A rather clueless defense of CAM from across the pond

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.