Respectful Insolence

ResearchBlogging.orgI almost feel sorry for acupuncturists these days. Almost.

Well, not exactly. Clearly, given the infiltration of woo into academic medicine, acupuncturists are in demand even in the most allegedly “science-based” of academic medical centers. After all, acupuncture is what I like to refer to as “gateway woo,” an unscientific placebo-based therapy that has somehow come to be viewed as seemingly respectable, as though there’s something to it. It’s not hard to see why acupuncture has achieved this status. Indeed, there was a time when I, the arch-skeptic, the guy who has built up one of the top skeptical blogs out there, the person who three years ago took over the Skeptics’ Circle willingly and enthusiastically when its founder, a blogger known as Saint Nate, decided that personal reasons prevented him from continuing to maintain his blog or the Circle, was less skeptical of acupuncture than I am now. I know, I know, it’s hard to believe, but it’s true. Don’t get me wrong, though. I never for a minute considered that the whole rigamarole about “unblocking” or “redirecting” the flow of that mystical life force known as qi had anything to do with whether or not acupuncture did or did not have efficacy treating disease or other conditions. That was clearly a holdover from the pre-scientific medicine times in which most beliefs about the causes of disease involved either the wrath of the gods or vitalism, the latter of which is, when you come right down to it, the philosophical basis upon which many “complementary and alternative” (CAM) modalities are based, especially the so-called “energy healing” modalities, such as reiki, therapeutic touch, and, of course, acupuncture.

Still, because unlike so many other “energy healing” methods, acupuncture involved an actual physical action upon the body, namely the insertion of thin needles into the skin to specified depths, it did not seem to me entirely unreasonable that there might be some sort of physiological effect that might produce a therapeutic result. And I’m apparently not unique, if the proliferation of acupuncture offerings in ostensibly “academic” medical centers is any indication. Lots of otherwise scientific and skeptical academic physicians seem willing to give acupuncture a bit of a pass because it seems to be more of a physical intervention than other forms of “energy healing.” In any case, that’s what I used to think until I actually did the unthinkable, until I actually started paying attention to the published scientific literature on acupuncture. That’s when I started to realize that “there’s no ‘there’ there,” if you know what I mean. Badly designed studies with either no controls or utterly inadequate controls tend to be the norm in the acupuncture “literature” (and I use the term “literature,” as in “scientific literature,” loosely).

Moreover, acupuncture is touted as having value for conditions and procedures for which there is no plausible (or even mildly plausible) physiological mechanism by which it could be reasonably postulated to have an effect. Arthritis, allergies, headache (especially if treated with laser acupuncture), back pain, gastroesophageal reflux disease (GERD), Parkinson’s disease, post-operative nausea, hot flashes in breast cancer patients caused by the anti-estrogen drugs they have to take, infertility, it doesn’t matter. Seemingly acupuncture can do it all; it’s the Swiss Army knife of CAM therapies. Moreover, the “explanations” given to explain “how acupuncture works” seemed increasingly less plausible to me. Most of these explanations involve counterirritation or the release of opioids, and I’ve had an increasingly hard time believing either of those explanations, even if these mechanisms do turn out to be at play, they could have anything other than nonspecific effects, with no mechanism to explain how acupuncture could possibly do all things attributed to it. One rule of skepticism, especially when it comes to medicine, is that you should be very skeptical of modalities that are touted to be useful for a wide variety of medical conditions that have very different pathophysiology. From a strictly scientific view, such modalities are alway highly suspect. Oddly enough, though, it seems that pretty much every “complementary and alternative medicine” (CAM) intervention can be described that way.

More amusingly, odd thngs seem to happen when when rigorous placebo controls are introduced to studies of CAM therapies, and that’s that sometimes the placebo control does better than the “true” acupuncture; i.e., the evidence for acupuncture, taken in its totality, is completely compatible with placebo effect.

As Harriet Hall put it in her excellent analysis of a study purporting to show that acupuncture is useful for GERD:

This study falls into the category of what I call Tooth Fairy science. You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists.

