Acupuncture - woo or not

[icerat]

Regarding the exploration of traditional modalities, I would wager that money has been better spent on bioprospecting (randomly testing against indications) than ethnobotany (testing against traditional indications).

What type of "indications" vs "traditional indications"?

If I was a betting man I'd wager the other way, but if I'm wrong I'm more than happy to accept that.

But I guess here we have a case in point. Is this worthy of study? Do you have a plausible mechanism to support your view that "bioprospecting" is better than "ethnobotany"?

I don't, so should I just ignore the question? I still want to know which is true, and knowing which is true would be valuable knowledge.

While millions may have been spent on studying say, homeopathy, has that been a "bad investment"? Maybe, maybe not - how many people have NOT bought homeopathic products because of the research showing it doesn't work? I'd venture to suggest it's quite a few.

 

[fls]

Well let see, you mention 3 items - herbal treatments, acupuncture, and homeopathy. You admit traditional herbal treatments are worth studying, and acupuncture may have some interesting aspects ... and your third option, homeopathy has a history of just over 200 years .... not exactly "thousands". Homeopathy is not a "traditional medicine" by any stretch.

Why single out homeopathy? Its development and use is identical to those of other SCAM therapies. Besides, don't you know that homeopaths trace its roots to Aristotle?

It was until someone came up with a testable theory. Their efficacy or otherwise did not change because the theory of their mechanism changed. Just because the greek's believe Wolf'sbane was a creation of the goddess Hecate doesn't stop it being as effective a poison today as it was for them.

You're missing the point. You are talking about stuff which is demonstrably efficacious, but due to unknown mechanisms. I'm talking about stuff which isn't demonstrably efficacious, which encompasses the entirety SCAM therapies, including acupuncture and traditional herbal therapies. Traditional medicine has not presented us with a way to discover efficacious therapies, only therapies of unknown or no efficacy. The question is, as a strategy, does the investigation of traditional therapies provide us with a better yield than science-based strategies. The NCCAM experiment has shown us that the answer is "no".

And that's where we disagree, and clearly where many others disagree since a great deal of effort has been put in to studying various versions of acupuncture.

Was that money well spent? It seems an awful lot of effort to come up with, at best, a slightly more effective painkiller than some intermediate strength painkillers, without really contributing anything to our understanding of human physiology.

Furthermore, there have been various quite sensible theories proposed as to why it might work, such as triggering endorphin release.

But that's hardly an effect due to acupuncture, since that appears to be the mechanism behind the non-specific placebo effect.

The idea you shouldn't even study something because someone has a bogus explanation of how it might work is irrational.

But no one has suggested that. What has been suggested is that we shouldn't study something (or at least, it should be way down on the list) if we have no reason to suspect that it works.

Linda

 

[fls]

Regarding the exploration of traditional modalities, I would wager that money has been better spent on bioprospecting (randomly testing against indications) than ethnobotany (testing against traditional indications).

Yeah, I think you can follow the money on this one. If ethnobotany were useful, pharmaceutical companies would be funding this strategy instead of bioprospecting.

Can anyone name a single drug discovered through ethnobotany in the last 25 years or so?

Linda

 

[fls]

Scientific plausibility does not depend on the practioners explanation. I can think of a variety of plausible reasons why basic acupuncture might work.

This is putting the cart before the horse. There is no particular reason to look for explanations until after you have shown that it works in any way that is different from the non-specific effects of expectation.

That's putting the horse before the cart. What's needed is some kind of evidence something might work. Large numbers of people believing something has worked for them is evidence. It's poor quality evidence that could clearly be cause by something else, but nevertheless it is evidence there's something worth investigating.

Actually, it's not evidence at all. Evidence is something which makes an idea more or less likely to be true. Since "large numbers of people believing something" is present occurs when that thing is ineffective, harmful or doesn't exist, the presence of belief tells you nothing about whether that thing is effective, safe or present.

