MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Guest post by Frank Van der Kooy

Some serious flaws in the scientific reporting of two acupuncture clinical trials, for the treatment of infertility and allergic rhinitis, were recently published on this blog. The overly positive way in which the researchers made their mostly negative results public, was also of concern. Both these studies were published by the researcher of the year, Prof Caroline Smith, of the National Institute of Complementary Medicine (NICM), Australia. The stream of comments and discussions that followed made me think of another commonly overlooked aspect when it comes to acupuncture clinical trials. Conflict of interest! In both these studies the authors declared to have no conflicts of interest and in other studies by this author this also seems to be the case. The question can be asked: If you are a practicing acupuncturist who runs a clinical trial of acupuncture, isn’t that, by default, a serious conflict of interest? The intention of this article is not an in-depth discussion of what a conflict of interest is, but rather to compare medical doctors with acupuncturists turned researchers. Let me explain.

Some medical doctors (GPs, surgeons etc.) decide to leave their practice after practicing 10-20 years to become full time researchers (and visa versa). Universities accept these people with open arms because they bring with them a wealth of knowledge regarding the practical side of medicine and healthcare in general. They are thus seen as an asset to any medical research project including clinical trials. Can the same be said about an acupuncturist? They also bring with them years of experience and thus they should also be a major asset to any acupuncture clinical trial. But I am afraid not!

Why? Medical doctors have a multitude of tools (drugs, surgical procedures, diagnostic tools etc.) at their disposal to treat all types of medical conditions. When will their background constitute a conflict of interest? When they publish a positive clinical trial of a specific medical intervention in which they have a vested interest. e.g owning shares in the company producing the medical intervention (financial interest) or if they have been staunch supporters of this intervention during their years of practice (emotional interest). Just imagine that you have prescribed a specific intervention to hundreds of patients over a long period of time, and you swore by it, and now you have to face them with a negative clinical trial result – that will be difficult. The former is easy to declare whilst the latter might be slightly more difficult.

Doctors also tend to focus on a specific disease e.g. cancer and will perform research with the existing tools at their disposal but also try to find new tools in order to improve the risk-benefit profile of the disease treatment. Thus, for a doctor there is the possibility that they might run into a conflict of interest, but due to the multitude of medical interventions out there this is by no means a given.

What about acupuncture practitioners turned researchers? An acupuncturist only has one tool at their disposal to treat all medical conditions. I can hear them say; but we stick needles in different places and depths etc. depending on the medical condition! Yes, but the fact remains that they can only stick needles into people – and that is a single intervention. So is this by default a conflict of interest? I would argue, yes, it is like having only one drug to treat all medical conditions. If you have treated hundreds of patients for various medical conditions with acupuncture and now suddenly you publish a negative clinical trial, you will not only be red faced when you run into your former patients – who paid for your evidence based acupuncture treatment – they might even sue you for misleading them. As an acupuncturist, you cannot allow the single tool that you have to be ineffective, otherwise people might start to question acupuncture. The fact that they have to protect acupuncture means that an acupuncturist will by default have a conflict of interest – no matter what medical condition they aim to treat.

If you have been emotionally and financially invested in acupuncture as a cure-all for 10-20 years, it will be very difficult, if not impossible, to publish a negative result as an acupuncture researcher.

Another aspect is that the acupuncture fraternity is a very tight knit community, where negative results are frowned upon because of everyone’s financial and emotional interests. Surely they will expel you from this community, if you publish negative results?

So how do acupuncture researchers go about running clinical trials? An example: Professors Smith and Bensoussan, both at the NICM, are currently registered as practicing acupuncturists. This means that they can legally practice acupuncture and, because they have been active for decades, they are also well known in the acupuncture fraternity. It is unknown, whether they are still actively practicing in their own practice or part-time in someone else’s practice, or if they have a financial stake in their former or someone else’s practice. Based on the fact that they are still registered as active acupuncturists, I can conclude that they do have an emotional and/or financial interest in the positive outcome of their acupuncture clinical trials.

