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Acupuncture for Macular Degeneration: Why I Reject the Evidence

This post is dedicated to two people who are frequent commenters on SBM, Stephen S. Rodrigues and Peter Moran. Rodrigues is an MD/acupuncturist who tries to persuade us that acupuncture is effective. Moran is a retired surgeon who objects to insulting language and thinks more can be accomplished by trying to better understand why people turn to CAM and by explaining the facts and reasons politely and dispassionately. He has claimed that he “could probably help [Rodrigues] understand better why his views are not having much impact.”

I recently wrote about supplements for age-related macular degeneration (AMD). There is evidence that the supplement mixture tested in the AREDS trial slows the progression of moderate to advanced disease. That is based on a good scientific study, although the study has not been replicated and there is reason to interpret its results with caution. Dr. Rodrigues commented with a link to a website advertising the Santa Fe acupuncture protocol, saying that he uses the method in his office and it helps some of his patients with AMD. The website claims that the Santa Fe acupuncture protocol will reverse vision loss from macular degeneration in 4 days or your money back. That is a bold claim. I will try to explain, as politely as possible, why I reject the claim, and why the evidence for it is unacceptable.

Two kinds of AMD: dry and wet

90% of AMD patients have dry AMD, where there is a thinning and breakdown of the retinal epithelial cells that support the photoreceptor cells (the rods and cones). It is asymptomatic in the early stages; then, as the disease progresses, visual acuity is lost and the unsupported photoreceptor cells die off. There is no medical or surgical treatment for dry AMD.

The other 10% have wet AMD, where blood vessels proliferate, leak, interfere with vision, and eventually destroy photoreceptor cells. Conventional treatment can’t cure AMD; it can slow progression of the disease but until the recent introduction of anti-VEGF drugs  it seldom improved visual acuity. Treatments include injecting potentially dangerous medications directly into the eye, intravenous injection of drugs with retinal photoactivation, photocoagulation with lasers (which can cause immediate reduction in visual acuity of three lines on the eye chart), and surgical removal of retinal lesions.

Why people turn to CAM

I fully understand the attraction of the Santa Fe protocol. People with AMD are desperate; they are going blind, and conventional treatments offer them little or no hope and are frankly scary. When they are told that an alternative treatment can reverse the damage that has already occurred, and when they are told the treatment is supported by testimonials, scientific studies, and a money-back guarantee, how could they not grasp at the only available straw of hope? Hope makes people feel better; but raising false hopes only to have them collapse after a substantial investment of time and money would ultimately make them feel worse. Does this protocol offer true hope or false hope? Let’s examine the evidence.

I can understand the attraction for acupuncturists, too. They want to believe they can help patients with a condition that can’t be treated any other way. Their patients report improvement and thank them profusely. Those who don’t improve are not likely to come back, so practitioners don’t see their successes in perspective with their failures. Confirmation bias takes over. Practitioners are gratified and reinforced. That kind of personal experience is very powerful but can be misleading. As Mark Crislip says, the three most dangerous words in medicine are “In my experience.” Humans regularly misperceive and misinterpret the meaning of their experiences, and that’s why we have to rely on the scientific method to correct our errors.

What is the Santa Fe protocol?

Dr. Alston C. Lundgren is a family physician turned acupuncturist. His website claims that his Santa Fe protocol is the only documented treatment to reverse vision loss in cases of both wet and dry AMD.

Apparently there are several versions of the protocol, as he added treatments through the years. On his website he describes three components:

  1. Small steel studs are inserted in regions of the ear whose nerve endings have been shown to correspond with specific areas of the brain. By stimulating these nerves, cortisone and oxygen-rich blood are induced in the region of the retina.
  2. Needle electrodes are inserted in the fat around the eyeball and are stimulated with a mild electrical current. These electrodes stimulate the retina and surrounding tissues and probably increase blood flow to the retina.
  3. In Spring 2007, a 3rd component was added – electrically stimulating the scalp over the visual cortex which occupies a considerable portion of the brain.

In one of his links, he describes his protocol as combining five types of acupuncture:

  1. German Ear Acupuncture to indirectly stimulate the optic nerve, the retina, and production of cortisol. (David Alimi, MD, Professor of Neurology and Ear Acupuncture at the University of Paris Medical School has demonstrated the one-to-one correspondence between points on the ear and areas of the brain.)
  2. Canadian Neuroanatomic Acupuncture with needle/electrodes surrounding the orbit which may increase blood circulation or directly affect the retina itself when electrically stimulated.
  3. Chinese scalp acupuncture – electrical stimulation over the visual cortex of the brain, hence reversing the damage of a stroke there.
  4. Japanese scalp acupuncture at points identified as stimulating the optic nerve and probably other areas of the brain involved in vision.
  5. French Energetics acupuncture to stimulate classic Chinese points affecting the eye, increase parasympathetic stimulus, and add energy to the patient for self-healing.

He says he has performed over 10,000 treatments on 1,500 patients and has improved the vision of 85% of them. He states that black eyes are a very common complication, so he routinely uses ice packs. He charges $250 per treatment, and typically administers five treatments on five successive days.

Dr. Lundgren is the only one who has published data on his method. He has no articles listed in PubMed. His website provides references, but they are all either articles he has written for an acupuncture journal that is not listed in PubMed (I couldn’t find it in any list of medical journal impact factors either) or PowerPoints he has presented at conferences. They all cover essentially the same material at different points in his journey, reporting data from his patients.

His published study

The most recent published article is this one published in the journal Medical Acupuncture in 2005. It reports a 69% improvement in vision. I will concentrate on the evidence for the Santa Fe protocol as presented in that study.

It reports a case series of 108 consecutive patients with ophthalmologist-diagnosed AMD who were treated by him at his clinic in New Mexico. 32% had wet AMD; 50% had dry AMD; 18% didn’t know which type they had. The patients gave informed consent, but there is no mention of oversight by an IRB. Treatment consisted of three acupuncture techniques:

  1. Auricular acupuncture to indirectly stimulate appropriate parts of the brain
  2. Neuro-anatomical acupuncture to directly stimulate the retina and periorbital tissue
  3. French Energetic Liver cerebral circulation stimulation to enhance eye function

For auricular acupuncture he says he does not clean the surface of the ear before inserting needles unless there is gross contamination. He leaves the needles in the ear until they fall out, anywhere from 2 days to more than a month later. He installs a gold semi-permanent needle (a stud?) for chronic stimulation of the most electrically active point. He applies electrical stimulation to the needles in techniques 2 and 3, but I couldn’t tell from his write-up whether he also uses electricity on the ear. He reports elsewhere that he treats daily for 5 days; but in this study he used weekly treatments, saying patients did not benefit from more than 3 treatments per week, and claiming that gaps of up to 4 months between treatments had no effect on the degree of improvement achieved. Each treatment session lasted 25-35 minutes. Patients were treated until they either dropped out or showed no further gains in 2 consecutive vision tests. He does not say how many patients dropped out. He says visual acuity improvements “did not seem to deteriorate for a year-and-a-half” but he provides no data. He describes other subjective improvements reported by patients: color vision seemed to improve (said to have been confirmed by testing in “several” patients), less contrast required for reading, improved ability to see in dim light or drive at night, straight objects no longer had wavy edges, scotomas shrank and disappeared, the “film over vision” or “fog” disappeared.

There were minor complications: ecchymosis in 10% of treatments, and a few infections around indwelling ear studs.

