Several years ago, Harriet Hall coined a term that is most apt: Tooth fairy science. The term refers to clinical trials and basic science performed on fantasy. More specifically, it refers to doing research on a phenomenon before it has been scientifically established that the phenomenon exists. Harriet put it this way:

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


There’s a lot of tooth fairy science out there right now. It’s been increasing in quantity ever since the rise of so-called “complementary and alternative medicine” (CAM), now known as “integrative medicine” over the last two decades. “Energy healing,” acupuncture, homeopathy, craniosacral therapy, reflexology, even faith healing, there’s no pseudoscience too ridiculous to be excluded from pointless clinical trials. What all these clinical trials share in common is that they are tooth fairy science. They study a phenomenon without its ever having been established that the phenomenon actually exists. Worse, because of the vagaries of he clinical trial process, bias, and even just the random noise in clinical trial results that produce seemingly positive trials by random chance alone, advocates of these pseudoscientific treatments can always point to evidence that their treatment “works.” The overall body of existing research on a treatment like homeopathy is negative, but homeopaths can always cherry pick individual studies and sound convincing doing it.

Here’s another one that I’ve become aware of. It’s a couple of months old, but better late than never. Unfortunately, it was funded by the American Cancer Society, which really should know better, and touted on its website with the headline Acupressure May Ease Breast Cancer-Related Pain, Fatigue. Yes, it’s a study of auricular point acupuncture (APA) in breast cancer patients, and it’s based on prescientific ideas with no basis in anatomy and physiology:

APA therapy is a form of traditional Chinese medicine (TCM) based on a concept called the meridian theory. It proposes that how you feel is governed by the flow of energy, or qi, through a network of invisible pathways that connect different organs in the body. Specific points on the ear correspond to specific areas of the brain, and these areas have a reflex connection with specific parts of the body. Stimulating the ear points can signal the brain to prompt reactions in the body to relieve symptoms, such as breast cancer-related pain.

“We have all the points on the ear that correspond to our body parts,” says Yeh. “That means I can always find a point on the ear to deliver treatment.”

Here we go again. Qi is a vitalistic concept; there is no such thing. Science has never been able to detect it, nor has any acupuncturist or practitioner of traditional Chinese medicine (TCM) been able to demonstrate that she can detect or manipulate it. When it comes to acupuncture, for example, which is based on the fantasy that sticking thin needles in “meridians” through which the qi supposedly flows will “unblock” the flow of qi, with healing effect, studies have consistently shown that it doesn’t matter where you stick the needles (thus invalidating meridians) and that, in fact, it doesn’t even matter if you actually stick the needles in. The result is the same and can be explained by placebo effects. And no, there are not points on the ear that correspond to different body parts; this is nothing more than a variation on reflexology.

So what about the study itself? Let’s take a look. Before I get to the study design itself, I can’t resist pointing out a particularly bit of silly pseudoscience in the introduction of the article:

Auricular point acupressure (APA) involves attaching a few very small plant seeds (eg, Vaccaria segetalis) with a small amount of adhesive tape to the outer ear and ear lobe of an individual to treat symptoms (eg, pain) throughout the body. Auricular point acupressure is a well-established treatment strategy in traditional Chinese medicine (TCM). In TCM, particular points on the ear are related to all parts of the human body, including each of the internal organs, and all meridians have reference points on the ear. In 1972, Dr Paul Nogier, a French neurosurgeon, retheorized that the outer ear represents an inverted fetus within the womb and therefore provides the acupressure points that correspond to all parts of the human body, including the internal organs. Nogier’s mapping and distribution of these specific auricular points—or acupoints—on the outer ear have since been widely used by therapists worldwide. Moreover, the World Health Organization considers auricular medicine as a form of microacupuncture that has therapeutic effects on the entire body.

The ear represents an “inverted fetus”? Give me a break. Acupuncturists will believe anything. Or so it would seem. One wonders if they’ll do a clinical trial based on meridians mapping to the butt. Why not? Others have believed this enough to be perfectly willing to accept an abstract for presentation. Maybe they used this map:

The first thing I noticed about this trial is how small it was. It only involved 31 patients, who were divided into two groups. One group received what was described as “active APA,” described as “featuring acupoints related to symptoms—seeds taped onto the designated acupoints for pain, fatigue, and sleep.” How were these acupoints selected? This you need to read:

The Chinese Standard Ear-Acupoints Chart was used as a guide to locate the active ear points.34 A systematic auricular diagnostic procedure was used to identify reactive acupoints for treatment.35 Identification of acupoints includes 3 steps: (1) query the participants about where they were experiencing pain in the body; (2) visually inspect the ear to see if there is any discoloration or deformity on the auricle; (3) utilize the electronic point finder to identify acupoints. The electronic point finder used in this study, manufactured by Auricular Medicine and International Research and Training Center (Hooner, Alabama), measures auricular cutaneous resistance to identify ear acupoints. In most cases, auricular acupoints on both ears were identified for treatment; however, if the participant’s pain was located on 1 side of the body, then only that side was tested and treated. The number of points treated and their specific locations on the ears of each patient varied slightly because each patient experienced pain in different body locations and the different pain projected onto different corresponding points according to somatic topography. Between 8 and 12 total acupoints were used for each participant.

Here we go again with more tooth fairy science. Once again, it has not been established that these auricular acupoints actually exist, much less that this woo machine can detect them by measuring auricular cutaneous resistance.

What about the controls? Basically, for the controls investigators used what they described as acupoints unrelated to the patients’ symptoms. Specifically:

Control participants had Vaccaria seeds taped onto the stomach, mouth, duodenum, and eye acupoints that were not related to the symptom cluster of pain, fatigue, and sleep disturbance.

I suppose that’s as good a control as any. Yes, I’m being sarcastic. I find it hard to restrain my…Insolence…when reading a methods section like this. In any event, the seeds were stuck to the ear acupoints with surgical tape, and the subjects were instructed to apply pressure to the seeds with their thumb and forefinger three times per day for three minutes each time, even if they were not experiencing any symptoms.

