Respectful Insolence

What the hell is going on with The New York Times‘ health reporting?

I’ve had my share of disagreements with the way that the NYT has covered various health issues over the years that I’ve been blogging, but I don’t recall ever having seen it embrace pseudoscience. I can recall being a bit miffed at some of the articles that the NYT has published about biomedical research and its various perceived failings. On the other hand, I’ve also praised the NYT reporting on various issues, such as medical radiation and the risks it can pose. But lately, it seems, the NYT has gone into the crapper with at least some of its health reporting. At least, it has when it comes to Tara Parker-Pope, who blogs on Well: Tara Parker-Pope on Health. First, she totally blew it when it came to interpreting a particularly awful bit of quackademic medicine studying transcutaneous electrical nerve stimulation (TENS) mislabeled as acupuncture, a misstep for which I applied a bit of not-so-Respectful Insolence to her.

Whoops, she did it again.

In fact, Parker-Pope not only did it again, but she “surpassed” herself when it comes to woo. Apparently, she’s been far more impressed by the recent spate of crappy studies on acupuncture than a halfway decent health reporter and blogger should be, because she’s laid down a rather credulous bit of woo entitled Studying Acupuncture, One Needle Prick at a Time. In her post, Parker-Pope demonstrates unequivocally that she does not understand the issues involved in applying science to acupuncture, which makes me wonder if she understands the issues involved in applying science to any medicine at all. Yes, it’s just that egregious, as you’ll see in a moment. She begins:

For at least 2,000 years Chinese healers have used acupuncture to treat pain and other ailments. Now Western doctors want proof that it works.


Whenever I see someone write about “2,000 years” during which Chinese healers have allegedly used acupuncture to treat all manner of ailments, I know I’m dealing with someone who knows little of the history of acupuncture and doesn’t realize that acupuncture in its current form bears little resemblance to ancient acupuncture. More importantly, however, after asking whether acupuncture “works” primarily or completely through placebo effects (a reasonable question that’s been answered time and time again: it does), Parker-Pope goes right off the deep end, spewing the same sorts of weasel words that so pervade quackademic medicine:

The debate was fueled last week by a study in the journal Arthritis Care and Research. Researchers from MD Anderson Cancer Center in Houston found that among 455 patients with painful knee arthritis, acupuncture delivered no more relief than a sham treatment.

Actually, patients got significant pain relief from both treatments — an average reduction of one point on a scale of 1 to 7. And critics contend that the study was poorly designed.

For one thing, they note, patients in both groups received treatment with needles and electrical stimulation; the main difference was that in the sham group, the needles were not inserted as deeply and the stimulation was far shorter in duration.

Funny that Parker-Pope appears to have finally noticed what I pointed out in my deconstruction of this execrably horrible study. Whether she saw my post or whether it was her commenters who pointed this out, I don’t know. In any case, either my memory is faulty, or Parker-Pope appears to have added a sentence to her original post (“Electrical stimulation was also used, although those in the sham group received lower voltage and far shorter treatments”) that I do not remember seeing in the original post. I noticed this in rereading her post, because when I wrote my original post about the TENS/”acupuncture” study, I distinctly remember poring over Parker-Pope’s post and posts by other bloggers, looking for even a hint of a mention that the acupuncture needles were hooked up to electricity. Indeed, I even made a point of observing in my original post that Parker-Pope “didn’t seem to notice that what was being studied was not acupuncture, but rather TENS, even though the authors refer to it as ‘acupuncture.’” In other words, Parker-Pope appears to be busted. She appears to have “corrected” her post without noting in an addendum that she has edited the original post. [NOTE ADDED: Ms. Parker-Pope responded, and I answered.]

Then, in the comments of the post, she tries to justify why the TENS (I refuse to call it “acupuncture”) group was indistinguishable from the sham TENS (again, I refuse to call it “sham acupuncture”) group by saying in the comments:

I think the difference is that this “sham” treatment is still a pretty active intervention — inserting needles and generating electrical stimulus. It’s not your typical placebo. It’s also interesting that the German researchers interpreted similar study results differently than American researchers.

No, no, no, no, no! It is a placebo. Nice try, though, Parker-Pope. Well, not really. It was a pretty crappy answer. Commenter Tim Kreider got it right when he used one of Steve Novella’s favorite gambits, suggesting that Parker-Pope replace the term “real acupuncture” or “true acupuncture” with the term “new potential blockbuster drug from Merck” and the term “sham acupuncture” with “placebo” or “sugar pill” and then ask herself: If a study found no detectable difference in effect or outcome between the new drug from Merck and the sugar pill, would Parker-Pope conclude that the new drug from Merck works? If not, then why does she think that this mutant form of acupuncture hooked up to electricity works? Her answer, cited above, shows that her cluelessness is breathtaking, as does her next gambit in her most recent post:

Rather than proving that acupuncture does not work, in other words, the study may suggest that it works even when administered poorly. But the real lesson, acupuncture supporters say, is how difficult it can be to apply Western research standards to an ancient healing art.

“People argue that there really are no inactive acupuncture points — pretty much wherever you put a needle in the body is an active point,” said Dr. Alex Moroz, a trained acupuncturist who directs the musculoskeletal rehabilitation program at New York University. “There is a body of literature that argues that the whole approach to studying acupuncture doesn’t lend itself to the Western reductionist scientific method.”

No, the reason that these studies show that acupuncture does not work is because they show that there is nothing about the “theory” behind acupuncture that matters to the act of sticking needles willy-nilly into people’s skin. Qi doesn’t matter. Meridians don’t matter. Meridians don’t correspond to any anatomic structure or physiologic structure, anyway, nor has anyone ever been able detect qi. It doesn’t matter where you stick the needles in. It doesn’t matter how you stick the needles in. As at least one study using an innovative approach to “sham” acupuncture shows (see below), it doesn’t even matter if you stick the needles in.

So, what about acupuncture “works”? Nothing.

Worse, Parker-Pope quotes an acupuncturist, who is using one of the oldest and most irritating alt-med tropes there is, namely dismissing all those inconvenient studies showing that acupuncture works no better than a placebo with the airy claim that “reductionistic” science just can’t study his woo. Even worse still, Parker-Pope is parroting the even more irritating tropes about “Western” science not being able to study “Eastern” woo. I don’t know about you, but if I were Chinese, I’d be profoundly insulted. There is no “Eastern” or “Western” science. The scientific method spans East and West. There is just science, and there are scientists in Japan, China, and elsewhere in Asia who are every bit as excellent as “Western” scientists, except that they aren’t “Western.” Similarly, there is no “Eastern” or “Western” medicine, and, in fact, as I have discussed before in China younger people seem to be abandoning traditional Chinese medicine for scientific medicine. Science-based medicine should also span both East and West, and there should be only science-based medicine. I can’t resist repeating a favorite question and answer. The question is: What do you call “alternative medicine” that works? Answer: Medicine! That’s because there are three varieties of medicine: Medicine that has been scientifically validated; medicine that has not; and medicine that has been shown by science not to work. Guess which two categories the vast majority of “alt-med” falls into? That’s right, “alternative” medicine that is validated by science is no longer “alternative.”

As for the whole “East”/”West” thing, that is a dichotomy every bit as false as the “alternative” medicine/medicine dichotomy, and it’s arguably racist to boot. After all, there doesn’t seem to be any love for ancient “Western” medicine on the same level as there is seemingly love for ancient “Eastern” medicine like acupuncture and traditional Chinese medicine. Why aren’t we balancing the four humors, even though we are trying to balance qi? Because it’s more exotic? She also seems unaware that the term “integrative” means nothing more than combining quackery with science-based medicine.

Oddly enough the study’s lead author, Dr. Maria E. Suarez-Almazor, was actually more reasonable and scientific than Parker-Pope. She points out that in a drug study an equal response between placebo and drug would indicate that the drug does not work. She even admits “We didn’t plan a study trying to show that acupuncture didn’t work. The results came out with no difference between the groups.” This to me is an implicit admission that their TENS/”electroacupuncture” did not work. That’s how clinical trials work. Usually acupuncturists are masters at explaining away negative results, but in this case Suarez-Alamazor seems to be admitting that her version of “acupuncture” didn’t work, and that is to her credit.

Parker-Pope then provides a list of acupuncture studies that are a catalog of commonly cited studies, the vast majority of which do not show what she thinks they show. For example, she writes:

A 2007 study of 1,200 back-pain patients, financed by insurance companies in Germany, showed that about half the patients in both real and sham acupuncture groups had less pain after treatment, compared with only 27 percent of those receiving physical therapy or other traditional back care.

When the German researchers tracked how much pain medicine the patients used, they detected a noticeable difference between real acupuncture and the sham treatment. Only 15 percent of patients in the acupuncture group required extra pain drugs, compared with 34 percent in the sham group. The group receiving conventional back therapy fared even worse than those receiving fake acupuncture: 59 percent of those patients needed extra pain pills.

This is the infamous GERAC study, and it is yet another study in which sham acupuncture was indistinguishable from “real” acupuncture. It is yet another study in which the correct interpretation of the results is that acupuncture does not work. Unfortunately, in the Bizarro World of CAM acupuncturists and credulous journalists like Parker-Pope spin these studies as evidence that acupuncture does work. Indeed, Orac was all over this study when it came out, applying a loving helping of not-so-Respectful Insolence to the study itself and to the credulous responses to it. In fact, this study was widely ripped apart by skeptical and medical bloggers when it came out, including Steve Novella, Ben Goldacre, and pj. Suffice it to say, we were not impressed.

My favorite example of this sort of willful misinterpretation of acupuncture studies by acupuncture boosters is the study in which the “sham acupuncture” group consisted of twirling the point of toothpicks against the skin. The results? What do you think? The toothpick placebo was just as effective as the “true” acupuncture and the “sham” acupuncture with needles. Yes, toothpicks are just as effective as acupunture. Odd that Parker-Pope didn’t cite that study, which is newer than the GERAC study, and more rigorous to boot, although she did cite a 2004 study in which, she admits, patients were not adequately blinded.

Parker-Pope then finishes up by citing a study from earlier this year that claimed to show that acupuncture relieves hot flashes in women undergoing breast cancer therapy better than pharmacological therapy. The study cited by Parker-Pope is a head-to-head comparison of the antidepressant Effexor versus acupuncture for hot flashes induced by anti-estrogen therapy in breast cancer. Unfortunately, this study had no “sham” acupuncture group at all. Basically, it was completely unblinded and tested what is in essence known to be a crappy treatment for menopausal hot flashes (antidepressants) induced by anti-estrogen therapy versus acupuncture. What a surprise that they ended up with fairly similar results, particularly given the small number of patients! The main findings were that acupuncture appeared to work as well as Effexor during the 12 week span of time during which subjects received either drug or acupuncture and that the effects of acupuncture were supposedly longer lasting than those of Effexor. There was a huge problem with the study, though. At least three huge problems, actually. First, the study was small, with only 50 patients. Second, there were a lot of patients lost to followup at the one year mark. By the 12 month mark, only 14/25 subjects were analyzable in the acupuncture group. In the Effexor group, only 13/25 were analyzable at one year. This is a very high rate of dropping out of the study. Indeed, by the “post” point (which is the 12 week mark, given that both therapies were administered for 12 weeks), in the Effexor group, 5 subjects had been lost to followup and four had discontinued treatment by the post-treatment analysis, while only one had been lost to followup and three had discontinued therapy in the acupuncture group.

