A special issue of Medical Care has just been published; it was sponsored by the Veterans Health Administration’s Office of Patient Centered Care and Cultural Transformation. A press release made the following statement about it:
Complementary and alternative medicine therapies are increasingly available, used, and appreciated by military patients, according to Drs Taylor and Elwy. They cite statistics showing that CAM programs are now offered at nearly 90 percent of VA medical facilities. Use CAM modalities by veterans and active military personnel is as at least as high as in the general population.
If you smell a bit of the old ad populum fallacy here, you may be right. But let’s look at the actual contents of the special issue. The most interesting article is about a study testing acupuncture for posttraumatic stress disorder (PTSD).
Fifty-five service members meeting research diagnostic criteria for PTSD were randomized to usual PTSD care (UPC) plus eight 60-minute sessions of acupuncture conducted twice weekly or to UPC alone. Outcomes were assessed at baseline and 4, 8, and 12 weeks postrandomization. The primary study outcomes were difference in PTSD symptom improvement on the PTSD Checklist (PCL) and the Clinician-administered PTSD Scale (CAPS) from baseline to 12-week follow-up between the two treatment groups. Secondary outcomes were depression, pain severity, and mental and physical health functioning. Mixed model regression and t test analyses were applied to the data.
The results show that the mean improvement in PTSD severity was significantly greater among those receiving acupuncture than in those receiving UPC. Acupuncture was also associated with significantly greater improvements in depression, pain, and physical and mental health functioning. Pre-post effect-sizes for these outcomes were large and robust.
The authors conclude from these data that acupuncture was effective for reducing PTSD symptoms. Limitations included small sample size and inability to parse specific treatment mechanisms. Larger multisite trials with longer follow-up, comparisons to standard PTSD treatments, and assessments of treatment acceptability are needed. Acupuncture is a novel therapeutic option that may help to improve population reach of PTSD treatment.
What shall we make of this?
I know I must sound like a broken record to some, but I have strong reservations that the interpretation provided here is correct. One does not even need to be a ‘devil’s advocate’ to point out that the observed outcomes may have nothing at all to do with acupuncture per se. A much more rational interpretation of the findings would be that the 8 times 60 minutes of TLC and attention have positive effects on the subjective symptoms of soldiers suffering from PTSD. No needles required for this to happen; and no mystical chi, meridians, life forces etc.
It would, of course, have been quite easy to design the study such that the extra attention is controlled for. But the investigators evidently did not want to do that. They seemed to have the desire to conduct a study where the outcome was clear even before the first patient had been recruited. That some if not most experts would call this poor science or even unethical may not have been their primary concern.
The question I ask myself is, why did the authors of this study fail to express the painfully obvious fact that the results are most likely unrelated to acupuncture? Is it because, in military circles, Occam’s razor is not on the curriculum? Is it because critical thinking has gone out of fashion ( – no, it is not even critical thinking to point out something that is more than obvious)? Is it then because, in the present climate, it is ‘politically’ correct to introduce a bit of ‘holistic touchy feely’ stuff into military medicine?
I would love to hear what my readers think.
52 Responses to Acupuncture for US military veterans: a victory of ‘political correctness’ over science?
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We got this kind of study everyday, everytime. And everytime the same bias of the A vs A+B treatement, bias known for decade… Even more in neurological disorder. How is it even possible that some “scientist” are still following this poor design ? And get published ? Money and time wasted again here.
I don’t know exactly why basic ethic and critical thinking are left brain dead here.
In the case of comportemental disorder, maybe people feel better thinking that something is wrong with their body and not their mind (kind of passive thinking), and then puncturing or massaging feel more appealing and less commitment than pure psychology.
I think then problem is that some of us may actually believe these wacky ‘trials’ are conducted with a scientific audience in mind.
They are not- they are done so that a headline grabbing result can be sent out to the media, who by and large have absolutely no critical faculties at all. It is just another form of dodgy advertising, and should fall within the remit of the Advertising Standards Authority and its counterparts overseas.