One thing leapt out at me right away. Well, maybe that’s the wrong word. One thing was conspicuous by its absence. I looked and looked but didn’t find it. What am I referring to? I didn’t find any mention of blinding procedure. Not surprisingly given that, there was no mention of assessing adequacy of blinding. (I suppose that’s rather hard to do if there’s no blinding.) So I have to assume that this study was not blinded, particularly given this description of the placement of seeds on the acupoints:

During the APA treatment, participants were asked to sit in a comfortable chair in an outpatient clinic. Acupoints on each ear were identified using both an electronic acupoint locator and systematic auricular strategies, which include visual inspection (ie, identifying palpation on the ear) and probing for tenderness. The acupoint locator has 2 probes: one was held by the participant, and the other was used by the PI to locate the acupoints. The locator makes a sound when the probe makes contact with acupoints corresponding to (1) particular target symptoms and/or (2) pain in particular parts of the body. When the locator sounded, participants were asked if they were experiencing pain in the particular part of the body corresponding to that acupoint or asked to describe the symptom they were experiencing. After acupoints were identified, the PI placed seeds on the acupoints for each participant using tape; this procedure took 5 to 10 minutes. The PI demonstrated the technique for applying pressure to the acupoints with the thumb and index finger and then asked the participants to perform the technique to verify that they understood the technique.

The ultimate machine that goes ping! In any case, although it’s unclear whether or not this is the case, it certainly sounds as though the PI (principal investigator, for those of you who don’t know the lingo) knew who was in the control group and who was receiving “real” APA right from the beginning. If that’s the case then it almost doesn’t matter what the results were; they’re meaningless. Unblinded acupuncture studies are basically even more worthless than the usual acupuncture study. Oh, what the heck? I’ve written this much already. I might as well finish it.

Participants recorded their symptoms at baseline using the M.D. Anderson Symptom Inventory (MDASI), which uses a 0-10 point numerical rating scale, with 0 meaning “not present” and 10 meaning “as bad as you can imagine.” It’s a widely used scale to measure cancer symptoms. They also recorded the World Health Organization Quality of Life (WHOQOLBREF), which is a 26-item questionnaire used to assess general quality of life in terms of physical, psychological,
social, and environment factors. These were assessed at the end of the trial period as well, and differences in various measures examined. What the investigators found is this:

After 4 weeks of APA, participants in the active APA treatment had reported a reduction of 71% in pain, 44% in fatigue, 31% in sleep disturbance, and 61% in interference with daily activities. The control APA group experienced some moderate reduction in these symptoms.

That’s from the abstract. Reading that, my first question was this: Why didn’t they provide the numbers for the control group as well? “Some moderate reduction”? What does that even mean? There’s also a key bit of information in the actual text that tells a lot more. For one thing, the data are presented in an enormous chart with differences between baseline and end of intervention for the experimental group, culminating with columns showing the difference between APA and control. It’s a very difficult-to-read method of presenting the findings, and I was puzzled as to why they didn’t just directly show changes in the various measures in the controls next to the changes observed in the APA group in graphical form of some sort. Be that as it may, here’s the key:

After the 4-week APA treatment, the mean scores for pain, fatigue, sleep, lack of appetite, distress, dry mouth, sadness, and numbness displayed decreases that were clinically significant (ie, defined as symptom decreases of Q30%; data available upon request). In addition, Table 5 lists outcomes of interferences and quality of life. Participants in the active APA group had higher improvement of interferences and better quality of life than did those in the control APA group; however, the difference of the improvement was not statistically significant.

So basically, most of the differences were not statistically significant. Worse, there are 18 different measures being examined in two time periods each, baseline to end of intervention and baseline to the one month followup. That’s 36 comparisons. I see no evidence that correction was made for multiple comparisons, although I could be wrong. (Again, the methods section of this paper really stinks in terms of providing key details needed to evaluate the study.) So is it a surprise that a handful of measures are borderline statistically significant? No, it is not.

Basically, between the lack of blinding and the apparent lack of correction for multiple comparisons, this is a negative study. Yet it’s being promoted as a positive study and used as the basis for further grant applications. Such is the way it works with the tooth fairy science that is “integrative medicine.”

Comments

  1. #1 herr doktor bimler
    December 29, 2015

    “We have all the points on the ear that correspond to our body parts,” says Yeh. “That means I can always find a point on the ear to deliver treatment.”

    “I never turn away suckers patients,” says Yeh. “I can always find some excuse to take money off them.”

    Auricular point acupressure is a well-established treatment strategy in traditional Chinese medicine (TCM). […] Nogier’s mapping and distribution of these specific auricular points—or acupoints—on the outer ear have since been widely used by therapists worldwide.

    So it is a time-honoured traditional modality that a French scammer pulled out of his arse in 1972. One that relies on the ancient Chinese technology of adhesive medical tape. OK.

  2. #2 capnkrunch
    December 29, 2015

    Thinking of yesterday’s post, this seems like a failure of peer review. This conclusion (actually the IMPLICATIONS FOR PRACTICE section):

    Our results suggest that APA may provide an inexpensive and effective complementary approach for the management of symptom clusters for breast cancer patients, and further study is warranted.

    Does not follow these results:

    Participants in the active APA group had higher improvement of interferences and better quality of life than did those in the control APA group; however, the difference of the improvement was not statistically significant.

    Even given the small sample size and poor study design, they still failed to do better than placebo. The dishonest presentation of results and the conclusion that doesn’t follow the results seems like something that someone should have caught.

    Ugh, and that ACS article… that’s the kind of credulous reporting I expect from HuffPo but Orac is right, the ACS ought to know better

  3. #3 Dangerous Bacon
    December 29, 2015

    Has anyone calculated the percentage of published clinical trials that consist of these dinky pilot studies?

  4. #4 Nom de Guerre
    December 29, 2015

    Funny, tooth fairy science seems identical to most Creationist “science”: instead of establishing that their deity of choice exist, they just assume so and go from there.

    Take Noah’s Flood, for example: that Yahweh exists and enacted a global flood is taken for granted. Instead they try to figure out how the kangaroos made it from Australia to the Middle-East!

