Weekend mailbag: A most telling comment

Eric is a con man.

What Eric is doing is not patient care, it is just deception.
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augustine, honey, I know you’re angry that medical science couldn’t help you become a functioning, rational adult, but shouldn’t you be more angry at your mother for dropping you on your head, rather than the doctors who couldn’t cure the brain damage?

Every paragraph is partly true. And the result is wholely false.

In a few patients, the symptoms are purely psychosomatic and placebo faith-healing will work on them – for a while at least. And some real doctors recognise this and refer their fantasist patients to quacks.

Research is profit driven, occasionally researchers do fake results, and negative results suffer from the ‘file drawer effect’.

A few chinese herbs have the medicinal effects ascribed to them…and this ascription is sometimes very old, as though that mattered.

And all this adds up to…what we all knew already. Placebo sometimes works and research is rarely pure. Eric seems to think these commonplaces somehow overturn ‘western’ medicine.

Jillian, you know that acupuncture is a placebo – something that doesn’t actually work – but you think it’s okay to encourage people to waste their money on it?

Maybe the primary value in acupuncture is just getting a person in a room with a care provider who listens to their problems; giving him or her a little gentle, caring physical contact; leaving him to lie in a quiet room for a few minutes, alone; sending him off into the world with a reassurance that he will feel better.

It sounds to me like you want a therapist instead. Why bother with the needles?

That’s often all that conventional medicine can offer, anyway.

I sincerely hope that you never get cancer. I’d be worried that you’d skip seeing a doctor for it because, for whatever reason, you fail to understand or appreciate the science that will help you live longer and better.

In the comment quoted, Eric also builds a huge strawman when he talks about “the belief that Western Medicine has pure scientific roots that back up every treatment”. Nobody said the scientific method was fool-proof, but the great thing about it is that it’s self-correcting.

Invoking the physiology of the placebo effect pharmacologically is what I want to do with my NO producing bacteria.

http://daedalus2u.blogspot.com/2007/04/placebo-and-nocebo-effects.html

Once you can invoke the physiology of the placebo effect pharmacologically, you can maximally invoke it. Once the physiology of the placebo effect is maximally invoked and “saturates”, then there is no more placebo effect to invoke via the props of needles, magic water, magic waving hands, magic words, magic herbs and unnecessary antibiotics.

My hope is that CAM will then slowly wither as patients find it is more expensive and doesn’t work as well as my bacteria.

It’s easy enough to give the ol’ smackdown to these people on this blog, but what do you do when they show up at your house for an important meeting (totally unrelated to medicine or woo) and in the course of conversation, start blathering about all sorts of woo–complete with anecdotes galore and the observation that “medical schools are FINALLY beginning to include an awareness of the importance of spirituality in healing in the curriculum”? It is so difficult to even try to be polite and nod when you want to scream.

Also, why is it that woo posters so often don’t know the difference between your and you’re–and similar grammatical blunders? Because they’re stupid? Or maybe just ignorant? I’m not implying that everyone has to be a great speller to demonstrate intelligence, but these type of errors seem especially common amongst the wooies and other unschooled (in science anyway) posters.

Jillian, you can’t just redefine the word ‘placebo’. Stating “A placebo is something that DOES work — just maybe not for the reasons patients think” implies that it simply functions in a different way than we thought, which is not the case. If it is biologically active at all, it is by definition not a placebo. A placebo is inert, and will not affect your body in any way other than the half-calorie or so it imparts from being digested.

You ask what the harm is in letting people go to acupuncturists as long as everyone knows it’s not scientific. The problem is, there are lots of folks who fully believe in it despite all evidence of its uselessness. Furthermore, it’s tough to treat psychosomatic illnesses, as you suggest, if the patient knows the treatment is a sham.

http://whatstheharm.net/

On another note: thank you, Seb30, for calling out augustine’s (inexplicably capitalized) “American Medicine” remark. I was thinking the same thing. Another hint: America is not the oldest or only player when it comes to medical research.

I’m currently going through a serious bout of sciatica and I’m getting thoroughly sick of the number of people who are telling me I *need* to see an acupuncturist or chiropractor.

They say “Oh yes, you don’t ‘believe’ in that”. As if there was something wrong in asking for evidence beyond anecdotes.

Here is Canada, woo is alive, well, and spreading like an invasive species.

Eric’s claim that:

“…many patients coming to my office having exhausted “allopathic” cures find quick and lasting relief.”

reminded me of a conversation I had a few years ago with a physician who worked in the pain medicine clinic at a large midwestern university. He said that he often had patients ask about “alternative” therapies, especially acupuncture, and that his usual answer was “If you feel it will help you, go ahead and try them, just let me know what you are doing.”

His rationale was that pain research showed about a 30% “placebo response” (meaning that 30% of patients reported a reduction in pain with placebo) and while he didn’t feel that giving placebos to a patient was ethical, he wasn’t opposed to self-administered placebos, so long as they were “harmless” and didn’t interfere with what he was doing. In addition, his clinical time was limited – with a long waiting list – and his time was better used seeing new patients than trying to convince people that acupuncture is nonsense.

I disagreed, arguing that the money, time and effort spent pursuing useless placebo treatments was a “harm” in and of itself, but I could see his point about utilising his time to see new patients rather than engaging in futile arguments.