Nothing has a plausible scientific mechanism until someone comes up with one. Plausible scientific mechanisms result from the initial study of a phenomenon. If you refuse to study it without a plausible scientific mechanism then you're left with nothing to study.

We are not talking about the investigation into new mechanisms for stuff that demonstrably works (we all agree that would be useful and interesting). We are talking about using what we already know to direct us towards investigating novel therapies - therapies for which there is otherwise no evidence of efficacy. This has also been a useful and interesting strategy, but again has nothing to do with traditional use.

While clearly one needs to prioritise, it would be a sad world if we couldn't find the time to investigate interesting phenomenen.

Exactly. And what makes something interesting is something that distinguishes it from the morass of random ideas.

Linda

 

[fls]

What type of "indications" vs "traditional indications"?

Let's take Taxol for example. The traditional use for the Pacific Yew was to help heal wounds and to improve potency. Using ethnobotany to guide investigation would never have led to us discovering its usefulness in the treatment of some cancers. That usefulness was discovered using bioprospecting, where collected plant extracts were tested in an NCI screening program for anti-cancer activity.

If I was a betting man I'd wager the other way, but if I'm wrong I'm more than happy to accept that.

If you can name a single useful drug discovered in the last 25 years through ethnobotany, compared to the many discovered through bioprospecting, that would help.

Linda

 

[icerat]

You're missing the point. You are talking about stuff which is demonstrably efficacious, but due to unknown mechanisms. I'm talking about stuff which isn't demonstrably efficacious, which encompasses the entirety SCAM therapies, including acupuncture and traditional herbal therapies.

Arrrggghhhhhhhh!!!!!! ... How the heck do you know it is nor isn't effacious if you refuse to test it because you don't believe the practioners explanation of why it might work????

You can't know whether something works or not without testing it, and you and others have said that if the theory given for why something might work is bogus, then it shouldn't be tested!

That's just irrational.

It may work perfectly well, just the practioners have the reasoning completely wrong.

Only way to find out is to study it.

Traditional medicine has not presented us with a way to discover efficacious therapies, only therapies of unknown or no efficacy. The question is, as a strategy, does the investigation of traditional therapies provide us with a better yield than science-based strategies. The NCCAM experiment has shown us that the answer is "no".

Rubbish. An enormous amount of modern medicine has developed from "traditional medicine". Just because over time there will be fewer and fewer things left to be discovered as having "real" effects does not invalidate the principle I'm talking about.

But that's hardly an effect due to acupuncture, since that appears to be the mechanism behind the non-specific placebo effect.

See my earlier comments re placebo needing a delivery mechanism. As far as I'm concerned, if acupuncture is shown to be triggering endorphin release, for whatever reason, and thus relieving pain, then the idea that acupuncture relieves pain is shown to be true. We may then research further and discover more effective mechanisms to get the same effect.

But to refuse to even study acupuncture because Qi can't exist? Irrational.

But no one has suggested that. What has been suggested is that we shouldn't study something (or at least, it should be way down on the list) if we have no reason to suspect that it works.

Then why did my original point cause such a response? Was there reason to expect acupuncture might work? Clearly, yes - thousands of people reported it worked. So it deserved study - despite the fact that the Qi theory was clearly bogus.

That's all I'm trying to say - just because a practioners theory behind why something works (or doesn't) may be bogus does not mean there's nothing to look at.

 

[fls]

Arrrggghhhhhhhh!!!!!! ... How the heck do you know it is nor isn't effacious if you refuse to test it

I don't refuse to test it. I simply recognize that there are billions of things to test, so I need to implement some sort of strategy to select out which things I am going to test first as they are more likely to be useful.

because you don't believe the practioners explanation of why it might work????

Because the practitioners' explanation of why it might work doesn't help me select out which things are more likely to be useful.

You can't know whether something works or not without testing it, and you and others have said that if the theory given for why something might work is bogus, then it shouldn't be tested!