  5. #5 JMV
    Upstate NY
    December 29, 2015

    Dear Orac, you’re obviously confused about science – if CAM research is done, let’s say a reliability study, then Kappa scores will reflect the removal of chance. If we see “..seemingly positive trials by random chance alone” , then even CAM practitioners understand that without removal of chance, reliability means nothing. And many of the CAM studies I have reviewed have been astute enough to report K or ICC scores for reliability. Be careful, your bias is showing.

  6. #6 Cate K
    December 29, 2015

    I seem to have a piercing through my brain according to the ear map but I don’t know whether that would be considered a good or bad thing. I’ll twiddle an earring every day and let you know if I feel 43% more intelligent after a week. Presumably I can get that published too?

  7. #7 MikeMa
    December 29, 2015

    CAM
    Cannot Advance Medicine
    Cash And Money
    Cretins Against Medicine
    Can’t Attain Maths

  8. #8 Johanna
    PDX
    December 29, 2015

    I was shocked when I was offered APA at Kaiser Permanente. I think my response was “Whoa, I thought this was a MEDICAL facility?”

    Go figure, the offer was withdrawn pretty quickly with a mumble of “Well, some patients found it helpful…”

  9. #9 jrkrideau
    At the bottom of the lake (the bottom end that is)
    December 29, 2015

    The electronic acupoint locator reminds me of a polygraph machine. Great face validity and a bit of placebo (or sometimes nocebo for the polygraph). Of course it will work, it’s so sciencey.

    One is also referred to OZ, The Great Wizard of,. Do not , I repeat DO NOT look behind the curtain.

  10. #10 Denice Walter
    December 29, 2015

    CAM
    Charlatanry And Mendacity

  11. #11 Denice Walter
    December 29, 2015

    @ Cate K:

    Ha!
    I have two through the EYES!
    ( I also have 3 extra ones on the left which I haven’t used for 20 years – I wonder if that has some arcane significance in their fantasy system?)

  12. #12 Narad
    December 29, 2015

    The ultimate machine that goes ping!

    It’s none too impressive looking.

  13. #13 TBruce
    December 29, 2015

    In 1972, Dr Paul Nogier, a French neurosurgeon, retheorized that the outer ear represents an inverted fetus within the womb and therefore provides the acupressure points that correspond to all parts of the human body, including the internal organs.

    Ben Carson, Eben Alexander, Russell Blaylock, Michael Egnor and this guy…what’s up with neurosurgeons?

  14. #14 Lowell Gilbert
    Massachusetts, US
    December 29, 2015

    Referring to this study as “tooth fairy science” is overlooking an important distinction that “the SkepDoc” intended when she invented the term. Of course it’s easy to spend lots of time investigating non-existent phenomena and getting garbage data; what’s more interesting is that you can get *good* data from investigating non-existent phenomena, but it will be useless as long as you don’t know what’s actually happening.

  15. #15 palindrom
    December 29, 2015

    Nom de Guerre —

    Instead they try to figure out how the kangaroos made it from Australia to the Middle-East!

    Well … I would assume they hopped, wouldn’t you? 🙂

    More seriously, I’m thinking that medical schools should include some discussion of CAM. I remember a discussion of homeopathy I had a few years ago with some med student’s I’d happened to be chatting with; interestingly none of them knew what it actually claims. I would think this kind of ignorance would leave them vulnerable to CAM types. When I did explain the principles, they were (to their credit) incredulous. Given the encroachment of quackademic medicine, inoculating the students with real knowledge wouldd be a real help.

    Of course, inoculating them will make them all autistic, so never mind, maybe.

  16. #16 John M
    Orlando, FL.
    December 29, 2015

    Orac’s Financial Pharma Ties: What He Didn’t Tell You
    By Jake Crosby
    http://www.ageofautism.com/2010/06/david-gorskis-financial-pharma-ties-what-he-didnt-tell-you.html

  17. #17 John M
    cbs4media@gmail.com
    December 29, 2015

    More on Orac:

    http://www.truthwiki.org/david-gorski/
    Here are some examples of his history and activity to learn more about him:
    •Orac has undisclosed financial ties to the vaccine industry.
    •He inadvertently admitted that vaccines can cause autism
    •When publicly confronted by Jake Crosby about autism in person, Orac made a very amusing and awkward attempt to evade the questions. You can see this here
    •A defecting blogger from the website that he is the Managing Editor of stated “ScienceBlogs is now ZombieBlogs, the undead, a heartless and soulless brain-eating monster that once was a beautiful living ideal.”
    •Orac has claimed that a vaccinated vs. unvaccinated study would be unethical – never mind the fact that the vaccine schedule as a whole has never been studied for long-term health outcomes.
    •He has no real knowledge about GMOs as is evident from a lecture when he was asked why he defends food derived from Genetically-Modified Organisms (GMOs), noting the lack of safety data in humans. Orac’s answer was: “All foods are genetically modified.”
    •He has been caught lying in an attack piece he wrote about Sharyl Attkisson
    •Immediately writes of Naturopathic medicine as a cornucopia of quackery
    •Objects to chiropractic and went as far as saying a girl who went to a chiropractor and died might qualify her for the Darwin Award

  18. #18 herr doktor bimler
    December 29, 2015

    what’s up with neurosurgeons?

    To be fair to neurosurgeons, when you look closer at Nogier’s career he turns out to be a homeopathic physician who acquired some neurology training but never practiced. If scamsites and mockademic papers call him a neurosurgeon, it’s the usual mantle-snatching mendacity . The auriculotherapists go on to assert that he was decorated by the French government for his services, although they are coy on the details of the decoration.

    Nogier is also credited with special Frequencies of Existence, coloured-light stimulation, and a special indetectable pulse (the Vascular Autonomic Sign). Because grifters gotta grift. And wouldn’t you know it, his son is carrying on the family tradition.

  19. #19 Leigh Jackson
    December 29, 2015

    “the World Health Organization considers auricular medicine as a form of microacupuncture that has therapeutic effects on the entire body”

    I don’t think they do. I really don’t think they do.

