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Acupuncture for Menopausal Symptoms

Acupuncture

A newly published meta-analysis of studies looking at acupuncture for symptoms resulting from natural menopause (not drug or surgically induced) by Chiu et. al. is entirely negative. That is not what the authors or the press release conclude, however.

This disconnect between the study results and the interpretation of those results is a persistent problem in medicine generally to some degree, but is endemic and profound within the CAM (complementary and alternative medicine) culture. Acupuncture in particular is promoted almost entirely based on this type of misinterpretations – the kind that can magically turn negative studies into positive studies.

In the abstract the authors conclude:

This meta-analysis confirms that acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause.

Let’s take a close look at the results, however. Indeed, when comparing acupuncture to no treatment controls there was a significant decrease in subjective symptoms in the pooled data. Outcomes were hot flash frequency, hot flash severity, other menopausal symptoms, and quality of life. Some of the included studies were large controlled trials, which the authors used to argue that their results are valid. They also point out that their results showed heterogeneity and lack of publication bias.

There are two major problems with the results, however, that contradict the authors’ conclusion, one moderate and one fatal. The moderate problem is that there is a lack of dose response. The authors write:

The effect size of acupuncture on hot flash frequency was not significantly associated with the number of treatment doses, the number of sessions, and the duration of treatment in weeks.

The same was true of hot flash severity. We like to see a dose-response effect to help confirm that the treatment effect is real. You might argue that acupuncture does not work that way, that even a brief treatment is sufficient and there is an early plateau in effect. This might be true (in which case longer sessions are unnecessary), but this argument amounts to special pleading, and at the very least implies caution in concluding the treatment works.

The second problem with the data, however, directly contradicts the authors’ conclusions:

Arguably, our findings showed that sham acupuncture could induce a treatment effect comparable with that of true acupuncture for the reduction of hot flash frequency. This result is in line with previous reviews. A compelling finding from a previous systematic review concluded that approximately 60% of RCTs revealed that sham acupuncture was as efficacious as true acupuncture, especially when superficial needling was applied to nonpoints.

A Cochrane review from 2013 concluded:

We found insufficient evidence to determine whether acupuncture is effective for controlling menopausal vasomotor symptoms. When we compared acupuncture with sham acupuncture, there was no evidence of a significant difference in their effect on menopausal vasomotor symptoms. When we compared acupuncture with no treatment there appeared to be a benefit from acupuncture, but acupuncture appeared to be less effective than HT.

Both reviews are essentially showing the same thing – when you compare acupuncture to sham acupuncture, there is no difference in outcome. The spin on these results, however, is entirely different. The Chiu review goes on to speculate about why sham acupuncture might also “work.”

We have pointed out this invalid logic many times. Especially when dealing with subjective symptoms, the only comparison that tells us anything reliable is a blinded comparison between a treatment and a control. Unblinded comparisons (such as between sham acupuncture and no treatment) are essentially useless, as subjective outcomes will be contaminated with placebo effects.

You also have to consider the quality of the study. Acupuncture studies in particular have a problem with unblinding (the subjects figuring out if they had real or sham acupuncture). The Chiu review summarized the rigor of the studies they reviewed, many of which had problems with allocation concealment, blinding of outcome assessment, and selective reporting. Such flaws easily explain the 40% of studies that show some small difference between treatment and control.

This pattern is typical of the acupuncture literature. The best quality studies consistently show no difference in blinded comparisons between treatment and control groups. The variables that define acupuncture – sticking needles into acupuncture points – do not make any difference to the outcome, therefore acupuncture (by any reasonable definition) does not work. The therapeutic ritual surrounding acupuncture has predictable placebo effects and nothing more.

A possible explanation for the dramatic difference in interpretation of the same data between the Chiu and the Cochrane reviews could be in a conflict of interest in the Chiu review. Although they disclose no conflicts of interest, all the authors are from Taiwan. A 1998 review found:

Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR.

From this data it is reasonable to conclude that being from Taiwan is a conflict of interest for acupuncture studies.

Conclusion

Yet again we see that the clinical data with acupuncture studies is essentially negative. In this case acupuncture does not work for menopausal symptoms. Proponents of acupuncture, however, turn the logic of science and clinical trials on its head by bizarrely concluding that no difference between treatment and control means the control works also (rather than the usual interpretation that the treatment does not work).

Believers apparently buy into this invalid logic. For example, the website Science 2.0 (a straight-up science news site) has the headline: Acupuncture Works To Reduce Menopause Hot Flashes – Meta-analysis. This is followed by a gullible article that accepts the authors’ biased conclusions without any critical analysis. The comments are also revealing, one stating the CAM party line very well:

You actually are quite uninformed here as to what “placebo” is. It is a mass misconception that “placebo effect” means something doesn’t work. The placebo effect actually proves that the body has a remarkable ability to heal itself. This is most relevant in the field of acupuncture – sadly, to fit acupuncture into the realm of “double blind studies” (which you would understand are horribly flawed if you spent any time in medical schools and in research classes (I have for instance) they had to come up with “sham acupuncture” which is completely flawed, because there’s no way to fake it.

No difference between treatment and placebo does mean that, as far as the clinical trial is concerned, the treatment has no specific effect. Sham acupuncture nicely controls for one aspect of acupuncture – alleged acupuncture points. At the very least we can conclude that acupuncture points have no basis in reality, which undercuts the traditional philosophy of acupuncture (at least as it is received today).

Other studies show that needle insertion, or insertion to depth, or elicitation of the alleged “de Qi“, also have no effect. You can actually “fake it” by using opaque sheaths and dull needles or even toothpicks that are not inserted, but neither the patient nor the acupuncturist can tell the difference.

Again, at the very least from all the data we must conclude that coaching a completely untrained person to poke the skin randomly with toothpicks, while putting on a halfway decent show, is just as effective as individualized acupuncture from a trained and credentialed acupuncturist with decades of experience. Therefore there is absolutely no basis for acupuncture philosophy, and no justification for training or credentialing of acupuncturists. Whatever they are teaching seems to be worthless.

A reasonable person can only conclude that acupuncture does not work, and that all the clinical research consistently shows that acupuncture conveys only illusory and nonspecific placebo effects for subjective symptoms.

Posted in: Acupuncture

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152 thoughts on “Acupuncture for Menopausal Symptoms

  1. Windriven says:

    Have any of these studies monitored frequency of hot flashes objectively? This should be an easy thing to do as one would expect a significant change in the galvanic skin response, especially on the torso, during hot flash. It might even be possible to correlate GSR magnitude and/or duration of the change in GSR with subjective measures of “severity.”

    1. KayMarie says:

      Have not checked which studies are in the meta-analysis but this one I found in a quick pubmed search did use objective measures.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292187/

      and this one discuses subjective vs objective measures http://www.ncbi.nlm.nih.gov/pubmed/23897855

      1. MadisonMD says:

        The first study you cite does not specify primary endpoint. There are many comparisons made (8 measures at 5 timepoints => so up to 36 comparisons are possible). Of these comparisons, 3 are reported statistically different (one doesn’t even compare with baseline, but with a later timepoint), with p values .02, .04, .05. No correction for multi-hypothesis testing. So conclusion:

        Findings may be used by Clinical Nurse Specialists to consider recommending acupuncture to improve sleep and reduce hot flashes in BCS.

        is fairly disingenuous. Of course the other conclusion is that a RCT is needed.

        But it is good to get objective measures, which may reduce the placebo effect. The objective measures should be applied to more plausible interventions.

    2. Serge says:

      I’m not looking any further, SSR will be along in a mo to ruin my night.

      Cottage pie, beer and golf for me.

      Have a good night all.

  2. goodnightirene says:

    Yet another nail in a coffin that nonetheless refuses to be slammed shut. At least twice a week I overhear someone in the neighborhood or at some function sing the praises of needling. The fact that practitioners are “licensed” goes a long way in creating an aura of respectability and effectiveness. Victims, er…clients, are told, of course, that “studies show it works!” as well, adding to an ever broader consensus that this “ancient Chinese practice” is a legitimate therapy.

