects but which does nothing for the medical condition studied)

          • As a short note, however, I’d love to see a study where there are 4 groups:
            1) real acupuncture
            2) sham acupuncture
            3) whatever drug is now being used the most in migraine treatment (either triptans or antiemetics)
            4) an ACTIVE placebo

            I think this is very important. Sasha, when you see the word “placebo”, what do you think it means? What is your description/explanation of “a placebo”?

          • Before I answer that, are you asking because I said “active” placebo?

          • Before I answer that, are you asking because I said “active” placebo?

            No. I had interpreted it as something that you copy/pasted and then forgot to erase. It wouldn’t be the first time, unfortunately, that it happens to me. Are you telling me there is more to it than that, or are you just curious? Anyway, the answer is no.

          • Yes, I’ve posted already regarding “active” placebos in response to your other post.

    • The points do exist and can be measured and found with a simple electro device which was invented years ago……numerous MRI scans prove it changes brain functioning……….why on earth would you take anything seriously from someone who says that energy does not exist? Where have you been for the last 40 years? The medical philosophy is flawless…….obviously you have never studied it. I’d have a lot more respect for someone who maintains an open mind. If you do not have an open mind, you are no scientist………..how can you learn more if you think you already know it all? Did it ever occur to you that the philosophy is so advanced that we are just now able to understand and measure it? You can’t say MRI’s are great for this but not for that………….double standard intended to prove bias, not learn the truth.

      • numerous MRI scans prove it changes brain functioning

        Not they don’t. All they show is that the brain notices that something is going on. You would also notice “changes” if you started pulling at the subject’s toes, or hammered her thumb, or tickled his tummy. That’s what brains do: they get input from the sensory system and they process that input. Just because the brain also notices acupuncture does not mean that anything remarkable is going on. What would be remarkable, is if the brain would *not* notice anything.

        why on earth would you take anything seriously from someone who says that energy does not exist?

        Who claims that?

        The medical philosophy is flawless

        Who claims that?

        I’d have a lot more respect for someone who maintains an open mind.

        What you call an open mind, we call gullible. An open mind accepts new things on the condition that there is convincing evidence for them. A gullible mind accepts any nonsense that is vaguely compatible with its own prejudices, and is not interested in evidence.

        ………..how can you learn more if you think you already know it all?

        How thinks he/she/they already know(s) it all?

        Did it ever occur to you that the philosophy is so advanced that we are just now able to understand and measure it?

        According to your own website, this is untrue. You make very lofty claims on your website.

        Fertility Restorationtm uses the wisdom (DNA) of nature to reset our stressed, mediocre functioning selves to an enhanced, optimal state. This optimal state is hardwired into our Primo Vascular System. It just needs activation.

        Research has documented that our own DNA cells become very active and communicative after needle, laser or kinetic stimulation. The Primo Vascular System, aka acupuncture meridians, contain hormones and stem cells, indicating why natural Fertility Restorationtm is so effective in improving all aspects of reproduction.

        You know what this gobbledygook indicates: You just make stuff up, exploiting the ignorance, gullibility and desperation of very vulnerable people. It is despicable.

        You can’t say MRI’s are great for this but not for that………….double standard intended to prove bias, not learn the truth.

        Yes, you can. It is perfectly possible to use a scale to measure a quantity of water. Now, try to use that same scale to measure a quantity of light. See how that will work out. There is a reason why other diagnostic methods didn’t go the way of the dodo when MRI came along.

        • If stimulating the brain does nothing, then why is the brain able to be stimulated. How come the new treatment for depression is magnetic brain stimulation? How come the military uses brain stimulation to enhance learning of drone operators? OH, boy, this is so dumb. You did not read the evidence of the Primo Vascular system obviously, so what’s the point of discussing it further? I think it’s hilarious that you believe all acupuncture patients are “gullible.” I gave treatments today to a neurosurgeon, 2 lawyers, a college professor, two nurses and a CEO. Desperate folk are desperate because western doctors have been unable to help them. You think I’m despicable because I CAN help them? You are despicable sir, if you think they should just go home and suffer and die because you are too lazy to read and learn. 85% of my clients have advanced degrees. I work in 2 reproductive endocrinologist offices who refer their patients to me. Mayo clinic here in Jacksonville offers acupuncture to their patients. The prestigious Jacksonville Orthopedic Institute now offers acupuncture treatment. The University of Florida is now offering acupuncture in their student clinics and performing research studies on kids. You are clearly WAY BEHIND the times. It makes me sad for you. But the good news, is you can learn to read and open the link and become informed. Whether you do that or not, is up to you. Meanwhile, I’ll enjoy hearing people tell me everyday, my back pain is gone, I look foward to coming here all week, I’m pregnant!, my shoulder pain is gone, I haven’t taken allergy medicine all week, I canceled my surgery, I played tennis with no pain today, I haven’t had a headache all month when I usually get them every day, my period is normal, I didn’t have cramps like I usually do, I had no heart palpitations this week, I slept all night straight through all week -that hasn’t happened in years, I was able to move my arm and cut a steak for the first time in ten years, I can walk on my prosthesis now when my doctor told me I’d never do that again and I’d most likely lose my other leg which now is perfectly fine, I am alive 15 years later after my doctor gave me only 3 to live,…………after doing this for 20 years, I could just go on and on………..yeah, I’m despicable………..!!! What a horrible person I am……….You realize that you are actually saying that I am the best magician in the world. If what I am doing to them has no effect on them, then I must be the MOST POWERFUL MASTERMIND EVER. Yeah, I’m like that bald guy on Xmen…… You’re making me laugh. Sure, I’ll be that for you!!!!!

          • If stimulating the brain does nothing, then why is the brain able to be stimulated.

            Your question seems to indicate that you ignore how the brain came into being: by natural evolution. There are no intentions here, and the question of “why” is therefore irrelevant. There is no “why”, there is only “how”.

            It may surprise you to learn that the brain is what makes us “us”. It is our central processing unit that enables us to move around, reason, notice and react to external stimuli and more. You may replace just about any organ in your body and you will still be you, but when you start cutting and pasting and stimulating certain parts of the brain, you stop being you and become someone else.

            We have billions of nerve cells in our brains, and MRIs just aren’t refined enough to know what is going on in our brain. All MRIs show is that “something” is going on in “some more or less vaguely defined area of the brain”. We do almost never know what it is, at the most, we may sometimes venture a guess, or convince ourselves that we seem to be detecting a pattern, but even if we can do that, we still don’t know, usually, what its meaning is.

            One of the shocks many medical students experience in their first years is that anatomy is a lot more difficult than the oversimplifications they have learned earlier. Anatomy is variable. Humans are all different to some degree. Brains are no exception to that. If MRIs and other techniques we use in our attempts to analyse what is going in a brain have shown us anything, it is how extremely variable brains are, and how much of the brain still completely defies any useful analysis. We will, almost certainly, be able to know a lot more in the future, but who know when that future will become the present? In ten years, a hundred, a thousand? If we knew that, we would be able to predict the future, and we can’t.

            To make it even more humbling, we can’t even do these things with computers yet. Programmes I have written well over two decades ago can still not be satisfactorily analysed now, while they are working. It is what we mean with holism. Although the quack industry likes to suggest that holism is something like “looking at the whole”, it is actually far more interesting than that, it is basically the idea that even in relatively simple systems, we cannot determine/predict what the whole will do when we only look at the parts. In the same vein, we cannot determine/predict what the parts will do when looking at the whole. Yet, malfunctions (diseases) can occur at every level.

            When you stick needles into people, you will, if your equipment is refined enough, see that the brain “does something”, but from there to claiming that a specific action will “change brain function” is just too far. We don’t know that, and we can prove it even less. When an acupuncturist makes such a claim, he/she will be dismissed outright because all such a claim demonstrate, is that the acupuncurist knows nothing about the brain and the rest of the nervous system.

            This is not convenient, it may not be pleasant, but it is true.

          • You are clearly WAY BEHIND the times. It makes me sad for you.

            Well then, please do enlighten this ignoramus. Looking at your very informative and clearly highly scientific site, there are a number of things I do not only not understand or am curious about, but am unable to find an explanation for. I am reasonably certain that while I may well be the biggest idiot at this side of the observable universe, there are probably other people on this very site who are eager to get such an explanation.

            So:
            1. What are DNA cells?
            2. Your site says that

            Fertility Restorationtm has been clinical proven to: Improves sperm count […] and ph for men

            Could you point us to the studies on which this sperm count and ph improvement is based? I am interested in the rest as well, but these would seem to be the ones around which there can be the least controversy.

            I’ll leave it at that for the time being, as I do not want to burden you too much.

  • Can I suggest a thought experiment?

    Imagine for a moment that I invent a new therapy. The exact details are not, I think, important but the one thing it’s important we all agree on is that my therapy doesn’t work. It has no effect on any known disease. No side effects either, which is a plus, I suppose. Now assume I set up a shop in the high street. I tell passers by that my therapy is good for all sorts of things – migraine, asthma, back ache, IBS, fatigue & tiredness, depression, anxiety, halitosis, fallen arches, basically I put no effort into selecting “likely” suitable conditions, I just kept painting conditions on the window until I ran out of space. Some people come in, pay my fee, and take my therapy.

    My question is this: What will those people think of the therapy?

    • most likely they will think NOT ANOTHER CHINESE TCM SHOP IN OUT HIGHSTREET !!!

      • 😉 Ah, but everyone knows about TCM these days. Only a special few know of my remedy which draws on the ancient traditional wisdom of the, um, Inuit. Yes, Inuit, that’s it. It’s new to the UK – none of your friends will have tried it. get a booking in now before I fill up! There are NO OTHER ACCREDITED THERAPISTS in the UK! I’ve been told that the other therapists associations will try to shut me down because they’re frightened I’ll put their members out of business – did I mention there are NO side effects? NONE AT ALL? People DIE after acupuncture, you know! They don’t put that on the leaflet, do they? Come in – I’ve just had a cancellation so I can fit you in right now. And not a moment too soon, if you don’t mind me saying. I can see life has been very eventful for you lately!

        But seriously – how will my patients report my therapy to their friends?

    • Pat, you’ve reminded me of the thought experiment I had ages ago about setting up shop in a busy high street somewhere. I’d advertise my business and paste my shop windows with long lists of alt-med treatments along with lists of the illnesses that they claim to treat. Each client that I managed to hook would be given the only known efficacious alt-med ‘cure’: My shelves would be lined not with pills and potions, but with books and articles written by Professor Ernst and others who dedicate their lives to exposing quackery for exactly what it is. My business wouldn’t make a profit, but videos of my ‘treatment sessions’ might become priceless 🙂

      • well while you’re imagining what it would be like, those who actually come and experience it find help and healing….if it didn’t work, like Noni Juice, it would have just died off…….people don’t let people stick needles in them for $100 a week if it didn’t work. They do it because it works. If you ever bothered to really inquire, and not just wonder, you’d find the truth.

        • people don’t let people stick needles in them for $100 a week if it didn’t work. They do it because it works. If you ever bothered to really inquire, and not just wonder, you’d find the truth.

          Perhaps. Maybe you could explain why “it works” turns into “it doesn’t work” when one starts to look at the results? Your diabetes is cured, or it isn’t. It can’t be cured when sitting with acupuncturist and not-cured when sitting with a doctor. A corpse is a corpse, regardless of how it died.

        • People stop (or never start) paying for it once they’ve learnt the truth that it doesn’t cure/treat the plethora of diseases/conditions that are claimed for it.

          Some readers may enjoy the satirical comedy “Serpessence” by Misha Collins:
          https://www.youtube.com/watch?v=qe7B8pT7_nw

        • Beth,
          Many people have enquired and put their findings with Cochrane. This research shows that it DOES NOT work. What more do you need; some ethereal being with a beard to part the clouds and personally tell you it is a load of nonsense?

    • No one seems too keen to suggest what happens if we try therapies which really don’t work. Anyone care to gues what happens if you set up with a therapy which doesn’t work – in fact, is so useless it doesn’t even have a placebo effect, i.e. how patients feels is EXACTLY how they would have felt if they hadn’t tried my therapy?

      Anyone? Then I’ll tell you what I think will happen – but step by step, making sure you agree with me or can prove me wrong at each stage before moving on. I’ve done this lots of times with supporters and practitioners of all sorts of alternative therapies. The results are – interesting.

      • I don’t think the “zero effect” is an attainable goal. At the very least, the patient will feel like he/she wasted her/his time.

        • I think that feeling of disappointment comes later – the patient has to notice no effect before they can be disappointed. 😉 But I actually don’t think a patient who has a therapy which has no effect will be disappointed in a large proportion of cases.

          We live a relatively long time, but we only die once. Most conditions are therefore either something time limited – a cold, a dose of food poisoning, a broken leg – or something which continues more or less indefinitely – arthritis, asthma, migraines.
          The conditions while persist are usually not constant – you might get more headaches this week than last, your arthritis might be less troublesome this week.

          Consider a person from each category. They feel badly enough to seek treatment – and it doesn’t matter whether this is a trip to their GP for conventional therapy or a trek up the mountain to have the chakras realigned. In our experiment, the therapies have no effect – so after a week the person feels just how they would without the therapy. In other words, a week after you feel poorly enough with either a self-limiting acute illness or a waxing & waning chronic illness, how do you then feel in comparison?

          I put it to you that you’re probably feeling better. In the first case – it’s a self-limiting condition – you’re getting better as you’d expect. In the case of the chronic condition, we’re seeing regression to the mean. You’re more likely to seek help when you’re in a “bad” part of the relapse/remit cycle, so a week or two later you’re more likely to have improved than got worse.

          In both instances, you see a chain of events: I felt bad, I took the therapy, I got better.

