So I was distracted yesterday from what I had intended to write about by an irresistible target provided me courtesy of Toby Cosgrove, MD, CEO of The Cleveland Clinic, who bemoaned all those nasty pro-science advocates who had had the temerity to link the antivaccine rant by the director of the Clinic's Wellness Institute to the quackery practiced there of whose affinity for antivaccine quackery Cosgrove appears to be oblivious. So I took care of that target, and now I'm back to the topic I had wanted to apply some Insolence to. Yes, there was no way I was going to allow this pseudoscientific and utterly unethical study pass uncommented on. No way. This study was nothing less than infant torture in the name of pseudoscience.
I'm referring to a study that started popping up on the news two days ago with headlines like this one, Colic study stirs prickly debate on acupuncture. (Gotta love those acupuncture puns and jokes.) Then there was this gem, The Soothing Benefit of Acupuncture for Babies, which was utterly credulous to the point of what I consider embarrassing. Seriously, TIME and Amanda McMillan? You couldn't even include a token skeptic viewpoint? Yours wasn't false balance; it wasn't even close to balance at all. You even ended the story with a quote from an "integrative medicine" advocate recommending that parents only take their babies to acupuncturists or traditional Chinese medicine practitioners who are "trained, licensed, and experienced."
The study being referred to was published in a journal that falls under the BMJ group of journals, namely Acupuncture in Medicine (AIM). It's a journal we've seen before, a journal that is vast repository of pseudoscience or, as Steve Salzberg referred to it, a fake medical journal. The study that provoked these stories was published by Kajsa Landgren and Inger Hallström in the Department of Health Sciences, Lund University, Sweden entitled Effect of minimal acupuncture for infantile colic: a multicentre, three-armed, single-blind, randomised controlled trial (ACU-COL). This study is the very epitome of quackademic medicine and, as Harriet Hall likes to call it, Tooth Fairy science.
First of all, there is no prior plausibility. The authors claim that there is:
Standardised acupuncture grounded in neurophysiology is a Western approach, while the hypothesis in Traditional Chinese Medicine (TCM) is that the effect of acupuncture depends on which points are used. While some argue that needling sensation (de qi) is necessary, others have demonstrated beneficial effects with minimal stimulation. There is a need for further research to compare standardised and individualised treatment, as well as to determine the optimal stimulation parameters and treatment intervals.
It is plausible that acupuncture may have positive effects in infantile colic as it is recognised to reduce pain, restore gastrointestinal function and have a calming effect. No serious side effects have been reported to date.
However, there really isn't a plausible (or even semi-plausible) physiological mechanism that would lead a scientist to believe that sticking needles into infants in locations defined by ancient, prescientific, vitalistic beliefs that have no anatomic structures associated with them that would likely to be positively impacted by sticking needles into them. Moreover, the thought of sticking needles into babies makes my skin crawl. This is not vaccination, where there is a definite and demonstrable benefit from the jab, but rather quackery rooted in pseudoscience.
Before I get into the details of the study itself, I can't help but point out that the study itself is highly unethical. All the documents that govern the ethics of human subjects in research, such as Belmont Report, the Common Rule, and the Declaration of Helsinki, emphasize that children are considered a vulnerable population because they cannot provide consent and have to rely on their parents to look out for their best interests, as well as how fragile they can be. That means that the protections for them in human subjects research must be even more rigorous than they are for adults. Similarly, Helsinki Declaration requires that there be compelling preclinical evidence from basic science and animal studies to justify human subjects research. There is no such body of evidence supporting using acupuncture to treat infants for colic—or to treat anything, for that matter. Yet, here we have a study subjecting babies to needles being poked into them in the service of trying to "prove," against all physiology, that ancient mystical vitalistic medicine "works." Having known parents with children with colic, which is excessive crying, I have some idea how desperate such parents can be, so much so that they might be willing to have a stranger stick needles into their children if they're told that this will stop the crying. I can't help but wonder whether the investigators to some extent took advantage of that desperation to sign up patients.
On to the study itself. First, infantile colic is not a minor problem. Basically, when a baby cries more than three hours a day for more than three days a week, it's considered colic, and colic is the cause of 10-20% of early pediatric visits and usually peaks at around six weeks of age. Its natural history is to get better, which makes it a perfect condition for quacks because almost anything they do to intervene will appear to cause improvement in any given infant.
This study was basically designed as a multicenter three-arm randomized single blind clinical trial:
Alongside usual care at their regular CHCs, recruited infants visited a study CHC [child health center] twice a week for 2 weeks. Infants were randomly allocated to one of three groups: group A received standardised MA at LI4; group B received semi-standardised individualised acupuncture inspired by TCM; and group C received no acupuncture. The CHC nurse and the parents were blinded to group allocation.