Finally, the study was completely unblinded, which made it pretty much worthless, a problem that could have easily been addressed by making sure both groups took pills, with the Effexor group getting Effexor and the acupuncture group getting a sugar pill. Come to think of it, the same problem applied to acupuncture. There was no sham group. Both groups should have gotten an acupuncture-type procedure, the acupuncture group receiving “true” acupuncture and the Effexor group receiving “sham” acupuncture. In other words, this study tells us about as close to nothing as a study can. It’s a perfect example of how small, flawed pilot studies that would be considered of very little value in evaluating any other “conventional” therapy are presented as strong evidence that acupuncture works.

Parker-Pope then finishes with a flourish:

But acupuncture believers say it doesn’t really matter whether Western scientific studies find that the treatment has a strong placebo effect. After all, the goal of what they call integrative medicine, which combines conventional and alternative treatments like acupuncture, is to harness the body’s power to heal itself. It doesn’t matter whether that power is stimulated by a placebo effect or by skillful placement of needles.

Why didn’t Parker-Pope just get an acupuncturist to write her article for her? She’s spewing the same sort on nonsense that acupuncturists spew to defend their woo. She’s cherry picking articles and, whether she realizes it or not, using the same sort of warped and deceptive language, appropriating terms like the derogatory word “Western” to denigrate scientific medicine. One can almost hear the sneer as she types the word “Western” at every opportunity to describe scientific medicine, thereby perpetuating a false and arguably racist dichotomy in which science is “Western,” “reductionistic,” and therefore unimaginative and unfeeling, while the “spiritual” and “holistic” are “Eastern.

She even makes it explicit in the comments. A commenter by the name of “vanina” writes:

This article illustrates well the frustration of western doctors at “proving” that acupuncture works. Simply put: you cannot examine a system of medicine that is a natural derivative of a culture/philosophy with a set of examining tools that are based out of a different culture/philosophy. For instance, western medicine is not very good at examining what cannot be seen. MRI’s, brain scans, blood work are all tools that have “unbiased” data used for analysis. In Acupuncture, the most basic unit of power is “Qi” or “life energy” – it is not quantifiable using western paradigms, there are no “scientific” tools that can measure how Qi flows through our bodies. Yet, acupuncture practitioners know how to assess this Qi through skillful practices of pulse taking, tongue observation, keen observations of a person over time – all this data is deemed worthless to a Western doctor because it is biased.

Trying to prove acupuncture works using western medical tools is like to trying to appreciate an orange using a bulldozer. The tool is inappropriate.

Whoa. This kind of sounds like something out of The Matrix. Like, wow, maaaaaaan! Soooooo deep. Like, maaaaan, it’s true. You really can’t appreciate an orange using a bulldozer. But you can crush it.

Whoa. Again.

That’s even deeper, maaaan. Like that nasty Western reductionistic science crushing nature, represented by the innocence that is the orange. Yeah, that’s it, maaaaan.

Seriously, do people actually read this stuff after they write it and realize how ridiculous it sounds?

Again, vanina’s comment is utter BS, a common and lazy excuse that purveyors of alt-med frequently use when their favorite form of woo fails when tested using well-designed science. It’s utterly wrong and betrays a complete misunderstanding of science. You’d think that a good science writer would call vanina out–or at least gently point out to her that this is an excuse of the “science doesn’t work” or “science doesn’t apply to my woo” variety. She might point out that this is nothing more than postmodernism applied to science, the claim that science is just “another narrative,” no more or less valid than the prescientific view of biology that underlies traditional Chinese medicine. But not Tara Parker-Pope. What she says in response to vanina is this:

Wow, you said all this much better than I did. Thanks!

Game. Set. Match. Tara Parker-Pope has gone woo. And be careful about letting the bulldozer crush that orange. There’s lots of vitamin C in it, and we wouldn’t want that to go to waste.

I’m told that until recently Tara Parker-Pope had in general been held in relatively high esteem among science and medicine journalists, at least around here. My old blog bud Abel Pharmboy, for example, liked her a lot. Unfortunately, something’s happened since then. Earlier this year, Parker-Pope was shilling for that woo-meister supreme, Deepak Chopra, embarrassment to physicians everywhere. She even appeared this April on the same program as Deepak Chopra and Mehmet Oz. Now she’s fallen for crappy studies that claim to prove that “acupuncture” works, while writing embarrassingly unscientific posts like the one I’ve been applying some not-so-Respectful Insolence to in which she agrees with credulous readers who dismiss scientific studies of “alt-med” with the claim that science can’t study them because clinical trials aren’t sufficiently “individualized” or don’t take into account the “whole patient” or the “whole package” that is acupuncture. These claims have always been BS; they’re no less BS when parroted by Tara Parker-Pope.

NYT readers deserve better. Much better.

Comments

  1. #1 Jeremy L
    August 25, 2010

    “People argue that there really are no inactive acupuncture points — pretty much wherever you put a needle in the body is an active point,” said Dr. Alex Moroz, a trained acupuncturist who directs the musculoskeletal rehabilitation program at New York University. “There is a body of literature that argues that the whole approach to studying acupuncture doesn’t lend itself to the Western reductionist scientific method.”

    So…is there any way I can disagree with you without being a 3,000 year old Chinese philosopher?

  2. #2 Anonymous
    August 25, 2010

    The New York Times has a huge responsibility for evidence-based reporting. Health and medicine issues must be reported with verifiable facts in hand. The “paper of record” must not fall prey to “wellness/lifestyle” type reporting just to get their page views and comments up; it’s just not responsible journalism for a publication with so much influence.

    Thank you for this important post.

  3. #3 Tara Parker-Pope
    August 25, 2010

    To clarify a point you raised, my original post on the M.D. Anderson study was not changed. It always referred to the electrical stimulation component of the study and no edits or changes were made after posting.

  4. #4 knotfreak
    August 25, 2010

    TPP has been grating on my nerves for some time now–her responses to comments often reflect science ignorance which is now showing up more blatantly. She is the typical well-educated-in-the-humanities (not a bad thing in itself), but totally dense on science, especially the scientific method, which is why she fails to use or understand studies correctly. Because such people are smart, they think they understand science without studying it directly.

    Thanks for exposing TPP. I’ve written her a few times, but she only defends herself with more of whatever I was complaining about.

  5. #5 cervantes
    August 25, 2010

    What vanina is really saying, and TPP is agreeing with, it seems to me, is that acupuncture is something to be appreciated as a performance, the way we might appreciate a play or a symphony. It is true that science can’t tell us whether that was a great performance of King Lear or not, but on the other hand the cast and director aren’t making any specific claims that it’s going to cure your impetigo.

    It may be that patients keep going back to the acupuncturist because they enjoy the performance, and I agree that an RCT measuring some health outcome isn’t going to assess that. On the other hand you could ask the people to write a review of their acupuncturist and what they like and don’t like about him. I suppose that would be a valid test.

  6. #6 superdave
    August 25, 2010

    This is just what happens when you replace newspaper articles with blogs.

  7. #7 Orac
    August 25, 2010

    Interesting that Ms. Parker-Pope seems only concerned with my memory, faulty or otherwise (next time I’ll save a web archive of the post; then there’ll be no question) of whether or not she went back and altered her first post, dated August 18, in response to criticism. (And assuming my memory is faulty I apologize, although I find it odd that I would have missed such a sentence when I spent so much time writing the original post. Mea culpa either way; even Orac screws up sometimes.) From my perspective, even if she had gone back and changed her original post, that would be be the least of her offenses. I only pointed it out because it seemed relevant.

    Far more egregious and disturbing is her poor reasoning, poor science, and cherry picking of studies that she clearly doesn’t understand, all in the service of defending quackery. About the criticisms contained in my post of those shortcomings, Ms. Parker-Pope says not a word. Perhaps she has no defense.

  8. #8 augustine
    August 25, 2010

    I like Tara Parker-Pope. She should write an article on the cult of scientism.

    “Psycho-analysis of a skeptic and their motives to hijack the enterprise of science”

    Maybe that would be a book.

  9. #9 Jojo
    August 25, 2010

    What get’s me about the commenter on the piece that said

    Yet, acupuncture practitioners know how to assess this Qi through skillful practices of pulse taking, tongue observation, keen observations of a person over time – all this data is deemed worthless to a Western doctor because it is biased.

    is that in my experience, the people who hold these beliefs are often the same people who complain about how authoritative “Western” medicine is. Talk about authoritative, asking people to essentially trust that you are an expert without any way to demonstrate it is about as authoritative as you can get.

  10. #10 SteveR
    August 25, 2010

    Have you read the Langevin study?

    http://www.uvm.edu/annb/faculty/langevin/

  11. #11 Orac
    August 25, 2010

    Which study?

    There does appear to be copious blog material there, though, doesn’t there?

  12. #12 jane
    August 25, 2010

    Orac, sorry, but something that is very possibly bioactive is NOT a suitable placebo; it is only suitable as an active comparator group. One type of TENS is not a “placebo” for another type of TENS, any more than aspirin could serve as a placebo for codeine.

    I fail to understand, further, how the never-replicated Toothpick study can be viewed as “rigorous” even though it clearly could not have been double-blind. Of the studies showing pronounced differences in efficacy between sham and real acupuncture, we are always told that those that were only single-blind are “worthless” for that reason alone.

    And finally, there certainly is a pro-Western (or pro-American) and anti-Asian bias among some followers of scientism – it has shown up nicely in the tai chi thread. Yes indeed, there are Japanese researchers doing top quality clinical trials (a methodology that anyway was invented by Muslims, not Westerners). But when Asian results conflict with American results, or when Asians study something Americans haven’t studied and the results don’t fit with the dogmas of scientism, they are often immediately dismissed as being presumably of low quality.

    As a cancer expert, you no doubt know that Japanese oncologists prescribe mushroom polysaccharide extracts to patients with certain cancers based on results from clinical trials that included thousands of subjects. Many American MDs philosophically dislike such products, but they have no contradictory studies to show. If you accept Japanese researchers as the equals of Americans, you would have to advise stomach cancer patients (if you ever dealt with any) that the best evidence suggested that they ought to take such an extract. Would you, given the opportunity, do so? Do you think most American physicians would do so?

  13. #13 sailor
    August 25, 2010

    “Unfortunately, something’s happened since then. Earlier this year, Parker-Pope was shilling for that woo-meister supreme, Deepak Chopra, embarrassment to physicians everywhere. She even appeared this April on the same program as Deepak Chopra and Mehmet Oz.”
    Maybe she discovered woo is more profitable than science. Deeppockets certainly has.

  14. #14 Denice Walter
    August 25, 2010

    Strangely enough, reading this post and gleaning from those of the past several days, I feel eerily transported back in time to the 1990′s and somewhat inappropriately dressed. I half-expect to read about research involving aromatherapy next. I characterize many forms of woo as being either “Grandma medicine” (“Drink this tea for your cold”) or “Spa medicine” ( services that make you *feel* better such as massage, skin care, etc.): the problem arises when these measures are promoted as “medical”, “curative”, or beyond the ken of “reductionistic science”. I recently visited a town built on woo- and hot springs (Calistoga, CA)- which is comprised of miscellaneous spa service providers interspersed with wine tasting rooms. Perhaps our puritanical heritage discourages openly pursuing physical pleasure so the word *therapeutic* often precedes the description of said spa service. Yes! “Therapeutic” hot mud baths for couples!

  15. #15 Orac
    August 25, 2010

    If you accept Japanese researchers as the equals of Americans, you would have to advise stomach cancer patients (if you ever dealt with any) that the best evidence suggested that they ought to take such an extract

    No I don’t. I have to read the studies and see if they are good studies and what the results were.

