Acupuncture is quackery. This cannot be repeated often enough, and, in fact, over the last several months I’ve developed a tendency to start all my posts on acupuncture by making sure to remind everyone that it is quackery. The reasons are many-fold. For one thing, the concepts behind acupuncture are based on the claim that somehow, placing little needles into the body along various lines known as meridians, somehow “redirects” the flow of vital life “energy” to healing effect. Never mind that this energy, called “qi,” has never been detected, measured, or characterized, nor have have “meridians” ever been shown to correspond to any detectable anatomic structure. Despite many fanciful attempts to relate acupuncture to a physiological relevant mechanism through which it “works” and even more blatant attempts to rebrand medical treatments as some form of “acupuncture”(such as rebranding TENS as “electroacupuncture”), acupuncture is nothing more than an elaborate placebo. That’s why twirling toothpick tips against the skin “works” just as well or better than “real” acupuncture. To top it all off, acupuncture and “traditional Chinese medicine” as we know it today were basically reinventions of Chinese folk medicine promoted by Chairman Mao to his people beginning a few years after World War II because his Communist regime couldn’t provide enough “Western” doctors to supply the health care needs of the Chinese.
That’s why it irritates me when I see articles published in mainstream news outlets like The Telegraph by people like Rowan Pelling entitled I really believe acupuncture helped me to get pregnant. When I saw the article, I was half-tempted to say, “No, it didn’t,” and leave it at that, but, while that would make a nice Tweet, it doesn’t work on a blog, particularly not this blog. So off we go. The scientific stupid doth burn brightly in this article, and the editors of The Telegraph should be ashamed for promoting such nonsense.
First things first. Living across the pond, as I do, I had no idea who Rowan Pelling is. Apparently she’s a columnist for The Telegraph. Apparently, she first achieved note (or notoriety) as the editor of a monthly literary/erotic magazine, and now also writes a sex advice column. Her bona fides as a medical columnist thus established, I couldn’t resist diving in, mainly because her column is a perfect example of the attitude that we have to overcome if quackery is ever to disappear. It’s definitely going to be an uphill battle.
Pelling starts out by trying to convince her readers that, yes, she really is down with this whole science thing, but she really should be cut some slack because she has a degree in English literature. I kid you not:
The surest way to start a spat over the dinner table in strictly rational and empirical, science-worshipping Cambridge, where I live, is to say that you think complementary medicine can sometimes prove effective. It’s tantamount, in many of my friends’ eyes, to declaring yourself a congenital imbecile.
I have enormous sympathy for their views on the matter. I understand that the only proper way of proving the efficacy of a particular treatment is the use of randomised controlled trials, and that anecdotes of “miracle cures” hardly amount to serious evidence. I would be the first to admit that you never hear of anyone who requires a heart by-pass, or liver transplant, being healed by homeopathy or Reiki. I find it just as terrifying as any doctor when a cancer patient declares they’d rather not have an operation because they’re going to sit in a pyramid and meditate with crystals.
At the same time, I have a degree in English literature and I am highly suggestible, hence my fondness for Hamlet’s quote: “There are more things in heaven and earth, Horatio / Than are dreamt of in your philosophy.”
This passage is actually very clever in many ways, even as it reveals a pit of ignorance about science that rather reminds me of the hole over which the city of Arcadia on Gallifrey was shown to be suspended in this weekend’s 50th anniversary Doctor Who celebration The Day of the Doctor, or maybe the pits underneath Isengard in The Lord of the Rings. (Yeah, I’m a geek.) How so? First, she expresses disdain for the “science-worshiping,” thus portraying proponents of science-based medicine as not just intolerant, but as “worshiping” science like a religion. Both are old tropes favored by quacks, but it’s rare to see them put together so seemingly effectively. Next, she assures us that she is just as disturbed as we are if a person uses quackery for something that matters, like coronary bypass, end stage liver disease, or cancer, but…
It’s the “but” that I would find highly offensive had my major been English literature or other liberal arts, because in essence she’s asking for a pass to believe in pseudoscience and quackery by virtue of her background, even going so far as to quote an oft-abused line by Shakespeare favored by quacks to do what Pelling just did: Paint those who question her belief in quackery as being unimaginative and unable to escape their “philosophy,” in this case, science, which—don’t you know?—is also the same thing as a religion. Well, played, Ms. Pelling! It’s the perfect lead in to the next justification, a discussion of Sarah Hunter, again someone I’ve never heard of, who apparently managed to conceive after a course of reflexology after having tried to conceive for 13 years. The story actually sounds a bit more complicated than that—for one thing, it is claimed that a psychic told her she would get pregnant—and, as we say, correlation does not equal causation, particularly when it comes to couples with unexplained infertility that suddenly, after trying, manage to conceive. I also note that she now runs a fertility business that claims to allow women to become pregnant “naturally without IVF.”
The rest of Pelling’s article involves appeals to personal incredulity, in which she basically claims that what’s happened to her is hard to explain any other way than that acupuncture helped her get pregnant:
I started referring friends with fertility issues (all in their late thirties and early forties) to Kite – with startling results. One publisher who had spent eight years trying to conceive a sibling for her son became pregnant within weeks of her first consultation and went on to have two more children. Indeed, only one of the 10 women I’ve referred didn’t conceive, saying after five sessions that it wasn’t for her.
Similarly hard to explain are the healing hands of Jane Evans, the independent midwife I hired for the birth of my second son. During the most intense part of the labour, she was massaging my back with her hands and I could feel a warm current of “electricity” flowing from her hands to my body in the most reassuring manner.
I know such stories prove little to the seasoned sceptic and, in the worst light, seem to offer false hope. I also see that Kite’s and Evans’s charisma and qualities of empathy are part of the wider picture.
As we say, correlation does not equal causation, and as I like to say, the pleural of “anecdote” is not “data.” Ten women who claim that this “healer” helped them get pregnant mean nothing. Pelling apparently knows this, which is why she cherry picks a single study that claims to have found that acupuncture increases a woman’s chance of becoming pregnant after a round of in vitro fertilization (IVF) by 65%. Of course, if one goes to the Cochrane review on acupuncture and assisted conception, a review that examines all the existing evidence through July 2013, one will find that the totality of the evidence is nowhere near as optimistic, with Cochrane stating with uncharacteristic bluntness for a review of a CAM modality that “there is no evidence of benefit for the use of acupuncture in participants undergoing assisted conception treatment around the time of embryo transfer or at egg collection in terms of improving the live birth rate, ongoing or clinical pregnancy rate.” Cochrane also noted that there is no evidence that acupuncture affects the miscarriage rate. In other words, Pelling’s cherry picked study aside, there is no evidence that acupuncture has any effect on IVF success rates.
Another aspect of this article that I found jarring was its undercurrent of sexism. I know it’s hard to label a woman as being sexist, but Pelling manages to succeed in earning at least a mild rebuke in that she peddles sexist stereotypes. She discusses about how, when she asked on her Facebook page whether anyone had experienced a therapy that seemed miraculous at the time, lots of women answered, while her male friends “mostly harrumphed.” Note the word choice, which implies lack of empathy and feeling coupled with close-mindedness, while the women were portrayed as empathetic and open to such unscientific twaddle. After this, she concludes:
Despite these stern testimonies, I cling to the belief that numerous people are helped through some of the more nebulous medical disorders (migraines, infertility, depression, insomnia, chronic fatigue, and gut problems) by CAM, even if what we’re harnessing is arguably the placebo effect.
Yes, us unfeeling males and our “stern testimonies.” Note that Pelling also throws some racism in there with this anecdote:
The historian and author Liza Filby told me she once ended up in hospital in China with severe swelling of every part of her body. The doctor’s diagnosis was “excessive Western living”. She was given acupuncture, “some odd tea that tasted like vinegar”, and a lecture on “the six excesses”. Finally, he told her: “Westerners know nothing of balance: they live a life of excessive indulgence, followed by excessive restraint.”
Yes, I’ve lost track of how many times I’ve complained about referring to science-based medicine as “Western” medicine and CAM as being more like “Eastern medicine.” The implication is that those of us from the “West” are incapable fo “balance” or “harmony with nature,” while those from the “East” are incapable of good science.
In any case, the old trope about CAM harnessing the “power of placebo” is the newest—and arguably most popular—trope now used by proponents of quackery to defend CAM. The reason is obvious. As CAM therapies have been studied, it has become increasingly apparent that treatments like acupuncture, therapeutic touch, reiki, and other “mind-body” therapies have no specific effects on any illness that have yet been detected. Their activities are consistent with placebo effects. Unfortunately, it has not been established that placebo effects alone can be effective treatments for any disease, and certainly no one has ever reported placebos having any detectable therapeutic effects on diseases with objective outcome endpoints, like death from cancer. Moreover, reliance on placebo effects can be dangerous in diseases like asthma. Worse, because most CAM modalities have no specific effects in and of themselves, invoking placebo effects through CAM requires lying to the patient, fallacious attempts to show otherwise not withstanding. There’s a reason why I’ve referred to the appeal to placebo effects by CAM practitioners as being the new paternalism.
Pelling finishes with a flourish of a false dichotomy:
It’s hard to disagree – particularly in the run‑up to the glut of Christmas and gloom of January. If part of that balance is reflexology, needles, a cheese-less Ayurvedic diet, or even a tincture of Allium Cepa, should anyone really berate us? It’s surely preferable to my friend Fiona’s suggestion for a miracle cure: “A bottle of vodka and a handful of sleeping pills.”
Here’s a hint. There’s nothing in “Western medicine” that recommends a “bottle of vodka and a handful of sleeping pills. It doesn’t matter if Pelling’s friend Fiona said it. Moreover, the alternative to reflexology, acupuncture, and homeopathic tinctures like Allium Cepa is science-based medicine, not a the straw man caricature of SBM that Pelling constructs.
125 replies on “A rather clueless defense of CAM from across the pond”
Let’s just call it Quackupuncture from here on out.