It is not my intent to support alternative medicine, but I did have some thoughts about the way in which we think about these “treatments” when it comes to mental problems. The preponderance of the evidence indicates that acupuncture is a theatrical placebo. Placebos do not change hard end points when studied, but result in improvement by changing the patient’s perception of his/her condition. This is not very helpful when the patient’s problem has a biological or biochemical basis that needs to be addressed. With some types of mental problems, the patient’s perception of the problem is primarily what the therapist is working to change. Having predictable ways to elicit placebo effects in these situations could have a better risk benefit ratio than other forms of treatment when the goal is to change perceptions.
Yes, I hate to be suggesting that quackademic medicine could have a place, but we should always be aware of what we are trying to achieve. If someone can design and conduct a decent study, I would have to go with the evidence.
yes, go with the evidence!
the evidence shows that acupuncture is a placebo. and to generate a placebo effect, we do not need a placebo treatment; an effective therapy given with time and compassion would do that too – and it would have the benefit of having a specific effect as well.
@ DavidCT,
If, and only if, the practitioner is fully qualified and registered to provide evidence-based psychological diagnosis and treatment might you comment have some plausible validity.
Alt-med practitioners are, by definition, so hopelessly deluded that they should be totally prohibited from having any contact whatsoever with the seriously ill and/or vulnerable members of society.
Note: A psychologist who dabbles in alt-med or religion [I repeat myself] is nothing other than a despicable charlatan.
Unfortunately there are now plenty of “Official” and state recognized certifications available in the alternate reality of alternative medicine. I made my comments because Dr. Ernst invited thoughts on the topic. My comments were not made in a vacuum. There was a recent episode of the touchy feely NPR show “On Being” where a psychiatrist ( I believe affiliated with Harvard) was speaking. He spoke about using what seemed like a shopping list of alt-med placebo effect generating treatments to treat traumatized patients. I am not certain that he realized that that was what he was doing.
I get the impression from Dr. Ernst’s comment that he only supports promoting placebo effects with a good “bedside manner”. This may be required by ethical considerations. I am not certain that it is the only or best way to get these benefits. For a profession like psychiatry where manipulating a patient’s perceptions and expectations is part of the treatment, is it ever ethical to use alt-med techniques to treat mental problems? I would suspect that readers of this blog would say no but it is certainly different than treating Ebola with homeopathy.
Essentially you have described part of the therapeutic effect of talk therapy. At least that has the reduced risk of not repeatedly having your skin pierced with needles by those using questionable infection control.
Acupuncture for US military veterans is as useless as NLP:
“Some have been made very unwell as a result of going there and have needed a lot of support from NHS and veterans charities”
http://www.bbc.co.uk/news/uk-wales-24617644
“Because there is no regulation anybody can set up as an NLP practitioner and the quality of their work is not monitored by anybody so that puts potential risks out in the field for anybody accessing those sorts of services.”
Substitute NLP for any branch of alt-med quackery and that statement equally applies. It makes absolutely no difference whether or not the quack is a registered quack.
Great comments. I would only add the additional problem of prior plausibility. What is the point of continuing to study something based on the ever invisible “chi”, “qi” or however you wish to spell it, that doesn’t exist. The emperor continues to be stark naked and the rabble continue to claim he is wearing beautiful clothes. Worse yet, a good share of the Royal Healers are offering to make even more imaginary clothes for the Emperor.
@Irene. As you may know the Chinese system of thought approaches reality from quite a different angle then we are used to in the West. The concepts of Chinese medicine can have different meanings depending on the the chosen perspective and the situation at hand. Things can even exist and not exist. If we follow your example, depending on your perspective the emperor’s clothing may change in fabric, size and color, or he may even be stark naked if you like. That’s perfectly fine.
Definitions in Eastern traditions are usually quite loose and broad. Words have no reality in themselves, and may be contradictory. Their function is to point towards an understanding that can not be grasped by intellectual endeavors only: experience and dedicated practice is also needed. So the Chinese tradition uses a less exclusively intellectual method then the scientific tradition, which does not been mean the Chinese system of thought is irrational.
So it might be easier to ridicule the concept of Qi then it is to understand it. I’ve tried to make the Qi concept more accessible and understandable in an article entitled: “Qi? There’s no such thing!” http://www.willempinksterboer.com/en/qi-theres-thing/ I’d be very happy if you’d be willing to read it.
