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566 thoughts on “Acupuncture Doesn’t Work

  1. jenny says:

    seems to be a site for doctors, but anyway will add my two cents. Went for accupuncture three days ago…just so that I would look good. Thought I’d give it a try. Well…my skin looked amazing. I had a great sleep. I have asthma, but haven’t used my inhaler now for three days. (before that used it several times a day, Ventolin). And I was having irritable bowel pain…all gone since the treatment.

    1. windriven says:

      @jenny

      Personal anecdotes have zero gravitas in this forum. I could as easily claim that a homeopathic remedy helped me lose 20 pounds and add 3 inches to my biceps.

      We do scientific studies and offer them for peer review in an effort to differentiate what is real from what people might feel because humans are notoriously susceptible to self-deception.

      I’m glad you’re well rested and look amazing. I’m glad that you haven’t used your inhaler for 3 days. But I would strongly advise you to keep the inhaler handy.

    2. Just a question. Don’t you find it at all suspicious that a single modality was able to treat three radically different systems (skin, asthma and ibd) and it was able to do so almost simultaneously?

      Do you actually think there are invisible energy lines which can not be seen by any person or instrument which go through your body (how did anyone discover something that can not be observed in any way?) and can regulate it?

  2. jenny says:

    sorry all these comments from JENNY….didn’t think they had gone through….but they had…

  3. cloudskimmer says:

    Dr. Rodrigues:

    There are a few things in your posts that I find alarming.

    You claim that acupuncture is surgery, because inserting a needle defines surgery. Are you billing your patients’ insurance for surgery in that case? Your website says only that you are board certified in Family Practice. Shouldn’t you be board certified in surgery if you are offering surgical services? And there are the other things like cardiology and gynecology, where you are also not board certified. Is giving a flu shot a surgical procedure by your standards?

    “I ran out of my short favorite 15mm needles. I only had longer 30 mm needles. Because they were longer I inserted them in deeper.”

    Wow! This really scared me. The needles were longer, so you shoved them in deeper. I hope your patients are all overweight or obese, because if you ever deal with a slender person, you are likely to penetrate organs, perhaps even a lung. Several people on this website have tried to get you to address the harm that has been done by acupuncture, including deaths. Why are you ignoring those? In the photo on your website, you show someone on the exam table with needles in their torso, so you are risking organ perforation. Something I noticed in observing an acupuncturist at work was they quickly pulled out the needles and threw them away; there was no attempt to inspect the needles to find out of a piece had broken off; leaving pieces of needles behind can be extremely hazardous. Are you similarly careless about leaving sharp needles in your patients?

    “Naysayers and provocateurs are interfering with the advancement of the powerful tool in modern medicine … my Acupuncture. In 2013, I’m convenience it will be adopted in a form that will highlight the tremendous benefits and comprehend it’s deep mysterious aspects.”

    This is really frightening, too. You are the sole repository of fantastic knowledge; everyone else is deluded or worse. You’d better hurry because only five months remain in the year for you to promulgate your ‘mysterious’ treatments. My guess is that at years’ end the status of acupuncture will be pretty much the same as it is now. The self-deluded will continue to be true believers, scientific studies will continue to show it to be an elaborate placebo. Would you care to set a deadline and some objective, measurable standards of what the world will be like in a short five months should your prediction be accurate? And no whining about how a small group of SBM website activists managed to stop your crusade, when those predictions fail to come true. It strikes me that you are the one mired on a flat-earth, while the rest of us try to convince you to look at the evidence and accept that it is round.

    This is where your argument really fails in this forum. It is clear that there is no evidence you can define that would cause you to change your mind. Your subjective observations outrank any study, however well-conducted. That attitude is not scientific. Your claims are testable; they have been tested and found wanting. Your solution is to not read them. To quote an editorial from the British Medical Journal concerning the work of Hill and Doll linking tobacco smoke to lung cancer, “It is said that the reader of an American magazine was so disturbed by an article on the subject of smoking and cancer that he decided to give up reading.”

    It really makes me sad, because you found your way here, to an excellent source of information that could make you a better Doctor. It sounds like you have a great deal of compassion for your patients and could be really excellent. That is why it is so sad that you have fallen into the trap of accepting quackery as real. So long as you remain a true believer, you will act as a conduit of bogus therapies to your patients. And if you are unable to accept the constructive criticisms offered here, you will probably descend into even more quackery. Why not homeopathy, reiki, therapeutic touch, chiropractic, aromatherapy. You even seem to accept bloodletting–is that done in your office? Can you balance the four humors? –unblock qi (chi?)?

    I also wonder if you notice those among your patients who don’t come back, who aren’t helped by your nostrums and simply disappear. Your basis of comparison is biased because you probably ignore the ones who aren’t helped and only see satisfied customers. There is likely even some selection among the ones who even show up, since the word is out that you are a firm believer in acupuncture, so those who don’t believe never make an appointment. This allows you to selection-bias your way to believing your experiences are entirely positive when they almost certainly are not.

    I guess you came here with the purpose of straightening out the Doctors on this website; you are probably sorry that you failed and they remain skeptical, only persuaded by objective evidence, good studies, and well-conducted reviews. You could figure out how to conduct your own studies, but you seem to have little interest in that, instead expecting people to change their minds based on the depth of your own belief, and the vehemence of your words. If you could somehow measure qi (chi?) that would be interesting to many, but it remains an unidentifiable chimera, sought by many and found by none. In that respect, you are far closer to the flat-earthers, refusing to even look at contrary evidence and believing only in your own experience–it does look flat, doesn’t it? I predict that you will abandon this website very soon, never to return, because it is clear that you don’t want to question your beliefs. This isn’t the place to stand on a soapbox and preach to the masses. Here the masses talk back, consider your arguments, and demand evidence in support of those arguments. You won’t find many true believers here; they just don’t last because their arguments are empty, and rely only on the charisma of their proponents.

    If you really wanted to answer the question of whether or not you are doing more than an elaborate placebo, you could to what Ray Hyman did when confronted with the claim that palmistry was untrue: he gave some of his customers readings contradictory to what he read in their palms. When they were just as happy with his readings as before, he was willing to change his mind and realized that palm reading was bogus. You could see how satisfied your patients are if you only do superficial needling, or put the needles in the wrong places–though how you could identify the wrong places is beyond me, since you seem to define them differently on every patient. If you do it wrong and the same patients are satisfied, that would clearly demonstrate that acupuncture is not effective, and should convince even you that your methods may not work.

    Good luck in your practice; I hope that one day you will return to the practice of medicine. In the meantime, you can take heart in some recent articles on this website about the failure of medical boards to enforce best-practice standards. You can last for a long time–probably even an entire career–practicing quackery instead of real medicine, particularly if you yourself are a true believer, as you certainly are.

    1. “Shouldn’t you be board certified in surgery if you are offering surgical services?”

      You should know better … are you a healthcare provider? Don’t you know the illogical world of billing and coding? Yes the use of any needle to treat is surgery!! So nurses can perform surgery. You don’t need a medical degree.

      1. WilliamLawrenceUtridge says:

        What kind of doctor are you?

        Nurses can perform local excisions and suture, I’m sure. They can’t perform appendectomies.

    2. “Wow! This really scared me. The needles were longer”

      Gee y’all don’t really know much about needles as therapy. Some needles are 30g 1/2 inch and yes I have 4 inchers@25g too. You have to. Or you are not doing your job wasting time and effort and money.

      I annoys me when I began therapy on someone who has had it before. “That needle is bigger than the one the other doctor used! Which is why his therapy failed and you are here.

    3. “And if you are unable …, you will probably … quackery. Why not homeopathy, reiki, therapeutic touch, chiropractic, aromatherapy. You even seem to accept bloodletting–is …? Can you balance the four humors? –unblock qi (chi?)?”

      Ms … all of medicine in 2013 is somewhat quarkery. I know this already!

      Quarkery is a pretender of medical skill. I am not a pretender. I actually know how to poke people with a needle (with good and noble intent) lol

      In 2013, a Quack with foul intent;
      A Quack with foul intent is a provider who does a type of procedure or surgical for financial gain when there are other options that are more effective and much safer.
      or
      Someone who professes to be a know it all who influences someone against a viable safe therapy that causes pain and suffering. These charlatans should be fined and jailed.

      Confession;
      Being a traditional medical doctor will lead to doing harm under the authority of the AMA. Today I practice myofascial release therapy with and without needles with a back ground in the practice of medicine.

      In the world of Therapy I would include life and living as a part of therapy.
      So homeopathy to bloodletting are valid when used in combination of a complete therapy program. All therapy would have to be overseen by a their general traditional medical provider. So folks have to do most to their therapy at home or in the work place.

      Chi is a force or the force of nature. Blocked force will cause illness.

      Thanks for allowing me another splurge … dang y’all are nice. If I was not here yall would really be bored to tears.

      Thank you .. thank you … thank you very much!

      1. WilliamLawrenceUtridge says:

        You actually believe in qi? You believe that there exists a life force that can be manipulated with needles, even though we can’t detect it with all the technology that exist today – capable of registering the fall of a single photon from three miles deep in an nickel mine? Why?

        So homeopathy to bloodletting are valid when used in combination of a complete therapy program.

        Why? They are completely useless, they just waste time and money. They are also accompanied by the pernicious influence of CAM, which discourages patients from getting conventional treatment such as vaccinations, or chemotherapy. Plus, bloodletting is not harmless, it breaks the skin which increases the risk of infection – for no good reason. Isn’t your argument akin to saying “the Department of Defence is justified in spending $160 on a hammer as long as it is used in combination of a complete defence program”? Don’t you think you’re better off with a normal hammer that doesn’t waste $150?

        What kind of doctor are you?

  4. Jenny says:

    I’m sitting here at my cottage, amazed I’m not having itritable bowel pain now four days after treatment. Not a placebo …cause I have no ax to grind with either western or eastern….happy to be pain free!

    1. Chris says:

      That is a nice story. Get a third party medical confirmation. Have them write up a case report, and then come back with its PubMed Identification Number.

      1. Jenny says:

        Hi Chris… Look , I don’t have any ax to grind. All I know is I got relief. Who knows for how long, but it was unexpected for me. Your comment about me getting a PubMed identification number? Ludicrous. I’m not a doc, scientist, acupuncturist. I own a store. Retail fashion. Just putting my info out there. All I know is I have irritable bowel pain daily. For about 8 years. I’m now close to four days without it.

        1. Chris says:

          I did not ask you to grind any axes. I just noted you posted a story, it was nice, but as an anecdote it is not data.

          If you want us to think this a relevant story, find an unbiased third party to take your info, follow it for a few months and then write a case report. If the case report ends up with a PMID, then we might consider it data.

          “For about 8 years. I’m now close to four days without it.”

          Well, that can change in a few days or a couple of weeks. And who knows, the next time it will go away without acupuncture. This is why anecdotes are not data.

          1. She just gave a testimony and you neanderthals are too short sighted to believe her. The essence with truth is how your feel. She feels better that is the truth.

            You can’t use the scientific methods on flesh and blood in this way. Throw out your logic you are attempting to figure out how God has designed the human body.

            BS monkey you will not read or discover what you are looking for outside of you soul.
            You have to look inward. Be careful about reading health books. You may die of a misprint.
            Mark Twain

            Read more at http://www.brainyquote.com/quotes/quotes/m/marktwain105716.html#StmjXiUqtbHohy4Q.99

            Vital note; Acupuncture is not magic and require a wellness program and a lifestyle assessment.
            NO treatment works all by itself!!

          2. Badly Shaved Monkey says:

            She just gave a testimony and you neanderthals are too short sighted to believe her.

            Thank you for the insult, but you seem to be confused. No one is disbelieving her account of her own symptoms. She says she feels better at the moment. So, we accept that she does.

            We are doubting the causal inference that she draws. As a competent physician, I hope you would do so too.

            If I give a patient a dose of NSAID and they show fewer signs of pain the following day, do I know that the NSAID caused them to feel less pain? No, I do not. It is likely that, on average, if I give the drug to a hundred patients and record their pain on the day after treatment it is likely to be less than if I gave them a placebo. That is why drugs get licences. Can I know for certain that the drug has reduced the pain in any specific single patient, no I do not and there is no way even in principle for me to do so.

            This line of reasoning should be self-evident and someone who has been through medical school should not have a problem with it. You worry me.

          3. windriven says:

            “She just gave a testimony and you neanderthals are too short sighted to believe her. ”

            My aunt Matilda just had acupuncture and her left great toe fell off and her spleen erupted. But she doesn’t have to shave her mustache anymore! That is my testimony and I expect everybody to believe every single word.

          4. WilliamLawrenceUtridge says:

            You can’t use the scientific methods on flesh and blood in this way. Throw out your logic you are attempting to figure out how God has designed the human body.

            God didn’t design the human body, it is the result of a blind evolutionary process that is sub-optimal, particularly given the increasing lifespan of humans. If God did design the body, he’s a bastard for designing in Huntington’s disease, vulnerability to smallpox, pediatric cancers, and those worms that burrow into children’s eyes and cause blindness. He’s a bastard for disabling the endogenous production of vitamin C. He’s a bastard for making a world where you have to have ten kids (and often three wives) just to ensure two or three of them survive and he’s a bastard for not providing a reliable way to control the number of offspring we have. Using logic, we have eliminated the burning-down of temples through the use of lightning rods, and smallpox. It turns out you can quite successfully use the scientific method on flesh and blood, and your complete failure to understand the history of medicine and human suffering is rather terrifying – particularly given your turning away from the very thing responsible for increasing life expectancy and reducing morbidity among humans in favour of your own personal experience.

            How do you know Jenny is telling the truth? How do we know she’s not one of your patients, or you? How do you know Jenny’s improvements are due to regression to the mean, or even merely confirmation bias in which she dismisses or trivializes pains today that she would have attributed to IBS five days ago?

        2. Jenny … you body is asking you for help and if the needles work accept it as part of your therapy. Add in a wellness program, establish good sleep hygiene, read a good soul-food book like the 4 agreements by Miguel Ruiz and let these folks alone. They will poison your progress.

    2. Badly Shaved Monkey says:

      And how can you tell, based on that experience, that your amelioration is neither placebo nor simple coincidence? Clue: You can’t.

      1. Hey Monkey stop poisoning her with you negativity!!

    3. windriven says:

      Jesus jenny, what gives. You apparently have insomnia, crappy skin, asthma and an irritable bowel. And all this was fixed with a single acupuncture treatment you received 3 days ago???

      You are either way out on the thin edge of the bell curve for gullibility or you are a spectacular fabulist. Care to tell us which it is?

  5. Badly Shaved Monkey says:

    Dr. R.

    Please understand that I have interacted with people like you on the internet for many years now and it is remarkable how consistently the purveyors of alt.med. practices wriggle and dodge when faced with even the simplest of direct questions. You are conforming to a familiar pattern. I think we’ve seen enough of your blustering rhetoric. Please make you next post some answers to the following questions.

    1. What’s the objective evidence that supports each of the specific therapeutic claims on your website?
    2a. What’s the objective evidence that supports the claim that acupuncture works in animals?
2b. On what conditions does it work?
    3. What would be the effect of a single instance of morbidity or death from acupuncture on your claim that acupuncture is “not dangerous at all”?
    4. Have you ever seen the articular surfaces of a severely arthritic joint?
    5. What is the purpose of control groups in scientific trials?

    Thank you.

  6. Still waiting for the answer to my question above.,,bored now.

  7. Badly Shaved Monkey says:

    You don’t have to coerce, me just ask

    Been doing that. You’ve returned to post anything but answers to those questions.

    But, maybe you’re about to do so.

  8. Badly Shaved Monkey says:

    While we’re, um, waiting for Dr R to return and post his answers, readers might be interested in looking at this page and the photograph on it.

    http://shoulderarthritis.blogspot.co.uk/2011/03/what-is-difference-between-shoulder.html

    It is relevant to my Question 4 for Dr R. I wonder if he can tell us why.

    1. That article is devoid of the truth. Myofascial Release therapy with and without needles will restore a joint back to “normal” health.

      I use to send my patient to the orhto guys with frozen shoulder and they only got worse.

      Travell has a beautiful chapter on the shoulder and she shows the provider how to unlock a shoulder with the above techniques.

      Exams under anesthesia are misguided

      1. Badly Shaved Monkey says:

        You seem to be having trouble with following a simple line of argument.

        a. You have asserted, in the context of arthritis, that “There is not such thing as bone on bone … it is a deception to make money.”

        b. I have asked you a simple and direct question: Have you ever seen the articular surfaces of a severely arthritic joint?

        c. I have shown you a picture. I linked to the page solely and only to show you a picture.

        d. You have headed off on another tangent.

        What does the picture show us, Dr Rodrigues? Do you recognise the structures? What is their condition?

        1. Clarify … this is not just about the Acupuncture needle, which is a powerful tool. It is about all of steel needles as tools;

          Why? Trigger points … some don’t believe in them … they do exist and they do wreak havoc on the soul. Stressed, malnourished and static muscles will collect errors of repair called Trigger points. TPs are errors of repair within muscles and connective tissues. These errors will whine and make you miserable and are the primary generators of most pain. These TPs generate pain signals and make muscles, weaker, stiff, stubborn, lock-up, shorter/tighter and work erratically.

          These stressed, tight and erratic muscles will compress nerves and cause neuropathy.
          The will restrict blood flow to cause pain and circulatory issues.
          They will exert unnatural forces that will pull joints out of alignment to accelerate degeneration, compress bursae and tendons (bursitis and tendonitis)
          They will alter normal muscular function to contribute to falls, imbalance and weakness.

          Muscles and connective tissues are grouped within myofascial tissues. The therapy that is as old as humanity is called myofascial release therapy. MFRT can be performed with hands and leverage. IMO, Once the muscles lock up to a certain point, mechanical energy alone can not ignite enough of the healing elements to complete the process. The only other tool available are the steel needle tools which depolarize and reboot the muscles as the healing cascade ignites. Under this dual effect complete healing has a better chance.

          C. Chan Gunn, MD, Travell/Simons, Edward Rachlin and George Hackett, MDs. All are myofascial dysfunction treatment gurus who use steel needles and noted decades ago that failed surgeries responded very well to needles, trigger point injections and physical therapy. MFRT is on a spectrum from stretching, massage, yoga to acupuncture, dry needling on to Travell’s injections.

          Prolotherapy, Steroid Injections and Botox Injections are modern versions of the Travell Injections and are misguided, less effective and will damage tissues and stall healing. These, in my opinion are off the table of choices because the others are the treatment of choice.

          “Dr. R.Please understand that I have interacted with people like you on the internet for many years now and it is remarkable how consistently the purveyors of alt.med. practices wriggle and dodge when faced with even the simplest of direct questions.”

          Sorry this is an assumption, you have not interacted with me before(I am unique as a human and as a person and as a provider who uses integrative tools in my practice)

          “You are conforming to a familiar pattern. I think we’ve seen enough of your blustering rhetoric.”

          Sorry you have made another assumption or presumptive observation; passionate and knowledge is not blustering.

          “Please make your next post some answers to the following questions.
          1. What’s the objective evidence that supports each of the specific therapeutic claims on your website?”

          I gave you the author list … it took me about 15 yrs to understand and implement their wisdom … good luck reading. The data on my site are distilled experiences. You will have to take my word. OR I can get you a few of my patient testimonies if you have not found them. They are what I call cause and effect evidence … punch someone in the eye and the eye will swell. These testimonies are from patient who suffered in pain for years and were never given therapy. Once Therapy was implemented they have less pain, take less pain meds, sleep better, have a better quality of life.etc. Some are totally without pain after 15 yrs of daily suffering. Would they recommend the therapy to others? Yes. Was it tolerable, safe etc? yes

          “2a. What’s the objective evidence that supports the claim that acupuncture works in animals?
”

          I don’t know other animals unless you are referring to humans as animals.
          The healing effect is auto-miraculous and can NOT be stopped with your conscious or subconscious. God given! Cut yourself and try to stop the healing with your thoughts, break your leg and try to stop the healing … impossible. Again the 1:1 testimonies are evidence enough for me.

          2b. On what conditions does it work?

          I works on most if not all ache pain or stiffness or medical conundrum … you name it.
          Another way to see this is to put pain into 2 categories;
          1. Pain that is going to possibly kill you very soon <72hrs.
          2. Pain that will cause you to want to kill yourself because it is unrelenting and no one seems to care or can help. This pain is where this needle therapy is best used.

          “What would be the effect of a single instance of morbidity or death from acupuncture on your claim that acupuncture is “not dangerous at all”?”

          I have used 10s of thousand of needles in every possible location on the human body.
          Even in the eye sockets. Safer than taking aspirin or motrin daily. There are just a few location that care should be taken … not even an extra amount … just care. The lateral neck, above and below the clavicle and at pulse locations ie femoral, brachial, carotid etc. To mitigate the lung puncture situation, I alway use shorter needles and go in at an angle so I will hit a rib before puncturing the lung (knock on wood).

          “Have you ever seen the articular surfaces of a severely arthritic joint?”

          Yes … uneventful and shocking how many reasonably normal there looked. Most patients who get replacement surgery do not see their removed joints. So the radiologist report will state degeneration and the pathology report will read the same. Hmmmm?

          REmember this Therapy is designed to restore health and alignment to joints and which will allow the intra articular structures to regenerate. Stem cells are activated in this healing process and those cells are God given, just awaiting the signal to kick-in. I always tell folks I would rather have a bum joint that could regenerate or rejuvenate. plus a natural joint will never forsake you. Why would I want a hunk of metal that has the real potential to fail in a catastrophic way any time I run, jump or fall. Gee, I have some patients who have undergone 2-3-4 redos just because of prosthetic failure or infection.

          ”What is the purpose of control groups in scientific trials?”

          Is this a test question?
          Natural healing has nothing to do with what humans consider scientific.
          We need science in medicine to prove or disprove something that is unnatural.
          Pills, chemicals, electro-shock, radiation therapy … oh and the dreaded study of the human brain, emotions and human nature …

          Human brain and emotion study is futile…too many variables.

          As I pointed out before you can not truly stop the human body from healing.

          This is the issues or the 300 lb gorilla in the room … what does stall or stop the healing which will lead to illness, sickness and pain and dysfunction. For complex and chronic pain issues it’s Trigger Points. ? did I talk abou myofascial pain and dysfunction as it relates to myofascial tissue illness and disease?

          1. WilliamLawrenceUtridge says:

            Do you believe acupuncture is useful for anything except the treatment of musculoskeletal complaints and perhaps pain?

  9. Badly Shaved Monkey says:

    Lest we get distracted but Dr R’s diversions, here again is the set of questions that he has not answered, although he said “You don’t have to coerce, me just ask. Maybe tonight or in the morn.”.

    1. What’s the objective evidence that supports each of the specific therapeutic claims on your website?
    2a. What’s the objective evidence that supports the claim that acupuncture works in animals?
    
2b. On what conditions does it work?
    3. What would be the effect of a single instance of morbidity or death from acupuncture on your claim that acupuncture is “not dangerous at all”?
    4. Have you ever seen the articular surfaces of a severely arthritic joint?
    5. What is the purpose of control groups in scientific trials?

    I don’t know exactly what time it is in your locale, but I think it is past time that you showed you can answer these questions.

    As I have already said, I have seen patterns of behaviour exactly like yours many times in debating SCAM therapies with Tru Bleevers. I find that Copy & Paste is my good friend. I shall simply keep repeating the questions until you answer them (low probability) or until you disappear in a huff {high probability).

  10. Badly Shaved Monkey says:

    Clarify … this is not just about the Acupuncture needle [snip: Irrelevant]
    “You are conforming to a familiar pattern. I think we’ve seen enough of your blustering rhetoric.”
    Sorry you have made another assumption or presumptive observation; passionate and knowledge is not blustering.
    “Please make your next post some answers to the following questions.
1. What’s the objective evidence that supports each of the specific therapeutic claims on your website?”
    I gave you the author list … it took me about 15 yrs to understand and implement their wisdom … good luck reading.
    Not good enough. Robust trial data, please.
    [snip]

    “2a. What’s the objective evidence that supports the claim that acupuncture works in animals?
”
    I don’t know other animals unless you are referring to humans as animals.
The healing effect is auto-miraculous and can NOT be stopped with your conscious or subconscious. God given! Cut yourself and try to stop the healing with your thoughts, break your leg and try to stop the healing … impossible.
    You make the claim on your website about non-human animals. You do know what’s on yor own website don’t you?
    Again the 1:1 testimonies are evidence enough for me.
    See Question 5
    2b. On what conditions does it work?
    I works on most if not all ache pain or stiffness or medical conundrum … you name it.
Another way to see this is to put pain into 2 categories;
1. Pain that is going to possibly kill you very soon <72hrs.
2. Pain that will cause you to want to kill yourself because it is unrelenting and no one seems to care or can help. This pain is where this needle therapy is best used.
    Irrelevant. The question is about the use of acupuncture in animals and requires you to produce robust evidence. Please do so.
    3. “What would be the effect of a single instance of morbidity or death from acupuncture on your claim that acupuncture is “not dangerous at all”?”
    I have used 10s of thousand of needles in every possible location on the human body.
Even in the eye sockets. Safer than taking aspirin or motrin daily. There are just a few location that care should be taken … not even an extra amount … just care. The lateral neck, above and below the clavicle and at pulse locations ie femoral, brachial, carotid etc. To mitigate the lung puncture situation, I alway use shorter needles and go in at an angle so I will hit a rib before puncturing the lung (knock on wood).
    You seem to have answered the question you would like to have been asked. Now answer the question you were actually asked.

    You have made an absolute claim on your website. Justify it or change your website.
    4. “Have you ever seen the articular surfaces of a severely arthritic joint?”
    Yes … uneventful and shocking how many reasonably normal there looked. [snip]
    And in others, what can you see where the cartilage is missing? What did the photo show you on that web page?
    5. ”What is the purpose of control groups in scientific trials?”
    Is this a test question?
    Yes. You are not doing well so far. Please answer the question properly.

  11. Badly Shaved Monkey says:

    Dr R,

    Can I make a suggestion? In your next post, write less, but write the actual answers to the actual questions. It would take a lot less time and be hugely more productive.

    1. I am amazed at your dizzying logic. You are so trapped in your logic you’ve forgotten humans are not machines. The scientific method depends on consistency of the elements. There are none in human nature.

      AND you expect the same system to rescue you from your plight??? They are the ones who imprisoned you, they will not release you from the chaos they are causing. Remember illness and dis-ease is driving our economy and the ill, uneducated, foolish, lazy and gullible are cash cows. You will have to release yourself.

      You have a vast amount of reading to do to gain some insight into myofascial pain and dysfunction. Start with something that a beginner can understand … this is not an jab. Devin is a genius and has helped thousands with her efforts, this info may help you … she is FB myofascial pages. The book will talk about stress and perpetuating factors for pain and misery … you should read it and discuss the chapters with your doctors.
      http://www.amazon.com/Fibromyalgia-Chronic-Myofascial-Pain-Survival/dp/1572242388

      1. Harriet Hall says:

        “The scientific method depends on consistency of the elements. There are none in human nature.”
        So what are you suggesting? That we ignore science and just treat patients any way we want? Should we go back to bloodletting to balance the humors? To Perkins’ tractors? They produced true believers and satisfied customers too.
        Again, you contradict yourself, because you have accepted that there is enough consistency for us to know that antibiotics don’t work for viruses.

        1. Yes we still give antibiotic to patient who obviously have cold because somewhere they get the idea that it will help to cure the cold. I wonder where they get these ideas? Try not to give a patient what they want and you will be out of business. Yes private practice is unfortunately a business.

          Patients these day tell you what they want … we are public servants (ok by me)

          I see my ideas are boggling your paradigm … sorry.

          I am suggesting that what scientist have discovered can not be fully applicable to the human body, mind or emotional make up.

          The first 15 yrs of my practice I follow the holy grails of the FDA/DEA/AMA as gospel.
          That works for a lot of issues ie Diabetes, Hypertension, Thyroid disease, Cancer surgery, Trauma, Gunshot wounds, Tumors, aneurysms, infectious diseases, Depression and Anxiety and in the ER. Modern medicine is a success in these areas.

          Once you factor in elements of free will, freedom, beliefs, stress, life, career, fast food and the conveyor belt and rat race of life … this is where it all falls short. This is where consumerism and the free markets clash.

          What do you do with a patient who had back pain and an abnormal MRI who decided to go to surgery and now is back in your office in even more pain how on opiates, muscle relaxant, insomnia meds and is miserable? Complaining of 15-20 thinks? Dr. Rod the surgeon won’t return my calls and says I have to go to the pain management doctor cuz he can not help me?

          Wait the frickin minute. You had surgery!!! He was suppose to have fixed you??!!

          or

          Hey doc the hand surgeon you sent me to did the surgery but I am not back to work cuz my hand still hurts and is now weaker and even more numb?

          or

          The neurologist put me on all these meds and I’m still having severe headache, blurry vision, ringing in the ears and can’t take care of my kids?

          What would y’all do? BSMonkey, Hall, Graham, Cloud, Wind, Chris, Novella!