One area that acupuncturists keep needling away at is infertility. Why, I don’t know. there’s no reasonable physiological rationale to conclude that acupuncture would have any effect whatsoever on infertility. Nonetheless, somehow in the CAM community it’s become conventional wisdom that acupuncture can somehow increase the chance of success for couples undergoing in vitro fertilization (IVF). Indeed, early this year I wrote about a meta-analysis that concluded that acupuncture did actually increase the success rate of IVF and why it did not show what its authors thought it showed. Tooth fairy science, indeed.

Now comes yet another study being publicized in the media that examines once again the question of whether sticking needles into women before they undergo IVF can increase their chances of conceiving. I could not help but be extremely amused by the title given to the ScienceDaily story about it: Placebo Acupuncture Is Associated With Higher Pregnancy Rate After IVF Than Real Acupuncture. You have to love a headline like that, and opening paragraphs like this:

A study comparing the effects of real and placebo acupuncture on pregnancy rates during assisted reproduction has found that, surprisingly, placebo acupuncture was associated with a significantly higher overall pregnancy rate than real acupuncture.

The study, published online in the journal Human Reproduction, looked at real and placebo acupuncture given on the day of embryo transfer in 370 patients in a randomised, double blind trial (where neither the patients nor the doctors knew which treatment was being given).

The researchers found that the overall pregnancy rate (defined by a positive urinary pregnancy test) for placebo acupuncture was 55.1%, versus 43.8% for the real acupuncture.

I bet that result caused some head-scratching. Or maybe even some wailing and gnashing of teeth. Or at the very least some confusion.

This reminds me of a study not too long ago that found a similar–shall we say?–disconcerting result in which acupuncture was studied for its ability to relieve arm pain from repetitive use injuries, which was funded, amusingly enough, by the National Center for Complementary and Alternative Medicine (NCCAM). Naturally, I had to go straight to the source. Fortunately, you, too, can do the same because the manuscript is available online for free for everyone, unlike most such papers, which are hidden behind a subscription firewall, not easily accessible by any but academics. The study, coming out of China, is entitled A randomized double blind comparison of real and placebo acupuncture in IVF treatment, and its lead investigator is Dr. Ernest Hung Yu Ng, Associate Professor in the Department of Obstetrics and Gynaecology at the University of Hong Kong (People’s Republic of China. So, let’s take a look at this study.

The hypothesis, not surprisingly, is that acupuncture could improve the efficacy of IVF and result in a higher pregnancy rate. The specific acupuncture regimen consisted of two 25-minute sessions, one before embryo transfer and one after embryo transfer was completed. Patient were informed of the study on the day of transvaginal ultrasound-guided oocyte retrieval (TUGOR), at which time a practitioner of traditional Chinese medicine (TCM) “diagnosed” thusly subjects who agreed to participate in the study:

A registered traditional Chinese medicine (TCM) practitioner (E.W.S.S.) categorized these patients’ conditions by the four diagnostic methods: observation, auscultation, interrogation and palpation according to the TCM principles (Maciocia, 1998). They were classified into the related syndromes which included Kidney Yang/Yin deficiency, Liver Qi stagnation with blood stasis, Spleen Qi deficiency with Phlegm and combination of those syndromes.

I wonder if spleen qi deficiency requires a splenectomy or if we can prescribe more yang or yin for a Yang/Yin deficiency. Sorry, couldn’t resist.

Patients were randomized to receive either “real” acupuncture of “sham” (a.k.a. placebo) acupuncture, and the placebo acupuncture needle was described thusly:

The Streitberger’s placebo needles (Streitberger and Kleinhenz, 1998; Asiamed, Pullach, Germany; 0.30 x 30 mm) were used. The appearance of the placebo needle was the same as the needle used in the real acupuncture group. The placebo needle was not fixed into the copper handle and the tip of the needle was blunt. When it was pushed forward against the skin, the needle slid into the handle and the whole needle appeared shortened. This also gave patients a pricking penetration sensation. To place the placebo needle in position, the Park’s placebo device (Park et al., 1999; Dong Bang AcuPrime, Exeter, UK) was used. The same acupoints and procedures as in the real acupuncture group were applied.

