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Wednesday, June 2, 2010

Acupuncture Takedown

At the end of last week a study was (surprisingly) published in Nature Neuroscience claiming to justify acupuncture. I say surprisingly, because many aspects of the paper are dubious. The fundamental biochemical findings were interesting and quite promising (which is presumably how the study made it into Nature Neuroscience), but the connections to acupuncture were overly belaboured and should have been harshly criticized during review. There have been three excellent blog reviews published since the article came out, and I highly recommend giving them a read:

The main take-home point (and why much of the language in this article should have raised flags for reviewers) is the fact that this study demonstrated at most a plausible mechanism for the localized pain relief claims of acupuncture. The actual efficacy of acupuncture as a legitimate pain treatment modality, like any other medical treatment, still needs to be demonstrated clinically (something which it has largely failed to do despite years of research), and this study has no bearing on the non-pain treatment claims of acupuncture. Unfortunately, the article fails to acknowledge the lack of clinical support for acupuncture as a treatment modality, as well as failing to acknowledge the many aspects of acupuncture which are in no way validated by these results (non-pain treatment claims, body meridians, and all the rest of the unsupported magic an acupuncturist spends years learning), all while claiming validation for acupuncture.

What angers me the most about situations like this is that negative result studies for alternative 'medicine' modalities never receive the same sort of coverage. The prestige and respect of the journal of Nature Neuroscience will now be co-opted by the alternative medicine community to justify far more than the only somewhat plausible technique of poking people with needles to provide temporary pain relief - all, of course, for a 'reasonable' price.


Andrej Karpathy said...

You say negative-results studies are almost never brought to foreground, but I wonder how many there actually are?

Because scientifically speaking you cannot conclude your paper with "and therefore acupuncture doesn't work", simply because you cannot ever exclude the possibility-- how do you know you haven't missed something? How can you be so sure? Was your sample size good enough? Most cases it isn't, and can't be.

So I don't really have many problems with acupuncture because if it works on some people (forget if it ACTUALLY works, if there even is such a thing), then that's good for them.

Tricky issues. But I definitely agree with being careful of research that jumps to conclusions, if I understood your point correctly.

Mozglubov said...

Hey Andrej,

To get an idea about negative studies (and the challenge in interpreting results), I would recommend following some of the links from Orac's post (namely, this one or this one). I know Steve Novella has previously discussed the number of studies, but I unfortunately cannot find that post right now. If you are really curious, I will try to do a little more digging and see what I can come up with.

You are correct that you cannot conclude "therefore acupuncture doesn't work", but that argument could also be used to defend things like the practice of bloodletting or homeopathy. What you can do is show there is no statistical benefit to an intervention beyond placebo (or, in the case of bloodletting, clear harm caused by the treatment).

Which brings me to the placebo result. If a treatment is effective solely because people think it should be effective, I do not think it is ethical to practice. Modern medicine is built on finding clinically effective treatments and therapies, and performing (with a significant price tag) sham interventions undermines that effectiveness. Not only does it use up significant health resources (particularly since it would seem all the training acupuncturists go through largely doesn't matter, so there is a vast educational waste as well), relying on ineffective modalities can prevent patients from seeking actual treatment (for example, there have been a number of heartbreaking cases over the last few years of children dying from treatable illnesses like diabetes and eczema(!) due to their parents' reliance only on prayer as an intervention). Additionally, treating patients as agents to be manipulated into thinking they will get better introduces what I view as a toxic element to the physician-patient relationship. There are already issues with the power dichotomy between doctors and patients, making it common practice to try and trick patients into feeling better would certainly complicate things.

Andrej Karpathy said...

Yes, but is it ethical for you to forbid someone the use acupuncture, citing your couple of studies, when they swear it worked for them and their ancestors?

There are many cases where modern medicine can't solve a particular symptom. In that case, after unsuccessfully seeking a conventional treatment, is it not reasonable for people to resort to alternative treatments that have at least a plausible experimental evidence?

In that sense I don't have problem with its existence. But certainly, I would expect every serious doctor to warn their patients of this issue and not attempt to hide the raging battle.

That being said, I'm somewhat on a fence about this issue myself :) and you bring up good points.

Mozglubov said...

I think acupuncture and other alternative health methods, no matter how traditional, still need to be subject to the same consumer protection regulations and standard demonstrations of efficacy as any other treatment modality. I am not advocating that acupuncture be banned outright, but its current incarnation of practice could hardly be defended as anything other than a purely commercial business. For an example of the claims that acupuncturists make, here is a link of claimed benefits that go far beyond pain relief (all with, as far as I can find, no evidential basis other than anecdotal).

It is true that modern medicine cannot always solve health issues, but that does not mean that there should not be any sort of consumer protection in place for the health claims of alternative practitioners. Fairly benign modalities like homeopathy or acupuncture might not be able to cause any worsening of physical health for incurably ill patients, but that doesn't mean financial harm should not also be guarded against (particularly when people are as desperate as incurably ill people generally are).