Another point that is often overlooked in the “alternative placebo therapy” discussion is that placebo therapies are often just as effective as “real” interventions for imaginary illnesses. People who are convinced that they have “subclinical hypothyroidism” (i.e. “hypothyroidism” in the face of absolutely normal T3, T4, TSH, TBG, free T3, free T4, TBI, etc) will do as well with a placebo as they will with thyroid hormone replacement (maybe better). In fact, a large proportion of the “worried well” would probably show as good (or bad) a response to placebo as they would to any pharmaceutical or surgical intervention.

I suppose it is only reasonable that imaginary illnesses can be treated with imaginary therapies.

Additionally, placebos are as effective as “real” drugs when there is no real treatment available. Treating Ebola with sugar pills (i.e. placebo or homeopathy – or is that redundant?) is probably just as effective as administering any of the available anti-viral drugs (none of which are known to be effective against Ebola).

However, when “alternative placebo therapies” are used in place of real therapies or palliative treatments, patients suffer needlessly. In addition, there are many documented cases of patients being harmed by the “alternative” therapies.

A 2001 liteature review by Yamashita et al in Complementary Therapies in Medicine – which can only be described as a “acupunture-friendly” journal – found 89 articles reporting acupuncture injuries between 1987 and 1999 covering 124 individual cases. Since these were all case reports, we can safely assume that this is just the “tip of the iceberg”.

Of these 124 cases, 25 were pneumothorax, 11 were hepatitis B and there were 18 cases of spinal cord injury. There were two fatalities from infection.

Before Eric – or someone like him – argues that this is only 124 serious injuries in 13 years, remember that these are only the published case reports – the total number of injuries (and deaths) is much greater.

Also, it could be (and probably will be) argued that “conventional” medicine has as many or more injuries and deaths on its account. However, “conventional” (“real”) medicine also has many, many more “saves” (illnesses cured, function restored, suffering alleviated, deaths prevented) in a single day than “alternative placebo therapies” can be legitmately credited with since the beginning of time.

Prometheus

I find this whole discussion, including the email, to be pretty amusing. I think it is a world of progress that discussions about acupuncture are no longer talking about efficacy, since everyone (legitimate, that is) is pretter much in agreement since there is nothing to it.

Instead, it is all about the question of the ethics of prescribing a placebo without telling the patient.

No pretense that acupuncture works, though

Pablo,

Acupuncture “works” in much the same sense that a glass of whiskey and lemon juice “works” when I have a cold – it can distract the sufferer from their symptoms long enough to let time cure the problem.

You are correct that the only question left – since even Eric admits that the efficacy is nil – is whether it is ethical to knowingly give a patient a placebo (outside of a study, where the patient knows that there is a chance of receiving a placebo).

And apart from the ethics of the matter, while we all accept that placebos can result in improvement of some symptoms, most people wouldn’t want their doctor to be giving them a placebo.

Prometheus

[Nobody said the scientific method was fool-proof, but the great thing about it is that it’s self-correcting.]

Before it “self corrects”, as you call it, what happens? Death and destruction in the name of science. Medical confidence requires amnesia.

Enough of this “Western medicine” stereotype!

I’m sure there is lots of good scientific medical research going on in China, Japan, Korea, Taiwan and loads of other places in the East.

Not all Asians are silly enough to think that tiger penis is the answer to everything.

Renee Najera @ 24 : Unfortunately people feed the trolls because Someone Is Wrong On The Internet.
Augie’s not even as good as a stopped clock, which is right twice a day. I originally thought he was some kind of “woo Poe” or something.

“Half of doctors prescribe placebos, survey shows”

That’s right American Medicine is also a sham.

Quite apart from the leap of illogic, there is a problem with the original formulation.

Mostly doctors prescribe placebos – because the patient insists on a pill of some sort. Rather than give them something expensive and dangerous or have them seek some inappropriate treatment, they give them something cheap and safe. Doctors are not prescribing them because they want to – far from it. They are most certainly not giving them a placebo in the hope it will work.

If more patients would accept that there is nothing to be done about some things, then less placebos would be required. It’s primarily a patient issue, not a doctor one.

Note that few doctors do think the placebo effect is worth it for it’s own sake – they just want to avoid the patient doing something bad. Only practitioners of woo think that the placebo effect is suitable as a treatment. Nor is it the only thing a real doctor does – again in contrast to woo.

@30 Uh, yeah, as if treating disease and writing code are analogous.

http://whatstheharm.net/acupuncture.html shows what the harm can be in having acupuncture done needlessly.

I feel sorry in some small way for acupuncturists, as persons who just blew a bundle and wasted many hours of their time learning something that isn’t true. Acupuncturists are in this way reduced to non-learning persons, at least for a large chunk of their lives, practicing something that on the surface and at it’s core looks patently foolish when closely examined.

But in the current milieu you can make a middle-class living as a mid-range practitioner without any pangs of guilt — doing acupuncture. If you honestly wanted to learn about Eastern culture you could have instead, for example, studied the Chinese language, and in about 10,000 hours of very hard work you would have skills that could be easily verified as real. But that would be a much more difficult path, and there are few jobs available on this basis. So why not fritter away your life pretending to study (and not pretending to be deceived by) a modern deception called acupuncture?