    Besides, plant extracts are not “alternative” medicine. They are natural products and can be studied using techniques of natural product pharmacology, just like Taxol (which comes from the bark of the Pacific yew tree). Again, you fall for the “East”-”West” dichotomy so beloved of woo supporters. Also, it’s very much recognized that the variety of stomach cancer seen in Asian countries is probably biologically different than what is seen in “Western” countries. For one thing, stomach cancer is much more common in Asia.

  16. #16 Todd W.
    August 25, 2010

    @jane

    anti-Asian bias among some followers of scientism – it has shown up nicely in the tai chi thread.

    You have some examples of this? From what I could see, most of the comments were of the “tai chi and similar exercises might be beneficial, but there’s no need to ‘qi’ woo.”

    If you accept Japanese researchers as the equals of Americans, you would have to advise stomach cancer patients (if you ever dealt with any) that the best evidence suggested that they ought to take such an extract.

    Orac brings up a good point. Although the findings of the Japanese researchers may be valid, they do not necessarily mean that those findings will be valid in an American (or Brazilian, South African, Libyan, Russian, British) population. There’s a reason that nearly every country requires clinical trials to be performed in a population representative of the target group. There may be genetic and/or environmental differences which contribute to whether or not a given treatment will work.

  17. #17 Ian
    August 25, 2010

    It is true that science can’t tell us whether that was a great performance of King Lear or not

    That simply is NOT true. Assuming you could get people to agree on an observable standard for “great”, with quantifiable criteria by which to measure it (blocking, pace, volume, clarity, what-have-you), science could absolutely determine the ‘greatness’ of a performance. The entire field of artistic criticism is based on the idea that a rigorous set of criteria can be used to evaluate whether or not something is good.

    It may not be able to tell you whether or not you’ll like something, but that’s an entirely different story.

  18. #18 viggen
    August 25, 2010

    Qi doesn’t matter. Meridians don’t matter. Meridians don’t correspond to any anatomic structure or physiologic structure, anyway, nor has anyone ever been able detect qi.

    I agree with the two points here, though my opinion on the last has already been well voiced–I have nothing new to add and I think it’s probably a matter splitting hairs. A very wrong model for something that does exist should be discarded as wrong.

    Well written Orac, thank you!

  19. #19 Militant Agnostic
    August 25, 2010

    Jane – your straw men are starting to aggravate my hay fever.

  20. #20 Karl Withakay
    August 25, 2010

    “Yet, acupuncture practitioners know how to assess this Qi through skillful practices of pulse taking, tongue observation, keen observations of a person over time”

    Actually, that’s a fairly reductionist method of assessing qi, really no less so that the methods of determining clinical depression. Such criteria shouldn’t be too difficult to codify and test for.

    You’d be better off invoking vitalistic detection of energy fields.

    I don’t know if I can comfortably conclude beyond any doubt that acupuncture is completely bogus (though I suspect it is), but what I can safely conclude is that when the location of needling doesn’t matter, and penetration or lack thereof of the needles doesn’t matter, the fundamental understanding of the practice and art of acupuncture is completely wrong.

    “People argue that there really are no inactive acupuncture points — pretty much wherever you put a needle in the body is an active point,” said Dr. Alex Moroz, a trained acupuncturist…”

    Translation: Traditional understanding of acupuncture is wrong, and meridians and chi points are irrelevant.

  21. #21 moderation
    August 25, 2010

    @ jane

    And … I am sure Todd W. and Orac would finish by saying that … yes, if the studies from Japan were of high quality and verified, it would be appropriate to integrate “mushroom polysaccharide extracts” into stomach cancer care. In which case the administration of “mushroom polysaccharide extracts” would become a part of science based medical practice, neither “western” or “eastern”.

    BTW, I am completely dismayed by the lack of discussion of “northern” and “southern” medicine. Surely we are missing out on half of the available medicine out there.

  22. #22 Trapper John
    August 25, 2010

    If there are “no inactive accupuncture points” and accupuncture works “even when done poorly”, why does one need extensive training to become an accupuncture therapist? Wouldn’t a simple course in sterilization followed by a quick “how to” on putting the needles in suffice? Seems like you could knock that out in a couple of days and on the cheap, too.

  23. #23 Karl Withakay
    August 25, 2010

    Scratch that, I can reasonably conclude that acupuncture is bogus. I can’t definitively conclude that random needling or poking & twisting of toothpicks have no effect beyond placebo, though this is what I suspect.

  24. #24 Pablo
    August 25, 2010

    Wouldn’t a simple course in sterilization followed by a quick “how to” on putting the needles in suffice?

    By all accounts, Trap, the “course in sterilization” is above and beyond SOP even.

  25. #25 Tzi
    August 25, 2010

    I had to comment on the article. I was especially stunned by the comments that the scientific methods of weighing “Western” medicines can’t apply. One can’t pick and chose when one finds the scientific method useful and when one doesn’t: the whole point of it is that it is universal. And if one doesn’t believe it’s universal: why on earth would it be trusted in any context?

    It must take some mighty cognitive dissonance to accept it in some (regional!) venues and not others.

    You know, I really can’t fault people who are ill and so desperate they will try even the ridiculous, but it’s honestly unethical for people to try to push this kind of BS to vulnerable people. It just perpetuates a dangerous meme. It reminds me of those people that claim to talk to ghosts for the purpose of praying on the grieving.

  26. #26 PDelaney
    August 25, 2010

    I believe it was one of the SBM bloggers who commented Eastern-vs-Western medicine dichotomy is like saying that Einstein practiced “Jewish physics”. Funny, it also works in Muslim countries like Pakistan.

  27. #27 Shasta
    August 25, 2010

    “integrative medicine, which combines conventional and alternative treatments like acupuncture, is to harness the body’s power to heal itself. It doesn’t matter whether that power is stimulated by a placebo effect or by skillful placement of needles.”

    so in other words, I could juggle shoes to “harness the body’s power to heal itself”, since it doesn’t matter what you do.

  28. #28 Militant Agnostic
    August 25, 2010

    Shasta @27

    I think watching someone juggle shoes would harness my body’s power to heal itself much more effectively than being stuck with needles unless I had just undergone chest or abdominal surgery.

  29. #29 Mephistopheles O'Brien
    August 25, 2010

    @72 Well, Trapper, the effectiveness of the treatment would be diminished if it took less time, cost, and effort to train and certify an acupuncturist than a cosmetologist. Besides, it takes a while to learn the patter and get over the fear of/sadistic pleasure in poking your fellow beings with needles or toothpicks.

    This, of course, is not meant in any way to denigrate the fine work performed by our nation’s licensed cosmetologists.

  30. #30 jane
    August 25, 2010

    moderation – You’ve actually raised an issue I care about deeply. Southern medicine almost always is restricted to small clinical trials, because researchers in the global South can rarely afford a large trial. Such small studies will automatically be called “worthless” or “meaningless” if they find benefit from traditional local treatments, which is regrettable both because Westerners will never test most such treatments, and because it conveys the message that “they” cannot do meaningful science themselves, but should wait passively to consume (to the extent they can pay for it) the products of our science.

    As for Eastern medicine, I have seen many times that if foreign scientists (Europeans, too, but especially Asians) use a method or think they know something that American MDs do not know about or believe in, the automatic presumption is that it is either “obsolete” or “untested and therefore woo” – or that even their largest trials, in their best journals, are not to be trusted. Sure, it could always be that their results don’t apply to Us (assuming We are not Asian-American) because we are in some unknown way different – but has that ever stopped us from promoting our version of medical science in their nations?

    Maybe it was poor tactics on my part to give a specific example of ignored Asian research. Orac, with a digression on plant extracts and an inaccurate ad hominem, cleverly avoids having to answer the most important question I raised, which is: Why should a treatment that may well be just as bioactive as the tested treatment, varying only in precise methodology or dose, be accepted as a placebo control? And what are the obligations of IRBs, or journal editors, when a researcher declares that of two very similar treatments, one is to be presumed to be not bioactive just because he wishes it to be, and the second is to be required to prove its superiority vs. the first?

  31. #31 Yojimbo
    August 25, 2010

    @17 Ian – “Assuming you could get people to agree on an observable standard for “great”… ”

    Um! That’s a mighty big assumption.

  32. #32 Todd W.
    August 25, 2010

    @jane

    but has that ever stopped us from promoting our version of medical science in their nations?

    What do you mean “our version”? Do you mean the manner in which we conduct clinical trials? Or do you mean the products of clinical trials being promoted in other countries?

    Orac, with a digression on plant extracts and an inaccurate ad hominem

    You brought up using plant material, not Orac. Also, there was no ad hominem in his comment. An example of an ad hominem is “You’re Democrat, therefore your argument is wrong.”

    Why should a treatment that may well be just as bioactive as the tested treatment, varying only in precise methodology or dose, be accepted as a placebo control?

    Orac is not saying that the TENS is a placebo. He is saying that the acupuncture is a placebo. TENS is active treatment. So, all the study was comparing was one type of TENS against another type of TENS. It was not comparing acupuncture to non-acupuncture.

  33. #33 T. Bruce McNeely
    August 25, 2010

    The entire field of artistic criticism is based on the idea that a rigorous set of criteria can be used to evaluate whether or not something is good.

    Wagner’s music is better than it sounds.

    – Edgar Wilson Nye

  34. #34 Scott
    August 25, 2010

    but has that ever stopped us from promoting our version of medical science in their nations?

    There’s no such thing as a “version of medical science”. Science is based on objective fact. It doesn’t come in different versions.

    Limitations on the conclusions that may be properly drawn from a given data set are factual; they are not subjective or cultural.

  35. #35 BCinDC
    August 25, 2010

    The “faulty” idea of an East-West dichotomy in medicine is a simple means of expressing two different ways of looking at health. The idea of Eistein’s “Jewish physics” is a funny one, but the analogy is misapplied here.

    Is there a difference between Eastern music and Western music or is there only one music? One could argue either way but it’s a waste of time.

  36. #36 cervantes
    August 25, 2010

    @#17 — “The entire field of artistic criticism is based on the idea that a rigorous set of criteria can be used to evaluate whether or not something is good.”

    Utter, unmitigated, falsehood. Not even in the same universe as the truth.

  37. #37 jane
    August 25, 2010

    ToddW – I personally tend to agree that an ad hominem should include a direct “therefore” statement, but it seems to be a regular behavior among believers in orthodox scientism to yell “ad hominem” whenever they are personally insulted or criticized, by which standard, it undoubtedly is an ad hominem to try to dismiss or invalidate others’ viewpoints in the eyes of the reading audience through derogatory remarks such as “Again, you fall for the “East”-”West” dichotomy so beloved of woo supporters.” And that’s not even true of me! Namecalling strangers tends to not work well, because if you actually know nothing about me, you can seldom avoid falling back on simplistic stereotypes or “projecting the shadow.”

    Scott – That sounds like the words of a person who is not able to see the cultural blinders he is wearing. Just as an example, Western-style medicine (which is not itself a science, but is the subject of this blog) is not practiced identically in every wealthy nation. Diagnoses vary, and preferred treatments for those diagnoses vary. A body of research that is considered definitive in one country may be unknown to or generally rejected by MDs in another. The orthodox Scientist, usually an Anglophone, prefers to resolve such problems with “We’re right, they’re wrong, nya nya.” The rest of us small-s scientists are forced to admit that not every issue can be boiled down to an “objective fact”.

