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Acupuncture Whac-a-Mole ™

Those who cannot remember the past are condemned to repeat it.
- George Santayana

Most people don’t have that willingness to break bad habits. They have a lot of excuses and they continue to produce bad clinical studies.
- Carlos Santana (Well, not the last 4 words.)

One is a guitar player, one is a philosopher. I get them confused.

I think George was in charge of SCAM research at the NIH. It was Dr. Gorski who first used the term Whac-a-Mole to describe what we do. The same badly-done studies are done over and over and misrepresented over and over, with only very minor variations on a theme. This is especially true of acupuncture, the most extensively studied pseudo-medicine in search of something, anything, for which it might be effective. They are still searching.

I loved going mano-a-mano with my kids when they were younger on the Whac-a-Mole machine in the Seaside arcade followed by root beer and elephant ears. It was the last time I beat either of them at any athletic endeavor. So I enjoy Whac-a-Mole, with mechanical rodents or bad research.

It sometime appears that pseudo-medicine researchers try and apply as many of the criteria to their research as possible that Ioannidis identified as rendering a clinical trial suspect.

  1. Small sample size? Check.
  2. High dropout rate? Check.
  3. Bad statistics? Check.
  4. Inadequate blinding? Check.
  5. Small effect size? Check.
  6. Underlying prejudice/bias in favor of an intervention? Check.
  7. Totally improbable intervention? Check.

Take the BMJ article, “Randomised clinical trial of five ear acupuncture points for the treatment of overweight people”. Please. It applies to this study where ear acupuncture was used as an adjunct to weight loss and found to be effective, only if you lend credence to terribly done clinical trials. Almost every error that could occur in a study, did occur.

Ear acupuncture has an origin story on par with chiropractic or iridology:

Auricular acupuncture therapy is based on the understanding [I do not think it means what you think it means - Ed.] that the external ear represents all parts of the human body, including the internal organs, and provides acupuncture points corresponding to these parts. Auricular acupuncture therapy was discovered by Dr Paul Nogier based on observations that backaches were cured after the patient received a burn on their ear. Dr Nogier pictured an auricle as a fetus that was curled up and upside down; he used his anatomical knowledge to treat diseases by applying pressure to the reaction points that represent the internal organs.

The mind boggles over the inanities that are pseudo-medicine origins. At least they could try and blame cosmic rays. or a radioactive spider (I am DC at heart, Marvel origins are lame. I suppose that will get more discussion than the entry).

Being completely disconnected with reality never stops a pseudo-medical study. Patients received five-point ear acupuncture, one-point ear acupuncture or sham acupuncture for eight weeks:

Treatment I subjects received unilateral acupuncture with indwelling needles at five ear acupuncture points (Shen-men, Stomach, Spleen, Hunger, Endocrine), which are generally used in Korean clinical treatments (see online supplementary figure S1).19 20 Treatment II subjects received an indwelling needle unilaterally at the Hunger acupuncture point only, whose specificity has been reported.19 Treatment groups received acupuncture in one ear on the first visit. One week later, the applied needles were removed and the same treatment was performed on their other ear. The needles used for the treatment groups were tack-like, 0.2×2 (head diameter×point length) mm-sized Dong Bang acupuncture needles. The heads of tack-like needles are fixed on surgical tape so that when the steel points are inserted, the needles remain attached to the skin (Suwon, Korea). The depth of insertion was 2 mm.
The control group received sham acupuncture at the five ear acupuncture points used in treatment I group at their first visit. The needles used for the control group were fixed on surgical tape, but were removed immediately after insertion (2 mm), while the surgical tape remained on the acupuncture points

I suspect that there was such a high drop out in the sham treatment as because they knew they were not getting acupuncture. As the study notes:

we did not test the blinding of the control group; participants in this group might have examined the adhesive dressings in their ears and found no needles.

A lousy placebo renders an already silly and poorly done trial completely meaningless, like most of the acupuncture trials.

Given that “A single doctor of traditional Korean medicine performed all treatments”, it is highly likely that the Clever Hans effect was taking place: subtle clues that suggested who was getting placebo.

Another flaw was while “Compliance with diet and exercise regimen was recorded by the patients and checked weekly at the clinic”, the results were not reported in the study and the main reason people dropped out was issues with following the dietary restrictions.

So while those in the treatment groups lost more weight than the sham group, there are so many flaws in the study that it would be impossible draw valid conclusions. Like almost all acupuncture studies.

My favorite part of the study was the fifth inclusion criteria: “Hygienic individuals”. At least they were clean, which is a good thing. I have seen one patient lose an ear from a piercing and infections are reported with ear acupuncture. Watching the sterile technique demonstration helps me understand why Dr. Oz had a volunteer rather than trying it himself.

But the real reason this trial is not valid is that Korean ear acupuncture is not real acupuncture. Real acupuncture is traditional Chinese. Or Japanese. No wait, hand acupuncture. Or foot acupuncture. No, it’s tongue acupuncture that is the real deal. That’s the ticket. Or perhaps it’s the Micro Acupuncture Point System. So many acupunctures, so little reality.