If the idea given for why something might work is bogus, then it doesn't distinguish that thing from the billions of other things that can be tested. I may as well decide to proceed alphabetically.

That's just irrational.

It may work perfectly well, just the practioners have the reasoning completely wrong.

Exactly. Whether or not one thing out of a billion works has nothing to do with the practitioners' reasoning, when means that it makes no sense to pay attention to the practitioners' reasoning when choosing what to test.

Rubbish. An enormous amount of modern medicine has developed from "traditional medicine". Just because over time there will be fewer and fewer things left to be discovered as having "real" effects does not invalidate the principle I'm talking about.

We culled out the few effective medicines based on traditional use long ago. Name something that traditional medicine has given us in the last hundred years.

See my earlier comments re placebo needing a delivery mechanism. As far as I'm concerned, if acupuncture is shown to be triggering endorphin release, for whatever reason, and thus relieving pain, then the idea that acupuncture relieves pain is shown to be true. We may then research further and discover more effective mechanisms to get the same effect.

We already know that we can get this same effect from sugar pills. Why bother with the needles and the magic and the thousands of wasted hours learning about made-up meridians?

But to refuse to even study acupuncture because Qi can't exist? Irrational.

Who said anything about refusing to study acupuncture?

Then why did my original point cause such a response? Was there reason to expect acupuncture might work?

You mean other than through the effect of expectation and the artefacts induced by the circumstances surrounding its use? No.

Clearly, yes - thousands of people reported it worked.

But thousands of people will always report that it works, even if it's completely ineffective.

So it deserved study - despite the fact that the Qi theory was clearly bogus.

Well, it does start with 'a', putting it near the top of the list.

That's all I'm trying to say - just because a practioners theory behind why something works (or doesn't) may be bogus does not mean there's nothing to look at.

Right. It's that there is barely any evidence that it is different than placebo which suggests that there's nothing to look at.

Linda

 

[icerat]

If you can name a single useful drug discovered in the last 25 years through ethnobotany, compared to the many discovered through bioprospecting, that would help.

I'm not familar enough with the terms to be able to make the judgement. From what I read on wikipedia, bioprospecting involves looking at traditional medicines to find items of possible worth, whereas ethnobotany has no such goal - though knowledge of ethnobotany would seem to be necessary for bioprospecting. The wikipedia article on bioprospecting gives several examples of where useful medicines have been developed after looking at traditional medicines. This nps.gov page on bioprospecting however mentions little about traditional uses.

The history of aspirin is just one example of a modern drug that has developed from "traditional medicine". You however, for no good reason, have limited examples to the last 25 years. When something occured has little to do with the principle I'm talking about.

 

[icerat]

I don't refuse to test it. I simply recognize that there are billions of things to test, so I need to implement some sort of strategy to select out which things I am going to test first as they are more likely to be useful.

That's fine, and sensible.

Because the practitioners' explanation of why it might work doesn't help me select out which things are more likely to be useful.

If the idea given for why something might work is bogus, then it doesn't distinguish that thing from the billions of other things that can be tested. I may as well decide to proceed alphabetically.

I would thing there's other things that may help discernement, such as reports of efficacy.

Exactly. Whether or not one thing out of a billion works has nothing to do with the practitioners' reasoning, when means that it makes no sense to pay attention to the practitioners' reasoning when choosing what to test.

Bingo! Glad you agree with me.

We culled out the few effective medicines based on traditional use long ago. Name something that traditional medicine has given us in the last hundred years.

This is irrelevant to the principle I'm espousing - practioners reasoning should play little to no role in deciding whether something is worth investigating or not.

That's all I've suggested and it appears that despite your insistance on arguing for the sake of it, you agree with me.

