Acupuncture Q&A

[vbloke]

from an email circulated around the company I work for:

Acupuncture is for more than treating bad backs and stopping smoking. Nick Williamson, Acupuncturist, will be coming in to give a talk about the basic concepts of Chinese medicine and answer any questions you may have.

The talk will take place on the ground floor conference centre from 12.00pm - 1pm on Wednesday 25 January. The presentation will be followed by a Q&A session."

Now, I'd obviously like to ask a few questions here, but what would be a few really killer questions to ask? Obviously, I'd like the appropriate killer answers to any guff this guy can come back at me with.

 

[Jeff Corey]

http://www.quackwatch.org/01QuackeryRelatedTopics/acu.html should do the trick

 

[Mojo]

You could ask him about whether the acupuncture points, meridians and their alleged regulation of the flow of "qi" can possibly be real in light of this:
Abstract

CONCLUSION: Acupuncture was no more effective than sham acupuncture in reducing migraine headaches

News story

It seems that it doesn't matter where you stick the needles!

 

[Dogdoctor]

from an email circulated around the company I work for:


Now, I'd obviously like to ask a few questions here, but what would be a few really killer questions to ask? Obviously, I'd like the appropriate killer answers to any guff this guy can come back at me with.

You will find that in dealing with proponents of acupuncture there are no questions that you ask that will affect them so much that they can't give a comeback rationale. The only way to effectively counter them is to be familiar with all of the research and common questions and answers. Believers are believers "damn the data it must be wrong".

 

[ChristineR]

Acupuncture works. All that stuff about "Chi" and "meridians" is bogus, and most of the claims are nonsense. There was an article about it in Skeptic some years ago. Apparently you can get the same effects with mild electrical simulation to the muscles. Large muscles are more effective than small, and you do not need to apply stimulation directly to the painful area.

It's not necessarily a good idea, or better than modern medicine, but it isn't a sham treatment.

 

[Rolfe]

Sounds like you can say "acupuncture works" if you simply create your own definition of acupuncture then.

Rolfe.

 

[vbloke]

It appears that I won't be present at the Q&A session, as I'd completely forgotten (how??? you ask) that I'll be at TAM4.
Fortunately, I have a skeputy that can go in my stead.

 

[Almo]

"Skeputy!" Great word!!

 

[vbloke]

*googles for it*
no matches!
I hereby lay claim to having coined a new word.

 

[Rolfe]

On Tuesday I attended (well actually I organised it) a meeting about the historical basis for veterinary acupuncture, where one of the speakers was a leading authority on ancient and mediaeval Chinese literature, who had been turned on to the incongruities of the claims made by veterinary acupuncturists by a sceptical vet. Most of the stuff was specifically about animals, and the conclusion was that there was no historical basis for believing that the Chinese had ever practised acupuncture on animals. It was all mistranslation, politically motivated, and in fact veterinary acupuncture was a western invention of the 20th century.

Human acupuncture was touched on as well of course, and that does have rather more historical support. However, the whole impact of the imformation was of a pile of ridiculous superstition that anyone with half a brain would have to be mad to think had any relevance to modern healthcare. It never had much of a following in China anyway, and it was banned as mediaeval superstition in the early part of the 20th century, until Mao realised that the only way he could claim to have a respectable number of "doctors" in the country was if he just called the village quacks "doctors". He also relished annoying the "West" by promoting something Chinese and superstitious. His own doctor quoted him as saying he wanted to promote it, but he didn't believe in it and wouldn't use it himself.

In China, people who can afford it head unerringly for modern scientific medicine. It's been estimated that maybe 5-20% will have Chinese medicine as well as the stuff that works though. In China, demonstrations of acupuncture are often set up to impress visiting westerners. It's all about ignoring the man behind the curtain, or in this case the ordinary anaesthetics and painkillers given as well that they aren't telling you about.

Most of what passes for acupuncture in the west was invented in France. It has gone through several cycles of popularity and discrediting in the last 150 years or so. People are always latching on to it, thinking that there are great discoveries to be made, but the closer they look the more there's nothing there except a fairly strong Hawthorne effect.

To quote a lecturer I heard last year, a specialist in the treatment of chronic pain, "well, carry on - so long as you realise it doesn't do any good, and it can kill you."

Rolfe.

 

[ChristineR]

Now that I can post links...

http://www.annals.org/cgi/content/abstract/141/12/901

I believe this is the first major study to use a needle encased in a plastic device that can be set to either poke the skin or actually insert the needle, so it was truly double blinded and controlled.

I'm not qualified to say whether the results in this study were good enough to justify acupuncture, or what the risks of acupuncture are. But it is not entirely a placebo or distraction effect.