Because of this inherent conflict of interest, and due to current strict clinical trial regulations, which makes it quite difficult (although not impossible) to fabricate or falsify data, they go for the next best thing – which is the design of their clinical trial e.g. the A+B versus A design. But it doesn’t stop there. As soon as a clinical trial fails to give a positive result, the results will be inflated to make it sound positive.

Why? Because they must prevent themselves from cognitive dissonance, they need to protect the single tool that they have, they must keep the acupuncture fraternity happy and they have to protect themselves against potential lawsuits from former (current) patients or a decrease in patient numbers (and thus financial income). On top of that – how would the media and the public react to an acupuncture clinical trial if the lead researcher declare that they have their own acupuncture clinic?  Surely these factors together amount to a conflict of interest and should be declared as such?

So what, in this context, is the main difference between a doctor and an acupuncturist? A doctor has a multitude of medical interventions. He or she might have a conflict of interest, if they work on a specific intervention in which they have a vested interest. An acupuncturist only has one intervention and therefore they have a vested interest by default – which they never seem to declare!

 

52 Responses to Conflicts of Interest: Is there a difference between Doctors and Acupuncturists turned researchers?

  • Ditto homeopaths, chiropractors, osteopaths, reflexologists, reiki…

  • I am an acupuncturist I would agree that there are potential conflicts of interest, but these are not limited to our profession. To be fair, I would also say that members of the sceptic community could have just as many potential conflicts of interest. I don’t mean this as an attack on the sceptic community, but I felt a discussion on this topic isn’t well-rounded without pointing out the potential conflicts of both parties.

    Wouldn’t a sceptic, especially one involved in research and especially those with a significant presence in the media have a vested interest in seeing more negative results regarding CAM research published? I would think so. Another potential conflict might be the source of funding for the research being done by the sceptic.

    Regarding your comments about the acupuncture “fraternity”, couldn’t one say the same about the sceptic “fraternity”? and that it might also be a very tight knit community, where positive results are frowned upon because of everyone’s financial and emotional interests. Surely they will expel you from this community, if you publish negative results?

    I would also like to point out that I have never met an acupuncturist who sees it as a “cure-all” and I certainly don’t. I’m sure there are some, but sweeping allegations like this are not accurate.

    • Another difference, one that I haven’t even pointed out, is that doctors tend to do research on things that are known to work – things based in science. Whereas acupuncturists, and the like, work with things that are known not to work – things that are not based in science. So my vested interest as an sceptic is to make sure that the public know what works and what doesn’t. (This blog post did have some interesting links which is unfortunately missing in the current version).

    • Doug, I would be delighted if one or more branches of alt-med could actually cure diseases that medicine is thus far unable to cure. I’m a skeptic who has a vested interest in ending diseases and the misery that they cause. Alt-med that actually works is not called alternative medicine, it is called medicine.

      What I thoroughly detest is the core alt-med modus operandi, which is providing unproven ‘treatments’, for a plethora of conditions (including many fabricated conditions), to the most vulnerable members of society: the chronically ill who have become so desperate that they are willing to pay what little money they have to anyone who provides them with false hope. False hope does temporarily improve subjective quality of life [general well-being] scores for the duration that the client believes they are taking control of their illness, or devolving control to their alt-med practitioner, which is a wonderful respite from the horrible truth that their incurable illness is devastating their quality of life. This aspect alone means that all branches of alt-med, on average, will score higher than the no treatment control group.

      Similarly, a going on holiday group would score higher than a didn’t go on holiday control group. Every alt-med practitioner who goes away on holiday is testimony to the fact that holidays are more effective for well-being than is the branch(es) of alt-med that they practise.

    • All good research scientists are skeptics. Scepticism is merely the formulation of the scientific method. By talking about skeptics and acupuncturists and/or any other alt med as different sides you are disclosing Prof. Ernst’s point that acupuncturists cannot do good research.

      Why would a researcher have a vested interest in seeing alt med fail? In medicine, a great number of drugs have been obtained from herbalism. The problem is that it is mainly those which are inactive for claimed disease states remain. Not even that is an insurmountable barrier as the artemisinin anti-malarial shows.

      Showing a significant and consistent effect for acupuncture would be surprising but not impossible. It would require high quality clinical trials with adequate controls but these are apparently unavailable. Why is this? Are acupuncturists hopelessly mired in their belief system or could it be that not being trained in clinical trial methodology their are amateurs at it. My own view is that it is a combination of both.

