Acupuncture – Disconnected from Reality
The primary goal of science-based medicine (SBM) is to connect the practice of medicine to the best currently available science. This is similar to evidence-based medicine (EBM), although we quibble about the relative roles of evidence vs prior plausibility. In a recent survey 86% of Americans said they thought that science education was “absolutely essential” or “very important” to the healthcare system. So there seems to be general agreement that science is a good way to determine which treatments are safe and work and which ones are not safe or don’t work.
The need for SBM also stems from an understanding of human frailty – there are a host of psychological effects and intellectual pitfalls that tend to lead us to wrong conclusions. Even the smartest and best-meaning among us can be lead astray by the failure to recognize a subtle error in logic or perception. In fact, coming to a reliable conclusion is hard work, and is always a work in progress.
There are also huge pressures at work that value things other than just the most effective healthcare. Industry, for example, is often motivated by profit. Institutions and health care providers may be motivated by the desire for prestige in addition to profits. Insurance companies are motivated by cost savings. Everyone is motivated by a desire to have the best health possible – we all want treatments that work safely, often more so than the desire to be logical or consistent. And often personal or institutional ideology comes into play – we want health care to validate our belief systems.
These conflicting motives create a disconnect in the minds and behaviors of many people. They pay lip service to science-based medicine, but are good at making juicy rationalizations to justify what they want to be true rather than what the science supports. We all do this to some degree – but, in my opinion, complementary and alternative medicine (CAM) is a cultural institution that is built upon these rationalizations. It is formalized illogic and anti-science conceals as science under a mountain of rationalizations.
Some recent news items and reports dealing with acupuncture demonstrate this disconnect quite well.
2009: Shaping up to be a really bad year for antivaccinationists
[Originally posted at: Science Based Medicine]
I will begin this post with a bit of an explanation. Between one and two weeks ago, there appeared two momentous news about the manufactroversy regarding vaccines and autism. No doubt, many SBM readers were expecting that I, as the resident maven of this particular bit of pseudoscience, would have been here last week to give you, our readers, the skinny on all of this. Unfortunately, as some know, my wife’s mother died, coincidentally enough, on the 200th anniversary of Darwin’s birthday and a day when one of those two momentous bits of news was released to the public, which is why I used one of my handful of posts written and then held in reserve. I’m back now, though, and I don’t think it’s too late to comment on these bits of news because now that over a week has gone by what I’ve seen has led me to draw some conclusions that I might not have been able to do, had I done my usual bit and been first off the mark (at least among SBM bloggers) discussing the story.
[Read the rest of this post at: Science Based Medicine]
Amish Home Burn Treatment: B&W Salve and Burdock Leaves
People in the Amish community have been using “The New Concept in Treating Burns” and their experience is recounted in a little booklet by that title. It is a compilation of articles, testimonials, and letters to the editor of a monthly newspaper Plain Interests, published in Millersburg PA.
The treatment, involving B&W ointment and dressings of scalded burdock leaves, was developed by John Keim, an Amish farmer and natural healer. The Amish have a tradition of taking care of their own, and they try to avoid hospitals whenever possible. In the booklet, they even recommend treating hip fractures at home without surgery. (Which, after all, is what we did before we had hospitals and surgery).
They claim that with the B&W burn treatment:
- Painful burns are rendered non-painful.
- Healing is faster.
- Painful debridement is not necessary.
- Skin grafting is not necessary.
- Scarring seldom occurs.
- Iatrogenic harm from hospitals is avoided.
- Patients can be treated at home at much less expense.
According to Keim, with his method it seldom takes more than seven days to get a completely new skin cover on second and third degree burns, and in over two decades he never had an infection. He saw only 2 cases of scarring, and they were minimal. He does not charge for his services.
Rainman – Link Between Precipitation and Autism
A new study published in the Archives of Pediatrics and Adolescent Medicine shows a positive correlation between counties in California, Oregon, and Washington with greater precipitation and a higher incidence of autism. While the results of this study are interesting, it needs to be put into proper context. Also of note, the authors had presented early results from this data previously.
Correlation is not Causation
This type of study is a correlational study, which means it asks whether or not there is a statistical correlation between two variables – in this case the rate of autism and the amount of precipitation. This type of data is extremely useful to medical science, but it has known limitations, which can be summarized by the statement that correlation is not causation.
I often see this principle used to dismiss correlation data entirely, but that is not the correct approach. Correlation, rather, needs to be considered in the proper context. When A correlates with B there are various possible interpretations: the correlation is a statistical fluke (coincidence); A causes B, B causes A, or both A and B correlate with another variable C, and there can be a variety of causal relationships among the three (or more) variables which would cause A to track with B.
Therefore, finding a correlation is a way to generate several hypotheses which can then be tested by further observations or research. That, in my opinion, is the best way to view correlational data – as a beginning step to help generate hypothesis. But they should not be used to reach firm conclusions.
It should also be noted that further correlations can be used to test various causal theories, and if multiple correlations all triangulate to a single causal hypothesis that can lead to a fairly confident conclusion – even in the absence of other evidence. For example, smoking correlates with certain types of lung cancer. There are no prospective studies in humans to establish that smoking causes lung cancer, but we can be confident that it does because the correlation holds up no matter how you choose to look at it. If smoking causes cancer (as opposed to other causal hypotheses stemming from the correlation) then we predict that increased duration of smoking increases risk of lung cancer, that stopping smoking decreases risk, that smoking unfiltered is more risky than filtered, etc. Each of the predictions turns out to be true, supporting the smoking causes lung cancer hypothesis.