Sincerely,
Christopher Harrumphrey Hickie, MD
I’ve seen (and occasionally been targeted by) appeals to sexism by female wooists.
Promotion of quackery is not something particularly associated with women (after all, many of the Usual Suspects are men, i.e. Joe Mercola, Mike Adams, Gary Null, the proprietor of whale.to etc.). It is true however that when challenged, some female woo advocates like Pelling fall back on the “men are meanies” trope.
It’s not as bad as the pharma shill gambit or comparisons to Nazis, but objectionable nonetheless.
There’s nothing in “Western medicine” that recommends a “bottle of vodka and a handful of sleeping pills.
On the contrary, it’s well known that alcohol enhances the effect of medications like sleeping pills, often with fatal results. So well known that, at least in the US, the medications in question come with explicit warnings that one should abstain from alcohol while taking them. There isn’t enough facepalm in the world for this kind of thermonuclear stupid.
And Ms. Pelling admits that the so-called effectiveness of her treatment may be nothing more than the placebo effect. and says this as if it were a Good Thing? If “declaring yourself a congenital imbecile”, as she put it, were her intent, this piece was a catastrophic success.
@ Dangerous Bacon:
“Most of the usual suspects are men”- YES
and I have observed thinly veiled attempts by the Meisters-in-charge to call ‘Sexism!” on SBM whilst they themselves indulge in paternalism, sexism, superficiality and support of traditional roles as more “natural or even more “spiritual”
A lot of woo involves methods to preserve youthful appearance and directly appeals to certain women** about their concerns -often in graphic and starkly derogatory detail.
Also there is unabashed woo-ing of females by supposedly attractive woo-meisters as well- telling them how wonderful and unappreciated they are prior to the sales pitch.
I find it hilarious when alt med, un-educated supplement salesmen discuss women’s health and women’s issues from their privileged, superior position.
Obviously there are tons more material but I have other work here today and an important errand later.
** as if men don’t have worries- I could elucidate that a bit!
The good part is, at least her friends are bright enough to see it. So not all hope is lost, she’s not in the endless circle of self reinforcement you get in some groups.
It’s *extremely* well known, so much so that even nondrinkers know it.
“It’s the “but” that I would find highly offensive had my major been English literature or other liberal arts, because in essence she’s asking for a pass to believe in pseudoscience and quackery by virtue of her background…”
Well, I winced. If only what followed had been “I know it’s only an elaborate placebo, but I ended up getting pregnant, so even though I know it didn’t really do anything, I am okay with that. Next time I’ll try massage.”
I have also not found women to be more empathetic than men. The author’s friends may say more about the author than about the general population.
And how anyone can generalize *half the world*, most of whom they obviously have not met, as living excessively… well. I’d say that was pretty stupid, and probably based on hearing some interesting propaganda or watching television to get information about “the West.”
If they’re not ashamed of James Delingpole they’re really not going to be the mildest bit embarrassed by giving space to Rowan Pelling.
That would be an effective permanent cure for just about anything.
From my experience as a female, I’ve noticed those who seem to try and convince me of woo’s worth seem to think I should respond more favorably to it because I am off the gentler sex. Many of those trying to convince me are other women, BUT, my experience is the original crank was a man. But those who have been taken in often rely on “men are meanies” argument when assume I’ll be easily convinced. NOPE.
I would be the first to admit that you never hear of anyone who requires a heart by-pass, or liver transplant, being healed by homeopathy or Reiki. I find it just as terrifying as any doctor when a cancer patient declares they’d rather not have an operation because they’re going to sit in a pyramid and meditate with crystals.
Since those are IMPORTANT things she’d never attempt to treat with quackery, and her promotion seems to be based upon fertility and related issues, where is the line drawn? Birth control? Ectopic pregnancy? Asserting something “may only be a placebo effect but that’s ok” is ok for what? What limit do we put on it? When is the time to step in and say, “ok, how about some evidence-based treatment?” It’s variable amongst woo-meisters, and that’s part of the problem: no standard of care. ESPECIALLY when money changes hands.
I would like to see these proponents start to offer their services to the less fortunate, or volunteer in developing nations like Doctors Without Borders, etc. See what’s more natural, health, and wellness-promoting, vs. those who proclaim those things but not without a fee.
Also, depending on what I was going for, a bottle of vodka and a hand-full of sleeping pills might be preferable, especially considering the lead involved Aruyvedic concoctions.
Well, I have a degree in English literature and I am highly insulted by your implication. Speak for yourself, my dear.
Right now the favorite way of closing down my objections to alternative medicine claims is to insist “It works if you believe in it!” Clearly, it wouldn’t work for me because I don’t have enough faith. Magic placebo effect indeed.
I once asked “if any medicine will work if you believe in it, then why doesn’t mainstream medicine work just as well as alternative medicine? After all, people have a lot of confidence in their doctors and in prescriptions.”
The answer: “I don’t know.” Which is honest enough — except that it’s accompanied by a clear indication that they don’t care either. Thinking things through rationally only harms the mind/body connection, which needs to be intuitive.
Nice tone trolling on this woman, but you plainly do have a sort of religious belief on this issue; it is hard to see any other explanation for your veneration of the Toothpick study, whose sloppiness and potential for bias you would surely have comprehended had the reported results been favorable to standard acupuncture. My religion, such as it is, does not dictate that acupuncture must work by qi or not at all, that it cannot work without breaking the skin, nor that one may never righteously compare the total effects of acupuncture directly to those of conventional treatment. Therefore, in my eyes the several studies showing greater net benefit for acupuncture than for conventional treatment at least equal the single weak and questionably interpreted Toothpick study, whereas in your eyes, no number of positive studies could ever challenge the ultimate verdict of the sacred Toothpick.
Meanwhile, though I have no opinion on the efficacy of acupuncture for infertility, I know someone who has now remained for years almost totally free of a once-chronic arrhythmia that “could never get better, only worse” while using acupuncture treatments that were shown to benefit that arrhythmia in two clinical trials. If I were to convert to your belief system and start preaching to him to give that up or be namecalled, I don’t think I’d get very far. And good for him.
Definitely, there’s a lot of sexism in CAM. The ones getting seriously rich are men, a disproportional number of the victims are women. And they draw in women by implying that science (as an abstract) is unfeminine and the culture of science (as a human activity) is sexist and unfriendly towards women.
Side note, based on a recent conversation I had with a friend who is inherently scientific but turned off by a lot of skeptics: Male skeptics, don’t be assholes to female skeptics or bystanders, and everyone remember that the real targets of the anti quackery movement should always be the perpetrators, not the victims.
At the risk of giving offense, I can’t help but wonder if the pleural of anecdote is a story about a persistent cough.
Jane – I don’t believe that Orac is tone trolling; he is saying that Rowan Pelling has written a credulous article that doesn’t correspond to the best known facts. He further states that she made statements that are overtly racist and sexist.
Which studies are you referring to here, Jane? Be specific.
Tell you what–let’s start with whatever single study you believe presents the most compelling evidence demonstrating acupuncture is an effective treatment for a specific non-self limiting injuriy or illness.
What does she imagine paneer to be? Anyway, everyone knows that cheese balances vata and vegetarians freeze to death in northern Europe without fermented foods.
As a long time reader of the Telegraph, a “serious” newspaper (or it used to be), I’ve noticed over the last few years regular articles espousing the supposed benefits of variety of quack remedies with the usual anecdotes. There’s got to be someone on the editorial team who is pushing this.
Harrumph. I spent over 20 years living in or around Cambridge, and I can tell you it is at least as full of complementary therapists as anywhere else i.e., sadly, to the brim.
I have heard many tales of couples only getting pregnant when they had given up hope. I wonder if resorting to a complementary fertility treatment was near enough to admitting defeat that these couples simply became more relaxed about getting pregnant, which finally allowed them to… get pregnant.
Oh, and I’d never heard of this hack/quack either.
jane,
I can understand you believing that over thousands of years of trial and error, Chinese acupuncturists found which points were beneficial for different conditions, and then came up with a spurious explanatory system i.e. meridians and qi. That makes a sort of sense. However, we now know that this is not how it happened at all.
Ancient “acupuncture” was, as Ben Kavoussi put it, astrology with needles, almost indistinguishable from medieval bloodletting and theories of humours. Modern acupuncture, the fine needles used, the meridians and the points themselves were introduced in the 1930s, moved away from the old positions over blood vessels.
Given this and the poor quality evidence for very small and mostly clinically insignificant effects of acupuncture, I fail to see why you defend it with such fervor.
Sorry, in a rush – link is long but intact.
Sastra:
No, you do not want them doing that. First of all, because they already do, and the results are predictably awful. Yet it discourages no one, because nobody sees their failures in the midst of such greater calamity. They go to disaster areas with their crystals and their needles and their therapeutic touch, they use up resources, they eat food and drink water, and they contribute nothing of use.
The most persistent offenders are the Scientologists, who sent planeloads of people into Haiti after the earthquake to perform auditing and other healing sessions with people. They came in totally unprepared, without even any food or water or idea of where they’d be staying, took up resources, and generally got in the way.
Calli Arcale #21 wrote:
You’re right — I certainly don’t!
(You quoted AnObservingParty, not me.)
@ Narad:
That site is amazing: I learn that, as a vata-pitta, I need not avoid cheese entirely and that sweets are not totally barred thus *ras malai* is alright. How did I know that?
Actually I’m taking an ailing person to the Pakistani Palace of Sweets and Savoury Treats which is his request. Curry is magic.
@ Krebiozen:
I notice that woo tends to gravitate to towns/ counties/ cities which are above average income level compared to their general area.
Fancy that.
Denice,
Especially curry with cheese; I recently made mattar paneer (that’s cheesy curried peas), but discovered at the last minute, when I tried to fry it, that the paneer I had just defrosted was actually wensleydale cheese (or similar). I threw in the cubes of cheese anyway, and it was delicious. Curried peas with cheese melting through it, what’s not to like?
Denice,
The only US university town I have been to is Ann Arbor, and that tendency does seem to manifest there too. Very much so.
