Respectful Insolence

Weekend mailbag: A most telling comment

Here’s a rather interesting (and telling) comment that, because it showed up on an old post, many readers might have missed:

As a practicing acupuncturist I can only say that my sham techniques have frequently and often created such a powerful placebo effect that many patients coming to my office having exhausted “allopathic” cures find quick and lasting relief.

Some doctors, having been impressed by my results have actually started referring patients to me.

The real sham is the belief that Western Medicine has pure scientific roots that back up every treatment. If only it were the case (for example) that drug studies were conducted in a scientifically neutral (instead of pure profit driven) methodology perhaps this would be true. It seems that mostly only studies that show what the manufacturer wishes to show ever get published (or is that just my faulty observation?)

I read recently that a physician accused of faking multiple research studies claimed it was due to Bipolar Disorder? Thank god he had the ability to fall back upon the proven science of psychology and the DSM manual to provide cause for lying for years.

It is a shame that my “sham” practice has helped many patients who continued to suffer after seeing their Western Physician, however they continue referring their friends so who are we to complain?

I have no doubt that further studies (via Western research methods) will continue to validate many of the techniques of Chinese Medicine. However, with thousands of years of knowledge and millions of patients treated, I am confident that acupuncture can be very effective even without these forthcoming studies.

This is a very typical attitude. In essence, Eric (the commenter) is saying that he believes that acupuncture works and doesn’t need any studies to tell him that. Oh, and, by the way, he doesn’t care if acupuncture “works” primarily through placebo effects. In the meantime, Eric can’t help but throw in the customary rants about big pharma controling medical research and references to uncontrolled observations in his patients that are prone to so many biases as to be useless.

Typical.

Comments

  1. #1 Rogue Medic
    August 14, 2010

    Eric is a con man.

    What Eric is doing is not patient care, it is just deception.
    .

  2. #2 augustine
    August 14, 2010

    http://www.usatoday.com/news/health/2008-10-24-placebo-doctors-ethics_N.htm

    “Half of doctors prescribe placebos, survey shows”

    That’s right American Medicine is also a sham. Can anyone say “Antibiotics”. I wonder what that placebo side effect count is?

    It would be nice to get a monetary cost of american medicine placebo and compare it to what you call “woo” costs. Then you would have to factor in all of the costs from side effects and death caused by American Medicine to get the true cost to society.

    You’re not interested in human well being. You’re interested in a method. A method that’ you’ve justified is the best for human well being. But if the method doesn’t help but actually hurts humans, screw it. You’re a science ideologist not a truth seeker. You’re way is one of the top killers in the U.S.

  3. #3 CanadianChick
    August 14, 2010

    augustine, honey, I know you’re angry that medical science couldn’t help you become a functioning, rational adult, but shouldn’t you be more angry at your mother for dropping you on your head, rather than the doctors who couldn’t cure the brain damage?

  4. #4 jillian
    August 14, 2010

    So what if acupuncture is a placebo? I think augustine is right that a lot of prescription meds are placebos; antidepressants, for example.

    Maybe the primary value in acupuncture is just getting a person in a room with a care provider who listens to their problems; giving him or her a little gentle, caring physical contact; leaving him to lie in a quiet room for a few minutes, alone; sending him off into the world with a reassurance that he will feel better. That’s often all that conventional medicine can offer, anyway.

  5. #5 Kapitano
    August 14, 2010

    Every paragraph is partly true. And the result is wholely false.

    In a few patients, the symptoms are purely psychosomatic and placebo faith-healing will work on them – for a while at least. And some real doctors recognise this and refer their fantasist patients to quacks.

    Research is profit driven, occasionally researchers do fake results, and negative results suffer from the ‘file drawer effect’.

    A few chinese herbs have the medicinal effects ascribed to them…and this ascription is sometimes very old, as though that mattered.

    And all this adds up to…what we all knew already. Placebo sometimes works and research is rarely pure. Eric seems to think these commonplaces somehow overturn ‘western’ medicine.

  6. #6 Kapitano
    August 14, 2010

    Every paragraph is partly true. And the result is wholely false.

    In a few patients, the symptoms are purely psychosomatic and placebo faith-healing will work on them – for a while at least. And some real doctors recognise this and refer their fantasist patients to quacks.

    Research is profit driven, occasionally researchers do fake results, and negative results suffer from the ‘file drawer effect’.

    A few chinese herbs have the medicinal effects ascribed to them…and this ascription is sometimes very old, as though that mattered.

    And all this adds up to…what we all knew already. Placebo sometimes works and research is rarely pure. Eric seems to think these commonplaces somehow overturn ‘western’ medicine.

  7. #7 doctorgoo
    August 14, 2010

    Jillian, you know that acupuncture is a placebo – something that doesn’t actually work – but you think it’s okay to encourage people to waste their money on it?

    Maybe the primary value in acupuncture is just getting a person in a room with a care provider who listens to their problems; giving him or her a little gentle, caring physical contact; leaving him to lie in a quiet room for a few minutes, alone; sending him off into the world with a reassurance that he will feel better.

    It sounds to me like you want a therapist instead. Why bother with the needles?

    That’s often all that conventional medicine can offer, anyway.

    I sincerely hope that you never get cancer. I’d be worried that you’d skip seeing a doctor for it because, for whatever reason, you fail to understand or appreciate the science that will help you live longer and better.

  8. #8 Seb30
    August 14, 2010

    That’s right American Medicine is also a sham.

    “American”? Glad to hear that the other western medicines are fine.
    Hint: there is a world outside of USA.

    Can anyone say “Antibiotics”.

    We can. On this very blog. There is an on-going campaign to reduce unnecessary prescription of antibiotics. In my country, it has been going on for more than a decade now. Still, old habits…

    I wonder what that placebo side effect count is?

    Any health treatment has a potential placebo side effect, unless you manage to administer it without the patient’s knowledge. It’s what placebo means – an effect related to the expectation of going better.
    When a placebo effect is the main outcome of a treatment, then there is an ethical problem. You are just plain lying to the patient.
    Unless you mean drug-specific side-effect? That’s not placebo, for sure. And any biologically active drug will have side effects. The trick is to weigth correctly the risk/benefit ratio.
    So, make up your mind: are you talking about giving a random pill to generate a placebo effect as the main effect, or are you talking about the side effects of a drug?
    Disclaimer: I’m no fan of eating plenty of little pills, so I am totally for reducing medication consumption. However, I’m not for replacing tested drugs by half-tested fashionable practices.

    It would be nice to get a monetary cost of american medicine placebo and compare it to what you call “woo” costs. Then you would have to factor in all of the costs from side effects and death caused by American Medicine to get the true cost to society.

    It would be nice to get the death toll of Jason Voorhees and compare it to the number of deaths the US army has been responsible for.
    Yes, I have been using a fallacy. Can you tell?
    A bad act stands on its own. That others are doing the same or worse is no excuse.

    As an aside, there are agencies to (imperfectly) register side effects and deaths due to medicine, and to take steps (sometimes) against bad doctors.
    Are such agencies only existing for woo practitioners?

  9. #9 Irene Delse
    August 14, 2010

    In the comment quoted, Eric also builds a huge strawman when he talks about “the belief that Western Medicine has pure scientific roots that back up every treatment”. Nobody said the scientific method was fool-proof, but the great thing about it is that it’s self-correcting.

  10. #10 FreeSpeaker
    August 14, 2010

    What Eric does not realize is that accupuncture is also allopathy. Hahnemann defined it when he said that everything that is not homeopathy is allopathy. Eric is an Allopathist.

  11. #11 daedalus4u
    August 14, 2010

    Invoking the physiology of the placebo effect pharmacologically is what I want to do with my NO producing bacteria.

    http://daedalus2u.blogspot.com/2007/04/placebo-and-nocebo-effects.html

    Once you can invoke the physiology of the placebo effect pharmacologically, you can maximally invoke it. Once the physiology of the placebo effect is maximally invoked and “saturates”, then there is no more placebo effect to invoke via the props of needles, magic water, magic waving hands, magic words, magic herbs and unnecessary antibiotics.

    My hope is that CAM will then slowly wither as patients find it is more expensive and doesn’t work as well as my bacteria.

  12. #12 jillian
    August 14, 2010

    Doctorgoo, you should not ascribe beliefs to me that were not evident in my comment.

    A placebo is something that DOES work — just maybe not for the reasons patients think. Many people find themselves with some kind of chronic problem that their MD’s cannot help them with: back pain, fatigue, headache, whatever. (Modern medicine is amazing and we are lucky to have it, but it does have its limitations.) Once they have been to the MD’s and still have the problem, they have every right to flail and fish for something that can give some relief. Many of these chronic problems probably have psychological/psychosomatic roots or elements, so what’s wrong with a therapy that has similar roots? Call it psychotherapy with needles if you like.

    As long as we agree that there is little or no scientific evidence for its efficacy, I don’t see the harm. Of course, many advocates for acupuncture don’t agree with this, or they argue that the science is irrelevant in the face of anecdotal evidence. That’s obviously a problem. There is still a kernel of truth in the original comment, though.

  13. #13 Knotfreak
    August 14, 2010

    It’s easy enough to give the ol’ smackdown to these people on this blog, but what do you do when they show up at your house for an important meeting (totally unrelated to medicine or woo) and in the course of conversation, start blathering about all sorts of woo–complete with anecdotes galore and the observation that “medical schools are FINALLY beginning to include an awareness of the importance of spirituality in healing in the curriculum”? It is so difficult to even try to be polite and nod when you want to scream.

    Also, why is it that woo posters so often don’t know the difference between your and you’re–and similar grammatical blunders? Because they’re stupid? Or maybe just ignorant? I’m not implying that everyone has to be a great speller to demonstrate intelligence, but these type of errors seem especially common amongst the wooies and other unschooled (in science anyway) posters.

  14. #14 jenbphillips
    August 14, 2010

    @ Jillian:

    Call it psychotherapy with needles if you like.

    If anyone were actually calling it ‘psychotherapy with needles’ this would be a very different conversation. The trouble is that acupuncture is peddled as having a specific therapeutic effect on specific physiological phenomena. The psychological benefits of having a kindly practitioner wafting incense and ancient wisdom over the the patient for an hour are scarcely acknowledged as a contributing factor at all, let alone the main contributor, to improvement. The harm, therefore, is in the dubious ethics of touting acupuncture as anything more than a placebo effect, even if some benefit can be derived from that effect. Of course placebos only work if people think they’re getting real treatment, so to be up front about the ‘psychotherapy with needles’ model would probably result in diminished improvements.

  15. #15 Lycanthrope
    August 14, 2010

    Jillian, you can’t just redefine the word ‘placebo’. Stating “A placebo is something that DOES work — just maybe not for the reasons patients think” implies that it simply functions in a different way than we thought, which is not the case. If it is biologically active at all, it is by definition not a placebo. A placebo is inert, and will not affect your body in any way other than the half-calorie or so it imparts from being digested.

