acupressure
Obesity is, as we all know, a huge public health issue. We therefore must no be amazed that the ‘SCAM brigade’ has collectively jumped on this bandwaggon – even auricualar acupressure is being promoted as a solution!
This study aimed to evaluate the impact of auricular acupressure on obesity and sleep quality in middle-aged Korean women. The single-blind, randomized, sham-controlled trial included participants aged 40-65 years with a Body Mass Index (BMI) of 25-34 kg/m 2 , divided into an experimental group (n = 30) and a control group (n = 29).
The intervention involved 8 weeks of auricular acupressure using ear seeds on five acupoints associated with obesity and sleep. Obesity outcomes were assessed using anthropometric indices (body weight, BMI, waist circumference, body fat mass, body fat percentage), while sleep outcomes were evaluated using the Pittsburgh Sleep Quality Index and actigraphy. Measurements were taken thrice: before the intervention, and at 4 and 8 weeks post-intervention start.
The experimental group demonstrated a significant reduction in obesity measures and improvement in sleep quality over time compared to the control group.
The authors suggest that their findings suggest that auricular acupressure may serve as an alternative nursing intervention for managing obesity and improving sleep quality in middle-aged women.
I have to admit that firstly I do not subscribe to ‘HOLIST. NURSE. PRACT.’ and secondly I am not willing to spend my money on buying this article. This means that I only can read the abstract of this paper. Thus my following explanations are speculative [but, as always, I am happy to change my tune once someone shows me that I was wrong].
So, how can a single- [presumably patient-] blind, sham controlled RCT of auricular acupuncture produce a positive result?
Fraud?
Not necessarily!
More likely, I think, is a phenomenon called ‘de-blinding’. For the above trial, this would mean that the control patients were treated with a sham procedure that was deemed to be indistinguishable from the verum by the trialists. But, in fact, patients managed to tell the difference between verum an sham. As the investigators did not check the success of their blinding procedure, they were able to call their study a ‘single-blind trial’, while in reality it was at least partly deblinded. If I am correct, the patients who were treated with the sham intervention fellt cheesed off for not receiving a real therapy and thus kept on eating, while the verum group did as told and controlled their diet a bit better.
In addition, ‘single-blind’, as applied to the patients, means that the therapists were not blinded. As they had a strong interest to generate a positive result, they would have used their verbal and non-verbal communication skills to influence their verum patients to reduce their obesity measures, e.g. by persualding them to excercise more and eat less.
In turn, these mechanisms together had the effect that “the experimental group demonstrated a significant reduction in obesity measures and improvement in sleep quality over time compared to the control group”.
QED
Alternatively, ‘single-blind’ might mean that the therapists were blinded. But, in this particular case, I don’t quite see how this would be possible.
Yes, there is yet another alternative: auricular acupressure might be effective in reducing obesity. If that is so, the current trial does not prove it!
This study compared the analgesic efficacy of acupressure and magnetic therapy (AMT) versus diclofenac sodium (DFS) in acute renal colic. A total of 138 patients with acute renal colic (visual analog scale [VAS] score ≥ 7) were randomized to AMT or DFS treatment. Primary endpoints included changes in VAS scores at baseline, 1-, 10-, 30-, and 120-min post-intervention, along with analgesic duration. Multiple linear regression evaluated the influence of treatment modality, gender, white blood cell (WBC) count, and other covariates on VAS scores at 10 min. Interaction effect analysis was additionally used to assess how these factors modified treatment efficacy.
The AMT group demonstrated rapid onset, achieving an 86 % VAS reduction at 1-min post-intervention (vs. baseline, P < 0.001), though pain rebound occurred after 30 min. The DFS group exhibited slower onset but significantly prolonged analgesic duration compared to AMT (23.6 ± 2.2 h vs. 2.4 ± 1.0 h, P < 0.001). Multiple linear regression revealed that AMT had the best analgesic effect (B = -6.22, P < 0.001). Male gender (B = 0.78, P = 0.026) and lower baseline WBC counts (B = -0.16, P = 0.026) were associated with higher VAS scores. Interaction analysis indicated enhanced AMT efficacy in male patients and those with lower WBC counts.
The authors concluded that AMT and DFS exhibit complementary “rapid-sustained” analgesic profiles in renal colic management, with gender and WBC levels significantly modulating treatment efficacy. A stratified analgesia protocol based on these factors may optimize patient outcomes.