Your legacy is that you did nothing much in your vocational life and got paid fairly well to do nothing much. Not bad for this merest carnival act in the traveling circus called CAM.

Off topic, but I thought Orac would like to know (if he hasn’t seen already) that Dr. Mercola posted in the bastion of pseudoscience known as the Huffington Post about the “cholesterol myth.”

http://www.huffingtonpost.com/dr-mercola/the-cholesterol-myth-that_b_676817.html

He peddles the usual tropes: cholesterol is actually good for you because all cells need it, it is a poor indicator of heart health, inflammation is a much better indicator, he claims that doctors don’t understand the importance of inflammation with regards to heart health, cholesterol drugs have terrible side effects, and finally he gives advice on how to lower cholesterol naturally, in direct contrast to the fact that he spent several paragraphs explaining cholesterol is natural, important and does not need to be lowered.

Augustine, I will not derail this comments section by responding beyond this comment. If Orac tackles this topic, then I will gladly engage you.

Until we meet again, I leave with a parting shot…the website is quite entertaining. It is also total bunk.

Of oucrse would have to ignore the fact that statins are actually Japanese and therefore presumably ‘Eastern’ Medicine.

[Blue Devil: Until we meet again, I leave with a parting shot…the website is quite entertaining. It is also total bunk.]

As the website says:

“The great tragedy of Science-the slaying of a beautiful hypothesis by an ugly fact.”

[Antipodean: Of oucrse would have to ignore the fact that statins are actually Japanese and therefore presumably ‘Eastern’ Medicine.]

No matter the locale, statins are thoroughly “western” and mechanistically derived.

[Lil Ruru:and lo! the rot had set in, so to speak. I shut up clinic after 4 years of practice.]

As you should have. And you also should have refunded all the monies you defrauded of all your customers. But I doubt it. You’re honest about your scientific “conversion”. But you’re not that honest of a person.

[I stumbled upon this when I took up a biology paper out of interest. The section on the scientific method led to critical thinking and from there to sites like this and evcforum, etc, etc]

Question to all SBMers : Does critical thinking promote atheism?

Question to all SBMers : Does critical thinking promote atheism?

Critical thinking promotes honesty and mutual respect, because critical thinking means you get to double-check what I say, and vice-versa.

If I make a claim about God or something supernatural, you are allowed to ask for evidence so you can verify the claim for yourself.

Deism, agnosticism, atheism, and personal religious experience that isn’t elevated to a political imperative for others are defensible positions.

Titmouse, I think you’ve been mislead or confused on empiricism’s pro’s and cons. Anyway, the question is do you think critical thinking promotes atheism?

Every paragraph is partly true. And the result is wholely false.

Beautiful. Yep, couldn’t agree more.

Also, what is it with all the tu quoque from eric and augustine here? Yeesh.

And to Augustine — Sure, I’ll take the bait. Yeah, I think that “critical thinking promotes atheism” in the sense that I think if more people were better at critical thinking there would be more atheists. Which is not to say there aren’t plenty of religious people who are also excellent critical thinkers, but I think that there are vast swaths of people who only believe in WhateverTheyBelieve because they’ve never really thought very hard about it. Or anything. If you could give those people a Magical Critical Thinking Pill, a lot of them would realize, “Hey, all of my reasons for believing in Thor are stupid and trite. Screw it!” Some of them might still choose to retain unfalsifiable beliefs for specific personal reasons, of course.

Another weird bit of “reasoning” from woo-woos is their accusing “western medicine” of having its occasional mistakes and con-men, as if that somehow calls into question the whole enterprise. By that same reasoning shouldn’t the woo-woos doubt themselves a whole lot more? Since every single homeopath, chiropractor, and acupuncturist is mistaken, a con-man, or both, alties consistently look a lot worse than “big pharma” by their own criteria.

augustine writes:
Before it “self corrects”, as you call it, what happens? Death and destruction in the name of science. Medical confidence requires amnesia.

So, the “ancient Chinese doctors” who figured out acupuncture, since they didn’t have access to modern diagnostic technology or even cadavers, must have done it by trial and error. Where do you think your science of acupuncture came from, mmmm? It was not handed down by the gods – it was invented by a bunch of quacks who ‘self corrected’ their woo until it was plausible enough to survive.

What a lot of woo-woos forget is that alternative medical practices are MORE guilty than science-based medicine of trial and error, getting it a bit wrong, and hiding it from patients. After all, it took science-based medicine less than 100 years to determine conclusively that acupuncture is a placebo – but acupuncturists weren’t able to figure that out over the course of however many hundreds or thousands of years of ‘experiment’ on live humans. Talk about irresponsibility!

Last year, because I was curious, I bought some acupuncture needles on Ebay and experimented with sticking them into various muscle/tissue parts of my arm/hand. Do you know what struck me as most interesting, though? The most interesting thing I noticed was that the needles came individually packed in radiation-sterilized packets! Tell me, do you think acupuncturists used to sterilize their needles before that horrible scientific reductionist Pasteur figured out why it was a good idea? Hell no. Needles are expensive, right!?

Do you re-use your needles? If not, you’re implicitly ceeding a very important point – namely that science is right about a lot of crucial things. It’s much more right than you’ll ever be, mister witch-doctor.

[I’m currently going through a serious bout of sciatica and I’m getting thoroughly sick of the number of people who are telling me I *need* to see an acupuncturist or chiropractor.]

