Acupuncture placebo better than acupuncture

[DC]

Move goals posts much? One study that is an indication and not conclusive?

You shame yourself with these tactics.

Tylenol is not not recommended to be used twice a week for chronic back pain, you have one six week study. Not studies and no replication.

Keep moving the goal posts DC.

I asked you already in the other topic.

What is the traditiinal treathment for chronic lower back pain in germany? i would apriciate a Link that will support your oppinion.
I find it strange that some layman is able to see such a serious flaw in such a study that had such an impact on Germany and Switzerland.

 

[Ivor the Engineer]

If you wonder whether the purported hypothesis changed after the experiment was performed and the results were in, you can look at the sample size calculations to get a clue.

In this case, the sample size for two-tailed testing would be about 180, while for one-tailed testing it would be about 140.

Yep, I was probably wrong about the change from one to two-tailed test, assuming they didn't just twiddle with the power*.

The results shouldn't be a surprise, since it has already been well-documented that acupuncture, in the sense that needles are inserted at acupoints, is not effective. Since research comparing acupuncture with no treatment has shown a significant difference (http://www.comoxvalleyacupuncture.com/pdf/paulus study.pdf), it does suggest that psychological factors can influence pregnancy in IVF.

Linda

I agree. Do you think this qualifies as an objective placebo effect?



*Yes, the latter part of this comment is an attempt to dig myself out of a hole.

 

[DC]

I'm making a guess at which studies you are referring to here, but they don't show that acupuncture or needling is any different from expectation. For example, in this study, the response to conventional treatment, acupuncture and sham acupuncture was the same during the course of the treatment. It was only several months after the treatment had finished, that a difference was seen in subjective evaluation of treatment effectiveness. We have already discovered that expectation greatly influences retrograde evaluation of treatment effectiveness (i.e. if you think you received an effective treatment, you remember your pain as greater before the treatment (compared to measures taken at the time) and less (compared to measures taken at the time) after the treatment). And we have already discovered that perception of pain varies with expectation.

As to whether or not anything should be made of the seemingly greater effect of sham acupuncture in this study...

Since prior studies show no difference between sham and real acupuncture, except as to the degree of blinding, it probably should be assumed that this is a fluke. Even though the researchers tried to make something of it in their conclusions, we are not under an obligation to do so.

Linda

Yes that was the study i refered to.

I find it very interesting that the traditional scientific therapy and medicamentation did perform so poorly compared to the Acupuncture and also the sham acupuncture.

yes indeed the big improvments was indeed registered 4 months after the acupuncture . of patients that had alread 8 years chronic backpain.

on Bad Science it was mentioned something interesting. That those patients didnt get helped by our normal medicamentations and therapy for 8 years.
I dont know if that is correct.

Also dont get me wrong, i dont belive in some magical healing, i suspect a placebo effect, also here did Bad Science mention some interesting points about culture etc. im sure you know it already.

But actually if such a "placebo" is able to help some people, more than normal therapy was able to in the past. what is wrong with it?
even if we dont really understand the mechanism behind it, if there is any.

i think it is a very interesting thing to studie further.

 

[fls]

Yep, I was probably wrong about the change from one to two-tailed test, assuming they didn't just twiddle with the power*.

No, I think that you were right - not that their explicit intentions were to use one-tailed testing, but that in all likelihood they implicitly assumed that they were testing a one-way relationship.

I agree. Do you think this qualifies as an objective placebo effect?

That's what I was wondering as well. But there are suggestions that successful pregnancy may be influenced by psychological factors (stress in particular) to a greater degree than one would guess.

*Yes, the latter part of this comment is an attempt to dig myself out of a hole.

I wondered about that a bit as well, though. You can't get the same result that they got if you use their numbers. It's close (slightly less than 180 vs. 185), but it's not the same.

Linda

 

[DC]

No, I think that you were right - not that their explicit intentions were to use one-tailed testing, but that in all likelihood they implicitly assumed that they were testing a one-way relationship.



That's what I was wondering as well. But there are suggestions that successful pregnancy may be influenced by psychological factors (stress in particular) to a greater degree than one would guess.



I wondered about that a bit as well, though. You can't get the same result that they got if you use their numbers. It's close (slightly less than 180 vs. 185), but it's not the same.

Linda

i find Acupuncture very relaxing.

 

[Dancing David]

I asked you already in the other topic.

What is the traditiinal treathment for chronic lower back pain in germany? i would apriciate a Link that will support your oppinion.
I find it strange that some layman is able to see such a serious flaw in such a study that had such an impact on Germany and Switzerland.

Oh gosh, appeal to herd authority? Appeal to authority? Do you come to a skeptics’ forum just to have everyone agree with you?

If you looked, you would find that there are three kinds (general types) of medication used in the treatment of lower back pain. And it is up to you; as you defend this research to show that they used the appropriate treatment protocol to compare acupuncture to medications remember.

