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Dr. Carlo Giovanardi: Spinning another negative acupuncture study

In May JAMA published a negative study of acupucnture and in vitro fertilization. Dr. Carlo Giovanardi, a physician and leader in acupuncture in Italy, was not pleased. As acupuncturists frequently do, he is now making excuses.

I write about acupuncture a lot because it’s a form of quackery that I once sort of believed in. Well, not exactly. I’m exaggerating a bit. Rather, it was a form of quackery that I wasn’t as skeptical of as, for example, homeopathy or energy medicine, both of which are examples of the most magical of magical thinking, with as close to zero biological plausibility as I can imagine, plausibility so close to zero as to be, for all practical purposes, indistinguishable from zero. Acupuncture, on the other hand, actually involves physically sticking needles into the skin. Of course, I never bought the idea that acupuncture somehow works because its needles redirect the flow of qi, a magical life force energy, to some sort of healing effect. I did, however, leave open the possibility that somehow do…something. Then, I actually started delving deeply into the acupuncture literature and found, not entirely to my surprise, that there’s just no “there” there to acupuncture. It’s a theatrical placebo. Such were my thoughts when reading this letter by Carlo Maria Giovanardi, MD, President of the Italian Federation of Acupuncture Societies (FISA), President of the Association of Medical Acupuncturists of Bologna (AMAB), What is the Scientific Contribution when the Study Methodology has so Many Limitations?

Dr. Giovanardi is referring to a randomized clinical trial published in JAMA in May testing whether acupuncture increases pregnancy rates after in vitro fertilization (IVF). As I noted at the time when I discussed it in my usual inimitable fashion, it was, unlike most acupuncture trials, large and well designed and that, not surprisingly, it was negative. Of course, as I like to say, if a treatment is claimed to work for almost everything, it probably works for nothing, and acupuncture is just such a treatment. While I can imagine potential biological mechanisms through which acupuncture might decrease the perception of pain, no matter how tenuous and unlikely, they’re not homeopathy-level implausible. On the other hand, there’s no even remotely plausible known mechanism by which acupuncture could have an effect on IVF success rates. Indeed, I even mocked the section of the paper that speculated about potential biological mechanisms as “woo babble” (like Star Trek technobabble, but with woo instead of science and technology).

In any event, Dr. Giovanardi wrote a letter to JAMA about the study and why he thought it had so many flaws that its conclusion that acupuncture doesn’t increase IVF success rates. Indeed, he’s peeved, and peeved that JAMA didn’t publish his letter:

The authors themselves identify five limitations to their study; however, in spite of them, they reach a definite and clearly stated conclusion (‘These findings do not support the use of acupuncture when administered at the time of oviarian stimulation and embryo transfer to improve the rate of live births’) which leaves no doubt as to the total inefficacy of acupuncture to improve birth outcomes among women undergoing IVF. Such a strong statement, therefore, is being supported by a trial, the limitations of which have been identified but not overcome.

I am sure we all agree on one point, namely that a methodologically incorrect article brings about misleading results which affect the choices of both medical doctors and patients; that’s why I wonder how the conclusions reached can be useful to acupuncturists and patients who decide to choose acupuncture as a therapy.

Methinks Dr. Giovanardi doth protest too much. When a study is negative, as this study was, this is what you write in the conclusion, that your study doesn’t support the use of the intervention for the condition for which it was tested in the clinical trial—because it doesn’t. That’s the conclusion for that one study. In general, such a statement doesn’t show the “total inefficacy” of any intervention, just the failure to find efficacy for that intervention in that study. Dr. Gionavardi appears to be reading more into the conclusion than a normal doctor would, mainly because, of course, he’s not just a physician but an acupuncturist. Hell, he’s the president of not just one, but two, Italian acupuncture associations! He also seems not to notice that the authors basically twist themselves into pretzels to try to make excuses for their result.

