Torturing rats in the name of acupuncture pseudoscience

Back when I started this blog, I hadn't yet become aware of the phenomenon known as quackademic medicine. This phenomenon, as you recall, is the infiltration of academic medical institutions that should be bastions of science- and evidence-based medicine by outright quackery. In quackademic medicine, we see Very Respectable Academic Physicians and Scientists wasting their time studying faith healing like healing touch and reiki, prescientific medicine based on primitive vitalism such as traditional Chinese medicine and (of course) acupuncture, and even sympathetic magic like homeopathy. It's gotten to the point where there are actually doctors who claim that scientific medicine is "truly nonsense," to which Orac responds, "Bullshit!"

Similarly, there are doctors who believe acupuncture is something other than prescientific superstition based on vitalism. They actually think there's something to it. I can understand; there was a time when I thought there might be something more than placebo to acupuncture. After all, unlike so much other alternative medicine, acupuncture involves physically sticking needles into the skin. It's conceivable that such minor trauma can trigger something or cause a neurological signal. Certainly I never believed that rot about qi (life energy) and how thin needles stuck into certain points in the body just so will somehow redirect or unblock that qi to healing effect. Of course, as my oeuvre here on this blog demonstrates, over time as I read the acupuncture scientific literature more and more it became very clear to me that acupuncture really is nothing more than theatrical placebo. It doesn't work.

Unfortunately, in the world of quackademia, of all the alternative medicine quackery (but I repeat myself) that is increasingly being "integrated" into integrative medicine, acupuncture appears to be among the most popular, the one taken the most seriously. That doesn't stop quackademics from doing more and more outlandish studies of acupuncture or its various bastard offspring. Worse, not content to stick needles into humans, acupuncture quackademics subject various animals, particularly rats and mice, to having needles stuck into them for no good reason. Worse, because of the way these experiments are generally done, they kill a lot of animals for no real gain in scientific knowledge.

But credulous journalists do lap these studies up:

A biological mechanism explaining part of the mystery of acupuncture has been pinpointed by scientists studying rats.

Stimulation with electroacupuncture – a form of the therapy in which a small electric current is passed between a pair of needles – blunted activity in a key hormonal pathway linked to stress, chronic pain and mood, the researchers found.

The findings provide the strongest evidence yet that the ancient Chinese therapy has more than a placebo effect when used to treat chronic stress, it is claimed.

Rats had needles inserted at an especially powerful acupuncture point known as stomach meridian point 36 (St36). Although linked to digestive problems and multiple other ailments, St36 is on the shin.

Traditionally, acupuncture involves unblocking energy paths known as meridians that flow around the body, keeping it in balance.

Won't someone think of the poor lab rats?

Usually, these stories are based on breathless press releases:

In animal models, acupuncture appears to impact the same biologic pathways ramped up by pain and stress, analogous to what drugs do in humans. Georgetown University Medical Center (GUMC) researchers say their animal study, published online in Endocrinology, provides the strongest evidence to date on the mechanism of this ancient Chinese therapy in chronic stress.

“The benefits of acupuncture are well known by those who use it, but such proof is anecdotal. This research, the culmination of a number of studies, demonstrates how acupuncture might work in the human body to reduce stress and pain, and, potentially, depression,” says the study’s senor investigator, Ladan Eshkevari, PhD, CRNA, LAc, associate professor in the department of nursing and the department of pharmacology and physiology at GUMC.

“We have now found a potential mechanism, and at this point in our research, we need to test human participants in a blinded, placebo controlled clinical study — the same technique we used to study the behavioral effects of acupuncture in rats,” says Eshkevari, a nurse anesthetist and licensed acupuncturist. She is assistant program director of the Nurse Anesthesia Program at Georgetown’s School of Nursing & Health Studies.

Won't someone think of the poor humans now? Not at that bastion of quackademia, Georgetown, where this study was done.

In any case, these stories follow a template. Basically, every study is represented as "the strongest evidence yet" that the "ancient Chinese therapy" (which, remember, really isn't particularly ancient, at least not the way it's practiced) is more than placebo and that a definitive mechanism has been found for this magic to work. In this particular case, notice how it's claimed that acupuncture does the same thing as actual drugs used to treat stress and pain. So it must be real! In every case, if you go and look at the actual study, there's way less there then is being sold. This case is no different, as I saw when I looked up the actual study, Effects of Acupuncture, RU-486 on the Hypothalamic-Pituitary-Adrenal Axis in Chronically Stressed Adult Male Rats.

The first thing I noticed about this study is a common bait-and-switch used by acupuncturists, in which they do something called "electroacupuncture" (EA), in which acupuncture needles are hooked up to an electrical source and a week electrical current applied. Whenever I see this bait-and-switch, the first question that comes to mind is: Those ancient Chinese must have been really brilliant to have discovered how to use electricity thousands of years ago. Obviously, attaching electrodes to acupuncture needles is a more modern twist on acupuncture, which is why the language about this "ancient Chinese therapy" is so grating. This is not ancient at all, nor is it acupuncture. Really, it's just transcutaneous electrical nerve stimulation (TENS) grafted onto acupuncture to produce a mutant Frankenstein monster of a therapy that has little to do with either. When I see a study like this, my usual reaction is a big, "So what?" This doesn't demonstrate that acupuncture works. If it demonstrates anything at all (which is questionable) it demonstrates that passing an electrical current through the skin has physiological effects.