    The only pertinent WHO reference I can find is this document from 1990:
    Report of the Working Group on Auricular Acupuncture Nomenclature

    http://apps.who.int/medicinedocs/en/m/abstract/Js7144e/

    A WHO disclaimer at the head of the document states that the document is not a formal publication of the WHO and the views expressed are solely the responsibility of the authors.
    Nevertheless the then Director-General of WHO, Hiroshi Nagajima, says in the report that AA is a microsystem of acupuncture of which little mention is made within the classical literature. AA as practiced in 1990, he says, is effectively the invention of Paul Nogier, who just happened to be present where and when the report was drawn up – in his home town of Lyon. Nowhere does Nagajima say that acupuncture of any variety has therapeutic benefits.

    It seems that a report was presented under the auspices of the WHO, though not in its name, in the home town of the man who had reinvented this little mentioned aspect of acupuncture in his own image. That is to say in the image of an auricular fetus – his invention, his image.

    What was the WHO thinking of? The answer is politics, of course. A large chunk of world public health needs was and still is catered for by scientifically nonsensical practices claiming to magically work. The WHO is prepared to accommodate all kinds of utter nonsense if enough people have put their faith in it.

  20. #20 Mortreal
    December 29, 2015

    What about the vagus nerve that connects all the organs in the body to the brain which can be accessed through the ear..? It has been shown that stimulating it can relieve pain for some people and things like that.

  21. #21 herr doktor bimler
    December 29, 2015

    the vagus nerve […] can be accessed through the ear..?

    The vagus or 10th cranial nerve can indeed be accessed through the ear, if you use a drill-bit, but you’re going to puncture the internal jugular vein and internal carotid artery in the process, so there will be side-effects.

  22. #22 rs
    December 29, 2015

    “it can relieve pain for some people and things like that.”

    Okay, but what about things like those and things like these, not to mention those other things?

  23. #23 MikeMa
    December 29, 2015

    John M,

    You are quoting Jake ‘six degrees of separation’ Crosby. No value in that source.

  24. #24 Not a Troll
    December 29, 2015

    Orac’s Financial Pharma Ties: What He Didn’t Tell You
    By Jake Crosby

    The ties Jake Crosby is claiming Orac has are pathetic. If he was working for Big Pharma his exposure wouldn’t even get him to the JV team much less a mansion and a yacht.

  25. #25 Denice Walter
    December 29, 2015

    @ John M:

    You can read ALL about Jake right here at RI by typing the crea… er.. young man’s name in the search box above.

  26. #26 Jazzlet
    December 29, 2015

    My SIL has been offered reflexology, reiki and aromatherapy as supportive therapies at the cancer care centre she attends. SIL loves the refexology, says it leaves her feeling wonderful … but she always did like having her feet massaged. It is at least a charity and not paid for by the NHS. It was really difficult listening to her rave about it wanting to be suportive (she’s on her third round of breast cancer), but knowing she’s being offered these bullshit ‘treatments’.

  27. #27 Sarah A
    December 29, 2015

    Even given the small sample size and poor study design, they still failed to do better than placebo.

    You’ve got it all backwards – what this actually shows is that pretend acupressure works just as well as “real” acupressure. Because something something placebo effect something something the mind can heal the body. Which makes it totally ethical to lie to your marks patients and charge them for the privilege.

    I guaran-freaking-tee you we will see this exact argument used to spin this study as support for the efficacy of acupressure.

    @JMV and John M: So…did you have anything relevant to say about the actual, you know, content of the post?

  28. #28 J Compofelice
    Houston
    December 29, 2015

    This writer engage in the most “Tooth Fairy” science. That is because science hasn’t seen something it dos not exist. Thank goodness that the writer was tasked with developing the drugs to reduce pain, calm nausea, relief for a headache and the hundreds of thousands of solutions that are now science. The writer is intellectually bankrupt and a fraud.

  29. #29 capnkrunch
    December 29, 2015

    Huh, lots of sCAM advocates seem to have missed the point. Actually several of the points.

    Sarah A@26

    Which makes it totally ethical to lie to your marks patients and charge them for the privilege.

    This reminded me of this passage from the ACS article [emphasis mine]:

    APA can be performed at home. However, it first requires a visit with a licensed provider who will tape small botanical plant seeds, called vacarria, to specific ear acupoints and teach you how to apply pressure to them with your thumb and index finger.

    How much does it cost to teach someone to squeeze their ear I wonder? I feel like when writing that passage the author should have come to a realization that this whole thing is a scam.

  30. #30 capnkrunch
    December 29, 2015

    Lots meaning 2 or 3 of course.

  31. #31 Argon one
    NYC
    December 29, 2015

    Haha reminds me of those surgeons who recommend surgery for knee pain when it’s been proven it rarely works! Except those surgeons make even more dinero! Quacks abound! Haha.

  32. #32 palindrom
    December 29, 2015

    That is because science hasn’t seen something it dos not exist.

    I’ll have that word salad with the vinegarette, but on the side, please.

  33. #33 The Peak Oil Poet
    New Zealand
    December 29, 2015

    @John M

    here’s a simple test for the honesty of your link

    try leaving a comment there that is in any way at all not one in support of their agenda

    it will not be approved

    blogs/sites that moderate out all but agreement can be trusted how much?

    pop

  34. #34 Not a Troll
    December 29, 2015

    The vagus or 10th cranial nerve can indeed be accessed through the ear, if you use a drill-bit, but you’re going to puncture the internal jugular vein and internal carotid artery in the process, so there will be side-effects.

    ROTFLMAO

    What I wouldn’t give for an upvote button here….

  35. #35 Science Mom
    http://justthevax.blogspot.com/
    December 29, 2015

    During the APA treatment, participants were asked to sit in a comfortable chair in an outpatient clinic.

    So participants got the Comfy Chair? How was that effect controlled for?

    @JMV and John M: So…did you have anything relevant to say about the actual, you know, content of the post?

    Eh, drive-by D-bags, they come and they go.

    I was watching a CNN health segment whilst sitting in the paed’s waiting room and was depressed to see that Sanjay Gupta recommended acupuncture for pain relief. Pathetic.

  36. #36 Johnny
    127.0.0.1
    December 29, 2015

    Well, according to the picture our host has posted, I see that they have found a way to (mostly) safely do something that they call acupuncture without wearing gloves. Sure, this treatment won’t do anything positive other than make some silly people think that something good is happening, but at least the threat of infection is reduced.

