Acupuncture - woo or not

[ponderingturtle]

I think that's where a little communication disconnect happens...some people are considering "placebo" to mean "sugar pill" where others are taking it to mean "sham acupuncture" (sheathed toothpicks tapped on the skin, so the patient doesn't know it didn't pierce the skin), and still others think it means "puncturing the skin with needles in random places, not trying to follow 'Qi meridians'".

The thing is some studies have used both and show that there is a difference between sham acupunctue and actualy putting needles in people.

 

[mazyloron]

The thing is some studies have used both and show that there is a difference between sham acupunctue and actualy putting needles in people.

Which is why I said sham acupuncture was "similar enough" to actual acupuncture. At least, from the studies I've seen, there is a difference, but it's not large enough to be definite proof.

There's also the possibility that, despite researcher's best intentions, the patients can tell the difference between the sham and actual needles. I've never tried it myself, but I would not be surprised at all if the average person could tell the difference.

The human body and subconscious mind can often tell a lot of things that we might not consciously realize...though I have not seen studies that show it, I would again not be surprised if some people might not consciously realize they're getting a sham treatment, but subconsciously they do, and the placebo effect is moderated. That is of course purely a guess on my part, but I would think it's a possibility that could explain the differences in reaction, that does not include an appeal to a supernatural agent such as Qi. I'd be interested to see a study testing that...but, alas, I do not have the power to command scientists to do my bidding. (And it's probably best for everyone that I do not have this power.)

 

[blutoski]

FWIW, The Cochrane Collaboration have some interesting reviews regarding acupuncture. Here are two links with rather positive outcomes.

Now, I'm not a doctor, so I'm not sure if I read these right, but they state that, at least for these ailments, acupuncture (be it 'real' or sham) is far from useless, right? And Cochrane's fairly highly regarded for it's reviews, right?

For its reviews of medicine, yes.

As it happens, Dr. Novella has pointed out that Cochrane's reputation is very poor where altmed literature reviews are concerned. To the point where it gives the whole project a black eye at this point.

His interpretation is that MDs are not very interested in this junk, so leave it to the quacks. The result is that the literature reviews for altmed routinely fail to adhere to the Cochrane standards that have generated their good reputation elsewhere.

Dr. Novella specified key shortcomings of the bafflingly positive Homeopathy literature reviews. I believe he has also written about this increasing problem on his blogs.

 

[blutoski]

FWIW, The Cochrane Collaboration have some interesting reviews regarding acupuncture. Here are two links with rather positive outcomes.

Now, I'm not a doctor, so I'm not sure if I read these right, but they state that, at least for these ailments, acupuncture (be it 'real' or sham) is far from useless, right? And Cochrane's fairly highly regarded for it's reviews, right?

I also recall that Dr. Novella discussed the problem with the conclusion drawn from this last experiment.

Experiments are established to test a specific question, or sometimes a few specific questions. Sometimes you observe something that leads to an alternative hypothesis, but these need to be tested in experiments designed specifically for them. ie: You can't do an experiment to learn X and conclude Y.

The experiment with the sham controls was designed to ask:

1. does it matter where you put the needles and
2. does it matter if you penetrate the skin

The answer to both appears to be 'no' for the patients' indication (was it pain?)

All we can conclude from the study is that it doesn't seem to matter where you put the needles, and it doesn't seem to require penetration.

ie: *** the key claims of acupuncturists are unsupported ***

Everything else is speculation that could be used to generate other hypotheses and be tested elsewhere:

1. maybe the effect is caused by jabbing the skin but not penetrating
2. maybe the effect is an artefact of reporting
3. maybe this, maybe that...

I support exploring these, but I cannot support assuming ad hoc alternative explanations for positive results are true until refuted, so acupuncture can just keep on trucking without change.

 

[mazyloron]

I also recall that Dr. Novella discussed the problem with the conclusion drawn from this last experiment.

Experiments are established to test a specific question, or sometimes a few specific questions. Sometimes you observe something that leads to an alternative hypothesis, but these need to be tested in experiments designed specifically for them. ie: You can't do an experiment to learn X and conclude Y.

The experiment with the sham controls was designed to ask:

1. does it matter where you put the needles and
2. does it matter if you penetrate the skin

The answer to both appears to be 'no' for the patients' indication (was it pain?)