Does the study demonstrate anything? Let's take a look. There were two experiments. In the first, the investigators divided the the rats into four groups. Three of these groups were stressed and were divided into groups receiving electroacupuncture; sham acupuncture (delivered to an area that is not an acupuncture point); and a third group that did not receive acupuncture. A fourth group of animals served as controls; they received no acupuncture and were not subjected to the stress stimulus. Two experiments were done. In the first, the animals received were placed in 1 cm deep icewater for one hour daily for 14 days, after which they were returned to their cages. On day 5 experimental treatments were begun, which consisted of acupuncture or sham acupuncture 30 minutes after the cold exposure. (Poor rats.) The acupuncture point used was St36, which in humans is on the leg, one finger width lateral from the anterior boarder of the tibia and four finger breadths below the patella. Its action and effects are said to include:

  • Tonify deficient Qi a/or Blood.
  • Tonify Wei Qi and Qi overall - low immunity, chronic illness, poor digestion, general weakness, particularly with moxibustion, very important acupuncture point for building and maintaining overall health.
  • All issues involving the Stomach a/or the Spleen - abdominal/epigastric pain, borborygmus, bloating, nausea, vomiting, GERD, hiccups, diarrhea, constipation, etc.
  • Clear disorders along the course of the channel - breast problems, lower leg pain.
  • Earth as the mother of Metal - will support Lung function in cases of asthma, wheezing, dyspnea.
  • Psychological/Emotional disorders - PMS, depression, nervousness, insomnia.

Whatever.

The nonacupuncture point used as "sham" for sham electroacupunture (sham-EA) was on the back 2 cm lateral to the tail region. The needles were then attached to an electroacupuncture machine via electrodes and were stimulated for 20 minutes at a frequency of 10 Hz with 2 mA output. Ten of the 14 rats in both the sham-EA and the EA St36 groups continued to receive EA for the 14 days that they were exposed to the cold stress. However, after 10 days, 4 of the animals in each of the sham-EA and EA St36 groups stopped receiving the EA treatments, whereas exposure to cold stress was continued for the remaining 4 days, to determine whether the effects of the sham-EA and/or EA St36 were long lasting.

In a second experiment, rats were assigned to five groups: Group 1 (no treatment and no RU-486); group 2 (no treatment but started RU-486 at day 10); group 3 (daily cold stress and start RU-486 at day 10); group 4 (sham EA + RU-486 + cold stress); and group 5 (EA + RU-486 + cold stress). The mice were also tested in other stress tests, including the forced swim tests and open field test. In this case, RU-486 was not used for its properties that allow it to work as a "morning after" pill, but rather for its ability to block the glucocorticoid receptor, the hypothesis being that however EA "works" it does so through glucocorticoid (steroids).

The first thing I noticed was that levels of ACTH (which stimulates cortisol production) and cortisol were not impressively different, particularly ACTH. Indeed, the differences in ACTH are so modest that my reaction was a yawn. Cortisol showed more difference, but a most unimpressive difference between EA and sham-EA. In the second experiment, there were a whole lot of graphs that didn't show much difference in anything. The best that the authors could say is that RU-486 didn't affect EA or sham-EA, but that ACTH didn't go up in the St36 group. It was reported that stress behaviors were less in stressed EA St36 animals, but looking at the graphs sure didn't impress me. Basically, the authors conclude that application of EA St36 after initiation of chronic stress prevents the stress-induced increases in the hormones evaluated, adding that "this action may be specific to EA St36 vs the sham points used, as sham-EA does not prevent the rise in stress hormones as effectively." One notes that sham did have an effect. The effect, if real, was very modest.

The kindest description of the conclusions of this study is that it shows that running electrical current through the leg, as opposed to running current through the skin of the back, might decrease stress by decreasing the effect of stress hormones. It does not show that acupuncture works. A more realistic description of these results is that they don't show much of anything interesting. One even wonders if, for instance, there is a simpler explanation, namely that having a needle stuck in the leg and having current run through it hurts less than having a needle stuck in the back and having current run through it. There's no way of knowing because we can't ask the rat.

What I can ask is why money is being wasted on silly experiments like this. The study was supported by an American Association of Nurse Anesthetists doctoral fellowship award. One would think that the AANA would have better things to spend its money on than this nonsensical "science."