Let me state clearly on behalf of the Respectful Insolence Ladies; none of us believe in Complementary/Alternative “medicine” for treatment of any disease/disorder/condition..or infertility.
@ Jane: Where have you been? IIRC, you made that same unsubstantiated claim about acupuncture stabilizing *your friend’s* arrythmia on this thread. When questioned about that unsubstantiated claim…you just disappeared.
https://www.respectfulinsolence.com/2013/01/16/more-credulous-reporting-on-placebo-effects/
Are you ready now to provide specifics…or are you still full of it?
Links please.
I have a degree in history and an orange cat.
The difference between my unrelated facts and hers is that neither of mine is a disadvantage in decision-making. I’m not arguing that because Hamlet (a fictional character) believed in ghosts, and then came to a bad end, that real people should also accept things without evidence. Is she sure she has a degree in English literature, if that’s her understanding of Shakespeare’s play? (Yes, if Hamlet hadn’t been in a revenge tragedy, he might have come out okay, and since he was he was probably doomed anyhow–but that still doesn’t make him a good source of advice.)
@ Calli
No, you do not want them doing that. First of all, because they already do, and the results are predictably awful. Yet it discourages no one, because nobody sees their failures in the midst of such greater calamity. They go to disaster areas with their crystals and their needles and their therapeutic touch, they use up resources, they eat food and drink water, and they contribute nothing of use
ZOMG. I must be more naive than I thought. That disgusts me. I knew about the Scientologists, but the others… I could never see someone like Mercola or Jones actually doing something like that for free.
the Telegraph, a “serious” newspaper (or it used to be)
I have only ever known the Torygraph as a purveyor of smug unchallenging pabulum, designed to tell its half-educated readership what they already believe and reinforce the certainty of their prejudices.
So in this case we have the obligatory and sufficiently-familiar Shakespearean quotation; cliches about “empirical, science-worshipping Cambridge”; the holistic and harmonious East…
The doctor’s diagnosis was “excessive Western living”. She was given acupuncture, “some odd tea that tasted like vinegar”, and a lecture on “the six excesses”. Finally, he told her: “Westerners know nothing of balance: they live a life of excessive indulgence, followed by excessive restraint.”
So someone went to a hospital in China where the doctors spent absolutely no money on treating her but took the opportunity to lecture her on Western inferiority. I am not sure what the message of the anecdote might be, except “don’t get sick in China”.
I would like to see these proponents start to offer their services to the less fortunate, or volunteer in developing nations like Doctors Without Borders, etc
ZOMG, no. About a year ago the Surgeon General’s office, which directs the Medical Reserve Corps, gently hinted to us local coordinators that we should “partner” with some entity calling itself Acupuncturists Without Borders*.
My official written response (endorsed by our director) was that I would be glad to accept any acupuncturist into our unit as a non-medical volunteer.
After all, we always need people who can unload trucks, set up tables and signage, hand out supplies, etc, jobs for which Acupuncturists Without Borders are probably qualified.
(Interestingly enough, a little digging revealed that AWB was so strapped for cash that it basically consisted of a website and one part-time employee. No wonder they wanted to hitch their wagon to the MRC’s star).
When I eat curry, there is “magic” alright–as in a magical “force field” that keeps family and pets repelled for 6-12 hours. It’s too bad, too, because it’s good.
Maybe they were trying to deflate her.
A completely off-topic but perhaps not extraneous comment….The veterinary profession has completely embraced acupuncture. One of the creepiest veterinary sleazes I’ve met in a while (I run a small animal sanctuary) stared at me devoid of affect–and thus empathy, I believe)–when I told her I had a very serious medical issue and was having trouble taking care of one of my animals. SHe immediately launched into a sales pitch for acupuncture for his problems.
Lo I discover that in order to qualify for malpractice insurance, licensed vets in the US must subscribe to all “standards of care” endorsed by the AVMA. These include an array of ridiculous homeopathic treatments as well as naturopathic “therapies” and, of course, acupuncture. I use five different vets. All of them peddle the very stupid Bach Rescue Remedy and about ten naturopathic preparations that are essentially dietary supplements. I’ve tried challenging them on the evidence for their use, and the argument is always that evidence in veterinary care must be held to different standards (?!?!. Anyway, acupuncture reigns unquestioned and unchallenged, and people are buying it.
Added to previous comment about acupuncture in veterinary medicine….I’m on the periphery of neuroscience as well as an old retired therapist who does a few other things now and has been an animal sanctuary director off and on.
There’s a growing body of evidence for subtle placebo effects in animals. I won’t use any vet who disputes that and tries to say otherwise. One longtime colleague who has spent a lifetime studying emotion and affective behavior in animals has identified many possible means of feedback between human and animal that moderates or potentiates a powerful cluster of placebo effects (my uninformed interpretation).
The complexity of placebo effects in animal medicine is beginning to emerge from a fog of denial. Perhaps the same might happen for humans in something like acupuncture if we can remove financial and other motives for failing to examine those possibilities.
@Sara #37: “There’s a growing body of evidence for subtle placebo effects in animals.”
Yes, pets do respond to a placebo effect, via cues from their carers. So do preverbal children. This is why acupuncture sometimes appears to work even in animals and babies, because it’s impossible to do a double-blind test.
What are these possibilities that haven’t been examined?
Ladies and gentlemen, welcome to 1984, where doublethink is the rule. Reading the excerpts provided by our host I could not stop myself from reading thinking about Orwell. “I know that empirical evidence shows acupuncture does not work, but I am self-admittedly naive so I will act like it does anyway.”
Now I am impatiently waiting for article about fairies from the same author, they are also said to live as long as you belive in them.
It isn’t only placebo effects at play here. In this account of the use of veterinary homeopathy the owner was convinced that the animal’s condition had improved when, to a trained vet’s eye, it had deteriorated. This anecdotal account (letter 3) from a vet describes the homeopathic treatment of acute moist dermatitis in a dog, where a marked worsening of the dog’s condition was seen as evidence of the treatment working:
This is similar to the way CAM practitioners treat humans: if your condition worsens, it’s a detox (Herxheimer) reaction and the treatment is working. I know that acupuncturists make similar claims. The vetpath website is worth a browse if you are not familiar with it, by the way.
Incidentally, how do acupuncturists know where to place needles in animals? Are there
ancient20th century pictures of the meridians and points on dogs, cats, horses, guinea pigs etc.?As for arrhythmia and acupuncture, he’s an abstract of one study (I found two or three of them but they were all behind paywalls):
So, just 80 patients in the whole study, with just 16 of them receiving acupuncture alone. And even with such a small group, it still shows that drug treatment works better than acupuncture.
@ Shay,
I’m assuming no one took you up on your offer?
This opens a whole new world of woo-fighting for me. I was hoping it would more make a point about motives anfd money and developed world luxury (of which a CAM is used in places like the US, Britain, etc.), but wow. Blows my mind that someone could see CAM being useful after a typhoon or earthquake or in the midst of a civil war or famine.
Yes, Sara: placebo effects are observed to occur in animals as well as humans. The only appropriate respond for you’re reminding us I can see is “Did you have a point?”
If acupuncture only ‘works’ by means of placebo effect then by definition it doesn’t actually work at all.
Right now I am envisioning what how an acupuncturist would proceed with my 19 lb, muscular and occasionally unruly, very large cat. Heh.
I’m assuming no one took you up on your offer?
Bingo. Just like the animal rights activitists who spent six months earlier this year making our dog wardens’ lives miserable, protesting the alleged inhumane conditions at the county shelter.
Our director offered to allow them to volunteer there (published in the local fishwrap). The response has been … nada.
Denice,
How could it possibly go wrong?
Of course cats are nature’s acupuncturists, which is why cat owners are always in such good health (apart from the toxoplasmosis).
@Kreb @46
Cat owners are healthier because of routine bloodletting administered by the cat.
Oh, and there are SOME vets who think woo is woo. I am a veterinarian, and, consequently, a seriously nightmarish client for the vet practice that sees my animals. I chose them BECAUSE there was no hint of anything but science-based medicine. It was never suggested that my old creaky dog have acupuncture, or massage (other than what I do anyway–it’s called petting), or anything else too weird for words. I wish I could say all my colleagues were so scientifically savvy, but I think there’s an optional class on acupuncture at the local vet school.
@ Shay @ 45
I’m not surprised the local animal extremists can’t be bothered to actually HELP the animals–that would involve working at something other than maintaining a state of personal outrage.
@janet
Our Animal Control officer was not a happy camper after the director made his offer, anticipating a flood of loopy crunchies squatting in her office and telling her better ways to socialize pit bulls.
She was very, very relieved when none materialized, I must say.
(I personally am the patient of a small polydactyl calico who obviously was given those extra toes for my health benefit).
Because I have an immense store of totally useless minutiae and trivia, I am linking to Hemingway’s polydactyl cat.
http://www.hemingwayhome.com/cats/
Denice Walter: 19 lb cat !!
@ lilady:
Yes and he’s not overweight. His toes on his hind paws are each about as large as my own smallest toes.
Google European wildcat you’ll get an idea.
Re the polydactyls:
someone managing a shop features excellent photos of a polydactyl cat’s front paws as its ‘opposable thumbs’.
It probably texts.
AdamG and Mrs Grimble – Go to PubMed and look up “atrial fibrillation acupuncture”; among the 15 links, which include case reports and brief mentions of small studies, will be:
Xu annd Zhang, Zhongguo Zhen Jiu 2007;27:96-8 (in Chinese), showing an acute cardioversion rate of 85% in the treatment group vs. 67.5% in the control group, which received IV amiodarone (a notoriously toxic drug).
Also Lomuscio et al., J. Cardiovasc. Electrophysiol. 2011;22:241-7. This is the study that was summarized in Mrs. Grimble’s link (which is not an abstract; the real abstract is available on PubMed). Recurrence rates are so variable that the difference between 27% and 35% in a small study is probably not statistically significant. However, the difference between acupuncture and sham or no treatment was, we are told, significant (p = 0.009 and 0.017). Further, one reason why rate control is every bit as good as rhythm control is that rhythm control drugs are very toxic, whereas acupuncture almost never has serious side effects.