          1. WilliamLawrenceUtridge says:

            Yes we still give antibiotic to patient who obviously have cold because somewhere they get the idea that it will help to cure the cold. I wonder where they get these ideas? Try not to give a patient what they want and you will be out of business.

            My doctors have examined me and said I didn’t have a bacterial infection and thus didn’t need an antibiotic. I accepted this and left without a prescription. The patient must be educated to accept that doctors know what they are doing – and public health efforts do exist to try to educate them. I find it troubling that you seem to believe in giving patients something, anything, to make them feel better, without appreciating that their subjective improvements may not be matched with objective improvements.

            I see my ideas are boggling your paradigm … sorry.

            Not really, I see your ideas as regressive, and your comments arrogant, and you filled with an incredible, unwarranted respect for your own opinion, a certainty that appears wholly ignorant of how certain (and wrong) our ancestors were. The paradigm you are adopting seems to be paternalistic and deeply flawed by a failure to appreciate why human reasoning and certainty can’t be trusted. For instance, you never seem to engage with the actual evidence base for acupuncture. You never seem to ask yourself, “why is it that I find acupuncture to be formidable and powerful, but scientific research never seems to reach a similar conclusion”. You use your own experience to discount the science, and use special pleading or logical fallacies (“God made our bodies”, and “bodies aren’t consistent”, and “I found a single theory that justifies my experience and don’t care if it has been tested”) to dismiss any criticisms. I’m sure you are a great doctor when it comes to pleasing your patients. I’m sure they are very satisfied. I just hope you don’t miss a diagnosis and accidentally kill one of them with your kindness.

  12. Badly Shaved Monkey says:

    Dr R,

    Harriet Hall just handed you your ass. You did seen to be having trouble finding it even with both hands.

    Now, address the point she has just made.

    Oh, and answer my 5 questions. Succinctly and relevantly, please. Here they are again;

    1. What’s the objective evidence that supports each of the specific therapeutic claims on your website?
    2a. What’s the objective evidence that supports the claim that acupuncture works in animals?
    
2b. On what conditions does it work?
    3. What would be the effect of a single instance of morbidity or death from acupuncture on your claim that acupuncture is “not dangerous at all”?
    4. Have you ever seen the articular surfaces of a severely arthritic joint?
    5. What is the purpose of control groups in scientific trials?

  13. Badly Shaved Monkey says:

    Dr R

    You seem easily impressed by testimonials. Here’s a recently discovered infomercial.

    We spoke to Mr Bryan Quetzalcoatl of Tenochtitlan. He said;

    I used to take two bottles into the shower, but not any more. I just take the still-beating heart of a human victim every morning and the Sun both rises and shines. No more apocalyptic bad-hair days for me.

    DAILY HUMAN SACRIFICE TO PRESERVE THE COSMOS
    It’s because YOU’RE WORTH IT

    Dr Rodrigues,

    That was a pretty powerful testimonial. Was Brian right to think that his practice of routine human sacrifice was essential to keep the Sun rising?

    1. This is deep! You know this and other societies still require human sacrifice just because we are human and are bloodthirsty and inhuman. All of us … you and I … Because we don’t do anything to stop the bloodshed.

      Why do we let kids starve to death around the world
      Why do we let mentally ill people walk the streets without care
      Why do we allow surgeons to freely decide which joints to steal? (Those precious God given joints)
      Why do we let desperate women put newborns in dumpster
      Why is war easier than diplomacy
      Why can’t we eradicate polio
      Why are we still using Thalidomide
      Why do we have fast food and junk foods so readily available to fatten the populace so we can prescribe more meds for diabetes, HTN and do gastric bypasses
      Why do we allow folks to say what they think and not be penalized for lying

      … because we are human. As human we are innately greedy, devilish and bias and should not be trusted.

      So who do I trust??? My patients! I they say doc that did nothing … so I keep trying and see the results.

      If they say, you got it right doc thanks … let keep along that path …

      I follow my patient’s guide and I trust what they feel.

      ===
      Oh I really not here to win (I’m used to loosing)… just to cause someone to think out of their paradigm.

      Tomorrow, i have super full schedule using my voodoo, wring chicken and bloodletting skills … busy busy busy. You will have to wait a while to have fun trash talking.

      Thanks again for letting me splurge!!

      1. Badly Shaved Monkey says:

        Once again Stephen, I asked you a question and you have done anything except answer it honestly and directly.

        Try again.

        Was Brian right to think that his practice of routine human sacrifice was essential to keep the Sun rising?

      2. Harriet Hall says:

        Dr. Rodrigues has told us “homeopathy to bloodletting are valid when used in combination of a complete therapy program.”
        So he accepts water placebos and Medieval bloodletting.

        He has said “Chi is a force or the force of nature. Blocked force will cause illness.”
        So he believes in fairy tales.

        He has admitted that he gives patients antibiotics in situations where they can’t help and can only harm, and that he gives patients what they think they want instead of what they need.
        So he is unethical.

        He has shown that he doesn’t understand the need for controlled studies, that he goes by testimonial evidence, that he rejects science in favor of various forms of nonsense.
        So he has no credibility.

        Whether or not he is a troll, he certainly is out of his element in a science-based forum. Let’s not encourage any more of this.

        1. Woo Fighter says:

          Don’t forget his use of “dis-ease,” the hallmark of every alternative quack and charlatan from Mercola to Robert O. Young and everyone in between.

          And he keeps saying things like “god-given” and “made by god” so I guess us athiests aren’t eligible to his treatments since we don’t believe in his god.

          I guess he believes in intelligent design over evolution. He also sounds like a bit of germ denialist.

          This guy really went to med school and took science courses?

      3. WilliamLawrenceUtridge says:

        Dr. Rodrigues, you appear to be missing a key point here. People in the past were just as certain as you about points which turned out to be wrong. The Catholic Church burned people alive with utter certainty that they were witches. The brain was regarded, with utter certainty, to be solely used to cool the blood. Doctors used lancets and purgatives to balance the humors, certain they were healing patients – and fought tooth and nail against challenges to their knives, emetics and laxatives. Blood itself was believed, with utter certainty, to be created and destroyed many times over throughout the course of the day and to flow like the tides (rather than circulating). People who believed this in the past were certain, just like you are certain. They were wrong.

        How do you know you are not wrong?

        Why do we let kids starve to death around the world
        Why do we let mentally ill people walk the streets without care

        These are economic, not medical problems. Medicine can tell us why children starve to death (caloric deficit) and what to do about it (feed them), but the redistribution of resources throughout the world is neither a scientific nor a medical question. It is political. Why do you bring these points up in this discussion?

        Why do we allow surgeons to freely decide which joints to steal? (Those precious God given joints)

        Doctors “steal” joints? What do they do with them afterwards? Sell them on the black market? This seems rather like a straw man, and irrelevant to the issues discussed on this blog.

        Why do we let desperate women put newborns in dumpster

        I don’t believe we “let” women do this. I believe desperate women may do this when faced with the inability to care for their children. It is a tragedy. Some countries, such as Germany and South Africa, and probably the US, offer “drop-off points” as alternatives, though greater societal support for contraception, safe and legal abortions and adoptions would probably be even more helpful. Again, this is not a medical question. Why are you bringing it up?

        Why can’t we eradicate polio

        This is a medical question! Because not enough people get the vaccine! Now why does that happen – and we’re back into nonmedical territories. Polio was almost eliminated back in 2006, you can read why it didn’t work here. Again, this is not really a medical question.

        Why are we still using Thalidomide

        Because it’s an effective treatment for leprosy and certain cancers. Its use is controled and restricted because it is a potent teratogen, which is why it is not used to treat morning sickness anymore.

        Why do we have fast food and junk foods so readily available to fatten the populace so we can prescribe more meds for diabetes, HTN and do gastric bypasses

        Well, food security would be one reason, farm subsidies another, but ultimately it’s because people are mostly free to do what they want even if it’s bad for them. Then there’s opposition to nanny states, and the failure to pay mothers and doctors to follow people around to nag them to eat better. I’m not sure what your point is, what does this have to do with acupuncture?

        Why do we allow folks to say what they think and not be penalized for lying

        In the US, it’s pretty much the first amendment, but there are penalties for lying (libel and slander are both crimes in most jurisdictions).

        So who do I trust??? My patients!

        Why? Didn’t you go to medical school? I go to a doctor because I don’t have the expertise to diagnose and treat myself. What if your patient is wrong? What if your patient believes they are better, but the tumor is still growing? What if your patient is unconscious, or delusional?

  14. Jenny says:

    Ok, I get it. It’s a peer review site. So much vitriol on this site. I thought I was just adding interesting info. I was just so amazed that after having irritable bowel daily that I was free of it. Wanted to share that bit of news. Now 5 days without pain. Even when pain comes back , I’m happy, because of being pain free for a wee bit. I am used to having pain despite trying to eat well etc. I get that you don’t like anecdotes . So ..goodbye and good luck to all of you

    1. WilliamLawrenceUtridge says:

      It’s not a peer review site, it’s a blog with a comments section (and an educated set of dedicated readers who rarely let fallacies go unchallenged). It’s not vitriolic to point out that humans might be wrong, and are bad at attributing causality.

      Does your pain come back, has it come back in the past five days? If so, how can you say you’ve had five pain-free days? It is these sorts of questions, which are challenging to our perceptions of ourselves as intelligent, rational creatures, that can lead us to more rational and empirically-grounded understandings of the world. I welcome challenges like this, it helps me improve as a person and more accurately appreciate the world I live in. You have to give up your self-perception as a smart person who doesn’t make mistakes, but there are definite benefits. For instance, I’m unlikely to waste time or money, or risk lung collapse, by receiving acupuncture.

  15. Jenny says:

    My last post then I will let you practitioners get on with things. First, I don’t have crappy skin. Just thought I’d try acupuncture as you get a good glow . ( I heard). And I did look great for that night. Second, no irritable bowel pain. Wonderful! …when I have pain daily normally! So, no , not falling apart. Just happy with the unintentional result. The acupuncturist asked me about my health but I really didn’t have any expectations. So, I will go now and let you do your thing…..

  16. Jenny says:

    To Dr R….you are right….these doctors would be bored… They all think the same. Some things in life are perhaps unexplainable. My husband is a physicist and concurs. Anyway, must go, wish everyone on this blog good health !! Last post I promise!

  17. um…again…

    If a patient interview trumps all average data. Doesn’t that mean that someone who says they “feel they have cancer” must be a better diagnostic than every other risk factor combined?

  18. Badly Shaved Monkey says:

    Stephen, here again are the questions that you seem so keen to evade. They’ve not gone away;

    1. What’s the objective evidence that supports each of the specific therapeutic claims on your website?
    2a. What’s the objective evidence that supports the claim that acupuncture works in animals?
    
2b. On what conditions does it work?
    3. What would be the effect of a single instance of morbidity or death from acupuncture on your claim that acupuncture is “not dangerous at all”?
    4. Have you ever seen the articular surfaces of a severely arthritic joint?
    5. What is the purpose of control groups in scientific trials?

  19. RTG says:

    Have any studies shown sham acupuncture to be more effective than active acupuncture? … just wondering.

  20. Badly Shaved Monkey says:

    Stephen R.

    Harriet Hall invites us to stop “feeding the troll”. She does have a point. You have shown yourself singularly resistant to honestly following a simple line of discussion.

    Let me simplify for the moment to a single matter that is easily resolved.

    You have asserted, in the context of arthritis, that “There is not [sic] such thing as bone on bone … it is a deception to make money.”

    But in severely arthritic joints, cartilage is often eroded away completely on both articular surfaces. I have seen this. Many orthopaedic surgeons will have seen this. Once the cartilage has disappeared it is obvious that there will be “bone on bone” contact in the joint. Your statement is simply false. There is no room for equivocation or fudging in this, you have made an incorrect assertion.

    Do you accept that “bone on bone” contact can occur in arthritic joints?

  21. Harriet we are all unethical … human are inherently unethical so why believe any “scientific” evidence.
    We as humans are liars.

    You all are lying with the intent to keep some suffering souls away from a viable safe nontoxic beneficial therapy be it aromatherapy, music or needles. This would be grounds for getting kicked out of medicine or your scientific fields.

    What do you do with a patient who had back pain and an abnormal MRI who decided to go to surgery and now is back in your office in even more pain how on opiates, muscle relaxant, insomnia meds and is miserable?
    or
    Hey doc the hand surgeon you sent me to did the surgery but I am not back to work cuz my hand still hurts and is now weaker and even more numb?
    or
    The neurologist put me on all these meds and I’m still having severe headache, blurry vision, ringing in the ears and can’t take care of my kids?

    What would y’all do? BSMonkey, Hall, Graham, Cloud, Wind, Chris, Novella!

    1. Badly Shaved Monkey says:

      What would I do? It would depend on many things, but I don’t lie to clients and I don’t sell interventions that have been objectively demonstrated to be useless.

      It is not given to us for every problem to be curable but it is iur job to be honest with patients/clients. It is very specifically not our job to sell easy lies because we lack any moral courage.

      I asked you a question. Answer it.

      Do you accept that “bone on bone” contact can occur in arthritic joints?

    2. G.Shelley says:

      Several other people have tried to get you to explain how you think you can tell the difference between acupuncture working and seeming to work because of placebo, regression to the mean, confirmation bias and other factors and you have shown no interest in doing so. I don’t know if this is because you simply don’t understand the questions, or just don’t care, because you are so convinced that your personal experience trumps the results of carefully regulated trials. You have not acknowledged some other analogies, but how about this – You dismiss the results because they are not “true acupuncture” Do you accept that the people who practice this “false acupuncture” have the same confidence in it that you have in your version and would ive the same reasons for knowing their acupuncture works

      I have another question. You have written a little about how you do acupuncture, but what do you consider acupuncture? Do the insertion points matter? Does the type of needle matter? Does the depth of insertion matter? Do you have a mechanism – is it chi, release of chemicals, stimulation of nerve cells? something else

      If you can’t answer these, I would have to agree with Dr Hall that you are not here to learn, or even discuss, but to troll.

  22. windriven says:

    “Harriet we are all unethical … human are inherently unethical so why believe any “scientific” evidence.”

    Really? I suppose in the most punctilious reading one might make that case. But the other side of that argument is that most people strive to be ethical, at least most people of my acquaintance, CAM quacksters excepted.

    And how on earth do you tie your bleak assessment of your fellow man with rejection of scientific evidence??? Science is structured to sift and resift, test and retest, examine and reexamine with the explicit intention of stripping away bias to expose the truth. Are you simply a denialist of anything but fantasy?

    You go on to pose a number of clinical what-ifs and, as I am not a physician, I will leave any specific answers to those who are. But I can absolutely assure you that no good physician believes the correct answer to any of your hypotheticals is to throw stuff against the wall to see if anything sticks.

  23. Mister Wu says:

    Thomas Edison clearly proved that the concept behind the lightbulb is clearly flawed by hundreds of tests examples so we clearly should discard our incadecent bulbs. His use of a carbon filiment on one test is an outliner and should be discarded.

    1. Badly Shaved Monkey says:

      And once he found a bulb that worked, it worked reliably, predictably and repeatedly.

      He did not sell people all the failed bulbs and claim that critics of these duds were too narrow-minded.

      I don’t think you understand your own point.

  24. João says:

    such a stupid comments in here… removing acne, skin diseases with acupuncture is the result of placebo effect? Explain that to me, i dont understand how placebo remove skins diseases, and all type of diseases … humans .. lol

    1. WilliamLawrenceUtridge says:

      This is because of the imprecision with which the term “placebo” is used – even by doctors and researchers. “Placebo”, used casually, means “anyone stupid enough not to realize they’re not on the active arm”. Placebo actually incorporates far, far more than this. It includes demand characteristics (where patients don’t necessarily feel better, but tell their doctors they do to avoid disappointment), it includes the release of endogenous substances in anticipation of relief (what most people think of as the “legitimate” placebo effect because it involves brain chemistry) and it includes regression to the mean. When you test people before and after a treatment, some will get better irrespective the treatment merely because of the passage of time. In a controlled trial well-matched across active and control arms, regression to the mean and natural healing get lumped into “placebo effects” because there is no way (or reason) to tease out the various strands of reported recovery.

      That is how “placebo” removes skin diseases (and cures cancer, and tuberculosis, and joint pain, and, and, and).

      Regards acne in particular, if the treatment arm overlaps with the transition from spring to summer in any way, increased time spent out of doors, in UV-containing sunlight which kills acne-causing bacteria can improve acne. If you don’t carefully control for seasonality during your tests, in particular if you recruit your groups at different times, acne can disappear.

      Medicine and medical research is complicated; pretending it’s simple doesn’t make it actually simple.

  25. Badly Shaved Monkey says:

    It seems that Stephen Rodrigues has left the building.

    I wonder if he’ll be back

  26. Jenny says:

    I wasn’t going to chime in anymore,..but a few people have asked if my irritable bowel pain had reverted to the mean . ( excuse my perhaps mistake in wording)…it’s day 8 with no pain. Otherwise, I have daily pain in my life. I did ask this on the blog: could acupuncture at least have relaxed my system enough to give me a break in pain?
    People I talk with do day they sleep really well after a treatment.

    1. Yes … Jenny … It’s important that Acupuncture is just one of the dozen things you need to do to free yourself from pain. YOU have to be proactive … fine the suggestions on my fb page.

      Some folks here think that a single entity pill discovered my a genius in a lab will cure all of the worlds ills. NOPE most drug are not engineered but stumbled upon. Like Prozac was originally thought to be a block buster weight loss medication …. Duh. They stumbled on one of my favorite meds of all times … I wish a few in the blog would take it.

      1. WilliamLawrenceUtridge says:

        If you have to try a dozen things to free yourself from pain, how do you know acupuncture is what is alleviating pain? And why should jenny care about alleviating pain if she still has an underlying medical condition? She could take morphine to alleviate the pain, then die of hyponatremia from untreated diarrhea. That seems like a bad approach. Not to mention – she could try acupuncture and die from a collapsed lung.

        Nobody here thinks there will ever be a single pill that alleviates all pain, you appear to have a simplistic view of both medicine and its critics. Commenters here view medicine as maddeningly complicated, and fraught with problems, and CAM promoters often step into the resulting gaps between science and needs to promise the moon and charge people for placebos.

        What kind of doctor are you?

    2. This is another view as to how acupuncture works in 2013.

      Remember iit is not about acupuncture but using it as part of an overall wellness program.

      Myofascial Pain and dysfunction is at to core of most medical conundrums in office practice.

      http://americannewsreport.com/nationalpainreport/acupuncture-the-most-powerful-therapy-in-medicine-8820052.html

      http://americannewsreport.com/nationalpainreport/chronic-pain-is-manageable-with-the-right-therapy-8819887.html

      http://americannewsreport.com/nationalpainreport/can-chronic-pain-be-cured-8820366.html

      1. WilliamLawrenceUtridge says:

        Why are you citing news reports instead of the scientific literature? Why are you citing news reports that cite Sarno and his non-accepted theory of the origins of back pain? Why are you citing as proof an article with a quack miranda warning?

        The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that! It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

        1. Well sir I sincerely hope a ligit blog that state ebm should have such a disclaimer.

          1. WilliamLawrenceUtridge says:

            This blog doesn’t give advice (beyond “avoid CAM, it’s a waste of time and money, deceptive, and often will give very dangerous advice”). It consistently refers to the scientific literature – the very thing needed for a site to avoid the quack miranda warning – and basic critical principles. It needs no such warnings.

    3. weing says:

      @Jenny,

      Hope you’re still feeling well. You mean to tell us that you have never had a day or group of days without pain prior to your “glow” job? Or never slept really well?

  27. pmoran2013 says:

    ” I did ask this on the blog: could acupuncture at least have relaxed my system enough to give me a break in pain?
    People I talk with do day they sleep really well after a treatment.”

    Good question! It is interesting, isn’t it, that for all our scientific sophistication we do not have a clear answer to this terribly simple question: “would this particular person feel better for having undergone an acupuncture treatment?”

    We have approximate answers (“– it doesn’t ‘work’ –”) that are probably adequate for most of the practical purposes of mainstream medicine. Patients have a different perspective and ask different questions.

    How are we to answer this?

  28. Jenny, it could be any number of non-specific effects. Firstly would be those involved in cognitive biases. You may have been in pain most days or even almost all, but it undoubtedly waxed and waned and you probably did have some pain free days and even pain free episodes. Selective memory (called confirmation bias) can easily make us all remember and focus in on one thing – the pain you had most days. Now you have a pain free day that happens to coincide with an acupuncture treatment and you are amazed and highly aware of this fact which can lead to a self fulfilling prophecy. Pain is a highly cerebral phenomenon – meaning that what we experience at a tissue level is highly modulated by what our brains actually perceive. Like when I stub my toe on the way to morning rounds and it aches all day vs when I stub my toe on the rocks heading in for an afternoon of glorious surf and the pain is completely gone in 5 minutes. It is also common to have causal misattribution. Meaning that it is very possible you were pain free before the acupuncture but in recalling the events changed the order of them, or were in fact still in pain for a little while after the acupuncture and then when it went away tried to recall what may have happened and changed the timing of the symptoms to coincide better with the acupuncture treatment. All of these phenomenon are very well documented and I have seen exactly these sorts of things crop up in my patient interviews when comparing their histories to objectively recorded data.

    Next we have the distinct possibility that there were specific effects of relaxation or general stress relief. Particularly IBS type pain is highly variable depending on the physiological and cognitive milieu going on. Stress and anxiety increase the attention to pain and can even cause different physiological effects leading to more pain producing physiology of the affected organ/tissue. This can even be the case without us knowing it – have you ever, for example, suddenly realized you have been clenching your jaw all day and relaxed and suddenly realized only after relaxation that it feels so much better? In this way pain can become a self fulfilling prophecy as well. Going in and having a new experience, typically theatrical, with a focus on relaxation could well have broken the stress/anxiety aspect of the pain.

    And lastly, pain – particularly IBS type pain – is simply highly variable. At any point it could quit for any period of time for absolutely no apparent reason. And while obviously unlikely, it could indeed have happened to coincide with the acupuncture treatment. Given how many people get acupuncture over time for various sorts of pain type conditions, it is not at all surprising that at least one person would have any one, some, or all of the factors coming together to produce what seems to be an effect.

    It is for all these reasons that we must actually look at science and data to determine if there is actually an effect specific to the treatment in question that could be used on other people in a consistent and reproducible manner. Acupuncture has been studied this way and repeatedly has shown that there really isn’t much there. And little reason to think that there would be.

    So yes, you could have actually had an effect on your pain from the treatment. But it is unlikely, heavily confounded, and almost certainly not a specific effect of the acupuncture itself.

    1. That is the most elegant explanation of how the human body doesn’t really works that I have every heard.

      A most accurate explanation can be found in the text of Travall/Simons Myofascial Pain and Dysfunction. She explains complex issues so a 7th grader can understand;

      Life causes stress, stress corrupts sleep, sleep derivation causes dizziness, nausea, tight muscles, headaches, gi upset, diarrhea and nervous. This effects you work day causing a drop in productivity and self-esteem which fuels the cycle of pain, insomnia, gi upset and worry … leading to fear which locks everything in to your soul.

      Then You go to your doctor who busy and not really listening gives you a pill that makes every thing worse … then you really think you going to suffer a miserable life. The cycle repeat and repeats even with another doctor.

      Finally someone tells you the truth (actually not true but really based on there ignorance) … “it is all in your head see a shrink.”

      1. WilliamLawrenceUtridge says:

        Considering Andrey was primarily discussing how cognitive attributions impact pain, it’s rather unsurprising it bears little resemblance to how the body works.

        The doctors I have heard about and been to have been quite willing to supply referrals to psychotherapists, psychiatrists or counselors (and massage therapists, chiropractors and physical therapists for that matter), and some are quite willing to simply sit and talk to patients about their lives and stresses. However, I don’t live in the US, I have a real health care system. Certainly changing how health care is delivered and paid for in the US would be extremely helpful to the population.

        What kind of doctor are you?

  29. I’ve already answered at the same time you posed your leading question. I don’t have much time to expound further since I have a fund raiser to attend, but the fact that you yourself can’t answer the question boggles my mind. After all the time you and I have spent dancing around these issues you should know better. There is, indeed, an answer. And yes, for the average person and for all practical purposes the answer is “it doesn’t work.” But we can – and I have just now and in the past – gotten much more nuanced than that.

    There is an answer. It is multifactorial and none of it requires that we ultimately conclude that acupuncture actually works in any reasonable sense of the word.

  30. Elegant but not complete the truth. Read Travell/Simons myofascial pain and dysfunction. You problem is 100% treatable.

  31. Here is a few test question so we can see how your clinical skills stack up to an intern.

    What do you do with a patient who had back pain and an abnormal MRI who decided to go to surgery and now is back in your office in even more pain how on opiates, muscle relaxant, insomnia meds and is miserable? Chief complaint; Dr. Rod the surgeon won’t return my calls and says I have to go to the pain management doctor cuz he can not help me now?
    or
    Hey doc the hand surgeon you sent me to did the surgery but I am not back to work cuz my hand still hurts and is now weaker and even more numb?
    or
    The neurologist put me on all these meds (metoclopramide, amitriplyline, atenolol and Vicodon)and I’m still having severe headache, blurry vision, ringing in the ears and can’t take care of my kids?

    What would y’all do? BSMonkey, Hall, Graham, Cloud, Wind, Chris, Novella!

    1. WilliamLawrenceUtridge says:

      It’s disconcerting that your advice in all three cases appears to be the same thing – platitudes and acupuncture.

      What is your advice to a patient who experiences an immediate sensation of grinding and chest pain while they breathe, an act that is now suddenly difficult?

      How do any of your examples support the use of acupuncture? You seem to keep saying “if real medicine is imperfect, acupuncture works”. That’s a logical fallacy (false dilemma). Acupuncture either works, or it doesn’t. The scientific literature consistently shows that it doesn’t matter where you put the needles, or whether you penetrate the skin, that it doesn’t treat anything but short-term pain and nausea, and that the most important characteristic is whether the practitioner is enthusiastic. How do you reconcile your experiences with the complete failure of the scientific investigation of acupuncture to support them? Are you even aware of the scientific research on acupuncture?

      What kind of doctor are you?

  32. Badly Shaved Monkey says:

    And he’s back…

    SSR, do you accept that “bone on bone” contact can occur in arthritic joints? I have asked this several times and given evidence that your assertion was false. I think it’s high time that you honestly addresses the issue.

    Your clinical scenario questions imply that you think you have a cure for all patients. You don’t. No one does. Ill-health can be a complete bitch. You imply that the doctor is under an obligation to ‘do’ something, but resorting to lies and theatrical placebo would be the actions of a scoundrel. Sometimes it’s the physician’s job to tell patients the unpalatable truth that medicine has reached its limits for them and the focus must switch to methods of coping. Any doctor who thinks otherwise is in the wrong profession.

    I have seen a number of situations in which clients have been told by us that nothing more can be done so they take their animal off to some SCAMster. We get to see the patient and its inexorable progress while the SCAMster fiddles away on the margins of the problem, taking the client’s money and spinning candyfloss fictions. I don’t criticise them for failing to provide cures or even symptomatic control, but I do criticise them for being idiots and/or frauds.

    1. And he’s back…
      “…do you accept that “bone on bone” contact can occur in arthritic joints? … honestly addresses the issue.”

      Why would I waste my time with a person, If you can’t get your head out of your stratosphere? Besides you won’t believe me. On any account some on this blog will benefit from my opinions and insights.

      Bone-on-bone is not a diagnosis and it can’t be defined in medicine. It’s actually a scare tactic to get patients who are suffering in pain to have a joint replaced. Now if you are interested in the reasons why patient’s suffer in pain, read the textbooks I have outlined. Travell, Hackett, and Rachlin realized this a half decade ago that observed that SOME patients who underwent joint replacements did well and SOME did ok and SOME were worse off. The reason was it was not the knee joint proper it was the myofascial tissues.

      1. Myofascial pain and dysfunction is the reason why surgery can not fix pain and why pain can not be treated solely with a pill. Travell/Simons et al realized that focused therapy at the joints was less successful that focusing the therapy on the muscles. Many physicians see pain issues as in joints or static structures; she understood that it is the muscles. She also discovered that treating the muscles would also alleviate a lot of movement disorders and pain syndromes. She noted that if the muscles were treated then the ligaments, nerves and circulatory dysfunctions would naturally resolve. Her therapy is called Trigger Point Injections. Over the years I have found other authors who have done a lot of work to clarify this disease and therapy, Edward S. Rachlin, MD., C. Chan Gunn, MD plus many others.

