Acupuncture appears to show results.

[Jeff Corey]

As to the lack of blinding mentioned in the abstract, here's the MIDAS measure that was used. Lack of a true placebo and control for experimenter bias is a strong suspect.

 

[Jeff Corey]

Sorry, here's the MIDAS scale.

 

[Bjorn]

Prof. Enrico Sacco teaches Pharmacology and Anestesiology at Padua Medical School (Northern Italy) one of the 5 best Italian medical schools. His specialties are Anestesiology and Neurology and he completed all his studies with top marks.

I accept these results because I've carefully checked the qualifications of all the people involved in this research and they are certainly more qualified than any member of this Forum. Moreover, there are no economic interests behind this research.

What is this about Dr. Sacco being so serious and qualified that he can't possibly cheat?

According to this, he has been willing to put his name on some dubious research reports before:

Since no one had any hard evidence to back up their suspicions, Dr Roberts contacted the co-authors: Dr Kazuo Okuchi of Nara Medical University, Japan; Dr Giulio Minoja, the ICU director of a hospital in Varese, Italy; and Dr Enrico Facco at the University of Padua, Italy. None of them could confirm the studies' legitimacy, so they were removed from the Cochrane database in 2006, pending investigation.

Dr Roberts also contacted the publishing journals. At least one editor admitted to suspecting Dr Cruz had fabricated his data, but said his editorial board had decided to run the study anyway.
When pressed further, the co-authors insisted that high-dose mannitol does work and that Dr Cruz was an honest scientist.

However they admit to not having any knowledge of the dozens of patients Dr Cruz supposedly treated. "I think they're spineless, really. They need to accept that they share authorship of the disputed studies, which means they have a responsibility to verify whether the findings are true or not," says Dr Roberts. "If the data are true, defend them, and if they're false, retract them — but they're doing neither. They seem to want to keep their heads down and hope it blows over. It's completely ridiculous," he adds, frustrated.

B

 

[BillyJoe]

TA,

You invited comment on an abstract of a paper on the supposed beneficial effects of acupuncture on migraine.
The original paper is available but only if you are a subscriber or pay US$39. So, in effect, we do not have access to it.
Linda used her background and expertise in these matters to provide a comment on the lamentably limited information available.
You then used the very lack of information that you failed to provide, and admittedly were unable to provide, against her.

Bad hair day was being kind.


But the study is flawed even from a reading of the abstract.
If you think it is not, please answer the following questions:
- Why did they use three controls instead of just one control?
- Why did they not just compare True Acupuncture (using the correct acupoints for migraine) with Sham Acupuncture (using incorrect acupoints)?

Using four groups diluted the number in each group to just barely acceptable numbers. With the drop out rate, this reduced the numbers even further. Using just two groups would have doubled the number in each group making them more than just adequate and therefore the results would have been more reliable. Not using the correct Sham Acupuncture protocol beggars belief. Why would you do that?

I stop short of implying an ulterior motive on the part of the reseachers, but it well known that positive studies tend to be published and negative ones tend not to get published.


Linda's first post was mostly about the placebo effect and how to properly account for it in a clinical trial. She did not discount the placebo effect. Quite the contrary. And she did not exclude the value of the placebo effect in a therapeutic setting. But the effect of placebo must be eliminated in a clinical trial where the purpose is to discover if the therapeutic intervention itself is effective. And you reduce the effect of placebo by ensuring that the placebo effect is the same in both groups (study and control). The researchers did not achieve this goal with any of their three control groups. Therefore the placebo effect will almost inevitable vary between the study and three control groups and therefore it is possible that this alone was responsible for the observed difference between the groups.


In my opinion, this clinical trial is useless. In fact, less than useless.
It is useless because the controls were inadequate and hence the results unreliable in answering the question for which the trail was designed: Is acupuncture effective in the management of migraine?
It was less than useless because it will be used by proponents of acupuncture as proof that it works and lead unsuspecting individuals like...um...Igor ...to think that, hey, maybe it does work.

 

[Normal Dude]

I think people must have missed my last post. I have access to the full paper.

Blinding is not mentioned or alluded to anywhere in the paper, BTW.

 

[BillyJoe]

Care to post some relevant extracts?

 

[Jeff Corey]

Another problem that Linda pointed out was the dropouts. This is termed "subject attrition" or "differential mortality" and can confound studies where a large proportion of participants leave before completing the study, in this case about one third. They might leave the different groups for different reasons, thereby thwarting the control procedure of random assignment and exposing the study to the threat to internal validity termed "subject selection".
So thus far, the study seems flawed. I still need more information, but so far we have:
1. No controls for the placebo effect,
2. No control for experimenter bias.
3. Large subject attrition with the potential for negating the control procedure of random assignment.