Indeed, Dr. Giovanardi latches on to the issue of the placebo control. In this particular study, non-penetrating sham acupuncture needles known as the Park sham needle. It’s a device with a retractable needle shaft and blunt tip. The sham needles were also placed in non-acupuncture points for the same duration as the “true” or “verum” acupuncture. Now here’s what Dr. Gionavardi doesn’t like about this:

My analysis starts with the generally accepted principle that no skin stimulation is inert, which implies that ‘sham acupuncture’ cannot be inert: any skin stimulation brings about central and peripheral responses (Birch S., A review and analysis of placebo treatments, placebo effects, and placebo controls in trials of medical procedures when sham is not inert, J Altern Complement Med, 2006). Effects have been observed when using non-needle sham, penetrating sham needles and non-penetrating sham needles, although they were different in size (MacPherson H., Influence of control group on effect size in trials of acupuncture for chronic pain: a secondary analysis of an individual patient data meta-analysis, PLos One, 2014).

The authors say that sham acupuncture can lead to weak physiological effects and the sham needle has been shown to stimulate different brain activity than acupuncture: this means, they recognize and accept the fact that sham treatment is not inert.

This argument amuses me to no end. The reason is simple. Dr. Giovanardi basically making the same point that skeptics have been making about acupuncture all along. It doesn’t matter where you stick the needles or even if you stick the needles in. That’s basically what he’s arguing by criticizing the use of sham needles as placebo control, particularly in this case because not only were these sham needles placed in nonacupuncture points but didn’t penetrate the skin. Accepting Dr. Giovanardi’s argument basically requires accepting what skeptics say about acupuncture; i.e., that it is nonspecific and nothing but a theatrical placebo.

Dr. Giovanardi then goes on with a bit of prestidigitation:

At the same time, their study addressed whether acupuncture was more efficacious than a placebo. This appears to be a contradiction in terms: how can sham acupuncture be defined as a placebo treatment? Placebo means being inert, by definition, whereas sham acupuncture is not, according both to the literature and to the article. Effects may be minimal, as researchers assume, but as a matter of fact such outcomes cannot be assessed, and therefore any speculation is possible.

Again, Dr. Giovanardi is basically arguing against the precepts of acupuncture here. Acupuncture claims that there are “meridians” through which “qi” flows and whose flow is redirected by the needles to healing effect. He’s in essence denying the results of the study by denying that there’s anything to the precepts of acupuncture. Seemingly realizing this, he quickly pivots:

First, if they decide to ‘minimize’ the effects, they admit that the effects are not only present but also remarkable and – let me repeat it –their impact cannot be assessed. Second, according to the Traditional Chinese Medicine, there are no points with no function, the whole skin being able to trigger physiological responses, as it is clearly revealed by the functions of the cutaneous regions called pí bù in Chinese (Maciocia G., The foundations of Chinese medicine: a comprehensive text for acupuncturists and herbalists, 1989; Ching N., The fundamentals of acupuncture, 2016).

This is the first I’ve learned of this. Acupuncturists will argue endlessly over which acupuncture points are best for what condition and which system of meridians to use; yet here Dr. Giovanardi seems to be admitting that even acupuncture itself teaches that it doesn’t matter where you stick the needles, all of which makes me wonde: Why do we need acupuncturists, anyway, then? Obviously, we don’t, because acupuncture remains quackery, but even if it weren’t I’m learning here that there’s no skill needed. Acupuncture is a pseudo-skill; that is, unless you count the theatrics needed for its theatrical placebo effect.

It’s a principle of clinical trials that you try to do your best to isolate the specific intervention being studied. In the case of acupuncture, the intervention is, well, acupuncture. But how does one define acupuncture? If it’s just sticking needles somewhere in the skin, then anyone can do it. Therefore, anything we consider “acupuncture” must conform to what acupunctures say it is and where they say the needles should be placed. The way to isolate acupuncture, then, must involve some form of “sham acupuncture,” be it needles placed in nonacupuncture points or sham needles that don’t penetrate the skin. In this case, the investigators chose both. Now, one can argue that it’s still worthwhile to include a no-needle “usual care” control, and if this were a study for which the primary outcome were not such a “hard measure” (i.e., pregnancy versus no pregnancy, live birth versus no live birth), I’d be more inclined to agree. Also, the authors had a pretty good reason for not including an “usual care” control, noting that their pilot study indicated that women would decline randomization in a trial that included a no-acupuncture, no sham acupuncture group. Personally, I have no problem with including such an additional control, except that it would add to the cost of the trial.