Apart from the fact that, as an equivalence trial, the study is hopelessly underpowered and its results therefore less than reliable, I have a further reason for not trusting its findings.
A renal colic is an acute and severe loin pain caused by a urinary stone moving from the kidney downwards into the ureter. The pain is often resistant to DFS or other conventional pain-killers and might require opioids. The pain usually peaks sharply, lasts for 20 to 60 minutes, and then subsides into a dull ache before the next “wave” begins. These waves are caused by the ureter’s peristalsis—the tube’s rhythmic muscular contractions—as it tries to squeeze the stone toward the bladder.
So, all I need to do to fake the effectivenesss of a so-called alternative medicine (SCAM) like AMT is to start treating patients when a wave is subsiding. This can easily appear as though AMT had a remarkable effect of 86%. Subsequently, the pain will recur. And this is probably what happened in this study! What I am trying to convey is that I am not convinced that AMT did much at all.
Moreover, I find it daft to conduct a trial where two SCAMs are tested together in one single treatment arm. Even if one would be convinced of the value of AMT – which I am not! – one would need to ask: was it the acupressure or the magnetic therapy that did the trick?
My conclusion is therefore yet again: if you design a silly study, you get a silly result.
Tuina, or Tui Na is based on the notion that imbalances of the life-force, qi, can cause blockages or imbalances that lead to symptoms and illness. Tuina massage is similar to acupressure in that it targets specific acupoints. Practitioners use fingers to apply pressure to stimulate these points.
Some people suggest that Tuina might benefit diabetic peripheral neuropathy (DPN), but the evidence is inconclusive. This review evaluated its clinical efficacy and safety for DPN treatment.
Ten databases were searched, covering the period from their inception to February 21, 2024. Relevant data were extracted from studies meeting the inclusion criteria, and a meta-analysis was conducted using RevMan
5.3 software.
A total of 24 randomized controlled trials (RCTs) involving 1,989 participants were included. Patients in the experimental group received Tuina in addition to routine treatments and nursing of DPN. Patients in the control group received routine treatments and nursing of DPN, including health education, dietary guidance, blood sugar control, and oral vitamin B or mecobalamin.
The meta-analysis showed that, compared to various control therapies, Tuina demonstrated a higher overall clinical efficacy rate and improved Toronto Clinical Scoring System (TCSS) scores, indicating that Chinese Tuina may provide benefits beyond conventional treatment. Furthermore, improvements were observed in the motor and sensory nerve conduction velocities (MNCV and SNCV) of certain specific nerves, such as the common peroneal nerve, sural nerve, and ulnar nerve. Although the differences in MNCV and SNCV of the tibial and median nerves were not statistically significant, the overall improvement in clinical outcome supports the notion that Tuina is superior to conventional treatment.
The authors concluded that Chinese Tuina therapy is a safe and effective treatment option for DPN. It can alleviate clinical symptoms and improve the MNCV of the common peroneal nerve as well as the SNCV of the sural and ulnar nerves. Its efficacy in the tibial and median nerves remains unconfirmed, highlighting a need for future large-scale, high-quality RCTs.
There are several reasons why I cannot accept the conclusion that Tuina is effective for DPN, e.g:
- All the RCTs were of the notorious A+B vs B design that – as discussed ad nauseam on this blog – does not control for placebo effects and thus never generate negative results.
- None of the RCTs were single or double blind which means that expectation and therapist influence would have impacted on the findings.
- All of the studes originate from China; we have often discussed why such studies are notoriously unreliable. Funding for the review was supported by the National Key Research and Development Program of China and Jilin Provincial Natural Science Foundation Project.
- Most of the studies are published in journals and/or laguages that are not accessible to non-Chinese readers.
- None of these serious limitations are discussed by the review authors.