Overall, the design of the trial appears pretty sound. It was randomized and double-blinded to the extent possible with a treatment like acupuncture, and, as all good double-blind studies do, patients were asked afterward to guess whether they were in the treatment group or the placebo group in order to assess the quality of blinding. The study was powered to detect a 15% increase in the rate of pregnancy based on the clinic’s usual success rate of 35%, which required 370 patients. (Note how it was assumed that acupuncture would increase the success rate of IVF.) Overall, on first glance, the two groups seemed to be comparable, although I was a bit disturbed to see that the statistics showing that they were, in fact, comparable in all the parameters measured were not included in the table summarizing the two groups. My other quibble is that I was a bit surprised that the primary outcome the investigators chose to look at was pregnancy rates as assessed by urine pregnancy tests. As anyone who’s ever undergone IVF knows, not all positive pregnancy tests result in an ongoing pregnancy or a live birth, not by a longshot. When discussing the success rate of IVF, what patients are interested in is the live birth rate. Anything less is a failure. Looking at the table of the results, I think I see why the authors were more interested in the overall pregnancy rate. It is the only outcome measure the produced a statistically significant difference between the two groups.

Let’s take a closer look. The overall pregnancy rate (a positive urine pregnancy test) was 43.8% for the “real” acupuncture group and 55.1% for the placebo acupuncture group (p =0.038). However, the numbers become less and less different as we go deeper into measurements of pregnancy that matter more. For example, generally after a round of IVF that results in a positive pregnancy test, the first big hurdle afterward is the 4 week ultrasound that is done to see if there is a fetal sac, and ongoing pregnancy is usually defined as a pregnancy resulting in a fetal heartbeat detectable by ultrasound by 8 weeks. The definition of live birth is fairly self-explanatory, although for purposes of this study it was defined as a live birth occurring after 24 weeks. In any case, clinical pregnancy rates for “real” acupuncture and placebo acupuncture were 38.9% and 49.2%, respectively (p=0.059); ongoing pregnancy rates, 31.9% and 40.5% (p=0.105); live birth rates, 29.7% and 38.4% (p=0.100). There was similarly no difference between implantation rates, miscarriage rates, or ectopic pregnancy rates. In fact, this study is not a study showing that acupuncture does anything to improve or harm success rates for IVF. It’s a negative study. There is no statistically significant difference between the outcomes in the only measure that patients really care about, live births. Indeed, there was in addition no difference between the groups in endometrial or subendometrial vascular density, nor were there any statistically significant differences in serum cortisol levels.

That doesn’t stop the authors from doing all sorts of contortions over the results in the Discussion section. For example, the authors did find a significant decrease in serum cortisol after both “real” and placebo accupuncture, as well as an improvement in uterine blood flow parameters. To me this suggests decreased stress in both groups more than anything else, entirely compatible with the placebo effect. What’s more interesting is how the authors try to explain their result after first expressing their surprise in the discussion:

We found a significantly higher overall pregnancy rate following placebo acupuncture when compared with that of real acupuncture. There was a trend of higher rates of clinical pregnancy, ongoing pregnancy, live birth and implantation in the placebo acupuncture group, although the differences did not reach statistical significance. Surprisingly, significant changes in endometrial and subendometrial vascularity, serum cortisol concentration and the anxiety level were documented following both real and placebo acupuncture.

Why surprising? After all, this is exactly what would be predicted by the hypothesis that acupuncture acts primarily as a placebo; specifically, no differences in primary outcomes (ongoing pregnancy rates and live birth rates) but possibly differences in measurements related to patient anxiety, such as cortisol levels and uterine blood flow. No surprise there, unless you believe in acupuncture. The authors do go on to make a point that I actually somewhat agree with. Specifically, they lament that they didn’t include a no-acupuncture group as a control. Of course, the problem with adding such a group is that it would make it impossible to blind the study subjects in the no-acupuncture control group to their experimental group assignment and thus render this study no longer double blind. That is not an insignificant problem. However, it might be interesting to do in order to estimate the magnitude of the placebo effect.

More amusingly, Dr. Ng went into some contortions to try to explain his “surprising” result in an interview. In essence, he likened placebo acupuncture to acupressure and then waved his hands thusly:

Dr Ng gave two possible explanations for the results: “Placebo acupuncture is similar to acupressure and therefore is good enough to improve the pregnancy rate. Or else, it’s possible that real acupuncture may, in some way, reduce the pregnancy rate of acupuncture.

