Tara Parker-Pope and the New York Times Well Blog: Acupuncture woo takes over

What the hell is going on with The New York Times‘ health reporting?

I’ve had my share of disagreements with the way that the NYT has covered various health issues over the years that I’ve been blogging, but I don’t recall ever having seen it embrace pseudoscience. I can recall being a bit miffed at some of the articles that the NYT has published about biomedical research and its various perceived failings. On the other hand, I’ve also praised the NYT reporting on various issues, such as medical radiation and the risks it can pose. But lately, it seems, the NYT has gone into the crapper with at least some of its health reporting. At least, it has when it comes to Tara Parker-Pope, who blogs on Well: Tara Parker-Pope on Health. First, she totally blew it when it came to interpreting a particularly awful bit of quackademic medicine studying transcutaneous electrical nerve stimulation (TENS) mislabeled as acupuncture, a misstep for which I applied a bit of not-so-Respectful Insolence to her.

Whoops, she did it again.

In fact, Parker-Pope not only did it again, but she “surpassed” herself when it comes to woo. Apparently, she’s been far more impressed by the recent spate of crappy studies on acupuncture than a halfway decent health reporter and blogger should be, because she’s laid down a rather credulous bit of woo entitled Studying Acupuncture, One Needle Prick at a Time. In her post, Parker-Pope demonstrates unequivocally that she does not understand the issues involved in applying science to acupuncture, which makes me wonder if she understands the issues involved in applying science to any medicine at all. Yes, it’s just that egregious, as you’ll see in a moment. She begins:

For at least 2,000 years Chinese healers have used acupuncture to treat pain and other ailments. Now Western doctors want proof that it works.

Whenever I see someone write about “2,000 years” during which Chinese healers have allegedly used acupuncture to treat all manner of ailments, I know I’m dealing with someone who knows little of the history of acupuncture and doesn’t realize that acupuncture in its current form bears little resemblance to ancient acupuncture. More importantly, however, after asking whether acupuncture “works” primarily or completely through placebo effects (a reasonable question that’s been answered time and time again: it does), Parker-Pope goes right off the deep end, spewing the same sorts of weasel words that so pervade quackademic medicine:

The debate was fueled last week by a study in the journal Arthritis Care and Research. Researchers from MD Anderson Cancer Center in Houston found that among 455 patients with painful knee arthritis, acupuncture delivered no more relief than a sham treatment.

Actually, patients got significant pain relief from both treatments — an average reduction of one point on a scale of 1 to 7. And critics contend that the study was poorly designed.

For one thing, they note, patients in both groups received treatment with needles and electrical stimulation; the main difference was that in the sham group, the needles were not inserted as deeply and the stimulation was far shorter in duration.

Funny that Parker-Pope appears to have finally noticed what I pointed out in my deconstruction of this execrably horrible study. Whether she saw my post or whether it was her commenters who pointed this out, I don’t know. In any case, either my memory is faulty, or Parker-Pope appears to have added a sentence to her original post (“Electrical stimulation was also used, although those in the sham group received lower voltage and far shorter treatments”) that I do not remember seeing in the original post. I noticed this in rereading her post, because when I wrote my original post about the TENS/”acupuncture” study, I distinctly remember poring over Parker-Pope’s post and posts by other bloggers, looking for even a hint of a mention that the acupuncture needles were hooked up to electricity. Indeed, I even made a point of observing in my original post that Parker-Pope “didn’t seem to notice that what was being studied was not acupuncture, but rather TENS, even though the authors refer to it as ‘acupuncture.'” In other words, Parker-Pope appears to be busted. She appears to have “corrected” her post without noting in an addendum that she has edited the original post. [NOTE ADDED: Ms. Parker-Pope responded, and I answered.]

Then, in the comments of the post, she tries to justify why the TENS (I refuse to call it “acupuncture”) group was indistinguishable from the sham TENS (again, I refuse to call it “sham acupuncture”) group by saying in the comments:

I think the difference is that this “sham” treatment is still a pretty active intervention — inserting needles and generating electrical stimulus. It’s not your typical placebo. It’s also interesting that the German researchers interpreted similar study results differently than American researchers.