I REST MY CASE
It does not happen every day that the prestigeous German FRANKFURTER ALLGEMEINE ZEITUNG publishes an in-depth analysis of TCM (Traditional Chinese Medicine) and even discusses several of the themes that we, here on this blog, have often debated. Allow me, therefore, to translate a few passages from the recent FAZ article entitled “Der Fluch der alten Dinge” (The Curse of Old Things):
… TCM has countless followers in many countries. ‘TCM is a wonderful medicine that thinks ‘holistically’, that sees not just one organ but the whole person and that offers very good treatment options,’ says Dominik Irnich. He heads the German Medical Association for Acupuncture. Although there is not evidence for all indications, TCM is ‘a scientifically based option for a number of diseases, the effects of which have been proven many times over’…
Meanwhile, Beijing wants to utilise the positive image of TCM to present itself in a good light and promote exports. The current five-year plan also provides for the creation of around 20 TCM positions for epidemic prevention and control. Critics, on the other hand, see patients at risk due to insufficiently tested therapies – and medicine as a whole: many studies are hardly valid and distort the state of science…
The top leadership of the Chinese Communist Party is using the ‘old things’ to increase its global influence and utilise TCM not only in its own country, but also as an export hit. The global TCM market is estimated to be worth many billions of euros annually, but there are no reliable figures – not least because it often includes illegally traded products such as rhino horn or donkey skin, which has led to mass killings.
Officially, Beijing prosecutes illegal trade and promotes science-based medicine, but the interests are intertwined. Even under Mao, traditional methods were used in China as a favourable alternative to imported medicines, and Beijing is currently increasingly allowing them to be reimbursed. At the same time, China’s leadership is trying to anchor TCM products in healthcare worldwide, for example as part of a ‘health Silk Road’ in Africa. During the Covid-19 pandemic, the state not only used TCM products en masse in its own country, Chinese foreign representatives also distributed them to Chinese people in Europe. This included a product based on gypsum, apricot kernels and plant parts called Lianhua Qingwen. According to a report published by the consulate in Düsseldorf, this was distributed even though the sale of medicines outside of pharmacies is generally punishable by law.
Beijing has also been successful at the level of the World Health Organisation (WHO), which promotes traditional medicine from China. ‘This was part of the interests and election programme of former Chinese Director-General Margaret Chan,’ says WHO consultant Ilona Kickbusch. The WHO drew up standards for acupuncture training, including knowledge of the ‘function and interactive relationship of qi, blood, essence and fluid’, as the document states.
In 2019, the WHO member states decided to add a chapter on ‘traditional medicine’ to the standard classification of diseases. Doctors can now code alleged patterns of ‘qi stagnation’ or yang deficiency of the liver. The umbrella organisation of European science academies EASAC criticised this as a ‘significant problem’: doctors and patients could be misled and pressure could be exerted on healthcare providers to reimburse unscientific approaches. Nature magazine found: ‘The WHO’s association with drugs that have not been properly tested and could even be harmful is unacceptable for the organisation that has the greatest responsibility and power to protect human health.’ …
In general, the study situation on therapies that are categorised as TCM is extremely confusing. The evidence is ‘terrible’, says the physician Edzard Ernst, who has analysed such procedures. ‘There are thousands of studies – that’s part of the problem.’ Many studies come from China, but it is known that a large proportion are invalid or falsified. It is almost impossible to report critically on TCM there: according to media reports, a doctor was imprisoned for three months in 2018 after criticising a TCM remedy. In 2020, Beijing even considered banning criticism of TCM, but refrained from doing so after an outcry.
According to Ernst, the quality of even some of the meta-analyses from the respected Cochrane Collaboration is ‘hair-raising’ due to the inclusion of unreliable studies, and according to some Chinese researchers, acupuncture works for everything. Prof. Unschuld said at an event a year ago that he was asked in China not to address critical issues.
‘In a country without the open and free critical culture that is common in democratic countries, the control mechanisms are missing,’ says Jutta Hübner, Professor of Integrative Oncology at Jena University Hospital. The inclusion of Chinese studies, which almost never report negative results, can create a much too positive image of TCM at a formally very high level of scientific evidence, without the results being reliable…
Instead of allowing the research to be carried out by proponents, it would be desirable ‘if the universities in particular remembered that they have the duty to be critical,’ says physician Edzard Ernst. However, some university clinics prefer to advertise TCM methods in order to attract patients and money.
Whenever a journalist wants to discuss the subject of acupuncture with me, he or she will inevitably ask one question:
DOES ACUPUNCTURE WORK?
It seems a legitimate, obvious and simple question, particularly during ‘Acupuncture Awareness Week‘, and I have heard it hundreds of times. Why then do I hesitate to answer it?
Journalists – like most of us – would like a straight answer, like YES or NO. But straight answers are in short supply, particularly when we are talking about acupuncture.
Let me explain.