*augustine:
Keep suffering! You’ll teach them that it’s all gobbledegook! You should go and get spine surgery just for kicks. Just to show them how much better it is than placebo.*

Why would I spend money for a treatment that has been proven NOT to work? I stick with modern medicine – with its science based approach

I read above (not going through 60 comments to find this again) the following idea:

rational people go to medical doctors, and when they can not offer anything, then they go to woo providers who not only give them hope, admitted placebo, but also comfort and an ear to talk to.

I’ve heard this claim from a number of people in the past who are not totally out in woo woo land, and it certainly justifies the idea that the acupuncture or what not can be warranted, even though there is a tiny risk harm (face it skeptics, acupuncture, even multiple sessions is less risky than back surgery or any surgery that requires general anesthesia).

My previous field of study was for a treatment for scoliosis, which had other uses for lumbar stability and relief for disk issues. I met many patients who went through the process described above and what I saw was that its simply not true that people actually go through the course of medicine before going to woowoo land.

Doctors generally try to avoid surgery and general anesthesia if they can due to the known risks. They will try external stabilization, a routine of exercise and stretching, muscle relaxants etc etc, unless the damage is severe. Many of the patients go for the pills, and quick things like braces, but rarely follow through on the physical therapy. Then when surgery come up, they jump ship and swim to the shores of Woo.

They don’t in fact go through everything that medicine has to offer. They only go through the parts that are most convenient for them. Then they can’t understand why I am upset when I have not seen them for 6 months while their back got significantly worse while they were pretending that needles or back cracking was fixing them.

This is what acupuncture has to offer, a distraction from the inevitable, a guarantee of a harder surgery, a harder recovery.

At least for serious back issues. Maybe things are not this dire for other ailments.

TechSkeptic–

I get the feeling that many people would rather do anything than physical therapy: pills, surgery, acupuncture, steroid injections, staying in bed with pain, anything.

Some years ago, I had problems with my rotator cuff. My GP sent me to an orthopedic surgeon [sic]. He referred me to a physical therapist, saying that that works in about 70% of cases, and if it didn’t, come back and we would try a cortisone shot. And if that didn’t work, he could operate. He also said he hoped never to see me again.

Some time after that, at the PT’s office, I asked whether some of that success rate was due to how regularly people went to PT and did their exercises at home. He allowed that that might be a factor.

I suspect that some of the 30% who go back to the orthopedic surgeon and say that PT didn’t work mean “the first couple of sessions at the office didn’t make it all better, and the exercises he sent me home with hurt.”

Chris, why don’t you read this site more carefully? You should know that when someone makes a dramatic-sounding claim that is not generally known to be true, Science requires him to be able to produce factual evidence in support of that claim. The cited study is adequate evidence that there is a small but real rate of injuries due to incompetent acupuncture practice, and that there were two related deaths in Japan during a 13-year period. To announce that there were really a “much greater” number of deaths during the studied period, one must have support from another source. When Prometheus uses the expression “we can safely assume,” we can read it as “I have no citation, but I believe this ought to be true.” That just won’t do.

Jane,

I have no citation for my assumption that actual number of acupuncture injuries exceed the number of published case reports; I am relying on logic.

We know that even with diseases where reporting is required by law that not all cases are reported – some are misdiagnosed, some have the reports mislaid or misdirected and some are simply not reported. This does not require a citation, only a passing knowledge of human nature.

I know that not all acupuncture injuries are reported in the medical literature from both personal experience – I am aware of at least three cases (two liver lacerations requiring emergency surgery and one case of bowel perforation leading to peritonitis) that were never published – and from an understanding of how case reports are generated and published.

Logic leads us to realise that even unusual and unexpected cases will only reach the medical literature if all of the following occur:

[1] Someone identifies the case as being worthy of publication.

[2] Someone takes the time to write a case report and submit it for publication.

[3] An editor at a medical journal feels that the case report is interesting or valuable enough – and written well enough – to justify publication.

[4] The author persists through the cycle of review, re-writes and re-review to final publication.

Again, logic – and an understanding of human nature – tells us that most acupuncture injuries, even if they result in hospitalisation or death, will not be published. This is not just true of acupuncture injuries, but of all medical case reports. If you did a literature search for case reports of measles, malaria (in the US) or shark bites (all of which are reportable or recorded), you would find that the number of case reports is far smaller than the number of reported cases.

Frankly, it’s not newsworthy that people untrained in real anatomy (as opposed to Chi meridians) repeatedly sticking long needles into patients will cause serious injury from time to time. As a result, only unusual or unexpected injuries will be published.

Supporting this is the nature of the cases reported by Yamashita et al – of the 124 cases, nearly 15% of them were spinal cord injuries. I was surprised with the relatively large number of spinal cord injuries, which would imply a very determined (and unlucky) acupuncturist. I suspect that this is an artifact of the unusual nature of the injury, further demonstrating that the total number of serious acupuncture injuries must be much greater.

Either that, or greater than one in seven serious acupuncture injuries involve damage to the spinal cord. Take your pick.

The fact is that we have no good idea how many patients have been injured during acupuncture – the medical literature only gives us the minimum number of injuries. Since we also have no idea how many people are treated with acupuncture per year, we have no way of knowing the injury rate. However, since we know – thanks to numerous studies – that acupuncture is no more effective than placebo, we know that the risk/benefit ratio of acupuncture is undefinably high (as division by zero gives a mathematically undefined result).

