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Acupuncture and mixed signals – A match made in heaven

Posted in Skepdude by Skepdude on September 6, 2009

Now, we all know the simple truth: regardless of the proposed mechanism of action, acupuncture still does not appear to work.  Any randomized, double blind studies that have been conducted on the matter have consistently shown it to be no better than placebo.  Of course, the acupuncture enthusiasts response to these results has been quite ingenious: “The fake acupuncture works just as well as the real thing.” They both work!!! Talk about mixed signals!

Today, I ran across this article which tries to  dispel these mixed signals and clarify the matter for us. From the get go my expectations were pretty low. Any article that claims to clarify how acupuncture works is bound to get ridiculous, and TheHorse.com does not disappoint in that regard. Why is this article appearing on a equine website?  Why they are talking about animal acupuncture obviously! Let’s get started with the ridiculing…I mean analyzing.

Although acupuncture is frequently used in human and animal health, it needs to be described in terms that most people accept and understand, said Narda G. Robinson, DO, DVM, MS, who recently authored a report on the topic.

Qi (Energy) flows through your body down the meridians (think of it as a road grid, like the square grid in Manhattan). Sometimes the energy flow is affected and it goes out of balance. You stick needles in specific acupoints to restore the balance and you feel better. What can be simpler to understand than that? What is so confusing about it?

Traditional Chinese medicine explains that the invasion of environmental agents, such as cold, wind, dampness, and heat cause pain, and an upset in Yin and Yang disrupts organ function. Acupuncture is supposed to correct this, but to today’s modern mind that sounds like superstition.

That’s because it IS superstition.

“We shouldn’t be selling mysticism as medicine,” Robinson said.

Yes! Finally a sensible person. This is what I have been saying all along! No need for mysticism, just science based medicine.

“Acupuncture is real medicine, based on anatomy and physiology,” she explained. “Getting the best results comes from seeing what’s right in front of us–muscle tension, imbalances in the nervous system, and the health impact of stress, malnutrition, and under- or over-exercise. Belief systems imported from China only muddy the message.”

Ah shoot, got me! For a moment there I thought they were gonna be sensible. Alas, no such luck! No, acupuncture is not real medicine based on either anatomy or physiology. And just what is an “imbalance in the nervous system”? Oh yeah, I know. It’s the modern version of the old mysticism of energy imbalance. I thought we weren’t selling mysticism anymore. What is this the Intelligent Design of the acupuncturists? Yeah, who needs to muddy the new mystic message with the old mystic message?

In medical terms, “Acupuncture appears to work because it dampens pain transmission in the nervous system, which means it turns down the ‘volume’ of painful impulses entering the spinal cord and brain, and changes our emotional state and reaction to painful stimuli,” she said. “Sophisticated brain imaging techniques have told us which parts of the brain are responding to acupuncture and when, providing a ‘real time’ window into brain function during and after acupuncture.”

I know, I know! It’s the parts of the brain that respond when someone is stuck with a needle, or a toothpick for that matter! And just how exactly does acupuncture dampen pain transmission and turn down the pain volume? Of course no one knows, they just claim it does.

Owners who want to use acupuncture to treat their horses should choose a veterinarian who approaches acupuncture scientifically, she said.

This is easy, there shouldn’t be any, since acupuncture is not a scientific modality!

Robinson recommended that owners find out the facts about any modality before using it on their horse.

Great, and that research should show the owners that acupuncture has never been shown to work. But then of course we can’t expect anyone to be aware of the criteria for good evidence and properly designed studies, so most likely they will be convinced by the anecdotes.

Oh acupuncturists, acupuncturists, when will you stop with the BS?

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18 Responses

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  1. dvd vierge said, on September 10, 2009 at 4:41 AM

    Acupuncture is one of the best medicine in the world but people are encourage it properly so it is not in news for too much.

    • Skepdude said, on September 10, 2009 at 9:49 AM

      HUH?

  2. Narda Robinson said, on May 6, 2010 at 1:21 PM

    Acupuncture is not scientific? When was the last time you read the physiologic literature on acupuncture?

    • Skepdude said, on May 6, 2010 at 5:00 PM

      Ok, well then Narda bring me up to speed. Point me to the science behind energy, meridians and the sticking of needles!

  3. Narda Robinson said, on May 6, 2010 at 5:51 PM

    Acupuncture is not about moving energy through invisible meridians. It’s about somatic afferent stimulation.

    For example, see Uchida S and Hotta H. Acupuncture affects regional blood flow in various organs. Evid Based Complement Alternat Med. 2008 June; 5(2): 145–151.