 

[fls]

I don't think I've done any of it, but have dissected a couple of lengthy but non-informative posts which the author has admitted were made on the basis of not having even read the complete report.

On the other hand, during our prior discussion on that transplant case, you insisted that a couple of off-hand remarks in a newspaper article trumped all the information I obtained from the complete report.

As usual with this sort of thing, I start a thread to have a reasonably intelligent discussion on a subject. A poster posting same opinionated rubbish on every subject, sweeping it away with a bunch of unsupported generalisations doesn't cut the mustard, for me.

That doesn't sound like it could be correct. I may be no Skeptigirl, but most of the time I provide reference materials to support my statements - especially if asked. I'm the one who actually posted the link to the research article in this particular thread - a piece of information not even the OP bothered to dig up as relevant to a reasonably intelligent discussion. And other than attacking me, you haven't challenged any of the details of my criticisms. I am struggling to find any correspondence between your complaints and my behaviour, or between your stated attitudes and your own behaviour.

If you're able to point out any actual relevant comments made by Linda in her initial posts, go ahead, because she's still batting .000 from where I'm sitting.

Well, duh. You don't use a bat in Kickball.

Linda

 

[BillyJoe]

Like myself, TA is into Cricket.

I suppose I'm banned from that thread now.

 

[Normal Dude]

Care to post some relevant extracts?

I'll take another look at it later tonight, but I saw no mention of controls/measures to account for bias, and no mention of the problem at all in the discussion section. Which I thought to be rather odd, considering the authors spend a good deal of text addressing how many acupuncture studies are incorrectly constructed.

ETA: If anyone wants it send me a PM.

 

[The Atheist]

Going back to the OP, why do you think because it seems that he is a specialist in pain therapy the trial should be well controlled?

The reference you supplied makes no mention of blinding, an essential part of any trial involving subjective assessment.

It didn't appear as though he was pushing an agenda, being involved in at least one debunking.

TA,

You invited comment on an abstract of a paper on the supposed beneficial effects of acupuncture on migraine.
The original paper is available but only if you are a subscriber or pay US$39. So, in effect, we do not have access to it.
Linda used her background and expertise in these matters to provide a comment on the lamentably limited information available.
You then used the very lack of information that you failed to provide, and admittedly were unable to provide, against her.

Bad hair day was being kind.

Mate, like I said, you can see it how you like, but this is the third or fourth thread where she's exhibited identical behaviour - coming in and posting a large amount of nothing.

Why bother?

But the study is flawed even from a reading of the abstract.

Then it's fairly unfortunate that she didn't explore the errors, instead offering an opinionated piece which should have been entitled, "Why I don't like it being acupuncture."

Linda's first post was mostly about the placebo effect and how to properly account for it in a clinical trial. She did not discount the placebo effect.

I'm pleased to see that it's not just me who was confused by Linda's thoughts on placebo effects. The context of her comments both here and in another thread seem to discount the value of it. She's now claimed that's not the case. Fine, I'll buy that. It does, however, scare the crap out of me that someone so appallingly bad at communicating what she thinks, in her specialist field, is teaching doctors.

In my opinion, this clinical trial is useless. In fact, less than useless.

You're probably right, but I'd rather see someone actually cover the points rather than stomp in, in CFLarsen fashion and cast a load of generalisations about the place. Christ, the amount of text in the first post could have covered the subject admirably, but it didn't. I find that quite tedious when it's repeated several times in several different threads, and all are qualified, obliquely, by another blanket statement admitting that she actually doesn't know. I think that's quite a dishonest tactic.

Like myself, TA is into Cricket.

I suppose I'm banned from that thread now.

Nah - I'll just book you a session with Peter Roebuck!

 

[BillyJoe]

Mate, like I said, you can see it how you like, but this is the third or fourth thread where she's exhibited identical behaviour - coming in and posting a large amount of nothing.

That has not been my experience.

Then it's fairly unfortunate that she didn't explore the errors, instead offering an opinionated piece which should have been entitled, "Why I don't like it being acupuncture."

Her first post was all about the placebo effect and how it was not accounted for in this clinical trial. That was "the error". And then she explained how not accounting for the placebo effect is a fatal error. That was "exploring the error".

I'm pleased to see that it's not just me who was confused by Linda's thoughts on placebo effects. The context of her comments both here and in another thread seem to discount the value of it. She's now claimed that's not the case. Fine, I'll buy that. It does, however, scare the crap out of me that someone so appallingly bad at communicating what she thinks, in her specialist field, is teaching doctors.

I'm not sure that I would be boasting about support from Ivor

I have had that problem on the odd occasion, but then I have always blamed myself for my lack of background knowledge (well, except for that first occasion ). But ask and you shall receive.