I hope this explains how I can state – with reasonable assurance – that the case reports are only “the tip of the iceberg” (or “tip of the needle”?). If it pleases you to imagine that I am simply making all this up in order to make acupuncture look bad, feel free to do so.

Prometheus

I deconstructed Eric the Poker’s comments here: https://www.respectfulinsolence.com/2009/06/electroacupuncture_the_bait_and_switch_o.php#comment-2728312

I got the biggest laugh at the very end, when he tries to talk up acupuncture’s alleged ancient Chinese history, ignoring the fact that a) Mao promoted it and the other folk remedies that had been given up centuries earlier because it was cheaper than real medicine in real hospitals with real doctors, and b) Mao didn’t believe in it himself.

Rogue Medic – Read more carefully, please; I did not claim that the Japanese study detected all complications that occurred during that period, nor did the authors of the study.

As for the efficacy question, which both of you have raised, I have noted before that the answer to whether or not acupuncture works depends at least in part (since we actually do not know whether it is bioactive) upon one’s definition of “works”; I am not going to change my definition, nor are you, so there’s no point in arguing further about it.

Routine complications of medical procedures (and many other life activities) are certainly underreported, but we usually have no basis for presuming that we know the size of the error, or that the “hidden toll” of things we don’t approve of must be much higher than that of things we do. Deaths, however, do tend to be reported someplace unless the victim’s child is really desperate to go on collecting their pension checks, so if people were dropping like flies from having visited acupuncturists, I would expect there to be some evidence available for some zealous anti-acupuncture crusader to uncover.

We do know that clinical trials of acupuncture report either no or few and minor adverse events, so the side effect rate, at least for those practitioners, is very low indeed (in marked contrast to pharma arms included in some stuies). Since acupuncture usually involves very fine needles placed only half an inch or so into muscle tissue, it would be extraordinarily rare to suffer pneumothorax or significant spinal injury; in some reported cases such injuries result from aberrant homebrew procedures. (Watch out what you do with those fabled Toothpicks, guys.)

Very rare complications, the medical version of the man-bites-dog story, are indeed more likely to get reported – perhaps especially if they were inflicted by an incompetent CAM practitioner whose field the reporting MD does not much like. People who suffer genuinely serious injuries will usually be seen by an MD sooner or later, so the alleged inability of acupuncturists to acknowledge “all of this harm” they do would not prevent reports from being made. I therefore highly doubt that there are hundreds or thousands of unreported dire cases of “damage to the spinal cord” out there. Minor skin infections, yes, probably are significantly underreported.

More from Dr. Crislip (you must listen to his podcasts to get the full effect):
http://www.pusware.com/quackcast/quackcast.mp3

References here:
http://moremark.squarespace.com/quackref/#8

@ Prometheus

I am aware of at least three cases (two liver lacerations requiring emergency surgery and one case of bowel perforation leading to peritonitis)

I have to ask: did the acupuncturist fall over his patient, or what?
I mean, I was under the impression that acupuncture is about sub-cutaneous insertion of needles. A few millimeter inside the skin at most. The liver or the guts are a bit more inside. Don’t tell me there are peoples who actually insert 10-centimeter long needles all the way to the hilt into peoples for a living.

Jane asks:

“I was under the impression that acupuncture is about sub-cutaneous insertion of needles. A few millimeter inside the skin at most. The liver or the guts are a bit more inside.”

I, too, was under the impression that acupuncture needles were placed – at most – a few millimeters into the skin. However, as the case reports (and my experience) indicate, not all acupuncturists are adept at gauging depth. Maybe they should put depth markers on the acupuncture needles.

She continues:

“Don’t tell me there are peoples [sic] who actually insert 10-centimeter long needles all the way to the hilt into peoples [sic] for a living”

To begin with, you don’t have to take my word for it – the Yamashita et al article says it all. Also, it is entirely possible that the acupuncturists who caused lung, liver, bowel and spinal cord injury weren’t doing it “for a living” – maybe visceral trauma is just a hobby of theirs.

Prometheus

To Vicki who said:

“If I have something a doctor can’t treat, I would rather she tell me.”

That’s fine, just don’t be surprised when your doctor’s clients start to look to other businesses that can. If I can’t solve a client’s problem, I don’t berate them for seeking assistance elsewhere like many seem to do here.

With all due respect, jane, I don’t think you can blame the Respectful Insolence readership of defining acupuncture very broadly, since it it isn’t really properly defined by even the practitioners themselves. Oh, certainly each practitioner has a definition of sorts, but they contradict one another.

And that’s part of the problem folks here have with acupuncture. You seem to be criticizing us for using a “no true Scotsman” argument to discredit any seemingly positive acupuncture studies. We’re not. We’re pointing out that the actual clinical practice of acupuncture is so ridiculously broad that it’s absurd to use one study to make conclusions about the whole of it. And yet that’s what acupuncturists routinely do. They’ll look at a study that says needling showed bioactivity in an animal (note: “bioactivity” is a pretty vague term) and use this as evidence that their particular conception of acupuncture is correct, even if their needling isn’t the same as in the study.