    Disclosure: I had acupuncture done in 1982 (by a Chinese MD) and absolutely felt that it worked. Looking back I can see numerous reasons that I might have come to that conclusion; for example, I completely overlooked for many years that I happened to be taking rx pain killers at the same time for another issue (dentistry complication) which is probably what relieved my tennis elbow. I did seem to feel an intense euphoria after getting the needles in the earlobes, but I remain skeptical.

    1. Peter S says:

      I’m the opposite. Thousands of dollars of treatments, both Chinese MDs and “licensed” Western non MDs, and the result was always the same — nada.

      1. Windriven says:

        I’m wondering why you continued long enough to spend thousands? Was this prescribed by a physician or did you have a general belief in acupuncture?

        1. Peter S says:

          Two things I guess: one, certain people told me I needed to stick with it for a while to get results, and two, believing what I was told that the skill of the practitioner made a tremendous difference and I had not seen the best people yet.

          1. Lytrigian says:

            I was fortunate enough to be inoculated against that last by seeing someone who was almost universally recognized as one of the top TCM experts on the West Coast. There was no question of him being one of the best.

      2. Chris says:

        So you went through menopause? Forgive me for assuming you had a Y-chromosome. I am learning lately to not make judgements based on first names.

        The thing I mostly noticed about menopause is that it came and went. Plus when I did get hot flashes they were in the middle of the night, and the next day was I sleep deprived enough to not remember the specifics.

        I can see why some women think they got help. Though truthfully, the last thing I wanted during a hot flash is someone sticking me with needles!

        1. WilliamLawrenceUtridge says:

          I am learning lately to not make judgements based on first names.

          Ironic given your name is “Chris”.

          1. Chris says:

            Exactly. ;-)

            I always remember one of the young ladies in the Nancy Drew stories was called George.

            I have not had time to read through of this, especially since I typically ignore the SSR exchanges, I was struck how much input is being put in by those with Y-chromosomes when I glance at the comment feed. Since the feed is not threaded, I am assuming they are responding to SSR.

            1. Chris says:

              Okay, just skimmed through the rest of the comment thread, and my assumption was confirmed.

              Instead of acupuncture, I suggest that a woman of a certain age somehow get a sleeping porch. A bed in an enclosed open porch, or a small room with a quiet air conditioner to cool things down, and jammies made with the newer wicking fabrics.

              This way you do not have to disturb your partner by tossing covers over him/her, thrashing around, etc. Plus it is cooler.

              (When we built our house we were talked into having a balcony off of the master bedroom. It was a very stupid thing, because we were not going to go get our coffee downstairs and then sit on the balcony, especially on the rainy days or the pounding with sun days. So we had it enclosed, where it has a bed for reading, large windows with bug screens (very important!) and is also large enough to start veggies from seed very early in the spring.)

              1. n brownlee says:

                Oh, Chris- my paternal grandparents had 2 big screened porches, both were adjoining bedrooms. The best sleep!

                Of course, the Texas of my childhood was un-airconditioned, and screen porches were pretty commonplace. Love them.

              2. Chris says:

                I remember the ones off of a couple of upstairs bedrooms in an uncle’s house in Minnesota. They were there for a reason.

                Though in my uncle’s house, the one off of the master bedroom was first used as a infant nursery, and then used as an office. The other one was a playroom. Though they both had large windows with screens (remember the state bird there is the mosquito!).

                Hence the idea to convert the *&^%$#! 5′ deep by 10′ long balcony on the south side of the master bedroom.

              3. Chris says:

                n brownlee, you will appreciate the most accurate article on menopause I have seen:
                http://blogs.plos.org/dnascience/2014/07/10/menopause-toolkit-summer-sci-fi/

                Enjoy.

                And for those who are married to a woman over forty, take special note of what you will also have to look forward to as an observer. I’ll looking at you Dr. Novella. If the mother of your children has not encountered this stage, she will soon. You have been warned.

              4. Chris says:

                Though, I do admit to sometimes enjoying the vivid dreams.

                But I also am from a family of sleepwalkers and talkers, so we tend to act out our dreams. Dear hubby was not too pleased to wake up in the middle of the night to see me leaning over him whispering gibberish. It kind of freaked him out.

                Yet another reason for the sleeping porch.

              5. mouse says:

                @Chris – I like you menopause link. I would have posted more in the menopause thread (or for me, peri-menopause, I guess) but first I was too exhausted to deal with it. Then I forgot. Then I couldn’t organize my thoughts enough to decide what to say. Then I just had to run to the bathroom. Etc.

                A few scattered thoughts. Firstly -I find it very hard to separate symptoms of disease (In my case Undifferentiated Connective Tissue Disease) from plain old menopause. For instance I had formication or parathesia for several months, which gradually dwindled to nothing with anti-malarial treatment. Was it the UCTD or a period of hormone adjustment? It doesn’t help that autoimmune diseases seem to interact with female reproductive hormones in a way which I don’t understand. Same for headaches, I sometimes have headaches that I thought were due to menopause, but I haven’t had one since I started taking the b12 for possible deficiency. Uncertainty reigns.

                Secondly – When I am going through a period of sleep disturbances (due to hot flashes or early waking) I find taking a Benadryl before bed can be helpful. It doesn’t prevent the hot flashes, but it does give me a better chance of falling asleep again after the hot flash.

                Thirdly, trampoline’s are not your friend.

                Fourthly. I’ve always had vivid dreams, although in recent years I no longer have the more pleasant ones (maybe that’s just life, not hormones though). But, I have welcomed the return of hypnagogic visions, little sparkling floating lights and shapes that I see before falling asleep. I haven’t had those since I was a child. The first time I saw them in the last year I thought “Welcome back old friend.”

              6. Chris says:

                I also use Benadryl to help with sleep. Except when the waking up drenched in sweat happened after four in the morning, because I did not want an antihistamine hangover at 8am.

              7. Andrey Pavlov says:

                @Chris:

                I’d be careful with long term use of benadryl as a sleep aid. I recall somewhere reading some data that showed that frequent chronic users (can’t remember the cutoffs they used to define that) experienced more decline in memory and other cognitive tasks than matched controls. Obviously it was not definitive data, but seems to be not unreasonable.

                Even without that though, dependence can be an issue. That is just a facet of anything and actually a problem my own mother developed. Despite being an Evil Pharma Shill (TM) I tend to think that fewer medications is better and I would advise sleep hygiene long before pharmaceutical sleep aids. Of course, I have no idea if you are actually using benadryl more than infrequently (which is almost certainly perfectly safe) or not. I am more just using your comment as a jumping off point to advise some caution since I know many people use it as a regular sleep aid without much consideration as to the long term consequences.

              8. Chris says:

                You do realize that the hot flashes in menopause are not every night? Using it once a week, or since I finally finished menopause, about once every other month is not going cause dependence.

                What we are describing is not a simple sleep disturbance. It waking up where your body temperature is actually elevated, and you are lying in a pool of sweat, plus you are fully await with every thought of the day going through your head. Perhaps after dreaming that you were being pursued by space aliens on a giant planet sized roller coaster, that then turns into a lake where you are splashing around with plesiosaurs.

                Just check in with us in about twenty five years when you will be sleeping next to someone who bolts straight up in bed, fans the covers to cool herself, and then spends the next three hours tossing and turning. And if she is from a family like mine who do walk and talk in their sleep, it will be punctuated with interesting if not intelligible dialog.

              9. Chris says:

                “fully awake with every thought of the day going through your head.”

                Also, you really don’t get to remember most of the vivid dreams.

              10. mouse says:

                @Andrey Pavlov – good to know on benadryl. I actually started taking it periodically years ago on the advice of my psychiatrist to help in insomnia due to restless legs as a side effect of SSRI. I’m told, it’s safer than many prescription sleep aids. It’s good to remember that insufficient sleep also has health/cognitive consequences, bit it’s good to remember if you can by with no sleep aid, that’s the way to go. I have always found sleep hygiene tips to be pretty useless for early morning waking.

                My sleep issues are also intermittent/premenstrual. If I have a problem one night, I know that heralds a few more nights of the same, so I take the Benadryl for three or four nights, about once a month.