      You make a veiled attempt to smear researchers by alluding to financial interests, perhaps you can be more specific. Scientists look for novelty, overturning the existing theory is the dream. However, to do so requires exceptional evidence because so much of science is now linked.

  • Frank, when you say things based on science, what exactly do you mean? If I insert a needle into the body to stimulate the nervous system or fascia and thereby influence the physiology of the body to induce some sort of therapeutic effect, how is this not scientific? Are you saying the nervous system and physiology don’t work or are unscientific?

    There is very little evidence to support most medical interventions, many medications are prescribed for off-label use and just as many have an unknown mechanisms of action. How is this scientific? Why are you not sceptical about this?

    Pete, I hear this statement all of the time that “Alt-med that actually works is not called alternative medicine, it is called medicine”, but it’s simply not true. I know the the sceptic community would like to believe that acupuncturists are a highly-organized unethical group of satanic charlatans praying on delusional patients, but a lot of people I’m sure think the same way about the sceptic community. Have you ever taken a family holiday? Sometimes it could be less stressful to be in the control group.

    If you really want to help people and end disease, like you say, why don’t you develop a treatment that works better and put all of us acupuncturists and CAM practitioners out of business?

    • @Doug,

      Why don’t CAM practitioners visit other CAM practitioners, instead of going on holiday? According to CAM practitioners, their treatments are safer than travelling by car to an airport, plus, they claim that their treatments are more effective than going on holiday.

      “If you really want to help people and end disease, like you say, why don’t you develop a treatment that works better and put all of us acupuncturists and CAM practitioners out of business?”

      I have developed a treatment that would not only be effective for a very large number of people, it would keep all CAM practitioners *in* business. If every CAM practitioner would simply open their mind wide enough to embrace all of the other branches of CAM, then each practitioner would see the true benefit of having regular treatments from all the other CAM practitioners in their locale. Seriously, it is impossible to be a good acupuncturist unless you are regularly attuned by at least the following: a Reiki Master; a homeopath; a reflexologist; an aromatherapist; and a nutritionist. If you feel the need to be provided with solid evidence for my assertion, then you are in dire need of booking an appointment with an applied kinesiologist.

      • Peter, thanks for showing your true self and your level of maturity.

      • Doug,

        The nervous system, and for that matter the whole human body, has been studied and researched for millennia using the scientific method. Many mistakes were made in the past and we still do not know everything. But at least this is what I call scientific. This hard work, and all the benefits that it has brought us, is now being replaced by energy flow through meridians which is a non observable and un-testable entity. To use needles to influence this “energy flow” is unscientific. Using non related scientific facts to “validate” unscientific treatments is an old trick and tends to work on many people. My former employer even used the quantum physical properties of light to explain the existence of “energy” flow through meridians -he has done it very well but just not good enough. Please see the link below.

        As for the statement that very few conventional medicine is evidence based is also a fallacy. You have to distinguish between “how” something works and “if” something works. You do not need to know how something works (mechanism of action) but you need to know that it works and that it is safe to use. If you know of anything that doesn’t work, in conventional medicine, and the public is being hoodwinked, then it is your responsibility to write a letter to the regulatory agencies in order to correct this wrong – that is what skeptics do.

        https://frankvanderkooy.wordpress.com/2016/02/23/misleading-the-public-complementary-medicine-at-universities-part-2

        • Frank van der Kooy said:

          This hard work, and all the benefits that it has brought us, is now being replaced by energy flow through meridians which is a non observable and un-testable entity. To use needles to influence this “energy flow” is unscientific.

          It’s never been clear to my how sticking needles into someone (at whatever depth and for whatever time, with or without twiddling) always manages to unblock the flow of qi, never to make things worse.

          It’s like homeopathy, where the magic water/sugar always manages to heal but never, ever harm.

          It’s like chiropractic, where the adjustments that are supposed to bring vertebrae back into alignment can never be over-adjusted and cause disease…

          • Alan, thanks for building some straw men in the middle of the conversation. I’m not sure what to do with it.