Compare this to a study with better methodologies: “Patient-Reported Outcomes in Women With Breast Cancer Enrolled in a Dual-Center, Double-Blind, Randomized Controlled Trial Assessing the Effect of Acupuncture in Reducing Aromatase Inhibitor-Induced Musculoskeletal Symptoms.”

This study worked hard to blind patients as to treatment arm:

Although the acupuncturists were not blinded to the assignment, in an effort to minimize the introduction of bias, the acupuncturists followed a prepared script when engaging in conversation with the participants. All other individuals involved in the care of participants were blinded, including the treating oncologist(s), nurses, and study team members. The participants also were blinded to their treatment assignment….Patients in the SA group received nonpenetrating, retractable needles placed in 14 sham acupoints located at the midpoint of the line connecting 2 real acupoints.

The endpoints are patient-reported symptoms, so one could predict the outcome before it happens. Any SCAM compared to a good placebo (i.e. the patient cannot tell it is placebo) will always be equivalent for any outcome that is subjective and better than no treatment. That result was best typified in the NEJM article comparing various fake treatments for asthma. No effect will be seen if the endpoint is objective. All pseudo-medical interventions are like kissing a skinned knee in a child – comforting but with no important physical effects.

Same as it ever was, fake and real acupuncture were equivalent in relieving symptoms. So abandon acupuncture, right? Especially since it is clear that acupuncture has as much basis in reality as the four humor theory of disease. Except for acupuncture based on auricular thermal injury.

I am a classicist. I have what would be the standard, perhaps Copenhagen, interpretation of clinical trials. If a therapy is compared to placebo and they are found to be equivalent, then the therapy does not work and should be abandoned.

There was a recent article in the NEJM where they evaluated patients with “knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis” and treated them with either arthroscopic partial meniscectomy or sham surgery. There was no difference in outcomes and they concluded:

…the results of this randomized, sham-controlled trial show that arthroscopic partial medial meniscectomy provides no significant benefit over sham surgery in patients with a degenerative meniscal tear and no knee osteoarthritis. These results argue against the current practice of performing arthroscopic partial meniscectomy in patients with a degenerative meniscal tear.

Nowhere could I find a review of the article that suggested that arthroscopic surgery worked if only you believe. It is an annoying interpretation of SCAM interventions, that since the outcomes are equivalent to placebo, you are getting an effect from the power of placebo. An example is from the Science 2.0 website:

Sometimes you just have to believe.

Acupuncture has proven to be effective, though it isn’t actually being done. When it comes to hot flashes due to breast cancer treatment, even skin pricks used to simulate acupuncture needle sticks might be enough to generate natural chemicals that improve symptoms, which would explain the results.

I’m sure that pharmaceutical companies would love that standard: if a drug is equal to placebo then use it: then you just have to believe. I remember the immortal words of B. Bunny: “What a Maroon.” I know, innuendo. Somehow rational thought flies out the door when pseudo-medicines comes innuendo.

Regular readers of my entries know my take on the preponderance of the literature as to the nature of the placebo effect: it is mostly a myth. Placebo is medical beer goggles, making diseases appear better when they are not. As I have mentioned in the past, SCAM = Placebo. Placebo = Nothing. Therefore SCAM = Nothing. Simple logic, n’est pas?

Acupuncture is like all pseudo-medicines: it only appears effective in flawed studies. As the methodologies improve, the efficacy fades until well done studies show no effect greater than placebo, aka no effect.

Posted in: Acupuncture, Clinical Trials, Critical Thinking, Science and Medicine

Leave a Comment (75) ↓

75 thoughts on “Acupuncture Whac-a-Mole ™

  1. windriven says:

    ““The moment you doubt whether you can fly, you cease for ever to be able to do it.”
    ― J.M. Barrie, Peter Pan

    “The moment that you believe you can fly, you know that you have ingested too much lysergic acid diethylamide and while you may act on that belief you are unlikely to do it twice.”
    ―J.T. Windriven

    Would that quackery offered that near certainty.

    1. James says:

      That sound like a beginning to a Darwin Award recipient

    2. Calli Arcale says:

      While it’s less relevant, I just love Douglas Adams’ line from “Life, The Universe, and Everything” (and also from “So Long, and Thanks For All the Fish”) on the subject of flying:

      “There is an art to flying, or rather a knack. The knack lies in learning how to throw yourself at the ground and miss.”

      1. windriven says:

        I love it! Haven’t read either one but they’re going on my list.

        1. John Milligan says:

          You really should start with “The Hitchhiker’s Guide to the Galaxy.” It starts the whole story off in a hilarious fashion, including the proof of the non-existence of God.

          1. Kiiri says:

            Douglas Adams is hilarious. If you like him then you should look for the audio book (read by him) titled Last Chance to See. It chronicles his journey around the world with a biologist and various other BBC types looking at rare/endangered animals. The book is good, his reading of it is a sublime.