 

[fls]

I'm not familar enough with the terms to be able to make the judgement. From what I read on wikipedia, bioprospecting involves looking at traditional medicines to find items of possible worth, whereas ethnobotany has no such goal - though knowledge of ethnobotany would seem to be necessary for bioprospecting. The wikipedia article on bioprospecting gives several examples of where useful medicines have been developed after looking at traditional medicines. This nps.gov page on bioprospecting however mentions little about traditional uses.

As I mentioned earlier, ethnobotany may help identify a small subset of natural sources which has a somewhat higher yield when subject to bioprospecting. But that seems to represent the limit of the useful knowledge which can be culled from ethnobotany.

The history of aspirin is just one example of a modern drug that has developed from "traditional medicine". You however, for no good reason, have limited examples to the last 25 years. When something occured has little to do with the principle I'm talking about.

You're welcome to come up with an example since aspirin if you want to go back more than 25 years. I was simply thinking of the time period in which ethnobotany has been promoted.

Linda

 

[fls]

I would thing there's other things that may help discernement, such as reports of efficacy.

'Fraid not. All you have to do is remember that homeopathy is supported with reports of efficacy to realize the uselessness of that particular 'help'.

That's all I've suggested and it appears that despite your insistance on arguing for the sake of it, you agree with me.

You were the one who called Soapy Sam and me "irrational" for suggesting this.

Linda

 

[icerat]

You're welcome to come up with an example since aspirin if you want to go back more than 25 years. I was simply thinking of the time period in which ethnobotany has been promoted.

Just because they gave it a label is irrelevant. Doesn't change the principle.

'Fraid not. All you have to do is remember that homeopathy is supported with reports of efficacy to realize the uselessness of that particular 'help'.

So? non sequitar. Thousands of people report asprin helps. That doesn't mean it doesn't. If thousands report asprin helps, it's worth investigating. If they happen to all believe it helps by balancing yin and yang, it's irrelevant to whether it's worth investigating or not.

You were the one who called Soapy Sam and me "irrational" for suggesting this.

No, I called you irrational for suggesting something should be excluded from investigation simply because the theory give by practioners is bogus. That is contradictory to your claim above that the practioner's theory should play no role - which is in fact exactly what I originally said.

 

[fls]

Just because they gave it a label is irrelevant. Doesn't change the principle.

Fine. I notice that you still haven't provided an example.

So? non sequitar. Thousands of people report asprin helps. That doesn't mean it doesn't. If thousands report asprin helps, it's worth investigating. If they happen to all believe it helps by balancing yin and yang, it's irrelevant to whether it's worth investigating or not.

What is also irrelevant is thousands who state that it works under circumstances where any would say it works. We investigated aspirin for different reasons.

Linda



No, I called you irrational for suggesting something should be excluded from investigation simply because the theory give by practioners is bogus. That is contradictory to your claim above that the practioner's theory should play no role - which is in fact exactly what I originally said.[/QUOTE]

 

[fls]

No, I called you irrational for suggesting something should be excluded from investigation simply because the theory give by practioners is bogus. That is contradictory to your claim above that the practioner's theory should play no role - which is in fact exactly what I originally said.

Except that I never suggested that.

I've only taken exception to your idea that anecdote counts for anything.

Linda

 

[icerat]

I've only taken exception to your idea that anecdote counts for anything.

So you believe anecdotes count for nothing in helping determine whether something might be worth investigating?

Sorry, I don't believe you. If a hundred people came around a corner and told you they'd just seen an alien spacecraft land down the street, you'd go look.

 

[fls]

So you believe anecdotes count for nothing in helping determine whether something might be worth investigating?

Sorry, I don't believe you. If a hundred people came around a corner and told you they'd just seen an alien spacecraft land down the street, you'd go look.

If the same people had told me this story every day for the last twenty years, and every time I went to look there was nothing there? You can bet your ass I wouldn't look.

Linda

 

[MikeSun5]

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?