            “It’s never been clear to my how sticking needles into someone (at whatever depth and for whatever time, with or without twiddling) always manages to unblock the flow of qi,never to make things worse.” Who said this, exactly?

            Qi, sugar water, homeopathy, chiropractic… anything else irrelevant to the conversation you would like to add?

          • Doug

            They would only have been straw men if they were used in an attempt to refute your argument. They weren’t: they were an addition to the conversation, inspired by Frank’s mention of meridians and energy.

          • “It’s never been clear to my how sticking needles into someone (at whatever depth and for whatever time, with or without twiddling) always manages to unblock the flow of qi, never to make things worse.”

            Here you go, Alan:
            http://www.amazon.com/Huang-Nei-Jing-Wen-Translation/dp/0520266986/ref=sr_1_1?ie=UTF8&qid=1465138783&sr=8-1&keywords=unschuld+su+wen

            A big part of the book seems to be on how things can go wrong, or “make things worse”. There’s also quite a bit on avoiding “whatever”, and will clear up your misunderstanding about “always manages”.

            Hopefully you didn’t buy any bridges from whoever gave you your info on acupuncture.

          • jm said:

            A big part of the book seems to be on how things can go wrong, or “make things worse”.

            The British Acupuncture Council say, “Acupuncture is one of the safest medical treatments…” and their website dedicated to safety, Acupuncture Safety Resource doesn’t seem to mention anything about acupuncture making things worse.

            One acupuncture teaching establishment says:

            Harms

            Harms associated with acupuncture can be listed as risks of the following:

            * Infection
            * Lesions including organ, vascular, and nerve puncture injury
            * Bleeding
            * Broken and migrating needle

            Negligence is involved in almost all cases of infection, organ or vascular puncture, bleeding and broken or migrating needle. Some infections and lesions are rare unexpected complications that might be avoided in the future.

            This list of harms seems to be the rather obvious and well-understood physical harms from sticking needles in someone but it doesn’t seem to include one for “making qi worse” or “manipulating qi in the wrong way”…

            Are customers adequately warned about the possibility that acupuncture could “make things worse”?

          • “This list of harms seems to be the rather obvious and well-understood physical harms from sticking needles in someone but it doesn’t seem to include one for “making qi worse” or “manipulating qi in the wrong way”…

            It’s rather obvious and well-understood that the list of harms IS a list of “making qi worse” or “manipulating qi in the wrong way”. Or were you just trying to be funny?

            “Are customers adequately warned about the possibility that acupuncture could “make things worse”?”

            Yup.

          • jm said:

            It’s rather obvious and well-understood that the list of harms IS a list of “making qi worse” or “manipulating qi in the wrong way”.

            Odd. Wikipedia says qi meant “life force energy (qi) flowing through meridians”. It does say that “many modern practitioners no longer support” it, but expanding the meaning of qi to encompass infection, lesions including organ, vascular, and nerve puncture injury, bleeding and broken and migrating needles, is something even Humpty Dumpty would be proud of, don’t you think?

          • “Odd. Wikipedia says…”

            Alan, I think you’re ready to add YouTube to your research library. Perhaps there, you can track down the elusive meaning of qi that you seem to quest for. It’s crazy how that one little word gets around, eh?

            There’s also probably a video or two where someone explains very basic Chinese medicine diagnosis. Actually, that’s probably on Wikipedia, too. And in the book I linked to. Good hunting!

          • jm said:

            “Odd. Wikipedia says…”

            Alan, I think you’re ready to add YouTube to your research library. Perhaps there, you can track down the elusive meaning of qi that you seem to quest for. It’s crazy how that one little word gets around, eh?

            Now that is very odd indeed…

            I was just following this expert advice:

            For further reading you could do worse than look at the wikipedia entry for acupuncture http://en.wikipedia.org/wiki/Acupuncture which offers a relatively sound overview of both qi and acupuncture practice.

            That’s a direct quote from the British Acupuncture Council.

            Are they wrong?

          • “Are they wrong?”

            I think they are spot on with that one – you could definitely do a lot worse than that link. Then again, you could do a lot better, too. (But we’ve talked about that before…you already have more than enough resources to get you started.)