He is aware of some of the limitations of his study. He acknowledges that further research is needed to determine that the results are due to the acupuncture protocol and are not skewed by patients’ increased experience in taking the tests, their desire to please the investigator by performing well, or the Hawthorne effect from simply being part of a study. He wonders if the improvement might be due to effects on eye muscle rather than on the retina. He recommends further research to optimize the protocol.

Why I reject this study

I will refrain from commenting on the rationale of using acupuncture for AMD and the possible underlying mechanisms. I’ll just say that the prior plausibility is very low. Of course, prior probability would have to be re-assessed if acupuncture could clearly be shown to work better than a placebo. Does this study constitute evidence that it works? I don’t think so.

I’ll try to explain in simple terms why I reject this study as evidence.

  • There was no control group. When you do almost anything, patients seem to improve; sometimes they improve if you do nothing, just from fluctuations in the natural course of illness. With any kind of intervention, they will consistently get better results than if they were just assigned to a waiting list. We can’t conclude a treatment is effective until we can be certain that patients wouldn’t have improved to the same degree without the treatment. Lundgren himself has pointed out several factors that could have invalidated the results and that could have been ruled out by using a control group (increased test-taking experience, desire to please the doctor, the Hawthorne effect).
  • Selection bias could have influenced the results. Subjects were not a representative sample of patients with AMD; they were self-selected and were a sample of convenience (consecutive patients in his practice). It was not representative of the general population, since it included far more patients with wet AMD than expected. He is known for using acupuncture, so those who sought him out probably had a prior belief in acupuncture, or at least were favorably inclined. They were paying him out of pocket and had a vested interest in the treatment. I don’t know if that would make a difference, but good science tries to control for all such possible confounders.
  • There was no blinding. The researcher himself treated all the patients. When testing visual acuity, he knew if it was a pre-treatment or post-treatment test, so he may well have been consciously or unconsciously biased in the way he conducted the test. Anyone who tests eyes can tell you encouragement improves performance. When I read the lowest line I can read on the eye chart, if the examiner encourages me to try the next line, I can usually read most of that line correctly too, although it feels to me like I’m just guessing.
  • The study design and reporting were sloppy. Treatments were given at varying intervals, techniques from different schools of acupuncture were combined in an apparently arbitrary fashion and sometimes were chosen because of anecdotal reports for other eye conditions. The number of dropouts was not reported, and he said some subjects dropped out because they weren’t improving, which would skew results based only on those who remained. It was scattershot: there were so many interventions at so many acupoints that there is no way to determine which were important.
  • The protocol is inconsistent with his descriptions elsewhere. I am left in confusion as to exactly what “The Santa Fe protocol” is. He keeps changing it. Is it eye/ear, eye/ear/scalp or eye/ear/elsewhere-in-body or eye/ear/two different kinds of scalp acupuncture? Is it daily for 5 days or weekly or at even longer irregular intervals?
  • Inadequate followup. He says the duration of improvement was “substantial” but provides no supporting data. He doesn’t report trying to follow up on dropouts.
  • No ophthalmologist was involved. Patients reported having been diagnosed with AMD, but we have no details; many of them didn’t even know whether they had the wet or dry type. A retinal specialist would have been able to examine the retina with an ophthalmoscope and dilation and do tests like fluorescein angiography, visual field testing for scotomas, and optical coherence tomography to determine whether the improved visual acuity was a reflection of improvement of the AMD or a spurious finding.
  • The results were inconsistent with his reports elsewhere: 69% improvement vs. 85-93%. It appears that efficacy was lower when more acupuncture techniques were added.
  • No IRB approval. It is unethical to do human experimentation without prior approval by an institutional review board to protect the rights of human subjects.
  • Publication in an obscure journal. It may be peer-reviewed, but only by other acupuncturists who would be inherently biased in favor of their discipline. I don’t know if he tried submitting it to any respected mainstream medical journals, but I am sure it would not meet their standards without substantial revision.
  • More. I could go on, but that’s enough to make my point.

In my opinion, this study is not good science and we cannot trust its results. It gives the appearance of having been designed not to rigorously investigate whether acupuncture might be effective for AMD, but to justify and promote the researcher’s own practice and to provide support for other acupuncturists who want to use it for that purpose.

What it could have been

This could have been good science. He could have recruited a retinal specialist, blinded the testing of visual acuity, documented detectable changes in the status of the disease itself, used an acceptable control group (perhaps stimulating the “wrong” acupoints, or randomizing with patients under routine care by a retinal specialist). He could have gotten IRB approval and been published in a PubMed-listed mainstream medical journal so others could have checked his work.

Conclusion

Studies like this are legion. We know that half of published research findings are false. When early positive studies, especially uncontrolled studies, are followed by more rigorous studies with an appropriate control group, the positive findings all too often evaporate. The only research on the Santa Fe protocol is by one acupuncturist; his work has not been replicated, and there has been no independent confirmation of any effect of acupuncture in AMD. The only other study I could find through a PubMed search for “acupuncture” and “AMD” is in Chinese and it is not relevant to the Santa Fe method: it compares a single method, traditional Chinese acupuncture, to treatment with medication. I don’t read Chinese, but as far as I could tell from the abstract, it doesn’t even seem to have any acupoints in common with Lundgren’s study.

It is highly unlikely that acupuncture or any other treatment could restore visual function in a part of the retina where the rod and cone cells have died; just as unlikely as the re-growth of an amputated limb. That would be extraordinary and would require extraordinary evidence, far stronger than the evidence of this study. I can’t rule out the possibility that acupuncture might improve vision in the undamaged areas of the retina by some mechanism, but in view of the entire body of evidence from acupuncture studies, that seems unlikely.

OK. I was as polite as I could possibly be. I was nice. I expressed understanding and sympathy for patients and providers. I didn’t insult or disparage the researcher. I didn’t say “It doesn’t work.” I didn’t advise people not to try the treatment. I looked at the evidence, found it wanting, and explained why. Does my post measure up to Dr. Moran’s ideals of civility? I think so. Will it help Dr. Rodrigues understand better why his views are not having much impact? I suspect it will not.

I welcome comments on the persuasiveness of this kind of post in comparison to posts with other approaches.

Posted in: Acupuncture, Clinical Trials, Ophthalmology

Leave a Comment (95) ↓

95 thoughts on “Acupuncture for Macular Degeneration: Why I Reject the Evidence

  1. Keating Willcox says:

    Job well done. You pointed out exactly the scientific reasons to doubt the study, and explained them clearly. If this treatment actually worked, there would be teams of investigators trying to replicate such good results. People will pay a lot to avoid going blind.

    1. mouse says:

      Good article Harriet Hall. I’m not a mind reader, but I doubt that you would have written it much differently without pmoran’s complaints. You generally don’t snark much. When you are impolite is is usually more in the ribald humor department (don’t change that :)), which the serious topic of AMD doesn’t lend itself to.

      I wanted to call this out. “Hope makes people feel better; but raising false hopes only to have them collapse after a substantial investment of time and money would ultimately make them feel worse.”

      There is much talk on this site about offering people hope. But you can’t get something for nothing. The emotional crash that many of us feel when it becomes clear that those hopes will not be realized can be devastating. In many, many cases it is not worth the temporary high that those hopes elicited in the first place.

      pmoran and I think a few others (but I can’t remember specific posters) seem to think that we should only discourage the hope that comes from placebo therapies in the cases of serious organic disease, such as cancer and probably AMD. But those with functional symptoms or chronic symptoms (such as with unspecific lower back pain, degenerative disc disease, arthritis) can also experience that emotional crash after a hopeful treatment loses it’s temporary “helpfulness”. Possibly, many patients end up feeling even worse than before when the feelings of helplessness, that “nothing works”, are only reinforce by the experience. I wish that fall out was considered more seriously by those that condone (? having a hard time finding the right word) placebo treatments.

