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 (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15870415&query_hl=1)CONCLUSION: Acupuncture was no more effective than sham acupuncture in reducing migraine headaches
News story (http://news.bbc.co.uk/1/hi/health/4508597.stm)

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. :D

[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?

[ChristineR]

I did the math in from the other article, and I couldn't get 2.8%.

Acupuncture:
8.95-2.22=6.73
Sham acupuncture:
8.95-1.98=6.97

So from there I tried....


(6.97-6.73)/6.97 = .035
6.73/6.97 = .97

(6.97-6.73)/8.92 = .027
(6.97-6.73)/8.95 = .027

Those numbers all come from the first four week period. Note that the sham treatments leveled off in effectiveness (as would be expected from placebo effects) but that the acupuncture group continued to show improvement.

At the end of the study there was a 10% difference between acupuncture and sham acupuncture.

In any case, these percentages aren't really meaningful. It's a pain scale, not a numerical measurement.

Do you really need me to tell you that hydrocodone is addictive, causes users to develop tolerances, and that overdoses can lead to heart failure?:confused:

[casebro]

From post #16: "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."

2.22 minus 1.98 = .24 8.95 guzzunta .24 = .026, 0r 2.6%

Now please compare it to REAL medicine...like aspirin? Ibuprophen? Vicodin?

Christine, do you know what pain is? My MD's give me Vicodin in bottles of 100. Am I addicted? No. How do I know? My half full bottle is 2 1/2 years old. Some addiction, eh? Would you like to start a "Wanna see my scars?" thread? (Fowlsound would win that one)

[ChristineR]

Trust me, I'm not going to participate in a "wanna see my scars" thread. I can win any medical gross out contest, but it gets tiresome after a while.

I don't want to sound judgemental, but if you have only taken 50 of your Vicodin in 2.5 years you are either in a lot of pain or you are not in the sort of pain I associate with severe, chronic arthritis. I watched my grandmother slowly die of Vicodin addiction. She was taking 200mg a day for a long time, and it destroyed her mind and body.

[TobiasTheViking]

Hmm.. i think i'm happy we have no vicodin in denmark(or that i don't know about it). For a period of 6 months i took atleast 8 normal pain killers a day, 12 wasn't out of the ordinary, and i think i did 16 once.

Just normal stock painkillers like aspirin(though not aspirin, differnet brand, same strength).

Oh, and no, i wasn't addicted.

The day i took 16, i was still lying on the floor crying in pain :( was on the verge of taking morphine.

[casebro]

Gee, Tobias, why didn't you go to the accupunctuator?

[TobiasTheViking]

Gee, Tobias, why didn't you go to the accupunctuator?
because i didn't wanna waste my money :D

[casebro]

Trust me, I'm not going to participate in a "wanna see my scars" thread. I can win any medical gross out contest, but it gets tiresome after a while.

I don't want to sound judgemental, but if you have only taken 50 of your Vicodin in 2.5 years you are either in a lot of pain or you are not in the sort of pain I associate with severe, chronic arthritis. I watched my grandmother slowly die of Vicodin addiction. She was taking 200mg a day for a long time, and it destroyed her mind and body.

My bottle is labeled 500mg, each. I doubt granny was addicted at 200mg/day. I would thinnk your granny also had some other age related ilness? Parkinsons? Dementia?

Meanwhile, back at the opening post.....

You still have not compared Acupunctuation to real medicne, only to placebo. Did granny try acupoking?

[ChristineR]

My grandmother had heart disease, but she did not have dementia. I can assure you she was addicted and was extremely messed up mentally by the Vicodin. There's nothing quite like waking up in the middle of the night to find a little old lady stealing the Vicodin. I'm probably confused about the 200 mcg. I think it may have been 5mg x 4. She also weighed about 87 pounds by this time.

She wouldn't have tried Acupuncture for a million dollars. She'd consider that Satanism. She also didn't drink or wear makeup, and she ended up stealing Vicodin out of the medicine cabinet and hiding it so she could take extra doses.

I never said acupuncture is superior to real medicine. I said it worked. It is not mysticism, or sympathetic magic, or placebo. It has real, measurable, testable, physiological results, and even if it's not very good results, it has the advantage of not being an addictive opiate.

[Jyera]

vbloke asked for killer question.

Here's one.
Q: Ask ... Can you use Acupunture to kill me?

A: Logically any medical science or remedies is a double edged-sword. It can heal and it can kill. (eg. Drug Overdose, poisoning, toxicity at high volume. If it cannot kill, it is possibly not potent enough.

I'm keen to put acupuncture to the ultimate test.

If the acupuncturist say "yes", then tie him down to a Challenge to kill you.