            Again, good hunting! (cue the Clouseau music)

          • Ah, jm. You fail to address the actual argument… but glad you agree Wikipedia is good.

            Is the meaning of the word ‘qi’ so broad (now) as to include injuries caused by tripping on the frayed carpet as a customer leaves the acupuncturist’s shop? Or do you hold with the BAcC’s silly superstring theory of qi? Or Humpty Dumpty’s?

          • @ jm on Monday 06 June 2016 at 15:53
            “Odd. Wikipedia says…”

            Alan, I think you’re ready to add YouTube to your research library. Perhaps there, you can track down the elusive meaning of qi that you seem to quest for. It’s crazy how that one little word gets around, eh?

            There’s also probably a video or two where someone explains very basic Chinese medicine diagnosis. Actually, that’s probably on Wikipedia, too. And in the book I linked to. Good hunting!

            @ jm on Tuesday 07 June 2016 at 02:32
            “Are they wrong?”

            I think they are spot on with that one – you could definitely do a lot worse than that link. Then again, you could do a lot better, too. (But we’ve talked about that before…you already have more than enough resources to get you started.)

            Again, good hunting! (cue the Clouseau music)

            Very amusing. If nothing else, you give rational people something to laugh at. You must be very strong; after all, picking and carrying those goal posts must take incredible strength and endurance.

          • Alan, I’m never sure if you actually are having a hard time with the concept of qi – or if you’re just playing dumb. Either way, it’s always fun to watch you try to cross the moat.

            https://www.youtube.com/watch?v=_jOtVy3t7-Q

          • It’s OK Frank, they make them with wheels these days especially for supporters of quackery.

          • Just another difference between doctors and CAM practitioners turned researchers. “State of the art”. We had Captain Hook a couple of hundred years ago and now we have computerised super alloy appendages whereas CAM remains to be the same. In the former there is a clear progression and in the latter is all all about defending the hook – the best there was a couple of centuries ago. And now all they can do is to show how “beneficial” the hook actually is in the face of progress.

          • The Primo Vascular System: The N-rays of Acupuncture? « Science-Based Medicine

            Unless the word ‘meridian’ also now includes ‘blood vessels’, ‘nerve fibres’, ‘bones’, ‘skin’, etc…

          • “Unless the word ‘meridian’ also now includes ‘blood vessels’, ‘nerve fibres’, ‘bones’, ‘skin’, etc…”

            It always has, Alan.

          • Oops! Humpty Dumpty just fell off the wall again…

          • “Unless the word ‘meridian’ also now includes ‘blood vessels’, ‘nerve fibres’, ‘bones’, ‘skin’, etc…”

            It always has, Alan.

            “jm” tirelessly adds twigs to the heap of evidence that says (s)he has no blinking idea what meridians are or what constitutes “Qi”.

            No one else does of course. These concepts are simple fantasies, but “jm” refuses to understand that.

            Upton Sinclair eloquently explained why:
            “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

          • You consistently crack me up, Bjorn. Thanks for that! You should re-read your comment, keeping the Sinclair quote in mind (it adds to the funny).

          • QED 😉

        • Funny, I never said anything about “energy flow” or “meridians”, but you didn’t refute what I explained as a scientific explanation for acupuncture.

          You’re right, my saying that “few” conventional medicine treatments are evidence based was incorrect. The number stated in articles and research I have read over the last few years has varied, but all were under 50% from what I remember. This was not a criticism of medicine, just pointing out the double standard. Isn’t this worthy of an investigation by sceptics?

          You know what else is an old trick? The modus operandi of sceptics who first claim that there’s no evidence that acupuncture works, then they say that they don’t like the evidence that we provide or start to provide their own definitions to refute the evidence, and lastly they cherry-pick terms from traditional Chinese medicine and want to argue about those also without properly researching them and translating them in a way that is most beneficial to their argument.

          The article is interesting, but again uses the familiar trick of using terminology in the way I described above. I assume you’re translating the Pinyin term Qi as simply as “energy” which almost every sinologist, most notably Prof Paul Unschuld, has said is incorrect. The term itself has a lot of different meanings which may be the same as already existing and recognised substances or functions of the body.