                “It waking up where your body temperature is actually elevated, and you are lying in a pool of sweat, plus you are fully await with every thought of the day going through your head. Perhaps after dreaming that you were being pursued by space aliens on a giant planet sized roller coaster, that then turns into a lake where you are splashing around with plesiosaurs.”

                Ugh – yes. My worst was the dream of being at the lake, seeing a splash in the water and seeing an alligator, then looking over at my children swimming and seeing ripples approaching my son – knowing it was another gator and, of course, not being able to move or call out. Don’t even want to go back to sleep after that. But mostly my dream are of the post apocalyptic or exam I haven’t studied for variety. The racing thoughts after waking is the worst then.

          2. n brownlee says:

            The variety of possible menopausal symptoms aren’t just funny- and they ARE funny- they may lead the sufferers and indifferent/lazy/mediocre damn doctors to attribute any and all random symptoms suffered by a “woman of a certain age” to – guess what- menopause! At age 47 my Carcinoid symptoms became more frequent and more pronounced, and I was also perimenopausal. Despite the fact that the menopausal hot flashes and Carcinoid flushes are not at all similar, that my lab work was abnormal and that I sometimes lost consciousness during a prolonged flush, they just kept handing me Estratest.

            Once my Carcinoid was under control, I had very little problem with menopause. I do hate the change in body shape, though. I’m an atypical “apple” type- narrow hips, long legs, not much waist. Any weight gain now means I look like Alice the Goon Girl from Segar’s Thimble Theatre.

            1. Chris says:

              It would be very difficult when combined with other issues, just like you and Mouse mentioned.

              “Fortunately” the only things that complicated my life, other than the shape changing and lack of sleep, was increased cholesterol and blood pressure, which my younger sister is just encountering. Those are much easier to diagnose and treat. But not with acupuncture needles!

    2. Frederick says:

      That coffin must now weights a hundreds tons, despite that, they always find enough believers ( and peoples who make money out of it) to continues carry it.

      In 1982, that’s a will ago, we forgive you for believing :-). When I was younger I thought chiropractors were reals doctor specializing in bones or something. And I believed In vital energy and bought into some UFO/conspiration.

      For the ear lobs, they are really sensible. They are, for some people, erogenous zone after all, it might be related to that. :-)

      1. goodnightirene says:

        Ha-ha! Erogenous zones–I thought of that, but not the same as arousal–just euphoria. I read somewhere once that there is something to this earlobe thing, but have never taken it seriously. Thank you for granting me dispensation for mt errors of the 80′s :-))

  3. Pete A says:

    The phrase “interpretation of results” has the connotation of being benign and perfectly acceptable behaviour. However, the wilful misinterpretation of data (by those supposedly qualified to undertake and understand research) is neither benign nor is it acceptable behaviour.

    In this context, the antonym “misinterpretation of results” does not mean a benign (naive) misunderstanding: it means, at the bare minimum, incompetence, but it usually means the deliberate action of giving “a false representation of the results”.

    Proponents of sCAM are generally very good at only one task: semantic obfuscation aka wilful obscurantism aka being the the real enemy of science.

  4. Andrey Pavlov says:

    I’m waiting for PMoran to show up and yet again tell us how incredibly rude and incompatible with the science it is to say “acupuncture doesn’t work.”

    Of course, one can only claim that “acupuncture works” if you stretch the meaning of “works” to the point of being an utterly useless word, which could be equally applied to anything.

    1. MadisonMD says:

      I am surprised we haven’t seen his submitted post yet. Maybe it is being revised/edited.

      1. Andrey Pavlov says:

        I read the version he put up on his own website. It certainly was in need of revision and editing. I will refrain from making a firm conclusion until such time but what he did have up there was mostly a rehash of the same things he has repeated endlessly here. There were a few small nuggets that, if fleshed out, might be interesting. I’ll just let my thoughts on that hang in limbo. But I am pretty settled on what he has put on offer in the comments here.

    2. Frederick says:

      The race is open between Moran and SSR! I vote for SSR, because “SSR” sound like a high end sports cars/motorcycles name. There’s also a racing wheel company called SSR.

      1. MadisonMD says:

        SSR couldn’t make a post that makes enough sense to be published at merola.com. And that is a pretty damn low bar.

      2. Thor says:

        You should have assumed SSR would be first. He just cannot resist the urge to put his foot in his mouth. He must be a masochist, of sorts, trying to get away with unicorn-science on this site, of all places. Then again, he probably loves all the attention he gets. If he is what is considered an educated spokesperson for CAM, the battle is already won. Only mentally compromised fools, could resonate with such a sod as he. Thank the stars for people like WLU who are willing, again and again, to clarify things for the fence-sitters and casual perusers.

        1. WilliamLawrenceUtridge says:

          and again and again and again and again and again until it’s so tedious you wish for an html code to make his keyboard fly off of his desk and break his nose out of pure boredom.

          1. Thor says:

            and again and again and… I’ve said it before, I admire your patience and reasoned responses (and wit and sass). You said once that you respond to woo-meisters mainly for your own satisfaction. But man,
            isn’t this case beyond the pale? I’m astonished (and often nauseated) by how delusional an awry mind can be. I fear that his mental state is one of all-encompassing faulty cognition, and pathological inability to use language, in writing at least. Scary, not only that he’s a doctor, but that he interacts with others at all.

            1. WilliamLawrenceUtridge says:

              You said once that you respond to woo-meisters mainly for your own satisfaction

              Steverino Stevemeister is the exception to that rule.

              I fear that his mental state is one of all-encompassing faulty cognition, and pathological inability to use language, in writing at least

              His inability to write in comprehensible sentences makes me wonder whether he is perhaps using a mobile device to type out his responses, but he might also simply be a faulty Turing engine.

              1. Windriven says:

                “he might also simply be a faulty Turing engine”

                I suspect the ‘fault’ is that it is running on a TRS-80.

    3. mouse says:

      Oh no! Please let sleeping dogs lay.

      1. Windriven says:

        “Oh no! Please let sleeping dogs lay.”

        Sorry mouse, but that dog ain’t gonna hunt (as long as we’re using canine metaphors). There are a raft of us waiting with bated breath for Peter’s post. I, for one, hope that he steers clear of tone-scolding and focuses on a different approach to debunking quackery. The tone thing stopped interesting me months ago and lately it doesn’t even bore me.

        1. Andrey Pavlov says:

          I, for one, hope that he steers clear of tone-scolding and focuses on a different approach to debunking quackery.

          If the preview I read is any indication, don’t hold your breath.

        2. mouse says:

          “Dog won’t hunt” always reminds me of that Primus song. My comment was more in response to the prospect of another lengthy comment exchange, rather than the proposed post.

  5. Travis says:

    I linked to this article as a rebuttal to the article on science 2.0 using rbutr (an amazing service in progress!!!)

    http://rbutr.com/rbutr/WebsiteServlet?requestType=showLink&linkId=4075190

  6. Pete A says:

    Andre, there is no need to stretch the meaning of “works” to the point of being an utterly useless word. In sCAM, “works” simply means that that the practice is earning revenue — it has nothing whatsoever to do with phrase “it works for the client” as in “medical efficacy”.

    1. Andrey Pavlov says:

      @Pete:

      No apologies necessary. Typos happen. The meaning is what is important.

      And yes, you are correct of course. But I think you may be missing the extensive background I have with PMoran in this regard.

  7. WilliamLawrenceUtridge says:

    The placebo effect actually proves that the body has a remarkable ability to heal itself.

    I wonder if the commentor would be comfortable with homeopathy being sold then, or perhaps Big Pharma’s latest chemical that showed results no better than placebo. “Take some asscomeoutizide, sure it gives you rectal prolapse, but aside from that it cures everything!”

  8. Pete A says:

    My humble apologies to you, Andrey Pavlov — it wasn’t a typo, it was my incompetence to correctly select the text for my copy/paste operation.

  9. Frederick says:

    I read the science 2.0 article, it is pathetic. I saw your article on your blog, and the comments from skeptico who posted it..