LI4 is an acupuncture point located here:
So basically, in Group A, babies were being needled in their hand, roughly where the thumb and forefinger meet because supposedly it has something to do with the large intestine. But get a load of the indications for this point:
Aversion to Cold. Fever. Sneeze. Regulates transpiration. Analgesia. Spasms in the channel, stomach, intestines and uterus. Toothache, head, eyes, arm and ear. Trismus. Bi syndrome. Hemiplegia. Contraction of the fingers. Tinnitus. Deafness. Redness and swelling of the eyes. Blurred vision. Nosebleed. Congestion and runny nose. Aphtha. Tension on the lips. Amenorrhea. Promotes labour. Retention of dead fetus. Stiff neck. Cold. Flu. Rhinitis. Conjunctivitis. Stye. Sinusitis. Epistaxis. Trigeminal neuralgia. Facial paralysis. Anxiety.
Well, that's clear.
Group B received "individualized" acupuncture, which means that the acupuncturist could basically do whatever he wanted. The authors describe it as
Following a manual, the acupuncturists were able to choose one point, or any combination of Sifeng, LI4 and ST36, depending on the infant's symptoms, as reported in the diary. A maximum of five insertions were allowed per treatment.
ST36 is on the lateral aspect of the leg just under the knee and is supposed to be used for gastric pain, vomiting, dysphagia, abdominal distention, borborygmus, diarrhea, indigestion, dysentery, constipation, abdominal pain, acute mastitis, emaciation due to general deficiency, palpitation, shortness of breath, poor appetite, lassitude, dizziness, insomnia, cough and asthma, pain in the knee joint, apoplexy, hemiplegia, beriberi, edema, depressive psychosis, and madness. In any case, whichever group they were in, infants receiving acupuncture received usual care and their parents usual advice plus treatment twice a week for two weeks, while infants in Group C received usual care and advice. Parents filled out questionnaires at four points
I initially was tempted to criticize this study over the lack of a true "sham" acupuncture group, and technically the authors should have, I can't help but note that, if there's one thing acupuncture studies have shown us, it's that it doesn't matter where you stick the needles and it doesn't even matter if you stick the needles in. Besides, there are so many other things to criticize it for. Be that as it may, as far as the subjects went, there were 426 infants screened, of which 157 were randomized and ultimately 147 started the intervention. There were 49 in each group, of which two dropped out in group A and one in group C. All infants were between two and eight weeks of age and had to be healthy with appropriate weight gain. Also, before inclusion they were required to have tried a diet excluding cow's milk protein from breastfeeding mothers and/or appropriate formula for at least 5 days.
So what were the results? Let's compare. First, here is what the authors say in the abstract:
The effect of the two types of acupuncture was similar and both were superior to gold standard care alone. Relative to baseline, there was a greater relative reduction in time spent crying and colicky crying by the second intervention week (p=0.050) and follow-up period (p=0.031), respectively, in infants receiving either type of acupuncture. More infants receiving acupuncture cried <3 hours/day, and thereby no longer fulfilled criteria for colic, in the first (p=0.040) and second (p=0.006) intervention weeks.
I could have predicted this result based just on the design of the study. First, I fully expected that both acupuncture groups would be superior to the control group, because that's how acupuncture studies always turn out because it really doesn't matter where you stick the needles. Next, notice the p-values. Now, I realize that p-values are not the be-all and end-all of clinical research, but these are some truly sad p-values, barely statistically significant, other than the last one.
However, these results are even wimpier than that if you look at the full dataset presented in Tables 2, 3, and 4 (which you can do if you like because this is an open access paper). Notice how many comparisons there are. Notice how the authors use either the Kruskal-Wallis H test, Mann-Whitney U test, or Fisher's exact test. The Kruskal-Wallis H test is a test that is used for more than two groups, while the Mann-Whitney U test is only used for two groups, an alternative to the t-test when the data is not normally distributed. Basically, the authors break the crying down into crying, fussing, colicky crying, and total crying and then measure percent decrease from baseline. They then use the Kruskal-Wallis H test for the three groups, A, B, and C. They also do the same analysis combining groups A and B (acupuncture groups) and comparing to group C. This latter move raised an eyebrow because it appears to have been done post hoc. In fairness, the authors did this because the trial stopped "when acupuncture became available without randomisation, before such time as a sufficient number of infants had been recruited to test the original hypothesis," but that doesn't make it less dicey.