 

[Mojo]

On Tuesday I attended (well actually I organised it) a meeting about the historical basis for veterinary acupuncture, where one of the speakers was a leading authority on ancient and mediaeval Chinese literature, who had been turned on to the incongruities of the claims made by veterinary acupuncturists by a sceptical vet. Most of the stuff was specifically about animals, and the conclusion was that there was no historical basis for believing that the Chinese had ever practised acupuncture on animals. It was all mistranslation, politically motivated, and in fact veterinary acupuncture was a western invention of the 20th century.

I thought that one of the reasons that acupuncturists were able to get away with making up all the stuff about meridians and the flow of qi etc. was that there was a taboo on dissection of human corpses, so what was actually inside the human body was a matter of pure conjecture. They had no way of knowing that there wasn't actually any structure corresponding to the phenomena they claimed.

Since there was presumably no taboo on cutting up non-human animals (how else could they eat them) this wouldn't arise in veterinary medicine.

 

[Mojo]

Now that I can post links...

http://www.annals.org/cgi/content/abstract/141/12/901

I believe this is the first major study to use a needle encased in a plastic device that can be set to either poke the skin or actually insert the needle, so it was truly double blinded and controlled.

I'm not qualified to say whether the results in this study were good enough to justify acupuncture, or what the risks of acupuncture are. But it is not entirely a placebo or distraction effect.

Assuming that the blinding really did work perfectly, this may show that actually inserting a needle into the body has some effect. It doesn't address the point raised in the study I linked to earlier, which suggested that it doesn't matter where you insert the needles.

 

[ChristineR]

Assuming that the blinding really did work perfectly, this may show that actually inserting a needle into the body has some effect. It doesn't address the point raised in the study I linked to earlier, which suggested that it doesn't matter where you insert the needles.

I far as I can tell it doesn't matter much where you insert the needles, except that larger muscles are better than smaller, a fact that supports the general theory of stimulating endorphin production. Even among TCM doctors there is no agreement on where the meridians are, let alone a coherent theory of Chi blockages and Chi buildup.

A mechanical, non-drug based way of reliably stimulating endorphins is something to take seriously. The JAMA migraine study is less interesting because it doesn't control for placebo effects. It simply discredits the already incredible theory of Chi meridians. The AIM knee study does indicate that inserting needles into the body can relieve pain.

 

[Dr. A Sheikh]

In acupuncture we do not use any medicine even then it works. There is no problem of avogadros application.

 

[casebro]

Now that I can post links...

http://www.annals.org/cgi/content/abstract/141/12/901

I believe this is the first major study to use a needle encased in a plastic device that can be set to either poke the skin or actually insert the needle, so it was truly double blinded and controlled.

I'm not qualified to say whether the results in this study were good enough to justify acupuncture, or what the risks of acupuncture are. But it is not entirely a placebo or distraction effect.

Here's an imterpretation of the results of that study at http://www.journalclub.org/2004/12/19/n39

"A second point relates to the results themselves, presented in Table 2 of the paper. The change from baseline for all five measurements is reported for the three groups (true acupuncture, sham acupuncture and education) at weeks 4, 8, 14 and 26. Taking one example, the WOMAC pain score was approximately 8.95 at baseline in the three groups. At week 4, it improved by 2.22 in the true acupuncture group, by 1.98 in the sham acupuncture group and by 0.84 in the education group.

This means that the benefit of true acupuncture over education was 2.22-0.84 = 1.38. Similarly, the benefit of sham acupuncture over education was 1.98-0.84 = 1.14. In this case, if the benefit of true acupuncture over education was 1.38, and that of sham acupuncture over education was 1.14, then one might conclude that 1.14/1.38 = 83% of the benefit of true acupuncture was due to the placebo (sham acupuncture) effect. I realize that this may not be a statistically correct assumption, but I believe it does represent a reasonable approximation. I would love to hear what statisticians have to say about this."

Soounds like acupunctuation don't work worth a damn.

 

[ChristineR]

Here's an imterpretation of the results of that study at http://www.journalclub.org/2004/12/19/n39

"A second point relates to the results themselves, presented in Table 2 of the paper. The change from baseline for all five measurements is reported for the three groups (true acupuncture, sham acupuncture and education) at weeks 4, 8, 14 and 26. Taking one example, the WOMAC pain score was approximately 8.95 at baseline in the three groups. At week 4, it improved by 2.22 in the true acupuncture group, by 1.98 in the sham acupuncture group and by 0.84 in the education group.