          That is what a totally functionless remedy will do EVERY TIME. So is it any wonder sceptics don’t accept anecdotal evidence of “it helped me”? This is why we want to compare remedies, to quantify, because it’s the ONLY way you can be sure you’re doing something which works. Or at least “reasonably sure” – more research can always uncover more evidence to refine our understanding.

          Any research into a remedy (conventional or alternative) which doesn’t directly address this problem will generate evidence of poor quality – even if the remedy really does work, the evidence is likely to be rejected. And this is where most CAM research falls down: the study design, the statistical pre-planning for power, study size etc are not done properly and the trial is thrown out. This isn’t anti-CAM bias. CAM practitioners often claim that conventional researchers reject their trials because we’re biased against CAM. They’re almost right – we’re biased against EVERYBODY. My colleagues look for the flaws in my work. I look for the flaws in theirs. This self-policing of quality is the cornerstone of the scientific method.

          So, there’s my contention: a functionless remedy will generate an apparent effect and hence one-sided observational evidence is therefore not a good reason to accept a therapy works.

          • I suggested that a functionless remedy will appear to cause an improvement in symptoms when used in both self-limiting and chronic relapsing/remitting disorders.

            No one has disagreed.

            Can I therefore take it that we all accept my argument to have merit? In other words, even useless remedies will produce the results we see for acupuncture, homeopathy, reiki etc. etc. Note that I’m not saying they don’t work, I’m saying that the evidence typically presented for them doesn’t allow us to decide whether they work or not.

            Or to put it another way:

            1) I believe people who attend an acupuncturist will report an improvement in their sysmptoms in teh short to medium term.
            2) I don’t believe it’s the needles which caused it.

          • 1) I believe people who attend an acupuncturist will report an improvement in their sysmptoms in teh short to medium term.

            I think that is exactly what the research shows.

            2) I don’t believe it’s the needles which caused it.

            Acupuncturists agree, since they are always so mad at sham acupuncture for hiding the effectiveness of real acpuncture.

          • “2) I don’t believe it’s the needles which caused it.
            Acupuncturists agree, since they are always so mad at sham acupuncture for hiding the effectiveness of real acpuncture.”

            I don’t follow – sham acupuncture does “hide the effectiveness of real acupuncture”, it reveals the non-effectiveness! If it isn’t the needles which cause the perceived improvement, we can throw away all the stuff about meridians and all the time wasted learning where to put the needles. Wouldn’t that be an benefit to humanity?

          • I don’t follow – sham acupuncture does “hide the effectiveness of real acupuncture”, it reveals the non-effectiveness! If it isn’t the needles which cause the perceived improvement, we can throw away all the stuff about meridians and all the time wasted learning where to put the needles. Wouldn’t that be an benefit to humanity?

            Absolutely, and I have said stuff to that effect several times already. That is why I am so puzzled: the acupuncturists are, for all intents and purposes, freely admitting that their gobbledygook is useless. Yet, they get nasty to people who say so. What is their problem? Since they always claim that money is not a consideration, and that they only want to “heal and help people”, they should be incredibly happy for getting what they want. But they are not. Why would that be?

          • Yes Pat, it’s totally possible that a 2 year frozen shoulder spontaneously freed up…and it just happened to be during an acupuncture treatment. Totally possible.

            Of course if that happened to me, I’d leave the treatment room and buy a lottery ticket.

          • And how many frozen shoulders clear up after a shower of rain, a total eclipse of the sun or change of Government? If you can show that of 500 people with frozen shoulders who got acupuncture more improved than a group of 500 people with frozen shoulders who got sham acupuncture, I’ll be impressed.

            But there is no quality data for acupuncture showing that, oddly enough.

          • Pat – I’m willing to bet that you’ve never treated a frozen shoulder. You’re not being skeptical. You’re either being monumentally superstitious or have a profound level of denial. Either way, I doubt 500 examples would make any difference to you.

          • Pat – I’m willing to bet that you’ve never treated a frozen shoulder. You’re not being skeptical. You’re either being monumentally superstitious or have a profound level of denial. Either way, I doubt 500 examples would make any difference to you.

            These fantastically impressive results always shrink into nothingness when they must be demonstrated. Why is that? What makes acupuncture so special that the results disappear when we attempt to look at them, even from behind the corner?

          • > Pat – I’m willing to bet that you’ve never treated a frozen shoulder.
            You’re right there – I’m a histopathologist. But my wife and a work colleague both had frozen shoulders which got better after some years. In the interim they had tablets, injections and physio, none of which seemed to have much benefit at the time. Then one day they got better (not the same day!)

            I don’t know why either of them got better. It might have been a delayed effect of the therapies. It might be just a matter of time. Or it might be something else – I think my wife’s shoulder got better the day we bought a new television, maybe it was that. The point I’m trying to make is that as soon as you have an element of randomness in any system, our minds fasten on perceived links which aren’t there. We’ve all read about footballers who insist on putting their left sock on first. Runners who insist on stepping on to the track right foot first. Opera singers who won’t have a particular flower in their bouquet for bad luck.

            Single cases with strong temporal association are very attractive to our minds (vaccines and autism, for example) but that’s because our brains didn’t evolve to analyse complex clinical scenarios. We got brains that protected us from bad things by being ridiculously over-associative – it’s better to run away from a tiger which isn’t hiding in the stripey grass ten times than not run away once from a tiger which is.

            I can’t say whether 500 samples would make a difference – it would depend on the trial design. I picked the number purely as an example. It might take 5000 or 50 – it’s not my field so I can’t begin to guess.

          • Not sure what you’re talking about Bart – I’ve seen it demonstrated many times. And you’re right, it certainly is fantastically impressive. If you get a chance to watch a skilled Ah Shi acupuncturist work a frozen shoulder…definitely take it.

          • Not sure what you’re talking about Bart – I’ve seen it demonstrated many times. And you’re right, it certainly is fantastically impressive. If you get a chance to watch a skilled Ah Shi acupuncturist work a frozen shoulder…definitely take it.

            If I can choose between an acupuncturist and “The Magician” (https://www.youtube.com/watch?v=mEnGkQS1lb8), I’ll take “The Magician”. Both have spectacular results that disappear into nothingness when one attempts to verify them, but “The Magician” has the added advantage of being good and unpretentious entertainment. The acupuncturist on the other hand, is sleep-provokingly boring.

          • Pat – “The point I’m trying to make is that as soon as you have an element of randomness in any system, our minds fasten on perceived links which aren’t there.”

            Spontaneous freeing of the shoulder after buying a television set – probably superstitious. Maybe not. Who knows. Acupuncturist palpating, assessing, saying “this is going to hurt”, inserting needles, shoulder is free…if you think that is a random, coincidental situation – you are superstitious to an extreme degree.

            If you hang onto that belief after the same thing happens to multiple patients, in the same way….I’d say you have some pathological issues with cause and effect.

          • The question is: would any perceived improvement be as frequent if we did the palpate & “this will hurt” and then DIDN’T insert the needles?

            As I said earlier – I accept that people who have acupuncture feel better. But I don’t think the needles did it.

          • Pat – “The question is: would any perceived improvement be as frequent if we did the palpate & “this will hurt” and then DIDN’T insert the needles?”

            The answer is no. It actually increases the pain.

          • “The answer is no. It actually increases the pain.”
            Do you a quality reference for this?

          • I certainly hope there have been no studies. That would be really sadistic for something so cause and effect.

  • Hi All,

    Acupuncture into a prosthetic hand (rubber hand illusion) produces experiences of ‘Deqi’.

    There have been two small trials showing that needles placed into a rubber hand that the subject has been conditioned to accept as part of their body schema produces the experiences associated with acupuncture.

    It is not about the body – it is about the central nervous system.

    The reaction to having its surface punctured – but not dangerously so. IM(H)O. All else follows from this weird experience and our reaction to it.

    eS1226

    Research Report Poster Display
    Number: RR-PO-308-23-Wed Wednesday 22 June 12:00
    RAI: Exhibit Halls 2 & 3
    AGAINST ALL REASON—EFFECTS OF
    ACUPUNCTURE AND TENS DELIVERED TO AN
    ARTIFICIAL HAND
    Bulley A.1, Thacker M.1, Moseley L.2,3
    1King’s College London, Medicine, London, United Kingdom,
    2University of South Australia, Adelaide, Australia,
    3Neuroscience Research Australia, Sydney, Australia
    Results: Experiment 1: Twelve of 14 participants reported
    perceptual effects, characteristic of ‘Deqi’, after acupuncture
    to the rubber hand, effects that are seldom reported in
    association with the illusion alone (Fischer’s p < 0.01). All
    participants reported that they strongly believed the rubber
    hand was not their own.

    A tiny study, yes, but WOW! unless an acupunturist can explain how the vast majority of normal people experience this central part of acupuncture from needles in plastic then where is the validity?

    Kind thoughts,
    Steve

    • It is not about the body – it is about the central nervous system.
      Now you have me seriously confused. Yesterday I learned acupuncture was about primo vascular channels. From the OP it also seems to be about shining laser beams as well as inserting needles.
      I think I’ll stay away from acupuncture.

  • Sasha wrote: “I’d love to see a study where there are 4 groups:
    1) real acupuncture
    2) sham acupuncture
    3) whatever drug is now being used the most in migraine treatment (either triptans or antiemetics)
    4) an ACTIVE placebo”

    There really isn’t any such thing as an “active placebo”. In a medical trial, “a placebo” is whatever you do to make it look to all involved that the experimental group and the control group are getting the same treatment. This is usually an inert pill – but it could be a soap without the active astringent if you’re researching acne, a wristband with a lump on unmagnetised iron if you’re look at magnetic bracelets, a phototherapy machine with the wrong type of bulb, a radiotherapy machine with the Xray source shielded by lead.

    The term “placebo effect” recognises the fact that we change a system when we try to measure it so if we’re testing an intervention, we are GOING to see a change from baseline (not necessarily for the better, there is also the nocebo effect!) and we want to be sure it’s the new pill/potion/therapy that’s doing it and not, say, asking people to turn up to clinic on a Tuesday for six weeks. That may sound odd, but let’s say I’m interested in migraine. You get 2-3 migraines a week and I’m trying my new treatment. I ask you to come to clinic every Tuesday for six weeks and I ask you about your headaches, take a few measurements and give you another pack of pills. After 6 weeks, you tell me you’re getting fewer migraines – but we don’t know whether it’s the pills doing it, the weekly relaxing drive through the countryside to get to my clinic, my pleasant demeanour, the year-old copies of Hello! in the waiting room – or something else. So we create two groups and give one the active pill, the others a visually identical inert pill, but otherwise the groups are treated the same. If both groups show the same drop in migraines – it’s not the active pill which did it and we can look at those Hello! magazines in another trial 😉

    The Daily Mail view of my trial is that “PLACEBO PILLS CURE MIGRAINE!” but that’s NOT what the trial showed. It showed that interacting with people changes them – whether that interaction is chemical, physical, biological or social. If acupuncture and sham acupuncture or the right homeopathic pill and the wrong homeopathic pill produce the same result it doesn’t mean they all work – it means none of them work and the change we saw – the placebo effect – is confusing the results.

  • Pat, the issue with comparing a drug to an inert pill – if patients on the drug improve, you don’t know if they improved because of the drug’s pharmacological effects or because they started experiencing side effects which made a drug into super-placebo. If patients and doctors “break blind” (an extremely common event) that will affect results. So, if you like, we can have 5 groups in the trial, including inert placebo and active placebo ( a drug that has no effect on migraines but will produce side effects in the population studied).

    • So, if you like, we can have 5 groups in the trial, including inert placebo and active placebo ( a drug that has no effect on migraines but will produce side effects in the population studied).

      That would be highly unethical. Like acupuncture: a therapy that has no useful effect, but does have side effects. No ethical trial designer would administer such a thing merely to test a new drug. Can you imagine the public outcry if it became known that *doctors* administer therapies with the explicit goal of harming the patient? We have rules against that sort of thing, ethical committees to prevent such horrendous practices.

      Side effects are exactly that: effects that are not part of the desired effect. Another popular name for them is “undesirable effects”.

      Side effects are not wanted. They are hated, and everything possible is done to eliminate them. I would submit that you study what clinical trials are all about, namely to find out if a therapy can be useful. If we already know what it does with sufficient confidence, the trials are over, except to compare its effectiveness against other therapies or perhaps for different uses.

      Trials are not a hobby of some “Frankenstein group”!

      • What you’re saying is incorrect. “Breaking blind” is extremely common and it has to do with comparing active drugs with inactive placebos. Once people begin experiencing side effects most of them realize which group they’re in, as do their physicians. This creates a super placebo effect in which you don’t know whether people got better because of the pharmacology of the drug or because they experienced side effects which led them to conclude they’re in a drug group and they got better. In fact, breaking blind is so common that it calls into question the very existence of double-blind studies. To account for that and eliminate super-placebo effect, researchers can and do study a drug in question as compared with an ACTIVE placebo (a drug that can produce side effects but is known not to have any effect on the condition studied). For more on that I refer you to Irving Kirsch’s excellent “The Emperor’s New Drugs”.

        Besides, research constantly skirts ethical issues, otherwise how can you study anything? When they wanted to study how doctors’ beliefs influence patients’ outcomes, they gave 2 groups of people IN PAIN inactive injections while telling doctors different things on what they were administering. Is that ethical? Probably not, you’re giving people in pain inactive compounds. But it sure helps you isolate what you’re trying to study.

        In all studies comparing sham surgeries to verum surgeries they fully anesthesize patients in sham groups to maintain blind. They also cut into them, stitch them back together and so on. Both anesthesia and cutting into people have side effects. Is that ethical? Research doesn’t follow the same rules as clinical practice.

        But for the purposes of studying acupuncture it’s not even that important, it’s more to study a drug and eliminate super-placebo effect. For acupuncture you can have just 4 groups without an active placebo group.