    The problem is that people think that placebo is the “mind power” over the body. They always seem to forget that in the “placebo” there a bunch of stuff. like People Lying, people thinking they are getting better but they are not, the symptoms going away by themselves. Before having any interest in science in medicine, I always thought that it was a mysterious effect, unknown. But it is not as great as it seems.
    http://www.pseudo-science.org have a great article on this ( a french article http://www.pseudo-sciences.org/spip.php?article1604 ) . I learn a lot reading this. Once you account for all the stuff that is inside the “placebo” the “real” placebo is super small. Like our writers here always point out, placebo is a complexe thing, and some people just oversimplified it to fit there view “it’s the power of the body” that is just naive.

  10. First you have to define Acupuncture and then Menopause, both of which really do not exist as a simplified concrete definition which is the flaw in most studies.

    So, In essence this discussion has no relevance in clinical medicine, only in your minds.

    Enjoy your game.

    1. WilliamLawrenceUtridge says:

      So what you’re saying is, you reserve the right to claim the definition of any treatment that doesn’t work to be the wrong definition?

      Sounds like you’ve constructed a killer combination of the moving goalposts and no true Scotsman fallacies.

      You’ve never actually defined acupuncture for us by the way, and you always insist that the definition used in research is wrong. Why not actually define it for us, since you’re obviously so clever?

      1. KayMarie says:

        And the definition on his web page makes it clear as mud

      2. KayMarie says:

        What I get for trying to do the blockquote code :-)

        “Acupuncture, Capital “A” is the ancient Chinese art of healing. So Acupuncture is a surgical procedure that uses a fine flexible filamentous needle to puncture certain points in the body. Small “a” acupuncture is just puncture or puncturing of the skin using a needle into a specific predetermined location.”

        1. Peter S says:

          Why is it a “surgical” procedure? That does not comport with this layperson’s understanding of surgery.

          1. Windriven says:

            It doesn’t comport with anyone’s understanding of surgery, Peter. The claim is pure nonsense. But then Steve’s mind is on a different plane than most of the rest of humanity.

        2. Oh … I have to change that! …

          The “A” vs “a” was to show the formal Tradition vs GunnIMS type … I have evolved past that idea.

          Thanks. i have to update my website. See yall later!

          1. WilliamLawrenceUtridge says:

            The “A” vs “a” was to show the formal Tradition vs GunnIMS type … I have evolved past that idea.

            What happened, you finally realized that the technology to forge filiform steel needles didn’t exist until the 17th century AD? Or you came up with a new excuse to use when one of your patients doesn’t respond?

            Thanks. i have to update my website. See yall later!

            Take your time. Take as long as you want. Take longer. Update the whole thing, starting with a comprehensive review of the research literature.

          2. Peter S says:

            From Dr. Rodrigues’ website:

            “In my practice I use all of these tools, hand-in-hand, in an impromptu fashion like an artist working on a painting or a musician on a production.”

            I’m not sure I would want my doctor to think of himself as an impromptu artist? That said, I do find the theory of dry needling interesting, as it seems in some people, such as myself, muscles can become shortened and contracted and it would be great if there were some intervention that could change that.

            1. Peter S says:

              This is an interesting article on dry needling. I am not qualified to evaluate it.

              http://www.jabfm.org/content/23/5/640.full

              1. WilliamLawrenceUtridge says:

                If acupuncture were treated like dry needling, I’d have much less problem with it. The authors themselves say – avoid blood vessels and lugs. Do that and use sterile needles, and 99% of the adverse effects of acupuncture disappear.

                That is however, a narrative review – which means the authors are much more free to pick and choose sources compared to a systematic review or meta-analysis. I also note that they restrict their commentary to musculoskeletal pain, which I also approve more than the “acupuncture can treat anything” approach.

                I’ll note that it’s flawed for the same reasons SSR’ arguments are flawed though – they rely on Travell & Simons to define things; well T&S based their books on clinical impressions, not controlled, rigorous research. And has there been comparative effectiveness research? Is dry needling better than massage? Further, the field has splintered much like acupuncture itself, into different schools and schisms. There’s not really different schools or schisms in chemotherapy, or how to disinfect a wound, and the disagreements are resolved by evidence, not assertion. Effectiveness over placebo, as discussed by the article, is not in evidence; it could be – but it’s not demonstrated yet. It’s better than no intervention, but then again, so would a nice chat with a sympathetic actor. At least they discuss the flaws and failings of the literature (and even know the literature exists, unlike Steve-O). Oddly they claim the probability of a type II error is high (a false negative) despite much evidence that type I errors (false positives in small-n trials) are much more common (a la John Ioannidis). There’s also the splintering of the data and goalpost-moving, claims the the lack of results is due to improper location, needle depth, better than usual care, indistinguishable from sham needling, etc. Disappointingly, from there they go on to basically say “but if it were effective, here are some people who got great results!”

                It also states “Its effectiveness has been confirmed in numerous studies and 2 comprehensive systematic reviews”, a claim about as outrageously at odds with the actual data discussed as the article Dr. Novella discusses.

            2. n brownlee says:

              “it seems in some people, such as myself, muscles can become shortened and contracted and it would be great if there were some intervention that could change that.”

              Physical therapists have some great exercises for that- work like a charm, really. But you have to do them – ideally, daily.

              1. Peter S says:

                Been there done that many times, as well as a whole bunch of other modalities, unfortunately. The problem remains the same.

      3. You missed it … I did that a while ago. See my post on Gunn.

        I see you are the voice of Novelle, does he give you a stipend?

        I see his business venture is starting to collect ads!

        1. Windriven says:

          “See my post on Gunn.”

          Why? It is a waste of time. You haven’t said one goddamned new thing in … since you appeared here. You are a one-trick pony with a trick that doesn’t work. Jesus. I feel sorry for you.

          But on to the subject at hand. Calling acupuncture surgery is like calling a horse a satellite. The one has nothing to do with the other. Acupuncture doesn’t even rise to the level of phlebotomy … other than by accident.

          “I see you are the voice of Novelle, does he give you a stipend?”

          Yeah, Dr. Novella sends each of us a check for $2500 every week. Mine usually arrives in the Thursday mail, I guess because I’m on the other side of the country. I’d really like it if he would go to direct deposit.

          1. Andrey Pavlov says:

            Yeah, Dr. Novella sends each of us a check for $2500 every week.

            Hey! I haven't gotten a check! And that would be around 4-fold as much as I make right now…. I sure could use the cash…

            As for SSR – I received a letter from the Department of Health and Human Services indicating that they had received my complaint of his blatant HIPAA violation and they are currently investigating to see if they have jurisdiction and authority to take action. It came directly from the Dallas office and it says they will complete their initial review "as quickly as possible." Not bad considering I only just sent in the complaint a few weeks ago.

            While I'd love to have SSR go down for the atrociously bad "medicine" he practices, if Al Capone can go down for tax evasion maybe SSR can go down for HIPAA violations.

            1. Windriven says:

              ” if Al Capone can go down for tax evasion maybe SSR can go down for HIPAA violations.”

              I’m keeping a good thought but, as a friend of mine said in another context, I’m not holding my breath. Texas is warm nest to such luminaries as Stash Burzynski and Andrew Wakefield.

            2. Thor says:

              Wow! Good for you, Andrey, for Texas, for the country. Perhaps not as monumental as Burzynski going down would be, but a small, meaningful, victory none the less. I’m feeling the most exhilaration I’ve felt in days! lol! But, I must have missed something. Have you shared the issue on SBM before? Which violation, if I may ask.
              Keep us posted.

              1. Andrey Pavlov says:

                @windriven:

                Yes, I know. But if nobody does anything then nothing will happen for sure. And a HIPAA violation is actually much easier to prosecute than the shenanigans B has been pulling. Also partly because B is intentionally trying to cover his ass. SSR doesn’t seem to have that level of awareness and intelligence.

                @Thor:

                Yes, I made the comment somewhere here when SSR created that Dropbox folder with his patients’ photos and video testimonials. I documented that he had them all and sent it to the HHS as a HIPAA violation. I had sort of forgotten about it until I got the letter.

              2. MadisonMD says:

                Andrey, were there any identifiers?

            3. Vindictiveness will not kill the message.

              I will let you know the outcome.