Most Acupuncture detractor would boast that acupuncture has no effect.
But as I understand, acupuncture is not just the needles, they uses TCM theory and Chi theory to decide which place to place the needle.

Asking these question allows the brave debunker to walk-his-talk. It is like drink "poison" which is actually placebo, or to drink "poisonous"-homeopathic solution.

If skeptics are so sure it doesn't work, then prove it!

If how ever the acupuncturist say "no", then you may mock them for the lack of potency of accupuncture. It'll really really put acupucture in the class of homeopathy. Just plain safe water, no danger.

But of course, if you really do it, get good people to ensure they don't cheat. Even if they did, I'm quite sure it'll go down in history.

[TobiasTheViking]

Just stick you with enough needles so you bleed to death.

[vbloke]

ouch, it's, ouch, not, working, ouch, yet, ouch

[Rolfe]

Here's one.
Q: Ask ... Can you use Acupunture to kill me?
Well, there have been fatalities due to acupuncture. Pneumothorax for one, fatal infections introduced by the needles for another (easy to happen if the acupuncturist doesn't believe that bacteria cause disease). So yes, you could easily kill someone with acupuncture. Inducing a tension pneumothorax would be my preferred method.

Jyera, we already remarked on how easy it is to say "acupuncture works" if you simply redefine acupuncture.

Rolfe.

[Jekyll]

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.
I read that historically the belief in qi flow arrises from the disection of hanged criminals on the sly.
Because the blood had settled (or maybe been drained out), they found hollow tubes running through the body so they assumed that the breath was being pumped through the body.
Qi is chinese for breath(with strong overtones of vitality) and this explains why the meridians correspond to the circulatory system so well.

Unfortunately I can't remember where I read this, so it might not be true. Is anyone in a position to confirm it or poke holes in it?

[Rolfe]

Although the lecture I attended as about veterinary acupuncture (and how the Chinese didn't do that at all, until it was introduced from the west in the 1960s), some mention was made of human acupuncture. I'm sure I recall the lecturer commenting that the "meridians" were originally blood vessels.

Rolfe.

PS. Of course the word "artery" comes from the early Greek or Roman belief that these vessels transported air around the body, because the specimens they were able to examine were all soldiers who had died from exsanguination, and the "arteries" were observed to contain air.

[Loon]

Q: Ask ... Can you use Acupunture to kill me?

A: Logically any medical science or remedies is a double edged-sword. It can heal and it can kill. (eg. Drug Overdose, poisoning, toxicity at high volume. If it cannot kill, it is possibly not potent enough.

Not quite. Massage has all sorts of therapeutic uses and yet lacks that easy road to lethality.

Aspirin can make you ill, but you'd have to be suicidal to make it kill you (the LD50 for a child is 104 mg/kg- a Bayer tab is 325 mg, so 10 pills has a 50% chance of killing a child- but I'd wager the choking risk is far higher). I suspect the LD50 for adult humans would be higher, but the MSDS I saw had no data on that.


On the other hand, anything you can think of can be used to harm someone.

[ChristineR]

I really don't think this is a redefinition of acupuncture. Sticking needles in people is my definition of acupuncture. All the stuff about Chi is not part of my definition.

[Jekyll]

I really don't think this is a redefinition of acupuncture. Sticking needles in people is my definition of acupuncture. All the stuff about Chi is not part of my definition.
Does it bother you that you might be better off going to a cop with a tazer for treatment, than a 'classically' trained accupunturist?

[ChristineR]

Does it bother you that you might be better off going to a cop with a tazer for treatment, than a 'classically' trained accupunturist?

I wouldn't go to a classically trained acupuncturist. Doesn't mean that no one ever should go to a modern acupuncturist. I'm pretty sure a cop with a tazer could not reduce pain levels.;)

TCM doesn't bother me any more that all the other quack treatments out there. If someone can get some good out of scientific acupuncture, I'm all for it.

[Rolfe]

Sticking needles in people is my definition of acupuncture. All the stuff about Chi is not part of my definition.And you still say you're not redefining acupuncture?

Rolfe.

[Rolfe]

Not quite. Massage has all sorts of therapeutic uses and yet lacks that easy road to lethality.

Aspirin can make you ill, but you'd have to be suicidal to make it kill you (the LD50 for a child is 104 mg/kg- a Bayer tab is 325 mg, so 10 pills has a 50% chance of killing a child- but I'd wager the choking risk is far higher). I suspect the LD50 for adult humans would be higher, but the MSDS I saw had no data on that.


On the other hand, anything you can think of can be used to harm someone.I could very easily kill you by sticking an acupuncture needle in you and twiddling it a bit. To my definition of twiddling, that is! Like I said, creating a tension pneumothorax would be the easiest way. It has in fact been done accidentally by poorly-trained acupuncturists, so it should be perfectly simple to do it on purpose.