In any case, there are a lot of comparisons, and only a handful of "statistically significant" p-values. David Colqhoun and Edzard Ernst were not impressed, either. Although I disagree with Colqhoun that "no correction has been used for multiple comparisons" (after all, the Kruskal-Wallis H test is basically an ANOVA test for non-normal distributions), but I do agree that the control for multiple comparisons were inadequate. The authors might have controlled adequately for multiple comparisons for each individual time point for each measure (e.g., crying or fussing), but they didn't control for the multiple comparisons over the four time points for all the variables measured. I also agree that the multiple comparisons with so few significant results (for example, 24 p-values reported in Table 2, with only three just below 0.05) raise numerous red flags and almost certainly mean little or nothing. I also agree with Colqhoun's other assessments, particularly the likelihood of Type 1 error (false positives).
But what about blinding? This is a single-blind test, in which the parents were supposed to be blinded to the treatment group but the acupuncturists knew the allocation. However, in the experimental design, the acupuncturists never interacted with the parents. A nurse would take the baby from the parents to the acupuncturists, who did their thing (or not in the case of the control group) in a back room. This is actually not bad. The authors also assessed blinding:
On four occasions the parents answered the question ‘Do you think your infant received acupuncture?’ with ‘yes’, ‘no’ or ‘don't know’. In group C, 21–29% of the parents guessed correctly (no acupuncture) on all four occasions, while the rest (71–79%) either thought that their infant had received acupuncture or didn't know (table 5). The percentage of parents in merged group A+B who correctly guessed that their infant had received acupuncture increased from 45% to 72% between the first and last occasions, while 28–55% were incorrect or didn't know.
By random chance alone, you'd expect a 50-50 mix of parents thinking their children had acupuncture and thinking their children didn't have acupuncture. Yet, somewhere between 71% and 79% of parents of infants in the control group correctly guessed that their children didn't receive acupuncture. This alone suggests to me a problem with blinding. The effect is similar in the acupuncture groups, with way more than 50% of the parents guessing correctly that their babies received acupuncture.
Finally, Ernst noted:
There was a (presumably random) imbalance in breastfeeding between the acupuncture group (62%) and the control group (49%) (Table 1). As the first paragraph implies that diet is an important risk factor for colic it is surprising that this imbalance is not discussed more in the paper or controlled for in the analysis.
This alone probably wasn't enough to explain the results, but when you add it to all the other problems with the study, the reality is that this is almost certainly a negative study. The handful of "statistically significant" results represent nothing more than noise, particularly given that the study size is pretty small. Let's just put it this way. An editor at AIM basically admitted that this is a negative study because its primary outcome prespecified in the protocol showed no difference:
So what we have here is a negative study that doesn't provide anything more than the weakest suggestion of any effect on colic due to acupuncture. Unfortunately, that hasn't stopped the acupuncture believers from being all over the press to point to the results as evidence that it is acceptable to stick needles into babies for any reason other than vaccination. Unfortunately, as the authors note, there are several of these studies already published that were "equivocal" and, taken together, are "conflicting." These are, when examined critically, actually negative studies. Acupuncture studies in children are child abuse, and this infant torture needs to stop.
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I agree with your assessment that these trials are unethical and that the treatment lacks any physiological plausibility. I'm also grateful for the fact that you listed the many indications given for the acupuncture points. The more indications for the points, the less likely that any of them can be manipulated to produce beneficial effects.
According to the Today Show clip, the results of several more trials of acupuncture in the treatment of infant colic are on the way. After literally 1000s of studies have failed to demonstrate that acupuncture has any benefits over placebo, there is no question that the practice itself is unethical and should be banned.
Several other studies of acupuncture for colic are mentioned in the introduction to the paper. Not surprisingly, they were characterized as "equivocal" and "conflicting," hence the "need" for this clinical trial. One more time, when you have an incredibly implausible treatment and the results of a clinical trial are "equivocal," that's a negative clinical trial. When you have a bunch of clinical trials that are "conflicting" and "equivocal," the conclusion is that the treatment works no better than placebo, not that the treatment needs more study.
Orac says: "By random chance alone, you’d expect a 50-50 mix of parents thinking their children had acupuncture and thinking their children didn’t have acupuncture. Yet, somewhere between 71% and 79% of parents of infants in the control group correctly guessed that their children didn’t receive acupuncture. "
It could be a blinding problem, or something as simple as noticing a lack of irritation on the babies skin. I'm assuming that getting stuck with acupuncture needles will irritate the skin the same as any other punctures/scratches. Since babies skin is generally a lot more sensitive then an adults, no red spots, no acupuncture. Now if they are giving their guess before seeing their child, that would definitely indicate something hinky with the blinding.