  38. #38 Tzi
    August 25, 2010

    Some commenters seem to be confusing medical treatments that have not been verified [yet] with “medical treatments” that have been rejected. There is a huge divide between things that medical science hasn’t tested yet (or even discovered) and those things that have been looked at and determined to be nothing but an over-hyped, expensive, placebo fad. The former category may turn out to include many placebo treatments but it also may include a lot of legitimate medicines and treatments that, for whatever reason, have not yet caught on in modern medicine.

    I’m sure there are treatments out there that legitimately work but just have yet to be tested and verified. Don’t confuse rejecting practices like acupuncture as dismissing everything non-mainstream as automatically false. If another region or culture is using a treatment that works and has merit, then great. I’m sure the people who are currently skeptical of it will be glad to incorporate it into accepted medicine once it has been tested and confirmed as effective.

  39. #39 Composer99
    August 25, 2010

    jane @30:

    Assuming you wish to advance the debate in a manner leading others to agree with you, can you provide specific examples of the kinds of things you assert are taking place?

    It’s all well and good to say these things happen, but without a specific example to review, how can I, or anyone else, come around to agreeing with you?

  40. #40 MikeMa
    August 25, 2010

    @jane,
    You complain that small studies are considered worthless by the bad old west. They are, in fact, of little value except as indicators to when larger studies are likely to prove fruitful. As indicators of performance, larger studies are more easily trusted due to statistics alone. Difficult to reach certain confidence levels with N<=30.

    You also use the word ‘believe’ to describe how a non westerner feels about his technique or method. The belief must be based in observable fact otherwise Dr. Jay Gordon would be right!

  41. #41 Composer99
    August 25, 2010

    jane @ 37:

    statement by jane:

    Scott – That sounds like the words of a person who is not able to see the cultural blinders he is wearing. Just as an example, Western-style medicine (which is not itself a science, but is the subject of this blog) is not practiced identically in every wealthy nation. Diagnoses vary, and preferred treatments for those diagnoses vary. A body of research that is considered definitive in one country may be unknown to or generally rejected by MDs in another. The orthodox Scientist, usually an Anglophone, prefers to resolve such problems with “We’re right, they’re wrong, nya nya.” The rest of us small-s scientists are forced to admit that not every issue can be boiled down to an “objective fact”.

    jane, what evidence do you have that this is the case? What definitive research in, say, France, Russia, or Singapore is being rejected out of hand by ‘Anglophone Scientists’?

    Can you come up with a specific example of a difference in medical practice in the US and some other wealthy state and explain why the difference is due to the ‘scientism’ of US medical researchers/practicioners?

  42. #42 Scott
    August 25, 2010

    Just as an example, Western-style medicine (which is not itself a science, but is the subject of this blog) is not practiced identically in every wealthy nation. Diagnoses vary, and preferred treatments for those diagnoses vary. A body of research that is considered definitive in one country may be unknown to or generally rejected by MDs in another.

    Not a single bit of that goes against what I said. Evidence is often ambiguous, local conditions vary, and hence such differences are indeed routine. That doesn’t in any way, shape, or form rebut the point that “does treatment X work in situation Y” is a question of objective fact, which is not in the slightest affected by culture.

    Postmodernism has its place in some fields – art is inherently cultural, for instance. In science, it has none.

    The orthodox Scientist, usually an Anglophone, prefers to resolve such problems with “We’re right, they’re wrong, nya nya.”

    Strawman. The scientist resolves such problems with “what does the evidence say.”

    The rest of us small-s scientists are forced to admit that not every issue can be boiled down to an “objective fact”.

    True. However, no such issues are in play here, as the extent and nature of the efficacy of acupuncture ARE matters of objective fact.

  43. #43 BCinDC
    August 25, 2010

    Can one of you “Western” people explain something. Why is it that advocates of the reductionist method insist on debunking studies which show stats like the GERAC study which showed:

    –Of 1,200 back-pain patients studied, app 50% of real and sham ac groups had less pain after treatment, compared with 25% for those receiving traditional back care.
    –Only 15% of ac group required extra pain drugs, compared with 34% in the sham ac group, compared with 59% of those receiving conventional back therapy.

    Only a mental midget cannot see that SOMETHING is going on here. Stubborn reductionists claim “placebo” based on the results of this study? I find that amazing.

    Obviously, the success rate of sham ac arouses curiosity. But let’s get practical – and by the way, “chi-woo” medicine is all about being practical. If you are a sufferer of back pain and saw these GERAC study results indicating that acupuncture treatment demonstrated basically a 50% drop in pain and medication requirements, would you be more or less inclined to try an acupuncturist?

    Instead, stubborn reductionists like Orac would rather debunk the study based solely on the anomaly of positive results from sham ac, an anomaly which likely will occur given the unique problems presented by acupuncture when designing control group testing.

    We can debate the meaning of sham ac showing positive results alongside regular ac, but in the GERAC study, as presented in Orac’s blog, real acupuncture beat both sham acupuncture and conventional back care. So exactly where’s the placebo indicated?

    Unless I’m missing something, Orac’s analysis of the GERAC study is disingenuous, blind, and/or stupid.

  44. #44 MikeMa
    August 25, 2010

    HTML got me @40. It should read N less than 30.

  45. #45 Composer99
    August 25, 2010

    jane’s comment on Scott having ‘cultural blinders’ also gets one to think.

    Is it not the case that the laws of physics operate the same across the Earth? Doesn’t the chemical reaction of, say, combustion, operate in the same way, everywhere?

    Is there some way that groups of humans, when sorted by culture or ethnicity, can be so different that the biochemistry underlying their health processes are fundamentally dissimilar? To the extent that different, traditional culturally-derived healing practices work in some and not in others?

    I can’t see how such could possibly be the case. Especially when one considers that science-based medicine is a novel deviation from the traditional, culturally-derived healing practicies as developed in Europe & the Middle East that would actually comprise ‘Western’ medicine.

    jane isn’t going so far as to state such a thing, based on her comments. But she seems to be inadvertently implying it.

  46. #46 jane
    August 25, 2010

    MikeMa – No, I don’t believe I said “bad old.” And as a practicing scientist, I get the whole stats issue, believe me. My point about Southern science was not that small studies, if they are the only ones possible, become perfect! It was that for many things in the global South, weak studies plus human experience are the best anyone is going to be able to do. (Likewise, it seems we will never be able to do a study of tai chi that everyone will accept as both rigorous and fair, until we are able to attach a computer to people’s brains and make them think they exercised when they were lyin on a couch.) In this circumstance, do people who are trying to decide what to use go with the best available science, even when it is limited, or do they accept the dictates of foreign Science that “we just know” everything their culture invented will be inferior or worthless?

    I do not want to spend further time pursuing this concept, as it’s moot – such decisions will be independently made by millions of people, not by you or me. But I do think it’s worth considering how the decision you might say people should make would differ if you lived in, say, rural Congo.

    Composer99 – That’s a pretty open-ended demand, and it’s hard to know what you want, which reduces my interest in agreeing with you. Any example of regional bias? Presumably, aside from the belief some people seem to have that we can presume anything Asian is a placebo because stupid woo-ish patients like Asian stuff, or that any Asian work must be “replicated” in America while American discoveries can be implemented worldwide? You can get on the Net yourself and find endless examples of prejudice from supporters of every single faction; if you dispute this, I can only conclude that you’re new to the Net.

    I do vividly recall a comment from one of these SBM/CSICOP blogs about some dying actress (Farrah Fawcett?) who went to Germany to get a cancer treatment not available here. (No, I am not going to spend the afternoon finding it for you; it has no particular significance above the thousand others you can find at random.) The immediate response of the Scientists was that it must be “woo.” It turned out to be a treatment offered there by mainstream oncologists – whereupon someone pontificated that it MUST be either abandoned here, and hence “obsolete,” or never used here, and hence “unproven,” experimental, and by implication quackish. Those were the only two options. It made strikingly explicit the assumption that American medicine is always best, and nobody else could ever, possibly be ahead of us.

  47. #47 Tzi
    August 25, 2010

    #43

    Only a mental midget cannot see that SOMETHING is going on here. Stubborn reductionists claim “placebo” based on the results of this study? I find that amazing.

    I don’t understand. You find it amazing that people would call something a placebo when it turns up results that are the same as the placebo?

    Placebo doesn’t mean it has no effect. It just means its effects are not due to the nature of the treatment itself.

    If you are a sufferer of back pain and saw these GERAC study results indicating that acupuncture treatment demonstrated basically a 50% drop in pain and medication requirements, would you be more or less inclined to try an acupuncturist

    Treating problems with a placebo intentionally is unethical. Just because it may produce better results than doing nothing at all does not suddenly make it a valid treatment. And, in fact, encouraging the use of such treatments for that reason just continues to perpetuate the dangerous misunderstanding that they’re useful and wastes suffering people’s money for nothing. If people are seeking out medical treatment, they should get it. They should not get the illusion of medical treatment. That anyone would argue otherwise is kinda horrifying.

    If I’m a sufferer of back pain, I want to find a treatment that is MORE effective than placebo. That’s how I know it’s a real treatment.

  48. #48 Orac
    August 25, 2010

    Unless I’m missing something, Orac’s analysis of the GERAC study is disingenuous, blind, and/or stupid.

    You’re missing something.

    Back pain is very much susceptible to placebo effects. This is something that has been well known for a very long time. That you are apparently ignorant of this very basic and well known observation is not my problem. It is also not my problem that you didn’t bother to click on the link leading to my detailed analysis of this study, written three years ago when the study was reported. I included it there so that I wouldn’t have to repeat myself (excessively), but you obviously didn’t bother to click on it and instead decided to ask questions answered in it. Fortunately for you, I am a benevolent blogger and will give you the link again:

    http://scienceblogs.com/insolence/2007/09/yawnanother_acupuncture_study.php

    Click it. Read it. Love it.

    My analysis above also linked to another good analysis here:

    http://pyjamasinbananas.blogspot.com/2007/09/acupuncture-for-back-pain.html

    If you read that, you’d see that there were other problems with the study that appear custom-made to minimize apparent effects of standard therapy. I mentioned this in my post:

    This analysis looks as though it is based primarily on a close reading of Table 5 in the paper and appears to be correct, but it’s even worse than that. These excluded patients were moved to the “nonresponder” group. After correcting for the use of “proscribed” treatments, over 50% of responders to conventional therapy were moved to the nonresponder group, whereas only around 35% of responders from the sham acupuncture and 33% of responders to acupuncture were moved to the nonresponder group. At the very least, this certainly accentuated the difference between the conventional therapy group and the acupuncture groups, which were not so large in the first analysis, making a relatively small difference into a large difference. What should have been done is that these patients using “proscribed” treatments should have been excluded from the analysis altogether, rather than moved to the “nonresponder” group.

    That all puts a rather different spin on the whole study that the media reports don’t tell you about, doesn’t it?

    Why, yes. Yes it does. Another issue was that the patients selected had had an average of 8 years of back pain. In other words, they were a preselected group for whom “conventional” therapy wasn’t working very well. When you take such a group and try something new, placebo effects are often accentuated.

    It turns out that there was lots of commentary on this study, which didn’t show what acupuncture advocates claim it showed. Steve Novella and Ben Goldacre, for instance, also commented:

    http://www.badscience.net/2007/09/acupuncture-and-back-pain-some-interesting-background-references/

    http://www.theness.com/neurologicablog/?p=14

  49. #49 Theodore MS3
    August 25, 2010

    “Only a mental midget cannot see that SOMETHING is going on here. Stubborn reductionists claim ‘placebo’ based on the results of this study? I find that amazing.”