Of course, I’m also neglecting to note that I have a problem with even doing this trial to begin with, given all the negative evidence, some of which I’ve discussed over the years going back to 2008, that acupuncture has any effect on the success rates of IVF procedures. Remember that, according to the Declaration of Helsinki, it is unethical to do a clinical trial without robust preclinical evidence in basic science and animal studies to justify doing it.

But Dr. Gionavardi isn’t done yet. Oh, no:

Minimal, superficial, sham, or ‘placebo’ acupuncture have been thoroughly investigated: it has been demonstrated that light touch of the skin stimulates mechanoreceptors coupled to slow conducting unmyelinated (C) afferents resulting in activity in the insular region, but not in the somatosensory cortex. Activity in these C tactile afferents has been suggested to induce a ‘limbic touch’ response resulting in emotional and hormonal reactions. It is likely that, in many acupuncture studies, control procedures that are meant to be inert are in fact activating these C tactile afferents.

Perhaps, but Dr. Gionavardi neglects to present any evidence that these effects result in any detectable effect on the outcome being studied, namely IVF success rates. Of course, his concern is, not surprisingly given the utterly negative study he’s criticizing, this:

Sham acupuncture may introduce bias against the treatment being tested and I share Lund’s point of view when she affirms that minimal acupuncture is not valid as an inert placebo-control despite its conceptual brilliance (Lund I., Minimal acupuncture is not a valid placebo control in randomised controlled trials of acupuncture: a physiologist’s perspective, Chin Med, 2009).

In conclusion, an important risk of bias exists in this study and what it actually lacks is a true control group (a care alone group). As already suggested by Zheng (Zheng C.H., Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis, Fertil Steril, 2012), sham acupuncture (Streitberger control) may not be an inactive control. More positive effects from using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.

Sure, and the Tooth Fairy might actually exist.

Basically, as we see all too often whenever a rigorously designed acupuncture trial produces a negative result, true believers find a way to discount it. Their belief is total, and, in their minds, there is no way that a result as resoundingly negative as this one could be correct. So they always find a rationale to discount the study, even if their rationale contradicts the rationale for their own “specialty” of acupuncture.

Theatrical placebo, indeed. Same as it ever was. Sadly, that doesn’t stop academic medical centers from selling this quackery, including the one where I did my general surgery training. That’s the same as it ever was, too.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

59 replies on “Dr. Carlo Giovanardi: Spinning another negative acupuncture study”

What he is saying is that any stimulation of the skin by any method at any site can be used to treat any disease.

Sorry, but that is the definition of quackery.

Basically. So if I poke him with an pencil will it cure his whatever? And why can acupuncture only do good? Why aren’t there acupuncture points that cause, say, a huge increase of the mucous output of the mucosal membranes? If acupuncture can cure everything why can’t it selectively make your nose run? (Obviously because it is utterly false.)

People really should take care about responding to something when they’re in a snit. They tend to say things they shouldn’t.

Does the thought of acupuncture simply have a psychosomatic effect on stressed individuals? If this is the case, acupuncture is a legitimate pain relief. Sometimes, I get stressed when submitting a comment here at RI and the mental imagery of getting acupuncture, during a particularly heated discussion, is relaxing (e.g., theatrical placebo).

Q. Has anyone done a study on acupunctures psychosomatic-effect.

MJD:
A suggestion for next time you consider a post: visualize acupuncture as practiced by Vlad the Impaler. I can assure you that the majority of the Orac’s readers greet your posts with the same enthusiasm that Vlad’s “patients” greeted the news of their upcoming “treatment.”

Strange. I get stressed whenever anyone tries to stick a needle in me, for any purpose. Freely contributing to a conversation, on the other hand, is usually quite relaxing.

Sometimes, I get stressed when submitting a comment here at RI

I know the perfect solution to that problem.

The readers of RI would thank you.

@ Chris Preston,

Orac (David H.Gorski) has been very open-minded about allowing my perspectives over the years but I strenuously object to my present auto-moderated situation.

@ Orac,

The Gorski name is well known for educating for equity and social justice (e.g., Paul C. Gorski)

https://paulgorski.efoliomn.com/Publications

Please release me from auto-moderation in the spirit of freedom of speech. I’d rather be banned from RI than intermittently censored.

Your friend,

Michael J. Dochniak 🙂

So MJD would rather be banned than moderated? Really?