It's still a problem with the blinding either way. It doesn't matter why the parents guess right; that they guess right more than would be expected by random chance alone makes me question whether the blinding was adequate. The authors do note that one parent reported seeing a drop of blood on the infant's clothes, and one reported seeing a mark on the infant's hand while the acupuncturists reported 15 incidents of minor bleeding. It's quite possible that more than one parent noticed this, but most didn't report it.
IANA Swedish lawyer, but I would consider this kind of study to be child abuse. It is too reminiscent of abusive parents who see their kids crying for what they think are insufficient reasons and saying, "I'll give you something to cry about!" Which sticking a needle in a baby would do.
FTR, I have no affiliation with Lund University or the city of Lund. My paternal ancestors are Danish, not Swedish.
Deeply bothered by this study as a pediatrician because as you note there is no scientific reason to think this would work to start with. Then to needle a baby is inexcusable. Also that "LI 4" point on a chubby baby's hand would not be so well-defined and there are arteries, veins and nerves in that snuffbox area that could be permanently damaged if hit by a needle. For vaccine administration, nurses and MAs are taught very clearly safe injection zones for vaccines in infants and children and this "LI 4" is nowhere near what I would consider safe for a needle. And , of course, that's not even considering the group where the infants were needled any old place the quackupuncturist felt like doing. Shameful. Just shameful.
Speaking of patients who have no way to push back on harmful or painful nonsense, this reminds me of a question I have and can't find a scientific answer to.
Is laser therapy (as used by vets to speed the healing of injuries and/or reduce pain) legit or nonsense? It doesn't seem plausible to me. But I'm no doctor and if it is quackery, it's the only non-scientific treatment my otherwise good vet offers.
@NJK: I'm not an expert on the subject, but depending how the laser is used, it might make sense. If they use the laser to cauterize the wound, it might help prevent infection and speed the healing that way. I can't tell from your description whether that's what they are doing, but if it is, it might be helping. If it's something else, particularly something that isn't a form of surgery or direct treatment to the wound, then it's probably nonsense.
Both Daughter #1 and Daughter #2 were collicky kids - I walked with them _a lot._ It runs in the family
My late BIL was an old-school physician. He suggested that Daughter #2 (who was far worse than her older sister) was just really hungry.
We gave her - even though she hadn't cut teeth and was still breast-feeding - a slurry of rice cereal and pureed lamb. Worked like a charm.
His mantra was "pay attention to Old Wives' Tales - they've had lots more babies than Old Obstetricians."
ymmv, to be sure.
Sad to see another RI article sticking it to acupuncture.
Why, just today I saw a heartwarming story about an aging Pittsburgh Steelers linebacker, James Harrison, who keeps his aching body going by spending $350,000 a year on "bodywork". That money goes to:
A dry-needling person
A natural path doctor
A physio-chiro masseur
He's still playing so obviously all of it works. Although for that much money, he should be able to get himself cloned and have the clone take all the physical abuse during games, while he relaxes on the couch at home.
You might want to pose your question at:
It’s an excellent source of science based veterinary information. He sometimes gives personal replies if you post, but the answer might already be there if you search.
"When you have a bunch of clinical trials that are “conflicting” and “equivocal,” the conclusion is that the treatment works no better than placebo, not that the treatment needs more study."
Call it ratchet science. Negative or equivocal studies are dismissed or used as encouragement to try again (the ratchet spinning backward). When a study, no matter how bad, shows a statistically significant effect the progress sticks (ratchet clicks forward). With a ratchet you can only move in one direction: forward. Every sham scientist needs one in their toolkit.
DB@10: This is why woo proliferates: too many people like Mr. Harrison have more dollars than sense and are willing to spend money on woo. I could cut his expenses in about half without breaking a sweat: keep the trainer, the doctor, and the three masseurs (not the physio-chiro guy), whose services might actually be doing him some good. Drop the other five. I hope the people he pays have other clients, because the average of $35k per person probably includes both dubious supplements and the employer portion of payroll taxes, and isn't enough these days to live a middle-class lifestyle.
As for "sticking it to acupuncture": was the pun intentional?
rs@12: When the only tool you have is a ratchet, every problem looks like a bolt.
@Eric Lund #8: Would I be correct in guessing that cauterizing is going to be painful, and nearly always performed under anesthesia? If so, I'm pretty sure that's not what this is. Instead, picture a cat wearing kitty-sized sun-tan goggles, in no apparent pain.
@darwinslapdog #11: Did you mean skeptvet.com ? Thanks, I'll check it out.
Re #3 & #4:
100% of the parents closely examined their babies for bruises, bleeding, and puncture marks, which presumably unblinded the trial for some unknown percentage. I mean, it's a baby! Who wouldn't search for the puncture afterwards? And 100% of them noted whether baby was howling in pain or howling because some kook had taken them into a room full of sharp things. Many parents at least claim they can tell the difference.
