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Acupuncture appears to show results.

I reckon the real reason so much crap research is performed is to fill the pages of medical journals.

If standards were tightened up, many would be reduced to the size of a small pamphlet issued once a year.
 
fls said:
Generally, the opportunities and the ability go hand in hand.
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I hope that is true, but then how come we are dissecting nearly every study we see here and finding flaws. Are we looking at a skewed sample on this forum?

fls said:
And I think the evidence-based medicine movement has helped in that it gives the average reader the skills to recognize poor study design.
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Yes, that has been a good step forward for "the average reader", but what about the average member of the public? All they hear is that acupuncture works and off they go.

fls said:
And this study was published in Headache and not the New England Journal of Medicine, which allows for it to have the impact it deserves.
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Meaning very little. But the public, and maybe even "the average reader" doesn't know that. A study is a study to them and they are unlikely to know in which journal it was published let alone where it stands in the hierachy.

fls said:
- at least we have a way to give a lower consideration to lower quality research. It is published in low impact venues, it fails tests that lead to it even being read (more on that below), and if read it fails tests that would lead to its adoption.
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It is good that the medical profession in general is able to determine what is good and what is flawed research. Except for the fringe dwellers amongst them. A doctor who gives lectures at CME events and who lists "homoeopath" as one of her qualifications, is likely to use any study at all that comes her way that supports what she does and impart this as facts to her audience.

fls said:
It definitely gives you useful information. It tells you whether it is worth your while to consider going through the details of the original report. It may give you enough information to reject the study outright as unlikely to give valid results.
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I am happy to say that, as a result of reading the posts of certain posters on this forum, I have acquired some fledgling skills in this regard myself :).
But what I meant was that I would prefer that the conclusions contained in these abstracts were reliable on their face - that I wouldn't have to read so many abstracts that I would have to reject outright, and that I would not have to read through the details of so many original reports in order to determine whether the information contained in the abstracts was reliable.
In other words, life is short.

fls said:
For example, the screening questions for a therapy study are "was the assignment of patients to treatments randomized" and "were all of the patients who entered the trial properly accounted for and attributed at its conclusion". One could decide, based on failing the second question, that this study was unlikely to give valid results and simply pass on it. However, it might not get you off the hook in those situations we often have at the JREF forums, where someone prefers to consider the study potentially valid anyway.
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Yes, exactly. And the wider public who are their audience.
I suppose we have to hope that a certain individual on this forum, who goes purely on the strength of an author's perceived reputation, does not have a wide audience. However, seeing that that certain individual is known to work for a big pharmaceutical company, that is probably too much to hope for.
 
Phytotherapist said:
Rolfe - I said before that if you are more qualified in the medical and pharmacological field than Prof Facco I would invite you for a free holiday in Italy. I'm so convinced you're not that I'm offering you 100,000£ (or even more) if you could prove you're more qualified than Prof Facco in the field of medical science.
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Wow! Where do I start?

This is now outstripping even Malcolm Kirkman, who announced that he would give £1,000 to the charity of the finder's choice, if anyone could produce a report of George Bush ever having visited a primary school after becoming President and before 11th September 2001. When this offer was immediately followed by a deluge of press reports, with photos, of a quite startling number of such visits (I began to suspect that said POTUS was more comfortable surrounded by people of his own intellectual compass), Malcolm simply said no, he wouldn't cough up.

I know the pound is falling against the Euro, but I didn't think it had got that bad. A holiday in Italy now costs £100,000? No wonder the press is reporting increased numbers of people planning to holiday at home this year!

Phytotherapist, would you kindly stop moving the goal posts? I'm getting whiplash.

Your original assertion, which is what I have been challenging all along, was as follows (my bold).

Phytotherapist said:
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.
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Right, not just Prof. Facco, but "all the people involved in the research". You've checked all their qualifications carefully. But you haven't chosen to share your findings with us. Nevertheless, you assert grandly that they (ALL of them, remember), are "certainly more qualified than ANY member of this Forum."