  37. #37 Gray Squirrel
    December 30, 2015

    Re. the linked picture of the quack machine:

    The spikey probe is nothing more than a standard type of probe that comes with every volt/ohm meter. The device itself may be a custom job or it may be derived from a toy “lie detector.” It would not surprise me that if you could do a picture-match search on Alibaba, you’d find it as some kind of electronic toy.

    As for upside-down fetuses mapped to ears, wasn’t Absinthe legal in France back in the 70s?

    I have a serious hypothesis as to why Kaiser and other respectable institutions are offering acupuncture

    Placebo reactors tend to be highly suggestible in general, and suggestibility may correlate (testable sub-hypothesis) with the propensity to become dependent on mind-altering drugs (“addictive personality”).

    By offering a placebo, Kaiser skims off a percentage of pain patients from the total who would otherwise need narcotics. This lowers Kaiser’s overall rate of narcotic dependency and abuse among its patients. That in turn leads to more prestige for Kaiser, that they can use in whatever way they find to be beneficial to themselves.

    Correlate narcotic usage per institution with acupuncture usage per institution, and you will probably find (primary hypothesis, testable) that the institutions that offer acupuncture have a lower level of narcotic usage.

    This doesn’t make acupuncture “real,” it just leverages a placebo effect. On balance I have to conclude that I’m OK with that, because we need to do something about the double-bind imposed on pain patients that forces some of them, including some who are not addicts, to get narcotics illegally.

  38. #38 Dianna Slowey-Thomas
    Gainsville,Fl.
    December 30, 2015

    TCM goes back hundreds of years. I have had acupuncture but the Asian Dr. never once touched my ear. This article points out the dangers of unethical and uneducated practitioners of a long practiced, eastern based medical science that incorporates multiple approaches when using a trained acupuncturist .The Western modified practice of Eastern medicine is an 18 month coarse while a true practioner spends years learning their art.

  39. #39 rs
    December 30, 2015

    “The Western modified practice of Eastern medicine is an 18 month coarse while a true practioner spends years learning their art.”

    No matter how long you study and practice nonsense, it remains nonsense. Ask any astrologer.

  40. #40 Meg
    December 30, 2015

    of a long practiced, eastern based medical science that incorporates multiple approaches when using a trained acupuncturist

    You mistakenly used the word “science”. Unless “eastern based” science is something radically different that what we here in the West know of as science.

  41. #41 Narad
    December 30, 2015

    BTW, as 2015 approaches its end, I have nearly $9 worth of free PACER burning a hole in my pocket. If anyone want some docket updates, please speak up.

  42. #42 Narad
    December 30, 2015

    ^ “wants”

  43. #43 herr doktor bimler
    December 30, 2015

    an 18 month coarse
    An 18-month coarse what? Inquiring minds would like to know.

  44. #44 Lighthorse
    December 30, 2015

    Speaking of “upside-down fetuses”, I was recently told of a case of breech presentation in which the pregnant mother was treated with acupuncture to the ankle area and the baby “turned around”. When I inquired as to whether imaging before and after acupuncture confirmed the change, I was told that it did. Comments are welcomed.

  45. #45 Lighthorse
    December 30, 2015

    @Gray Squirrel #40: IMO, your hypothesis is bang on and extendable to so much of CAM (Confounded Aberrant Medicine).

  46. #46 doug
    December 30, 2015

    If breech presentations could be fixed with acupuncture, I would bet that every large animal veterinarian on the planet would be using it.

  47. #47 Dangerous Bacon
    December 31, 2015

    Not sure to what extent this qualifies as “tooth fairy science”, but since I didn’t get Orac anything for Xmas, this will have to oblige as a late present:

    http://abcnews.go.com/Health/wireStory/woman-beats-dui-rap-claim-body-brews-alcohol-36017912

    The Ohio doc who reportedly tested this woman has quite an interesting website relating to his fields of specialization (he’s into “detox” and other forms of integrative/functional medicine).

    http://kanodiamd.com/our-care/

    A couple of cursory Pub Med searches turn up very scanty information on auto brewery syndrome/a.k.a. gut fermentation syndrome, with a couple of case reports noted in children with short gut anomalies. Skeptics might conclude this sounds like a great get-out-of-jail-free card for people who believe they have a Candida Overgrowth problem, and a lucrative practice opportunity for altie docs, but perhaps we need to be open-minded here.

    *does this syndrome place one at risk for spontaneous human combustion? If your body’s churning out that much alcohol and you’re near an open flame…eek!

  48. #48 palindrom
    December 31, 2015

    Dangerous — I remember a news story from years back about a guy who had some kind of exotic intestinal parasite he had picked up in Japan, which brewed alcohol in his gut. He was actually quite miserable until it was finally diagnosed and treated. Hardly anyone believed him. At one point he checked himself into a hospital to prove that he wasn’t drinking, and his doctors accused him of having his wife smuggle in alcohol for him.

  49. #49 Delphine
    December 31, 2015

    #42, I’m gonna say correlation does not equal causation. How far along was the mother? Most breech babies will turn on their own by around 36 weeks.

    I’d be interested in knowing where Mom was in the pregnancy. Babies flip around all of the time, until get too big and run out of real estate.

    My youngest sister was breech, my mother was 45 and we were living in a resource-poor setting. My parents (both physicians) tried various non-invasive methods to turn her, in desperation. She was born frank breech.

  50. #50 herr doktor bimler
    December 31, 2015

    Not sure to what extent this qualifies as “tooth fairy science”, but since I didn’t get Orac anything for Xmas, this will have to oblige as a late present:
    http://abcnews.go.com/Health/wireStory/woman-beats-dui-rap-claim-body-brews-alcohol-36017912

    I see that Cordell comes into the story as the main authority on “auto intoxication”, who came to the rescue of the drunk driver by finding her a suitably compliant doctor. Cordell is an Aromatherapist and essential-oil grifter, who squeezed out her publication on the alleged syndrome though a bottom-feeding vanity-press journal from SCIRP. The issue came up here in April:
    http://scienceblogs.com/insolence/2015/02/26/poor-poor-pitiful-andy-wakefield-dissed-again-this-time-by-the-oregon-senate-committee-on-health-care/#comment-394078

    The Ohio doc who reportedly tested this woman has quite an interesting website relating to his fields of specialization (he’s into “detox” and other forms of integrative/functional medicine).

