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.
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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:
Coincidences happen, but isn’t this rather convenient?
There are three ways that acupuncture is known to reduce pain perception, involving blood flow, nerve signals and the relief of natural pain-killers. I don’t know anything about meridians and find it hard to relate to notions of energy flow and qui, but the scientific explanations do make sense to me. For a simple break-down of the three explanations, I suggest the following link: http://www.theedinburghmassage.co.uk/acupuncture/default.htm
@Matthew Priest
Unfortunately, you provide no evidence for any of your hypotheses.
Matthew Priest said:
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/
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.
Especially if the laser is aimed at the eyes!
LOL!
LOL
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?
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Well, there is one thing for certain, you believe they exist;
http://www.bethacampora.com/conditions-treated.html
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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
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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.”
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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?
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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.
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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:
Oh, I think the dear prof is teasing us as well… 🙂
…certainly is interesting to watch though…wish I had a bingo card for the comments.
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?
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;
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“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
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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…………
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?
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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?
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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.
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.
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Another poster has said it and I believe it is probably true; Edzard has something up his sleeve.
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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…
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.
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:
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.
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.
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.
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”
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
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.
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?
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.
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?
@Sandra
Good grief.
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.
Water has also been shown to be biologically active. That does not mean by any stretch of the imagination that “water therapy” has any effectiveness at all for any specific condition.
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.
Well, if that is so, it is an open-and-shut case, isn’t it? They are using the quacks’ most powerful weapon: fantasy.
In fairness, most of the studies were placebo controlled. Take another look at Table 1.
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.”
I already listed 8 things that are wrong with the analysis.
Even taking into account all the comments – especially from David Colquhoun – shouldn’t the title of the article say “Laser acupuncture”, not “Acupuncture”?
I wonder if anyone has done any work on the benefits of taser acupuncture…
@Pat Harkin,
How would you find enough police to “administer” the treatments? 🙂
The upside, of course, is that you only ever “want” one treatment.
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:
Why? Do you know of any?
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.
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:
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:
What do you believe causes those changes you see?
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 USUALLY ANSWER:
1) the ones who come back are clearly not cured
2) the ones who don’t come back might have been killed by your therapy, for all you know.
A good site to refer people to to find out about homeopathy is http://discoverhomeopathy.co.uk/
🙂
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:
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:
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
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:
Does the fact that people keep going back to astrologers mean that astrology works?
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:
Word salad.
What function?
So where are the studies that test acupuncture as practised by you and others?
Why and what do you believe would be an appropriate tool?
“What function?”
All functions, and everything else. It’s a model of comparing things.
@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.
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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.
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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.
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
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.
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.
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.
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
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:
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?
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:
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?
Irrelevant. We are discussing acupuncture here.
No one is saying that, but your bifurcation fallacy exposes your inability to think critically.
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.
It is called ‘experience’.
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.
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.
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.
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.
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:
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.
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!
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.
Do you really think you have to respect other people’s opinions?
This showed up in my Twitter feed today and I was reminded of your comment.
Linda,
You already believe acupuncture works, so all of the research that demonstrates it to be a mild placebo means nothing to you. It is called Confirmation Bias when you actively seek those things which re-affirm your beliefs.
@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:
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:
ROFL!
Please put aside the vitriol and unfounded assumptions and accusations and please have a go at answering the question I asked.
I did. These are the impressive results:
Link:
https://www.google.ca/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=%22primo%20vascular%20channels%22
https://www.google.ca/search?q=%22primo%20vascular%20channels%22&rct=j#q=primo+vascular+system
check this one out
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………..
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’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
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:
‘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.
I’m not proposing any. But the evidence shows that not sticking pins in or sticking pins in the ‘wrong’ places is equally ineffective.
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.
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?
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.
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)
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?
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.
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.
Who claims that?
Who claims that?
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 thinks he/she/they already know(s) it all?
According to your own website, this is untrue. You make very lofty claims on your website.
You know what this gobbledygook indicates: You just make stuff up, exploiting the ignorance, gullibility and desperation of very vulnerable people. It is despicable.
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!!!!!
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.
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
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.
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
Lovely video, with a great message. One I have put at the top of my list of keepers!
Serpessence, indeed.
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.
I think that is exactly what the research shows.
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?
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.
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.
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.
That’s probably a very good idea, FrankO.
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).
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.
You seem to have missed this part:
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.
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.
Ahhh, you’re a “journalist”. If so, that might explain something.
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
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.
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:
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’.
I think this quote from RationalWiki says it better than I can:
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.
Are you an acupuncturist?
I’m a sceptic’s sceptic!
Regards
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.
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.
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?
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:
Tu quoque. There is nothing wrong in only ripping apart altmed studies – no ‘balance’ is required.
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.
How would you test the competence of an acupuncturist?
Glad to hear it. When do you expect the work to be published?
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:
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.
Which ones? And how come that the world’s leading expert, Edzard Ernst, has not been informed of and/or impressed by these studies?
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.
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.
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.
Here’s a few:
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0093739
http://www.ncbi.nlm.nih.gov/pubmed/25158837
http://www.ncbi.nlm.nih.gov/pubmed/25077452
http://www.ncbi.nlm.nih.gov/pubmed/25033919
http://www.ncbi.nlm.nih.gov/pubmed/25103909
http://www.ncbi.nlm.nih.gov/pubmed/24728839
http://www.jams-kpi.com/article/S2005-2901(13)00052-6/abstract
http://www.ncbi.nlm.nih.gov/pubmed/24559812
http://www.hindawi.com/journals/ecam/2013/795906/
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.
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:
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 😉
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.
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.
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
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.
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.
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.
Who’s definition? MacMillan dictionary:
Reference: http://www.macmillandictionary.com/dictionary/american/quack_1#quack_4
Oxford dictionaries:
http://www.oxforddictionaries.com/us/definition/american_english/quack#quack-2
My definition:
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!
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.
That seems to be a pretty universal rule. I recently watched a lecture by Alistair McGrath, christianity promoter, where he said this:
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
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.
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:
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.
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.
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.
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.
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.
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.
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.
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.
You make a very good point, FrankO, and one I see myself. I have friends who can’t seem to stop whining about who nasty and vicious doctors are, who intent they are on causing harm, and how “alternative medicine practitioners” are so much better, and “besides, most of them are medical doctors too”, and then, when they have a genuine disease, they scurry to Princess Margaret Hospital, or North York General, or Sunnybrook, St. Joseph’s, Toronto Western… CAMH and when they come out, all I hear is about how nasty doctors are, how thoroughly lazy, how they are vicious power hungry dictators intent on harming their patients for profit… and it is not only patients either.
Here in Toronto, we have Cees Baas, a medical doctor who is also a homeopath, on record as saying that homeopathy is not nonsense and that it works, but when people phoned into the television programme he was in, he told them that there was a medical reality behind their condition and that they should go see a doctor. So, if I take this guy at his word, homoeopathy works mainly or only for conditions that have no underlying medical reality. I find myself in agreement with that assumption. As far as I can tell, acupuncture is equally effective, except that it also does real physical harm.
Jonathan
I think you’re confusing two separate phenomena. General public does not question “the scientific method”, it questions how a lot of conventional medicine is practiced which has little to do with the scientific method.
Jonathan
First of all, let’s examine the myth that all practitioners of TCM, Ayurveda, etc are “non-scientists” while all who went to medical school are “scientists”. There’s absolutely no evidence to support this point of view and this blog, if you scroll through some of the comments, provides plenty of examples. A scientist is someone who can look at evidence or, better yet, gather evidence himself and draw conclusions. There are plenty of people in conventional medicine AND TCM capable of doing it, there are plenty of people within both fields who are not. There is a recent discussion on one of the medical blogs in US about NNT. One MD cites a study of urologists that examined their understanding of statistical metrics. Only 42% of urologists in that study said they understand what NNT is and can explain it to others and only 20% understood relative risk reduction and absolute risk reduction. I bring up this point, as well as my earlier posts about SSRIs, cardiac stents, statins and so on, not to “attack” conventional medicine but to show that this idea that so many “sceptics” toil under that allopathic medicine is scientific and everything else isn’t IS FALSE.
Also real scientists and sceptics do not use logical fallacies and ad hominem attacks the way it’s done on this blog. Even calling all acupuncturists “alternologists” and “quacks” is a practice that’s outside genuine scientific or sceptical debate. First of all, factually it is incorrect. There are plenty of MDs who practice acupuncture or refer patients to it. Both of my acupuncture teachers are MDs, my mother was an OB/Gyn who also practiced acupuncture, there’s a whole medical society of acupuncture practitioners in the US and so on. But even if there was not one MD practicing acupuncture, to reflexively call someone a quack because they’re practicing something you don’t understand is not scepticism. It’s just stupid.
Of course, besides all of this, the question of quality acupuncture studies still remains but it seems that Matthew Bauer can talk about it much better than I can. My hope is that TCM practitioners will soon be able to design and conduct studies that will properly reflect what an amazing medicine acupuncture is.
Sasha said:
It seems that acupuncturists are already quite adept at conducting studies that are positive (sometimes only just). But until that Nobel Prize winning breakthrough is published, what do you think acupuncturists should be claiming about their dark art?
I think we should just sit back and let wonkers like you make pathetic comments. “Sceptics” and “scientists”. Please, what a joke.
Sasha said:
Oooh! Nasty. But please let us all know if you ever come across good evidence – that’s all really anyone here has been asking for.
Thank you. So far, the only evidence you have presented is that you can be nasty. Why is that?
Hi Sasha,
“My hope is that TCM practitioners will soon be able to design and conduct studies that will properly reflect what an amazing medicine acupuncture is.”
Hopefully, future studies will look at everything included in actual treatments (exercise, tuina, moxa, patient ‘homework’, etc) rather than just the effects of the needles. And, hopefully start using the language of Chinese medicine. Earlier, you mentioned the Western diagnosis of “headache” compared to CM patterns. Headache, low back pain, IBS…unless the subjects of the study are properly diagnosed using the methods and terminology of the art, there really doesn’t seem to be much point. A study on ‘acupuncture for low back pain’ without specifying CM diagnosis wouldn’t seem to have much value.
Actually, quite the opposite. I think there’s the very real fear that something like “using points x, y, and z has been shown to be effective in the treatment of IBS” could lead to recipe-like treatments, seriously diluting a quite powerful medical system. I hear more and more of new acupuncturists measuring to find points rather than palpating, for instance. That’s kind of disturbing, on many levels. There’s plenty of recipe-based medicine out there – CM should avoid that sinking ship.
On the other hand, actually relevant studies are definitely needed. I think for a couple of reasons. New disease patterns seem to be showing up (from overuse of antibiotics, diet/food, incredibly potent pharmaceuticals, things like that). As they say “injury from illness is easy to treat; injury from medicine is very difficult to treat”.
And of course there’s the whole relatively recent lineage gap in Chinese medicine, and how physicians are trained. Finding a teacher that can transmit skills, treatments, etc that have been continually refined for at least hundreds of years (if not longer) is getting harder and harder to do, as the older generation dies off. Relevant clinical studies, while certainly not the ideal, seem to be becoming an unfortunate necessity rather than an additional tool to grow the art.
Take that all with a grain of salt – I don’t practice Chinese medicine. My main interest is as a patient, having been treated by TCM, ah shi, and classical pratitioners. (And the issue of studying “acupuncture” without differentiating is a whole other topic). But I’d love to hear your thoughts.
Hi jm
RCTs are designed to isolate a mechanism of action so they’ll always study one thing at a time. That differs from real life practice, conventional or TCM, where any experienced clinician will use whatever tools they have to help a patient. In fact, old Chinese medical texts say: first you must help a patient correct his life style and diet and only if that doesn’t fix the problem, you use needles and moxa. Classically herbs are used last because, being pharmocological agents, they have more side effects.
You’re right, pattern differentiation is the heart and soul of CM. Any verum group treatments would have to be individualized to reflect it. Pattern differentiation, together with proper dosage and true practitioners is what hopefully will help CM design studies to prove that its effects are beyond placebo.
I wouldn’t worry too much about CM slipping into cookbook prescriptions. There’s a lot of that already but there also practitioners studying classical texts and practicing from the roots, so to speak. Cookbook treatments work, often better than whatever other conventional treatment is out there, but they will never outperform root treatments.
As far as acupuncture education in the West, I think it’s actually getting better in many ways. There are more and more practitioners coming back after years of studying and working in China to pass on what they’ve learned. It’s better that what was there 20 years ago. If you’re interested in this topic, you can look into the work of Andrew Nugent-Head, for example. A lot of his videos are on youtube.
not at all!
RCTs are for differentiating clinical effects caused by different mechanisms, e. g. specific and non-specific.
I’m sorry, you’re right. What I meant to say in response to jm’s suggestion to also study diet and exercise since they’re part of CM – you have to isolate what you’re studying otherwise we don’t know whether it was acupuncture or diet and so on.
Diet and exercise are part of medicine. That’s why we have dietitians and physiotherapists. I think it would be wise to go to them, rather than some alternologist.
Sasha – “…you have to isolate what you’re studying otherwise we don’t know whether it was acupuncture or diet and so on.” True – if you’re studying something like low back pain and want info on the role acupuncture plays compared to diet, exercise, tuina, etc…isolation makes sense.
If you’re comparing different modes of treatment for low back pain, it doesn’t make sense to me to compare acupuncture with conventional treatment, chiropractic, physical therapy, etc. If that’s the data you’re looking for – it would make more sense not to isolate the acupuncture aspect but use a full CM treatment.
Thanks for your thoughts on education, and root/cookbook. And for Andrew’s name – I’ll definitely check out his videos.
I’d say that before anything else, TCM practitioners would need to conduct studies which can prove that acupuncture is effective beyond placebo effect and patients improve beyond “regression to the mean”. If that can be done, it would be interesting to compare acupuncture to whatever other therapies are available. My clinical experience says that in many cases acupuncture can come out ahead. But individual clinical experiences are anecdotal evidence as far as researchers are concerned.
Sasha – I’d have to disagree with you. I think data on full, actual treatments would be much more useful for patients. Patients are more likely to look at research on what treatment woks best for their particular condition, rather than acupuncture vs placebo effect.
If you take something like Crohn’s, for instance – if there was data comparing various actual treatments, patients would end up seeing an acupuncturist/CM doc sooner rather than later. And if that were the case, it would be faster and easier to treat.
Jm — I totally agree with you regarding having full data available that compares the different treatments for each condition/illness rather than just data for each treatment versus its placebo equivalent.
Many people who have chronic incurable illnesses (myself included) have tried or are likely to try alt-med just in case it provides even a little short-term relief from some of their daily symptoms. The huge problem for patients is which type of treatment to select out of the many that all claim to treat their illness (or some of its symptoms).
Currently, I think it is perfectly reasonable to call the whole of alt-med (aka sCAM) “quackery” because it still hasn’t produced the data that you and I are suggesting. Even if the whole of alt-med is nothing other than many varieties of theatrical placebo, that doesn’t mean that all of its placebos are equal for each illness and/or for each patient. E.g. if a practitioner provides only “tea and sympathy” to their clients, it won’t work very well if the client enjoys Assam tea and doesn’t like the Darjeeling tea served by the practitioner.
What we must always keep in mind is two essential questions:
1. Do the benefits of treatment X outweigh the risks for illness Y?;
2. Is the practitioner adequately qualified and trained to identify those clients who need to be referred to a medical specialist? (E.g. Properly identifying clinical depression instead of misidentifying it as the co-morbid depression expected in cases of chronic illness.)
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If properly conducted alt-med treatment comparisons were undertaken it wouldn’t surprise me if the results showed that the type of treatment that works best might depend more on the personality traits (or some other disposition) of the patient than on the illness/symptoms they suffer.
Collectively, the alt-med industry has far greater than adequate monetary resources to conduct these long-overdue studies.
Pete –
“Currently, I think it is perfectly reasonable to call the whole of alt-med (aka sCAM) “quackery” because it still hasn’t produced the data that you and I are suggesting.”
And you’re totally free to do that, of course. I’m not sure how many people will take what you have to say seriously after that, but you’re totally free. Somewhere in the 463 comments I ‘translated’ what Franko said. Not to be a smart ass or dismissive, but to really let him know what he’s saying. When people use terms common to other medical systems without knowing what they mean…you can’t really be surprised when you’re viewed as a lunatic. Or at least not serious about having a conversation.
One recent comment includes “The only aim of this is to create a feeling of ‘exotism’ when selling the crap remedies to west and make ton of money. Because you know, fancy ‘qi meridian’ sounds way more mysterious than ‘pray god’ for today westerner”
If you understand how ridiculous that sounds, or things like “two life forces” or whatever, it’s no wonder that conversations end. Which is too bad – in glancing through some past posts, the was one person in particular that is very well versed on both Chinese medical science and Western medical science. He would have been a great resource if there was any real interest in a conversation about treatments, evidence, etc. It’s rare to find an individual that is that well versed in both systems.
But it doesn’t take very long to figure out that the majority of commenters, and the author of the posts, are not really that interested in a conversation.
I don’t know what chronic illness you’re dealing with, and you certainly didn’t ask for my advice. I’d be happy to share what we’ve learned the hard way (my wife has been dealing with some chronic isssues for the past 25 years, as a result of Lyme disease). But the last time I offered unsolicited advice on a chronic issue (that is very easily managed, it turns out), I instigated a shit storm by someone who turned out to be an actual, dictionary definition quack. Who knew?
Jm — The plethora of various alt-med practitioners who I paid over the decades (because I naively believed their assurances to cure my illness) were all quacks: they willingly took my money despite having no empirical evidence whatsoever to support their claims of efficacy. Each time it transpired, after months or years of treatment, that their treatment wasn’t working, some referred me to someone they knew who practiced a different type of alt-med (including various forms of TCM); others blamed me for it not working — even to the extreme level of such things as not yet having adequately learnt the lessons from my previous incarnations (karma).
There are no words in the English language to adequately describe the true depth of despair, and the sadness beyond belief, that they collectively caused me suffer. Alt-med practitioners neither document nor publicise the harm that they cause to some of their clients.
Very fortunately, during my darkest depths of utter despair, I discovered the book “Trick or Treatment? Alternative Medicine on Trial” and finally realized that, far from being a faulty person who’s hopelessly unable to learn his lessons from this and previous incarnations, I actually have an incurable medical illness that is heavily preyed upon by each and every branch of alt-med that exists. These predators are nothing other than quacks, charlatans, vendors of snake oil, but most of all, they are despicable health frauds.
Also very fortunately, NHS England has provided me with extensive evidence-based psychotherapy to help me undo some of the devastation caused by the plethora of quacks who were sucking the life out of me financially, physically, mentally, and emotionally.
Jm, despite our sometimes very strong disagreements, I send my sincerest best wishes to your wife in her suffering. Genuine caring and empathy sent to a fellow sufferer of long-term illness is the only type of ‘medicine’ that I’m fully qualified to give.
If any of your recommended treatments actually worked then she would now be cured rather than still suffering. Sorry to be so harsh, but we must all accept the truth no matter how unpleasant we may find it to be.
Hi Pete,
My wife’s experience was pretty similar to yours, although the quacks in question were MDs. Plethora, referral, ‘it’s all in your head’, etc. The whole gamut. She didn’t start recovering until working with a physical therapist (trained by an osteopath, using methods considered unproven and ‘alt-med’ on this list) and learning and practicing qigong. She never used acupuncture – metal in her skin (including earings) makes her pass out. So that didn’t seem like a good choice :).
It took a while, but she got most of her life back – but with some probably permanent tendon and ligament pain and weakness.
Until a couple of years ago where she ended up in the ER, misdiagnosed, prescribed antibiotics that were being used off label and should never be given to someone with a history of connective tissue issues…and then spent the next 6 months trying to walk without rupturing her Achilles tendon. From what we can tell, that damage seems to be permanent as well (not just the Achilles, but all of her tendons & ligaments). But, she had some good years in between. So that’s something, anyway.
Our track record with western med has been pretty poor – but I think it’s important to differentiate between poor quality practitioners, and the medical art itself.
Short story – I understand your frustration, and am glad to hear that you’ve found things that are working. Well, that’s not really accurate. I can’t claim to understand your frustration – but I can understand the frustration of your family members/loved ones, unfortunately.
My main motivation for following this blog is to understand the thinking of the thinking of the current western med system (in particular the ‘evidence-based’ crowd) so that when my wife recovers from this round of quackery abuse – we have as many tools as possible to prevent yet another round. I realize that this blog represents the extreme, fundamentalist crowd and is nowhere near the norm – but I’m hoping that will keep me from getting lulled into trusting without verifying…again.
Many thanks for your reply, jm, I understand what you’ve said.
Sincerest best wishes,
Pete
Thanks Pete – and best wishes to you and yours. My tai chi teacher’s teacher was fond of saying “Every day, a little progress.” If we can all be that lucky…
We call things like this ‘straw men’ and ‘red herrings’. I don’t believe these ‘myths’ nor am I aware of anyone who does. I am, however, very much aware of the sort of people who like to spread the idea that these ‘myths’ exist.
Bart – what myths are you talking about? Maybe your post ended up in the wrong place?
You are correct, jm. Something must have gone wrong. Sorry for the confusion. Thanks for saying so. I’ll see if I can post it in the appropriate location.
Who does that?
I have only glanced at the paper but the first forest plot (on Page 10) struck me – the top figure (for Myofascial pain/ musculoskeletal trigger point at the end of trial) represents the largest number of relevant trials, and it shows an interesting pattern. All seven significant trials came prior to 2004 but after 2005, not one of the seven trials has been significant. This is usually indicative of some tightening of methodology. The authors conducted a risk of bias assessment and seem to claim no bias is at work, but this pattern normally suggests some bias has been eliminated through time
Even if there is no bias, with regard to the question of power (raised above) – you can calculate the sample size required to detect the mean effect size – take the above example where the effect size was reported at .49 – with 80% power, 53 are needed in each group – so in the analysis for Myofascial pain/ musculoskeletal trigger point (at the end of trial), outlined above, none of the trials seem adequately powered. Thus it’s quite feasible that the analysis above is tapping into the kind of false positives that emerge in underpowered trials
“And they do, not just a little either, but rather spectacularly so.”
– I only wish that were so. Unfortunately, despite amazing successes in treating acute diseases there are a host of chronic illnesses that mainstream medicine fails miserably to alleviate – persistant pain, dyspnoea, fatigue, poor circulation, IBS, obesity, depression etc. It is especially these that drive patients to the alternative therapists because conventional medicine has no remedy or isn’t interested (or isn’t paid enough) or blames the patient for being ill or denies that there is an illness at all. There are an awful lot of unwell people who are not at all impressed with the results of going to see their doctor.
We can and should learn from the therapeutic skills of the alternative practitioners who have very many satisfied customers, not just vilify them for not being trained scientists.
Regulation of health benefit claims is a tempting idea but a brief look at the cosmetics industry will show that weasel words and careful phrasing will get around any rules you can make.
Jonathan – nicely said.
Jonathan Pitts Crick said:
That about nails it. Unless and until it can be shown that acupuncture has specific therapeutic benefits – and that they outweigh the harms – there is no reason to consider them any more effective than fortune tellers (who no doubt also have very satisfied customers), or having a nice chat over a cup of tea.
It’s true that cosmetic advertisers expend a lot of effort pushing the boundaries of advertising but they are frequently challenged and do sometimes lose and have to modify their advertising. That is not a reason for not regulating claims though is it? At the moment, it doesn’t take much effort to find acupuncturists many wild claims about treating all sorts of medical conditions and we know there is scant evidence – if any – to back them up. The ASA’s rules on advertising the likes of acupuncture are pretty clear and straightforward: why don’t acupuncturists abide by them?
You have just pointed out what no one in the medical profession has ever claimed. Just because the accomplishments of medicine are spectacular, does not mean that there are no more problems. However, that also does not mean that those who prefer fantasy to facts are better at solving them.
As for the cosmetics industry, indeed, and that is also what the quacks do. Just because the quacks are employing and are going to employ legal trickery to fool their victims, is not a very good reason to make it even easier for them and let it all be.
There is no lock that can’t be picked or circumvented, but locks are doing a pretty good job nevertheless.
Might it be due to lack of people willing to lay down the considerable time and effort needed to prepare and file properly substantiated complaints about specific cases. The ASA seem to be a willing and effective administration but they need help from the ‘public’.
Björn Geir said:
Watch this space… 😉
A fascinating blog and commentaries: well done Edzard!
I came to this area as a skeptic: while I have been researching laser medicine/photobiomodulation for almost 30 years, and have practised ‘western’ acupuncture, I was never fully convinced that using laser was a viable alternative to needles for acupuncture treatment. Two reviews later, and the evidence seems to be mounting, notwithstanding the recent JAMA trial by Hinman et al which had some significant issues.
This is very much worth a read – especially for those who like to compare wildly unproven acupuncture with the gold standard proof of conventional medical procedures: http://needlechat.com/conventional-medicine-or-double-standard-medicine/
Worth a read, if you fancy something clearly biased.
Are you arguing with the content or the intention of the content? Because if it’s with the fully referenced content in this article, then you better provide evidence to the contrary rather than voicing your biased opinion about it being biased. This article investigated why medical doctors recommend something that isn’t evidence based and provided evidence for why these things are not evidence based.
Your straw man argument just proves you have no intention in engaging in a conversation rather than throwing the baby out with the bath water, as you pseudoskeptics often do.
Craig,
Did you actually read the title of this thread and the content of the text? It is about acupuncture, strangely enough. I don’t know how that could have been missed.