No, no, no, no, no! It is a placebo. Nice try, though, Parker-Pope. Well, not really. It was a pretty crappy answer. Commenter Tim Kreider got it right when he used one of Steve Novella’s favorite gambits, suggesting that Parker-Pope replace the term “real acupuncture” or “true acupuncture” with the term “new potential blockbuster drug from Merck” and the term “sham acupuncture” with “placebo” or “sugar pill” and then ask herself: If a study found no detectable difference in effect or outcome between the new drug from Merck and the sugar pill, would Parker-Pope conclude that the new drug from Merck works? If not, then why does she think that this mutant form of acupuncture hooked up to electricity works? Her answer, cited above, shows that her cluelessness is breathtaking, as does her next gambit in her most recent post:

Rather than proving that acupuncture does not work, in other words, the study may suggest that it works even when administered poorly. But the real lesson, acupuncture supporters say, is how difficult it can be to apply Western research standards to an ancient healing art.

“People argue that there really are no inactive acupuncture points — pretty much wherever you put a needle in the body is an active point,” said Dr. Alex Moroz, a trained acupuncturist who directs the musculoskeletal rehabilitation program at New York University. “There is a body of literature that argues that the whole approach to studying acupuncture doesn’t lend itself to the Western reductionist scientific method.”

No, the reason that these studies show that acupuncture does not work is because they show that there is nothing about the “theory” behind acupuncture that matters to the act of sticking needles willy-nilly into people’s skin. Qi doesn’t matter. Meridians don’t matter. Meridians don’t correspond to any anatomic structure or physiologic structure, anyway, nor has anyone ever been able detect qi. It doesn’t matter where you stick the needles in. It doesn’t matter how you stick the needles in. As at least one study using an innovative approach to “sham” acupuncture shows (see below), it doesn’t even matter if you stick the needles in.

So, what about acupuncture “works”? Nothing.

Worse, Parker-Pope quotes an acupuncturist, who is using one of the oldest and most irritating alt-med tropes there is, namely dismissing all those inconvenient studies showing that acupuncture works no better than a placebo with the airy claim that “reductionistic” science just can’t study his woo. Even worse still, Parker-Pope is parroting the even more irritating tropes about “Western” science not being able to study “Eastern” woo. I don’t know about you, but if I were Chinese, I’d be profoundly insulted. There is no “Eastern” or “Western” science. The scientific method spans East and West. There is just science, and there are scientists in Japan, China, and elsewhere in Asia who are every bit as excellent as “Western” scientists, except that they aren’t “Western.” Similarly, there is no “Eastern” or “Western” medicine, and, in fact, as I have discussed before in China younger people seem to be abandoning traditional Chinese medicine for scientific medicine. Science-based medicine should also span both East and West, and there should be only science-based medicine. I can’t resist repeating a favorite question and answer. The question is: What do you call “alternative medicine” that works? Answer: Medicine! That’s because there are three varieties of medicine: Medicine that has been scientifically validated; medicine that has not; and medicine that has been shown by science not to work. Guess which two categories the vast majority of “alt-med” falls into? That’s right, “alternative” medicine that is validated by science is no longer “alternative.”

As for the whole “East”/”West” thing, that is a dichotomy every bit as false as the “alternative” medicine/medicine dichotomy, and it’s arguably racist to boot. After all, there doesn’t seem to be any love for ancient “Western” medicine on the same level as there is seemingly love for ancient “Eastern” medicine like acupuncture and traditional Chinese medicine. Why aren’t we balancing the four humors, even though we are trying to balance qi? Because it’s more exotic? She also seems unaware that the term “integrative” means nothing more than combining quackery with science-based medicine.

Oddly enough the study’s lead author, Dr. Maria E. Suarez-Almazor, was actually more reasonable and scientific than Parker-Pope. She points out that in a drug study an equal response between placebo and drug would indicate that the drug does not work. She even admits “We didn’t plan a study trying to show that acupuncture didn’t work. The results came out with no difference between the groups.” This to me is an implicit admission that their TENS/”electroacupuncture” did not work. That’s how clinical trials work. Usually acupuncturists are masters at explaining away negative results, but in this case Suarez-Alamazor seems to be admitting that her version of “acupuncture” didn’t work, and that is to her credit.