Patients therefore might very well be wise to try acupuncture and see if it works for them before going on, say, amiodarone, which can cause other, more dangerous arrhythmias, plus irreversible lung damage, liver damage, thyroid damage, eye damage, and on and on. I do indeed know someone who made that exact choice and so far it has worked out very well for him. Lilady, who only knows how to argue via ad homs, seems to think it’s okay for her to claim that I must have invented this person out of whole cloth – why?? – if I don’t obtain all his medical and acupuncturist’s records, post them on a public website, and provide you a link. Don’t think he’d go for that.
So froth away, lilady. You remind me of an MD who tells a person suffering from statin toxicity after rechallenge that her muscle pain must be all in her head: any experience that an individual human has that does not fit with your belief system can’t just be the result of natural variability or idiosyncrasy, but must be non-existent, because your beliefs must always and in every case be right. That, my dear, is what I call a religion.
@Denise:
I don’t know about texting, but she’s dam’ good at standing on keyboards.
The idea of veterinary woo really frosts me…if you want to waste your money on something that has never been proven to work go ahead. But if you inflict it on a poor dumb beast who can’t bypass you to ask the vet for something to stop the pain instead of twigs and toothpicks…arrgh.
@ Jane: I asked you some specific questions about your “friend” on the other thread…which would not have compromised his identity:
https://www.respectfulinsolence.com/2013/01/16/more-credulous-reporting-on-placebo-effects/
What the heck is “Wenxin Granule”?
http://www.productsx.net/sell/show.php?itemid=160
P.S. I don’t read Chinese and you are still full of it.
Re the polydactyls:
I have a posable thumb right here!
http://3.bp.blogspot.com/-532AfHXHG88/UoAepkfEQDI/AAAAAAAAN6I/pN8i6vJKu0A/s1600/paws.JPG
(not my cat, but one of my acquaintance).
The risk of becoming an intermediate host of T. gondii from exposure to a litter box is limited to about 2 weeks, tops, in the life of the cat, on the off chance that it picks it up the parasite in the first place. Raw pig liver doesn’t seem to be a good idea, though. It appears that municipal drinking water is a frequent culprit.
On the other hand, my eldest will bite upon overstimulation. Got one last night while reading and absent-mindedly petting. Get it to bleed, then chlorhexidine, then topical gentamycin. Looks good today, but there’s doxycycline as a backup.
Does Jane?
Giving the poly a pill is a challenge.
(I usually let the spousal unit do it).
Ah, dear, dear lilady. Here are the “questions” that my failure to pre-emptively answer caused you previously to refer to the gentleman’s existence or experience as “bullshit”, together with their answers.
“Why was the man seeking a atrial ablation for intermittent episodes of A-flutter?”
As I said repeatedly, he wasn’t seeking an ablation, but a cardioversion. I noted in an earlier thread, perhaps that one, that your apparent lack of awareness that these are two utterly different procedures is worrisome in a former nurse. When he had arrhythmia, it had been persistent, each period continuing for months, so “intermittent” is also the wrong word. It would rarely be sensible to get cardioversion for a recurrent paroxysmal arrhythmia.
“What medication was the man prescribed by a cardiologist, before the cardiologist referred him to electrophysiology cardiologist?”
He was taking a beta blocker and low-dose digoxin (which had been necessary for effective or tolerable rate control during his first diagnosed long periods of flutter), as well as two blood pressure drugs and one unrelated pill. No rhythm control drugs, though the electro he saw the most tried repeatedly to pressure him to take a very toxic drug. He also went on warfarin for some weeks to try to get approved for a cardioversion; before that, he’d been on aspirin.
“Did the man undergo cardioversion?”
This is another one of those points where if I did not answer your question, it was because the question was too loony to be believable. I specifically stated in my first mention of this case that because he was facing a lengthy delay in cardioversion, with at least another month or more to wait, he went to try acupuncture, and almost immediately after the second session, he spontaneously converted. He did ten weeks of weekly acupuncture sessions and then went to biweekly sessions, where he also gets treatment for things like backaches. Since then, he’s never had more than a rare period of arrhythmia lasting hours or a day or two, though he was told that he would certainly have it for the rest of his life, no matter what he did to modify his risk factors.
“Where are the studies that you claim show acupuncture to be effective in restoring normal sinus rhythm?”
Cited above. You know, I don’t understand the sort of religious belief that says “I think any person should rather have X symptom than use Y treatment and not have that symptom.” To me, pragmatism is what matters. If you personally have a symptom whenever you eat a certain food, or your symptom goes away when you drink a certain tea, have at it. If there is evidence from scientific studies that a substantial fraction of people might experience the same effect, as in this case, great – but if there’s not, so what? People with paroxysmal AF, which is a rather different condition, report all sorts of ways of avoiding or stopping it, some of which may be idiosyncratic; since such methods are not Scientifically Proven, should they assiduously avoid those methods and, effectively, seek to maximize their suffering?
“Radix Codonopsis Pilosulae, Rhizoma Polygonati, Radix Notoginseng, Succinum, Radix Et Rhizoma Nardostachyos.”
I.e., “poor man’s ginseng,” rhizome of Solomon’s Seal, another pseudoginseng, amber, and rhizome of spikenard.
@Jane,
I suffer from paroxysmal AF. I have struggled to identify the trigger factors – caffeine and alcohol play their part, long since abandoned now, but as to what drives the AF at other times is unclear (PS I am a consultant physician, and have an electrophysiological consultant looking after me).
I take beta blockers, but have declined flecainide, and also declined ablation at the moment.
Now I previously had episodes 3 or 4 times a week, but recently have had no episodes (a “spontaneous” cure, as you would call it?). So what led to this?
If I were a gullible idiot, I might have concluded it was because I had acupuncture. (actually I didn’t). The real reason is obviously because I took my dog for a walk down to the beach instead of the usual walk in the park the day before my “cure”. Stands to reason, doesn’t it? Nothing else was different, and so the coincidence is just too great to ignore.
Walking dogs on the beach cures PAF.
@ dingo 199: My husband was in A flutter, January 2002. He was originally treated for flu with Tamiflu 10 days prior when he was in normal sinus rhythm and feeling achy. He went to our PCP, because he was feeling winded when climbing stairs; his resting HR was 180. He declined an ambulance and drove himself to the ER. I arrived shortly thereafter and it was determined his liver enzymes were elevated. The GI doctor did not do a virology study and the ID doctor I called in to consult was “reluctant” when I insisted on a virology panel. P.S. he had acute onset EBV:
http://www.cdc.gov/ncidod/diseases/ebv.htm#specific
He underwent cardioversion immediately, which put him in normal sinus rhythm, after he underwent a TEE (Transesophageal Echocardiogram), to rule out blood clots
After the cardioversion his cardiologist wanted to put him on Amiodarone, and I refused that medication on his behalf…because a close relative had one of those rare reactions to that medication. He died on December 31, 2001 on a ventilator because of Amiodarone ARDS lung damage.
That relative was ineligible for cardioversion because of an aortic aneurism.
My husband underwent a minimally invasive R atrial ablation for A-Flutter June, 2005 after that cardioversion and a minimally invasive L atrial ablation for A-Fib September 2008. Following the L atrial ablation, he was prescribed Sotalol and LMW heparin injections while titrating coumadin into therapeutic range.
Both procedures were life savers for my husband who underwent a minimally invasive drug eluting cardiac stents placement procedure, February 2011.
@ Jane: You’re still fill of it.
Lomuscio et al., J. Cardiovasc. Electrophysiol. 2011;22:241-7.
Fortunately the authors take a second bite of the cherry and report the same data set in an open-access journal:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312232/
Lomuscio et al. report that ineptly-performed acupuncture increased the rate of recurrence to 69% (i.e. 9 cases out of 13 in the “sham acupuncture” arm), compared to 54% without treatment (13 cases out of 24 untreated patients).
I am a bit puzzled, then, that anyone would claim that acupuncture almost never has serious side effects, when that seems to be what it is doing here if the Neiguan spot is missed. Unless, of course, we conclude that the numbers are simply too small and the variations within each group are too large for valid comparisons.
Narad,
It is not too unlikely if you have enough cats about the place and aren’t careful about hygiene around kittens’ litter boxes. I subscribe to the “crazy cat lady (or occasionally man) syndrome” hypothesis. You don’t often find people with their homes full of hamsters or terrapins, but cats…
I may be cynically biased as, for reasons too long and tedious to go into here, I recently found myself in the middle of a ‘cat war’ between two, er, eccentric women who both seem to collect stray cats, and one of whom doesn’t believe in neutering cats and does suffer from toxoplasmosis (or so she says).
Sigh. Link works at beginning.
I have to run out, but what’s the congenital transmission rate for kittens? They have to be taught to hunt. This item, which is 12 years old, mentions that transmission by milk is “suspected.”
[…] A rather clueless defense of CAM from across the pond [Respectful Insolence] (scienceblogs.com) […]
Narad,
Vertical transmission is rare according to this paper.
This paper on the impact of toxoplasmosis infection on host behavior might be interesting to those who have access. I’m still clinging to the crazy cat person hypothesis, based on my anecdotal experiences and cognitive biases.
When I wrote “toxoplasmosis infection” I meant, of course, “toxoplasmosis” or perhaps “toxoplasma infection”.
Yah, it occurred to me on my way to the store that neonatal shedding would be of little consequence given the way that mother cats deal with kitten scat. Not too many people wind up dealing with kittens of this age, although I’ve done it for one (he who bit me last night) from day zero.
I don’t think I’ve read the Webster, but it’s made the rounds enough that I’m familiar with the results as far as mice are concerned. It seems wholly speculative as a real-world effect on predation behavior, but this isn’t exactly uncommon when it comes to F. catus, as Vox Felina is often called upon to note.