    You ask what the harm is in letting people go to acupuncturists as long as everyone knows it’s not scientific. The problem is, there are lots of folks who fully believe in it despite all evidence of its uselessness. Furthermore, it’s tough to treat psychosomatic illnesses, as you suggest, if the patient knows the treatment is a sham.

    http://whatstheharm.net/

    On another note: thank you, Seb30, for calling out augustine’s (inexplicably capitalized) “American Medicine” remark. I was thinking the same thing. Another hint: America is not the oldest or only player when it comes to medical research.

  16. #16 T. Bruce McNeely
    August 14, 2010

    Goofus (I like that epithet) has never explained why other countries who spend less get better results from their medical services than the USA.
    Hint: they all use science-based medical systems, pretty much the same as the USA.
    Another hint: I’m pretty sure that all have better access to the system because of some type of “socialized” medical plan.
    Yet another hint: there is no significantly greater use of SCAM in these countries.
    And another: vaccination use is much the same as in the US.

    Conclusion: more universal access to medical services results in better health, lower costs and longer life.

  17. #17 Canadian Curmudgeon
    August 14, 2010

    I’m currently going through a serious bout of sciatica and I’m getting thoroughly sick of the number of people who are telling me I *need* to see an acupuncturist or chiropractor.

    They say “Oh yes, you don’t ‘believe’ in that”. As if there was something wrong in asking for evidence beyond anecdotes.

    Here is Canada, woo is alive, well, and spreading like an invasive species.

  18. #18 Bronze Dog
    August 14, 2010

    I find the doublethink typically involved with woos and placebos interesting:

    They have the mantra of “health freedom,” claiming that they want the patient to be the decision maker. (Though, of course, we all know that “health freedom” is typically a euphemism for “caveat emptor.”)

    And yet, many of them, apparently including Jillian, don’t seem to think much of informed consent. Lying to the patient, allegedly for his own good, is a return to the “doctor knows best” paternalistic model.

    Informed consent is the rule of the day, which I’m pretty sure all us skeptics agree with: The patient makes the ultimate decision between the treatments, and we want that decision to be based on the best available evidence.

  19. #19 Prometheus
    August 14, 2010

    Eric’s claim that:

    “…many patients coming to my office having exhausted “allopathic” cures find quick and lasting relief.”

    reminded me of a conversation I had a few years ago with a physician who worked in the pain medicine clinic at a large midwestern university. He said that he often had patients ask about “alternative” therapies, especially acupuncture, and that his usual answer was “If you feel it will help you, go ahead and try them, just let me know what you are doing.”

    His rationale was that pain research showed about a 30% “placebo response” (meaning that 30% of patients reported a reduction in pain with placebo) and while he didn’t feel that giving placebos to a patient was ethical, he wasn’t opposed to self-administered placebos, so long as they were “harmless” and didn’t interfere with what he was doing. In addition, his clinical time was limited – with a long waiting list – and his time was better used seeing new patients than trying to convince people that acupuncture is nonsense.

    I disagreed, arguing that the money, time and effort spent pursuing useless placebo treatments was a “harm” in and of itself, but I could see his point about utilising his time to see new patients rather than engaging in futile arguments.

    Another point that is often overlooked in the “alternative placebo therapy” discussion is that placebo therapies are often just as effective as “real” interventions for imaginary illnesses. People who are convinced that they have “subclinical hypothyroidism” (i.e. “hypothyroidism” in the face of absolutely normal T3, T4, TSH, TBG, free T3, free T4, TBI, etc) will do as well with a placebo as they will with thyroid hormone replacement (maybe better). In fact, a large proportion of the “worried well” would probably show as good (or bad) a response to placebo as they would to any pharmaceutical or surgical intervention.

    I suppose it is only reasonable that imaginary illnesses can be treated with imaginary therapies.

    Additionally, placebos are as effective as “real” drugs when there is no real treatment available. Treating Ebola with sugar pills (i.e. placebo or homeopathy – or is that redundant?) is probably just as effective as administering any of the available anti-viral drugs (none of which are known to be effective against Ebola).

    However, when “alternative placebo therapies” are used in place of real therapies or palliative treatments, patients suffer needlessly. In addition, there are many documented cases of patients being harmed by the “alternative” therapies.

    A 2001 liteature review by Yamashita et al in Complementary Therapies in Medicine – which can only be described as a “acupunture-friendly” journal – found 89 articles reporting acupuncture injuries between 1987 and 1999 covering 124 individual cases. Since these were all case reports, we can safely assume that this is just the “tip of the iceberg”.

    Of these 124 cases, 25 were pneumothorax, 11 were hepatitis B and there were 18 cases of spinal cord injury. There were two fatalities from infection.

    Before Eric – or someone like him – argues that this is only 124 serious injuries in 13 years, remember that these are only the published case reports – the total number of injuries (and deaths) is much greater.

    Also, it could be (and probably will be) argued that “conventional” medicine has as many or more injuries and deaths on its account. However, “conventional” (“real”) medicine also has many, many more “saves” (illnesses cured, function restored, suffering alleviated, deaths prevented) in a single day than “alternative placebo therapies” can be legitmately credited with since the beginning of time.

    Prometheus

  20. #20 tim gueguen
    August 14, 2010

    It’s definitely something I regularly wonder about, how many “cures” atrributed to woo, faith healing, etc. were actually the result of the person in question not being afflicted with the illness in question in the first place.

  21. #21 Pablo
    August 14, 2010

    I find this whole discussion, including the email, to be pretty amusing. I think it is a world of progress that discussions about acupuncture are no longer talking about efficacy, since everyone (legitimate, that is) is pretter much in agreement since there is nothing to it.

    Instead, it is all about the question of the ethics of prescribing a placebo without telling the patient.

    No pretense that acupuncture works, though

  22. #22 stripey_cat
    August 14, 2010

    Jillian. Antidepressants are *not* placebo. If you really think they are, I’ll be willing to do a double-blinded demonstrations (so long as there’s someone to give me the real drug once I go crazy – normally about 5-6 hours from my forgetting to take a dose before my behaviour is odd enough that someone asks me to check I’m still on my meds). I agree they are not appropriate for every patient (especially relatively mild cases of depression), but that is not the same as not effective at all.

  23. #23 Prometheus
    August 14, 2010

    Pablo,

    Acupuncture “works” in much the same sense that a glass of whiskey and lemon juice “works” when I have a cold – it can distract the sufferer from their symptoms long enough to let time cure the problem.

    You are correct that the only question left – since even Eric admits that the efficacy is nil – is whether it is ethical to knowingly give a patient a placebo (outside of a study, where the patient knows that there is a chance of receiving a placebo).

    And apart from the ethics of the matter, while we all accept that placebos can result in improvement of some symptoms, most people wouldn’t want their doctor to be giving them a placebo.

    Prometheus

  24. #24 augustine
    August 14, 2010

    [I'm currently going through a serious bout of sciatica and I'm getting thoroughly sick of the number of people who are telling me I *need* to see an acupuncturist or chiropractor.

    They say "Oh yes, you don't 'believe' in that". As if there was something wrong in asking for evidence beyond anecdotes.

    Here is Canada, woo is alive, well, and spreading like an invasive species.]

    Keep suffering! You’ll teach them that it’s all gobbledegook! You should go and get spine surgery just for kicks. Just to show them how much better it is than placebo.

  25. #25 augustine
    August 14, 2010

    [Nobody said the scientific method was fool-proof, but the great thing about it is that it's self-correcting.]

    Before it “self corrects”, as you call it, what happens? Death and destruction in the name of science. Medical confidence requires amnesia.

  26. #26 Rene Najera
    August 14, 2010

    Why, oh, why do you keep feeding Augustine? He knows that evidence-based medicine works. He goes to his MD when he has anything as small as the sniffles. And he takes antibiotics for his UTIs the minute he feels the burn.

    He’s just an attention whore, plain and simple. Why you keep having to try to reason with him is beyond me.

  27. #27 ambulocetacean
    August 14, 2010

    Enough of this “Western medicine” stereotype!

    I’m sure there is lots of good scientific medical research going on in China, Japan, Korea, Taiwan and loads of other places in the East.

    Not all Asians are silly enough to think that tiger penis is the answer to everything.

  28. #28 Calli Arcale
    August 14, 2010

    Yes; in fact, ambulocetacean, most Asians only use “Asian medicine” if they’re too poor to afford proper care. Mao Zedong encouraged it for precisely that reason — he had promised his new communist utopia would deliver medical care to the people, but a billion people is an awful lot to care for on what was at the time a bankrupt economy. The answer? Acupuncture, herbal medicine, whatever he could sell as “truly Chinese” (whether it was or not) and persuade the people to accept at an affordable price tag.

    Of course, what amuses me the most about Eric’s post is that he’s resorting to the “medicine has these flaws, ergo use acupuncture” failing to realize he has given no argument whatsoever in favor of acupunture (besides that he has a thriving business.)

    Well, he does also point out that he has a lot of demand. But that’s also true of casinos and state lotteries; popularity of them doesn’t make gambling a viable retirement plan.

  29. #29 DLC
    August 14, 2010

    Renee Najera @ 24 : Unfortunately people feed the trolls because Someone Is Wrong On The Internet.
    Augie’s not even as good as a stopped clock, which is right twice a day. I originally thought he was some kind of “woo Poe” or something.

  30. #30 Chance Gearheart
    August 14, 2010

    @Rene Najera

    I’ve chosen to stop attempting to approach him with healthy debate, and just ridicule him instead because of his refusal to debate for the sake of debate and instead attempt to troll people into a corner. Of course, it could just be me playing the Athiest Conspiracy up still, you know, for that paycheck and all.

    Maybe this will help explain him a little further:
    http://lol.i.trollyou.com/LOL-I-TROLL-YOU.png

    It generally helps to either imagine a picture of “LOLCATS”, or replace anything he types with a combination of “whargarbl, derp, or durr”. He’s much more useful and amusing in that manner.

  31. #31 Mark P
    August 14, 2010

    “Half of doctors prescribe placebos, survey shows”

    That’s right American Medicine is also a sham.

    Quite apart from the leap of illogic, there is a problem with the original formulation.

    Mostly doctors prescribe placebos – because the patient insists on a pill of some sort. Rather than give them something expensive and dangerous or have them seek some inappropriate treatment, they give them something cheap and safe. Doctors are not prescribing them because they want to – far from it. They are most certainly not giving them a placebo in the hope it will work.

    If more patients would accept that there is nothing to be done about some things, then less placebos would be required. It’s primarily a patient issue, not a doctor one.

    Note that few doctors do think the placebo effect is worth it for it’s own sake – they just want to avoid the patient doing something bad. Only practitioners of woo think that the placebo effect is suitable as a treatment. Nor is it the only thing a real doctor does – again in contrast to woo.

  32. #32 Coder
    August 14, 2010

    “If more patients would accept that there is nothing to be done about some things, then less placebos would be required. It’s primarily a patient issue, not a doctor one.”

    Agreed. I wish my software clients would just accept that the software they paid me to write just doesn’t work. It sure would make my life a lot easier.