    Doctors Data? ‘Quantumpathic therapy”? And his site lists “keeping drunk drivers on the road by providing exculpatory diagnoses of this non-existent syndrome” as one of his professional specialities? Goodness me, he must be very very honest and competent.

  51. #51 Gilbert
    December 31, 2015

    “auto intoxication” is a thing, herr doktor bimler #48. If one ingests a *killer strain*, a strain that supresses other cultures, such as Lalvin K1V-116 then one may wear a permagrin on his face eating all that starchy ‘food’ people are fed in various *institutions* and LoL at the doc that it was the medication.

  52. #52 herr doktor bimler
    January 1, 2016

    “auto intoxication” is a thing, herr doktor bimler #48

    If you mean “drunk driving”, then yes, it is a thing. Mendacious frauds like Cordell are also a thing, and skeezy bullsh1t-fountain lawyers are a thing.

    Alcohol-fermenting gut-dwelling yeasts? All it will take to convince me is a poop sample , where the yeast continues to perform its trick in a laboratory recreation of the pH and the peristalsis and the digestive enzymes, but that is apparently too much to ask.

  53. #53 palindrom
    January 1, 2016
  54. #54 herr doktor bimler
    January 1, 2016

    Nope, that NRP segment just repackages the same press release from Barbara Cordell — aromatherapist scum (she offers to treat AIDS and cancer with essential oils) and adroit self-publicist — and the article she paid a SCIRP journal to publish. “This guy is sh1t-faced all the time and swears he never drinks! We cannot imagine any explanation, so it must be divine intervention miracle yeast!”

  55. #55 palindrom
    January 1, 2016

    I stand corrected! One usually doesn’t associate NPR with such lazy journalism.

  56. #56 anthony
    chicago
    January 1, 2016

    People like you make me sick. Go suck a toothsfairy dick

  57. #57 Jake
    Canada
    January 2, 2016

    For all the “skeptics” out there. Try using your brains for thinking and do some research once in awhile, if you type Acupuncture into pubmed you get about a zillion results and its also the oldest and most widely used medical system in the entire world. Part of the problem is most people don’t know anything about the placebo effect, it has been studied widely and it is an important part of any medical treatment but its also measurable and only a fraction of people are susceptible to it. My guess is about the same percentage of people who are easily hypnotized are the same people who are easily influenced by placebos. Acupuncture isn’t like this, in fact it suffers from the opposite effect because mot people who haven’t tried are extremely skeptical. The typical first time Acupuncture patient will ask something like “So how is a tiny needle in my hand supposed to help my allergies or my headache?” or “How does this actually work anyway?” and then when it works they’re pleasantly surprised. This is in stark contrast to say vaccines or prescription drugs which are advertised on TV and almost everywhere in the media is a constant barrage of propaganda about how wonderful they are which greatly increases the amount of placebo effect these medications benefit from. Any real skeptic would do something like say READ THE INSERT ON THE VACCINE and come to the conclusion that 700 possible side effects including death or permanent paralysis might not be worth the risk. Not to mention all of the major so called ‘prestigious’ medical journals contain around 30% non repeatable unverified articles. You call yourselves skeptics but you are never skeptical of your loving gov’t or the medical establishment or big pharma who have been caught time and again being unethical and outright criminal. Apply some of your half ass skepticism to vaccines. I challenge anyone to show me a well designed double blind study that shows vaccines to be safe or effective but I won’t hold my breath since I know there aren’t any. Modern medicine is an epic failure which hasn’t cured a single disease in the last 100 yrs and cannot even cure heartburn.

  58. #58 Chris
    January 2, 2016

    Jake: “.. if you type Acupuncture into pubmed you get about a zillion results and its also the oldest and most widely used medical system in the entire world. ..”

    Appeal to popularity fail.

    “.. READ THE INSERT ON THE VACCINE ..”

    Appeal to CYA lawyer written insert fail.

    “.. well designed double blind study that shows vaccines to be safe or effect..”

    Appeal to ignorance of the Belmont Report fail.

    “Modern medicine is an epic failure which hasn’t cured a single disease in the last 100 yrs and cannot even cure heartburn.”

    Completing the illiterate wall of fail is this declaration of ignorance of basic history.

  59. #59 rs
    January 2, 2016

    “Any real skeptic would do something like say READ THE INSERT ON THE VACCINE and come to the conclusion that 700 possible side effects including death or permanent paralysis might not be worth the risk.”

    Imagine if they placed an insert on the door of your car or on your kitchen cutlery.

  60. #60 herr doktor bimler
    January 2, 2016

    I challenge anyone to show me a well designed double blind study that shows vaccines to be safe or effective
    A challenge! Papers at 20 paces!

    but I won’t hold my breath
    Then what are the stakes?

    since I know there aren’t any
    Whoops, looks like Jake has reneged already.

  61. #61 Narad
    January 2, 2016

    Not to mention all of the major so called ‘prestigious’ medical journals contain around 30% non repeatable unverified articles.

    Somebody didn’t bother actually reading Ioannidis.

  62. #62 Kephren
    Canada
    January 4, 2016

    First, excuse my poor English.

    If the outcomes from this article were real, they would not be the resultats of APA or whatever therapy that is. Also, I always laugh a little when a paper provides only relative changes in percentage. Always a nice trick to magnify the importance of the results. When it happens, I tell my clients that if I buy 2 lottery tickets, I have doubled my chances but my odds are still laughable.

    Don’t forget the ear’s skin has axons coming from the spinal trigeminal nuclei, which can influence the vagus nerve activity. A shift toward a parasympathetic activity modulated by the stimulation of the vagus nerve would produce similar results in pain sensitivity and fatigue. Various papers have examined the effects of non-invasive vagus stimulation (mostly TENS). Check it up.

    Just like spine mobilisations/manipulation, massage therapy and osteopathy altogether, the effects are purely neurophysiological and they never last.