      Trigger points injections are a type of myofascial release therapy that your Physical Therapist will know about. Myofascial tissue release therapy is on a spectrum from simple stretching, yoga, Pilates, hands-on manipulations, acupuncture, dry needling to finally Travell trigger point injections.
      2. There are no cures per se but we have “Therapy” that will help to ignite nature which will restore and heal. Once healing is complete, only in the future can we say if it’s cured. Cure or not Therapy must continue.
      3. If you never offer patients “Therapy” you are remiss and should be reprimanded.
      4. The only person who can tell you if Therapy is working is the individual patient who has the complaints. NO instruments, scan, MRI or a Shrink are needed just the raw data given by the patient. (i know what you are thinking … yes I have to believe what the patient is saying! I have to trust them and they have to trust me.)
      5. Before Travell/Simons, I have to admit, I had to fib or tell little white lies to save face, play the game of being a “Doctor” and preserve my status. NOt anymore! I am free to tell the truth, no ego, no blame, no false facades or deceptions.
      6. Today I am certain that medicine can offer something to help patient feel better. Really feel better and have a better quality of life. ( I Know what you are thinking … where does feelings come into medicine or the scientific methods) Well there is a part of medicine that is the human dignity part related to the Art of medicine, which has been left out over the past 25 yrs.
      7. Once you understand Travell/Simons you began to see the deceptions all over the healthcare industry. Why would a for profit entity want to get you well when it’s goal is to make money off of illness and misery.
      8. Massage, Chiropractic, Traditional Chinese Medicine/Acupuncture, Ayurvedic and other hands on therapy are truly valid therapies but the business of medicine, bias, competition gets in the way of health and wellbeing. If you reimburse a fair rate, no provider would want to beat the system. Can you imagine what would happen if a massage therapist helped a knee pain patient decide not to have replacement surgery??!! Ortho-docs would yell and scream!
      9. IMO, the idiots and frauds are rampant in the healthcare field and in the scientific fields that support them. (This site is one of the places that is presenting false and biased information)

      1. Badly Shaved Monkey says:

        Bone-on-bone is not a diagnosis and it can’t be defined in medicine.

        Of all the damn fool things you have said, that wins the prize. When I open a joint and see bone rubbing on bone, I can call it bone on bone contact.

        You, sir, are an idiot and I’m not even finding you amusing any more.

  33. Badly Shaved Monkey says:

    This bears a specific comment;

    Hey doc the hand surgeon you sent me to did the surgery but I am not back to work cuz my hand still hurts and is now weaker and even more numb?

    There is the obvious possibility that neither you nor the hand surgeon was good enough at your job and the problem is fixable by someone who is more competent. If the primary physician now resorts to nonsensical placebo he deprives the patient of that opportunity. This is yet another risk posed by SCAM therapies.

    How can we know that we have exhausted all effective therapies? It’s going to vary from case to case. But if you divert the patient into useless SCAM therapy then you can be completely sure that you have prevented their access to something better.

    1. Unacceptable … you believe in science and if the science allows a surgeon to fix carpal tunnel … why is the patient still in pain? Surgery can’t fix pain!!! Therapy is the better option.

      1. WilliamLawrenceUtridge says:

        Surgery can fix pain when the pain is due to problematic anatomical structures. Appendectomy is quite effective at relieving the pain of appendicitis, and has the added benefit of the patient not dying when their appendix bursts – a benefit not found with acupuncture.

        What kind of doctor are you, MD, DO? ND?

        1. Coudskimmer says:

          Evidently Rodrigues is a real MD who claims to be a general practitioner, which is evidently supported by his education, and a pediatrician, gynecologist and acupuncturist, which are not. In light of the unethical practices he admits here, would it be possible to initiate an investigation by the Texas Medical Board?

          Licensure of Dr. Rodrigues
          http://reg.tmb.state.tx.us/OnLineVerif/Phys_ReportVerif.asp?ID_NUM=453622&Type=LP&LicensePermit=K3434

          File a complaint
          http://www.tmb.state.tx.us/consumers/complain/placecomp.php

          It just seems really sad that people like this are allowed to practice medicine because, as a patient, this is the kind of person I want to avoid. He also has his very own website http://www.drstephenrodrigues.com/ where he makes a lot of unsubstantiated claims.

          1. MadisonMD says:

            Cloudskimmer: Obviously this fellow is a nut. However, I don’t think it appropriate to file a complaint to a medical board on the basis of comments on this blog. Also, keep in mind that the specialty of Family Medicine encompasses primary care in adult and children, minor surgical procedures and some aspects of Ob/Gyn.

            It is truly depressing that any physician would believe that a series of anecdotes are sufficient to guide medicine and back up an absolute claim of non-toxic effects by saying “knock on wood.” This unscientific model of medicine was effectively suppressed for nearly a century after the Flexner report… and here we are now with a postmodern resurgence. In spite of my sadness, I think it best to take pride in this open forum and not engage in any threatening behaviors (beyond perhaps revoking posting privileges in very rare circumstances).

        2. cloudskimmer says:

          MadisonMD: I agree that this blog should not constitute grounds for a medical board complaint; there is a chance that Rodrigues doesn’t really believe what he posts here. However, there may be people who have left his practice because of his beliefs, and perhaps even been harmed by him, and it could be a good thing for them to file a complaint. I also realize that the medical billing codes are ridiculous, and that GPs provide basic pediatric and gynecological services. That being said, it does not appear that Rodrigues is practicing best-practice medicine.
          From newspaper articles and the saga of Burzynski, medical boards seem unable to deal with even fairly outrageous malpractice, so reporting doctors would appear to be futile. Reporting may establish a paper trail and help later on. It’s also a big problem to sort out unjustified reports from those indicating a real problem; it’s easy to sympathize with the regulators as well.
          It’s good that Rodrigues plainly posts information about his practice on his website; that allows people who want to avoid such nonsense to go elsewhere.

  34. Badly Shaved Monkey says:

    Having just used a particular word in a recent post, an old joke occurs to me.

    Q. How do you know when a politician is lying?
    A. You can see his lips move.

    In the current context;

    Q. How do you know when a SCAMster is lying?
    A. He uses the word cure.

    Cure is a funny word and one that conventional physicians shy away from in my experience. It is frankly presumptuous and all too often inapplicable to chronic medical conditions. But SCAMsters throw the word around with wild abandon. My personal hunch is that their track-record of so-called cures comprises mostly patients who just drift away with their original problem still present. Responsible doctors describe such patients as “lost to follow-up”, the SCAMster calls it a cure.

    1. Unacceptable!! What type of excuse is lost to follow up???!!! Most pain patient give up because the surgeon who fixed them have no idea how to help them once the fix did not work. So the patients are lost in a sea of disrespect.

      1. Badly Shaved Monkey says:

        Try to answer my questions and you might sound a bit less like the comic relief.

        You have evaded them so far. One can only wonder why a competent physician would have such a problem.

      2. Badly Shaved Monkey says:

        Here are those questions again. Please try to pay closer attention to the arguments.

        1. What’s the objective evidence that supports each of the specific therapeutic claims on your website?
        2a. What’s the objective evidence that supports the claim that acupuncture works in animals?
        
2b. On what conditions does it work?
        3. What would be the effect of a single instance of morbidity or death from acupuncture on your claim that acupuncture is “not dangerous at all”?
        4. Have you ever seen the articular surfaces of a severely arthritic joint?
        5. What is the purpose of control groups in scientific trials?

      3. WilliamLawrenceUtridge says:

        It’s not acceptable, that’s rather BSM’s point.

        What kind of doctor are you, an MD or a DO? Some other sort? A PhD?

  35. Jenny says:

    I’m wondering: my husband had bad neck pain that his doctor couldn’t help with. He saw a chiropractor . Didn’t work. Tried acupuncture. A touch of relief at least. Tried massage. Same deal. Tried another chiro: eureka. This guy saved him. So maybe, like in all facets of medicine, some people are good at what they do. Some not. How many acupuncturists were involved in this study? And were some of them not great? No doubt. My acupuncturist has 8 years of training. Some people can do needles after a limited time.

    1. WilliamLawrenceUtridge says:

      You should read the article you are commenting on. This is not a single study. It is an assessment of the whole of the literature, which is itself several thousand articles. Taken as a whole, the best studies show that it doesn’t matter where you put the needles, it doesn’t matter if they penetrate the skin, but it does matter if the practitioner is enthusiastic. In fact, in well-conducted tests, it matters far more than anything else.

      And incidentally, neck pain is one of the few conditions for which there is some good evidence for support.

    2. Andrey Pavlov says:

      Jenny, how about the simple idea that enough time had passed for his pain to improve? What if that 2nd chiro didn’t help and he went and saw a homeopath and took a sugar pill and then his pain went away? Or went to a Reiki master and had someone magically wave his hands over your husband’s neck and then the pain went away? What if he hadn’t seen anyone and the pain still went away? What if he noticed that the day his pain went away he was wearing mis-matched socks?

      That is why individual experience is not at all useful for determining causation. Even many studies aren’t good for that – correlation does not equal causation, after all. At best, the experience could generate a hypothesis to be tested. And that has been tested and shown pretty much across the board that whatever effect there is is extremely small and almost entirely attributable to placebo effects and placebo responses.

      Does it at least make sense why saying that whatever happened just before your husband’s pain went away actually caused the pain to go away doesn’t work?

  36. Wow. This is one of the single most complete anti-science screeds I have read in a long time. I mean really, you hit so many of the oldies (but goodies!) that it boggles the mind. If there is anyone out there who is feeling somewhat convinced by this rant but has an inkling that there must be something wrong with it but just can’t put your finger on it, please, let me know. I will be happy to non-judgmentally dissect it apart and demonstrate exactly why 99% of what was written is complete and utter garbage.

    You should be ashamed of yourself if you really are a physician. But it is clear that the system has failed you and left you so completely muddled that you are probably nearly unsalvageable.

    Which is why I won’t waste my time deconstructing you unless it will actually have a chance at being helpful to someone else. You are undoubtedly beyond reproach.

  37. Jenny says:

    Andrey….for the record, I’m interested…..I’m not a scientist but I myself am having good results with accupuncture….

    1. Badly Shaved Monkey says:

      Jenny

      We keep coming back to the same problem. You say “results”. That requires a causal relationship between the acupuncture and your current self-described clinical status. Many lines of evidence suggest that such a relationship probably does not exist and is even less likely to exist for objective measures of your health status.

      That is the very simple principle that we are trying to get across to you. And we would regard it as a success if you at least admitted this principle and showed some evidence of bring able to apply it.

      You need to be less promiscuous with your faith in medical or pseudomedical therapies. And, yes, exactly the same principle would apply if you had just been prescribed some allegedly brilliant anti-IBS drug. Scepticism entails a consistent approach to all medical claims. We apply it to conventional medicine as well. The crucial difference is that, almost without exception, SCAM therapies fail under scrutiny whereas conventional treatments are more robust.

  38. Badly Shaved Monkey says:

    Jenny

    Further to what I have just said, read what Mark Crislip has just written;

    http://www.sciencebasedmedicine.org/i-refute-it-thus/

    And to misquote Sheldon Cooper, http://youtu.be/oD14by0a-Nc

    “Reality, thou are a heartless bitch.”

    Reality doesn’t care what you want to be true. If you use acupuncture to treat a dangerous disease, you will probably die. When SCAMsters dissuade thousands of their followers from vaccinating their children, children die. It is the inevitability of those causal relationships that means we find SCAMsters morally repellent. And the solution is so simple, don’t get fooled by personal experience, either your own or others’. If you do get fooled then Stephen Rodrigues and his friends are waiting for you at the bottom of the rabbit hole with their acupuncture needles raised like punji stakes. Watch where you’re walking!

    1. Jenny says:

      Well don’t worry I will be careful with all medical advice. But frankly, my doctor can’t help me. So will try four more treatments of acupuncture and see what happens. The reason I’m on this site is because I am interested. But rather than ingest drugs that haven’t helped I will continue for a while. I hear what you ( or maybe someone else said) about a previous treatment can be the cause of improvement.

      1. weing says:

        “But rather than ingest drugs that haven’t helped I will continue for a while.”

        Why would anyone ingest drugs that don’t help? I suppose for the same reason others would go for acupuncture treatments that don’t help. Well, at least your husband can get some rest. For a while.

      2. WilliamLawrenceUtridge says:

        It is a terrible shame, but medicine does not have an effective, safe treatment for all conditions. IBS is one of those conditions unfortunately. Doctors are forced to admit that, and often they are either ashamed or disappointed in their inability to help patients. At some point, a good doctor should say “I’m sorry, I have nothing else to offer you. All I can do is continue to monitor your condition and follow-up with the scientific literature in hopes of a new clinical trial or treatment.” At some point they are obligated to, and should, admit they have nothing further left to offer (and stop charging you for ineffective treatments).

        SCAM practitioners have no such qualms, and their solution is often to keep pulling treatments from their Never-Never Land quiver of magic, to keep you coming back, to hook you on their particular brand of over-promise, under-deliver and consistent charges. Look for the acupuncturist to claim you need “maintenance treatment” for instance.

        R. Barker Bausell’s Snake Oil Science goes into these topics in greater detail, it’s an excellent read and I highly recommend it.

  39. Hello Jenny, I appreciated your interest. Let me start with asking you if you have read my response as to why acupuncture may seem to have worked for you yet still not be a uniquely and specifically efficacious treatment? What have you garnered from that? It is not a “test” – I merely wish to understand what you have gotten from my writing so I can start from there and clarify any misconceptions or miscommunications on my part.

  40. Jenny says:

    Thanks Andrey. I’ve been reading a lot about acupuncture today. About the difficulty of doing a double blind test. That acupuncture treats the whole person and each test would be particular to the needs of the patient. It’s not like giving 2,000 people the same pill created in a lab. The British journal of medicine reports on the efficacy of many standard western treatments that have such poor results that they too would be called witchcraft. I went in for acupuncture merely for a facial! I felt so relaxed when I went to get off the table. Like when I have a massage. A total body slam of relaxation. No placebo there! Felt like jelly. So I figure at the minimum there is a great relaxation that happens and that can only be good. The side-effect? No irritable bowel pain. I have pain daily otherwise. People on this site have inferred I maybe forget that there ate days without pain. Tell that to my husband who rubs my back every night. Every night. ( great guy)….so Andrey, not exactly sure of your background but that is on essence my story. Thanks..

    1. WilliamLawrenceUtridge says:

      How does acupuncture “treat the whole person”? I’m sure your acupuncturist has told you this, but the treatment is always the same – shallow insertion of narrow, silicon-coated steel needles. The location varies, but considering there has never been any scientific test proving the location matters, that’s not really a selling point.

      I think you mean the “British Medical Journal”, now rebranded “BMJ”. Do you have a specific citation, or are you repeating something your acupuncturist told you? And also note that even if your claim is true, that many “western” treatments (could you specify the line of longitude past which they cease to function? I wasn’t aware of geographic limitations to medicine.) don’t work – that doesn’t mean acupuncture works. CAM practitioners like to pretend that if they can criticize real medicine, this somehow means their brand of quackery magically works. This is untrue, which you should be able to see. If I have a dose of antibiotics for a lung infection, whether it works or not has absolutely no relation to whether surgery will cure my appendicitis. Acupuncture either works, or it doesn’t – totally independent of other methods of treatment. Anybody who uses a line like this is either being deliberately deceptive, or hasn’t thought about the argument very clearly. Creationists, AIDS denialists, nearly every unscientific approach anywhere in the world, use a similar argument. If I can identify flaws in evolution, that means the Bible (specifically, the version used by fundamentalist protestant sects – definitely not the one used by Catholics, or the Pentateuch, or the Jehovah’s Witness) is true. If antiretroviral treatments do not offer a cure, then AIDS is not caused by HIV and/or does not exist. Reality is quite different, of course.

      You don’t think “relaxation” could have effects on the body? Doesn’t IBS have a psychogenic component, such that for some patients mere relaxation can alleviate some symptoms temporarily? Why do you think “relaxation” could not have a placebo component?

  41. Sorry guys and gals … I assumed that this was a place of enlightenment of common sense individuals. For some reason y’all heads are stuck in your own stratosphere or on some self absorbed mission.

    Why all the focus on the word Acupuncture? There are many types, variations and the procedure can’t be equated to a chemical in a double blinded study. Y’all have to shift out of your narrow paradigm to began to understand the discipline. Acupuncture is not what y’all think it is and actually if you ignore Gunn’s contributions you will never be able to fathom it’s true power. Acupuncture does not work the way everyone think it does. It’s really about a tool, a philosophy and a way of life. Gunn takes the tool and turbo charges the results.

    Does this group actually think that modern medicine is scientific and not trials and error?

    A healthy amount of skepticism is healthy but y’all are over the top and I would consider a corrupting force ? good or evil? or just plain old pathological.

    @Jenny this is not the place to learn from open minded individual who have your best interest at heart.

    I will poke around a make my opinion know to balance the chaos.

    1. G.Shelley says:

      “Acupuncture is not what y’all think it is and actually if you ignore Gunn’s contributions you will never be able to fathom it’s true power”
      You keep saying this. If acupuncture is not what we, or the people who have studied it is what we think it is, then define it. At least we would be able to see if you have invented some hyperspecific form that somehow has not been studied

      “Does this group actually think that modern medicine is scientific and not trials and error?”

      I’m not even sure what this means. I think you mean “Trial and error” as this was sparked by a review of clinical trials. Are you suggesting modern medicine is not based on scientific research that passes through several levels of testing before it is approved? That a new drug won’t be tested in cells, animal models and human populations before being released? That there won’t be work done to establish the mechanism of action? Or something else? Perhaps all you mean is that we don’t have a complete understanding of the human body and all the possible interactions, so may have to test dozens of compounds before identifying a candidate? That would be a rather pointless comment and show a fundamental lack of understanding of this site.

    2. WilliamLawrenceUtridge says:

      “Enlightenment through common sense” often looks like trite bits of fortune-cookie wisdom to me. “Control your pain so it does not control you”, “Do not question a wise doctor”, “Look both ways before crossing the street”. Science is frequently counter-intuitive and very much not common-sense. It is iconoclastic, it challenges preconceptions. It rarely offers enlightenment beyond a very limited question – but for that question, you can be reasonably sure of your answer. Acupuncture, in contrast, is a series of schisms. It’s closer to religion than science. And the reason is, people were using irrelevant criteria, in a context that didn’t understand disease, illness or the human body, to decide what “worked”. Further, it has been subjected to the “trials and errors” of science – and the result is summarized in the article. Acupuncture doesn’t work, beyond equivocal, short-term relief of symptoms strongly vulnerable to placebo effects in the first place. You are attempting to rationalize and hand-wave these results, mostly by irrelevant criticisms of real medicine or appeals to your own experience. That’s not science. You could conduct an experiment here by the way – modulate your affect and track the results. Be less enthusiastic with some, more with others, but otherwise deliver your services as usual – see who improve more. It’ll be the ones for whom you act more excited.

      Looking at Gunn’s contributions, they seem to be limited to mostly letters to the editor. A couple articles from the late 70s, early 80s.

  42. windriven says:

    @Stephen S. Rodrigues

    ” I assumed that this was a place of enlightenment of common sense individuals.”

    And so it is Stephen, excepting you and your credulous ilk. These pages are devoted to science and medicine. We aren’t swayed by navel-gazers, though they are always welcome.

    But those, like you, who claim that their pet foolishness is immune to the evaluative powers of science go a yard too far. While scientific medicine was busy developing surgical techniques to replace failing hearts, acupuncture was accomplishing what? While scientific medicine vanquished smallpox and all but vanquished polio, acupuncture vanquished what? While scientific medicine learned to save 800 gram premature babies, acupuncture learned to save who from what?

    You saps live in a society where scientific medicine has beaten back scourges that forced most of humanity to early graves in past eras and yet because scientific medicine hasn’t beaten back every ache and pain, real or imagined, we are supposed to swallow the acupuncture fantasy as holy writ? That requires a level of stupidity you won’t find here.

    You believe in acupuncture? As Dr. Crislip noted on Friday, reality doesn’t care. You want rational people to recognize acupuncture as a valid and useful therapy, prove that it works. Studies have been done and redone. Acupuncture does not differentiate itself from placebo. You still believe in acupuncture? Tell it to Santa Claus.

  43. weing says:

    @Stephen,

    Let’s see if I understand you correctly.

    “Why all the focus on the word Acupuncture? There are many types, variations and the procedure can’t be equated to a chemical in a double blinded study.”

    Only chemicals are able to be studied in a controlled fashion? That’s news to me.

    “Y’all have to shift out of your narrow paradigm to began to understand the discipline.”

    So scientific study is too narrow? To understand your discipline we have to stop using science and the discipline of the scientific method? I see.

    “Does this group actually think that modern medicine is scientific and not trials and error?”

    What do you think ‘scientific’ means anyway?

    “A healthy amount of skepticism is healthy but y’all are over the top and I would consider a corrupting force ? good or evil? or just plain old pathological.”

    Because we won’t accept unscientific claims? Practicing science-based medicine is a corrupting force or pathological? Non science-based practice practices would be healthy?
    I’ve got a paper here that, I can sell your for $250k, cheap, the rights to the Brooklyn Bridge.
    You can set up a toll booth and recoup your money in a day. Wanna buy? Now don’t be pathological, just shift out of your narrow paradigm, it isn’t some chemical I’m trying to sell you.

  44. pmoran2013 says:

    While Rodrigues will have an exaggerated perception of what acupuncture can achieve, as practitioners of almost anything invariably do, it is almost equally likely that Andrey and the typical SBM position underestimates what can happen in individual cases from its use.

    I contend that the scientifically correct answer to Jenny’s original question should have been a simple : “we cannot say for sure (whether she would feel better for a program of acupuncture)” —.

    # No scientific study precludes the possibility, although many undermine the necessity for any precise acupuncture protocol

    # There is no implausibility, there being several ordinary and widely accepted mechanisms whereby a program of acupuncture (or of any similarly complex therapeutic interaction) might have limited beneficial effects for patients with subjective, stress-related, or psychosomatic complaints.

    # It is very likely that mankind will have evolved such mechanisms to deal with sickness and injury.

    # The possibility of benefit is supported by anecdotal reports, laboratory studies into the effects of therapeutic suggestion (always!), and also comparative RCTs. Most room for argument lies with the overall “average” strength of any benefits and how such methods might perform in different patients populations.

    We medical sceptics desperately want to be able to answer “no!’ to such questions, but this is for reasons other than scientific certainty. Mainly we are terrified that people might get the wrong idea, becoming vulnerable to medical pseudoscience, or mistakenly believing that we endorse it. These are moderately valid concerns, but they have nothing to do with “the science”, meaning the truth of the matter, nor do they reflect the clear best interests of the parties that medicine exists to serve.

    These conflicting influences are also producing muddled science. “Acupuncture doesn’t work!”, we are told, yet in response to a well-analyzed study on asthma patients it was accepted without challenge that non-specific symptomatic responses to acupuncture could be powerful enough to pose a danger, through such patients not realizing how sick they were. This is inconsistent with the prevailing view that placebo/non-specific responses are either entirely illusory or too small to be bothered with.

    We can wriggle out of this, of course. We are world champions at moulding argument to fit desired positions. We can defend the former statement by saying that “of course” we are using the words “acupuncture”, “doesn’t” and “work” in ways that have specific meaning for medical science.

    But that is not quite the question that patients are asking, when desperate to feel better, and having perhaps exhausted other options, and when usually not giving one fig for the niceties of medical science.

    Andrey, I think we will be better equipped to talk to people like Jenny when we have sorted out better what is going on in our own minds. This is also not asking you to use acupuncture. There remain practical hurdles to that.

    1. MadisonMD says:

      pmoran says that the truly scientific answer is “we cannot say for sure” “No scientific study precludes the possibility” etc. for acupuncture. This also holds true for voodoo, Perkin’s tractors, homeopathy, bloodletting, feng shui, aromatherapy, shamanism, ear candling, color puncture, ghosts, angels, UFOs, etc. etc. etc. to help you Jenny.
      However, if you and pmoran want to really understand scientific evidence, you first have to accept that there is no “absolute proof” of anything (I know this is shocking to non-scientists). The strongest evidence combines plausible well-defined known mechanism of specific effects with evidence for these specific effects in well-controlled clinical studies (i.e. Science-Based Medicine– you should read a few articles about it on this blog). No evidence can disprove any unscientific treatment, so the best term is unproven. So, you decide how to proceed– medicine (i.e. use that which has strong evidence) versus an unproven fanciful remedy of your choosing. As pmoran points out (though not truly in the spirit of science) none have been disproved… only they are unproven. And I am very happy if you feel better even if it is regression to mean or power of suggestion.

      PS: Jenny: If you choose your unproven (or as pmoran seems to be suggesting–placebo) treatment, it might be wise to choose based on safety. You might go with voodoo– safer for the needles to go into your doll than into you.

  45. Hi Jenny,

    You asked what my background is. I hold a BA in medical anthropology in which I studied many alternative medical modalities such as Traditional Chinese Medicine (TCM), Ayurveda, Vietnamese hot/cold therapies, etc. Additionally I hold a BS in evolutionary biology, did post-graduate research in molecular pharmacognosy (the pharmacology of plants and natural materials, a practice often labeled as “alternative” but indeed extremely science based and “mainstream”), am currently 2 months away from graduating medical school, and continue to do my own research as well as do peer reviews and grant proposal reviews. I will also add that the professors in my medical anthropology degree absolutely believed in the efficacy and veracity of so-called alternative treatments and indeed used the same common tropes we see here of “Western BioMedicine” vs “Eastern Holistic Medicine,” saying that “Western” medicine is good at acute problems and trauma, but terrible at chronic diseases, and definitely stating that the “reductionist” techniques of “Western” medicine could not properly examine the effects of alternative medical practices. I also have received acupuncture treatments myself, and have felt some pretty profound effects during the treatments. I graduated fully believing in alternative medicine and even wrote my medical school personal statement about “integrating” the best of all types of medicine (this was, unfortunately for me, a couple of years before that actually became rather in vogue).

    So now that we have that out of the way, it is a common fallacy that is often used by alternative medicine proponents to try and claim that their modality cannot be tested by “Western” medicine techniques (using that term, BTW, is actually somewhat racist and creates a false dichotomy). But that simply couldn’t be further from the truth. Think about it – if you claim that [X] has an effect, I don’t need to know how [X] works in order to apply it and measure the outcome. It doesn’t even matter what [X] is, if there is an actual effect it should be measurable when I do it to people. Now some difficulty can arise when creating a good placebo arm. Acupuncture was a little difficult to do that with. Now there are excellent retractable needles and very good placebo arms possible and when trials are done with it, they show absolutely no difference between people actually getting acupuncture and those with the sham needles. There have been many such studies, and the conclusion is that the effect is the same whether you get stuck or not, that it doesn’t matter where you put the needles (i.e. in a “real” acupuncture spot or just randomly), whether the person doing it has actual training in acupuncture or not, and in fact using a toothpick and twirling it (with the patient seeing this!) is just as effective as “real” acupuncture!

    So what would you make of those findings Jenny? To add to it, both fake and “real” acupuncture had more effect than doing nothing at all – it is just that they both had the same effect which was small. So we do lots of tests in lots of different ways and find that every way we can make a “fake” treatment has some small effect and that the “real” treatment we are testing has the exact same effect as the “fake” one. What conclusion would you draw from those results?

    You go on to say that it has to be “individualized” and it can’t be like giving the same pill to 2,000 people. That also doesn’t matter. In actual medicine we don’t just test 1 same formulation and nothing else. If something is more complex, or has more components to it, we simply test a therapy rather than a single entity. In other words, we test “appropriate therapy” vs sham. Which is exactly what we have done with acupuncture. We don’t tell the acupuncturist “You can only put 7 needles in exactly these same spots for every single person.” We say “Do whatever it is that you are supposed to do for this condition that we are testing” and then compare that to doing it “wrong” (i.e. not what the acupuncturist would do, by using sham needles that don’t pierce the skin, or piercing the skin in the wrong places, or just twirling a toothpick over the skin). And we find that a “real” acupuncturist doing what (s)he is claiming is supposed to help the condition gets no better results than fake acupuncture. So what conclusion would you draw from that?

    (Now, when I am asking you to draw these conclusions, I am asking you to believe that such data and studies exist. Assume that and decide what conclusion you would make based on that data. If you don’t believe that data exists, that is a different story, but then I would have to refer you to more of the writing here with references to the primary literature which you can then review yourself. But it is many hundreds of articles, so for now let’s just go through principles and trust that I have done the reading [I have] and that what I am saying is true. You can then verify for yourself the literature if you feel so inclined)

    Yes, we often report on the lack of efficacy of our own medical practices. The fact that there is actual medicine that has no efficacy doesn’t make acupuncture more effective. Think about your statement – absolutely all of modern medicine could be 100% wrong, but that in and of itself wouldn’t make acupuncture effective, would it? Besides, finding the errors in our own practice is exactly what science and science and science based medicine are all about. We should be striving to get rid of bad practices – something I am very passionate about.

    You then say:

    I went in for acupuncture merely for a facial! I felt so relaxed when I went to get off the table. Like when I have a massage. A total body slam of relaxation. No placebo there! Felt like jelly.

    If you refer back to my original comment to you, I did explicitly state that relaxation could have well been a factor in the acupuncture treatment and that could have proven beneficial for your IBS pain. I agree that is not placebo per se, you did have that effect. But you even said it yourself – “like when I have a massage.” In other words, nothing unique or specific about acupuncture. It was just a means to induce a very relaxed state that happened to work on you at that time. That is how I felt when I got acupuncture. I have a chronic joint disease with nearly constant pain in all of my joints. It never really goes away, it just waxes and wanes. Usually I forget it is even there. I felt this amazing wonderful relaxation getting acupuncture for my pain. I felt as though it truly helped. Until the costs (financial and time) of getting more acupuncture treatments started getting too much. And then I noticed the effects diminishing. Then I learned about why acupuncture is mostly placebo and guess what? The effect went away entirely. Acupuncture does nothing for me at all.