This entry in the Annals of Credulousness is a standout (then again, Oberlin), but it does lead to the Lafferty paydirt (I had no idea that there was now a metric for the “strength” of the “superego”).
The practical problem remains that it’s really freaking hard to get the parasite from a cat unless you happen to be ingesting its feces at just the right time.
There’s some kind of off-colour joke about Ms Pelling becoming pregnant after receiving a bunch of little pricks, but making that joke would lower the tone of this blog, as well as being terribly misogynist to boot.
dingo199 – If you’d started walking your dog daily and your AF went away, I’d keep walking the dog. As I have said before, it is possible that the benefit observed by the individual I mentioned is pure coincidence and unrelated to the statistical benefit observed in clinical trials, and that his former electro was just stupid or trying to sell procedures in telling him that his condition could never get better. But it doesn’t cost him much to keep doing what was directly associated with a putatively unlikely cure.
herr doktor bimler – The trial had four arms, and the difference between the two low-recurrence arms and the two high-recurrence arms is statistically significant, while the difference between relatively similar values is not. People who regularly read publications that involve statistics see that kind of situation constantly. Of course, a larger study could provide more precise statistics. There’s a wide gulf of value judgements between people who hope that such a study will be done and people who hope that it won’t be.
lilady: “@ Jane: You’re still fill of it.”
Full, dear. I could argue in return that your story is “bullshit” – for one thing, very few atrial ablations can be called “lifesaving” – but instead, I’d like to comment on the fact that your constant reliance on ad hominems is direct evidence that your beliefs are religious in nature.
You see, in any society that allows any intellectual freedom, people’s beliefs will vary. Thus they are confronted with the question: if the factual and moral dogmas of My Favorite Deity are self-evidently true, how can it be that many others don’t accept them? The only answer for most monotheists is that they haven’t “heard the truth”, if that’s possible, and otherwise, that they are bad, inferior people: they are the Reprobate, or they are infidels who serve the Devil.
Now, you have certain beliefs that you expect everyone to adopt. Some are theoretically provable (e.g., acupuncture can’t possibly work via nervous system stimulation), while others are obviously value-dependent (e.g., certain scientific data and human experiences shall be treated as unquestionable, others rejected out of hand). If you belong to the appropriate civil religion, you will term these beliefs Rational. If by this you actually meant that they could be derived by applying logic and reason to widely accepted or personally observable facts, without no influence from culture or emotion, then you would be able to lay out arguments for each belief that would convince anyone with a little intelligence and education who was willing to read the arguments.
But you can’t – not that I have seen you try. You’re surrounded by educated, informed people who do not share all of your beliefs. If those beliefs are unquestionably true, why not? Like the theist, you fall back on the idea that those who disagree do so because they are fundamentally inferior people. They are irredeemably stupid, ignorant and Irrational, no matter what their educational and scientific background. Or better, perhaps they are evil and seeking to deceive the righteous (hence, everything I say, including well-publicized facts and personal observations, can be pretended to be lies and “bullshit”).
Most such beliefs are unprovable, but we all must have them to get through our daily lives. You have a cold; do you want some ginger tea? To say either yes or no, you must have some sort of belief, and it must be derived in part from your culture and emotions. Therefore, it’s not a flaw in your brain or your beliefs that many of the latter are unproven. It is, however, an intellectual failing when a person starts to assert that her unproven beliefs must be everyone’s dogma.
typo apology – “without influence”
Women can certainly be sexist, even (or maybe especially?) about women, particularly when it comes to gender-essentialist stereotypes. I have a degree and a half in English literature (my Master’s is in essentially applied rhetoric, but all my electives were in literature), and I’m not that kind of credulous. Maybe a little naive about people sometimes, and definitely embarrassed by her assertion that English degree = ditz, but accupuncture? Phft.
The trial had four arms, and the difference between the two low-recurrence arms and the two high-recurrence arms is statistically significant, while the difference between relatively similar values is not.
And when you pool the groups into larger groups not because of a prior hypothesis, but on the post-facto basis of patterns in the data, then the hurdles for using the same data to test the significance of that grouping become higher. Did the authors apply the appropriate correction?
There are, after all, seven ways to group four arms into two larger groups, giving you multiple bites at the significant-finding cherry.
More importantly, after pooling experiment arms in the pursuit of significance, the outcome is this:
A larger group of patients, dominated by ones receiving treatment but including some receiving acupunctural non-treatment, responded better than a group comprising those receiving sham non-treatment and those receiving overt non-treatment. This doesn’t actually tell us anything about acupuncture.
People who regularly read publications that involve statistics see that kind of situation constantly.
As indeed do people who regularly *write* publications which involve statistics.
I didn’t see any cherry-biting. There were four prespecified groups – amiodarone, acupuncture, sham acupuncture, and control. Pooled active vs. non-active groups might provide more impressive P values, but the original abstract on PubMed explicitly states that there were statistically significant differences among individual groups, though not between amiodarone and acupucture. I don’t have access to that paper at the moment, but another publication in which they reference it also says that acupucture was significantly different from the two non-active groups considered separately.
You see what you are doing: you don’t like the results, but you can’t actually demonstrate that they aren’t, as reported, statistically significant. You imply that you regularly write papers that use similar statistics? In that case, if their numbers were blatantly erroneous, surely you would be able to explain why. Therefore you settle for hinting darkly that the researchers must have, somehow, phonied up their numbers, because some “alternate way of knowing” tells you that they just can’t be true. In other words, we’re back to: “They report observations I don’t like; they must be bad people.”
@ Jane: Did you forget that we have proof on this thread about asthmatics, that you are indeed, “full of it”?
https://www.respectfulinsolence.com/2013/01/16/more-credulous-reporting-on-placebo-effects/
You first commented on placebo effects for asthmatics who underwent needling (comment # 13). You claim to be a scientist (small s) with a list of publications, yet you didn’t know the difference between subjective and objective outcomes. You then proceeded to insult every other poster on that thread.
Here’s your comment at # 47 where you first introduced us to your “friend” who you claim is successfully treating his A-Fib with acupuncture:
“I also can’t say whether or how acupuncture works for an unspecified “tachycardia”, but at least two clinical trials and a case report have reported it to have some benefit for atrial fibrillation. The individual I know who used it to stop the persistent atrial flutter he was allegedly doomed to suffer forever has no way of knowing for certain that he remains free of it because he continues to use acupuncture, but he doesn’t seem inclined to stop so long as he remains healthy. He says it makes his knees feel better too. Who am I to tell him that his knees don’t really feel better and he must be stupid or gullible to think they do? Nope, not going there.”
“Nope, not going there” Jane? That didn’t prevent you from blathering on…and on…about NSAIDs, Reynaud’s Disease and seizure disorders.
I started posting at # 84, asking you for some details about your “friend’s” “doomed to suffer forever A-Flutter”. You were very evasive and then proceeded to insult me, with Ad hominem references to my supposed age-related dementia.
BTW, I don’t give a flying fvck about your ignorant, uninformed opinion about my husband’s minimally-invasive life-saving cardiac procedure.
You’re still full of it, Jane.
You see what you are doing: you don’t like the results, but you can’t actually demonstrate that they aren’t, as reported, statistically significant
Naturally that’s not how I see my comment…
I read it as two things:
1. A minor request for clarification, in case some out there has access to the paper: did the authors apply a Bonferonni correction for repeated comparisons (or the equivalent), to compensate for their post-facto grouping of arms? If not, it doesn’t invalidate the study, but makes it a an exploratory one — an inconclusive report of an interesting observation which someone with access to more patients might want to check.
2. More importantly, the observation isn’t that interesting. To repeat… the authors report that the group pooling treated patients and acupunctured ones, performed better than the group pooling sham-acupunctured and untreated patients. So there is a difference among treatments but we don’t know where.
There were four prespecified groups – amiodarone, acupuncture, sham acupuncture, and control
And the decision to pool them into two larger groups (out of all the possible arrangements for pooling them) was post-facto — done on the basis of their results, to enhance the difference between the larger groups. It was “capitalising on chance”. When using the same results to test that difference was significant. you need more stringent statistics.
Remember that the objections above only apply to comparisons between the pooled active groups and the pooled non-active groups, as in the figure included in the authors’ paper that is available from PubMed. (I don’t know if the authors would agree that they might just as well have combined acupuncture and nothing into one group, amiodarone and sham acupuncture into another. There are cases when alleged post-hoc analyses have turned out to be part of the original study design. But so be it.) The objection DOES NOT apply to comparisons between amiodarone and real acupuncture, between amiodarone and sham acupuncture, or between real acupuncture and sham acupuncture. Those are individual treatment arms and comparisons among them are the fundamental purpose of the study. If you think that the results are not interesting – well, that’s a value judgement.
We do know precisely where the differences are. The study abstract reports the number of persons in each arm and the percent recurrence in each arm, which should allow you to calculate the number with recurrence. You could then take those eight numbers and do some stats. Of course, sometimes one kind of statistics will say that there is a definite trend and another will say that there is not, so if you got a P value above the sacred but arbitrary .05 using a method other than the authors’ method, that would not be definitive, but it would reduce confidence in the strength of the results. If you got higher P values than they report using the same method, that would be grounds for suspicion. On the flip side, if you can’t find a way to get P>.05 using a method you can explain in public, then you might need to stop slandering the authors.
“Slandering the authors”? Hey now. I like to think that when I slander someone I do a more thorough job of it.
Is this the study you are discussing, or is it the same authors’ earlier one? I’m having trouble understanding the study design of the one I link to above. Why are they comparing amiodarone or acupuncture to no treatment or sham acupuncture, as in the Kaplan and Meier plots of Figure 3? I can see no rational basis for this. We know amiodarone works already. The comparison in Figure 4 is between baseline, and during acupuncture, and after follow-up, not with a control group, which doesn’t really tell us much. I find myself suspecting that the authors are trying to manipulate their presentation of the results to make them look as positive as possible. I also wonder why there is a statistically significant difference between sham acupuncture and no treatment, with the sham acupuncture patients doing worse.
