Acupuncture Doesn’t Work

Long post is long. Thanks for all the responses, and sorry for this big mess of words.

How did it work for you and millions of others? And how was this different than say taking a sugar pill?

Actually, given how poorly regulated supplements are, you might be taking a sugar pill instead of something that contains Glucosamine-Chondroitin...but that's another story.

I kind of skimmed over some of this (though I think I've read it before), but I don't particularly care to read about it. When all I care about is whether a treatment works, why would I read about how it might work in a study involving mice? Especially when there are thousands of other studies to look at (involving humans)?

If the effect was strong and worked as described, it should easily be demonstrated in clinical trials. It's not. I didn't really really look into the specifics of that mouse study, but it doesn't surprise me that they found some positive effect with acupuncture. There tends to be some large positive effects found when doing initial research with animals, but these effects tend to go away once you start studying them in humans (usually with more rigorously designed studies). And I mean that of all treatments, acupuncture or otherwise.

This exact study is referenced in some of the links I provided. For reference:
http://www.sciencebasedmedicine.org...re-is-nothing-more-than-an-elaborate-placebo/
http://www.sciencebasedmedicine.org/an-acupuncture-meta-analysis/

I would recommend reading those articles since both Steve and Dave are much better at explaining this than I am, but I will try to summarize some of the main points. This study seemed to show two things. First, there is a huge benefit to receiving treatment vs no receiving treatment. Of course, this is pretty much useless when trying to figure out the benefits specific to acupuncture. Second, according to their studies, real acupuncture "outperformed" sham acupunture when it came to pain relief. However, the effect is quite small. They claim it is statistically significant (and it probably is), but it is likely clinically insignificant and completely imperceivable. With their numbers, they're basically saying that you would rate your pain as a 3 out of 10 with acupuncture vs 3.5 out of 10 with sham acupuncture (the control being a 6 out of 10 if no treatment was applied IIRC). A difference that small is not really anything to get excited about.

All that in a study that appears to be TRYING to make acupuncture look good (it was from a group called the Acupuncture Trialists’ Collaboration after all ). There are enough problems/bias in the study that even the 5% difference can likely be wiped out.

At what point do we decide that we know enough about this? I think the results are fairly conclusive. In fact, they were probably fairly conclusive many years (and many thousands) of studies ago. Why continue to pursue this anymore? As I said earlier, should we be pursuing research on toothpick treatments as well?

Placebo doesn't just mean it was in your head.

http://www.csicop.org/si/show/the_poor_misunderstood_placebo

There are some strong physiologial responses that take place when one believes he/she is receiving treatment (and believes/hopes to feel better). In anticipation of feeling better, the body can limit the secretion of stress hormones and activate production of things like endorphins (which provide pain relief).

I think people are underestimating/misundertanding the impact of placebos. It is a very strong and difficult effect to account for, especially when many variables are involved. As pointed out in one of my links, researchers often try to design their studies so they can keep many of the variables the same, and only change the variable they want to study (see real vs sham acupuncture). With this, they can differentiate the effects coming from placebo vs the effects they are actually trying to study. If treatment A results in 80% improvement and treatment B results in 75% improvement (while no treatment results in 0% improvement...kind of unlikely, but let's go with that), you could take those results to mean that ~75% improvement seems to be tied to placebo (assuming treatment B is a "sham" anyway...though guess you could also argue that both treatments work well :grin. Note that you don't really have any idea what impact the placebo has unless you do something like that (i.e., you'll need to run the test with multiple inputs).

It seems very difficult for researchers to outright deny the impact of placebo on their research, and that is the case even for well designed trials. I think it would be very difficult to deny the impact of placebo in something anecdotal (I certainly wouldn't do that, not without running several more tests where I switched up the inputs and felt I could safely attribute the effects to something else).

If you are promoting acupuncture (while knowing that science shows no benefits to such treatment), then you are rejecting science. Maybe you don't always reject science...although I would assume what is more likely is that you are using other things to help you make these decisions (perhaps your just don't prioritize science).

It allows people to start doubting what science says (after all, they wouldn't bother trying acupuncture if this wasn't the case). When you start doing that, it can lead to doubting science in other ways (chiropractic, homeopathy, vaccinations, etc.).

I would assume that if acupuncture actually helps these people, there probably is a "traditional" solution that can work for them, though they might not know about it.

True, though I believe the "standards" behind acupuncture are much less rigorous than they are for "traditional" medicine. Doesn't seem like a practice that cares much for standards (one acupuncturist might treat/diagnose one way, while another might be completely different). It is a minor point, I admit. I'm just pointing out that the standards for "good" acupuncture likely aren't up to the same standards as traditional care, and thus, the risks might be a big higher in comparison.