Categories

More like this

At the risk of once again irritating long time readers who've hear me say this before, I can't resist pointing out that, of all the various forms of "alternative medicine" other than herbal medicines (many of which are drugs, just adulterated, impure drugs), acupuncture was the one treatment that,…
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…
Believe it or not, there was a time when I didn't consider acupuncture to be a form of woo. I know, I know, it's hard to believe, given the sorts of posts I've done recently on acupuncture, but it's true. Certainly, I didn't believe the whole rigamarole about needles somehow "restoring the flow of…
At the risk of repeating myself (but, then, since when did such concerns ever stop me before?), I'll just start out by mentioning that, of all the non-herbal "alternative" medicine remedies out there, I used to give a bit of a pass to acupuncture. No, I never did buy any of that nonsense about how…

Is there somewhere that one can find the meridians and acupuncture points for rats all carefully laid out? Or do these idiots simply rely on the astounding similarity of rat anatomy to human anatomy? Jeebus, what a gigantic crock of BS.

Its action and effects are said to include

I noticed that the link in that sentence is to a site called theory.yinyanghouse.com . They keep using that word. I don't think it means what they think it means. WTF is "Earth as the mother of Metal" supposed to mean? That list of alleged effects reads like a laundry list; it isn't even logically self-consistent.

Again I have to ask: What was the IRB that approved this thinking? (I am aware that the organization in question might not be officially called an IRB, but it looks like an IRB, quacks like an IRB, and waddles like an IRB, so I will call it an IRB.) Where is the prior plausibility for this experiment? As you note, electroacupuncture is not quite the same thing as traditional acupuncture. It would be one thing if traditional acupuncture did work; if it did, it would be reasonable to expect electroacupuncture to work in a similar way. But studies have shown that the effects of traditional acupuncture are consistent with placebo effects. Electroacupuncture might in that case work via some other mechanism, but that argument would have to be made in detail.

By Eric Lund (not verified) on 23 Jul 2015 #permalink

With one exception, the nurses I work with are immune to woo. Somehow I can't see our local college of nursing putting up the funds to do something like this.

FYI: IRBs review human research, technically for animal research it is a Institutional Animal Care and Use Committee IACUC who does the oversight. However their role in the research does seem to be pretty similar.

FWIW in five element theory the 5 elements relate to other ones in two ways. In one each element is created from the next and in the other the element controls/regulates another element. So you get treatments that may according to the theory target other related meridians. They do sometimes use ancestor type terms to describe the relationships so one up the creative cycle is mother, two up the creative cycle is grandmother. Probably comes from the popular ancestor worship thing, but I wouldn't cite me as an expert on that.

I'm not sure how the four humors were considered to be related to each other, but there may be similar types of things in other pre-scientific worldviews that generate sentences that make sense from within the perspective of that view that make no sense in isolation from without.

A needle stuck in a rat leg hurts less than a needle stuck anywhere in my body. Maybe some prospect for safest acupuncture.

By Daniel Corcos (not verified) on 23 Jul 2015 #permalink

As an alumn, I can't tell you how embarrassing this and the entire recent Georgetown Medicine Magazine devoted to integrative medicine is to me. As far as I can tell, their CAM program seems to be limited to the Department of Physiology as part of the Masters degree program. So far, the courses in quackery are not part of the medical school curriculum, but I fear it's only a matter of time. Sadly, when you read the website as to why they're doing this, it's just trope after trope that comes up, with a healthy helping of populism ("people are interested!"). Only letters from my colleagues who are also concerned alumni and me threatening to withhold donations will help, but even that is unlikely to make a difference. Very disappointing.

By Dr. Chim Richalds (not verified) on 23 Jul 2015 #permalink

Well, I stand corrected. It is definitely offered as an elective for medical students. Only a lucky few will be able to study at the Kaplan Center (http://www.kaplanclinic.com/) as part of a 4th year family medicine elective. Dammit. Time to write another letter to the Dean.

By Dr. Chim Richalds (not verified) on 23 Jul 2015 #permalink

The ST36 point (if "needled" correctly) happens to be right on the sciatic nerve (a useful coincidence). It's been used as a way to do electrical stimulation of the vagal nerve without more invasive methods. I did a didactical seminary during my PhD in pharmacology on this (ie not my thesis, but a paper I picked up and presented to faculty for 1h). I actually used the exact same picture as this blog post to illustrate where the ST36 was in a mouse (and rat).

That paper is here (in Nature Medicine): http://www.nature.com/nm/journal/v20/n3/full/nm.3479.html

As a skeptical pharmacologist, the title did its part and I checked it out, then picked it to present it. The group itself is more interested in vagal modulation in inflammation and septic shock. And their control is much better: a needle right on the ST36 without electrical stimulation (no better than no needle). So they actually show that acupuncture doesn't work, it's the electrical current that does the trick (and the survival studies are quite explicit). The study has its limitations, but they have more to do with their model and what they're looking at than with the electrical stimulation itself.

So electroacupuncture, done to actually stimulate precise neurons, may be useful. I know about the ST36 site, I can't really speak for other "traditional" acupuncture sites. And without electrical current, those needles are indeed useless.

