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Acupuncture
Posted: 02 June 2013 08:32 AM   [ Ignore ]
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I found an excellent article blasting acupuncture, which calls it a “theatrical procedure.”  


David Colquhoun, Ph.D. and Steven Novella, M.D., have coauthored a hard-hitting article which concludes that that acupuncture is worthless for pain relief. [Colquhoun D, Novella S. Acupuncture is theatrical placebo. Anesthesia & Analgesia 116:1360-1363, 2013] Their report concludes that “the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance.” The full text of the article can be downloaded from the journal Web site.http://www.anesthesia-analgesia.org/content/116/6/1360.full.pdf. However, a version on Colquhoun’s blog contains links to dozens of supportive documents. http://www.dcscience.net/?p=6060. 

http://www.quackwatch.org/00AboutQuackwatch/chd.html

Quackwatch is an excellent source of information about alternativevmedicine claims.

Dr. Novella is the host of The Skeptics Guide to the Universe, a weekly podcast that can be accessed from ITunes or from their website: http://theskepticsguide.org/

For those not familiar with the podcast, it is a lively discussion of “myths, conspiracy theories, pseudoscience, the paranormal, and many general forms of woo-woo, from the point of view of scientific skepticism. The show also features discussions of recent scientific developments in layman’s terms, and interviews authors, people in the area of science and other famous skeptics. The host of the show [Dr. Novella] has been particularly active in debunking pseudoscience in medicine. His recent activities include opposing the claims of anti-vaccine activists, homeopathy practitioners and individuals denying the link between HIV and AIDS.” http://en.wikipedia.org/wiki/The_Skeptics’_Guide_to_the_Universe

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Posted: 02 June 2013 09:23 AM   [ Ignore ]   [ # 1 ]
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SGU has long been one of my favorite podcasts. Dr. Novella has done an excellent job exposing acupuncture as nothing more than a placebo, and a sometimes dangerous one at that.

Edit: corrected an autocorrect typo.

[ Edited: 02 June 2013 01:01 PM by DarronS ]
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Posted: 02 June 2013 12:52 PM   [ Ignore ]   [ # 2 ]
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There is a commercial (unconsciously, to be sure) demonstrating that. It is of a woman on the table and a man commenting on the needles, then saying that he is not the acupuncturist, as a man walks in eating a sandwich… I howled, but I don’t think many people will pick up on the joke. I can’t remember what the commercial was actually advertising though.

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Posted: 02 June 2013 12:57 PM   [ Ignore ]   [ # 3 ]
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asanta - 02 June 2013 12:52 PM

There is a commercial (unconsciously, to be sure) demonstrating that. It is of a woman on the table and a man commenting on the needles, then saying that he is not the acupuncturist, as a man walks in eating a sandwich… I howled, but I don’t think many people will pick up on the joke. I can’t remember what the commercial was actually advertising though.

Probably Geico! smile

Lois

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Posted: 02 June 2013 12:59 PM   [ Ignore ]   [ # 4 ]
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DarronS - 02 June 2013 09:23 AM

SGU has long been one of my favorite podcasts. Dr. Novella has done an excellent job exposing acupuncture as nothing rode than a placebo, and a sometimes dangerous one at that.

Not only acupuncture, but most “alternative medicine” claims.

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Posted: 02 June 2013 04:07 PM   [ Ignore ]   [ # 5 ]
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asanta - 02 June 2013 12:52 PM

There is a commercial (unconsciously, to be sure) demonstrating that. It is of a woman on the table and a man commenting on the needles, then saying that he is not the acupuncturist, as a man walks in eating a sandwich… I howled, but I don’t think many people will pick up on the joke. I can’t remember what the commercial was actually advertising though.

If memory serves, that is for a Holiday Inn Express commercial.

They also have one for some guy writing on a chalk board and in walks a professor-looking guy straight out of Independence Day who says wonderously that the guy solved some equation. The acupuncture commercial isn’t as impressive when paired with it’s companion commercial.

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Posted: 02 June 2013 04:24 PM   [ Ignore ]   [ # 6 ]
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DarronS - 02 June 2013 09:23 AM

SGU has long been one of my favorite podcasts. Dr. Novella has done an excellent job exposing acupuncture as nothing more than a placebo, and a sometimes dangerous one at that.

Edit: corrected an autocorrect typo.

I am quoting MacGyver from another thread: “...Acupuncture studies have often shown similar results when sham acupuncture is compared to treatments given by “trained ” acupuncturists. Its often just the touch that is important rather than the actual specifics of how it is done…”

(He was responding to a study that I cited that showed some evidence of efficacy for massage done in a certain way on preemies.) But his statement infers that there exists some studies supporting something that is done in the use of accupuncture by “trained ” accupuncturists.