Next thing you'll be telling us is vagina eggs don't work.
@ Christine Rose:
I don't know about babies but when I tried acupuncture ( to invstigate the woo at no cost) I was unable to see any marks after the sessions - altho' I did bleed profusely from one point.
HOWEVER cupping left horrendous bruises.
At least nobody is cupping babies yet.
Official acupuncture sites always claim no pain, no blood, no bruise, 1 in 10,000 complication rate, etc. But whenever someone asks on a message board, a bunch of folks chime in: "Oh yeah, I bruise all the time." I doubt if there are any honest statistics on bruising, bleeding, and pain from acupuncture.
What could possibly go wrong??
Unlike steel-jacketed, mercury filled dumb dumb golf balls, jade eggs don't roll across the whole courthouse marble floor when they fall out.
Actually, there's a nice teachable observation here about one reason why people can swing to believing in acupuncture and TCM...
I spent many years in martial arts and I've watched people interact with some of these concepts (and I know from personal experience how appealing the notion can be). Part of why acupuncture points are selected as they are is because they are also martial arts target points. Chinese martial arts and TCM healing 'arts' labor under the notion that targets used to hurt can also be used to heal. It is not uncommon in folk stories that highly skilled martial artists doubled as healers because they could apply their skills in both ways, supposedly.
Take LI4, for instance. There's a practical, empirical experiment that can be done here. As diagrammed in the picture above, you can find the pressure point application: just pinch the webbing between your thumb and first finger at the point in the picture and gently dig in. You pinch across the webbing from the inside of the palm and from the back so that you dig through the webbing with one finger in the pinch bearing directly down on the point through the meat of your hand. When you find the delicate spot that hurts sharply, you've hit LI4. Digging in to that can hurt a lot! You can use this point in a hand shake to drop someone to their knees.
Seeing this done by someone who knows how to apply it is a powerful agent for opening someone's mind to the notion that pressure points are a real thing. There are a lot of other ways to manipulate the human body that cause similar pain... like the funny bone, for instance. Where this swings toward woo is that people who see pressure points used are lead easily to believe that these points can be manipulated in other ways, like by needles with the intent to heal. I'm not kidding when I say that you can take acupuncture maps and use them to probe around and find these sensitive spots. The practical, hands-on that goes with this sort of an exercise can be very convincing to a lot of people. I've been around people in martial arts who swallow the whole thing: they see the pressure point application and the philosophical dualism that hurting and healing are two sides of the same coin is very appealing.
To be clear, I'm not suggesting acupuncture works. I'm saying that there is a good reason why many people are lead to believe it works. I've watched people fall all the way in, Reiki and the whole voodoo energy healing smack, and even had a time where I wondered myself if there wasn't something to this acupuncture thing... largely based on this experience. I've discovered more than a few masters and students of Chinese martial arts who moonlight as TCM quacks in large part because they can't really accept one thing without swallowing a huge dose of the other.
viggen@22: But here is a key difference between martial arts and acupuncture: There is observational evidence, as well as prior plausibility in some cases (as you note with the LI4 point), that hitting your opponent in these places is likely to cause your opponent to fall. The assumption that these same points have healing properties is simply magical thinking. There is absolutely no reason to believe the latter even if you believe the former.
In other news, today the BBC News website has a feature story on the "medical" practice of one of our old "friends", Robert O. Young. This story puts a face to one of Young's victims, Capt. Naima Houder-Mohammed of the British Army, who sought out treatment options when her breast cancer recurred in 2012, and unfortunately, found Young. Young took this young woman and her family for more than $77k, and the story includes a screen capture of an e-mail Young sent her demanding that she wire the money for her "treatment" before getting on the plane. The "treatment" turned out to be intravenous sodium bicarbonate--basically baking soda. Of course the treatment failed, and Capt. Houder-Mohammed returned to the UK to die with her family. She was 27.
There is apparently no change to Young's legal status since Orac last posted about the case: Young has been convicted on two counts of practicing medicine without a license, but has apparently not been sentenced yet: he "now faces up to three years in prison."
Following a manual, the acupuncturists were able to choose one point, or any combination of Sifeng, LI4 and ST36, depending on the infant’s symptoms, as reported in the diary. A maximum of five insertions were allowed per treatment.
Was hoping to save up my outrage for tomorrow.. Alas, it is not to be. Just gross and wrong on so many levels.
@Eric Lund: let me point out that viggen isn't defending the magical thinking. He's simply trying to explain why people buy into it.
I've also been involved in the martial arts for many, many years. I've observed the exact same kind of thinking he described. He's right about the pressure point at L14. I was taught that exact same pressure point in hapkido.