        The problem is that so much of acupuncture research out there is rubbish. Like a recent one that concluded that acupuncture isn’t helpful in knee OA. People were given 8 weekly acupuncture treatments and then asked 12 months later how their knees feel. I don’t even need to look at the rest of study methodology to know that this is crap. If someone came to me with knee OA and asked if they can do 8 treatments and hope to feel better a year later, I’d tell them to save their money.

        • What is “extremely common”? It doesn’t seem to be all that common to me, and from what I know, there is great reluctance to “breaking blind”. You have evidence to back up your claim?

          Yes, I am well aware of the sham knee surgery trial. It is almost impossible not to be aware of it when one is even remotely interested in the field. But maybe that is the point. Exceptions confirm the rule, and because it is so rare, everyone is using the same example. This type of thing is so rare because most everyone considers it profoundly unethical to perform surgery, an act that is not without risks for the person undergoing it, for no other reason than to have a base of comparison. Just because one group has found a way to be convincing enough to be allowed to do this, will not change my mind. This is a matter of principle and before I would defend such a thing, I’d need some serious convincing. This case, to me, is pretty much an open-and-shut one, but there are more interesting cases.

          You may want to look into “Liberation therapy” for Multiple Sclerosis, a dramatic and, in my opinion, profoundly unethical case. Patients *demanded* it, and they got it. Unfortunately. In my view, just because a patient demands a dangerous treatment is not a reason to provide it. However, even knowing what they know, doctors sometimes have a very hard time saying no to a patient, no matter how much they would want to.

          • I do have evidence to back it up. But before I provide it, let’s see what evidence you have for your saying that “breaking blind doesn’t seem all that common to you”. You ask for evidence for facts that you don’t like but are ok to pass your opinions as facts. What “seems” to you is irrelevant, evidence is important as you sceptics keep pointing out.

            So, before I provide my evidence, let’s hear your evidence that breaking blind isn’t common.

          • The age-old response of the quack.

            You made the claim. You provide the evidence. That’s how it works.

          • Sham knee surgery to repair arthritic joints is hardly an exception. The results of another trial “Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear” published in New England Journal of Medicine showed no difference between two procedures. Once again people were anesthesized, cut, stitched, etc.

            In 2009 two trials of vertebroplasty, also published in NEJM, failed to show benefit of verum vs sham.

            There was another one: Controlled trial of percutaneous laser myocardial revascularization to improve angina symptoms in patients with severe coronary disease. Conclusion? Treatment with percutaneous myocardial laser revascularization provides no benefit beyond that of a similar sham procedure in patients blinded to their treatment status.

            So, as you can see, sham knee surgery for orthroscopic knees is hadrly an exception that proves the rule. Besides, what principle are you trying to defend? The only way to know ANYTHING in research is to compare verum vs sham. You seem to be OK subjecting acupuncture to research (as it should be) but when it comes to drugs or surgeries – or, no, that would be unethical! Comparing a drug to an active placebo is “Frankenstein trial”. Then, how do you know whether what you’re doing isn’t a placebo?

            The whole history of medical research would be considered unethical in clinical practice and I can give numerous examples. So, if you want to talk about subjecting acupuncture to research, fine, I agree. As long as you’re willing to look at what true research shows about surgeries, pharma drugs, etc.

            For more on this, you may want to look into the work of David H. Newman, MD and his excellent Hippocrates’ Shadow. He’s ER doc, Director of Clinical Research for Mount Sinai School of Medicine, and a pretty smart guy. It may be a hard read for you because he will debunk so many things that you hold so dear to your heart but it’s a good read.

          • You got me there. I am such an idiot, aren’t I. I call such trials exceptions, and there you are, proving beyond the shadow of a doubt that they are in fact common.

            Let’s see. Let us assume for the sake of argument that these numerous trials have all been performed in the US, and that no other country performs any trials.

            You name four trials and there was the first one. That makes 5.

            As of 03 March 2015, there are 16,398 trials with posted results in the US. The number you quote is 5. Bear with me here while I clean my glasses and dust my abacus and try to remember the higher mathematics I learned in primary school.

            5 divided by 16,398 is, wow, times 100 rounded to 2 decimals, phew, this is getting complicated. Let’s ask Mr. Computer. He tells me this boils down to 0.03%. Astonishingly common indeed.

            Compare that to the nice and gentle, compassionate acupuncturists, who stick needles in 100% of their victims, with 0 clinically significant results.

            Doctors are such monsters, aren’t they. But, I am stubborn and narrow-minded. Even these astonishing data cannot convince me. I’ll stay with Prof. Ernst.

          • Ok, I think we’re done here. The reason I brought up other trials was not to show that researchers are monsters but to refute your statement that knee OA trial was an exception that proves the rule and that there are more trials that compare sham surgeries to verum. And I mentioned them not because I wanted to accuse anyone of anything unethical. Research doesn’t follow the same ethical rules as clinical practice and that is ok because that’s the only way research can be done.

            And nowhere in my comments did I ever say that MDs are monsters. Why would I? Both of my parents are MDs, so were two of my grandparents, my uncle, aunt, cousin. I almost became an MD myself.

            So, I like MDs and I think the world wouldn’t be able to function without them. I especially like MDs who have developed a capacity for critical thought. You, on the other hand, have shown that not only can you not think critically, you have difficulty constructing a logically coherent argument on ANY topic.

            So let’s drop it, it’s just a waste of my Qi. For evidence on the phenomenon of “breaking blind” in trials comparing a drug to inactive placebo I refer you to Irving Kirsch and his book. In the largest trial to date on this phenomenon it’s been established that up to 80% of patients and 87% of providers are able to correctly guess which group they’re in.

          • The reason I brought up other trials was not to show that researchers are monsters but to refute your statement that knee OA trial was an exception that proves the rule and that there are more trials that compare sham surgeries to verum.

            You seem to have missed this part:

            You name four trials and there was the first one. That makes 5.
            As of 03 March 2015, there are 16,398 trials with posted results in the US. The number you quote is 5. Bear with me here while I clean my glasses and dust my abacus and try to remember the higher mathematics I learned in primary school.
            5 divided by 16,398 is, wow, times 100 rounded to 2 decimals, phew, this is getting complicated. Let’s ask Mr. Computer. He tells me this boils down to 0.03%. Astonishingly common indeed.

            Obvious question, given your reaction: how much lower does the number need to go before it meets your criteria for “exceptions”?

        • “The problem is that so much of acupuncture research out there is rubbish.” – well why can’t some acupuncture enthusiasts do some decent research? As I have argued (above) there is no need to include a placebo arm unless you are trying do isolate a specific mechanism of action – if it shows a clinically significant (not just statistically significant) benefit then acupuncture “works”. It’s then up to the mainstream medical scientists to figure out why – and if the conclusion is that its mainly psychological (which is not intrinsically different from neurological) that does not invalidate it.

          • Indeed. As David Colquhoun (and not only him either) has stated ad nauseam: statistical significance isn’t it. Statistical significance does not mean that something is significant. At most, it means that you attempted to reduce the probability that what you are claiming is nonsense. It is an arbitrarily chosen cut off point. Clinical significance is where the importance is. A statistically significant finding that is clinically insignificant has no value for a patient. Just as a PC that is 5% faster isn’t worth paying extra for, few patients will ever notice a 5% difference between two tumours, or two cold durations or whatever.

          • Indeed, clinical significance is important, not statistical significance. As clinicians, we need to let patients know. You can start with all the millions out there taking SSRIs. Not only most of them haven’t been shown to perform better than placebo, whatever improvement there was, it wasn’t clinically significant.

          • I absolutely agree with you. Acupuncturists need to get their act together and start coming up with good research to back up their claims. Like designing verum acupuncture groups to focus on pattern differentiation which is absolutely essential to produce good results in TCM. And to do more to explain to people why studies like the one I cited above for knee OA are rubbish and don’t prove or disprove anything about acupuncture.

          • Jonathan, including placebos (both active and inactive) will help rule out a bunch of things including how well the drugs that we now use actually work for a condition and how acupuncture compares to a drug treatment. So, to go back to that JAMA migraine study, an ideal study would be one without placebo wash-out period that has 5 groups:
            1) sham acupuncture
            2) verum acupuncture
            3) a drug
            4) inactive placebo
            5) active placebo

            The only caveat – have acupuncturists design protocols for verum acupuncture group. TCM doesn’t treat conditions it treats patterns that a patient presents with. For a GP a headache is a headache is a headache. For an acupuncturist different patients with headaches can have up to 12 different patterns that manifest as headache. You have to individualize treatment in verum acupuncture group depending on a patient’s pattern.

          • First of all, there is this thing, and I know it’s inconvenient, but it’s called an MRI…………when we do acupuncture on someone, and then scan their brain, we can see the response that the body had to the treatment. For some reason, acupuncture haters, do not consider MRI’s valid proof of acupuncture’s effect, although they would support drugs that change MRI scans………so MRI proof is good if it’s something you “believe” in, but it’s not proof if you don’t………..your bias is making you very un scientific.

          • First of all, there is this thing, and I know it’s inconvenient, but it’s called an MRI…………when we do acupuncture on someone, and then scan their brain, we can see the response that the body had to the treatment.

            Not even close. All you see is that the brain notices something. It’s what brains do. Crawl into the machine and have someone hammer your big toe. You’ll see that the brain notices that as well. It does not indicate that these actions have any curative powers whatever. It merely shows that the brain is not dead and that the nervous system is shuttling signals around.

          • Only an idiot would claim that there are no issues with psychiatric drugs. They are, however, the best or the least bad we have and scientists and doctors are doing whatever they can to find better or less bad alternatives. The results are breathtakingly successful, considering where we stood, mere decades ago.

            The picture gets even better when we look at the competition. Psychiatry (including non-pharmacological psychiatry, which the quacks for some reason seem to completely ignore) has measurable and demonstrable results. Acupuncture and homoeopathy, on the other hand, have no results, or if they do, results that are so infinitesimal we aren’t able to detect them.

            Thanks to modern psychiatry, we now have far fewer people hearing their god tell them that they have to kill someone and are happy to oblige, and when we do have such a case, Canadian Vince Li comes to mind, it seems that it is almost invariably *before* the diagnosis was made, not after.

            So, while the issue of “are there problems with psychiatry” is an important one, it is not a very good way to prove the superiority of the popular quackeries. It seems that the quacks are acting like the crabs in a basket: pulling everyone else down because they can’t get up. Pointing out problems with psychiatry or any other element of medicine, which do indeed exist and are not being denied either, will not miraculously turn the popular quackeries into real medicine and their imaginary positive clinical effects into real ones.

    • “If patients and doctors “break blind” (an extremely common event) that will affect results”
      In a well-designed trial, this is an astonishingly rare event. Enormous amounts of effort are put into making sure there’s no way – other than by having access to the trial randomisation register – for this to happen. It can occur – for example, in the early days of HIV therapy, patients were able to work out they were in the placebo arm of the trial because they didn’t get anaemia from the marrow-suppressive side effects. But these days almost no trials use “pure” placebo – the vast majority of trials are drug A vs drug B.

      “Pat, the issue with comparing a drug to an inert pill – if patients on the drug improve, you don’t know if they improved because of the drug’s pharmacological effects or because they started experiencing side effects which made a drug into super-placebo.”
      Quite right. You don’t know why any individual patient reported the changes they reported. If I give you a drug and you drop dead, I don’t know whether it’s because the pill is poison or you had a heart attack. But if all 100 of my experimental group die and only one of the control group – I think I can conclude cyanide is not the same as sugar.

      And I think you’re tieing yourself in knots with this “side effect super-placebo” concept – you seems to be saying the side effect of a drug is it has the effect you want…

      I REALLY think you don’t understand the concept of placebo – which is not surprising. It is a very hard concept to grasp and just about none of the journalists I’ve ever seen write about it understood it. They all think the sugar has an actual direct effect, and that’s what the “placebo effect” is. But it isn’t – you can get the “placebo effect” for a drug which isn’t even administered! If you have an IV line in, and I tell you I’m giving you morphine but give you saline, you’ll get a response – a placebo effect. But is the saline having an effect? No – and I can prove it by telling you I’m giving you morphine, fiddling with your drip and not injecting the saline. The “placebo effect” still occurs. It’s NOT an actual effect caused by the inert substance administered.

      • Do you have evidence to back up your claim that breaking blind is “an astonishingly rare event”? I have evidence to back up my claim that it isn’t. But I’m waiting to hear on yours and on somebody else who just said that “it doesn’t seem to them that breaking blind is extremely common”. And while you’re at it, how about some evidence that “these days there are almost no trials which use pure placebo and vast majority of trials compare drug A to B”? Because that certainly conflicts with what I’ve read on this issue.

        Out of everything I wrote about “super-placebo effect” what led you to conclude that I’m among journalists who think that sugar pill has an actual direct effect? Please go back to my comments on breaking blind and super-placebo effect and cut and paste what was it exactly that I said which shows that.

        Honestly, after spending a few days on this sceptics’ blog I think some people here have reading comprehension issues. A big problem for a sceptic. After all a sceptic, a TRUE sceptic needs to be able to read data and come up with his conclusions. Hard thing to do when reading comprehension is missing.

  • I think I’d rather concentrate on *if* it works before trying to understand how. To see how well acupuncture is doing, this is a good start: http://www.dcscience.net/2013/05/30/acupuncture-is-a-theatrical-placebo-the-end-of-a-myth/

    • Yes I’ve seen that and it’s exactly my point: unless the acupuncturists can do a simple randomised intention-to-treat trial of acupuncture vs. no treatment (ignoring for now all the questions of placebo) and show a clinically significant result the rest is a non-starter. I can’t understand why any rational person would still be undertaking (or submitting to) acupuncture in the absence of such a result.