All we can conclude from the study is that it doesn't seem to matter where you put the needles, and it doesn't seem to require penetration.

ie: *** the key claims of acupuncturists are unsupported ***

Everything else is speculation that could be used to generate other hypotheses and be tested elsewhere:

1. maybe the effect is caused by jabbing the skin but not penetrating
2. maybe the effect is an artefact of reporting
3. maybe this, maybe that...

I support exploring these, but I cannot support assuming ad hoc alternative explanations for positive results are true until refuted, so acupuncture can just keep on trucking without change.

Well put. I've been trying to say the same sort of thing for a while now, but couldn't explain it so well.

 

[icerat]

Soapy Sam (and a few others) ... if I claim the space shuttle's rockets work through the power of prayer by tibetan monks, does that make the space shuttle's rockets "woo"?

I find some people are too quick to dismiss something because of implausible mechanisms as described by proponents.

Clearly "qi" is almost certainly bogus, but that does not immediately invalidate acupuncture as a therapy. I think the jury is still out on that one. At the least it appears it may be an effective delivery mechanism for the sometimes very effective treatment known as "placebo".

And it's there I think we perhaps need a paradigm shift. Placebo works - and it also needs a "delivery mechanism". At what point do we decide the nature of the delivery mechanism makes something unethical?

 

[mazyloron]

Soapy Sam (and a few others) ... if I claim the space shuttle's rockets work through the power of prayer by tibetan monks, does that make the space shuttle's rockets "woo"?

No, but it makes it darn hard for anyone to make any improvements, or troubleshoot any problems that we encounter when using them.

ETA: "Oh look, the shuttle blew up. I guess we need to pray harder next time. Problem solved."

I find some people are too quick to dismiss something because of implausible mechanisms as described by proponents.

I can't speak for others, but I would say - as I have said before in this thread - that there might be something to the trigger point theory. It's possible that some acupuncturists have been accidentally taking advantage of an actual bodily mechanism, without realizing it. If that's the case, then we need to isolate that mechanism and learn more about it, so we can use it to help people.

That in no way means we should be encouraging people to keep studying Qi and learning the meridians so they can help restore people's energy fields to heal them. And if we simply say "acupuncture works", that is what people will think. We have to point out that, no, "traditional acupuncture" does NOT work, and it's only coincidence that it's had an effect, and here is why...

Clearly "qi" is almost certainly bogus,

Fixed it for ya.

but that does not immediately invalidate acupuncture as a therapy.

But it does immediately invalidate the central theory of acupuncture, that there is an invisible energy field flowing through our bodies, and it can get out of alignment, and through the use of pins inserted into the body, proper flow can be restored and health can be restored. The premise is based on that energy field. If there's no energy field, then attempting to manipulate it is pointless.

I think the jury is still out on that one.

How so?
If A then B.
A is false.

At the least it appears it may be an effective delivery mechanism for the sometimes very effective treatment known as "placebo".

It does seem to be a more effective way to take advantage of placebo. But, to do so, we must either lie to patients knowingly, or allow others to delude themselves into believing their non-scientific, irrational thinking, simply so they can help people purely by accident, and only some of the time.

And it's there I think we perhaps need a paradigm shift. Placebo works - and it also needs a "delivery mechanism". At what point do we decide the nature of the delivery mechanism makes something unethical?

When the delivery method involves actively deceiving the patient. Or, when it involves allowing people with no medical training to carry out medical procedures, because they sometimes, accidentally work.

 

[Tapio]

Thanks, mazyloron and blutoski! Clears things up a bit. Just makes me wonder why Ernst & Singh would base their whole book (Trick or Treatment-alternative medicine on trial) on the reviews by TCC...they ought to know better, eh?

So you're saying that in your opinion the abstracts of the reviews I posted aren't really describing the actual data? Now, I definitely do not support letting acupuncturists and whatnot roaming free to do their juju without strict regulations. But I'm very interested in these studies, whatever the conclusions are - if they are valid. So if I can't trust TCC on these matters, could you point me towards some other source from which to update my knowledge from time to time? Is there such?

 

[blutoski]

Soapy Sam (and a few others) ... if I claim the space shuttle's rockets work through the power of prayer by tibetan monks, does that make the space shuttle's rockets "woo"?