Acupuncture is part of ‘Traditional Chinese Medicine’ (TCM). It is said to re-balance the life forces that determine our health. As such it is seen as a panacea, a treatment for all ills. Therefore, the question, does it work?, ought to be more specific: does it work for pain, obesity, fatigue, hair-loss, addiction, anxiety, ADHA, depression, asthma, old age, etc.etc. As we are dealing with virtually thousands of ills, the question, does it work?, quickly explodes into thousands of more specific questions.
But that’s not all!
The question, does acupuncture work?, assumes that we are talking about one therapy. Yet, there are dozens of different acupuncture traditions and sites:
- body acupuncture,
- ear acupuncture,
- tongue acupuncture,
- scalp acupuncture,
- etc., etc.
Then there are dozens of different ways to stimulate acupuncture points:
- needle acupuncture,
- electroacupuncture,
- acupressure,
- moxibustion,
- ultrasound acupuncture,
- laser acupuncture,
- etc., etc.
And then there are, of course, different acupuncture ‘philosophies’ or cultures:
- TCM,
- ‘Western’ acupuncture,
- Korean acupuncture,
- Japanese acupuncture,
- etc., etc.
If we multiply these different options, we surely arrive at thousands of different variations of acupuncture being used for thousands of different conditions.
But this is still not all!
To answer the question, does it work?, we today have easily around 10 000 clinical trials. One might therefore think that, despite the mentioned complexity, we might find several conclusive answers for the more specific questions. But there are very significant obstacles that are in our way:
- most acupuncture trials are of lousy quality;
- most were conducted by lousy researchers who merely aim at showing that acupuncture works rather that testing whether it is effective;
- most originate from China and are published in Chinese which means that most of us cannot access them;
- they get nevertheless included in many of the systematic reviews that are currently being published without non-Chinese speakers ever being able to scrutinise them;
- TCM is a hugely important export article for China which means that political influence is abundant;
- several investigators have noted that virtually 100% of Chinese acupuncture trials report positive results regardless of the condition that is being targeted;
- it has been reported that about 80% of studies emerging from China are fabricated.
Now, I think you understand why I hesitate every time a journalist asks me:
DOES ACUPUNCTURE WORK?
Most journalists do not have the patience to listen to all the complexity this question evokes. Many do not have the intellectual capacity to comprehend an exhaustive reply. But all want to hear a simple and conclusive answer.
So, what do I say in this situation?
Usually, I respond that the answer would depend on who one asks. An acupuncturist is likely to say: YES, OF COURSE, IT DOES! An less biased expert might reply:
IT’S COMPLEX, BUT THE MOST RELIABLE EVIDENCE IS FAR FROM CONVINCING.
Dry needling is a therapy that is akin to acupuncture and trigger point therapy. It is claimed to be safe – but is this true?
Researchers from Ghent presented a series of 4 women aged 28 to 35 who were seen at the emergency department (ED) with post-dry needling pneumothorax between September 2022 and December 2023. None of the patients had any relevant medical history. All had been treated for a painful left shoulder, trapezius muscle or neck region in outpatient physiotherapist practices. At least three different physiotherapists were involved.
One patient presented to the ER on the same day as the dry needling procedure, the others presented the day after. All mentioned thoracic pain and dyspnoea. Clinical examination in all of these patients was unremarkable, as were their vital signs. Diagnosis was confirmed with ultrasound (US) and chest X-ray (CXR) in all patients. The latter exam showed left-sided apical pleural detachment with a median of 3.65 cm in expiration.
Two patients were managed conservatively. One patient (initial pneumothorax 2.5 cm) was discharged. The US two days later displayed a normally expanded lung. One patient with an initial apical size of 2.8 cm was admitted with 2 litres of oxygen through a nasal canula and discharged from the hospital the next day after US had shown no increase in size. Her control CXR 4 days later showed only minimal pleural detachment measuring 6 mm. The two other patients were treated with US guided needle aspiration. One patient with detachment initially being 4.5 cm showed decreased size of the pneumothorax immediately after aspiration. She was admitted to the respiratory medicine ward and discharged the next day. Control US and CXR after 1 week showed no more signs of pneumothorax. In the other patient, with detachment initially being 5.5 cm, needle aspiration resulted in complete deployment on US immediately after the procedure, but control CXR showed a totally collapsed lung 3 hours later. A small bore chest drain was placed but persistent air leakage was seen. Several trials of clamping the drain resulted in recurrent collapsing of the lung. After CT-scan had shown no structural deformities of the lung, suction was gradually reduced and the drain was successfully removed on the sixth day after placement. The patient was then discharged home. Control CXR 3 weeks later was normal.
