Straw-Man, likes walks on the beach, red herrings and Shifting Goalposts, seeks like-minded True Scotsman.
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…and, as a general rule, those claimed results do not appear when the studies are replicated outside of China.
AFAIAA, there is some evidence that non-specific acupuncture (i.e. it doesn’t matter where you needle them, strongly suggesting that the effect is mostly or entirely placebo) might be of slight benefit in reducing nausea during cancer treatment etc. There is no substantial evidence that it works for anything else.
See Chapter 2 of this for a good lay summary:
See also:
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At the risk of hypothesising well out side my limited area of limited expertise, I would suggest that the real effects your wide and others are noting is not due to the acupuncture, but simply the rewarding experience of being noticed and being taken seriously.
In other words, it could be the medical equivalent of the Hawthorne Effect.
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Thanks for the definitions!
So, am I correct in reading the consensus among the gathered bbs cognoscenti as a belief that both are placebo-peddling quackery? (I’m not seeing a lot of confidence being expressed in either form.)
Same. I’ve known several people who claimed that acupuncture was the best treatment for their chronic ailments. It’s a relatively harmless technique for chronic pain management, compared with opioids. Consumer Reports even mentions acupuncture as an effective alternative method of pain management, though with caveats.
Also, I don’t think “placebo effect” means what people think it means.
“in a 2011 survey Consumer Reports subscribers found it helpful.”
I think I just lost all respect for Consumer Reports. Maybe they should rename themselves Popular Quackery.
The bulk of the evidence strongly suggests that any benefits of acupuncture are purely placebo.
However, the research into the placebo effect also suggests that acupuncture is exactly the sort of thing that you would expect to induce a very strong placebo effect. Ritualistic, transgressive, personalised, slightly invasive, wrapped in fancy nonsense. And, ultimately, we don’t care that much if it’s “just” a placebo effect: a healthier patient is a healthier patient, however they got there. All too often, the placebo effect is the most effective treatment available.
As placebo-based quackery goes, acupuncture is less offensive than most. It’s unlikely to interfere with concurrent evidence-based therapies, and it’s unlikely to cause direct harm so long as basic infection control procedures are followed. The only major danger (assuming clean needles) is the possibility that patients may forego necessary treatment of serious conditions because they’re using acupuncture instead.
So where you end up is the bioethics debate about the use of placebos.
Is it okay to lie to your patients if you’re doing it for their benefit? Is it ethical to charge money for a treatment that you know to be inert? Does the answer to that question change as the price increases? Should the performers of placebo rituals be people who know that it’s just theatre, or is it better if they believe their own bullshit? What are the ethics of training clinicians in these techniques? How much consideration should we give to the value of promoting evidence-based reasoning more generally?
BTW, anyone who hasn’t seen this already would probably find it entertaining:
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Anything that only works when people really believe in it, does not work. the issue I see here is that when something like this becomes accepted, eventually people are going to be diverted from effective and proven treatments because of economics. Worst case, we end up in a world where people get told that their plan does not cover antibiotics for that bacterial infection, but healing touch is available.
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Is the converse also true?
“anything that always works, even when people disbelieve it, does work”?
That seems sensible.
Most medical treatments don’t work all the time. And some medicines that were once quite efficacious are no longer so.
Personally, I am very hard-headed. I don’t generally believe things without direct evidence.
So, after many mainstream corporate medical shamans with impressive credentials had failed to cure my ills, and had even given me new illnesses through side effects of their treatments, and repeatedly told me that I had osteoarthritis and would never, ever be free of pain, I decided to go with evidence based treatment (aka experiment and observation) instead of faith based treatment (aka trusting white coated hierophants who claimed to be basing their treatments on evidence).
I got one of those hippy alternative quackery magazines and started making phone calls and trying crazy treatments. And miraculously, I no longer have osteoarthritis, and haven’t had it for decades now. I credit this to my exercise of the scientific method.
People often forget that a true conclusion can be reached from false premises and bad reasoning. If I think objects fall towards the ground because magic invisible fairies are cursing them, they still fall to the ground anyway, even though I’m wrong. Similarly, if I think vaccination can’t work because it is based on homeopathy, it still works anyway
If a person can’t give a convincing explanation of why acupuncture should work, that doesn’t mean it can’t work. I’ve never once heard a convincing explanation for how SSRIs work, and psychiatrists are handing them out like Halloween candy.