    We know that placebos have positive effects. That has been well documented in the scientific literature. There are some catches though. First off these benefits are directly proportional to how the treatments are advocated to the patient. If the patient is told x treatment is amazing then they tend to have a higher placebo response (something this recent acupuncture study shows well). We also know that the more invasive and even painful the placebo the more effective it is. Placebo surgeries are more effective then placebo pills for example. We also know that the more expensive a placebo is the more effective it is. When those three things become combined is where most medical practitioners start to become very anxious, because in order to use a placebo we must lie, torture, and or exploit patients.

  50. #50 Todd W.
    August 25, 2010

    @jane

    “Again, you fall for the “East”-”West” dichotomy so beloved of woo supporters.” And that’s not even true of me!

    Your arguments seem to denigrate “Western” medicine as if it is somehow fundamentally different than “Eastern” medicine. As such, you are creating a false dichotomy, though perhaps not intentionally. You are frequently saying that “Western” or American scientists dismiss “out of hand” studies from other regions. That strikes me as a bit of a straw man, since you provide no examples of this happening. The science stands or falls on its merits. At any rate, he is not saying you are wrong because you share something similar to “woo supporters”. It’s more of an “and” thing. I could see that there may possibly be a bit of poisoning the well, perhaps, by using the phrase “woo supporters”.

    It is true that studies from certain regions may be looked at with a bit more caution than others. For example, studies on certain topics coming out of China are viewed with hesitancy and scrutinized a little more closely. Part of this is due to a rather unfortunate history of plagiarism and falsified data in a disproportionate number of past studies. However, even then the studies are not, as far as I’m aware, dismissed out of hand simply because it is from China.

    It is also true that certain areas may be less able to fund larger studies, meaning that the research they put out may be (though not always) of lesser quality than research from a location that can afford a larger study. This is not a matter of cultural bias, really. If, say, Paraguay puts out a small study and the U.S. puts out a study of the same size, the U.S. study is not, simply by virtue of being from the U.S., a better study, and I doubt anyone here would claim such. Each study must be judged on its own merits.

  51. #51 augustine
    August 25, 2010

    [Is it not the case that the laws of physics operate the same across the Earth? Doesn't the chemical reaction of, say, combustion, operate in the same way, everywhere?]

    The answer is simple. Medicine is NOT a hard science. Some of the more ardent science blogging scientisimists get that confused.

    Get this Medicine=/=Science. Got it? Good!

    Even if your name tag says “scientist” on. Medicine still does not equal science. Got it? Good!

  52. #52 Composer99
    August 25, 2010

    jane @ 46:

    I am not suggesting you need to agree with me on anything. I am suggesting that, if your objective is to secure agreement from me (or anyone else), on American medics rejecting, out-of-hand, practices or studies from other countries, then you will need to provide specific examples.

    You are the one making the claim that research or practice outside the US is being unfairly rejected by American practicioners, ergo the burden of supporting the claim rests on you. How ‘new’ to the Net I am is irrelevant.

    Not being able to read your mind, I don’t know what research or practices you are thinking of when you make statements as in comments #30 or 37.

    The Farah Fawcett comment is something to go on, at least, so I will see what comes up.

  53. #53 Calli Arcale
    August 25, 2010

    Jane, if you’re not attempting to create an east-west dichotomy, then why do you say things like The orthodox Scientist, usually an Anglophone, prefers to resolve such problems with “We’re right, they’re wrong, nya nya.” It seems to me that to some extent, while you may not believe in an east/west dichotomy, you do seem to have a bit of a chip on your shoulder about Anglophones, and I’m not sure why. Do you doubt the prevalence of skeptical Francophone scientists, for instance, considering such beasts to be an oddity? Or, for that matter, skeptical Chinese or Japanese scientists? Or Indian or Pakistani or Korean? Why throw that in there about Anglophone scientists if you do not feel there is a significant cultural difference in how science is practiced?

    Science is science. While some cultures may be better or worse at applying scientific principles and while some scientists may be jingoists (and I would not dispute with you on that — scientists are human too), science is science. Either they’re being systematic and careful about what they do, or they are taking shortcuts. Where they come from is really not important.

  54. #54 Todd W.
    August 25, 2010

    @jane

    Presumably, aside from the belief some people seem to have that we can presume anything Asian is a placebo because stupid woo-ish patients like Asian stuff, or that any Asian work must be “replicated” in America while American discoveries can be implemented worldwide?

    Do you have examples of people engaging in this sort of behavior? In this thread, as well as the tai chi thread, I don’t recall anyone presuming that “anything Asian is a placebo because stupid woo-ish patients like Asian stuff”. Rather, the argument is that concepts, such as “qi” lack evidence and, in many cases, plausibility. That is why it is woo-ish, not the other way around. And the cultural heritage of the concept has nothing to do with it, either, as evidenced by the same approach taken to “Western” concepts like balancing the humours or homeopathy. However, there is a tendency for people who are “woo-friendly”, so to speak, to view things from the Orient as inherently better than so-called “Western” medicine, simply due to “ancient wisdom” or some other irrational reason, rather than there being any objective evidence to support it.

    Again, “it’s woo because it’s Asian” is not what anyone here is claiming. Though do provide examples otherwise if you feel that people are engaging in such.

  55. #55 jane
    August 25, 2010

    BCinDC – I’ve given up debating that issue. To you and me, something “works” if after you use it, you obtain lasting relief. To the orthodox, it only “works” if it demonstrably acts through a mechanism that would work on a coma patient (the fact that coma patients don’t suffer back pain notwithstanding). Absent solid proof of acupuncture’s mechanism(s), it will never be possible for two people with different definitions of “works” to come to an agreement.

    Scott – “”does treatment X work in situation Y” is a question of objective fact.” No, it isn’t. See the above comment. Neither Science, nor science, nor “objective fact” can tell us which definition of “works” we must all favor. Even in less touchy situations (e.g., placebo-controlled pill-pops), scientific data do not say Yes It Works or No It Doesn’t. There are observed numbers and there are stats to estimate the likelihood that the difference (or lack of difference) is real. You are almost never 100% certain of something. Even if you are, there remains the question of weighing costs and benefits, which is not a purely scientific issue.

    Composer99 – I think we’ll stop with this exchange (you can have the last word, go ahead) because your remarks above, though fully literate, so grossly distort my position as to require the conclusion that you have no genuine interest in dialogue leading to any agreement. Two points of distortion:

    1. I did not say that definitive data were rejected by scholars from other countries, but that data believed to be definitive were. I gave before the example of mainstream Japanese oncology, whose “settled science” Americans place little or no weight on. By contrast, America’s belief in widespread statin use, and trust in studies that purport to justify it, far exceeds that in many European countries. In truth, neither group is relying on 100% certain data; if we’re going to be intellectually honest, we can’t just assume that our culture or subculture is always right.

    2. It’s simply ludicrous to claim that I implied different ethnic groups had “fundamentally different” biochemistries. I said the precise opposite in saying that results of clinical trials done in Japan should be considered meaningful by Americans, while Orac suggested that those trials should be ignored, until replicated in America, because Japanese might be biochemically different in some way. Do you not think, when you misrepresent people in this way, that your target audience can scroll up and down to see for themselves what wicked racist thing I must have just said?

  56. #56 Scott
    August 25, 2010

    It is true that studies from certain regions may be looked at with a bit more caution than others. For example, studies on certain topics coming out of China are viewed with hesitancy and scrutinized a little more closely. Part of this is due to a rather unfortunate history of plagiarism and falsified data in a disproportionate number of past studies. However, even then the studies are not, as far as I’m aware, dismissed out of hand simply because it is from China.

    It’s relevant in this context to observe that similar things happen with studies from all sorts of places. Authors with known axes to grind have their papers viewed with greater caution. Anything appearing in Medical Hypotheses is taken with a shovelful of salt.

    Being conservative in the interpretation of studies of a new drug which were funded by the manufacturer of that drug is a very similar sort of thing, too.

  57. #57 Todd W.
    August 25, 2010

    @jane

    I said the precise opposite in saying that results of clinical trials done in Japan should be considered meaningful by Americans, while Orac suggested that those trials should be ignored, until replicated in America, because Japanese might be biochemically different in some way.

    Where did Orac suggest that? I saw him say that the study would need to be evaluated before recommending it and that there might be differences between the two populations. He said nothing of replicating it in the U.S.

    If the study a physician reads the study and finds that it is well-designed and conducted and the results sound, there may be reason to recommend the treatment to their patients. Before it becomes accepted practice, though, it would be good to have studies replicating it in the new population to make sure that it will actually be of benefit and that differences in genetics or environment do not diminish the effects.

  58. #58 Theodore
    August 25, 2010

    Jane as a patient would you like us to sell you a 100$ pill for back pain that is complete rubbish as long as we lie convincingly and persuade you that it works?

  59. #59 Scott
    August 25, 2010

    No, it isn’t. See the above comment. Neither Science, nor science, nor “objective fact” can tell us which definition of “works” we must all favor.

    Semantics won’t help you here, since everyone involved is using the same definition of “works” – “makes the patient feel better.” Which is still objective fact (the feeling better is subjective, but whether that subjective feeling takes place is objective).

    Even in less touchy situations (e.g., placebo-controlled pill-pops), scientific data do not say Yes It Works or No It Doesn’t. There are observed numbers and there are stats to estimate the likelihood that the difference (or lack of difference) is real. You are almost never 100% certain of something.

    While true, it has no relationship to the question. Imprecisely known objective facts are still objective facts.

    Even if you are, there remains the question of weighing costs and benefits, which is not a purely scientific issue.

    And also an issue that has no relevance to the question at hand.

    It’s simply ludicrous to claim that I implied different ethnic groups had “fundamentally different” biochemistries.

    The point is that such is the only way to justify the claims you’re making…

  60. #60 Scott
    August 25, 2010

    Semantics won’t help you here, since everyone involved is using the same definition of “works” – “makes the patient feel better.” Which is still objective fact (the feeling better is subjective, but whether that subjective feeling takes place is objective).

    Oh, and a preemptive note – if you have any intention of responding by claiming that because feelings of pain are subjective, asking patients if they feel less pain is not objective, you WILL be laughed at.

  61. #61 Karl withakay
    August 25, 2010

    PalMD had an excellent, highly relevant post on his blog today.

    Every patient is an experiment:
    http://scientopia.org/blogs/whitecoatunderground/2010/08/24/every-patient-is-an-experiment/

    An excerpt from the middle of the post to whet your appetite:
    “Science-based medicine relies on data from large studies, but these data do not create a cookie-cutter approach to medicine. The data tell me what is likely to happen when I fail to control blood pressure, and guide me toward success at reducing the risks of hypertension. What the data don’t tell me is how much my patient can afford to spend on medicine, how well they’re able to remember their medicine, whether they will tolerate a particular medicine or not. Each patient is an experiment, but one based on an extensive and living repository of data.”

  62. #62 rob
    August 25, 2010

    since most of europe lies east of the prime meridian, by definition, most of europe practices eastern medicine.

  63. #63 augustine
    August 25, 2010

    ["What the data don’t tell me is how much my patient can afford to spend on medicine, how well they’re able to remember their medicine, whether they will tolerate a particular medicine or not. Each patient is an experiment, but one based on an extensive and living repository of data."]