Trying to give as accurate an explanation as possible risks been misunderstood by those with insufficient background. Trying to be understood by those with a scattering of knowledge on a subject risks saying things that are not actually exactly true.

On the other hand, I find her discussion of the placebo effect easy to understand and very helpful. I think those of you who are confused about what she has said on the subject must have taken "the effect of placebo must be eliminated from a clinical trial" to mean "throw out the placebo effect because it is not important" or something like that.

Christ, the amount of text in the first post could have covered the subject admirably, but it didn't. I find that quite tedious when it's repeated several times in several different threads,

But with all that text, and several repeats of the same, it seems you still did not understand her explanation of the placebo effect. Would even less words have fared better do you think?

and all are qualified, obliquely, by another blanket statement admitting that she actually doesn't know. I think that's quite a dishonest tactic.

Well, I think you need to pick up that mirror again, TA.

She has done nothing dishonest in this thread. She said, in that very first post, that she "doesn't know" what is in that inaccessible original report, but that there is something to be gleaned from that abstract that you provided for us to comment on. And, indeed there was and it was that the trial is fatally flawed.

Nah - I'll just book you a session with Peter Roebuck

Pete_r friggin' Rowback??? (Where are me gloves?)

 

[Jeff Corey]

Is there an echo in here?

 

[BillyJoe]

Is there an echo in here?

 

[The Atheist]

On the other hand, I find her discussion of the placebo effect easy to understand and very helpful. I think those of you who are confused about what she has said on the subject must have taken "the effect of placebo must be eliminated from a clinical trial" to mean "throw out the placebo effect because it is not important" or something like that.

Nope, that not what I was saying at all.

I raised the subject of placebo because I wasted a couple of pages discussing the same subject with her previously. If you go back to my original reply to her, I did say that it was a lovely [and unnecessary] explanation of the placebo effect.

But with all that text, and several repeats of the same, it seems you still did not understand her explanation of the placebo effect. Would even less words have fared better do you think?

Mate, that's just rubbish. I've just checked the posts in case I'd missed a couple, but I was right, Linda has hardly mentioned placebo has hardly mentioned, barring one answer to Ivor which I accept as her position. You're arhuing from what you think was said rather than what was.

Well, I think you need to pick up that mirror again, TA.

She has done nothing dishonest in this thread. She said, in that very first post, that she "doesn't know" what is in that inaccessible original report, but that there is something to be gleaned from that abstract that you provided for us to comment on. And, indeed there was and it was that the trial is fatally flawed.

Sure it was, and a couple of posters have been sensible enough to cover that off in a few short sentences. Given the alternative between making some sensible comments and assumptionm - and from a person who is in a position to know better - I would have far preferred to see the sensible option. Just doesn't seem possible. I even pointed out that she was probably right, but her case was poorly-presented and poorly-directed.

As Linda says in her sig - she doesn't care whether people agree with her or not.

Just as well.

 

[BillyJoe]

I raised the subject of placebo because I wasted a couple of pages discussing the same subject with her previously. If you go back to my original reply to her, I did say that it was a lovely [and unnecessary] explanation of the placebo effect.

Hmmm...maybe I misunderstood your intent then...

Originally Posted by The Atheist

Linda: When it comes to the placebo effect, our perception of relief is strongly related to our expectation.

Lovely explanation - thanks.

I thought I detected irony there. Sorry

Mate, that's just rubbish. I've just checked the posts in case I'd missed a couple, but I was right, Linda has hardly mentioned placebo, barring one answer to Ivor which I accept as her position. You're arhuing from what you think was said rather than what was.

Her whole first post has placebo effect written all over it!
(In the remaining posts she has been reduced to trying to defend that one)
Here is just the first paragraph:

Linda: When it comes to the placebo effect, our perception of relief is strongly related to our expectation.

If we think a particular treatment will make us feel better, it will tend to do so - this is the placebo effect. The greater our belief in the treatment, the better we will tend to feel - ie the greater the placebo effect.

Linda: And there's no getting around the fact that acupuncture is very good at setting up expectations. It's dramatic, mysterious and ritualized.

If a treatment is dramatic, ritualised and mysterious it will tend to have a powerful placebo effect. Acupuncture has these characteristics.

Linda: And as soon as you give some clues that expectations should be reduced (such as clues as to whether you are getting sham acupuncture), you see a corresponding reduction in the perception of relief.

As soon as the patient starts to realise that he is in the control group and not actually receiving true acupuncture, the powerful placebo effect of acupuncture will start to diminish.

Linda: The fewer clues you give that you may be receiving a sham treatment, the closer the results between the sham and the true acupuncture.