  33. #33 mr brinkman
    August 15, 2010

    @30 Uh, yeah, as if treating disease and writing code are analogous.

  34. #34 "GrrlScientist"
    August 15, 2010

    unfortunately, woo is alive and well in germany, too. it is absolutely disgusting to walk into an apotheke looking for ibuprofen or something (anything!!) for a migraine, only to be confronted with a big damned line of people waiting to be interviewed by the sales clerk before being allowed to purchase 8 or so pills. meanwhile, the shelves are stocked with all sorts of woo remedies, herbs and other nonsense, readily and easily purchased without having to undergo the semi-public 20-questions routine.

    when i go back to visit the states, one of the first things i intend to do is visit the local drug store and purchase as many pills and cremes as i can to bring back with me, so i can avoid these infernal lines filled with nosy germans who eavesdrop on every little physical complaint i describe to the sales clerks.

  35. #35 Kitto
    August 15, 2010

    http://whatstheharm.net/acupuncture.html shows what the harm can be in having acupuncture done needlessly.

  36. #36 Vicki
    August 15, 2010

    Coder–

    I think you mean “I wish my software clients would just accept that I can’t do what they want, and stop wasting their time and money on my product.”

    If I have something a doctor can’t treat, I would rather she tell me so than write a prescription for something I’ll have to pay for (even sugar pills come with at least a copay), and tell me to come back every month to have blood drawn so they can adjust the dosage.

  37. #37 DevoutCatalyst
    August 15, 2010

    I feel sorry in some small way for acupuncturists, as persons who just blew a bundle and wasted many hours of their time learning something that isn’t true. Acupuncturists are in this way reduced to non-learning persons, at least for a large chunk of their lives, practicing something that on the surface and at it’s core looks patently foolish when closely examined.

    But in the current milieu you can make a middle-class living as a mid-range practitioner without any pangs of guilt — doing acupuncture. If you honestly wanted to learn about Eastern culture you could have instead, for example, studied the Chinese language, and in about 10,000 hours of very hard work you would have skills that could be easily verified as real. But that would be a much more difficult path, and there are few jobs available on this basis. So why not fritter away your life pretending to study (and not pretending to be deceived by) a modern deception called acupuncture?

    Your legacy is that you did nothing much in your vocational life and got paid fairly well to do nothing much. Not bad for this merest carnival act in the traveling circus called CAM.

  38. #38 titmouse
    August 15, 2010

    I hate acupuncture and all the rest of so-called “Traditional Chinese Medicine” because I love the poor, rapidly disappearing rhinoceros.

  39. #39 bluedevilRA
    August 15, 2010

    Off topic, but I thought Orac would like to know (if he hasn’t seen already) that Dr. Mercola posted in the bastion of pseudoscience known as the Huffington Post about the “cholesterol myth.”

    http://www.huffingtonpost.com/dr-mercola/the-cholesterol-myth-that_b_676817.html

    He peddles the usual tropes: cholesterol is actually good for you because all cells need it, it is a poor indicator of heart health, inflammation is a much better indicator, he claims that doctors don’t understand the importance of inflammation with regards to heart health, cholesterol drugs have terrible side effects, and finally he gives advice on how to lower cholesterol naturally, in direct contrast to the fact that he spent several paragraphs explaining cholesterol is natural, important and does not need to be lowered.

  40. #40 augustine
    August 15, 2010

    Bluedevil,

    You might want to read this. The cholesterol theory is dead. You’ve been duped. Other rationalizations for the continued use of big pharma drugs are currently being explored. “Inflammation” seems to be all the rage now.

    http://www.thincs.org/

  41. #41 bluedevilRA
    August 15, 2010

    Augustine, I will not derail this comments section by responding beyond this comment. If Orac tackles this topic, then I will gladly engage you.

    Until we meet again, I leave with a parting shot…the website is quite entertaining. It is also total bunk.

  42. #42 augustine
    August 15, 2010

    “Deconstructing the Placebo Effect and Finding the Meaning Response”

    http://www.annals.org/content/136/6/471.full

    For some of the more boisterously confident posters who do not understand what the placebo “means”. You know who you are.

  43. #43 antipodean
    August 15, 2010

    Of oucrse would have to ignore the fact that statins are actually Japanese and therefore presumably ‘Eastern’ Medicine.

  44. #44 muteKi
    August 15, 2010

    @38 titmouse:

    I was actually at the Albuquerque zoo earlier today and saw that these non-cures were a major use for the horn.

    I’m very disappointed. I like them too.

  45. #45 augustine
    August 15, 2010

    [Blue Devil: Until we meet again, I leave with a parting shot...the website is quite entertaining. It is also total bunk.]

    As the website says:

    “The great tragedy of Science-the slaying of a beautiful hypothesis by an ugly fact.”

    [Antipodean: Of oucrse would have to ignore the fact that statins are actually Japanese and therefore presumably 'Eastern' Medicine.]

    No matter the locale, statins are thoroughly “western” and mechanistically derived.

  46. #46 Little_Ruru
    August 15, 2010

    Some, perhaps many, acupuncturists honestly believe in what they practice. I did and this is due to not having a basic grasp of logic and the scientific method. If there is a gap in this part of your education then you miss the circular reasoning in the TCM theory and are unable to properly assess efficacy (the lack thereof) of the treatments in clinical practice. I stumbled upon this when I took up a biology paper out of interest. The section on the scientific method led to critical thinking and from there to sites like this and evcforum, etc, etc and lo! the rot had set in, so to speak. I shut up clinic after 4 years of practice.

    @DevoutCatalyst:

    Yes, I wasted a lot of time and money studying acupuncture. I am by no means an apologist but critical thinking is not the default for everyone. I was raised in a very anti-science household and thought I knew better. Some of us unfortunately learn the hard way.

  47. #47 augustine
    August 15, 2010

    [Lil Ruru:and lo! the rot had set in, so to speak. I shut up clinic after 4 years of practice.]

    As you should have. And you also should have refunded all the monies you defrauded of all your customers. But I doubt it. You’re honest about your scientific “conversion”. But you’re not that honest of a person.

    [I stumbled upon this when I took up a biology paper out of interest. The section on the scientific method led to critical thinking and from there to sites like this and evcforum, etc, etc]

    Question to all SBMers : Does critical thinking promote atheism?

  48. #48 https://me.yahoo.com/a/MfVjaVMK1NpHjCg62YBlE.UHTTJCXEQ-#5352c
    August 15, 2010

    Any health treatment has a potential placebo side effect, unless you manage to administer it without the patient’s knowledge. It’s what placebo means – an effect related to the expectation of going better.

    Early in my med tech career, I was out collecting blood samples and one of the nurses stations was “giving report”.

    The subject of part of this ‘report’ had been given a mild stool softener to counteract the inevitable constipation of bed rest. Because it was given in the evening, the patient assumed it was a sleeping pill and for the first time during the hospital stay, had slept soundly. Patient commented “that was a great sleeping pill” and asked for more.

    For the rest of the stay, the patient was given the laxative, because the placebo effect produced sound sleep. The nurses were told to keep the placebo effect going by not disabusing the patient of the notion that it was a sleeping pill.

  49. #49 titmouse
    August 15, 2010

    Question to all SBMers : Does critical thinking promote atheism?

    Critical thinking promotes honesty and mutual respect, because critical thinking means you get to double-check what I say, and vice-versa.

    If I make a claim about God or something supernatural, you are allowed to ask for evidence so you can verify the claim for yourself.

    Deism, agnosticism, atheism, and personal religious experience that isn’t elevated to a political imperative for others are defensible positions.

  50. #50 René Najera
    August 16, 2010

    Oh, Augustine… You know better than to bait us like that. Critical thinking and believing that you’re not the end-all-be-all of all things are not mutually exclusive nor collectively exhaustive. You know this. You’re a prime example.

  51. #51 augustine
    August 16, 2010

    Titmouse, I think you’ve been mislead or confused on empiricism’s pro’s and cons. Anyway, the question is do you think critical thinking promotes atheism?

  52. #52 augustine
    August 16, 2010

    Rene,
    Do you believe critical thinking promotes atheism?

  53. #53 James Sweet
    August 16, 2010

    Every paragraph is partly true. And the result is wholely false.

    Beautiful. Yep, couldn’t agree more.

    Also, what is it with all the tu quoque from eric and augustine here? Yeesh.

    And to Augustine — Sure, I’ll take the bait. Yeah, I think that “critical thinking promotes atheism” in the sense that I think if more people were better at critical thinking there would be more atheists. Which is not to say there aren’t plenty of religious people who are also excellent critical thinkers, but I think that there are vast swaths of people who only believe in WhateverTheyBelieve because they’ve never really thought very hard about it. Or anything. If you could give those people a Magical Critical Thinking Pill, a lot of them would realize, “Hey, all of my reasons for believing in Thor are stupid and trite. Screw it!” Some of them might still choose to retain unfalsifiable beliefs for specific personal reasons, of course.

  54. I never understood how woo-woos can attack big pharma’s profit motives, and then charge their customers cold cash for comfort. I guess the first part of the brain that woo attacks is whatever detects hypocrisy.

  55. Another weird bit of “reasoning” from woo-woos is their accusing “western medicine” of having its occasional mistakes and con-men, as if that somehow calls into question the whole enterprise. By that same reasoning shouldn’t the woo-woos doubt themselves a whole lot more? Since every single homeopath, chiropractor, and acupuncturist is mistaken, a con-man, or both, alties consistently look a lot worse than “big pharma” by their own criteria.

  56. #56 jane
    August 16, 2010

    Prometheus: “Before Eric – or someone like him – argues that this is only 124 serious injuries in 13 years, remember that these are only the published case reports – the total number of injuries (and deaths) is much greater.”

    Evidence?? Citation??

  57. augustine writes:
    Before it “self corrects”, as you call it, what happens? Death and destruction in the name of science. Medical confidence requires amnesia.

    So, the “ancient Chinese doctors” who figured out acupuncture, since they didn’t have access to modern diagnostic technology or even cadavers, must have done it by trial and error. Where do you think your science of acupuncture came from, mmmm? It was not handed down by the gods – it was invented by a bunch of quacks who ‘self corrected’ their woo until it was plausible enough to survive.

    What a lot of woo-woos forget is that alternative medical practices are MORE guilty than science-based medicine of trial and error, getting it a bit wrong, and hiding it from patients. After all, it took science-based medicine less than 100 years to determine conclusively that acupuncture is a placebo – but acupuncturists weren’t able to figure that out over the course of however many hundreds or thousands of years of ‘experiment’ on live humans. Talk about irresponsibility!

    Last year, because I was curious, I bought some acupuncture needles on Ebay and experimented with sticking them into various muscle/tissue parts of my arm/hand. Do you know what struck me as most interesting, though? The most interesting thing I noticed was that the needles came individually packed in radiation-sterilized packets! Tell me, do you think acupuncturists used to sterilize their needles before that horrible scientific reductionist Pasteur figured out why it was a good idea? Hell no. Needles are expensive, right!?