Parker-Pope then provides a list of acupuncture studies that are a catalog of commonly cited studies, the vast majority of which do not show what she thinks they show. For example, she writes:

A 2007 study of 1,200 back-pain patients, financed by insurance companies in Germany, showed that about half the patients in both real and sham acupuncture groups had less pain after treatment, compared with only 27 percent of those receiving physical therapy or other traditional back care.

When the German researchers tracked how much pain medicine the patients used, they detected a noticeable difference between real acupuncture and the sham treatment. Only 15 percent of patients in the acupuncture group required extra pain drugs, compared with 34 percent in the sham group. The group receiving conventional back therapy fared even worse than those receiving fake acupuncture: 59 percent of those patients needed extra pain pills.

This is the infamous GERAC study, and it is yet another study in which sham acupuncture was indistinguishable from “real” acupuncture. It is yet another study in which the correct interpretation of the results is that acupuncture does not work. Unfortunately, in the Bizarro World of CAM acupuncturists and credulous journalists like Parker-Pope spin these studies as evidence that acupuncture does work. Indeed, Orac was all over this study when it came out, applying a loving helping of not-so-Respectful Insolence to the study itself and to the credulous responses to it. In fact, this study was widely ripped apart by skeptical and medical bloggers when it came out, including Steve Novella, Ben Goldacre, and pj. Suffice it to say, we were not impressed.

My favorite example of this sort of willful misinterpretation of acupuncture studies by acupuncture boosters is the study in which the “sham acupuncture” group consisted of twirling the point of toothpicks against the skin. The results? What do you think? The toothpick placebo was just as effective as the “true” acupuncture and the “sham” acupuncture with needles. Yes, toothpicks are just as effective as acupunture. Odd that Parker-Pope didn’t cite that study, which is newer than the GERAC study, and more rigorous to boot, although she did cite a 2004 study in which, she admits, patients were not adequately blinded.

Parker-Pope then finishes up by citing a study from earlier this year that claimed to show that acupuncture relieves hot flashes in women undergoing breast cancer therapy better than pharmacological therapy. The study cited by Parker-Pope is a head-to-head comparison of the antidepressant Effexor versus acupuncture for hot flashes induced by anti-estrogen therapy in breast cancer. Unfortunately, this study had no “sham” acupuncture group at all. Basically, it was completely unblinded and tested what is in essence known to be a crappy treatment for menopausal hot flashes (antidepressants) induced by anti-estrogen therapy versus acupuncture. What a surprise that they ended up with fairly similar results, particularly given the small number of patients! The main findings were that acupuncture appeared to work as well as Effexor during the 12 week span of time during which subjects received either drug or acupuncture and that the effects of acupuncture were supposedly longer lasting than those of Effexor. There was a huge problem with the study, though. At least three huge problems, actually. First, the study was small, with only 50 patients. Second, there were a lot of patients lost to followup at the one year mark. By the 12 month mark, only 14/25 subjects were analyzable in the acupuncture group. In the Effexor group, only 13/25 were analyzable at one year. This is a very high rate of dropping out of the study. Indeed, by the “post” point (which is the 12 week mark, given that both therapies were administered for 12 weeks), in the Effexor group, 5 subjects had been lost to followup and four had discontinued treatment by the post-treatment analysis, while only one had been lost to followup and three had discontinued therapy in the acupuncture group.

Finally, the study was completely unblinded, which made it pretty much worthless, a problem that could have easily been addressed by making sure both groups took pills, with the Effexor group getting Effexor and the acupuncture group getting a sugar pill. Come to think of it, the same problem applied to acupuncture. There was no sham group. Both groups should have gotten an acupuncture-type procedure, the acupuncture group receiving “true” acupuncture and the Effexor group receiving “sham” acupuncture. In other words, this study tells us about as close to nothing as a study can. It’s a perfect example of how small, flawed pilot studies that would be considered of very little value in evaluating any other “conventional” therapy are presented as strong evidence that acupuncture works.