Notice that this has become a semantic argument!

eg: yesterday, acupuncture is defined as X. But X doesn't work. OK: we'll redefine acupuncture to Y and throw the burden of proof on critics to prove that that doesn't work either. Better prepare Z, AA, BB, CC, DD to keep this racket alive.

With this approach, in twenty years, acupuncture could be the act of stuffing a carrot in my butt.

I find some people are too quick to dismiss something because of implausible mechanisms as described by proponents.

I'd say that implausible mechanisms like magic are great reasons to dismiss something a priori.

Clearly "qi" is almost certainly bogus, but that does not immediately invalidate acupuncture as a therapy. I think the jury is still out on that one. At the least it appears it may be an effective delivery mechanism for the sometimes very effective treatment known as "placebo".

Oh, pleeeease... Placebo is not a "treatment" - it's an experimental artefact of unknown nature and of little - if any - applied use.

And it's there I think we perhaps need a paradigm shift. Placebo works - and it also needs a "delivery mechanism". At what point do we decide the nature of the delivery mechanism makes something unethical?

Placebo does not 'work' except for very strained definitions of 'work'.

Tapio asked a good question about the Cochrane Collaboration's reviews, and so it's important to understand that one of the most comprehensive reviews of 'placebo effect' has been done by Cochrane, and the conclusion is that there is very little evidence that there even is such a thing.

This is why it's so frustrating: when the effect is so marginal that it's barely detectable, it's far from a 'treatment'. It's very likely that it's just background noise. That's not something an ethical person should charge money for.

 

[Satra]

Hallo people

- I didn't ever get akupunktur (I write it in German spelling, that's my way not to have a mistake in the word).

- several persons I -partly- personally know and trust got it and continue to get it and it works on them.

- several persons I do not know so well got it and told me it didn't work on them.

- a friend of mine who is not spiritual at all (she says) went through a formation in acupressure. the difference between puncture and pressure is that puncture works with needles and pressure by pressing with the fingers.
She loves to use and to get it and has very positive results, she told me. And she did it to me, it was very nice, I felt marvellously relaxed afterwards. but I didn't have any physical problems, I could have get rid by that and tell you about.


- I went to a weekend for spontanious Qi-Kung or how you may spell that.
there I got an highly intense feeling for my flow of Qi, and a blocking I had disappeared while we made an exercise. That knocked my sock's off (what a funny expression, I had to take it, even if I didn't wear socks that day).
It was an easy exercise, I really liked it, and all of a sudden I got a huge pain in a point in my arm. it was absolutely shocking, and I had a short scream by fright and pain.

The teacher had told us that in case of pains it would be a good sign and we just should continue the exercise as far as possible. So I did that. It was really aking, at a precise point in the arm, as big as the nail of my little finger I'd say (I've got little fingers). It was difficult to relax my face, and I even had a few little tears by pain.

And after few minutes I could notice how it got slowly better and better. After 10 or 15 min it disappeared entirely.
And suddenly a huge mighty warm feeling got through all my body like a wave. I got a feeling of immense happyness and thankfulness and relief, feeling linked to everything. So intense all this that I broke out in tears and heavily sobbed. Then I felt absolutely wonderful, I felt the effect for several weeks, just that I got problems to express my personal energy, so that that weakend then.

That is about Chi or Ki or Prana or Life-Energy. How you want to call it.
It flows through our body, yes.

So, the principle of acupuncture and acupressure has to work.


- I see one "problem":
it seems that the meridians move a little through anyones body, as the master on the weekend told us.

that means also that they are not exactly at the same place for everyone.

so -I- would NOT go to an acupunturist without intuition or energetical perception.

I don't like dogmata and "it's like this!", I don't trust such notions. So I am sure that a very sensitive person with enough training may be even more efficient than a learned acupuncturist without any sensitivity. During a time I regularly made massages to people and developped a precise feeling which points of a body is blocked. And those who had a place aking were astonished I mostly found the place without even touching them. A sensitive person can feel that, those places have a different energy.

If I'd train that regularly for more time and more often, I'm convinced I could do this very well. My brother can, besides. He's a natural talent for massages, regularly gives massages to his parents and in fact I learned some things out of his approach (no matter that he's a boy of 11, and no matter that he just does it and has no intellectual approach nor technique). One day he gave me massage without touching me, just going with his hand all over my body from feet to the top of the head. I had felt sad before and was absolutely astonished how I felt refreshed and happy after that. So that also about energy(-flow).