"One even wonders if, for instance, there is a simpler explanation, namely that having a needle stuck in the leg and having current run through it hurts less than having a needle stuck in the back and having current run through it." (Sorry, I can't seem to master HTML)

IMO, having a needle stuck in the back and having current run through it hurts about the same as having a needle stuck in the leg and having current run through it. I can only relate this to having an electromyogram. I thought the technique was probably taken, used and enhanced down in the School of the Americas.

Poor rats!

As for the article here, the behavioral data is not impressive (the hormonal levels are a bit better). Their controls are lacking though, and it's interesting that their SHAM group seems to have an effect, which the authors disregard. The authors also make no mention of the sciatic nerve, or any nerve... They extrapolate a lot on weak results...

The needles were then attached to an electroacupuncture machine via electrodes and were stimulated for 20 minutes at a frequency of 10 Hz with 2 mA output.

I'd love to know how much ancient Chinese literature they scoured to conclude that these were the most appropriate values to test.

By Rich Woods (not verified) on 23 Jul 2015 #permalink

The most frustrating thing about studies like this is when doctors assume I don't know any better and suggest acupuncture for pain management. Worse, if I were in a position that I was stuck with the doctor who suggested it, refusal to try their placebo could be considered being difficult as a patient.

I’d love to know how much ancient Chinese literature they scoured to conclude that these were the most appropriate values to test.

There is also a total lack of any analysis of current distribution from the needles. The needles were 1-inche [double sic], but no mention is made as to exactly how they were inserted. A one inch needle fully inserted into a rat would be approximately equivalent to a 10 to 12 inch needle inserted into a human. Unless it is inserted perpendicular to the skin (eek!) it would likely cover a lot of those magic points, so the assumption that it would influence only the chosen point is likely complete nonsense. If the needles barely pierce the skin, even at 2 mA the current density would be quite high proximal to the needles.

It wouldn't surprise me in the slightest if the rats produced a much more positive response to food treats, and maybe some gentle handling - unless the torture had made them go to max stress levels just from human proximity. If I were one of those rats, the humans would be pulling back bloodied stumps if they reached for me.

This is doubly sad and annoying, as rats are in fact very smart and social creatures, much more so than most people imagine them to be. My friend Olga has a pair, "Rat" and "Chicken," and they are as genuinely attached to her as any other slightly more traditional pet. (And vice versa.)

Poor rats. :(

IACUCs, who review proposed animal research, don't always look at the science of the research, but rather what will happen to the animals. The reasoning for this is the assumption that the funding body has already evaluated the science. In this case, there didn't seem to be much science to evaluate. (This is why we can't have nice things.)

Dr. Chim Richalds

Thanks for the link.This article from the magazine sums things up perfectly.

“This is where I’m now stuck,” she explains. “I’m trying to get grant funding to do research on humans to see if these discoveries translate.” Eshkevari remains hopeful that, with rising interest from both the public and scientific communities, this next critical step will find support. “When people read these kinds of studies, because they’re fairly novel, the general public gets interested,” says Eshkevari. “Chronic stress, PTSD— these are very real for people, and we’re learning more and more that stress affects all our systems, shortening telomeres, and causing heart disease and GI disturbances. If we can find an alternative to drugs to help chronic stress, then I think we’re moving the needle at least a little bit.”

Back in the classroom, Eshkevari and her students discuss how care providers can recommend treatments like acupuncture without understanding how it works. She notes that scientists do not know the exact mechanism for how inhaled anesthetics work, but that doesn’t prevent their widespread use.

Discuss.

By Roger Kulp (not verified) on 23 Jul 2015 #permalink

stress affects all our systems, shortening telomeres

I foresee a bright future for Dr Eshkevari in telomere quackery.

By herr doktor bimler (not verified) on 23 Jul 2015 #permalink

Mrs Woo,

That is not good that you are getting suggestions like that from doctors. I can't believe the pressure to believe something that is phony. Well, there's CBT but that's another story.

Also, out today - an article in the NYT regarding people who don't tell their doctors about receiving acupuncture and chiropractic treatment. Some of the comments there were just the opposite where they were treated oddly by their doctors for going this route.

Sometimes I wish there was an equivalent of Match.com for finding doctors. Ditto for landlords.

By Not a Troll (not verified) on 23 Jul 2015 #permalink

Thank you JP. Truly adorable. I used to know a librarian who was always asking for shredded newspaper and such for her adopted lab rats. She was not PETA or anything, just felt bad for the used up rats. She would adopt them and get them veterinary care to see them through what remained of their (often tumor-ridden) lives. It was a small town and everyone kind of got behind the effort to help with the vet bills--and the shredded newspaper. My spouse had two pet rats as a child--Philip (of Macedonia) and Alexander. Thanks for sharing the photos.

By darwinslapdog (not verified) on 23 Jul 2015 #permalink

Oh, just to stay on topic, Mrs Woo needs to send this, as well as Orac's other needling takedowns, to her silly referring physicians.