      I’m not sure if this comment will show. I had several disappear over the week-end. Not sure if it’s the SBM system or mine.

      1. mouse says:

        Oh hey, it went through, yeah!

      2. WilliamLawrenceUtridge says:

        pmoran and I think a few others (but I can’t remember specific posters) seem to think that we should only discourage the hope that comes from placebo therapies in the cases of serious organic disease, such as cancer and probably AMD. But those with functional symptoms or chronic symptoms (such as with unspecific lower back pain, degenerative disc disease, arthritis) can also experience that emotional crash after a hopeful treatment loses it’s temporary “helpfulness”.

        An approach that trivializes the significant pain that accompanies arthritis, back pain and degenerative disk conditions. Just because it can’t kill you doesn’t mean it can’t make you want to kill yourself. Having experienced significant back pain, I can’t imagine what it would have been like to live with it for months or years.

      3. Harriet Hall says:

        “I doubt that you would have written it much differently without pmoran’s complaints.”

        I would have tried to inject a bit of humor and color to make it more interesting. I would have called the study ridiculous and said it was junk science that should never have been published. I wouldn’t have called the researcher an idiot, but I would have expressed an opinion about his claim and called a spade a spade. I think it is perfectly appropriate to ridicule “evidence” that is ridiculous.

        I didn’t enjoy writing this experimental post, and I doubt if people enjoyed reading it as much as they enjoy some of my other articles. I think strongly expressed opinions are more persuasive than a dispassionate “medical journal” style.

        1. mouse says:

          That’s good to know – HH. That must be why mind reading is considered a cognitive distortion. We are so often wrong when we attempt it. Now we know what we were missing.

          I will say that I still enjoyed the piece, (although not more than many of your other pieces.) Your delineation of the flaws in the research was very clear, concise and easily understood and also I learned a bit about AMD.

          I suspect you are going to have to write a Gorskian length piece if you want to make the lack of spice more obviously painful. ;)

    2. Noori says:

      Thank you for this article. I’ve had macular degeneration since I was 30 years old and now after 19 years of progressive degradation I was looking into this treatment option, but was doing web research because the skeptic in me kept on saying, “if this is so hot of a treatment, why did I not hear about it from other sources, like the mainstream news.” So, glad to have found your article on the web. I’d rather know the truth than to build false hope and come crashing down later. I’ve already done that by trying hyperbaric oxygen therapy 3 years ago.
      Thank you!

  2. Windriven says:

    “For auricular acupuncture he says he does not clean the surface of the ear before inserting needles unless there is gross contamination.”

    “There were minor complications: ecchymosis in 10% of treatments, and a few infections around indwelling ear studs.”

    I am speechless. Well, almost. This guy is an MD. Presumably he understands the germ theory of disease and the importance of sterile technique. Further, as the distinguished Dr. Crislip has noted, infections are inflammatory and inflammation is prothrombotic. In the worst eventuality, an infection can be far more than ‘just’ an infection.

    The experimental design, if one can call it that, strikes me as nothing more than window dressing; an effort to gussy up hocus-pocus and make it appear sciency. Just as in exposition, efforts can be made to elucidate or to obscure. It is more than I can swallow that the ad hoc experimental design was constructed by an educated person to test and inform. Therefore, one has to believe that it was intentionally constructed to dress a cow flop in a lab jacket.

    Very dispassionate. Very clear. Very likely to put a smile on PM’S face. Not so likely to provoke a single neuron from firing within the impenetrable skull of Dr. Rodrigues. And while I have no empirical evidence, the Santa Fe protocol is such a prima facie howler, I think you showed super human restraint. That said, next week I hope we see a bit more Harriet and a little less Peter.

    1. “This guy is an MD. Presumably he understands the germ theory of disease and the importance of sterile technique. Further, as the distinguished Dr. Crislip has noted, infections are inflammatory and inflammation is prothrombotic.”

      Insignificant!! As compared to:
      https://www.dropbox.com/sh/hnojq9d8ig892bo/AAC4wS5oOQxscyVJBFLsYC66a

      1. Windriven says:

        Insignificant? Why? Even if all your fantasies about “failed surgeries” are 100% accurate, WTF does that have to do with using basic sterile procedure when someone penetrates a patients’ skin?

        You see Steve, that kind of thinking is what makes you a laughingstock around here.

      2. WilliamLawrenceUtridge says:

        Steve himself doesn’t really believe in germ theory – he sees no reason to worry about skin sterility with acupuncture “unless the person works in a slaughterhouse or cleans up poop for a living“. One might observe that the people coming to him are ostensibly sick, and hence might have some sort of immune issues that might, just maybe, cause them to have a problem when any one of several flesh-eating bacteria are driven deep under the skin.

        Also, Steve, I’m never going to click on your stupid link, but I will again point out that the safety and effectiveness of acupuncture are not linked in any way to the safety and efficacy of any other medical procedure. Why do you keep trying to distract people from the fact that you can’t justify your practices with scientific evidence?

        Never mind, I know why.

  3. BillyJoe says:

    boring Boring BOring BORing BORIng BORINg BORING BORING BORING BORING BORING BORING BORING

    1. goodnightirene says:

      What IS your point Billy?

      1. Windriven says:

        It would seem to be that draining all sense of the writer’s personality from the post does not necessarily make for the most enjoyable reading experience. I’m on the BillyJoe side of the line. A little ‘slap and tickle’ is the icing on the cake, the hollandaise on the asparagus, the butter on the peas.

        1. Andrey Pavlov says:

          Indeed. I think it needs to be understood that there is a necessary and useful difference between a blog and a Cochrane report. Or even SfSBM. The data is there – it isn’t like the authors here are doing novel work. They are integrating existing work and making it more accessible, more thought provoking, more engaging. You know – a blog. If the idea was to be as dispassionate a drone as possible and not make even the most eensy weensy of potentially inflammatory remarks… well, there are better sources for that material out there!

          That said, the SfSBM and Quackwatch are also doing exactly that – developing that dispassionate collection of information and reference. Because, as has been pointed out here innumerable times, most people (including physicians) are shruggies not because they don’t care but because there are not really many reliable sources of information on CAM.

          But in the meantime, I enjoy reading Dr. Crislip. I don’t enjoy reading primary source articles in the same way.

          1. irenegoodnight says:

            Well…again, I wouldn’t DISagree, but I come here for concrete evidence to give to my myriad “friends” (average people down the block) who never fail to mention their Chiro or the Great Oz, so I like this post because it clearly refutes the pseudo medicine. Perhaps I misunderstand blogs and their purpose–I am not an internet vet. But, then again, I do so love Dr Crislip’s posts. I even love Dr Gorski’s posts because at the end of the day (and it can be a looooonnnngggg day) he offers up the evidence and explains the shortcomings of what quacks try to pass off as evidence.

            1. Andrey Pavlov says:

              GNI:

              No doubt. There are multiple audiences to be had. In some cases, I agree that a blog post is not the best. There are times that I just pull primary sources from them, knowing that something in a post (here or elsewhere) will cause my interlocutor to dig in heels. But that just means that this blog is not a source for all audiences. But then again, it can’t be.

              But there is a building repository and collaboration with Quackwatch in order to fill in those gaps. Which is, IMHO, quite laudable. But it still doesn’t mean that his blog should be something it isn’t.

  4. PB says:

    “1. Small steel studs are inserted in regions of the ear whose nerve endings have been shown to correspond with specific areas of the brain…”

    LoL!