If done properly. Unfortunately, things are never done properly at all times, even with properly trained professionals. Be it acupuncture, traditional medicine, web site coding, or basketball. Humans make mistakes. In some cases, the risks are worth it. A surgeon might make a mistake during a heart transplant, and due to complications, the patient might not survive. But the benefits to receiving that transplant are worth that risk. For acupuncture, the benefits seem negligible, if not nonexistent. Why even take any risk then?

I assumed the "poking with toothpicks" treatment did not actually result in the skin being broken. There are a number of risks with actual acupuncture that results from breaking the skin (local hematoma, nerve damage, punctured lungs, infection, etc.). Admittedly, you would potentially have some of those other risks (e.g., fainting), but much fewer risks overall.

I want to help the patient, but I also want to do it the "right way." In this case, I want to isolate where the benefits are coming from, and then remove any risks associated with the things that aren't actually impacting the patient in any positive way. In other words, I'm trying to help the patient even more.

Well, you wouldn't operate like that. I wouldn't run an experiment (with Dwight as the only test subject), and openly mislead him into believing he's receiving acupuncture, only to rub it in his face later on by telling him it was all a lie. The goal isn't to convince Dwight of anything, but to try and help "treat his ailment."

In such a scenario, I would probably "condition" him to the treatment, and slowly wean him off the toothpick poking. Essentially, we'd be focusing on the part of the treatment that actually is helping him shoot 80%, which isn't the needles or the toothpicks most likely.

As I alluded to earlier, if this actually did happen, it is likely relaxing for 1-2 hours a day/treatment (or something along those lines) that is helping him with this. In the event that we can rule out those other things, then perhaps acupuncture would have a case. Of course, it would be VERY difficult to rule out other things (especially by myself).

I believe the problem with acupuncture is that people are misattributing what is actually working, and associating it with acupuncture when it should be associated with something else. It is likely that acupuncture doesn't actually work for a single person, but the things that are often tied to acupuncture DO help many people. Let's focus on those things instead of randomly sticking needles into people.

As an example, let's suppose I have a new treatment I want to perform, which I dub "RC Cola's miracle pain relief." A patient comes in, and we discuss Houston Rockets basketball for an hour. I slap the patient twice in the face with a rotting fish, and then I give a shot of morphine to the area that is experiencing pain. Everyone who takes the treatments ends up feeling much less pain afterwards. I can come up with all sorts of BS about how talking Rockets basketball and rotting fish slapping helps reduce pain, but in reality, this has little to nothing to do with any benefits patients receive from this treatment. This would be evident in any clinical trials studying this treatment (patients who do not talk about basketball and receive no rotten fish slapping receive benefits comparable to those who do receive those things). We could then remove those variables from the treatment, and focus on the things that likely did help reduce pain (like the shot of morphine).

That essentially is what is going on with acupuncture I believe.

Actually, I'd say they DO know what that alternative thing is. I've alluded to many of the likely factors in this thread. They know it ISN'T acupuncture, so the other variables involved are likely the cause for the benefits. In many cases, we do recommend patients take these treatments.

Of course, some of this is due to the placebo effect, and that is difficult to prescribe. Doctors are well aware of this effect, and they realize that if they give someone a sugar pill and guarantee that the patient will feel better, a large number of patients will indeed feel much better (less pain, less depression, increased weight loss, lower blood pressure, better memory, etc). But this is largely seen as unethical, and doctors generally don't do this (even though it would help out a lot of people with a lot of problems). Acupuncture is essentially an expensive, more dangerous sugar pill.

 

Yes, I responded to that post in my previous monster post. I point out that this particular study is actually what was referenced in several of the links I provided. I recommend reading their breakdowns since they are far more articulate than I am. Needless to say, it doesn't really indicate that acupuncture works, IMO anyway.

I haven't really done a lot of research on Gua Sha. I can take a look at it when I get the chance though. I'm naturally skeptical of the treatment (as I am with just about any treatment), and I can't say the little bit I've seen so far is very encouraging. I'll try to check out some studies, but I'm going to assume that it probably mirrors what we see with acupuncture.

Honestly, unless I see something like "dozens/hundreds of double-blind, placebo controlled studies suggest statistically and clinically significant benefits" about a treatment, I probably wouldn't be too optimistic about the treatment.

 

Without more information, I can't really say one way or the other (I don't know what "it worked" means, hence the question). If we're talking about pain, then it likely "worked" as a placebo (like with many supplements), assuming some deficiency wasn't also involved. But I can't say for sure without more specifics.