After seeing some of your sketchy responses to fls, I had to go back to this post to find out you didn't actually believe that homeopathy or acupuncture works... I agree with your idea of a placebo "delivery mechanism." My ex-girlfriend had persistent back pains that went away when she spoke to a "healer" over the phone, so your idea makes perfect sense.

As far as acupuncture, I think the jury is NOT still out. Numerous studies have shown that acupuncture is effective no matter how it's performed -- whether it's performed incorrectly or even just perceived to be performed by the patient. Even when it's not really happening, it works.

Anyway, I'll attempt to answer your last question. For adults, I'd say live and let live. If you want quackupuncture or you want to take sugar pills, that's fine. If your child is sick, diseased, or hurt, and you take them to an acupuncturist or a homeopathic doctor, that is neglect, IMO. Placebos only work on those who know what to expect. I think giving placebos to children (or anyone unaware) is unethical.

 

[Badly Shaved Monkey]

As I mentioned earlier, ethnobotany may help identify a small subset of natural sources which has a somewhat higher yield when subject to bioprospecting. But that seems to represent the limit of the useful knowledge which can be culled from ethnobotany.



You're welcome to come up with an example since aspirin if you want to go back more than 25 years. I was simply thinking of the time period in which ethnobotany has been promoted.

Linda

Artemisinin?

However, regardless of how you think that fits in to the merits of bioprospecting versus ethnobotany as starting points for search strategies, I think that an important point has not been covered so far.

The interaction between plausibility and "traditional use" varies among the different modalities. Just because 100 herbs have been tested because of traditional use and found to be useless for the indication under investigation doesn't mean the 101st won't work either. There is a basic plausibility to plant products having biological effects that, say, Reiki lacks.

In contrast, we don't need another trial of homeopathy. Although, strictly speaking each trial of homeopathy has tested just one remedy or method of prescribing against one type of problem we have enough failures that, coupled with its inherent lack of plausibility, we can reject the whole modality. Acupuncture, similarly, has now so thoroughly failed for both musculoskeletal problems and non-musculoskeletal problems that we can reject it. Here, though, I do think the problem is complicated by this "trigger point" business, where the principles of its application differ so much from 'proper' acupuncture that using the term "acupuncture" for it seems to be a hindrance rather than a help because it entrains a whole load of fanciful intellectual baggage involving qi and meridians.

Really, it all comes down to the issue of prior probability. Implausible mechanism lowers prior probability and stands as a major negative factor when trying to organise an efficient search for useful therapies. It does not lower the chance of success to zero, but it must be attended to when trying to design an efficient search strategy.

I think the dispute between Linda and icerat centres on how much does "traditional use" influence prior probability when searching for useful biologically derived products. If the currently unexplored realms of "traditional use" contain almost nothing but useless products, having harvested a number of low-hanging fruit a long time ago, then it offers little advantage over a systematic search for active products that pays no regard to traditional use.

 

[Tapio]

Anyway, I'll attempt to answer your last question. For adults, I'd say live and let live. If you want quackupuncture or you want to take sugar pills, that's fine. If your child is sick, diseased, or hurt, and you take them to an acupuncturist or a homeopathic doctor, that is neglect, IMO. Placebos only work on those who know what to expect. I think giving placebos to children (or anyone unaware) is unethical.

Well said. To accompany kids on the list, I would also add the sick elderly and some of the mentally ill. Which, in fact, comprises the group towards which the recent new Finnish regulations of who can legally be treated by alternative therapeutic treatments is aimed at.

 

[Tapio]

So you believe anecdotes count for nothing in helping determine whether something might be worth investigating?

Sorry, I don't believe you. If a hundred people came around a corner and told you they'd just seen an alien spacecraft land down the street, you'd go look.

Actually, I probably wouldn't. Unless they were all screaming their heads off and the air was filled with noise from emergency vehicle sirens. Anyway, when and where do you personally draw the line? Btw, have you heard of the Hindu Milk Miracle?