And probably most tellingly, acupuncturists who do use the “chi” model will point even to the positive results of sham acupuncture studies as evidence of their methods, although the study really showed that the chi model is nonsense — if acupuncture works, it obviously has nothing to do with chi, so why do so many acupuncturists persist in talking about chi and meridians and things?

BTW, very low-depth acupuncture with extremely thin needles is a relatively modern concept, made possible only by modern technology to produce the extremely fine needles required. “Traditional” acupuncture really does involve larger needles inserted to a greater depth. That you are not familiar with this doesn’t mean it doesn’t happen, and if you say it’s wrong to associate injuries from it with acupuncture, then I’m afraid it is you who are using the “no true Scotsman” argument.

@jane

Modern acupuncture is what we are talking about

Which kind? Chinese? Japanese? German? Hand? Foot? Ear?

jane:

What citations do you think I should provide?

Anything that shows poking a person with needles does anything other than raise the risk of transmitting disease.

All I see you do is complain about our data, when you present absolutely none. We can’t even figure out what you are actually going on about.

Rogue Medic – Read more carefully, please; I did not claim that the Japanese study detected all complications that occurred during that period, nor did the authors of the study.

Well, let me reread what jane wrote.

Prometheus: “Before Eric – or someone like him – argues that this is only 124 serious injuries in 13 years, remember that these are only the published case reports – the total number of injuries (and deaths) is much greater.”

Evidence?? Citation??

That’s everything.

Yes. That’s all she wrote. 🙂

All jane added was two words and several more question marks than necessary. Maybe jane put a lot of thought into those question marks. Maybe jane thinks that I have misinterpreted the superfluous question marks as some form of spasm. Maybe jane thinks that jane is being especially cryptic.

To which word might jane attribute some sort of extremely complex meaning?

Or.

To which question mark might jane attribute some sort of extremely complex meaning?

Is jane claiming some sort of synergy between a word and a question mark or between two question marks?

I think that Prometheus did a nice job of addressing jane’s augustine-like response.

jane seems to be claiming that every statement made by someone who uses evidence to learn what works, must be based solely on evidence.

jane does not appear to want to use logic, but expects others to abandon logic, just to play along.

Without logic, the evidence is meaningless.

As for the efficacy question, which both of you have raised, I have noted before that the answer to whether or not acupuncture works depends at least in part (since we actually do not know whether it is bioactive) upon one’s definition of “works”; I am not going to change my definition, nor are you, so there’s no point in arguing further about it.

Whether something works depends on whether it works better than placebo.

It does not matter if we are examining whether a surgical procedure works, whether a drug works, or whether acupuncture works.

A surgical procedure that is no better than placebo, is just a placebo.

That surgical procedure does not work. The placebo effect is what is working.

A drug that is no better than placebo, is just a placebo.

That drug does not work. The placebo effect is what is working.

Acupuncture that is no better than placebo, is just a placebo.

Even the best individualized specialist performed acupuncture is no better than placebo.

All of acupuncture is just a placebo.

Acupuncture does not work. The placebo effect is what is working.

Denying that acupuncture is a placebo requires a misunderstanding of the research that has compared acupuncture with placebo acupuncture and found that they are both placebos.

Acupuncture is just another placebo.

Acupuncture does not work.

Pretending that this is a matter of how one defines imagines the word works is nonsense.

Routine complications of medical procedures (and many other life activities) are certainly underreported, but we usually have no basis for presuming that we know the size of the error, or that the “hidden toll” of things we don’t approve of must be much higher than that of things we do. Deaths, however, do tend to be reported someplace unless the victim’s child is really desperate to go on collecting their pension checks, so if people were dropping like flies from having visited acupuncturists, I would expect there to be some evidence available for some zealous anti-acupuncture crusader to uncover.

Ooh! Ooh! Ooh! I know how to answer this one!

Evidence?? Citation??

I am just kidding. Why would jane have any evidence?

It seems that jane would rather blame the victim, than blame the acupuncturist fraud.

jane seems to suggest that no liability attaches to the acupuncturist fraud for the death.

By proposing some imagined crime, jane appears to be trying to wash the acupuncturists’ frauds’ hands of these deaths, but multiple wrongs do not make something right, although multiple wrongs may attract attention.

Acupuncture is just defrauding patients customers for financial gain at the expense of the patients’ customers’ wealth and health.

We do know that clinical trials of acupuncture report either no or few and minor adverse events, so the side effect rate, at least for those practitioners, is very low indeed (in marked contrast to pharma arms included in some stuies).

We know that people participating in studies also are being scrutinized much more closely than when practicing independently, so the stabbing a needle in the wrong spot just for a placebo effect rate can be expected to be lower than in the less supervised world outside of research.

That’s not a chi spot! That’s my liver!

Since acupuncture usually involves very fine needles placed only half an inch or so into muscle tissue, it would be extraordinarily rare to suffer pneumothorax or significant spinal injury; in some reported cases such injuries result from aberrant homebrew procedures.

As if aberrant homebrew acupuncture is any worse than acupuncture served with wine in a marble tiled office.

As a pathologist, jane is explaining that acupuncture is OK, because acupuncture is only stabbing people a little bit. There is no reason to believe that jane has any understanding of what lies beneath the skin.

Based on jane’s misunderstanding of anatomy, the injuries and deaths reported in this CAM journal should never have happened.

Never.