Puncturing the Acupuncture Myth
“Alternative” medicine is by definition medicine that has not been scientifically proven and has not been accepted into mainstream scientific medicine. The question I keep hearing is, “But what about acupuncture? It’s been proven to work, it’s supported by lots of good research, more and more doctors are using it, and insurance companies even pay for it.”
It’s time the acupuncture myth was punctured – preferably with an acupuncture needle. Almost everything you’ve heard about acupuncture is wrong.
To start with, this ancient Chinese treatment is not so ancient and may not even be Chinese! From studying the earliest documents, Chinese scholar Paul Unschuld suspects the idea may have originated with the Greek Hippocrates of Cos and later spread to China. There’s certainly no evidence that it’s 3000 years old. The earliest Chinese medical texts, from the 3rd century BC, don’t mention it. The earliest reference to “needling” is from 90 BC, but it refers to bloodletting and lancing abscesses with large needles or lancets. There is nothing in those documents to suggest anything like today’s acupuncture. We have the archaeological evidence of needles from that era – they are large; the technology for manufacturing thin steel needles appropriate for acupuncture didn’t exist until 400 years ago.
Acupuncture for Hot Flashes – Or, Why So Many Worthless Acupuncture Studies?
In yet another round of science by press release, a particularly unimpressive acupuncture study is making the rounds of the major news outlets proclaiming that acupuncture works. I guess that is a sort-of answer to my title question – why are so many scientifically worthless acupuncture studies being done?
Let’s take a look at this particular study to see why it is so weak. All I have to go on is the press release, since the study is not published. It was presented at a scientific meeting – which is legitimate, I just don’t have access to it. (The bar for publication in a peer-reviewed journal is much higher than presentation at a meeting, and there may, in fact, be changes to the text prior to publication.) But we can still say a great deal about this study from the information provided.
4 Minute Exercise Machine
I know I should exercise regularly, but I’m congenitally lazy and am ingenious at coming up with excuses. There’s an exercise machine that sounds like the end of all excuses, a dream come true. You’ve probably seen the ads in various magazines. The ROM Machine: “Exercise in Exactly 4 Minutes per Day.” It claims that you can get the same benefit, at home, from 4 minutes a day on the ROM as you can from 20 to 45 minutes aerobic exercise plus 45 minutes weight training plus 20 minutes stretching at the gym. It allegedly balances blood sugar and repairs bad backs. It is for everyone from age 10 to over 100.
The Importance and Limitations of Peer-Review
Peer-review is a critical part of the functioning of the scientific community, of quality control, and the self corrective nature of science. But it is no panacea. It is helpful to understand what it is, and what it isn’t, its uses and abuses.
Thanks, Jenny McCarthy! Thanks for the measles!
I would like to take this opportunity to echo my co-blogger Steve’s sentiment and thank Jenny McCarthy.
What? You say. Has Gorski completely lost his mind? (Or maybe you used another word besides “mind,” a perhaps not so savory word.) Not really. I just agree with Steve that accomplishment should be recognized, and there’s no doubt that in her year as the new celebrity spokesperson for the antivaccination movement, Jenny McCarthy has pulled off a major coup.
She’s helped reignite a movement that was until her entrance (and especially the entrance of her far more famous boyfriend Jim Carrey, who’s said some things just as breathtakingly dumb as Jenny has) more or less moribund, to the point where it’s now become so effective that measles is coming back far faster than I had thought possible. Between her tireless prosletyzing on Oprah Winfrey’s show that vaccines caused her son’s autism and that “biomedical” quackery can “cure it”; her organizing of a march on Washington, D.C. this summer to push an explicitly antivaccine agenda disguised under the deceptive and disingenuous (but brilliantly Orwellian) slogan “Green Our Vaccines“; her holding celebrity fundraisers (complete with Britney Spears, Hugh Hefner, and Charlie Sheen, yet!); and her fronting WWE events to raise money for Generation Rescue, she’s done it all in a little more than a year. And she’s not resting on her “laurels” (such as they are), either. This September, she will be publishing the followup to her previous book on “healing autism” (with quackery), Mother Warriors: A Nation of Parents Healing Autism Against All Odds. No doubt she will again appear with Oprah to fawning acclaim to make the unfounded assertion that vaccines injured her son to make him autistic and that her favored forms of quackery have successfully “healed him.”
In light of these “accomplishments,” it’s only right that we all give Jenny (and Jim) the “thanks” they deserves for their role in bringing the measles back to the U.S.
Recognizing Dubious Health Devices
The public is often left to fend for themselves in the marketplace of medical devices and health aids. Current regulations in most countries are inadequate to prevent grossly misleading claims in advertising and to provide adequate evidence for safety and effectiveness for products on the market. So it is helpful for consumers to be aware of the red flags for dubious devices to watch out for.
I came across this ad for The Rebuilder, which purports to be a treatment for painful neuropathy. About 2.4% of the population has some kind of peripheral nerve damage (neuropathy), which means there are about 7.2 million Americans with neuropathy. In most cases there is no cure (although there is effective treatment for some of the symptoms of neuropathy) so it is not surprising that neuropathy is a common target for questionable treatments and devices.
The ad is full of misleading or unsupported claims and blatant misinformation and provides an excellent example of the many features of quackery marketing to look out for.
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