          Acleron, I have made no such attempt, veiled or otherwise. I am only pointing out that people identifying as sceptics have just as much potential conflict of interest as acupuncturists. I don’t think that a researcher would have a vested interest in seeing alt med fail, but I think a sceptic might, and for the motives which I described. The other point that I wanted to make is that people claiming to be sceptics should be sceptical about everything, not just the things they choose or don’t like. Why don’t I see the sceptical community involved in researching ineffective or dangerous conventional medical treatments? This would surely provide a much greater public benefit than only being sceptical about CAM. I consider myself sceptical too, but I am sceptical about everything, especially sceptics. I think that more research should be done on both CAM and conventional medicine, but when it is done by researchers on either side (sceptic or practitioner) that needs to be disclosed as a potential conflict of interest for the reasons both sides have mentioned.

          Honestly, I don’t know why I’m wasting my time here. I think I just wanted to show the public that the sceptic community aren’t any different than those that they criticise and mock, although many in the community like to try to claim the moral and scientific high-ground more often without earning it.

          Frank and Acleron, thanks for being more civil and professional that a lot of your colleagues.

          • “all were under 50% from what I remember” – perhaps, but you forgot to mention that these figures refer to the treatments (conventional AND alternative) that are currently available.
            have you found the figures for the treatments commonly used yet?
            they are around 80-90%.
            keep on looking!

          • Wouldn’t a sceptic, especially one involved in research and especially those with a significant presence in the media have a vested interest in seeing more negative results regarding CAM research published? I would think so

            I apologise (again) it isn’t veiled it is explicit. So why would a researcher, who has to be a skeptic, have a vested interest in showing alt med to be ineffective?

            Being skeptical is often interpreted as being cynical of one thing or another. It isn’t, it is a mode of thinking that prizes evidence and logic over wishful thinking. The results of that mode are everything from science including the findings that various drugs are ineffective and even dangerous. Where did you think that such disclosures came from? Scepticism is not restricted to science, anyone can use it but it requires an understanding of the concept of quality of evidence.

            Being skeptical of skeptics is fine but you must be able to consider that if you cannot defeat an argument with logic and/or evidence then the argument might have merit. Have an open mind, consider the possibility that the effects you see may not be caused by acupuncture.

            The quality of evidence put forward by alt medders is generally poor and does not match the claims made. It is not cherry picking to identify such problems. If you think it unfair to judge it as poor then make the argument but be prepared to be rebutted.

          • Doug writes

            This was not a criticism of medicine, just pointing out the double standard. Isn’t this worthy of an investigation by sceptics?

            You might be interested in the All Trials campaign, which is a skeptic initiative. http://www.alltrials.net/

            If you have any other constructive suggestions about how misleading information about mainstream treatments can be challenged, feel free to share.

    • @ Doug on Saturday 04 June 2016 at 17:30 and other times

      “Frank, when you say things based on science, what exactly do you mean? If I insert a needle into the body to stimulate the nervous system or fascia and thereby influence the physiology of the body to induce some sort of therapeutic effect, how is this not scientific? Are you saying the nervous system and physiology don’t work or are unscientific?”

      “Science” isn’t doing something and wishing there is a reaction. Science is a about testing something and quantifying the effects; not some airy-fairy notion about I feel better. Do you think oncologists are whether their patients feel better, or do they do imaging and pathology testing to determine the success of the treatments? I shouldn’t even ask such a question but you are so far detached from reality, it is necessary.

      “There is very little evidence to support most medical interventions, many medications are prescribed for off-label use and just as many have an unknown mechanisms of action. How is this scientific? Why are you not sceptical about this?”

      Cure a disease and ask the question again.

      “Pete, I hear this statement all of the time that “Alt-med that actually works is not called alternative medicine, it is called medicine”, but it’s simply not true. I know the the sceptic community would like to believe that acupuncturists are a highly-organized unethical group of satanic charlatans praying on delusional patients, but a lot of people I’m sure think the same way about the sceptic community.”

      Tu Quoque and indicative of the level of your argument. Tawdry and predictable, from a charlatan.

      “Have you ever taken a family holiday? Sometimes it could be less stressful to be in the control group.”