To the Georgetown alum: Keep writing those letters. And remember, you are not alone in your embarrassment--we all share your shame, even here in the supposedly no-nonsense Midwest.

By darwinslapdog (not verified) on 23 Jul 2015 #permalink

The n=7 did not impress, neither did the p-values of .05 for such a small sample size. Unfortunately it's had the desired effect, and that is to get the media to distribute this as significant. It's the very devil to convince people otherwise after the fact...

@JP - my ex had rats named Frankie and Johnny. They were quite personable. Chickens are amazingly intelligent and have more self-control and/or can predict patterns of reward better than human toddlers. Maria Elena really ran our roost for awhile. So far, my biggest animal challenge seems to be motherless colts. The current one has always been headstrong and a little disrespectful (I started his early foalhood spending a lot of quiet time with him in hopes he would find me safe and comforting. He goes from happy to see me to jumping all over me, definitely unsafe, in a matter of two seconds if allowed). I know mothers bite and kick, so I started using a whip to teach personal space, but he still is headstrong, uppity... I thought lots of early time together would make his handling easier, but it seemed that familiarity breeds contempt.

I can't see any good reason to treat a rat (or any other living creature) this way for the defense of blood letting.

Peer 1, good catch.
I'm not qualified to evaluate it properly, but it does seem to me extraordinarily improbable, especially given the small sample sizes. It looks to me more like something I would expect from evaluation of different fairly tightly controlled manufacturing processes than provoked responses in bio-beasts.

I would also like an explanation of exactly how it is known that the sham-acupuncture (superfluous adjective if ever there was one) points should be expected to be less effective than the "real" points. Again, where are the volumes of ancient Chinese wisdom on rat acupuncture, with or without added electrical stimulation? The whole damned thing is just such a crock of sh!t.

I wish there were a way to electronically send these so-called researchers something that would cause them all to have a couple of months of nightmares of huge rats chewing off their lips. Let 'em try some of their stupid magic to calm the stress of that. It is hard not to Godwin this thread.

@Mrs. Woo:

I always smile thinking about you and your chickens and various other critters. Thanks for the Night Vale recommendation, BTW; I've been enjoying it.

What was that Animal Care Committee (or US / Hong Kong equivalent) thinking of when they approved this study? Ice water? Wading around in presumably 0 C water for an hour at a time? If a human did this they almost certainly would be hospitalized. And humans don't have a tail to drag in ice-cold water.

Why in the devil would they use unequal n's? Group1 = Group2 = 7 & Group3 = Group4 = 14 for a total of 42. I cannot imagine why anyone would willingly use an unbalanced design. Can any one suggest a reason? Well other than stupidity?

I didn't read the much of the study but a quick look at the Figures is not reassuring but perhaps I am being too critical since I tend to think that anyone using dynamite charts in this day and age is already showing dubious judgement.

http://biostat.mc.vanderbilt.edu/wiki/Main/DynamitePlots

And interestingly from: http://biostat.mc.vanderbilt.edu/wiki/Main/StatisticalPolicy

Dynamite plots often hide important information. This is particularly true of small or skewed data sets. Researchers are highly discouraged from using them, and department members have the option to decline participation in papers in which the lead author requires the use of these plots.

# Chim Richards

My deepest sympathy re the magazine.

#JP
Cute rat but big! I used to know someone whose two pet rats rode on the handle bars of his bicycle. It got stares from the tourists in the market.

By jrkrideau (not verified) on 24 Jul 2015 #permalink

jkrideau, can I ask you to post your crit on pubpeer (no the required). See link a few posts up.

Mrs Woo:

my ex had rats named Frankie and Johnny. They were quite personable.

*groan*
Of course, ♫ Frankie and Johnny were sweethearts... ♫

By Jenora Feuer (not verified) on 24 Jul 2015 #permalink

I am a trained acupuncturist with a masters degree in acupuncture. Research can be a tricky thing. I understand there was 50 years of dedicated and honest research into the relationship between cigarettes and cancer before a causal link was established. I read a wonderful piece written in the 1950s by an MD who stated that thirty years of research had proved there was absolutely no reason to suspect any ill health effect from cigarettes and that indeed the anecdotal evidence of ill health was due to an unconscious fear of hell fire. We know differently today because over time the amount of anecdotal information led to an increase in research. What we need is more research not less. There is enough evidence of acupuncture's efficacy that insurance companies cover it. This must be some evidence that people receive some benefit. Insurance companies don't like to pay for things not proven to be successful. I personally would love to see a study on the treatment of fever in children. Hard to doubt a sudden reduction in fever. It's easily and objectively measured. Ear infections with fever are so satisfying to treat. Seeing a child screaming in pain one minute and calmly being read to five minutes later always feels like a good use of my time. I am always frustrated when people ask how acupuncture works and expect that I will be able to answer in 50 words or less. That is like asking you to briefly explain how the digestive system works. It's a complex system with endless detail. Acupuncture is equally difficult to explain. If I balked at the existence of stomach acid because I had not been properly educated you would not take me seriously. You have not been properly educated about acupuncture which is why I have a hard time listening to your critiques without laughing. Yes the ancient texts have an antiquated language. We spend three to four years learning this system and examining the meaning behind the language used. Your lack of understanding of acupuncture is not an excuse for being so widely dismissive of a system of medicine being used by millions around the world. In China all acupuncturists are also MDs. It is a highly respected branch of medicine and practiced by men and women who fully understand the complex workings of the body. They chose to practice acupuncture not because they don't understand medicine they do it because as trained MDs they observe that it works and research done in that country supports it.