Kind regards from the rabble
Willem
About
Willem
In that page you linked to, you said:
Why is that not a non sequitur?
What explanatory power does the word qi provide?
Alan, you should probably just stick with the dictionary definition, and call it a day:
氣 qì ①air; gas ②smell ③spirit; vigor; morale ④vital/material energy (in Ch. metaphysics) ⑤tone; atmosphere; attitude ⑥anger ⑦breath; respiration
Well, we never got a sensible, cogent explanation from you, jm, so I wondered if Willem could oblige.
Breath/respiration should be easy enough for you. Go with that one. Should clear up the whole ‘vital force’ issue as well.
LOL!
Indeed, jm! The dictionary definition of the word metaphysics that applies here is: abstract theory with no basis in reality.
Pete 628 – What this [④vital/material energy (in Ch. metaphysics)] is referring to is thought, emotion…things dealing with the mind rather than the physical structure of the body.
@ Alan – LOL indeed. Might not get the precise measurements you’re after, but you could definitely get a pragmatic sense of the idea. Stop breathing for an hour. Then let’s discuss your observations about the whole vital energy concept, and how mythological it is.
.
Let me know when you’re done with your experiment.
What I’ve tried to make clear is that in my understanding Qi is not a thing behind the observable reality neither can it be separated from it. It is what is observed. But the fact that it is not-a-thing, does not mean that it is nothing. Qi describes tendencies, movements, and reactions in a unstable polar ever changing reality that constantly strives to restore balance. Qi can not be understood without understanding Yin Yang. Those poles are perceived as one, as in ‘light’ and ‘dark’ in which the possibility of each one is determined by the other. whereas if we interpret ‘light’ and ‘dark’ analytically with our verbal intellectual mind we have a mental impression of each one on their own, joined together externally by ‘and’. These last sentences are derived from Henri Bortoft’s illuminating work, ‘The wholeness of nature’. Chinese philosophy attempts to understand the parts from the ‘whole’. The whole is something else then the sum total of the parts. The meaning of a sentence can not be found in the words. In his comment Jm summed up a number of correct possible translations of Qi but he totally missed the point. If someone tries to read Kant for the first time he just might see a bunch of words. With repeated effort the meaning of the text will disclose itself. The diagnostic process in Chinese medicine is a similar process.
One problem that is overcome when we use this perception of reality in a healthcare setting is the highly problematic separation of ‘mind’ and ‘body’ in western medical thinking. For life is the interplay between the two. They are two inseparable sides of one phenomenon. If I see a patient I strive to understand the symptoms from the tendencies, movements, reactions, compensations I see taking place in ‘the whole’ using my the explanatory model of Yin Yang and Qi. The distinction between mind and body is no longer a obstacle. I don’t have to choose between treating the body or the mind, or understanding the problem from either a mental/emotional or a physical perspective. I understand that if I treat the one I will always influence the other and vice versa. The Qi concept transcends body and mind. This an example of the explanatory power of the Qi concept (not the word!), that is also illustrated with a simple example in my article. Of course this approach has it’s limitations. It’s jus t another paradigm….
the separation of mind and body that you claim exists in conventional medicine is largely a myth and a straw-man to serve quacks who say they have a monopoly on holism.
I didn’t use the term holism, leave alone I think Chinese medicine has a monopoly on it. I’ve just tried to explain why the Chinese model with it’s Qi concept offers a helpful perspective. Holism is a term that can be defined in many ways and therefore always leads to misunderstanding in discussions. If I look at common practice in conventional healthcare I feel the separation of mind and body is far from a myth…
WELL – YOUR ‘FEELING’ IS WRONG!
@Willem – “In his comment Jm summed up a number of correct possible translations of Qi but he totally missed the point.” Yup. Somewhere on this blog, Tom Kennedy wrote up a great explanation of qi. Since that didn’t seem to solve Alan’s problem with understanding qi…I figured the current dictionary definition would do better.
.