  63. #63 Lilli
    January 4, 2016

    So if we’re going with the assumption that acupuncture, osteopathy, spinal manipulation, etc. function on the placebo effect, how would you explain their effects on animal patients of veterinarians who practice these modalities? Science has demonstrated repeatedly that there is no good basis for the placebo effect in animals. Although sometimes owner perception may stand in as a “placebo effect” of sorts if the owner believes that something helps when in reality it makes no difference, there have been demonstrated observable differences/improvements in animals following these alternative modalities that cannot be attributed to placebo effect. Thoughts?

  64. #64 Narad
    January 4, 2016

    Science has demonstrated repeatedly that there is no good basis for the placebo effect in animals…. Thoughts?

    Substitute “plants” for “animals” and “homeopathy” for “acupuncture.”

  65. #65 herr doktor bimler
    January 4, 2016

    So if we’re going with the assumption that acupuncture, osteopathy, spinal manipulation, etc. function on the placebo effect

    If only someone would write a blogpost suggesting that one needs, first of all, to demonstrate that they function at all.

  66. #66 herr doktor bimler
    January 5, 2016
  67. #67 Debi
    Europe
    January 5, 2016

    I would rebut all of you’re statements, but you are talkiing out of your arse.. science is to observe and study.. not to decide before even looking.. which you make abundantly clear in your moronic rant.. fortunately its not my job to enlighten and educate you. good luck with the cancer you are brewing inside yourself with all your hatred and vitriol

  68. #68 Mephistopheles O'Brien
    January 5, 2016

    Debi,

    I would rebut all of you’re statements, but you are talkiing out of your arse.

    In other words, you’d rebut Orac’s statements but you can’t.

    science is to observe and study.. not to decide before even looking.. which you make abundantly clear in your moronic rant.

    I think that Orac made it quite clear that the point of science is to observe and study – so I guess I agree with you. Unless your convoluted statement is intended to mean something else.

    fortunately its not my job to enlighten and educate you.

    Then why did you bother to comment?

    good luck with the cancer you are brewing inside yourself with all your hatred and vitriol

    If Orac is creating excess sulfates, then I suppose that could cause health problems. If you have studies to show that hatred causes cancer, please share.

  69. #69 Mephistopheles O'Brien
    January 5, 2016

    @Lilli – I am not a veterinarian (nor do I play one on TV). The question of placebo effects in animal experiments has been discussed before. As I understood the answer, it was that 1) without proper blinding, the people conducting the tests (or the animal owners) are aware of the treatments and this influences their perception of how the animal responds and 2) animals such as dogs, cats, and horses can certainly respond to how people react, which can be interpreted as improvement.

    Do you have evidence that placebo effects cannot work for animals? What studies show a significant clinical effect for acupuncture in animals? As a bonus question, how were the animal acupuncture points determined?

    Thanks.

  70. #70 Krebiozen
    January 5, 2016

    Lilli,

    So if we’re going with the assumption that acupuncture, osteopathy, spinal manipulation, etc. function on the placebo effect, how would you explain their effects on animal patients of veterinarians who practice these modalities?

    I believe these “effects” are mainly the result of motivated reasoning on the part of the practitioner and the patient, or in this case, the animal’s owner.

    Science has demonstrated repeatedly that there is no good basis for the placebo effect in animals.

    I’m not sure what you mean by this. A large portion of what we call the placebo effect is the result of non-specific factors like regression to the mean. I suspect you are referring to the suggestion portion of the placebo effect, which may well also occur in animals – a sick animal that is paid attention to, whether through being needled or given homeopathy, may behave differently to one that is not.

    Although sometimes owner perception may stand in as a “placebo effect” of sorts if the owner believes that something helps when in reality it makes no difference, there have been demonstrated observable differences/improvements in animals following these alternative modalities that cannot be attributed to placebo effect. Thoughts?

    You might find the veterinary voodoo site interesting; they address the use of useless altmed treatments in animals in an amusing way. I find this paper particularly entertaining, as various veterinary acupuncturists are bemused by the inconsistent effects they observe, but instead of recognizing that they are being deceived by their cognitive biases into seeing patterns in noise, the author descends into magical thinking, concluding:

    We must abandon double-blind trials in all investigations on therapies that involve the self-healing properties of the body.

    I am reminded of Pooh and Piglet walking around a tree and mistaking their own footprints in the snow for those of a heffalump.

  71. #71 palindrom
    January 5, 2016

    A quiz for the regulars:

    How did I (and probably many of you) figure out that Jake@55’s comment was very likely crank nonsense (for the pedants, how did I come up with a high prior probability of this) without reading a single word?

  72. #72 Lawrence
    January 5, 2016

    @Pal – “wall o’text” and no paragraphs.

  73. #73 palindrom
    January 5, 2016

    Lawrence @70 — Ding ding ding! We have a winner!

  74. #74 Kephren
    Canada
    January 5, 2016

    @Lilli

    Do no confuse placebo effect and neurophysiological effects. Placebo (or nocebo by the way) are mostly based on prior experiences and expectation. Neurophysiological effects are anything that modulates the pain sensitivity threshold via the autonomic nervous system or pain related circuitry (prefrontal cortex, PAG, amygdala, hippocampus, dorsal horn, etc.).

    The biggest problem with Physical Therapists, Chiropractors, Osteopaths, Massage Therapist, Acupuncturists, is that they believe in the pathoanatomical effects of their hands-on treatment. Science has proven that you can not stretch a fascia, that there are no such things as micro subluxation of the spine, that you can’t break scar tissues with your hands and that radiological findings do not correlate with pain and disability. The treatments are “effective” only because they have short term neurophysiological effects on pain modulation. The long term outcomes are often not better than wait-listing or placebos because chronic pain is mostly an associative disorder where the position or movement triggers an exaggerated threat response in a classical conditioned manner. No wonder behavioral therapies are often better than medication in chronic pain conditions. But still, therapists sell their mumbo jumbo to their clients with “joint stiffness, fascia stiffness, scar tissue adhesion, meridians, chakras” and other junk because it’s much easier to explain that stuff to clients than teaching them pain neurophysiology.