Yes, it's magical thinking. We know that people look for patterns. This is one of them. I think a takeaway is if we can figure out how to recognize the patterns that lead to magical thinking, we have a tool for helping people break out of that mold.
@Eric Lund #24: Young has been convicted on two counts of practicing medicine without a license, but has apparently not been sentenced yet: he “now faces up to three years in prison.”
I was just reading the report at BBC's website myself. Undoubtedly, Young will also have to face the wrath of more than a few from the fraternity of Sandhurst.
@Gilbert: No, I know what they're talking about, I think--you drape the baby over your arm, support it with your other hand, and rock it back and forth, or else gently joggle the baby. It is a very effective baby-soothing move, and you certainly aren't shaking the baby a la shaken baby syndrome.
In other news:
As a Congressman, Tom Price invested in stocks for pharmas and medical device companies and then introduced legislation that would benefit those companies. One of the pharma start-ups gave him a sweetheart early buy-in deal not available to the general public. He's claiming his broker bought the medical device stock w/o his knowledge. So, what, he doesn't get emails about transactions on his account? Yup, the perfect pick for HHS.
Betsy DeVos thinks states should decide whether or how to implement the Individuals with Disabilities Education Act, despite the fact it's a federal law. The charter school expansion she spearheaded in Michigan has already resulted in greatly reduced availability of services for kids with disabilities. She also stated opposition to the idea of a gun ban in schools "citing one school [in Wyoming] that needs one to protect against grizzly bears."
EPA nominee Scott Pruitt isn't just a climate-change denier, as AG of Oklahoma he sued the EPA 13 times. Six of these cases remain outstanding, but he told the Senate yesterday he would not recuse himself from those cases if confirmed, thus making him both plaintif and defendant.
And in a non-medical-or-science bit of post-Truth news, our old buddy Ben Swann "aired a six-minute 'investigation' into Pizzagate" on CBS46 Atlanta Tuesday night. (Don't blame CBS, channel 46 is just an affiliate, not an O and O, and the network has no say in affiliate's news programming.) Swann apparently still has ties to Russia Today, the Putin English language propaganda channel where he worked between 2013 and 2015, and his Truth in Media web outfit has the same phone number as the Republican Liberty Caucus of South Carolina, having announced a partnership with the national RLC in 2013. That year, Swann "was a featured guest at the Republican Liberty Caucus national convention alongside Ted Cruz, Reince Priebus, and Rand Paul." Observant readers will note that was just around the time he began working for Russia Today.
[tongue mostly in cheek, but still...] Do we know where Putin stands on vaccines? Could both Ben and the Donald be getting their anti-vaxer cues from the Kremlin? Well maybe the new administration will make an exception to the 'health freedom' free-for-all and put a damper on TCM just to PO Beijing.
Wow, just f-ing wow.
First, the "study" is the very picture of fouling child abuse.
Second, beriberi, f-ing, nest fouling seriously?!
While openly considering using the majority of a box of acupuncture needles to load a blunderbuss, using rock salt for packing, I've considered how many nutritional diseases are "cured" by acupuncture and consider how many likely died of tetanus instead.
Fortunately, I've never felt the inclination of possessing, handling, purchasing, or even touching a blunderbuss.
But, I'd happily give the acupuncturists involved, along with any medical professional stupid enough to participate in the study a cookie. Here, let me reach into the cat box and retrieve it.
Sixteen pregnancies, one ectopic pregnancy that was aborted against a Roman Catholic hospital's policy (I was away on maneuvers with the military and couldn't give my consent (why that was needed is beyond this cradle catholic)) and only two live births makes us a lot overprotective of children.
One baby with colic and two grandchildren, who this grizzled veteran was the only one who could soothe them with colic (one was eventually diagnosed with reflux, which passed when the child was able to sit upright).
My magical cure: Hold the child facing forward, cradled with my arm along the chest, through the thighs, supporting the buttocks with the hand, the opposing hand supporting the first hand. That splinted the abdomen and lower thorax, giving support and apparently soothing whatever was hurting and the view distracted the infant.
Which was fine with me, I always did love to hold and play with babies and children.
Oh, kids never win a funny face making contest with me. I have a naturally funnier looking face.
Well, off to check on dinner. I'm making a chicken, marinaded in a spiced yogurt sauce, "Chinese stir fry vegetables", boiled in my own spiced sauce and potatoes (I don't do rice often, I'm hungry 20 minutes after I eat it).
Ahhh, looking promising!
To the people talking about laser therapy for dogs, there are many things called "laser therapy". The one you are probably referring too is low level laser therapy (or LLLP, or cold laser therapy), and it is quite quacky.