Remember herd authority is not rational, just because a bunch of people do something, it can still be wrong. The study we discussed is not using whatever is recommended as 'traditional treatment of chronic back pain with medications', so for you to run around with your sign that says "Acupuncture and sham acupressure are shown to be more effective than traditional medicine in the treatment of chronic lower back pain" is false. they did not use a protocol that included that in the study, not did they use a no-treatment group, therefore the study is flawed, it may be indicative but it is not conclusive.

When the study compares effects with "traditional medicine" it should make sure that it is using the recommended treatment.

FLS: This is about the study where they used NSAIDs twice a week as the 'traditional treatment with medicine', what is the prescribed course of treatment for chronic lower back pain with NSAIDs? Wyeth only gives for acute lower back pain and so DC disputes that is the recommended treatment. Thanks.

I could be wrong.

 

[fls]

Yes that was the study i refered to.

I find it very interesting that the traditional scientific therapy and medicamentation did perform so poorly compared to the Acupuncture and also the sham acupuncture.

But they didn't. At six weeks (just as the treatment finished), the response among the three groups was the same.

yes indeed the big improvments was indeed registered 4 months after the acupuncture . of patients that had alread 8 years chronic backpain.

on Bad Science it was mentioned something interesting. That those patients didnt get helped by our normal medicamentations and therapy for 8 years.
I dont know if that is correct.

Also dont get me wrong, i dont belive in some magical healing, i suspect a placebo effect, also here did Bad Science mention some interesting points about culture etc. im sure you know it already.

But actually if such a "placebo" is able to help some people, more than normal therapy was able to in the past. what is wrong with it?
even if we dont really understand the mechanism behind it, if there is any.

i think it is a very interesting thing to studie further.

You need to consider that chronic back pain waxes and wanes. If you took the same measurements on that group of patients over a period of eight years, you would probably find that sometimes the measures, in the absence of any particular treatment, were as good as those found at the end of the study. And since enrollment in a study tends to select out those patients who are experiencing a waxing of their symptoms, it's not a surprise to find that later measurements co-incide with a waning of their symptoms. Even the group that received conventional treatment showed a significant improvement in their symptoms during and at the end of the study.

Part of the 'placebo' effect is what I just described - an artifact of the selection process. We also know that expectation (another component of the placebo effect) influences the perception of pain. It seems that the idea of magic is a strong inducer of expectation. I'm not necessarily against the idea of leaving it at that. But I think we would be better served by exploring those aspects, because maybe we could do better than simply fooling people.

Linda

 

[DC]

Oh gosh, appeal to herd authority? Appeal to authority? Do you come to a skeptics’ forum just to have everyone agree with you?

If you looked, you would find that there are three kinds (general types) of medication used in the treatment of lower back pain. And it is up to you; as you defend this research to show that they used the appropriate treatment protocol to compare acupuncture to medications remember.

Remember herd authority is not rational, just because a bunch of people do something, it can still be wrong. The study we discussed is not using whatever is recommended as 'traditional treatment of chronic back pain with medications', so for you to run around with your sign that says "Acupuncture and sham acupressure are shown to be more effective than traditional medicine in the treatment of chronic lower back pain" is false. they did not use a protocol that included that in the study, not did they use a no-treatment group, therefore the study is flawed, it may be indicative but it is not conclusive.

When the study compares effects with "traditional medicine" it should make sure that it is using the recommended treatment.

FLS: This is about the study where they used NSAIDs twice a week as the 'traditional treatment with medicine', what is the prescribed course of treatment for chronic lower back pain with NSAIDs? Wyeth only gives for acute lower back pain and so DC disputes that is the recommended treatment. Thanks.

I could be wrong.

Sorry when i am a little sceptic. You claimed that the traditional treathment was not properly. I asked you what it would be, the only thing you brought up was something about acute back pain.

here is what they used as guideline

AKDÄ. Empfehlungen zur Therapie von Kreuzschmerzen. 2 ed. Düsseldorf, Germany: Nexus GmbH; 2000.

meanwhile they have an updated version of 2007 online. But found it only in German.

The health insurance accepted it. I shall reject it because some selfdeclared sceptics claim that the traditional treathment was not correct?

Prove it, and i write to my health insurance and complain that they support woo based on flawed studies.

I think this studie should also show that we might consider improving the traditional treathment.

 

[DC]

But they didn't. At six weeks (just as the treatment finished), the response among the three groups was the same.



You need to consider that chronic back pain waxes and wanes. If you took the same measurements on that group of patients over a period of eight years, you would probably find that sometimes the measures, in the absence of any particular treatment, were as good as those found at the end of the study. And since enrollment in a study tends to select out those patients who are experiencing a waxing of their symptoms, it's not a surprise to find that later measurements co-incide with a waning of their symptoms. Even the group that received conventional treatment showed a significant improvement in their symptoms during and at the end of the study.

