Acupuncture appears to show results.

[BillyJoe]

It is baffling. On the one hand, it is dismissed as meaningless, yet it means we accept the power of belief to actually alter symptoms of a disease. Or even to get rid of a disease.

My offer remains open, robinson.

 

[Skeptic Ginger]

It is not difficult to explain the brain body connection, robinson. If neural activity in the brain affects the release of neurotransmitters that then assist or inhibit the immune response, there really is no mystery there.

It also is understandable that hormones which evolved to help the body in times of stress could have additional detrimental side effects especially now that we are not usually stalked by predators.

 

[fls]

So what was not clear to me in this report was did they use the foam in the real study group and just insert the needles further than in the sham group or did they just use the foam in the sham group?

I still didn't get the impression the placebo control in this study was as good as it could have been.

From the response given by one of the authors, the foam was only used in the sham groups.

I agree that the placebo controls could have been better.

Linda

 

[robinson]

My offer remains open, robinson.

What offer?

 

[BillyJoe]

What offer?

My wife is a computer expert and she can fix your hard drive which is obviously faulty.

 

[BillyJoe]

Is anyone else experiencing problems posting on the forum?

For example on another thread I have two identical post posted ten minutes apart.
I didn't do it.

And my post above was edited apparently.
I didn't do that either.
(When I click on the "Edits: 1" in that post is says that the old version was my previous post responding to robinson)

Maybe I should send my wife to America to fix this server as well as fixing robinson's hard drive.

 

[robinson]

That was punishment for your ad hominum against my hard drive. Don't do it again.

 

[BillyJoe]

That was punishment for your ad hominum against my hard drive. Don't do it again.

That's robinson trying to pass the turing test.
F for Fail.

 

[Phytotherapist]

I was thinking whether to reply or not to the gentleman that is only concerned to attack me. I'm afraid that he will be disappointed that Chiropractic in Italy has not been recognized. For a profession in Italy to be recognized it needs to be statutory regulated. Chiropractic has no such status. The Italian Ministry of Finance introduced an amendment to the 2008 budget in which it allocated some money to the Italian NHS for the chiropractic treatment within the NHS (as the previous year) and recomended to the Ministry of Health the introduction of a register of Chiropractors. Of course the Ministry of Health will not do it because the Italian Supreme Court (Corte di Cassazione) sentenced that Chiropractic is a medical act and therefore only MDs are allowed to practice it. Therefore this act of the Ministry of Finance is anticonstitutional. On the other hand, Chiropractors are tolerated if they abstain from making diagnosis and prescribing a cure. Thus, there are about 300 Chiropractors with the D.C. title that actualy practice in Italy with an estimated 4,000,000 people visiting them. The average charge for the first treatment is 140 EUR for the first treatment and 70 Eur for subsequent treatments, and usually people get 10 treatments. This is one of the busiest and more rewarding professions. I have an American friend that got the biggest Volvo car from one of his clients (they are not patients according to our law). Obviosly the client's satisfaction is high. It never happened to me to get a car from a single patient.

I said that Chiropractic will never be accepted by the Italian Medical Schools (there are no schools of Chiropractic in Italy), whereas Phytotherapy and Acupuncure were accepted (Masters) although they are not considered specialties (e.g. Cardiology, Dermatology etc.). Prof. Ernst said "Herbal Medicine (he means Phytotherapy), for instance, can do good. If I was mildly depressed, I think St John's Wort would be a good treatment. It has fewer side-effects than Prozac. Acupuncture seems to work for some conditions and there are relaxing techiques including Hypnotherapy, that can be effective. They should not be used on their own, but as complements to standard medicines."

The gentleman that keeps insulting me, is not an MD or a specialist in any medical field and sentences that Acupuncture and Astrology are the same (ineffective). Do I have to trust the Italian top Medical Schools, Prof Ernst or Prof Facco, or someone that knows nothing and claims that the works are more important than qualifications? This because he is not qualified and I've never seen an unqualified person doing a good research work. The only thing he knows is to insult the person (me). This is why I didn't post a lot of material on Phytotherapy, already translated in English, which is not on internet. I think Prof Facco and I have more important things to do (we work on average 12-14 hours a day) than to get insulted.

I apologise to other members for this. If the insults stop then I may reconsider my position and convince the author to reply to all your doubts and questions.