    So that is what we mean when we say that acupuncture doesn’t work. Relaxation, calm, massage, etc do have salubrious effects and we know this from a scientific standpoint. But all acupuncture is is a dramatic and theatrical way to get someone to relax and nothing more. And only if you happen to be the kind of person for whom it would work. My fiance, for example, is deathly afraid of needles. Watching her get her flu shot every year is like a grotesque comedy. She literally gets pale and sweaty and nearly passes out at just the thought of a needle piercing her skin. Yet the shots she has to get work. Do you think that acupuncture would work for her?

    So I figure at the minimum there is a great relaxation that happens and that can only be good. The side-effect?

    Correct. But the key here is that it is not something intrinsically unique about acupuncture. There are many other ways you could relax. However, while indeed uncommon, there are dangerous side effects from acupuncture. Kim Ribble-Orr (google her name) as a prime example. Infection can happen – and does, unless one uses sterile needles and gloves, and even then there is still a risk. Needles in the face can pierce facial nerves and cause pain or nerve damage. I’ve actually had needles stuck in me that undoubtedly went through a nerve and caused a serious searing pain. The acupuncturist had to pull it out and use another needle. Thankfully I had no permanent damage, but it could potentially happen and was certainly unpleasant.

    People on this site have inferred I maybe forget that there ate days without pain.

    I inferred that. And I still think it, along with the non-specific effects above and the other common cognitive biases and fallacies we are all prone to I mentioned in my first comment to you, explain the apparent effect of acupuncture.

    Does that make sense to you? Is there anything that is unclear or that you disagree with? Do you see why I would say that someone can have a perception of effect and even actually have a modest genuine effect and yet still not demonstrate that it was a direct cause of the acupuncture itself?

  46. almost equally likely that Andrey and the typical SBM position underestimates what can happen in individual cases from its use.

    Sorry Peter, but I do not. I have experienced the effects myself. If anything, I should be biased to overestimate the effects. Plus you are implicitly stating we should accept that treatments which don’t work may be of benefit on an individual basis that we can’t predict. Taken as is that is justification for doing literally anything and just hoping it works. I’m sorry Peter but I don’t practice medicine where I throw shit on the wall and see what sticks.

    I contend that the scientifically correct answer to Jenny’s original question should have been a simple : “we cannot say for sure

    I contend this is BS. In many cases in medicine we cannot know “for sure” what is going on, period. I had a patient who seemed to have a pauci-immune Class 3 or 4 lupus nephritis with possible “atypical” TTP. I couldn’t tell him for sure what he had. But plasmapharesis didn’t work and immune suppression helped. So I can give him a differential of possible ideas. Same with acupuncture. I can know for sure (to within a very good scientific certainty) that acupuncture did not specifically do anything for Jenny. And I can come up with a list – we call them “differentials” in medicine, but you should know that – of what may have been the case, each of which much, much, much more likely to have produced the effect Jenny is experiencing than a direct causal relationship from acupuncture.

    Your answer is namby pamby BS hiding in the slimmest of shadows. Which is exactly exemplified by this statement:

    No scientific study precludes the possibility, although many undermine the necessity for any precise acupuncture protocol

    Of course not, Peter. That’s not how science works. No scientific study precludes the possibility of a teapot orbiting Venus either. Or that magical elves are spawned for pico-seconds when someone takes aspirin and that is actually what inactivates cyclooxygenase. So that is a wimpy and ridiculous position to hide behind.

    There is no implausibility, there being several ordinary and widely accepted mechanisms whereby a program of acupuncture (or of any similarly complex therapeutic interaction) might have limited beneficial effects for patients with subjective, stress-related, or psychosomatic complaints.

    But now we are not talking about acupuncture Peter. We are talking about any non-specific placebo interaction. If I claimed that my stand-up comedy act cured IBS and indeed, IBS patients came to my act and laughed jovially at my supreme whit and then felt better, would you say that it was really my comedy act that did it? Would you recommend my act over anyone else? Ridiculous. You know what the underlying mechanism is and it has nothing to do with me or my specific jokes. And it is the same with acupuncture. It is a theatrical placebo and nothing more.

    It is very likely that mankind will have evolved such mechanisms to deal with sickness and injury.

    Please Peter. Don’t delve into ridiculous just-so stories as if adding more bullet points to your list, no matter how stupid they are, add strength to your claims. I am actually in a bit of a rush to meet a friend for a bike ride this morning so I won’t lay waste to this asinine comment in detail, but please don’t forget I did my undergrad in evolutionary biology and still keep up with the field. This is such a paltry and useless statement that you should be downright embarrassed at grabbing for such thin and wispy straws.

    <blockquote.The possibility of benefit is supported by anecdotal reports, laboratory studies into the effects of therapeutic suggestion (always!), and also comparative RCTs. Most room for argument lies with the overall “average” strength of any benefits and how such methods might perform in different patients populations.

    The possibility of cognitive bias, reporting error, placebo effects (legit ones), and placebo responses (the “fake” ones) are supported. Not actual efficacy of acupuncture specifically.

    We medical sceptics desperately want to be able to answer “no!’ to such questions, but this is for reasons other than scientific certainty.

    Have you seen my responses? They are far from “no!” And yet I can indeed be scientifically certain that acupuncture itself has no intrinsic value and is nothing more than an elaborate placebo. You, on the other hand, seem to revel in hiding in the “acupuncture of the gaps” and keep trying to come up with post-hoc rationalizations as to why it maybe, could be, just possibly, have some effect in someone, in some way, some how. I’ve dealt with a lot of creationists Peter, and your tack for acupuncture seems to take a lot of lessons from them.

    These conflicting influences are also producing muddled science. “Acupuncture doesn’t work!”, we are told, yet in response to a well-analyzed study on asthma patients it was accepted without challenge that non-specific symptomatic responses to acupuncture could be powerful enough to pose a danger, through such patients not realizing how sick they were. This is inconsistent with the prevailing view that placebo/non-specific responses are either entirely illusory or too small to be bothered with.

    I honestly cannot believe you said that. Really??????????????

    Yes, we have said – all along and without fail – that people can indeed trick themselves into believing their symptoms are better or ignoring them altogether without actually being better. Perhaps you need to review the difference between a “sign” and a “symptom” Peter. And yes, the exact same thing can and does happen in cancer quackery. Never mind that painful festering lump in your breast, my magical sodium bicarb solution is actually helping. Right up until you die.

    And you take that, and somehow take it to mean that the science in any way supports the power of placebo? As anything beyond a self delusion?

    Andrey, I think we will be better equipped to talk to people like Jenny when we have sorted out better what is going on in our own minds

    Yes Peter, you really do need to sort out what is going on in your own mind. Because you should be downright ashamed of what you have just written as someone who actually does know how science works and how to actually read literature. Your rants of apologia for acupuncture read like a creationist defending intelligent design and that should be setting off nuclear alarm bells in your head.

    Un-muddle your own thinking and realize that “nuanced discussion” does not mean “hiding behind bullshit and error bars.”

    1. pmoran2013 says:

      Andrey, you have done exactly what I predicted, making the science answer a different question to that generated by Jenny’s practical needs.

      Like Windriven, you make a case for why the mainstream might choose not to embrace acupuncture, much of which I agree with. These discussions always come back to that, when that it is not actually the only question, or even the one being asked of us.

      With your answer especially your dismissal of certain observations as “self-delusion”, you are trying to assume too much control over the lives and experiences of others — more than you have any right to..

      On the science we are not far apart. It is how we wish to apply it.

      .

      1. windriven says:

        Peter, I credit you with making me far more sympathetic to the plight of those who do not find success with their medical doctors and to their yearning for relief from whatever modality might offer succor.

        But the other side of this is that I have lost all patience with medical doctors who peddle bullshit and with those patients who flounce at the first moment that they discover their physician doesn’t have Harry Potter’s wand.

        The physicians who abet this crap impede the growth of medicine, they make practice more difficult for their more serious colleagues and they may endanger the health of their patients in ways they haven’t considered when turning them over to charlatans and fools.

        And the patients who flounce do so with the absolute assurance that when something horrific visits them, they will be again embraced by a medical doctor who takes his or her profession seriously. Personally, I’d leave them to the tender mercies of their frigging naturopath.

        Medicine doesn’t have all the answers. But it is looking for them in a structured way. Medicine is becoming more integrative in ways that really matter; embracing the contributions of nurses and NPs and PAs and a whole range of other professionals. Good. Do that and do it more.

        But godammit, that is vastly different from actively exposing patients to whom physicians have a solemn professional responsibility to nitwits with doctor fantasies.

        If I’m wrong Peter, show me where. Yours is a reasonable voice and subtle and textured argument. But from my perspective you sometimes give your empathy control over your intellect.

      2. Andrey Pavlov says:

        Fine then. I think that educating people and exposing delusions for what they are is a good thing. You would rather let them live in a world of capricious self delusion allowing for other believers and shysters to take advantage of an obviously incorrect belief.

        If that’s the case, that’s fine. We do merely have a difference of opinion. The problem is that evidence is on my side as to which opinion provides for a better life. I’ll admit not always on the individual basis or in the immediate term but as a goal to strive for generation over generation, yeah. I’d be pretty confident saying that the best thing that humanity has ever done is create, refine, and practice rigorous science to peel away and expose all the delusions and false beliefs and really find out how the universe works.

        So you go right ahead and keep arguing that we should allow people to be deluded and to be taken advantage of for their delusion. Just don’t use really bad arguments like the bullet-point creationist-style drivel you tried to get to stick to the wall before.

  47. windriven says:

    “it is almost equally likely that Andrey and the typical SBM position underestimates what can happen in individual cases from its use.”

    ?

    So what? I could create a ‘therapy’ that places EKG electrodes over ‘specially selected energy nexuses’ and hook these up to an ultrasound-size roll around cart, empty of electronics save a lot of switches and dials and a display showing random tracings. I could build a whole narrative of bull-ya around it and sell the therapy for $250 per treatment. And I’ll bet that I would come up with my share of patients who deeply believed and would loudly attest that electrowindrivenology had changed their lives, freed them of pain, and made the tumor on their kidney disappear.

    Does that mean that medicine should embrace electrowindrivenology?

    If that is the standard then let’s just hire a bunch of massage therapists and life coaches and dress them in white coats and call them medical professionals. Send patients with intractable conditions to them for consultations. Let them touch, massage, guide, listen – but nothing invasive. It will be safer than acupuncture and would accomplish at least as much good.

    1. pmoran2013 says:

      Windriven: “Does that mean that medicine should embrace electrowindrivenology?”

      I specifically stated that there are practical hurdles in the way of mainstream medicine using methods like acupuncture.

      So, no, — I am talking about answering questions honestly, in complete consistency with what the science permits, and with regard to objectives of medicine, which is to help patients as best we can.

      There is no future in doing anything else. Note how Jenny’s own experiences may create complete dissonance with the unqualified assertion “acupuncture doesn’t work”.

      She may well accept that this may be a psychological reaction to certain influences, but won’t care or will try to believe otherwise. It is weird that the public generally can understand the role of psychological influences in medicine, but we choose to think that is too complex for them.

  48. Jenny says:

    Thanks everyone. I have learned quite a bit. I’m a fashion person. Degrees in textile design. I make my own fabrics. Not a scientist. ( husband is a physicist however)…I understand a lot of what has been said. I just have one comment: I get wonderful relaxation from massage, I get a good sleep, and that I think in a stress filed life is magical. And, I get the same relaxation from acupuncture. So it makes me think that there is a stimulation happening to my system. Maybe it only lasts a short time, a day perhaps. Don’t know. But the ability to relax your body I think can only have positive effects on your total health. One other very interesting thing; years ago, my friend recommended an acupuncturist for my ibs. He lived far away but I went. I had an asthma attack by the time I got there. I had walked up steep hill. The guy said” before I treat you for anything lets get your breathing back to normal”…I was on table prone. Worst position to get breathing under control. Within minutes I was ok . If I were to wake in the night, for example, and not use ventolin, it does not go away. I promise you all this happened. Now, it did not cure asthma, ( by the way buteyko breathing helps)…only worked for a few hours. However, that incident proved something to me. That something happened fast! I have gleaned lots of good info from you all on the efficacy of acupuncture and will be more mindful. However…some of you said” just because some western treatments don’t work doesn’t mean that acupuncture does…” That is not what I meant. I meant that those doctors are not considered quacks just because some of their treatments don’t work.

    1. WilliamLawrenceUtridge says:

      husband is a physicist however

      Two points, assuming your husband helps you with these comments or your health care overall:
      1) Physicists can be wrong, and can be quacks (cold fusion, for instance, attracted the interest of some physicists)
      2) Medicine is different, quite a bit so, from laws of motion or interactions of particles. Those particles are not reactive to observation while people are (bar quantum physics, but even there the comparison is not remotely the same – people are far more complicated).

      But the ability to relax your body I think can only have positive effects on your total health.

      Do you think a collapsed lung or infection at an acupuncture site would be relaxing?

      Regards acupuncture and asthma, you might want to read this post. You might be quite calm, which makes your breathing feel better – and you might just choke to death shortly thereafter because your calmness masks an underlying, rather serious condition.

      That is not what I meant. I meant that those doctors are not considered quacks just because some of their treatments don’t work.

      Commenters here, and editors, are also quite critical of doctors who continue to deliver mainstream treatments that don’t work. And it really depends on what you are talking about – medicine is based on aggregate data. Randomized controlled trials can tell us how many patients got better on active treatment, as a whole. It says little about how individual patients will react, only that overall your chances are better with specific treatments for specific conditions. Acupuncture, meanwhile, based on thousands of studies, is consistently found to work little better than placebo. Not the same thing.

      1. windriven says:

        “Physicists can be wrong, and can be quacks (cold fusion, for instance, attracted the interest of some physicists)”

        WHAT? Never. well, almost never :-)

        But just to be clear Pons was an electrochemistry and Fleishmann a chemist. Neither were actually physicists per se. Cold fusion attracted far more skepticism and derision than interest from the physics community.

  49. All we can advise you here Jenny is some caution. There are indeed acupuncturists who are dangerous quacks and don’t follow sterile technique and do cause serious injury (once again, Kim Ribble-Orr comes to mind but there are other examples).

    The reality is that relaxation most certainly can help your condition. Both genuinely and directly as well as by taking your mind off the pain of your condition. It has also been demonstrated that in mild to moderate asthmatics acupuncture can make them forget about, downplay, and/or ignore their symptoms without actually being treated. This is simply a facet of human psychology. If you had an asthma attack and someone managed to calm you down somehow, you would indeed feel relief. As we know, most asthma attacks are self limiting particularly when the trigger is gone. Hiking up a hill and getting a mild asthma attack followed by taking the time to calm down and relax sounds to me like your asthma would have abated entirely on its own in the exact same time frame. Toss in some acupuncture to distract you from your breathing difficulty and you merely think that it abated sooner.

    There is no need for magical effects to come into play and no need to say that all the literature and study on acupuncture as actually wrong because it all still fits in quite neatly with everything we do know about the (lack of) efficacy of acupuncture and how people tend to react to placebos.

    Nobody here – especially me – is denying the ability of placebo to change your perception of symptoms nor the ability of relaxation to alter physiology in a way to help alleviate certain types of symptoms. What we are saying is that acupuncture itself is simply not doing those things. As Windriven said, we could make up any completely random theatrical placebo and it would have the same effects. Of course, different people are different, so some will respond better to needles some to electronic gizmos, some to “all natural” things, whatever their own particular psychological make up predisposes them to. Which fits in with why all those things don’t work for me anymore – I’ve learned enough to not be psychologically predisposed to them anymore. I find them silly and funny, not something I can take seriously. And someone may find magically waving your hands over them to be silly while finding needles in magical meridian points to be serious. The point is that there is nothing intrinsically about acupuncture that is effective. It is merely a way of taking advantage of psychological predispositions people have. In that sense it “works” but not in a way that we can ethically, consistently, or effectively exploit.

    The problem we here have with these sorts of modalities is that they come packaged with a whole mythology that must lie to people in order to have any effect. And the people who are doing it are usually deceived and while in one sense what they do may be benign or even modestly helpful, it is impossible to separate their bad methodology from everything else. I mean think about it. Would you be willing to do acupuncture if everyone accepted and told you that it was pure theatrics and no more effective than an app on your iPhone that has all sorts of random number readouts and transmitted a “special” radio frequency to tune into your pain and cancel it out? If you knew and accepted that it was purely an elaborate placebo delivery device, would you honestly be willing to pay for it and do it?

  50. jenny says:

    thanks for your replies and taking the time. I am sure there are some non sterile accupuncturists out there…just like some doctors who are not up to snuff. ( my mom’s doc would syringe ‘stuff” out of her ear, open his window and throw it in the yard…:) However, the amount of damage done by medicines that have crazy side effects is horrendous. Not to mention the human error in dispensing drugs. Not to mention the infections in hospitals. Not to mention the contraindications. SO…we could concur that the world of western medicine is not so safe either. Drugs (even when used in a proper treatment plan for the individual, and work for their maladay) often cause problems over time. But I sure wouldn’t throw out the entire western medical philosophy based on this. I like my doctor. She is a good diagnostician. Sees me for maybe 4 minutes but I am glad that she is sharp and tuned in. But she only prescribes drugs or tests or treatments. All sometimes good. For other issues not so good. I am taking alot of the info on this site to heart and appreciate your knowledge and the fact that you have read alot of data. What continues to gall me is the dismissive answers that the accupuncturist who stopped the asthma attack would have luck/time on his side and that I would have returned to normal breathing anyway. NOT TRUE. I know my body well. I am 48 years old. If I sit up, relax, …MAYBE I might get my breath back in 45 minutes. That is my own personal experience. An accupuncturist, with me prone, got my breathing to normal with 2 minutes?! Absolutely not possible via ANY other method other than ventolin. Sorry for the caps….but I know my own experience. The accupuncturist did not cure my asthma. I was in the same condition a few hours later. But, guess what, he saved me a puff of ventolin. In other words, the effect was the same with ventolin or the accupuncturist. I really appreciate all your info and it has had an effect on me and I will proceed with caution. On another note, for another post: Buteyko breathing for asthma helps individuals….discovered by a doctor in Russia…watching patients breathing ….

    1. Badly Shaved Monkey says:

      I was in the same condition a few hours later. But, guess what, he saved me a puff of ventolin

      Of course the evidence would suggest that a different narrative is more accurate. The acupuncturist made you feel temporarily better by relaxing you. Meanwhile your airways remained prone to spasm and the undeniable signs of this asserted themselves sometime later. Fortunately Ventolin was sufficient to intervene and produce a real objective benefit on your airways. There was however a risk, even if small, that when the attack reasserted itself you could have ended up hospitalised or dead. Reality is, as I have already said, a heartless bitch

      I’m not sure you’ve really grasped the problem of subjective improvement in the face of objective persistence or deterioration of the medical condition.

        1. oops … this is the lady with pain and allergies
          http://youtu.be/-GL6y0_EcQA

          1. WilliamLawrenceUtridge says:

            Why are you posting youtube videos? Anyone can make a youtube video, there’s no guarantee that they are telling the truth. The reliability for Cochrane reviews are better though, and for acupuncture, the results are negative.

            Which do you find more convincing? Why?

            What kind of doctor are you?

    2. weing says:

      @Jenny,
      What galls me is your gullibility and that at 48 you haven’t learned that you are the easiest person to fool. Nothing is without risk. There are always side effects. There is no perfect medication or treatment. Medicine is medicine and seems mundane. You are looking for the exotic. Fine. Some quacks will make money off of you. Hopefully, you won’t get hurt. But, it’s a crapshoot.

      Regarding Buteyko:
      http://www.sciencebasedmedicine.org/buteyko-breathing-technique-nothing-to-hyperventilate-about/

      1. Unimaginable that weing is insulting the feeling of Jenny … Inhumane. it is easy to hide behind the avatars … harder to find who you really are.

        1. WilliamLawrenceUtridge says:

          Why would knowing who I am make my points more or less credible?

          What kind of doctor are you?

        2. weing says:

          @Stephen,

          You can tell her there is a tooth fairy and that Santa is real. I am the mean one who tells her they’re not real. Maybe she’ll get so angry with me, she may decide not to have another irritable bowel attack just to spite me, and prove that acupuncture cured her? I doubt it though.

    3. weing says:

      @Jenny,
      BTW, when you were having your asthmatic attack, did you use your peak flow meter before and after the ‘treatment’?

    4. WilliamLawrenceUtridge says:

      However, the amount of damage done by medicines that have crazy side effects is horrendous. Not to mention the human error in dispensing drugs. Not to mention the infections in hospitals. Not to mention the contraindications.

      What does this have to do with the efficacy of acupuncture? If you are avoiding real medicine in favour of adverse-effect-free treatments, you are essentially letting your symptoms go untreated. Also, people have died from acupuncture, and sustained punctured lungs, and indeed – skin cancer. Oh, and infections. For instance, how do you feel about AIDS?

      That medicine is imperfect is not a reason to abandon it. Do you drive? What about car accidents? Do you walk? What about tripping and slamming your head into a rock? All life carries risks, medicine is no different – except medicine is carefully monitored for its risk:benefit ratio, and involves gatekeepers with significant training and expertise. Nobody pretends medicine is completely safe. In fact, doctors are mandated to treat their patients only in cases of informed consent – which means informing you of all the risks of the procedures they use. Were you informed of the risk of punctured lungs during your treatments? Or infections? Ruptured pericardium?

      Sees me for maybe 4 minutes but I am glad that she is sharp and tuned in.

      That’s a problem with the health care system, not medicine. The US is unique among first-world countries in that it lacks a true health care system, and I believe the populace suffers for it. Want longer than a 4-minute appointment? Pay for it out of your own pocket. Or ask for real health care reform.

      You might want to reconsider your embrace of Buteyko breathing by the way.

  51. Badly Shaved Monkey says:

    By the way, Jenny, you can’t say “It can’t be a placebo I really felt better” whereas you have said that or it’s equivalent several times.

    You keep saying you are learning a lot hear and bring made to think. However, you keep repeating the tropes and lies of the SCAM community.

    Please, show that you have learned something. Explain in your own words why “It can’t be a placebo I really felt better” is an erroneous assertion.

    1. I can not believe mr monkey is telling jenny what she is feeling!! That is inhumane.

      1. WilliamLawrenceUtridge says:

        He’s not telling her what she’s feeling. He’s telling her that her recovery might not be due to specific effects. You may not understand the difference, given your apparent propensity to tell patients whatever they want to hear.

        What kind of doctor are you?

        1. Badly Shaved Monkey says:

          Stephen

          WLU clearly understood what I wrote. That only serves to emphasise my point about your cognitive failures.

      2. Badly Shaved Monkey says:

        Stephen

        You seem to have some fairly serious problems with reading comprehension and following logical arguments.

        Read again what I wrote above. I have not contradicted Jenny’s self-description of her feelings. I have criticised the causal inferences she draws and pointed out that subjective experience and objective outcomes are not equivalent.

        If you blustered less and thought a bit more carefully you would earn more respect here.

        You’ve still not answered my questions.

  52. Badly Shaved Monkey says:

    Blame Steve Jobs for the typos in that post!

    By the way, Jenny, you can’t say “It can’t be a placebo I really felt better” whereas you have said that or its equivalent several times.

    You keep saying you are learning a lot here and being made to think. However, you keep repeating the tropes and lies of the SCAM community.

    Please, show that you have learned something. Explain in your own words why “It can’t be a placebo I really felt better” is an erroneous assertion.

  53. jenny says:

    There is a neurologist on Neurologica blog that uses accupuncture and gets great results. I see that Steve Novella has commented on that blog as well. Others comment that the studies have major flaws with the participants. LOOK…I’m not a scientist…but I am interested in this, I am open to discussion….the comments that I have not learned are again dismissive. JUST because I am looking for answers and not swallowing anything (inlcuding the last person that replied to me) hook line and sinker does not mean I haven’t learned anything. You are showing your stripes. Please, not necessary to comment to me any further. I am in middle ground with accupuncture and will continue to find information. But not here anymore.

    1. Jenny here is a link that will give you all the resource to figuring out what to do. I took the course in ’97 and everyday I am amazed at the healing ignited by the needles. Remember … it is not just about Acupuncture but it is a way of life with the needles as tool. http://www.medicalacupuncture.org/

  54. Badly Shaved Monkey says:

    “I am open to discussion”

    I’m not sure you are. You have been presented with arguments and evidence that disprove your opinions but have simply reiterated them.

    I have simply asked for you to show some evidence of the learning you say you have done. I’m not saying you haven’t learned. You keep saying you have. So show something tangible that has resulted from this learning.

    Being open minded is good, but you also need to learn to close off options that are not valid. Otherwise you can never make progress. Medicine has a history of useless therapies that have been abandoned. The world of SCAM is a repository of useless therapies that won’t go away peacefully because people have vested their lives and their livings in them.

  55. jenny says:

    that accupuncture perhaps doesnt cure problems….that is what I have learned.(..but there are other effects other than cures…)
    that you have to be careful with infection..
    and I learned that many people on science based blogs are not convinced about the participants in the study.
    that’s it for now….have to do my own research into my own work….

    1. Jenny says:

      My last comment. You just blew it with ” reconsider buteyko”….my friend , a trumpet player, can now continue being a musician due to his rigorous attention to the buteyko method. He’s 100 percent off meds. But I know you don’t like anecdotes. Your mind is closed. No need to comment further. Your stripes are showing. I was quite polite through all this and I don’t believe all the claims made by acupuncture . But you are obviously blinded.

      1. WilliamLawrenceUtridge says:

        I’m not blinded, I’m unconvinced by anecdotes. My mind is open to being convinced through well-conducted scientific research. Do you have any?

  56. pmoran2013 says:

    “These conflicting influences are also producing muddled science. “Acupuncture doesn’t work!”, we are told, yet in response to a well-analyzed study on asthma patients it was accepted without challenge that non-specific symptomatic responses to acupuncture could be powerful enough to pose a danger, through such patients not realizing how sick they were. This is inconsistent with the prevailing view that placebo/non-specific responses are either entirely illusory or too small to be bothered with.”

    Andrey:I honestly cannot believe you said that. Really??????????????
    ———————————————–

    This was one of my main concerns, yet you chose to completely misread it. I was not claiming that acupuncture has objective effects upon asthma (that study showed it did not), but suggesting that if it has the ability to obscure symptoms to this degree in asthma, then it is unwise to be disputing that it might significantly control symptoms in other areas where that is desired.

    We can’t have it both ways.

    1. WilliamLawrenceUtridge says:

      Pete, from my recall of the study, all objective measures reported no improvement. The areas where change was demonstrated were at the levels of subjective reporting. The interpretation, in my mind, would at best be we learned a new way in which subjective symptoms can be centrally re-interpreted and/or minimized (assuming that it’s not merely reporting bias on the part of the patients). To assume that it’s controlling some aspect of asthma symptomatology we’ve hitherto-missed, is less parsimonious than that patients have re-interpreted sensations at a conscious or unconscious level (or opioids were released).

      1. pmoran2013 says:

        WLU: “To assume that it’s controlling some aspect of asthma symptomatology we’ve hitherto-missed, is less parsimonious than that patients have re-interpreted sensations at a conscious or unconscious level (or opioids were released).”

        Yes, agreed. At its simplest level psychogenic factors probably influence symptom perception through a person simply paying less attention to symptoms, having taken action regarding them and gotten on with their lives.

        With many illnesses the severity depends upon patient focus. If you have ever been sea-sick you will know that the more you allow the symptoms, or boat movement to intrude on your consciousness the more likely you are to succumb to it. Focus upon steering the boat or trimming the sails and the sickness will abate.

        This is how some illnesses can entirely evaporate or become better coped with once there is reassurance that there is nothing seriously wrong, or a satisfying explanation has been found (perhaps whether correct or not).

        Now, look at something like acupuncture. There is the “time out” element –the patient is for a little while isolated from the agitation and responsibilities of daily life. There is intense distraction from everything else while someone sticks sharp things into you (or pretends to, in the sham versions of almost equal apparent effectiveness). There is the opportunity for relaxation, rumination and psychosocial support in a caring environment.

        We have not yet introduced the concept of a “placebo effect” in its usual sense of a treatment-related result of expectancy, conditioning, endorphin release or whatever, and you already have a combination of elements that might allow a resetting of pain tolerance, or improved patient coping through having obtained reassurance that, at least for a short while the pain seemed not so bad and will likely be so again. Then you do it many times over, over some weeks in a program of continuing care that a more supposedly science-based practitioner has no justification for. This is to be regarded as a trivial medical intervention?

        We have no idea what additional relief might be possible with an especially charismatic and confident “healer”. Scrub that — we do, actually — their patients often tell us of this, but we choose to poo-poo those perceptions also , even while otherwise usually accepting the reality of human responsiveness to strong suggestion.

