YI have seen acupuncture work day in and day out for the last five years.

You mean you *think* you have seen it work. Humans are far too fallible for that to be reliable.

You waste time trying to “prove” its effect with “science”
Acupuncture is not rooted in science you jackass.
Acupuncture is rooted in Taoism. It’s rooted in the Chinese concepts of yin and yang. It’s rooted in the ART of observation.

Utterly irrelevant, and not even wrong. If it has an observable effect (which would include subjective pain relief!) then it can be studied scientifically.

Open your eyes. Western medicine kills people every day.
It’s what, the 4th leading cause of death in this country. “Iatrogenic”. Ever heard of it.

Even more irrelevant; the failings of medicine don’t have any bearing at all on the efficacy of quackery.

People are waking up to this up profit based “science” as you call it, where every one is squeezing every last cent out of th system that they can.

Just like acupuncturists, chiropractors, naturopaths, homeopaths, etc. Your point? Except perhaps that real doctors generally work ethically, instead of scamming people out of their money while providing no benefit.

What you call placebo, I call healing. Just because you cant explain it doesnt matter to the person who doesnt have cancer anymore, does it?

Now see, you’re assuming that it works. When the evidence is quite to the contrary. Whereas if acupuncture has actually cured cancer, it should be a simple matter for you to prove it. But you won’t, of course, provide any actual evidence.

The “proof by vigorous assertion” and “proof by profanity” don’t actually prove anything at all.

Healing is possible. Prevention is now in the hands of what you call “alternative” medicine. I call it simply… medicine. It is traditional. It has been used for centuries, and there is wisdom in it.

Traditional, used for centuries, and enthusiastically endorsed – yep, just like slavery.

Social support and beliefs affect a patient’s ability to rebound from illness, Dr. McDiarmid added, pointing out that over half of the people who respond to antidepressants do so because of the placebo effect.

http://www.nytimes.com/2009/09/20/us/20shaman.html?_r=1&em

I have my doubts about Cochrane reviews these days. Edzard Ernst commented on one questionable review on his blog http://www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4123523&c=1 (free registration). He suggested the review (of Chinese herbs for endometriosis) was to good to be true.

My response was that several years ago I saw a list of some Cochrane reviewers and some had bogus credentials (e.g., naturopathy; sorry, I lost track of that link). Ernst responded that limiting who may participate in the reviews was not “PC.”

My point was that AFP gave acupuncture an “A” strength of evidence rating for low back pain, neck pain, headache (chronic idiopathic), and headache (migraine) corresponding to “consistent, good-quality patient-oriented evidence.” I do not think that is accurate. The evidence for acupuncture is consistent with the hypothesis that it works no better than placebo. This looks to me like a double standard: if they looked at a drug that was not consistently better than placebo, they would not give it an A rating.

In fact, different publications of the AAFP have given different opinions. The FP Essentials Home Study module #359 on headache, April 2009 reads “A Cochrane review of acupuncture in migraine headache supported the value of true acupuncture compared with sham acupuncture. However, many of the 26 studies had methodologic flaws, and the reviewers concluded the evidence was insufficient.”

If the evidence is insufficient, it does not deserve an A rating.

……”Acupuncture, exercise therapy, multidisciplinary rehabilitation programs, massage, behavior therapy, and spinal manipulation are effective in certain clinical situations.”

From this, Harriet declares: “AFP PROMOTES ACUPUNCTURE”
It is impossible(to an objective, unbiased reader) to conclude(per AFP above) that Harriet’s reference “PROMOTES” acupuncture.

Instead, it is balanced in it’s approach to chronic low back pain- a condition for which allopathic treatment has a dismal record. The AFP/CE article suggests and acknowledges that acupuncture may be effective “in certain clinical situations” Evidence supports that AFP assertion.

Harriet’s elevation of this statement to “promotion” is a disengenuous exaggeration.

Any of you techo-pseudo-scientist got any bright ideas on what is going on in primary health?

If “non-specific” acupuncture works as well as “traditional &/or individualized” acupuncture then the underlying principles and understanding of acupuncture are all invalid, and the Chinese have been mistaken for “thousands of years” about how acupuncture “works”.

The claim that “non-specific” acupuncture works actually overlaps the actual science of acupuncture a bit: Meridians are BS, chi doesn’t exist, and all you need to do is randomly poke yourself with toothpicks; why pay someone else to do it if all their expertise in unnecessary? I guess it helps to sell the placebo if you have a convincing showman doing the performance.

