Skepfeeds-The Best Skeptical blogs of the day

Is this meant to be humorous?

Posted in Skepdude by Skepdude on May 13, 2009

I usually rely on LiveScience for good articles, but I ran accross this article regarding, not surprisingly given the trend of the past few entries, the new acupuncture study that showed that toothpicks are just as good as needles. I don’t know what to make of it. It is not clear that it is meant to be sarcastic, so I am a little worried. What do you think about it?

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Acupuncture Does Not Work for Back Pain

Posted in Science Based Medicine by Skepdude on May 13, 2009

Here goes Steven Novella’s take on the latest acupuncture study.

A new study which randomized 638 adults to either standard acupuncture, individualized acupuncture, placebo acupuncture using tooth picks that did not penetrate the skin, and standard therapy found exactly what previous evidence has also suggested – it does not seem to matter where you stick the needles or even if you stick the needles through the skin. The only reasonable scientific conclusion to draw from this is that acupuncture does not work.

But let me back up a minute. Imagine if we were evaluating the efficacy of a new pain drug. This drug, when tested in open trials (no blinding or control) has an effect on reducing pain – it is superior to no treatment. When compared to a placebo, however, the drug is no more effective than the placebo, although both are more effective than no treatment.

Now imagine that the pharmaceutical company who manufactures this drug sends out a press release declaring that their drug is effective for pain, but that their research shows that a placebo of their drug is also effective (FDA applications are pending). Therefore more research is needed to determine how their drug works.  Would you buy it?

That is the exact situation we are facing with acupuncture research.

Acupuncture is the traditional Chinese medicine practice of placing thin needles to a specific depth through the skin in specific acupuncture points in order to treat illness and relieve symptoms. Claims for acupuncture, including the number and location of acupuncture points, have changed greatly over the centuries, but there is no scientific evidence base for any of these claims. Acupuncture is philosophy-based medicine, not science-based medicine. The presumed mechanism for acupuncture, according to TCM, is that the needles unblock the flow of chi (life energy) through the body. Acupuncture points are supposed to corresponds to the pathways through which chi flow, correlating to specific organs or functions in the body.

Modern proponents of acupuncture come in two basic flavors – those who promote so-called medical acupuncture, and those who restrict their claims to symptomatic relief of pain, nausea, and other symptoms. Medical acupuncture is the claim that acupuncture can actually treat real medical diseases, like cancer. It is dependent entirely on the TCM philosophy of acupuncture, including the flow of chi. Medical acupuncture is pure pseudoscience without any basis in science or evidence and does not require further consideration.

Some proponents of symptomatic acupuncture have divorced their claims from the original philosophy of acupuncture, claiming that the needling works through more prosaic mechanisms, such as the release of pain-relieving endorphins or through nerve stimulation. While these explanations are plausible, they are post-hoc speculations and have not been demonstrated to occur to a clinically relevant degree.

But before we speculate about possible mechanism, we need to establish that acupuncture has an effect – that it works for some specific indication. This has not been established, despite rather robust clinical research efforts. If there were not a cultural inertia to the notion of acupuncture the existing research would have been sufficient to abandon this modality as a dead end.


Another acupuncture study misinterpreted

Posted in Respectful Insolence by Skepdude on May 13, 2009

I was going to handle this myself, but then I found out Orac handled this already, and who can beat Orac when it comes to this sort of stuff, right?

I have to hand it to acupuncture mavens. They are persistent. Despite numerous studies failing to find any evidence that acupuncture is anything more than an elaborate placebo whose effects, such as they are, derive from nonspecifice mechanisms having nothing to do with meridians, qi, or “unblocking” qi. Moreover, consistent with the contention that acupuncture is no more than an elaborate placebo, various forms of “sham” acupuncture (needles that appear to insert but don’t or acupuncture in the “wrong” locations, for example) produce results indistinguishable from “real” acupuncture.

That record won’t change with the latest acupuncture study for low back pain that was published on Monday and is making the rounds through the media. Let’s start with a news report on Medpage Today:

WHEELING, W.Va., May 11 — Acupuncture was more effective than conventional treatment for relieving lower back pain in a randomized trial, but performed no better than poking patients gently with toothpicks.The editors of Medpage Today should really know better than to publish nonsense like this. They shouldn’t have allowed a story about this particular study to start out by saying that acupuncture was bound to be “more effective” than conventional treatment because this study showed nothing of the sort, for reasons that I’ll discuss later. Actually, I bet that astute regular readers here will be able to identify immediately exactly why such a conclusion is unjustified when I describe how the study was done. If not, I promise I’ll make it painfully clear to you by the end. I’ll also feel like I’m repeating myself because I’ve mentioned this very same defect in acupuncture studies. In any case, the study did show that “real” acupuncture was no better than sham acupuncture.

Back to the study. It appeared in Archives of Internal Medicine and was published by a team of investigators led by Dr. Daniel Cherkin of the Center for Health Studies in Seattle; investigators from Northern California Kaiser Permanente, Cancer Research and Biostatistics in Seattle; Department of Family Medicine, Oregon Health and Science University; and (of course) the National Center for Complementary and Alternative Medicine, National Institutes of Health. Yes. NCCAM had a hand in this study. Is anyone surprised? In any case, the study was entitled A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain (Arch Intern Med. 2009;169(9):858-866).


Acupuncture for Bad Backs: Even Sham Therapy Works

Posted in News by Skepdude on May 13, 2009

Anyone who has suffered from back pain knows that when the throbbing gets bad enough, you’ll try anything to find relief — heating pads, acupuncture, pain relievers, physical therapy, even poking yourself with toothpicks.


Yes, toothpicks. Researchers at the Group Health Center for Health Studies in Seattle found that “fake” acupuncture using toothpicks instead of needles was as effective as the traditional Chinese healing method for relieving back pain. (See pictures of spiritual healing around the world.)

Daniel Cherkin, a senior investigator at the center, gathered 638 patients with chronic low back pain, none of whom had ever had acupuncture, and gave them one of three different acupuncture treatments. One group received individual care in the classic model of the ancient Chinese practice in which the acupuncturist analyzes the patient’s overall health by studying his body and lifestyle, taking his pulse and looking at his tongue (practitioners believe that the condition of a person’s tongue is indicative of his total health state) and designs a customized set of acupuncture points that are most likely to relieve pain.

Another group received acupuncture at standardized points, which experienced practitioners agree can help the majority of back-pain sufferers. A final group received the toothpick treatment. These patients were poked with toothpicks inserted through the acupuncture needle tube at the standard points — but unlike with traditional acupuncture, practitioners did not penetrate the patient’s skin. Instead, they pricked and then twirled the toothpick to simulate a needle going in.

Cherkin and his team followed up with the patients at eight weeks, 26 weeks and a year after their sessions to find out how much pain they were experiencing. After eight weeks, twice the number of patients getting any type of acupuncture — whether it was customized, standard or sham — reported improvements in their ability to function, such as walking or going up and down steps without pain, compared with those sticking with traditional care.