The authors concluded that post-dry needling pneumothorax is, contrary to numbers cited in literature, not extremely rare. With rising popularity of the technique we expect complications to occur more often. Patients and referring doctors should be aware of this. In their informed consent practitioners should mention pneumothorax as a considerable risk of dry needling procedures in the neck, shoulder or chest region.
The crucial question, in my view, is this: do the risks of dry-needling out weigh the risks of this form of therapy? Let’s have a look at some of the recent evidence that we discussed on this blog:
- Spinal Manipulation and Electrical Dry Needling for Subacromial Pain Syndrome: A Nonsensical Trial
- Dry needling is useless for rehabilitation after shoulder surgery
- High velocity, low amplitude techniques are not superior to no treatment in the management of tension-type headache
- Which treatments are best for acute and subacute mechanical non-specific low back pain? A systematic review with network meta-analysis
- Acupuncture for chronic pain: the new NICE guideline
- Acupuncture for the Relief of Chronic Pain? A new, thorough synthesis fails to produce strong evidence that acupuncture works
The evidence is clearly mixed and unconvincing. I am not sure whether it is strong enough to afford a positive risk/benefit balance. In other words: dry needling is a therapy that might best be avoided.
After the nationwide huha created by the BBC’s promotion of auriculotherapy and AcuSeeds, it comes as a surprise to learn that, in Kent (UK), the NHS seems to advocate and provide this form of quackery. Here is the text of the patient leaflet:
Kent Community Health, NHS Foundation Trust
Auriculotherapy
This section provides information to patients who might benefit from auriculotherapy, to complement their acupuncture treatment, as part of their chronic pain management plan.
What is auriculotherapy?
In traditional Chinese medicine, the ear is seen as a microsystem representing the entire body. Auricular acupuncture focuses on ear points that may help a wide variety of conditions including pain. Acupuncture points on the ear are stimulated with fine needles or with earseeds and massage (acupressure).
How does it work?
Recent research has shown that auriculotherapy stimulates the release of natural endorphins, the body’s own feel good chemicals, which may help some patients as part of their chronic pain management plan.
What are earseeds?
Earseeds are traditionally small seeds from the Vaccaria plant, but they can also be made from different types of metal or ceramic. Vaccaria earseeds are held in place over auricular points by a small piece of adhesive tape, or plaster. Applying these small and barely noticeable earseeds between acupuncture treatments allows for patient massage of the auricular points. Earseeds may be left in place for up to a week.
Who can use earseeds?
Earseeds are sometimes used by our Chronic Pain Service to prolong the effects of standard acupuncture treatments and may help some patients to self manage their chronic pain.
How can I get the most out my treatment with earseeds?
It is recommended that the earseeds are massaged two to three times a day or when symptoms occur by applying gentle pressure to the earseeds and massaging in small circles.
Will using earseeds cure my chronic pain?
As with any treatment, earseeds are not a cure but they can reduce pain levels for some patients as part of their chronic pain management programme.
________________________
What the authors of the leaflet forgot to tell the reader is this:
- Auriculotherapy is based on ideas that fly in the face of science.
- The evidence that auriculotherapy works is flimsy, to say the least.
- The evidence earseeds work is even worse.
- To arrive at a positive recommendation, the NHS had to heavily indulge in the pseudo-scientific art of cherry-picking.
- The positive experience that some patients report is due to a placebo response.
- For whichever condition auriculotherapy is used, there are treatments that are much more adequate.
- Advocating auriculotherapy is therefore not in the best interest of the patient.
- Arguably, it is unethical.
- Definitely, it is not what the NHS should be doing.
Dragons’ Den is a British reality television business programme, presented by Evan Davis and based upon the original Japanese series. The show allows several entrepreneurs an opportunity to present their varying business ideas to a panel of five wealthy investors, the “Dragons” of the show’s title, and pitch for financial investment while offering a stake of the company in return.
It has been reported that Giselle Boxer began selling needle-free acupuncture kits for ears after being diagnosed with myalgic encephalomyelitis (ME). She said the technique had helped improve her own health. Ms Boxer worked for advertising agency before starting her business. A researcher on the show had contacted her to ask if she would like to take part.
Entrepreneur and former footballer Gary Neville was so impressed with her pitch he made her an offer in full before the Dragons had a chance to begin asking questions. She said the impact on the business since the show aired had been “bonkers”. “It’s just been a complete whirlwind,” she said.