    That’s interesting. He blames the patient if he get’s less than expected results. He does not question the method or the conclusion drawn from data. The experiment, to him, is to find the right patients to fit into his box. The patient fails him. Not he fails the patient. Sort of an ego saving strategy don’t you think?

    I wonder if this attitude toward the data (patient) interferes with his placebo effect.

  64. #64 jane
    August 25, 2010

    Scott – your “pre-emptive straw man” is rather entertaining to me, since it shows how badly your worldview compels you to mischaracterize me. Nor will semantics help YOU, since the fact is that we do not all use the same definitions, and science provides no basis for selecting one. Your message 58 does not provide a basis for further functional dialogue, so I’ll quit arguing with you as well, giving you the last word.

    But I do hope that word will include some explanation of how MY “claims” imply drastic biological differences between Asians and white Murcans, with reference to claims that I have actually made rather than claims you imagine I might make. This new line of argument seems to border on the actively delusional.

  65. #65 Scott
    August 25, 2010

    your “pre-emptive straw man” is rather entertaining to me, since it shows how badly your worldview compels you to mischaracterize me.

    If you feel you’ve been mischaracterized, you should explain how. That characterization is, I assure you, completely my honest opinion as based on your arguments thus far.

    Nor will semantics help YOU, since the fact is that we do not all use the same definitions, and science provides no basis for selecting one.

    Please explain how this invalidates the objectivity of asking “does this make the pain less.”

    Your message 58 does not provide a basis for further functional dialogue, so I’ll quit arguing with you as well, giving you the last word.

    Translated: You realize you don’t have any credible answer to the arguments put forth, but are unwilling to admit you were wrong.

    But I do hope that word will include some explanation of how MY “claims” imply drastic biological differences between Asians and white Murcans, with reference to claims that I have actually made rather than claims you imagine I might make. This new line of argument seems to border on the actively delusional.

    You claim that medical science is different for Easterners and Westerners. This can only be true if Easterners and Westerners had different biochemistry. Ergo, an implicit claim for differing biochemistry.

  66. #66 Robert
    August 25, 2010

    …Yet, acupuncture practitioners know how to assess this Qi through skillful practices of pulse taking, tongue observation….

    As a small child, I bit the end of my tongue off. Thankfully, I have no memory of that event, nor was Western (I know) medicine able to reattach it. It was 1963, whatta you want?

    So my question is, would topungue observation be valid for me?

    Or is 90% good enough?

    Would the woo meister know?

  67. #67 Gopiballava
    August 25, 2010

    Jane: “Absent solid proof of acupuncture’s mechanism(s), it will never be possible for two people with different definitions of “works” to come to an agreement.”

    Wait, are you claiming that we won’t accept acupuncture unless we have a mechanism? Do you genuinely have no clue about how studies are conducted and their results analyzed?

    If a well controlled study showed that purple pill bottles worked better, we’d be using purple pill bottles while searching for a mechanism. We would be diligently searching out a mechanism for as long as it took to find one. I’ve read enough prescribing information leaflets filled with “I don’t know” that I am very intolerant of people who claim that science based medicine requires a mechanism before it accepts something.

    People bring up the implausibility of acupuncture because, in conjunction with the negative study results, it is quite relevant. Demonstrable facts about physiology make acupuncture’s mechanism seem unlikely. That is not on its own a reason to disbelieve in it. However, when combined with the fact that acupuncture has been demonstrated to work comparably to placebo, progress would be better served looking for the mechanisms that make both real and sham acupuncture work.

  68. #68 jane
    August 25, 2010

    Gopiballava – I probably have more of a clue about how to conduct research than you do, but it also appears that you genuinely have no clue about how these comment-thread arguments have been going for the past couple of weeks. There is indeed a faction that will not accept acupuncture, no matter how many studies show it provides relief to patients, unless it is proven to them beyond a shadow of a doubt that it is not “Just a Placebo.” Also, you are repeating as statements of fact points that have proven to be in serious dispute.

  69. #69 Karl Withakay
    August 25, 2010

    I nominate Jane @62 for the Jody award, awarded for any commenter who represents the ideals and standards of argument and logical discussion of a commenter in a thread on skeptico that caused another commenter named Jody to post the following reply

    “And the moral we learn from that last comment, Boys and Girls, is that if you can’t win an argument on its merits, take a shit on the desk and leave.”

  70. #70 jane
    August 25, 2010

    Charming, Karl. Maybe you can say “shit” a few more times after I say that I presume anyone who enters a conversation like that to be too far beneath me intellectually to be capable of a reasoned discussion.

    Comment threads have a certain rhythm, and in my opinon, if it is clear that nothing but further fruitless bickering over minutiae, repetitive assertions of previously stated beliefs, or personal attacks will occur between two people, at least one of them should bow out so that the thread is not lengthened by an endless back and forth. It’s a courtesy to other readers. If you are never willing to give it a rest and let others have the last word, people think – at least if they view you as a heretic or infidel – that you’re a bandwidth-hogging jerk. But if you give it a rest without having done the impossible task of answering all legitimate and phony arguments against your position to everyone’s satisfaction, you are running away. Just one of those little things that shows the inherent irrationality of human behavior. :-)

  71. #71 Michael
    August 25, 2010

    “I did not say that definitive data were rejected by scholars from other countries, but that data believed to be definitive were. I gave before the example of mainstream Japanese oncology, whose “settled science” Americans place little or no weight on.”
    Jane, there have been studies on publication bias in Asian countries. For example:
    http://www.dcscience.net/Vickers_1998_Controlled-Clinical-Trials.pdf
    Scientists do sometimes view data from these countries with skepticism because they come up with positive results more often than Western countries. That’s not racist- nobody is suggesting that Chinese-American scientists should be suspected of only publishing positive results.

  72. #72 Gopiballava
    August 25, 2010

    Jane: “There is indeed a faction that will not accept acupuncture, no matter how many studies show it provides relief to patients, unless it is proven to them beyond a shadow of a doubt that it is not “Just a Placebo.”

    Do you believe that acupuncture has been shown to be better than placebo? Can you point to the two best studies you believe demonstrate this?

    Do you believe that it is ethical for a healthcare provider to offer treatment that works but is indistinguishable from a sham version of the same treatment?

    If acupuncture performs as well as, say, poking toothpicks against the skin, should we consider acupuncture to be an accepted part of clinical practice?

  73. #73 Rogue Medic
    August 25, 2010

    @ 43 BC in DC,

    Only a mental midget cannot see that SOMETHING is going on here.

    Yes, something is going on. That something is called the placebo effect.

    Stubborn reductionists claim “placebo” based on the results of this study? I find that amazing.

    If you understood the placebo effect, you might not be so amazed. All treatments should have to prove that they are better than placebo, not just CAM.

    Obviously, the success rate of sham ac arouses curiosity.

    The placebo effect is far from completely understood.

    That does not mean that we should endorse the use of placebo treatments.

    By the way, kissing it and making it all better is also a placebo treatment, but you won’t find many parents selling this form of treatment.

    But let’s get practical – and by the way, “chi-woo” medicine is all about being practical.

    But let’s get practical gullible – and by the way, “chi-woo” medicine is all about being practical gullible.

    There. I kissed it and made it all better.

    Unless I’m missing something, Orac’s analysis of the GERAC study is disingenuous, blind, and/or stupid.

    What you appear to be missing is reading comprehension.
    .

  74. #74 Composer99
    August 25, 2010

    jane, while it is certainly the case that I am not predisposed to agree with your conclusions, it is not set in stone that I am predestined to disagree with your conclusions for the rest of my life.

    However, since you are the one making claims as shown below, it is up to you to support them.

    jane claim (post #30):

    moderation – You’ve actually raised an issue I care about deeply. Southern medicine almost always is restricted to small clinical trials, because researchers in the global South can rarely afford a large trial. Such small studies will automatically be called “worthless” or “meaningless” if they find benefit from traditional local treatments, which is regrettable both because Westerners will never test most such treatments, and because it conveys the message that “they” cannot do meaningful science themselves, but should wait passively to consume (to the extent they can pay for it) the products of our science.

    and also (post #30):

    As for Eastern medicine, I have seen many times that if foreign scientists (Europeans, too, but especially Asians) use a method or think they know something that American MDs do not know about or believe in, the automatic presumption is that it is either “obsolete” or “untested and therefore woo” – or that even their largest trials, in their best journals, are not to be trusted. Sure, it could always be that their results don’t apply to Us (assuming We are not Asian-American) because we are in some unknown way different – but has that ever stopped us from promoting our version of medical science in their nations?

    jane claim (post #37):

    Scott – That sounds like the words of a person who is not able to see the cultural blinders he is wearing. Just as an example, Western-style medicine (which is not itself a science, but is the subject of this blog) is not practiced identically in every wealthy nation. Diagnoses vary, and preferred treatments for those diagnoses vary. A body of research that is considered definitive in one country may be unknown to or generally rejected by MDs in another. The orthodox Scientist, usually an Anglophone, prefers to resolve such problems with “We’re right, they’re wrong, nya nya.” The rest of us small-s scientists are forced to admit that not every issue can be boiled down to an “objective fact”.

    jane claim (post #12):

    As a cancer expert, you no doubt know that Japanese oncologists prescribe mushroom polysaccharide extracts to patients with certain cancers based on results from clinical trials that included thousands of subjects. Many American MDs philosophically dislike such products, but they have no contradictory studies to show. If you accept Japanese researchers as the equals of Americans, you would have to advise stomach cancer patients (if you ever dealt with any) that the best evidence suggested that they ought to take such an extract. Would you, given the opportunity, do so? Do you think most American physicians would do so?

    jane claim (from post #54):

    I said the precise opposite in saying that results of clinical trials done in Japan should be considered meaningful by Americans, while Orac suggested that those trials should be ignored, until replicated in America, because Japanese might be biochemically different in some way.

    From what I can tell from those verbatim quotes (thank you, ctrl-c/ctrl-v), the claims you are making are as follows:

    1. Japanese oncologists routinely prescribe some sort of fungal polysaccharide extracts to certain cancer patients and American oncologists ought to prescribe such extracts as well on an egalitarian point (accepting Japanese researchers as equal to American ones).

    2. Small clinical trials from poorer countries showing clinical benefits from traditional, culturally-derived practices are generally rejected out of hand by Westerners, with cultural-imperialist implications.

    3. Different wealthy countries employ varying medical practices for similar diagnoses (e.g. you actually give a specific example elsewhere, when pressed, about Farrah Fawcett and cancer). Researchers/practicioners in America (or in the English-speaking world as a whole? hard to say) are asserted to reject the reasoning behind this variance out of hand as a matter of cultural prejudice.

    If you actually read what you wrote, the claims being made are very vague.

    I, or anyone else, could agree that, in specific cases, research or practice in other parts of the world is being rejected in the US for non-scientific reasons. But since it is you making these vague claims, it is up to you to support them with evidence.

  75. #75 Composer99
    August 25, 2010

    The ugh troll in #63 misses the point entirely, as usual.

    PalMD is tailoring his treatment to his patient to maximize its effectiveness (you know, so the treatment actually works) and minimize adverse effects.

    Notice how, unlike sCAM practitioners, when a regimen does not have the desired effect, PalMD changes the treatment to respond to the requirements of the patient – until he finds something that works, while also being aware that patients are human beings, who are occasionally forgetful or neglectful.