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http://needlechat.com/conventional-medicine-or-double-standard-medicine/
“Where all we talk about are needle therapies”
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From it;
“According to the hardcore pseudoskeptics,”
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“Coming from Acupuncture training based on Traditional Chinese Medicine theory, I primarily prefer to treat pain.”
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“if an Acupuncturist says, “I know Acupuncture is helping people get better, I just don’t understand how it works”, then he is laughed at and called a quack. This type of prejudice needs to stop. We should be focusing more on head to head studies comparing Acupuncture to drugs & physiotherapy to prove whose medicine is more beneficial for conditions like chronic pain, headaches, insomnia and certain types of stress and end the double standards in medicine for the benefit of all patients.”
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No bias?
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We call this “Tu Quoque” (http://en.wikipedia.org/wiki/Tu_quoque, “Latin for “you, too” or “you, also” or the appeal to hypocrisy is an informal logical fallacy that intends to discredit the opponent’s position by asserting the opponent’s failure to act consistently in accordance with that position.”), a “Logical Fallacy” (http://en.wikipedia.org/wiki/List_of_fallacies), something of which alt-meds are particularly good, when it suits them.
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By all means, more research is needed into all methods of healthcare, but let us use our limited resources for scientifically based healthcare, not some metaphysical meandering about needles, meridians, and other sham nonsense. If all of the studies have shown NO benefit from acupuncture apart from a placebo and statistical noise, isn’t it time for you to rethink your beliefs, or is “beliefs” the operative word and from which you will not be shaken regardless of evidence?
I completely agree with you, as well as with your next comment. I only think that a good case could be made for replacing “beliefs” with “desires”. Given the information and reactions from the alternologists and quacks in this forum, it seems at least plausible that their zeal to defend acupuncture has little or nothing to do with how well it (doesn’t) work.
Frank Collins – You are making a blanket statement that all people who use needles are trying to direct the flow of a metaphysical qi, this is not the case. Medical acupuncture, sports acupuncture, dry needling and intramuscular stimulation use real anatomy and physiology as a foundation for their needle therapies and do not think about qi, meridians and other metaphysical theories.
Manual therapies, regardless of what they are, all currently have the problem of showing efficacy beyond a sham treatment in RCTs right now for pain, including physiotherapy which is science based, is it not? Unless I’m missing something? Who’s out there treating chronic pain without the use of opioids? I agree, we should be moving away from a metaphysical model, and this is already happening over in China, but the west is lagging slowly behind. I don’t think all needle therapies should be thrown out together because one of them chooses to believe in qi. I think, like Edzard Ernst has seen while evaluating the laser acupuncture meta analysis, there is some value to acupuncture, but I highly highly doubt it has anything to do with qi.
Craig – “Who’s out there treating chronic pain without the use of opioids?” You were being sarcastic, yes? It’s hard to tell sometimes on this blog.
Craig, you have a point. There is also a plethora of evidence to show that witch doctors sticking pins into effigies of people has effects ranging from dire health problems to sudden death. Only pseudoskeptics refute this effect; real skeptics have bothered to explain and document the results in terms of cognitive science and the extraordinary power of the nocebo reaction — a reaction invariably exploited by the sCAM industry and many other fields of quackery.
Defending quackery in the 21st Century is no longer generally considered to be particularly clever/smart/cool, it is becoming an increasingly career-terminating stance. Homeopathy has recently lost all of its credibility, acupuncture is next; as clearly demonstrated by the special pleadings and outright insults of its adherents littered throughout the 530+ comments on Edzard’s article. Your comment being just one example of the death throes that promotors of acupuncture are exhibiting.
It really is high time to stop milking the vulnerable and to undergo the pains of finding a real job that ethically funds your desired lifestyle.
And I’m guessing physiotherapy is exempt from your biased views? Despite lacking the hard evidence for efficacy beyond a placebo?
Assuming, for the sake of argument, that physiotherapy is so horrible that it scatters bones and explodes skulls the moment a physiotherapist does so much as entering the room, how does that make up for the lack of evidence in favour of acupuncture, which is the subject of this blog?
Craig, you are either hopelessly ignorant of the evidence supporting physiotherapy for certain conditions or you are simply lying in order to carry on your pretence that acupuncture is as efficacious as medicine — it isn’t, otherwise it would already be a branch of medicine rather than vociferously clinging to the wilting tree of quackery to which it truly belongs.
I realise this may come as a tremendous and unsurmountable shock to someone of your excquisite intellect, but lying is not usually accepted as valuable evidence in scientific circles. I suggest you attempt to dazzle us with real arguments. You make the claim, you come up with the evidence to support it.
You have presented no argument other than accusing me of lying. Please show me the evidence that physiotherapy is significantly superior to a placebo in a large scale RCT. Until then, I believe the argument of further head to head studies are warranted, minus the idea that qi has anything to do with acupuncture’s effects.
In fact, the only evidence presented by you or anyone else in these comments section regarding the original post of a meta analysis for laser acupuncture has been your biased anecdotal opinion that there MUST BE something wrong with the studies, there MUST BE fraud, because it CAN’T WORK because acupuncture believes in qi.
No where in the studies is directing the flow of qi mentioned, so your continuous grasping at straws to support your arguments is quite frankly boring me. Either respond to my questions, or let someone of a greater intellect do so in your place.
You *are* lying. You make claims you can’t prove and that go against what research has told us so far, i.e. you are lying. It is your right to dislike that statement, but until you can provide good quality and credible evidence for your claims, the statement holds.
You actually make it hard sometimes for us not to have evidence of your less than honourable intentions. Please *do* provide the evidence that “I or everyone else” claim that acupuncture can’t work because acupuncture believes in qi. Also, please do explain how acupuncture is even able to believe in anything at all.
The truth is that Traditional Acupuncture treats the individual, the symptoms are simply ‘alarms’ alerting the practitioner that the patient is out of balance. The symptoms get worse and louder the more out of balance the individual has become. Traditional acupuncture focuses on restoring health to the individual by treating the individual causative factor of disease at the levels of Body, Mind and Spirit required. Symptoms reduce and die away ovef time as a result of the health being restored to the patient. It’s silly to try to fit acupuncture to western medicine theories of ill health. Acupuncture is an individual heaing modality of the
And what has this to do with their claims that they cure people, even though they cannot provide evidence of it? The patient’s disease cannot be cured at the acupuncturer’s office and then return at the doctor’s office, only to be cured again at the acupuncturer’s office to return at the doctor’s office. It is either cured or it isn’t. Yet, acupuncturists make all types of claims, but fail to show these claims are true.
I know not of any licensed acupuncturist who makes claims of ‘curing’ anyone.
there is a chap called SIMON GLEAVE who has this on his website:
“Acupuncture helps with fertility issues of both men and women. Recent research shows that acupuncture treatment can significantly reduce stress and anxiety levels which are detrimental to successful conception and pregnancy. Research also shows that acupuncture has profound physical effects on the body such as increasing blood flow to the uterus and helping to address hormonal imbalances. Acupuncture takes an holistic approach to a person’s health and fertility problems aiming to bring balance, harmony and health to ones body, feelings, emotions, mind and spirit.”
and this:
“Amongst its many benefits acupuncture has been shown to:
•reduce the stress and side-effects related to IVF;
•enhance the development of healthy eggs;
•facilitate embryo implantation by increasing the blood flow to the womb and thickening the uterus lining.”
sounds very close to a therapeutic claim of cure to me!
It’s very carefully worded – it doesn’t say “cure”, it just says “help”. I can “help” someone across the road – whether they wanted to cross or not!
But I’d like to see his evidence that acupuncture enhances the development of healthy eggs. Come to that, I’d like to know what he means by a “healthy egg”. I assume it’s a “holistic health, not just the absence of disease” 😉
I suspect he argues “acupuncture reduces stress”, “stress is a cause of infertility” therefore “acupuncture will help infertility. I’ve worked this out from first principles so I don’t need to prove or demonstrate it.”
If you are gong to refer to my website please also refer to the fact that I am a proferred provider of acupuncture to patients of Midlands Fertility Service who provide both NHS and private assisted fertility services. However, My contributiion to the discussion iis to give the perspecrive of an acupuncturist not to ridicule conventional or complementary medicine
I AM IMPRESSED!!!!
There is also a link on my sore to this on the British Acupuncture Council website:http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/infertility-art.html
I think we should ask for the definition of ‘help’.
Are you aware of the Advertising Standards Authority’s rules on advertising acupuncture?
Perhaps you’re more aware of the Federation of Holistic Therapists’ Code of Conduct and Professional Practice, particularly section 6, and their advertising guidance?
“sounds very close to a therapeutic claim of cure to me!”
Not nearly as close as you referring to acupuncture as quackery, as Peter and Sasha pointed out.
http://edzardernst.com/2015/02/acupuncture-new-meta-analysis-suggests-it-is-effective-beyond-placebo/#comment-65070
All you are showing here, is that you know that you are lying. Prof. Ernst has posted the evidence. YOU have concluded that this means acupuncture is quackery. That seems to be an eminently correct assessment. But Edzard Ernst did not make the connection. YOU did.
By posting this claim, you are accusing Prof. Ernst of posting the only credible evidence available with respect to acupuncture: that it is nonsense. IF you want this evidence to NOT be posted, YOU are admitting to dishonesty.
Prof….why didnt you copy the text from my homepage which clearly indicates my holistic approach and makes no claims of cure….not that my fertility page makes such claims. It really sickens me that acupuncturists dedicate their lives to helping patients and are just ridiculed. I strongly believe that acupuncture needs to be evaluated within the context that it is practised. It would be foolish of me to evaluate or try to understand western medicine solely through the eyes of eastern medicines understanding of reality and of no use simply to ridicule treatments websites of practitioners.
WHY DID I NOT COPY MORE?
because I can bear such nonsense only in small doses.
Many, many years ago when I used to run a natural foods store (a time incidentally when prevalent medical/scientific opinion was that what you ate made negligible difference to health) we used to get letters from some of our wackier customers. They were often written in funny coloured ink and they used CAPITAL LETTERS ALL THE TIME. We used to call them SHOUTY LETTERS and associated them with interesting but unstable individuals.
“Unstable” is gently put. That dude should be on lithium. Every comment he’s made so far makes him look like he’s in a middle of a nervous breakdown.
There is only one very simple thing you have to do to stop the accusations that you are making claims: stop making them. Advertise your acupuncture for the most positive it can possibly be: entertainment. Let me post what I have in my Google profile:
Why not do what is necessary to lose the quack designation? Stop making ridiculous baseless claims and misleading your victims. Eventually, after people have forgotten the claims, you may even become respectable. Since people have very short memories, it probably won’t take very long either.
To quote from the ASA’s Guidance on Health Therapies & Evidence:
@Sasha
““Unstable” is gently put. That dude should be on lithium. Every comment he’s made so far makes him look like he’s in a middle of a nervous breakdown.”
Really? If the content is anything to go by, he makes sense which, incidentally by comparison, you don’t.
Anyway, if acupuncture is effective, why don’t you recommend a course of that witchcraft in preference to a BIG PHARMA (see, I can do it too and it didn’t kill anyone) product.
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You are an unpleasant person. Sorry, Edzard, I couldn’t contain it.
In my experience, promoters of BIG PLACEBO like to claim how their methods are “gentle” (which has me so disgusted byt now, that my toes are curling every time I hear the word), and they are quite good at putting up fake smiles, but don’t risk pointing out the slightest detail, for they become nastier than Mauriac’s Knot of Vipers right away. That’s what one gets with people who are not interested in anything but their own wallets and are willing to do anything and everything to fatten them.
Well, that didn’t take long:
Source: http://www.acucure.co.uk/
But maybe you don’t think being a member of the British Acupuncture Council is the same as being ‘licensed’, particularly since you don’t seem to be a member of it?
To clarify acupuncturists graduate with a degree awarded from a university and a licentiate from the college they studied at. This then makes them eligible to be a member of bodies such as the british acupuncture council or the federation of holistic therapists of which I am currently a member. So a license is a qualification that enables you to join your council of choice.
…and this is where you learnt to make all those bogus claims?
I do not make any bogus claims Prof did you check the link and the references in the BAcC site? But you are still missing my point acupuncture theory applies to acupuncture. A proper understanding of TOM theory is required to evaluate it plus an open mind…acupuncture works with such concepts as Jing Shen Qi you cant just apply the tools of acupuncture to another system of medicine.
fair enough: “you cant just apply the tools of acupuncture to another system of medicine” – BUT WE HAVE TO APPLY THE SAME SYSTEM OF EVIDENCE ! so show me the evidence for your therapeutic claims, and I will retract that you make bogus claims.
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/infertility-art.html
Acupuncture is a useless treatment. Don’t take my word for it.
Information provided by the British Acupuncture Council:
What idiot would use acupuncture, a dangerous procedure, to get even less impressive results than acupressure, a much safer procedure?
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/infertility-art.html
Yes you do. If you don’t, you must erase the claims from your website. As long as the claims are there, you are making them. At the very least, you should post something like this:
Nonsense. A patient is either cured, or is not cured. Acupuncture has no known positive effects except for making obscene amount of money for its practitioners.
Simon GLEAVE said:
Clearly, a university degree is not a prerequisite to calling yourself an acupuncturist nor practising acupuncture.
And clearly a licence from a trade body is not the same as, say, the licence to practise medicine a medical doctor has, so it’s not clear why the FHT or anyone else would call it a licence.
But to get back to your claim, you said:
I’ve pointed out one BAcC member who is making claims to ‘cure’. Do you accept that he is a licensed acupuncturist? I’ve not had a good look, but I suspect I could find many more making similar claims. To my mind, that is a big problem.
Simon GLEAVE said:
If advertising claims are not in accordance with what the ASA allow and, if they were to be challenged and the ASA ruled they were misleading and not substantiated, would that not make them bogus?
But do you think it’s acceptable to pass the buck to the BAcC to claim that because they claim it, it must be acceptable?
A tautology?
You talk about an open mind, so what would it take to make you change your mind about acupuncture having specific effects over placebo?
@Simon Gleave,
“acupuncture works with such concepts as Jing Shen Qi”
At least you have cleared up something for me. Since acupuncture is premised on religion (Taoism), I can now, more confidently than ever, discount it as having any claim to being a credible form of treatment.
Daoism which underpins acupuncture was not a religion originally. It was a system of observing natural phenomena, a precursor of the scientific method which later developed. Acupuncture developed from these observations of natural phenomena. Later on Daoism became (for some) a religious practice with its own set of rituals and superstitions. For others it remains in its pure form – a system of observation. By the way, the same thing happened to other revolutionary movements – teachings of Buddha and Christ, for example. The fault lies not with the originators of the teachings be they Daoists, Buddha or whoever. The fault lies with the followers who later change the teachings to accomodate their preferences.
@Sasha
“Daoism which underpins acupuncture was not a religion originally. It was a system of observing natural phenomena, a precursor of the scientific method which later developed. Acupuncture developed from these observations of natural phenomena. Later on Daoism became (for some) a religious practice with its own set of rituals and superstitions. For others it remains in its pure form – a system of observation.”
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Since you are very good at rewriting history, you should edit Wikipedia to ensure its compliance to your version of history. http://en.wikipedia.org/wiki/Taoism
“By the way, the same thing happened to other revolutionary movements – teachings of Buddha and Christ, for example. The fault lies not with the originators of the teachings be they Daoists, Buddha or whoever. The fault lies with the followers who later change the teachings to accomodate their preferences.”
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Well, acupuncture has something in common with Jesus; there is no evidence for the efficacy of acupuncture nor the existence of Jesus. (The Romans were meticulous record keepers, even keeping records of their vineyards and wine production near the Scottish border – it was warmer then – but not a skerrick about one J. H. Christ.
Anyone with an access to the internet can edit Wikipedia pages. Wikipedia is not a reliable historical source.
Fortunately for humanity, Wikipedia is a very much more reliable resource of information than is Sasha.
Sasha, you are incorrect in stating “Anyone with an access to the internet can edit Wikipedia pages.” Wikipedia is moderated in order to minimize the incessant bleating of trolls, pseudoscientists, politicians, quacks, and others with vested interests, from misinforming its worldwide readership. If you don’t like a page then change it, but make absolutely sure to include solid evidence that supports your reasons for changing it.
And, unfortunately for humanity, so many “sceptics” on this blog like to present their opinions as facts. Well, maybe not so unfortunately, because most of humanity has no idea that this blog exists.
Here’s what Wikipedia itself says of its reliability:
“Wikipedia is not considered a credible source. Wikipedia is increasingly used by people in the academic community, from freshman students to professors, as an easily accessible tertiary source for information about anything and everything. However, citation of Wikipedia in research papers may be considered unacceptable, because Wikipedia is not considered a credible or authoritative source.”
Notice the last sentence about citing Wikipedia in research.
Don’t like what Wikipedia says about itself? How about Harvard then:
“Nevertheless, when you’re doing academic research, you should be extremely cautious about using Wikipedia. As its own disclaimer states, information on Wikipedia is contributed by anyone who wants to post material, and the expertise of the posters is not taken into consideration.”
That’s why when someone links me to a Wikipedia page as the ONLY evidence to support an argument on Daoism, I question it. It also lets me know that the person isn’t a researcher but I already knew that about a lot of people commenting on here.
Sasha, you missed the most obvious reason why Wiki pages are unsuitable sources for citation in research work: they are regularly updated, duh! Citations need to reference static documents, not dynamic documents. A researcher would know this; a cherry picker wouldn’t. As you consider Wikipedia to be so unreliable I doubt you’ve noticed that articles are are backed by references. E.g. the page on acupuncture has 8 entries under Bibliography and 302 entries under References.
Your many (often acidic) comments on this post have made me thoroughly convinced that acupuncture is nothing other than a theatrical placebo and that its apologists are trying desperately hard to hide the fact that selling it as a medical treatment is tantamount to committing health fraud.
Perhaps you could point me to a definitive list of which illnesses are cured by acupuncture. In my bumbling research efforts, I’ve been unable to find even one illness that it cures — short-term relief of certain types of pain seems to be the only thing that could be claimed for it.
Lastly, do you find acrimony to be an effective means of convincing people that you are right and they are wrong? In my humble opinion, your behaviour in the comments demonstrates that you are condescending, belligerent, but most of all, far more untrustworthy than Wikipedia as a source of accurate information.
Regular updates have nothing to do with it. You can go back to what I posted to see why.
And you conveniently forget that I just completely refuted your argument by using references! You just move on to another diversion, in this case, my “acidic” comments. This is a tried and true tactic on this thread isn’t it? Make a claim and when it’s refuted, move on to something else without ever acknowledging that you’ve made a claim.
My comments turned acidic when I saw what is being said on here. You can claim that my acidity convinced you of something regarding acupuncture but it would hold as much water as me claiming that being called “acushill, liar, alternologist, quack”, etc makes me doubt science. It’s a ridiculous claim!
Science is science and people commenting on here is something else that has nothing to do with science. As I keep pointing out, some of you can’t even make a logically coherent argument that can’t be refuted with a quick google search. Your claim on Wikipedia is the latest example of it.
Anyway, I’ve spent enough time on this nonsense. It taught me a lot about myself and I will use it to improve myself. It also taught me a lot about what passes for “scepticism” at least in these circles. I’ll follow Jonathan’s wise example and bow out of further arguments.
I distrust Wikipedia as well, but Wikipedia remains a “go to” destination in spite of this, for one simple reason: there tend to be a lot of references, and hence, Wikipedia is an excellent starting point.
Sasha, Where is your pointer to a definitive list of which illnesses are cured by acupuncture?
In its absence, I can conclude only that the best response you can provide to vitally serious medical questions is throwing a tantrum. Your replies suggest that you are not a genuine researcher, you are a shill for quackery.
You did not refute my argument with references, you twisted it to support your agenda. My argument was, and still is, that you are a much less reliable source of accurate information than is Wikipedia.
You wrote “Regular updates have nothing to do with it.”, which demonstrates only your ignorance, not mine 🙂
Thanks for your replies, they provide both good entertainment and further evidence that acupuncture isn’t efficacious for anything other than earning money via exploitation. If you agenda is to support acupuncture then you are failing, miserably.
There are several on this very forum. But if acupuncturists do NOT cure anybody, what is their use, except as expensive entertainers?
For someone so mightily engaged in a medical discussion it seems you have a fairly superficial understanding of what medicine realistically involves. The Chinese have a smart saying, “Medicine can only cure curable diseases, and then not always.” Very little chronic disease is ‘cured’ by any medicine – conventional or complementary. What medicine can often do is to improve, stabilise, reduce the suffering of disease. If it is holistic medicine (in other words medicine that tries to look at the arisal of disease in the context of a person’s whole life), it can also offer understanding, reconciliation, wisdom. As BKS Iyengar, the great yoga teacher, said, “yoga can help cure what need not be endured, and help endure what cannot be cured.”
Individual based on the age old theories of Traditional Oriental Medicine (TOM). Please note that Traditional Chinese Medicine TCM is only one type of acupuncture and a part of TOM.
Traditional Acupuncture is an holistic Health system this difference reallys needs to be appreciated.
Fair enough. What is a holistic health system and how does it differ from actual medicine?
Simon says; (http://www.traditionalacupuncturetherapy.co.uk/)
“You don’t need to be ill to benefit from Traditional 5 Element Acupuncture. A course of preventative treatment helps you to achieve and maintain optimal health.”
Does “holistic” mean that it will lighten your wallet when there is nothing wrong with you?
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Also;
The “Five Elements” are those discarded concepts borne from ignorance of latter day science.
http://www.tcmworld.org/what-is-tcm/the-five-elements/
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Simon studied “Gross anatomy, physiology, pathology and pharmacology of each of the body systems with relevant acupuncture topics included in each area.” but doesn’t sat whether this included the locations of the fabled “meridians”.
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He mentions “Acupuncture is considered safe for all ages and may safely be used alongside conventional medicine. “, but fails to warn of possible damage to nerves or blood vessels.
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He is qualified to level reiki so has fully accepted “energy healing”;
“USUI Reiki Healing
I offer USUI Reiki healing and I am qualified at USUI Reiki level 2.”
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He charges like a wounded bull for his placebos, but is quite happy to use the benefits of real science to take money;
“First appointment: £65
Following appointments: £45
I can accept payment by cash, cheque or internet banking transfer.”
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Simon offers many other forms of “treatment”; http://www.traditionalacupuncturetherapy.co.uk/massage
“Gua Sha – great for treating pain.
Japanese Style Cupping – great for treating pain.
Moxibustion Therapy – great for relaxation and treating pain.
Therapeutic Massage – great for relaxation.
Acupressure – great for symptoms, pain and relaxation.
Ashi Needling – great for pain.
Six Divisions Acupuncture great fot symptoms, pain and relaxation.”
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Simon, if this sounds derisive, it is because that is my intention, unapologetically.
Traditional Oriental Medicine is an actual system of medicine it is widely practised around the world. Holistic treatment treats the individual and aims to restore wholeness and a better state of all round health. Health means much more than simply the absence of disease. Treatment focusses on the roots of disease and is not based on the presenting symptomatic picture only.
Simon,
You’ve answered the first part of the question but not the second. How do you see what you’ve described as holistic treatment being different from what mainstream medicine does? Because to me they sound pretty much the same.
“Holistic treatment treats the individual and aims to restore wholeness and a better state of all round health.”
Please define ‘wholeness’. How is it measured? What physiological mechanisms underpin it?
“Health means much more than simply the absence of disease.”
Please tell us what health means. How is it measured? If I have no disease, what is it in my physiology that can be adjusted to improve my health?
Please define ‘holistic’.
And how do you find the root causes of a disease?
Traditional Chinese medicine is a system that dates from a time when medicine was based on superstition. If I were Chinese I’d be deeply insulted at the suggestion that the Chinese have learned nothing since then.
In fact it isn’t even ancient. As practiced now it’s a hangover from Mao Zedong’s great proletarian revolution.
I feel sorry for people who have been deceived by low-grade universities that rin courses and teach nonsense at a high price. If I were in their position I’d be inclined to sue the universities that give a “BSc” that is so deceptive.
Always the same mumbo-jumbo. Eastern vs western medicine, like the science is not the same on the different cardinal point. The only aim of this is to create a feeling of ‘exotism’ when selling the crap remedies to west and make ton of money. Because you know, fancy ‘qi meridian’ sounds way more mysterious than ‘pray god’ for today westerner (pray god is a bit on the downhill now).
Hopefuly we can try to sell homeopathy to our today easterner.
Indeed. I think it nicely shows that these people consider themselves charlatans. It does not matter *how* one intends to treat a disease. Before the treatment, the patient either has the disease or doesn’t. The same is true after the treatment. If a doctor decides the patient still has the disease, and the acupuncturist decides the patient has been cured, it only means that one of them is wrong. They can’t both be right.
David, your references to the history or acupuncture are simplistic. Firstly I would say that acupuncture and Chinese herbal medicine arose during a time of astonishing discoveries in multiple fields of science, mechanics, engineering etc. Many of these non-superstitious discoveries occurred hundreds (sometimes well over a thousand) years before they were discovered in the West. There were also significant medical discoveries that predated modern medicine by similar periods of time. Secondly, the history of tradition medicine over the last 100-200 years, was (like all medicine) significantly influenced by economic, cultural and historical factors. A major factor that threatened and nearly destroyed much traditional knowledge was the the reaction to China’s humiliation by Western powers in the 19th century. Military power was seen as proof of Western superiority and aping the West and rejecting the old was widespread. The survival of Chinese medicine in the 1930s and its subsequent support by Mao was in large part due to the commitment of traditional practitioners and the support of their millions of patients.I’ve heard you spout off about the modern history of acupuncture before but I have to see that in the academic traditions I am familiar with (rather than ignorant populism) there is usually a genuine attempt to be well informed before making such strong assertions.