Caroline, I assume that in order to complete your Masters Degree, you would have been required to complete at least some education around statistics, yes? It's not like you'd throw around your credentials if they came from a diploma farm, particularly as you tell MDs that they are inadequately educated. Being that you're so proficient in your area of practice as to trust your own anecdotes for treating bacterial infections of the ear, why don't you perform the study you want, one performed by believers? Surely if accupuncture is as effective as you say, there's nothing to lose and only positive results to report.

tl;dr version: Caroline - citation needed.

Hard to doubt a sudden reduction in fever. It’s easily and objectively measured. Ear infections with fever are so satisfying to treat. Seeing a child screaming in pain one minute and calmly being read to five minutes later always feels like a good use of my time.

Why Caroline, that suggests a really great study of acupuncture that doesn't involve torturing rats! Just set up at an urgent care center and offer parents the opportunity for their children to get acupuncture for their ear infections before any other treatment.

I'm thinking how to set this up ... Some parents will say no so we exclude them. The rest are obviously self-chosen but we divide them randomly into three groups: real acupuncture, sham acupuncture, and no treatment. Then we observe the children for, say, ten minutes after real or sham acupuncture or nothing and someone who does not know who got what treatment records how many stop screaming and are ready to be read to. And then the children go on to get standard of care as necessary.

I've never designed a study so maybe some of the experts here can tweak this. But just think, Caroline, you can run a solid study that will convince all the doubters!

we divide them randomly into three groups: real acupuncture, sham acupuncture, and no treatment.

If there's enough volume, you might add an arm that gets real acupuncture in points for a completely different, unrelated diagnosis.

By Mephistopheles… (not verified) on 25 Jul 2015 #permalink

And what sort of university gives degrees in acupuncture?

By Denice Walter (not verified) on 25 Jul 2015 #permalink

"If we can find an alternative to drugs to help chronic stress, then I think we’re moving the needle at least a little bit"

Huh? If you move the needle, you'll miss the meridian point, and it won't work! (heheheh)

But seriously, forget the Mouse Torture Ethics Review Boards. I want to know who green-lights these face-palmingly flawed research designs under the delusion they could possibly yield significant results.

Now, I don't know anything about what constitutes statistical significance in variances in ACTH levels, the unequal 'n' values flew right past me, and while I know enough Tufte to pretty much ignore any kind of bar graph, I didn't know about the specific problems with 'dynamite plots' (thanks for the educational, jr!). But I didn't need expertise on any of that to see big red flags here. 'Assorted stuff I learned in grad school' left me with the following method for evaluating experimental studies:
___
1. Look for terminological double-shuffles:
a) Do the different physical manipulations performed actually conform to the labels the researchers have applied to the variables?
b) Is whatever the research measures a valid and reliable index of the variable it's claimed to represent?

2. Look at the control groups(s). If they don't adequately address plausible explanations for results beyond the 'variable' supposedly being tested, it ain't science. Part of this: If the physical manipulation performed has not been conclusively and exclusively established as an instance of the applied label by prior research, THAT must be among the possibilities addressed via controls.
___

Let's pass on 1-b for now, just for sake of argument, and imagine that the 'stress' appearing in an otherwise-healthy rat during two weeks of 60-minute-per-day exposures to hypothermia is analogous to the 'stress' felt by a human patient experiencing chronic pain from an ongoing physiological ailment. (Yeah, I'm skeptical...) Let's further imagine that the levels of the hormone measured, and the actions counted inthe behavioral tests are analog indicators of the degree of this 'stress' being experienced by a rat, such that the results would map onto a human being's apparent level of 'stress' in terms of subjective mood, difficulties in performing certain physical and mental tasks, etc. (Yeah... but we're just doing a thought experiment...)

OK, the rats were divided into three subject groups, labeled as follows:
1) "No Electoacupuncture": given the ice water baths and returned to their (solitary) cages.
2) "Sham Electoacupuncture": 30 minutes after being plucked from the freezy pool, stuffed head first into a sock, acupuncture needles stuck in each ass cheek, and "stimulated for 20 minutes at a frequency of 10 Hz with 2 mA output."
3) "Electoacupuncture": same as above. but with the needles stuck into the meat of the thigh.

The justification for assigning the 'Electoacupuncture' label to the thigh-needled rats, and the 'Sham Electoacupuncture' label to the ass-needled rats: the needling point on the thigh is allegedly analogous to the position of alleged 'stomach meridian acupoint 36' on human beings, and there are no such alleged acupoints on the allegedly analogous areas of the human bum.