              1. Andrey Pavlov says:

                This has nothing to do with vindictiveness Stephen. You are a danger and a menace to your unsuspecting patients. For that alone you should have your license revoked. But you are also in violation of HIPAA. It is not vindictive to take appropriate action against a violation of law. I have no compunction about making your life difficult for all of the above reasons.

              2. Thank you for looking out after patient well being against abuses and misleading statements. That is my mission also. At least we have something in common.

                IMO, this site is improperly titled, it should be a cynic’s view of science and medicine.

                Do you think this is false and misleading? I’m absolutely certain it is to to many lay persons! Should it be reported?
                “Acupuncture Doesn’t Work”
                http://www.sciencebasedmedicine.org/acupuncture-doesnt-work/

              3. WilliamLawrenceUtridge says:

                Vindictiveness will not kill the message.

                I will let you know the outcome.

                I have no vindictiveness, I’m just disgusted at your inability to even understand basic criticisms.

              4. Lytrigian says:

                Vindictiveness will not kill the message.

                Says the guy who accuses everyone who disagrees with him of being shills. “Who sent you?” “Are you paid a stipend?” But Andrey is the vindictive one. Yeah, right.

            4. Harriet Hall says:

              If any of you get a check, please let me know. It would hardly be fair for commenters to get paid when us bloggers and editors haven’t ever been paid a penny for our work on SBM.

              1. Sawyer says:

                One time while doing work for my father, I took an extra 2 minute break over lunch to finish typing a comment here. I got paid for those 2 minutes.

                Harriet might not get paid a penny, but I’m living the sweet life with that 40 cents I took in while commenting on SBM. Clearly Steve is getting millions of dollars from Big Pharma, and in turn diverting it through mid-sized landscaping companies in an elaborate hoax to turn working class Americans against acupuncture. It’s the perfect plan.

            5. Windriven says:

              “Hey! I haven’t gotten a check!”

              Have you checked with Morris Bart?*

              *For those of you who don’t live in the New Orleans area, Morris Bart is a personal injury attorney whose smiling face graces billboards and TV ads asking the age old question: “Have YOU gotten YOUR check yet?” You know, you just can’t make this sh|t up. I wonder how much ole’ Morris contributes to Lousiana having the second highest auto insurance costs in the nation?

              1. Andrey Pavlov says:

                Morris Bart has the creepiest face I’ve ever seen. And there was a billboard of him on the road back from the hospital.

              2. WilliamLawrenceUtridge says:

                Jebus, it’s like someone explained the concept of smiling to him and he’s still working on it.

                “So, I open my lips slightly to show my teeth, and contract the muscles responsible for pulling up the corners of my mouth. Boom, nailed it.”

                “Sir, you look like the Joker’s corpse being prepared for a funeral.”

                “OK, got it, I’ll work on it. Man, this would be easier if I had actual emotions.”

        2. WilliamLawrenceUtridge says:

          You missed it … I did that a while ago. See my post on Gunn.

          I addressed Gunn a while ago, at least one of your posts on his work, here. To repeat – Gunn’s publications are old, are books (and thus not peer-reviewed) and the entire state of trigger point therapy is still in preliminary stages of understanding what they are and how to treat them. There’s no studies I’ve seen that convincingly establishes acupuncture as the best, the only or even a promising treatment. Do you have any? One doesn’t merely cite a book like it were the bible – one must demonstrate that the book is trustworthy and has led to developments in the field.

          I see you are the voice of Novelle, does he give you a stipend?

          I’m not. But even if I was – so what? Even if I were being paid by Satan himself using Osama Bin Laden’s personal bank account, that doesn’t invalidate my points.

          I see his business venture is starting to collect ads!

          Yeah, because SBM hit one million page views a while back – and that kind of traffic requires revenue to pay for the servers.

          And again, so what? Because you can’t think of an intelligent rebuttal you try to change the subject?

          1. “Pain is centrally-mediated, after all, so simple reassurance could be a factor in at least some cases in “dialing down” the urgency, intensity or emotional burden of the raw sensory stimuli.”

            That definition is very elegant but is totally wrong because it is incomplete and there is no way to test it for it’s validity.

            All the other concepts are incomplete and have flaw too!

            The difference is that older definitions have a treatment options that is correlational which is beneficial to patients – today.

            That word salad is all but a set of ideas, concepts and jargon which can not help anyone who has pain and dysfunctions.

            Darn it quit talking for your bosses, let them talk for themselves!

            1. KayMarie says:

              “All the other concepts are incomplete and have flaw too!”

              Well except for whatever the heck yours are that you can’t articulate in a way that any other human can understand. Please don’t try to convince me you are like one of the ancient Chinese masters who may only reveal the secrets to the next lineage holder so is required to obfuscate the one and only truth to keep it out of the hands of mere mortals who could not possibly understand and would only use the knowledge in dangerous ways. Because honestly, their writings for the great unwashed are generally much less obtuse.

              I swear I felt less dizzy after getting off of a carnival ride on a day where there were very few people in the park so they gave us a bunch of extra time. Your explanations go ’round and ’round and never get anywhere, and never get anywhere near a testable hypothesis or coherent model of reality (or pseudo-reality).

              And I use trigger point stretches on my pain because they seem to work, dammit. :-)

            2. WilliamLawrenceUtridge says:

              That definition is very elegant but is totally wrong because it is incomplete and there is no way to test it for it’s validity.

              No way to test, are you kidding? Take two groups of patients with pain. The first group gets acupuncture. The second group gets an equivalent amount of time with a doctor who gives a very careful exam, ask a lot of questions about the pain, other symptoms, and life in general, then ends with a strong, reassuring statement. Boom. Validity tested.

              And how is it incomplete?

              All the other concepts are incomplete and have flaw too!

              And how are they incomplete, and why do they have flaws? And if you are the only person to successfully deliver acupuncture in a unique and helpful way, why do so many swear by it?

              You say a lot of stuff, but apparently don’t actually think it through. For instance, you are apparently asking us to believe that acupuncture got it wrong for thousands (or perhaps hundreds, depending on whether acupuncture is actually a form of bloodletting – before the use of fine steel needles it appeared to actually be simple bloodletting with much larger traditional instruments) but somehow you, and only you, managed to get it actually right such that you deliver something beyond merely a placebo effect. The altenative is, of course, you are also merely delivering a placebo and you’ve fooled yourself into somehow thinking you are special and managed to crack the acupuncture code that eluded everyone else.

              The difference is that older definitions have a treatment options that is correlational which is beneficial to patients – today.

              That word salad is all but a set of ideas, concepts and jargon which can not help anyone who has pain and dysfunctions.

              Speaking of word salad…none of this makes any sense. I have no idea what you are trying to say. Your utter lack of ability to put together a coherent sentence to explain your beliefs is further evidence against your claim to have discovered a unique brand of healing that has eluded all others.

              Darn it quit talking for your bosses, let them talk for themselves!

              Stevie, Dr. Novella will never, ever waste his time on you. Your ego will not be gratified by his attention. You are an insignificant waste of time to him. You’re a waste of time to me as well, but someone has to point out how wrong you are.

              Also, if you can’t even form a coherent defence against me, a mere peon, a sketpical midget, a barely-there commentor who doesn’t even attend TAM let alone get invited as a speaker, how will you manage against a headliner? Why not try actually engaging with me and showing evidence you even understand my criticisms before demanding the attention of much more important people?

            3. simba says:

              “Darn it quit talking for your bosses, let them talk for themselves!”

              That sounds very much like “Stop showing me that multiple people disagree with me!”

    2. Serge says:

      Aaaaagh! Back to the beer.

      1. Windriven says:

        Serge, you know it’s not just for breakfast anymore.

  11. Frederick says:

    Yeah there’s add on the site, theybhav no choice like WLU points out. But Ssr you should be happy, a lot of those ads promote stupid non senses, and cam.

    Beside SSR, if sbm making money (of course it doesn’t, it is just to pay the expense) from our skepticism invalidate our assertions, than your own assertions and arguments also become automatically invalid too, because you also make money from it. And like i said, non of us make money out of this ( well i wish i would, that way i wouldn’t have to work at my old boring factory for the summer) only you do so, you are selling you bs remember?