      • Jonathan – how many people actually make treatment decisions based on the results of clinical trials/studies/whatever? Seriously, if you have data on that, please post it. I’ve been asking around since discovering this blog about a year ago – people that love acupuncture, people that have never had a treatment, people who think it’s hocus pocus, the ‘meat & potato’ folk (to borrow Peter Deadman’s phrase) who will only ever use allopathic med…and not a single person bases healthcare decisions on the results of studies.

        My favorite was an ER doc – we were working on his knee (he was doing everything to avoid knee surgery). His response was something like “don’t confuse research with real world treatment”.

        • By the way, both TCM and Western medicine are allopathic, as well as Ayurveda. The only one that isn’t is homeopathy.

          • Sasha – true enough. I should have capitalized Allopathic.

          • And you believe homeopathy is a credible treatment? Coming from a family of MDs , as you claim, and you don’t understand basic chemistry?

          • From what I wrote, what led you to conclude that I believe in homeopathy? I don’t believe or disbelieve in it, I don’t know enough about it to have an opinion. All I’ve said is that Western medicine, TCM, and Ayurveda are all allopathic and only homeopathy isn’t. You can google “allopathic” to see what it means.

            Not only do I understand basic chemistry, I also understand biochem and organic chemistry. I had to take it as part of pre-med.

            And why would you think I am a journalist?

            Once again, reading comprehension is seriously lacking for some on this blog…

          • “From what I wrote, what led you to conclude that I believe in homeopathy? I don’t believe or disbelieve in it, I don’t know enough about it to have an opinion.”
            Really, after all you know about homeopathy or are you foxing? Since you “know” about all sorts of chemistry and understand the principles of homeopathy, how is that you can “believe or disbelieve” (not that your believing actually matters) in something that is logically and scientifically flawed?
            .
            “And why would you think I am a journalist?”
            Because you used the term in relation to yourself. Or were you foxing then too?
            .
            “Once again, reading comprehension is seriously lacking for some on this blog…”
            Is that self-inclusive, or do you not possess a mirror?
            .
            In fact, your constant reference to others’ logical fallacies brings to mind the Fallacy Fallacy, where there is the false citing of fallacies. You say plenty but, under any close scrutiny, there isn’t much of substance.

        • It’s certainly true that clinical trials are somewhat detached from the real world – you only have to look at all the exclusions to entry in almost any trial – but in my field, cardiology, most treatments currently used have reasonably solid evidence of efficacy (one big exception being non-statin lipid lowering drugs). There are some situations where a controlled study is considered unethical because the treatment is “obviously” helpful (e.g. defibrillation for VF) and some that look promising but are at an early stage in development and so are not ready to be given a fair trial. Generally treatments that have been tested and not shown to benefit are abandoned fairly quickly.

          One major problem is the cost of undertaking a trial when there is no patented wonder-drug or gizmo involved to make someone a fat profit if benefit is shown – it is extremey difficult to get funding for even a basic trial in this situation and this is why I have some sympathy for the “alternative” practitioners. I think the NHS should help to fund properly designed simple studies, chosen by the enthusiasts to have the greatest possible likelihood of a positive result and if a few of these are negative then the whole idea can be put to bed.

          • Jonathan, there are more issues in cardiology than what you mention. In October of last year British Medical Journal published an analysis of research on statins by Dr. John Abramson. His group determined that for all but the very highest-risk people, statins did not save lives and did not reduce the frequency of serious illness. Thus 80% of all statins prescribed in the US, for example, are unnecessary. For more on that you can google Assault on Science by David H. Newman, MD

            It is also estimated that 98% of all cardiac stents put in in the US don’t do anything. The same goes for ACLS. For more on that you can look up David Newman’s book and another book “Doctored” by the MD who runs Long Island Jewish’s CHF program.

          • “One major problem is the cost of undertaking a trial when there is no patented wonder-drug or gizmo involved to make someone a fat profit if benefit is shown –”

            That point came up a lot when I asked about choosing therapies based on research/clinical evidence. The common response was: there’s no money to be made on things like acupuncture, only money to be lost by the mainstream medical industry. I don’t know how accurate that perception is, but it does seem to be a pretty common view.

            Regardless of the reason, I’m quite glad that new age/bleeding edge fields like yours have reasonably solid evidence of efficacy.

          • That is indeed a common argument, and it is demonstrable nonsense. Non-patentable products are making tons of money for very large companies. Vitamin C, for example. Utterly non-patentable, but hundreds of millions of dollars are made by selling it every year. As for acupuncture, the claim is doubly invalid. Acupuncturists make oodles of money selling this useless “service” and there are patents on top of that, dozens and dozens of them:
            Just Google “acupuncture patents” (link: https://www.google.ca/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=%22acupuncture+patents%22)

          • Bart – I’m not sure if you meant that link to be a joke…but I’m definitely going to print some of those out and take them into the office. Thanks for the morning laugh!

          • Now it is my turn to be a little puzzled.

            I definitely had to suppress a few giggles while reading some of the patents, but the point I was making remains a serious one: people who claim that no money can be made with acupuncture *because* it cannot be patented, are dead-wrong. Acupuncture is eminently patentable, just as so much other nonsense is patentable.

            Whether those patents will ever lead to riches greater than the dreams of avarice remains to be seen, of course, but given that the market for acupuncture seems to be growing, it does not seem such a stretch to assume that those who sell the products involved will see their market and therefore their revenue increase as well.

            On op of that, since it is all based on evidence-free thinking, one would think that whomever comes up with an attractive story will be well-placed for a chance to make loads of money with very little effort.

          • “… it does not seem such a stretch to assume that those who sell the products involved will see their market and therefore their revenue increase as well.”

            It actually does seem like quite a big stretch, but an amusing stretch!

          • “Patent medicines are compounds promoted and sold as medical cures that do not work as promoted… The promotion of patent medicines was one of the first major products highlighted by the advertising industry, and many advertising and sales techniques were pioneered by patent medicine promoters.”
            http://en.wikipedia.org/wiki/Patent_medicine

          • “Not to be confused with Pharmaceutical patents.”
            http://en.wikipedia.org/wiki/Patent_medicine

        • how many people actually make treatment decisions based on the results of clinical trials/studies/whatever?

          Approximately none, I would hope. Only Jenny McCarthy is brilliant enough to replace years of gruelling studies and internships with a casual afternoon Googling on the laptop between the crumbs on the kitchen table and a child screaming on her lap while making dinner.

          Clinical trials aren’t intended for lay people. They are intended for professionals. That’s why they’re published in medical journals and not in “The Sun”.

          • “Only Jenny McCarthy is brilliant enough to replace years of gruelling studies and internships with a casual afternoon Googling on the laptop between the crumbs on the kitchen table and a child screaming on her lap while making dinner…”

            Jenny McCarthy isn’t the only one. This website is littered with casual Googling standing in for accuracy. There’s at least one nice example on this post – FrankO couldn’t have spent very long researching the terms he dismisses as outdated. Otherwise, he wouldn’t have made that comment. In a different post about acupuncture, Edzard references balancing two life forces. More quick googling gone awry. There are many many more examples, some funnier than others.

            You say “Clinical trials aren’t intended for lay people. They are intended for professionals.” Good to hear that you think that. I’m sure you were planning on pointing that out to Jonathan (“I can’t understand why any rational person would still be undertaking (or submitting to) acupuncture in the absence of such a result.”), yes?

      • Jonathan, there were plenty of trials of acupuncture (sham and verum) vs no treatment. Including the one I posted earlier from JAMA that compared sham and verum acupuncture vs putting people on acupuncture wait list. That gave both sham and verum acupuncture the NNT of 3. Believe me, you don’t want to compare acupuncture to no treatment, most of the time acupuncture will come out far ahead.

        • Believe me, you don’t want to compare acupuncture to no treatment, most of the time acupuncture will come out far ahead.

          That’s precisely why we don’t usually compare to “no treatment”, and why we use placebos instead. What you are saying here is what Prof. Ernst said in the very first paragraph of his post:

          Whenever researchers develop an apparently credible placebo and the results of clinical trials are not what acupuncturists had hoped for, the therapists claim that the placebo is, after all, not inert and the negative findings must be due to the fact that both placebo and real acupuncture are effective.

          Question: why would you want to use expensive acupuncturists, if fake acupuncture, that requires no training, no studying, no investments, has exactly the same results? I actually can think of a few reasons, but not a single one of these reasons has anything to do with curing disease.

  • I don’t understand the logic of accupuncture (and accupunturist).
    They don’t seem to know that, if your ‘theory’ contradict most of what we know in biology, chemistry or physics, the rather small effect they got in some trial (usually bad designed) it’s just error or bias. Accupuncture is in the place for thousand years and still, in the thousand trial, no one is able to show something really convincing. How is this even possible ? If the effect was real and reproducible, at the age of quantum physics, we should be able to notice it (i don’t even talk about understand it).

    Like homeopathy, chiro, etc, etc … Claim are otherwordly but no or very small clinical effect are shown.
    And still, when you don’t believe them, they call you ‘unscientific’ or ‘closed minded’. Come on, come make some work in hard science and let’s talk about it : maybe they could understand what is a ‘sound evidence’.

    • And still, when you don’t believe them, they call you ‘unscientific’ or ‘closed minded’.

      I think this quote from RationalWiki says it better than I can:

      An open mind is a mind that is receptive to new ideas and information. It is often compared to a closed mind which will reject ideas without any consideration.

      While there is some philosophical validity to the distinction between open and closed minds, particularly in the case of empiricism, when used in an argument on the internet it’s almost always a form of whining. Being told to be “open minded” about something — like being made to listen to Michelle Malkin for example — is usually a code for “you’re not going to like this, but I want to subject you to it anyway”. Conversely, being told that you are “closed-minded” is generally a means of asserting that “I don’t like the fact that you’re proving me wrong, so I will pretend that your failure to agree with my argument is a philosophical deficiency”. Being told you are “close minded” simply shows that the one writing is confused about the difference between “open” and “far” (or is simply lazy in their writing).

      http://rationalwiki.org/wiki/Open_mind

  • There are advantages to using a placebo. The concealment of allocation, and reduction of selection bias. For example we would hope that a placebo pill appears (to the doctor, patient and assessor) similar to that of an active treatment. However, it is evident that placebos can be active vs inactive. It can be difficult to develop an inactive placebo or in many cases unethical. One questions the validity of sham acupuncture as a placebo. Would a doctor be able to ascertain whether they were inserting needles into the body. Would a patient be able to uncover whether they were having needles inserted into the surface of their body or not? However, an effective placebo can blind the doctor, patient and assessor, thus reduce subversion. Nonetheless subversion can and does occur.

    An advantage of an effective placebo is that patients are less likely to report on events differently, therefore any differences can be better judged and associated with treatment. Still, the effectiveness of a placebo and placebo control is questionable and debatable (even in the medical arena). Placebos can be uncovered, therefore cause an array of technical issues.

    To be fair, it is important to discuss the limitations of placebo. A placebo cannot be used effectively for many medical treatments, nor can a placebo always produce a useful answer. Traditional double blind randomised controlled trials are therefore not always the best.

    It’s important to point out that the effect of a treatment is the efficiency of the biological effect of treatment, plus any benefit as a result of a placebo effect. A placebo helps to estimate efficiency not effectiveness. In the case of acupuncture it appears that acupuncture has been shown to be effective. Placebo’s do need to be developed correctly, and in my opinion “sham” acupuncture is an active treatment. The definition of acupuncture is the insertion of acupuncture needles, inserting acupuncture needles is acupuncture. Then of great interest is the fact that both sham and true acupuncture have a measurable effect. In well designed trials ‘acupuncture’ always comes up on top of that compared to ‘sham’ acupuncture. Raising a point that ‘true’ acupuncture is better than ‘sham’ acupuncture. To conclude, when fellow scientists state that acupuncture is nothing but placebo, I would point out that acupuncture is being used as an ineffective placebo, and that true acupuncture in quality conducted trials statistically and consistently comes on top.

    Lastly, this thread is full of bias! It highlights the difficulty faced by medical professionals and CAM professionals with regards to assess research, in an non biased manner. For those interested in Meta Analysis, I highly recommend the textbook ‘Introduction to Meta-Analysis by Borenstein et al. ISBN 978-0470-05724-7.

    • George, you have raised some very important and interesting points about using placebos. Please read the article “Placebo, Are You There?” by Jean Brissonnet, translation by Harriet Hall at:
      http://www.sciencebasedmedicine.org/placebo-are-you-there/

    • Thank you for the link Pete. Hope you are well.

      In response to Edzard Ernst’s third option ‘Acupuncture might be more than a placebo, after all. This notion might be unacceptable to sceptics.’

      I agree.

      Acupuncture is not a placebo. Sham acupuncture is questionable. Reading the (interesting), link it is evident that ‘polemics’ have been given little consideration. For example Randomisation (if conducted properly) controls for regression to the mean effects and temporal confounding. The ‘known’ ‘not known’ and ‘unknown’ confounders.

      That aside, both fields of health, life and social science acknowledge the importance of interaction, a famous statement comes to mind ‘A doctor should at least act like a member of the therapeutic team.’ And teachings that acupuncturists’ should take into account the patients ‘mindset’ in relation to their illness as an auxiliary aspect of treatment, not totality.

      Interestingly, during conversation, it transpired that the measurable effects and differences of ‘intervention’ were taken into account in Ancient Chinese classical texts (according to various scholars of this discipline). For example, lower levels of practice were known to affect patient outcome; the practitioner should aim for higher levels of practice and greater effects. Rather fascinating.

      CAM does not have the monopoly of doctor/clinical and patient therapeutic relationships. Such factors influence both paradigms. However, I’d suggest that CAM could teach us much about this phenomenon…

      • ” Randomisation (if conducted properly) controls for regression to the mean effects and temporal confounding.”
        Not true!
        Randomisation has the main purpose of controlling for selection bias.