Orac does not have to provide “freedom” for anyone: it’s his blog, his rules.
he allows WAY more leeway than most any other blogger would.
Freedom of speech, as guaranteed in the US constitution, is not about individuals but the government
( Dorit could inform you better than I can so I won’t continue)

If someone came into my house and started swearing profusely ( which probably wouldn’t bother me but I include it purely as an example), started insulting me or ( more likely) was spouting right wing claptrap or alt med nonsense, I could toss him or her out because it is MY HOUSE and my rules.

RI is Orac’s place: his digital home.

Right now, various woo-meisters/ political loonies are shrieking about freedom of speech and censorship because their material is not being allowed on facebook, youtube, twitter, Wikipedia etc. as if those entities are REQUIRED to provide them with a platform or means of free advertisement on the web. It doesn’t work like that: These companies can do as they like.
You can compare them to media, like newspapers or television channels, which can be private or public:
do they have to print articles people submit or broadcast tapes they get from viewers? NO.
If they HAD to, there would be no advertising industry.
If you want a free platform, blogs, facebook and twitter are available.

So MJD would rather be banned than moderated? Really?

Apparently.

A casual reader might indeed wonder why MJD bothers to post at all here, given the level of stress he claims it gives him. But the casual reader should know that MJD is just a garden variety attention seeker.

I strenuously object to my present auto-moderated situation

Why? You whine and whine, but you haven’t explained why your babbling is so fucking urgent.

I assume “auto-moderation” means that your comment automatically does into moderation to be either accepted, in which case it is posted but with an unavoidable time delay; or rejected, in which case it is not posted at all. Is that right?

BTW, Michael Dochniak said “in the spirit of free speech” so referenced to the first amendment by some posters above are not really relevant.

” Why do we need acupuncturists, anyway, then?”
If he’s correct, we could just wave our hands over the patient and.. no wait, that’s Reiki.

No one mentioned that he’s from Bologna ?”

( although I must admit when my leg hurt me a lot I DID try both toothpick acupuncture and finger acupressure mimicking the points the authentic Chinese acupuncturist used. No results).

“it doesn’t matter where you stick the needles, all of which makes me wonde: Why do we need acupuncturists, anyway, then?”

This calls for an animal study. Bring in the cats!

If it’s just sticking needles somewhere in the skin, then anyone can do it.

Somehow, the only effect I’m getting from catupuncture is aggravation, bleeding, and the occasional script for Augmentin.

Oddly enough, no. Hibiclens is kind of magical for preventing local inflammation, though, and it also seems to stop superficial bleeding, which is pretty helpful when one’s prothrombin time is a wee bit high, as in we can’t do this lumbar puncture.

A bit of Googling set me straight on a misconception I had, and I am probably not the only person to have had this misconception. The initial sounds of “acupuncture” and “accurate” are quite similar, enough to lead the unwary to suspect an etymological relationship between the two words. Both words are indeed of Latin origin, but the similar sound turns out to be coincidental. The “acu-” prefix in “acupuncture” comes from the word for “needle”, whereas “accurate” is derived from Latin “accurare”, from “ad-” + “curare”, meaning to do with care. This detail ruined the snark I had planned on Dr. Gionavardi admitting that acupuncture wasn’t so accurate.

FTR, my views on acupuncture have evolved in a similar fashion to Orac’s. It is not a priori implausible that sticking needles into a patient would have some effect, even though the proffered explanation of qi flowing through meridians never made any sense. But the point of sham acupuncture is that it provides a control for whether or not needles were actually stuck in. And the results are quite convincing: there is no evidence that the effect of true acupuncture is significantly different from the placebo effect of sham acupuncture.

When I studied physiology I thought that MAYBE it worked as an irritant or MAYBE it stimulated endogenous opiates but eventually I came to understand it as smoke-and-mirrors poppycock.

When I had acupuncture ( someone else paid) the “doctor” first prodded points with her incredibly bony fingers: I thought that this might have helped initially. A later treatment included cupping ( which I’ve already described in detail) and made me decide that I could handle the pain but not cupping. Perhaps patients get so upset by the bruises that they get distracted from experiencing milder pains.

The “acu-” prefix in “acupuncture” comes from the word for “needle”

So acupressure is actualy a wrong name?

