Accupuncture is real

[apoger]

I'm assuming medicine has to deal with this issue of not being to disguise or conceal actual treatment quite a lot?

Not really.
Medication is usually taken orally or injected. It's easy to blind all participants under such circumstances.

Surgery cannot be done double blind, but also does not produce ambiguous results (comparatively). If a tumor is removed from a patients colon, we don't ask the patient if they feel like it worked... we send the sample down to the lab for analysis.

The issue with acupuncture is twofold. One is that it's single blind, but also that it's proponents are down to judging pain relief, which is hugely subjective and difficult to measure.

If it isn’t possible to truly "blind" the experiment/research how could acupuncture be tested?

With difficulty.
If the effect of acupuncture is nothing more than a very minor relief of pain, then it will require a huge number of well controlled trials in order to establish that the effect is genuine.

 

[T'ai Chi]

Sham needles, my bottom.

How can you make something which looks like a needle and feels like a needle, but isn't a needle?

Take a look at this:

http://www.medical-acupuncture.co.uk/journal/1999dec/8.shtml

How would that fool anyone?

Consider it like a magic trick. You're trying to not give the patient any reason to suspect that it isn't a real needle. I could see it being pretty effective.

 

[apoger]

You're trying to not give the patient any reason to suspect that it isn't a real needle.

Many experimenters have tried not to transfer information to the target of a study, yet the information leaks anyway. Hence the question of potential experimenter bias.

 

[T'ai Chi]

Many experimenters have tried not to transfer information to the target of a study, yet the information leaks anyway. Hence the question of potential experimenter bias.

Sure, that's certainly a possibility. We'd need to see more specifics of the study before coming to any solid conclusion.

 

[Soapy Sam]

Accupuncture is also used by many physiotherapists to relieve muscle tension. I understand the idea is less to release spasm in an entire muscle, than in localised areas. (I may be using "spasm"to mean "spasticity". I apologise for my ignorance). My point is that the release of tension ought to be more amenable to objective measurement (perhaps of extension) than relief of pain.
The double blind problem remains .

 

[rightbrain]

The issue with acupuncture is twofold. One is that it's single blind, but also that it's proponents are down to judging pain relief, which is hugely subjective and difficult to measure.

Wouldn't that be true of all analgesics? (The subjective pain relief part, that is.)

There are always going to be subjective areas of medicine. Unavoidable, when you're treating human beings. For reasons of ethics and/or practicality, you can't run perfectly objective, double-blinded, randomized, controlled studies on everything. How would you double-blind a study on garlic, since its active constituent is the smelly part? How can you measure relief of depression or bipolar disorder without relying on patient history and questionnaires? How do you ethically study an experimental, possibly dangerous drug in young children? How do you perform a double-blinded 20-year study on whether birth control pills raise the risk of breast cancer?

That's why clinical studies, epidemiological surveys, and cohort studies are so important in medicine.

I'm not sure there's any practical way to perform a double-blind trial of acupuncture, since someone has to perform the procedure (training people to perform a "sham" medical procedure seems silly, if not downright unethical).

And at least there's no evidence acupuncture increases the risk of heart disease.

 

[BPScooter]

Well, although it might just remove the human element of the explanation, wouldn't it just be possible to have a laser-guided robot thingy get close to, say, a participant's hand? Like in a box? Put your hand in the box, this laser beam thing will map your hand, this robot hand/needle object will come close to your hand and maybe touch your hand, maybe shine a special LED laser at your hand, maybe stick a needle into your hand, ... just the back of your hand... or not. (substitute: buttocks, back of neck, leg, crown, any other chi-bearing personal flesh). Of course the actual poking condition is likely more detectable, so the idea would be to find a "meridian" that doesn't feel such things readily. That seems like part of the point, so to speak. The treatment places seem to me to be in places that are sort of dull. Unless I missed the part where we put needles in our fingertips, nostrils, tongues, etc. as a routine part of it.

The participant could then be blind as to their particular condtion, but they will know that there are 3 or 4 options, and they are just to relax and report their pain relief.

I don't know, it seems like it could be done.

 

[Rolfe]

This is also being discussed on an email list I'm a member of. The following was posted just recently.

Another more clever method was demonstrated on a television show. (I can't remember if it was the PBS Scientific American series or the short-lived series by Skeptical Inquirer.) A researcher invented a device to blindly insert the needle. It's spring-loaded, held against the skin (or, perhaps, it grabs the skin--I can't remember exactly), and inserts the needle. You cannot see if the needle is inserted. The tool is left in place throughout the treatment. When it is removed, the needle comes with it. The tool can be loaded with a needle--or not. Neither the therapist nor the patient would know whether or not a needle had been inserted. Even the acupuncturist couldn't tell if a needle was really there when he used it on himself, as the tool causes more sensation by itself than the needle does. Using the tool, he had found--much to his disappointment--that there seemed to be no difference between the effects with and without the needle.

I'm a bit doubtful if acupuncturists would accept something like this as valid acupuncture practice, even suspecting that they might suddenly decide it wasn't if it wasn't getting results, but it's an interesting approach.

Rolfe.

 

[Badly Shaved Monkey]

Looking at acupuncture sceptically I've never seen why it might not have actual benefit.

I would agree with that. In contrast to homeopathy, I can at least come up with physiological principles by which it might do something. However, accepting, in principle, that it might work is not the same as accepting that it does work and I would still be more surprised than not if good blinded trials were to show real useful effects.

 

[rightbrain]

FWIW, here's another recently published study (also single-blinded) on the efficacy of acupuncture in relieving pain from osteoarthritis of the knee. This one involved electrostimulation of the chi points.

British Medical Journal study

 

[TheBoyPaj]

Consider it like a magic trick. You're trying to not give the patient any reason to suspect that it isn't a real needle. I could see it being pretty effective.

So do you think you would be unable to tell the difference between a needle piercing your skin and a blunt piece of metal which retracts on contact? I'm sure I could, and I view as dubious any study which would suggest that it was a plausible method of blinding.

 

[T'ai Chi]

So do you think you would be unable to tell the difference between a needle piercing your skin and a blunt piece of metal which retracts on contact?

Without undergoing either, that is unknown. However, suggestion goes a long way. If the patient believes he/she is getting needles inserted in them, they might get fooled.

 

[Peter Morris]

T'ai Chi/Whodini/jzs may see himself as a thorn in the sides of skeptics, but he's just a little prick.

Oh, we are sharp today, aren't we? Are you able to pinpoint his errors?

 

[BPScooter]

But isn't part of the deal with acupuncture supposed to be that even though you know darn well that a sharp needle is going into your skin, you apparently feel no pain? Key words being "see" and "feel pain"? I remember a trick where you have two points, like straightened out paper clips, and put them on the back of your friend's neck, say half an inch apart, and ask whether they feel one or two. It's really hard to do. They can feel the pressure, but can't distinguish the point source(s).

So if putting a needle in a place that is not well furnished with those types of nerves causes no pain, OK with me. The blinding becomes important here. If you can't see what happened, and you felt a little prick but didn't know if there was a needle or not, that might be equivalent, right?

Maybe the best acupuncture points are those that the patient can see, too. Are there any points that are totally invisible to the patient? I don't know, but it seems like the back of the neck might be a good place to start. Somewhere on the back, maybe. Round up a bunch of participants that suffer from something cured by the back-of-neck-point and then do a study. Self reported pain relief under treatment, with a control group. Sounds fun!