    Do you re-use your needles? If not, you’re implicitly ceeding a very important point – namely that science is right about a lot of crucial things. It’s much more right than you’ll ever be, mister witch-doctor.

  58. do you think critical thinking promotes atheism?

    Of course. Atheism (along with moral nihilism and anarchism) is the most rational position anyone can take, given the evidence that’s available at this time.

  59. #59 Canadian Curmudgeon
    August 16, 2010

    [I'm currently going through a serious bout of sciatica and I'm getting thoroughly sick of the number of people who are telling me I *need* to see an acupuncturist or chiropractor.]

    *augustine:
    Keep suffering! You’ll teach them that it’s all gobbledegook! You should go and get spine surgery just for kicks. Just to show them how much better it is than placebo.*

    Why would I spend money for a treatment that has been proven NOT to work? I stick with modern medicine – with its science based approach

  60. #60 Chris
    August 16, 2010

    jane, why don’t you read Prometheus’ post more carefully. You will find this paragraph:

    A 2001 liteature review by Yamashita et al in Complementary Therapies in Medicine – which can only be described as a “acupunture-friendly” journal – found 89 articles reporting acupuncture injuries between 1987 and 1999 covering 124 individual cases. Since these were all case reports, we can safely assume that this is just the “tip of the iceberg”.

    With the author name, date and journal title it is easy to find this: http://www.ncbi.nlm.nih.gov/pubmed/11444889

  61. #61 TechSkeptic
    August 16, 2010

    I read above (not going through 60 comments to find this again) the following idea:

    rational people go to medical doctors, and when they can not offer anything, then they go to woo providers who not only give them hope, admitted placebo, but also comfort and an ear to talk to.

    I’ve heard this claim from a number of people in the past who are not totally out in woo woo land, and it certainly justifies the idea that the acupuncture or what not can be warranted, even though there is a tiny risk harm (face it skeptics, acupuncture, even multiple sessions is less risky than back surgery or any surgery that requires general anesthesia).

    My previous field of study was for a treatment for scoliosis, which had other uses for lumbar stability and relief for disk issues. I met many patients who went through the process described above and what I saw was that its simply not true that people actually go through the course of medicine before going to woowoo land.

    Doctors generally try to avoid surgery and general anesthesia if they can due to the known risks. They will try external stabilization, a routine of exercise and stretching, muscle relaxants etc etc, unless the damage is severe. Many of the patients go for the pills, and quick things like braces, but rarely follow through on the physical therapy. Then when surgery come up, they jump ship and swim to the shores of Woo.

    They don’t in fact go through everything that medicine has to offer. They only go through the parts that are most convenient for them. Then they can’t understand why I am upset when I have not seen them for 6 months while their back got significantly worse while they were pretending that needles or back cracking was fixing them.

    This is what acupuncture has to offer, a distraction from the inevitable, a guarantee of a harder surgery, a harder recovery.

    At least for serious back issues. Maybe things are not this dire for other ailments.

  62. #62 augustine
    August 16, 2010

    [Why would I spend money for a treatment that has been proven NOT to work? I stick with modern medicine - with its science based approach]

    Like I said, keep suffering. There is one last resort. Try TechSkeptic’s woo. His mantra is “you just haven’t seen me yet” which is much different other woo.

  63. #63 Vicki
    August 16, 2010

    TechSkeptic–

    I get the feeling that many people would rather do anything than physical therapy: pills, surgery, acupuncture, steroid injections, staying in bed with pain, anything.

    Some years ago, I had problems with my rotator cuff. My GP sent me to an orthopedic surgeon [sic]. He referred me to a physical therapist, saying that that works in about 70% of cases, and if it didn’t, come back and we would try a cortisone shot. And if that didn’t work, he could operate. He also said he hoped never to see me again.

    Some time after that, at the PT’s office, I asked whether some of that success rate was due to how regularly people went to PT and did their exercises at home. He allowed that that might be a factor.

    I suspect that some of the 30% who go back to the orthopedic surgeon and say that PT didn’t work mean “the first couple of sessions at the office didn’t make it all better, and the exercises he sent me home with hurt.”

  64. #64 Rogue Medic
    August 16, 2010

    augustine responses to: http://scienceblogs.com/insolence/2010/07/a_misstep_in_castigating_huffpos_journey.php#comment-2650979

    You seem to have returned to the idea that science should promote religion. You seem to think that anything that does not promote religion promotes atheism. As usual, you are really only promoting ignorance.

    You show me a scientist who understands G-d and rejects G-d.

    I did not make any claims about scientists rejecting God.

    Are you claiming that theists who understand science-based medicine do not understand God?

    Do you see the dillema? If the facts are the same then how did they come to diametrically opposing conclusions using the same facts?

    Why do you come to the conclusion that they are looking at the same facts?

    What led to Behe’s embarrassment was his decision to ignore facts that did not support his bias. If you are going to claim that something is faulty, or impossible, you need to look at the research on it. He chose to dismiss research even though he admitted that he had never looked at it.

    He is ignoring the facts that do not support his bias, so the claim that they are using the same facts is not even close to true.

    Only using facts that support one’s biases is just bad reasoning.

    See what I mean? He doesn’t “really” understand science or he has been discredited and he “doesn’t count”.

    Science is about having to prove that your claim is true, or that it cannot be falsified. Scientists accept the results, when their claims are falsified.

    Science-based medicine is about having to prove that your treatment is safe and efficacious.

    I am not aware of any reason to believe that God opposes science-based medicine.

    Few religions take any position opposed to science-based medicine, although Scientology and some branches of Christian Science seem to.

    I don’t deny science. Many scientists don’t deny the existence of a god. The problem is the definition and boundaries of science.

    Then maybe you should explain what it is about science-based medicine that you find to be a problem. A problem that is not limited to isolated religious sects.

    What if one doesn’t deny science and believes in a god? Where does this person fit in serfdom?

    Serfdom?

    I guess you wanted to make it clear that you do not approach this with any bias at all.

    You are just rephrasing my statement.

    Where is there anything about science-based medicine that depends on a rejection of God?

    Is science infalliable? Does it give us the truth? Can it ever?

    Science is not infallible.

    Science depends on looking for and correcting mistakes.

    Science is a process for getting closer to the truth.

    You appear to be looking for a God in science.

    Science is not a God.

    You are asking irrelevant questions.

    You are asking the wrong questions.

    Is truth temporal?

    For Christians, the New Testament changed the truth of The Bible.

    The truth of the Old Testament and the truth of the New Testament differ temporally.

    Science is a process for getting closer to the truth, not for claiming what the ultimate truth is.

    Is the reality of practical medicine being confused with science by calling it SBM?

    What do you mean by the reality of practical medicine?

    Science is a process, not a result. You seem to be caught up in the idea that science is a result, rather than a process for arriving at results – results which should not be worshipped, because they are just steps on the path of science.

    originally Posted by: Rogue Medic | July 12, 2010 4:29 PM
    http://scienceblogs.com/insolence/2010/07/a_misstep_in_castigating_huffpos_journey.php#comment-2652874

    No response from augustine.

    It seems that even augustine does not pay attention to augustine’s questions/comments. They all seem to be just interchangeable drivel in the eyes of augustine.

    .

  65. #65 jane
    August 16, 2010

    Chris, why don’t you read this site more carefully? You should know that when someone makes a dramatic-sounding claim that is not generally known to be true, Science requires him to be able to produce factual evidence in support of that claim. The cited study is adequate evidence that there is a small but real rate of injuries due to incompetent acupuncture practice, and that there were two related deaths in Japan during a 13-year period. To announce that there were really a “much greater” number of deaths during the studied period, one must have support from another source. When Prometheus uses the expression “we can safely assume,” we can read it as “I have no citation, but I believe this ought to be true.” That just won’t do.

  66. #66 augustine
    August 16, 2010

    I never understood how woo-woos can attack big pharma’s profit motives, and then charge their customers cold cash for comfort. I guess the first part of the brain that woo attacks is whatever detects hypocrisy.

    Speaking of profit motive….

    http://www.onlineprnews.com/news/53064-1281650223-worldwide-vaccine-market-is-predicted-to-increase-at-a-compound-annual-rate-of-97.html

    “Pneumococcal and “combination” DTaP vaccines are driving growth in the pediatric sector, while influenza and hepatitis vaccine products are driving sales in the adult segment of the market. Future growth in adult vaccines will be driven by increased acceptance and new products.”

    More acceptance means more propaganda on the way. You’ve got more work to do for pharma SBMers. Too bad you guys don’t get paid for your ideology. Somebody is though.

  67. #67 Prometheus
    August 16, 2010

    Jane,

    I have no citation for my assumption that actual number of acupuncture injuries exceed the number of published case reports; I am relying on logic.

    We know that even with diseases where reporting is required by law that not all cases are reported – some are misdiagnosed, some have the reports mislaid or misdirected and some are simply not reported. This does not require a citation, only a passing knowledge of human nature.

    I know that not all acupuncture injuries are reported in the medical literature from both personal experience – I am aware of at least three cases (two liver lacerations requiring emergency surgery and one case of bowel perforation leading to peritonitis) that were never published – and from an understanding of how case reports are generated and published.

    Logic leads us to realise that even unusual and unexpected cases will only reach the medical literature if all of the following occur:

    [1] Someone identifies the case as being worthy of publication.

    [2] Someone takes the time to write a case report and submit it for publication.

    [3] An editor at a medical journal feels that the case report is interesting or valuable enough – and written well enough – to justify publication.

    [4] The author persists through the cycle of review, re-writes and re-review to final publication.

    Again, logic – and an understanding of human nature – tells us that most acupuncture injuries, even if they result in hospitalisation or death, will not be published. This is not just true of acupuncture injuries, but of all medical case reports. If you did a literature search for case reports of measles, malaria (in the US) or shark bites (all of which are reportable or recorded), you would find that the number of case reports is far smaller than the number of reported cases.

    Frankly, it’s not newsworthy that people untrained in real anatomy (as opposed to Chi meridians) repeatedly sticking long needles into patients will cause serious injury from time to time. As a result, only unusual or unexpected injuries will be published.

    Supporting this is the nature of the cases reported by Yamashita et al – of the 124 cases, nearly 15% of them were spinal cord injuries. I was surprised with the relatively large number of spinal cord injuries, which would imply a very determined (and unlucky) acupuncturist. I suspect that this is an artifact of the unusual nature of the injury, further demonstrating that the total number of serious acupuncture injuries must be much greater.

    Either that, or greater than one in seven serious acupuncture injuries involve damage to the spinal cord. Take your pick.

    The fact is that we have no good idea how many patients have been injured during acupuncture – the medical literature only gives us the minimum number of injuries. Since we also have no idea how many people are treated with acupuncture per year, we have no way of knowing the injury rate. However, since we know – thanks to numerous studies – that acupuncture is no more effective than placebo, we know that the risk/benefit ratio of acupuncture is undefinably high (as division by zero gives a mathematically undefined result).