        This is also before we even consider the human needs other than symptom relief that patients inevitably bring into medical interactions.

        If you accept even a small part of the above you may understand why the almost exclusive focus of SBM on a “working better than placebo” model of medicine, while of absolute importance to many vital aspects of medical practice, may be much less so for others including many of those responsible for CAM use.

        1. WilliamLawrenceUtridge says:

          …and as always, the solution to me is to improve doctor communication and real medicine, not to embrace quackery. And again we part ways. I’m not arguing that nonspecific effects are not important, I have made that very pont several times – merely talking to a doctor helps people feel better. I am saying those nonspecific effects are best delivered in the context of actual medical care rather than pretend medical care with a bent for corroding trust in the actual medical system.

    2. Andrey Pavlov says:

      It is you that keeps wanting to have it both ways. I know you are Australian but when I lived there I found that they actually had a solid comman of the English language.

      but suggesting that if it has the ability to obscure symptoms to this degree in asthma, then it is unwise to be disputing that it might significantly control symptoms in other areas where that is desired.

      That is an evidence free assertion. Obscuring a symptom – by reporting bias or by psychological modifaction of sensory input – is not controlling the symptom. Yes, you can most certainly self delude yourself into believing your asthma symptoms are ameliorated without one whit of actual change. Yet that is not control.

      And that is precisely how people are taken advantage of and you know it. They fall prey to the delusion for myriad reasons you most definitely know. And then they spend their money, their time, and many times their health chasing this delusion. This obscuration of symptoms. Right up until they die or come close enough to be forced to see their delusion. Or in my case when it gets a bit tiresome and the effect wanes.

      So no, it is not unwise to dispute that it “might significantly control symptoms in other areas where that is desired.” Because there are myriad reasons to think it is not a net benefit, extremely difficult to administer, capricious, not actually helpful, and unethical to boot.

      I get it Peter. You’re trying to play the tack of the kindly ol’ skeptic who is OK with the benign and maybe-slightly-possible-if-you-strain-your-brain-to-near-breaking-point CAMs so you can seem more credible when you come down like a mean ol’ grumpy pants like Dr. Gorski on the stuff that can really lead to rapid death.

      I disagree with that tack and I think there is plenty of evidence to demonstrate the harm in it. It’s like telling your friend he is really good at skiing and then he finally tries a double diamond slope and breaks a leg. Honesty is always the best policy. Not your hiding in the tiniest of gray areas.

      And using creationist-style, really poor (ok that’s redundant) argumention to boot. Sheesh.

      1. pmoran2013 says:

        “– but suggesting that if it has the ability to obscure symptoms to this degree in asthma, then it is unwise to be disputing that it might significantly control symptoms in other areas where that is desired.”

        Andrey: That is an evidence free assertion. Obscuring a symptom – by reporting bias or by psychological modifaction of sensory input – is not controlling the symptom. Yes, you can most certainly self delude yourself into believing your asthma symptoms are ameliorated without one whit of actual change. Yet that is not control.
        ___________________________

        “Evidence-free?” This is simple logic, or lack thereof.

        I see that “obscuring” and “controlling” were poor choice of words. Substitute “offering some symptom relief” and tell me why it makes sense to believe that acupunture can relieve symptoms enough to be dangerous in one situation yet not be helpful in another, where symptom relief is all that is desired?

        Presumably there is something “real” here to the patient. What special knowledge of the matter do you have that enables you to dismiss this as somehow “unreal”, or unworthy in some other respect?

  57. However, the amount of damage done by medicines that have crazy side effects is horrendous. Not to mention the human error in dispensing drugs. Not to mention the infections in hospitals. Not to mention the contraindications. SO…we could concur that the world of western medicine is not so safe either.

    Yes. And my own area of research interest is called “comparative effectiveness research” which is specifically geared to finding ways to minimize the harms associated with the treatments we have. This is an ongoing process and even an ACGME mandate (the governing body for my post-graduate training).

    But that doesn’t make acupuncture – or any other so-called CAM modality – work. Or be useful. Or a net benefit. Everything has risks and benefits. We must weigh them when we make decisions. Yes, the are some benefits to acupuncture. It is just that they happen to be very small and the same as any other random intervention that someone buys into. And there are negatives. At a minimum time and money. At the opposite end of the spectrum, a popped lung and a ruined life and athletic career. But when the benefit is tiny and illusory any risk is simply too much.

    If you still wish to do it because you enjoy it, by all means. I fully endorse and believe in the notion of autonomy. You can do absolutely whatever you want to your body. But I also believe it is the ethical and professional responsibility of those with the relevant expertise to inform and protect those that don’t.

    In the same way that I like the fact that there is a licensing system for plumbers and that if one of them rips me off and sells me junk, doesn’t work up to code, over-charges me, or whatever I have recourse. Someone can identify that for me and protect me from that mistake (whether the plumber meant to be a shyster or wether he was just incompetent and didn’t know how to do it right). I don’t know very much about plumbing at all. So I would like it that when I agree to something that I can trust it is a reflection of reality.

    The same for acupuncture or any other medical modality. Including my own. I hold myself and my peers (and they me) to a very high standard. So when an acupuncturist is telling you lies about the mechanism and what acupuncture can actually do, we should have a way of making sure you know that. And stop them from doing that so you don’t get tricked by it. If you still want to do it knowing that it is nothing but a placebo and that it could harm you, then by all means go ahead.

  58. >Avatars are fear based and IMO you loose Credibility, reliability etc

    >Yes, I was a B student, but that does not make my ideas less valid. Thank goodness clinical medicine is not rocket science.

    >If I read it as an insult … Jenny would have too. That is the problem with human communications … words are not the best way to communicate.

    >http://blog.ted.com/2013/04/06/ted-weekends-explores-the-truth-about-medical-studies/

    1. Badly Shaved Monkey says:

      Yes, I was a B student, but that does not make my ideas less valid.

      Let’s call it coincidence

      So we see that, when it suits you, you ican deploy the principle that correlation does not equal causation. Now you just have to apply it to clinical medicine.

      Answer my questions, please.

      1. Mr Monkey you are not looking for answers but to argue your points … if you can’t find the answers to your questions … maybe you are asking the wrong questions.
        Once the question is valid the answer will appear.

        1. WilliamLawrenceUtridge says:

          What kind of doctor are you? Do you have a PhD in astrology?

          Most of us here look to the scientific literature for answers.

      2. windriven says:

        Rodrigues is oh so metaphysical:

        “Once the question is valid the answer will appear”

        ” That is the problem with human communications … words are not the best way to communicate”

        Saying random crap is much easier than formulating thoughtful, coherent answers to probing questions. Throughout this thread Rodrigues has revealed himself to be a poseur. If he is a medical doctor, I’m the pope.

  59. MadisonMD says:

    SS Rodrigues: “Thank goodness clinical medicine is not rocket science.” No, not rocket science. But you good clinical medicine is also not astrology with needles.

    Jenny: You say acupuncture and massage are both relaxing. Go with massage. The risk/benefit ratio is better and false claims are less prevalent.

    1. Interesting (i have not read the article completely) YES … IMO … Acupuncture is a mythology, social construct, theology, philosophy with needles.

      The needles are the truth and will be true forever. The mythology or made up part can be formulated to fit any era … thus include falsehoods.

      The needle, as a tool, forces the neuro-chemical-electrical-hormonal-mechanical effects that ignites the healing cascade and resets tight muscles. A dual simultaneous effect.

      This TRUTH phenomenon of Nature/Force/Energy/God is not every going away … it will never be nullified!

      Believe it or not … your choice.

      @Jenny … the beauty and beast of myofascial tissues and pain is that it will evolve to be more dense, tight and stubborn. If you start early in the evolution as most of us, your daily activities will be enough to keep up with healing. Wait or delay and the muscles will tighten, contact and compress onto themselves and healing will stall. Once this happens only tool with a dual effect is the needle.

      This is where modern medicine, foolish/arrogant/biased/egotistical/greedy providers have failed and should all be held accountable. Maybe personal injury attorneys will open the eyes of the blind.

  60. Paul Coyne says:

    Wow – did Mr Rodriguez really invoke Ben Goldacre there in his defence? BG is very good on the failings of “big pharma” and all that. I wonder what he has to say about homoeopathy?????

    1. Paul Coyne says:

      Rats! Let me be the first point out that I meant “acupuncture” there. Let this be a salutary lesson in re-reading one’s posts before hitting submit

      1. He has no bearing on the way I practice. He only confirms my suspicions. As most of the commenter here. I have lost faith in scientist, researchers, etc of medicine. My patients and I have been let down by a misguides discipline call medicine. I know there are quality providers out there who work diligently with the paltry tools given to them. (I was attempting to be one as many of my mentors)

        There are so many patients in need of care, there won’t be enough providers to care for them except to prescribe medications. My only concern are the clinical outcome of my practice.

        I am here to balance the misinformation as it relates to pain and needles. I jointed the discussion to give a real world view of what really works on the frontlines.

        Instead I’m here arguing with naysayer and provocateurs defending what I see with my own eyes.

        Hey y’all the earth is round!!! Amazing how blind some folks are.

        1. weing says:

          Who are you gonna believe? The science or your lying eyes?

          1. LOL …. we are are all liars … so I will believe what I witness. Who are you going to believe? If a patients states this works and you deny them a viable therapeutic options … This may be the best place for attorneys to come in and inspire us all in a court of law. Oh yes … Science and the courts are not about the truth.

          2. WilliamLawrenceUtridge says:

            we are are all liars … so I will believe what I witness.

            I don’t think you are a liar, I think you sincerely believe what you say. You have the stink about you of a true believer, certainly. What you are, however, is simply wrong and unwilling to look at contrary evidence. Why do you think your experience is so at odds with what well-controlled scientific investigation consistently finds?

            Also, it looks like you are using your claims of people being “liars” to simply ignore dissenting information, to rationalize why your beliefs are not supported by science.

            Who are you going to believe?

            Not “who” but what. I will believe a randomized controlled trial of adequate methodological rigor.

            If a patients states this works and you deny them a viable therapeutic options

            I think of it more in terms of refusing to encourage them to risk lung punctures in pursuit of an equivocal effect for a limited number of symptoms, often accompanied by a corrosive and pernicious dialogue regarding the scientific method and reality-based medicine. So, basically, I’m encouraging them to avoid you. I mean, acupuncture is better than homeopathy, but when you set the bar that low you aren’t really saying much.

            Science and the courts are not about the truth.

            Technically true and substantively false. The courts are about the truth of a matter relative to a point of law – did this person, to the best of our knowledge, do X, which is a crime? That’s for criminal courts anyway, civil courts are more about contracts I believe (making it more like “did this person breach this point of contract”, but I could be wrong as I’m not a lawyer). Science, on the other hand, is not so much about truth as it is about reality. You appear to believe you hold the truth, which has nothing to do with reality.

        2. weing says:

          Check the 2 table illusion. I know they are the same but I see them differently.
          http://infohost.nmt.edu/~armiller/illusion/tables.htm

        3. WilliamLawrenceUtridge says:

          My only concern are the clinical outcome of my practice

          Yes, and that’s why you don’t get any respect here.

          Hey y’all the earth is round!!! Amazing how blind some folks are.

          The eyes give the impression the earth is flat. It is only through science and study that we know it is round. The eyes, perceptions, can deceive, much like clinical experience.

          1. If you are so stubborn that you never venture out of you comfy paradigm you will never witness this phenomenon.

        4. “There are so many patients in need of care, there won’t be enough providers to care for them except to prescribe medications.”

          Whereas people who are willing to perpetuate a mythology in the name of a treatment which is pretty close to nothing don’t require a lot of training – you have your pick of the dishonest and ignorant.

          1. Jonathan … you have not understood what I am trying to say, The tool is the truth, the mythology is a myth. The tool can be used by anyone…. feeling less superior is frighten to you? The tool is so profound … a patient can use it at home and …. oh my god … not need to take a pill or actually see a doctor!

        5. windriven says:

          “As most of the commenter here. I have lost faith in scientist, researchers, etc of medicine. ”

          If you actually are, as you claim, a physician, what do you base your practice on? If it isn’t on science then what, you’re experience? That would make you the poster boy for Crislip’s Law.

          Have you discussed your ad hoc approach to medicine with your state board?

        6. “As most of the commenter here. I have lost faith in scientist, researchers, etc of medicine.”

          How about people who dress up some piece of tired ethnomedicine just so they can feel like they’re more powerful than they are? You seem pretty positive about that.

          “Instead I’m here arguing with naysayer and provocateurs defending what I see with my own eyes.”

          Argument requires having a cogent point…I’m pretty sure you don’t qualify.

        7. WilliamLawrenceUtridge says:

          As most of the commenter here. I have lost faith in scientist, researchers, etc of medicine. My patients and I have been let down by a misguides discipline call medicine.

          Maybe you are just a really bad doctor. Like, Jay Gordon, Bob Sears bad.

  61. Andrey Pavlov says:

    I see that “obscuring” and “controlling” were poor choice of words.

    Yes, and I’ll remind you that around me you need to be rather careful. You are very slippery with your language and shifting frames of context so as to try and sneak by your points that lack evidence.

    Substitute “offering some symptom relief” and tell me why it makes sense to believe that acupunture can relieve symptoms enough to be dangerous in one situation yet not be helpful in another, where symptom relief is all that is desired?

    Well, besides our apparent philosophical differences in that I value truth, honesty, and understanding the universe whereas you seem content to turn a blind eye and let people be deluded because it happens to be convenient to you, the mechanism of this “symptom relief” is not acupuncture.

    Presumably there is something “real” here to the patient. What special knowledge of the matter do you have that enables you to dismiss this as somehow “unreal”, or unworthy in some other respect?

    Because by this argumentation you should also be supporting Reiki, homeopathy, therapeutic touch, magnetic bracelets, power bands, and any other random ridiculous thing that happen to be “real to the patient.”

    So no Peter, acupuncture is not “real to the patient.” She found a particular bit of hokum that happened to lead to just enough self-delusion at the right time to trick herself into ignoring her symptoms. That, coupled with possibly some sort of genuine physiological modulation secondary to relaxation and stress reduction which is, once again, not intrinsic to acupuncture but is a by-product of the interaction at that specific time. Not unless you wish to argue that all the above modalities are actually “real to the patient” in any meaningful way beyond the cognitive neuroscience curiosity of how well we can delude ourselves and maintain cognitive dissonance.

    In other words, it was a lot of luck and can change at a whim. And I do not buy into your claim of efficacy for “symptom relief” either. There are better ways to do it, and when you look at the actual corpus of data, one can only reasonably conclude that whatever actual effect is left over after accounting for reporting error, bias, Hawthorne effects, and other anomalies of trial design and statistics is rather small and pretty useless.

    At every turn you inevitably find yourself fighting for the tiniest sliver of an actual effect without seeming to care how small it is, how ephemeral it is, and how it is all based in deception. We, as a species, would be much better off eschewing such stupidity.

    1. pmoran2013 says:

      Andrey:”Well, besides our apparent philosophical differences in that I value truth, honesty, and understanding the universe whereas you seem content to turn a blind eye and let people be deluded because it happens to be convenient to you, the mechanism of this “symptom relief” is not acupuncture.”

      Again defining the question to suit your own purposes, even if this should, in effect, deny a person the possibility of limited relief from troublesome symptoms that the mainstream has not been much help with.

      There is no high moral ground in that. It not only requires a very self-serving interpretation of the science and of human medical experience, it is mean-spirited, dog-in-the-mangerish, immature, and reflective of a puzzling lack of confidence in the ability of scientific medicine to hold its own against any challenge.

      As I have said before, nothing is more destructive of the pseudoscientific basis of these methods than that their effects can be readily explained through mundane mechanisms, as I have done in my last reply to WLU. Nowhere have I advocated pseudoscience.

      I am aware of the tightrope that we might be forced to walk by my ruthless evaluation of the truth of these matters, but that, too, should not lead us into corrupted dealings with the science, or into losing sight of what we doctors are here for.

      Andrey: “At every turn you inevitably find yourself fighting for the tiniest sliver of an actual effect without seeming to care how small it is, how ephemeral it is, and how it is all based in deception. We, as a species, would be much better off eschewing such stupidity.”

      I refer you again to my last reply to WLU which is not talking about “trivial” effects. I am also appalled that you feel you have the right to make THAT judgement on behalf of all of mankind.

  62. Badly Shaved Monkey says:

    Again defining the question to suit your own purposes, even if this should, in effect, deny a person the possibility of limited relief from troublesome symptoms that the mainstream has not been much help with.

    But here you are assuming that a ‘real’ placebo effect is capable of having a large and durable effect on symptoms. I think that is open to significant challenge and is not really supported by the trial evidence according to my reading of it. Simple regression to the mean, survivor bias and mis-reporting by therapist and patient seem more likely to me to be the major components of reported improvements under SCAM therapy, which is precisely why the proclaimed large clinical benefits disappear into the statistical noise once good controls are applied. Even the asthma study that compared real acupuncture to sham and to no acupuncture, and whose results you have alluded to, did not really allow a claim to be sustained that the placebo response (real or sham vs none) was truly so large as to be worth the time, effort, money and reliance on deception.

    People like Jenny and her (indeterminately durable) improvement after acupuncture may simply be another example of survivor bias: she would not have turned up here touting its benefits if she was not feeling better, but the next 20 of her acupuncturist’s patients have not all lined up here to say the same. This is why uncontrolled testimonial is useless and does not provide evidence for a placebo effect.

    I will allow that there must be some difference between conditions with a large subjective element and those that are more objectively experienced even by a patient, but I have not been awfully impressed by the strength of the placebo effect as reported in trials even of subjective components. Ben Goldacre is inclined to play up the spooky power of the placebo effect, but I am not so keen to do so. And conceding the SCAMsters the power of placebo just feels like an excuse not to call a spade a bloody shovel. Yes, they exploit the placebo effect, but the placebo effect ain’t all that much and it certainly does not compensate for their wide range of medical misdemeanours.

    As a vet, even if there could be an effect on the subjective experience in people, I think I can legitimately dismiss those therapies as feckin’ useless in my patients. I have seen plenty of nocebo by proxy where the poor bloody animal gets worse while its owner thinks the magic pills or magnetic collar are working wonders.

    1. pmoran2013 says:

      BSM: “But here you are assuming that a ‘real’ placebo effect is capable of having a large and durable effect on symptoms. I think that is open to significant challenge and is not really supported by the trial evidence according to my reading of it. Simple regression to the mean, survivor bias and mis-reporting by therapist and patient seem more likely to me to be the major components of reported improvements under SCAM therapy.”

      Firstly, are ” time outs” for relaxation and rumination/meditation, or the potential distractant or counterirritant effects of acupuncture legitimate components of a “placebo effect”? That is arguable. There is no good reason why these cannot be regarded as having authentic symptomatic activity through their own mechanisms with subjective complaints and stress-related or psychosomatic conditions.

      Andrey, for that matter, has just now rather ambitiously claimed that he can provide the same influences within mainstream medical care, so they are apparently only to be despised when someone else does it. Andrey doesn’t yet know it, but the mainstream would actually have great difficulty in constructing and getting patients to accept and pay for any equivalent “science-based” program of influences. Patients won’t come back three times a week for the same old bit of TLC, but they will if it is perceived as part of a program of vaguely credible program of treatment. All that is needed for the necessary credibility in relation to acupuncture is the testimonial of others, which of course science-based medicine totally rejects.

      The mainstream may nevertheless still have sound OTHER reasons for not endorsing acupuncture for routine patient care, but that is no excuse for not looking at it clearly and without bias. We owe that to people like Jenny and I make no apologies for keeping on coming back to this matter.

      The standard SBM interpretation of the evidence makes acupuncture look like “placebo” because ALL non-specific influences factors are “controlled away” by the usual study design. We subject the “real” and “sham” groups to a combination of non-specific influences then say, “see, it works no better than ‘placebo’”.

      What does that mean for the patient’s actual experience? We have no way of knowing for sure. When you compare acupuncture programs to “waiting list” or “usual care”, substantial differences almost always emerge, supporting what a body of anecdotal and laboratory evidence and considerable plausibility also suggests. Such studies are able to support a modestly useful average effect even after allowing for a likely contribution from reporting biases. Survivor bias and regression to the mean should affect both groups equally in those comparisons.

      Secondly, as I have tried to point out, we are talking about an area of medicine which is not only to do with perceptions regarding symptom strength, but ideation as to the nature (Moerman’s “meaning”?) of the underlying illness. People despair and become anxious when symptoms nag away all the time, and even partial temporary relief could enable a beneficial re-evaluation of one’s illness status, habits of mind in relation to it, expectations regarding prognosis, and coping in other ways.

      I have mentioned previously how CAM users often describe substantial euphoria after using what we would regard as “quack” treatments. The euphoria will be temporary, but I see no reason why such experiences might not have more enduring influence, even perhaps helping to dislodge some out of self-perpetuating “illness modes”. Medicine is a very complex thing.

      I am well aware that this is just one interpretation of the evidence but it is absolutely consistent internally and externally, more so than some of the muddled argument that sometimes emerges on these pages. The truth is we have no idea what people are feeling, even whether reporting biases can themselves feed into a degree of symptom relief.

    2. “This is why uncontrolled testimonial is useless and does not provide evidence for a placebo effect.”

      Hmmm what about a controlled testimonial?
      The ones I presented all were in moderate to severe pain for weeks to month and one guy for 15yrs. Most were not exposed to myofascial release therapy with needles. You think placebo can accomplish such a miraculous effect??? NO!

      They all had some improvement in pain, some had complete resolution of their pain.
      Remember this is not about Chinese Acupuncture but about Therapy with and without needles.

      Word of mouth from a believer is profound. Hey the world his round!!!

      1. WilliamLawrenceUtridge says:

        A controlled testimonial would be known as a case study, and they are useful primarily, almost solely, for hypothesis generation. As a mature field of study, they would be useless in acupuncture. Instead, we rely on controlled trials – the best of which consistently find acupuncture to be of marginal clinical and statistical significance.

  63. There is no high moral ground in that. It not only requires a very self-serving interpretation of the science and of human medical experience, it is mean-spirited, dog-in-the-mangerish, immature, and reflective of a puzzling lack of confidence in the ability of scientific medicine to hold its own against any challenge.

    You vacillate between the rhetoric of a creationist and that of a religious apologist. Guess what? I also believe that we should rid the earth of the delusion of religion and the false comforts it brings to people. If you want to talk about a “powerful” placebo that’s likely the grand-daddy of them all. And when the religious apologist condemns me for being “mean-spirited” for pointing out that someone’s belief in a magical sky fairy is delusional because it “takes away” their faith and the comfort, happiness, and joy they feel in an otherwise “cold and heartless” universe I have the same response. (Yes, I’m making the point that your defense of acupuncture in this or any case is the same as defending religious delusion, because the underlying principles and mechanisms of the patient/person “feeling better” is the same with the same expectancy of outcomes)

    As I have said before, nothing is more destructive of the pseudoscientific basis of these methods than that their effects can be readily explained through mundane mechanisms, as I have done in my last reply to WLU. Nowhere have I advocated pseudoscience.

    What you continually fail to realize is that in a game of delusion vs reality it is not sufficient for science to merely stand there, holding the right answers. These are ideas that can be argued to a (a literal) wall and leave the arguer convinced he has won the day. No, it is not sufficient to know what we know and contentedly sit by and graciously say, “You’re not quite right but when you want to know more come on over and I’ll explain.” Because only those of a scientific and inquisitive mind will come and know. Those who enjoy their CAM delusion will continue to do so, build societies, garner private funding, rally popular support through advertising and rhetoric (devoid of science, of course), and then come over and argue that they are popular and therefore deserve a seat at the table. Oh wait. That’s exactly what has happened.

    I am also appalled that you feel you have the right to make THAT judgement on behalf of all of mankind.

    I don’t actually get to make decisions for all of mankind. Nobody does. Unless you somehow fancy me a lot more powerful and influential than I am. However, I can make that decision based on the evidence (including history) and act concordantly. Which is exactly what I am doing. And I am in good stead doing so.

    Personally I am appalled that you actually know science and how it works and somehow think you should just keep that to yourself for fear of bruising the feelings of the dainty and deluded. But my worldview is one where I win because I am most in line with reality and because more people will ultimately agree with me. Rhetoric and evidence are my only coercive weapons and I will use them incessantly and brutally if need be.

    As for your response to WLU… as per usual you go off the rails in one very important way. You have described nothing that I cannot do in my patient interactions. Or any physician. All you have described is caring and what used to be called “bedside manner.” And yes, we know the utility of this. And yes, everyone here has acknowledged it countless times. Where we seem to differ is that we want to incorporate that into our practice of actual medicine rather than using a vehicle of deception to deliver it. And we have very good reasons for believing that delivery of such a “non-trivial medical intervention” via deluded pseudoscientific practices is, on the whole, a harm. And that is the key and how you slip around in the language.

    Note that except for the “sticking needles” part you have described any generic patient-practitioner interaction. Then you close by rhetorically asking “This is to be regarded as a trivial medical intervention?” with “this” clearly referring to acupuncture. Yet it was not acupuncture that had the profound effect. It was everything except the acupuncture (since, as you even pointed out, we don’t even need to stick the needles in for the entire process you describe to work!). So…. why again are you trying to say acupuncture has any utility? You use these literary sleights of hand very regularly and it certainly belies your own muddled thinking.

    So yes, those non-specific effects of acupuncture should absolutely be incorporated into medical practice. I have never argued that they are not profound nor lack utility. I actually use them pretty much every day in my own dealings with patients. When I have a patient who is scared and confused (just had one last week who didn’t understand what was happening) I sit down and explain things. And it works pretty darned well. I don’t need to refer them to an acupuncturist to be fed a bunch of lies and false platitudes to trick them into relaxing and feeling better. I just do that myself, well within the confines of truth and reality.

    And, at least in the US, the system is changing to reflect that and allow us to do it. We can now bill more for cognitive aspects of medicine, including counseling sessions. We can follow up our inpatients on a regular basis in outpatient clinic and have entire sessions billed as just “counseling.” So when you say:

    Then you do it many times over, over some weeks in a program of continuing care that a more supposedly science-based practitioner has no justification for.

    I call bull$hit. Because I am as pedantic a science based practitioner as you can imagine and I see justification for it. And I will be able bill for it. And I would be willing to bet my first month’s intern salary that Dr. Gorski takes the time to do exactly the same with his patients even when he can’t bill for it.

    Do we need to improve it? Yes. Do we need to pay more for it? Yes. Do we need to emphasize it more in medical school to engender a culture of doing that more regularly? Yes. Is all of that happening? You betcha! Does any of this mean we should go soft on or turn a blind eye to ridiculous pseudoscience like acupuncture? No.

    The fact that some of our ranks don’t care enough to do it or aren’t hip to the science to know its value doesn’t mean acupuncture (or any other CAM) gets a bye. It just means we need to continue to reinforce and improve our own ranks. Not outsource compassion and bedside manner to frauds and the deluded.

  64. I wrote a much longer reply to Peter that essentially said the same thing.

  65. A says:

    And that is actually a very important point that Peter conveniently glossed over – in the dissection of the asthma article we agreed that at best these were the effects if taken entirely at face value. He ignores the part where we also point out that a large part of the perceived effect is likely due to trial artifact rather than actual “symptom relief.” So it either does very little in actuality (most likely) or it can dangerously trick patients into ignoring symptoms which could potentially become lethal. But of course, Peter eschews such nuance when defending quackery like acupuncture and deriding our “stridency” in denouncing it.

  66. Oh please Peter. Your arguments are the muddled ones. And continue to talk as if we are somehow entirely oblivious to the notion that non-specific interactions, “time outs,” “relaxation,” etc are indeed quite valuable tools and provide their own direct benefit to the patient and to outcomes. So stop trying to argue what we already know and agree upon as if that proves what we don’t agree upon.

    Andrey, for that matter, has just now rather ambitiously claimed that he can provide the same influences within mainstream medical care,

    Why, yes indeed I can. And I do. In fact, I just had my evaluation for the completion of my current rotation (exams are in two days) and my attending commented that he found it “quite impressive” that I have such an excellent bedside manner and can establish good rapport with my patients. And I do exactly what the acupuncturists do without all the bull$hit. I talk to them, sit down, take some time, explain things so they understand, advise them to take some time and reflect, write down questions to address the next time I visit, etc.

    so they are apparently only to be despised when someone else does it

    And now is when I am back to regretting ever entering into discourse with you. Because you are so fracking thickheaded and use such bull$hit rhetorical tactics like this that it took all my restraint to not write even more expletives which you so rightly deserve.

    No, Peter. I don’t despise good bedside manner and interpersonal communication skills to advocate relaxation and self-reflection to engender the benefits of non-specific health related interactions because “someone else” is doing it. I despise it when quacks do it couched in the context of pseudoscience. Do you really think I despise it when nurses do it? Or physical therapists? Or orderlies? Psychologists? Family members?

    You should be downright ashamed that you are making such absolutely asinine arguments to continue to support your muddled – and false – arguments.