Parker-Pope then finishes with a flourish:

But acupuncture believers say it doesn’t really matter whether Western scientific studies find that the treatment has a strong placebo effect. After all, the goal of what they call integrative medicine, which combines conventional and alternative treatments like acupuncture, is to harness the body’s power to heal itself. It doesn’t matter whether that power is stimulated by a placebo effect or by skillful placement of needles.

Why didn’t Parker-Pope just get an acupuncturist to write her article for her? She’s spewing the same sort on nonsense that acupuncturists spew to defend their woo. She’s cherry picking articles and, whether she realizes it or not, using the same sort of warped and deceptive language, appropriating terms like the derogatory word “Western” to denigrate scientific medicine. One can almost hear the sneer as she types the word “Western” at every opportunity to describe scientific medicine, thereby perpetuating a false and arguably racist dichotomy in which science is “Western,” “reductionistic,” and therefore unimaginative and unfeeling, while the “spiritual” and “holistic” are “Eastern.

She even makes it explicit in the comments. A commenter by the name of “vanina” writes:

This article illustrates well the frustration of western doctors at “proving” that acupuncture works. Simply put: you cannot examine a system of medicine that is a natural derivative of a culture/philosophy with a set of examining tools that are based out of a different culture/philosophy. For instance, western medicine is not very good at examining what cannot be seen. MRI’s, brain scans, blood work are all tools that have “unbiased” data used for analysis. In Acupuncture, the most basic unit of power is “Qi” or “life energy” – it is not quantifiable using western paradigms, there are no “scientific” tools that can measure how Qi flows through our bodies. Yet, acupuncture practitioners know how to assess this Qi through skillful practices of pulse taking, tongue observation, keen observations of a person over time – all this data is deemed worthless to a Western doctor because it is biased.

Trying to prove acupuncture works using western medical tools is like to trying to appreciate an orange using a bulldozer. The tool is inappropriate.

Whoa. This kind of sounds like something out of The Matrix. Like, wow, maaaaaaan! Soooooo deep. Like, maaaaan, it’s true. You really can’t appreciate an orange using a bulldozer. But you can crush it.

Whoa. Again.

That’s even deeper, maaaan. Like that nasty Western reductionistic science crushing nature, represented by the innocence that is the orange. Yeah, that’s it, maaaaan.

Seriously, do people actually read this stuff after they write it and realize how ridiculous it sounds?

Again, vanina’s comment is utter BS, a common and lazy excuse that purveyors of alt-med frequently use when their favorite form of woo fails when tested using well-designed science. It’s utterly wrong and betrays a complete misunderstanding of science. You’d think that a good science writer would call vanina out–or at least gently point out to her that this is an excuse of the “science doesn’t work” or “science doesn’t apply to my woo” variety. She might point out that this is nothing more than postmodernism applied to science, the claim that science is just “another narrative,” no more or less valid than the prescientific view of biology that underlies traditional Chinese medicine. But not Tara Parker-Pope. What she says in response to vanina is this:

Wow, you said all this much better than I did. Thanks!

Game. Set. Match. Tara Parker-Pope has gone woo. And be careful about letting the bulldozer crush that orange. There’s lots of vitamin C in it, and we wouldn’t want that to go to waste.

I’m told that until recently Tara Parker-Pope had in general been held in relatively high esteem among science and medicine journalists, at least around here. My old blog bud Abel Pharmboy, for example, liked her a lot. Unfortunately, something’s happened since then. Earlier this year, Parker-Pope was shilling for that woo-meister supreme, Deepak Chopra, embarrassment to physicians everywhere. She even appeared this April on the same program as Deepak Chopra and Mehmet Oz. Now she’s fallen for crappy studies that claim to prove that “acupuncture” works, while writing embarrassingly unscientific posts like the one I’ve been applying some not-so-Respectful Insolence to in which she agrees with credulous readers who dismiss scientific studies of “alt-med” with the claim that science can’t study them because clinical trials aren’t sufficiently “individualized” or don’t take into account the “whole patient” or the “whole package” that is acupuncture. These claims have always been BS; they’re no less BS when parroted by Tara Parker-Pope.

NYT readers deserve better. Much better.