There are a lot of issues with that paper – references to Mao or an emperor which are nothing but red herrings. Appeals to emotion – “acupuncture is dead”. Says who? And so on. It is more of an op-ed rather than a scientific paper of any significance.
Sure. What does he know? He’s only one of our leading experts.
As I’ve said before, no one has heard of your “leading experts”. Not the Mayo Clinic, nor the Cleveland Clinic, nor the Sloan Kettering Center, nor the Australian health authority, nor the many hospitals in the US which are adding acupuncture to their outpatient departments. Not Kaiser Permanente – the largest HMO in the US which pays for acupuncture because its clients ask for it. Not Aetna, Blue Cross, United – all insurers that cover millions of people. Not VA which covers all the vets in the US. Not Chinese government or Indian government which between them rule over a quarter of humanity. Not Canadian government that regulates the practice of acupuncture, nor the Russians who’ve had acupuncture in hospitals since late 1950’s and have done a lot of good studies on it.
“Leading experts” for whom? For six guys on some sceptics’ blog?
if we are just ‘6 guys on some sceptics’ blog’, why do you continue discussing [perhaps insulting would be the more appropriate term] with us? I suspect the answer is [in ‘unstable’ bold]: BECAUSE SOMEHOW, DESPITE YOUR TOTAL IGNORANCE OF SCIENCE, EVIDENCE AND SUCH LIKE, YOU KNOW WE ARE RIGHT.
As is often said: attack is the best defence. BIG PLACEBO purveyors have nothing but attack in their arsenal, since they have no other knowledge, culture, education or substance. They are pathetic excuses for human beings.
Edzard, to use this logic I can claim that the reason you’re spending so much time trying to debunk acupuncture is because you somehow secretly believe that it works.
I can tell you why I went on this blog and spent a whole week on it. I’m interested in why, so far, verum acupuncture hasn’t performed well vs sham acupuncture in SOME studies. As George just posted using Cochrane there are studies that show acupuncture benefit. To say that I haven’t found any reasonable discussion on acupuncture on this blog would be an understatement.
Now about insults… Do you feel insulted? And if so, why? I just looked at the claim of “leading authority in acupuncture” for you and DC and then looked if there’s evidence to support it. There’s not much. One of the perks of being a “leading authority” in anything is that people actually listen and try to implement your recommendations. So far, as all the examples show, the world is moving in the exactly opposite direction from what you and DC recommend. Thus, I question how much of a leading authority you are on this subject.
Indeed. You have just once again demonstrated that lying is one of your better talents, perhaps the only one.
Not only does the Mayo Clinic know who Edzard Ernst is, he has been known to write for them as well.
All it takes to know that, is to use Google. But I am suspecting that you are too intellectually challenged to be interested in such sordid things as evidence:
http://www.mayoclinicproceedings.org/article/S0025-6196(11)62774-2/abstract
Just to make it clear: the above reference PROVES beyond any doubt at all that you have no interest in what is true.
““Leading experts” for whom? For six guys on some sceptics’ blog?”
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Argument from popularity, but you would know that, surely? You’re big on fallacies but they are your fallback strategy, particularly the Fallacy Fallacy.
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I’m also sure you can convince yourself of anything, as long as personal interest is involved. Speaking of which, what personal interest do these “six guys” have? Perhaps facts, evidence and truth drive some people more than money and self-interest? It is an interesting notion though I doubt it would interest you.
Well, a brave anonymous hero like you really doesn’t need an answer, do you? I have to confess that a picture is clearly emerging. It takes time to gather evidence, but it is starting to look quite conclusive by now: you do seem to have one talent. The evidence is just too overwhelming to deny: you can lie with the best of them and seem to have no qualms about it.
While that seems to be pretty much an open and shut case now, there are still some issues with respect to the root causes and mechanisms. Does this lying come naturally to you or did you have to take lessons to get this far? I know that some alternologists go to acting school to hone their skills. Did you go to acting school as well, or did you acquire them in some other way? If so, what training did you follow to learn how to subdue your conscience? Or were you just born without feelings?
I’m afraid that your account of the history is the sanitised version that has more to do with sales than with reality.
Acupuncture and moxibustion were banned by the Chinese emperor in 1822. And Mao Zedong’s late conversion to it was a cynical political move to stir up nationalism: he’s on record as not himself believing in it. Now it is still partly bound up with nationalism, but mainly it’s now just big business. Like most big business, truth is secondary to making money.
The is something bordering on racism in the suggestion that the Chinese are stuck in the past.
On the contrary David, there is cultural arrogance and perhaps racism too in your stance. Taking a superficial glance at one of the richest forms of traditional medicine we have, practised through 2000+ years of history and into the present day by many hundreds of thousands of committed doctors, used by countless millions of patients, and dismissing it with a wave of your hand as superstitious and worthless is intellectually feeble. It wouldn’t even be worth bothering to argue with someone so scantily informed as you apart from the fact that you have greater influence in this debate than you deserve. If I were to pick up on one or two facts about biomedicine, for example the hundreds of thousands of iatrogenic deaths it causes, and dismiss it as useless, unscientific (it’s not ‘scientific’ to kill patients) etc., and ignored its strengths and the suffering it eases, I would rightly be dismissed as ignorant.
where did you learn to use all this fallacies so eloquently?
Probably in acupuncture class. After all, it’s not like they have much else to learn.
Well, I’ve studied, practised, reflected on and read very widely on Chinese medical history, Chinese medicine, and indeed all medicine for forty years. I’ve worked in Chinese hospitals, been to numerous research conferences and attended lectures by a wide range of eminent doctors and professors. I’ve used my brain, tried to be respectful of things I did not at first understand or appreciate, and held a healthy scepticism (in fact most people in the field of complementary medicine would think that I am a cynic). In fact I’m such a fan of scepticism that I think you and others on this page give it a bad name. Scepticism is a welcome default position to prevent us swallowing the junk thrown at us by all kinds of people – politicians, economists, the military, religious teachers, medical authorities (both conventional and complementary) and so on. But scepticism also has to be open, fluid, respectful and ready to change it’s mind, and I see no sign of that here.
studied a lot but learnt nothing?
Damn Edzard, you beat me to it.
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I thought Sasha was the queen of fallacies but Deadman (I hope that isn’t a sick joke) takes the crown. Actually, I am impressed that someone can fit so many into a single paragraph. Bravo for ignorance and a total lack of lucidity.
FFF: fanatical fallacy fixation
There are plenty of Chinese who are not insulted at all. There are probably more Chinese who get acupuncture every day than anyone else on the planet.
There are also different ways in which acupuncture is practiced. Some of them are based on Nan jing which is an ancient text.
It’s been quite interesting to spend the last few days on this “sceptics” blog. So many statements are presented as facts but for anyone with any basic knowledge of the matter they are nothing but empty, pompous words without anything to back it up.
The Chinese who use TCM are, on the whole, those who cannot afford real medicine. There is excellent real medicine in China but most people cab’t afford it. They don’t have an NHS.
I don’t think that it’s sensible to underestimate the time that sceptics have spent in investigating the various forms of superstitious medicine which they criticise. You can’t expect to get all the references to back up statements in comments. It’s up to you to read the papers and check the facts.
Once again, whenever you say things like “superstitious medicine”, it’s wise to add “in my opinion”.
At this point, the one thing going for a sceptic regarding acupuncture is verum vs sham comparisons. “Regression to the mean” theory conflicts with what the clinical practice is showing us. People usually can figure out pretty fast whether doing nothing is the same as doing something especially if they have to pay for that something out of pocket. Besides, when you migraines go away completely after a series of acupuncture treatments that’s not “regression to the mean” that’s getting better. The same goes for severe allergies, asthma, trophic ulcers, sinus infections. I can go on and on and these are just examples from my practice.
As far as RCT’s, I can’t claim that I’ve looked deeply into the studies’ methodologies but some who have, say that there are significant issues with them: dosage, lack of TCM differential diagnosis, lack of proper training for practitioners in verum group. I think that Matthew Bauer and others involved in this work are putting together trials that will correct these errors. Once those studies are out, we can look for verum vs sham comparisons.
But you don’t need to wait for them, you can test your assertion that “anyone with toothpicks” will do as well as a trained acupuncturist. I’d love to see the results of that study.
Perhaps. It would be hilarious to see if a random person with a toothpick would achieve the same results, especially if it was filmed.
What we *do* know, however, is that acupuncture with needles and fake acupuncture with toothpicks achieve similar results. while perhaps slightly less comical, it is probably a lot more interesting, because using toothpicks instead of needles would make acupuncture a lot safer. Infections, collapsed lungs and pierced hearts are rather more difficult to achieve with toothpicks than with needles, after all.
The most interesting question, I think, is this: why are acupuncturists insisting on using dangerous needles when toothpicks are just as good?
“Traditional Oriental Medicine is an actual system of medicine” – wrong
“it is widely practised around the world.” – sadly, right
Hey, this thread seems to be degenerating into a slanging match. Aren’t there any folks here interested in learning from discussion?
Protagonists from both points of view have put their cases quite forcefully enough without the need to insult each other.
It is clear that a lot of conventional medicine is practiced without good RCT evidence, especially physiotherapy and surgery, and even much routine drug use is based on “protocol” rather than evidence (see the recent data on metoclopramide for post-operative nausea). It is also clear that there is very little RCT evidence that alternative medicine techniques are better than placebo. This suggests that either no adequate studies have yet been done or that much of the benefit IS a form of placebo response.
It is not a valid defence of acupuncture to point out that some aspects of convention medicine are just as unfounded and it’s not justified to call acupuncturists quacks when you would not include orthopedic surgeons in this category just because they routinely use non-evidenced techniques.
So what is the real issue? Edzard started the discussion with the headline “Acupuncture: new meta-analysis suggests it is effective beyond placebo” – obviously this is an example of alternative medicine being “damned by faint praise” and the question being addressed is: why are there not convincing RCT data on efficacy of acupuncture given that it’s been around a long time and has been widely practiced in many prestigious institutions around the world?
So far the acupuncture supporters have not come up with a an answer that satisfies the sceptics. The objection that RCTs are not appropriate as TCM is a different kind of “science” is not going to convince any sceptic – if a technique does any good it must be able to be shown to do so, not just depend on belief. Sasha has rightly criticised me for assuming that alternative practitioners are “basically non-scientists” – but if they do have any scientific training (and I agree that many medics have forgotten theirs) they should recognise the need for reprodicible evidence to support their claims. Anecdotal experience and tenuous logical arguments are not enough and can be highly misleading as the history of medicine shows.
My own conclusion is that the problem lies in confusion about the meaning of placebo.
If a treatment only has a placebo effect it doesn’t mean it has no effect: it means that the effect is not based on the specific mechanisn being tested against placebo. Therefore if the main benefit of acupuncture is based on the whole process from self-referral (typically) to follow-up support and only a small proportionto the actual sites punctured – then comparing the therapy with sham version makes no sense (e.g. like comparing Amoxyl with unbranded amoxycillin, finding there is no difference and saying therefore Amoxyl doesn’t work).
So what should acupuncture be compared with? It has been stated by several contributors that against ‘no treatment’ acupuncture does show benefit. So what are the real-life alternatives? Standard drugs with their attendant side-effects prescribed by family doctors; the same drugs prescribed by specialists; self-help discussions with patient groups; physiotherapy; ‘healthy living’ programmes; walking a mile a day (this would be my favourite); intensive exercise training; meditation; yoga …? Sceptics and enthusiasts have to agree on some type of practical alternative treatment option to act as a valid control in a randomised intention-to-treat trial.
Edzard, you are in an ideal position to propose such studies, get agreement from the acupuncture community and set them up to answer the questions once and for all.
we did studies with acupuncturists – but today I cannot set them up anymore: I am retired.
Dear Ezard Ernest, Researchers, Acupuncturists and Rude Skeptics.
This is for you. A call for professional acupuncture research, non-bias scepticism. This is limited. Look at the type of acupuncture used in trials, research design and methodology. Question your knowledgeable in terms of advantages and weaknesses. Move forward and develop strategies in collaboration.
Best wishes
https://youtu.be/QUW0Q8tXVUc
Dear Lying Enthusiast,
It has all been done. Hundreds of times. Just because you don’t like the results, doesn’t make them unprofessional or untrue or non-obtained.
Do the honourable thing, and stop selling your unprofessional rituals with health claims. Sell them as entertainment, and become a morally adequate professional entertainer instead of a morally despicable quack.
Start working for a living instead of lying for a living.
Greetings
P.S. Calling you out on a lie is not rude, it’s honest. Rude is when you insult the messenger. It is not the messenger’s fault that your rituals don’t work.
Sorry, I did not know. Is there anyone now who is in a position to sort this out. It does seem that a mainstream academic unit is required to conduct an adequately powered study with objective assessment of benefit…
What do you think is the answer?
George, Jonathan
That’s a question for acupuncturists. If they believe yet more research is necessary, it’s up to them to do the trials. But don’t forget, there are trials being done all the time, but time after time, when they are published, we find that they have serious and obvious flaws. Why can’t they get their act together? An impartial observer might think they were trying to prove acupuncture works and, as someone said that they “view research mostly as a promotional exercise”.
Jonathan
In addition to Matthew Bauer, there are a few other people in the acupuncture community (that I know of) who’re either interested or are already doing some sort or research. If you need names, let me know and I’ll see if I can put you in touch.
Jonathan –
“if a technique does any good it must be able to be shown to do so”
Somewhere in this comment thread, Matthew references a study done on low back pain. The acupuncture group got something like 1 ½ (maybe a little over, can’t remember) times better results than conventional care. He cites the study – but it doesn’t really matter (I don’t think it does, anyway). A technique (acupuncture) was compared to a full treatment (conventional care).
Acupunture is one tool among many that a CM doc would use. Even those specialising in acupuncture would probably not use it exclusively in a treatment. Even though it outperformed conventional care, the results were pretty clinically dismal. Pratitioners get way better results, consistently. But I suppose it’s interesting to note how much of a role the technique itself plays in the scope of a total treatment.
The acupuncturists I work with, have talked to, read articles by…gather evidence at the time of treatment. Pulse, tongue, shen, etc are observed and treatments adjusted accordingly. If that was done during the study…it wasn’t mentioned. I’m not sure how you would quantify something like ‘slippery kidney pulse’ or shen in the first place.
Apples aren’t being compared to apples. Many on this thread are confusing the technique of acupunture with the work of someone who specialises in acupunture.
@Jim
I am not making aspecial case for acupuncture – the same applies to each CM approach or all combined. So if a CM practitioner thinks he or she is doing an effective job then a study of [the most appropriate CM technique or combination of them] with [a reasonably practical alternative (as above)] as treatment strategies should show a significant advantage in terms of some clinically meaningful objective criterion.
Otherwise it’s just the notoriously unreliable anecdotal “evidence” which nobody with critical faculties should take seriously.
Jonathan – in the study Matthew referenced, both acupuncture and ‘sham’ acupuncture outperformed conventional care. That wouldn’t be unreliable anecdotal “evidence”, so shouldn’t people with critical faculties seriously opt for acupuncture over conventional care?
I didn’t think you were making a special case for acupuncture – I was just saying that a full treatment, rather than isolating a technique, would get different results.
Actually, it would make no difference whatsoever, because you would then use acupuncture+whatever in one arm and sham+whatever in another. You would still be testing acupuncture, and given its impressive property of only getting actual results when researchers aren’t looking, you would still not get any actual results worth reporting.
Also if sham and real are getting the same results, would it then not be better to go with the easier, cheaper and safer modality and let the acupuncture implements gather dust in some forgotten corner? That’s the point with this type of resultd: acupuncture is useless, since sham gets the same results.
The part I do not understand is how acupuncture would somehow be valuable by not being better than something else? It’s like buying a Ferrari instead of a Mini Cooper to drive downtown Toronto: it only makes some vague sense if you need a status symbol, not efficacy.
The very fact that acupuncturists are yodeling a different song, can tell us only that are scientifically/skeptically inadequate, or that they have an agenda they are not talking about.
Bart – Sham acupuncture outperformed conventional care, acupuncture (needling only, no other therapy) outperforms sham acupuncture. Those were the results of the study.
Tell me why an evidence based practioner should not refer low back pain patients to an acupuncturist.
In that case, I don’t know what study you are referring to jm. I thought he mentioned two:
Both are giving the same results: more improvement than conventional care, no difference between sham and real acupuncture. What this shows is that acupuncture is useless. Why would one use real acupuncture, if the much cheaper and less dangerous fake version gives you the same results?
Second, since the difference with conventional care is the same for both, we must assume that there is something in the acupuncture-like rituals that give a stronger placebo effect, and while that is great, one still has to deal with the ethical implications of lying to patients and the long-term destructive influence this has on the trust between doctors and patients.
I don’t know what you think, but I categorically refuse to be treated by a doctor who is lying to me.
Bart – I was referring to the first one (sham acupunture was done by needling non-traditional points – second one used toothpicks). You come to the odd conclusion that acupunture is useless. 47% vs. 27%? Far from useless, especially considering they weren’t using a complete treatment that you would receive from an acupuncturist and comparing it to a full conventional treatment.
“I don’t know what you think, but I categorically refuse to be treated by a doctor who is lying to me.”
Me too. Since there have been several references to studies showing the benefits of acupuncture (Edzard’s post, Matthew’s references, Peter Deadman’s links) on this thread alone – it would seem that any doc claiming that there is no scientific evidence for acupuncture would be lying.
Any commenter making the no evidence claim would be lying as well.
No. I come to the very logical conclusion that acupuncture is useless because it has similar results as sham acupuncture. Many people seem to have a problem understanding that when sham acupuncture has similar results as real acupuncture, this is a finding of some importance. It means that experts who have been instructed to do everything WRONG, are having the same results as experts who have been instructed to do everything RIGHT.
As I have said already, this means that acupuncture can be replaced by non-acupuncture. This has several advantages, not the least of which is the saving of money for the patient. Now, I find it intriguing that both non-acupuncture and acupuncture have similar results, higher than some other modalities, but what is obvious, is that the needles aren’t where it is at. So, again, what is it in the acupuncture STYLE that seemingly creates an effect, since it is NOT the needles?
To put it differently, perhaps clearer: imagine that gas for your car costs two dollars a litre and that tap water costs 5 cents a litre. Now, imagine that twenty litres of gas (40 dollars) take you from Toronto to Ottawa and that twenty litres of water (1 dollar) take you there as well. Will you then really insist on using gas? Be honest to yourself!
So now, why would you prefer real acupuncture if sham, which is cheaper and less dangerous, gives you the same results? It makes no sense unless you see real acupuncture as a status symbol and a way to demonstrate how much money you have to burn. Yes?
Similar results for real and sham do not by definition indicate that there is no effect, but they *do* indicate that there is no reason to use real acupuncture, i.e. real acupuncture is useless.
It’s elementary, my dear Watson.
Bart – “Be honest to yourself!”
Honestly, any evidence based practioner with a patient presenting with low back pain should inform the patient:
1. The evidence is that a standard needling protocol from an acupuncutist slightly outperforms sham acupuncture.
2. Both needling protocol and sham acupunture significantly outperform conventional care.
3. If you see an acupuncturist, the treatment will involve much more therapy than just needling. Logically, there would be even more benefit…although we don’t know how much more.
4. While the risk of harm from needling is incredibly rare, it can happen.
5. Risk is greater from conventional care.
They should counsel their patients, in terms of risk/benefit:
1. Treatment from an acupuncturist, including needling and other therapy – best results, minimal risk, low cost.
2. Treat yourself at home – no risk, better benefit than conventional care. Costs nothing if you already own toothpicks.
3. Conventional care – significantly less therapeutic effect, greater risk, costs more.
So basically, any truthful, evidence based practitioner would tell their patients to avoid the risk and expense of conventional care since they would get much better, risk free results with placebo. And with minimal risk, they could significantly increase results by seeing an acupuncturist. To do otherwise, they would be lying.
They have. Lots of times. But, for some reason, when the results come out, only the skeptics are still agreeing. The fact is that the effectiveness of acupuncture, one of the most-tested modalities in the the history of medicine, has not been demonstrated to any meaningful extent.
He has. He has dedicated his life to it. Other independent teams have answered these questions as well. The questions have been answered, once and for all. The only reason they are still being asked, is because its purveyors don’t like the answers and want to blur the issue. They seem to think that repeating the questions ad nauseam and lying about the results is Halal.
It isn’t, but so be it. Let them whine as loudly as they want in the caves the original versions of their rituals were born. Acupuncture is part of that great repository of human nightmares, together with the geocentric model of the universe, the flat earth, miasmas, the phlogiston theory, Yahweh, Allah, levitation, clairvoyance…
Science is not a democratic process. It is about finding out the realities of the universe, not about what is most popular. Facebook is a lot better for that, and it has science to thank for its existence. Science works and has results.
Jonathan,
I agree with the need for reproducible evidence. We need it as much as sceptics for one simple reason. A lot of acupuncture training goes into developing differential diagnostic skills, specific needling techniques, and pulse and tongue diagnosis. These techniques take literally years to develop. If properly designed studies fail to show verum vs sham difference then we, as acupuncturists, need to re-examine what we’ve been taught. If they do show a difference then we can continue honing those skills.
To answer your question of who can help sort this out, I think you can start with Matthew Bauer. I know the work he does with Acupuncture Now Foundation and I respect it. He posted on this blog earlier so you can ask him directly. Or you can just google him.
Jonathan and others. I am not a researcher but I would say that there are many challenges in conducting reliable acupuncture research. When testing the effects of a simple biomedical intervention e.g. a new pill, the dose is defined, and all patients get the same medicine exactly. Even so, I imagine there are many challenges, pitfalls and compromises in achieving good research and we know from Ben Goldacre that vested interests may significantly affect which research is published and which is not. Acupuncture is a different beast. Look, as a parallel, at yoga research. There’s quite a stack now showing favourable outcomes but it’s very hard to assess what is going on because yoga is such a variable activity. Different styles of yoga may emphasise anything from meditation, through gentle stretching, to challenging physical practice etc. The yoga might be practised daily, or just once a week in a class. It might be presented as a purely physical or as a spiritual activity.
Acupuncture research is similar. Treatment in research studies might be given by a nurse, a doctor, a non-medical acupuncturist, someone who has done a few hours training, or someone who has studied and practised for years. Needling might be minimal (few needles, minimal stimulation and therefore not that different from sham) through to powerful – many needles, intense stimulation (in the 2000-year acupuncture tradition, needling technique is often presented as an art to be mastered). Treatment might be given daily, weekly or even less frequently. Needles may be removed immediately after insertion or stained for long periods of time. Beyond this, the majority of qualified acupuncturists would normally tailor treatment to the individual patient and might well change the it at each visit to match changing circumstances. They might additionally use moxibustion, electro-stimulation, gua sha (skin scraping).
None of this means that research cannot be devised that will suitably test acupuncture, but it is very hard to assess the results of any research where these issues have not been acknowledged and addressed to some degree at least. STRICTA guidelines (http://www.stricta.info) have been devised to assist this process but I am not clear how widely these are used.
I have read Stricta, and I may be mistaken, but it looks largely like a bunch of hokum specifically designed to blur the issues and divert attention from the stuff that really matters.
Acupuncture is just as easy/difficult to test as any other modality. Clinical trials are far more flexible and adaptable than alternologists tend to claim. I suggest you read a few articles or books on trial design and find out what is actually going on. The only reason acupuncture is “difficult” is because the disappointed acupuncturists are trying to find excuses for why the trial didn’t result in what they claim. Acupuncturists are like the soccer players who claim they lost a match because of the rain or the bad grass or whatever, conveniently omitting to mention that the other team was playing in the same conditions.
Real medicine doesn’t work like that. For example: we have accepted vitamins because when we test them, they work, even though then-current knowledge predicted they would not. We have rejected blood letting because when we studied it we found it does a lot of harm, even though then-current knowledge said it did a lot of good. All this stuff takes time, years, decades, or more to sort out, but medicine evolves. Acupuncturists, on the other hand do essentially nothing but yell about what horrible people scientists are.
The expert here is Edzard Ernst, who has conducted and was also otherwise involved in several trials, and trials just aren’t conducted the way alternologists like to claim or suggest. When he, and his colleagues do trials, they are attempting to find out if whatever they are testing has a reliably identifiable and reproducible effect, and how big that effect is.
Contrary to what a pathological and proven liar like Sasha says, the man has sacrificed years of his life to study it all. He is world-renowned, highly respected, and for good reason, and when certain disreputable individuals such as snake-oil shill Prince Charles tried to shut him up, he used his own money to keep his department going for as long as he could.
Reread the first paragraph of his post:
Is this really possible or is Edzard Ernst hallucinating or blathering? You will find he is not. He is only telling the truth. Who do you think provides the expertise for the acupuncture part of these trials? I think you will find out they are acupuncturists, not seamstresses.
Think about it: if this really were Big Pharma trying to eliminate it all, how then is it possible that acupuncturists have never been able to design a trial that has genuine results? Mean question: have they ever honestly tried?
Dear Alan,
The question is for us all. We should all aim to critique research properly. As evident when it comes to acupuncture research a range, and combination of skills are required.