The use and marketing of this therapy greatly outpaces what might be supported by the LLLP literature, which suffers from basically the same problems as acupuncture and other alternative medicine interventions (small study sizes, risk of bias, no plausibility, etc).
Barret has talked about it a couple of times on Quackwatch, and concluded this is probably just a very fancy way of locally heating the skin, which some people do find soothing.
Is it too early for a food tangent? I'm making kulebyaka, a Russian dish which involves salmon, chopped hard boiled eggs, mushrooms, rice, and (sorry Narad) dill.
On topic: I noticed that Orac changed the title of the article to focus on the tortured infants rather than the sleepless parents. Good editorial choice.
Oh, for an edit function. The salmon mess goes into a puff pastry crust...
On ne protiv. (He's not against them.) I'm pretty sure the anti vax stupidity originates solely with Trump. Though he arguably takes the Kremlin line on many other issues...
I so want to blame Putin for everything ;-).
He must want to weaken America by creating a measles epidemic, then... [/joke]
I suspect (though it may be wishful thinking on my part) that in private moments Putin is thinking: Bozhemoi, what have I done? His plan was to weaken the US by casting doubt on President Hillary Clinton's legitimacy, but that plan has Gone Horribly Right with Trump actually winning. Which means Putin has to work that much harder to keep Trump on the reservation, because Trump is a loose cannon with nuclear weapons who has expressed displeasure at the fact that Russia has about 7300 warheads while the US "only" has 7100. And Putin has to worry about how much other intelligence agencies know about the kompromat his spooks have on Trump, and when those other agencies will leak what they know.
Some of that material has already been leaked, resulting among other things in the following joke:
Q. What is the difference between a garbanzo bean and a chick pea?
A. Donald Trump has never had a garbanzo bean on him.
(Thank you. I'll be here all week. Remember to tip your server.)
Well, we're about to have our very own Putin on a golden throne whom you can blame for everything. See Masha Gessen on the Samantha Bee Show.
(I actually got to meet Masha once over a lunch at UM. Her brother and my advisor also go way back...)
I do realize that you might have been semi-joking when you asked about Putin's stand on vaccines, but there is some fake news out there about how Putin claimed that America was dumbing down its citizenry with GMOs and vaccines. Very odd.
Butter, I hope. I seem to have accidentally invented some sort of cauliflower porridge in bright green oil tonight, but the flavors showed promise.
But of course.
Grapeseed? We used to use it when I lived in a "commune" in Portland, and I seem to remember that it had a distinct almost neon green hue.
But OF COURSE acupuncture works for baby colic. The baby quickly learns that when she cries too much, somebody comes along and sticks a big hurty needle in her - no more crying!
very effective baby-soothing move
The only thing that worked for Delphinette during the "purple crying" phase was for one of us to put her in her car seat and drive around.
My husband was doing this in the middle of the night one time and when you get to a stoplight, you can't stop the motion of the car, otherwise, your little treasure awakens. So he'd come to a stop, but rock the car, gently. Brakes, no brakes, brakes, no brakes, until the light changed to green.
A police officer pulled alongside him, motioned him to pull over, and declined to give him a ticket for stunt driving when he heard my husband's explanation for his 3 AM driving skills. On your way, Sleepless Dad. Be careful.
i wouldn't worry about this bit of 'research'. Acupuncture is from China so TrumPutin ain't havin' it. And you know both the Donald and the Vlad had to have been very collicky babies, since they're collicky old cocks now, so they won't be supporting anything to Calm the Crying in the next four years.
@Delphine: I should have said, "effective for our kids, sometimes." That phase is tough. I have a month-old baby now, and so far he doesn't seem to cry too much. Kid 1 was mildly colicky, and we walked the halls carrying her in a baby wrap quite a lot.
No, oil that separated from coconut milk. I should have foreseen this event, but I was tinkering with a recipe to try to avoid buying stuff that I wasn't going to use again for a coon's age. It was supposed to be a paste masala.
Same old same old, Acupuncture doesn't work so we have to keep testing it.
One point re blinding, there were two acupuncture groups and one control. If the parents knew that 2/3 of babies were in acupuncture groups vs 1/3 non-abused, wouldn't most tend to guess their child had been needled? Basic probability would dictate that all parents would predict their offspring were in an acupuncture group, but of course most people don't really get maths.
Possibly. But that's not so much how people think. I concede that probably more than 50% would guess their children had been needled, but I also don't think it would rise to 67% (i.e., two-thirds). Also, I don't think that accounts for how few parents in the control group thought their children had been needled whether your criteria for random chance is half or one-third. Also, the point is that, if parents really couldn't tell whether their child had been in an acupuncture or control group, their answers come down to guesses, and should thus break 50-50 to yes or no.