    I hope this explains how I can state – with reasonable assurance – that the case reports are only “the tip of the iceberg” (or “tip of the needle”?). If it pleases you to imagine that I am simply making all this up in order to make acupuncture look bad, feel free to do so.

    Prometheus

  68. #68 Rogue Medic
    August 16, 2010

    @ 63 jane,

    What reason do you have for claiming that this one acupuncture injury and death case series is exhaustive?

    A bunch of case reports is just a sampling of what is available in the published case reports.

    Should we assume that acupuncture miraculously avoids having the records of acupuncture injury cases sealed at the conclusion of trial?

    Should we assume that acupuncturists recognize the harm they do, even though they continually deny that acupuncturists cause harm?

    Should we assume that acupuncturists document and publish all of this harm, that acupuncturists still deny occurs?

    Why?

    Case studies are only anecdotal samples.

    This does not even include the harm that comes from avoiding treatment by a real doctor.

    If there is a real medical condition, but the patient seeks help from an acupuncturist, then the person is delaying the benefit of real medicine.

    If the patient is not really sick, then there would seem to be no harm from acupuncture. This is a mistake. This just reinforces the fantasy that acupuncture works.

    Acupuncture does not work, except for the acupuncturist trying to separate customers from their money.
    .

  69. #69 Phoenix Woman
    August 16, 2010

    I deconstructed Eric the Poker’s comments here: http://scienceblogs.com/insolence/2009/06/electroacupuncture_the_bait_and_switch_o.php#comment-2728312

    I got the biggest laugh at the very end, when he tries to talk up acupuncture’s alleged ancient Chinese history, ignoring the fact that a) Mao promoted it and the other folk remedies that had been given up centuries earlier because it was cheaper than real medicine in real hospitals with real doctors, and b) Mao didn’t believe in it himself.

  70. #70 TechSkeptic
    August 16, 2010

    Vicki,

    Yes I think you are mostly right. However, and I admit this is just my observation not a detailed study, I find that people avoid surgery more than PT.

    Is pretty incredible, and your trips to the PT further support my contention that people who travel to the land of woo, often do it because the evidence based alternative requires too much work or is too scary for them to do. So instead, they often end up hurting themselves more.

    This is one of the reasons that I find Whatstheharm.net not as compelling as it could be or should be. I love that the site is there. It can often provide the evidence needed to put an end to a dumb contention (Much like MAAF does for the “no atheists in foxholes” nonsense). But it doesnt cover the reality of woo creating an environment where serious problems are left to fester longer than they should ultimately ending up with a more difficult and expensive treatment with an even worse recovery rate.

    One thing I continue to credit the woos with however, I have known the most caring and compassionate doctors, who are so time pressed that they are simply unable to express their actual desire to heal to their patients. One doc I worked with spoke into his recorder, and talked about the patient in the third person, while the patient was in there. Talk about feeling like a lab rat! But this is not aspect of uncaring or a pharma led profit machine, its actually a result of the financial realities of having a practice. If the docs had more time to spend with patients, if they didnt feel pressured to move them along in order to have a decent facility, it would be a lot easier to incorporate some of the benefits of a woo treatment. Overall healthcare would get better.

    well I’m rambling now.

  71. #71 jane
    August 16, 2010

    Rogue Medic – Read more carefully, please; I did not claim that the Japanese study detected all complications that occurred during that period, nor did the authors of the study.

    As for the efficacy question, which both of you have raised, I have noted before that the answer to whether or not acupuncture works depends at least in part (since we actually do not know whether it is bioactive) upon one’s definition of “works”; I am not going to change my definition, nor are you, so there’s no point in arguing further about it.

    Routine complications of medical procedures (and many other life activities) are certainly underreported, but we usually have no basis for presuming that we know the size of the error, or that the “hidden toll” of things we don’t approve of must be much higher than that of things we do. Deaths, however, do tend to be reported someplace unless the victim’s child is really desperate to go on collecting their pension checks, so if people were dropping like flies from having visited acupuncturists, I would expect there to be some evidence available for some zealous anti-acupuncture crusader to uncover.

    We do know that clinical trials of acupuncture report either no or few and minor adverse events, so the side effect rate, at least for those practitioners, is very low indeed (in marked contrast to pharma arms included in some stuies). Since acupuncture usually involves very fine needles placed only half an inch or so into muscle tissue, it would be extraordinarily rare to suffer pneumothorax or significant spinal injury; in some reported cases such injuries result from aberrant homebrew procedures. (Watch out what you do with those fabled Toothpicks, guys.)

    Very rare complications, the medical version of the man-bites-dog story, are indeed more likely to get reported – perhaps especially if they were inflicted by an incompetent CAM practitioner whose field the reporting MD does not much like. People who suffer genuinely serious injuries will usually be seen by an MD sooner or later, so the alleged inability of acupuncturists to acknowledge “all of this harm” they do would not prevent reports from being made. I therefore highly doubt that there are hundreds or thousands of unreported dire cases of “damage to the spinal cord” out there. Minor skin infections, yes, probably are significantly underreported.

  72. #72 Chris
    August 16, 2010

    jane, there is a risk for multiple reasons from poking people with needles (not the least is the lack of basic hygiene practices) with no real evidence it does anything.

    Perhaps acupuncture practitioners should just stick to using toothpicks.

    You would love how a infectious disease doctor sees acupuncture:

    I you want to get the willies watch a video on acupuncture, Japanese or otherwise. Barehanded, no hand washing, the practitioner touches the area to be pierced, no alcohol wipe is used, and the junction of needle/skin is manipulated. The Kiiko style, to judge from the photographs on the website, does not include gloves. These videos should be entitled “How to transmit infectious diseases.”

  73. #73 Chris
    August 16, 2010

    More from Dr. Crislip (you must listen to his podcasts to get the full effect):
    http://www.pusware.com/quackcast/quackcast.mp3

    References here:
    http://moremark.squarespace.com/quackref/#8

  74. #74 jane
    August 16, 2010

    Chris – That does not sound like an ideal method, but probably not many people actually get sick from it. Few infectious diseases are transferred by skin-to-skin contact, and the new needles that are inserted into the skin are a lot cleaner than the objects that constantly give us paper cuts and splinters (through skin that carries just as many bacteria as an acupuncturist’s) without inducing lethal infections.

    It’s interesting how, based on a single study, the Toothpick has assumed such an unchallenged propaganda role. Despite the possibility that sham acupuncture itself has both placebo activity and bioactivity, there are many studies in which “sham” acupuncture, nonpenetrating and/or in the wrong spots, is inferior to real acupuncture. There are also studies in which it is not. The CSICOP crowd takes it as an article of faith that all studies showing differences between sham and real acupuncture are “worthless”, whereas all studies showing no differences are “rigorous”; many acupuncturists believe the exact opposite. Neither is a scientific attitude. A truly objective observer, I think, would conclude that we do not yet really understand what conditions maximize either the bioactivity, if any, or the placebo (or super-placebo) activity of acupuncture.

    That being the case, supposing that you wish to try the method for your back pain, you can try to maximize pain relief by employing the best-tested traditional technique, or you can choose to reduce the safety risk from miniscule to virtually zero by Poking Yourself with a Toothpick, at the possible cost of experiencing less relief. The nice thing about a free country is that every individual can make that decision for himself based on his risk tolerance, philosophical beliefs, and how much his back hurts.

  75. #75 Seb30
    August 16, 2010

    @ Prometheus

    I am aware of at least three cases (two liver lacerations requiring emergency surgery and one case of bowel perforation leading to peritonitis)

    I have to ask: did the acupuncturist fall over his patient, or what?
    I mean, I was under the impression that acupuncture is about sub-cutaneous insertion of needles. A few millimeter inside the skin at most. The liver or the guts are a bit more inside. Don’t tell me there are peoples who actually insert 10-centimeter long needles all the way to the hilt into peoples for a living.

  76. #76 Chris
    August 16, 2010

    jane, you need to adjust your sarcasometer.

    And figure out that some of us don’t take those who demand evidence, yet fail to produce any to support their contentions.

  77. #77 Prometheus
    August 16, 2010

    Jane asks:

    “I was under the impression that acupuncture is about sub-cutaneous insertion of needles. A few millimeter inside the skin at most. The liver or the guts are a bit more inside.”

    I, too, was under the impression that acupuncture needles were placed – at most – a few millimeters into the skin. However, as the case reports (and my experience) indicate, not all acupuncturists are adept at gauging depth. Maybe they should put depth markers on the acupuncture needles.

    She continues:

    “Don’t tell me there are peoples [sic] who actually insert 10-centimeter long needles all the way to the hilt into peoples [sic] for a living”

    To begin with, you don’t have to take my word for it – the Yamashita et al article says it all. Also, it is entirely possible that the acupuncturists who caused lung, liver, bowel and spinal cord injury weren’t doing it “for a living” – maybe visceral trauma is just a hobby of theirs.

    Prometheus

  78. #78 Rogue Medic
    August 17, 2010

    jane, you need to adjust your sarcasometer.

    Wouldn’t that be something like a collision between matter and anti-matter?

  79. #79 Coder
    August 17, 2010

    To Vicki who said:

    “If I have something a doctor can’t treat, I would rather she tell me.”

    That’s fine, just don’t be surprised when your doctor’s clients start to look to other businesses that can. If I can’t solve a client’s problem, I don’t berate them for seeking assistance elsewhere like many seem to do here.

  80. #80 jane
    August 17, 2010

    Chris – I entered this discussion to complain about others’ practice of demanding evidence, yet failing to provide any to support one’s own contentions, if you will recall. I did not myself make any specific claims about the side effect rate or the mode of action of acupuncture (it’s not an article of faith for me, so I’m waiting for solid scientific evidence). What citations do you think I should provide? I did refer in general terms to the existence of a body of conflicting scientific literature that anyone who is pontificating on this subject should already be aware of, but if you purport to doubt whether these publications exist, I suppose I could give you some PubMed search terms to start with.

    Prometheus – If you will reread the thread, you will note that the comment to which you responded was by Seb30, whose gender is unknown (at least to me). However, I completely concur with Seb30’s comment. If you TRIED to inflict serious injury by using an acupuncture needle as a weapon, short of sticking it in someone’s eyeball, you would find it difficult. Such injuries are therefore very unlikely in normal practice. One case of pneumothorax from “acupuncture” that I have heard of involved some guy at home doing it to himself with very large “needles.” Around here, some people feel free to personally redefine acupuncture to exclude anything shown to be effective (e.g., if needling acupuncture points has proven bioactivity in an animal study, that wasn’t acupuncture, because it didn’t work by affecting the flow of chi!). I would be inclined to define acupuncture so as to exclude any use of needles big enough to serve as cocktail skewers.

  81. #81 Calli Arcale
    August 17, 2010

    With all due respect, jane, I don’t think you can blame the Respectful Insolence readership of defining acupuncture very broadly, since it it isn’t really properly defined by even the practitioners themselves. Oh, certainly each practitioner has a definition of sorts, but they contradict one another.