Once upon a time, I would have defended acupuncture.

As a youngster, I spent a lot of time in martial arts and I brushed up against Qi. I’ve met quite a few martial artists who have the default perspective that Qi is a real thing and that if only the science looked a bit harder, a scientific mechanism for it would eventually be revealed. What I learned is that Qi is a thing that exists in your head; in my experience, it’s a collection of real sensations that a pre-scientific culture wanted to give a name to. Unfortunately, that name is outdated and the mechanism of gradually learning how physiology actually works has pushed Qi into being a dissociated mystical something-or-other that is no longer actually attached to anything. It has evolved into The Force ™ as it came west. For instance, a feeling that could be considered Qi is the zing that goes with striking your funny bone, or the feeling which goes with being hungry, or the feeling which goes with having an orgasm –the Taoists have some crazy sex regulation practices that go along with Qi “optimization”. We’ve got other better names for how these things work now, so Qi got displaced out of the explanation for them. I don’t think it’s a mistake that acupuncture point maps have some similar arrangements to nervous system physiology (not being a medical doctor, I once tried comparing an acupuncture dummy to a basic physiology book… if you omit the meridians, the points themselves often seem to correspond to anatomical features that we have other explanations for). That was one of the reasons I was willing to support the idea of acupuncture.

To a martial artist, acupuncture is a small hop of the imagination: if you strike someone in the funny bone, you cause them a zing that affects their Qi… clearly they felt it, so you did something to them. By extension, maybe you can moderate the manipulation, say by using a tiny needle to prod it, you can regulate the affect, right? I was willing to grant that maybe something was there. I think this is why people continue to design clinical studies to test it. It really can seem like there must be something to it… people come upon it and want to believe it.

Two major things have persuaded me away from it. First, as I mentioned, if you look carefully enough at what people refer to as Qi, you realize that there are better explanations for what they’re trying to talk about if you just sit down and look for those explanations. This is like someone failing to do a literature review and assuming they already know enough to be cogent in the discussion, then not realizing that they’re trying to discuss a modern medical model using pre-scientific concepts. Second, it became clear to me that the martial art manifestation of Qi, at the pressure points which correspond to acupuncture points, cannot possibly be by manipulation of a real anatomical structure. What exactly are they sticking the needles into? If they’re sticking needles into nerves, how is it that they expect to be able to find the nerve using such poor maps to guide such a tiny needle into such a small target as a nerve body? With martial arts, when striking at a pressure point you have a big bulky finger or knuckle with a lot of surface area to it, which is like a scatter gun in comparison to a tiny acupuncture needle. Acupuncturists haven’t got the tools necessary to actually find the points they think they’re looking for… if they did, they would simply be micro-surgeons making money doing real medicine. My views have drifted more toward science on this topic with the realization that martial arts are themselves riddled with idea junk. Lots of things are preserved in oral traditions because someone with more authority said they should be preserved, not because those things actually work as advertised. People want to believe and don’t ask hard questions.

I don’t defend acupuncture now. People who want to believe in it haven’t really looked that deeply at where it came from or seriously questioned whether its claims have been tested. I hold up my period of affection for acupuncture as proof positive that just the right snake oil at the right time can take anyone in. People aren’t perfect.

I’m currently reading and reviewing a couple of German crime-novels where there is a lot of fighting and hitting, or manipulating acupuncture points or meridians and it annoys the hell out of me. On part of me want to write acupunture is utterly bs, while the other part wants to be a bit more diplomatic and just write, some fighting techniques are unbelievable.

Speaking of needles, yes, there is such a thing a self-acupuncture, although it seems mainly to exist on YouToob.

@Renate

Martial arts schools can be a little bit frightening. They have an ideology filter. You cannot advance in a martial arts school if the instructor does not approve of your ideology. The problem then is that the instructors tend to believe a lot of crazy things and they expect their students to agree with those things. As a result, the deeper you get into a martial art, the more likely you are to be surrounded by students who have bought into whatever the instructor believes, hook, line and sinker. People who don’t believe it get weeded out and the ones who stay get insulated in an ideological echo chamber. In some schools, students slide gently out of reality as they progress toward masterhood. Some of those people really believe in two-finger death touches and projected Qi-bolts. Moreover, the master gets an out: because the technique is too dangerous and might hurt the student, the master never has to prove that the technique actually works as advertised. There are even some schools which indoctrinate the students into taking pratfalls whenever the master uses high level techniques, leading the master to believe that their garbage works. Empty Force (EFO) or Yellow Bamboo for example.