    • Skepdude said, on May 6, 2010 at 10:35 PM

      Oh really? Do you mind explaining what “somatic afferent stimulation” means TO YOU? I know somatic means of the body, as opposed to the mind, and afferent means going forward, but I have no idea what those three words mean to you, as a whole.

      I thought acupuncture was about qi blockages, along the meridians, and using needles to unblock the energy. That’s what the NCCAM seems to think too (http://tinyurl.com/cur3wa), but hey everything can be justified so long as you can change definitions on the fly right?

      And where are the links? You don’t suppose I have a copy of the June 2008 Evid. Based CAM (oxymoron!) do you?

  4. Narda Robinson said, on May 7, 2010 at 1:04 PM

    Somatic afferent stimulation refers to the stimulation of sensory nerves via afferent fibers. It doesn’t so much matter what the terms means to me as what it refers to physiologically. Search on pubmed.gov using the terms “acupuncture somatic afferent stimulation” and you will find examples of papers exploring the physiology of acupuncture, including the citation I provided.

    To help you out, here’s the link:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396473/

    The energy-based acupuncturists still imagine that they are working with energy and qi blockages. Medical acupuncturists realize that what’s going on are physiologic changes as a result of nerve stimulation. That should be consistent with what I wrote in the paper which is why I didn’t understand why you were mocking me and my writing.

    • Skepdude said, on May 7, 2010 at 1:45 PM

      You’re pointing to a study on rats to support your point that acupuncture is scientific? As far as scientific evidence goes studies on rats rank quite low, and you must know that. Show me double blinded studies on humans that show it is effective.

      I’m willing to leave aside HOW it works, you seem to support the increased blood flow hypothesis. Fine. Forget about that at all, just show me double blind, scientifically acceptable studies that show an effect at all beyond placebo.

      I challenge you that you will not be able to find 3 randomized, double blind, properly controlled studies, outside of China, that show that acupuncture has any effect beyond placebo.

  5. Narda Robinson said, on May 7, 2010 at 1:54 PM

    First, how would one design a double-blind study and not know whether they are inserting a needle or not?

    Second, rat studies are done to investigate mechanisms of action of acupuncture, much like other physiologic investigations.

    Third, if you are interested in finding randomized, controlled trials in humans, spend some time on Pubmed.gov . You will find several, including:

    J Clin Oncol. 2010 Apr 20. [Epub ahead of print]
    Acupuncture for Pain and Dysfunction After Neck Dissection: Results of a Randomized Controlled Trial.
    Pfister DG, Cassileth BR, Deng GE, Yeung KS, Lee JS, Garrity D, Cronin A, Lee N, Kraus D, Shaha AR, Shah J, Vickers AJ.

    Chin Med. 2010 Mar 23;5:11.
    Effects of acupuncture to treat fibromyalgia: A preliminary randomised controlled trial.
    Itoh K, Kitakoji H.

    Chin J Integr Med. 2010 Feb;16(1):71-4. Epub 2010 Feb 4.
    Clinical efficacy of acupuncture on the morphine-related side effects in patients undergoing spinal-epidural anesthesia and analgesia.
    Jiang YH, Jiang W, Jiang LM, Lin GX, Yang H, Tan Y, Xiong WW.

    I don’t have links for free downloads of these articles.

    • Skepdude said, on May 7, 2010 at 2:09 PM

      How do you do a double blind acupuncture study? Like this:

      http://www.openmedicine.ca/article/view/189/235

      • Narda Robinson said, on May 7, 2010 at 2:28 PM

        Really? What they showed was that the analgesic effect of the penetrating and non-penetrating needles were similar, an effect potentially derived from mechanoreceptor stimulation. Since the somatic afferent stimulation associated with acupuncture involves to a large extent mechanoreceptors, there is overlap here from the neurophysiologic stimulation of both conditions.

        In addition, there is the potential analgesic effect from the pain-eliciting electrical stimulation. If the electrical stimulation is turned up high enough to elicit pain, there’s likely to be an endogenous analgesic response that will complicate the determination of which response was due to the needle and which was due to the electrical stimulation.

        • Skepdude said, on May 7, 2010 at 2:46 PM

          The point is that the “real” acupuncture and the fake acupuncture produced the same result. That is the text book definition of placebo. You can interpret that as you wish, but so long as we’re talking about scientific evidence the verdict is that acupuncture produces results that are identical (statistically speaking) to placebo!

          Furthermore, you asked how to do a double-blind acupuncture study, I showed you how. It can be done.

          • Narda Robinson said, on May 7, 2010 at 2:51 PM

            Designing a methodologically sound study requires selection of a suitable placebo. Stimulating loci within the same spinal segmental territories does not qualify as a suitable placebo for acupuncture.