    And that’s part of the problem folks here have with acupuncture. You seem to be criticizing us for using a “no true Scotsman” argument to discredit any seemingly positive acupuncture studies. We’re not. We’re pointing out that the actual clinical practice of acupuncture is so ridiculously broad that it’s absurd to use one study to make conclusions about the whole of it. And yet that’s what acupuncturists routinely do. They’ll look at a study that says needling showed bioactivity in an animal (note: “bioactivity” is a pretty vague term) and use this as evidence that their particular conception of acupuncture is correct, even if their needling isn’t the same as in the study.

    And probably most tellingly, acupuncturists who do use the “chi” model will point even to the positive results of sham acupuncture studies as evidence of their methods, although the study really showed that the chi model is nonsense — if acupuncture works, it obviously has nothing to do with chi, so why do so many acupuncturists persist in talking about chi and meridians and things?

    BTW, very low-depth acupuncture with extremely thin needles is a relatively modern concept, made possible only by modern technology to produce the extremely fine needles required. “Traditional” acupuncture really does involve larger needles inserted to a greater depth. That you are not familiar with this doesn’t mean it doesn’t happen, and if you say it’s wrong to associate injuries from it with acupuncture, then I’m afraid it is you who are using the “no true Scotsman” argument.

  82. #82 jane
    August 17, 2010

    Straw man. (Also, I always have a good laugh when I see CSICOP types trying to practice psychic powers by telling us the contents of other people’s minds.) Modern acupuncture is what we are talking about; if ancient Chinese physicians were more likely to injure patients with their larger needles, that is irrelevant to today’s consumer. However, while ancient acupuncture did begin with large needles and continued to use them for a long time, fine steel needles were also employed at least sixteen hundred years ago. Apparently, it is you who are not familiar with what quality of manufacturing is possible without “modern technology.”

  83. #83 Todd W.
    August 17, 2010

    @jane

    Modern acupuncture is what we are talking about

    Which kind? Chinese? Japanese? German? Hand? Foot? Ear?

  84. #84 Calli Arcale
    August 17, 2010

    First off, I am not attempting to read your mind. I’m attempting to read your *post*.

    My point is that you seem to be objecting to collecting things other than extremely fine needle low-depth acupuncture under the term “acupuncture”, and are blaming us for doing so, despite the fact that it is in fact *acupuncturists* who have made this grouping. There are acupuncturists who use large needles, as mentioned in the case studies reported above, and they advertise themselves as acupuncturists. Blame them if you feel you must blame someone.

    I’m not sure why you think it’s irrelevant that ancient Chinese acupuncturists may have used larger needles. You say it’s irrelevant to the modern consumer, yet you’ve acknowledged that injuries have happened from such practicses. You seem to want to distance those injuries from what you consider “true acupuncture”, so I’d think you want even more to point out that this is an archaic technique which is being practiced today, and that stamping it out would reduce injuries due to acupuncture.

    I’d like a reference about fine steel needles being used in acupuncture 1,600 years ago. Historical re-enacting is one of my hobbies, and the Medieval period is of particular interest to me. I know of many methods for drawing wire, and in fact know a number of people who actually do it, because they disdain using modern manufactured steel for their projects due to the lack of historical accuracy. It is upon their expertise that I base my opinion. We take needles seriously for granted nowadays, because we have machines that can churn out thousands per second. That was not the case when blacksmiths were making them by hand.

    Medieval medicine, all across Eurasia, was quite different then as well. Chinese medicine was quite different from European medicine, but it wasn’t exactly like modern “Traditional Chinese Medicine” either, which, like everything, has evolved considerably. It’s unwise to assume that because something like a modern technique was used and that it was passed down through tradition that it was necessarily equivalent to what is done today.

    (That’s why I used “traditional” in quotes in my post at 81. Determining what is really traditional is trickier than it might at first seem.)

  85. #85 Chris
    August 17, 2010

    jane:

    What citations do you think I should provide?

    Anything that shows poking a person with needles does anything other than raise the risk of transmitting disease.

    All I see you do is complain about our data, when you present absolutely none. We can’t even figure out what you are actually going on about.

  86. #86 jane
    August 17, 2010

    Calli – You’re still unable to deduce what I think, feel, or want from my posts, so I’d give up on that tack if I were you.

    The general understanding derived from Asian medical literature, not in dispute as far as I know, is that historically there was a sort of toolkit of “nine needles” traditionally used for acupuncture and bloodletting, including ones specifically for bloodletting and large ones to shove into painful joints (surely not pleasant; indeed, I do think that is irrelevant to the present discussion, for the simple fact that nobody does it anymore). One of the “nine needles” is known in English as “filiform” or “miniature” and was the model for the modern acupuncture needle. Fine needles were developed after the Chinese manufacture of steel began in the 400s, and were further refined by the Japanese in the 1700s. I get all of this from secondary sources. I am not an Asian language expert (assuming that you’ll accept Asian historical literature as evidence of what technologies the writers possessed), so I have no more access to primary sources than you do. However, nobody to my knowledge has suggested that the English secondary sources have been systematically falsified. Go to Google Images and search for “nine needles” and you can find Chinese as well as English illustrations of the traditional needle types.

  87. #87 Rogue Medic
    August 17, 2010

    Rogue Medic – Read more carefully, please; I did not claim that the Japanese study detected all complications that occurred during that period, nor did the authors of the study.

    Well, let me reread what jane wrote.

    Prometheus: “Before Eric – or someone like him – argues that this is only 124 serious injuries in 13 years, remember that these are only the published case reports – the total number of injuries (and deaths) is much greater.”

    Evidence?? Citation??

    That’s everything.

    Yes. That’s all she wrote. :-)

    All jane added was two words and several more question marks than necessary. Maybe jane put a lot of thought into those question marks. Maybe jane thinks that I have misinterpreted the superfluous question marks as some form of spasm. Maybe jane thinks that jane is being especially cryptic.

    To which word might jane attribute some sort of extremely complex meaning?

    Or.

    To which question mark might jane attribute some sort of extremely complex meaning?

    Is jane claiming some sort of synergy between a word and a question mark or between two question marks?

    I think that Prometheus did a nice job of addressing jane’s augustine-like response.

    jane seems to be claiming that every statement made by someone who uses evidence to learn what works, must be based solely on evidence.

    jane does not appear to want to use logic, but expects others to abandon logic, just to play along.

    Without logic, the evidence is meaningless.

    As for the efficacy question, which both of you have raised, I have noted before that the answer to whether or not acupuncture works depends at least in part (since we actually do not know whether it is bioactive) upon one’s definition of “works”; I am not going to change my definition, nor are you, so there’s no point in arguing further about it.

    Whether something works depends on whether it works better than placebo.

    It does not matter if we are examining whether a surgical procedure works, whether a drug works, or whether acupuncture works.

    A surgical procedure that is no better than placebo, is just a placebo.

    That surgical procedure does not work. The placebo effect is what is working.

    A drug that is no better than placebo, is just a placebo.

    That drug does not work. The placebo effect is what is working.

    Acupuncture that is no better than placebo, is just a placebo.

    Even the best individualized specialist performed acupuncture is no better than placebo.

    All of acupuncture is just a placebo.

    Acupuncture does not work. The placebo effect is what is working.

    Denying that acupuncture is a placebo requires a misunderstanding of the research that has compared acupuncture with placebo acupuncture and found that they are both placebos.

    Acupuncture is just another placebo.

    Acupuncture does not work.

    Pretending that this is a matter of how one defines imagines the word works is nonsense.

    Routine complications of medical procedures (and many other life activities) are certainly underreported, but we usually have no basis for presuming that we know the size of the error, or that the “hidden toll” of things we don’t approve of must be much higher than that of things we do. Deaths, however, do tend to be reported someplace unless the victim’s child is really desperate to go on collecting their pension checks, so if people were dropping like flies from having visited acupuncturists, I would expect there to be some evidence available for some zealous anti-acupuncture crusader to uncover.

    Ooh! Ooh! Ooh! I know how to answer this one!

    Evidence?? Citation??

    I am just kidding. Why would jane have any evidence?

    It seems that jane would rather blame the victim, than blame the acupuncturist fraud.

    jane seems to suggest that no liability attaches to the acupuncturist fraud for the death.

    By proposing some imagined crime, jane appears to be trying to wash the acupuncturists’ frauds’ hands of these deaths, but multiple wrongs do not make something right, although multiple wrongs may attract attention.

    Acupuncture is just defrauding patients customers for financial gain at the expense of the patients’ customers’ wealth and health.

    We do know that clinical trials of acupuncture report either no or few and minor adverse events, so the side effect rate, at least for those practitioners, is very low indeed (in marked contrast to pharma arms included in some stuies).

    We know that people participating in studies also are being scrutinized much more closely than when practicing independently, so the stabbing a needle in the wrong spot just for a placebo effect rate can be expected to be lower than in the less supervised world outside of research.

    That’s not a chi spot! That’s my liver!

    Since acupuncture usually involves very fine needles placed only half an inch or so into muscle tissue, it would be extraordinarily rare to suffer pneumothorax or significant spinal injury; in some reported cases such injuries result from aberrant homebrew procedures.

    As if aberrant homebrew acupuncture is any worse than acupuncture served with wine in a marble tiled office.

    As a pathologist, jane is explaining that acupuncture is OK, because acupuncture is only stabbing people a little bit. There is no reason to believe that jane has any understanding of what lies beneath the skin.

    Based on jane’s misunderstanding of anatomy, the injuries and deaths reported in this CAM journal should never have happened.

    Never.

    Actually, if the treatment is something that does not work, such as acupuncture, then there is no excuse for the injuries to ever happen.

    To simplify for those bad at risk management.

    No benefit divided by a known risk equals unreasonable risk.

    jane is recommending stabbing people to produce a placebo effect.

    jane’s excuse is that acupuncture has not been reported as the direct cause of death for a lot of people – at least, not yet.

    So, for jane, it is OK to kill people for something that doesn’t work.

    jane seems to be saying, As long as acupuncture victims are not yet dropping like flies, how can anyone suggest that acupuncture fraud is a bad thing?

    (Watch out what you do with those fabled Toothpicks, guys.)

    The patient does not get stabbed with the toothpicks.

    The toothpicks are just something harmless to compare the acupuncture against. Still the acupuncture is not any better than misguided toothpick taps. Sometimes the acupuncture is not even as good as the toothpicks.

    Very rare complications, the medical version of the man-bites-dog story, are indeed more likely to get reported – perhaps especially if they were inflicted by an incompetent CAM practitioner whose field the reporting MD does not much like.

    jane’s defense is that many injuries are not reported, because the doctor is not critical of acupuncture?

    Priceless.

    jane claims there is some sort of important gradation of the competence of people who sticks needles where needles should not be stuck.

    A competent CAM practitioner quack vs. an incompetent CAM practitioner quack?

    The competence is already known, when we identify a person as a CAM practitioner quack.

    A competent person does not recommend, or treat with, fraud.