“So far there is no evidence that real acupuncture would adversely affect IVF outcomes because, in a previous meta-analysis of several acupuncture studies, the pregnancy rate was higher in the acupuncture groups than in the control groups. However, we cannot draw a firm conclusion about this from our current study as we did not compare the two groups with a third control group patients who received neither forms of acupuncture. Further studies should be conducted to compare placebo or non-invasive acupuncture and controls without acupuncture.”

You can sense the desperation. At least, I can, especially looking at his rationalization for the latter explanation, namely that “real” acupuncture somehow reduces the pregnacy rate. Of course, such a result would in fact be interesting if true, because it would indicate a physiological effect due to “real” acupuncture distinguishable from placebo acupuncture. That it would be a negative one wouldn’t matter. Any physiologic effect attributable to acupuncture would be of interest, whether positive or negative.

Unfortunately for woo-meisters and acupuncture boosters, the best explanation for this result is that there is no difference between the two groups (there isn’t, in fact) combined with a random finding of a seemingly “statistically significant” difference in one parameter, namely the overall pregnancy rate as measured by the rate of positive urine pregnancy tests in each subject group. Combine that with a hypothesis with a very low prior probability, which significantly increases the likelihood of a false positive result, as John Ioannidis has shown, and there’s no real difficulty in explaining Dr. Ng’s result. The only thing unusual in this case is that the false “positive” result was a “positive” in the “wrong” direction.

Alas for poor Dr. Ng, he was tripped up by the vagaries of comparing two different (and almost certainly equal) placebos against each other. Do such studies long enough, and inevitably sometimes the “wrong” placebo will win. I bet this study will teach Dr. Ng one lesson, though.

I bet he’ll never make the mistake again of including the best possible placebo control in any future study of acupuncture that he undertakes.

REFERENCES:

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Comments

  1. #1 Mojo
    November 17, 2008

    Maybe the BMJ should start up a new journal of Placebo in Medicine instead of their acupuncture one.

  2. #2 Scott
    November 17, 2008

    I don’t see any mention in the paper of controlling for multiple comparisons. (Though at least they did use a two-tailed P-value despite their assumption that the effect would be beneficial.) Is this something that is sufficiently routine to be assumed, or is it safe to conclude that if they didn’t say it, they didn’t do it?

    I suspect the latter. And if so, it would be very interesting to know whether that one statistically significant result remained so after such correction.

  3. #3 Joseph
    November 17, 2008

    Seemingly acupuncture can do it all; it’s the Swiss Army knife of CAM therapies.

    All CAM therapies are the Swiss Army knife of CAM therapies.

  4. #4 Phoenix Woman
    November 17, 2008

    Poor Dr. Ng. He’s faced with the cutting damage that his Occam’s Razor of a study does to acupuncture’s status as an alleged evidence-based treatment, or the quite real danger of physical harm from the proponents of a millenia-old woo. I do not envy him.

  5. #5 MC
    November 17, 2008

    I can see future paper:

    “Acupuncture effective in treating fertility: a reanalysis of an important dataset”
    –Desoto and Hitlan

  6. #6 Zig
    November 17, 2008

    You are looking at it the wrong way. Let me start by saying I am a (computer, math) scientist and a skeptic. I also have a genetic mutation in the group of palmoplantar keratosis (http://www.emedicine.com/derm/topic589.htm), a very rare, hereditary contition that all males in my family have. There is no known cure in western medicine.
    My brother, less skeptic than I, decided to try electric accupuncture after it was offered to him by a chinese doctor. He did 6 months of daily therapy 3 years ago, and the condition has dissaperared since then, without having to continue therapy.
    I recently started the therapy myself, I didnt do it before because it takes a lot of time and has to be done daily. My thick, rough skin has started to recede, and its a matter of time until it goes away completely. I can send you pictures if you want, and more references about me, you will see that you can find my name in many places in the web including scientific patents.

    I think the correct way to look at it, is to completely ignore all explanations of why it works. Instead, focus on the fact that we still know little about the body, compared to all that there is to know about it. The chinese have had thousands of years to experiment with the body, who knows how, maybe doing human experiments with prisoners, I dont know.

    I think it has to do with electricity somehow, because using electricity with the needles makes this particular therapy much faster. Maybe there are electricity patways that traditional accupunture can affect, and using electricity on top of it makes it faster.