 

[JJM]

I was thinking whether to reply or not to the gentleman that is only concerned to attack me. I'm afraid that he will be disappointed that Chiropractic in Italy has not been recognized. {snip}

I am not at all disappointed. I asked you if the American chiros are confused, and you say they are. That is good news.

As for your herbal claims- you say you would prefer St Johns Wort over Prozac; where is that data?

 

[Sherman Bay]

Use only two groups: active and control.

Inadequate. You are missing the most important group of all: the placebo control.

Without it, you don't know if the effects you observe are real or in the mind.

I haven't read all pages of this thread, so forgive me if someone has brought this up already, but I would like to recommend a book, Snake Oil Science, The Truth About Complementary and Alternative Medicine, by R. Barker Bausell.

It gives the most comprehensive and clear examination of the placebo effect I have ever seen in lay literature. Bausell says:

The placebo effect is real and is capable of exerting at least a temporary pain reduction effect. It occurs only in the presence of the belief that an intervention (or therapy) is capable of exerting this effect. This belief can be instilled through classical conditioning, or simply by the suggestion of a respected individual that this intervention (or therapy) can reduce pain.

So if you design a test for acupuncture, you must not only show that it is more effective than controls, but that it is more effective than a placebo. In other words, you must subtract the placebo effect from the observed effect to arrive at the true effect of the treatment.

 

[BillyJoe]

Sherman Bay,

I think your "placebo control" may be equivalent to my "control" group.

What I want the study to do is to determine if the particular set of acupuncture points recommended for a particular disease have any effect. So the placebo/control group of the trial should be treated identically in every way to the active group, except that a different set of acupuncture points (those recommended for a different disease) are used.

If it cannot be shown that a particular set of acupuncture points are any better than any other set of acupuncture points, then we are well on the way to showing that you may as well stick the needles in anywhere you like, thereby discrediting the concept of "meridians".


But my point was to use only two groups.
This is for two reasons. Firstly, only two groups are needed and, secondly, there are usually insufficient patients in most of the studies I have seen to have more than two groups, considering that you need at least 50 patients in each group to have any chance of getting a statistically significant effect.

regards,
BillyJoe

 

[Sherman Bay]

Billy Joe, I highly recommend you read the Bausell book (it's an easy read!). He gives examples of studies where only two groups were used: control and placebo. In a typical case, the placebo group showed a statistically significant effect over the control group.

But we know that both groups received the same active ingredient (none). Why the difference? The placebo group was under the impression that they were being treated, the control group was not. This is what's known as the placebo effect, and the best explanation we have come up with is that either the mind causes a true effect due to belief, or the mind thinks something good is happening. (There's some evidence for both theories.)

This is related to the Hawthorne Effect, also called the Experimenter Effect, where subjects, eager to please, tell the researcher what they think the researcher wants to hear.

These bogus results need to be subtracted or isolated from real effects (if any) before the test results have any validity. Since the placebo effect is very likely the only thing really happening in Alternative Medicine tests, we need to control for it more than ever. So the minimum number of groups would be 3.

 

[Jeff Corey]

... you need at least 50 patients in each group to have any chance of getting a statistically significant effect...

Not really, at least in behavioral science. In some cases n = 50 in each group will yield a statistically significant, but practically useless result. In a between groups design, it is felt that at least 10 subjects in a group are needed to demonstrate that a robust effect will yield statistical significance. With a weaker effect, maybe n = 20 in a group might be needed.
The ns do not always justify the means.

 

[BillyJoe]

Sherman Bay,

I am familiar with the placebo effect and the Hawthorn effect, but I think you need to describe for me the three groups you would use in a trial of the effects of acupuncture before I can reply any further.

Jeff Corey,

Okay, forget that bit. All I'm trying to do is maximise the number of patients in each group by using the least number of groups, because the more in each group the more reliable the result.

 

[Jeff Corey]

...This is related to the Hawthorne Effect, also called the Experimenter Effect, where subjects, eager to please, tell the researcher what they think the researcher wants to hear....