This means that the benefit of true acupuncture over education was 2.22-0.84 = 1.38. Similarly, the benefit of sham acupuncture over education was 1.98-0.84 = 1.14. In this case, if the benefit of true acupuncture over education was 1.38, and that of sham acupuncture over education was 1.14, then one might conclude that 1.14/1.38 = 83% of the benefit of true acupuncture was due to the placebo (sham acupuncture) effect. I realize that this may not be a statistically correct assumption, but I believe it does represent a reasonable approximation. I would love to hear what statisticians have to say about this."

Soounds like acupunctuation don't work worth a damn.

Actually, look at his (her?) conculsion.

* For the improvement in WOMAC pain score, at weeks 4, 8, 14 and 26, the percentages of the improvement attributable to placebo acupuncture were: 83%, 74%, 55% and 59%.
* For the improvement in WOMAC function score, at weeks 4, 8, 14 and 26, the percentages attributable to placebo acupuncture were: 43%, 46%, 58% and 52%.
* For the patient global assessment score, the corresponding percentages were: 50%, 38%, 52% and 0% (no effect from sham acupuncture).

Although these numbers are derived by me and may not be strictly correct, I think they do give an idea that about half of the benefit from acupuncture in this study was due to a generic placebo effect equivalent to sham acupuncture, and about half of the effect was specific to the real treatment. That’s not a bad overall result for acupuncture, considering how important the placebo effect is pain therapy.


So after the 26% week study:

41% of the pain reduction was not attributable to placebo
48% of the function improvement was not attributable to placebo
100% of the improvement in global assessment score (whatever that means) was not attributable to placebo.

I actually find those to be pretty impressive numbers. They're certainly better than many drugs. For the SSRIs (Prozac, Xoloft, et al), 80% of the effect may be placebo, yet they are still widely prescribed because they are safe and better than nothing.

What I can't comment on is what these pain score reductions mean in practical terms.

 

[casebro]

I actually find those to be pretty impressive numbers. (snip)
What I can't comment on is what these pain score reductions mean in practical terms.

SOoo, the pre-treatment scores were 8.95. pain scores after the study were: acupunctuation is 6.73, placebo treatment ia 6.97, showing that sticking needles into your body can lower the pain by 2.8 percent . Yuh, sure, I'll take needles stuck into random places on my body for a 2.8% reduction in pain.

What do we need to compare here? Comparative risk/benefit, vs Relative risk/benefit?

Relative benefit: acupunctuation relieves pain 43% better than placebo.

Comparative benefit: after 26 2 hour sessions, for a total of 52 hours, acupunctuation patients have 98% as much pain as placebo patients .

How come they didn't compare to Hydrocodone? or even aspirin?

 

[ChristineR]

SOoo, the pre-treatment scores were 8.95. pain scores after the study were: acupunctuation is 6.73, placebo treatment ia 6.97, showing that sticking needles into your body can lower the pain by 2.8 percent . Yuh, sure, I'll take needles stuck into random places on my body for a 2.8% reduction in pain.

What do we need to compare here? Comparative risk/benefit, vs Relative risk/benefit?

Relative benefit: acupunctuation relieves pain 43% better than placebo.

Comparative benefit: after 26 2 hour sessions, for a total of 52 hours, acupunctuation patients have 98% as much pain as placebo patients .

How come they didn't compare to Hydrocodone? or even aspirin?

Where are you getting 2.8%?

The true acupuncture group dropped -3.79 from 8.92 to 5.13.
The sham acupuncture group dropped -2.92 from 8.90 to 5.98.

The true group had 85% as much pain as the sham group.

That's -.87 from acupuncture alone, or about a 10% reduction in pain due to acupuncture and a total 40% reduction in pain.

Hydrocodone is addictive and dangerous. If you took it for chronic pain, you'd likely die.

 

[casebro]

Where are you getting 2.8%?

The true acupuncture group dropped -3.79 from 8.92 to 5.13.
The sham acupuncture group dropped -2.92 from 8.90 to 5.98.

The true group had 85% as much pain as the sham group.

That's -.87 from acupuncture alone, or about a 10% reduction in pain due to acupuncture and a total 40% reduction in pain.

Hydrocodone is addictive and dangerous. If you took it for chronic pain, you'd likely die.

I got my statistics from the article quoted in posting #16, above. All groups started with the same pain (Womac scores). Re-read that cite, and do your own math.

But, using your figures, placebo lowers pain by 30%. 52 hours of Acupunctuation lowers pain an additional 10%. My Vicodin lowers my pain about 80% for 20 cents.

Your statement "Hydrocodone is addictive and dangerous. If you took it for chronic pain, you'd likely die". Yup, someday. Afterall, the death rate for all causes is....ONE. Can you supply a cite? Or even the overall addiction rate? Or even the death rate for any particular drug addiction?