  12. WilliamLawrenceUtridge says:

    Thank you for looking out after patient well being against abuses and misleading statements. That is my mission also. At least we have something in common.

    That’s where you are wrong. Science-based medicine is about using evidence to guide decision-making. Your approach is to use a decision you’ve already made to guide yourself to evidence that will support it. Science. You’re doing it wrong.

    IMO, this site is improperly titled, it should be a cynic’s view of science and medicine.

    Why is it cynical to ask for evidence before believing? Is it cynical to take have a ring appraised if someone tries to sell it to you for $1,000,000? Is it cynical to doubt someone’s claim that they can double your money in a week if you give them $10,000 right now?

    Is it cynical to ask a doctor what evidence supports the claim they can cure cancer with baking soda or urine?

    Do you think this is false and misleading? I’m absolutely certain it is to to many lay persons! Should it be reported?
    “Acupuncture Doesn’t Work”
    http://www.sciencebasedmedicine.org/acupuncture-doesnt-work/

    Do you not see the difference between a HIPAA violation and a discussion about the flawed evidence base within the scientific literature? And who are you going to report it to by the way? The internet police? I hate to tell you, that’s not what INTERPOL stands for.

    1. Serge says:

      Ha ha! Love it!

  13. Jopari says:

    The moment I saw the title I was thinking: Great, Stephen S. Rodrigues again. Scrollin on I came to his “Vengeance will not silence the message.” post. Nice, messiah.
    Stephen, your posts so far have only made me cringe from the ineffectiveness of your argument, your dogmatic belief ill-supported by evidence, and your own vindictiveness.
    Honestly, if we’re all cynical and paid off, at least take the rant elsewhere.

    1. Windriven says:

      “the ineffectiveness of your argument, your dogmatic belief ill-supported by evidence, and your own vindictiveness.”

      You forgot barely comprehensible structure and syntax. I sometimes read one of Steve’s Tourettian eruptions and am left with a sensation not unlike the ‘brain freeze’ one might get from shotgunning a Slurpee.

      1. Egstra says:

        “Tourettian eruptions ”

        A+ on that one!

      2. Jopari says:

        True, I forgot that, gives me a headache everytime. I have to force myself not to skim his posts.

      3. Frederick says:

        «You forgot barely comprehensible structure and syntax»

        Yeah, At least I have I Excuse for my poor syntax and grammar.

        Oh yeah this is off topic, but stupid question coming from a computer geek, despite My hardware, OS and network knowledge I have no idea how Html work… ( So how do we use those html command, Like blockquote ?

        1. goodnightirene says:

          Oh, I hope someone answers that–I feel sooooo HTML-inadadequate!

          As to SSR, can he really be an MD–that’s sooooo scary!

          Sooooo sorry for the soooooo’s. I’ve been over at the neighborhood party for awhile and I just don’t seem to process beer very well in my dotage. O_o

        2. JD says:

          Here’s a blockquote example (remove all of the *’s), I really hope this doesn’t do something strange:

          using blockquote is fun

          using blockquote is fun

          If you wanted to add a hyperlink, that goes like this:

          Burzynski’s house is massive (REFERENCE)

          Burzynski’s house is massive (REFERENCE)

          1. JD says:

            That did nothing. Just add to the outsides of each of these where the *s are:

            *blockquote* blockquote is fun */blockquote*

            *a href = “WEB ADDRESS HERE”>TITLE YOU WANT IN TEXT*/a*

          2. JD says:

            One last time. Just add less than “” signs where the asterisks are (they didn’t show up above), to close out, I apologize that I failed so very miserably at this.

            Here’s a decent tutorial

            1. goodnightirene says:

              Many thanks–and glad I got back to these comments in a roundabout way. :-)

        3. Windriven says:

          Frederick, visit w3scools.com. They offer complete details for all of the HTML tags along with clear examples of use and structure. It is very difficult to demonstrate here.

          1. WilliamLawrenceUtridge says:

            Am I the only one who sees “You may use these HTML tags and attributes:” below my comment window? It doesn’t note that you have to close the tag (by adding the same code after the text you are tagging, but with a forward slash between the first angle bracket and the tag content), but it does specify which tags you can use.

            1. Windriven says:

              All true William but for the uninitiated, experimenting with HTML tags can lead to a succession of effed up comments that clutter the landscape. I’d rather they see the tag in question as it should be formatted and, hopefully, get it right the first or second time.

              Occasionally I forget to close a tag and, for instance, bold type will run to the end of my comment. An edit button would be a nice feature. Some systems allow an edit for some finite period, then the button disappears or ceases to function, one supposes so that goal posts can’t be moved in response to follow on replies.

              1. Nell on Wheels says:

                Allowing editing for a specific amount of time would be very nice. Despite Windows spellcheck and repeated proofing, I never see some mistakes until I click “Submit.”

                A preview option would make HTML errors very obvious before submitting.

              2. Lytrigian says:

                An edit button, or at least a preview so you can make sure you haven’t missed a close tag or something before you commit.

                It’s blockquote that always makes me triple-check, since I’m so likely to make an unnoticed typo.

              3. Chris says:

                “All true William but for the uninitiated,”

                For them it takes a while to figure them out. I briefly tried to learn them on my own a few years ago, but only really started to use them once I started to take classes at a community college before applying to grad school (which I got into, only having to drop out, again).

                And like anything, you have to use it or lose it! I did learn to program in Javascript, but since I have not done that for close to four years I’ll have to start almost from the beginning. The logic I remember since it is similar to FORTRAN, Basic, MIMIC aka “Modified Integration Digital Analog Simulator”, LSD aka “Language for Structural Dynamics”, DMAP aka “Direct Matrix Abstraction Language” and the system languages required to get jobs done on a VAX, Cyber and Cray (which I only used once, it’s not good for time series analyses of only six degrees of freedom)… but the vocabulary and syntax is what often changes.

                Yeah, I used to be intelligent, but then I had kids. I have dabbled a bit with Mathematica. Sometimes it is also elusive, especially when I was doing Fourier series.

          2. Nell on Wheels says:

            I second w3schools.com. Until you understand and get the hang of using the various tags, you can copy their examples and replace their text with yours. Here’s the page for using Blockquote:

            http://www.w3schools.com/tags/tag_blockquote.asp

            The panel on the left of that page has an alphabetical list of HTML Tags to allow you to find explanations and examples of the other tags listed below the comment window on this page.

          3. mouse says:

            I third or fourth the http://www.w3schools.com recommendation.

            I do not often code, but when I do, I use w3schools.

            it’s very good for folks who want to learn or only use html occasionally.

            1. WilliamLawrenceUtridge says:

              Hah, beer joke.

        4. Chris says:

          How to use a blockquote: <blockquote>Put paragraph of person you are quoting in here.</blockquote>

          To get dark letters, substitute the word “strong” for “blockquote.” For italics use “em” or “cite.”

          How to embed links: <a href=”http://www.sciencebasedmedicine.org”>Put page title in here.</a>

          Also, the comment feed shows the raw HTML used by others:
          http://www.sciencebasedmedicine.org/comments/feed/

          1. mouse says:

            but, but, but, how did you get the chevrons to show? They always disappear for me…or do something awkward like break the internet.

            See! I bet there’s no chevron blockquote chevron above.

            1. Chris says:

              There is separate HTML code for the chevrons. It is (spelling it out): “ampersand” “l” “t” “semicolon”
              and “ampersand” “g” “t” “semicolon”

              The “lt” between the & (ampersand) and ; (semicolon) is for the “less than” sign, and the “gt” is for the “greater than” sign.

              1. Lytrigian says:

                But you can use that same system to show it properly.Going out on a limb with no preview feature:

                &lt; and &gt;

              2. Chris says:

                Oh, wow! The angle brackets show up on the feed, but not the HTML. Look quick:
                http://www.sciencebasedmedicine.org/comments/feed/

              1. mouse says:

                Okay – entities. Thanks for the link!
                Believe it or not, I actually worked for years in digital arts/design, first interactive children’s books on CD-rom (anyone remember those? Lion King?) then web development at the start of the ecommerce boom. But I was on the creative side. I designed the branding, layouts, graphics, then cut everything up and sent the assets over to our producers to write the HTML, DHTML, Java, etc.