    Andrey doesn’t yet know it, but the mainstream would actually have great difficulty in constructing and getting patients to accept and pay for any equivalent “science-based” program of influences.

    Really? I wouldn’t know? Because I haven’t spent two years working with patients and being taught – and implementing – that exact model? Maybe they didn’t teach you those sorts of things when you went to medical school, but along with a few other tidbits of information they do demand that of us. In fact, I could have failed my medicine exams if I didn’t adequately discuss the social circumstances of my patient and how it relates to the illness.

    And really? What a bald-faced evidence-free assertion. Why wouldn’t patients pay for an equivalent science based program of influences? I mean, the biggest complaint we always hear is that the doctor didn’t have enough time to see or talk to the patient. And they pay psychologists to sit and talk, don’t they? Why must it be delivered in a vehicle of pseudoscience, delusion, and deception?

    Yes, I can fracking well do just as good a job connecting to my patients and meeting their non-specific needs as some charlatan acupuncturist. And the fact that you don’t think that is possible is probably the sort of attitude your generation of physician had to get us into this mess in the first place. It will be a relief when your ilk retire and let us who do believe we can be compassionate and actually have a therapeutic relationship with our patients in the context of real medical care take over.

    But hey, let’s keep muddling our way through Peter’s muddled thinking. So, first we have that patients won’t pay for extra TLC and weekly visits if an actual physician does it and won’t accept it if it is actually “science based” yet:

    Patients won’t come back three times a week for the same old bit of TLC, but they will if it is perceived as part of a program of vaguely credible program of treatment.

    Well gee, Peter, what could a “vaguely credible program of treatment be?” Seems that “medicine” and “science” are pretty credible. And indeed exactly what most people actually want. It is only the small fringe of really nutty and crunchy folk who absolutely eschew science and go sun-gazing or whatnot. But everyone else wants science to back it up!. Why do you think even the homeopaths love touting equivocal studies? Why do you think every freaking ad on TV endorses the validity of product by saying “scientifically tested?” Well guess what? We’ve actually got the science. And the pseudoscience charlatans cherry pick and bend the data to give the false impression of scientific legitimacy.

    So there goes your ridiculous assertion that people wouldn’t be keen on it if it were “part of an equivalent science-based program.”

    <blockquote.All that is needed for the necessary credibility in relation to acupuncture is the testimonial of others, which of course science-based medicine totally rejects.

    At least this we can agree on. Well, the first part at least. People are undoubtedly unduly swayed by testimonial, often to their detriment. SBM does not reject this as a known fact. We do, however, reject the testimonial. So what? That is exactly our point – we need to demonstrate why the testimonial is not worth consideration and shed light on the fact that these are pseudoscientific ideas purveyed by quacks and deluded believers.

    but that is no excuse for not looking at it clearly and without bias.

    I suggest you re-evaluate to whom that comment is directed.

    The euphoria will be temporary, but I see no reason why such experiences might not have more enduring influence, even perhaps helping to dislodge some out of self-perpetuating “illness modes”

    This may surprise you (though it shouldn’t and only will because you don’t actually take care and read what I and others here write, you just blather on about your own high-and-mighty ultra-nuanced position) but I agree with you. And actually, I’ll bet my second month’s intern salary that Dr. Gorski does too. And that is actually why it is an even bigger problem and of more concern.

    Once you get someone on the path of pseudoscientific thinking because of that long-lasting effect from the perceived euphoria or whatever from [insert BS CAM treatment here] it opens up the door to much more and much worse things. At a minimum it becomes a perpetuating thing opening them to continued harms of the treatment without lasting benefit. At most it can lead to eschewing actual medicine for fantasy. And the worst is that if a physician endorses it – either directly or tacitly by turning a blind eye – that lends more legitimacy and makes it much more difficult to explain why this load of bull$hit is OK but that load is one to stay away from.

    In any event, the fundamental point I agree on. Which is why I incorporate all those non-specific effects into my own practice as often as I can and consciously taking advantage of what we have learned from the “better than placebo” studies.

    So stop arguing your straw men, stop arguing the points we agree upon as if they prove those that we don’t, and for Raptor Jesus’ sake stop embarrassing yourself with such pitiful arguments as you have been proffering lately.

  67. pmoran2013 says:

    Andrey, eventually you will have to confront the questions I raise, because it is the science that continues to raise them. I first started asking them on SBM long before this item was published in 2010. by a group very experienced in meta-analysis. It is basically asking the same questions that I am. Read their discussion.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001416/?tool=pmcentrez

    Also, if you are going to describe my arguments as “pitiful” you need to either produce a coherent counterargument, or produce evidence that nullifies my appraisal of how people may react to some kinds of medical intervention.

    As it is you now seem to have changed your tune, and agreed with me on some matters.

    But your next tack is contemptuous of the public, if your only case is that if we let people experience benefits from such methods they will be forever at risk from over-confidence in pseudoscience. The public has shown that it has more sense than that, in the extremely small number of persons who profess to use “alternative methods” exclusively, even after some decades of considerable hype regarding them and wide experience of them.

    Also acupuncture has been in wide use in many countries without evidence that this happens to a degree that would justify us saying that acupuncture cannot help anyone when we have reasons to be very unsure about that.

    We need to keep asking ourselves “what is most important here?” Sometimes, in medicine, it is the short-term needs of the individual.

    1. windriven says:

      I hope you will forgive my intrusion in what has become a conversation between you and Andrey but this caught my eye:

      “The public has shown that it has more sense than that, in the extremely small number of persons who profess to use “alternative methods” exclusively”

      Exclusivity seems an awfully high bar. It is difficult to find good evidence of general sCAM use in the US but I recently ran across this meta out of the UK.

      Clin Med. 2013 Apr;13(2):126-31. doi: 10.7861/clinmedicine.13-2-126.

      The abstract says in part:

      “Across surveys on CAM in general, the average one-year prevalence of use of CAM was 41.1% and the average lifetime prevalence was 51.8%. In methodologically sound surveys, the equivalent rates were 26.3% and 44%, respectively.

      ” Herbal medicine was the most popular CAM, followed by homeopathy, aromatherapy, massage and reflexology. ”

      26% of respondents admitting CAM use within the past year is, to me, a frighteningly large fraction.

      ***

      I’d like again to encourage you to take Dr. Gorski up on his invitation to guest blog. Your exchange with Andrey has been interesting to follow – but like a sword fight there is lots of action but it is easy to miss what the battle itself is actually about; the forest is lost for all the trees.

      To wit: the BMC that you cited basically says that testing acupuncture is difficult. I’m guessing most here would agree.

  68. Also, if you are going to describe my arguments as “pitiful” you need to either produce a coherent counterargument, or produce evidence that nullifies my appraisal of how people may react to some kinds of medical intervention.

    I have. Many times in the past. In long posts, carefully researched and well referenced. You haven’t changed your tune since then, so please feel free to reference them and re-read as necessary. The only thing my long well referenced posts were able to achieve is to get you mad and decide that my thoughts, opinions, and evidence were not valid because I haven’t had as much clinical experience as you. Since then you haven’t brought anything new to the table, just more rhetorical tactics and bad argumentation. I’ve already refuted the content, but now you are continuing to pound your head against the wall like a creationist. In particular that desperate grab at an evolutionary reason to justify the profundity of the placebo effect.

    But hey, I’ve got a little time today so I’ll quickly demonstrate why that is such a ridiculous comment you made. Your claim, in essence, was that it would make sense for us to have evolved a psychogenic healing mechanism a la the placebo effect. While certainly plausible it is definitely not probable. Selection pressures have to do with successful breeding. So we only really need to develop something that will trick us into hobbling along long enough to pass on our DNA. Which, as you may recall, was typically done early in the 2nd decade of life with death around the 3rd decade of life for most of our species’ history. And it has only been since the advent of science based medicine that this has significantly changed. Which is why your creationist-style list of reasons why maybe, just perchance, placebo effects should be given more serious thought is made even more pitiful by that desperate flail at adding in an evolutionary argument for no reason beyond it sounded good to you at the time and added one more bullet point to make your argument seem (very) superficially more convincing.

    So I don’t really need to provide evidence to nullify your claims since you aren’t actually making any real claims lately. You are arguing from rhetoric, not evidence, and your logic and rhetorical tactics are poor. I’ve been pointing those out by demonstrating your slippery use of language, your straw men, and your penchant for trying to prove something we agree upon to use as evidence for something we don’t and then further extrapolating that to some sort of benefit. Of course, even further muddling your own arguments is this duplicitous notion that on the one hand the intervention (acupuncture) must have some great utility that we just haven’t explored and are to dogmatic to recognize, yet on the other you clearly see why we can’t use the intervention! If something has benefit we should be able to use it and if we can’t then that means, by definition, the harms outweigh the benefits. Which is exactly the case with acupuncture. It is just that you focus in on the narrowest of definitions of harms to extol the virtues of acupuncture and then are forced to recognize the broader sense of harm in admitting we can’t actually take advantage of it. Well, you simply can’t have it both ways. Except that you try to by having your argument distill down to this notion that we should be “nicer” and then turn a blind eye to such practices as a way of having our cake and eating it too. That’s fine on an individual level and quite honestly is something I’ve done in actual practice with actual patients. Sometimes, in those cases, the benefits do outweigh the harms. Which brings me to the next point:

    As it is you now seem to have changed your tune, and agreed with me on some matters.

    Nope. I most certainly have not. I have become more nuanced in my conversation and indeed incorporated new evidence into my rhetoric, but my basic thesis, my thoughts, and my general attitude have not changed in any fundamental way. We have, except for a few very minor points, always agreed on the things we currently agree on.

    In fact, as you may recall, it was I who introduced the use of the terms “placebo effects” and “placebo responses” to adequately differentiate what we are talking about since you have this ongoing tendency to muddle and obfuscate language. It was I who has always commented her that I believe psychotherapy is an active intervention (go ahead, look back at the relevant posts and my comments and see how I have argued that non-specific effects from patient-practitioner interaction are best considered active treatment modalities. And how those conversations and comments did not involve you. And how they do not clash with any of my other thoughts and writings on placebo effects and responses).

    Andrey, eventually you will have to confront the questions I raise, because it is the science that continues to raise them.

    But here’s the thing – you aren’t actually raising any questions. At least nothing profound, new, or original. Certainly not to me, anyways. You just keep hedging this idea of trying to keep giving the benefit of the doubt in the face of ever vanishing doubt.

    To draw an analogy, your argument about acupuncture is like trying to argue we should be OK with using whips on our patients because the marks the lashes leave are small and there is the salubrious effect that them running from us whipping them leads to weight loss and improved health outcomes. OK, maybe that wasn’t a great analogy, but try and read into what I mean.

    You are arguing for the side effect of an otherwise useless and potentially harmful treatment. I am arguing that the side effect is not unique to the treatment and can be incorporated into actual treatments. You are desperately trying to hide in the tiny uncertainty and the fringe minority of people who would – for all practical purposes – respond best and almost solely to such pseudoscientific interventions. I am arguing for the certainty of an insignificant (if present at all) direct effect from acupuncture and the large majority who would find only temporary reprieve without long-lasting salubrious effects (remember, I can match Jenny’s anecdote with my own about acupuncture).

    But mostly I am arguing that a simple change of view – a cultural change – would completely nullify the last sliver of an argument you are clutching to. Just do a thought experiment Peter. What do you imagine the effect would be if I could snap my fingers and everyone in the world knew and believed the facts about acupuncture? Specifically that it was not contingent on the needles or penetration of the skin or any specific points and that it all had to do with the interaction between the patient and practitioner and taking the time to relax and distract yourself from your current condition?

    Do you really think people would be clamoring to sign up for that treatment? Or do you think they would advocate for spending more time with their doctor and taking their acupuncture money to go to the spa and get a massage and a manicure?

    And finally I’ll get to the “evidence” you have presented me with. Which doesn’t at all argue in your favor.

    Firstly, you should note the significant heterogeneity of the studies and how hard it was to find well done ones. This means that whatever effect size they are finding must be overestimated. Because there must exist both placebo effects and placebo responses. Heterogeneity in studies lends to larger placebo responses. So automatically you must take the results here to be a best possible case scenario.

    That said, I agree with you that in some cases the effect size can be rather impressive. But lets look at it in more detail.

    Note that the largest – and only robust – effect size for non-specific effects is that in chronic pain conditions. I won’t rehash it here, but I have written extensively about why that makes sense and why that is not at all unique to acupuncture. Feel free to reference my old writing to you. Nonetheless, I am once again not surprised nor does it change my argument.

    Particularly poignant, however, is when you look at short term pain outcomes. You notice that the effect size is much smaller and the CI’s overlap zero. Once again in accord with everything I have written in the past. In other words, even the non-specific effects don’t actually have a robust effect! Not directly, anyways. Furthermore, the heterogeneity does not exist in the short term groups, but does exist in the other two groups… i.e. the ones that demonstrate an effect. Funny that, how decreasing heterogeneity and improving the trial design decreases the effect size.

    Even more to the point:

    In exploratory subgroup analyses (see Additional file 1, Table S3), effect sizes differed significantly according to the level of cointervention (larger if less cointerventions) and according to the type of sham intervention (larger if no skin penetration). Nonspecific effects tended to be larger in trials with a larger sample size, a lower risk of bias, and a clearly predefined outcome, but the differences were not statistically significant. In multivariate meta-regression analyses, only the association with level of cointerventions approached statistical significance (P = 0.07). Trials with larger effects of sham over no acupuncture reported smaller effects of acupuncture over sham intervention than trials with smaller nonspecific effects (β = -0.39, P = 0.029).

    In other words, doing other stuff (i.e. confounders and/or actually helping your patient with real medicine instead of pseudoscience) increased the effect size of non-specific effects. Not penetrating the skin had larger effect sizes. The only thing that seemed to predict effects well was other interventions, though even that didn’t seem to be so great. And, of course, the bigger the sham effect size the smaller the difference between real and sham acupuncture.

    So once again, we have great evidence that acupuncture does nothing in and of itself. And that when patients are doing just acupuncture, the effect size becomes smaller.

    Furthermore:

    In seven trials, effects over no-treatment groups were large (SMDs were above -0.7); in nine trials, these effects were moderate (between -0.4 and -0.7); and in 16 trials, these effects were small (< -0.4).

    Most trials showed a small effect size.

    As if that weren’t enough:

    Larger trials yielded significantly less positive results than smaller trials (SMDs -0.15 (95% CI -0.31, 0.01) vs -0.59 (95% CI -0.93, -0.24); P < 0.001). Specific effects were also smaller in trials with lower risk of bias and more intense cointerventions, while skin penetration and condition did not have a significant influence.

    Yep, larger and less bias = less effect size.

    So what exactly were you trying to demonstrate with this article? That in chronic pain, changing things up, getting the patient to have a different attitude and confront their problem by doing other things to actually help improve their condition, and spending some extra time with them helps? Because that is all this really shows us – and exactly what I have known all along and advocate incorporating – actively and conscientiously – into actual medical practice.

    Because what it certainly doesn’t show is that acupuncture does anything of utility.

    Read their discussion.

    Indeed. I’d rather read their results. Though in the discussion they do raise yet another valid point that is often glossed over – the effect sizes only ever exist in comparison to no-intervention or wait-list groups, which are certainly prone to a nocebo effect. If I added another arm to the trial where I berated the patients and beat them with a stick occasionally I bet I could demonstrate even larger effect sizes.

    1. David Gorski says:

      I have. Many times in the past. In long posts, carefully researched and well referenced. You haven’t changed your tune since then, so please feel free to reference them and re-read as necessary. The only thing my long well referenced posts were able to achieve is to get you mad and decide that my thoughts, opinions, and evidence were not valid because I haven’t had as much clinical experience as you.

      So I’m not the only one who’s noticed the similarity between Dr. Jay’s behavior and Peter’s behavior, am I? :-)

      1. pmoran2013 says:

        Yes, I am sure that it is quite puzzling, David. The difference with me is that I have “been there and done that”. I cut my own “healthfraud teeth” on all this stuff.

        I have personally been through all the phases of medical scepticism, from “this nonsense can’t possibly ‘work’”, through “anyway, it’s all just placebo” and more latterly “well, placebos don’t do anything much, either”, which is where medical scepticism now largely rests awaiting further directions.

        I have at one time or another supported all these positions just as enthusiastically anyone here, but I have a strong feeling that we are now fighting yesterday’s battles, that the major next area of interest now lies in areas we are ill-prepared for, through never having felt the need to explore all that somewhat unfamiliar territory that lies outside of “working better than placebo”.

        Sure, we can still find people with which to argue about the memory of water, or the technicalities of “energy medicine”, but I suspect the main game lies elsewhere and that we will be forced to confront its implications sooner rather than later, quite possibly and most forcibly by those despised “pragmatic” studies showing that CAM practices do as well if not better than the mainstream with some conditions.

        It will not necessarily affect mainstream medicine much, but we may have to change our tune (once again) in other ways.

    2. pmoran2013 says:

      I was going to shut up but must respond to some misinterpretations of a scientific study — .

      Andrey :

      In other words, doing other stuff (i.e. confounders and/or actually helping your patient with real medicine instead of pseudoscience) increased the effect size of non-specific effects.

      ————————————————————————-

      PM: No it didn’t. It reduced them.

      Also, even in the “low intensity” of co-intervention group there was an effect size of .29. which is not necessarily something to be ignored when most of these patients had chronic pain.

      It is also unwise to over-interpret such studies if the question being tested is whether any specific patient testimonial concerning CAM reflects true patient benefits or not. These are averaging effects in a somewhat artificial clinical environment. It is suggestive evidence without being conclusive.

      ————————————————————-
      Andrey : Larger trials yielded significantly less positive results than smaller trials (SMDs -0.15 (95% CI -0.31, 0.01) vs -0.59 (95% CI -0.93, -0.24); P < 0.001). Specific effects were also smaller in trials with lower risk of bias and more intense cointerventions, while skin penetration and condition did not have a significant influence.

      Yep, larger and less bias = less effect size.
      ———————————————————–

      PM: This is referring to specific effects, i.e. comparisons between 'real' and 'sham' which I have acknowledged are small enough to be explained by small losses of blinding.

      Small points–

      Any nocebo effect on waiting list patients would be likely to be counteracted in the results by the patients being "treated" not knowing for sure whether they are supposed to be better or not (if presumably properly informed) .

      So how, then, did mankind evolve any adaptive responses to injury or illness? Your evolutionary argument does not work, since we probably inherited all these mechanisms from remote forebears.

  69. Jenny says:

    Just one question: I go for a massage. Lights are dimmed, music is on. Circulation improved. Leave feeling great. Definite chance for my body to experience a state of relaxation. Must have great physiological effects. Now: I go for accupuncture. Lights are on. No music. I brace myself slightly due to tiny pin pricks. I get off table 30 minutes later with same jello body. I’m wondering what happened to my body?

    1. weing says:

      You mean you can’t figure it out? There’s only one way to relax?

    2. WilliamLawrenceUtridge says:

      There’s a strong chance that it’s at least in part, probably a significant part, still placebo effects – which are not unitary. Merely because we use the same term “placebo” doesn’t mean it always has the same effect. Needles are better than pills, more needles are better than less, surgery is better than needles, dramatic is better than quotidian, exotic is better than familiar, and both very old and very new are more effective than stuff from the past 50 years. See how many boxes acupuncture ticks off there.

  70. Jenny says:

    Funny…nobody can really answer my simple question . I’m not saying accupuncture does all sorts of miraculous things….just that the procedure is NOT relaxing , BUT I get off the table feeling like jelly. I happen to know my bodily responses by now, and feeling like jelly doesn’t happen due to a placebo effect. Perhaps feeling a bit relaxed, sure. But total body slam…..nope!

    1. MadisonMD says:

      Right on Jenny, Your question was “I’m wondering what happened to my body?” It seems that what happened was you were relaxed by both acupuncture and by massage both. That’s what happened. You get the same great jelly feeling with both. Now, given that– which is better? You had less pain during massage. It probably cost less. During massage there was absolutely no risk of a needle <a href="http://news.nationalpost.com/2013/07/04/judo-acupuncture-needle/"entering your pleural cavity. Nobody did silly things like read your tongue and see which way your pulse was pecking (well–maybe that part is entertaining). So it seems that massage is the best choice.

      pmoran: Do you think that massage also could meet the short-term needs of people? It worked for Jenny.

      1. MadisonMD says:

        Broken link above. Here it is.

    2. pmoran2013 says:

      Jenny: “I’m not saying accupuncture does all sorts of miraculous things …”

      That is all that we need people to understand. We can be quite sure that it will have little, probably no effect upon disease processes.

      “.. just that the procedure is NOT relaxing , BUT I get off the table feeling like jelly. I happen to know my bodily responses by now, and feeling like jelly doesn’t happen due to a placebo effect. ”

      It does sound as though you could be entering a similarly relaxed state, once over the apprehension concerning the needles. If you don’t think that is likely then I personally have no other suggestions.

      Although, if the acupuncturist told you to expect such a sensation then it could well be in part a response to suggestion, which is one kind of placebo response.

    3. weing says:

      “Funny…nobody can really answer my simple question”

      Of course not. Especially if you set your mind to it that you already know the answer.

  71. pmoran2013 says:

    “pmoran: Do you think that massage also could meet the short-term needs of people? It worked for Jenny”

    Yes indeed, but perhaps with less predictability depending upon the patient.

    What is odd is that massage is more acceptable to many as an authentic, proper medical intervention, while acupuncture, which might be able to recruit a greater variety of psychological and physical influences gets despised, simply because of its association with pseudoscience.

    It is more invasive, has a more “medical” aura, and also a little oriental mystique. These allow patients to hang more expectations upon it, in addition to the minor physiological responses.

    1. Badly Shaved Monkey says:

      Peter

      Massage vs acupuncture

      The latter pretends to be a complete system of medicine and panacea and brings in its trains whole host of anti-scientific and outright dangerous nonsense.

      The former is a nice rub for the bits that ache.

      I find them easy to distinguish.

      You will note how our friend SSR goes on and on about his bleedin’ trigger points and musculoskeletal pain but constantly evades any questions about the much broader claims that are made for acupuncture and that he himself makes on his own website.

      I remain firmly in the camp that says anecdotes like Jenny’s sit firmly in categories of regression to the mean and/or survivorship bias.

      1. pmoran2013 says:

        BSM: “I remain firmly in the camp that says anecdotes like Jenny’s sit firmly in categories of regression to the mean and/or survivorship bias.”

        Then, sadly, BSM, I suspect it is you that needs to think again.

        Regression to the mean is used in different ways but it always means the reversion of a symptom, sign or lab result back to a level which more commonly applies for that person. It is not appropriate to invoke it as a cause of a new sensation such as relaxation after massage (if that is what is happening above — I have only seen a few recent posts) ..

        Similarly survivorship bias is an influence upon external observers, such as a practitioner who only gets to see his good results (as with people like SSR), because the poor results don’t keep coming back . It tells us little or nothing about what happened with any individual.

        1. Badly Shaved Monkey says:

          OK. Time for an anecdote to illustrate my point.

          I had my varicose veins endo-lasered. I didn’t want a GA. “That’s brave”, said every nurse who came in to do the paperwork. The procedure entails infiltrating the entire length of the affected leg around the veins with a large volume of saline doped with local anaesthetic. This is to protect the surrounding tissues from excess damage from the laser threaded down the vein. It hurt. Really quite a lot. However, the procedure became weirdly relaxing after a while and afterwards I was distinctly euphoric and relaxed.

          I think we can all agree that the word ‘endorphins’ would appear in any discussion of these events.

          My point? It was the laser that fixed my veins not the needles and no one claims otherwise.

          Acupuncturists make claims for dramatic effects on diseases but have no good evidence that objective outcomes are improved. Our friends Jenny and SSR are here defending acupuncture in one small area of its claimed applicability: conditions with a strong psychosomatic effect. Even so, Jenny may feel euphoric and relaxed after a session, but we currently cannot say whether, even on an n=1 basis, that she is going to experience long-term amelioration of her problem from the intervention and the evidence mostly suggests that she will not.

          Regression to the mean does not therefore refer to her immediate sense of relaxation any more that did mine. It refers to the state of the underlying disease. So, even if she stays well for some time we still cannot know whether acupuncture did it or she was just due an improvement. Frankly we also don’t know what other changes she has made contemporaneously with her latest foray into SCAMland. Her acupuncture may just be a bystander.

          Survivorship bias absolutely does apply here. She would not be posting here if she did not think she was better. We are hearing nothing from that acupuncturist’s other patients so we know nothing about whether she is typical or a 1 in 1000. If her report is just a 1 in 1000 fluke then the amelioration of her symptoms (and I use the word advisedly in contrast to clinical signs) may be just regression to the mean, a point I have already made.

          1. pmoran2013 says:

            My remarks applied specifically to the validity of Jenny’s perceptions, with a bearing upon whether sceptics are justified in being as dismissive of them as is usual in such interchanges. You are invoking matters outside of that.

            As you also say, we can have no certainty as to how useful this procedure might be for her in the long term. So I ask, is any threat to her well-being from this experiment real enough to justify a thoroughly mean-spirited and discouraging, even aggressive exchange, with her?

            She knows that acupuncture is no miracle-worker.

  72. jenny says:

    reply to WEING…..No, haven’t set my mind to it. Maybe you have. I personally don’t give a rats you know what whether accupuncture does what it says or not. Don’t care. I happen to know that my body feels super relaxed. Would NOT happen from an enthusiastic accupuncturist. Sorry….been around too long for that game.

    1. Badly Shaved Monkey says:

      Your claim of omniscience is noted.

      And rejected.

    2. weing says:

      Spoken like a true believer. You expect us believe you are really experiencing something special? Not just the mundane placebo effect? You are immune to placebo effects?

  73. Jenny says:

    Hey monkey. You have a scintillating personality. I can tell

  74. WilliamLawrenceUtridge says:

    Jenny, you may dislike BSM’s comment but that doesn’t mean it isn’t true. You have been asking questions and others have been answering them civily for the most part. If you didn’t come here for dissenting information, why bother posting a comment at all?

    The issue seems to be, you appear to be attributing your subjective feelings of relaxation to some specific effect of the needle. Others, including myself, are pointing out that to date, we have discovered no good evidence for the specific effects of needling. However, numerous studies have demonstrated that the nonspecific effects of needling are quite significant.

    Further, you are asserting that this relaxation is not, can not, be due to placebo effects, and it has been pointed out that your certainty in this is misplaced. At the minimum it is an open question.

    One must add to the discussion the risks of acupuncture, which tend to be small but do exist. You risk infection (does your acupuncturist wear gloves and sterilize the skin before inserting the needle?), bruising, clots, and there are (very) rare but (very) real examples of punctured lungs, nerve damage, even (skin) cancer and death. If acupuncture is the only way you have found you can get specific symptom relief, then there’s not much to discuss. If there are other ways to achieve the equivalent effect that do not present such risks, then they are worth considering.

    Unlike most CAM practices, acupuncture does present an immediate risk of harm (and I’m guessing you were not told of the more serious possible consequences – note that doctors and drug manufacturers are forced to do this for all interventions, a double-standard). You should be aware of these risks so you can evaluate them in relation to their potential benefits. If you make that decision, fine. But at minimum, don’t you think as a consumer, as a patient, as a human, you should be making an informed one?

  75. Last year I attended a vascular surgery journal club. I happened to sit next to a vascular surgeon who worked with John Fogarty back in the ’60s. He told me the story about how everyone thought he was nuts when he talked about using a balloon tipped catheter to do minimally invasive embolectomies. “You see,” he told me, “we had all been trained in a certain way and thought about things in certain ways. It took a medical student without our biases seeing the problem with fresh eyes to bring something new to the table.” [I paraphrase from memory of course, though Fogarty himself says something similar.

    I have personally been through all the phases of medical scepticism, from “this nonsense can’t possibly ‘work’”, through “anyway, it’s all just placebo” and more latterly “well, placebos don’t do anything much, either”, which is where medical scepticism now largely rests awaiting further directions.

    I’m sure that may be the way you see it. It is not the way I see it. I see your statement there as buying entirely into the CAM propaganda that has emerged under the selective pressure of existing in a world that generally demands some evidence for efficacy and them having none. It was their PR schtick that evolved through those stages, independent of the skeptical community. Yes, it is also true that placebo effects (as distinguished from responses) have slowly been coming to the fore with many deniers in our camp along the way. But for my entire educational career the overwhelming theme has been exactly as I have been saying – placebo effects and responses exist and should be taken into consideration with the effects capitalized on by incorporating them into our every day medical practice.

    So your little blurb there is superficially accurate but misses the very important point that we aren’t back on our heels and left holding the bag. We are addressing the claims of the CAM contingent as they come along. First they claimed efficacy of fantastical claims. That is rightfully called quackery. Then they claimed efficacy of slightly more plausible claims as a “trojan horse” for the quackery. We rightfully called that a placebo effect. Now they are back on their heels and holding the bag, whining piteously that the placebo effect is powerful and useful in its own right, regardless of the vehicle of delivery. So yes, we rightfully say that it is not as profound, is very limited in its application, and when packaged with the whole pseudoscientific package (as weing rightly pointed out) is simply more harm than benefit.