I see no reason why stimulation of the nervous system through needles could not have some effect on AF, though if acupuncture does have such an effect I suspect it is more by luck than by judgment.
My brother was born with a hole in his heart and also suffered from paroxysmal tachycardia, which my mother was taught to treat by pressing hard on his eyeballs. It sounds barbaric, but the stimulation of the vagus nervewould slow down his heart. These days he relies on a pacemaker. My point is that physical stimulation can have effects on the heart’s pacing.
Sorry, I seem to lost the ability to properly close href tags recently. The link works anyway.
Is this the study you are discussing, or is it the same authors’ earlier one?
The earlier one — ref. 15 in the WJC paper. The WJC paper is reviewing the same ground, hence the cursory description of the study design.
54 patients were “on anticoagulant therapy and were randomized to acupuncture, sham acupuncture and no antiarrhythmic therapy”; while a separate group of 26 patients already “on amiodarone was considered as a reference group.” I’m guessing here that for the randomised patients not to be placed straight on AMIO then they differed in some way from the “reference group” — milder cases, perhaps? — so any comparisons become problematic.
I also wonder why there is a statistically significant difference between sham acupuncture and no treatment, with the sham acupuncture patients doing worse.
You may have misread the Abstract (which only states that the sham groups and untreated groups were both worse than the AMIO group; the higher recurrence among sham acupuncture controls does not seem to be significant).
Jane misread the abstract in comment #51, taking these same two comparison (with (p = 0.009 and 0.017) as “the difference between acupuncture and sham or no treatment”. So in the interests of parity, it is probably my turn to misread the abstract now.
Jane @78:
The objection DOES NOT apply to comparisons between […] real acupuncture and sham acupuncture
The Abstract does not report that comparison.
comparisons among them are the fundamental purpose of the study
…so if the results were significant, why are they not reported?
We do know precisely where the differences are. The study abstract reports the number of persons in each arm and the percent recurrence in each arm, which should allow you to calculate the number with recurrence. You could then take those eight numbers and do some stats
If only reverse-engineering the raw data were so easy! But I call your attention to the closing words of that paragraph:
This does remind me that I meant to squeeze in a remark somewhere relating my surprise at my cardio’s mentioning that VI4GR4 is supposed to be gangbusters for Raynaud’s, which I had said seemed to be worse this year. I forgot to crack wise about whether it had been directly compared with the well-known vasodilator “rheumatis’ medicine”.*
So there it is.
* The caption is of course wrong—Granny was Jed’s mother-in-law, not a Clampett.
Thanks for the “Forbidden” link, Narad. 🙂
HDB,
No, I misread the later paper, which states:
For some reason I read “or” as “and” in the second paragraph, which makes all the difference.
I don’t usually have this much trouble getting my head around a study’s design, which makes me suspicious it may not be designed with clarity and transparency in mind.
herr doktor bimler – You’re right that I quoted the wrong P values from the abstract. However, as noted above, we are also told that the differences between real acupuncture and sham or no acupuncture were indeed statistically significant. But you’re wrong to imply that there is something fishy about controlling for well-known risk factors. In fact, since the people who had already been put on amio may have been more likely to have low ejection fractions – one of the few reasons that can justify using that very toxic drug, provided you’re a rhythm-control true believer – and people with heart failure are more susceptible to AF, correcting for LVEF would be more likely to have increased than decreased the apparent superiority of amiodarone over acupucture.
Krebiozen, the reason you compare acupuncture to amiodarone “which we know works” is that if you compare acupuncture only to sham acupuncture (which may well be equally bioactive in many cases) and/or to no treatment, even obviously positive results could still be presumed by some parties to be so far inferior to conventional treatments that nobody should consider using them. In this case, the head-to-head comparison allows people with values permitting it to conclude that the difference in benefits is not so great, considering the relative risks, that it’s not worth trying acupuncture. Most of the world outside America considers studies that compare two active treatments to be at least as informative as studies that compare only an active to a lack of treatment.
You, by the way, slander the authors in the message above by suggesting that because you misread a word and were otherwise confused, perhaps their study was intended to be unclear and non-transparent! (They report heretical results: I bet they are Bad people.) I have no problem comprehending the basic study design. If the writing is not perfect, well, I note that they are Italian and writing in their second, or more likely third, language. I would not dream of attempting to write a journal publication in my third language, so from that perspective I think they did a pretty good job.
lilady – You respond only with more falsehoods, unsupported questionable medical claims, cursing and character assassination (if I happened to mention that the sun rose in the east, you’d likely say that I “claimed” it). All this just reinforces your resemblance in my mind to a fundamentalist confronted with confident rejection of one of his dogmas. Can you say anything positive for yours? Pick out any premise that, in your mind, supports your fervent denial of any possible benefit from acupuncture for any condition, state it explicitly, and offer a proof for it that depends only on the application of logic and reason to generally accepted facts. Since I claim to be a publishing scientist with a science PhD and further claim to have taken a course in symbolic logic way back when, I claim that I’ll be able to recognize an airtight case if it is presented and that I’ll admit it if so. If you can’t even try to do that, well, I am trying to stop arguing about religion with the religious; “it wastes your time and annoys the pig.”
jane,
You misread my comment. In the Kaplan/Meier plot they didn’t compare acupuncture to amiodarone, they apparently compared acupuncture and amiodarone as a group to no treatment and sham acupuncture as a group. I asked what the point of that is as it makes no sense to me.
Not at all. It has nothing to do with me misreading what they wrote or any prejudices I may or may not have. I have read hundreds, perhaps thousands of studies over the years and I have rarely struggled to understand what a study’s authors were trying to do as I have with this one. It has nothing to do with them writing in their second language either, I simply don’t see what they were trying to achieve with the study design they used.
They had two groups, the first was patients with persistent AF who underwent electrical cardioversion to restore sinus rhythm and who were on anticoagulant therapy; these patients were randomized to either acupuncture, sham acupuncture or amiodarone. The second group were patients with frequent symptomatic paroxysmal AF episodes present for at least a 6-mo period, mostly on antiarrhythmic drugs; these patients were all given acupuncture.
Clearly the first group of patients were more unwell than the first group, but only a third of them were given acupuncture, while the less unwell second group were all given acupuncture. These two groups were combined in the statistical analysis, making it more likely that acupuncture patients would have a better outcome.
Also there was no control group for the second group, they just compared the number of episodes they had before and after acupuncture. This seems like a terrible way to design a study. Have I misunderstood this somehow?
In that case, perhaps you could explain why they combined the two groups for their analysis and also take look at Figure 3 in the study I was referring to and explain to me what they were trying to achieve. I don’t get it.
Sorry, there’s a typo in that comment, it should read:
There was a control group on amiodarone.
Also, it should read “more unwell than the second group”, perhaps I shouldn’t try to comment and cook at the same time.
[Curried parsnip soup with wholewheat bread rolls full of seeds and topped with sunflower seeds, since you ask]
But you’re wrong to imply that there is something fishy about controlling for well-known risk factors
I did not imply any such thing, and I have to wonder what strange presuppositions you are bringing which allow you to draw such an inference.
What I pointed out was the impossibility of your earlier suggestion — of reverse-engineering the researchers’ original data, and using it for my own statistical tests — because as well as analyzing the proportions of recurrence, they had (quite rightly) controlled for other variables.
Only A THIRD of the MORE unwell group got acupuncture BUT ALL of the LESS unwell group got it
and these groups were combined!!!!
PLUS no controls for the second group ( LESS unwell).
Put into (my own) numbers
Acu group = X more unwell + 3X less unwell
no acu group= 2X more unwell + 0 less unwell
etc.
Doesn’t that say it all?
They had two groups, the first was patients with persistent AF who underwent electrical cardioversion to restore sinus rhythm and who were on anticoagulant therapy; these patients were randomized to either acupuncture, sham acupuncture or amiodarone. The second group were patients with frequent symptomatic paroxysmal AF episodes present for at least a 6-mo period
There was a control group on amiodarone.
Not strictly true. The authors were conscientious about describing the amiodarone group as the reference group, because they were not controls. They were not balanced for clinical state.
So the original paper (behind paywall) reports 80 patients, in two groups — 26 who’d been put on amiodarone, and 54 who were healthy enough to randomise to acupuncture or sham or complete non-treatment.
The second paper in WJC reprises those data, but includes a second study with a third group of patients, as corroboration.
SO Figure 3 in the WJC paper is pooling the first two groups (but not the 3rd group) — it combines the AMIO reference group of 26 patients with the healthier 18 patients receiving acupuncture, and compares them against the 36 patients who were receiving inept acupuncture or nothing, and finds a significant difference… “significant” in the statistical sense but not in the sense of “telling us anything useful”.
HDB,
That makes a little more sense, thanks. I decided to focus my attention on the study I can access the full text of, as I have been misled by abstracts before. I am still separately bemused by:
(i) the two groups, the persistent AF group randomized to acupuncture, sham acupuncture or nothing, and the paroxysmal intermittent AF group all getting acupuncture and
(ii) that Kaplan Meier plot that doesn’t appear to tell us anything useful at all.
I also meant to emphasize the fact that the WJC group that were all given acupuncture were also mostly on antiarrhythmic drugs. I can’t see how that was controlled for in the study.
This has given me a headache; perhaps I have low-T.
Jane: Just because you were caught on another thread making stuff up when you confused subjective and objective end points of a study on the effects of acupuncture and asthma patients, does not give you the right to make Ad hominem attacks on other posters.
Did you happen to read my husband’s medical history that I provided to dingo199 on this thread? Did you happen to draw the conclusion that my husband’s persistent a-flutter was diagnosed as viral (EBV) cardiomyopathy? He was hospitalized for ten days before he underwent successful cardioversion and then maintained on Toprol. I refused Amiodarone on his behalf because a close relative was on short term Amiodarone and developed ARDS and died while on a ventilator for three months.
My husband then developed persistent A-Flutter…underwent a successful R. atrial ablation and a few years later underwent a successful L. Atrial ablation for persistent A-Fib. Both were minimally invasive procedures (femoral artery cannulation).