                Just when I started making some real money, I decided that I might strangle the next client who, after in-depth interviews, planning, comps and final pages, told me “This isn’t right, we just want tabs like Amazon.” So I put in my notice.

                Every time I think of re-entering that field I look at the loooong list of new skills HTML, JavaScript, CSS…all new photoshop, etc. and I STILL would have to deal with clients who want it to look like, well probably Instagram or Pinterest, now.

                Designing apps seem like they would be fun, though.

                I really should learn HTML – or better my carpentry skills, or do more relationship building in the arts community. I just can’t decide.

              2. Lytrigian says:

                @mouse — There’s not much point in learning HTML these days. I’m pretty sure that close to no one codes by hand anymore. Knowing how to format a simple tag or two for a forum post is pretty much all you’ll need, and you can get Firefox plugins to take even that bother off you.

              3. mouse says:

                @Lytrigian – Cool! Well carpentry it is then.

          2. WilliamLawrenceUtridge says:

            “cite” is supposed to be used for italicizing titles of publications (i.e. journal names or book titles) specifically. What the difference is, I’m not sure. I would guess something to do with automated analysis or something.

            1. Chris says:

              It just works better than using “i”

              1. WilliamLawrenceUtridge says:

                Try using “em” instead, “i” is apparently old (but still supported) html.

            2. Lytrigian says:

              The original theory of HTML is that text would be marked up semantically, leaving it up to the browser how to render it. Tags like “cite” are vestiges of that idea. In the event, graphical designers wanted more control over the appearance of a rendered page, so HTML is now more about that than semantics.

        5. Frederick says:

          Thank for all the answers! as funny as it seem, I know a lot about PC, but more about hardware, OS and networking, I have knowledge on my own as a big gamer since 1997, but i’m also In college right now. You want to know how UDP, TCp, routes/routers or switches works, I can explain it, but HTML and stuff like that is not my area of expertise. I have never build web pages, or blogs, too lazy for it lol.
          And Yes the codes are there under the comment window, But I didn’t know how t use them, and i did not want to like stupid by randomly trying.

          @Windriven : Thank! I will definitively get a look at that, after all It will make one more skill that could be useful!

          @Irene He don’t worry about it, The important is that you wanted to help :-)

          I have been wishing to add a link “inside” a word for week now, Now I can do it ( well if i doing it right)
          Acupuncture is like MAGIC!

          crossing finger…

  14. Jopari says:

    Though, come to think of it, if all the quacks left, life would be excessively boring.

    1. WilliamLawrenceUtridge says:

      The dullness of life would be compensated for by an increased duration due to better medical care, and more money to spend on other interesting things like travel. CAM is mostly an opportunity cost in addition to being an offence to reason.

  15. mouse says:

    IreneGoodNight “Sooooo sorry for the soooooo’s.” etc

    LOL! Irene careful of that coding under the influence. ;)

    1. Serge says:

      I think I’m under the same influence, I’m still chuckling about INTERPOL.

  16. Frederick says:

    True beliefs dies hard, One of my friend, a awesome person, but he want to belief spiritual stuff etc, post that yesterday… turn out Science proven without a doubt acupuncture Work! We are wrong… Yeah right

    I won’t comment or debunk it because I don,t want to hurt his feeling, but all this stuff is so ridiculous. there’ no reference, no explanation. Science “evidence” for he true believers, they barely need anymore than low standards ones.

    1. Frederick says:

      Damn I forgot to use donotlink.com. Click Here instead. those site do not deserve any more clicks.

    1. WilliamLawrenceUtridge says:

      What do you think is going to happen except people might show up to mock you and your assertions, as usual?

      1. simba says:

        Views, I’m assuming? Haven’t looked at the website

        1. Windriven says:

          You haven’t missed much.

    2. Windriven says:

      So Steve, I clicked on the link and searched on your name and guess what? You aren’t there. Of course most of us have known you weren’t all there for a long time.

  17. Jack Forster says:

    An interesting article. I’m a licensed acupuncturist in New York State, and I taught the required science classes at one of the acupuncture schools (neurology, anatomy, and pathology.) I actually stopped practicing acupuncture because as time went by, and I came to better understand science and statistics, I realized there is a tremendous amount of self-deception and intellectual dishonesty in the profession. I’m still in touch with some friends I went to acupuncture school with –one of them (a very smart woman) just posted a link to a study purporting to show acupuncture efficacy for improved balance in post-stroke patients. The article to which she linked fails to link to the original study; it fails to discuss outcome measures; it fails to discuss study duration; it was not blinded; the sample size was minute, and on and on, and this is unfortunately all too typical. It was very painful after investing years and a lot of effort into learning Chinese medicine to realize on what shifting sands the entire profession is built, but I still don’t regret it, because while learning some actual science did upset my illusions about traditional Chinese medicine, it gave me something incredibly valuable, which is the ability to think critically and logically. Well, less uncritically and less illogically, shall we say. There are many who practice Chinese medicine with great sincerity, but sadly sincerity is poor armor against self-deception.

    1. Windriven says:

      It say a good deal about your ethics and your character that you abandoned the practice once you recognized its failings.

      1. I would blame the student’s Master or the student himself and not the 5000 yr old discipline. I would have to discourage anyone without the drive to try to become a Mastery of anything.

        You say you were an instructor?
        That is unfortunate and I hope your students did not sense your frustration and bias which could have potentially tainted a young free thinking mind. It takes a special person to admit this and move on to the next venture.

        Thank you for your efforts and Godspeed.

        1. WilliamLawrenceUtridge says:

          I would blame the student’s Master or the student himself and not the 5000 yr old discipline. I would have to discourage anyone without the drive to try to become a Mastery of anything.

          5,000 years ago China was in the Bronze age at best, more likely the late paleolithic. What did they use as needles? Bronze isn’t tough or sharp enough to be used to create filiform needles, and the earliest “acupuncture needles” were used for bloodletting and were not fine or thin – they were quite large.

          Further, if it worked 5,000 years ago, scientific testing today should show efficacy. Why doesn’t it?

          Further-further, the earliest text we have (The Yellow Emperor’s Inner Cannon) describes bloodletting, not acupuncture, and doesn’t even specify specific points.

          Don’t invoke history if you don’t even know it.

          You say you were an instructor?
          That is unfortunate and I hope your students did not sense your frustration and bias which could have potentially tainted a young free thinking mind. It takes a special person to admit this and move on to the next venture.

          If a technique can only be taught to certain people, and those people are only defined as “those who truly believe”, that suggests religion and faith, not fact and science. What you’ve described is a situation where you’re maximizing the benefits for customers who visit charismatic practitioners who express powerful feelings of control and effectiveness. You’re essentially saying that acupuncture only works as a placebo – which scientific studies repeatedly bear out.

          1. KayMarie says:

            While it is a controversial view, I feel one always should be cautious with claims for how ancient something is from China. Some people say we should believe all claims of thousands of years, but the evidence tends to suggest more recent origins for most things.

            In some cultures new and shiny is always considered the best thing, so being the first guy to figure something new out is a bonus when trying to promote it. Chinese culture, on the other hand, tends to revere the ancient and mistrust the new so anytime anyone comes up with something new they find a way to tie it to some historical figure. There are just too many no one ever referred to this thing in print, even indirectly (you’d think someone would mention the miraculous healing of thousands of people over multiple centuries), before some guy in 1850 wrote a book based on a scroll no one can confirm existed that was written by Lao Tze or one of the other famous ancients.

            I do find it ironic in a way when the it is only good if it is 5,000 years old intersects with the it has to be the newest latest thing culture we tend to live in here in the USA. So you gotta invent something new (so not what your Master taught because new and improved) but still gotta try to make it sound like you understand what people were doing 5000 years ago better than anyone else.

            1. WilliamLawrenceUtridge says:

              Placebo effects are enhanced through, among other things, association with both newness and ancient wisdom.

              “Use this, the latest research on quantum physics shows it works” and “Use this, it has been used by Amazonian shamans for over 10,000 years” both can elicit stronger placebo responses than “use this, it was proven effective in the mid-1940s.