    In other words, you’re blinkered in their PR.

    that the major next area of interest now lies in areas we are ill-prepared for, through never having felt the need to explore all that somewhat unfamiliar territory that lies outside of “working better than placebo”.

    I feel pretty well prepared for it. How many times have I said that I actually use that knowledge to improve my delivery of medical care? Haven’t the authors here at SBM written posts saying exactly the same thing? (Hint: yes, they have). You are arguing into the wind.

    Sure, we can still find people with which to argue about the memory of water, or the technicalities of “energy medicine”, but I suspect the main game lies elsewhere and that we will be forced to confront its implications sooner rather than later, quite possibly and most forcibly by those despised “pragmatic” studies showing that CAM practices do as well if not better than the mainstream with some conditions.

    Agreed. Which is why it is important to educate people on the flaws and faults of studies and how those are magnified by science journalism, how we can effectively trick ourselves, and why none of that has anything to do with the direct and intrinsic utility of a specific therapy such as acupuncture.

    Though even you can’t seem to grasp that last part.

    Your response to Jenny is not at all unreasonable. Where you and I differ is I would consciously go the extra step to point out that memories are known to be fallible and change over time as we access them in order to conform more to our preferred and/or easy narrative. This then becomes a self fulfilling prophecy.

    But now here is a prime example of where you demonstrate just how completely muddled you are:

    BSM:Do you think that massage also could meet the short-term needs of people? It worked for Jenny

    pmoran: Yes indeed, but perhaps with less predictability depending upon the patient.

    Why, pray tell, would massage be less predictable than acupuncture? On what basis can you possibly make the assertion that the reliability of effect between the two is any different? You can’t. The only thing you can do is look post hoc and see that for Jenny the acupuncture was more profound than the massage. Once again, my own anecdote negates Jenny’s in that massage is much more profound for me. I get up off the table with my head swimming (in a good way).

    This comment belies your own unsupported bias for acupuncture for some reason.

    What is odd is that massage is more acceptable to many as an authentic, proper medical intervention, while acupuncture, which might be able to recruit a greater variety of psychological and physical influences gets despised, simply because of its association with pseudoscience.

    It is not odd at all, unless you just completely tune out everything we here have been writing at you. As wieng said well, acupuncture is not just associated with pseudoscience it is pseudoscience – complete with its own fundamental premises for how to diagnose, treat, and even what diseases exist. That is a pretty formidable difference!

    Furthermore, the massage itself has direct effects. It is not just a means to trick you into laying still in a room. This is distinctly different than acupuncture, as the needles themselves do not do anything directly. In fact, the meta analysis you linked to even demonstrated smaller effect sizes when needles were actually inserted into the skin. So really, you actually find it odd that we would be OK recommending massage over acupuncture?

    Lastly, as I have commented many times in the past, intent is important in these cases. Yoga is great exercise and I would recommend it to my patients (I do it myself) unless it was for the purpose of re-aligning chakras and channeling energy to cure some disease. The same with massage and our own Paul Ingraham has documented this well. You can indeed make massage very quack-ish and woo-y and I certainly would eschew that in the same way I would acupuncture. In fact, it took me a while to find a masseuse who didn’t heap that ridiculous garbage on top of just a good deep tissue massage.

    It is more invasive, has a more “medical” aura, and also a little oriental mystique. These allow patients to hang more expectations upon it, in addition to the minor physiological responses.

    And now more of your own bias. It is you who assumes that to be the case. As I said to Jenny, my fiance is deathly afraid of needles. Do you really think that it being more invasive would make it more likely to help? How about people who don’t buy into the oriental mystique? What about people who really like Norse mythology and therefore get more out of a Swedish deep tissue massage?

    Which was exactly the point of my thought experiment that you didn’t address. And I will not stop bugging you about that, so at the minimum at least address that point. Do you really think that say, back in WWII, the population of the US would have loved acupuncture? Do you think that “oriental mystique” would have been a big selling point?

    The point is you keep trying to make a special case for acupuncture when there is none. The whim of a culture can magnify or eliminate all the non-specific benefits of it. Because they are not directly and inextricably tied to the actual intervention itself. Which is why any reasonable scientist would eschew the unnecessary variable and capitalize on the parts that actually bring benefit to the patient.

    Which brings me to something you raised about Jenny and her experience. No, I am not saying she is lying. And no, I am not saying she doesn’t actually experience what she claims. I absolutely believe her on face value. In exactly the same way that I believe someone when they say they saw the Statue of Liberty disappear when David Copperfield did his magic trick. All I am saying is that she is mis-attributing what she is experiencing and misinterpreting what it means. The same way I would if someone was absolutely convinced that David Copperfield really was a bona fide wizard.

    So how about it Peter? Any response to my thought experiment?

    1. pmoran2013 says:

      Andrey: “pmoran: Yes indeed, but perhaps with less predictability depending upon the patient.”

      Why, pray tell, would massage be less predictable than acupuncture? On what basis can you possibly make the assertion that the reliability of effect between the two is any different? You can’t.”
      ——————————————————
      I am sick of responding to things you have not thought through. As WLU has just pointed out the strength of placebo influences (which you elsewhere acknowledge exist) are related to many aspects of the therapeutic experience, including its perceived invasiveness.

      So part of my answer to this was already laid out, in the following line: “It (acupuncture) is more invasive, has a more “medical” aura, and also a little oriental mystique. These allow patients to hang more expectations upon it, in addition to the minor physiological responses.”

      It is exhausting reading your long replies, especially when so much of it is like this, or merely restatements of weakly supported positions, or presumptuous analyses of my mental deficiencies.

      You mention having set out a thought experiment for me somewhere, I cannot find it with a reasonable effort. It sounds interesting. Can you, in as few a words as possible, state what it was?

      1. MadisonMD says:

        the strength of placebo influences (which you elsewhere acknowledge exist) are related to many aspects of the therapeutic experience, including its perceived invasiveness.

        Great idea. Maybe sham surgery would work better than acupunture, pmoran. How about we replace acupuncture with mammary artery ligation?

  76. Jenny,

    As I have said to pmoran, I don’t think you are lying about your experience and I truly believe that you are confident and have good reasons to think about it the way you do.

    What some of us here, myself included, have been trying to say is that it is very easy to misattribute the reasons for having such experiences. We are all prone to such things and in fact, I used to have the same profound experiences when I had acupuncture for my chronic pain in the past. Yes, I do know what chronic pain is like and it sucks. I get used to a baseline level of pain – in every joint of my body – and mostly ignore it. But sometimes it flares up and makes me miserable, sometimes I just pay attention to it more (like during boring lectures I am forced to attend :-D). And I tried everything. All the drugs, everything the rheumatologists suggested, various supplements, Chinese traditional medicines, and yes, even acupuncture. I’d had it before as a kid as a local anesthetic to remove some glass from my foot, I was midway through a degree in medical anthropology where my professors taught that Chinese medicine and acupuncture were 100% legit, and it was my own medical doctor doing the acupuncture so I was definitely primed for something.

    And it worked! Now granted, I was getting electroacupuncture which is a different beast, but none the less I would feel downright euphoria. I felt high while getting it. But that wore off after a while. It became a hassle to make the appointments, it was expensive to a starving student (man will it be nice to not be a starving student one of these days), and occasionally it was actually uncomfortable and I left feeling basically no different or even worse sometimes. At the time I just figured it was just like the other drugs – they “worked” and then wore off for some reason, just because my body was so screwed up. Now, if I get acupuncture, it does absolutely nothing for me. The whole aura and mystique of it is gone, no placebo, no nothing.

    What I have is a clinically diagnosed Ehlers-Danlos. And losing weight and getting in shape helped. Something my doctors had been telling me all along, but I simply wasn’t on board with. Now, when my pain flares up I can trace it back to being sedentary for too long. I get back on a good workout regimen and it is back under control.

    So when you ask us what is going on, we have told you – it is truly a placebo effect. Part of that is you ignoring your pain, part of it is the pain being on a natural downturn, part of it is actual physiological changes that alter the way your gut is acting and actually decreasing the pain, and a few other things are likely contributing to it as well. But the point is there is really nothing going on as a direct result from the needles. If you happened to have found a particularly charismatic masseuse or homeopath or reiki master and the same confluence of factors came together you’d be experiencing essentially the same thing and telling us the same stories except for what intervention it is you are convinced can’t be a placebo. I know this isn’t the answer you wanted to hear, but there really isn’t a better one (even pmoran has to admit that) and the evidence demonstrates to us that this is by far the more likely explanation than anything directly related to the acupuncture itself.

    I just want to be clear that this is not in any way a dismissal of your experience, what you are feeling, or to say that you yourself don’t have good reasons for believing what you do about the acupuncture. It is merely to say that you are almost certainly misattributing those feelings and falling prey to the same cognitive biases and logical fallacies that every human being is prone to.

  77. Jenny says:

    Thank you for this reply. It’s not caustic like some others from supposedly educated people. Anyway…my acupuncturist uses gloves, sterilizes my skin, opens each needle from an individual package. I get relief. Plain and simple. Don’t know what else to say. If most folk here would like to attribute it to placebo/charm/lighting/memory loss, whatever may be, then my question has not been really answered sufficiently for me. Fine. I’m just curious about the very real rush of relaxation. (Doesn’t happen in this way from any other treatment I have received). So, I appreciate your attempts and won’t pursue this particular line of questioning anymore. Cheers, jenny

  78. Jenny says:

    Ok Andry…thanks. Will continue with 6 more treatments and see what happens….

  79. MadisonMD says:

    What is odd is that massage is more acceptable to many as an authentic, proper medical intervention, while acupuncture, which might be able to recruit a greater variety of psychological and physical influences gets despised, simply because of its association with pseudoscience.

    Huh? Why is it odd that something associated with pseudoscience is less acceptable? Would it be acceptable to you if I charged you $50 to make you feel better with N-rays?

    Neither massage nor acupuncture is a medical intervention. They both are relaxing. Both could improve subjective feelings of wellness. Massage is more acceptable because (a) It is NOT associated with pseudoscience; (b) Its practitioners are less apt to make false health claims; and (c) it has less risk.

    pmoran, You mostly sound reasonable but your strong preference for needles and tongue reading over or other forms of relaxation for “meeting the short-term needs of people” is irrational.

    1. pmoran2013 says:

      MadisonMD, the question is whether acupuncture (or massage) is (almost inadvertently?) helpful to certain patients, not whether they fit into your definition of what constitutes a “medical intervention”.

      It is a free-standing question that deserves, on behalf of our employers (patients) as ruthlessly rigorous a scientific answer as any other question in medicine and regardless of any discomfort the mere possibility of that creates for most mainstream medical and scientific minds.

      Irrespective of the answer there would remain many reasons why the mainstream might find it impossible to ever endorse acupuncture for routine patient care, including the difficulty in disentangling it from TCM theory. So there is no reason not to ask the question

  80. MadisonMD says:

    pmoran: It’s tough to parse your reply. When I strip out textual baggage, it seems to boil down to:
    “It is worth asking whether acupuncture is helpful to some people.”

    I don’t think that is worth asking at all. Jenny already answered it. Andrey already answered it. You already answered it. It is helpful to some people. No more research is required.

    The essential questions are:
    (1) Is acupuncture the optimal way to deliver placebo?
    (2) Is it ethical to lie to patients regarding the efficacy of acupuncture to enhance placebo?
    (3) Should we invest scarce research dollars in research on acupuncture or other forms of placebo? Or should we invest them solely in devising more effectual medicines that will ultimately obviate the need for placebo.
    (4) If we research acupuncture, are we required to provide written informed consent to subjects that it is placebo?

    Feel free replace ‘placebo’ with ‘psychosomatic’ if you espouse a very limited definition.

    1. pmoran2013 says:

      MadisonMD: “It is helpful to some people.”

      Then you are presumably with me against the tendency of some SBM writers to too dogmatically dismiss patient-reported subjective benefits as entirely illusory, or as so close to that that it doesn’t matter for any purpose? Note how this seems to be BSM’s take-home message after quite a long association with this site.

      You might also, in that case, agree with me that describing the status of acupuncture with the bald statement “it doesn’t work” is a morally, medically and scientifically unjustified attempt to unduly influence public opinion and behaviour in this matter. It is disingenuous to post hoc claim to be applying a special meaning to that phrase, as Andrey does, when there is utterly no question as to how the public will interpret it.

      Some Answers –

      (1) Is acupuncture the optimal way to deliver placebo?

      Actually, probably yes, in an amenable population, because of the sheer number of psychological and minor physiological influences it recruits. But they are all non-specific. Any similarly complex combination of influences might perform the same. A program of regular massages would be the closest that mainstream medicine might be able to come up with since that has modest credibility within our profession. . .

      (2) Is it ethical to lie to patients regarding the efficacy of acupuncture to enhance placebo?

      Speaking of “textual baggage” — :-) It is not yet established that acupuncture should be lumped entirely in with placebo (relaxation, distraction, endorphins?) . However, if a patient raised acupuncture or I was tempted to suggest a try of it to a desperate patient with no other options, I would say no more than “it seems to help some people” which, according to you, is a truthful statement.

      If they wanted to know more I would tell them that I thought it probably mainly via relaxation, distraction and other psychological and non-specific means.

      (3) Should we invest scarce research dollars in research on acupuncture or other forms of placebo?

      Briefly, no — there is no point to repeating studies where we can now predict the outcome beforehand. What we do need, however, is objective surrogate measures for symptom severity. , They might eventually arise from neurophysiology. in the meantime any new studies into any of these matters should concentrate upon as objective measures as possible, such as pill counts, time off work — that type of thing.

      (4) If we research acupuncture, are we required to provide written informed consent to subjects that it is placebo?

      I am not sure that I can answer that. What question is the study trying to answer?

      1. Badly Shaved Monkey says:

        some SBM writers to too dogmatically dismiss patient-reported subjective benefits as entirely illusory, or as so close to that that it doesn’t matter for any purpose? Note how this seems to be BSM’s take-home message after quite a long association with this site.

        It may seem to you, but I have no idea why it does since I have laboriously explained several times that I do not regard the subjective experiences as illusory.

        Oh, well. I give up.

  81. You still haven’t addressed my thought experiment Peter. Have a little intellectual honesty and address it.

    SBM writers to too dogmatically dismiss patient-reported subjective benefits as entirely illusory, or as so close to that that it doesn’t matter for any purpose?

    I won’t speak for others, but that is not my stance and you have been unable to address it. Instead you attack that straw man repeatedly.

    You might also, in that case, agree with me that describing the status of acupuncture with the bald statement “it doesn’t work” is a morally, medically and scientifically unjustified attempt to unduly influence public opinion and behaviour in this matter.

    Interesting. You think it is unjustifiable to tell people that a modality which itself has no benefit but has the side effect of placebo effects and responses doesn’t work? Because that is the crux here. Acupuncture is not doing anything. The science tells us that rather clearly.

    It is disingenuous to post hoc claim to be applying a special meaning to that phrase, as Andrey does, when there is utterly no question as to how the public will interpret it.

    I am applying no special meanings. You once again gloss over the study you yourself showed me which demonstrates smaller effect sizes when the needles penetrate the skin. We both know where you do or don’t stick the needles doesn’t matter. So what part of “acupuncture” is “working” in any way, Peter? Is it the “acu” or the “puncture?”

    So when someone asks “does acupuncture work?” I can say “No.” Nothing about the actual practice of what “the public” interprets as “acupuncture” is actually “doing” anything. And in a very clear and real way that is the case – because any reasonable person of the public will not like to be signing up and paying for something when it is everything except that thing which is leading to any actual or perceived benefits.

    This is where you are intellectually dishonest and disingenuous because you cannot admit that there is absolutely nothing unique or special about acupuncture in evoking placebo effects and responses. In fact you keep on trying to assert that it is unique well beyond any realm of evidence or science.

    (1) Is acupuncture the optimal way to deliver placebo?

    Actually, probably yes, in an amenable population, because of the sheer number of psychological and minor physiological influences it recruits. But they are all non-specific. Any similarly complex combination of influences might perform the same.

    Once again, nothing unique about acupuncture. You are even forced to admit it yet refuse to actually act on the ramifications of your admission.

    But furthermore you make an absolutely ludicrous leap in order to justify your stance on acupuncture. Based on what possible evidence can you assert that “acupuncture is an optimal way to deliver a placebo?” Ah yes, by glossing over the inconvenient fact that actual penetration with needles is associated with a smaller effect size and ignoring my thought experiment.

    It is not yet established that acupuncture should be lumped entirely in with placebo (relaxation, distraction, endorphins?)

    Oh sweet Raptor Jesus on a pogo stick. Really? All the data – once again including the study you admonished me to read the discussion of – show no appreciable difference between any manner of applying “acupuncture” and somehow you still are desperately grabbing at straws to say that it isn’t quite yet able to be lumped entirely within placebo?

    However, if a patient raised acupuncture or I was tempted to suggest a try of it to a desperate patient with no other options, I would say no more than “it seems to help some people” which, according to you, is a truthful statement.

    And I would consider that unethical because I know that the only means by which they are likely to get that acupuncture is by going to someone who believes in it as a whole system of nonsensical medicine. It would be like me genuinely believing that marijuana is a good choice for my patient and telling him to go find a drug dealer to buy it. Even if I was right about the marijuana helping in that case, exposing my patient to the risks – legal and physical – of procuring it via illicit drug dealers would be unethical. And so it is with acupuncture.

    NB that this is different than a patient who is already receiving treatments. I would ask about it and counsel the patient. But I cannot recommend it and if a patient asks I would feel obligated to caution them against it for exactly those reasons. You know “informed consent” and all.

    Stop dodging around and confront the problems with acupuncture that you gloss over and/or conveniently ignore. You make unwarranted assumptions that are much more likely to be false or well demonstrated to be false in your endeavor to salvage acupuncture as the placebo that may be worth turning a blind eye to. Now that is unethical and paternalistic.

  82. My remarks applied specifically to the validity of Jenny’s perceptions, with a bearing upon whether sceptics are justified in being as dismissive of them as is usual in such interchanges.

    Yes, we are justified in being dismissive. In the exact same manner that someone who claims a near death experience can be dismissed. Or someone who claims to have “felt the holy spirit” or some other such nonsense. Yes, those experience may have felt real to the person but that does not actually make them real.

    As you also say, we can have no certainty as to how useful this procedure might be for her in the long term. So I ask, is any threat to her well-being from this experiment real enough to justify a thoroughly mean-spirited and discouraging, even aggressive exchange, with her?

    When you tell a believer their beliefs are false they are always perceived as “mean spirited and discouraging.” Having your beliefs challenged is always difficult. But you must not be paying attention if you think that our responses to Jenny here have been “thoroughly mean-spirited.” Do you really believe my comments to her can be characterized that way?

    She knows that acupuncture is no miracle-worker.

    Perhaps. But she falsely attributes any benefits, real or perceived, to acupuncture.

    And you are still dodging my very pointed questions about the thought experiment and the reality that your own reference undermines your position. Convenient to ignore the gadfly that you simply can’t address because you don’t have the evidence to back up your assertions. But after all, it is easy to dismiss me because I just don’t have the mountains of clinical experience you do and thus your opinion is worth more than mine.

    Also funny how pretty much everyone here can see the science and evidence for what it is and is commenting how much more you are reading into it to try and make the assertions you are. Which, btw, are once again unclear. What is it that you are trying to say? You admit there is nothing special about acupuncture (while at the same time claiming it is special and reserve the sliver of hope that it has some direct effect), you admit we can’t use it in actual medical practice for myriad reasons, you admit that at least the bulk of the effects seen are from placebo responses and effects (though we quibble about the size of each component), so what is left? You “challenge” us to address the questions raised by the concept of non-specific effects having large sizes and genuine physiological effects. We have. I certainly have. Yet you still keep tying it back to acupuncture which is a total non-sequitor. It has been established that the acupuncture itself is not of interest or utility, but that the non-specific effects are. What more do you want? And why must we adopt you attitude toward the pseudoscientific and otherwise non-utile delivery vehicle for the effects?

  83. @BSM:

    Exactly my own frustration with pmoran. He says there are questions raised – there are. He says that non-specific effects can be profound and potentially useful. I agree. He says that we cannot dismiss the subjective experience of an individual as being made up or them lying, knowingly or not. I also agree.

    And then he insists on somehow trying to tie that all together as evidence for the utility of acupuncture and as a problem for us in medical practice. Yes, I agree it requires a little more nuanced discussion and clear delineation as to what exactly one is talking about, but that is something we have been doing, is it not? I have also been clear that I absolutely believe Jenny and that she most certainly experienced what she did, but that she is merely mis-attributing the experience to the acupuncture itself and likely magnifying the perceived effect size due to numerous confounding cognitive biases we all have.

    Or am I totally off base? Do you read something different in what I have said? (assuming you have been reading it, of course).

    1. Badly Shaved Monkey says:

      We agree in all the essentials as you have just expressed them and also below (http://www.sciencebasedmedicine.org/acupuncture-doesnt-work/comment-page-2/#comment-140562).

      I don’t see how the case can be put any more clearly, so in the catchphrase of Dragon’s Den, “I’m out.” http://youtu.be/U_LsCRgs_Pg

  84. MadisonMD says:

    pmoran:.

    You might also, in that case, agree with me that describing the status of acupuncture with the bald statement “it doesn’t work” is a morally, medically and scientifically unjustified attempt to unduly influence public opinion and behaviour in this matter. It is disingenuous to post hoc claim to be applying a special meaning to that phrase, as Andrey does, when there is utterly no question as to how the public will interpret it.

    Wow. I’m stunned by your ejaculation of what is justified “morally, medically, and scientifically.” How personally invested are you in acupuncture?

    “Acupuncture doesn’t work” is a scientifically accurate statement, explained in Dr. Novella’s post. If you want to redefine ‘works’ to include the placebo effect, then I have some fantastic magnets and a few herbs to sell you for $50 each. They work according to you. To be consistent, please also admit the effectiveness of homeopathy, sugar pills, Perkin’s tractors, bloodletting and just about every patent medicine from the 19th century. Your definition of ‘works’ generates a wonderful portal into quackery. Enjoy your journey over there.

    From your response to my questions, pmoran, you seem to think that it is unethical to lie to enhance placebo. You also seem to think it is useless to engage in further studies of acupuncture. I agree with you here.

    1. Andrey Pavlov says:

      I’m in complete agreement. That is the point that I have been trying to make. Acupuncture can only “work” in the sense that homeopathy “works”. And I am quite content saying homeopathy doesn’t work. And when someone says, “But my homeopathy made me feel like a million bucks and my legs all wobbly! Nothing else does that! That’s no placebo!” I will be obliged to tell them they are mistaken and that the homeopathy could not have possible had that affect. I can, and do, say that with utmost confidence. I imagine pmoran would as well.

      I agree that with acupuncture I cannot say it with as much confidence as homeopathy. Probably not quite as much as with reiki either. But definitely still with enough confidence to it doesn’t work. And bolstered by the fact that the actual effect size is still disputable small to moderate but undisputably not from anything that the acuncture itself is doing.

      Yet Peter will undoubtedly rebut with something along the lines of hiding in the small window possible, though not highly likely, for effect to be directly through something unique to acupuncture itself. Regardless of how insignificant that may be. But he’ll also try to muddy the picture by saying that placebo effects – there real, physiological changes induced by psychogenic influences which I agree exist – come as a result of acupuncture and since that causes objective physiological change we cannot say that acupuncture “doesn’t work.” Since it is objectively “working.” Yet he’ll conveniently ignore the fact that those placebo effects are a side effect of everything except the actual acupuncture itself (the putting of needles in or on the skin). Heck, he’ll continue to gloss over that the meta analysis he himself tried to rally to his defense actually demonstrated a smaller effect when the needles penetrated the skin. And of course when it comes to the myriad other studies which show so much equivocal results and so much study heterogeneity with so many very different things being called “acupuncture” he glosses over the underlying fact that there simply is not good data to say that acupuncture does “work” robustly and plenty to tell us that at a minimum the signal is so weak it is consistently drowned out by noise. He even admits that other elaborate rituals within a friendly cultural construct could likely have the same salubrious effects.

      But no. Acupuncture to him cannot be said not to work, is likely the optimal delivery system for placebo, and challenges the “stridency” of science based medicine’s condemnation of it as “not working” and nothing but an elaborate placebo. Because gosh darn it, some people have misattributed their state of health to an acupuncture session and, becoming convinced of its efficacy, and it sure probably maybe helped them out. But we can’t use it. Even though it’s totally awesome for some people. So we should just be less mean to the acupuncturists. Or something. I still can’t quite figure out what Peter’s end game is. What it is he is actually advocating us to do besides be less mean, by his standards of course.

  85. weing says:

    Think of acupuncture and other placebos as masturbation. Does something happen? Yes and no. Would you prefer the real thing?

  86. The more I think about it the more ridiculous the Argument from Antiquity becomes. There are so many examples of things that were thought true for extremely long times overturned unequivocally I just can’t fathom how people can still rely on that argument after even the slightest amount of thought. In fact, as a sort of by product from the way science works and of course the fact that most of our history as a species was very much pre-scientific there are – and should be – more things that were thought right for a long time that have been shown to be wrong. In other words, having been thought correct for a long time actually decreases the prior probability of it being right! At some point we will reach a break point where that will cease to be the case, in fact it is entirely possible we already have or are very nearly there. But from a simple thought experiment standpoint being a very long standing idea – particularly one formulated >1-200 years ago – significantly decreases the Bayesian prior that the idea is actually correct.

    Actually this is very similar in thought to Ionnidis’ paper in which he discusses the likelihood of any scientific paper being published to be accurately reflective of reality (I think that is much less ambiguous than saying “is correct” or “true”). So I think it is reasonably safe to say that those numbers are more or less the upper bound of the likelihood of something being accurate and true. Which means anything prior to those methodologies must have a vastly lower likelihood.

    But you don’t even need that much sophistication in thinking about it to realize just how ridiculous the Argument of Antiquity actually is.

    1. WilliamLawrenceUtridge says:

      For me, the thing is – if something is old and right, it should be demonstrable through research. If it’s old and wrong…

      If it’s a powerful effect, it should be observable with smaller groups and fewer studies. If it’s a mild or weak effect, you will need more tests and a larger n. And if it’s present, but extremely weak, such that you need 3,000 studies to identify it, then perhaps it’s not worth the time, effort or risk.

  87. JAW says:

    I’m confused…accupuncture can be effective for pain and nausea. (True in my case)…so it’s like taking Tylenol without toxic build up of drugs? …I’m three treatments into a series of six and keeping my own journal .Dont worry I won’t put any anecdotal info here….I will make my own judgements. I was at a funeral today where I gabbed for a bit with a doctor who refers patients to accupuncture. For pain. The doc said to me,” whatever, works for most of my patients…”

    1. WilliamLawrenceUtridge says:

      Nope, acupuncture may unreliably for some people alleviate subjective pain and nausea. It doesn’t heal the injured tissue, nor does it cure the food poisoning making you nauseated. It doesn’t work all the time, it doesn’t work for some people, and it doesn’t necessarily work over the long term. It does pose a risk of infection, bruising, clots and the other consequences of penetrating the skin. I actually don’t have that much problem with acupuncture from a pure clinical treatment perspective with a few caveats (as part of treatment by a real doctor, use retracting needles, don’t penetrate the skin, avoid delicate tissues, no “thousands of years of use”, no “qi“, and above all, no bashing real medicine). From a scientific perspective, there are tremendous limitations to the claim that acupuncture has any specific effects and can be most sensibly explained as a series of interventions that combine to deliver an enhanced placebo. The real problem with acupuncture (aside from the direct risks of puncturing a lung or HIV infection) is the corrosive effect most of the practitioners have on real medicine because of the massive pile of fallacies they throw out (witness Stephen’s constant harping about the dangers of medicine, the evils of pills, the greed of doctors, et al).

      The doctor you talked to is what we refer to as a “shruggie”. Sure, whatever works for your patients…unless they decide to start seeing the acupuncturist instead of a doctor. Unless they decide to use tiger penis instead of herceptin to treat breast cancer. Unless they decide they have chronic Lyme disease instead of simply being middle-aged. Properly contextualized, CAM is not particularly harmful and can be useful for the worried well as a way of giving them candy while keeping them healthy. However, it’s deceptive, infantilizing, and wastes both time and money. Not to mention, if you have a bit of nausea one day, and decide to go to your acupuncturist – are they qualified to distinguish it from pancreatic cancer? Given that can kill you over the course of months, how would you feel about spending six of your remaining 12 weeks getting stabbed with needles rather than ticking off a bucket list? Particularly if you didn’t know it was your last 12 weeks on earth?

      I wonder what your shruggie doctor thinks about that?

  88. Jenny says:

    Oops …signed off wrong…it’s Jenny, back again ;)

    1. And this is just the acupuncture part …. once you use it as Travell/Simons, Myofascial pain and dysfunction or Gunn or Rachlin … the results are more profoundly better.

    2. WilliamLawrenceUtridge says:

      What kind of doctor are you?