You have not shown us any studies to prove that acupuncture alone without Amiodarone, which you claim your “friend” underwent, is successful in treating paroxysmal A-Flutter/A-Fib or persistent A-Flutter/A-Fib.
Are you certain that your “friend” wasn’t suffering from “Holiday Heart”, eliminated the ETOH and caffeine and convinced himself and you that acupuncture cured him?
http://heartdisease.about.com/od/atrialfibrillation/a/holiday_heart.htm
These comments might be a lot less gassy if you could do them in lambda form.
I am still intrigued by this statement (Jane @51):
acupuncture almost never has serious side effects
Is this an empirical observation? — “acupuncture has not been reported to have serious side effects (excepting the occasional pneumothorax)”? Or is it a statement of principle — “acupuncture can only affect the body in a beneficial way”?
Now evidently the authors of the Lomuscio study adhere to the latter principle, for they were conducting sham acupuncture as a control, i.e. needling patients in places away from the intended node — which would be unethical if they accepted any possibility that this could have deleterious effects. I note in passing that they evidently espouse what one might call “strong acupuncture”, i.e. they believe that it is not needling per se which improves health, but has to be needling in the right place laid down by 70 years of age-old tradition. This allows them to treat the misdirected needling group as a control.
But even so, the 13 sham-acupuncture patients performed *worse* than the untreated patients. Due to the small numbers, one can discount this difference as unproven, if one clings to certain arbitrary probability levels as a shibboleth.
But if we are open-minded enough to accept that the Italian group’s results deserve further study, we also accept that this negative effect from misdirected acupuncture also deserves further study. Does anyone have any ideas how this can be done ethically? How ethical can acupuncture research be, with the possibility of needling the wrong spot and worsening the patient’s condition?
Krebiozen – the paper whose complete text is available online includes discussion of some previously published data from the study whose full text is not freely available. That paper’s Figure 3 does compare two active treatments together to two non-treatments together, which is not ideal; a figure with four lines would have been more busy but more informative. However, the original paper did compare people receiving only acupuncture to people receiving only amiodarone. I am not sure how people have started declaring the opposite. Perhaps there is not much more to be said about this paper. It is certainly small and preliminary but I see no reason not to think that it offers adequate justification for doing more definitive studies. (And so long as those studies are not done, I see no reason for patients not to try promising, relatively cheap and safe alternatives.)
herr doktor bimler – The numerous clinical trials that have been done on acupuncture report very few side effects; this statement is not a religious dogma but a fact. If acupuncture research involving wrong-point “sham” acupuncture were unethical because of the hypothetical possibility that such would make the patient’s condition worse, then (a) almost all research on novel pharma drugs or devices would also be unethical and (b) you could confine yourself to comparing acupuncture to no treatment or to conventional treatments accepted as active, both of which provide data more relevant to consumer interests. However, there are some studies in which various types of nerve-stimulating “sham” acupuncture are equal to traditional acupuncture and better than placebo, and some in which they are inferior to acupuncture. Thus there may be clinical equipoise regarding whether non-traditional and traditional acupuncture are equal for a little-studied condition – and that makes studies with a sham arm both ethical and potentially valuable sources of information as to mechanism.
lilady – Heh! Again you try to make this about me being a Bad person – unstated premise, if lilady says that a person makes things up, they must be making things up. I take it that you cannot provide an explicit rational justification for your fervent beliefs on this issue.
As to our continuing dispute over AF details: (1) there certainly are not adequate studies to Prove that acupuncture works for arrhythmia, but there are a few small studies (I cited two) and multiple case reports (not cited) that suggest that it may. (2) Atrial fibrillation is rarely fatal if rate control drugs are available so that the sufferer does not develop or remain in heart failure. AF carries some long-term health risks, but ablation is seldom urgently necessary to “save a life” and has short-term risks of its own. (3) The person I speak of had had multiple periods of months in persistent atrial flutter, as I said many times. I seldom see him drink, and almost never more than one drink at a time. Again you turn to pathetic ad hominems – he was probably just a boozer; someone so wicked as to use acupucture would surely also be so stoopid that he kept guzzling liquor daily with a symptomatic arrhythmia, right? By the way, he DOES drink a lot of coffee, and I suggested several times that he give it up before literature review I was doing on his behalf led to evidence that [except for individuals who find themselves to be sensitive] caffeine in reasonable doses has little effect on AF incidence. Anyway, he’s healthy and happy with his coffee and I don’t want to be a noodge.
However, there are some studies in which various types of nerve-stimulating “sham” acupuncture are equal to traditional acupuncture and better than placebo
I thought acupuncture was placebo. What is placebo?
Alain
“lilady – Heh! Again you try to make this about me being a Bad person – unstated premise, if lilady says that a person makes things up, they must be making things up. I take it that you cannot provide an explicit rational justification for your fervent beliefs on this issue.”
Your posts are all one needs to judge your veracity.
Fess up Jane. You don’t have your “friends” medical records and I have my husband’s medical records.
Did you happen to “catch” an earlier comment of mine and the fact that my husband was diagnosed with viral (acute onset EBV) cardiomyopathy…a rather unusual serious consequence of contracting EBV as an adult:
http://www.ncbi.nlm.nih.gov/pubmed/20561866
Those studies about acupuncture for paroxysmal cardiac arrythmia are here. The authors state the limitations of the studies:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312232/pdf/WJC-4-60.pdf
“These data were obtained in 2 small study populations and the recurrence rate was documented during control visits or by the patients’ perception of symptoms. In particular, when considering data obtained in patients with paroxysmal AF, it must be pointed out that the numbers were small and that patients were treated with different antiarrhythmic drugs, and no sham acupuncture was used to rule out a placebo effect. Nevertheless, the persistency of the antiarrhythmic effect
of acupuncture on symptomatic AF during the 10-mo
follow-up period make this possibility unlikely. It must be also stated that for economic reasons we were unable to use a trans-telephonic monitoring system or internal or external loop recorders to detect asymptomatic or brief self-terminating AF episodes. Finally, this was a single center study with an active acupuncture team led by a cardiologist with a recognized training in traditional Chinese Medicine.”
Have you ever heard of GIGO (Garbage In, Garbage Out) as applies to studies which are underpowered, where patients are on antiarrythmic drugs, where there are no placebo controls and patients subjective statements are used in lieu of external loop monitors, Jane?
Looks like the conversation is about over. I don’t have anyone’s medical records, including my own or my husband’s (I should have his, as he once suffered a life-altering malpractice cascade, but he didn’t want to sue). Even if I said I had this individual’s medical records, what follows from that? I’d hardly post them online for the likes of you.
Can you provide literature citations demonstrating that ablations are essential to the survival of people with EBV cardiomyopathy who have AF? Or more briefly, “Evidence, please?”
There are a LOT of studies of AF that report only symptomatic episodes. I imagine that getting people to wear monitors 24-7 for a year of follow-up would be intolerably burdensome. I do not recall ever seeing it done. A large fraction of the population have brief moments of unnoticeable atrial arrhythmias, but they don’t notice or care, and there’s no real evidence that, even from a healthist perspective, they “should” care. Dismissing studies that count long symptomatic episodes as dealing with “patients’ subjective statements” not only throws away most of the literature, but makes it clear you have no interest in patients’ actual needs. As for the last sentence, you offer a litany of nonsense and ignorance (for example, there were BOTH a no-treatment control and a sham acupuncture control; what more do you want?).
I don’t want your “friend’s medical records”….and you just confirmed for us that your “friend’s” story is your interpretation of your “friend’s” anecdotal story.
I know (at least) one person whose symptoms were made decidedly worse by acupuncture. She has chronic pain, and drugs can do only so much, so decided to give it a try. Once.
A mutual friend has concluded that the fact that acupuncture could make things worse means, not that poking needles into people is a bad idea, but that there’s clearly something going on there. Said mutual friend is unusual, I think, in both getting acupuncture and accepting that there might be bad as well as good effects.
So her work was really nothing more than a testimonial, complete with the usual sCAM logical fallacies.
They need some better editors at that paper.
Much-belated response…There is some kind of real dysfunction going on in this blog. I. Am. In. Your. Camp. I run an animal rescue group and have done similar work for 60 years. I’ve seen the placebo effect and argued with vets about it for almost fifty years. They invariably claim that it doesn’t exist, and that’s of course nonsense.
Everything I have ever written on this blog has been interpreted as some kind of adversarial position or has received a mocking, careless comment that shows the responder didn’t actually read my message. I’m probably much older than many of you, and I’m distressed that the commenters here are so blindly defensive that they no longer bother to read a new responder’s comments. It’s a little crazy here. I glanced in today to see what the tone was.
Please, people. I was a clinical psychologist for almost 50 years. There is too much aggression/defensiveness here for me. Please step backwards and put your heads out into the healthy air. Whew. What a toxic place. Last post by me for certain.
Thanks for this blogger’s highly educational content and close attention to the critical issues. No thanks for the vitriol and irrationality of commenters, though. Have at it.
Sara, I am sorry if we offend you. Perhaps you would prefer the dialog over at AgeOfAutism. They are always so much nicer and courteous than us, since it is heavily moderated.
What a completely ignorant comment. Do you really believe I am one of the loonies? You clearly have not read my comments. Your attempt at sarcasm is foolish. With such a mindlessly adversarial collective mindset, it’s no wonder that this blog has become a playground for people blinded by their own obtuseness.
I have spent decades defending science-based medicine against loonies. Clearly this is not the place for a productive discussion that advances that campaign.
Sara, I’m sorry that others here apparently jumped to conclusions about your comments. A few people here do have hairspring triggers, no doubt brought on by years of dealing with alt med “loonies”. I appreciate your comments, and now that you have told us your background, I hope you will stick around as I expect you have much to add.
OK Sara, fine. So what’s you plan to advance this campaign? What do you want us to discuss? Because so far all you’ve done is complain about how we’re not following your seemingly arbitrary rules.