    That is exactly the opposite of the kind of blaming the patient that sCAM artists routinely engage in (either because the patient failed to follow the ridiculously-complicated protocol, or wasn’t thinking the right thoughts, or wasn’t letting his/her ‘qi’ flow properly, and so on…)

  76. #76 Composer99
    August 25, 2010

    jane @55:

    2. It’s simply ludicrous to claim that I implied different ethnic groups had “fundamentally different” biochemistries. I said the precise opposite in saying that results of clinical trials done in Japan should be considered meaningful by Americans, while Orac suggested that those trials should be ignored, until replicated in America, because Japanese might be biochemically different in some way. Do you not think, when you misrepresent people in this way, that your target audience can scroll up and down to see for themselves what wicked racist thing I must have just said?

    Indeed, I don’t think you deliberately meant such a thing at all (as I said (post #45): “jane isn’t going so far as to state such a thing, based on her comments. But she seems to be inadvertently implying it.”). But Scott’s point was that conclusions in medicine are drawn from a collection of data (e.g. of facts) and these are not as subject to cultural variance as you appear to imply in your reply to him (in post #37).

  77. #77 Karl Withakay
    August 25, 2010

    Either I got Jane’s comment number wrong, or something popped out of moderation of bumped her comment number higher.

    64 is the current number of her Jody award winning comment. :)

  78. #78 Skeptic Grad Student
    August 26, 2010

    That article drove me to comment on it as well, something I rarely do.

    TPP’s been getting worse and worse over time, her latest vaccination piece was pretty bad, but this is just complete nonsense.

    One of the things I hate most about this entire ‘Western’ appellation that’s applied to SBM in articles such as this is it essentially whitewashes away the amount of good science being done in ‘Eastern’ lands, and also makes the burden for scientists trying in good faith to isolate drugs/treatments from traditional herbal remedies even larger.

  79. #79 John2
    August 26, 2010

    Jane, you have made several comments now on how you think that you must be more intelligent than other posters, or how you think that you have a better handle on research than them, and you then use this as an excuse not to answer the very valid comments that have pointed out that your worldview seems to be based on proof by assertion. Do you not see how weak an argument this is, avoiding backing up your points by claiming mental superiority?

    Also a person swearing in a post is not indicative of low intelligence. I, for example, have a good few degrees in physics, including a doctorate in particle physics, yet am still happy to use crude language when describing your witterings on here as as big a pile of steaming shit as I’m likely to see, and when pointing out that you must have received your education from a really shitty crapheap of an institution if this is what you think rhetoric, argument, or exposition of a point is about.

    Now, is there any hope in christ shitting felch-hell that you’ll stop avoiding people’s very valid questions, and actually provide an example or two to back up your bat-shit crazy allegations?

  80. #80 John2
    August 26, 2010

    On the Eastern Versus Western science thing, I was living in Blackheath while doing my doctorate, which as any fule kno is bang on the prime meridian a few hundred yards South of where it is defined. I can categorically state that my thesis is distinctly piebald, with the pieces which I wrote while in the office in Kensington being completely reductionist, those bits written at home fifty metres into the East coming out much more holistic, and the few bits penned in the pub right on the 0 degree line being close to unreadable.

  81. #81 Mooloo
    August 26, 2010

    When the Japanese first started making cars, they had a hard time persuading the West that they were as good as Western cars. They were better, and cheaper, and in the long run that beats patriotism. Same with electronics – I recall finding buying a Korean video a bit iffy twenty years ago, but would buy a Samsung without hesitation now.

    If “Eastern” medicine was more effective than “Western” medicine, it would be winning the battle of the wallet. Strawmen arguments about scientists not accepting foreign ideas aside, the proof would be seen by all the neutral parties. They would buy the cheaper, better, products.

    Yet while the “East” has produced huge multinationals that dominate all sorts of industry, it has made little headway in medicine. If anything, the residual effects of the “Eastern” way of looking at disease can be shown to be holding them back.

  82. #82 Todd W.
    August 26, 2010

    @jane

    There is indeed a faction that will not accept acupuncture, no matter how many studies show it provides relief to patients, unless it is proven to them beyond a shadow of a doubt that it is not “Just a Placebo.”

    Evidence, please.

  83. #83 BB
    August 26, 2010

    “…but I don’t recall ever having seen it embrace pseudoscience.”
    You’ve haven’t read Jane Brody’s article enough in that case.

  84. #84 Scott
    August 26, 2010
    There is indeed a faction that will not accept acupuncture, no matter how many studies show it provides relief to patients, unless it is proven to them beyond a shadow of a doubt that it is not “Just a Placebo.”

    And who exactly would that be? All I see are people pointing out that the weight of the evidence strongly indicates that acupuncture is, as a matter of objective fact, “Just a Placebo”. If that weight of evidence were to point the other way and conclusions did not change, THEN you’d have a point. But it does not, so your charge is entirely unfounded.

    But if you give it a rest without having done the impossible task of answering all legitimate and phony arguments against your position to everyone’s satisfaction, you are running away.

    If you “give it a rest” without making any meaningful attempt to answer any of the legitimate and respectfully presented arguments that conclusively demonstrate your position to be utterly wrong, then the only credible interpretation is that you are, indeed, running away. Happens all the time, and if you have enough experience to be talking about “the rythym of comment threads” you should know that.

  85. #85 Marilyn Mann
    August 26, 2010

    Orac

    I thought you and your readers might be interested in this Health News Review review of the NYT article:

    http://www.healthnewsreview.org/review.html?review_id=3099

  86. #86 David N. Andrews M. Ed., C. P. S. E.
    August 26, 2010

    jane: “The rest of us small-s scientists are forced to admit that not every issue can be boiled down to an “objective fact”.”

    What the fuck is a ‘small-s scientist’? I mean, really… what are you talking about? There’s scientists, and that is it. The focus of different groups of scientists may differ, but they use methods common to all those who practise science.

    jane: “The orthodox Scientist, usually an Anglophone, prefers to resolve such problems with ‘We’re right, they’re wrong, nya nya.’”

    This is what you think science is about? Because, if it is, the following should make us wonder about the quality of your training:
    “And as a practicing scientist,…”

    If you are a practising scientist, and you think that scientists resolve problems the way you said in the above quote, then you really can’t be very good as a scientist – if at all you actually are one.

    As for Augie: “Get this Medicine=/=Science.”

    We are aware of that. However, what we are aware of (and that you obviously bloody aren’t aware of) is that medicine advances through the application of science in gaining evidence for a given treatment’s efficacy. How the fuck someone with your intellect missed that one, I don’t know!

    Oh, but then – your intellect isn’t very strong, is it? That’s why all your ‘arguments’ are so bloody empty! Maybe we all know why you missed that: it’s because you are too thick to understand that process!

  87. #87 jane
    August 26, 2010

    @82 Todd demands “Evidence” for my statement that “There is indeed a faction that will not accept acupuncture, no matter … unless it is proven to them beyond a shadow of a doubt that it is not “Just a Placebo.”"

    Todd, please read or reread the comments in just this thread. Shortly before your comment, we have:

    @72, “Do you believe that acupuncture has been shown to be better than placebo? Can you point to the two best studies you believe demonstrate this? Do you believe that it is ethical for a healthcare provider to offer treatment that works but is indistinguishable from a sham version of the same treatment?”

    @73, “All treatments should have to prove that they are better than placebo, not just CAM.”

    If you are not aware that many people here are strenuously opposed, often on claimed ethical grounds, to the use of placebos no matter what benefits patients derive, you are either very new or not paying attention. While acupuncture has not actually been proven to be Only A Placebo, if it were, I would still be happy to use it. Obviously, Gopiballava and Rogue Medic would not.

    Now, I keep trying to explain that that point of dispute is not scientific but cultural. Can you cite scientific data that prove that we should not use placebos even when they relieve a condition, or that it’s unethical to do so? I am sure you cannot. Those are value judgements. When you insist that yours are the only correct values for everyone, though you cannot prove their correctness, your philosophy has become a form of religion.

    One worthy tenet of your faith is a strong respect for (most) facts. When commenters make errors of fact, you react by presenting facts. When they are perceived to err in value judgements, some of you, unable to prove that your beliefs should be adopted, react with open anger and character assassination. Others reiterate values talking points that don’t put their own beliefs to a real test, or repeat facts or alleged facts as if they can resolve the values debate. I see no great difference between these responses and those of a fundamentalist asked to prove that his anti-gay stance should be universally adopted.

    One of the tenets of every person’s religion is that his own cultural tradition is superior, and scientism is no different. I am familiar with it only in the Anglophone countries, but it would not surprise me at all to hear that there are Japanese scientism-snobs looking down their noses at inferior American science. When the special status of a person’s culture is threatened, he often gets upset about it, as in Composer99′s example (@74):

    “Researchers/practicioners in America (or in the English-speaking world as a whole? hard to say) are asserted to reject the reasoning behind this variance out of hand as a matter of cultural prejudice… But since it is you making these vague claims, it is up to you to support them with evidence.”

    Now, I certainly did not say that, e.g., if American and European medical organizations disagree on the amount of screening radiation we should all soak up, the Americans must be prejudiced. No, I think that the fact that they derive different conclusions from the same data proves that BOTH sides are humans who belong to a culture and are influenced by its values, and thus, everyone’s opinion is in part subjective. Composer99 twists this belief into the strawman of “America or Anglophones are the biased ones.” This is a mark of a person who gets angry at the very suggestion that his own country’s experts might be no more lofty and rational than those from Foreign.

    I will conclude by saying that I personally try not to be religious about anything. While you have to hold opinions and make value judgements to function in the real world, mine are not 100% fixed. I am easily informed on issues of fact; I am willing to change my mind on issues of values, but require convincing. If you conflate these two types of issue, I will presume that your values are unthinkingly held. If you assume the superiority of your values as a premise, you will not do a good job of selling them. And if you react to dissent by verbally abusing unbelievers, they won’t want to buy.

  88. #88 Todd W.
    August 26, 2010

    @jane

    I see. The thing is, though, most of the folks here arguing against the use of acupuncture are arguing the scientific aspects of it. The question of whether it is okay to prescribe a placebo is a wholly different matter entirely, and not something that anyone here has commented on. So, your opinion that there are people who, no matter what, will go against acupuncture is a bit of a strawman not supported by evidence.

    Certainly, the question of when it is okay to lie to a patient and when it is not is important, and this becomes an ethical, rather than scientific, question. It is a much greyer area and one which I, personally, am not comfortable delving into too readily. Are there situations where a patient may benefit from being lied to? Yes. Is it universally acceptable to lie to patients? No.

    When it comes to acupuncture, since the literature suggests that using sham needles (i.e., needles that appear to be like real ones but don’t break the skin – note: not toothpicks) garner the same or similar effects to real needles, then using real needles is to be avoided, due to an increased risk of infection without any significant increase in benefit. From a risk-benefit examination, then, sham needles are a better choice than real needles. So there is no justification to use real acupuncture.

    This doesn’t really address the ethics of when to use a placebo, though.

    As always, though, I’m willing to be shown that I am wrong. Just present the evidence.

  89. #89 Composer99
    August 26, 2010

    jane, re your comment #86:

    I invite you to read your own comments on this thread. Please review my post #74 and look at the blockquoted citations from your own posts. They are copy/pasted verbatim (and I cite post #s so you can go back and verify). I am not going to re-post them in whole or in part in this comment.

    Based on your comments, as far as I can tell, you are making vague claims of cultural prejudice on the part of American and/or Anglophone medical practitioners/researchers which you appear unwilling to support (or, so it appears, even acknowledge).

    I find it bizarre that you are accusing me of mis-representing your position or making up a strawman of your position when, taking what you yourself have written at face value, it seems (to me, anyway) reasonable to conclude what I have in the above paragraph.