I have not researched the proportion of sources of the generation of acupuncture trials. It may be a good MSc project, for someone.
However, in my opinion, I doubt the British Acupuncture Council has the funds or is one of the main contributors to acupuncture research.
The British Acupuncture Council should increase and allocate finances for the evidence-base required for integrated healthcare. There is the British Medical Society of Acupuncture; I am unsure of their involvement. They may be more active. Mr. Peter Deadman of the Journal of Chinese Medicine may be in a better position to fund acupuncture research?
The design and conduct of acupuncture clinical trials require a range of expertise and collaboration. Pragmatic RCTs are one way forward.
For example:
http://www.plosmedicine.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pmed.1001518&representation=PDF
I have read Edzard’s opinion of this trial.
I hear you though Alan, it is a waste of resources and perhaps unethical to conduct poor quality research. It gets no one anywhere. Apart from it is time to address this.
Regards
George Bocs said:
If your question is about the lack of good evidence for acupuncture, then, no – it’s a question for acupuncturists.
But what are they doing about it? It’s their members who are earning a living from acupuncture after all.
Agree about getting the funding, but you need to slow down before talking about ‘integrated healthcare’! First, provide evidence that acupuncture has specific effects (ignoring the fact that the best evidence to date says it doesn’t) then we can start talking about integrating it with EBM. As Dr Mark Crislip said:
You’d have thought they would have been at the forefront of research and practising EBM. My complaint about them for their advertising claims in relation to their clinic at the Royal London Hospital for Integrated Medicine was upheld, so I’m not confident they are all that interested in evidence.
All these organisations and practitioners; not so much good research…
Dear Alan,
‘If the question is about the lack of good evidence for acupuncture, then no – it’s a question for acupuncturists.’
We should all look at critiquing research appropriately. Reviewing the real issues of research design and methodology, in a non-bias manner.
In the context of acupuncture, it is evident that the problem is a lack of good research. I have not heard anyone raise this issue! Therefore, I suggest that the aim should not be to suppress a practice, due to a lack of good research and hence evidence, but an aim to improve it. To make well informed decisions.
I think it is correct to enforce advertising standards Alan, and your work is praiseworthy. I think it is correct to call for an evidence-base.
Regards
The issue of lack of good research has been raised by acupuncturists a few times here but the thread is too long so you probably didn’t see it.
Ok Sasha. Thank you. Did you see the link to the research trial of Acupuncture for Depression? It’s a very good study.
Regards
No, didn’t see it. I’ll look.
I don’t look at depression studies too much because depression is so amenable to placebo. That’s why the whole SSRI thing is a bit of a joke.
Yes, what are the acupuncturists waiting for? Some time has passed since Mao reintroduced their craft. As an industry that commands rather high rates, it has produced very little of substance. At the very least, “ill will” is a plausible explanation for this appalling lack of enthusiasm.
And here’s another sham vs verum comparison from Cochrane reports:
Individuals with chronic neck pain who received acupuncture reported, on average, better pain relief immediately after treatment and in the short-term than those who received sham treatments. Individuals with chronic neck pain with symptoms radiating to the arms who received acupuncture reported, on average, better pain relief in the short-term than those who were on a waiting list.
Another impressive report. Wow, you sure know how to gather evidence.
Let’s see. This is the link you forgot to mention for some reason: http://www.cochrane.org/CD004870/BACK_acupuncture-for-neck-pain
I suggest that this hardly substantiates the lofty claims made by acushills.
This is not a claim made by “acushills”. Man, you really need to learn how to converse without resorting to some sort of direct insult. In any truly scientific or scholarly debate you’d be booted out long ago.
“There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment.” This is a conclusion reached by Cochrane after analyzing all available data and adjusting for those inadequacies that you mention.
And, frankly, I’ll take Cochrane’s recommendation any time over that of what you people come up with.
@Bart B. Van Bockstaele
Obviously you don’t go along with the acupuncture theory of meridians, chi etc. but if you look at the whole bundle including the history of the tradition, the personal interaction, the ritual, the potential neurological effects of needling (or other nerve stimulation) you must see that, at the least, there is the strong possibility of some beneficial effect even if you would attribute all or most of it to a psychological or ‘placebo’ effect.
So given that a placebo benefit is still a benefit, if acupuncture turns out to be the best placebo in town then it’s still worth having in those conditions where conventional medicine has nothing to offer.
You may personally feel that the practitioners and patients are deluded and you may even feel that the patients are deluded and the practitioners are just acting the part but if the patient s benefitting it is still a valuable service.
The issue is *if*. Many alternologists argue this, and one would think it makes sense, but it doesn’t. The reason is that the placebo effect is a small effect, is notoriously unreliable and acupuncture is not without risks, from minor bruising, over fainting to collapsed lungs and death. We do not know how often these negative effects occur because acupuncturists don’t keep records, but the point is that the benefits are minimal and the risks not zero. That’s not a good combination.
Also, consider the ethics: in order to get these minimal results, the patient is being lied to and told an unlikely and largely disproven story that distorts the patient perception of reality. Some people think that lying to patients is halal. *personally* I disagree, but even if I did not: what type of a basis to build a trusting patient-doctor relationship are lies? How can I trust my doctor if I know he/she may be lying to me, knowingly and willingly?
The issue of harm from acupuncture is a good examle of non-evidence-based fire-raising. Have any trials shown a significant incidence of harmful effects (apart from a little bruising which is arguably part of the treatment or a vasovagal reaction which is much more likely with simply taking a blood sample)?
As I said earlier all the alternative therapists I have met are convinced of the benefit of the treatment even if they may have oubts about the background “theory” or tradition. It’s because their patients keep coming back and saying how much better they are feeling. The hard work they have put into learning the craft and this reinforcement of positive feedback are pretty powerful influences to convince them and this in turn increases (at the least) the placebo effect for the patients. So all this talk of lying to people does not represent the real situation IMHO. Likewise many regular doctors, when other modalities have failed, may recommend alternative approaches on the basis that “they might work”, privately hoping that even if the specific treatment is of doubtful value the placebo effect will be strong enough to keep the patient happy and aid natural recovery. It’s not helpful and not true to say the treatment definitely won’t help. Expressing uncertainty in a positive way is not the same as lying. Clinical medicine is a lot more complex than clinical trials.
Jonathan
As George mentioned earlier, Cochrane library provides quite enough evidence on acupuncture effectiveness beyond placebo and even more evidence on acupuncture effectiveness beyond conventional therapy.
As I’ve said before, at this point the only thing going for an acupuncture sceptic is sham vs verum comparison but even that doesn’t always hold up. (We’ll leave aside for now the point that George raised earlier and which I’ve heard before that the whole idea of sham acupuncture is questionable because acupuncture itself is an intervention).
For example here’s what Cochrane review says about acupuncture for tension headaches:
“Small but statistically significant benefits of acupuncture over sham were found for response as well as for several other outcomes”.
And: “In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.”
There’s more there but I don’t want to make it too long.
And here’s another one from Cochrane that puts the whole sham vs verum thing to question:
Compared with sham treatment P6 acupoint stimulation significantly reduced: nausea (RR 0.71, 95% CI 0.61 to 0.83); vomiting (RR 0.70, 95% CI 0.59 to 0.83), and the need for rescue antiemetics (RR 0.69, 95% CI 0.57 to 0.83)
Why did you not post the link? Because of this, perhaps?
http://www.cochraneprimarycare.org/sites/cochraneprimarycare.org/files/uploads/pearls/175_Wrist%20acupuncture%20effective%20for%20prevention%20of%20postoperative%20nausea%20and%20vomiting.pdf
I didn’t get it from that link. I got it from cochrane library. Here’s what it says for main results:
We included 40 trials involving 4858 participants; four trials reported adequate allocation concealment. Twelve trials did not report all outcomes. Compared with sham treatment P6 acupoint stimulation significantly reduced: nausea (RR 0.71, 95% CI 0.61 to 0.83); vomiting (RR 0.70, 95% CI 0.59 to 0.83), and the need for rescue antiemetics (RR 0.69, 95% CI 0.57 to 0.83). Heterogeneity among trials was moderate. There was no clear difference in the effectiveness of P6 acupoint stimulation for adults and children; or for invasive and noninvasive acupoint stimulation. There was no evidence of difference between P6 acupoint stimulation and antiemetic drugs in the risk of nausea (RR 0.82, 95% CI 0.60 to 1.13), vomiting (RR 1.01, 95% CI 0.77 to 1.31), or the need for rescue antiemetics (RR 0.82, 95% CI 0.59 to 1.13). The side effects associated with P6 acupoint stimulation were minor. There was no evidence of publication bias from contour-enhanced funnel plots.
Perhaps not. But the original paper isn’t much more convincing, is it? Even though your quoting was somewhat more complete this time, for which I congratulate you, you still did not bother to include the link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113464/pdf/nihms284338.pdf
There is a reason why scientists spend so much of their time providing references and are even using special software to help them do exactly that. References are not provided for entertainment.
And then, there is this part of what you quoted yourself, which is indeed in the original 64 page paper:
In my book, that casts serious doubts on the reliability of the differences between sham and real.
Also not uninteresting here is that the results are deemed comparable to the drug approach, which doesn’t really mean much either, given the rather inadequate source data, but also since there are good reasons to think that the pharmacological approach is sadly inadequate. We just don’t have anything better and less unreliable at the moment.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003281.pub3/abstract
This is the link. It is harder to design an adequate study that would control for all of those things for acupuncture (a minor surgical procedure) as opposed to a pharmocological intervention. How many similar procedures employed by conventional medicine are subjected to this type of scrutiny (physiotherapy, etc)?
A little harder – but not much. All you need is a prescribing acupuncturist and a delivery acupuncturist with a researcher stood in between randomly allocating “acupuncture as prescribed” or “acupuncture, not as prescribed”. The easist method is to manage the patients in pairs and swap the envelopes 50% of the time.
I would say that if you want to test sham acupuncture properly, then for sham group you can’t have a delivering acupuncturist. You’d need to have someone who never held a needle before perform sham procedures. Just keep them away from upper thoracic area. Maybe mark sham points on extremities for them to needle. I don’t know if marking points would violate an RCT requirement of some sort.
Ah, the old “Let’s build an experimental design we can refute if we don’t like the results” ploy. Sorry, not falling for that. Real acupuncturists delivering “real” acupuncture in both arms of my trial – a bit like comparing a drug I think is a pain killer with one I think isn’t. If the two arms of the trials give the same result – as I suspect even you think is the case – then the positioning of the needles is revealed to be irrelevant. We can drop all the meridians nonsense and move on. If people still want to be acupuncturists, we’ve also shortened the training considerably. They still need the people skills and accounting and how to stick needles in safely, but they can forget the “wisdom of the ancients”.
Alternologists are often said to be economical with the truth. So are you. Only when you seem to think you can no longer get away without doing so, do you post a reference, and what reference are you posting? An *abstract* of the full article I posted a link to before. Why is that? What is so terrible about the truth you are so reluctant to share? Why are you doing your best to make people jump through hoops to verify your claims? Why not simply confirm that this is indeed the article your quote was based on, but instead post something no serious researcher will accept as a trustworthy source of information?
It seems obvious that Big Placebo is not only guilty of the tricks it accuses medicine of, but is actually using those tricks with far greater enthusiasm and zeal than the “medical establishment”. Why is that? Could the enormous amounts of money streaming in with virtually no overhead, no red tape, no research, no effort have something to do with it?
Those tests have been done numerous times already. When you apply acupuncture the wrong way (a type of sham), you are applying acupuncture “not as prescribed”. And this is what Edzard Ernst mentioned in the second sentence of the first paragraph of the post:
As Captain Picard would say: “There goes the other shoe. They know.”
This is reply is about as revolting as it gets. Maybe, the industry would care to hand over its records, but there aren’t any, are there? In spite of that, we know that acupuncture is a dangerous affair, that it causes lungs to collapse and hearts to be pierced, resulting in severe illness and death. These are tactics worthy of criminals, not would-be healthcare providers.
“it causes lungs to collapse and hearts to be pierced, resulting in severe illness and death” – references? True, these are theoretical risks but have they actually happened more than once in the entire modern history of acupuncture? OK there is no official register of acupuncture procedures but there is little doubt that such cases presenting to emergency departments would be written up as case reports.
“These are tactics worthy of criminals” – you are really going over the top here, it discredits your argument.
not as rare as you seem to assume:
~ 100 fatalities
> 100 articles on pneumothorax on medline
~ 20 cardiac tamonades
+ huge under-reporting
So there’s not “minimal risk” with acupuncture…it’s more like “phenomenally rare risk”. As in, you are much more likely to die from a lightning strike. As far as therapies go, you’re more likely to choke while taking a medication than have an adverse effect from acupuncture.
remember a thing called RISK/BENEFIT BALANCE?
“not as rare as you seem to assume:
~ 100 fatalities
> 100 articles on pneumothorax on medline
~ 20 cardiac tamonades
+ huge under-reporting”
Dear Edzard,
Please can you present further data:
1: ‘100 fatalities.’ Did these occur in the UK? Or other. Please state.
2: ‘>100 articles on pneumothorax on medline.’ Who caused pneumothorax using acupuncture? What training and qualification did those inserting needles have? If any.
3: ‘Huge under-reporting [of incidences].’ Can you provide data of this estimation?
4: What is the denominator? ‘100’ out of how many treatments? 40 million, more or less?
5: Over what time period were these results accumulated? A year? Or do these figures reflect the reported cases ever to exist? Other?
I suspect that the issues presented could be due to a lack of adequate training in acupuncture. Just reinforces how important it is for acupuncture to be statutory regulated (in the UK).
Regards
1: ‘100 fatalities.’ Did these occur in the UK? Or other. Please state.
INTERNATIONALL
2: ‘>100 articles on pneumothorax on medline.’ Who caused pneumothorax using acupuncture? What training and qualification did those inserting needles have? If any.
YOU’LL HAVE TO STUDY THE ARTICLES ON PUBMED
3: ‘Huge under-reporting [of incidences].’ Can you provide data of this estimation?
WHEN WE DID OUR UK SURVEY, WE FOUND THAT NONE OF THE AEs HAD BEEN REPORTED; THIS MEANS UNDER-REPORTING = 100%
4: What is the denominator? ‘100’ out of how many treatments? 40 million, more or less?
UNKNOWN
5: Over what time period were these results accumulated? A year? Or do these figures reflect the reported cases ever to exist? Other?
WHICH FIGURES ARE YOU REFERRING TO?
FEEL FREE TO GO ON MEDLINE AND DO YOUR OWN ‘HOMEWORK’
Thank you Edzard,
I expected that data. When one presents numbers, a bit more description is need to make an informed decision or judgement. Unless of course, one wants to use the data for their own purposes and intentions.
In the UK the British Acupuncture Council has an excellent safe profile. This could be a result of highly trained acupuncturists.
Regards
or of the absence of a monitoring system?
Dear Edzard,
I believe the British Acupuncture Council has an excellent system in place and safety profile. Perhaps you could contact them? It’s so important that acupuncturists are trained to similar high standards.
I have found this thread interesting. Thank you Edzard for the blog and posting all comments. I have to disappear now as I have a big project to get on with.
Have a good weekend everyone! You have my email should you like to meet for a cup of tea. I do need to correct your A+B theory.
Kindest Regards
Yes it *could*, but given that acupuncturists are not keeping and/or are destroying any records, we can’t know that, can we? Also, why would acupuncturists bother to disappear data, if acupuncture were so fantastic? It is not the medical establishment’s fault that acupuncturists are into making sure there is no evidence. Absence of evidence may not be proof of absence, but it sure is evidence of absence. Ask any unicorn. Even more so if the non-existence of evidence is the result of (non-)actions of those making the claim of its existence.
There seems to be a lot of deliberate misinformation in this discussion. There is overwhelming evidence for the safety of acupuncture and we have to ask what the motives are of people who attempt to claim otherwise.
http://www.bmj.com/content/323/7311/486
http://www.ncbi.nlm.nih.gov/pubmed/19420954?dopt=Abstract&holding=f1000,f1000m,isrctn
http://www.bmj.com/content/323/7311/485
Interesting links. So you think that voluntary reporting by people who are doing their best to avoid having records is reliable? What a novel idea. For your information, not even the authors of the first study you link to are admitting to at least the possibility of bias.
The authors of the last study include an individual who your colleague detractors have attempted to discredit. He happens to be the owner of this blog and the world’s first professor of alternology. You may want to study more of his writings, and stop being so gullible when acupuncturists are dreaming up their next Big Thing.
“remember a thing called RISK/BENEFIT BALANCE?”
Excellent point! I should have added that to my comment to Bart – not only is there evidence that acupunture has significantly better results for low back pain than conventional care, but it comes with significantly less risk than choking on the meds used in conventional care.
Thanks for pointing that out. Hopefully MDs are informing their patients that acupuncture has better proven benefits, with much much lower risk.
It certainly would be the ethical course, putting the risk of acupuncture in perspective.
George Bocs said:
Please do tell.
Oh, by the way, I caught the BAcC describing themselves as a ‘UK Statutory Regulator’ last night. They have a website for their Acupuncture Research Resource Centre. Their domain name arrcsymposium.org.uk is registered to the ‘British Accpuncture [sic] Council’ as Registrant and they describe themselves as ‘Registrant type: UK Statutory Body’.
I’ve pointed it out to them but they’ve not corrected it yet. Very embarrassing and misleading.
You are knowingly and willingly lying by omission. Why is that?
You are knowingly and willingly lying and you are exploiting the fact that alternologists generally and acupuncturists specifically are not keeping records. You are acting like Bernie Madoff. Why is that? How can you be so proudly dishonest, in flagrant disregard of the dangers to the gullible victims of this dangerous practice?
You know what this means, don’t you? It means that you are not only tolerating but actively promoting what could be termed “premeditated murder”. You should be proud of yourself. I couldn’t. I have a conscience that bothers me too much.
That is the part that bothers me most, and it seems to be almost a condition for qualification: the absence of anything remotely resembling records. While it is hard to prove because we can’t look in people’s heads, it is almost proof positive that there is a percentage of alternologists who are so eager to make money that, when they have to choose between not making money and killing their customers, will kill those customers without giving it a second thought.
Not keeping records, and then use the very absence of records to claim safety? How despicable can a person be? To me, that indicates premeditation and intention.
Bart – “You are knowingly and willingly lying by omission. Why is that?”
What are you talking about? I think your “lying” rants on here jumped the shark a while ago.
For the THIRD time: if sham and real have the same results, that indicates that one should go with sham, not with real acupuncture.
There are two possibilities I can see for your lack of understanding: you lack the thinking powers needed to see why this is so, in which case you have my pity, or you are desperately continuing your attempts of swindling gullible and vulnerable people, in which case you have my contempt. I hope for the first, but fear for the latter.
George Bocs said:
Odd, then, that they appear to make no mention of it on their website, isn’t it?
On their ‘Is acupuncture safe?‘ page, they say:
Yet all they refer to is two surveys from over a decade ago but omit to provide any references to them.
They do have other pages that mention risks, but they play them down. One page (Risk associated with pneumothorax and acupuncture) even mentions a paper by Edzard, but they also say they debunked the ‘myth that the commonest cause of pneumothorax was acupuncture treatment’, by phoning round all the A&E departments in London…
Are you sure they have any kind of a system?
The maths is getting harder Please answer the following:* I used my calculator.
Dear Alan,
I would assume the British Acupuncture Council does have a thorough system in place for the reporting of incidences. As this professional body is very robust self-regulated body. If you ask them direct they will inform you.
I am not sure about the British Medical Society for Acupuncture?
Or physiotherapy or osteopathy the list could go on.
Acupuncture should be statutory regulated. Particularly as fatalities have occurred internationally. Only qualified acupuncturists with an expected amount of adequate training should be providing acupuncture. If inadequate trained acupuncturists (weekend or -six months training) continue to provide acupuncture in the UK there is likely to be an increased and preventable risk to the public in the UK.
Regards
In the same way you are assuming acupuncture is effective for anything besides enriching acupuncturists? It may surprise you to learn that some of us prefer not to assume, but to look for evidence instead.
You are like a lost “Bart” in a colander.
Regards
It is quite ok to have an opinion. As long as it is clear that it is an opinion. For example one states “in my view” or “I assume” or “I think” …
You know nothing about this though. Always mixing facts with your distorted view. Or pretending that your opinion is fact when it is not. It’s quite an obvious trait of yours. Shame on you.
Bart, as you are a qualified acupuncturist, that knows all about sham acupuncture why don’t you discuss the sham methods and techniques used in the studies you bark on about? It’s called a critical appraisal. To start you off think about:
Needle techniques used
Location of needling, depth
Acupuncture points and practice
The condition for which sham was applied
And so on…
George Bocs said:
I would assume they don’t until there was evidence to the contrary. Your statement about them being a ‘professional body’ and a ‘very robust self-regulated body’ simply begs the question. But if public safety was paramount, wouldn’t a mandatory AE reporting system be essential?
Again, I find nothing on their website, so I will assume for now that they don’t have one.
Or chiropractic…
Not it shouldn’t.
If an acupuncturist harms someone, there are already laws that protect consumers. But since – as has been pointed out – there is no monitoring system, we cannot know how consumers are being harmed.
Surely the best way to avoid harm by acupuncturists is simply to get them to use toothpicks instead of needles – as has been pointed out many times, it appears to be equally effective and there seems little doubt it’s safer, hence the harm-benefit balance would be far more favourable. It still doesn’t do that much, though – but neither does acupuncture. And acupressure works as well as acupuncture, doesn’t it?
But if acupuncturists want to stick needles in people and their customers are aware there is scant evidence of any specific benefit, perhaps most of the serious harm can be avoided by training them were not to stick their needles and only use needles that go in a few millimetres? That additional training wouldn’t add much to their overall training and might save countless lives and reduce other harms of acupuncture.
So, is anything being done to stop these ill-trained acupuncturists sticking needles in people?
Nothing will be done.
Because acupuncture is not statutory regulated. I can’t call myself an osteopath and start treating patients as the title is protected and one needs to be trained in osteopathy.
Bart could stick needles into any patient or as Bart prefers toothpicks.
Bart is under the impression there is no difference between a qualified acupuncture health professional, someone with poor inadequate limited training and qualification with members of the public that might want to take a shot at treating themselves.
Anyone can call themselves an acupuncturist and do it!
Bart is correct, as it currently stands unqualified puncturing is occurring!
Unless acupuncture is regulated the public are at risk of Bart conducting minor surgery…
I think the World Health Organisation has recommendations of what it takes to train to be an acupuncturist. I think…
Maybe Acupuncturists would prefer not to be statutory regulated like many on this thread would prefer. However, with this stance comes potential problems.
What is the difference between physio and acupuncture evidence-base?
In my view..
…
Surprising isn’t it!
Regards
George
Bart – “For the THIRD time: if sham and real have the same results, that indicates that one should go with sham, not with real acupuncture.”
That’s pretty much what I said here:
http://edzardernst.com/2015/02/acupuncture-new-meta-analysis-suggests-it-is-effective-beyond-placebo/#comment-65367
You say “…or you are desperately continuing your attempts of swindling gullible and vulnerable people”
Swindle people? How so? You think I get some kind of benefit from docs informing patients that acupuncture and sham acupuncture are safer and more effective than conventional care? That makes no sense.
I don’t remember reading that acupuncture and sham were SAFER than conventional care. Maybe you could quote that part.
For the rest, as I have said: it is an interesting phenomenon. It does show that acupuncture is unnecessary for the condition tested, since it is clearly not the acupuncture that does it here. After all, that is why we use sham in the first place: to compare the needles with no needles, and to compare acupoints with non-acupoints. The question, as I have said before, is therefore: what is it in the acupuncture STYLE that seems to make it more effective than conventional treatment? That is, of course, on the condition that different, independent teams working in other centres, preferably in other countries and/or continents, are getting similar results.
Alan – “It still doesn’t do that much, though – ”
Toothpicks seem to significantly outperform conventional care, according to the evidence. I’m surprised you’re not worried about the dangers of infected splinters, though.
jm said:
Good grief. Have you learned nothing from this thread?
Why on earth would you jump to that conclusion? But who on earth said they had to be wooden?
George Bocs said:
I thought you said the BAcC was a ‘professional body’ and ‘robust’?
Why would not being statutory prevent them from setting up a robust AE monitoring system and strictly enforcing compliance actions to protect the public? But perhaps you think they should be given statutory regulation and then sometime later start to worry about whether they’re protecting the public or not?
That’s the problem with the statutory regulation of chiros and osteos: all it does it protect the title. It makes no attempt to define what they can and can’t so, exposing the public to unnecessary harms.
If the outcomes toothpicks achieve are on a par with the far more dangerous practice of puncturing the skin with sharp needles, then why would anyone support the latter?
Indeed. I have all the qualifications I need to call myself an acupuncturist. I would never do it, of course.
If statutory regulation of acupuncturists was to be along the lines of the chiros and osteos, the only difference it would make is that bart wouldn’t be able to call himself an acupuncturist. He could call himself a ‘Skin Puncturing Therapist’ and do exactly the same thing. Statutory regulation of quackery protects quacks only and does not protect the public.
Possibly. But in the absence of good evidence it has any specific benefits…
Sometimes (often) I think it’s the poorly trying “skeptic” that is actually in wonderland!
I can’t comment any different to what I have done. If that’s your interpretation so be it. Toothpicks it is. I know who I’d rather visit should I require acupuncture. A professionally and adequately trained acupuncturist. Otherwise I may be risking my heart.