    But, seriously. This has got to be the most ridiculous thing I have read in a while. Pretty much EVERY part of the body has a somatotopic representation in the brain and even spinal cord.

    Thank you for the patient take down, Dr. Hall. I think most of us would have a hard time dissecting this article as…nicely, and yet thoroughly, as you did.

  5. David Weinberg says:

    Harriet. Nice job deconstructing Dr. Lundgren’s acupuncture claims. I have to take issue with one thing you said:

    Conventional treatment for wet AMD is far from satisfactory; it can slow progression of the disease but seldom improves visual acuity.

    Fortunately, that is no longer true. As demonstrated in my article on anti-VEGF therapy for macular degeneration . Patients treated with ranibizumab, had an average significant improvement in vision. Patients treated with the other anti-VEGF drugs do about the same.

    One other little twist in Dr Lundgren’s data. His website offers a money-back guarantee if vision does not improve with treatment.

    1. Harriet Hall says:

      Thanks, Dr. Weinberg. I know you are a retinal specialist and I had hoped you would read this and correct any errors, since AMD is far from my area of expertise. I edited that statement and linked to your article. I hope the revision meets with your approval.

    2. Lucentis
      ranibizumab
      Drug Monograph
      Entire Monograph
      Black Box Warnings
      Adult Dosing
      Peds Dosing
      Contraindications/Cautions
      Drug Interactions
      Adverse Reactions
      Safety/Monitoring
      Pharmacology
      Manufacturer/Pricing
      Patient Education
      Pill Pictures
      Add to Interaction Check
      Dosing Calculator

      Adverse Reactions .
      Serious Reactions
      endophthalmitis
      retinal detachment
      cataracts
      MI
      stroke
      Common Reactions
      conjunctival hemorrhage
      ocular pain
      vitreous floaters
      IOP incr.
      foreign body sensation
      ocular discomfort/irritation
      blurred vision
      ocular hyperemia
      retinal disorder

        1. Do you see the flaw in your argument?

          If not this is a dreadful misuse of logic and science and no sense of reality or common sense.
          :(

          1. WilliamLawrenceUtridge says:

            Do you see the flaw in your argument?

            If not this is a dreadful misuse of logic and science and no sense of reality or common sense.

            I see my argument, which I know is flawed, as being exactly the same flaw of yours. But perhaps you can enlighten me. Please feel free to attempt to explain the flaw and we can see if we agree.

    3. toots says:

      Lundgren references Gragoudas et al. 2004, as an anti-VEGF medication. That study showed pegaptanib scoring significantly against sham injection. Lundgren claims that only 34% of AMD patients receiving ranibizumab show improvement – no reference given.

      He claims 93% of AMD patients receiving “conventional” therapy plus acupuncture show benefit – without specifying exactly what those conventional therapies are. These improvements were found after four acupuncture treatments at the end of one week. No long term results given.

      All this in his paper presented at the 18th International Congress of Eye Research, Beijing, 2008.

      Brown et al. 2009, which you reference in your article, contradicts his claim about ranibizumab. As you show, Brown found improvement lasting two years for the average patient.

      If Lundgren used acupuncture as an adjunct to ranibizumab, his results would be just what we would expect.

  6. Kausik Datta says:

    Excellent read. I have only one minor beef. The word ‘evidence’ in the title should have been in quote marks, “evidence”. As it stands, “Harriet Hall rejecting evidence” gave me quite the jolt.

    … Wait. May be that was the point!

    Well played Dr. Hall, well played. Move along folks, nothing to see here.

  7. NJank says:

    You do mention the ‘slew of techniques’ thrown together here as a treatment. I would also think it’s worthwhile to make the distinction that you make on your Acupuncture Reference Page:

    “…This is not acupuncture – it is transcutaneous electrical stimulation (TENS), which is an accepted treatment for chronic pain, masquerading as acupuncture.

    This is not a quibble. Science requires unambiguous definition of terms and concepts. If acupuncture is said to be something scientifically then it must have some specific and unique characteristics. In medicine that means it should have a specific mechanism of action – and it is that mechanism that we would call acupuncture. Electrical stimulation is no more acupuncture than if morphine were injected through a hollow acupuncture needle and then claimed that any resulting pain relief was due to “acupuncture.””

    perhaps there is some aspect of nerve electrostimulation that could do something, somewhat like that which is hypothesized (doubtful, but at least testable). in any case, according to your definitions, a good part of what he’s doing shouldn’t accurately even be called acupuncture if it is combined with electrostimulation.

    1. Do you see the flaws in your logic?

      This one in particular, “In medicine that means it should have a specific mechanism of action”

      Many medications used in medicine do not have a specific mech of action.

      If you do not, and if you care than rethink your argument.

      1. Windriven says:

        “Many medications used in medicine do not have a specific mech of action.”

        Really??? There may be some medications where the mechanism of action is not well understood. But for very many others the mechanism is quite well understood. And for virtually all a broad and plausible general mechanism is accepted.

      2. WilliamLawrenceUtridge says:

        Many medications used in medicine do not have a specific mech of action.

        While it’s true that we don’t know the specific mechanism of action for some drugs (how the molecule interacts with a receptor and the intracellular cascade that it causes the main and adverse effects). However, merely because we may not know the exact cascade doesn’t change the fact that the drug’s effects is based on a molecule interacting with a receptor. Acupuncture is in the same field as homeopathy, where it has to essentially posit a wholly new branch of physics or chemistry in order to work.

        Two different drugs with different mechanisms of action are comparable to a Ferrari and a Tesla – both have different engines, and while I understand how an internal combustion engine works, I’m guessing when it comes to the Tesla. That being said, I know both use an engine to turn rotary motion into linear motion using gears and tires. In this model, acupuncture would be comparing the Ferrari and Tesla to a flying carpet. If you can’t prove the carpet flies, there’s no point talking about how it flies.

  8. goodnightirene says:

    I see no reason to cater to Rodrigues, although I have a touch of sympathy for pmoran–at times. I have argued similarly at times (and received the accompanying derision). I’m still not sure what a “tone troll” is, but I know when I’m being told off.

    There are posts here that would not be helpful to pass on to a fence-sitter because they would be seen as offensive. This post is exemplary in that respect, but I can’t think of any of yours, Dr. Hall, that are not. You write in a very matter-of-fact style that few could argue with, so why worry about inconsequential critics?

    1. Windriven says:

      ” I have a touch of sympathy for pmoran–at times.”

      Peter has used up every scintilla of empathy that I had; squandered it on complaining about style when he has valuable things to contribute on substance. William Faulkner writing the Miss Manners column. Christ.

      1. irenegoodnight says:

        Well, if you put it that way…what can I do but agree :-)

    2. simba says:

      For me it’s the opposite. I feel sorry for Rodrigues, because he cannot see beyond his own prejudices, and doesn’t seem to understand what constitutes evidence of efficacy, choosing to treat clinical experience as sufficient. I had an interest in trigger point therapy long before I started commenting here, but found a paucity of solid evidence despite looking in the appropriate journals. I was genuinely hoping that Stephen Rodrigues would be able, as someone using this therapy, to point me in the direction of the evidence. So as someone who was excited about the therapy myself, I have some sympathy.

      Of course instead all I got was accusations of being paid to ask questions, and statements that there was a conspiracy hiding the truth. So I figured if he can’t put up the evidence, and no-one else I’ve seen has been able to either, then it’s likely there isn’t any that would distinguish it from any of the other untried or tried-and-failed therapies.