In fact that shifting problem could be an explanation for the fact that some people don't feel better after the treatment, I imagine. If the one who gives the treatment "follows the book" and doesn't get the true point, that perhaps won't work?

In fact, I think that in medicinal methods everyone has his favorites. Not every method may be adequate for everyone...? ( I take antibiotika and feel worse after taking them than before. And after stopping to take them my immunitary system does not really function. So everybody should experience which methods are the right ones for him, I'd say.)

 

[Tapio]

Satra, did you follow my advice given earlier in the Organics - thread? Did you read through the VFF threads?

Do you understand that your stories of experiences of acupuncture, qi, prana (concepts I'm very familiar with), as nice and inspiring they might be, do not - I repeat - DO NOT mean that any of those concepts or ideas behind them are real? Do you understand this?

 

[blutoski]

Thanks, mazyloron and blutoski! Clears things up a bit. Just makes me wonder why Ernst & Singh would base their whole book (Trick or Treatment-alternative medicine on trial) on the reviews by TCC...they ought to know better, eh?

So you're saying that in your opinion the abstracts of the reviews I posted aren't really describing the actual data?

TCC does not actually do studies. What they do is review studies in the literature based on a set of established standards. The good news is that most TCC literature reviews follow the rules, and their reputation remains good compared to other processes.

However, just because a review was comissioned by TCC doesn't mean it followed their standards, and people can identify the deficient reviews by observing departure from these standards.

Mostly, TCC reviews are excellent, so their reputation is still good.

Now, I definitely do not support letting acupuncturists and whatnot roaming free to do their juju without strict regulations. But I'm very interested in these studies, whatever the conclusions are - if they are valid. So if I can't trust TCC on these matters, could you point me towards some other source from which to update my knowledge from time to time? Is there such?

Good question. I think the approach is to trust TCC until otherwise educated by a trustworthy source.

This is also the somewhat subtle difference between Evidence Based Medicine and Science Based Medicine (as described by Dr. Novella and others) - once you grasp the distinction, a lot of this starts to make better sense.

 

[icerat]

Notice that this has become a semantic argument!

eg: yesterday, acupuncture is defined as X.

Acupuncture has never had a solid definition. From what I understand different schools and traditions have quite different methodologies, but all call themselves "acupuncture".

The only common factor seems to be sharp implements.

With this approach, in twenty years, acupuncture could be the act of stuffing a carrot in my butt.

Depends how sharp it is

I'd say that implausible mechanisms like magic are great reasons to dismiss something a priori.

By this poor logic, a new guinea highlander given an antibiotic by a witchdoctor who tells him it's "white man's magic" should reject it.

Oh, pleeeease... Placebo is not a "treatment" - it's an experimental artefact of unknown nature and of little - if any - applied use.

Placebo does not 'work' except for very strained definitions of 'work'.

You may want to review - A Comprehensive Review of the Placebo Effect: Recent Advances and Current Thought Donald D. Price, Damien G. Finniss, Fabrizio Benedetti, Annual Review of Psychology, January 2008, Vol. 59, Pages 565-590

Tapio asked a good question about the Cochrane Collaboration's reviews, and so it's important to understand that one of the most comprehensive reviews of 'placebo effect' has been done by Cochrane, and the conclusion is that there is very little evidence that there even is such a thing.

And I have a systemic bias against meta-analysis, let alone other reported problems with TCC, so it doesn't have as much weight with me as it might with you. In any case they did find an effect for pain management and did not look at other areas such as psychological disorders, where it perhaps would have most use.

This is why it's so frustrating: when the effect is so marginal that it's barely detectable, it's far from a 'treatment'. It's very likely that it's just background noise. That's not something an ethical person should charge money for.

Except of course it's my understanding some studies have found what you pay influences the effect!

It's not a simple issue and I'm not suggesting it is. I'm just curious about the issues that would arise if a accepted clinically effective "placebo treatment" was to be found.

 

[blutoski]

Acupuncture has never had a solid definition. From what I understand different schools and traditions have quite different methodologies, but all call themselves "acupuncture".

The only common factor seems to be sharp implements.