However, Edzard’s statement was with regard to international boarders. I hope that the UK treatment seekers can see the difference between a Bart and a professional.
Regards
Alan- “Good grief. Have you learned nothing from this thread?”
One thing I’ve learned is how well many commenters can ignore evidence.
“There’s no evidence!”
[Peter Deadman provides a handful of links showing evidence of the effectiveness of acupuncture]
[…crickets…crickets…crickets…]
“There’s no evidence!”
I would have at least expected the usual, ‘yeah, but those are crappy studies’ type of thing. The lack of any response to Peter’s references is quite telling. But not surprising.
As far as the toothpicks go – do you know what kind of toothpicks were used in the study? Do ALL toothpicks perform better than conventional care (for low back pain, anyway)? More importantly, why are docs still recommending conventional care, when there’s evidence that toothpicks are better?
“Why on earth would you jump to that conclusion?”
It’s not that big of a jump. You seem to fear many benign things. Toothpicks are a choking hazard – and since choking is much more likely than a problem with acupuncture…I’m surprised you don’t fear toothpicks.
When Bart mentioned this before, it was called “mean spirited” by one of your brethren. Thank you for rehabilitating him. He’s feeling all warm and fuzzy now.
Bart does indeed prefer those, but since he is a professional, he uses highly sophisticated ones:
Bart is of the same opinion. It seems that the absence of a conscience is a self-selecting requirement for acupuncturists.
I think these toothpicks may score even higher efficacy than standard toothpicks:
http://www.bigislandparty.com/images/P/pi_16434-01.jpeg
“I think these toothpicks may score even higher efficacy than standard toothpicks:”
They’d be wonderful for blinded studies because you can’t see where the pointy end is… 😉
Bart – “I don’t remember reading that acupuncture and sham were SAFER than conventional care. Maybe you could quote that part.”
I think Peter provided some links. You could also google it. Also google choking, or getting hit by lightning.
“For the rest, as I have said: it is an interesting phenomenon. It does show that acupuncture is unnecessary for the condition tested, since it is clearly not the acupuncture that does it here.”
Also pretty clear that instead of conventional care, docs should be referring to acupuncturists. They provide more than needling. Or they could just do sham acupuncture themselves, and get greater benefit with less risk. Why do docs continue with conventional care and expose their patients to unnecessary risk?
“The question, as I have said before, is therefore: what is it in the acupuncture STYLE that seems to make it more effective than conventional treatment?”
I have no idea what you mean by that. But this is pretty clear:
“You know what this means, don’t you? It means that you are not only tolerating but actively promoting what could be termed “premeditated murder”.”
Really? You’re accusing me of actively promoting premeditated murder? Are you being serious, or are you just being a serious asshole? Based on your other comments on this thread, I’d bet on serious asshole. But I’d like to know for sure.
You tell me. Maybe you could explain what you said here:
Bart –
““You know what this means, don’t you? It means that you are not only tolerating but actively promoting what could be termed “premeditated murder”.”
Really? You’re accusing me of actively promoting premeditated murder? Are you being serious, or are you just being a serious asshole? Based on your other comments on this thread, I’d bet on serious asshole. But I’d like to know for sure.
I’m bowing out of this discussion now, I think. I do have one last comment for Bart, though. I see you practise a variety of traditional Japanese arts. My understanding is that these are highly refined practices, that would therefore be expected to refine the practitioner. It’s odd, then, that you are so ill-mannered, so coarse, and so strangely driven to make ridiculous statements. Whatever you think about acupuncturists (and I think a lot of them are a pretty fluffy), one thing they are definitely not is money orientated. Most barely earn a pittance. Secondly, whatever you think about the evidence for or against acupuncture efficacy, nearly every one I have met (and I have met many) is sincere in their intention and dedication to help relieve suffering in others. And whatever mechanism you think is at play I would say that they very often succeed in varying degrees. They are not liars nor are they murderers. I am finding it hard to resist replying to you in kind (because you really deserve it) but instead will quote the immortal words of Arthur Sullivan, discussing a colleague, “No one can have a higher opinion of him than I have, and I think he’s a dirty little beast.”
I see. Another one of those things where scientists and sceptics are getting it all wrong. When there is evidence to back something up, it is an opinion. When there is not, it is a fact. You really do know what you are doing, don’t you?
I think I have said enough in this thread. Thank you Edzard and all the other contributors to this interesting discussion which has helped me to clarify my thoughts on the subject and pointed me to further reading. I am confident that Bart will “have the last word”… 🙂
Of that, I think we all can be quite sure, unfortunately…Thank you for your input Jonathan. It was one of a few measured responses here.
Bye Jonathan. Nice to meet you online. I suspect that Bart is in love with you know who ;-)…
George
No, Bart is clearly in love with Edzard. If he got any more sycophantic we’d have to call in the surgeon.
I did not know – you even have humour [this made me laugh out loud!]
🙂 It did cross my mind whether Bart is the wife. Very loyal.
Regards
@George Bocs
Good grief.
You should know. You’re the one who gets his information from Watkins Books.
Most skeptics, including this one, have gone through that until we realise that the poster is only trying to distract us. Even though I might sometimes make an exception, I have learned not take the bait anymore.
Someone wants to present evidence? By all means: post the link and say why this particular link is worth spending time on.
Also, there is something rather perverse about claiming that scientific studies are made by unknown, unimportant, incompetent shills paid for by vicious monsters that are intent on protecting Big Pharma, and then suddenly screaming victory and “We told you so” when these unknown, unimportant, incompetent shills publish something that could, with a lot of creativity and ill-will be vaguely interpreted as evidence, however weak, that a particular scheme works.
The toothpick trial and the acushills’ reactions to it is a very good example of that.
There is one thing this thread has reinforced with me; that “True Believers” will not ever change their view no matter what the evidence.
`
It does not matter that sham acupuncture is the same as “real” acupuncture (whatever that is), that Mao revived a dead superstition for his own political ends, that RCTs find no efficacy apart from a mild placebo, or that there is no explanatory mechanism, “True Believers” will not be open to reality.
`
One other aspect of the “True Believer” is that they are, the vast majority at least, not the most intelligent people. I have come to believe most are of roughly average intelligence, but they feel special because of a special knowledge, in this case, acupuncture; notwithstanding they don’t have the capacity to fully understand it. Sad but true. They cannot be shown the incontrovertible evidence and acknowledge its validity, which makes having a discussion with them pointless.
`
People such as George (and many others) posture and make grandiose statements, but he is no different and the paucity of intellectual capacity becomes very obvious.
I debated posting anything more here as I am most interested in constructive dialog and don’t have much confidence this is the place for such a thing but I wanted to share a study that I believe is important for several reasons. This study was conducted by two pediatric anesthesiologists at Stanford University Hospital – one of the very top university hospitals in the U.S. They studied the impact of using acupuncture on 10 infants, ages 1 to 15 months, in the neonatal intensive care ward that were recovering from dramatic, lifesaving surgeries and of course were on heavy-duty sedatives and analgesics. When trying to wean infants like this off of those drugs it is common to have drug withdrawal complications and these doctors wanted to see if the use of acupuncture would ease those complications and speed the withdrawal off of those drugs. They saw dramatic reductions in the medications needed in all 10 infants.
These doctors work in one of the most highly skilled areas of modern medicine; sedation and analgesics to support recovery from lifesaving surgeries on patients who are more closely monitored than any virtually any other patients. They follow very strict protocols about calculating how much of what drugs to give these infants so the ability to measure the impact of acupuncture was quite acute and not based on subjective reports of the patients. I hope some of you will read the details of each of these 10 infants because, while these are no doubt more dramatic cases than would be typical for most acupuncture patients, this gives an idea of something that has been totally missing from this whole blog thread – that acupuncture is making substantial improvements in real people with real problems every day in most areas around the world.
I would also add that these doctors who conducted this study were hired and trusted by one of the premier teaching hospitals in the U.S. and that means they are among the very top of their profession so the idea that only someone of lower than average intelligence would be a “true believer” in acupuncture (Frank) or that they just want to “fatten their wallets” (Bart) is insulting, childish, and completely out of touch with reality. I had a child in one of those neonatal intensive care units over 35 years ago and as grateful as I am to the amazing miracle of modern medicine technology and those trained in it that saved my son’s life, I wish they would have had acupuncture available for him as he did end-up with permanent brain damage, likely as a result of the heavy sedatives he needed for the seizures he suffered after his third surgery. Those of us who provide real care to real people with acupuncture know its potential even if we don’t yet know how to prove it beyond doubt in controlled studies. We will figure it out eventually because we are dedicated to learning how to bring this safe therapy into the mainstream.
http://online.liebertpub.com/doi/abs/10.1089/acu.2014.1048
1) appeal to authority = classical fallacy
2) the study proves absolutely nothing
My guess is that the poor babies were simply tired of screaming after a while. I can’t help but wonder how this ever got through the ethical committee. In my opinion, sticking needles into babies on the basis of prescientific myths, is revolting; maybe not as horrible as the genital mutilation they are often subjected to, but that doesn’t make it suddenly acceptable.
‘
I agree that it proves absolutely nothing. I ate a tub of ice cream yesterday, and weighed 4 pounds less this morning. If I follow the reasoning of this study, the ice cream was highly beneficial to me. I can even dream up a mechanism through which it worked this miracle. But then, I am just an idiot, and somehow too lacking in intellectual abilities to believe such post hoc ergo propter hoc conclusions.
More revolting than some asshole making accusations of premeditated murder? Still haven’t answered my question, Bart.
1. Yes.
2. What question was that?
Bart –
“2. What question was that?”
You said “““You know what this means, don’t you? It means that you are not only tolerating but actively promoting what could be termed “premeditated murder”.”
My question that you refuse to answer:
Really? You’re accusing me of actively promoting premeditated murder? Are you being serious, or are you just being a serious asshole? Based on your other comments on this thread, I’d bet on serious asshole. But I’d like to know for sure.
I didn’t and don’t refuse to answer that question. In fact, I thought I did, but since I can’t find my answer, I have to accept that I didn’t, even if I remember something else.
.
I am not accusing you of anything. I have merely come to the conclusion that promoting premeditated murder is indeed what you are doing. Give me some other, reasonable, explanation and I’ll consider changing my mind, but I didn’t arrive at this conclusion by following the latest bitchslapping superhero and filling my bladder and head with Bud Light. I looked at the information accessible to me, I looked at the stories told by acupuncturists and acupuncturist promoters, including you, and that is my conclusion.
Bart –
“I am not accusing you of anything.”
At least your sticking with the theme of the comment thread.
I would say this studies proves that in some top mainstream medical institutions acupuncture’s potential is being taken seriously by some very bright and serious authorities.
you are fond of fallacies, aren’t you?
When I was at med school, my main interest was anatomy. I remember that Dr. Aline Vandevelde told us about the origins of the trapezoid muscle. She was immediately ridiculed by other students who chose to believe the story told by someone else, then head of the anatomy department, who hadn’t dissected a single corpse in the 40 years or so before then. He was the authority. He was extremely good, I was told, because he played the violin beautifully. He had seniority, was a very good story teller, and – not unimportant in those days in Belgium – he was a male, not a female. In other words, there could be no doubt: he was right and she was pathetic.
.
When I pointed that out to Dr. Vandevelde, she said that she merely described what she saw, but that with so much opposition to her standpoint, it certainly could stand another look and that she would change her story if she was wrong. When we went to check in the dissection room, she turned out to be right. Every single corpse was as she had described.
.
It taught me that “authority” in the scientific sense is a title that must be earned by hard work, dedication and integrity in search of what is so, not in the search of stories that people will like. I do not know the people you are talking about, they have not earned any respect, and their heartless penetration of helpless babies’ skin with needles in a mockery of a “study” that can never be proven right or wrong can only lead me to the conclusion that their goals are not honourable or that they are intellectually deficient, or both.
@Matthew
“I debated posting anything more here as I am most interested in constructive dialog and don’t have much confidence this is the place for such a thing but I wanted to share a study that I believe is important for several reasons.”
It is constructive IF you stop using logical fallacies and try to understand some basic science.
`
“This study was conducted by two pediatric anesthesiologists at Stanford University Hospital – one of the very top university hospitals in the U.S. They studied the impact of using acupuncture on 10 infants, ages 1 to 15 months, in the neonatal intensive care ward that were recovering from dramatic, lifesaving surgeries and of course were on heavy-duty sedatives and analgesics.”
As stated below, Appeal to Authority.
How did this get past the ethics committee? Two surgeons stuck needles into babies and they were allowed to do that? Does your morality not bristle at the idea?
Even if one was to choke on their conscience and accept that the study was reasonable, where was the control group, and who stabbed the kids (oops, administered the treatments)?
“When trying to wean infants like this off of those drugs it is common to have drug withdrawal complications and these doctors wanted to see if the use of acupuncture would ease those complications and speed the withdrawal off of those drugs. They saw dramatic reductions in the medications needed in all 10 infants.”
As there was no control group, how does this “study” have any credibility? Did anyone not consider that very young children thrive on human contact and interaction, even if it is to stab them? Consider what the absence of human contact did to Romanian orphans when adopted into caring families? (I forget which but a book by either Dr Martha Stout or DR Robert Hare, doctorates in psychology and the latter the foremost authority on sociopathy.) The converse, high levels of contact, may have the opposite effect?
`
“These doctors work in one of the most highly skilled areas of modern medicine; sedation and analgesics to support recovery from lifesaving surgeries on patients who are more closely monitored than any virtually any other patients. They follow very strict protocols about calculating how much of what drugs to give these infants so the ability to measure the impact of acupuncture was quite acute and not based on subjective reports of the patients.”
How can anyone measure the impact of acupuncture when there is no control group? It seems more like Confirmation Bias than anything? Seriously, this “study” is worthless and only a “True Believer” would think otherwise.
~
“I hope some of you will read the details of each of these 10 infants because, while these are no doubt more dramatic cases than would be typical for most acupuncture patients, this gives an idea of something that has been totally missing from this whole blog thread – that acupuncture is making substantial improvements in real people with real problems every day in most areas around the world.”
Only True Believers would think so.
~
“I would also add that these doctors who conducted this study were hired and trusted by one of the premier teaching hospitals in the U.S. and that means they are among the very top of their profession so the idea that only someone of lower than average intelligence would be a “true believer” in acupuncture (Frank) or that they just want to “fatten their wallets” (Bart) is insulting, childish, and completely out of touch with reality.”
This says nothing about the specialists apart from naivety. You should read a book titled, “Why People Believe Weird Things: Pseudoscience, Superstition, and Other Confusions of Our Time” by Michael Shermer.
So, apart from the Appeal to Authority, you now go for the favourite of many, the Ad Hominem.
`
“I had a child in one of those neonatal intensive care units over 35 years ago and as grateful as I am to the amazing miracle of modern medicine technology and those trained in it that saved my son’s life, I wish they would have had acupuncture available for him as he did end-up with permanent brain damage, likely as a result of the heavy sedatives he needed for the seizures he suffered after his third surgery.”
I’m sorry to hear that but it still is no justification for acupuncture and all of your anecdotes and Confirmation Bias won’t make it real.
`
“Those of us who provide real care to real people with acupuncture know its potential even if we don’t yet know how to prove it beyond doubt in controlled studies. We will figure it out eventually because we are dedicated to learning how to bring this safe therapy into the mainstream.
http://online.liebertpub.com/doi/abs/10.1089/acu.2014.1048”
“real care…. With acupuncture”? If acupuncture is efficacious, ALL of the RCTs would have strong positive results, but they don’t. In fact, NONE do. The REAL medicine 35 years ago is what saved your son’s life, not some superstitious mumbo-jumbo which has no mechanism or proof.
`
How hard is that to understand?
Here is how I would summarize this study: “A world-leading university hospital, after obtaining institutional review board approval and informed consent from parents, conducted a small (10 patient) prospective case study testing the effectiveness of a minimally invasive procedure in the recovery of patients in a neonatal intensive unit. The procedure, while in widespread use, had never been tested in this setting before. Their findings, published in a peer reviewed medical journal, found that in all 10 cases this procedure appeared to be successful in reducing the need for analgesic and sedative medications, sped discharge from the ICU, was well tolerated by the infants and did not cause disruption for ICU support staff or doctors. The authors of this study, acknowledging its small size, called for further, larger prospective RTCs to “evaluate the statistical merit of these findings.”
Now – I don’t understand what is unethical or constitutes bad science about the above. It seems the only problem the acupuncture true disbelievers have is that the procedure was acupuncture. Remove that one bit of information and the above summery would not be controversial at all; in fact, it would seem to be indicating something quite hopeful to investigate further. Only someone who has closed their minds to new studies on acupuncture because they believe the matter already settled would see this otherwise as far as I can tell.
The problem is that just about every one of the over 3000 trials of acupuncture that have been done ends up saying “more research is needed”. If that happened with a drug it would have been dumped long ago. If 3000 trials have failed to produce conclusive evidence, that seems to me to be a good reason to stop. Do you really want to pay for another 3000 trials?
“Their findings, published in a peer reviewed medical journal (1), found that in all 10 cases (2) this procedure appeared to be successful (3) in reducing the need for analgesic and sedative medications (4), sped discharge from the ICU (5), was well tolerated by the infants (6) and did not cause disruption for ICU support staff or doctors (7).”
(1) So? Has anyone taken it seriously?
(2) 10 cases and no control group.
(3) “Appeared” is the operative word. Do you want pharmaceuticals tested like that? What about testing an Ebola vaccine in such a simplistic manner?
(4) How does anyone really know? Confirmation Bias at its best.
(5) See (4).
(6) “well tolerated”? By babies who were doped up? This is laughable.
(7) Well, that’s alright then. So long as no one was disturbed.
`
“The authors of this study, acknowledging its small size, called for further, larger prospective RTCs to “evaluate the statistical merit of these findings.””
What else could they say? As for “statistical merit”. you think it has some and I don’t because there was [B]No control group[/B].
`
“Now – I don’t understand what is unethical or constitutes bad science about the above. It seems the only problem the acupuncture true disbelievers have is that the procedure was acupuncture.”
Matthew, please no Tu Quoque; you can’t seem to help yourself with Logical Fallacies. Tit-for-tat is not an intellectual way to hold a discussion.
It is true that the large part of the objection is because it is acupuncture. As many alt-meds are want to argue that the mechanisms of many drugs is not known or fully understood, the same [B]nearly[/B] holds true for acupuncture. While we know the action of drugs is at a chemical level and, while the action is not known yet, as molecular biology and related sciences progress, that action will become known. This may cause some drugs to be discontinued while the actions of others may be refined and improved.
Acupuncture, conversely, has no known mechanism nor has a valid action be posited. What started as meridians, qi, and yin and yang has not progressed to a point where an explanation is even in progress. What started with a basis in the supernatural remains as witchcraft.
`
” Remove that one bit of information and the above summery would not be controversial at all; in fact, it would seem to be indicating something quite hopeful to investigate further. Only someone who has closed their minds to new studies on acupuncture because they believe the matter already settled would see this otherwise as far as I can tell.”
Everyone, I hope, is happy for new studies to reveal something about acupuncture that shows it is not a mild, short-term placebo, but nothing has to date. How many studies do you want before it becomes obvious that none have shown any real significance?
If you are going used terms like “closed minds”, make sure you have a mirror close by.
But we now understand clearly why you are so fond of acupuncture.
We can also, from the name of the journal (“MEDICAL ACUPUNCTURE”) make an educated guess as to why the article got through the “peer review” process.
We can understand that the authors must be a caring, charming and persuasive lot and that they must have petted and pampered the little patients since the staff was so thrilled that someone even exclaimed that a patient “loved the needling”, or something to that effect.
I can understand why the authors did not bother to do any blinding or control group, as they are obviously convinced that acupuncture works, they just wanted to show it also works in this setting.
They seem to compare to historical cases but they do not set up any kind of proper representation of their results, only that the staff was happy. Perhaps that was the main endpoint?
But there is one part of this whole project I would like to dwell on and ask you (Matthew Bauer) about.
It is regarding the choice and location of acupuncture points. From what I understand, the concept and practice of sticking needles in the ear for pain was developed de novo in the fifties by one Paul Nogier. There did not exist such a discipline before as far as I know, the chinese went for other points. Later, chinese aficionados developed this further and made maps of points in the ear that practically fill it up completely to cover a lot of different effects I presume?
Even if a proper controlled crossover study of auriculotherapy was published in JAMA (Melzak et al. 1984), which incidentally failed to show the effect of said therapy on pain, the authors do not refer to that study which is considered to be the most reliable of them all. Strange, in the light of their
In figure 1 of the article the authors show the chosen points for their project on the outer ear.
1) Is there research behind the choice of these points for the project. The article does not say?
2) How do they know they are pricking exactly the right point in a (premature) neonate. The ear is a very small area. Or does it not matter so much if you hit another different point?
3)How did they go about putting effective “acupressure” on these exact points between the needling sessions as they describe in the article? The neonate ear is minuscule.
Perhaps I should write to the authors and ask them to describe or even write a method article on this daunting task.
4) How come, the authors being knowledgeable in the art and science of acupuncture, call their chosen method for “acupuncture”, not “auriculotherapy”, which is the proper name for Nogier’s invention. Acupuncture is allegedly an ages old chinese methodology, auriculotherapy is a mere half century old method invented in practice by one man.
Oh, and another thing.
The article says:
Isn’t “De-Qi” a subjective sensation felt by the receiver? How can the practitioner feel it?
I cannot find any reference to it.
Or??
Figure 1:
As a point of clarification regarding this study – while I see some theories regarding the possible mechanisms – physical touch, etc., I have not seen anyone questioning if these 10 infants did indeed benefit from this experiment by requiring less medication and speeding their discharge from the ICU. I think this is important to establish so I can offer my response. It is one thing to discuss issues relating to possible mechanisms and another if people are questioning if there were any positive effects – the effectiveness vs efficacy issue.
Also a reply to some of Bjorn’s questions. They used a combination of auricular and traditional body points the auricular points based on the protocol refined by the National Acupuncture Detoxification Association – a protocol used in many countries for drug addiction. Yes, there has been research done on this protocol but like much acupuncture research some studies showed measurable efficacy others did not.
I missed a couple of things before sleepily pushing “Post”:
The link to the figure: http://imgur.com/01DmJdw
The last three words of the sentence: “Strange, in the light of their formidable reference list.”
I am sure that thanks to the superposition of the infinitesimal singularity and the infinite quantic field, this is only an obstacle for those who have not studied the spiraling forces of the astral black hole of qi and de-qi duality in any depth.
No. He wants us to pay for them as we did for the 3,000 previous ones, so that he can go on making money to pay for that nice beach mansion.
I wonder if we could look at medical records and see whether people having blood taken or lines inserted undergo spontaneous resolution of their migraines or IBS…
I think we should look instead at how large the numbers are or people who did *not* experience spontaneous resolution of migraines or IBS.
Good point. In order to remedy that gap in your knowledge, you could do worse than start with reading ‘Trick or Treatment’, a book written by Edzard Ernst and Simon Sing.
Since I have never met a true disbeliever, I can’t comment on that. They are said to exist, usually by believers, but then, there also believers who claim Al-Buraq served as Muhammad’s personal Boeing 747, others who claim Jesus rose from the dead, still others who Elvis and Hitler are alive and there are even some who claim acupuncture can be used to perform open-heart surgery without anesthesia. As a result, I not sure that I should give much credence to what believers say. They seem to be able to believe anything they put their absent minds to.
Remove that one bit of information and the above summery would not be controversial at all; in fact, it would seem to be indicating something quite hopeful to investigate further. Only someone who has closed their minds to new studies on acupuncture because they believe the matter already settled would see this otherwise as far as I can tell.
1. Why would you want to remove information?
2. Do you really think that we would suddenly accept penetrating babies with needles if the practice go another name?
3. The above summary is not in question, what is in question is the original study, which is not a study at all, simply a collection of 10 case reports.
4. Yes, the matter was settled before the “study” began. Since the setup is so that nothing, except spelling and grammar errors, can be substantiated or invalidated by it, it was unnecessary to even do the experiment.
Pat Harkin said:
It’s those who inject insulin daily I’m worried about…
I expect they live forever, as long as they remember to keep moving the injection sites.
Really? Do you actually read responses, do you understand them, or do you simply treat them the way you treat evidence?
Get it now?
” Those of us who provide real care to real people with acupuncture know its potential even if we don’t yet know how to prove it beyond doubt in controlled studies.”
It really isn’t rocket science. Have you tried doing any trials?
Well then. Let’s take you at your word.
‘
Acupuncture works so fantastically well that you are using a well-known trial to claim that acupuncture is twice as effective as usual care. That is indeed what the paper shows, and it is what you claim in your propaganda.
‘
However, the paper also shows that there is no difference between standardised acupuncture and individualised acupuncture, which seems to be in some contradiction with the oft-heard claims that acupuncture is at its best when highly individualised. Your propaganda does not mention this. Why is that?
‘
Interestingly, the trial paper also shows that there is no difference between sticking needles into people and poking them with toothpicks. For some reason your propaganda fails to mention this as well. Why is that?
‘
If these are mere oversights, I am sure you will be very happy this was pointed out to you and you will add this to your propaganda in order to make it more balanced and objective, yes?
‘
If, on the other hand, you do not add this to your propaganda, we will know what you really stand for, don’t we?
‘
Constructively yours,
‘
Bart.