Which has no bearing at all on whether or not any sort of needle-twiddling can be therapeutic. Lots of things are simply poisonous, with no medical benefit.

Rolfe.

[ChristineR]

And you still say you're not redefining acupuncture?

Rolfe.

What would you like to call sticking needles into the large muscles, possibly applying an electrical current, in order to stimulate endorphin production and reduce pain levels?

[Rolfe]

Something else.

Rolfe.

[ChristineR]

Something else.

Rolfe.

Hedging a bit, are we?;)

[Rolfe]

You just invented a procedure of your own. How should I know what to call it? It's not acupuncture though, except by redefining acupuncture.

Rolfe.

[ChristineR]

You just invented a procedure of your own. How should I know what to call it? It's not acupuncture though, except by redefining acupuncture.

Rolfe.

I didn't invent any procedure. These are procedures being used by people who call themselves acupuncturists. Sometimes the term "scientific acupuncture" is used, but that is also used by the guys who unblock the meridians. I also found a reference to "Evidence-based neuro-electric stimulation," so if you prefer, I will stop referring to acupuncture and call it evidence-based neuro-electric stimulation.

[Rolfe]

That would be a good idea, and should clarify the discussion. To go back to your original statement:Acupuncture works. All that stuff about "Chi" and "meridians" is bogus, and most of the claims are nonsense....You then went on to describe a very specific procedure that you said did work. However, how can you say "acupuncture" works, in the same breath as you say that chi and meridians are bogus, when the overwhelming majority of people who practise acupuncture consider these features to be essential, indispensible parts of acupuncture? And when many acupuncturists do stuff which is very very different from what you now describe as evidence-based neuro-electric stimulation.

You can't simply slice out a tiny corner of a practice, claim that this works, and thus declare that the entire field "works", while explicitly denying the vast swathe of its practices.

As I said, I was at a big discussion meeting about acupuncture last week, and the speaker poined out that in order to decide who had pratised acupuncture and when, you had to define acupuncture. He gave four criteria. My notes are in the car, but he included the use of very fine needles causing minimal trauma, their positioning according to meridians, and their use to manipulate chi. I've forgotten the fourth, maybe you have to twiddle the needles.

You refer tosticking needles into the large muscles, possibly applying an electrical current, in order to stimulate endorphin production and reduce pain levelswhich excludes almost everything that is actually practised as acupuncture, and indeed everything that was ever done by the Chinese. It needs a new name, and "evidence-based neuro-electric stimulation" sounds reasonable to me.

Now, about that evidence. Can you provide references? As I understand it the evidence that this can relieve pain is scanty, due to difficulties with blinding, and the stuff about endorphins is only speculation.

Rolfe.

[ChristineR]

Classic acupuncture, with needles, is a primitive form of neuro-electric stimulation. Some practitioners claim the needles aren't necessary at all, but the mechanisms are poorly understood and not well studied (as you pointed out). The point is that even when the practitioner believes he is unblocking meridians and all that stuff, he is getting real, measurable results from the neuro-electric stimulation. This sort of bogus theorizing is common in the history of medicine, and it often turns out that what sounds silly (positioning of needles) has a valid clinical basis (maximizing endorphin production) even if the historical theory gives a nonsense explanation (unblocking Chi).

Classic acupuncture involves inserting the needles and then twirling them, which generates a weak electric current. Many classic acupuncturists also put an electrical charge on the needles.

I posted this before, but here is a link to the large NIH study which actually managed to be blinded and controlled. They used needles, and the practitioners were positioning the needles based on meridians. Nonetheless, there were actual results. They may have gotten better and safter results with the techniques of evidence-based neuro-electric stimulation, but they got results. The acupuncture worked.


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

Here's a SI article about it:

http://www.csicop.org/si/2003-03/acupuncture.html

There was also a cover story in Skeptic some time ago, but I don't think it's online.

Your speaker may not consider the modern techinques to be "acupuncture," but then what I'm saying is that "acupuncture is a subset of techniques of neuro-electric stimulation, which is a poorly studied but effective technique." And as I said before, I would consider sticking a thin needle into a person to be acupuncture, even if you are not positioning the needles according to TCM theories.

[casebro]

The first link is busted.

From the second link, in which there are no statistics given, only

"By 2001 functional magnetic resonance imaging (fMRI) studies, especially those of Professor Z.H. Cho of the University of California Medical School at Irvine, demonstrated significant supporting evidence of a biological basis for acupuncture"

You realize that "significant" means "statistically significant", and NOT that patients got any significant relieve of symptoms? Like way back at post #16, 2.8% is NOT of significant benefit, though it is "statistically significant".

[Rolfe]

Measurable results? Indeed?