No one’s denying that there was a quarter under you pillow when you woke up in the morning, we just say there’s no evidence or reason to believe that the tooth fairly put it there.

So why haven’t acupuncture researchers been able to come up with a control that they think is a placebo?? When you use the “stage dagger” retractable needles and there is no penetration of the skin, and the patient can’t tell if it was a real or sham needle, how can you call that “nonspecific acupuncture”? If you want to define any skin stimulation anywhere on the surface of the body as “acupuncture” the whole concept of acupuncture becomes meaningless. If you think nonspecific acupuncture is effective, why bother with all the rigamarole about acupuncture points and meridians? Maybe stroking the skin or giving a massage is equally effective?

To get back to the medication analogy, would you argue that the sugar pill might really be effective?

He says some patients respond to acupuncture, but some patients respond to every kind of quackery. I, for one, would like to know which my patients are responding to.

He argues that individualized acupuncture might be better, but does not comment on the trial cited above that showed that individualized treatment was not better.

In response to the trial he cites in his last comment, I offer R. Barker Bausell’s trial described in “Snake Oil Science” where the only factor correlating with success of real or sham acupuncture was whether the patient believed he had received the real thing. Those who got the real thing and believed it was the sham treatment were less likely to respond; those who got the sham treatment and thought it was the real thing were more likely to respond.

I can condone telling a patient that other patients have thought acupuncture helped them, but I would preface it with the statement that scientific testing had not shown it to be effective, and that the apparent effects were compatible with placebo response.

Dr. Kelly has still not told us whether he would prescribe a medication that had not been shown to be superior to a placebo.

I wonder how Dr. Kelly accounts for the various studies which utilized sham needles which don’t break the skin, or did tailor the acupuncture to individual patients, and still didn’t find any effect beyond placebo.

For example:

http://www.ncbi.nlm.nih.gov/pubmed/19433697?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Discussed in this post:

http://www.sciencebasedmedicine.org/?p=492

And particularly:

One wonders whether he’d support giving patients sugar pills and telling them it’s a painkiller.

Or if you prefer, telling them it may make them feel better.

Many of those who post to this site are quick to criticize, perhaps with incomplete understanding of what they are criticizing. In my own practice of acupuncture, I treat people every day who have not had their symptom patterns (pain or non-pain or both) improved with standard “Western” medical evaluation and treatment. Some don’t respond to acupuncture, some respond minimally, some respond moderately, and some respond completely. Those that respond well are very happy that they are feeling much improved, are able to do more, function better, etc. They don’t care if we “scientists” would describe them as having a “placebo” effect or a nonspecific or specific effect of acupuncture. That is my point. To offer a trial of acupuncture to patients that request it, in the hope that it improves symptoms, quality of life, or functional status is not lying to them. If they get better, I’m never sure exactly why, though they will usually credit the acupuncture treatment. If they don’t get better, all I know is that what I did was not helpful.

I don’t have the time to go into the issue of sham acupuncture in great detail, but suffice to say, the best sham (in my opinion) would be that no needle actually picured the skin anywhere, but also that the patient could not tell one way or the other (ie., effective patient blinding as to treatment status, “real” vs “sham”). I would refer you to the 2007 Mayo Clinic study of acupuncture treatment for fibromyalgia in which this type of blinding was effectively accomplished. In this study, despite using a standardized protocol rather than individualized treatment, “real” acupuncture did outperform “sham” acupuncture with statistical significance, using a standard fibromyalgia symptom score that has been used in other studies of fibromyalgia treatment.

Robert Kelly MD

I would also strongly suspect that providing a sympathetic ear in a relaxing environment could be done much more cheaply than what acupuncturists charge – a very significant point given what health care costs these days. Paying a premium for what is, in the end, just so much window dressing seems exceedingly questionable.

And while there may not be placebo-controlled studies demonstrating that such sympathy and relaxation are actively beneficial (though in one light, all the acupuncture vs. standard care studies could be so construed), that’s not much of a problem since that’s not presented (explicitly or implicitly) as if it has any specific effect.

Anyway, given that the question such a study would ask is simply “does it feel good” I think that anecdote, prior plausibility, and personal experience are actually enough to answer confidently in the affirmative. Not EVERYTHING needs to be rigorously tested.