    The fact is that I have a genetic mutation that affects production/control of keratin and causes it to grow on my palms and soles. The doctor did the therapy only for my hands, and only my hands are getting better, not my soles.
    Historically, we know from my family history that my great-grandfather had it, that starts showing at 4 months of age, and that it never goes away.

    Think about it.

  7. #7 Zig
    November 17, 2008

    Sorry for repost, I typed my email wrong. Its correct here in case you want to contact me. Zig

  8. #8 Joseph C.
    November 17, 2008

    Zig,

    Thanks for the steaming pile of logical fallacies. I think we’re going to have to tear up your skeptic’s card.

  9. #9 Orac
    November 17, 2008

    I don’t see any mention in the paper of controlling for multiple comparisons. (Though at least they did use a two-tailed P-value despite their assumption that the effect would be beneficial.) Is this something that is sufficiently routine to be assumed, or is it safe to conclude that if they didn’t say it, they didn’t do it?

    D’oh! How did I manage not to notice that the authors appear not to have controlled for multiple comparisons? An excellent point.

  10. #10 Marilyn Mann
    November 17, 2008

    Can you say, John P. A. Ioannidis, Why Most Published Research Findings Are False?

    http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0020124

  11. #11 jayh
    November 17, 2008

    I think the correct way to look at it, is to completely ignore all explanations of why it works. Instead, focus on the fact that we still know little about the body, compared to all that there is to know about it.

    No that’s not the correct way to look at it. It’s ok not to have a known mechanism. However, if you don’t have a known mechanism, then you need to prove repeatable correlation to the hypothesized treatment. This is exactly what failed above. Even with no known mechanism, if the accupuncture ACTUALLY worked, we would see clear statistical evidence. It did not.

    You can’t have it both ways. If you have NO established mechanism AND NO statistical evidence that it works… you are definitely outside of science and into wishful thinking.

    For your health problem: how do you establish whether this treatment did anything, as opposed to the condition doing its own ebb and flow?

    and the condition has dissaperared since then, without having to continue therapy.
    I recently started the therapy myself,

    If the condition was cured, then why did you find it necessary to restart?

    My thick, rough skin has started to recede, and its a matter of time until it goes away completely.

    How do you know it’s only a matter of time?


    The chinese have had thousands of years to experiment with the body, who knows how, maybe doing human experiments with prisoners, I dont know.

    idle speculation is not science. Btw, why would you expect them to have any special knowledge when they got SO VERY MUCH other stuff wrong?

  12. #12 Dianne
    November 17, 2008

    One rule of skepticism, especially when it comes to medicine, is that you should be very skeptical of modalities that are touted to be useful for a wide variety of medical conditions that have very different pathophysiology.

    While I basically agree with you, just to point out that occasionally one treatment can be effective in multiple diseases of apparently different pathophysiology. Aspirin is good for relieveing headaches, reducing menstral pain, and preventing heart disease. Imatinib is useful in CML and GIST, two apparently very different tumors. The basic difference being that if a rational researcher sees a single drug acting in two apparently different diseases he or she generally looks for an underlying similarity to explain why that should be whereas the average woomeister will simply conclude that their treatment is good in all circumstances.

  13. #13 Bronze Dog
    November 17, 2008

    Let’s see:

    Doggerel #46 implied in presenting an anecdote.

    I think the correct way to look at it, is to completely ignore all explanations of why it works. Instead, focus on the fact that we still know little about the body, compared to all that there is to know about it. The chinese have had thousands of years to experiment with the body, who knows how, maybe doing human experiments with prisoners, I dont know.

    Doggerel #14 with the appeal to the ancients, who were probably very sloppy in their data collection.

    I think it has to do with electricity somehow, because using electricity with the needles makes this particular therapy much faster. Maybe there are electricity patways that traditional accupunture can affect, and using electricity on top of it makes it faster.

    No point into getting into hypothetical explanations until you can prove there’s something to explain beyond confirmation bias, regressive fallacy, and so forth. Do a larger study to show a verifiable effect, rather than a pair of anecdotes.

  14. #14 scote
    November 17, 2008

    “Placebo Acupuncture Is Associated With Higher Pregnancy Rate After IVF Than Real Acupuncture.”

    Great, now they’ll be advertising it for birth control!

    Sigh…

  15. #15 Murray Bowles
    November 17, 2008

    And if placebo acupuncture is so good, I can’t wait to see what homeopathic acupuncture can do!