Part of the 'placebo' effect is what I just described - an artifact of the selection process. We also know that expectation (another component of the placebo effect) influences the perception of pain. It seems that the idea of magic is a strong inducer of expectation. I'm not necessarily against the idea of leaving it at that. But I think we would be better served by exploring those aspects, because maybe we could do better than simply fooling people.

Linda

I'm not necessarily against the idea of leaving it at that.

leave it at that? no, atm maybe but not on long term.

But I think we would be better served by exploring those aspects, because maybe we could do better than simply fooling people.

yes i like that. and a 8 year studie would be very interesting and tell us alot more.

 

[Lothian]

Is it just me that struggles to understand DC?

 

[DC]

Is it just me that struggles to understand DC?

no

most have alot trouble with that.

 

[Lothian]

no

most have alot trouble with that.

Thnkas.

 

[fls]

FLS: This is about the study where they used NSAIDs twice a week as the 'traditional treatment with medicine', what is the prescribed course of treatment for chronic lower back pain with NSAIDs? Wyeth only gives for acute lower back pain and so DC disputes that is the recommended treatment. Thanks.

I could be wrong.

Dictator Cheney indicated that the study I linked to earlier was the study under discussion. It doesn't state that NSAIDs were only used twice a week. It says they were used to the maximum daily dosage.

I don't know what the specific guidelines were, but from the list of treatments given, they look like they were probably reasonable. The google translation of the guidelines indicates that it's meant to be evidence-based. NSAIDs are used in chronic low back pain although the evidence is not as strong as it is for acute low back pain.

Linda

 

[fls]

Is it just me that struggles to understand DC?

It's just you.

Linda

 

[Dancing David]

Sorry when i am a little sceptic. You claimed that the traditional treathment was not properly. I asked you what it would be, the only thing you brought up was something about acute back pain.

here is what they used as guideline

AKDÄ. Empfehlungen zur Therapie von Kreuzschmerzen. 2 ed. Düsseldorf, Germany: Nexus GmbH; 2000.

meanwhile they have an updated version of 2007 online. But found it only in German.

The health insurance accepted it. I shall reject it because some selfdeclared sceptics claim that the traditional treathment was not correct?

Apparently you don't know what herd mentality or critical thinking is. Too bad.

The burden is on them to show that they followed the protocol.
Sorry, I can't speak Duetche and my Italiano and Espanol are conversant but not to this level.

Prove it, and i write to my health insurance and complain that they support woo based on flawed studies.

I think this studie should also show that we might consider improving the traditional treathment.

You haven't demonstrated that either.


If you aren't a critical thinker, then good for you.

 

[Dancing David]

Dictator Cheney indicated that the study I linked to earlier was the study under discussion. It doesn't state that NSAIDs were only used twice a week. It says they were used to the maximum daily dosage.

I don't know what the specific guidelines were, but from the list of treatments given, they look like they were probably reasonable. The google translation of the guidelines indicates that it's meant to be evidence-based. NSAIDs are used in chronic low back pain although the evidence is not as strong as it is for acute low back pain.

Linda

the one we discussed earlier was only twice a week to the max dose.

This one here:
http://archinte.ama-assn.org/cgi/content/abstract/167/17/1892

discussed here:
http://www.webmd.com/back-pain/news/20070924/study-acupuncture-eases-low-back-pain

Acupuncture was delivered in 10, 30-minute sessions conducted over six weeks. Patients who received conventional treatments had a similar number of total treatments, which included exercise, pain medication, and nonsteroidal anti-inflammatory drugs (NSAIDs).

The acupuncture groups were allowed to use medication for acute episodes of back pain only. This consisted of NSAID use no more than two days a week during the treatment period.

That is what made me think they only took the NSAIDs twice a week, but it could just be the acupuncture group that did.

 

[fls]

That is what made me think they only took the NSAIDs twice a week, but it could just be the acupuncture group that did.

I think it's simply awkward wording.

Linda

 

[fls]

Dictator Cheney,

If you could provide a link to the page that includes the guidelines for NSAID use in the Empfehlungen zur Therapie von Kreuzschmerzen, I think I could clear up this issue by looking at a google translation.

Linda

 

[Skeptic Ginger]

Give them credit for "Our results indicated that the placebo acupuncture
may indeed lead to a higher pregnancy rate. However,
we cannot draw a firm conclusion because a control arm
without any acupuncture was not included for comparison."

If only they had been so honest in the introduction.

 

[Skeptic Ginger]

Skepti

This bugs me a bit, not you, but the posters like the one at the beginning who didn't know the difference between a "random sample" and random assignment and thought that one needed over 300 people to do an internally valid experiment. And others who sniggle at p=.038. Two tailed, of course.

Yes, the introduction and discussion are packed with manure. But one credo I learned was, "The data talks, BS walks."
I fault the editors for not gleaning the wheat from the chaff here.

In a more positive note, at least they published. Most negative outcomes end up on the cutting room floor. That's another problem with medical research. This is a positive step at least, even if they still need to get a bigger clue about the real significance of that 'no treatment' arm.