No. You are confusing three different problems in experimental design.
The Hawthorne effect had to do with changes in worker productivity allegedly due to changes in illumination. Others have pointed out how those seven studies were confounded by other variables. The common, but wrong, conclusion was that every time you change conditions, productivity increases.
That was different from the experimenter effect, also called the Rosenthal Effect, which showed that experimenters, or those who recorded the data, could be inaccurate because of preexisting information, biases, hypotheses or theories. Experimenters who do not believe in the Rosenthal effect have had difficulty in replicating his results.
The "eager to please" subjects come under a completely different category of demand characteristics, where subjects figure out what the experimenter expects and play along. Then there's the "Screw You Effect", where the undergrads forced to participate in experiments in Psych 1 figure out what not to do and do it.

 

[Soapy Sam]

Non-detailed poll on the subject of definitions:-
If I take a long, sterile, stainless steel needle, shove it into someone's heart and waggle it around, there is a fair chance it would be murder.

But would it be accupuncture?

 

[Sherman Bay]

Non-detailed poll on the subject of definitions:-
If I take a long, sterile, stainless steel needle, shove it into someone's heart and waggle it around, there is a fair chance it would be murder.

But would it be accupuncture?

No. Look up meridians, which have no relationship to actual body parts as known to modern medical science.

The Hawthorne effect had to do with changes in worker productivity allegedly due to changes in illumination. Others have pointed out how those seven studies were confounded by other variables. The common, but wrong, conclusion was that every time you change conditions, productivity increases.
That was different from the experimenter effect, also called the Rosenthal Effect, which showed that experimenters, or those who recorded the data, could be inaccurate because of preexisting information, biases, hypotheses or theories. Experimenters who do not believe in the Rosenthal effect have had difficulty in replicating his results.

From Bausell's book:

The Hawthorne Effect...soon came to represent a tendency for experimental participants to behave differently when they know they are on trial...trial participants not only behave differently but have a tendency to provide experimenters with what they think the experimenters want to hear.

Granted, the two effects are not identical, but just some of several effects that need to be controlled for.

As to the sample size, also from the same book,

Small clinical trials simply cannot be counted on to produce reliable results. And while there are differences of opinion regarding the optimal size of a clinical trial, the minimum acceptable number of participants for trials that do not involve rare diseases...is no less than fifty participants per group.

To answer Billy Joe's question about the 3 groups I propose (treated, non-treated controls, placebo controls), it is devilishly difficult to make an acupuncture trial unbiased without letting the participants know which group they are part of. Think of how easy it is for a drug trial, where all pills can look the same!

But I'll try. Remember that the placebo effect works only if the subject expects it to be effective, or believes he is truly receiving effective treatment, or at least thinks it's likely that he is receiving effective treatment. So one group receiving "sham" acupuncture could be told that they were receiving the real thing; another group told that their needle points were chosen to NOT be on meridians. That would require splitting into sub-groups, but I don't have a better idea at the moment.

 

[BillyJoe]

Sherman Bay,

Well then, tell me specifically what is wrong with using just the following two groups:
1) True Acupuncture.
2) Sham Acupuncture.
The groups are identical except that, in the Sham Acupuncture group, the wrong acupuncture points are used.

If you believe any other groups should be used, please explain why?

 

[fls]

No. Look up meridians, which have no relationship to actual body parts as known to modern medical science.

I agree, and that reinforces a point I (and others) made early in the thread. Sticking needles in to people is not the same as acupuncture. The study in question did not test acupuncture, but rather needling (for want of a better word. There aren't any studies that have shown that acupuncture is effective, although needling may be.

To answer Billy Joe's question about the 3 groups I propose (treated, non-treated controls, placebo controls), it is devilishly difficult to make an acupuncture trial unbiased without letting the participants know which group they are part of. Think of how easy it is for a drug trial, where all pills can look the same!

But I'll try. Remember that the placebo effect works only if the subject expects it to be effective, or believes he is truly receiving effective treatment, or at least thinks it's likely that he is receiving effective treatment. So one group receiving "sham" acupuncture could be told that they were receiving the real thing; another group told that their needle points were chosen to NOT be on meridians. That would require splitting into sub-groups, but I don't have a better idea at the moment.

I can't tell what you are trying to test with this proposed design. If all you want to test is acupuncture, then all you need are two groups - an acupuncture group and a sham (as in non-acupoint needle insertion) acupuncture group. Previous studies have shown no difference between these groups.

Linda