I would have to disagree with you on Chinese medicine having a monopoly on holism. Ancient Greek medicine, Thai medicine, Lanna medicine, Tibetan medicine, Ayurvedic medicine, etc. would be great examples.
@jm You probably did the right thing keeping your comment short! I never meant to claim a monopoly of holism for Chinese medicine. The best book I’ve read on holism is Henri Bortoft’s ‘The wholeness of nature’ about Goethes way towards a science of conscious participation in nature.
@Willem – ah, I misread your comment about holism. My bad.
Why do you think it is a non sequitur Alan. Maybe I’m to stuck in my own line of reasoning to see this? So please explain!
Willem said:
I wanted to understand your reasoning behind saying that ‘you can never find qi’ because ‘everything is made up of qi’. Everything is made of molecules, atoms. subatomic particles, etc, but that doesn’t imply we can never ‘find’ any of them. Similarly, we can measure all sorts of energy. If that is not your meaning, what is and can qi be measured?
What Willem is saying is that “Qi” is the tooth-fairy
Interesting: you’ve pinpointed the spot where the translation is a bit off! In Dutch I’ve used the term ‘omvat’ for which ‘includes’ might have been a better translation then ‘made of’. The notion that things are made up of Qi gives the wrong impression that we can find Qi by dissecting reality. This is not the case. The Yin Yang Qi concept is a way to categorize and understand observable phenomena. The Chinese didn’t know that matter consists of molecules and atoms, but they derived from their observations that reality is in a constant state of flux and that solidity is an illusion. Polarity was identified as the cause of this perpetual motion. This notion is confirmed with the identification of atoms and molecules.
So (in my understanding) Qi can not be separated from the phenomena. For instance, fever can be measured and it can be understood as Qi, but it is not caused by Qi (although in clinical practice it is often talked about in this way). The Qi therefore can not be measured separately from the fever.
To make things more complicated Qi can not be fully understood with the intellect only. As said before: the understanding of Qi comes with practice and experience. This means that my understanding of Qi will differ from for instance the understanding of Qi of an acupuncturist with a degree in physics. In the Chinese tradition this is not really a problem. Chinese Philosophy does not strive to find an objective truth. In this regard it is interesting to read the work of Michael Polanyi.
Testing is fine, being (self)critical is a great virtue, to use your intellect is a necessity, but from my perspective I look with wonderment (is that correct English?) at the attempts to consider and prove medicine as a objectifiable hard science. It is as if the world came to a stand still after Karl Popper. I believe that the form of thus created medicine has led to the rise of alternative medicine. The people that come to my practice are neither deluded nor desperate. Usually they are unsatisfied with the explanations and solutions offered by their doctors. They are uncontended customers. Professor Ernst does not want to take a critical stance towards conventional medicine, but if he really wants to fight alt med, he should. Only a self critical analyses of what is going wrong in medicine can take alt medders out of work. If this leads to a better way of serving patients, please do!
Willem said:
I don’t know whether to laugh or cry at that!
It seems that qi is so nebulous or trivial as to be incapable of being pinned down to anything useful. And by useful, I think I mean that it appears to have no explanatory power, never mind any predictive power. Would you not agree?
Do whatever feels best to you Alan. If you get to emotionally unstable you might want to seek professional help! And of course I don’t agree. But you will never understand what you don’t want to understand. If your whole object is to prove me wrong that’s fine with me, but I’m not ineterested in that sort of conversation. It can be considered as stagnation of Qi. It’s not going anywhere….
Willem said:
Do you think that ‘diagnosis’ was necessary?
Which bit don’t you agree with? That qi seems to be nebulous or trivial? Or that it has no explanatory or predictive power? Why?
I certainly would like to understand – that’s the whole point of questions, don’t you think? Simply accepting what you say might be easier, but accepting that which is not explained and – it seems – doesn’t elicit answers when questioned, is not understanding: it’s merely blind faith.
That’s the whole point of science: keep trying to show hypotheses are wrong and never give up asking questions and trying to disprove. Progress cannot be made if someone gives up at such an early stage.
You are, of course, entirely free to answer or not answer.
I think it’s the lack of answers that’s causing the stagnation here.
“I certainly would like to understand”
.