      1. Windriven says:

        “I feel sorry for Rodrigues, because he cannot see beyond his own prejudices, and doesn’t seem to understand what constitutes evidence of efficacy, choosing to treat clinical experience as sufficient.”

        I don’t know, simba. I’ve been all over the board on Rodrigues. Many here have carefully worked through the biases that plague his thinking with him – all to no avail. It is one thing to be blind, quite another to refuse to look at the evidence.

        I like the guy’s passion, but passion without discipline is, well, childish. And potentially harmful. Rodrigues is a licensed physician seeing patients every day. It is them, not Rodrigues, for whom I feel sorry.

        1. simba says:

          You’re probably right, I haven’t been engaging with him as long. But I can see that if you thought you’d seen great results, it might be easier to construct an elaborate conspiracy than to face facts.

          I agree with you that it’s the patients who really pay the price.

        2. lol
          I think you guys are lost in space too!!

          Except in this regard, I have more clinical experience, knowledge and wisdom so you guys are at a major disadvantage so I’m giving you breaks. :)

          1. WilliamLawrenceUtridge says:

            Except in this regard, I have more clinical experience, knowledge and wisdom so you guys are at a major disadvantage so I’m giving you breaks.

            Clinical experience is incredibly unreliable. Clinical experience led bloodletters to keep cutting open George Washington, orthopedic surgeons to scrape out cartilage from knees and you to proclaim acupuncture the solution to everything.

            Wisdom is knowing where your limitations in knowledge are, and the value of controlled studies and the general scientific literature – which you appear to have no familiarity with.

            Why is that? Why don’t you know anything about the scientific literature surrounding acupuncture? Are you incompetent?

          2. Windriven says:

            You? Wisdom? That’s the funniest thing I’ve heard all week. Lucky you didn’t write tomorrow. ‘Cause tomorrow Crislip’s blog is likely to be the funniest thing I’ll read all week. But then that’s the good kind of funny. Your kind of funny isn’t the good kind of funny.

      2. WilliamLawrenceUtridge says:

        Simba, have you seen Paul Ingraham’s tutorial on the subject? My apologies if I have recommended it before and forgotten.

        http://saveyourself.ca/tutorials/trigger-points.php

        1. simba says:

          Thank you for the reference, yes, I have, it’s an excellent summary. He seems to have come to similar conclusions on the current state of the evidence for efficacy. It’s a really exciting area, I really hope the evidence actually turns up.

          http://saveyourself.ca/articles/trigger-point-doubts.php

      3. TrPs are not understood very well and the Ingrahams notes are incomplete, shortsighted and biased.

        TrPs go thru and evolution, of the classic description are not valid before or after that transition. They still need effective therapy or they will case the muscles to devolution which will lead to a deeper embedded disease, most pain and more dysfunction. I would consider that negligent.

        Don’t be swayed by the TrP naysayers, the guy who promotes this idea has an agenda and I would not trust his analysis.

        1. WilliamLawrenceUtridge says:

          TrPs are not understood very well and the Ingrahams notes are incomplete, shortsighted and biased.

          Can you give some specifics? What aspects of the scientific literature is he not citing? What information does he not include? What sources does he omit, or summarize inaccurately? On what do you base your criticisms, is it mere clinical opinion? How do you know it’s more trustworthy than that of a bloodletters’ in the 19th century, or an orthopedic surgeon who swore by knee cartilage debriedement in the 1980s?

          TrPs go thru and evolution, of the classic description are not valid before or after that transition. They still need effective therapy or they will case the muscles to devolution which will lead to a deeper embedded disease, most pain and more dysfunction. I would consider that negligent.

          What is the transition? What metabolic or cellular changes occur at that point? If someone doesn’t respond to your therapies, do you tell them “Oh, your trigger points haven’t gone through their transition yet”? Because that seems like goalpost-moving and hand-waving to excuse your treatment failures to me. And if they wait until it is worse and they come back, and it still doesn’t work, do you tell them “Oh, it’s been too long, it’s now a deeper embedded disease and I can’t treat it/it’ll be a lot more treatments (and more money for me)”? Because that also looks like post-hoc rationalization to explain away a failure that allows you to preserve claims of “clinical experience of efficacy”.

          The point is – if there is something to your claims, if they represent reality rather than nonsense, then there will be trends and principles that can, and should, be tested. However, since you never test your claims, you will never know if you’re wasting time and money.

          Medical negligence is usually determined by deviation from the standard of care. Do you know what the standard of care is?

          Don’t be swayed by the TrP naysayers, the guy who promotes this idea has an agenda and I would not trust his analysis.

          But you, who make money from this, and who obviously bases considerable amounts of your self-esteem on your “clinical experience”, you don’t have an agenda? Why do I, or anyone else, have an “agenda” merely because I ask you for basic scientific citations to support your claims? Citations you repeatedly fail to provide, despite dozens, even hundreds of requests. Are you an incompetent researcher or doctor? Did your medical school not talk about the scientific process or how to evaluate a medical study? Did you even pass?

          1. The research and analysis is your job, I’m not in a position to school or spoonfeed you all.

            DON’T BE SO LAZY HIDING BEHIND WORDS LIKE “PLACEBO, BLOOD LETTING ETC!!! Get off your butts and expand your worlds!!

            “clinical experience” is what seasoned physician have to use when the science part of medicine fails. It fails quite often too.

  9. Frederick says:

    Excellent article, Mme Hall. You do not said : “it does not work” But I will say it. It freaking does not work!
    Prior plausibility is very low indeed! If stimulating nerves and tissue with little needle and electricity could make them regenerate, we will already have Star Wars Style regeneration Tanks!

    That study is just another marketing stunt. Eyes are not so simple, I had 4 surgery for my eyes between 9 month and 5 years old, I was a bad case of strabismus, plus lot of other viewing problem. My Ophthalmologist, Dr. Magda Omsy, Who followed me between 9 month and 18 years old, was a reality competent One. She explain, even as i was a young one, how eyes work and thing like that. It is so complex, you really think that if there was something that easy to do to cure eyes problems, we will already be using it.

    Also how in this universe could putting needle around you ears could do anything to the tissue inside your eyes? it is ridiculous, an preposterous.
    And all those flaws in the study are ridicule, even a lay man like me can see them easily .

    I don’t know for PMoran, I don’t read his post much, but for SSR this will do nothing, because for him anecdotal evidence trump objective evidence and reality. Even if he’s lying and he is not a true believer, He will continue to be like he his because he makes money out of it. Although by now I think that he’s so deeply in those beliefs, he his totally blinded by them. If he was only a Scamer he will not spend so much time trolling in here.

    1. WilliamLawrenceUtridge says:

      One must be careful with the claim of prior probability, because suprising associations are always possible – paraneoplastic syndrome being one. The TV show House was basically eight seasons of examples – and much as it was fiction, it still had some basis in realistic anatomy and physiology. But what is really uncovered in cases like these are regular anatomical processes operating in conventional, well-understood but surprising ways that are replicable and reliable. It’s not magic, which is basically what is used to support most CAM.

      1. Frederick says:

        Well you’re right of course. I don’t have lots of medical knowledge, but i understand what you mean, but since acupuncture does have any effect for starters, the probability is low, and if electruc shock helped regenerate tissu, we should have known for a long time. I don’t mean that we should dimiss without research everything that seem weird, on the contrary, but that particular protocol was pretty implausible from the start.

        1. WilliamLawrenceUtridge says:

          I agree completely, I just like to urge caution as a general practice whenever statements are made that overstep the line of what we can and do know.