            Yes, you pointed to one way that researchers claim to have developed a suitable double-blinded approach to acupuncture. I pointed out to you flaws in the methodology.

    • Skepdude said, on May 7, 2010 at 2:20 PM

      Now to address the other studies you mention:

      J Clin Oncol. 2010 Apr 20. [Epub ahead of print]
      Acupuncture for Pain and Dysfunction After Neck Dissection: Results of a Randomized Controlled Trial.
      Pfister DG, Cassileth BR, Deng GE, Yeung KS, Lee JS, Garrity D, Cronin A, Lee N, Kraus D, Shaha AR, Shah J, Vickers AJ.

      STUDY WAS NOT BLINDED

      Chin Med. 2010 Mar 23;5:11.
      Effects of acupuncture to treat fibromyalgia: A preliminary randomised controlled trial.
      Itoh K, Kitakoji H.

      STUDY WAS NOT BLINDED. ONLY 16 PARTICIPANTS.

      Chin J Integr Med. 2010 Feb;16(1):71-4. Epub 2010 Feb 4.
      Clinical efficacy of acupuncture on the morphine-related side effects in patients undergoing spinal-epidural anesthesia and analgesia.
      Jiang YH, Jiang W, Jiang LM, Lin GX, Yang H, Tan Y, Xiong WW.

      REALLY??? THIS IS JUST A MESS. THEY DON’T EVEN EXPLAIN, NOT EVEN FLEETINGLY IN THE ABSTRACT, HOW THE ACPUNCTURE WAS APPLIED, OR HOW IT WAS CONTROLLED FOR. HORRIBLE STUDY, SO FAR AS ONE CAN TELL FROM THE ABSTRACT.

      Is this the best “scientific evidence” you have to base your conclusions on?

  6. Narda Robinson said, on May 7, 2010 at 1:59 PM

    Here’s another one, from Germany:

    http://archinte.ama-assn.org/cgi/content/full/167/17/1892

    German Acupuncture Trials (GERAC) for Chronic Low Back Pain
    Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups

    Michael Haake, PhD, MD; Hans-Helge Müller, PhD; Carmen Schade-Brittinger; Heinz D. Basler, PhD; Helmut Schäfer, PhD; Christoph Maier, PhD, MD; Heinz G. Endres, MD; Hans J. Trampisch, PhD; Albrecht Molsberger, PhD, MD

    Arch Intern Med. 2007;167(17):1892-1898.

    Although you are likely to point out that the outcome from verum acupuncture was like sham in this study, the fact is that there was neuroanatomical overlap in the points selected between the verum and the sham groups, indicating that similar spinal segments were affected.

    This is one of the biggest problems with acupuncture research; i.e., incorrect selection of a control or sham group because the designers of the study lack an adequate understanding of the neural basis of acupuncture.

    • Skepdude said, on May 7, 2010 at 2:30 PM

      This one is even better. And yes you hit the nail right on the head: There was practically no difference between “real” acupuncture and the fake one. That shows that “real” acupuncture does no better than placebo, which is the point I’ve been making all along!

      So let us recap your evidence: You provided 4 studies. 3 of them don’t meet the basic standards of what would be considered acceptable scientific evidence. That’s 75% of your evidence. the last one did have some blinding but it proved MY point not yours.

      Care you reconsider your position?

  7. Narda Robinson said, on May 7, 2010 at 2:32 PM

    As I said, the problem with many “controlled” acupuncture trials is that they erroneously select sham points. That is, they fall within the same spinal segmental levels as the verum points and thus stimulate similar neuroanatomic domains.

  8. Skepdude said, on May 7, 2010 at 3:46 PM

    Designing a methodologically sound study requires selection of a suitable placebo. Stimulating loci within the same spinal segmental territories does not qualify as a suitable placebo for acupuncture.

    Yes, you pointed to one way that researchers claim to have developed a suitable double-blinded approach to acupuncture. I pointed out to you flaws in the methodology.

    What stimulation do you refer to? They used non-penetrating needles. The purpose was to test how much, if at all, skin penetration does anything and the answer is, not at all. Other studies have been done where needles were inserted in the wrong points: same reulst. Another study used toothpicks to pinch people into believing a needle penetrated their skin: the same result.

    What we see here is that the moment you blind, if only the subjects, all of a sudden it doesn’t matter if the needle penetrates the skin or not, and it doesn’t matter where the needle penetrates. This is classic placebo effect.

    You want to show acupuncture works. Find a study where the “real” acupuncture does statistically better than the fake one! Then get it published in a real peer reviewed journal. Then replicate it. Get those studies peer reviewed. Repeat, lather rinse and you’ve shown acupuncture to work! Until then, it’s nothing but magical thinking.


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