Pretty much.

For the sake of focusing on a working definition, I try to depend on the regulatory body here in BC. The certification does seem to revolve around both the principle of meridians and needle insertion. Ancillary practices are based on these principles (eg: fire cupping and acupressure).

Depends how sharp it is

Yes, I guess I was trying to emphasize that altmed seems to vindicate itself a lot through victory by redefinition.

By this poor logic, a new guinea highlander given an antibiotic by a witchdoctor who tells him it's "white man's magic" should reject it.

I don't see the problem with that. He should reject it based on that shabby reason.

You may want to review - A Comprehensive Review of the Placebo Effect: Recent Advances and Current Thought Donald D. Price, Damien G. Finniss, Fabrizio Benedetti, Annual Review of Psychology, January 2008, Vol. 59, Pages 565-590

I'm aware of the paper. It's not a "comprehensive" review. It is a review of weak positive results / ignoring or dismissing the negative studies / and consequential exaggeration of the implications for reification and ultimate clinical potential.

It's similar to anomaly hunting. The connection between the physiological findings in some cases and reported improvement in outcomes is speculative. It also ignores that the difference between treatment and nontreatment groups is close to zero, which makes promoting clinical application very questionable.

And I have a systemic bias against meta-analysis, let alone other reported problems with TCC, so it doesn't have as much weight with me as it might with you.

No, I think we're on the same page - I'm pretty cool regarding meta-analysis. But the Cochrane Collaboration publication is not a meta-analysis: it's a literature review. Their first task is to filter for quality, and the second task is to evaluate the meaning of the quality papers.

In any case they did find an effect for pain management and did not look at other areas such as psychological disorders, where it perhaps would have most use.

Actually, they looked at all the literature available that attempts to isolate a placebo effect, and pain was the only indication that showed even a trace of positive result, and it was inconsistently reported in the literature. Many studies showed no difference between the placebo and untreated groups, for example. This is consistent with the placebo effect being background noise.

It's also important to observe their conclusion was very qualified: they pointed out that there's no way to tell if reported improvement for this indication can be distinguished from reporting bias.

Except of course it's my understanding some studies have found what you pay influences the effect!

It's not a simple issue and I'm not suggesting it is. I'm just curious about the issues that would arise if a accepted clinically effective "placebo treatment" was to be found.

Let's not count our chickens before they're hatched.

 

[arthwollipot]

- a friend of mine who is not spiritual at all (she says) went through a formation in acupressure. the difference between puncture and pressure is that puncture works with needles and pressure by pressing with the fingers.
She loves to use and to get it and has very positive results, she told me. And she did it to me, it was very nice, I felt marvellously relaxed afterwards. but I didn't have any physical problems, I could have get rid by that and tell you about.

Acupressure (aka Shiatsu) is basically deep tissue massage. And it works for all the things that massage works for - tension, headache, etc. I use shiatsu principles when I massage.

 

[MikeSun5]

Acupuncture has never had a solid definition. From what I understand different schools and traditions have quite different methodologies, but all call themselves "acupuncture".

This is one thing that I've noticed many people tend to ignore. There are posts in this thread suggesting that the human body has "trigger points" and sticking needles in them (or touching them) can release endorphins, relax muscles, etc. Treating muscular pain is only a part of traditional acupuncture.
On wikipedia it shows that most of the points and meridians supposedly directly deal with your organs. That, my friends, is woo.

mazyloron brought up sham-acupuncture. If acupuncture actually did work, would sticking needles in the wrong places really have no result at all? Would it not have a negative effect on the patient? Wouldn't there be an acupuncture point to make your spleen or stomach stop working? Have there been any "operating room mishaps" in acupuncture like in western medicine?
Or maybe there are only positive results because there no "bad" acupuncture. Only good.

As far as the claims that acupuncture can work for headaches and muscle pain... I remain skeptical. Pain is a slippery slope in medicine.
Prove that sticking my earlobe with a pin releases endorphins in my knee, and I'll admit that one particular application of acupuncture may be valid. Other than that, acupuncture is as scientifically valid as crystal therapy.