As long as the patient is unable to see any difference between the treatment he is getting and true acupuncture, the longer the placebo effect of true acupuncture will continue to be felt.

Linda: When you get to the point where you give no discernible clues (needles pierce the skin at non-acupoint places, the provider is blinded), the results are indistinguishable.

If the patient cannot discern any difference between true acupuncture and sham acupuncture (such as using different acupoints form those recommended for migraine), the placebo effect from both will be the same.

....and therefore the results will be indistinguishable, because acupuncture itself has no effect.
I get it now: you object to Linda's "assumption" that acupuncture is a useless treatment - or should I say that she has seen no evidence from numerous clinical trials of any convincing effect from acupuncture so that now she takes the view, until proven otherwise, that acupuncture has no effect.

Is that right?

Given the alternative between making some sensible comments and assumption - and from a person who is in a position to know better - I would have far preferred to see the sensible option. Just doesn't seem possible. I even pointed out that she was probably right, but her case was poorly-presented and poorly-directed.

Fair enough, that is your opinion, that it is an "assumption" that she has made

Perhaps, on the other hand, she has seen too many "beneficial effects" from acupuncture from too many poorly controlled trials, and zero effect whenever the control is optimal and the blinding double that, after a while, she has decided to make a call.

But, if you haven't reached that point yet, that is hardly Lind's fault.

Sure it was, and a couple of posters have been sensible enough to cover that off in a few short sentences.

I did as well, but I feel my efforts were below Linda's. Still, each to their own. If you want it short and simple....

As Linda says in her sig - she doesn't care whether people agree with her or not.

She didn't say she doesn't care. I don't think she wouldn't be teaching medical students and physicians if she didn't care.


regards,
BillyJoe

 

[The Atheist]

Her whole first post has placebo effect written all over it!

Er, that's what I said.

I was referring to this bit:

But with all that text, and several repeats of the same, it seems you still did not understand her explanation of the placebo effect.

I didn't see any more than a passing mention after the first post. I think we might be talking past each other - I thought you were saying she'd gone further than the first post.

If the patient cannot discern any difference between true acupuncture and sham acupuncture (such as using different acupoints form those recommended for migraine), the placebo effect from both will be the same.

I get it now: you object to Linda's "assumption" that acupuncture is a useless treatment - or should I say that she has seen no evidence from numerous clinical trials of any convincing effect from acupuncture so that now she takes the view, until proven otherwise, that acupuncture has no effect.

Is that right?

Not quite. The only assumption I can have a laugh at is Mary's. Regardless of the likelihood of it being JABS*, to assume that and write a thousand word post refuting it, seems downright counterproductive.

Fair enough, that is your opinion, that it is an "assumption" that she has made

See? You knew that.

Perhaps, on the other hand, she has seen too many "beneficial effects" from acupuncture from too many poorly controlled trials, and zero effect whenever the control is optimal and the blinding double that, after a while, she has decided to make a call.

Yet had she done that, I would have applauded the point.

If the post had consisted of, "I've seen several reports which started out making claims like the OP, but which have ultimately been all found to have used flawed methodology." it would have required a hell of a lot less words and made a lot more sense than what was posted.

Because I keep seeing this precise behaviour repeated in every discussion I've been involved in with her, I'll continue to call it.

Anyway, I've said my piece a couple of times now - the discussion stands and I'm fine with it.

*Just Another B******* Study.

 

[Ivor the Engineer]

Sorry for the confusion over Linda's POV, but when she comes out with snappy one-liners like this (now in DeeTee's sig. bolding mine):

"The entire practice of homeopathy can be substituted with the advice to "take two aspirins and call me in the morning." - Linda

it makes it hard to fathom what her opinion is on the placebo effect and its practical uses in medicine.

BTW BillyJoe, Linda's answer to my question can be interpreted in a number of ways. I'd ask for clarification, but based on past experience I don't think I'll bother.

 

[BillyJoe]

Well, posters must be allowed to approach a topic in whatever way they see fit. If the original paper had been available there would certainly have been a lot of scope to expand upon that first post, and to confirm or deny the impressions provided by the abstract .

Anyway, I am happy to leave it there.

....provided I get the last say.

 

[BillyJoe]

Sorry for the confusion over Linda's POV, but when she comes out with snappy one-liners like this (now in DeeTee's sig. bolding mine):

Originally Posted by fls
"The entire practice of homeopathy can be substituted with the advice to "take two aspirins and call me in the morning." - Linda

it makes it hard to fathom what her opinion is on the placebo effect and its practical uses in medicine.

I hope you are not saying that you support homoeopathy because of its placebo effect!

BTW BillyJoe, Linda's answer to my question can be interpreted in a number of ways. I'd ask for clarification, but based on past experience I don't think I'll bother

I wonder why my experience is different.