This isn't about me. It's about everybody here. You've said that you know, for CERTAIN, that there is no member of this forum who is more (or even equally well) qualified than any of the people involved in the research you're talking about.

This is all you've offered to back up your assertion.

Phytotherapist said:
Prof. Enrico Sacco [sic] 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.
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This is meaningless. I don't know what status the title "Professor" has in Italy. In Britain it denotes a senior academic, while in the USA pretty much anyone who teaches undergraduates is some sort of "professor". I also don't entirely relate to the "top marks" thing - it sounds like the sort of thing the MAS collective come out with. Are university exam results made public in Italy right down to publishing the actual marks? This would be very unusual. What is "top marks"? He got 100% is every paper he sat? I don't think so. He had the highest marks of his year in every paper he sat? Really? How do you know? (And in what way would that be relevant, as undergraduate exam marks aren't really relevant to post-graduate attainment.) Now you don't get "marks" for many higher degrees, in particular the PhD. Though I suppose you might do for Masters degrees or speciality boards. So what exactly are you talking about?

Really, you've told us nothing about Prof. Facco except that he teaches at a university. Heck, I've done that. "One of the best 6 UK veterinary schools" (Royal Veterinary College, University of London), no less. For over six years. I've also taught veterinary medicine at Cambridge university, on a temporary contract. I'm currently teaching (non-veterinary) undergraduates as a minor off-shoot of my current clinical post.

What about his academic awards? His medical degree, and his post-graduate qualifications? How about sharing those?

In a spirit of general openness, I'll record that I have two "first" degrees, one in veterinary medicine (BVMS, in 1976) and one in pure biochemistry (BSc, in 1978). Sadly, I have to report that the latter was only an upper second class honours however, and one person in the class got a First, so it wasn't "top marks". I have also a PhD (graduated in 1986) which was carried out jointly between the departments of veterinary clinical biochemistry and veterinary pharmacology. As I said, this doesn't come with marks, but I would point out that I was awarded the degree with the requirement for an oral examination being waived on the basis that the external examiner declared mine was one of the best theses he had ever seen. I have also been awarded a Fellowship of the Institute of Biology, and the designation "Chartered Biologist". That's without going into the years of experience in my subject, the years of university teaching and the text-books I have published.

Now I fully accept that Prof Falco may well be able to trump this, if you ever get round to telling us his academic qualifications.

However, that's not what you claimed. You claimed that "all the people involved in this research" are "certainly" more qualified than "any member of this forum".

So, is every single person involved in this research more qualified than I am, based on what I have just told you?

Is every single member of the JREF Forum less well qualified than Prof Falco?

Actually, you said that every single member of the JREF Forum is less well qualified than every single person involved in this research.

You're nowhere near to substantiating this claim, and I suggest you withdraw it.

Rolfe.
 
Phytotherapist said:
Rolfe - I said before that if you are more qualified in the medical and pharmacological field than Prof Facco I would invite you for a free holiday in Italy. I'm so convinced you're not that I'm offering you 100,000£ (or even more) if you could prove you're more qualified than Prof Facco in the field of medical science.
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Out of interest, can you point us to a source that gives Prof Facco's qualifications?
And can you explain what you mean when you say "qualified in the field of medical science"?
 
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Just for reference, here are some of Prof. Facco's published papers from BioInfoBank (Pubmed returns the same papers):

ETA: Wait one.

here it is

http://lib.bioinfo.pl/auid:1914506

ETA II: I couldn't find a page of his on the Padova University website, but then my Italian is not so well.
 
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BillyJoe said:
I hope that is true, but then how come we are dissecting nearly every study we see here and finding flaws. Are we looking at a skewed sample on this forum?

...snip...
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Because excellence in any field is always the exception and not the rule and that's simply because excellence is very hard to achieve and that holds whether we write a book or we are doing research.

Fortunately we can be much more objective about what is good, bad, excellent or just plain old OK research than we can about the next Booker Prize winner!
 