    Can you clarify how I am to interpret these statements as anything other than claims that American/Anglo scientists tend to reject foreign research out of cultural prejudice/scientism?

    For the record, by the way, I am not an American, and I will quite happily acknowledge that Americans are hardly pinnacles of rationality compared to the other 95% or so of the world’s population.

  90. #90 Chris
    August 26, 2010

    I am mostly ignoring this, having had a go at “jane” and her worthless studies a few weeks back (along with Scott’s treatment of it).

    Though I found this statement amusing:

    moderation – You’ve actually raised an issue I care about deeply. Southern medicine almost always is restricted to small clinical trials, because researchers in the global South can rarely afford a large trial.

    Funny, I had just been in a hotel in Canada where the television had BBC World News (which was also the news my brother watches in his apartment in Denmark). One news story told that Australia has been immune to most of the global financial woes. Though the recent election results were a bit of a worry.

    I am pretty sure there is some very fine research that comes out of Australia (I hear about it often in the Nature News and Scientific American podcasts). Does she think that it is located somewhere else on this globe? Just like the folks who think homeopathy is not “western” and are confused when asked when did Germany get transported “east.”

    Carry on, it just gets more fun as she digs herself deeper, and deeper and deeper!

  91. #91 Gopiballava
    August 26, 2010

    Jane: “While acupuncture has not actually been proven to be Only A Placebo, if it were, I would still be happy to use it.”

    If a patient asked you how you knew where to place the needles, would you tell them that it didn’t matter? If the patient kept asking questions, would you admit that poking them with toothpicks would also work?

    Why would you use only a placebo if you had the opportunity to use a treatment that was better than placebo? You still get the placebo effect when you’re giving better-than-placebo treatments.

    It seems like you’re implying that I would offer patients nothing, or would deny them something useful. I would offer patients better-than-placebo therapies. When you offer placebo alone, some patients will take that over a therapy that is better than placebo. Thus, you will get at least some patients who will be worse off.

    Also, you seem to be ignoring that in some cases placebo effects are due to experimenter bias – that the patient may not have even perceived an improvement.

  92. #92 Versus
    August 26, 2010

    Great post, Orac. I am intrigued by this concept of “reductionist” Western medicine. Reductionism is simply breaking down complex phenomenon by analyzing the simplest, most basic physical mechanisms that are in operation during the phenomenon. Ok,so, if acupuncture can’t be explained by “reductionism” could someone please explain it some other way that makes sense?

  93. #93 Ant
    August 27, 2010

    Actually, Gopiballava #91, Tzi #47 said, “Treating problems with a placebo intentionally is unethical.”

    But I think he’s mistaken, as (at least in the UK), GPs do prescribe placebos for some patients – but only where they’re suffering no ailment for which orthodox medicine would be more efficacious.

    Jane #many, few would dispute that acupuncture can provide relief to some patients. In this sense, it “works”. But no studies have shown that the mechanism by which it works has anything to do with meridians or qi, or indeed that it is anything else but a placebo effect – and because of the cost, the pain, and the “theater” (which provides positive psychological reinforcement), it is a strong placebo effect (that is, it can outperform other placebos).

    There might be cases where a patient may prefer some kind of placebo, even if it’s less efficacious, perhaps because it has fewer or less serious side effects. (Hmm… does being locked in the clinic count as a side effect of acupuncture?)

    But acupuncture is still woo.

    And one of the problems with woo – likely the most serious one – is that it deflects people from seeking advice, and receiving orthodox, efficacious treatment, from a qualified medical practitioner.

  94. #94 Ant
    August 27, 2010

    Hmm… re #93, “the pain” is overstating any discomfort, I think; I should have said, “the invasiveness”.

  95. #95 IHC Jay
    August 27, 2010

    Besides pain, apparently some are claiming acupuncture cures infertility? That seems like something very dangerous to play around with. No amount of placebo is going to make someone fertile again.
    And that could have psychological effects I believe.

    http://www.berkeleyhealingacupuncture.com/acupunctureFAQ.php

    Under “What conditions are treated by acupuncture?”

  96. #96 E
    August 29, 2010

    Like IHC Jay, I get irked when alternative medicine overstates itself. This is something I observe all the time when it comes to thyroid disease. Here’s a random link:

    http://healingdeva.com/thyroid_acupuncture.htm

    This website is fairly typical in claiming thyroid disease is on a list of uses for acupuncture put together by the World Health Organization. Yet, I’ve never come across anything that tells me this is accurate. I have seen the following WHO document (sure to make your head melt), but it doesn’t say anything about thyroid disease:

    http://apps.who.int/medicinedocs/en/d/Js4926e/5.html#Js4926e.5

    ~

    It just can’t be repeated enough that engaging in acupuncture is risky. For one thing, it’s incapable of picking up on something serious that could be occurring, like thyroid cancer.

  97. #97 Jerry
    September 1, 2010

    Hmm, my posts got deleted? somehow what I said really irked you or what? I am a scientist also (but not a medical researcher). So you truly believe in science, scientific methods and scientific debate, why do you censor my criticism of your writing?

    In a nutshell, as I said in my earlier (now deleted) posts, most medical research studies are based on case studies (or “controlled” experiments), often using a small sample, and the conclusions are based on statistical inference. It’s probably the best method we have today. However, simply because such studies do not prove that acupuncture works on the samples does not mean that acupuncture does not work for some people for some ailments. This is because our medical scientific knowledge is still very limited, and we still do not have all the tools to understand and measure the human body-mind network yet.

  98. #98 Jerry
    September 1, 2010

    The whole problem I have with the so-called studies about “acupuncture”, either to prove it works or to disprove it is that most of these studies are purely designed, and the researchers didn’t really what to measure or how to measure anything but “subjectively” — this probably can be said about some Western medicine research studies also.

    It’s like “scientists” in the 18th century using the techniques available now then to test whether people can actually communicate remotely via “radio waves” — a concept that didn’t exist at the time.

    Just today’s science can’t tell anything us the effect of acupuncture doesn’t mean that it’s all placebo, or woo, just like “scientists” in the 18th century couldn’t measure the effect of radio waves doesn’t mean people can’t communicate wirelessly.

    If you guys are truly scientists, well, you need to admit that the honest answer about acupuncture is that we still don’t know, but it works for some people at least for some diseases (well, this can be said about a lot of Western medicine pills), whether through “placebo” or not. Or as someone above claims, acupuncture simply leads to “stronger” placebo effect!

    It’s funny that in medicine research, often some unknown effect is attributed to the “placebo” effect. But does one need to ask why the “placebo” effect exists in the first place? Doesn’t it mean that somehow the human brain sometimes functions as a “healing” machine on its own? So there must be a mind-body connection that the scientists today still largely do not understand. Well, the human body and mind are very, very complex machines — it probably defies the “conventional” (and prevailing) Western scientific methods, namely, analytical methods by breaking big things into small parts and then focusing only on a tiny part (e.g., a chemical compound, or a single gene).

    The emergence of new science — “complexity theory”, the study of complex adaptive systems — still has a long, long way to go!!!

    In summary, instead of being open-minded, most of you guys here (that includes in particular the author of the article, Orac) sound like a bunch of dogmatic theologists. Just because my theory can’t prove it exists, it can’t exists! Such altitude is most dangerous to the progress of science! The scientific knowledge we have today, in particular, when it concerns about human body and mind, is still very limited. Most medicine research studies are mostly case studies based on statistics, we really don’t truly know why many drugs work, or work only for some people to a good effect, but not other. So please, do not make the “science-based” medicine a dogma, just because the evidence is not there yet.

  99. #99 Orac
    September 1, 2010

    I assure you, I have not deleted any of your posts. I do not delete posts. Ask any of the regulars here: Other than those of banned commenters (and there have only been maybe three of those over the last six years), I never delete substantive comments. I do occasionally delete comments that are nothing but spelling, grammar, or style flames because they add nothing to the discussion. Occasionally, if I’m in a bad mood I’ll delete comments that are nothing more than pure pedantry with no substance other than a trivial “gotcha.” However, I did not delete any of your posts, and I do not see them caught in my spam filters. If they’re no longer there, I have no idea why that is.

  100. #100 Johnny
    September 1, 2010

    Hmm, my posts got deleted? somehow what I said really irked you or what? I am a scientist also (but not a medical researcher). So you truly believe in science, scientific methods and scientific debate, why do you censor my criticism of your writing?

    I think you will find your silly comments on this page –
    http://scienceblogs.com/insolence/2010/08/another_worthless_acupuncture_study_misi.php

    Orac doesn’t censor (or not much, just spam and socks). His skin is so thick that you’d need an oil drilling rig for effective acupuncture…. if there *was* such a thing as effective acupuncture. I doubt you have no power to irk him.

  101. #101 Todd W.
    September 1, 2010

    Methinks Jerry is thinking of his posts over on the “Another pointless “acupuncture” study misinterpreted” thread.

    Jerry, before accusing a blog host of deleting message, make sure you have the right thread.

  102. #102 Chris
    September 1, 2010

    Jerry, it looks like your missing posts are over there:
    http://scienceblogs.com/insolence/2010/08/another_worthless_acupuncture_study_misi.php

    I figured since the first claims to be correcting an earlier post.

  103. #103 Mephistopheles O'Brien
    September 1, 2010

    Jerry, for your example, in the 18th century testing that someone is able to communicate at a distance using some means that is not audible is simplicity itself. You may not be able to derive Maxwell’s equations and your theory of how it works may well be wrong, but you could at least objectively test the limits of the phenomenon.

  104. #104 kenic
    September 3, 2010

    Jerry, for your example, in the 18th century testing that someone is able to

  105. #105 Chris
    October 26, 2010

    Now that is some heavy duty stupid spam… copying from a post of a dude who did not realize his post was not deleted, but on a completely different thread!

  106. #106 yiwu
    October 28, 2010

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  107. #107 Mark
    November 3, 2010

    Acupuncture works ! As a licensed Acupuncturist in NYC, I treat a lot of pain. There are numerous well done studies using MRI before and after insertion of needles showing about 70% reduction in pain by MRI images and dozens of other studies. Best proof is that people come and use acupuncture for the past 3,000 years. Do you need anymore proof ?

    Here is my site if anyone wants to read testimonials or get more info.
    http://www.newyorkacupuncturecenter.com/index.html
    Be well.
    Mark Moshchinsky, L.Ac(NCCAOM)
    Tree of Life Acupuncture

  108. #108 Todd W.
    November 3, 2010

    @Mark

    Best proof is that people come and use acupuncture for the past 3,000 years.

    Umm…that’s not good proof of anything. People used bleeding for quite a long time to balance the humors, yet it didn’t actually do anything. Longevity of a practice does not make that practice correct. It just means that people think it works.

    As to studies, lots of well-controlled studies found no difference between acupuncture using the correct meridians and acupuncture using incorrect/random spots. It’s also been shown that it doesn’t matter whether you actually break the skin or not.

    With that in mind, I certainly hope you are not actually breaking the skin, since that increases risk (i.e., infection) without providing any added benefit.

    Oh, and testimonials don’t fly here. Actual studies published in high-quality, peer-reviewed journals, such as you might find on PubMed are much better.

    Bottom line: you are practicing placebo medicine.

  109. #109 Chris
    November 3, 2010

    Mark:

    Best proof is that people come and use acupuncture for the past 3,000 years. Do you need anymore proof ?

    Yes, because argument from antiquity is lame. Plus you are a spammer.