The tiny beads are a needle-free form of auriculotherapy, designed to stimulate specific points of the ear to address physical and emotional health concerns. “It completely transformed my life alongside lots and lots of other things like diet, lifestyle changes, meditation, breathwork and movement,” said Ms Boxer. She has since had a child and claimed she was fully healed within a year. “It was like a full overhaul of my life,” Ms Boxer said. Her business, Acu Seeds, sells kits for people to use at home and made a £64,000 profit in its first year, she added.
On the Acu Seed website, we learn the following:
Ear seeds are a form of auriculotherapy, which is the stimulation of specific points of the ear to support physical and emotional health concerns. They are a needle-free form of acupuncture that have been used in Traditional Chinese Medicine (TCM) for thousands of years. TCM teaches that the ear is a microsystem of the whole body, where certain points on the ear correspond to different organs or body parts. Energy pathways (or ‘qi’ or vital life energy) pass through the ear and ear seeds stimulate specific points which send an abundant flow of energy to the related organ or area that needs attention. Think of it like reflexology, but for the ears instead of feet.
Ear seeds also create continual, gentle pressure on nerve impulses in the ear which send messages to the brain that certain organs or systems need support. The brain will then send signals and chemicals to the rest of the body to support whatever ailments you’re experiencing, releasing endorphins into the bloodstream, relaxing the nervous system, and naturally soothing pain and discomfort. Some people use ear seeds alongside acupuncture treatments as they may help the effects of acupuncture last longer between sessions.
I am impressed by the lingo used here:
- support physical and emotional health concerns – the seeds support the concerns but not the health?
- a needle-free form of acupuncture – sorry, the seeds don’t puncture anything; they exert pressure; therefore it’s called acuPRESSURE.
- have been used in Traditional Chinese Medicine (TCM) for thousands of years – no, it was invented just a few decades ago by Paul Nogier.
- TCM teaches that the ear is a microsystem of the whole body – TCM teaches plenty of nonsense but not this one.
- Energy pathways (or ‘qi’ or vital life energy) pass through the ear –Qi is nothing more than a figment of the imagination of TCM advocates.
- send an abundant flow of energy to the related organ or area – only if you believe in your own fictional form of physiology.
- Think of it like reflexology – which btw is also nonsense.
- nerve impulses in the ear send messages to the brain that certain organs or systems need support – only if you believe in your own fictional form of physiology.
- The brain will then send signals and chemicals to the rest of the body – only if you believe in your own fictional form of physiology.
- help the effects of acupuncture last longer – help the non-existing effects of acupuncture last longer?
One the website, we also learn what for which conditions the treatment is effective:
Ear seeds may support a broad spectrum of health concerns including anxiety, stress, headaches, digestion, immunity, focus, sleep and fatigue. Our ear seed kits include the protocol ear maps for these eight health concerns and each protocol uses between 3 to 5 ear seeds. Ear seeds have also been found to support with women’s health issues like menstrual issues, libido, fertility, postpartum issues, inflammation, menopause and weight loss. The ear maps for these issues are given in our women’s health ear seed kit bundles. The specific combination of seed placements will support your chosen health concern. Further issues that they may support with are addiction, pain, tinnitus, vertigo, thyroid health and more.
Here, I am afraid, we might have a major problem:
THERE IS NO GOOD EVIDENCE TO SUPPORT ANY OF THESE CLAIMS!
I thus do wonder whether the venture of Giselle Boxer might be a case for the Advertising Standards Authority.
This study evaluated the effect of ear acupressure (auriculotherapy) on the weight-gaining pattern of overweight women during pregnancy. It was a single-blinded randomized clinical trial conducted between January and September 2022 and took place in health centers of Qom University of Medical Sciences in Iran.
One-hundred thirty overweight pregnant women were selected by a purposeful sampling method and then divided into two groups by block randomization method. In the intervention group, two seeds were placed in the left ear on the metabolism and stomach points, while two seeds were placed in the right ear on the mouth and appetite points. Participants in the intervention group were instructed to press the seeds six times a day, 20 minutes before a meal for five weeks. For the placebo group, the Vaccaria seedless label was placed at the same points as the intervention group.
A digital scale with an accuracy of 0.1 kg was used to weigh the pregnant women during each visit. Descriptive statistics, independent T-test, chi-square, and repeated measure ANOVA (analysis of variance) test were used to check the research objectives.