        • It is true.

          Properties of Randomisation are that Randomisation:

          Controls for regression to the mean effects
          Controls for temporal confounding
          Elimination of selection bias at baseline

          That is an error on your behalf Father. Of the first kind…

          • having a control group controls for regression towards the mean;
            randomising the groups controls for selection bias.

          • We can go backwards and forwards me: true. You: not true or You: divert. BUT there is NO doubt about it, Randomisation (if conducted properly):

            Controls for regression to the mean effects, temporal confounding, and selection bias at baseline.
            Regards

          • if you say so
            from Wiki:
            The advantages of proper randomization in RCTs include:[36]
            “It eliminates bias in treatment assignment,” specifically selection bias and confounding.
            “It facilitates blinding (masking) of the identity of treatments from investigators, participants, and assessors.”
            “It permits the use of probability theory to express the likelihood that any difference in outcome between treatment groups merely indicates chance.”

            There are two processes involved in randomizing patients to different interventions. First is choosing a randomization procedure to generate an unpredictable sequence of allocations; this may be a simple random assignment of patients to any of the groups at equal probabilities, may be “restricted,” or may be “adaptive.” A second and more practical issue is allocation concealment, which refers to the stringent precautions taken to ensure that the group assignment of patients are not revealed prior to definitively allocating them to their respective groups. Non-random “systematic” methods of group assignment, such as alternating subjects between one group and the other, can cause “limitless contamination possibilities” and can cause a breach of allocation concealment.[36]

          • George, real acupuncture (i.e. the application of multiple skin piercing needles) is an extremely intrusive, invasive, and intimate form of alt-med treatment; as are alt-med treatments such as enemas.

            People who willingly pay for such treatments (or willingly subject themselves to expenses-paid clinical trials), despite the absence of empirical evidence of its efficacy for any known health condition, obviously have a suppressed level of our innate disgust response.

            Some of the commentators (especially the most vitriolic) have forced me to seriously consider the possibility that real acupuncture using needles inserted into the skin will sometimes/often show much stronger effects than sham acupuncture due to the fact that the real version contains very obvious connotations of sadomasochism (sadistic practitioner; masochistic clients) and less obvious implications of Stockholm syndrome (or similar) in the clients.

            Beth Acampora wrote: “…people don’t let people stick needles in them for $100 a week if it didn’t work.” Very true! To which I must add that people wouldn’t be paying a lot more per week to be deeply humiliated by properly trained BDSM practitioners if the treatments didn’t work. The only differences being that BDSM practitioners don’t claim to cure diseases neither do they attempt to explain the efficacy of their art and craft using the absurdities of the Chinese meridian system, Qi, yin and yang.

            Matthew Bauer wrote: “We hope to have one paper published by the end of this year that shows a clear separation between verum and sham acupuncture when at least 2 treatments a week were given for at least 6 weeks compared to trials that used less than this amount.” Oh joy! It is very easy to design a study to confirm a hypothesis: alt-med relies on this methodology. However, scientific knowledge is accumulated by continually testing each hypothesis against the null hypothesis. If you re-read Matthew’s statement with the word acupuncture replaced by BSDM then you might begin to understand why skeptics continually point out the tiresomely motivated reasoning that is the keystone a priori of all alt-med / sCAM / Integrative Medicine.

          • That is an error on your behalf Father. Of the first kind…

            Are you an acupuncturist?

          • I’m a sceptic’s sceptic!
            Regards

          • The only differences being that BDSM practitioners don’t claim to cure diseases neither do they attempt to explain the efficacy of their art and craft using the absurdities of the Chinese meridian system, Qi, yin and yang.

            That is why, according to my definition, BDSM practitioners are entertainers, and acupuncturists are quacks. The part I find revolting, is that BDSM practitioners do get in trouble and are targeted by news broadcasts, and neighbourhood organisations, while I cannot find the same for acupuncturists. In other words, our society seems to despise entertainers more than quacks. That’s a good indication that skeptics and scientists still have a lot of work ahead of them.

          • “George, real acupuncture (i.e. the application of multiple skin piercing needles) is an extremely intrusive, invasive, and intimate form of alt-med treatment; as are alt-med treatments such as enemas.
            People who willingly pay for such treatments (or willingly subject themselves to expenses-paid clinical trials), despite the absence of empirical evidence of its efficacy for any known health condition, obviously have a suppressed level of our innate disgust response.
            Some of the commentators (especially the most vitriolic) have forced me to seriously consider the possibility that real acupuncture using needles inserted into the skin will sometimes/often show much stronger effects than sham acupuncture due to the fact that the real version contains very obvious connotations of sadomasochism (sadistic practitioner; masochistic clients) and less obvious implications of Stockholm syndrome (or similar) in the clients.
            Beth Acampora wrote: “…people don’t let people stick needles in them for $100 a week if it didn’t work.” Very true! To which I must add that people wouldn’t be paying a lot more per week to be deeply humiliated by properly trained BDSM practitioners if the treatments didn’t work. The only differences being that BDSM practitioners don’t claim to cure diseases neither do they attempt to explain the efficacy of their art and craft using the absurdities of the Chinese meridian system, Qi, yin and yang.
            Matthew Bauer wrote: “We hope to have one paper published by the end of this year that shows a clear separation between verum and sham acupuncture when at least 2 treatments a week were given for at least 6 weeks compared to trials that used less than this amount.” Oh joy! It is very easy to design a study to confirm a hypothesis: alt-med relies on this methodology. However, scientific knowledge is accumulated by continually testing each hypothesis against the null hypothesis. If you re-read Matthew’s statement with the word acupuncture replaced by BSDM then you might begin to understand why skeptics continually point out the tiresomely motivated reasoning that is the keystone a priori of all alt-med / sCAM / Integrative Medicine.”

            Pete,

            Stockholm syndrome is an interesting point, particularly with regard to chronic, untreatable conditions. Regards.

        • Randomisation has the main purpose of controlling for selection bias

          Indeed. One could possibly argue that controlling for selection bias and temporal confounding are side effects of randomisation, but even that would be more an indication of lack of understanding of the process than a real effect.

          • Really?! I’m not here to keep educating you on the unique features randomisation. vYou should know this already (if you are an educated, practiced and experienced researcher/scientist). If you are not, do not pretend you know anything about it. If you would like further information or an explanation ask politely.

      • Acupuncture is not a placebo. Sham acupuncture is questionable.

        Maybe. If it looks like a duck and it quacks like a duck it probably is a duck, i.e. even if that were true, what it would show is what has been said repeatedly already: acupuncturists should be taken out of the picture and replaced by anyone picked off the street. Since there is no difference in effect, and it would be a lot cheaper, there is no use for acupuncturists. Even if it does not show that acupuncture is a placebo, it does most definitely show that it is unnecessary.

        • Resorting to Wikipedia (like EE) I won’t pretend that I know much about ducks, unlike you. However:

          ‘…a duck is a common name for a large number of anatidae family of birds…’

          So if it looks like a duck, it could be a duck, but it is probably a geese i.e not a duck. Or a loon. Let’s not confuse our ducks!

      • “Acupuncture is not a placebo.”
        Really, George? Do you know that for a fact? If so, I suppose you have some evidence; evidence which contradicts the research in Cochrane?

        • If so, I suppose you have some evidence; evidence which contradicts the research in Cochrane?

          Evidence is for lowly scientists and skeptics. Acupuncturists don’t need to waste their time and scorch their scarce and noble neurons with such sordid minutiae. Evidence is beneath them. They just know.

        • Frank, frankly it’s not rocket science! I suggest you a) read the post prior to the post you quoted where I make a proactive effect to discuss placebo. b) search the cochrane library yourself using ‘acupuncture placebo’ or other. c) You ought to present the cochrane library’s research of primary outcomes with regards to acupuncture not being a placebo or being a placebo ‘the contradictory evidence’ (it’s quite cheeky to ask me to do your work for you). d) I often encourage my students to seriously think about the question they want to ask. For example, your question isn’t really a good question. It needs more work. It’s a hybrid attempt. Regards.

          • “Frank, frankly it’s not rocket science!”
            Gee George, did you think of that one all by yourself? Nah, you probably needed some help; maybe from one of the thousands of people who have said it before.
            `
            “I suggest you a) read the post prior to the post you quoted where I make a proactive effect to discuss placebo.”
            I did but it doesn’t make much sense in the context. The good prof titled the thread according to the reported meta-analysis and in the body raised questions. To say that he meant that acupuncture is definitely not a placebo is to misread, not only the article, but some of the critical responses, particularly Prof Colquhoun’s.
            `
            “b) search the cochrane library yourself using ‘acupuncture placebo’ or other.”
            Why? Prof Ernst has laid out a lot of evidence which shows it to a placebo. If you can demonstrate otherwise, please do so? (And, if you are going to make pretensions of cleverness, is writing properly too much to ask?)
            `
            “c) You ought to present the cochrane library’s research of primary outcomes with regards to acupuncture not being a placebo or being a placebo ‘the contradictory evidence’ (it’s quite cheeky to ask me to do your work for you).”
            The “contradictory evidence” is that it is not a placebo. The ball is still in your court. (As for “cheeky”, it is more “cheeky” to try to invert the onus.)
            `
            “d) I often encourage my students to seriously think about the question they want to ask. For example, your question isn’t really a good question. It needs more work. It’s a hybrid attempt. Regards.”
            Your students? Are you trying to impress anyone with this, rather than point out the issue with the question. As it turns out, the premise of your response is incorrect.
            As for students, I can only wonder who those poor suffering people might be?

            At this stage, the only person who thinks you are clever is you.

          • ‘Gee George!’ Very good.

            Your question was poor, it did not matter how I responded.

            However, you have made more of an effort this time around (which is an improvement).

            The next step I would suggest is to try (if possible) to leave egotistic and rude comments, to the side.

            Then maybe a decent conversation can be had.

            Acupuncture is not a ‘placebo’.

            Research has shown acupuncture not to be effective. Research has shown acupuncture to be effective. Fact. More evidence is required. These are not new or isolated issues.

            Now, what would you like to discuss?

            Regards

          • Frankly,

            Do you know what a placebo is?

            Acupuncture is not a placebo. Acupuncture is an intervention. Yes, a treatment. Placebo is likely to be part of an acupuncture treatment. Acupuncture is an active treatment. Sham acupuncture is questionable. Quality acupuncture in research is recommended. However, it is probably worth mentioning that if you suffer from peripheral joint osteoarthritis and you want to get better, join an acupuncturist waiting list.

            I’ll repeat myself. There is research that shows that acupuncture is effective. There is research that shows acupuncture is not effective. Fact. Evidence is suggestive of a requirement of quality research design and methodology in acupuncture trials. Not that acupuncture is a scam. You refuse to accept this; your issue (try psychotherapy).

            The Cochrane Library did not magic anything up. To imply that researchers’ are silly or that I am ‘silly’ is a reflection of your maturity and intelligence.

            Take a look at the Cochrane library. You may find recommendations regarding:

            sham acupuncture
            bias
            sample size
            and so on…

            I personally recommend that you take a look at STRICTA guidelines.

            A quick search page 1 of the Cochrane Library reveals:

            There is insufficient evidence to judge whether acupuncture is effective in treating cancer patients. There is little evidence to support or refute acupuncture for the treatment of insomnia. There is insufficient evidence to determine whether acupuncture is effective for controlling menopausal vasomotor symptoms. Limited evidence shows that acupuncture for schizophrenia may have some antipsychotic effects. Do you know what insufficient evidence means? I’d be interested to hear your response.

            There is low to moderate evidence compared to standard therapy that acupuncture improves pain and stiffness of fibromyalgia. There is consistent evidence that acupuncture provides the additional benefit to treatment of acute migraine attacks. Acupuncture should be considered a treatment option. Acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension headache.

            Therefore, there is evidence that acupuncture has been shown not to be effective, recommendations have been made to improve acupuncture research. There is also evidence that acupuncture is effective, and that acupuncture should be recommended. No magic. Sorry.

            I’d be interest to know what acupuncture qualification Edzard Ernest has/had?
            Regards

          • “Research has shown acupuncture not to be effective. Research has shown acupuncture to be effective. Fact. More evidence is required. These are not new or isolated issues.”
            Effective? As a placebo or otherwise? There is no evidence and making silly claims won’t make evidence magically appear.
            `
            “The next step I would suggest is to try (if possible) to leave egotistic and rude comments, to the side.
            Then maybe a decent conversation can be had.”
            “Now, what would you like to discuss?”
            `
            And I repeat;
            “At this stage, the only person who thinks you are clever is you.”
            Anytime you can do better than this last effort, I’ll respond but you wasted precious electrons on a pointless post. Pointless and pretentious.

  • I mentioned in an earlier post that “The research done thus far has not been a fair test of acupuncture’s true potential but with more time we hope to address those problems and better show what acupuncture can and cannot do”. I wanted to elaborate on this. My observation is that acupuncture skeptics are quick to tear apart any of the many acupuncture studies that show verum acupuncture being superior to sham/placebo acupuncture. They cite things like low numbers of subjects, issues with blinding and so forth and that is fair enough to do (as long as they apply the same vigor to mainstream therapy studies). But I think none of these skeptics realize that many of the studies that do not show verum acupuncture to be superior to sham/placebo controls are typically fatally flawed for different but equally valid reasons. The two main reasons most of those studies are flawed is in the qualifications of the ones doing the needling and the frequency (dosage) of the needling.
    Because acupuncture is a technical procedure requiring a certain skill level to get the best results, the training of those who do the needling matters. You would never design a study to test a surgical procedure without first assuring that those doing the surgery were well qualified. Many acupuncture studies, especially those done in the earlier days, were done by those completely unqualified -literally someone with no experience who picked-up an acupuncture text book to find the points. Even today, studies are being done with under qualified practitioners doing the needling. The dosages issue however, is an even greater problem.
    You would never conduct a trial on a drug without first establishing just what the effective dosage of that drug should be. How could you test it against a placebo control unless you first figure out the clinically effective dosage? Yet virtually no acupuncture trials publish information on how they established the frequency and number of treatments believed to be necessary to give the verum acupuncture a chance to do the best it can do. Few acupuncture trails even bother to detail exactly how the treatments were spaced for the test subjects or if those subjects adhered to those dosages. The study on the laser treatment that this thread generated made clear that in order for the verum treatment to be effective beyond the sham control, it had to be given at a certain dosage that was established by experts as being at the right level. The same thing should take place for any acupuncture trial but amazingly, this has never been called for. A group of us are investigating this now and hope to report on it soon. It is only reasonable to set a standard for acupuncture trials calling for those doing the needling and establishing the effective dosage to be qualified to do so and any trial not doing this should be tossed. Very few of the hundreds of acupuncture trials published so far can meet this very reasonable minimal standard.