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The Neurochemical Basis of Pain Relief by Acupuncture, vol. 1 &2 by Dr Ji-Shen Han would be enough to dispel the myth that electro acupuncture is not real. A medical doctor who does not believe in the metaphysical aspects acupuncture, just evidence based science. Spend a little time reading the over 1000 pages. Then, if really serious go medical school in China and study Chinese Medicine. Yes, it is five years, and study of western science is mandatory in addition to Chinese medicine because it is still medical school. Now you really are able to render an opinion based on a education, experience and science.
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Cochrane’s take on that one:
When it comes to evidence-based medicine (which is somewhat different from gamble-and-anecdote-based), Cochrane is the gold standard. It’s a non-profit independent organisation that specialises in organising and publishing meta-analyses.
A meta analysis is when a team of researchers begin by establishing a question and standards of evidence, then go through all of the published scientific literature, weighting the results on the basis of the quality of the methodology.
The order of that is important; they don’t just subjectively throw out studies they don’t like, they establish in advance objective rules as to exactly what defines good research and declare those rules in their published analysis. It’s the best method we have for making an accurate synthesis of medical knowledge.
Even when it’s a high-quality study by top-notch scientists, you never base a medical conclusion on a single study. There’s just too much innate variability in biological systems for that to be a safe thing to do. You have to look at all of the evidence.
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Truth has no place in a Doctrowist Outrage, especially one with a click bait headline.
BTW: this is one of the funnel plots from that meta analysis.
A funnel plot is a way of visualising medical effectiveness and research quality at the same time.
The X axis is the effect of the treatment; if it’s above zero it means that the measured outcome is higher than with the treatment it’s compared to, below zero is lower. As the outcome in this case is a pain measurement, low is good. The vertical line is the weighted mean. The Y axis is a measure of study quality (defined mathematically by standard errors of their data). High on the graph is good (i.e. closer to Y=0 thanks to the inverted axis), low is bad.
What this plot is saying is that two of the really crappy studies showed no significant difference. The moderately crappy studies favoured acupuncture, but the effect ranged from tiny to small. Of the better studies, three of the four showed nothing happening while the fourth showed a very small advantage for acupuncture.
Funnel plots are used for other reasons, though: they can also tell you if publication bias is a major factor and if a field has been studied with sufficient depth to provide confident conclusions.
A well-researched field with no significant bias should produce a plot like this:
The dodgy studies are down the bottom, the better ones are up the top, and they all focus in together towards the approximately true answer.
A field where there’s strong publication bias (e.g. nearly all the studies are funded by Pharmacorp, and they bury all the negative results without publication) will look like this:
What the acupuncture vs sham acupuncture for peripheral joint osteoarthritis plot tells us is that there hasn’t been a lot of research into this question, there’s possibly a bit of publication bias in favour of acupuncture and most of the research has been of fairly low quality. Also, the worse the study, the more likely it is to favour acupuncture.
The balance of the research so far strongly suggests that there’s nothing there (especially if we focus on the better-conducted studies), and that even if there was something there it’s too small to be clinically useful or justify a lot of resources spent on further investigation.
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Yikes, it’s like the Army is taking advice from Gwyneth Paltrow’s Goop. What’s next? Battlefield hoo-ha steaming?
I like to think that medical schools in China teach “medicine that works everywhere”, not some culture-specific “Chinese Medicine”.
The post is not about “electro acupuncture”, no-one mentioned “electro acupuncture” until now, and I have no idea why johnm1 is pimping it out in this thread.
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Would you accept "We spent a shitton of money developing them, so they must be good for something "?
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Some, but unfortunately not all.
Mao promoted TCM as a way of covering for the inability of his government to provide effective medical care to the peasantry. Similar things happened in India with Ayurvedic therapies, and the tradition continues with assorted African dictators promoting bullshit AIDS cures.
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Don’t give Trump ideas. Ideas involving humour theory and bloodletting.
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