  16. #16 D. C. Sessions
    November 17, 2008

    One area that acupuncturists keep needling away at is infertility. Why, I don’t know.

    Let me guess: patients are desperate (thus willing to spend loads of $$$), the odds for first-time success are low (meaning they’ll spend it again), and the outcomes uncertain enough that it’s far from obvious whether the outcomes have anything to do with the interventions.

    How many did I miss?

  17. #17 Dave Ruddell
    November 17, 2008

    And if placebo acupuncture is so good, I can’t wait to see what homeopathic acupuncture can do!

    Is that where they use thinner and thinner needles, or just fewer needles? I mean, if 100 needles produces an effect, imagine how strong it will be if you only use one!

  18. #18 H. Broderix Wu-Peddle of the Gölpost-Schifft Institute
    November 17, 2008

    Oh, Orac !!!!! ~~ you call yourself a ”skeptic” but WHO is skeptical of the ”skeptic” ~~ hmm?

    A simple use of the datas you yourself present shows you are WRONG. First, look at research result you quoted:

    The researchers found that the overall pregnancy rate (defined by a positive urinary pregnancy test) for placebo acupuncture was 55.1%, versus 43.8% for the real acupuncture.

    Subsecutively, you make a good point that makes part of my point for me!!!!:

    live birth rates, 29.7% and 38.4% (p=0.100).

    Notice the DIFFERENCE??!?! No?!? Let me do the math for you. The difference in + pregnancy test between real and sham groups is 11.3%, whileas the difference in live birth* groups is 8.7%.

    Right there, you see? 2.5% of + pregnancy tests that ended up as a ”failure” (non live birth) were prevented by the trained and artfull utilizations of ancient and TRUE!!! knowledge of qi. These were lives that were never meant to be, that were not unnaturally carried on to a non live birth ”failure” because the women had their energy pathways optimized with the timeless accepting knowledge that Western medicine just never does get.

    Someday you will see the truth and beauty of the real world ~~ the intuitive word!! ~~ but until that day you do, being as you are just a baby-young soul teething on materialist ”skeptical-ism”, us older souls will look on with humble patience and tolerance born of earthly virtue, as always the Elder must upon the Young.

    We will all pray for you to Grow, Child…

    * Agreeing with you for once ~~ `ha ha!` ~~ that live birth is a more meaningfull measure.

  19. #19 Peter Hansen M.D.
    November 17, 2008

    Thanks for looking into this study. I was dismayed that my patient undergoing IVF was coerced into receiving acupuncture. The office made it clear that they wouldn’t be comfortable performing IVF without acupuncture.

    I think I will call them now, and tell them that if they are doing real acupuncture, they are decreasing the yield compared to fake acupuncture! I will be happy to perform the fake acupuncture, (for a fee, of course :))

  20. #20 Orac
    November 18, 2008

    Heh. I like the way you think. ;-)

  21. #21 Miss Cellania
    November 18, 2008

    How do you do “fake” acupuncture? You either stick someone with a needle or you don’t. And bless the subjects in this study. IVF patients have had so many needles shoved in them already, it’s a wonder they even notice a couple extra.

  22. #22 Scott
    November 18, 2008

    You use special needles that collapse, so neither the acupuncturist nor the patient actually knows whether they went in.

  23. #23 Confused
    November 18, 2008

    One area that acupuncturists keep needling away at is infertility.

    Look out! He’s got a pun! And apparently, he’s not afraid to use it!

  24. #24 Christophe Thill
    November 18, 2008

    A bit of nitpicking. Acupuncture is sticking a needle at a certain point. Wouldn’t a better design involve 4 groups: “real” acupuncture, sham needle on the “real” point, real needle on a sham point, sham needle on a sham point ?

  25. #25 Confused
    November 18, 2008

    Also: another interesting control group would be those who receive acupuncture but do not receive IVF. I’d be interested to see if there was an increase in false positives on urine-based pregnancy tests.

    Although you might need a pretty large sample size to pick it up. :/

  26. #26 Scott
    November 18, 2008

    Christophe, I seem to recall that such studies have in fact been done – all four result in essentially equivalent results. But dealing with sham points is harder since if you do that you can’t really blind the acupuncturist anymore.