      I cannot see the point of this nonsense, other than trying to show how clever you are. Clever? Naaah.

      “If you really want to help people and end disease, like you say, why don’t you develop a treatment that works better and put all of us acupuncturists and CAM practitioners out of business?”

      There are many treatments that work better than your witchcraft because they cure diseases. Tell me, are you vaccinated? Do you have any blood tests, imaging, or even your blood pressure taken? Why, when sticking needles in will fix all ills associated with any abnormalities?

      “Peter, thanks for showing your true self and your level of maturity.”

      I’m no fan of Pete’s but he took you to the cleaners and two things happened; you are too dopey to see what happened, and you resorted to an Ad Hominem. I think you illustrated his point adequately.

      “Honestly, I don’t know why I’m wasting my time here. I think I just wanted to show the public that the sceptic community aren’t any different than those that they criticise and mock, although many in the community like to try to claim the moral and scientific high-ground more often without earning.”

      You are “wasting” your time here because you are a pretentious twat who thinks he is a lot cleverer than he actually is. Invoking the Tu Quoque as a parting gesture only confirms the feebleness of your arguments. There is no “moral or scientific high-ground”; there is only the progress of science and research, something about which clowns like you who poke needles into people think they are doing.

      If you want to make grandiose claims, back it with grandiose evidence. No evidence? I suppose the only alternative to bullshit your way through making absurd statements in a sanctimonious smug way and hope you won’t be challenged.

      I have a challenge for you. When you post a cure for a disease, any disease will do, let me know. Pseudo-intellectual twats like you annoy the tripe out of me. My disappointment is that I can’t say this to you face-to-face.

      Sorry Prof, but this idiot has had more than a fair hearing and has given nothing but nonsense.

    • Doug,

      There might even be another difference. “State-of-the-art” Where conventional medicine and interventions always aim to improve by increasing benefit and reducing risk (and making it more cost effective) by developing new drugs etc. Alternative medicine cannot really be improved on, it is a finished package eg. you can stick needles into people but that is it, you can crack a baby’s back to treat colic but that is it (chiropractic) or you can give water/sugar to people but that is it. The only thing that can be “studied” is the application of acupuncture etc. on different medical conditions.

      One would think that at my former employer, who is the self proclaimed best in the world in CAM research, a lot of effort would go into identifying the mysterious forces that cause disease. But they don’t. The only thing they do is conducting clinical trials of acupuncture etc. on different medical conditions. Maybe because the current state of the art is what it is and it cannot ever change?

  • I’m glad you found something to criticise in what I wrote but as I expected you didn’t refute the main points I was trying to make.

    I know how the game you’re trying to play works. Do you mean “commonly used” as in the treatment of high cholesterol, for example? We can both focus on the data that best supports our argument, but I would rather hear your response to my comment “people claiming to be sceptics should be sceptical about everything, not just the things they choose or don’t like. Why don’t I see the sceptical community involved in researching ineffective or dangerous conventional medical treatments? This would surely provide a much greater public benefit than only being sceptical about CAM and would also lend it more credibility.” I am not asking this as a way of attacking you in any way, I am genuinely curious.

    • COMMONLY USED like in treatments that are actually used every day across all conditions.

    • “should be sceptical about everything, not just the things they choose or don’t like” – I totally agree, and I think I am!
      when I was invited to speak at a sceptic conference for the 1st time, I started by saying: I AM SCEPTICAL EVEN ABOUT SCEPTICISM. but, if it’s alright with you, I write about things, I have studied extensively and feel I know well enough to write about – and that happens to be alternative medicine.

    • Doug: “Why don’t I see the sceptical community involved in researching ineffective or dangerous conventional medical treatments?”

      Some do go after the medical treatments.

      Others prefer the comfort of going after the “soft therapies” which is alt med perhaps because it takes less study.

      • They do go after medically applied drugs and other treatments. Strangely, there is not a strong core of doctors and scientists resisting the conclusions obtained from the evidence with barf worthy arguments. Even stranger, the conclusions reached are obtained with exactly the same methods as is used to show that most alt med is totally useless, quacks will accept one but not the other.