          1. Frederick says:

            Yeah, I got it, :-) thanks I will be more careful. Good advice!

            1. WilliamLawrenceUtridge says:

              Meh, I see it as a douchey-but-necessary reminder for skeptics to not get cocky, an injection of dissent to avoid the appearance and reality of an echo chamber, and an attempt at the humbleness that science should bring.

              I don’t really like doing it, it’s pedantic and nit-picky and more than a little sanctimonious. And besides, who the hell am I anyway, the self-proclaimed Devil’s Advocate?

              But still, but still.

  10. George Tullington says:

    All medical staff without a single exception have no-stress easy do-nothing jobs.
    Anybody with a enough free money handed to them by their parents can pass medical school. It’s absolutely no different than sCAMmers & their reiki/homeopathy/natural crap.

    Medical staff pulled more excrement on me today, arrogantly assuming I’m supposed to know their “policies”, forcing me for no reason to go 7 miles to get pre surgical bloodwork & EKG. And I have no car. And there are no busses in the area.
    Why? Because they have NOTHING to do at a medical doctor’s office other than to cause trouble for patients. Absolutely NOT a medical necessity.

    The only difference between MDs and the scammers of homeopathy/reiki/accupuncture/physical therapy is that MDs’ treatments actually work. Pharmaceutical drugs actually work.

    MDs and their staff are simply expendable useful tools. Nothing more.

    The real tell that FUNDAMENTALLY MDs & nurses & their staff are mentally no different than sCAMMERS & fraudsters as have been pointed out here:
    every single one of them is mentally incapable of voting for anyone other than a mainstream political party.

    They are all not math PhDs. Hence, for all practical purposes, the “mainstream” medicine & the scamming medicines are mentally equal. NEITHER group is the MEDICAL RESEARCHER or DRUG TESTERS themselves, which requires hard work, because actually requires abstract thinking.

    Yes – I am talking about the activity: any individual human is capable of one minute being an MD and the next a nurse and the next a reiki scammer and the next a child molestor and the next a great defender of children’s rights – not the individual, although such fluctuations throughout a single lifetime between such widely variant human activities is rare, since the most important thing to humans is their habits, no matter how stupid, to stick with whatever activity they are doing.

    1. Woo Fighter says:

      You don’t deserve any medical treatment with your patronizing, insulting and degrading opinions about all the hardworking, dedicate, selfless people who devote themselves to healthcare. You have no idea about the sacrifices these people made and make every day of their lives to take care of a$$holes like you who have no appreciation for them.

      I sincerely hope some of your doctors and other healthcare workers see these ludicrous posts of yours and tell you to go to hell the next time you show up to lie to them to get them to write you a prescription for what you need.

      And grow up regarding transportation: I”m so sorry the professionals you needed to see for your tests weren’0t considerate enough to set up their clinic next door to your house, so you wouldn’t be inconvenienced having to travel a whopping seven miles. Have you ever heard of a taxi? Or asking a friend for a lift?

      You’re such a dick I doubt you have any friends to ask for a lift, however.

    2. Woo Fighter says:

      “Anybody with a enough free money handed to them by their parents can pass medical school.”

      This is one of the most offensive things I have ever read. I’d like to see you try to pass medical school just because you can afford to pay the tution.

      What do YOU contribute to society, anyway, that allows you to be so smug, insulting and feel you’re so superior? Have YOU ever saved a life in an operating room? I bet you think it’s easy to perform open heart surgery.

      Douchebag.

      1. Andrey Pavlov says:

        “Anybody with a enough free money handed to them by their parents can pass medical school.”

        Some 8% of my 2nd year class failed. In the US there is typically about a 5% attrition rate (PDF). And that is after having met the bar to get in in the first place, which is not easy at all. Some 50% of applicants don’t even get in, so you are already selecting for a higher than average student body.

        Just go to any med school library on a given evening and weekend and see how many people are there studying.

        This is one of the most offensive things I have ever read.

        I don’t see it as offensive really. Just indicative of both the profound ignorance and motivated reasoning of someone who has already decided that the medical profession is a waste of time.

        That’s fine. Don’t go to med school and don’t seek our services. Thankfully you live in a society where you are both unlikely to need our services and if you do we will still treat you, despite your wrongheadedness. To co-opt a phrase (and make it true), there are no people like yourself in ICU’s.

      2. Getheren says:

        This is one of the most offensive things I have ever read. I’d like to see you try to pass medical school just because you can afford to pay the tuition.

        Unfortunately, I have to agree, at least temperedly, with both of you. The statement is to some degree true, though not in the absoluteness of its phrasing; and it is also offensive from several directions. (It would be nice if we lived in a world in which “offensive” had a strong two-way correlation with “untrue”, but take a look around you.) All medical schools are not equal in rigour and preparation of their students for practise. And it’s worth pointing out that a degree marks competent completion of a prescribed course of study, not whether the person holding it is a rigorous thinker, rational and sane. It particularly doesn’t mark whether someone who was a rigorous thinker, rational and sane at some earlier time still is.

        In the end, asserting that someone is right, or smart, because she possesses a medical degree is a fallacious appeal to authority.

        Fortunately, the practise of accreditation is effective against the worst of degree mills. However, the standard of requirements for both degree-granting and licensure is based on minimally acceptable competence rather than excellence; there is no process for revoking degrees and (for good reasons) the process of revoking licensure is generally more stringent than the process of granting it.

        Any academic qualification that is sufficiently desirable for its economic or social-status benefits becomes a currency, and as such is subject to pressures of inflation, debasement and counterfeiting — the reason why accreditation exists. This is becoming a very large issue with education in general in the U.S., as the economic and social-status value of degree-holding has come to overwhelm its value as a meaningful marker of learning, and the result is dumbed-down curricula. That larger issue is a subject for another day and another blog, but I mention it to point out that medical education is not immune to this effect.

    3. weing says:

      “They are all not math PhDs.”
      Of course not. If you are a math PhD, then it must be super easy to become one.

    4. Frederick says:

      At first I thought you just copied and pasted your ranting from the other topic, Nope, it seem you did another, it is the same, no reflection, no understanding style of rant. Just reaction. It’s funny how you think you are in possession of the absolute truth, in that sense you are yourself no different that the people you describe, especially scamer, because they believe so much in themselves and their belief. they can’t see otherwise. Any you comment do not make any sense anyway.

      1. Woo Fighter says:

        “… every single one of them is mentally incapable of voting for anyone other than a mainstream political party.”

        I want to know how George seems to know who “every single” medical professional votes for. And what difference that makes to their abilities as healthcare professionals. And finally, who does Georgie think they SHOULD be voting for?

    5. WilliamLawrenceUtridge says:

      All medical staff without a single exception have no-stress easy do-nothing jobs.

      Wow, tell that to a pediatric oncologist, or an ER physician. Are you trolling, or just an asshole?

      I hope the next time you have a major infection or trauma you open your discussion with the doctors and nurses with this little rant.

      Medical staff pulled more excrement on me today, arrogantly assuming I’m supposed to know their “policies”, forcing me for no reason to go 7 miles to get pre surgical bloodwork & EKG. And I have no car. And there are no busses in the area.

      I bet you really let whoever told you this have it with both barrels too – and with good reason, surely the front-line staff person is the one making decisions about where to place crucial infrastructure.

      But hey, at least you got a walk in, exercise is good for you.

      Note how I’m being heartless and dismissive of your pain and suffering? It’s because your opening salvo of “doctors don’t care about anyone and they’re stupid” made me not care about you. And I’m not a doctor, I just think it’s offensive to label an entire profession. Would you ever say “all black people are…”?