    People who suffer genuinely serious injuries will usually be seen by an MD sooner or later, so the alleged inability of acupuncturists to acknowledge “all of this harm” they do would not prevent reports from being made. I therefore highly doubt that there are hundreds or thousands of unreported dire cases of “damage to the spinal cord” out there. Minor skin infections, yes, probably are significantly underreported.

    jane has misread the response by Prometheus, perhaps intentionally, to make jane’s point seem almost valid. This is a review of journal articles, not a review of medical records. Not that acupuncture involves medical records, those might be alternative medical records.

    While starting out with advice to read two words and four question marks more carefully, jane appears to have ignored her own advice to read more carefully.

    jane also ignored the influence of the all-too-common practice of sealing medical records following malpractice cases, even though I had already mentioned it.

    Finally, there is probably much more harm from the delay in seeking real medical care, than from the fumble fingered frauds stabbing too deeply.

    No, I do not have a citation for that. It is just a logical conclusion.
    .

  88. #88 Chris
    August 17, 2010

    Come on, jane… tell us why poking someone with needles does something other than spread disease!

    Let us look at this case report of injury after acupuncture. Ah, but that is not all, check out the references of papers on injury from acupuncture:

    2. Rampes H, James R. Complications of acupuncture. Acup Med. 1995;13:26–33.

    3. Norheim AJ. Adverse effects of acupuncture: A study of the literature for the years 1981–1994. J Altern Complement Med. 1996;2:291–7. [PubMed]

    8. Lau SM, Chou CT, Huang CM. Unilateral sacroilitis as an unusual complication of acupuncture. Clin Rheumatol. 1998;17:357–358. [PubMed]

    9. Hadden WA, Swanson AJ. Spinal infection caused by acupuncture mimicking a prolapsed intervertebral disc: a case report. J Bone Joint Surg Am. 1982;64:624–626. [PubMed]

    10. Ernst E, White A. Life-threatening adverse reactions after acupuncture? A systematic review. Pain. 1997;71:123–126. [PubMed]

    11. White A, Hayhoe S, Hart A, Ernst E. Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ. 2001;323:485–486. [PMC free article] [PubMed]

  89. #89 Vicki
    August 17, 2010

    As a follow-up to Rogue Medic: A lot of Americans don’t have health insurance, or have very limited health insurance.

    A lot of people who use acupuncture don’t trust actual doctors.

    Put those together, and a fair number of people who are injured by acupuncture aren’t going to get to a doctor and report the injury. That assumes they make the connection: if you assume acupuncture is safe, and get sick with an infection several days later, you may not mention the acupuncture to the doctor, if you see one.

  90. #90 Calli Arcale
    August 17, 2010

    jane:

    Calli – You’re still unable to deduce what I think, feel, or want from my posts, so I’d give up on that tack if I were you.

    If you’d come out and say it, that might help. Are you not interested in being understood?

    In the chance that you are:

    Fine needles were developed after the Chinese manufacture of steel began in the 400s, and were further refined by the Japanese in the 1700s.

    “Fine” is a relative term; what was the actual size of the needle? It is my understanding (and I’ll have to dig up the references later) that needles were much thicker in that period, due to different techniques for making them. It is only from the 18th Century on that we’ve been able to make the kind of hair-fine needles that are available today, mostly because of improvements in wire-drawing techniques. (Super-fine wires certainly did exist in antiquity and certainly the medieval period, but of more malleable metals such as gold.)

    For reference, according to Wikipedia, modern acupuncture needles are typically 0.18 to 0.51 mm thick. (Wikipedia goes on to state that these are painless as they are smaller than a hypodermic needle, but in fact, some hypodermic needles are within the larger end of that range — and are pretty much painless as well, unless you happen to hit a nerve.)

    I get all of this from secondary sources. I am not an Asian language expert (assuming that you’ll accept Asian historical literature as evidence of what technologies the writers possessed), so I have no more access to primary sources than you do.

    I am certainly willing to accept Asian historical literature, in translation as I also am no Asian language expert, or secondary sources. I am seriously interested on this point, because of my interest in medieval history and technology. I have found that the matter is somewhat difficult to research due to contradictory evidence from different sources, as well as the fact that some ternary sources will represent themselves as secondary ones. I’d be very interested indeed to read a source showing that manufacture of very fine needles (less than .51 mm diameter) of a substance strong enough for needling was possible in medieval China. I didn’t think they (or anyone else) could draw wire that small until relatively recently.

    (Note: “relatively recently” means the last few centuries.)

  91. #91 jane
    August 17, 2010

    Well, if anyone wants to see an example of a whole field of straw men (not to mention a couple of ad homs) just read Rogue Medic’s last post. Not worth further attempts at dialogue.

    Chris – I cannot tell you WHY acupuncture “does anything other than spread disease.” I can tell you THAT, for example, actual scientific studies indicate that people who use acupuncture for back pain get more relief than people who take drugs, while suffering far fewer adverse events. I have no idea WHY that should be. I think it is possible for science to answer this question, but only if researchers come at it from the position that (a) we do not already know the answer, and (b) the answer might turn out to be of practical value no matter what it is. If we – like certain recent commenters – demand that everyone accept on faith that acupuncture is Only A Placebo and Therefore Worthless, we will be incapable of learning more. Like the old Zen story has it, if your cup is already full, there’s no room for more tea in it.

  92. #92 Todd W.
    August 17, 2010

    @jane

    actual scientific studies indicate that people who use acupuncture for back pain get more relief than people who take drugs, while suffering far fewer adverse events

    Please share it with us. Keep in mind that the acupuncture and drug cohorts should be comparable (i.e., same diagnosis, preferably similar intensity, age and gender-matched, similar treatment history, PT, etc.). Also, the drug used in the drug treatment arm should be indicated for back pain and be the “gold standard” treatment option.

    If we – like certain recent commenters – demand that everyone accept on faith that acupuncture is Only A Placebo and Therefore Worthless

    Who is demanding that anyone accept anything on faith? Those saying that acupuncture is nothing other than an elaborate placebo are basing their statements on the published literature.

    A question for you: the scientific literature has shown that there is no difference between needling the “meridians” vs. random location, nor between actual needle insertion vs. non-insertion. Assuming that there is a genuine effect, then would you recommend that actual insertion of the needle should never be done, since there is no benefit over non-insertion and greater risk (e.g., of infection, of nerve damage, etc.)?

  93. #93 Chris
    August 17, 2010

    jane:

    I can tell you THAT, for example, actual scientific studies indicate that people who use acupuncture for back pain get more relief than people who take drugs, while suffering far fewer adverse events.

    Evidence?? Citation??

    Here is something then perhaps you can do, find a Youtube video of acupuncture done with proper hygiene. Because Dr. Crislip did not find any.

  94. #94 jane
    August 17, 2010

    Calli – I believe some of the illustrations available online of the “nine needles” are derived directly from historical literature. The “strong enough substance” was steel. A Chinese-language illustration of the “nine needles” from the Zhen Jiu Da Cheng (1602, apparently containing or derived from the Yellow Emperor text) shows two types as being quite slender for the full length (though a precise diameter is not possible to determine), with a thicker handle. In a couple of English illustrations the filiform needle is shown as being thicker at the top, tapering to a very fine point.

    These were no doubt an expensive specialty item, but I don’t have any trouble believing that the Chinese, whose technology and craftsmanship were quite advanced, could make good steel needles in pre-industrial times. Look at the gizmos made for cataract surgery more than 2000 years ago. We tend to assume that people in the past were less competent and knowledgeable the farther back you go in time (and, for many people, the farther you get from the West), whereas sometimes the exact opposite is true.

  95. #95 Chris
    August 17, 2010

    Also, don’t use the crappy cites you tried last week.

  96. #96 Prometheus
    August 17, 2010

    Jane states:

    “If you TRIED to inflict serious injury by using an acupuncture needle as a weapon, short of sticking it in someone’s eyeball, you would find it difficult. Such injuries are therefore very unlikely in normal practice.”

    It is tempting to ask “Evidence??? Citation???”, but that would be childish. In fact, I have already provided a citation that contradicts Jane’s assertion (Yamashita, et al). I suspect Jane has not read the article (or even the abstract) because the authors make it clear that most of these complications were inflicted by “trained” acupuncturists. One of their conclusions was that training should be improved. They also warn against “self-treatment”, but I seriously doubt that the spinal cord injuries were self-inflicted.

    While I grant that the acupuncture needle seems ill-suited to causing grevious bodily harm, the data suggest that it can be done. As the lawyers would say, res ispa loquitur (“the thing speaks for itself”).

    I would direct Jane to Dr. Yamashita’s most recent publication in the matter, which is available free on-line:

    Yamashita H, Tsukayama H. Safety of acupuncture practice in Japan: patient reactions, therapist negligence and error reduction strategies. Evid Based Complement Alternat Med. 2008 Dec;5(4):391-8.

    In this article, Dr. Yamashita (who is a licensed acupuncturist) shows that – in a large training and treatment center – the rate of serious complications is very low. This is reassuring until you get the the section titled “Forgotten Needles”. Imagine how this problem might play out in the more common setting of a solo acupuncturist.

    The more pertinent issue, however is that it is all risk and no benefit. When compared to sham needling, acupuncture fails to show any effect. In fact, one study (Goldman et al. Acupuncture for Treatment of persistent arm pain due to repetitive use: A randomized controlled clinical trial. Clin. J. Pain. March/April 2008 24(3):211-218) showed that sham acupuncture was better than the real thing – which some die-hard acupuncture promoters have “spun” to mean that acupuncture “works” even if you don’t break the skin. If you accept that interpretation, please call me immediately about an exciting real estate investment opportunity.

    On a more serious note, if acupuncture “works” without breaking the skin, why not use the sham needles and avoid all risk (except, of course, the unavoidable damage to your bank account)?

    Prometheus

  97. #97 jane
    August 17, 2010

    In a recent thread on this blog, which I am sure you both saw, I cited several papers that compared acupuncture directly to drug treatment arms. I will not abuse our host’s bandwidth by repeating the same information in detail; go look it up. (As an aside, many humans outside clinical trials have also anecdotally reported that acupuncture provided relief when drugs did not; this says nothing whatsoever about mechanism, but from a pragmatist’s perspective it is interesting.)

    Todd W – there is no consensus that needling is equivalent to non-needling. While I’m on the subject of fallacies, this is called “cherry-picking” – presuming that, when evidence is incomplete, complex, and contradictory, the studies that support a favored viewpoint are to be taken as the last word on the subject.

    Chris – I am sure Dr. Crislip tried very hard. If acupuncture were virtually never done with proper hygiene – I’m not saying you have said this, although you seem to be dropping the hint – yet people rarely get sick from it, one would have to wonder whether the definition of “proper,” as specified apparently solely by people who never practice acupuncture, were too restrictive. It might – note, I say MIGHT – be rather as if an American-trained “nutrition scientist” were to come into our kitchens and gasp in horror at the absence of written food safety protocols, triple sinks, and constantly calibrated thermometers, the cat strolling around, and what have you, and announce that Traditional Cooking was a terrible disease risk and we should all give it up. Sometimes people do get sick from home cooking, but much more often they get tasty, affordable, nutritious food; the risk-benefit balance favors the traditional practice by a large margin.