It isn’t hard for me to understand how some of these people start to believe in acupuncture or even Reiki.

In addition to this, the masters get treated like priests (or Gods) and they can begin to take advantage of and abuse students because of the power differentials present within the social structure of the school. You cannot defy the will of the master because it might get you ostracized or kicked out. The environment can skirt dangerously close to cult-like.

@Narad, there is a lot of very interesting stuff on Youtoob indeed;-)

I’m about where you & Orac are about this, though I’m willing to allow that any placebo that helps some percentage of the public have less pain should be available for that purpose. If for no other reason than to reduce the risks of all those people being on opioids.

OK, so here’s a possible way to do a blind study, where the subjects don’t know whether they’re getting acupuncture or sham treatment:

Use a topical anaesthetic to numb up the area that’s to be “treated” with acupuncture or sham treatment. Then administer nitrous oxide to basically put the subjects to sleep. Have them wear eyeshades and earphones with instrumental music, to block auditory and visual cues from the goings-on in the room.

The point being, those preparations would make it extremely unlikely that the patients would know what is or isn’t being done to them (acupuncture or sham), and that should solve the problems of patients seeing or feeling the “treatment.”

Is this any good?

The authors say that sham acupuncture can lead to weak physiological effects and the sham needle has been shown to stimulate different brain activity than acupuncture: this means, they recognize and accept the fact that sham treatment is not inert.

Aha! The No True Placebo arguement, step-sibling to “different ways of knowing.”

the sham needle has been shown to stimulate different brain activity than acupuncture

The deuce you say. I can scarcely imagine how one would pull this off with FMRI.

“( although I must admit when my leg hurt me a lot I DID try both toothpick acupuncture and finger acupressure mimicking the points the authentic Chinese acupuncturist used. No results).”

Well, tickling yourself also tends not to work very well either.

It’s unfair, but “Italian science” is starting to resonate in the same fashion as “British cuisine” and “French efficiency”.

Well, cats tend to furiously lick or bite themselves if they have discomfort but then again, they ARE cats.
re “Italian science” –
recent vaccine imbroglios and Ruggeiro braggadoccio ( aids denialism, anti-vax) don’t make them look so great ( although I think that the vaccine governmental miasma may have been resolved)

Well, cats tend to furiously lick or bite themselves if they have discomfort

Which includes the psychological. My friend’s cat has licked her abdomen bald and is starting in on the right lower extremity. Back to kitty Prozac. Poor thing is semiferal and can’t go outside because of the architecture.

I’ve found that applying pressure to a mild injury can help temporarily alleviate the pain. Like when you wack your knee and immediately garb it and rub the injured spot. I remember someone telling me that the nerves that transmit pain signals (and itch) also transmit pressure, so if you apply pressure to something that hurts or itches it will interrupt the pain signal (briefly). I’ve found this works on bug bites, but that might be more distraction than anything else.

It’s unfair, but “Italian science” is starting to resonate in the same fashion as “British cuisine” and “French efficiency”.

They’re all as delicate as a semi truck?

Alain (stuck in the oxymoron dept)

I still need to do a side-by-side comparisom of canned corned beef hash, Libby’s vs. “Mary Kitchen” (scare quotes because it’s unsubtly Hormel rather than… ah screw it). A man needs his dog food and eggs once in a while.

We buy about six months worth at at time. Got some German dog food at the minute, called Rocco, that actually smells quite edible.

I do two cans a year at the maximum. Gotta ask my dad which brand he prefers, as this guilty pleasure is of his doing.

Narad:

Dude, if hipsters and Hawaiians can do fabulous foodie fantasies** with spam- why not you and corned beef hash?

No, not my cup of tea though

** spam “sushi”. SRSLY.

Meridians are unfalsifiable; Qi is unfalsifiable; acupuncture points are unfalsifiable. And we are now told that acupuncture needles are unfalsifiable – no valid form of sham acupuncture is possible.

Dr. Giovanardi’s belief in the efficacy of acupuncture knows no scientific bounds.