 

[mazyloron]

This is one thing that I've noticed many people tend to ignore. There are posts in this thread suggesting that the human body has "trigger points" and sticking needles in them (or touching them) can release endorphins, relax muscles, etc. Treating muscular pain is only a part of traditional acupuncture.
On wikipedia it shows that most of the points and meridians supposedly directly deal with your organs. That, my friends, is woo.

mazyloron brought up sham-acupuncture. If acupuncture actually did work, would sticking needles in the wrong places really have no result at all? Would it not have a negative effect on the patient? Wouldn't there be an acupuncture point to make your spleen or stomach stop working? Have there been any "operating room mishaps" in acupuncture like in western medicine?
Or maybe there are only positive results because there no "bad" acupuncture. Only good.

As far as the claims that acupuncture can work for headaches and muscle pain... I remain skeptical. Pain is a slippery slope in medicine.
Prove that sticking my earlobe with a pin releases endorphins in my knee, and I'll admit that one particular application of acupuncture may be valid. Other than that, acupuncture is as scientifically valid as crystal therapy.

Another good point that has gotten overlooked. Acupuncture is not "sticking needles into a person and causing something - anything - to happen." It makes specific claims, including that poking a needle into a specific spot will cause an observable change in the functioning of a specific organ. That puts it in the same realm of woo as reflexology, and countless other quackeries.

I like MikeSun5's point about putting needles into the wrong places - if the right places heals, wouldn't the wrong place harm, at least some of the time? If I lay someone down and start randomly poking acupuncture needles into their back (to the 1/4" depth that is recommended, so I don't actually hit any organs), if the Qi and meridian theories are correct, wouldn't I be as likely to mess something up and, say, cause them to get kidney stones (since supposedly acupuncture can cure that)?

If a treatment can only ever have two options: 1) noticeable, beneficial effect, or 2) no effect at all, then it's probably not really doing anything. When you affect a change to a person's body, you are forcing it to do something it's not currently doing...and when you force a change, it has the chance to not be for the better. Usually a much bigger chance, in fact. It's much easier to screw something up than to fix it.

Yet, with acupuncture, the only real risk seems to be using dirty needles, or poor insertion technique causing pain or bleeding.

A good example of this is massage, specifically deep-tissue (as Arthwollipot mentioned before). Done right, it can be a wonderful, relaxing and healing experience. But, if you try it without proper training and practice, you are far more likely to cause a lot of pain and potentially serious harm.

 

[icerat]

By this poor logic, a new guinea highlander given an antibiotic by a witchdoctor who tells him it's "white man's magic" should reject it.

I don't see the problem with that. He should reject it based on that shabby reason.

Well that is where we really do disagree. I'm all for testing it and seeing if it works and then working out the real reason why it works. There's a reason why pharmaceutical companies spend a fortune investigating folk remedies and myths to see if there's anything too them - often there is, just not for the reasons tradition dictates.

 

[Soapy Sam]

Soapy Sam (and a few others) ... if I claim the space shuttle's rockets work through the power of prayer by tibetan monks, does that make the space shuttle's rockets "woo"?

I find some people are too quick to dismiss something because of implausible mechanisms as described by proponents.

Clearly "qi" is almost certainly bogus, but that does not immediately invalidate acupuncture as a therapy. I think the jury is still out on that one. At the least it appears it may be an effective delivery mechanism for the sometimes very effective treatment known as "placebo".

And it's there I think we perhaps need a paradigm shift. Placebo works - and it also needs a "delivery mechanism". At what point do we decide the nature of the delivery mechanism makes something unethical?

I'm unsure why you mention me here. My opinion is that traditional Acup is a load of dingoes' kidneys. I agree that sticking needles in people is likely to have some effect. I doubt it will be beneficial , for the same reason randomly adjusting an engine is unlikely to improve performance- but yes, of course it will sometimes if done often enough.
(And if you take notes it stops becoming random and verges into something dangerously like science).

My point above is that while dry needling most certainly is not traditional acupuncture, it's done using acupuncture needles and to the patient it "looks like" acupuncture. As many PTs seem to refer to it as such, confusion will arise.
As for sticking carrots up your butt, I don't think anyone is likely to mistake that with any aspect of traditional Chinese medicine. They use ginseng for things like that.

 

[icerat]

I'm unsure why you mention me here.

Because IMO your posts have indicated a propensity to reject something as ineffective or false purely because the theory behind it is bogus rather than because of evidence it's ineffective.

I think that's poor logic.