A person's qualifications are irrelevant in this case. The acupuncture research was flawed, Full Stop
 
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BillyJoe said:
I hope that is true, but then how come we are dissecting nearly every study we see here and finding flaws. Are we looking at a skewed sample on this forum?
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We are looking at a highly skewed sample.

Many times these studies are chosen specifically because they are not generally accepted by mainstream medicine - they are provided as support for DIM, they represent something newsworthy from a lay perspective, they are reporting on something truly cutting edge, someone wishes to give the appearance of controversy, etc. This makes them more likely to have significant flaws (that research supporting DIM has those characteristics that increase the likelihood of invalid results is essentially a tautology) and makes it more likely for someone (either the authors, the DIM supporter or the reporter) to attempt to draw conclusions that are not supported by the data from the research.

Yes, that has been a good step forward for "the average reader", but what about the average member of the public? All they hear is that acupuncture works and off they go.
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Well, this goes to the root of the problem, which is the attitude that the average person can and should 'figure this out for themselves'.

Meaning very little. But the public, and maybe even "the average reader" doesn't know that. A study is a study to them and they are unlikely to know in which journal it was published let alone where it stands in the hierachy.
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And their unconcern is when I would feel my ignorance most acutely - when I don't even know that I don't know something (ummm...that probably doesn't make sense).

I am happy to say that, as a result of reading the posts of certain posters on this forum, I have acquired some fledgling skills in this regard myself :).
But what I meant was that I would prefer that the conclusions contained in these abstracts were reliable on their face - that I wouldn't have to read so many abstracts that I would have to reject outright, and that I would not have to read through the details of so many original reports in order to determine whether the information contained in the abstracts was reliable.
In other words, life is short.
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I agree that it would be nice, but c'est la vie.

There are specific strategies you can use to be more efficient. The screening questions I mentioned earlier are part of a larger strategy on how to stay up-to-date. But, why are you reading abstracts in the first place?

Yes, exactly. And the wider public who are their audience.
I suppose we have to hope that a certain individual on this forum, who goes purely on the strength of an author's perceived reputation, does not have a wide audience. However, seeing that that certain individual is known to work for a big pharmaceutical company, that is probably too much to hope for.
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He did not answer, but I wonder if he is unusual or whether the culture of evidence-based medicine has yet to permeate Italy.

Linda
 
Normal Dude said:
Just for reference, here are some of Prof. Facco's published papers from BioInfoBank (Pubmed returns the same papers):

ETA: Wait one.

here it is

http://lib.bioinfo.pl/auid:1914506

ETA II: I couldn't find a page of his on the Padova University website, but then my Italian is not so well.
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The rest of the papers with his name on them seem to be perfectly ordinary, mainstream medical publications. Of course one has to watch the "with his name on them", because sometimes authors are added for relatively peripheral contributions (such as the anaesthetist who kept the patient asleep while the work was being done :D ), but he is the first author on a couple which look like normal scholarship.

But, as Deetee said, publications are not qualifications. It was his qualifications Phytotherapist was so impressed by, but so far he has failed to share these with us.

To say, this guy's other papers look perfectly rational and he seems to have decent medical qualifications, isn't an unreasonable remark. It's a relevant observation, even though, as JJM notes, it doesn't take away from the fact that the acupuncture study was poorly designed.

However, Phytotherapist was indulging in a perfectly outrageous piece of argument from authority. He not only declared that Prof. Facco's qualifications were outstanding (without actually telling us what they were), he declared that they (and indeed the qualifications of everyone involved in the research, possibly even including the lab technicians) were superior to the qualifications of every single member of this forum. Thus, he declared, he was prepared to accept any conclusions this genius might publish at face value, no matter what criticisms the dunces on the forum might advance.

JJM is quite right. Facco's qualifications are irrelevant to any judgement of this individual paper, even if they might colour our initial approach to it. Phytotherapist is behaving in exactly the same way as Dana Ullman and the other homoeopaths behaved about Rustum Roy's spectroscopy - never mind the glaring errors in the publication, the man once had a paper published in Nature so everything he writes must be gospel truth!