Point being, it is easy to discredit an entire field of alternative medicine, and indeed easy to discredit ALL of the fields of alternative medicine, because there is so much done that is pure quackery.  My metaphorical question is should assume that with all of the bath water that we throw out, that there is never a baby going with it?

I think that if we automatically were able to discredit all of accupuncture, we would do a service to all who might be harmed or ripped off by it.  But I think that we should take care not to discourage further legitimate research in the process.  Even if it is shown that accupuncture has no positive effects other than placebo, wouldn’t it be nice to know the exact mechanism of the placebo so that that knowledge could be used? 

I think that the biggest problem is that there is not near enough unbiased research done in the various fields of alternative medicine.

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Posted: 02 June 2013 05:09 PM   [ Ignore ]   [ # 7 ]
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TimB - 02 June 2013 04:24 PM

I think that the biggest problem is that there is not near enough unbiased research done in the various fields of alternative medicine.

There is plenty of unbiased research on alternative medicine. Google is your friend. Start with searching on “steven novella acupuncture” and you’ll get a good overview of the last few years’ research. The biggest problem is Congress passed a law in the 1990s (I believe) limiting the Fed’s power to regulate alternative medicine.

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Posted: 02 June 2013 09:05 PM   [ Ignore ]   [ # 8 ]
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DarronS - 02 June 2013 05:09 PM
TimB - 02 June 2013 04:24 PM

I think that the biggest problem is that there is not near enough unbiased research done in the various fields of alternative medicine.

There is plenty of unbiased research on alternative medicine. Google is your friend. Start with searching on “steven novella acupuncture” and you’ll get a good overview of the last few years’ research…

I googled “steven novella acupuncture” and looked at he 1st two involving meta-analyses.  In both cases, the meta-analyses research authors concluded a positive effect from acupuncture compared to no-treatment.  One of the studies showed a slight positive difference between accupuncture and the blind control of sham accupuncture.  The other study showed no difference between accupuncture and sham accupuncture.

The folks that actually did the research interpreted the results, basically, as accupuncture works but by nonspecific means and further research is indicated.

Novella’s take was that the researcher’s conclusions were bunk and that the studies actually mean that accupuncture does not work and should not be used and that no further research should be done.

This is the first accupunture research results that I have looked at, but my take is that it suggests that accupuncture has an effect but that the effect is that of a placebo.

My take on Novella’s take is that he is proficient at pointing out biases that may be in play in the interpretation by others of research they have conducted.

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Posted: 02 June 2013 09:37 PM   [ Ignore ]   [ # 9 ]
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Look, I have no investment in whether accupuncture works or doesn’t or if it works, but only as a placebo.  (I don’t know anyone who has ever had it or anyone who practices it. I have little interest in the subject. So I don’t think I am biased about it.) Still, IMO, critical thinking involves examining our own possible biases, not just those of others. Also, I am mindful of Sagan’s Baloney Detection rule #3: “Arguments from authority carry little weight—“authorities” have made mistakes in the past.  They will do so again in the future. Perhaps a better way to say it is that in science there are no authorities; at most, there are experts.”

So is an expert who makes part of their living identifying quackery, and has invested a significant portion of their lives identifying quackery, going to be biased towards finding quackery?  Maybe.

So if we really want to be extra-good critical thinkers, it seems to me that we should look at the research ourselves and determine what we think it means.

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Posted: 03 June 2013 04:50 AM   [ Ignore ]   [ # 10 ]
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TimB - 02 June 2013 09:37 PM

Look, I have no investment in whether accupuncture works or doesn’t or if it works, but only as a placebo.  (I don’t know anyone who has ever had it or anyone who practices it. I have little interest in the subject. So I don’t think I am biased about it.) Still, IMO, critical thinking involves examining our own possible biases, not just those of others. Also, I am mindful of Sagan’s Baloney Detection rule #3: “Arguments from authority carry little weight—“authorities” have made mistakes in the past.  They will do so again in the future. Perhaps a better way to say it is that in science there are no authorities; at most, there are experts.”

So is an expert who makes part of their living identifying quackery, and has invested a significant portion of their lives identifying quackery, going to be biased towards finding quackery?  Maybe.

So if we really want to be extra-good critical thinkers, it seems to me that we should look at the research ourselves and determine what we think it means.