      Why on earth are you citing a bibliography from 1997 that was archived in 2004? I mean, there are numerous meta-analyses that date from the past year that incorporate the highest quality acupuncture trials that, rather than a sloppy list where you can’t tell the quality. They’re negative. Your url is barely better than plugging “acupuncture is worthless” into a search engine (which gets 4.7 million hits by the way). Did your education cease in 1997, or is it a year of special note to you personally? Also, that list doesn’t include the most recent results, which control for needle penetration, which show that penetrating the skin appears to be totally unnecessary.

      It’s like you don’t know how research works, or how to do it properly. It’s almost as if you were only interested in science if it supports your conclusion a priori. Which is almost certainly the case.

  89. Jenny says:

    There seems to be lots of talk about HIV on here….I ‘ve only go e to a very clean facility, each needle in a separate package that has to be ripped open. My skin is cleaned with antiseptic as well…from a laypersons point of view seems much more likely of side effects from drugs. And as for an acupuncturist missing a cancer diagnosis….well, that’s why I see my doctor always who is a good diagnostician. But she in 18 years hasn’t really helped me with irritable bowel ( my mom has it too)… So I don’t go to acupuncturists for all things…..I go to my chiropractor who is great ( rarely need to go now)…. I see a naturopath that helps me to some degree….I get massages….so don’t worry the public is not that dumb to have total faith in one thing. OH…. On an interesting side-note: years ago I worked for an organization that would need people to host events. The easiest ones to work for?? The drug companies. Because they had tons of money to throw around and woo doctors….

    1. weing says:

      @Jenny,
      Very interesting. Your doctor hasn’t really helped you with your irritable bowel. You’ve sought out a chiropractor who helped you greatly. So much so that you rarely need to see him now. But, not enough apparently, as you had to seek out a naturopath that also helps some. But, again not enough, as you go for massages that also help. Again, not enough, as you are now going for acupuncture, which is also helping you so, so much. Do you get the pattern? All the CAM is helping you so much. Only the actual medicine is not really helping you. Why? Because drug companies have money to throw around to woo doctors. That sounds really logical. Doesn’t it?

    2. WilliamLawrenceUtridge says:

      That’s fine, but discussions are always informed based on aggregate risks (by your rationale, medical discussions would never include any mention of risks since they are also low).

      As usual, the discussion is polluted by comparison with drugs – the choice is not “acupuncture or drugs”, and the comparison should not be either. The choice is “should I have acupuncture at all”. As I stated in my previous comment, I don’t have huge problems with acupuncture given firm limitations – one of which is a discussion of the risks. The risks are exacerbated when the patient, or the practitioner, is deluded enough to believe acupuncture is a substitute for actual care. If they do, their life is in danger. If they don’t, then it is merely an expensive placebo.

      Why do you see a naturopath? They are either completely redundant to a nutritionist, or they provide completely useless advice such as “use homeopathy”, or they provide unfounded and risky advice (“Here, try this herb. In rats it reduced nausea”; know what reduced nausea in rats with perfect safety? Thalidomide).

      Yes, the fact that Big Pharma throws around money is an issue, we are well aware of this and it’s a problem. Despite doctors protestations of innocence, there is excellent scientific evidence that it works, too, and they shift prescribing habits. The medical community is well aware of this, and attempts are being made to address it. Ben Goldacre’s Bad Pharma goes into this and related problems extensively, it’s part of conventional care’s ongoing attempts to improve itself along with CME and research on how to improve care.

      But, as usual, the fact that Big Pharma throws around money has nothing to do with the safety and efficacy of acupuncture. Can you please stop ignorantly throwing this fact around if you want to talk about acupuncture? The choice is not “acupuncture or drugs”, one can both or neither. If you choose acupuncture and drugs, you are increasing your risks and benefits because you are choosing both.

  90. pmoran2013 says:

    Very cute, Weing. :-)

    To others —

    I favor an approach which focuses more upon CAM’s real dangers. It would be firm where advice and opinion needs to be firm, but softer where compassion and the primary objectives of the practice of medicine outweigh other considerations. .

    For example, patients with the irritable bowel syndrome can be in misery on and off for years before most cases seem to eventually ease up. So, within limits, whatever helps Jenny over her bad periods, even if for only a while, cannot be all bad and we should be unreservedly wishing her well, with a minimum of undermining of her perceptions.

    We don’t have to regard every interchange as part of a righteous crusade against pseudoscience. There is a tightrope to be walked therein, but anticipated gains in empathy and patient trust (see below) may help us to walk it together.

    Few on SBM would argue strongly against that approach when thinking of their own patients. Why should our public stances be unnecessarily confrontingly different (“Acupuncture doesn’t ‘work’” )

    My approach would be only slightly different in emphasis, but it would have major practical implications for how we deal with “healthfraud”. For example, “it seems to help some people” as a generic attitude to reported subjective responses to CAM, is not taking upon itself the Quixotic task of elevating whole populations to the degree of scientific sophistication needed to even start to answer deceptively simple questions like “does acupuncture ‘work’?” and “if so, how?”. Those with the wit to be at all receptive to sceptical modes of thought will already have a good idea how it thinks.

    Above all, such an approach, while being quite consistent with the scientific data, removes some of the dissonance created when supposed scientific opinion conflicts starkly with intense personal experiences or compelling testimonial. We see this every time a CAM supporter visits these pages.

    If you will we, might have a duty to permit people to “fool themselves” when that may be what they are most medically in need of, while offering firm advice when that would be unwise.

    1. MadisonMD says:

      I mostly agree with this pmoran. One could accurately honestly state that acupuncture, supplements, homeopathy, and many (harmless) forms of quackery have placebo or psychosomatic effects that help some people. However, I diverge on three crucial points:

      (1) Honesty is required. Physicians need to be honest about nonspecific, placebo, or psychosomatic effects. Nobody deserves to be misled or lied to by a clinician in a position of authority. A major problem here is that most acupuncturists will make false health claims and minimize risks. Mr./Dr.? Rodrigues is a good example.

      (2) No promotion of magical thinking. Our patients are faced with conflicting health recommendations daily. While we may permit individuals to ‘fool themselves,’ it is important nevertheless to promote rational and critical thought. A patient-physician encounter, is not an appropriate forum for a “righteous crusade against pseudoscience.” However, it is a teaching moment in how to choose amongst magical and rational health choices, and how one can know the difference.

      (3) Avoid quacks. Often acupuncturists, naturopaths and other alternative providers provide multiple forms of quackery. They read tongues. They make fake diagnoses. They give herbs. They make medical recommendations. I have encountered more than a few who recommend that patients discontinue medical treatments. This is dangerous.

      Most Americans do not use acupuncture. Most view it as a fringe practice. I view it as the same. If a patient tells me s/he uses it, I might discuss some of the above. If a patient says he/she is interested in acupuncture, I might express the reservations above. If a patient asks me for advice regarding symptom management, I would not recommend it for the reasons above.

      The Science-Based Medicine blog is not a forum for patient-physician interactions. The title of this post– Acupuncture doesn’t work– stands and is fully accurate.

  91. Jenny says:

    To William Lawrence:I understand many of your points. But as a doctor ( I believe you are?) you have shown your ignorance by asking why I see a naturopath. Well, the naturopath recommended things never mentioned by my doctor or by nurses when I was in hospital with a severe bout 6 years ago. Naturopath recommended a very watery brown rice soup (congee) and slippery elm which soothes the digestive tract. When I have a severe bout I do this regimen , slowly adding veg and meat to it, and it’s good. Typical to dismiss this world of naturopathy for many doctors unfortunately. The rest of your response I have to look at again….off for breakfast…. But the point about naturopathy really irked me

    1. WilliamLawrenceUtridge says:

      I am not a doctor.

      You have shown your ignorance in seeing a naturopath, the profession is inherently worthless. It is either redundant, or it is wrong.

      How do you know your practice isn’t lengthening the duration of your symptoms? How do you know it’s not doing long-term harm to your digestive tract? How do you know it’s not leading to nutrient deficiencies? How do you know the slippery elm bark isn’t making things worse? If you take medication, it may interfere with its absorption.

      Naturopaths irk me. They claim to be “cutting edge science” practitioners, while using homeopathy which was disproven over a century ago. They don’t understand that “cutting edge science” often means “in a test tube” or “in a rat”, ignoring the number of medications that were proven in a test tube or rat, but then failed in human trials. And they frequently oppose vaccination because, apparently, they are fucking idiots.

  92. Hi Jenny,

    WLU is not a physician and generally makes that rather clear. Easy enough to miss though.

    However, as for naturopathy, he is right. Coming up with different things than a physician would is easy – we are bound by evidence and science. Naturopaths know no such bounds and can – and do – recommend whatever they can make up. That is why we are indeed very much against them, because their fundamental basis for understanding the human body and pathophysiology is not just different, but demonstrably wrong. Homeopathy, for example, is a core requirement for the education and certification. There simply cannot be any question that homeopathy is 100% pure placebo in the most literal sense – sugar pills.

    In your specific case, the naturopath recommended nothing quite earth shattering. Yes, it may have been specifically for the congee but the real point is to have something very bland and readily digestible. Something a dietician or even myself as a physician can and would recommend. In fact, I’d be willing to bet your physician did recommend such a diet. It just happens that through some extra suggestion, the novelty of it, and perhaps a genuinely better fit the recommendation for congee seemed more effective and because of the temporal correlation it stuck in your mind whereas the physician recommendation did not. The slippery elm is not something I am familiar with but would be willing to bet has no effect at all except to heighten the placebo effect you feel from the ritual of eating congee during your painful episodes.

    But I can assure you that we do not merely dismiss naturopathy because they are different or think different things to us. In fact, the bedrock of science and scientific inquiry is to be around as many people who think differently to you as possible! We love being challenged and love even more being proven wrong. I never learn more than those times someones demonstrates to me I have been mistaken. But we must all speak the same language of evidence and scientific rigor. And the naturopaths do not. Their claims fail spectacularly when held up to scientific rigor and their premises are known to be false. It is for these reasons we dismiss them. They simply do not have evidence to support their claims and plenty to demonstrate them false.

  93. I favor an approach which focuses more upon CAM’s real dangers. It would be firm where advice and opinion needs to be firm, but softer where compassion and the primary objectives of the practice of medicine outweigh other considerations.

    Agreed. And exactly what I have been advocating as well. And what I practice. And what I see Drs. Gorski and Hall practicing.

    For example, patients with the irritable bowel syndrome can be in misery on and off for years before most cases seem to eventually ease up. So, within limits, whatever helps Jenny over her bad periods, even if for only a while, cannot be all bad and we should be unreservedly wishing her well, with a minimum of undermining of her perceptions.

    Ah, now there’s the rub. You are advocating that we here, in an online forum, on a website devoted to drilling down the the essence of the nitty gritty of topics, where she has come to us and not the other way around, tiptoe around the topic so as to try our best to maintain her delusion. Sorry Peter, but that is quite unreasonable.

    Now, with my patient on an individual basis, in my private consultation room, I may work harder to be a little more diplomatic. I may well say something along the lines of “well some people seem to think it works for them, despite evidence showing that it probably doesn’t. If you find benefit then I won’t ask you to stop, but please pay attention for [X,Y,Z potential harms] and feel free to read up on the topic to determine for yourself what makes sense.”

    Few on SBM would argue strongly against that approach when thinking of their own patients. Why should our public stances be unnecessarily confrontingly different (“Acupuncture doesn’t ‘work’” )

    Right back to the old disagreement we’ve long had. Because it is a completely different audience, Peter!. Why would I have a different approach when speaking to a child, or a layperson, or a fellow doctor, or a fellow non-medical scientist, or a room full of medical students I am lecturing, or writing an article for mass consumption? It is you who quite unreasonably thinks that the different stance is “unnecessarily confronting.” You realize that you are essentially demanding that all such conversation be censored to some degree in order to preserve the feelings and delusional beliefs of those who may happen upon our pages? You may have an argument if I went door to door and asked random people “Do you believe acupuncture works?” and then drowning them in studies and rhetoric if they say yes. That would be “unnecessarily confronting.” But writing on our own part of the intertubes about topics we find compelling in an unreserved but fair and evidence based manner is perfectly reasonable.

    The internet is a place where people choose to go and should damned well have the option to have their false beliefs shattered to bits. That is, in large part, why there is a large “rise of the nones” and significant backlash against religious ideology. Because there are no longer ways for tone trolls (aka priests) to silence and censor criticisms leveled against their delusional beliefs. Well, the same with pseudoscientific ideology in the realm of medicine.

    I believe we have a higher ethical standard to live up to in our physician-patient interactions and I would absolutely decry a physician who metaphorically slapped the acupuncture needle from granny’s hand. But this is not a physician-patient interaction. Jenny has come here and here is where her beliefs get challenged. If she doesn’t like it, she can go elsewhere. If she keeps standing up to it, then hopefully we’ve done some good and planted a seed to get her critically thinking. And if not, then nothing’s gained and nothing’s lost.

    So will you accept that your argument continues to boil down to being a tone troll and that we have noted it and dismissed it?

    For example, “it seems to help some people” as a generic attitude to reported subjective responses to CAM, is not taking upon itself the Quixotic task of elevating whole populations to the degree of scientific sophistication needed to even start to answer deceptively simple questions like “does acupuncture ‘work’?” and “if so, how?”.

    Funny. My goal is to elevate whole population to that degree of scientific sophistication. But then again, I’d rather educate for change than waste my time waddling through the middle ground of accommodationism and letting people continue to be deluded and tricked into spending their money frivolously. I suppose I’m just less paternalistic that way.

    Above all, such an approach, while being quite consistent with the scientific data, removes some of the dissonance created when supposed scientific opinion conflicts starkly with intense personal experiences or compelling testimonial. We see this every time a CAM supporter visits these pages.

    Except that this is a very provincial and short sighted outlook. Yes, it might be a bit more favorable in a certain context for the short term. But the moment someone – and you best believe some sCAMster will – looks just a bit more deeply and then rightfully calls us out for being soft on one type of CAM but hard on another what is our response? We are forced to say “Well, yeah, but this other one has more harm and we were just being patronizing and paternalistic in tacitly endorsing this other one since you dumb lay public can’t possibly understand the nuance of our discussion so we figured we should just let you have that one and delude yourselves so we can save up our righteous indignation for when we think you are hurting yourselves more.”

    Wow. What an arrogant and paternalistic way to go about things. Deciding where the harm is significant enough to you and translating that to everyone else in order to decide when you will be nice and slippery with your rhetoric. That actually sounds like a pretty terrible idea to me, especially these days.

    If you will we, might have a duty to permit people to “fool themselves” when that may be what they are most medically in need of, while offering firm advice when that would be unwise.

    Once again, that could be argued on an individual patient basis within the construct of an actual physician-patient relationship. It cannot be argued here, on the web, where there is no such relationship and those very same CAM supporters come to us and not the other way around.

    Oh, and you still haven’t addressed my thought experiment. But good job on being a tone troll and chucking in a demand for a little censorship to boot.

    1. WilliamLawrenceUtridge says:

      In your consultation room, you would work harder to be diplomatic. It’s harder to be blunt when you’re facing a person, and even when being blunt it is very possible to convey concern and sympathy through tone, posture and expression. And it’s far more evocative for the patient as well, since it’s easier to tell if you are being sincere or not.

      It’s hard to deal with a patient on the web, since you don’t have all the details, you can’t necessarily ask and get answers to questions, you don’t know if someone is telling the truth, you can’t order labs, you can’t review treatment notes, etc. etc. etc. and that’s not even covering the tone and person-to-person interaction elements.

      In addition to being rather unwilling to allow logical fallacies and bad science to stand, on the internet I’m also ill-inclined to let patient testimonials stand unchallenged. If someone demands that I believe them that “it worked for them”, this isn’t a website they control. If they want to bathe in their unchallenged confirmation bias, they can start a website. I will be polite, even as I do my best to point out why they might be wrong. I am wrong all the time. I like it when it is pointed out to me, so I can improve. If you want unstinting echo chamber discussion, go somewhere else.

      1. MadisonMD says:

        In your consultation room, you would work harder to be diplomatic. It’s harder to be blunt when you’re facing a person, and even when being blunt it is very possible to convey concern and sympathy through tone, posture and expression. And it’s far more evocative for the patient as well, since it’s easier to tell if you are being sincere or not.

        WLU: You would be surprised at how often a patient appreciates being told the blunt truth. It must be diplomatic, non-judgmental and given with the sole purpose of helping the patient. The degree of certainty by which the truth is or is not known should also be told. In any case, the truth must out– it is integral to the doctor-patient relationship. Under these conditions, most patients are appreciative. You, too, deserve as much from your physician.

    2. pmoran2013 says:

      Andrey: “But the moment someone – and you best believe some sCAMster will – looks just a bit more deeply and then rightfully calls us out for being soft on one type of CAM but hard on another what is our response? ”

      The answer would be obvious to you if you had thought this through to the same extent as I have. On the one hand we are talking about subjective responses, that will be affected by myriads of factors, that are not easy to pin down in scientific study, and where “life or limb” outcomes are usually not involved.

      On the other hand we will be talking about claimed objective changes in serious disease states in which outcomes are readily measured and beneficial effects, if as marked as is typically claimed, should be easy to demonstrate in the simplest of clinical studies.

  94. Jenny says:

    Hi Andrey,
    I’m in Canada by the way…but I thought naturopaths had something like 6 or 7 years education. I’d like to add that my sharp, lovely doctor talked about bland food, but I tried that. For years. Didn’t help a lot. The watery rice soup a different thing. When I was hospitalized for four days no mention of nutrition.But this is off the accupuncture theme….I just find now that your biases are making me less interested in turning to this blog any further. It’s not that I haven’t taken some of the info to heart and will take heed , …but honestly, it just seems typical of doctor rants. My own doctor will remain an important part of my care. I will continue to research info and thank you to all for taking time to respond ….

    1. WilliamLawrenceUtridge says:

      Naturopaths have an undergraduate degree, followed by four years education in naturoapthy. I know because I looked into it years ago as a possible career choice. Meanwhile a doctor has an undergraduate degree, several years of medical school, and an internship for another couple years – far, far more than a naturopath, and focused on real science and reality rather than discredited nonsense we inherited from the Greeks. You say this is a “typical rant” by a doctor (not a doctor, by the way), but it’s so much like the Emperor in the story “The Emperor’s New Clothes”. People loudly proclaim the superiority of naturopaths, meanwhile ignoring the recommendations made by naturopaths are hardly earth-shattering. For instance, the consumption of congee is the go-to recommendation for Asian cultures when sick, much like chicken broth is in the West. Have you ever tried chicken broth? They are used for the same reasons – easily digestible while still providing some nutrients. So this is an example of naturopaths once again stealing from somewhere else rather than providing any meaningful commentary based on their central dogma. Want a naturopath to impress me? Show me a way for them to transfer vital energy to keep people alive. I’d stick with a banana bag myself.

      The definition of “bland” is a slippery one by the way. Rice is almost pure carbohydrate, a diet high in rice runs the risk of causing nutrient deficiencies. There’s no protein, and polished white rice has almost no fiber. Wheat, which might have been your go-to choice instead, is considerably more complicated. It has almost twice as much protein for instance, more than twice as much fat, and the types of protein and fat are different. Fruits and vegetables are high in fiber, which white rice (particularly white rice gruel) would have little of.

      Your doctor spends years looking after your health, making sure you don’t die, a naturopath recommends congee and suddenly they’re comparable professions. Yeah, shit like that is why doctors rant about naturopaths. Ever notice how something is always in the last place you look? Yeah, in this case, the solution happened to be in the last person you talked to. I bet if you went to a TCM practitioner next, they would recommend acupuncture, herbs…and congee.

      1. Harriet Hall says:

        Consumption of white rice-based foods has been associated with an increased risk of stroke. http://www.ncbi.nlm.nih.gov/pubmed/21051005 I bet the naturopath did not discuss this or any other possible side effects.

        The NMCD lists slippery elm as possibly effective for sore throat but insufficient information to rate for any other indications. Wonder how the ND decided to pick it? What criteria do they use to select from the variety of untested herbal meds?

    2. weing says:

      “I just find now that your biases are making me less interested in turning to this blog any further.”

      Are you sure it’s not your biases that are doing this? Since we are not confirming them? And please don’t call it research. Call it looking for confirmation. Research is looking for disconfirming evidence. You stumbled upon it here. It is obvious you don’t like it and don’t want to look at it anymore. Enjoy your rice and watch out for the arsenic.

    3. In Canada a Naturopath has any undergraduate degree. Any one at all…literature, early Elizabethan poetry, interpretive dance. So that’s a minimum three years and then places like the CCNM offer a four-year course to become an ND.

      Let’s look at what they learn…

      56 Lecture hours in anatomy. That’s it. About the same amount of time they spend learning acupuncture points. Something for which there is absolutely no evidence for their existence, correspondence to practice OR efficacy.

      They also spend about as much time learning homeopathy – something that is so unlikely to be true it’s not funny.

      While I’m sure that there may be something of value in there, it’s hard to believe that there’s much.

      “The watery rice soup a different thing. ”

      Nothing magical about 粥. It’s also been made wrong if it’s watery. It should be more like a porridge. Ordering 薄稀稀粥 is for old folks.

      1. WilliamLawrenceUtridge says:

        Not just old people, some people enjoy the flavour (again, the same way we would enjoy chicken soup, and possibly for the same reasons) and it is a food given to the sick and invalids. I could completely understand why you would do this, it is an easily digested source of calories. You know, just like her doctor told her to eat in general terms, even if he didn’t identify this particular option.

        1. Jook (Cantonese for Congee) is generally (or in my circle of friends and family anyway) regarded as comfort food and eaten so I’m not surprised that people might eat it when they are sick. I’ve also seen people feed it to infants.

          If there is a practice of giving it to people who are very, very sick. It might explain the aversion I’ve seen to eating it this way.

          1. Should read: “as comfort food. So I’m…” and “If there is a practice of giving it very thin to…”

            We need an edit feature on posts.

          2. WilliamLawrenceUtridge says:

            Your facebook picture makes that statement…surprising. I’m not saying white folks can’t enjoy congee (I don’t, but whatever), but I didn’t even know it existed until one cold, dim sum morning when someone ordered this awful bowl of blandness.

            But hey, more for you, right?

          3. “Your facebook picture makes that statement…surprising.”

            Want to see surprise?…You should see the looks I get when I buy a Chinese newspaper.

            Anyway my wife is Chinese.. Even so I’ve always had a pretty broad palate. I’m not sure if he was testing me but the first time I took my father-in-law out to dinner (prior to marrying his daughter) he ordered something that was made of lungs and kidneys. Evidence suggests I passed.

            I agree Jook, on it’s own is pretty much the definition of bland. You almost always have something in it like seafood, 100 year eggs or preserved meats.

        2. Hah, I was actually looking for a different comment in the recent comments but came upon this.

          Congee is an often requested recipe in the parents of Chinese children with cleft lip and palate forum that I used to frequent. Lots of orphanage records have Congee or Jook (I believe) listed as a daily food (although sometimes translated as porridge). Since many kids have cleft surgery soon after being adopted there’s a need for soft food options. Many of the kids are not yet big on trying a lot of foreign (American) foods. It’s something nice to offer. I never knew if my congee was right, it was thicker than the Congee served at the restaurant(s) in China and more leek flavored, maybe.

          Sorry, to interrupt your discussion just brought back memories.

  95. Andrey Pavlov says:

    Hi Jenny,

    I can’t comment directly on exactly what naturopathy is like in Canada but I am reasonably certain it is close enough to that in America that my points still stand.

    That said, length of education is not a good measure by which to judge the competence of someone. That said, by the time I am doing with my education I will have had 17 or 18 years rather than the 6 or 7 of a naturopath. In fact, I already have 9 years under my belt and still have another 6-8 depending on exactly the course I am looking to take.

    But the real point is not how long they are taught, but what they are taught. And the majority of it is pseudoscientific quackery like homeopathy, iridology, appliead kinesiology, etc.

    You say I have a bias – but I do not. Nor do any of the othe authors here. A bias would imply that I am dismissing the claims of a naturopath just be (s)he is a naturopath. I am not – I am dismissing them on the basis of science, evidence, and logic exactly the same way I would dismiss or accept any claim made by any person.

    The fact that your naturopath was able to make a specific recommendation for a specific food that seems to help you more is simply not very impressive and almost certainly just a lot of luck. As has been pointed out, you wouldn’t be telling us this story if it hadn’t happened to work for you. There are simply very few people telling the story – we expect random chance to come into play and eventually someone will find the favor of that chance.

  96. and even when being blunt it is very possible to convey concern and sympathy through tone, posture and expression. And it’s far more evocative for the patient as well, since it’s easier to tell if you are being sincere or not.

    Precisely.

  97. Jenny says:

    Gosh you are eloquent….
    I tried meds for years….years….didn’t help me. Sorry to say it ( oops,…testimonial)….
    So, you ( and other doctors) are saying that natural substances that helped me quite a bit are worthless.) doubt it. Like somebody said in an earlier post based on Dragons Den ….I’m out. I get where you are coming from. You get where I am coming from. ….

    1. weing says:

      “I tried meds for years….years….didn’t help me.”
      Probably true. I don’t know what was tried and how they were tried. Chances are, nothing really helped you. More than likely, you are experiencing waxing and waning symptoms and mis-attributing the natural variations in your symptoms to your CAM interventions.

      1. Harriet Hall says:

        I had shoulder pain with restricted range of motion for a year, then I tried X. The next week, my shoulder was pain-free and my full range of motion was back. What do you think X was? Acupuncture, homeopathy, herbal remedies, chiropractic? No, I did absolutely nothing, and the symptoms went away on their own. But if I had tried any of those CAM treatments, I would naturally have attributed my improvement to them.

        1. WilliamLawrenceUtridge says:

          Definitely one of my favourite stories :)

          1. This is a good example of why we are arguing about what is true, truth and scientific evidence. All of which are relative. All our analysis of the articles are just our own biased opinions and assumptions. This is why this discussion is going in circles. Everyone statement hangs on a word or phrase which keeps this game going.

            Sorry to naysayers, but needles, hands-on care, mind-body, earthy therapies and man-made chemicals will be with us for all eternity. These treatments have evolved based on our DNA.

            Every therapy topic we have discussed just assist nature. Nothing works alone and must be used in combination with a well balance therapeutic plan. Guess who should decide what is best for them are the patients themselves. NO bureaucrats, scientist, insurance companies and surely not us.

            I am the only one here, just a coincidence (not an ego statement) who is in the practice of clinical medicine, who actually treats and manage complex pain, who understands acupuncture, needles, myofascial release therapy, what it is what it is not, how it seems to work or doesn’t work and whose only agenda is to help folks who want to understand these issues.

            I can only imagine what you are thinking now … LOL … I won’t take it personal!

            ( If you are afraid to ask a personal question, just email me privately. Some of y’all will have to see a mental health provider in addition because your therapy will be incomplete.)

          2. AnObservingParty says:

            @ Stephen,

            No, scientific evidence is not relative. That’s what makes it science. I do not think relative means what you think it means.

          3. WilliamLawrenceUtridge says:

            Science is the effort to generate empirical, and thus nonsubjective information, to overcome the confirmation biases and other negative habits of the human brain. Seriously, what kind of doctor are you? Apparently whatever medical education you had didn’t take.

            While we can disagree regarding the interpretation of the empirical findings, the validity of the instruments and the like, the process of science uses objective measures as much as possible. For instance, how many people can tell the difference between penetrating and sham nonpenetrating needles? Turns out – not many.

            Sorry to naysayers, but needles, hands-on care, mind-body, earthy therapies and man-made chemicals will be with us for all eternity. These treatments have evolved based on our DNA.

            This just seems like word salad, I don’t think your sentence contains any semantically meaningful information.

            Bureaucrats and scientists are great people to decide how resources should be distributed, because they rely on evidence. If patients decided what was reimbursed, we would be paying for 36 month stretches of antibiotics for chronic Lyme disease, the Liberation Procedure for multiple sclerosis, and antibiotics for rhinoviruses – because patients lack the medical knowledge and distance from their symptoms to evaluate whether there is evidence for their recovery.

            When you are treating people for complex pain and the like, what kind of medical designation do you use? An MD, an ND, a DO? Are you a medical doctor?

            I’m thinking you are credulous and unable to even understand the criticisms ventured for you.

    2. WilliamLawrenceUtridge says:

      You may doubt we are wrong, and believe slippery elm helps you. But that doesn’t make you right. Confidence is no substitute for evidence.

      Yes, I understand where you are coming from – a human brain, which is better at generating confirmation bias based on personal experience than it is questioning whether its personal experience reflects reality. Don’t forget, the part of your brain that assesses your symptoms is the same part of your brain that has decided they have abated (due to tree bark).

    3. Woo Fighter says:

      Jenny,

      Just out of curiousity, did your naturopath happen to, er, sell the slippery elm that was recommended to you?

  98. Badly Shaved Monkey says:

    And they frequently oppose vaccination because, apparently, they are fucking idiots.

    Thank you. Mr Hammer, meet Mr Nail.

    I am glad I was not consuming a hot drink when I read that. Coffee-snort risk = Extreme

    1. WilliamLawrenceUtridge says:

      You’re welcome :)

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