IOW, the 'study' STARTS by assuming 2 things it sets out to 'prove': 1) meridian acupoints actually mean something. 2) needling reduces stress.

1)
If the premise is 'rats are analogous to people', I ask, do you think getting a needle shoved into your ass-cheek might result in a higher stress level than getting a needle shoved into your thigh? Well, we're humans, we have social taboos and other psychological 'noise' rats aren't supposed to have, right? But if you have any experience handling mammals — e.g. a house cat — how do the odds of purring contentment turning to "ROWR!" and a scratch on your forearm correlate to the proximity of your contact point with the region of the kitty's genitalia (even if, uhhh... not actually present...)? More to biological science: how does the enervation of St36 compare to that of the butt-needle spot in terms of pain sensitivity in general (apart from the 'don't touch the jewels' instincts a socio-biologist would expect to be hard-wired in as a means of projecting DNA into future generations)?

What kind of 'scientist' fails to consider the possibility that rats just don't don't get as upset from being stuck in the thigh as they do from getting stuck in the ass? More importantly, what kind of study application review process fails to notice that MIGHT be a confounder, and fails to suggest the 'Sham Electoacupuncture' group is only an apples-to-apples control if the needles are stuck in what would be considered a neurologically/psychologically equivalent spot by a rat expert who has no knowledge of or belief in acupuncture? Assuming St36 isn't just any old spot on the thigh, then there ought to spots nearby that aren't acupoints, yes?

2)

Before initiating the study the animals in all 4 groups were acclimated for 4 days by study personnel who handled them twice a day for 3 minutes. After the 3 minutes of handling, [all] were placed in a cotton sock headfirst, with their hind paws and tails exposed.

It just leaves me shaking my head that allegedly 'scientific' researchers who manipulate the experience of mammals are not required to provide detailed explanations of the nature of those manipulations, reveal how test subjects react to them outside of the context of the experiment, or consider how these things might affect the alleged 'findings.'

How were the rat and sock oriented: was the rat level in the sock, or facing head down? How was sock held: by human hand, or a mechanical suspension of some kind? How was the rat's body supported: just it's full weight hanging head down in the sock; with some hand support; it's back on a lab table after getting the sock on; upright on it's paws on a lab table after getting the sock on? How do reviewers of the research fail to consider that some of these things might affect a rat's mood?

More significantly, what does 'acclimated' mean in terms of the rat's behavior and mental state? How do the rats react to going into the sock the first time, and how has that changed by the eighth preparation session? Do they progress from righteously PO'ed to yawning 'whatever, dude' resignation? Do they go from mild fear and confusion to "Hoo boy, it's time for the Sock Game!" enthusiasm. I could imagine that if i was kept caged by myself in a sterile medical lab, any kind of diddling with a human being and sock could quickly become the highlight of my day.

The language in the paper is vague (of course0, but it appears the "No Electoacupuncture' group received the same 'acclimation protocol' as the other rats, but then spent the next 2 weeks alone in their cages while the others were taken out and handled twice a day. 'Scuse my apoplexy, but how does anyone with half-a-brain imagine this is a satisfactory control? How do the reviewers fail to say: 'You need to take the No Electoacupuncture rats out of their cages, put them in socks, and do something physical with them not involving needles on the same schedule as the rats getting the needles.' [I'd suggest gently tapping their thighs at NOT-St36 with a finger, but that might confound the findings via hypotheses of rodent reflexology... :-) ]

Perhaps the litany of error is tiring the reader, but I must mention one other important matter. ALL the things the researchers did to their various groups of rats may well have functioned INTERACTIVELY, such that their affect could not be gauged by studying them each individually. E.g. under 'normal everyday life conditions,' having its head put in a sock for a few minutes might possibly be a bummer for all rats all the time. However, the researchers were putting their rats in the socks 30 minutes after plucking them from the ice water, enough time for their body temps to normalize at room temperature. Could it just be possible that a rat still feels cold even after it's body temp returns to normal, or that it remembers being really, really cold very, very recently – the stress is supposed to carry over after all – and thus that 'room temperature' is weak-sauce relief and what the rat really wants is to be warm – making the inside of a cotton sock just the ticket?

Could it just be possible that a lab rat's emotional state – including it's stress – is affected by how it comprehends its relationship with its human handlers, and that having the humans subject it to a repeated routine of cold-water torture followed by 20 minutes of positive attention careful handling and inescapable passivity inside a warm sock whipsaw it's little brain into some wacko place where it doesn't know which end is up, and it's ready to turn into some rat version of Comrade Tanya?
___

Alas, similar research design problems plague a wide range of studies of subjects that have nothing to do with medi-woo, and legitimated academic fields have given this work validation as 'legit science'. The acu-pushers are just rats feeding off the rotting flesh of a much larger corpus...