There was a statistically significant difference between the auriculotherapy and placebo groups immediately after completing the study (1120.68 ± 425.83 vs. 2704.09 ± 344.96 (g); = 0.018), respectively. Also, there was a substantial difference in the weight gain of women two weeks (793.10 ± 278.38 vs. 1090.32 ± 330.31 (g); < 0.001) and four weeks after the intervention (729.31 ± 241.52 vs. 964.51 ± 348.35 (g); < 0.001) between the auriculotherapy and placebo groups.
The authors concluded that the results of the present study indicated the effectiveness of auriculotherapy in controlling the weight gain of overweight pregnant women. This treatment could be used as a safe method, with easy access, and low cost in low-risk pregnancies.
In order to understand these findings, it is worth reading the methods section of the paper. It explains what actually happened with the two groups:
After providing explanations to familiarize the participants with the working method and answering their questions, the participants were requested to be comfortable. The first author who has an auriculotherapy certificate did the intervention. The intervention began by disinfecting both ears with a 70% alcohol solution. After determining the location of metabolism and stomach points in the left ear and mouth and appetite points in the right ear related to weight and appetite control, the researcher placed the seeds on the desired points… The intervention lasted for a total of 5 weeks. The seeds were changed twice a week (once every three days) by the researcher. The participants in the intervention group were taught to press the seeds 6 times a day for one minute each time. The pressure method was to use moderate stimulation with continuous pressure. In the first session, the researcher fully taught the participants the amount of pressure and the duration of it in a practical way and asked them to do this once in her presence to ensure that it was correct. Participants were recommended to do this preferably 20 minutes before eating. The researcher reminded the participants in the intervention group of their daily interventions by phone or text message. Each night, they were asked to check if they had followed the instructions and completed the daily registration checklist. In each seed replacement session, which was performed every three days, the checklist of the previous session was viewed and checked, and a checklist was received every week at the same time as the participants were weighed. Subjects were also emphasized in case of any symptoms of allergies or infections and pain as soon as possible through the contact number provided to them to discuss the issue with the researcher to remove the seeds.
In the placebo group, instead of real seeds, a label without Vaccaria seed (waterproof fabric adhesive) was placed by the researcher at the desired points in both ears, and the participants did not receive training to compress the points. They also did not receive the list of daily pressing points. All follow-ups and replacement of labels were performed in the same way as the intervention group in the placebo group. Finally, all participants were requested to notify the researcher if any seeds or labels were removed for any reason. It should be noted that pregnant mothers were unaware of the nature of the group to which they belonged.
It seems clear, therefore, that the patients were NOT blinded and that the verum patients received different care and more attention/encouragement than the placebo group. This means firstly that the trial was NOT single-blind, as the authors claim. Secondly, it means that the outcomes were most likely NOT due to ear acupressure at all – they were caused by the non-specific effects of expectation, extra attention, etc. which, in turn, motivated the women to better control their weight. Consequently, the conclusions of this study should be re-phrased:
The results of the present study fail to indicate the effectiveness of auriculotherapy in controlling the weight gain of overweight pregnant women.
In addition, I feel that the researchers, supervisors, peer-reviewers, editors should all bow their heads in shame for trying to mislead us.