Bravo Tim.  Bravo!  Like you I have no interest in either types of medicine. I think your “bathwater” argument is relevant.
I also think there is too much knee-jerk reaction on this debate.
Obviously, like you said there are vast amounts of quackery and shams.
My interest in this debate stems purely from economic/political angles.  What kind of hold does large corporate or professional interests have over the
dissemination and execution of healthcare. It could be that all CAMs are fake, I just want to be sure that the standards are fair and equitable.
My other point in this long debate is the standard of the patient.  What makes that person feel comforted or soothed? Surely this is relevant and requires further
investigation. Maybe it could be shown that some of the CAMs are better suited in a Cost/Benefit analysis than more expensive traditional, clinical treatments are.
Afterall we know our current healthcare system is a wreck…with or without CAM.
How much AMA or Big Pharma treatments are being given out now that are a waste of resources and wholly unnecessary?  Studies and articles say lots.
That’s all. Maybe CAM isn’t a solution..it probably isn’t. But I recoil when I see the defenders of Industrialized medicine knee-jerk against alternatives.
Seeking alternatives-whether CAM or not, is one thing our healthcare system is in big need for!  It’s not a time for closed minds.

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Posted: 03 June 2013 08:21 AM   [ Ignore ]   [ # 11 ]
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Interesting thought:

Is there value in the placebo effect if it helps someone?

For example, I will outline a a couple of my practices that could very well be “worthless”:

1). Lavender—it supposedly helps with anxiety (like taking a mild dose of xanax). I spray my pillow and office with it to “relax.”

2). Reflexology—i have a handful of smooth rocks I picked up on the beach and keep them under my desk and massage (by rubbing my bare feet on) while working at home

Both of the above are not approved by the medical community, to my knowledge. They very well may have no real value to me other than my mind (the placebo effect).

So for some, maybe it is possible that acupuncture relieves pain. It’s just a different modality than traditional pain-killers (and probably healthier); of course, the disclaimer is that no one should omit official medical treatments or consultations by an MD and to still keep up with all appointments and checkups smile

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Posted: 03 June 2013 04:37 PM   [ Ignore ]   [ # 12 ]
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Acupuncture can have very real negative results. Most Accupuncturists don’t wear gloves when piercing the skin. I would lose my job were I to have such poor technique. Not sure if the put alcohol on the skin to clean it before placing the needle, but that could be the source of infection, which IS a complication. So are pneumothoraxes from the needle piercing the lung, which doesn’t take much if you are a thin person.

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Posted: 03 June 2013 05:39 PM   [ Ignore ]   [ # 13 ]
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TimB,

I certainly encourage everyone to evaluate the evidence for themselves. But there is a problem in that most people aren’t trained to do so (not saying you, since I have no idea). If a study is published and the abstract says “Acupuncture worked,” most people will stop there and accept the conclusion. At best, they may find both positive and negative studies and say “There’s a controversy and we don’t know yet if it works.” However, this would be the result of a cursory search of the literature for every therapy out there, from homeopathy and prayer at one end of the quackery scale to perfectly mainstream therapies at the other. Critical appraisal of the literature according to the principles and techniques of evidence-based medicine requires training. Heck, I’m spending 3 years completing a master’s degree in epidemiology primarily so I can understand the strengths and weaknesses of research studies in terms of their specific design, execution, and statistical analysis.


So when you characterize Dr. Novella’s analysis as “proficient at pointing out biases that may be in play in the interpretation by others of research they have conducted,” you are essentially correct, but you seem to be interpreting that as a form of bias or blind negativity rather than as a specific skill set and knowledge base necessary for interpreting the scientific literature. It’s not that Dr. Novella doesn’t have biases, of course. We all do. However, the purpose of controlled research is to compensate for very specific biases (e.g. selection bias, recall bias, regression to the mean, Hawthorne Effect, etc. ad nauseum) with specific methodological tools (e.g. randomization, prospective design, control groups, etc). Bias is always present, it’s simply a question of evaluating how effectively a specific study, or a body of literature, controls for it. The general public can rarely appreciate the complexities of this, and in my experience neither can most clinicians and even all researchers.

So we’re stuck either having to develop extensive expertise in every field we wish to evaluate for ourselves, or to decide whose expertise to rely on. This can, of course, lead to the argument from authority fallacy, but it isn’t identical. If we accept a claim solely on the basis of their authority as an expert, we are committing the fallacy. If we judge some sources of information as more credible than others on the basis of what we know about the expertise of the sources, then we are making sensible use of experts in lieu of trying to be experts in everything ourselves.  The reality is that Google University is a two-edges sword, and in my own limited areas of expertise I find it frequently very misleading to the public and my colleagues. So I do think a case can be made for trying filter the information by identifying the relative reliability of various sources. This does, of course, introduce another source of bias, but it seems better than the bias inherent in assuming we are all capable of independently evaluating the evidence in every possible field where there is a dispute.