I must confess that I am disappointed. Acupuncture was never of much interest to me, but I certainly wasn’t against it. I remember having learned about it in 70s, when it became popular once again, and being told about it in Ghent by my professor of physiology who was excited enough to spend lecture time talking about how it works, and it then just disappeared again into obscurity, because it didn’t seem all that useful and that was it.
.
What I have read here, doesn’t convince me of anything, except that acupuncturists are not to be trusted. They bring no intriguing evidence, and when they – reluctantly – bring evidence, it only seems vaguely convincing when I don’t go looking for the actual study.
.
When I can find the actual study, I discover that the study doesn’t say what the acupuncturists say it does, or they conveniently forget to mention the parts that show that there is no reason to use acupuncture.
.
I also have had to find out that acupuncturists have are not only economical with the truth, but that they have no problems with outright lying. Why would I, or anyone else for that matter, give the benefit of the doubt to proven liars?
.
Since acupuncturists have demonstrated beyond the reasonable doubt that they are not to be trusted, considering that acupuncture so far has been unable to suggest that there are any compelling reasons to use it, and taking into account the dangers inherent to this practice, I can only conclude that acupuncture and acupuncturists are bad news and that the public is well advised to stay away from them.
Bart –
You’re revolted by the studies done at Stanford. You think that acupuncture is premeditated murder.
What are you doing about it, other than ranting on “Six Guys on Some Sceptics’ Blog”? Have you contacted Stanford? Perhaps they didn’t do the thorough research that you’ve done before using acupuncture on babies. Ethically, shouldn’t you pass along the results of your diligent research? Or do you think by posting here, you’ve done your part, and you can walk away with clean hands?
Also, premeditated murder is pretty serious. Don’t you owe it to society to do something about it? Have you contacted lawyers, the RCMP, Amnesty International? Again, isn’t it your ethical responsibility?
Put your money where your mouth is, Bart. Grow a pair. Don’t just incessantly rant – DO something about it. Or shut the fuck up.
“You think that acupuncture is premeditated murder.”
How else would you describe using a treatment that has no merit and the potentially terminally ill (but treatable) person does not seek real medical treatment? Stupidity? Duplicity? Shamanism? Confidence trick?
‘
“Put your money where your mouth is, Bart. Grow a pair. Don’t just incessantly rant – DO something about it. Or shut the fuck up.”
jm, are you a REAL man, with big balls, who likes to badger people with macho words? I like to talk face-to-face with those sorts of numbnuts who are too macho for their own good. Then I can tell them face-to-face to “shut the fuck up” and to go bully somewhere else. Take a dose of your own advice!
“How else would you describe using a treatment that has no merit and the potentially terminally ill (but treatable) person does not seek real medical treatment? ”
So what are you actually doing about it?
“I like to talk face-to-face with those sorts of numbnuts who are too macho for their own good.”
Me too.
By trying to inform people, whenever I come across a situation where they are using witchcraft, that it nonsense and tell them why. Sadly, in this day of philosophical relativism, the proliferation of nonsense such as acupuncture on the web, the payment of such “treatments” by health funds, the lack of education in even basic science, and the failure of educators to teach critical thinking, it is hard to convince people that it is, in fact, nonsense.
`
This may give more credence to Bart’s view that the propagators of this stupid witchcraft are, in reality, murderers. The death isn’t something they see so they continue on their merry way spreading more misinformation, and therefore, disease and death.
`
By the way, jm, where is the macho talk? I have come to expect from you, since your capacity at reasonable discourse is limited.
So what you’re saying, is that something on the level of premeditated murder really isn’t important enough that you would go out of your way to do anything about it. But if you happen to be in the neighborhood…you would voice your opinion.
Your conviction moves me.
jm
“So what you’re saying, is that something on the level of premeditated murder really isn’t important enough that you would go out of your way to do anything about it. But if you happen to be in the neighborhood…you would voice your opinion.
`
Your conviction moves me.”
Firstly, in regard to the latter, who cares what you think?
Secondly, it is important but there are stumbling blocks; people, like you, who proliferate ignorance and stupidity so even media reports of acupuncture being a scam doesn’t influence many people. Trying to educate people, at a local level, is a means at my disposal, so I try to.
Frank –
We aren’t talking about acupuncture being a scam, we’re talking about your belief that acupunture is premeditated murder. Ignorance, stupidity, and the media shouldn’t stop you from going to the authorities for something that serious. That would make you an accessory to premeditated murder.
In which case I find your local education policy morally reprehensible.
Not quite. There are very many cases like this, and there are only so many sceptics and scientists, and there are only so many legal ways to defend against them. That is the strongest point scam artists have to defend themselves: safety in numbers. The other strong point is that society as a whole does not seem to care much about protection from scam artists.
Society seems to be quite tolerant of certain types of murder. Take agencies who organise Mount Everest climbs. Depending on the source, between 5 and 10 percent of Mount Everest climbers stay on the mountain, or come back in a body bag. Society does not seem to have a problem with this.
On the other hand, society goes hysterical over the idea that a ten year old might witness the uncovering of a teat, the very thing he/she was suckling on just a few years earlier. How many children have been harmed because they had to witness such an event, I wonder? I really wonder, since there are – to the best of my knowledge – 0 (zero) documented incidents of children maimed or killed by the uncovering of a teat, or even – heaven forbid – the uncovering of a vagina or a penis.
In contrast with this, society seems to have no problems with clowns who think there is “kidney in the heart” sticking needles into people. It reminds one of the multitudes who have been and are being killed to please unseen, unfelt and generally undemonstrable deities.
The main weak point in the sceptical approach is that scammers and quacks are guided by a different morality: that which favours their own pockets, and as a result, by the time the sceptic/scientist (who *is* subject to certain rules) has gathered all the evidence, the quack/scammer has often moved on to greener pastures. Unfortunately, life isn’t fair, and those who serve the Mammon are often the least fair of all. It will not prevent the sceptic/scientist from doing her/his utmost to combat these evil forces.
Bart,
You’ve been quite clear about your belief that acupuncture is premeditated murder. Let’s review. You said:
“You know what this means, don’t you? It means that you are not only tolerating but actively promoting what could be termed “premeditated murder”. You should be proud of yourself. I couldn’t. I have a conscience that bothers me too much.”
I don’t believe that acupuncturists treat patients with the intent of killing them – which would be premeditated murder. Apparently, you do. A bizarre belief, but there are lots of bizarre beliefs on the interweb. Whatever.
You have a conscience that bothers you too much? Really? You believe that acupuncturists are pre-planning intentionally killing their patients – and you’re not reporting it to the RCMP? Your conscience doesn’t bother you THAT much, apparently.
Then you said:
“Society seems to be quite tolerant of certain types of murder.”
Again, really?? What society is tolerant of premeditated murder? Canada certainly isn’t.
And then you said:
“…the sceptic/scientist (who *is* subject to certain rules) has gathered all the evidence…”
I take it you consider yourself a sceptic/scientist? Exactly what rules are you subject to? You’ve gathered all the evidence, and determined that acupuncturists intentionally set out to kill their patients. You feel comfortable with that conclusion, it follows the rules you are apparently subject to? Really? Are you sure?
The way I see it, there are two possibilities:
1) You truly believe that acupuncturists are intentionally trying to kill patients. And you’re not reporting the situation to the proper authorities.
2) You’re an asshole. I don’t mean that to be an insult. I mean it literally. You’re just talking shit. Using the term premeditated murder adds a level of drama, flowery language and all that. Exagerating for theatrical effect, blah blah blah, even though you know it’s crap.
I really hope it’s number 2, Bart. Because if it’s number 1, your moral and ethical standards are sub-human.
jm,
Typically, your views are skewed. You’ve taken the “attack is the best form of defence” option, which comes as no surprise.
~
You’ve taken a point, misconstrued and then magnified it, so your hyperbole looks as though you are the most concerned with human life and wellbeing, except you’re not. You are so heavily into acupuncture and alt-med, any perverse defence (attack) will do. You’re only interested in your own standpoint, not others. Your professed sincerity is a sham.
~
You also know full well that while governments and regulators are blind to your type of witchcraft, you can continue to practice your nonsense and potentially kill people. The problem is that you won’t know you are a murderer because your victim will die at home or in hospital. If not dead, there is nerve and blood vessel damage you won’t see either, because the victim will seek real health care.
~
Anyway, two things; you make me puke, and you are on my ignore list. Who cares what a witchdoctor thinks?
It looks as though you got lessons from William Lane Craig or some similar religionist. When someone uses a word in a well-defined context, it is considered bad manners to then take that word out of that context, give it another meaning, and then use that meaning to attack the user. But then, alternologists are not renowned for their good manners, and this, sadly demonstrates once again that acupuncturists can be just as despicable as any con artist.
Lying may be appealing to your ignorant, bored fans, but it is not a basis for any reasonable exchange of opinions, ideas or facts.
You are demonstrating that acupuncturists can be even more vicious and disgustingly dishonest than I already thought, and don’t give a damn about the well-being of their customers.
I have to throw up.
I’m starting to think that Hannibal Lecter wasn’t so bad after all. I don’t like to think that, but facts are facts.
Frank ‘n Bart,
So, number 2 then, I take it? Using terms like premeditated murder as a petty dig, or for drama, or whatever, is pretty low class. Even for this blog. But it still remains – if all you’re doing about the ‘dangers of acupuncture’ is posting petty rants on a blog, or ranting to people you happen to run into, is pretty telling. You obviously don’t find it THAT serious of a situation.
Bart, thanks for this one: “When someone uses a word in a well-defined context, it is considered bad manners to then take that word out of that context, give it another meaning, and then use that meaning to attack the user.”
Your statement could be the synopsis of this blog, just counting the mis-use of traditional medicine terms alone.
jm – You’re performing for an empty theatre. This thread is already ridiculously long and ludicrously boring… Everyone has left for more important pastimes.
Calling Prof. Ernst “some sceptic” and the rest of your comment beautifully demonstrates how manly you are. I can’t win and not even compete on those terms. I prefer to use my brain. To give you a starting point: it’s that pudding-like thing in that roundish object sitting on your neck. You may wish to ask your nurse what its function is, and how he/she knows that, unless of course, he or she is an acupuncturist, since acupuncturists’ anatomy is said to be different from that of Homo sapiens.
I had been referring to it as “The FOXy Onion”, but I started liking Sasha’s “Six guys on some sceptic’s blog” better.
Until this last string of comments. Now I’m back to the FOXy Onion.
Gawd, would you please try to make some sense? We know you are a bonehead but we try.
Sorry Frank. I’ll type slower for you next time.
Apologies – I have had a lot of projects that needed finalising. Is there a link to the ‘Bart tooth-pick’ research?
Alan, I missed your comments. Apologies.
George
Yes there is: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832641/pdf/nihms164975.pdf
If you go on Youtube and look up Matthew’s Acupuncture Now Foundation, you will see that they use this very trial to claim that acupuncture is twice as effective as conventional care. Which is what the trial says.
However, that very same trial also says that fake/bad acupuncture, where needles are stuck in the wrong places is equally effective, indicating that learning where to put the needles isn’t very important.
That very same trial also show that toothpicks are equally effective as real and bad/fake acupuncture, indicating that the needles aren’t doing it either.
Conclusion: yes, there is a difference between conventional therapy and acupuncture, but that difference isn’t caused by what we would consider to be acupuncture. It is something else. The most parsimonious explanation is that it is the ritual that makes the difference.
I wonder why the Acupuncture Now Foundation neglects to mention most of this information. I call this “lying by omission”, but then, I have no intention to buy a farm in Tuscany, or a mansion or a Ferrari, so my opinion may be biased toward reality.
However, that very same trial also says that fake/bad acupuncture, where needles are stuck in the wrong places is equally effective, indicating that learning where to put the needles isn’t very important.
Thank you Bart. For the link. I would like to point out that you have seriously misread and misinterpreted the study. Shame on you.
First
1) The study does not stipulate anywhere ‘fake/bad’ acupuncture.
The study is a four armed trial that included:
a) ‘Real Acupuncture’ (individualised treatment prescribed by an acupuncturist and delivered by another, for chronic back pain).
b) ‘Standardised Acupuncture’ (for chronic back pain based upon an expert consensus of effective acupuncture treatment for chronic back pain).
c) ‘Simulated acupuncture’ (for chronic back pain, using acupuncture points based upon an expert consensus of effective treatment for chronic back pain). Simulated acupuncture was conducted by acupuncturists, that were not ‘blind’ to the procedure…
d) ‘Usual care.’
2) Needles were not stuck in the wrong places
a) In fact the study states that ‘simulating’ insertion was conducted by acupuncturists at the eight acupuncture points used in the standardised acupuncture treatment. The standardised acupuncture treatment and acupuncture point locations of which was deemed by experts to be effective treatment for chronic low back pain. The study states that the patients’ appear to have been stimulated (pricked, acu-pressured) at acupuncture points and thus acupuncture point locations that are effective for the treatment of chronic back pain i.e the right places.
Regards
George
You have just shown that I am able to misremember something and make a mistake. I am devastated. What a horrible monster I am. I tried to jump through the window, but my head is too thick. I guess I’ll have to settle for self-flagellation, or maybe a glass of fresh, organic, unprocessed, all-natural hemlock juice would do.
So, let’s recapitulate:
The study did not show that personalised acupuncture is better than standardised acupunture.
The study did not show that personalised and standardised acupuncture are better than toothpick acupuncture.
The conclusion, therefore, is this:
Acupuncture-style treatments scored twice as high as conventional treatment.
Toothpick acupuncture is as good as other types of acupuncture and is therefore the preferred treatment.
Logical questions to be asked after this trial:
1. What is it in the acupuncture style treatment that makes it more effective than traditional treatment?
2. Why would anyone want to take the risk of using real acupuncture?
I wonder why the Acupuncture Now Foundation neglects to mention most of this information. I call this “lying by omission”, but then, I have no intention to buy a farm in Tuscany, or a mansion or a Ferrari, so my opinion may be biased toward reality.
Bart. May be you should go on a holiday. Take a break. Relax, unwind. Focus. They say Tuscany is nice.
George
You floored me. You got me. There is no defence against this devastatingly logical, clear, honest, proven and totally to-the-point argument. I am throwing myself at your feet in abject admiration.
You may want to hold your horses George. This large study convincingly demonstrates that it is of no importance where you stick your needles:
http://archinte.jamanetwork.com/article.aspx?articleid=413107
There is even more evidence pointing to the same. See references in the discussed papers
The authors of this large and technically credible study are obviously biased towards acupuncture as can be discerned by their discussion and overenthusiastic interpretation of the effect in the acupuncture arms vs. the controls, which do not seem to have been properly blinded to the fact they were not receiving the therapy being studied! Even if it is statistically different from the control group, I am not impressed by the quantitative difference, which the authors tend to exagerate.
For me, what these and many more studies are saying is that the ritualistic nature of the performance of acupuncture, with all the props and limelights, add a strong element of expectation and comfort that leads to a more positive response when interviewed for the end-point assessment. The contents of the script is irrelevant, it is the glitch and glamour that evidently impart the desired effect.
The Acupuncture Now Foundation’s “Twice as Effective and Safer” video was produced to help educate those suffering from chronic low back pain that acupuncture has been shown in research studies to be twice as effective as conventional care and it is also known to be safer. Both of those statements are true and are important news to anyone suffering from chronic low back pain. That both the Gerac and Seattle studies also found little difference between what they called (but, in fact was not) “real” acupuncture and “sham” acupuncture was also eluded to in our video. When the question is asked that if acupuncture was known to be twice as effective as conventional care and is safer then why don’t more doctors recommend it and why don’t more insurance companies cover it, the answer is that there is confusion over how it works and some believe we should not using it until we understand everything about how it works. That is also true. Some still think it is placebo. Others think sticking needles perhaps anywhere causes real physiologic changes that can ease health disorders. And those of us who actually use this therapy in the real world are convinced the poor design of these studies that do not bother to first establish the effective dosage of acupuncture and/or use well-trained acupuncturists result in the real acupuncture underperforming. The bottom-line for those suffering is also reflected in the video when the character says as long as acupuncture is known to be safer and it is more effective who cares how it works? I have heard those very words from many of my patients. They just want relief and off the drugs and I am grateful I am able to do that for most of them (well above the effective percentages in these studies).
When you consider that conventional care for chronic low back pain often means the long-term use of pain medications and that these medications harm hundreds of thousands a year leading to liver failure and even death, I will never apologies for working to educate those suffering about a therapy that is more effective and safer. Safety plus effectiveness trumps questions regarding mechanisms for any clinician responsible for providing care. I don’t understand the motivation of those who would rather people use less effective and more dangerous therapies.
I said in earlier posts that we are working to show that many studies that do not show so-called “real” acupuncture outperforming “sham” may well be due to not giving the real acupuncture a real chance to perform at its best due to undertreating and poorly trained acupuncturists. A group in China recently published a study looking at just those issues and found this was the case. See –“Analysis and Thoughts about the Negative Results of International Clinical Trials on Acupuncture “ https://www.google.com/search?q=Analysis+and+Thoughts+about+the+Negative+Results+of+International+Clinical+Trials+on+Acupuncture&oq=Analysis+and+Thoughts+about+the+Negative+Results+of+International+Clinical+Trials+on+Acupuncture&aqs=chrome..69i57.4596j0j8&sourceid=chrome&es_sm=93&ie=UTF-8
Both of those statements are true and are important news to anyone suffering from chronic low back pain.
Dear Matthew Bauer,
It is good news for sufferers of chronic low back pain that would like to try acupuncture to see if acupuncture or acupressure may help to relieve their suffering.
Regards
George
Why? To see if they are affected by the Placebo Effect?
Yet another sad case of the “No true Scotsman” fallacy.
@Matthew,
What do REAL doctors do in the REAL world? Close their eyes and hope?
`
Your posts are characterised by logical fallacies; Special Pleadings in particular. This is the first time I’ve heard of acupuncture “dosages” and how important it is supposed to be. What else do you have up your sleeve, just in case another study finds the same lack of evidence as all of the others?
`
(“eluded” means to have escaped from, “alluded” is referring to something.) This is also a pointer to the general state of mind of the alt-med; possible nice person, well-intentioned, but just not very bright.
Well then, after this shocking publication in such a prestigious journal, what is keeping acupuncturists from doing proper trials? No, acupuncturists prefer to have other pay for these and devote their time and energy to them while they sit back, relax, have a pint and giggle in the back room. Even religionists are more honest. They, at least, employ officially designated apologists.
It is now 2015, a little over 43 years after interest for it was rekindled in the western hemisphere by James Reston, and what do we get from the acupuncturists? Meaningless dribble, and unfounded criticism of every trial that does not happen to be a fluke in the direction they would like.
Acupuncturists are hurrying from lantern post to lantern post, attracted by idle hope, like mosquitoes, waddling steadfast and bright-eyed like drunken sailors, and they are producing equally impressive results.
I am not so sure. In my opinion, quacks tend to be friendly only to those who bring them money, and at best indifferent to those who don’t. They become a lot less friendly when asked pointed questions, and downright hostile when pointed out that some of their claims might not be all that well founded. They remind me of the Jesus of the Bible: quite nice to those who kowtow to him, but nasty to those who don’t.
That is an egregious lie. Since there are no reliable records of harm done by acupuncturists, there is no way this claim can be substantiated.
Hi guys. Here’s a newish study for you guys to have a look at:
J Integr Med. 2015 Mar;13(2):99-104.
Acupuncture accelerates recovery after general anesthesia: a prospective randomized controlled trial.
OBJECTIVE:
This randomized prospective study aims at comparing the effect of two acupoints (Yongquan, KI1 and Renzhong, DU26) with sham acupuncture and no acupuncture on the time to recovery of consciousness after general anesthesia by means of the Bispectral Index monitor (BIS).
DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS:
This is a prospective randomized controlled study. We randomly assigned 50 patients to 5 groups during recovery from surgical anesthesia. Four groups had acupuncture on KI1 (group A), DU26 (groups B), both KI1 and DU26 (group C), and sham points (group D), and one had no acupuncture (group E).
MAIN OUTCOME MEASURES:
Bispectral Index (BIS), time to spontaneous eye opening, time to tracheal extubation, and time to following commands were measured as the main outcome measures.
RESULTS:
Time to spontaneous eye opening differed among groups (P=0.002), as well as time to tracheal extubation (P<0.000 1) and time to following commands (P=0.000 6). BIS values differed significantly among groups both 5 and 10 min after the end of anesthesia (P<0.000 1 and P=0.000 4, respectively). BIS values of groups D and E were lower than those of the other groups and those of group C were higher. The same pattern was observed also 15 and 30 min after the end of anesthesia, although the difference among groups was not significant at these time points (P=0.164 and P=0.104, respectively).
CONCLUSION:
Acupuncture on DU26 and KI1 accelerates recovery of consciousness after general anesthesia. Moreover, a possible synergistic effect of DU26 and KI1 is suggested. This issue may play a role in the optimization of operating room management and raise interest about the usefulness of acupuncture on unconsciousness states of different nature.
Why?
The article is behind a pay wall, which means it’s out of my reach and therefore I cannot assess it. I never accept abstracts as a source of information. Browsing Prof. Ernst’s blog is enough to learn why this would be a bad idea indeed.
The abstract is a bit curious. 50 patients in 5 groups seems ridiculously small to measure recovery after general anesthesia, which is, to the best of my knowledge, a *very* variable measure. Moreover, BIS is a controversial measure. Yet, that’s the one getting most attention.
The language is strange as well. The authors seem to be confused as to the difference between “significant” and “statistically signifant”.
Why do they not mention “how much” these times have shortened? Would that not be the most interesting thing to mention, in light of the title?
In short: whether or not the article is interesting, the abstract tells us nothing.
Comments after a very brief look-see…
The study was done in 2006-7: why has it taken 8 years to publication in a journal of no reputation?
The study’s based on groups of only ten patients, two of which became N=8 and N=9 with drop-outs.
There’s no indication of how the sham acupuncture was done.
ANOVA done with a set of 5 such small groups stretches its statistical point a very long way, but the data on times to spontaneous eye opening and tracheal extubation look very black and white.
My conclusion: if you stick pins in the feet of patients recovering from anaesthesia you accelerate their time to consciousness recovery by 5-8 minutes (10 minutes instead of 15-18). This may not be surprising.
As far as I’m concerned the study loses all credibility in its discussion. The explanation of the effects seen is as follows.
Leaving aside all the yin-yang/heaven and earth incomprehensible spiritual guff, if the authors believe that the kidney resides in the heart they need to re-read the Ladybird book of anatomy.
Obviously, McMinn and Hutchings, Heinz Feneis and Aline Vandevelde all got it wrong. I wonder where acupuncturists are operated upon when they have a brain tumour. The sigmoid, perhaps?
Matthew,
I have a question in relation to this;
“And those of us who actually use this therapy in the real world are convinced the poor design of these studies that do not bother to first establish the effective dosage of acupuncture and/or use well-trained acupuncturists result in the real acupuncture underperforming.”
I did question this new information about an “effective dosage” and wonder how this may affect me in the “real world”, as you put it? Occasionally, I get splinters in various parts of my body, arms, hands, feet, legs, or even on the body. I then use a needle or piece of sharp stick to pick or dislodge the splinter.
My question is this; does this constitute acupuncture? Is it only the original splinter (is it worse if it is metallic) regarded as acupuncture, or the device used to remove it, or both?
If it is acupuncture, am I “dosing” correctly for something, “overdosing” perhaps, or is there some random physiological effect on my health through these seemingly innocent processes?
`
“The bottom-line for those suffering is also reflected in the video when the character says as long as acupuncture is known to be safer and it is more effective who cares how it works? I have heard those very words from many of my patients.”
Doctors thought bloodletting and leaches worked until someone conducted a trial and found out they didn’t. That is what is happening to acupuncture now.
I am happy to answer any serious question and while yours did not seem to be serious I will make a comment: Anytime someone puts forward a study that reflects positively on acupuncture’s efficacy, people in forums like this are quick to pounce on it and rip it apart for what they believe to be methodological flaws. Fair enough. But when I bring up what some of us see as two quite serious methodological flaws in acupuncture trials that don’t show efficacy (beyond sham); namely no criteria for establishing an effective dosage and the training of those doing the acupuncture, no one in this forum seems to think these are relevant when they clearly are. This seems like a double standard.
The frequency and total number of acupuncture treatments over time is absolutely critical to the success of this therapy and all I have been saying is that until this issue and that of training are addressed any study not taking these elements into adequate consideration are easily as flawed as those without robust blinding or sub-optimal numbers of participants.
Matthew, I have a serious question for you. How do you know that acupuncture is a better treatment than, say: chiropractic; homeopathy; and Reiki? Let’s be totally honest, Reiki (especially distant Reiki) must carry a much lower risk of harm than inserting physical objects into patients.
Even if the efficacy of acupuncture is on a par with homeopathy and/or Reiki, this is insufficient to advocate acupuncture because the risk-benefit ratio must be quantified in order to recommend treatments for each health condition and for each patient.
I’ve never seen an evidence-based guide to alt-med/sCAM modalities that would reasonably and responsibly guide someone who is ill towards the most appropriate branch of alt-med. Medicine mandates the utilisation of reporting, accounting, feedback, and independent auditing procedures — all of which appears to be remarkably absent in the realm of 21st Century alt-med/sCAM.