    • Matthew Bauer said:

      My observation is that acupuncture skeptics are quick to tear apart any of the many acupuncture studies that show verum acupuncture being superior to sham/placebo acupuncture. They cite things like low numbers of subjects, issues with blinding and so forth and that is fair enough to do (as long as they apply the same vigor to mainstream therapy studies).

      Tu quoque. There is nothing wrong in only ripping apart altmed studies – no ‘balance’ is required.

      But I think none of these skeptics realize that many of the studies that do not show verum acupuncture to be superior to sham/placebo controls are typically fatally flawed for different but equally valid reasons. The two main reasons most of those studies are flawed is in the qualifications of the ones doing the needling and the frequency (dosage) of the needling.

      That may be so, but it’s not a concern of a skeptic: it’s a problem for those trying to support acupuncture to resolve.

      Because acupuncture is a technical procedure requiring a certain skill level to get the best results, the training of those who do the needling matters. You would never design a study to test a surgical procedure without first assuring that those doing the surgery were well qualified.

      How would you test the competence of an acupuncturist?

      A group of us are investigating this now and hope to report on it soon.

      Glad to hear it. When do you expect the work to be published?

      It is only reasonable to set a standard for acupuncture trials calling for those doing the needling and establishing the effective dosage to be qualified to do so and any trial not doing this should be tossed. Very few of the hundreds of acupuncture trials published so far can meet this very reasonable minimal standard.

      Until such better evidence is available, what claims do you think should be made about acupuncture?

      • Alan – Thank you for your excellent questions. I agree the issues I raised are problems supporters of acupuncture are responsible to address. What is most needed is a consensus building process to develop Best Practice guidelines so that we can not only help inform practitioners but also researchers. The organization I helped found is calling for this now as we take on the issue of refinements that need to be made to acupuncture research. Because there is no well-funded acupuncture lobby and most acupuncturists have only private practice available to them to earn a living, organizing acupuncture supporters is very difficult. As for what constitutes a well-qualified Acupuncturist for research purposes, in my opinion they should be trained in some sort of institution accredited by an outside agency to teach established course materials in traditional acupuncture theory as well as a basic level of biomedicine and have at least 5 years of full-time clinical practice experience. MDs with a few hundred hours of reading books or watching videos would not qualify. MD’s should have the full training standards established by the WHO not the limited standards plus the years of full time acupuncture practice.

        We hope to have one paper published by the end of this year that shows a clear separation between verum and sham acupuncture when at least 2 treatments a week were given for at least 6 weeks compared to trials that used less than this amount. I don’t feel at liberty to give more details as this study is part of a Ph.D. thesis currently under evaluation by one of our researchers. We hope to have another one published early next year looking further into the issue of treatment dosage in trials.

        As for claims about acupuncture even being quite conservative one could certainly say it is gaining acceptance within both human and veterinary mainstream medicine, some studies show it to be at least as effective and in some cases more effective than conventional care, and it has an excellent safety record. One could go much further depending on who is giving the information. I actually have a serious suggestion for those who say if acupuncture is in fact only placebo (something not argued much in veterinary medicine) then physicians should not refer or encourage their patients to use it. As an Acupuncturist, I am perfectly comfortable with a physician telling their patients that while acupuncture has shown itself to be clinically effective in many trials often those trials found it did not matter where the needles were placed so acupuncture may only be placebo. Then the patient can decide if they care whether or not the benefits from acupuncture are due to placebo and the physician has done nothing unethical. As someone who treats hundreds of people a year suffering a wide range of problems, I can tell you that when I tell my patient that skeptics think acupuncture is only placebo, they tell me they don’t care why it is working. They are just thankful to feel so much better, be getting their lives back and getting off all the drugs.

        • Matthew Bauer said:

          when I tell my patient that skeptics think acupuncture is only placebo, they tell me they don’t care why it is working.

          That hoary old chestnut. It’s a straw man: skeptics don’t think that any improvement is due only to placebo. But it gets to the nub of the whole problem: the inability to eliminate the far more mundane and probable causes for the improvement, instead, jumping to the conclusion that it was the pins and meridians wot did it.

        • some studies show it to be at least as effective and in some cases more effective than conventional care,

          Which ones? And how come that the world’s leading expert, Edzard Ernst, has not been informed of and/or impressed by these studies?

          and it has an excellent safety record.

          Isn’t that slightly inexpensive? Since there are no records, there can be no safety record. Furthermore, cases of minor and major damage caused by acupuncture are not exactly unheard of in the literature.

          say if acupuncture is in fact only placebo […] then physicians should not refer or encourage their patients to use it.

          Physicians should indeed not refer or encourage their patients to use it, in my opinion. However, the opinions with respect to placebos are divided. For good reasons. At a time when it was still reasonable to think that placebo effects are very important, it seemed rather cruel not to make use of them, although even then, there was a not-so-small group that thought that lying to patients is not acceptable, and not a very good basis for a trusting doctor-patient relationship either. Given that it takes a while to convince large groups and given that this is a judgment call, the consequences seem obvious, and my personal condemnation of the practice is not particularly likely to make this disappear any time soon.

          something not argued much in veterinary medicine

          Is that actually so? Veterinary medicine would be a prime candidate for placebo use. A priori, it would seem obvious that it is a lot easier to convince the owner of an animal that there is nothing wrong with the animal than it would be to convince the owner that there is nothing wrong with himself or herself. Also, even if it is indeed not argued much about, that is an obvious mistake. It should indeed be a very important subject. The same is true, perhaps to a somewhat different extent, for pediatrics and geriatrics.

          • Below are two studies that found acupuncture to be near or just above twice as effective as “conventional care” for chronic low back pain. While the so-called “real” acupuncture did not out preform the so-called “sham” acupuncture all were TWICE as effective as the therapy most people are prescribed for this very common problem. And what is “conventional care” for these patients? Mostly pain meds and PT. Most PT therapies have not been vigorously tested against some sort of placebo controls and the pain meds can be dangerous and addictive. The U.S. Centers for Disease Control has called the use of opioid medications the worst drug epidemic in the history of the U.S. and deaths from those has surpassed auto accidents as the leading cause of accidental deaths in adults. The most common pain medication in the world, acetaminophen, was found in a recent large RTC (story on this linked below) to be no more effective than placebo for acute low back pain and other recent studies found the harm caused by this drug may be worse than previously thought linking this medication to deaths, cardiovascular, renal, and gastrointestinal adverse events and the mechanism behind this drug’s pain relieving effects are largely unknown. So, acupuncture – real or sham – is twice as effective as the conventional care that can lead to addiction, death, and organ damage for this very common disorder that we spend billions treating. I can’t understand why anyone would feel they were being more ethical advising people to use the less effective and more dangerous “conventional care” for this disorder when acupuncture has been shown to be twice as effective and safer.

            As for acupuncture’s safety record, of course it is not without risk and that is why appropriate training is needed. There have been studies showing that acupuncture done by specialists with higher level training has a better safety record than when it is done by those without that level of training but both groups incidents of serious or fatal events is far below that of both prescription and OTC medications. In the U.S. where I am based, Acupuncturists are required to have malpractice insurance and claims are very low.

            1. Haake M, Müller HH, Schade-Brittinger C, et al. German acupuncture trials (GERAC) for chronic low back pain. Arch Intern Med. 2007;167(17):1892-1898. At 6 months, positive response rate was 47.6% in the real acupuncture group, 44.2% in the sham acupuncture group, and 27.4% in the conventional therapy group.
            2. Cherkin D, Sherman K, Avins A, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169(9):858-866 At eight weeks, mean dysfunction scores for the first three groups (individualized acupuncture, standardized acupuncture, simulated acupuncture) were 4.5, 4.5, and 4.4 points compared to 2.1 points for conventional care. Symptoms improved by 1.6 to 1.9 points in the first three groups and 0.7 in the conventional care group.
            http://www.medicalnewstoday.com/articles/290243.php

          • Given that my time is limited, but I still wanted to post a reply, it’ll have to be a terse one, based on cursory reading.

            Let’s assume for the sake of argument that these were flawless trials (I seem to remember this not to be the case, but let’s assume it for now), my conclusion would have to be the following:

            Something intriguing seems to be going on, but clearly, acupuncture is not the interesting part, since there is no real difference between “real” and “fake”. So, what do these two things have in common that they do not have in common with the other treatment? What makes the group of acupuncture style treatment different from the traditional treatment? I think that merits investigation, but if I were an acupuncturist, I would certainly not be excited about these studies.

          • Peter Deadman on Sunday 08 March 2015 at 19:47
            Here’s a few:

            And professor Ernst, who has made the study of alternology his life’s work, has somehow missed out on them? Or are they just as impressively unimpressive as other studies?

          • the thing is that one can find a handful of positive trials for almost any quackery. this is why wise men [and women] insist on systematic and critical assessments od THE TOTALITY of the available evidence. if we do this for acupuncture, there is precious little to write home about: http://www.ncbi.nlm.nih.gov/pubmed/21440191

          • I think that review is great, and it contains a lot of very interesting information.

            The serious adverse events and deaths are fascinating. It definitely puts the safety claims by acupuncturists in a different light. For something that has no demonstrable benefits it seems unacceptable, especially in view of the fact that there is no way of knowing how often these adverse events actually occur. I can’t help but wonder to what extent acupuncture (dis)services buyers are aware of the dangers. Would they be equally hysterical about acupuncture as they are about, say, paracetamol?

            I think that this says it nicely:

            In conclusion, many systematic reviews of acupuncture for pain management are available. Yet they only support few indications, and contradictions abound. Acupuncture remains associated with serious adverse effects.

            What I still can’t understand (or accept) is that quacks can apparently practice with impunity. Are they not “illegally practicing medicine”?

          • What I still can’t understand (or accept) is that quacks can apparently practice with impunity. Are they not “illegally practicing medicine”?

            Bit of a Catch-22. We can’t shout at them for practicing medicine illegally while also saying what they’re doing isn’t medicine 😉

          • Bit of a Catch-22. We can’t shout at them for practicing medicine illegally while also saying what they’re doing isn’t medicine 😉

            Good argument, but I would submit that what we say or do not say is not important here. They are claiming it. And what they claim is demonstrably untrue (since they are officially not qualified). They are swindlers. They should be caught and dealt with.

          • I like to ask people to think about a bucket of dice. If I throw a lot of dice, about 1/6th of them will come up with a 6. Not exactly 1/6th but about that. If I only throw 6 dice, the chances of just 1 is actually quite small (I think it’s just over 0.4 and the chance of 1 n in n rolls of an n-side die tends toward 1/e = 0.368 as n gets larger). But if I roll one die 6000 times, I’ll get about 1000 sixes and I can count them and conclude whether the number I get suggests that the die is fair or not. I’m not a statistician, but I’d be amazed to get no sixes or 500 sixes. That would make me worry about my die.

            But suppose I don’t look at all 6000 rolls. Let’s say I roll 36 dice a day for six months and look at each days results in turmn. Although my six month data shows the die is fair, I’ll bet that there’ll be a day in my six months where I don’t get any sixes, and another day where I get 12 or more – both WAY off the six I’d expect. Does that prove my die is loaded? NO! It doesn’t. Even though I can probably go through the 6 months of data and find a dozen times the die LOOKS to be unfair.

            This process is called cherry-picking. In any process with a random element, if you do it often enough, you’ll get an interesting result. You hear the term “statistically significant at p<0.05" a lot. This (most commonly) means "We'd only expect to see this result by chance one trial in twenty", – trials may use a different number, but 0.05 to 0.01 are fairly common. So what does this mean? Well, it means that if 20 researchers do the same trial on an intervention which doesn't work, there's a good chance one or more of them will get a positive result. It also means if I choose to do one trial but measure 20 things, there's a good chance one will pop up. If I do my functionless therapy and ask about headaches, nausea, rashes, joint paint, fatigue, bloating, constipation, diarrhoea, insomnia, asthma, hay fever, weakness, aching muscles, menstrual irregularities, dry eyes, dry mouth, ankle swelling, irritability, tension and backache there's a VERY good chance my trial will show my therapy affects one symptom at a statistically significant level. This is because my study is badly designed. If I said at the beginning "My therapy is good for backache", the result would have meaning but what I actually did is shoot an arrow in the barn door and paint a target around it.

            Unfortunately, a lot of research (both complimentary and conventional) has bad statistical design, although a lot of effort has been put into improving conventional research in recent years. This is why we regard some journals as being more reliable than others – their review process is more rigorous in looking for sources of error. A sad side-effect of the internet is that it's now really easy to set up a totally rubbish journal which provides the scientific equivalent of "vanity publishing". Submit a paper, pay a small fee and bingo! you've got a publication to put on your CV.

          • Edzard, please post the full text in pdf.