      They are all not math PhDs.

      You know what profession I think is a “no-stress easy do-nothing job”? Math PhD. Bunch of lazy do-nothings. Don’t they know we have computers to do our math for us now?

      I like how you compared doctors and CAM practitioners to child molesters by the way – that was a classy touch. Even Windriven thinks that was over the top.

    6. lilady says:

      What are you blathering about George?

      Pre surgical testing is standard protocol and the fact that you do not have a car is not the fault of the doctors and the nurses. Take a cab or ask a friend to provide transportation.

      Alternatively, you could just cancel your surgery…so that you don’t have to subject yourself to the care of doctors or nurses who you do not trust.

  11. mouse says:

    GT
    “All medical staff without a single exception have no-stress easy do-nothing

    Look! It’s a big red sign saying “Troll ahead.”

    Remember friends, the best way to prevent trolls is to not feed them.

    I know it’s hard. It might be a bit easier if you skip reading this guys comments in the future.

    1. Missmolly says:

      Oh mouse, I <3 u! Was just about to say the same thing only grumpier, and there you were being awesome and sensible! Thanks for the reason injection Xxx

    2. Frederick says:

      Yeah your right, we should feed the mouse instead! :-)
      A funny thing: One of my best friend Nickname is Mouse! We call him that way for 20 years now ;-)

  12. A_M_B says:

    I have been reading science based medicine for a long time and wanted to offer some support for this kind of post.

    It isn’t as entertaining for me (apparently to write either) but clearly written, well researched posts like this on individual studies are really interesting and something I can share with less rational friends to help lead them through/explain thought processes. For them the snarking (which I like- ’cause you’re right) puts them off and gives them a (real or not) ad hominem basis to go on and disregard the facts within.

    I hope posts like this crop up every so often but that normal service predominates.

    1. Harriet Hall says:

      Do you think your “less rational friends” would be put off by a strong expression of opinion after the facts were laid out? Something along the lines of “this was a useless, ridiculous experiment that never should have been done, much less published.” Or “from all we know about science, this treatment couldn’t possibly work”? Or “this is an example of junk science and Tooth Fairy science”?

      When something is ridiculous, I find it hard not to ridicule it. I think some people respond to ridicule and strong interpretations more than to a purely factual presentation. Am I wrong?

      1. Greg Goldmacher says:

        Harriet – I’d like to add one more deficiency to the list you’ve identified: as far as I can tell, the endpoint was not defined in advance. If you don’t pre-specify what kind of measured change (and over what timeframe) you accept as success, it’s easy to retrospectively choose data that present a treatment in the most favorable light.

        As to whether a dispassionate approach or a harsher approach works better, it depends on your audience. On this blog, you have an audience that is generally inclined to favor science and evidence (with some notable exceptions), so pretty much any approach you use will be favorably received. With a mixed audience, I agree with A_M_B that starting off with a harsh tone can set minds against you, so that they don’t hear the content as well. I like your idea of starting off with a more factual and neutral tone, and then closing with a strong “editorial” opinion. By that point, people will either have absorbed the facts, or not, and a strong take-away is good from a rhetorical point of view.

      2. A_M_B says:

        Hello,

        I think that some would be and some not (a near useless answer I know); I reckon the majority of my less rational friends (I seem to have a few) would be fine with a strong expression of opinion after facts especially the latter two examples you give. I should get to find out soon as I’ll be seeing a few of them next month and I’ll try this out on them…

        I agree with the desire to ridicule the ridiculous and that this works for the majority of people likely to read this blog (myself included) especially those who are already a bit onside (even if on a fence somewhere) hence my support for normal service predominating.

  13. Easy to Monday morning quarterback and most statements are valid.
    Harder to consider the ethical, social and emotional cost of this treatment and the outcomes. Harder to delve deeper into the study to refine the study to get a better idea of the truth. The treatment protocol should be a foundation to do further studies to address Hall’s issues. Throwing out the whole for the small is not science at all.

    “In my opinion, this study is not good science and we cannot trust its results.”
    Opinions and trust are at the core of all science and medicine. I don’t trust my own opinions and certainly do not trust most pharm or device studies. Remember Vioxx.

    1. Harriet Hall says:

      Did you understand what I said about the unreliability of uncontrolled studies and the need for blinding? Do you trust the results of this uncontrolled, unblinded study? Why should this one study be a foundation to do further studies? Why shouldn’t the entire body of acupuncture studies be a foundation to stop studying acupuncture?

      1. The proper studies have been done, What you did prior was cherry pick.
        Expand your search, open your mind and your conclusion will be different.

        Sorry but I’m certain that the definitions of Acupuncture are incomplete and need refinement. The needle is the key component and the philosophy is just about a balanced way of life. Acupuncture is a surgical procedure … plain and simple. In some pain syndrome it is the best tool and maybe the only tool to eradicate the pain.

        1. WilliamLawrenceUtridge says:

          The proper studies have been done, What you did prior was cherry pick. Expand your search, open your mind and your conclusion will be different.

          What studies have been missed? Particularly by the many systematic reviews that have been done? Why not drop a couple in here, instead of linking to a drop box containing pictures of surgical scars? Give us some pubmed numbers, we’ll look at the results. Plunk us down a couple primary studies to review. You’ve been asked for this many times but you either ignore it, or drop in something irrelevant. Why is that?

          Sorry but I’m certain that the definitions of Acupuncture are incomplete and need refinement.

          Such as? What would a “complete” definition be?

          The needle is the key component and the philosophy is just about a balanced way of life.

          The theory behind TCM and acupuncture (keeping in mind that there are many non-Chinese variants of acupuncture, none have been proven to work, and all are quite different, suggesting a more of a religious rather than empirical basis) is about balancing magic energy that is undetectable. Sure, there’s also a bunch of nonsense about hot and cold foods that feed or starve your yin and yang, but the acupuncture-specific parts are about manipulating qi, aren’t they?

          Acupuncture is a surgical procedure … plain and simple. In some pain syndrome it is the best tool and maybe the only tool to eradicate the pain.

          Why do studies keep finding that it doesn’t matter where you put the needle, or if you penetrate the skin or not? Why does acupuncture keep failing scientific tests?

        2. Harriet Hall says:

          The proper studies have been done to show that acupuncture improves vision in AMD? Really? Where are they? I couldn’t very well cherry pick when I only found one study to pick from.

        3. Harriet Hall says:

          I asked before and didn’t get an answer: Did you understand what I said about the unreliability of uncontrolled studies and the need for blinding? Do you trust the results of this uncontrolled, unblinded study? Would you start using a drug on the basis of one single study that was not controlled or blinded? What was your reasoning when you first started using the Santa Fe protocol?

      2. “stop studying acupuncture”
        This is an irrational and biased statement.
        That is like saying stop studying human nature, wound healing or global warming??!!

        1. Harriet Hall says:

          No, it’s like saying stop studying bloodletting to balance the humors.

        2. WilliamLawrenceUtridge says:

          This is an irrational and biased statement.
          That is like saying stop studying human nature, wound healing or global warming??!!

          Scientific study of acupuncture has resulted in the conclusion that it is of equivocal use in the treatment of two symptoms, pain and nausea, and can treat and cure no actual diseases. How much money must be thrown testing more conditions when the scientific understanding of anatomy and biology suggest that it is unlikely to ever produce a meaningful treatment or cure? What is irrational about saying “studying acupuncture is expensive and produces few results, so we should stop spending the money”? Would you support testing every single drug for potential effects on every single medical condition, on the off-chance that it turns out to be right? Should we test thalidomide for the topical treatment of moles and warts, tuberculosis, sunburn, cysts, necrotizing fasciitis, schizophrenia, etc. just in case? Where will the money come from?