Meridians are unfalsifiable

Well, they’re completely ad hoc as well as being a moving target, so what’s to falsify?

Qi is unfalsifiable

It’s baldfaced Bad Fazzm. It can be rejected on purely epistemological grounds.

On the up side acupuncture does have the coolest names, for instance one site on the medial aspect of the upper arm is called “point of the window of heaven” it is used to treat – if the internet source I looked up is correct – asthma, wheeze, haemoptysis, cough, epistaxis, thirst, and my favourite “pain in the medial aspect of the upper arm”. Sort of a homeopathic vibe going on there.

When I went under the needle many years ago and felt all woozy and kinda high after, I thought there might be something to the needles in the earlobes bit–maybe releasing endorphins or some such. Now, of course, I am skeptical that that is even hypothetically possible. Can you have a placebo la-la-la feeling? Maybe it was just somehow soothing?

I’m never sure I really understand the placebo effect even though I keep re-reading everything SBM has to say about it.

If it were just earlobes, I’d be simply dubious — yes, they have a dandy blood supply, but it’s capillaries, right? The rest of the ear seems to be of only local utility for drug delivery. I’ll stop there.

Well, Mark Crislip is gone now so perhaps you can start believing there is actually such a thing as “the placebo effect”.

The short version of Gionavardi’s letter is that it is not possible to scientifically test acupuncture, because reasons, but I know acupuncture works and that should be good enough for you. It is a very amusing read.

Of course if they had just used a “care alone” group as Gionavardi wanted, he would have simply picked up his goalposts and placed them somewhere else.

Speaking of negative evidence:

J.B. Handley’s “How To End The Autism Epidemic” was officially published just yesterday, and there are already nearly 50 glowing five-star reviews of it on Amazon (curiously, not only did all these enthusiastic folks somehow manage to plow through the book in a day or less, but it apparently reached them through a mysterious osmotic process (hardly any are verified purchasers).

Excerpts make clear that J.B’s book, far from being the “game-changer” that fans proclaim, is just more of the same moldy old antivax tropes packed inside a different book cover. Medical coverups, profiteering docs, evil government, Hannah Poling, Vaxxed, lack of vaccine safety studies, blah, blah, blah.

AoA claims that not one mainstream outlet covered the release ( today). I heard his interview at Bolen- not much as you say. He was supposed to have a book signing in Rockland County NY today but I haven’t found the location listed anywhere. I might have gone to hear his rap if it were nearby.

Well, darn – without a more aggressive promotional campaign how are non-devotees to find out that J.B.’s book is a “game-changer”??

Not only does my municipal library system not carry the book, two separate in-state interlibrary loan programs don’t list it either. Although they don’t have “How To End The Autism Epidemic”, there are other fascinating how-to titles available for loan, like “How To Enforce National Prohibition” and “How To End Unnecessary Roughness In The Workplace”*.

*we only want _necessary_ roughness in the workplace.

A quick search showed this was held by my local book store. But a click on the link took me to a 404 page.

Some ferreting around discovered, I could down load it as an audiobook for a premium over the price of the paperback from Amazon.

Off topic…

Denice Walter writes, “So MJD would rather be banned than moderated? Really?”

MJD says,

It is my desire to continue responding to Orac’s postings, and infrequently, including those that have a special historical significance.

http://scienceblogs.com/insolence/2011/05/10/anti-vaccine-contortions-they-never-end/

https://respectfulinsolence.com/2011/12/02/mr-michael-dochniak-meet-prometheus/

Extend me some godd*mn respect – Col. Jessup (Movie: A Few Good Men)

It is my desire to continue responding to Orac’s postings

That makes one of you.

Extend me some godd*mn respect

Earn some.

@ Billy Joe:

OF COURSE, you ‘re correct:
he says the spirit of “freedom of speech” BUT like many in the alt med/ anti-vax arena, he at some level expects that he should be given a chance to speak up as a matter of course. He – and others- complain that they’re being censored or prevented from having a media outlet. He makes a lot of demands: a guest post, release from bond… em,, moderation etc.

Whoever runs a blog can allow whatever they please: witness AoA or Jake Crosby. Orac can do as he likes: he is not required to do anything. I am just reminding MJD of this reality.

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