          • Prof. Ernst … you need to temper your language. A quack is by definition a person who dishonestly claims to have medical knowledge; a charlatan. Leaving aside your opinions about acupuncture for the moment, that is a stupendously ill-advised and arrogant dismissal of the hundreds of thousands of acupuncturists – including considerable numbers of MDs and doctors working in Chinese hospitals – who practise acupuncture. You set yourself up as a sceptical guru and acquire a few dedicated followers and then lose all sense of proportion. Regarding safety of acupuncture, you also know perfectly well that large UK and German studies of acupuncture as practised by qualified practitioners, found it to be substantially safe, with very few severe adverse events. Opinions are easy but history is long. Best to write in a way that you wouldn’t feel ashamed by your intemperance and over-certainty in 10, 50, 100 years.

          • and where exactly did I say that acupuncturists are quacks?

          • I quote you: “the thing is that one can find a handful of positive trials for almost any quackery”

          • and in your mind this means acupuncturists are quacks!?!?
            go home and learn to read properly!

          • If in a discussion of evidence for acupuncture, someone references positive studies and you respond “the thing is that one can find a handful of positive trials for almost any quackery” please explain how I am misreading this (or as you put it “go home and learn to read properly”) as anything other than saying acupuncture is quackery.

          • in a discussion about surgery, a surgeon show me a few studies suggestion that surgery is evidence-based. I am not impressed and answer “the thing is that one can find a handful of positive trials for almost any quackery”.
            GOT IT?

          • Perhaps this is because English is not your first language. To anyone with a decent grasp of the language there is no way of understanding your comment about quackery other than that you are including acupuncture in quackery. To argue otherwise is specious and presumably comes from the fact that you wrote in haste and are now trying to backtrack. The only other conclusion is that this exchange is an example of your unsound comprehension and reasoning powers.

          • POSSIBLY – OR IT COMES FROM YOUR FAILING TO GET A FAIRLY SIMPLE POINT. I just found this on your website which seems to suggest the latter possibility to me:
            “qigong helps to strengthen the body, especially the feet, knees, legs, hips, waist and back. By strengthening the lower body in this way, the Kidneys are tonified and agility and balance improved. Whilst the lower body is strong and full, the upper body is soft and relaxed, indeed softness and relaxation are the underlying principle of all qigong practice. This softness in the upper body helps to sink the qi, counteracting the tendency of yang qi to rise excessively – a design flaw of the warm yang body…” [http://peterdeadman.co.uk/why-i-practise-qigong/]

          • Well I’m sure all the other following this discussion can form their own opinions about what you said. We have an English expression, ‘when you’re in a hole stop digging’.

          • as English is not my native language, I have no idea what you mean.
            but I do agree that others will be able to make up their minds.

          • as English is not my native language, I have no idea what you mean.
            but I do agree that others will be able to make up their minds.

            One possible explanation: When you have been caught, don’t make it any worse for yourself by volunteering even more incriminating information.
            I submit that is what acupuncturists are doing all the time. They don’t have to, but they do. In their zeal to prove the doubters wrong, they are constantly strengthening the case against them by creating new nonsense. Psychics seem to be a lot smarter in this respect.

          • POSSIBLY – OR IT COMES FROM YOUR FAILING TO GET A FAIRLY SIMPLE POINT

            Given the meaningless gobbledygook many acupuncturists write on their websites, I would submit that this is a plausible hypothesis.

          • I am sure you know from your considerable medical knowledge that terminology is not always not it seems. We could fall about laughing at hearing a diagnosis of basin on fire disease but would not be laughing if it was us who had PID. When evaluating the terminology of a culturally different science, the respectful (and therefore respectable) person takes enough time to understand what it actually means.

          • I suggest it is because you made the connection and are now realising you freely admitted that acupuncture is quackery and acupuncturists are quacks. You indicted yourself. Don’t feel particularly stupid. It happens in “Columbo” all the time: https://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CB0QFjAA&url=http%3A%2F%2Fen.wikipedia.org%2Fwiki%2FColumbo&ei=Gub9VLbuLJK1sATyh4CADg&usg=AFQjCNH3fBG6vA6FE27X2cS_w6swDJupeg&sig2=AVdKO_S96U4dIjOWy23wqg&bvm=bv.87611401,d.aWw

          • go home and learn to read properly!

            I think we have a case of William Lane Craig style acupuncturist objectivity here:

            Acupuncturist: whatever I am saying, no matter how false, it is true.

          • I quote you: “the thing is that one can find a handful of positive trials for almost any quackery”

            In other words, you freely admit that acupuncture is quackery and that acupuncturists are quacks. Congratulations. Honesty is hard to come by these days, but you did it.

          • and where exactly did I say that acupuncturists are quacks?

            Nowhere, as far as I can tell. I also think it is not relevant, since many or most acupuncturists seem to be doing everything in their power to qualify, including some who are active on this very forum.

          • A quack is by definition a person who dishonestly claims to have medical knowledge; a charlatan. Leaving aside your opinions about acupuncture for the moment, that is a stupendously ill-advised and arrogant dismissal of the hundreds of thousands of acupuncturists – including considerable numbers of MDs and doctors working in Chinese hospitals – who practise acupuncture.

            Who’s definition? MacMillan dictionary:

            a doctor who is not very good, or someone who cheats people by pretending to be a doctor

            Reference: http://www.macmillandictionary.com/dictionary/american/quack_1#quack_4

            Oxford dictionaries:

            A person who dishonestly claims to have special knowledge and skill in some field, typically in medicine:
            [AS MODIFIER]: quack cures

            http://www.oxforddictionaries.com/us/definition/american_english/quack#quack-2

            My definition:

            If one is providing a treatment with demonstrable medical benefits, one is a provider of medical services. If the treatment has no demonstrable benefits, one is an entertainer. If one claims such benefits anyway, one is a quack.

            Just because you call that arrogant, does not make it untrue. I’m sure Bernie Madoff wasn’t all that pleased either when he got called names, but that didn’t change the facts.

            I suggest you be more honest and straightforward. Take an example from senator Dudley J. LeBlanc, who was far more transparent when he was asked what Hadacol was good for: “It was good for five and a half million for me last year.”

          • I agree with Peter. You wrote: “the thing is that one can find a handful of positive trials for almost any quackery. this is why wise men [and women] insist on systematic and critical assessments od THE TOTALITY of the available evidence. if we do this for acupuncture, there is precious little to write home about”

            And now you’re indignant that someone understood it as you equating acupuncture with quackery? Really?

          • yes, really!

          • I agree with Peter. You wrote: “the thing is that one can find a handful of positive trials for almost any quackery. this is why wise men [and women] insist on systematic and critical assessments od THE TOTALITY of the available evidence. if we do this for acupuncture, there is precious little to write home […]

            Please clarify. You agree with Peter, but you quote correctly and in so doing, you show that Edzard Ernst did NOT say the things Peter claims he did. Are you suggesting that Prof. Ernst should abstain from writing what is true, because you don’t like the conclusion you arrived at on that basis?

          • What I’m suggesting is that Peter Deadman is right. Anyone who reads the above paragraph will most likely conclude that the author equates acupuncture to quackery. So, for Edzard Ernst to claim that’s not what the paragraph implied is disingenuous.

          • In other words, the quack is always right, even or especially when he/she is wrong. I feel like I’m back in Jesuit school.

          • this is why wise men [and women] insist on systematic and critical assessments od THE TOTALITY of the available evidence.

            That seems to be a pretty universal rule. I recently watched a lecture by Alistair McGrath, christianity promoter, where he said this:

            Richard Dawkins says he is a tyrant. One answer might be that Richard Dawkins is talking about a god he has invented, rather than a god Christians actually know.

            McGrath can only get away with his claim of “a god christians actually know” in contrast with Richard Dawkins’ tyrant, if these christians choose to cherry pick their old and new testaments, and discard the torture and the genocide and all those other nice things.

            That’s why the scientific/skeptical method is so beautiful to me: it is simple, elegant and helps us to not delude ourselves. It may not always be pleasant, especially not if our preconceptions are being challenged, but once one has learned one does not have to prove anything, and simply strives to find out what is true, that apprehension completely disappears and one can always be excited at the possibility of learning something new.

    • You also mentioned in an earlier post that

      Bart – I wanted to respond to your needlessly mean spirited and completely uninformed characterization of an Acupuncturist as someone who needs no knowledge or effort and who makes people happy by just telling them want they want to hear and then rakes in the cash and that doctors have it tougher has they have to take responsibility for their patients. Such a caricature is not only insulting to Acupuncturists (which I guess you find to be fair game) it is also insulting to our patients. You know nothing about what takes place between a qualified Acupuncturist and their patients.

      In response, I have admitted that it is indeed quite possible that I am rather ignorant, and I have asked you to provide some information to enlighten me. You haven’t replied to my questions at all. Why is that?

      • Bart asked – “In response, I have admitted that it is indeed quite possible that I am rather ignorant, and I have asked you to provide some information to enlighten me. You haven’t replied to my questions at all. Why is that?”

        Time constraints. I am more than happy to have actual constructive dialog and answer all serious questions. I will refrain from snark if others do the same. Please remind me of your questions as I got a bit lost with so many comments.

        • Time constraints. I am more than happy to have actual constructive dialog and answer all serious questions

          Fair enough. My time is limited as well.

          If I am wrong, and I most certainly may be, it has been, after all, well over 3 decades since last I set foot on UK soil,
          could you tell me what the requirements are to establish oneself as an acupuncturist in the UK?

          Let’s assume for the sake of argument and to frame the issue that I am about to finish high school and that I would love to open an acupuncture practice next to my favourite book store, Foyles (if they still exist).
          1. What does UK law require me to do and,
          2. after that, what would you advise me – if anything – to do on top of that?
          3. Could you provide links to the appropriate government websites, acupuncture organisation websites, acupuncture school websites…

          I am sure, I am not the only one interested in learning this, and as the president of an organisation that promotes acupuncture, you are certainly in an excellent position to provide that information.

          Thank you.

          • I am sorry I am not that knowledgeable about acupuncture regulation and education in the U.K. as I am in the U.S. and only know our regulations here well. The organization I work with is in the process now of compiling authoritative information on many aspects of acupuncture practice and regulation in many countries and hope to have a good database of this in the next 6-12 months. The little I do know about acupuncture regulation and education in the U.K. is that it is one of several countries whose government unfortunately has not seen fit to regulate but actually allows anyone to do acupuncture without any required training. Responsible Acupuncturists there have established honours degree level training programs and organizations for voluntary registration the largest of these being the British Acupuncture Council (their website is linked below). In other words, they try to assure that there are well trained and regulated Acupuncturists available to the public despite the government’s refusal to recognize and regulate Acupuncturists as they do with other health care professionals. This is quite unlike what we have in the U.S. where no one is allowed to preform acupuncture unless they are a licensed health care professional. Unfortunately, even in the U.S. where we have strict standards for the education, licensing, and regulation of the practice of acupuncture specialists (usually titled Licensed Acupuncturist) the several other health care professionals who have acupuncture in their scope of practice are not required to take any independently accredited education or pass any examinations regulated by independent accredited agencies. My understanding is some countries do not want to establish regulation for Acupuncturists because they think that will make it seem like they are officially recognizing acupuncture as a legitimate therapy. So, despite acupuncture being introduced and growing in the West, the means by which we can assure those preforming this therapy have adequate training has been greatly hindered. When critics call us quacks and ridicule our level education and lack of professionalism this has made it so much harder for us who advocate for adequate training and regulation. This lowering of the bar to practice acupuncture means too many practicing it don’t get the results they could have with better training in both research and practice.

            http://www.acupuncture.org.uk/index.php?option=com_content&view=featured&Itemid=21

          • Fair enough. You may, however, make it more clear on the website that you are a US club, not a UK or international one. I did not find any address, not even on the contact page. That makes you look like a swindle site. If you aren’t, you should correct that oversight as soon as you can, because I am sure I am not the only one who notices these obvious alarm signals.

            I agree with the countries that do not want to regulate out of fear of giving legitimacy to an unproven therapy. Once again, we hear all types of lofty claims, but no consistent, independently replicable and verifiable evidence. That is why acupuncturists are considered quacks by many, including myself. The big problem is right there in the open: it is one thing not to have evidence, but claiming fantastic results in spite of the absence of evidence, kicks it all up to a whole different quacklevel.

            As I say in my Google profile:

            If one is providing a treatment with demonstrable medical benefits, one is a provider of medical services. If the treatment has no demonstrable benefits, one is an entertainer. If one claims such benefits anyway, one is a quack.

  • @ jm & Bart B. Van Bockstaele
    Re funding: I wasn’t saying that there’s no money to be made from acupuncture but that there’s no commercial incentive to do good trials on it – if fact the opposite.

    @ Sasha
    Yes i agree that primary prevention with statins and stents for stable coronary disease are over-used but this is mainly in the US where incentives are high.

    Re tratment vs. no treatment: as DC pointed out above (Tuesday 03 March 2015 at 20:10) the placebo effect, while important in proper statistical analysis of a specific mechanism of action (eg pharmacological) are not generally strong enough to be a useful treatment in themselves. So, if acupuncture vs. no treatment is wildly successful (and observer bias etc. has been excluded) then the conventional medical community should get on with finding out what component is important. So different placebos have to be chosen to tease out particular parts of the overall treatment as being important. For example, if sham acupuncture works almost as well as the “expert” version then the valuable part of the process is what they have in common: the puncturing or the sensation or the ceremony involved or even the simple fact of one-to-one personal interaction.
    We shouldn’t lose sight of the fact that a benefit that is reproducibly significant should be harnessed in conventional medicine. My concern is that the mechanistic approach to medicine can miss the point that what is a problem for research can also be a powerful ally in therapeutics.