  • Acleron, my comments were only intended to point out that sceptics might have the same conflicts of interest as acupuncturists and I will repeat do not apply to researchers in general. If you consider that a smear then so was the original post that I was replying to.

    “So why would a researcher, who has to be a skeptic, have a vested interest in showing alt med to be ineffective?” Why are you saying that a researcher has to be a sceptic? I explained the reasons why they might have an interest showing in showing acupuncture to be ineffective. Please re-read my post, but to summarise, for all of the same reasons that sceptics might: bias, financial, community/peer pressure, threatened belief system, reputation…

    I think that you have a different definition of “sceptic” than what I see in my Cambridge and Oxford English dictionaries. I also will not allow you or the sceptic community to claim that “thinking that prizes evidence and logic over wishful thinking” only belongs or applies to you. Many acupuncturists would agree with this statement, but simply disagree over what constitutes good evidence.

    “The results of that mode are everything from science including the findings that various drugs are ineffective and even dangerous. Where did you think that such disclosures came from?” Well, from a lot of sources, but most often from research or reporting from health care professionals and most likely had nothing with the fact that anyone was a sceptic.

    Whether or not my arguments have logic, evidence or merit is something we will never agree on. Both sides have polarised opinions and their own biases which is what I am trying to point out. I do have an open mind, and I am always considering whether the effects I see may not be caused by acupuncture. I would suggest you might do the same and consider whether they are. I know what you think the research says, but I think more and better quality research is needed and should be evaluated by someone more impartial than a sceptic or acupuncturist before we close the case.

    I would also like to add that I’m not trying to win an argument, rather just to present another viewpoint. Although, the sceptics would obviously see their community as the ones who are right and not biased in any ways, so does everyone else about theirs.

    I am not, nor have I ever been an “alt medder”, whatever that is. I would say that same about the evidence provided by sceptics, however, It’s more often the conclusions drawn from the research that I think are poor or simply wrong.

    • It usually devolves to a definition of good evidence. Alt medders consider their personal observations are good but scientists have observed that such evidence suffers from confirmation and cognitive bias. Nobody is immune from such biases but the difference is that scientists recognise it and try to eliminate it through controls and blinding. It is instructive that acupuncturists both in this article and a previous one reject these controls as unnecessary.

      The call by alt medders of all stripes for better evidence for their alt med just confirms that good evidence to support their claims is not available.

  • Scepticat, thanks for the link, I’ll have a look.

  • Alan, sorry, my mistake. Can I suggest a new fallacy called “straw man by proxy” or “3rd party straw man?”

  • Hi and thank you for a great guest post.

    “If you have been emotionally and financially invested in acupuncture as a cure-all for 10-20 years, it will be very difficult, if not impossible, to publish a negative result as an acupuncture researcher.”

    Do you think this could also apply to researchers who have a long history of teaching their complementary medicine but not necessarily ever treating patients? I imagine many researchers will be employed at institutions where students can do a course in the same complementary medicine being researched, and it would be awkward for these researcher/teachers to publish negative results if they contradict what their students are being taught.

    • For sure. Otherwise they must concede that what they were teaching for the past 10 years is incorrect and not based on science. I think many students struggle with the scientific underpinning of these CM courses – some leave, others might be convinced by the innovative way by which the teacher explains the science behind CM. But a teacher in CM will never say that what he is teaching is useless and thus they have a conflict of interest by default as well. For them CM works although they cannot explain how it works (but this doesn’t matter) and any negative report comes from Big Pharma etc. They belief!

      In one of my earlier comments I’ve added a link where you can read how convincingly the science behind TCM is explained by a believer – it will be easy for a student or for the public in general to fall for it.

      • Thanks Frank, I agree that it is reasonable to say that researchers have a potential conflict of interest if they are currently treating patients or teaching students to use the same complementary medicine that they are ‘testing’ in their research. I think it could also extend to researchers who are not actively treating patients or teaching, but are well-known figures promoting their complementary medicine institutions, who students and the public may look up to.
        In some of your previous comments and your own blog you mentioned senior researchers of complementary medicine who are silent if there is any negative attention directed at their work. I believe I have observed this as well and it seems to work every time! Everyone else quickly forgets about it and it’s back to business as usual.

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