LOL! (as you would say) I think the evidence is against you on that one, Alan.
Alan, you are confusing a nitpicking discussion on a blog with the scientific process. You merely asked me a question and I have tried to explain. So either you lack the faculty to understand or my explanation falls short. Either way, I have better things tot do!
I pointed out a problem early on in what you said in that article, yet it seems no one is willing to answer the questions. There also seems to be a problem in understanding the need and purpose of asking questions.
Pete 628 nails it here.
Dodgy answer as expected.
And I agree with the point raised by Pete.
LOL! (as you would say)
Straw man, Red herrings and ad hominem are well known logical fallacies.
But in this thread the most important issue is the simple fact that the authors of the paper in queation imply that treatment A can meaningfully be compared with A+B.
Given there were no sham controls, the editor should never have published the paper, unless he wished the media, the public, and those who do not read Edzards’ wisdom to be misled.
If he did not want to do that, why did he publish?
” The people that come to my practice are neither deluded nor desperate. Usually they are unsatisfied with the explanations and solutions offered by their doctors.”
They just don’t want to understand how it work and they ARE desperate most of the time (it’s why this kind of quackery is very unethical, you use distress), it’s not the same thing. It’s better to think that you have super healing power that can alter the reality than be just a bunch of atom that will disapear very soon. Magical thinking come from fear of the unknown or deny of the reality (if the reality does not seems ‘right’ for our ego : if the reality mean you are nothing and will disapear). This kind of fear give birth to religious beliefs and all those mumbo jumbo reiki-acupuncture-whathever. Because we are mortal the health quackery have good days.
“They are uncontended customers. Professor Ernst does not want to take a critical stance towards conventional medicine, but if he really wants to fight alt med, he should.”
As always, it’s not the aim of this blog. M Ernst point out flaws in alt med, not in standard med, other blog are doing this. It’s like saying that you docotor isn’t selling cookie.
By the way…
“The notion that things are made up of Qi gives the wrong impression that we can find Qi by dissecting reality”
Did you ever think that old chineese concept are just plain wrong ? Or at least that they were just some pre-model of reality and now we got far better model so we don’t need them anymore ? Like science do, you know… The greek, Gallileo, then Newton and then Einstein : the same idea about gravitationnal effect, but it started with a ‘force’ and ended with the time space geometry. No one would ever think to use old greek concept of accelerated mouvement to describe gravitation, because… They are wrong. Qi concept is exactely the same, it could be useful at the time when no one could have a clue about atom and particle but now it’s just useless. However, pseudo-scientific and quack don’t take this in account and love to use fallacy (because qi is old concept so it must be true) and just f—- physics.
The proof is here : qi is invisible, but here, we can’t detect it by any mean but it play a role on our condition ! And you can’t even detect the EFFECT of the qi, nothing, you just have to accept that is here, like… God almighty ! Everywhere, everytime, but invisible for human eye ! It’s the same beliefs : acupuncture ; pray. And as all beliefs, they are out of science and affect only the mind of the believer in a relativistic manner (clue : science by definition isn’t relativist at all).
Quark – seems like you would be happier with the “氣 qì ⑦breath; respiration” definition as well.
Willem Pinksterboer has done a remarkable job of highlighting the core tenets of alt-med quackery:
1. The principles of each branch of alt-med defy: understanding by any individual human; rational explanation; scientific validity.
2. Non-believers in alt-med must be swiftly diagnosed as being in urgent need of undergoing alt-med treatment.
3. Espousers of alt-med and their sheeple must stalwartly resist both the scientific method and critical thinking.
Hello Pete 628. Your fellow members of the church of new born positivists hail you for ‘nailing it’ in your comment. Your statement under 1. is your notion of things. I don’t agree, but it’s fine with me. But who did I diagnose, who did I advice to undergo alt-med? Where did I state that “espousers of alt-med and their sheeple must resist both the scientific method and critical thinking” or anything similar?
I admire the wording of your comment (I am not a native speakers as you probably have noticed), but the content is garbage Pete. Or are false allegations and reaching conclusions bases on preconceived ideas part of critical thinking these days?