@ Sara
I think the point Chris was making is that the friction produced by free discussion between opposing viewpoints is preferable to a mutual admiration society where everyone agrees with one another b/c opposing views are censored (AoA being a prime example.) As Terry Pratchett said, “Pulling together is the aim of despotism and tyranny. Free men pull in all kinds of directions.”
Way to stick the flounce, BTW.
Actually, it is one our standard replies to those who tone troll. Obviously if we are rude and obnoxious, they should really check out other blogs.
Personally, I think it is ignorant to complain about the tone of a blog in what would be your very first comment on it. It would help if one actually lurked for a while, and also be specific one which comments are offensive.
By the way, I could have pointed Sara to some Reddit threads. Perhaps the one where after a young lady wrote how she enjoyed a book by Carl Sagan received several replies threatening to rape her.
This is the internet, and there is very little moderation on this blog. Some people just need to grow a spine, and if they do not like the tone… make sure that you respond in a manner you expect others to emulate.
This strikes me as an odd position to take, given that you yourself have shown neither an inclination to address the specific responses to your comments @36 and 37 nor much in the way of evidence having “actually read” them.
Narad: ” your comments @36 and 37″
Oops. so she did comment before. I glanced at that comment, but not having much knowledge of the subject I figured there were others who could address it.
Sara,
I don’t see any evidence of that on this comment thread. As Narad pointed out you were asked to elaborate on your observations about placebo effects in animals at #38 and #43 (both reasonably polite responses) but you did not respond, and the conversation moved on. I don’t see any responses to you after that, though the discussion about placebo effects in animals you started continued for a while.
What placebo responses in animals were you referring to, and what do you think this adds to our understanding of acupuncture etc. in humans?
Okay, I spent about an hour working on a longer, more diplomatically phrased version of this, and then lost the damn thing in a computer crash, so I’m not writing at such length this time.
There’s this thing called Poe’s Law. I’m not going to go look it up so I can get the wording just right; the essence of it is “If you think people will have to know you’re kidding, because what you claim to believe is so absurd, you are wrong because someone out there really does believe that, if not something ten times as absurd.”
I’ve seen Poe’s Law lead to a lot of misunderstandings. Person A is new to skeptical circles, and makes a joke like “Oh, well, it’s perfectly obvious that we should live on nothing but water and berries; that’s the perfect diet and obviously it would keep us in perfect health for 150 years!” Person A is offended when People B-E don’t get the joke, and treat her as if she was perfectly serious. Person A doesn’t know, as People B-E do, about Breatharians, people who believe that a diet of nothing but air and light will keep them in perfect health.
Something similar happens sometimes when Person A isn’t trying to make a joke, but is just trying to bring up an interesting point … which happens to be a point that gets frequently seized upon and twisted beyond all recognition by illogical people, with whom People B-E have had too much contact.
Just as Person A thought her diet suggestion must be recognized as a joke, because no one would seriously propose something so absurd, Person A thinks that everyone must recognize that she’s only stating one simple fact. Why? Why, because no one would state that one simple fact and then act as though it immediately validated some elaborate theoretical construct, of course! No one would be that illogical!
Except that People B-E have been dealing for years with people who take a tiny little sliver of fact and jump from that to absolutely unwarranted conclusions. Once you’ve dealt with someone seriously suggesting that “the perceived health benefits of supplements can be just placebo effects” means the dramatic and lasting drop in measles cases following introduction of the measles vaccine might be due to placebo effects, then you tend to feel you know what’s coming when someone talks about how “financial and other motives” have apparently created a “fog of denial” about “the complexity of placebo effects.”
Person A may think People B-E should have realized she wasn’t suggesting that a financially-motivated conspiracy of Big Pharma and Big Surgery and Big Everything That Isn’t Altie have been hindering the research that’s almost guaranteed to show that acupuncture (or energy healing, or naturopathy, or chiropractic manipulation) is the panacea for all human ills. But given that People B-E have dealt with countless people who have shown up to claim exactly that, what reason do they have to think Person A isn’t yet another?? Obviously, the answer “because that conspiracy theory is ludicrous” didn’t stop the others.
Antaeus,
I don’t think this is a Poe’s Law problem, I suspect that Sara is suggesting that placebos do have objective effects that have been ignored. I may be wrong. Either way, I hope Sara will come back and discuss this further. I would value her input whether I agree with it or not.
Krebiozen –
I didn’t suggest that it was a Poe’s Law problem. I suggested that it might be a misunderstanding with a similar root cause: a newcomer feels offended that the regulars in the place she’s just come to aren’t giving her credit for common sense. But if she realized what a large number of people came before her, who turned out to be deficient in common sense, she’d understand why the regulars don’t assume everyone to have common sense until proven otherwise.
As for placebos having objective effects, let’s not forget that there is an actual placebo response, distinct from the category of “placebo effects”. Dr. Paul Offit’s latest book addresses the placebo response at some length.
@ Antaeus
#117 was the short version?! Actually, I like your wording of Poe’s Law better than the “official” version. Mind if I borrow it (should the occasion arise)?
Antaeus,
Point taken.
I understand the “placebo response”, i.e. a patient thinking that a placebo has had a physical effect when it hasn’t, to be one of several factors collectively referred to as “placebo effects”. Have I misunderstood? How do you understand a “placebo response” to be “distinct from the category of “placebo effects””?
Sarah A –
Well, comparatively shorter. 😉 And feel free to steal my wording, I consider it a compliment.
Krebiozen –
It seems I misspoke when I suggested that the placebo response was “distinct from” the general category of placebo effects. It’s actually part of that category, but at the same time, it has a distinction that the rest of the category does not share.
“Placebo effects” has come to mean any effect by which a patient perceives a benefit from an intervention, but the intervention is not the source of the benefit.
Sometimes there is no actual benefit. A dieter may think it’s her latest fad diet that’s helping her lose so much weight… when in fact, she isn’t losing any weight. The dieter perceives a benefit where there isn’t one.
Sometimes the benefit is real, but it’s unrelated to the intervention. Someone who’s taken a homeopathic remedy for a cold may give the remedy the credit for the cold going away. Well, the cold did in fact go away, but the remedy didn’t play any part in it.
Sometimes the benefit is real, but comes from the patient changing their behavior around the intervention, not from the intervention itself. Someone who’s started taking St. John’s Wort may be heartened by the belief that soon the world won’t feel so oppressive to them, and they can start enjoying life more, doing things they used to do like getting out to see friends. They start doing those things, and of course those things are in themselves good for their mental health.
When I’m referring to the “placebo response”, however, I’m referring to the original phenomenon first observed in World War II, where patients who thought they had received morphine in preparation for surgery, who had actually received saline instead, experienced substantial pain relief.
It could be argued that this is a placebo effect of the first variety, that patients only perceived themselves as having less pain, instead of actually having less pain … but not only is it kind of a head-scratcher to try and figure out how one could actually have the same amount of pain, but perceive less of it, it also doesn’t match what’s known now about the brain actually releasing neurotransmitters when the person thinks they’re getting the intervention. Moreover, when those neurotransmitters are interfered with… the placebo response stops working, even if the person still believes they’re receiving the medication. This is clearly something different from the dieter who only thinks their diet is working because they’re not actually measuring their weight.
It’s possible that we have useful discoveries still to make about the placebo response. It’s even possible that there are other similar mechanisms of the brain that are waiting to be discovered, and that can be usefully employed once they’re better understood. It’s possible that acupuncture will turn out to be useful in activating some of those mechanisms.
For the record, I’m mildly skeptical of the first two propositions, and extremely skeptical of the last, but I’ll try to keep an open mind. After all, before the placebo response was demonstrated to be real, it would have seemed quite as unlikely.
Antaeus,
I have a few loosely connected thoughts on the placebo response. I agree that the placebo response you were referring to is qualitatively different from other elements of the placebo effect. I think we skeptical materialists sometimes forget how important subjectivity is, that all our experiences are subjective to some extent, and that finding ways of altering a patient’s subjective experience is important. I also agree that there is more to discover about the placebo response. I think we probably already know enough to develop science-based placebos that do not require either lying to patients or a belief in supernatural phenomena (qi, meridians, dilutions past Avogadro having an effect etc.).
However, I am skeptical about Dr. Henry K. Beecher’s tale from WW2 (which appears to concern a single patient). A quick look through PubMed reveals other publications by Beecher with titles suggesting he found that experimental pain is not susceptible to placebos, and that a psychologist has to be present for placebos to work with pathological pain.
Every tale about the power of placebos I have looked at closely has failed to live up to its hype (Google my ‘nym for a good example). I have mentioned here before the often-cited sham knee surgery that was as good as real knee surgery that turns out to be because that type of real knee surgery had no effects on mobility, i.e. both sham and real surgery were equally useless. There are other similar examples, often the result of comparing placebo with baseline instead of with no treatment (i.e. the placebo effect was due to regression to the mean or because the condition was self-limiting).
The idea that placebo pain relief is mediated through endorphins is attractive, but there is experimental evidence that this isn’t the case. For example this study found that placebos can induce analgesia even when naloxone (an opiate blocker) is given and that naloxone alone can induce pain, and concludes that these effects together make it look as if naloxone blocks placebo pain relief, but it doesn’t.
I think we have to remember that pain is not just impulses sent down nerves, it is the brain’s response to those impulses. Once we think of it this way, I think most of the head-scratching about “perceived pain” disappears. It also allows us to understand how pain can exist without the nerve impulses, in phantom limb pain, for example.
I recall looking at clinical trials comparing acupuncture and opiates for treating cancer pain which found that acupuncture, supposedly a super-placebo, has barely clinically significant effects. The operations in China that were allegedly performed under acupuncture analgesia only, but that turned out to have also included heavy doses of sedatives and other drugs, spring to mind.
Orac, here’s some more acupuncture rot for you to deconstruct.
http://www.iol.co.za/lifestyle/scientists-query-ear-acupuncture-study-1.1624077
Krebiozen –
I was unaware of a lot of that research (so, it seems, was Paul Offit) – it does change the picture significantly. Thanks!