Hello Pete – thank you for your questions. Sorry for the long response. You are right that some therapies such as Reiki, homeopathy, etc, likely have less risk than acupuncture. I think part of your concern over a lack of reporting and an evidence based guide comparing alt-med modalities stems from the unfortunate disparity in practice regulations in different countries. In China, of course, acupuncture is not “alt-med” but part of their mainstream medical system. In the U.S., the practice of acupuncture is regulated and only licensed/certified and regulated professionals are allowed to provide that therapy. Some of the alt-med therapies you mention (Reiki , for example) are (as far as I know) not regulated anywhere while others (such as chiropractic) are, at least to some degree. Lumping all the “alt-med” approaches into one group when there are such important differences in how they are practiced does not do justice to the issues at hand.
You said “Medicine mandates the utilisation of reporting, accounting, feedback, and independent auditing procedures — all of which appears to be remarkably absent in the realm of 21st Century alt-med/sCAM.” Not as entirely absent as you might think, but yes, much more needs to be done in that regard. All the more reason practices like acupuncture should be regulated so those reporting procedures can be instituted such as we have in the U.S. Here, any adverse event from acupuncture or concern with the practitioner can be reported to the State licensing Board that regulates that practitioner for possible disciplinary action and any practitioner. Also, those practice acupuncture can be sued for malpractice just like mainstream practitioners. I would also point out, however, that those reporting systems are far from optimal in mainstream medicine so anyone looking for how to improve patient safety should not only focus on alt-med.
You also stated that the “risk-benefit ratio must be quantified in order to recommend treatments for each health condition and for each patient.” That would, of course, be ideal but that does not even exist completely for mainstream medicine. We do have some convincing evidence that even poorly done acupuncture is twice as effective as conventional care for chronic low back pain and every reason to believe it is far safer so why don’t we just start there? Trying to find the funds to compare every possible treatment for every possible condition seems unlikely for now.
I can only speak for the practice of acupuncture as that is my field but I would say that we could be much farther along in addressing all the legitimate concerns you raised if this practice did not face such stiff opposition. Often, most of the merger resources proponents of acupuncture could muster went toward fighting for the right to get the chance to practice this therapy. We were/are ridiculed, relegated to the margins, and then criticized for not having the high professional standards of the mainstream. Despite all this, acupuncture is now rapidly gaining in acceptance within mainstream institutions. Why? Because when given a fair chance in real-world clinical settings, this therapy usually impresses with its benefit to risk ratio. The Acupuncture Now Foundation was founded to help this transition into the mainstream by encouraging better standards and to educate the public, other healthcare professionals, and health policymakers about what acupuncture can and cannot do.
Pete,
There’s been a lot of talk on here about the mechanism for reporting side effects, etc. In my wife’s travels in various forums trying to manage her situation, a common theme seems to be the reporting of side effects of various drugs. You may have run into the same thing?
For a while, she was on a mission to have people report their experiences. At the very least, reporting to their doc. It seems that there are a few main reason’s people don’t:
– they don’t know there’s a system in place to do so
– they don’t want to get their doc in trouble, or piss them off and be dropped as a patient
– they are too tired/sick/otherwise dealing with fallout from meds, and reporting would be one more giant thing to do
– the science says it should work, so their experience is just part of the process
– they have no faith that it would make any difference
On the other hand, the acu’s I work with are very clear about having patients report back if a treatment isn’t working, bad experience, etc. And making sure patients are comfortable doing so.
You say “Medicine mandates the utilisation of reporting, accounting, feedback, and independent auditing procedures — all of which appears to be remarkably absent in the realm of 21st Century alt-med/sCAM.”
All of those things have always been a part of traditional medicine practice – they are very necessary and valuable tools for effectively treating patients. Log onto some Chinese med, Tibetan med, etc sites for practitioners (you’ll probably have to set up an account) and you’ll find what you’re looking for.
Matthew — Thanks for your interesting reply. Being in the UK with its NHS, it is difficult for me to picture how other healthcare systems operate around the world. Here, alt-med is rebranding itself as “integrative medicine” aka “integrated medicine” in its attempts to gain respectability and attach itself to the NHS. It seriously bothers me that the many branches of alt-med haven’t integrated themselves, which means that patients have to take pot luck.
A shining example of properly integrated medicine is our NHS mental healthcare system. I’ll try to illustrate how it works using the relatively common conditions anxiety and depression (these tend to be co-morbid conditions). These conditions have wide range of treatment options: various psychotherapies and various pharmaceuticals. It would be absurd to allow patients to take pot luck, as they would have to with alt-med modalities. Instead, they are personally assessed by a clinician who will use well-tested instruments such as the GAD-7 and PHQ-9 questionnaires. The second step is selecting a treatment plan that is most suitable for the individual patient. During the course of treatment the patient’s progress is regularly assessed (and documented) and the treatment is changed if necessary. At the termination of treatment, a follow-up appointment is made so that the long-term effect of the treatment can be measured (and documented).
Clearly, if the patient has not made long-term progress then they will be offered a different treatment plan. This system is scientific because: it is uses active patient monitoring rather than relying on patient complaints; the documentation is used to continuously improve the treatments; it is fully audited and the effectiveness of the various treatments are publicised.
Even if alt-med is nothing other than many different forms of theatrical placebo, it needs to get its act together before it can be deemed anywhere near a professional system of healthcare. It is well know that red placebo pills work better for some conditions and blue pills work better for some other conditions. It is also well known that placebos can have up to a 30% success rate for a wide range of illnesses. How do we know these things? Because they have been established using adequately powered multiple RCTs.
My objection to alt-med isn’t because it seems to be a collection of theatrical placebos; my strong objection is that most of its practitioners are unqualified to diagnose health problems that need specialist treatment. E.g. nearly all of the practitioners are hopelessly incapable of distinguishing between such things as: depression versus clinical depression; anxiety (caused by rational fears) versus anxiety disorders; tiredness caused by overwork versus tiredness caused by a medical condition.
Most (perhaps all) branches of alt-med each claim to be a panacea: even if this turned out to be true, it is the practitioners who are totally unqualified to practice 21st Century medicine, which makes them extremely dangerous to their clients — especially because they don’t have to abide by the reporting, accounting, and auditing procedures that are mandatory in medicine.
Note: I’m not attacking you, Matthew, I’m just sharing my deep concerns. Sorry for such a long comment!
—————————
Jm — Thanks for your thoughtful reply. I agree with your reasons for people not reporting their experiences. I’d like to add an item to your list: perhaps most people don’t really know how to present negative feedback, and/or how to make a complaint, to a medical practitioner because most of us have not been taught how best to present our bad news / justifiable criticisms in a professional manner. It’s always intimidating for a layperson (e.g. a patient) to question the expertise of a professional (e.g. a practitioner). It might be fair to say that most people don’t even know how best to complain about a faulty domestic appliance or a mobile phone service.
My reply to Matthew (above) hopefully makes clear that my (often harsh) comments on Edzard’s blog are based on the situation in the UK, which is perhaps unique? We have Prince Charles interfering in politics, including trying his best to get alt-med integrated into the NHS with no regard to whether or not the practitioners are suitably qualified, accountable, and audited to practice any form of medicine. As I comment using my real name I can’t always say exactly what I’d like to say 🙂 But you know me well enough by now to get the gist of my comments.
Best wishes,
Pete
Hi Pete – very good comments. Thanks for the opportunity for serious discussion. I don’t try to defend anything but acupuncture/Chinese medicine because that is the system I know so I don’t suggest if something like acupuncture has a place in mainstream medicine that means the whole of alt-med should too. Each system has to demonstrate its legitimacy. In China, acupuncture is integrated with modern medicine and those practicing acupuncture there are trained in modern medicine as well so they know how to diagnose and work with modern medicine although I am not suggesting their system is optimal.
In the U.S. we have a mixture of government and private insurance and both systems rely a lot on some form of “managed care” where procedures have to be justified via some sort of oversight system. I consult with a company that specializes in managed care for some alt-med practices especially chiropractic and acupuncture. In this system, all practitioners must be credentialed into their provider networks and show they operate in a professional manner. For example, we not only make every effort to see our network Acupuncturists use only disposable needles, we make them demonstrate that they dispose of them according to local laws. We have over 5,000 Acupuncturists in our nation-wide network and we monitor if they get any complaints either to us directly or their state licensing boards and will discipline or expel from the network if they do. We will also report them to their state board if we find them violating regulations.
One of our programs is with a large health plan/hospital group in Southern California and they send patients to our Acupuncturists only after being seen by their Primary Care doctor and then also being seen by a pain management (Physical Medicine) specialist. These patients have already had at least a few different therapies tried on them before they are sent for acupuncture and then the Acupuncturists only gets 5 or so treatments at a time before they have to supply progress reports to justify any further treatment. Those reports include the patient’s own assessment of their progress and the Acupuncturists findings including monitoring of symptom intensity, frequency, functional capability, and medication levels as well as things like range of motion tests if applicable. If a patient is not progressing, no further treatments are approved and patients are referred back to their doctor.
This program has proved so popular the health plan has continued to extend it several years past the original three year trial and there are annual surveys done by outside agencies to measure patient satisfaction using a survey system used in conventional medicine. These surveys come back constantly above the scores for conventional care.
One thing we worked hard on here in the U.S. is training Acupuncturists to know when to refer. Any alt-med system should be doing the same. The managed care system the company I consult with has refined their system over years and it works quite well to limit abuses and mismanagement. For example, they found many chiropractors were doing far too many x-rays and they put a stop to it and now their policies on x-rays has changed the way most chiropractors in the U.S. mange x-rays. There are problems in alt-med no doubt, but acupuncture has a place within the mainstream although we need rational oversight to see we limit the bad apples and ineffective treatment.
Dear Björn Geir,
First, I have a few questions:
This large study
convincingly
demonstrates that
it is of no importance where you stick your needles:
http://archinte.jamanetwork.com/article.aspx?articleid=413107.
How? I can not locate sufficient details of the treatment intervention(s) for each group. Can you?
The authors of this large and technically credible study
Technically credible? Please state your reasons for determining this study to be:
a) a large study?
b) technically credible?
which do not seem to have been properly blinded to the fact they were not receiving the therapy being studied!
I agree.
Even if it is statistically different from the control group, I am not impressed by the quantitative difference, which the authors tend to exagerate.
Please expand?
For me, what these and many more studies are saying is that the ritualistic nature of the performance of acupuncture, with all the props and limelights, add a strong element of expectation and comfort that leads to a more positive response when interviewed for the end-point assessment.
This surprises me (based upon your background). What happened to utilitarianism? I question whether your moral value, stance is rational…
Regards
George
Now George. If you think you are winning points by sneaky ad hominems and silly insinuations you are severely mistaken. If anything, it only indicates your own moral deficiencies.
If you want more details than are given in the article, why don’t you contact the authors. As for your other questions, did you really read the article or…?
@Björn Geir,
I don’t know why you expect any different from George. When did he make any sense?
True Frank. Seems a hopeless case. Didn’t we have a troll here some time ago who called himself “George”? Wonder if its the same. This one reads references like the Devil reads the Bible.
Now George. If you think you are winning points by sneaky ad hominems and silly insinuations you are severely mistaken. If anything, it only indicates your own moral deficiencies.
Sneaky ad hominems’?! That’s you:
This large study convincingly demonstrates that it is of no importance where you stick your needles:
http://archinte.jamanetwork.com/article.aspx?articleid=413107
However, when you’re asked a reasonable question such as:
How? I can not locate sufficient details of the treatment intervention(s) for each group. Can you?
You then reply:
If you want more details than are given in the article, why don’t you contact the authors. As for your other questions, did you really read the article or…?
Suggesting that indeed you are the sneaky ad hominems’ person.
You are trying to convince me that the study is technically credible (I am a researcher, I can read for myself, you make many statements without justification):
This large study convincingly demonstrates that it is of no importance where you stick your needles:
http://archinte.jamanetwork.com/article.aspx?articleid=413107
The authors of this large and technically credible study
Yet, the deficiency is on your part, you are unable to expand on your statements and present scientific reasoning. Attempt to answer my questions please.
Quite emotive:
Even if it is statistically different from the control group, I am not impressed by the quantitative difference, which the authors tend to exagerate.
The question is did you read the article properly, critique it? Obviously not… I take it you are unable to respond to my questions above.
Regards
George
Q.E.D.
Indeed!
You may want to hold your horses George.
Why? I am not the one making erroneous statements and conclusions…
Thank you for the ‘new’ link to a different research article. I’ll have a proper look at it and get back to you. First I have a few questions. To follow.
George
Björn Geir on Monday 30 March 2015 at 14:24
True Frank. Seems a hopeless case. Didn’t we have a troll here some time ago who called himself “George”? Wonder if its the same. This one reads references like the Devil reads the Bible.
Q.E.D! Nice. Really Nice and Grown up. What a gentleman.
Please. ‘This one reads references like the Devil reads the Bible.’ You suggested I read references! However, I have not yet, as there are still issues with the first article of which you fail to comment. Maybe next time think twice before you try to trick people.
Another case of damaged ego! I see Frank is still injured…
I am not sorry that you find my posts that request you to justify your comments ‘troll’ like which signifies that perhaps you are claiming my posts to be inflammatory, off-topic, extraneous…
My comments certainly are relevant, reasonable and justified in response. Obviously, you can not handle being asked let alone challenged. Hilarious!
George
Reading references? You?? How dare he! Acupuncturists don’t need to read references, do they? That is just one of those make-work jobs for menial busy-body scientists. Acupuncturists shouldn’t pollute their precious brains with sordid things like references and facts!
You should absolutely stay away from reading references. You might stumble on something that is actually true, and that would be unpardonable, would it not?
“Another case of damaged ego! I see Frank is still injured…”
You appear to be blissfully unaware that performing such antiquated psychiatric diagnoses of people, who you have never met in a clinical setting, flies in the face of both medical ethics and modern clinical psychology. Your responses are typical of, and expected from, alt-med shills. Note: I’m not diagnosing you, I’m simply pointing out your escalating level of fuckwittery and your declining level of credibility.
Dear Pete,
You appear to be blissfully unaware that performing such antiquated psychiatric diagnoses of people, who you have never met in a clinical setting, flies in the face of both medical ethics and modern clinical psychology.
It is not difficult to assess an injured ego, particularly not on here. It is transparent (behaviour and responses indicate a lot). Certain people very quickly become rude, spiteful, and some even swear when their assumptions are challenged or their beliefs and reasoning is questioned.
I’m simply pointing out your escalating level of fuckwittery and your declining level of credibility.
Regards
George
QED!
Indeed!
Regards
George
Injured by you, George? You latter yourself.
`
When you say something that makes sense, it may be worthwhile; while you pump out drivel, there is no point. The only person who can’t see that is you.
Ok.
Now I’m curious. I posted details of a study this morning where there was no possibility of patient expectation or placebo because the patients were unconscious. And what response do we see from this bunch of enthusiastic sceptics? Nothing, nada, zilch. Now I’m sure you’ll find something wrong with this study – you always do – but why does nobody speak up? If I was uncharitable I’d guess that you’re waiting to hear from headmaster Ernst and then you can all jump on the bandwagon.
Alternatively, Edzard wasn’t able to approve comments until this evening.
Suspecting evil intentions seems to be an inevitable characteristic of the alternological mind. Could it have something to do with the dishonesty, so vital to alternological practice? After all, many, if not most of them, love to tell their gullible victims fascinating tales of how the medical establishment, the government and Big Pharma are colluding to harm and exterminate the poor defenseless citizens for their own benefit, do they not?
Actually Peter, This study is done in a setting I am very familiar with. I work with doing short, surgical procedures in a high volume, specialised center where we concentrate on doing the same procedure over and over with a very standardised anesthesia and it is very important that the patients awake promptly but safely without undue delay so we can use the theater day to its fullest extent. We have been at this for more than six years and I must say we have no undue delays due to patients not waking up promptly after the operation. That problem can be solved with simple management of the anesthesia, we do not need to fiddle with needles in the patients soles or lips.
What I am saying is that this study attempts to look at a possibility of improving something we have already perfected.
I started this morning to work on a comment about this study. I made notes but was only halfway into the thing when I realized the weather was brilliant and the dogs and the wife wanted to go out. So this had to wait.
My (raw) notes from this morning will have to suffice as support for my general verdict that this study was both unnecessary, poorly designed, poorly performed and the results are neither useful nor credible:
I had intended to write this up as I would have a peer review but this will have to do. I have no wish to spend more time on this bad example of biased research attempts.
And just onre more thing.
The authors are obviously deeply entrenched in acupuncture pseudoscience as evidenced by the following passage from the discussion:
This baloney is not something written by people with genuine medical training, experience and insight.
Good reply Bjorn. The study has obvious weaknesses though I would question some that you pick out. I am sceptical about the ‘credible explanation’ issue. I’ve been reading about Jerry Morris’s influential 1950s studies on the benefits of exercise (medical science at that time hadn’t clicked that exercise was good for you, even though it was known in every historical medical culture from Hippocrates onwards). They were widely rejected initially because they lacked biological plausibility. I also don’t think you comment about ‘pseudoscience’ has validity. Firstly because an intervention can be effective even if the theory is awry (“it works in practice but will it work in theory?”). Secondly because – however tempting it might be to dismiss the theoretical framing of a different medical system – it is unsound to do so without taking the time to discover what richnesses it may hold. Finally I disagree that needling the sole of the foot is less painful than needling its lateral margin. I have done both many times. Nor is it quite correct to talk of needling the upper lip. The needle is directed towards the root of the nose. True it induces a distinct and strong sensation but so does needling most acupuncture points.
Peter Deadman said:
Then why waste our time with it?
Your strawman is a poor one Peter. What this story tells us is not that acupuncture will one day become accepted, it tells us that the natural scepticism that is a necessary part of medical safety does not preclude the acceptance of methods that prove themselves useful. Acupuncture (the modern, thin-needle, more benign form of the ancient bloodletting torture) has had a fair chance since it was reinvented in the early part of last century. It has still not proven to be more than at most an effective form of duping the patients or waking them up from anesthesia a little bit earlier when applied to some of the bodies more sensitive parts (as evidenced by the exercise we are discussing.
Why do grown-up, educated people continue hoping for an alternative truth? The idea of an alternative, “eastern” reality has never shown itself to be more than a figment of some peoples imagination. The baloney[sic] that I took as an example is an exact copy from the article. It has no correlation in any known reality and only demonstrates how enamoured the authors are with wishful, magical thinking.
Have a good day. The sun is shining, the frost is mild and the world is beautiful so I will not spend more energy or thought on this useless article. Reality is more fun.
Cheers,
Björn
And just onre more thing.
The authors are obviously deeply entrenched in acupuncture pseudoscience as evidenced by the following passage from the discussion:
According to TCM, loss of consciousness is due to
yin-deficiency or yang-deficiency syndrome or Jue syndrome
due to unbalance between qi and blood induced by deficiency
of qi and accumulation of phlegm[28]. Consciousness is
supported by kidney that resides in the heart. This may be
a clue to understand the observed mechanism of action of
KI1, which is the jing-well point of the kidney channel[26].
But the loss of consciousness may be also due to an imbalance
between yin and yang and this justifies the beneficial effect
of DU26, “the core of man”, located near the meeting point
of Renmai with Dumai channels, the meridians receiving
yang from heaven and yin from earth respectively. In fact
DU26 is traditionally indicated as the single most important
resuscitation point[27]. This baloney is not something written by people with genuine medical training, experience and insight.
Interestingly, this is probably an example of some of the stuff written by people with genuine biomedical and traditional Chinese medical training, experience and insight. There are epistemological and ontological scientific divergences. It is a paradigm – perspective matter. However, the type of applied practice varies. In the UK there are medical professionals that apply TCM (acupuncture) but omit features, such as the term Qi and so on. Yet they use the fundermental aspects. Sounds odd though, doesn’t it. Especially, for those without specialised training in the field.
Regards.
@George
If you can show us a credible explanation of how this gibberish:
can, by epistemological/ontological or whatever means, be parsed to represent functional reality, I might be persuaded to consider it as something other than excrementum tauri.
Until then, the credibility of this so called “article” is null and void.
Or you could just look it up yourself. It’s not secret knowledge – and there’s plenty out there written for the layman, on the subject of Chinese med basics. You might even stumble across the answer to your deqi question from earlier.
@George Bocs
It doesn’t take specialised training to recognize antiquated, meaningless, spiritual nonsense that may have made some sort of sense a very long time ago but has zero relevance to reality.
“There are epistemological and ontological scientific divergences.” Ontology is the term that describes philosophers pulling stuff out of their backsides. There’s no science involved. If people feel comfortable basking in erudite-sounding language that conveys nothing capable of definition or measurement so be it, but don’t use this to confuse and con well-meaning but gullible people.
@George Bocs
It doesn’t take specialised training to recognize antiquated, meaningless, spiritual nonsense that may have made some sort of sense a very long time ago but has zero relevance to reality.
Traditional Chinese medicine has relevance to reality. Maybe not your reality, but reality nonetheless.
There’s no science involved. If people feel comfortable basking in erudite-sounding language that conveys nothing capable of definition or measurement so be it, but don’t use this to confuse and con well-meaning but gullible people.
Traditional Chinese medicine requires self-correction, it is not a perfect system but what is?
“There are epistemological and ontological scientific divergences.” Ontology is the term that describes philosophers pulling stuff out of their backsides.
I had not viewed philosophy of science in that manner before!
It is important to view arising issues from more than one perspective, details that do not fit the expected are often very important.
Traditional Chinese medicine is refutable. However, making prior assumptions about concepts and ideas because ‘it is outside the box’ is poor. Also one could take into consideration the epistemological and ontological scientific divergences (and similarities) of traditional Chinese medicine in health research.
Regards
George
It is a word salad, complete nonsense.
~
“the meridians receiving yang from heaven and yin from earth respectively”
The metaphysical nearly always gets a mention so total crapola.
~
“Interestingly, this is probably an example of some of the stuff written by people with genuine biomedical and traditional Chinese medical training, experience and insight. There are epistemological and ontological scientific divergences.”
You’ve surpassed yourself with this lot. Did you cut out words, put them in a hat, and throw them on a table?
Of course not. Why would I do that!
I am fully aware (excuse the pun) that my comment would recieve such responses.
However, just because one doesn’t understand something, does not mean it doesn’t exist in some form.
One would require specialised training to understand traditional Chinese medicine constructs.
Regards
George
“However, just because one doesn’t understand something, does not mean it doesn’t exist in some form.”
There is a lot I don’t understand, and there are a lot of people who understand much more, as well as the Laws of Nature. What you are proposing isn’t some fundamental change of knowledge; this isn’t a Galileo scenario. This is about some longstanding witchcraft that has no place in modern science.
~
“One would require specialised training to understand traditional Chinese medicine constructs.”
Or one could undertake a more productive specialised training and study medicine, and provide a useful service to humanity. TCM and acupuncture is something only in which the worried well in First World countries can afford to indulge. Is there the same take-up in the Ebola affected countries? Are many Nigerians using TCM to treat their malaria? Are the sub-Saharans with elephantiasis using TCM to cure themselves of their worms?
~
If TCM is so effective, it would be readily apparent, but it is not. There are some people for which being being a practitioner of an “exotic” form of “healthcare” feeds their fragile, deficient personalities and makes them feel special. Defending TCM, for these people, isn’t about whether it works, but defending their egos. All your posts point to this, George; it is all about you. (there are some others in this camp, jm for one.)
~
RCTs should show a real effect, not some piddling fringe nonsense, virtually indistinguishable from statistical noise. And this last sentence is an apt description of you; piddling fringe nonsense.
Frank – it’s getting harder and harder to distiguish you from a religious fundamentalist. Same parochial focus, different details. Bully for you!
“Frank – it’s getting harder and harder to distiguish you from a religious fundamentalist. Same parochial focus, different details. Bully for you!”
~
Make sense and spell properly and I might be bothered responding to the nonsensical crap you post. You do get an A+ for Logical Fallacies though. Keep up the good (?) work.
Sorry Frank – here’s the missing ‘n’. You should be able to make sense of it now. No need to respond, though.
“Sorry Frank – here’s the missing ‘n’. You should be able to make sense of it now. No need to respond, though.”
~
This shouldn’t need to be said, however, you leave little choice. Your post characterises the problem you, and others of the alt-med persuasion, have in processing language and understanding.
I said, “Make sense and spell properly”, not use correct spelling so as to make sense. Your problem with spelling is separate to the problem of making sense.
~
I’m responding only because something so straightforward is understood by most, and this is my little way of helping you. (Sad.)
OK, Peter, I’ll take your bait. The two ‘acupuncture points’ used are 2 of the most painful points that can be done. Kidney-1 is on the sole of the foot (the only TCM point on the sole), and DU25, also known as Governing Vessel 26, is just below the nose and above the upper lip in the phitrum. These points are on sensitive nerves and even with firm finger pressure hurt. Essentially this study found that if you torture people they wake up faster.
It was a small study (50 total, 10 in each group) and while the tortured patients woke faster, the study concluded “The same pattern was observed also 15 and 30 min after the end of anesthesia, although the difference among groups was not significant at these time points.”
Would you rather wake up in extreme pain at 5 or 10 minutes with a needle being twisted in the bottom of your foot and your upper lip, or at 10 or 15 minutes without unnecessary acute pain?
OK, Peter, I’ll take your bait. The two ‘acupuncture points’ used are 2 of the most painful points that can be done. Kidney-1 is on the sole of the foot (the only TCM point on the sole), and DU25, also known as Governing Vessel 26, is just below the nose and above the upper lip in the phitrum. These points are on sensitive nerves and even with firm finger pressure hurt. Essentially this study found that if you torture people they wake up faster.