Where is the part when you answer the asked question ?
Or maybe you don’t have a clue…?
@willem
As the answers to your questions to Pete 628 are so simple and straightforward, let me expedite the matter by providing some answers:
Your customers
Here
Of course not. That would constitute an oxymoron. But they are the prerequisit for your own dependence on an income providing career in useless pseudo-medicine.
I’m speechless that with your intellect, your were not successful at using Acupuncture and manipulations to help your patients get well.
After using these modalities to help thousands of my patients, there a reasons why you were not successful. True scientist must understand why things work and why the do not work or just ask a Master. The only way to be successful at a discipline is to take the time and effort theru all the levels to being a master. Novice, journeyman, expert to Mastery.
With these disciplines you are almost guaranteed to see some improvement in a patient’s overall well being. If you understand what your are doing, why you are doing it and for what reasons you’re doing it you should see improvement.
In my experience of watching hundreds of novices fail, I’ve collected a few reasons to explain.
Their motivation to master the discipline petered out, they were sidetracked by life, they did not put in the time and effort, did not have a mentor, were too fearful or timid and do not ask questions to move forward.
There is no doubt that Acupuncture and all of it’s variations work to treat a multitude of ailments. But if your heart is not into it this discipline or you have ulterior motives — your results will be less than expected. Or You have a reason to disparage the discipline with some type of agenda.
If you truly want to understand how profound this therapy can be, I have a few references that will clear up this dilemma. Mainly read C. Chan Gunn, MD.
the word delusional comes to mind.
Indeed. His problem is obvious.
Alan Henness,
If the Nightingale Organization is about truth, I have a “hot potato” for you.
Did you know that the replacement of a natural joint is illogical and that pain can easily be treated with PT, Acupuncture and all of it’s variations.
I think that amputation of a natural joint with one that is guaranteed to fail is an egregious tragic act of mankind.
What do you think?
Stephen S. Rodrigues said
LOL! I take it you didn’t bother to read our website?
Ahh… Steve Rodrigues has appeared on the scene!
He is a well known commentator on another blog many of us frequent. I applaud his choice of not hiding behind a pseudonym.
If he decides to stick around we may be in for some serious demonstrations of his dogmatic belief in a particular branch of acupuncture, usually called dry needling, where they stick the needles into deep tissues occasionally causing untoward trauma and sometimes serious infections.
His Youtube-demonstrations of autoquackery are quite interesting but I especially recommend his video of him doing his best to inflict deep infection or pneumothorax or both on an unsuspecting woman.
Note his peculiar choice of wearing a glove on only one hand while fondling the shaft or even point of the needle with the bare fingers of the other. I hope he at least washed his hands. Remember, he is sticking the needle into very deep and sensitive tissues. The area he is poking in the video is where the top of the thoracic cavity often reaches surprisingly high up above the collar-bone. Many pneumothoraces have resulted from poking needles there. If, on top of a pneumothorax, bacteria are introduced, the patient might end up like Kim Ribble-Orr, with a career-ending, life-threatening infection.
Björn Geir, Your arguments are empty. I’m just amazed how narrow minded and stubborn some people can be by choice. or are you being paid or getting some reward?
Well, I am a bit flattered that you know me from other sites. It’s kinda fun taking on this role as Acupuncture/GunnIMS/Travell/Dry or wet needling advocate. I’m learning a lot about human nature and man-UN-kindness.
But, remember I’m one of tens of thousands of providers who use needles all over the world. So disparaging me is no big deal. Well you know, I only have a few thousand years of evidence to back me up.
The few and rare adverse events are a drop in the bucket, when viewed on a comparative basis with Conventional Medicine. Remember factor in a few thousands of years and then compare that to how modern doctors opt to amputate joints for the treatment of pain. When in reality humans have always been able to safely treat the aches, pain and stiffness of life with the use of hands-on therapy, manipulations and doohickies.
Needles are a very safe way to treat many many office based ailments. Get more info on alternatives, Acupuncture here:
http://www.medicalacupuncture.org/
or
http://www.istop.org/
or
http://nccam.nih.gov/health/whatiscam/chinesemed.htm
As I said 🙂