As far as acupuncture goes, it is a particularly complex area because of the volume of studies, the intensity of the placebo effects it can generate, the difficulty in properly blinding clinical trials, and the tremendous heterogeneity in the quality of the literature. I have spent several years compiling and shaping my own understanding of the literature, and FWIW my conclusions are pretty close to Dr. Novella’s”

1. The traditional theories behind acupuncture (Ch’i, Yin/Yang, meridians, etc) are mystical nonsense.
2. The “scientific theories behind acupuncture (trigger points, endorphins, etc) are plausible but inconsistently and not convincingly demonstrated.
3. Sticking needles in people has measurable physiological effects
4. Sticking needles in people has a significant placebo effect (defined as a positive impact on the person’s perception of their symptoms WITHOUT any detectable improvement in objective measures of their health status that are not affected by belief and expectancy)
5. The same physiological and placebo effects can be generated by pretending to stick needles into people, poking them with toothpicks, banging their toe with a hammer, and lots of other mildly noxious stimuli.
6. There is no consistent, high-quality evidence that acupuncture has any meaningful impact on objective measures of health.
7. There is some evidence that it has small effects on subjective symptoms such as pain and nausea, but this effect is of questionable clinical relevance and only occasionally appears to be any greater in “real” acupuncture compared to “fake” acupuncture.
8. The risks are low but minor side effects are common and serious side effects, including death, are occasionally seen.

So overall, an enormously complex literature developed over many decades appears not to be able to demonstrate any consistent, meaningful benefits other than a strong placebo effect. Is this worth employing? Well, there are ethical questions about telling people something is effective just to get them to feel better through a placebo effect, but there might be situations in which it would be appropriate and worthwhile (not, however, in my field where the placebo effect works on the owners to a much greater extent than on the patients). Is this small benefit worth the small risk? How much of our finite healthcare resources does a therapy like this, and further research on it, deserve? I don’t think the problem is one of inadequate research. There is great variation in the quality of studies, but there is a correlation with quality and outcome such that higher quality, better controlled studies are less likely to show a positive effect. That strongly suggests there is no effect beyond placebo.

Anyway, I don’t discourage you from having your own opinions or disagreeing with authority figures. That’s a huge part of what CFI is about. I just thought my perspective might be useful given the time and energy I’ve sunk into this area.

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Posted: 03 June 2013 07:12 PM   [ Ignore ]   [ # 14 ]
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mckenzie,

Your perspective is appreciated, and as always, well stated.  As I indicated, I have little knowledge of or interest in acupuncture. But I am pleased to hear that there is not a dearth of research on the subject.  (I don’t think that is the case in all areas of alternative medicine.)

I stand by my inference that experts may, in some cases, be overly influenced by their own contingencies in interpreting their own and the research of others, and that we should thus be cautious when accepting what they present. As I indicated, I have no knowledge of Novella’s work other than looking at two of his posts on meta-analyses done by other researchers (that he chose to talk about).  Thus I refrained from specifically naming him as having such a bias, though I did infer such as a possibility.  If you, being knowledgeable of his work, support his assertions, then I consider that to be a strong point in his favor.

I also acknowledge your point that we do not all have the time or wherewithal (or, I would add, level of interest ) to be effectively knowledgeable about every subject.  And thus I agree that some level of reliance on experts is necessary.  Thus I should moderate the following statement that I made: “...it seems to me that we should look at the research ourselves and determine what we think it means.”  Rather, I would say that when relying on experts, we should remain cautious and alert for indications that the experts may have their own confounding contingencies that effect their interpretations.

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Posted: 04 June 2013 05:30 AM   [ Ignore ]   [ # 15 ]
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asanta - 03 June 2013 04:37 PM

Acupuncture can have very real negative results. Most Accupuncturists don’t wear gloves when piercing the skin. I would lose my job were I to have such poor technique. Not sure if the put alcohol on the skin to clean it before placing the needle, but that could be the source of infection, which IS a complication. So are pneumothoraxes from the needle piercing the lung, which doesn’t take much if you are a thin person.

Good point to consider. I’ve consider acupuncture as I’ve had massage therapy that was helpful. I would want to make sure the acupunturist was safe and sterile. I’ve watched youtube vids on it to see how it was done and come to think of it, the guy doing the demo was not wearing gloves. Hopefully the needles are sterile!

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