I'd just like Phytotherapist to acknowledge that in fact he has no idea at all of the qualifications of most of the members of this forum, and that his claim about the superior qualifications of the people involved in the acupuncture paper is therefore groundless. And then, and more importantly, to acknowledge that any piece of published work stands or falls on its own merits, irrespective of the name or names at the top.

Then, normal service might be resumed on this thread.

Rolfe.
 
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Rolfe said:
The rest of the papers with his name on them seem to be perfectly ordinary, mainstream medical publications. Of course one has to watch the "with his name on them", because sometimes authors are added for relatively peripheral contributions (such as the anaesthetist who kept the patient asleep while the work was being done :D ), but he is the first author on a couple which look like normal scholarship.

But, as Deetee said, publications are not qualifications. It was his qualifications Phytotherapist was so impressed by, but so far he has failed to share these with us.

... snip ...

And then, and more importantly, to acknowledge that any piece of published work stands or falls on its own merits, irrespective of the name or names at the top.

Then, normal service might be resumed on this thread.

Rolfe.
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You will get no argument from me. :D Post 152 accurately describes my position.
 
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Linda - I contacted the author of course. I know what you mean for "blinded". Could you repeat in your own words what you exactly mean for blinded? Then I'll give you the author's aswer in English.

Jeff Corey - Your Italian is perfect. Would you mind translating it in English (you know my English is bad)? If you wish I can help you becoming the Italian Cultural Attaché in New York. You are fully qualified for that job.

I'll answer to other questions next time because I'm going to watch a football (soccer) game.
Rolfe - By the way, Capello is the English team manager earning millions and his English is not that perfect. As you can see only proper qualifications are really important in all fields of life.
 
Rolfe - one more thing: why should I share his qualifications with people that insults me? You are so intelligent so find it by yourself!
 
Phytotherapist said:
Rolfe - one more thing: why should I share his qualifications with people that insults me? You are so intelligent so find it by yourself!
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P: "My Dad's bigger than your Dad!"
R: "How do you know, you've never even seen my Dad."
P: "Well, I just know my Dad is bigger. So big in fact that if he isn't bigger than yours I'll give you all my sweeties"
R: "OK then, so how big is your Dad?"
P: "Nah nah nee nah nah - I'm not going to tell you! If you are so clever you can find out yourself!"
P stomps off into the corner, sucking his thumb.
 
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Phytotherapist said:
Linda - I contacted the author of course. I know what you mean for "blinded". Could you repeat in your own words what you exactly mean for blinded? Then I'll give you the author's aswer in English.
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Blinding refers to knowledge.

The practitioners providing the acupuncture treatments knew whether they were giving TA, RMA or SMA (per the abbreviations used in the paper). That is, they were not 'blind' as to which treatment they were providing when interacting with the patients.

The participants in each group were treated differently, making it possible for the participants to identify which group they belonged to. The TA and RMA groups were both exposed to the TCM approach. And the RMA and SMA groups received their treatments through small foam cylinders.

As I mentioned in my first post, we expect to see improvement in the perception of pain based on the expectation of relief, even if acupuncture otherwise has no specific effect whatsoever. And we also know that those people who think they are getting true acupuncture will have greater expectation of relief than those people who think they are getting sham acupuncture. The small differences between the groups are exactly what we'd expect to see if acupuncture had no specific effect whatsoever and some people in the mock acupuncture groups had lower expectations due to recognizing that they were in the mock acupuncture group. No effort to overcome this major problem is described in the paper. A simple step that is often taken is to ask the participants what group they thought they were in. There is no indication that this important check was performed.

Since the results are exactly what we'd expect to see in the absence of blinding, if acupuncture had no specific effects, then it is not possible to use the results of this study to conclude that acupuncture has a specific effect if blinding was not present.

Linda
 
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