    • Jonathan Pitts Crick said:

      Re funding: I wasn’t saying that there’s no money to be made from acupuncture but that there’s no commercial incentive to do good trials on it – if fact the opposite.

      What about the moral imperative of being able to demonstrate that your treatment is doing more good than harm?

      • The impression I have is that alternologists and quacks think that moral imperatives are something only medical practitioners should take into account, and that they themselves are exempt from that, for reasons they don’t seem eager to divulge.

    • Re funding: I wasn’t saying that there’s no money to be made from acupuncture but that there’s no commercial incentive to do good trials on it – if fact the opposite.

      Excellent point. Boiron, the world’s largest manufacturer of homoeopathy publicly admitted
      this very fact a few years ago here in Canada by stating that there hasn’t been
      a lot of demand for clinical studies. That is, of course, not the only reason, and not even the most important one, but we have no reasons to doubt that admission, and since it is an admission by the company, not outside speculation, it is an important point (link: http://youtu.be/8cA_oGiNTOk?t=8m22s). Big Placebo thrives in a world of uncertainty and ignorance, the same environment religion and any other evidence-free beliefs
      and their purveyors thrive in. This can easily be seen in the comments here as
      well. When alternology and quackery are criticised, their promoters tend to
      attack the messengers, not the message. For good reason. If they attack the
      message, they can’t win, and their game isn’t about what is true or what is best
      for people. It is about making money. The victims be damned.

  • “their game isn’t about what is true or what is best for people. It is about making money.”
    I think you are being over-cynical about people’s intentions. In my experience the practitioners of even the most wacky therapies firmly believe in their techniques and this is re-inforced by positive feedback (in both senses) from their patients. Being basically non-scientists this is “evidence enough” for them. Their self belief and genuine concern for the patients are IMO the strongest drivers of the placebo effect.

    Cynical charlatans obviously exist and can be successful for a while but human intuition usualy rumbles them eventually.

    • I think you are being over-cynical about people’s intentions.

      Perhaps, but since I lack the ability of looking into people’s heads and see what they are actually thinking, the doubt about their intentions will always remain and those doubts can only be strengthened by observation.

      There are several elements that make me doubt the good intentions of many alternologists and quacks. What Boiron says, “There hasn’t been a lot of demand for clinical studies”. doesn’t seem to indicate sincere belief. First of all, depending on what “a lot” means, it seems either rather convenient or a blatant lie, and given that they mention “research ” on their home page, I think there is at least a basis to suspect an intentional swindle, even if it is not absolute proof. It seems stretching plausibility beyond its limits when one does not at least suspect some less-than-noble motives.

      Dr. Oz, certified medical doctor, is on record raving about “miracle pills” *and* admitting in a more skeptical setting that he has no evidence.

      Matthew Bauer, acupuncture promoter, says here I know nothing about acupuncture, which may of course be true or not far from it, but offers no evidence and does not seem to deem it necessary to set the record straight, even when asked.

      Beth Acampora, does pretty much the same thing, spraying a lot of vitriol, but offering any verifiable evidence, and answers to reasonable questions do not seem to be forthcoming. Yet, she seems to have no problems writing the most preposterous nonsense on her website.

      “Sasha” is very active, and sometimes even has comments that are not totally devoid of truth, but offers no evidence for acupuncture and seems to think that criticising medicine, rightly or not, is the correct answer to questions about acupuncture.

      Harriet Hall, wrote for Oprah Magazine and/or the Oprah website, but that co-operation was of a very short duration. Why?

      It is, of course, possible that these just happen to be the few bad apples in an orchard of well-intentioned ones, but wouldn’t this be rather extraordinarily improbable?

      I am certainly open-minded enough to accept to look at evidence that these people are well-intentioned but, so far, though the elements presented here are hardly undeniable proof, they do at least suggest that the intentions are going in the opposite direction.

      • OK accepting that there are a good number rogues out there I think that you should also recognise that in the general population there is a strong thread thread of out-and-out disbelief in the scientific method – even that it is a sinister plot by “the establishment” to fool the public for commercial or political purposes. We may feel quite the opposite: that scientific method is the main protection against being fooled – but we are in a small minority. So it’s not surprising that a lot of alternative therapists hold the “truth as revealed to me” world view, and so do our patients.

        My whole thesis is that those in mainstream medicine should do it better than the quacks i.e. use the best of scientific method as well as the personal interest, support and reasonable conviction in the effectiveness of our proposed treatments to maximise the non-pharmacological benefits, not denigrate them as “just” placebo effect.

        • the general population there is a strong thread thread of out-and-out disbelief in the scientific method – even that it is a sinister plot by “the establishment” to fool the public for commercial or political purposes.

          That is unfortunately so. Not even a retarded ostrich can deny this. It is also one of the things quacks, perhaps almost universally, are feeding on.
          It is why I keep whining about teaching children the skeptical/scientific method from the youngest age possible.

          My whole thesis is that those in mainstream medicine should do it better than the quacks

          And they do, not just a little either, but rather spectacularly so. I think it can become even better, by eliminating the double standard:

          A television maker who systematically sells television sets that don’t work, gets in trouble. A pharma product that doesn’t work is investigated and eventually disappears from the market, with the company left to pay gigantic fines. An acupuncturist who is utterly unable to show that her/his practices have any beneficial effect at all, is allowed to continue. A priest who claims God loves you and heals everything, even though there is not a shred of evidence, is allowed to continue. Why?

          I am advocating that any product/action for which health benefits are claimed, must be required to prove it beyond the reasonable doubt. It makes no sense that, say, Aspirin, is held to standards higher than, say, acupuncture. You make the claim? You prove it and/or provide references to such proof You can’t? You recant your claims, retract your product, return the money you took from your victims. You don’t? You suffer the consequences. It simply makes no sense at all that quacks can get away with claims that are unsubstantiated.

          That will not eliminate quackery, not by a long shot, but it will at least give us a basis to act on.

          There are no benefits to treatments that don’t have benefits, except to the wallets of the purveyors. There is nothing wrong with this. I watch Star Trek. Because I love it, not because it has health benefits. Other people eat chocolates, because they love them, not because they have health benefits, and other people climb Mount Everest, definitely not for the health benefits. If you want people to turn your skin into a sieve, all the power to you, but the quack selling you the treatment is not to make any unfounded health claims.

          It is no more complicated than that. People (adults) should be free to do to themselves and order to have done to themselves whatever they want, but the people performing those acts should not be allowed to make unsubstantiated health claims.

          If a treatment has health benefits, these benefits are demonstrable. If they are not, they don’t exist. That does not entirely exclude the possibility that some benefits go undetected, but it most definitely means that those undetected benefits are so unimportant that they are not worth being detected.

          If one is providing a treatment with demonstrable medical benefits, one is a provider of medical services. If one is providing a treatment that has no such benefits, one is an entertainer. If one claims medical benefits that cannot be proven, one is a quack.

          People’s health is too important to toy with it.

          • Hi Bart,

            “I am advocating that any product/action for which health benefits are claimed, must be required to prove it beyond the reasonable doubt.”

            I don’t think it should stop there. When writing a prescription, the prescriber should educate the patient about the medication – the process it has to go through, including patents & the side effect disclosure process once a medicine gets approval for use, but before it’s out of patent.

            The prescriber should also mention that for new drugs, there is no data on long term effects beyond a reasonable doubt. Nothing inherently good or bad about that, but prescribers should be clear when they utilize new age medications.

            After all, people’s health is too important to toy with it.

          • I don’t think it should stop there.

            No it shouldn’t. And for real medications it doesn’t. I suggest you read the information all patients must receive. Not as ordered by some future legislation, but as ordered by current legislation. Let’s take an example of one of the newer treatments out there: Tecfidera for multiple sclerosis: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002601/WC500162069.pdf

            Pages 43-49 contain information every patient in the EU MUST receive. The information has been specifically written to make it as easy to understand as possible.

            It would be delighted if the quacks were required to do the same. Imagine how acupuncture patients will react when they read about bruises, fainting, infections, collapsed lungs, damaged hearts… for no demonstrable benefits. They might think twice before they accept. It would make life for real doctors substantially easier. It would increase the probability that patients get the best treatment available for their condition.

          • Bart – your acupuncturist doesn’t go over potential risks with you before treatment? That’s odd…you should find a different one. Even though the greater risk is probably an allergic reaction to the hand soap in the bathroom…they should still tell you there’s a risk. However small.

            Thanks for the heads up on the EU approach to medications. Next time I need meds for something, I’ll fly on over. I bet docs in Europe might even have to tell you if they’re making the prescription off label, too. Sadly, not in the US.

            “They might think twice before they accept.” Good point. I now think twice before taking ibuprophen, after actually reading the insert. Holy crap. Talk about a risk/benefit ratio that’s a bit askew. It’s amazing you can buy that stuff over the counter. I’m certainly glad you can…but it is amazing.

          • I would not know. I don’t go to acupuncturists, because I do not like people who make claims they cannot substantiate.

            As for Ibuprofen and any other medicine: the side effects mentioned are *possible* side effects. Just because they are mentioned does not mean you will get them. Most side effects are both rare and mild, but they may not be, sometimes. You make a good point though: many people are so uneducated that when they read the leaflets they think they are going to die from acute poisoning. Which of course, is rather unlikely.

            However, people should take medications seriously. Medications are generally very safe IF AND ONLY IF taken as required. Safe does not mean one should eat them like candy. After all, cars are safe too, but if you drink yourself silly and then drive blindfolded over the freeway, your chances for survival are not great.

            The information is provided for a reason. I realise that many people think it is beneath them to read it, but that is beyond stupid: the information is not provided for entertainment. Reading it is not optional.

            Similar requirements exist in the US: https://www.google.ca/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=site%3Afda.gov%20%22package%20insert%22

          • Bart – “I would not know. I don’t go to acupuncturists, because I do not like people who make claims they cannot substantiate.” So basically, your claim about acupuncture patients not being informed about the risks is unsubstantiated.

            “As for Ibuprofen and any other medicine: the side effects mentioned are *possible* side effects. Just because they are mentioned does not mean you will get them.” Same with acupuncture and all other treatment modalities, as it turns out. Go figure.

          • Bart – “I would not know. I don’t go to acupuncturists, because I do not like people who make claims they cannot substantiate.” So basically, your claim about acupuncture patients not being informed about the risks is unsubstantiated.

            Perhaps, but if we assume that these acupuncture customers *are* informed: i.e. no demonstrable benefits, but well-documented evidence of harm up to and including death, we have to tentatively conclude that acupuncturists are targeting particularly vulnerable people.

            “As for Ibuprofen and any other medicine: the side effects mentioned are *possible* side effects. Just because they are mentioned does not mean you will get them.” Same with acupuncture and all other treatment modalities, as it turns out. Go figure.

            The difference being that there are demonstrable and demonstrated benefits attached to Ibuprofen, and that informing the patient is not a matter of choice but one of law. I’d suggest that the difference is not negligible.

        • There is indeed an out-and-out disbelief in the scientific method; but this disbelief is highly selective. People seem to have no problems with the technological spin-offs from science — cars, aeroplanes, televisions, computers, smart phones, space travel and the rest — but they distrust, among others, genetically modified plants (but not medicines such as insulin that are produced from genetically modified organisms). They readily accept the latest science news if it tells them that specific foods or drinks are good or bad for you, even when a glance at the scientific source of such information shows that such effects are very tiny to non-existent in most cases. Yet they are not so sure about the science when it comes to matters such as global warming. And very many obviously disbelieve the science showing that it’s dangerous to smoke and to use mobile phones when you’re driving.
           
          In other words, people are in truth highly selective in their disbelief of science. Which suggests they don’t really understand science properly at all; they are all working on a curious mixture of the things that were instilled in them when they were very young, and the things that seem obvious (even when such ‘common sense’ is very wrong). The impact of the post hoc ergo propter hoc rationalization is amazingly potent, and fuels most, if not all, superstitions (see Skinner’s pigeon experiments from the 1930s). It undoubtedly fuels most belief in ridiculous medical claims. People commonly lack any sense of self criticism. If they ‘know’ something is true from personal experience, it is unlikely they can be persuaded away from that view. Hence, religious beliefs, confidence in absurd forms of medical ‘therapies’, racism, sexism, and many of the other ‘points of view’ that blight human behaviour.
           
          But there is one other important factor: the severity of disease. Most of the people who happily avail themselves of the various forms of witchcraft that concern Edzard Ernst’s blog posts (as opposed to those who offer the nonsense for sale) have either little or nothing wrong with them, or they suffer one or more forms of chronic pain. People usually reject any diagnosis of psychosomatic causes of their symptoms, even though such everyday things as blushing, weeping, goose pimples and sexual arousal are all examples of psychosomatic effects. Symptoms of psychosomatic origin will respond well to empathetic care from a third party — probably a better response than to any medical treatment.
           
          However, when the same people suffer serious trauma, or infection, or other unequivocal acute pathologies, suddenly they no longer request the camomile teas, the acupuncture needles and the spinal manipulations: they want the blood tests and the scans, the surgery and the pharmaceuticals. The few who maintain their insistence that they can be cured by homeopathy or ear candling or reiki or faith healing or other snake oils merely provide business for the manufacturers of wooden caskets.
           
          There is one glaring exception among serious illnesses — the many different forms of cancer. These are rarely acute conditions; in a lot of cases they can be chronic and debilitating illnesses. And cancer treatments in many forms of the disease still leave medicine shrugging its shoulders helplessly. No-one can blame those who suffer in this way for clutching at straws when they suffer from long-acting, incurable disease. The shame in such circumstances falls entirely on the shoulders of those who avidly sell their quack nonsense to such desperate people.
           
          Human nature lets us all down, a lot of the time. Science has gone a long way to showing what’s true and what’s not true in our world, but in too many circumstances people still lack the openness of mind that’s needed to distinguish convictions from reality.