So what do you think this technique can cure? In the 19th century it was promoted as a cure for cholera. How about that?

Rolfe.

[Loon]

I think what this research shows is that accupuncture (or at least the sticking of needles in the body at various locations, to avoid the definition war) can have a measureable and statistically significant beneficial effect. Alas, this doesn't mean much (other than maybe the impetus for research that would tell us why) because we have treatments that have a much greater effect.

[Rolfe]

Since it doesn't seem to matter where you stick the needles, it's very difficult to say whether there's anything going on beyond fairly marked suggestibility. I'm waiting to see any support for either "evidence-based" or the assertion that endorphins are involved.

There's no denying that when you stick a pin in someone's body, the person and the body tend to notice. Thus it's hardly surprising that you can measure things happening in the brain and some chemicals (like cortisol and glucose) increasing in the blood. This is as you would expect, simply as a result of having pins stuck in you.

If at the same time you tell people that this pin-sticking will have a beneficial effect on some extremely subjective symptom, I for one am not necessarily bowled over with astonishment if a fair number of the subjects dutifully report experiencing exactly that effect.

When acupuncture was originally introduced (and it has come and gone in several waves over the last couple of hundred years) it was claimed to cure all sorts of illnesses. Soulie de Morant, who was a great French acupuncture proponent in the early years of the 20th century, was convinced it could cure cholera.

That sort of claim has now been entirely abandoned as preposterous. Even claims that actual anaesthesia can be achieved using acupuncture are being gradually relinquished as reproducible evidence fails to be accumulated. What we are now seeing is a retreat into the realm of the wholly subjective, such as the relief of chronic pain, and even (God help us) giving up smoking! Traditional Chinese Medicine? Smoking??

Now, I simply can't see any evidence beyond what you'd expect from the known fact that you can influence people to report different perceptions by psychological suggestion, and the idea that reinforcing these suggestions by sticking needles in the patient seems neither paranormal, surprising, nor evidence of some great new field of medicine.

Rolfe.

[ChristineR]

It's the same link I gave before, an abstract of a double blind study that used a tube device that either inserted a needle or poked a person. Tests on the device indicated that patients could not tell if they were getting real acupuncture, or were just being poked. There was a signifigant difference between the improvement in the poked group and the punctured group, and the confidence level was 95%. If the blinding device really does work as claimed, this could not have been due to placebo or suggestion. So far as I know this is the only large acupuncture study to effectively blind the patients.

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

I know of know evidence that acupuncture cures anything, certainly not cholera. But thousands of useful drugs and procedures do not cure anything. It can be used to treat pain, just as hydrocodone can.

The 2.8% was after four weeks. After 26 weeks, it was much higher. What this shows is that if you're not willing to go through a lot of sessions, you may not get much relief. But there's been very little study of how best to adminster evidence-based neuro-electric stimulation, so it's pretty impressive that they got such good results using Chi theory.

The endorphins are just a theory, so far as I know, but they do seem to fit the known facts. That stuff about the MRI is too vague--I really don't know what they're talking about.

[Rolfe]

Evidence-based? One study? I don't think so.

Oh yes. It can be used to treat pain. So can sugar pills. The question is, is there any useful effect? One study? Come again.

Neuro-electric? Well, I presume electricity is inolved, but why neuro? Of course there are nerves everywhere in the body, but what's so "neuro" about this?

I see we're already down to "electric stimulation". Hmmm, we'll soon see the usual false analogies with TENS devices coming out I suppose.

One study? The jury hasn't even begun to hear the case yet, I'm afraid.

Rolfe.

[ChristineR]

I wouldn't give much credence to one study, but it's actually more like one blinded study, lots of unblinded studies, and some animal studies. I think there's pretty strong evidence at this point that acupuncture does in fact have some effect beyond placebo. Not a real amazing effect.

Still, if nobody can replicate this, I will be willing to return acupuncture to the list of non-treatments. The study does appear to have been well designed, and the confidence level was 95%. But it wouldn't be the first study to crash and burn....

[Rolfe]

Animal studies!!!!

:dl:

Oh dearie, dearie me!

Look, I've sat through too many hours of forensic shredding of the evidence in this area to be able to summarise it at all sensibly, but I really do think you are reading far too much into a few hopeful publications by enthusiasts. And with the greatest respect, and no doubt about to be taken to task for appeal to authority, I tend to give the senior lecturer in the department of pain management at the John Radcliffe quite a lot of credence.

Rolfe.

[ChristineR]

You're the one with the Kitty Avatar.:)

Okay, I agree to wait and see, although I still think there is a measurable effect above and beyond placebo and suggestion. I wouldn't suggest anyone run out and get acupuncture, but people in pain have been known to try things.