  75. #75 Stuart Mathieson
    Dunedin. NZ
    January 6, 2016

    No shortage of anti-vaxers having their say. Age of Autism.
    “Comments are moderated, and will not appear until the author has approved them.” We know what that means.

  76. #76 Orac
    January 7, 2016

    @John M: I find it highly amusing that you reference Mike Adams’ TruthWiki entry on me. Hilarious!

  77. #77 Steve
    United States
    January 7, 2016

    I agree that acupuncture research is often poorly done. So was the research for this article.

    While frequently used by acupuncturists that practice TCM, Auricular therapy does not stem from TCM. It is not part of meridian theory nor does the external ear fall on ANY of the meridan lines.

    Terry Oleson, PhD is considered an expert in this field and lectures internationally. In his book, ‘Auriculotherapy Manual’, offers a number of explainations, “A systematic representation of the body exists in neurons in the cerebral cortex, in the subcortical thalamus, and in the reticular formation of the brain stem. This brain map has the same overall pattern as the map on the ear, representing the body in an inverted orientation.”

    It is estimated that acupuncture is 3000-6000 years old. The Chinese saw a phenomenon and tried to explain it with the best understanding at that time. There is some current and compelling fMRI studies showing specific and effects that acupuncture has on the brain.

    As a modern acupuncturist, I believe that it is this effect on the central nervous system that gives the great clinical outcomes I see everyday. Until fMRI devices can be used clinically at an affordable price, I will continue to be pragmatic. I will use the ancient ideas about how to choose point prescriptions as long as this the most effective choice.

  78. #78 Chris
    January 7, 2016

    Steve: “Auricular therapy does not stem from TCM.”

    Perhaps you should target the correction to the authors of the paper that Orac quoted on “ACA.”

    “There is some current and compelling fMRI studies showing specific and effects that acupuncture has on the brain. ”

    Citations needed.

  79. #79 Chris
    January 7, 2016

    Terry Oleson’s biography from Amazon:

    Terry Oleson, Ph.D. is an internationally known lecturer in the field of auriculotherapy. Receiving his Ph D in Psychobiology from the University of California at Irvine in 1973, he went on to do pioneering research on auricular diagnosis and auriculotherapy at the UCLA Pain Management Center in Los Angeles. Besides being the author of numerous scientific articles, Dr. Oleson is the Chair of the Department of Psychology and the Division of Behavioral Medicine at the California Graduate Institute. Dr. Oleson also serves on the faculty of Emperors College of Traditional Chinese Medicine and as President of the Center for Oriental Medical Research and Education (COMRE).

    Also, it looks like his more recent PubMed indexed paper is from 2003 PMID 14499035), and lists his affiliation with the “Emperor’s College of Traditional Oriental Medicine.” Not exactly current. Giving lectures is not exactly research.

  80. #80 Chris
    January 7, 2016

    “There is some current and compelling fMRI studies showing specific and effects that acupuncture has on the brain.”

    Also any citations will need to be considered in light of this fMRI experiment.

  81. #81 herr doktor bimler
    January 7, 2016

    his book, ‘Auriculotherapy Manual’, offers a number of explainations

    A single explanation would suffice, if it had evidence. Multiple explanations convey a sense of desperation.

  82. #82 Krebiozen
    January 7, 2016

    “A systematic representation of the body exists in neurons in the cerebral cortex, in the subcortical thalamus, and in the reticular formation of the brain stem. This brain map has the same overall pattern as the map on the ear, representing the body in an inverted orientation.”

    So every part of the body maps to a part of the brain apart from the ear, which maps to the same bits as the rest of the body?This quaint idea is based on microcosm/macrocosm, “as above so below” fractal mystical BS, not science.

    There is some current and compelling fMRI studies showing specific and effects that acupuncture has on the brain.

    Waving a gun in someone’s face or stamping on their foot also has specific effects on the brain.. That doesn’t mean they are useful therapeutically.

  83. #83 JustaTech
    January 7, 2016

    Steve @77: 3000-6000 years is quite a range. In fact, it seems to cover several of the major “ages” of technological development. There is some academic disagreement about the specific time period of the Bronze Age in China, but the dates you’ve given start firmly in the Neolithic (stone age) through the Bronze age.

    Can you tell me please how Neolithic people were able to make the hair-thin needles used in acupuncture?

    Also, can you please be more specific about which culture or cultures in China developed acupuncture? Did it arise once and spread, or was it developed independently by more than one group?

  84. #84 Chris
    January 7, 2016

    Steve, you should check out this article Orac wrote a while ago. It is on a therapy with as much scientific plausibility as auriculotherapy.

    Justa Tech: “Can you tell me please how Neolithic people were able to make the hair-thin needles used in acupuncture?”

    Did they have teeny tiny porcupines as pets, from which they could get teeny tiny (but brittle) needles?

  85. #85 Karen Vaughan
    United States
    January 13, 2016

    It is quite easy to describe how the auricular acupuncture microsystem works since all of the major nerves have branches in the ear, While the chart of the upside down fetus was taken by Nogier it reflects folk knowledge that has been significantly updated by research, notably that done by Dr. Li Huang. There is a detailed modern ear map that is used to train practitioners of contemporary auricular acupuncture. When I studied with Dr, Huang she showed hundreds of four foot slides of ears complete with western diagnoses from her Beijing hospital,

  86. #86 Karen Vaughan
    January 13, 2016

    Chris,
    In central America acupuncture is done with thorns today, or alternatively with small probes, We do not know whether the system came over the Bering Straits in rudimentary form or was a parallel development, but normal porcupines might yield acupressure instruments, Thin filiform needles are a rather recent development.

  87. #87 Dangerus Bacon
    January 13, 2016

    ” When I studied with Dr, Huang she showed hundreds of four foot slides of ears”

    Any CME one gets from a course offered by this woman is _earned_.

  88. #88 Chris
    January 13, 2016

    “It is quite easy to describe how the auricular acupuncture microsystem works since all of the major nerves have branches in the ear,”

    Citation needed. Make sure it is not published on Htrae.

    “In central America acupuncture is done with thorns today, or alternatively with small probes”

    Which country? Guatemala? El Salvador? Belize? Make sure to provide actual verifiable evidence.

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