  98. #98 Todd W.
    August 17, 2010

    @jane

    In a recent thread on this blog, which I am sure you both saw, I cited several papers that compared acupuncture directly to drug treatment arms. I will not abuse our host’s bandwidth by repeating the same information in detail; go look it up.

    So, rather than just providing the paper titles and authors, or the PubMed IDs, you want us to go slogging through old comment threads hunting for citations that you provided that may or may not be relevant to the current discussion? Um, no. Either provide the citations here, or provide a link back to the comment(s) where you originally provided them.

    there is no consensus that needling is equivalent to non-needling. While I’m on the subject of fallacies, this is called “cherry-picking”

    Ah, but it is the acupuncturists themselves who point to the studies showing that sham acupuncture is as good or better than “real” acupuncture who say, “See! Even the placebo works!” If we take their trained, expert opinion on these studies as accurate, then which should be the recommendation: puncturing the skin or not puncturing the skin?

    presuming that, when evidence is incomplete, complex, and contradictory, the studies that support a favored viewpoint are to be taken as the last word on the subject.

    So, are you saying that the studies supporting the viewpoint that acupuncture is a placebo should be taken as valid, or that the studies supporting the viewpoint that acupuncture is not a placebo should be taken as valid?

  99. #99 Todd W.
    August 17, 2010

    Blockquote fail…sigh.

  100. #100 jane
    August 17, 2010

    Prometheus – Straw man. (Also cherry picking.) Prometheus implies that I have claimed injuries will never be inflicted in the practice of normal modern acupuncture, whereas I have said that they are very unlikely to occur and hence will be rare, as borne out by Yamashita et al. (which also included injuries from nonstandard practices and amateur practitioners). You recall that I jumped into this discussion because the reference cited by Prometheus supports only the conclusion of low but nonzero rates of serious adverse events, yet he proceeded to fantasize that this proved the rates were actually high. I’ll jump back out now, as it seems pointless to continue to argue about what is for some here an article of faith on which varying opinions and uncertainty are not worthy of consideration.

  101. #101 Todd W.
    August 17, 2010

    @jane

    I’ll jump back out now, as it seems pointless to continue to argue about what is for some here an article of faith on which varying opinions and uncertainty are not worthy of consideration.

    Translation: Rather than provide citations to back up my claims, I’m going to bow out. These science-minded individuals who base decisions and opinions on the evidence are asking for that which I cannot provide.

  102. #102 Prometheus
    August 17, 2010

    Jane,

    If you look at the comment that immediately preceded your last, you’ll see two examples of how to provide “bandwidth-friendly” citations. Even the longest of these citations takes up only a few kilobytes.

    Rather than saying “look it up yourself” – the hallmark of trollhood – please, in the future, at least provide some indication of your source. I can’t tell you how many times I’ve been frustrated in my attempts to find a mysterious source referenced only as “a study that shows everything I claim.”

    You don’t have to provide a citation for everything you say (this isn’t a scientific journal), but you should at the least provide a citation for everything you cite as an authoritative source.

    Even as little as the primary author and the year of publication would make the search infinitely easier.

    Prometheus

  103. #103 Calli Arcale
    August 17, 2010

    I ran the image search you suggested, jane, and got everything from line drawings to photos to a set of Schmetz sewing machine needles to progressively less relevant hits. One of the drawings gave lengths; none gave diameters. Those images are consistent with what I understood previously of the limitations of pre-industrial wire drawing. One was associated with text (the source of which I don’t know; it appears to be a scholarly work and is thus either a secondary or ternary source) explaining the needles a bit. It did not give gauge or diameter, only saying that the finest needle was “hair-fine” and “corresponded in form to the most common of the current needles” which still doesn’t clear it up. I’m interested to know *how* thin they could go. I mean, I know they could make thin wire. I’ve said I know people who do it, duplicating the ancient methods. I’m just not convinced they could make them *that* thin. More significantly, I didn’t find any giving a date to the artifacts. Those could be 200 years old, which is well within the timeframe of modern metallurgy.

    That text looked the most interesting of what I found, though again, I haven’t established it’s provenance. Here it is, in case you’re interested. It goes into a little more detail of the historical use of all nine of the needles, not just the short filiform one.
    http://www.itmonline.org/arts/bleeding.htm

    It is true what you say, that many people tend to underestimate the technological skills of the ancients. That doesn’t mean that all claims of ancient skills should be taken at face value. Major breakthroughs in wire drawing (the essential technology behind metal needles) occurred at several key points. The oldest known wire comes from ancient Egypt, and are about 4,000 years old, but was made by a fundamentally different method than modern wire — the oldest examples are actually beaten into that shape, while later examples were made from thin strips of metal, which were then rolled into wires. “Modern” wire drawing (where a piece of metal is pulled through progressively narrower openings) originated in the medieval period, though scholars disagree exactly when or where it originated. This method is a definite prerequisite for truly hair-fine needles, even ones larger than .5 mm. Though it was refined in the industrial period with the advent of wire-drawing machinery, the basic technique is the same — heat the metal just enough, and then pull it through progressively smaller holes.

  104. #104 Prometheus
    August 17, 2010

    Even though Jane has “left the building”, I’ll respond.

    I don’t believe that I’ve claimed that acupuncture had a “high” complication rate, only that it was non-zero and almost certainly higher than you would deduce based only on published case reports. In fact, I later cited a prospective study that found the rate of serious complications from acupuncture – in a large training and treatment center – to be very low.

    My point is and was that acupuncture doesn’t have a zero comlication rate, so those claiming “What’s the harm?” need to acknowledge that there is – in fact – a non-zero risk of death or serious injury.

    None of this would be a bar to acupuncture’s acceptance as a treatment modality, since all medical therapies carry a risk of death or serious injury. However, since acupuncture has been shown – repeatedly – to be no better than placebo (and one study, Goldman et al 2008, has shown it to be less efective than placebo), the benefits (zero) do not justify the risks (non-zero).

    I have no objection to competent adults inflicting acupuncture on themselves for recreational purposes, but I do object to helping them pay for it through my taxes or insurance premiums.

    Prometheus

  105. #105 Rogue Medic
    August 17, 2010

    jane,

    Well, if anyone wants to see an example of a whole field of straw men (not to mention a couple of ad homs) just read Rogue Medic’s last post. Not worth further attempts at dialogue.

    The old I win, then run away.

    I can tell you THAT, for example, actual scientific studies indicate that people who use acupuncture for back pain get more relief than people who take drugs, while suffering far fewer adverse events. I have no idea WHY that should be.

    Were they getting the acupuncture placebo in addition to the standard treatment? Adding a placebo is expected to produce a better result, so that would not be a surprise.

    I think it is possible for science to answer this question, but only if researchers come at it from the position that (a) we do not already know the answer, and (b) the answer might turn out to be of practical value no matter what it is.

    Research that does not approach subjects in that way is not valid research.

    Research needs to be set up to be objective – in other words, there is no advantage given to any hypothesis.

    When this has been done with acupuncture, the result has been that acupuncture is just a placebo.

    Throw a tantrum, jane. Create a straw man about a whole field of straw men, jane. Go ahead, again.

    The objective research by acupuncturists shows clearly that acupuncture is just a placebo.

    If we – like certain recent commenters – demand that everyone accept on faith that acupuncture is Only A Placebo and Therefore Worthless, we will be incapable of learning more.

    How silly of me.

    jane considers the use of objective research to be accepting on faith.

    Hardly someone who can make any credible comments about being incapable of learning more, although jane may serve as an excellent object lesson.

    Like the old Zen story has it, if your cup is already full, there’s no room for more tea in it.

    jane’s cup appears to be overflowing with misdirection, the altie specialty.
    .

  106. #106 Chris
    August 17, 2010

    Prometheus:

    It is tempting to ask “Evidence??? Citation???”, but that would be childish.

    :-p

    You will notice that I posted a link to where a list of her cites were deconstructed by Scott, cut and pasted here (she apparently thinks electroacupuncture is equivalent to needles, which is funny because today she has gone freaky over needle size!)… Scott said:

    11914160: Only single-blind, with four groups of placebo, diclofenac, electroacupuncture, and diclofenac+EA. Accordingly it must be considered to not have a meaningful placebo control – no single placebo can be appropriate for both treatments, and there is no mention that the single-treatment groups received a placebo of the other treatment. Also, any success of EA does not validate acupuncture since electrical stimulation has known physiological effects.

    15971087: Unblinded, and EA.

    17378197: Unblinded with no placebo.

    12390610: Unblinded with no placebo.

    1729516: Unblinded with no placebo.

    20038728: Unblinded with no placebo.

    15385352: Unblinded, but at least there was a proper control (the ONLY one on the list which did). EA.

  107. #107 Rogue Medic
    August 17, 2010

    Chris,

    Thank you for digging that up. I was not going to go looking, even with the likelihood of comic relief at the end of the journey.

    For anyone who does not understand how to find the abstracts, go to the link below (PubMed) and enter a number from the comment by Chris in the search box, then click on search. Or just add the number to the end of the url below.

    http://www.ncbi.nlm.nih.gov/pubmed
    .

  108. #108 Seb30
    August 17, 2010

    Er, Prometheus, I (#75) am not jane.
    And I don’t doubt your words. I was just shocked to discover that acupuncture is quite more dangerous than I thought (liver laceration?).

    I was genuily surprised to learn that the practice of sticking pointy things deep into other human beings is that grossly underregulated. Again, it’s worse than I believed.
    I mean, we have more than 6000 years of warfare proving that humans are somewhat vulnerable to pointy things. I would have expected that anyone going into this type of business would have to show a basic understanding of anatomy (like a surgeon, by example) before being allowed to go porcupine on someone’s else spine.

  109. #109 Prometheus
    August 20, 2010

    Seb30,

    Sorry about that – I was on a roll, responding to Jane’s inane comments and typed the wrong name. My apologies.

    It is even more frightening than you think – the Yamashita et al article was looking at acupuncture injuries in Japan, where all acupuncturists (except those who practice only on themselves) must be licensed.

    In the US, Alabama, Mississippi, North Dakota, South Dakota, Oklahoma and Wyoming have no laws regulating acupuncture. Those states that do license acupuncturists generally only require that they have graduated from an “accredited” school of acupuncture and have passed one of the national acupuncture exams.

    So, after graduating from a school that teaches about imaginary Chi flowing along imaginary meridians and passing a test assessing their ability to recall these fantasies (and paying a fee), 44 states (and the District of Columbia) will provide a license to stick needles into people for money.

    In addition, most states allow physicians, dentists and chiropractors (and, in those states that license them, naturopaths) to practice acupuncture without special certification or licensure.

    In my home state, it’s harder to get a commercial driver’s license than it is to become a licensed acupuncturist – and the truck drivers get random drug testing.

    Be afraid…be very afraid!

    Prometheus

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