Later On

A blog written for those whose interests more or less match mine.

Another pointless "acupuncture" study misinterpreted

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Interesting post by Orac:

At the risk of once again irritating long time readers who’ve hear me say this before, I can’t resist pointing out that, of all the various forms of "alternative medicine" other than herbal medicines (many of which are drugs, just adulterated, impure drugs), acupuncture was the one treatment that, or so I thought, might actually have a real therapeutic effect. Don’t get me wrong; I never bought magical mystical mumbo-jumbo about "meridians" and "unblocking the flow of qi" (that magical mystical life energy that can’t be detected by scientists but that practitioners of woo claim to be able to manipulate for therapeutic intent). The point is (sorry, couldn’t resist) that acupuncture actually involves doing something physical to the body, namely inserting thin needles into it. Shorn of its trappings of prescientific Eastern mysticism, acupuncture struck me as something that might have something to it.

Five years ago.

Since I started actually studying acupuncture and acupuncture studies, I’ve become acutely aware that my previous assessment was incorrect, and my pointing that out from time to time sometimes results in comments along the lines of, "We don’t need to hear this again." Tough. For the benefit of new readers and readers who might not have read some of my previous posts on acupuncture before, I consider it important to reinforce that I have, in fact, undergone a bit of a change of heart. I have reviewed studies that showed that sham acupuncture works as well or even better than "true" acupuncture, with the needles placed right where those fancy acupuncture charts say they should be placed and that you don’t even need needles. Toothpicks with their points twirled against the skin will do. I’ve also come to realize that many of the explanations postulated by acupuncturists and doctors who believe in acupuncture are actually far less interesting than actual scientific results that they produce in their search for "proof" that "acupuncture works." Sometimes, acupuncturists substitute active sorts of treatment for acupuncture and call it something else, like "electroacupuncture, which involves hooking up a weak electrical current to acupuncture needles. Electroacupuncture is in essence nothing more than transcutaneous electrical nerve stimulation (TENS), an accepted modality to treat pain.

Add to the evidence pile yet another study demonstrating that acupuncture is placebo medicine, reported in Arthritis Care & Research by a team of investigators based primarily at the M.D. Anderson Cancer Center that I heard about via the TIME Magazine Wellness Blog. The study, entitled A Randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication, demonstrates about as unequivocally as one can imagine that one form of so-called "acupuncture" is, as far as can be detected, virtually all placebo. What is surprising about this study is not so much that it shows that acupuncture doesn’t work. In fact, it doesn’t actually show that, because what is being used is not acupuncture. What is being used is "electroacupuncture, which is in essence nothing more than TENS! More amazingly, no one whom I’ve yet seen seems to be mentioning this. In essence, the results of this study are entirely consistent with the hypothesis that it doesn’t matter whether you place TENS needles on acupuncture points or not. Will wonders never cease? Actually, that’s not quite the right interpretation, as we shall soon see.

Let’s, as they say, go to the tape. Rather, let’s go to the study.

The study was actually a rather straightforward nested randomized design. First, certified acupuncturists were trained to communicate in one of two styles, either "high expectation" or "neutral expectation. I’ll only mention in passing all the description about how all the acupuncturists were licensed in Texas (who cares, given that it’s licensing woo?) and that they all had at least two years of experience. 455 patients were randomized first to acupuncturists using one of these two styles of communication, after which they were randomized in a nested fashion to "sham" or "real" acupuncture, the latter of which was called "traditional Chinese acupuncture" or TCA. I don’t understand how TCA can be called TCA, given that there weren’t electrical sources to hook up to needles 2,000 years ago, but that’s what it’s called in he paper. Thus, the experimental groups were as follows:

  • High expectation/TCA
  • High expectation/sham
  • Low expectation/TCA
  • Low expectation/sham
  • Waiting list control

More importantly, acupuncturists were trained thusly:

Continue reading.

Written by Leisureguy

19 August 2010 at 11:23 am

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