Group C is a little bit less than a 2 sigma outlier, if my head is working correctly at the moment.
@Narad: Each group had 49 patients, at least initially. The square root of 49 is 7. Which makes the 2σ range run from 22 to 78 percent, assuming that nominally 50 percent of parents should have guessed that their kid was in the control group. Still, that's enough to raise issues with the blinding. If the expected fraction was closer to 33%, as Prog John plausibly (but not necessarily correctly) argues, the 2σ range becomes 5 to 61 percent, which does not overlap the 71 to 79 percent range quoted. (Aside: why are they quoting a range here? The parent either guessed, or didn't guess, that their kid was in the control group, so they should know the exact percentage.)
I didn't mean to suggest otherwise. That's practically an absorption line, if you get my drift.
JP: there is some fake news out there about how Putin claimed that America was dumbing down its citizenry with GMOs and vaccines.
Some troll "Imaskeptic" copy-pasted it into a previous thread:
Whoever made it up in the first place had cleverly attributed it to Putin, knowing how much this would appeal to the Putin-loving boot-licking subset of antivaxxer:
"When your children are barely human, psychologically-altered bots, their nerve cells and synapses failing to connect, and their neurodevelopmental processes dulled to the point of restricting them to sub-human level repetitive grunts and gormless stares, what are you going to do then?"
Vote for them.
Just more of your usual demand that science be suppressed to serve scientism:
1. Spout a lot about how Ancient, Prescientific (non-white-invented) interventions cannot possibly work just because they are Prescientific and Ancient, so no point in looking at the research.
2. Decree that we must automatically reject results of a study because parents of more control-group infants guessed their kids were probably in the control group. Of course, that is what you would expect to see if in fact the control group were not improving as fast, no matter what the intervention was.
3. Decree that the babies were "tortured" even though it was reported that most did not cry during treatment.
4. Decree that there isn't and can never be enough evidence to justify a human trial of an intervention you dislike - even a bunch of other human trials, which will be decreed to be negative even when they report positive results.
Why do you hate Trump so much? You perfectly share his attitude towards consensus reality: "it is what I want it to be."
Jane: Acupuncture in it's current form owes a lot more to Chairman Mao than 'ancient wisdom.'
Secondly, you don't even acknowledge reality.
Jane@52: Whatever prior plausibility acupuncture may have had evaporated when studies showed that not only does it not matter where you stick the needles in, it doesn't even matter whether you stick the needles in. That's what Orac means by a "theatrical placebo". And that's why this study was unethical: it was a test of a proposed treatment that has no prior plausibility.
I'll repeat this, even though I suspect you will willfully fail to understand: Although acupuncture is not implausible on its face the way some other forms of woo (such as homeopathy or reiki) are, it has actually been shown in clinical trials not to work. Before these trials were conducted it was possible to believe there was some (as yet unknown) mechanism by which acupuncture might work, but there is no need to invoke a causal explanation when the placebo effect suffices.
1. Spout a lot about how Ancient, Prescientific (non-white-invented) interventions cannot possibly work just because they are Prescientific and Ancient, so no point in looking at the research.
I have a vague suspicion that Orac sometimes spouts a lot about recent, white-invented interventions (e.g. homeopathy), so the implication that he targets particular races or historical epochs is noncupatory.
Delphine @41: My brother was the complete opposite. Put him in the car seat = turn on the screaming. Take him out? Blessed quiet. The only time he didn't scream in the car seat was the time he had meningitis.
It was not a trait to endear oneself to older siblings.
of cousre I agree that the paper is nonsense.
I'm surprised by the statement that you disagree with me when I said "“no correction has been used for multiple comparisons” ". That's the jelly bean problem, and what sort of ANOVA is used has nothing to do with that probelm. A bit more explanation at http://www.dcscience.net/2017/01/20/if-your-baby-is-crying-what-do-you-…
Leaving aside the Not Ancient part of acupuncture, I can't help but note that I don't recall Jane ever pitching one of her trademark hit-and-run fits over auricular acupuncture, which is as White as Crab Rangoon. Where's the outrage over this appropriation of Culture?
Speaking of Culture:
"Probiotics to prevent infantile colic"
The global scientific community has yet to produce a single paper about microbial regulation of immune response to vaccination leading to adverse reaction.
Let's not forget medical skeptics' favorite example on prescientific medicine : bloodletting and the theory of humors, whose creators were AFAIK quite white.
Also, it's less about something that cannot work because it is ancient, and more about something that doesn't necessarily work because it is ancient, thus the need to check. And I have seen Orac and colleagues at the other blog look at the research.
Babies magic tea is an organic herbal home remedy to prevent baby colic. I've used this tea for both my babies and settled their colic.