Subjecting prisoners to quackery

I’ve at times been asked where I come up with my blogging material. Since I’ve become fairly popular, one major source has been readers sending me stories. I often don’t have time to respond, and most of them don’t interest me enough to be motivated to write, but there are enough that do that I consider my readers to be a major source of material. Then there are medical and surgical journals, as well as sources like EurekaAlert! Then there are my numerous RSS feeds that I peruse on a daily or every-other-day basis in the evening or early in the morning. Then, of course, there are the various websites with–shall we say?–a pro-CAM orientation. It was from one of these that I found a story that appalled me almost as much as the infamous “battlefield acupuncture” stories I’ve come across recently. Now, instead of subjecting our best and bravest to pseudoscientific woo, now they’re subjecting another population that lives in conditions where they can easily be taken advantage of to placebo medicine:

Beyond the iron gate, the fence and the razor wire, 10 inmates in maroon uniforms sit in stillness, listening to the serene sounds of sitar music. Eyes closed, hands folded, they await the tiny pricks of acupuncture needles being inserted delicately in their ears.

Ancient Chinese medicine came to Baltimore’s jail 16 years ago with the promise of curbing the cravings of drug addiction. Since then, acupuncture has been the centerpiece of a treatment program that serves nearly 700 inmates each year.

Modern science has not found solid evidence that it works. Still, the inmates claim that with acupuncture, all they crave are the meditative moments it brings. They say it soothes them and helps clear their cluttered minds to find the strength to confront their addiction.

“I’ve done buprenorphine and methadone, but neither one of them could compare to those needles,” says Derrick Brooks, 42, who’s battled heroin his entire adult life. “Those needles put you in touch with stuff that’s within you that no pill or nothing else could do.”

Here we go again…

In the case of the Air Force, it’s a woo-friendly acupuncturist Air Force physician named Richard Niemtzow who wanted to bring acupuncture to the men and women under his command, evidence be damned, on the basis of a couple of very poorly done, unblinded studies and his “personal experience.” This time around, we have an acupuncturist and judge:

District Judge Jamey H. Hueston thinks every addict should try it. “I am a huge fan of acupuncture,” says Hueston, who presides over the city’s drug court. “I have sent people in there kicking and screaming, resentful and scowling at me. And later they say, ‘Judge, thank you.'”

Acupuncture is the key element of the Addicts Changing Together Substance Abuse Program administered by the city’s drug court. Beginning for women in 1993 and for men three years later, the program steers nonviolent offenders to a rigorous 45-day behind-bars regimen in lieu of a longer prison sentence.

Lovely. I wonder if the reason has anything to do with the acupuncture or more to do with the much nicer conditions that the prisoners can expect if they participate in the program:

In addition to 25 acupuncture sessions, inmates get group and individual counseling, GED training and life-skills classes. Recently, the program added a family mediation option for addicts who long ago burned family bridges but want to mend them.

Participants reside in a separate dorm at the Baltimore City Detention Center, away from the general population, and are encouraged to rely on each other for support.

Gee, you don’t think that all that training, life-skills coaching, and counseling, along with getting to live in a separate dorm away from all the other riff-raff living in the general prison population, have anything to do with it, do you? Naaahhh! Perish the thought! And it really coun’t possibly have to do with how the acupuncture recipient then gets to chill out and sit quietly for 30 to 40 minutes after a session with lights dimmed and soft music playing to promote relaxation and meditation? No way! Needles. It’s got to be the needles. And the woo. Don’t forget the woo, namely the qi. Oh, and the endorphins, the usual “science-y” blather that acupuncturists use to justify their woo:

Eastern medicine experts say what is at work is not just New Age wishful thinking.

The treatment causes the body to release feel-good chemicals called endorphins, which go to the same receptors in the brain that are turned on when someone takes drugs, says Dr. Lixing Lao, director of the traditional Chinese medicine program at the University of Maryland’s Center for Integrative Medicine.

The technique works to treat pain in the same way, says Lao, who works closely with Maryland Shock Trauma Center, treating patients who have been critically injured.

“The concept is very obvious,” he says. “If acupuncture works for pain, it should work for heroin addiction.”

Dr. Lao. Why did it have to be Dr. Lao?

We’ve met Dr. Lao before; he’s the woo-meister who’s brought reiki to one of the premiere trauma hospitals in the nation and has been spewing mystical nonsense about redirecting or unblocking the flow of a magical life energy that no scientist can detect in what should be a bastion of science- and evidence- based medicine. In fact, Dr. Lao is director of traditional Chinese medicine research at Maryland Shock Trauma, an oxymoron if ever I heard one.

But, hey, it’s cheap, and it must be working, right? Surely the City of Baltimore must have data on the outcomes of these inmates after they complete the program. Surely officials must know how many of them stay clean after they get out.

Uh, no, not quite:

The state Division of Correction does not track inmates after they complete the program and does not keep data on whether addicts stay clean. But Mohammad Riaz Ahmad, the program’s director, points to studies elsewhere that suggest acupuncture’s effectiveness. A Yale University study found that 55 percent of participants tested free of cocaine during the last week of acupuncture treatment, compared with 24 percent and 9 percent in two groups that did not have acupuncture. But a follow-up study contradicted the earlier findings, and researchers said the topic needs more research.

Let me get this straight. The City of Baltimore is paying a firm $40,000 a year to provide acupuncture and it has no idea if it’s doing any good helping imprisoned addicts beat their addiction? Way to go, Baltimore! As for the Yale study referenced, I couldn’t find the original one, but I did find what appears to be the followup study. It’s actually pretty good in that it uses a sham needling control in non-meridian locations and a relaxation alone control. True, that made it impossible to completely blind the study; so subjects were told that the study was comparing two kinds of acupuncture and relaxation to see which was better. Because it was a well-designed study, I bet you can guess what it found. At least you can if you’ve been reading this blog regularly.

Nothing. Nada. Zip. There was no difference between any of the groups. Also, a large meta-analysis done in 2005 found no effect due to auricular acupuncture on addiction treatment outcomes. True to form, the larger and more rigorously designed the study, the more likely it is to find no difference between placebo acupuncture and “true” acupuncture, and this study was no exception; but even worse, it didn’t even find a difference between acupuncture and relaxation therapy.

So why not chuck the acupuncture and stick with the relaxation therapy? Easy! Relaxation therapy is boring and so…conventional.

Basically what we have here are advocates basically subjecting prison inmates to quackery and lying to them by telling them it will help them beat their addictions. I know, I know, they’re not really lying because they truly believe that acupuncture helps. That doesn’t matter; they’re still cheerfully selling a lie to prisoners, and the City of Baltimore is being taken for a ride by true believers who spew confident claims:

“We are not saying it’s curing addiction – there is no cure for addiction,” says Dave Wurzel, a certified acupuncturist whose firm does the jail’s treatments. “Just like there is no cure for heart disease or diabetes. All we are doing in addiction treatment is lowering the risk factor that this person will die today of his or her addiction.”

Of course, as we’ve already seen, neither the Baltimore prison system, the city, nor Mr. Wurzel have a scintilla of evidence that acupuncture is doing anything of the sort.