Are you sure you are an Ex-Acupuncturist? I doubt it! …
@Peter Deadman
“And what response do we see from this bunch of enthusiastic sceptics? Nothing, nada, zilch.” Not true!! You are demonstrating the limits of your ability to use your eyes. There are three responses if you take the small trouble to search just below your post citing this study. (But I acknowledge this particular thread has become vastly overlong and the limited and poor indentation layout for successive responses makes it all unwieldy to navigate.)
Unlike Bart, who hit a paywall looking for the paper and could comment only on the abstract, I read through the paper quickly. (It’s free to access at http://www.jcimjournal.com/jim/showAbstrPage.aspx?articleid=S2095-4964%2815%2960159-5.) Like I said in more detail in my post its problems are as follows. (1) extremely small groups of patients (8 to 10 in each of 5 groups), but the differences (9-11 minutes arousal from anaesthetic in three acupuncture groups versus 15-18 minutes in sham acupuncture and no Rx groups) are indeed substantial. (2) The authors’ explanation of the effects in the discussion is pseudoscientific, spiritualistic gobbledygook. (3) Somebody more expert than me at statistics will probably have something to say about use of repeated ANOVA testing with such small groups: one on-line ANOVA calculator website I looked at refused to accept such minimal data.
I also wondered why it has taken 8 years for such a tiny study to make it into print in a piss-poor sCAM journal. That datum alone hints at problems that may not be evident on a cursory look-through the paper.
In my post I said that the method of sham acupuncture was not stated. This is incorrect: the sham acupuncture involved (the same type of?) needles stuck in parts of the foot other than the ‘proper’ acupuncture points.
A study this amazingly tiny gags for replication with larger (and fewer) groups of patients. The sham acupuncture needs to be blinded from the acupuncturists administering it (if you’re a proponent of something and you know you’re doing a sham version of it, do you really do it with the same involvement?).
I have other concerns. Is it possible to perform acupuncture on someone’s foot without manipulating that foot? In which case the effects seen may be the result of reflexological effects, not acupuncture. We all know that different parts of the foot communicate with different internal organs. Moreover, it can’t be ruled out that the words spoken next to the unconscious patients and the parts of the body touched transferred spiritual heat from a higher dimension as in, e.g., reiki. Having words such as ‘sham’ and ‘no treatment’ possibly uttered next to you when recovering from anaesthesia may disturb your karma, or your yin and yang, or your vital essences.
Don’t forget, the authors of this paper offer a TCM explanation for their findings, which includes the valuable observation that “Consciousness is supported by kidney that resides in the heart”, without comment.
Thank you for that, FrankO. I had actually found the link, thanks to your previous message, and I glanced at it. What a sorry excuse for a paper!
The sham acupuncture needs to be blinded from the acupuncturists administering it (if you’re a proponent of something and you know you’re doing a sham version of it, do you really do it with the same involvement?).
I agree. I think there is potential for subversion using some forms of ‘sham’ acupuncture. Which would lead to an overestimation in outcome.
Regards
George
I just heard a marvellous comment about acupuncture on a radio comedy show… “Sticking needles in your body may cure your disease, but it could be fatal for your voodoo doll!”
@FrankCollins
Acupuncture has a place in science, whether we like it or not. Nothing you can do about that. Apart from have an opinion.
Regards
George
“One would require specialised training to understand traditional Chinese medicine constructs.”
Or one could undertake a more productive specialised training and study medicine, and provide a useful service to humanity.
@FrankCollins
Acupuncture has a place within healthcare. It is a useful complementary medicine, for some conditions.
Regards
George
Then you haven’t read much of this thread.
TCM and acupuncture is something only in which the worried well in First World countries can afford to indulge. Is there the same take-up in the Ebola affected countries? Are many Nigerians using TCM to treat their malaria? Are the sub-Saharans with elephantiasis using TCM to cure themselves of their worms?
@FrankCollins
In 2008, of an estimated 57 million deaths worldwide, 31% of deaths were attributed to cardiovascular diseases. 13% to cancers, and 15% infectious or parasitic diseases.
3.5 million deaths were as a result of lower respiratory tract infections and 0.8 million deaths as a result of malaria. Never mind TCM, where is medicine?!
Regards
George
Another Red Herring to try to avoid answering reasonable questions.
~
Medicine is attempting to find cures, something acupuncture cannot do.
Or one could undertake a more productive specialised training and study medicine,
Are you a doctor?
Regards
George
Is the question relevant, or yet another attempt at a Rd Herring, in which you are well versed?
@FrankCollins
Hello Frank,
I’m travelling with work. Thank you for your kind nudge.
I think the question is a red herring, to an extent. Mainly because it’s kind of irrelevant. Although I think I can see your point. If you would like to provide some background information that maybe useful.
I think that one can promote choice, rights and diversity in support of a range of occupations. It is up to the individual whether they wish to study to become an acupuncturist; nurse; artist; surgeon; doctor; physio; IT specialist; dancer; or other. One can do (hopefully) what appeals to them. Is it a good idea for everyone to study exactly the same thing?!
I have suggested that I think acupuncture has something to offer patients suffering with for example chronic pain. Particularly when biomedical treatment interventions are unable to provide beneficial means of pain management and people suffer.
It also is not a case of traditional Chinese medicine being equililivant to biomedicine or superior, may be this is where you are going wrong…
What are your concerns?
I’m not that convinced or influenced by an ‘anchoring’ approach, where irrelevant information is presented to compare-to-compete two completely different levels of models and modes of health provision. One being primary healthcare and the other a complementary approach.
Hope that helps
Regards
George
@George,
“I think the question is a red herring”, then why ask it, since you admit “it’s kind of irrelevant”?
~
“I think that one can promote choice, rights and diversity in support of a range of occupations. It is up to the individual whether they wish to study to become an acupuncturist; nurse; artist; surgeon; doctor; physio; IT specialist; dancer; or other. One can do (hopefully) what appeals to them. Is it a good idea for everyone to study exactly the same thing?!”
I agree that the world requires different occupations and Adam Smith made the point well. The example occupations you cite all serve a purpose for the community, except one, and it is no accident you snuck acupuncturist in. All are useful and, apart from the artists, are are based on science, except one. Pursuing an occupation solely because it “appeals” may justify many choices, but not pursuits for which there is no evidence.
~
“I have suggested that I think acupuncture has something to offer patients suffering with for example chronic pain. Particularly when biomedical treatment interventions are unable to provide beneficial means of pain management and people suffer.”
All you are suggesting is that a known placebo is better than nothing; hardly a justification for relieving the foolish from their money or the medical system from badly needed funds.
~
“I’m not that convinced or influenced by an ‘anchoring’ approach, where irrelevant information is presented to compare-to-compete two completely different levels of models and modes of health provision. One being primary healthcare and the other a complementary approach.”
No one said that. What has been said, repeatedly, is that both (all) forms of proposed care be subject to the same standards of evidence. In the case of acupuncture, it is found wanting.
~
“t also is not a case of traditional Chinese medicine being equililivant to biomedicine or superior, may be this is where you are going wrong…”
I have no idea what you mean.
@FrankCollins
The example occupations you cite all serve a purpose for the community, except one, and it is no accident you snuck acupuncturist in. All are useful and, apart from the artists, are are based on science, except one. Pursuing an occupation solely because it “appeals” may justify many choices, but not pursuits for which there is no evidence.
I did not sneak acupuncture in. I listed acupuncture first.
The whole topic is about acupuncture. I am not sure why you would conclude that.
An interesting question:
Is acupuncture a science? You state acupuncture is not a science. I’d be interested to hear your thoughts as to why?
Regards
George
@FrankCollins
but not pursuits for which there is no evidence.
There is evidence. One is incorrect to state that there is no evidence.
No one said that. What has been said, repeatedly, is that both (all) forms of proposed care be subject to the same standards of evidence. In the case of acupuncture, it is found wanting.
I agree. Proposed care should be subject to the same standards of evidence. This also means that the same standards of criticality be applied to all forms. I do not see any attempts at evaluating the evidence base and conduct for GP, or clinical medicine. Why is that so?
> research for various conditions (other than migraine, low back pain, osteoarthritis of the knee, IBS, depression) that are treated with acupuncture need to be done. It is early days with regards to rigorous research.
Acupuncture produces beneficial change, that is evident. Not solely as a result of placebo/hawthorne effect. I think i’ll review ‘sham’ and publish an article. There are many errors. All mechanisms require exploration. To move forward existing research design and methodology requires analysis with regard to emerging findings.
Regards
George
*Equivalent
Regards…
George
@FrankCollins
Or one could undertake a more productive specialised training and study medicine,
Are you a doctor?
Is the question relevant, or yet another attempt at a Rd Herring, in which you are well versed?
“I think the question is a red herring”, then why ask it, since you admit “it’s kind of irrelevant”?
Red herring:
I was referring to the statement you made: ‘or one could undertake a more productive specialised training and study medicine.’ Not my question to you asking if you were a doctor. Never mind…
Regards
George
@George,
“Are you a doctor?”
I can’t recall saying that, however, I did say it isn’t relevant.
“Acupuncture produces beneficial change, that is evident.”
True, but the mechanism has been explained by the placebo effect.
“Not solely as a result of placebo/hawthorne effect.”
Are you sure you understand the so-called “Hawthorne effect”? (I just discovered Mayo was Australian born, tres embarrassment!) The whole Hawthorne experiment was a disaster, from beginning to end. James E. Lee dismantled the usefulness of this less than rigorous attempt as studying human behaviour. Strange though George, uncharacteristic of you to make statements you don’t believe will be challenged (sarcasm alert, awoooogaaaah).
“I think i’ll review ‘sham’ and publish an article. There are many errors. All mechanisms require exploration.”
That is a significant point; the problem is acupuncture has no mechanism in the laws of nature.
“Perhaps ‘acupuncturists’ and ‘skeptics’ could point me in the direction of where you both believe adequate placebo(s) have been used in clinical trials of acupuncture. I’d be interested to compare views and evaluate.”
Very funny, all of it is a placebo according to all of the evidence.
I wouldn’t go that far. I can believe that sticking needles in people might have an affect – we’re not designed to be poked full of holes! – but I’ve yet to see evidence that the effect is likely to be beneficial.
PERHAPS acupuncture, by breaching the skin’s immune barrier, promotes an immune response which – oh, I don’t know, does something somewhere. But I can see a mechanism whereby acupuncture MIGHT have an effect, though I don’t see any decent evidence that it does.
Homeopathy, on the other hand, requires so much else of current scientific thinking to be wrong that I can’t believe there’s a mechanism. It needs all of analytical chemistry to be wrong and if there was anything in it, the processes which make the silicon wafers which make up the important bits of this computer wouldn’t work, so I can’t help but think that anything posted on the internet saying “Homeopathy works!” is proof that it doesn’t.
Perhaps ‘acupuncturists’ and ‘skeptics’ could point me in the direction of where you both believe adequate placebo(s) have been used in clinical trials of acupuncture. I’d be interested to compare views and evaluate.
Regards
George
3.6. Application site
The most common sites for the application of laser
acupuncture were trigger points (39%). Subgrouping to
perform another analysis to examine any difference of the
effects on pain with different application sites was performed. No significant difference was observed between
the subgroups at the end of intervention and during the
follow-up period (p > 0.05). However, only the application
at trigger points showed a positive effect in favor of laser
acupuncture; this was not seen in case of application at
acupuncture points or tender points. (see Appendix 5).
…………………………………………………………………………..
So the laser over trigger points had an effect but not over acupuncture points. So what does this say about laser and trigger points?
I suspect it says less than you suspect.
The problem with studies like this iss… OK, perhaps “problem” is too strong a word, but sub-grouping makes the results impossible to interpret unless you have some mid-level of above knowledge of statistics. If I have a die, and I want to test if it’s fair, I roll it lots of times – say 1000 – and see how the results are distributed, and can assign a statistical probability to it.
But if I then break those rolls into groups – first 100, second hundred etc, every tenth roll, every 13th roll etc. – I can build a large number of groups and the more I create, the better chance that some random variation will show up as apparently “significant” in one group. This is, conceptually, the opposite of meta-analysis, which pools all the small groups together to make a bigger, more reliable group.
It’s interesting that one subgroup showed this result. The correct response is now to do another trial, looking ONLY at this sub-group in new patients. If the effect is real, it should show up. If it’s a statistical anomaly, it shouldn’t.
I’ve just speed-read this entire thread, which has strayed a fair bit from what particularly interests me; laser acupuncture.
It’s quite likely I’ve missed something, but it seems to me that a salient point has been omitted.
If shining a bright red light on a part of your skin is as good as traditional acupuncture… isn’t it bleedin’ obvious that traditional acupuncture is a load of bollocks?
Cheers
Steve
PS I’m not a scientist.
@Steve Thompson,
Yes, unless you are of the alt-med persuasion.
I think that it mainly demonstrates to what length scientists and skeptics are willing to go in their attempts to accommodate the charlatans and give them every chance to demonstrate that there is some truth in their nonsense, however infinitesimally small the probability may be.
Viruses are infinitesimally small……so are certain lethal bacterium……..many microscopic things can wreck havoc….ever been saved at work by a text……..why is it so hard to believe that a small group of bio-phonic messages entering the brain effects you……..it does it all the time…..a whiff of a certain scent can trigger memories, which trigger thoughts which trigger reactions in your sub conscious to your conscious…….it’s not science fiction any longer………modern science has proven it…….years ago……research the Primo Vascular Channels…..if they have no effect, why do you have them??? Look at the new emerging bio photon therapy treatments in western medicine…..It’s what the Chinese have been talking about for 1000s of years…….it’s not that hard to understand…..Y’all act like everything has already been discovered and there is nothing new to learn……it’s really not a scientific attitude….it’s an institutional attitude………and we all know the problem with institutionalized things……….and institutionalized minds………….you don’t have to be in an institution to be bound up by it…..If Ernest can admit he was wrong, and look at all the damn letters after HIS name, you can too.
“…..if they have no effect, why do you have them???”
WE ALSO HAVE A LOT OF OTHER THINGS, BUT THAT DOES NOT MEAN THAT STICKING NEEDLES IN THEM MAKES US HEALTHY!
“… bio photon therapy treatments in western medicine…..It’s what the Chinese have been talking about for 1000s of years…”
ARE YOU SURE?
“If Ernest can admit he was wrong, and look at all the damn letters after HIS name, you can too.”
YOU SHOULD SEEK HELP – IF ONLY FOR CORRECTLY COPYING MY NAME!!!
For your information: bacterium is the singular form of the word, bacteria is the plural form.
I just looked [19 April 2017 at 12:42] for Primo Vascular Channels on Google. It gave me FIVE results. It seems that the world is not particularly interested in these channels.
Furthermore, even IF you were able to demonstrate that these channels do indeed exist, that would tell us NOTHING about them being the mechanism through which acupuncture works.
You have all work still ahead of you.
Yes, I can change my opinion. I often have. However, there needs to be a reason for such change. You haven’t provided one.
The only work I have to do is the work right here in my full time 20 year clinic. I have given over 60,000 acupuncture treatments. I am booked next week like every week. I am a licensed primary care acupuncture physician in the state of Florida. Mayo Clinic refers to me. I have practice privileges and work regularly in local reproductive endocrinology offices……full of MDs…..who call me to do treatments for THEIR patients…..The proving work has already been done………and for the damn millionth time…….there is NO SUCH THING as a placebo effect……y’all seriously need to get with it……..
@Beth Acampora on Wednesday 19 April 2017 at 23:30
“The only work I have to do is the work right here in my full time 20 year clinic. I have given over 60,000 acupuncture treatments. I am booked next week like every week.”
What does that show; just a fool stealing from the gullible, and that you are willing to profit from the easily deceived. That makes you, implicitly, a thief and a fraud.
“I am a licensed primary care acupuncture physician in the state of Florida. Mayo Clinic refers to me.”
There is no such thing as a “primary care acupuncture physician”; it is an oxymoron. When you have the authority to even lance a boil, you will be far more qualified.
“I have practice privileges and work regularly in local reproductive endocrinology offices……full of MDs…..who call me to do treatments for THEIR patients…..”
So, you deal with some doctors who don’t understand in the same way you don’t understand?
“The proving work has already been done………and for the damn millionth time…….there is NO SUCH THING as a placebo effect……”
When you can provide evidence to refute the current evidence, please do?
“y’all seriously need to get with it……..”
Are you as seriously stupid as you appear?
You should become an adviser to Donald Trump. He likes alternative facts almost as much as you do.
Frank, you’re frothing at the mouth again. Put the cap back on the glue, and go get some fresh air.
@jm on Thursday 20 April 2017 at 15:46
“Frank, you’re frothing at the mouth again. Put the cap back on the glue, and go get some fresh air.”
The comments apply equally to you. The non-meds have the same detachment from reality. Bruising people with a stick is as absurd as sticking needles in points which don’t exist. No wonder the Chinese banned it years ago. It is a pity they couldn’t ban stupidity too.
As you have nothing constructive to say, you resort to the only device you have available; half-baked nonsense.
“…non-meds…half-baked…don’t exist…”
Your comment is packed with cries for help, Frank.
@jm on Friday 21 April 2017 at 08:59
“Your comment is packed with cries for help, Frank.”
The concern fallacy. Why is it only a crackpot non-med who bruises people with a stick saying this?
Introspection isn’t one of your strengths, along with critical thinking, reason, logic, and analytical thinking. Go and play with the kiddies who still believe in fairies and magic.
Good grief, Beth! Your comment contains so many inaccuracies (never mind the spelling errors) it’s hard to know where to start.
“Viruses are infinitesimally small”. No, they range from about 20–300 nm in size and can easily be visualized by electron microscopy. Pandoravirus is an exception — a giant at almost 1 µm in diameter.
“so are certain lethal bacterium [sic]”. Bacteria, whether or not lethal, are way bigger than viruses (there are even viruses that infect bacteria). Typically 1–2 µm in diameter, they vary from spherical shapes to rods and helices many µm long. They can be seen by light microscopy.
“research the Primo Vascular Channels…..if they have no effect, why do you have them???” We don’t have them. They’re nonsense made up by a small group of scientists in an attempt to explain acupuncture points. They have the same reality as N-rays. The publications about them overlook the fact that, if they have the properties ascribed to them, they’d have been observed repeatedly by the tens of thousands of scientists who routinely do microscopy of tissue samples.
“Look at the new emerging bio photon therapy treatments in western medicine…..It’s what the Chinese have been talking about for 1000s of years”. Please point us to any Chines document thousands of years old that mentions ‘bio photon therapy’. Bio photon therapy is a piece of nonsense that, like all pseudo-medical tricks, sounds sciencey enough to convince people who are largely ignorant of science. There are diseases that respond to light therapy, but this has been known to medicine for years. Calling light therapy ‘bio photon therapy’ and pretending it can cure all manner of diseases is pure fantasy.
“Y’all act like everything has already been discovered and there is nothing new to learn……it’s really not a scientific attitude….it’s an institutional attitude”. Not at all. It’s the proponents of pseudo-medicine who insist their many and varied delusions have nothing new to learn. They actually set up supportive institutions in an effort to give themselves credibility.
They have in common that they almost all originate from one individual’s self-declared concept(s)*, have no convincing evidence to confirm they are effective therapeutically (beyond placebo effects), and typically remain unchanged for many years — hundreds of years in some cases. They sometimes even insist that ‘ancient knowledge’ is a positive advantage over new discovery. While science and (real) medicine progress at an ever-increasing pace, Big Snakeoil — the sole focus of Ernst’s blog — remains trapped in its origins. The impression of ‘nothing new to learn’ you obtain from reading this blog comes entirely from the proponents of camistry who tend to work that way.
*Primo Vascular Channels started out this way, too!
@Beth Acampora on Wednesday 19 April 2017 at 17:01
Beth is a well known fruitloop who has posted the same nonsense regularly, but doesn’t appear interested in nullifying her profound ignorance of reality. She has a high level of cognitive dissonance and takes relativism to a new level (in good company with many others though, jm, Buffoon L-B, among the notables).
http://www.bethacampora.com/
http://www.bethacampora.com/contact-us.html
http://www.bethacampora.com/conditions-treated.html
The way she writes is a good insight into the way she thinks.
Hi,
I don’t know if anybody is out there yet about this artivle, but I read this in the analysis:
“Studies involving … application of laser therapy to nonacupuncture points were not considered”
Based on my understanding this would have been the most important differentiator between acupuncture and random stimulation.
As I see someone had already asked this, but I don’t see any reflection:
http://edzardernst.com/2015/02/acupuncture-new-meta-analysis-suggests-it-is-effective-beyond-placebo/#comment-64618
Gábor
fixed
What they did do was to classify trigger and tender points as acupuncture points – whilst stating that the existence of these points is controversial. To which I say: no more so than acupuncture points.
It’s nonsense to describe all this as laser acupuncture. It’s no such thing.
It’s laser therapy pure and simple.
Laser therapy and acupuncture stimulation works because it stimulates your own body’s ability to make light…….If you’re not up on your research you won’t know what bio photons are……….you won’t know that the areas of the body called “acupuncture points” utilized in Traditional Chinese Medicine have been clinically proven to exist (you can find them with a machine), they are structurally different than the cells surrounding them, the locations of the traditional acupuncture points when stimulated release twice as much nitric oxide (NO) than the surrounding cells…Needling acupuncture points create changes in brain activity greater than needling non points………Here’s some links you can SUCK ON…..although all of you are SO BIASED that your scientific pretensions are obvious………meaning you won’t care that research proves anything……..you are pre programmed to reject it regardless…….NOT SCIENTIFIC AT ALL…………..just proves you are not scientific…..you all are just a bunch of HATERS………stupid ones at that…..
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498898/
https://www.ncbi.nlm.nih.gov/pubmed/23395475
https://www.ncbi.nlm.nih.gov/pubmed/18494380
https://www.ncbi.nlm.nih.gov/pubmed/15876491
@Beth Hopkins on Friday 01 September 2017 at 19:25
Beth, you’ve done all this before, except you went under the moniker of “Beth Acampora” of http://www.bethacampora.com/ and http://www.bethacampora.com/contact-us.html.
It appears you are taking the same loony line as others in that the body can now “make light” and the old bogus “bio photons”, what ever they are. As an aside, from where do these “bio photons” originate and to where do they go? No one has produced any evidence, by that I mean real evidence, not those (ahem) studies to which you have linked. None of them show anything other than wild conjecture about changes, however small, and greater conjecture about what they may do. This should not need to be said, however, wild assertions and spurious fiddling about is not research.
You believe because you want to believe, nothing more. Your rant shows your level of maturity and your failure to understand that wishing doesn’t make it so. You may well be a nice person, that I don’t know but one thing is certain, you are another A-grade loon wrapped up in the supernatural with no understanding of reality.
Suck on this…………. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761672/
“Moniker”…!!!???!……one is a maiden name…..one is a married name you moron……..
You guys are so dumb. It’s ridiculous. You think you’re scientific……….lol
I don’t “believe” — I witness daily and KNOW as do all my happy patients. You know NOTHING about the subject……..you are arguing with a licensed professional….. The STATE OF FLORIDA gives me a license to perform acupuncture as a PRIMARY CARE PHYSICIAN……..so yes….you are so much smarter than the Board of Medicine in the State of Florida……….. fucking dumb ass……..oh my goodness.
You will not find much sympathy here. We are simple people, not used to this level of sophisticated American alternologist language. Why not be an educator and teach us what it means and what evidence it is based on?
Beth,
dont´t be so angry, why all this verbal abuse? Aren´t there some acupoints that you can trigger to reduce your aggression level?!
🙂
Regarding your “Suck on this” remark and paper reference:
I have acted as a reviewer for quite a few articles for mid- to high impact journals.
The article you cite must really be a “great” review article… I stopped reading after the first sentence.
Quote:
“It has long been accepted that acupuncture, puncturing, and scraping needles at certain points on the body has effects of analgesia, anesthesia, and treatment of various diseases.”
If the author starts his/her review with such a one-sided statement, it is evident that he/she is not objective.
Further, it is published in the “Chinese Journal of Integrative Medicine”. The “impact factor”, which is a indication of the quality of scientific journals, was 1.346 last year, which is very low.
Two reasons for me not to waste any more time on this obvious piece of crap review.
Yet another make-believe doctor playing the “indignant professional” gambit. I am struggling to find this amusing anymore.
You may have a paper or two Beth, that says you can call yourself ‘primary care physician’ within the state boundaries of Florida, that does not mean you are competent to be one and certainly would not come close to being accepted outside America. If an acupuncturist with your meager merits tried to claim this title on the other side of the Atlantic, he would be literally thrown out followed by a scornful shake of heads.
A glance at your fancy website provides ample evidence that notwithstanding your politically (not scientifically or rationally) motivated fancy Florida license (I bet it has a gold stamp 🙂 ), you do not come close to having what it takes to be a physician, primary care or any other kind. You have no medical education. The set of therapeutic claims you present has been more or less disproven. For example has it been definitely shown that acupuncture does neither increase fertility nor IVF success rates. If you were a genuine medical physician you would have abandoned these claims as inefficient.
@Beth Hopkins – Acampora, AP on Friday 29 June 2018 at 19:42
Thanks for proving my point.
@FC:
…..”you’re another A-grade loon wrapped up in the supernatural with no understanding of reality”…..Priceless!
@BH: “Just a bunch of haters” ….
vs just a bunch of dumb asses who fall for mendacious research and the vested financial interests that produce it….I’ll stick with the hate of such any day.
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