          Unlike acupuncture, human nature, wound healing and global warming all have extensive objective evidence for their existence. You have yet to provide any such evidence for acupuncture.

    2. AdamG says:

      I don’t trust my own opinions

      Then why do you blindly trust the opinions of your patients?

      1. “Then why do you blindly trust the opinions of your patients?”

        No challenge to this statement!!!???

        Do you all see the flaw in this concept?

        If you don’t there is no hope for any of you!:(

        1. Windriven says:

          No Steve, no challenge. Opinions are like a$$holes, everybody has at least one and most of them are full of excrement.

          Now understanding a patient’s perceptions is another thing entirely. “I feel less pain after an acupuncture treatment” is something to understand and believe. “Acupuncture cured my arthritis” isn’t.

          No one ever said that some patients don’t perceive a reduction in pain after acupuncture treatment. What we’ve said is that the perceived relief is no better than placebo.

          In other words the likelihood is that I could construct an elaborate placebo based on massaging a special blend of olive oil and mashed bananas into painful areas and other ‘special’ pain centers and in carefully controlled studies achieve perceived pain relief roughly equivalent to your results from acupuncture.

          It is great that the patient perceives less pain. But that isn’t because of acupuncture per se. Or because of banana moosh.

        2. WilliamLawrenceUtridge says:

          No challenge to this statement!!!???

          Do you all see the flaw in this concept?

          Why don’t you explain it to us? Because so many of your arguments seem to be purely bluffing.

          Show us your cards Steve, lay down an argument and show us your brilliance.

    3. MadisonMD says:

      I don’t trust my own opinions

      Well, there is something to agree on. I don’t trust your opinions either.

    4. WilliamLawrenceUtridge says:

      Easy to Monday morning quarterback and most statements are valid.

      It’s not comparable to Monday morning quarterbacking, since science is not a football game.

      Harder to consider the ethical, social and emotional cost of this treatment and the outcomes.

      It’s hard to consider the costs when you don’t know whether a treatment is effective or not effective. How do you what the costs when you don’t even know the science or the risk-benefit ration? The science suggests, quite strongly, that acupuncture is not effective.

      Harder to delve deeper into the study to refine the study to get a better idea of the truth.

      What studies have you delved deep into? You provided a big list, which you apparently hadn’t read. Why don’t we start with one study. Can you provide us with one study that demonstrates acupuncture is effective under well-controlled conditions?

      The treatment protocol should be a foundation to do further studies to address Hall’s issues. Throwing out the whole for the small is not science at all.

      Wow, way to miss the point. Dr. Hall is pointing out that this, the “best evidence” for acupuncture and AMD, is useless, a garbage study that lacks a coherent methodology that can support a condition. If acupuncture works, it should be demonstrable in well-controlled trials. Why do studies keep finding it doesn’t work? What are they doing wrong? Again, one study please.

      Opinions and trust are at the core of all science and medicine. I don’t trust my own opinions and certainly do not trust most pharm or device studies. Remember Vioxx.

      You don’t trust your own opinions? Then what do you base your massive, endless harping about the magic of acupuncture on? You’ve never cited any meaningful science, and apparently you don’t trust your own opinion – therefore from where do you draw your conclusions?

      If you can’t trust scientific studies (and you shouldn’t – you should trust the body of studies), what can you trust?

      And what about Vioxx? It’s an effective pain treatment (let me remind you – acupuncture’s effectiveness appears to be based on just the placebo effect), with an unrecognized cardiac risk. It proves that postmarketing surveillance is necessary, and independent scientific trials should be run before approval. It doesn’t prove that science doesn’t work, it proves that the regulatory system needs improvement.

  14. BTW, since you guys are not needle savvy so most of the concepts are absolutely foreign thus any comments would be incomplete, out of context and incoherent.

    1. n brownlee says:

      Apparently, the patients aren’t “needle savvy” either, since they can’t tell the difference between genuine, penetrating acupuncture needles, non-penetrating retracting needles, wooden toothpicks, and simple surface pressure – and are as likely to claim positive effects from any of them. And in spite of being asked about this point (ha ha) at least a dozen times, you just ignore it. You never answer. You are a fraud.

      1. @n brownlee
        “the patients aren’t “needle savvy” either,”
        So you hate patients that much that you do not trust what they say??

        I have explained what Acupuncture is and is not … dang already … I think you do really understand.

        1. WilliamLawrenceUtridge says:

          So you hate patients that much that you do not trust what they say??

          Patients used to claim bloodletting was an effective treatment. If a patient requested bloodletting with leeches and lancets, would you provide it? Would you provide lumbar fusion surgery because a patient said it would help? Would you write a recommendation for knee cartilage debriedement because the patient swore it helped with their arthritis in the other knee?

          You’re supposed to be a doctor. You’re supposed to be an expert and a guide to medicine, a gatekeeper to providing the best care within your knowledge, experience and the scientific literature. You have abdicated all of these responsibilities in favour of the fallacies that led humanity astray for thousands of years. Seriously, “because my patients asked for it” is a terrible reason. Do you hand out powerful and addictive opiates on the basis of “because they asked for it”? What’s your stance on an apotemnophiliac asking for a limb amputation?

          I have explained what Acupuncture is and is not … dang already … I think you do really understand.

          Really? Where? You keep claiming you’ve “defined acupuncture” and that “scientists got it wrong”, but it seems like you’re lying. I’ve asked for your definition of acupuncture repeatedly and I can’t recall you ever responding. Are you bluffing and hoping that nobody notices?

          Please, link to your definiton, or provide a new one here – I’m interested. Also, be sure to link to the studies that use your definition of acupuncture to test it and prove it effective, I’m interested in those too.

        2. n brownlee says:

          Sure I do. I trust the many patients who, in the blinded tests, swore that fake, non-puncturing, placebos of acupuncture miraculously helped their problems. Just as many patients affirmed the effectiveness of the placebos as affirmed the effectiveness of acupuncture with penetrating needles.

          Don’t you trust the perceptions of those patients? Why not?

    2. JD says:

      BTW, since you guys are not needle savvy so most of the concepts are absolutely foreign thus any comments would be incomplete, out of context and incoherent.

      Right, because the posters here who have devoted entire careers to understanding the complex processes underlying human health, including surgeons, just cannot grasp the infinite complexities of jabbing needles into someone in order to “re-align qi” that flows like the rivers in China. It is just too much for their limited intellect. Hey, are you best friends with George Tullington?

      No conspiracies mentioned in this particular set of nonsensical ramblings, but I have an alternative one to propose, based on my reaction to reading through comments spanning numerous posts. Maybe the end game is to induce such severe frustration and headache that we all turn to acupuncture. I’ll even propose a name, SSR-induced cephalgia. That would be an effective way of drumming up business. My condition has deteriorated substantially today, sign me up for a poking immediately. Just hope there’s no failure to practice sterile technique and that I don contract cutaneous tuberculosis.

  15. Hear ye!!!

    I’m done for now!!!

    I’ll be back in a while just to see if you all have broken the logjam!!!

    1. Windriven says:

      Take your time.

    2. WilliamLawrenceUtridge says:

      Hear ye!!!

      I’m done for now!!!

      I’ll be back in a while just to see if you all have broken the logjam!!!

      Gone to brush up on your medical literature perhaps? Please don’t bother coming back, you offer nothing that a random phrase generator could not.

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