It's funny how CAM practitioners can tell us about all these great unmistakeable objective effects of their favorite CAM -- like Caroline here, or the homeopath who could cure pertussis in two minutes -- and yet somehow the studies don't focus on those great unmistakeable objective effects; they focus on things like torturing rats.

Oh, and Caroline, I suppose there might be an ethical problem with using children in your study, but adults do get ear infections (I've had a couple) so you could use adults in your study instead. And of course adults get fevers and go to the urgent care center for that. So how about it, Caroline? Will you set up the definitive test of acupuncture? Do it for the rats!

Link fail. Sigh.

By Mephistopheles… (not verified) on 25 Jul 2015 #permalink

" Ear infections with fever are so satisfying to treat." Some sort of tympanocentesis?

By Daniel Corcos (not verified) on 25 Jul 2015 #permalink

# Peer 1
I can post my critique but what do you think is relevant? I am fairly sure the stupidity comment is not really a good point althought likely valid.

I was thinking small and unequal n's as main point (i.e a lot of noise vs effect) and perhaps a ref to the dynamite plots but a lot of disciplines still seem to use them. Ugh.

By jrkrideau (not verified) on 25 Jul 2015 #permalink

@ Mephistopheles O'Brien:

I found it!

YES and it's pretty much as I suspected: Bastyr and universities with TCM or OM in their names.

Although I'm sure the Quackademics offer acupuncture as well in some form.

By Denice Walter (not verified) on 25 Jul 2015 #permalink

It’s easily and objectively measured. Ear infections with fever are so satisfying to treat.

Caroline -

Given that you have a masters degree in acupuncture, can you tell me how acupuncture treatment provides relief to an ear infection? Does acupuncture kill the bacteria or virus that have infected the ear? Does acupuncture reduce the inflammation in the ear? Does acupuncture just reduce the pain of an ear infection, leaving the infection to carry on...infecting? Does acupuncture reduce the fluid buildup in the ear?* Does the child know that if they complain of continued ear pain, that they will have even more needles stuck in them?**

Also, why don't acupuncturist wear gloves?

*If so, are you needling an acupuncture point on the ear drum, because I have no trouble believing that would reduce the fluid buildup.

**Because children love needles.

This site has some truly choice quotes that I'd just like to share, http://www.alternativevet.org/acupuncture.htm

Traditional Chinese Medicine (TCM) advocates the use of herbs, chiropractic manipulation, nutritional input (i.e. diet) and lifestyle modification, as essential companions to acupuncture. This may explain some of the failures of the modern application of veterinary acupuncture that is commonly performed by needling alone in a 'non-holistic' and strictly reductionist ‘Western’ way. It is (or should be) a truly holistic therapy. See also: Moxibustion.

Love the idea of animal lifestyle modification. Presumably that's getting dogs to take up yoga and cut back on the caffeine?

At the AVMC, we also inject vitamins into acupuncture points and have applied the injection of homeopathic medicines into acupuncture points (the specific remedies must be chosen to integrate carefully with the acupuncture treatment, to avoid clashes).

Why of course they need to be carefully chosen.

More disturbingly they link to a study in which rats spinal cords are cut so they can be treated with acupuncture. Now I'm not a huge fan of animal experimentation but I accept there is still no alternative for some medical research. This however sounds like a complete waste of rat lives.

#48 Cate K

What's wrong with 'animal lifestyle modification'?

The counselling sessions might be a bit fraught but treadmills for the puppy or kitten (just lock them in and away they go), no more treats between meals and so on. I understand regular swimming sessions for horses are common but you need a fairly large pool if you are not near a lake or ocean.

I wonder about placebo effects though.

By jrkrideau (not verified) on 26 Jul 2015 #permalink

The problem would not arise were graduate stidents still obliged to demonstrate fluency in Latin, , for such was the wisdom of the ancients that the Romans ate their doormice instead of experimenting upon them.

By Mnestheus (not verified) on 26 Jul 2015 #permalink

In China all acupuncturists are also MDs [sic].

I'm inclined to doubt this. See, e.g., here and then note that that Chengdu's acupuncture school is distinct from its medical degree programs proper.

You can, in Sweden, be -forced- by the state to take an acupuncture course (over an infinite number of treatments I guess) if you're ill. I was forced, but I got off it after two treatments when I started talking about physical violence on my part.
But this is troubling too. There are real effects for people when quackery wins.

By Per Keyser (not verified) on 31 Jul 2015 #permalink

Just a little open mindedness is required by all. Asprin has been used for a few thousand years in its natural form. So you are saying this was all hocus pocus until the official synthesized form came out? There are so many examples of ancient traditional medicines now used in modern medicine http://www.ncbi.nlm.nih.gov/pubmed/20509453

By Els BAKKER (not verified) on 26 Sep 2015 #permalink

There are so many examples of ancient traditional medicines now used in modern medicine h[]tp://www.ncbi.nlm.nih.gov/pubmed/20509453

This citation (to a paper written in Danish, no less) does precisely nothing to bolster your "so many examples" assertion.