  27. #27 chancelikely
    November 18, 2008

    Scott: I imagine you could blind the acupunturist if you just teach him sham acupuncture beforehand.

    Takes more preparation, and you’d have to keep the sham acupuncturist away from “real” acupuncturists, but I think you could do it.

    Are there different “schools” of acupuncture that use different points?

  28. #28 Joe
    November 18, 2008

    Scott, you really cannot blind the acupuncturist to that false needle. A well-practiced needler would surely see and feel the difference, and one can simply press it on a finger nail to see if it retracts.

    As for multiple controls in a test, I am not aware of any that had four arms as suggested by C. Thill. If you have a citation that would be nice. I do know that needling false points has been the placebo in other studies.

    This study reported a barely significant difference between two arms of 185 subjects, each. (The significance is probably not correctly reported since they looked at so many factors). If one took those groups and cut them in half (for the four-arm study) one would not even have subjects (per arm) for that. Given the high cost of clinical research (per subject) one needs to home-in on the most concise question.

    The 2001 PBS-Nova opus “Evolution” had a bit about a species of lizard that is strictly female and reproduces by parthenogenesis. However, it seems that some physical contact with other females enhances the parthenogenesis. That may be precedent for a sham prick working better than the real thing.

  29. #29 Tracy W
    November 18, 2008

    The chinese have had thousands of years to experiment with the body, who knows how, maybe doing human experiments with prisoners, I dont know.

    No matter how many thousand years they had to experiment, the important question is did they come up with anything effective?

    Also, I’m curious, how are you planning to investigate whether it was the acupuncture or the electrical current, or the combination of the two that had the effect? Were Chinese doctors playing around with electricity for thousands of years?

  30. #30 Patrick Caldon
    November 18, 2008

    To be honest I’m mildly impressed that Dr Ng had the intellectual honesty to publish the results that he plainly thought were nonsense. It’s just a shame he hasn’t had the courage to accept the most straightforward conclusion yet.

    I guess it’s also a shame that he’s probably going to try another presumably expensive and almost certainly pointless trial. Let’s hope he sees that he’s got a much better chance of coming up with an interesting result looking in another field.

  31. #31 North of 49
    November 22, 2008

    @ November 17, 2008 4:47 PM

    “Gölpost-Schifft Institute”.

    That’s a keeper.

  32. #32 Rob W
    November 29, 2008

    @Patrick — I disagree that such trials are pointless (as long as they’re at least relatively scientifically rigorous; this one’s fairly good as they go)… and I guarantee that they will be less expensive than the money *currently* spent on applying unsupported alternative treatments.

    It’s dangerous to discount popular “alternative” treatments — every once in a while, further study turns up an aspect of the alternative treatment that’s actually useful, and it can move from “alternative” into “mainstream”… and if not, study will hopefully be able to cut down the waste of money on ineffective treatments.

    The placebo effect is also deserving of continued study (though accidental study will perhaps not be as efficient…), as it *does* serve a valuable function, though how to employ it ethically is tricky.

  33. #33 eddie
    November 29, 2008

    It’s official!

    Acupuncture damages your fertility. Just wait ’til the anti abortion nuts get a hold of this…

  34. #34 Tim
    December 10, 2008

    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6SYP-4SDPX46-2&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=452104ed749efb1a3f43c27486aae2c8

    Just one 2008 study conducted by a joint project between Harvard Medical School, MIT + Harvard’s Martinos Center for Biomedical Imaging, the director of Neurotherapeutics at Massachusetts General Hospital using fMRI and PET scans to monitor brain activity.

    “Statistical analyses with paired t-tests showed that the reduction in pre- and post-treatment pain ratings was significantly greater in the acupuncture group when compared to the placebo group (P < 0.05).”

    “A priori brain regions demonstrating greater [11C]diprenorphine binding decreases (associated with greater endogenous opioid release) in the verum group versus the placebo group were observed in the right medial OFC, leftmedial PFC, right thalamus, and right insula. A greater binding increase in the verum group versus the placebo group included bilateral insula, right medial PFC/ACC, left OFC, and right brainstem. Common fMRI and PET changes (increased fMRI signal and decreased [11C]diprenorphine binding associated with greater endogenous opioid release) during verum acupuncture were seen only in the right medial OFC. There were no common fMRI and PET changes during placebo acupuncture.”

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