Actually, if the treatment is something that does not work, such as acupuncture, then there is no excuse for the injuries to ever happen.

To simplify for those bad at risk management.

No benefit divided by a known risk equals unreasonable risk.

jane is recommending stabbing people to produce a placebo effect.

jane’s excuse is that acupuncture has not been reported as the direct cause of death for a lot of people – at least, not yet.

So, for jane, it is OK to kill people for something that doesn’t work.

jane seems to be saying, As long as acupuncture victims are not yet dropping like flies, how can anyone suggest that acupuncture fraud is a bad thing?

(Watch out what you do with those fabled Toothpicks, guys.)

The patient does not get stabbed with the toothpicks.

The toothpicks are just something harmless to compare the acupuncture against. Still the acupuncture is not any better than misguided toothpick taps. Sometimes the acupuncture is not even as good as the toothpicks.

Very rare complications, the medical version of the man-bites-dog story, are indeed more likely to get reported – perhaps especially if they were inflicted by an incompetent CAM practitioner whose field the reporting MD does not much like.

jane’s defense is that many injuries are not reported, because the doctor is not critical of acupuncture?

Priceless.

jane claims there is some sort of important gradation of the competence of people who sticks needles where needles should not be stuck.

A competent CAM practitioner quack vs. an incompetent CAM practitioner quack?

The competence is already known, when we identify a person as a CAM practitioner quack.

A competent person does not recommend, or treat with, fraud.

People who suffer genuinely serious injuries will usually be seen by an MD sooner or later, so the alleged inability of acupuncturists to acknowledge “all of this harm” they do would not prevent reports from being made. I therefore highly doubt that there are hundreds or thousands of unreported dire cases of “damage to the spinal cord” out there. Minor skin infections, yes, probably are significantly underreported.

jane has misread the response by Prometheus, perhaps intentionally, to make jane’s point seem almost valid. This is a review of journal articles, not a review of medical records. Not that acupuncture involves medical records, those might be alternative medical records.

While starting out with advice to read two words and four question marks more carefully, jane appears to have ignored her own advice to read more carefully.

jane also ignored the influence of the all-too-common practice of sealing medical records following malpractice cases, even though I had already mentioned it.

Finally, there is probably much more harm from the delay in seeking real medical care, than from the fumble fingered frauds stabbing too deeply.

No, I do not have a citation for that. It is just a logical conclusion.
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As a follow-up to Rogue Medic: A lot of Americans don’t have health insurance, or have very limited health insurance.

A lot of people who use acupuncture don’t trust actual doctors.

Put those together, and a fair number of people who are injured by acupuncture aren’t going to get to a doctor and report the injury. That assumes they make the connection: if you assume acupuncture is safe, and get sick with an infection several days later, you may not mention the acupuncture to the doctor, if you see one.

Well, if anyone wants to see an example of a whole field of straw men (not to mention a couple of ad homs) just read Rogue Medic’s last post. Not worth further attempts at dialogue.

Chris – I cannot tell you WHY acupuncture “does anything other than spread disease.” I can tell you THAT, for example, actual scientific studies indicate that people who use acupuncture for back pain get more relief than people who take drugs, while suffering far fewer adverse events. I have no idea WHY that should be. I think it is possible for science to answer this question, but only if researchers come at it from the position that (a) we do not already know the answer, and (b) the answer might turn out to be of practical value no matter what it is. If we – like certain recent commenters – demand that everyone accept on faith that acupuncture is Only A Placebo and Therefore Worthless, we will be incapable of learning more. Like the old Zen story has it, if your cup is already full, there’s no room for more tea in it.

jane:

I can tell you THAT, for example, actual scientific studies indicate that people who use acupuncture for back pain get more relief than people who take drugs, while suffering far fewer adverse events.

Evidence?? Citation??

Here is something then perhaps you can do, find a Youtube video of acupuncture done with proper hygiene. Because Dr. Crislip did not find any.

Also, don’t use the crappy cites you tried last week.

In a recent thread on this blog, which I am sure you both saw, I cited several papers that compared acupuncture directly to drug treatment arms. I will not abuse our host’s bandwidth by repeating the same information in detail; go look it up. (As an aside, many humans outside clinical trials have also anecdotally reported that acupuncture provided relief when drugs did not; this says nothing whatsoever about mechanism, but from a pragmatist’s perspective it is interesting.)

Todd W – there is no consensus that needling is equivalent to non-needling. While I’m on the subject of fallacies, this is called “cherry-picking” – presuming that, when evidence is incomplete, complex, and contradictory, the studies that support a favored viewpoint are to be taken as the last word on the subject.

Chris – I am sure Dr. Crislip tried very hard. If acupuncture were virtually never done with proper hygiene – I’m not saying you have said this, although you seem to be dropping the hint – yet people rarely get sick from it, one would have to wonder whether the definition of “proper,” as specified apparently solely by people who never practice acupuncture, were too restrictive. It might – note, I say MIGHT – be rather as if an American-trained “nutrition scientist” were to come into our kitchens and gasp in horror at the absence of written food safety protocols, triple sinks, and constantly calibrated thermometers, the cat strolling around, and what have you, and announce that Traditional Cooking was a terrible disease risk and we should all give it up. Sometimes people do get sick from home cooking, but much more often they get tasty, affordable, nutritious food; the risk-benefit balance favors the traditional practice by a large margin.