My ‘ALTERNATIVE MEDICINE HALL OF FAME‘ (the group of people who have managed to publish nothing but positive findings about a dubious therapy) currently consists of 20 members (unless I have forgotten somone, which is possible, of course):
- Jorge Vas (acupuncture, Spain)
- Wane Jonas (homeopathy, US)
- Harald Walach (various SCAMs, Germany)
- Andreas Michalsen ( various SCAMs, Germany)
- Jennifer Jacobs (homeopath, US)
- Jenise Pellow (homeopath, South Africa)
- Adrian White (acupuncturist, UK)
- Michael Frass (homeopath, Austria)
- Jens Behnke (research officer, Germany)
- John Weeks (editor of JCAM, US)
- Deepak Chopra (entrepreneur, US)
- Cheryl Hawk (US chiropractor)
- David Peters (osteopathy, homeopathy, UK)
- Nicola Robinson (TCM, UK)
- Peter Fisher (homeopathy, UK)
- Simon Mills (herbal medicine, UK)
- Gustav Dobos (various SCAMs, Germany)
- Claudia Witt (homeopathy, Germany/Switzerland)
- George Lewith (acupuncture, UK)
- John Licciardone (osteopathy, US)
Today, it is time to add the 21st member. My last post was about a weird study co-authored by someone who struck me as truly remarkable. Terry Oleson is employed by the Department of Traditional Oriental Medicine, Emperor’s College of Traditional Oriental Medicine, Santa Monica, CA, USA. On ‘research gate‘, he describes his expertise as follows:
- Cognitive Psychology
- Clinical Psychology
- Biological Psychology
- Clinical Trials
- Addiction Medicine
- Allied Health Science
Oleson received his BA in Biology from the University of California, Santa Barbara, in 1967, his MA in Psychology from California State University at Long Beach in 1971, and his PhD from UC Irvine in 1973. He went on to conduct a postdoctoral scholarship at UCLA at that time, where he conducted pioneering research in auricular diagnosis and auriculotherapy. Since many years, Oleson has published on auricular acupuncture and acupressure, at least one book and the papers listed below. This is an oddly dubious and biologically implausible so-called alternative medicine (SCAM). Terry Oleson – whom I never knowingly met in person – and his research are all the more remarkable: in his hands auricular therapy seems to work of just about everything:
- Effect of auricular acupressure on postpartum blues: A randomized sham controlled trial. Complement Ther Clin Pract. 2023 Aug;52:101762. doi: 10.1016/j.ctcp.2023.101762. Epub 2023 Apr 10.PMID: 37060791
- Auriculotherapy stimulation for neuro-rehabilitation. NeuroRehabilitation. 2002;17(1):49-62.PMID: 12016347
- Acupuncture: the search for biologic evidence with functional magnetic resonance imaging and positron emission tomography techniques. J Altern Complement Med. 2002 Aug;8(4):399-401. doi: 10.1089/107555302760253577.PMID: 12230898
- Commentary on auricular acupuncture for cocaine abuse. J Altern Complement Med. 2002 Apr;8(2):123-5. doi: 10.1089/107555302317371406.PMID: 12013511
- Clinical Commentary on an Auricular Marker Associated with COVID-19. Med Acupunct. 2020 Aug 1;32(4):176-177. doi: 10.1089/acu.2020.29152.com. Epub 2020 Aug 13.PMID: 32913483
- Comparison of Auricular Therapy with Sham in Children with Attention Deficit/Hyperactivity Disorder: A Randomized Controlled Trial. J Altern Complement Med. 2020 Jun;26(6):515-520. doi: 10.1089/acm.2019.0477. Epub 2020 May 20.PMID: 32434376
- Application of Polyvagal Theory to Auricular Acupuncture.Oleson T.Med Acupunct. 2018 Jun 1;30(3):123-125. doi: 10.1089/acu.2018.29085.tol.PMID: 29937963
- The effect of ear acupressure (auriculotherapy) on sexual function of lactating women: protocol of a randomized sham controlled trial. Trials. 2020 Aug 20;21(1):729. doi: 10.1186/s13063-020-04663-x.PMID: 32819441
- Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology. Obstet Gynecol. 1993 Dec;82(6):906-11.PMID: 8233263
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Auricular electrical stimulation and dental pain threshold. Anesth Prog. 1993;40(1):14-9.PMID: 8185085
- Rapid narcotic detoxification in chronic pain patients treated with auricular electroacupuncture and naloxone. Int J Addict. 1985 Sep;20(9):1347-60. doi: 10.3109/10826088509047771.PMID: 2867052
- Investigation of the effects of naloxone upon acupuncture analgesia. Pain. 1984 Jun;19(2):201-4. doi: 10.1016/0304-3959(84)90872-8.PMID: 6462730
- Electroacupuncture & auricular electrial stimulation. IEEE Eng Med Biol Mag. 1983;2(4):22-6. doi: 10.1109/MEMB.1983.5005987.PMID: 19493718
- An experimental evaluation of auricular diagnosis: the somatotopic mapping or musculoskeletal pain at ear acupuncture points. Pain. 1980 Apr;8(2):217-229. doi: 10.1016/0304-3959(88)90009-7.PMID: 7402685
14 papers about a dodgy SCAM without the hint of a negative finding! I hope we can all agree that this achievement makes Terry a worthy member of my ‘HALL OF FAME’, a group of people who, like Terry, have been able to publish nothing but positive findings about the most dubious SCAMs.
Welcome Terry!