              Of course, it probably depends on the person; I would like to think I would have a stronger response to something proven effective 70 years ago than 7,000 years ago or 7 months ago.

    2. Andrey Pavlov says:

      I’ll second windriven and give big kudos where they are deserved.

      1. Jack Forster says:

        Thank you both. It was very difficult, and the whole experience was actually incredibly intellectually enriching. It was _very_ interesting teaching science courses in a school that offered a degree in Chinese medicine –it got to the point where I found myself challenging my students quite often, on everything from the existence of _qi_ to misinterpretations of quantum mechanics, which are often –depressingly often –brought up as rationalizations for irrational beliefs, but that’s another rant entirely. The whole problem of an evidence base for alternative and complementary medicine is far from a simple matter of deception being deliberately practiced on unsuspecting patients –many acupuncturists are incredibly dedicated and quite sincere; the profession has attracted some extremely intelligent and hardworking individuals over the years. There was considerable hope in the early years of acupuncture practice in this country that it might be placed on a solid evidence base, and the belief that there is a rational foundation for acupuncture is still held by many in the profession. Certainly there is cynical profiteering but most of the acupuncturists I know genuinely believe they are offering something of value to their patients. I worked for a couple of years in a practice begun by the department chief in one of the most respected cancer centers in the country (Dr. William Fair, at Memorial Sloane Kettering), who became interested in Chinese medicine after being diagnosed with colon cancer and finding that an extract of Chinese herbs was very effective in vitro against his cancer cells; there was enormous hope in the early days. Against this background of optimism, we have to consider how generally poorly science, and critical thinking, are taught –think for a moment about what an awful job we mostly do teaching math and science and it’s hardly surprising most Americans think “science doesn’t know everything” is a reasonable rebuttal to the obvious irrationality of astrology or homeopathy. I think it’s essential for us to try as much as possible to avoid adversarial, ad hominem tones when addressing this problem. It’s an oft-quoted truism that you can’t reason someone out of a position they did not reach by reason, but my own experience –both for myself and in teaching –has been that you actually can.

        1. @Jack Forster
          You make interesting points as you should under the circumstance not being a medical doctor who went through medical school and had to practice for a decade in an environment without needles. I have to admit the concepts are old ancient, foreign and do not fit into our modern views of the world.

          But wow, i am amazed that you could not comprehend any consistency from the use of the needles? Reading the patient and the tissues via the needles takes practice, time and effort before you can master the instrument. The art of medicine and/or Acupuncture is way more adaptive and intuitive than what you read in books, paper or journals.

          Read my other post to get an idea of my take of this ancient disciple. It will be with us forever. It is simple actually; stimulate tissues-RBC, WBC, platelets and stem cells, ignite the healing cascade-classic and relaxed muscles-via the laws of muscle design, all together in one event. The reason for the therapy is in the muscles in the form of faults in the repair process of muscles.

          If you decide to give it another heartfelt try, read C. Chan Gunn, MD and overlap your grids over the trigger point patterns and then a lightbulb should go off.

          1. Windriven says:

            Are you back again? Hasn’t Texas lifted your license yet?

          2. WilliamLawrenceUtridge says:

            I have to admit the concepts are old ancient, foreign and do not fit into our modern views of the world.

            Well, the larger problem is that despite extensive testing, the treatments of traditional Chinese medicine simply don’t work at all. It’s not a “paradigm” problem, it’s an empirical results problem. Acupuncture just doesn’t seem to work.

            But wow, i am amazed that you could not comprehend any consistency from the use of the needles? Reading the patient and the tissues via the needles takes practice, time and effort before you can master the instrument. The art of medicine and/or Acupuncture is way more adaptive and intuitive than what you read in books, paper or journals.

            It sounds like you’ve just got a built-in excuse for why acupuncture doesn’t work. If someone like Jack can’t cure patients reliably, that means “they didn’t read the patient”. Or maybe they just needed more time and effort, right? It’s never the acupuncture, it’s always the acupuncturist. All you’ve done is set up a system by which you delay and make excuses until the customer gets better merely because time passed.

            Read my other post to get an idea of my take of this ancient disciple. It will be with us forever. It is simple actually; stimulate tissues-RBC, WBC, platelets and stem cells, ignite the healing cascade-classic and relaxed muscles-via the laws of muscle design, all together in one event. The reason for the therapy is in the muscles in the form of faults in the repair process of muscles.

            If you decide to give it another heartfelt try, read C. Chan Gunn, MD and overlap your grids over the trigger point patterns and then a lightbulb should go off.

            If this is all true, why does acupuncture research consistently find that it doesn’t matter if you penetrate the skin or not? Toothpicks work just as well as needles, and more important than toothpicks or needles is a friendly doctor.

            How do you explain these results?

  18. orthomol femin Yes, really, and I have faced it. let’s discuss this question.

  19. freespeechisahumanright says:

    This works for my sister and her PMS, did the articles cover that too?

    1. Chris says:

      Did the articles cover that your sister thought acupuncture? Of course not, a study of N=1 is worthless.

      Acupuncture does not work. If you think it does, then produce the verifiable evidence showing that it actually works, not anecdotes. If you just keep declaring “It worked for me! It worked for me! Look at me, it worked for me!”, we’ll just think you are gullible and have not really read the articles on this blog.

    2. WilliamLawrenceUtridge says:

      This works for my sister and her PMS, did the articles cover that too?

      PMS is primarily a pain-based set of symptoms (at least that’s the most salient symptom), and acupuncture is effective at alleviating pain (as long as you think you are getting it and your doctor is pleasant). Not to mention, the symptoms of PMS are labile, and would be expected to fade relatively quickly anyway, perhaps a couple days. It’s almost tailor-made to respond to placebo effects.

      1. mouse says:

        WLU I think you are thinking of cramping pain during menstruation. Pre-menstrual Syndrome typically starts before menstruation – associated with hormone shifts and has a broad range of symptoms*.

        I don’t think pain would be considered the most salient. The symptoms of bloating, sadness, irritability, brain fog and insomnia seem to be ones brought up in conversation the most.

        *http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002474/#adam_001505.disease.symptoms

        1. WilliamLawrenceUtridge says:

          Quite possibly, I lack the plumbing and the sensitivity to claim a deep understanding of things. I bow to basically anybody else’s greater understanding.

          Anyway, I should have gone to pubmed. This was the most recent systematic review. Despite it’s cheerleader conclusion, actual analysis of the results is much more revealing. There were eight studies of acupuncture. They do include a set of measures to examine the risk of bias, six of them (random number generation, concealed allotment, patient blinding, assessor blinding, completeness of outcome data, and selective outcome data reporting). Of these 48 total possible measures, two indicated a “low” risk of bias, four indicated a “high” risk of bias, and the remaining 42 were “uncertain”. So these were the best eight trials that could be found (one of which may have been a systematic review), all were basically of completely unclear adequacy, and the final results of the study are basically equivocal. My assumption would be that most of the trials weren’t blinded, most didn’t use adequate controls (i.e. sham needles as well as needling location) and some probably involved either medication or no treatment interventions (both of which are far less dramatic than acupuncture, and drama increases placebo effects).

          So the systematic review found some trials (221), most of which were discarded, and the remaining eight were for some reason included despite lacking adequate information to determine proper scientific controls.

          So yeah – no indication acupuncture works for PMS.

          1. mouse says:

            Possibly you lack the plumbing? WLU did you have a uterus, ovaries and breasts lying around that you’ve just misplaced in the back of your closet? :)

            Regardless, the plumbing doesn’t always help. I’ve met women who swear up and down that, not only do they never have PMS (a reasonable assertion) but also that PMS doesn’t exist (not so reasonable).

            I’m not sure what sensitivity has to do with it, though. It’s just looking stuff up on uptodate, nih.gov or some other reliable medical reference site – Those sites don’t require you to hold their hand, be sympathetic, buy them ice cream or flowers or make them cocktails.

            Opps, Sorry, I’m giving you a hard time WLU. I’m dangerous when I’m putting off doing summer school work with the kids.

            Good job with the MedPub reference!

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