Blockquote fail…sigh.

@jane

I’ll jump back out now, as it seems pointless to continue to argue about what is for some here an article of faith on which varying opinions and uncertainty are not worthy of consideration.

Translation: Rather than provide citations to back up my claims, I’m going to bow out. These science-minded individuals who base decisions and opinions on the evidence are asking for that which I cannot provide.

I ran the image search you suggested, jane, and got everything from line drawings to photos to a set of Schmetz sewing machine needles to progressively less relevant hits. One of the drawings gave lengths; none gave diameters. Those images are consistent with what I understood previously of the limitations of pre-industrial wire drawing. One was associated with text (the source of which I don’t know; it appears to be a scholarly work and is thus either a secondary or ternary source) explaining the needles a bit. It did not give gauge or diameter, only saying that the finest needle was “hair-fine” and “corresponded in form to the most common of the current needles” which still doesn’t clear it up. I’m interested to know *how* thin they could go. I mean, I know they could make thin wire. I’ve said I know people who do it, duplicating the ancient methods. I’m just not convinced they could make them *that* thin. More significantly, I didn’t find any giving a date to the artifacts. Those could be 200 years old, which is well within the timeframe of modern metallurgy.

That text looked the most interesting of what I found, though again, I haven’t established it’s provenance. Here it is, in case you’re interested. It goes into a little more detail of the historical use of all nine of the needles, not just the short filiform one.
http://www.itmonline.org/arts/bleeding.htm

It is true what you say, that many people tend to underestimate the technological skills of the ancients. That doesn’t mean that all claims of ancient skills should be taken at face value. Major breakthroughs in wire drawing (the essential technology behind metal needles) occurred at several key points. The oldest known wire comes from ancient Egypt, and are about 4,000 years old, but was made by a fundamentally different method than modern wire — the oldest examples are actually beaten into that shape, while later examples were made from thin strips of metal, which were then rolled into wires. “Modern” wire drawing (where a piece of metal is pulled through progressively narrower openings) originated in the medieval period, though scholars disagree exactly when or where it originated. This method is a definite prerequisite for truly hair-fine needles, even ones larger than .5 mm. Though it was refined in the industrial period with the advent of wire-drawing machinery, the basic technique is the same — heat the metal just enough, and then pull it through progressively smaller holes.

jane,

Well, if anyone wants to see an example of a whole field of straw men (not to mention a couple of ad homs) just read Rogue Medic’s last post. Not worth further attempts at dialogue.

The old I win, then run away.

I can tell you THAT, for example, actual scientific studies indicate that people who use acupuncture for back pain get more relief than people who take drugs, while suffering far fewer adverse events. I have no idea WHY that should be.

Were they getting the acupuncture placebo in addition to the standard treatment? Adding a placebo is expected to produce a better result, so that would not be a surprise.

I think it is possible for science to answer this question, but only if researchers come at it from the position that (a) we do not already know the answer, and (b) the answer might turn out to be of practical value no matter what it is.

Research that does not approach subjects in that way is not valid research.

Research needs to be set up to be objective – in other words, there is no advantage given to any hypothesis.

When this has been done with acupuncture, the result has been that acupuncture is just a placebo.

Throw a tantrum, jane. Create a straw man about a whole field of straw men, jane. Go ahead, again.

The objective research by acupuncturists shows clearly that acupuncture is just a placebo.

If we – like certain recent commenters – demand that everyone accept on faith that acupuncture is Only A Placebo and Therefore Worthless, we will be incapable of learning more.

How silly of me.

jane considers the use of objective research to be accepting on faith.

Hardly someone who can make any credible comments about being incapable of learning more, although jane may serve as an excellent object lesson.

Like the old Zen story has it, if your cup is already full, there’s no room for more tea in it.

jane’s cup appears to be overflowing with misdirection, the altie specialty.
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Chris,

Thank you for digging that up. I was not going to go looking, even with the likelihood of comic relief at the end of the journey.

For anyone who does not understand how to find the abstracts, go to the link below (PubMed) and enter a number from the comment by Chris in the search box, then click on search. Or just add the number to the end of the url below.

http://www.ncbi.nlm.nih.gov/pubmed
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Seb30,

Sorry about that – I was on a roll, responding to Jane’s inane comments and typed the wrong name. My apologies.

It is even more frightening than you think – the Yamashita et al article was looking at acupuncture injuries in Japan, where all acupuncturists (except those who practice only on themselves) must be licensed.

In the US, Alabama, Mississippi, North Dakota, South Dakota, Oklahoma and Wyoming have no laws regulating acupuncture. Those states that do license acupuncturists generally only require that they have graduated from an “accredited” school of acupuncture and have passed one of the national acupuncture exams.

So, after graduating from a school that teaches about imaginary Chi flowing along imaginary meridians and passing a test assessing their ability to recall these fantasies (and paying a fee), 44 states (and the District of Columbia) will provide a license to stick needles into people for money.

In addition, most states allow physicians, dentists and chiropractors (and, in those states that license them, naturopaths) to practice acupuncture without special certification or licensure.

In my home state, it’s harder to get a commercial driver’s license than it is to become a licensed acupuncturist – and the truck drivers get random drug testing.

Be afraid…be very afraid!

Prometheus