    3. BillyJoe says:

      Your “quotes” gave me a laugh. Almost as good as the Douglas Adams quotes. But, if you die before reading “The Hitchhiker’s Guide to the Universe” and his other books, you’re going to hell.

  2. Alex says:

    Here’s a correct link to quote of Carlos Santana. http://www.brainyquote.com/quotes/quotes/c/carlossant454488.html

    1. Thor says:

      Alex, thankfully Dr. Crislip was being his characteristically humorous self. You missed the parentheses after Carlos’ name stating, “Well, not the last 4 words”.

  3. fractal says:

    “Show no effect greater than placebo, aka no effect” – does this mean essentially there really is no “placebo effect” since improving without treatment sometimes happens and there’s no way to know if it’ s genuinely because of the placebo or not?

    1. windriven says:

      @fractal

      The placebo effect appears to be subjectively real but objectively insignificant. Improvement without treatment, regression to the mean, is not the same as placebo.

      1. BillyJoe says:

        Actually, in clinical trials, placebo means all of these things. It includes everything not caused by the treatment under study, including regression to the mean.

        1. Andrey Pavlov says:

          This is where Peter and I can often get into a big back and forth. I think that the nomenclature surrounding placebo is a bit muddied and that it is important to understand and define terms. I generally refer to placebo effects (plural) and placebo responses to differentiate two broad categories.

          Commonly, placebo responses are what is meant by clinical trial control groups’ apparent effects. These include things like regression to the mean, natural variation in disease course, subjective filtering, Hawthorne effects, expectancy bias, a wish to please the researcher/physician, etc. In other words “placebo” in a clinical trial is a catch-all for anything that causes a perceived change in the state of the pathology in question that is not specifically ascribable to the intervention being tested.

          Placebo effects are actual, objective, and measurable changes in actual physiology as a result of tricking a person into believing they are receiving an actual treatment. Benedetti has done some of the best work on this as have Hrobartssen (sp?). These include primarily conditioned responses wherein endogenous substances are released by the body which actually do have physiological effects. It requires a functioning brain to happen and that brain needs to be deceived into believing it is a genuine treatment. There is an interesting exception in that there are both conscious and subconscious levels of this and the unconscious part is mediated by Pavlovian classical conditioning (which means I’m totally an expert, right? ;-)) In this case you do not need active deception since once the effect is conditioned you can tell the person you are giving them a placebo and the effect will still occur. The catch is that you do need an actual stimulus to happen consistently and then alternated with placebo in order for it to happen. Meaning that you cannot give a placebo but tell people it is true and develop the conditioned response.

          Before anyone gets all over this idea of being able to condition the response and then no longer need to lie about it, it is still tricky to do. The response is still subject to extinguishing just like any other conditioned response and to be maintained will need to have actual medicine rather than placebo administered randomly. The effect size is variable and unpredictable. And it has limited application in that only certain types of responses can be conditioned in this way. Plus, as humans, we have higher order cognitive function that can modify expectancy effects and thus makes the response even more variable.

          All of these things come into play when someone says “placebo” effect of a clinical trial. The genuine placebo effects will be much more or less prevalent depending on exactly what is being studied and how. Studies of antibiotics on infection will have very little, if any, placebo effects but could have some placebo responses (though also very little). Studies of pain will obviously have a lot of both.

          I agree with windriven in that we need to be more precise in our language and that, strictly speaking, regression to the mean etc. should not be called placebo responses, but in practical terms that is what is lumped together in clinical trials and makes up at least part of the total effect that we call placebo.

          1. BillyJoe says:

            “I generally refer to placebo effects (plural) and placebo responses to differentiate two broad categories.”

            I gather from this that these are not “official” categories.
            In which case, you could weave your name into there somewhere and become famous. (:

            1. Andrey Pavlov says:

              @BJ:

              LOL. To my knowledge they are not referred to as such. However, I find it pedantically annoying to have eponyms for everything. In medicine Bouchard’s nodes are distinct from Heberden’s nodes. Both are exactly the same thing – osteoarthritic nodules – just in different locations – the proximal vs distal interphalangeal joint.

              I’d rather not become “famous” so that med students can curse my name ;-)

    2. Young CC Prof says:

      People have studied that. It appears there is a placebo effect, but it mostly appears as short-term improvement on subjective measures like pain. Placebos don’t change lab tests, and they tend to stop working after a while.

      Interestingly, some placebos are more “effective” than others. Acupuncture is elaborate, often combined with listening to the patient, hence it has a stronger placebo effect than other false treatments. (Yes, you heard me right.)

    3. BillyJoe says:

      It’s a bit of a stretch, but placebos can reduce stress which can reduce the risk of heart disease.

      1. Andrey Pavlov says:

        @BJ:

        Not such a huge stretch since we know the role that catecholamines play in progression of heart disease. In a otherwise very healthy heart in someone with no disease and no genetic predisposition for forming mature plaques, it will have little or no effect whatsoever. So I think in a strict sense it would reduce the risk of heart disease, but would reduce the risk of someone with heart disease worsening and with a strong predisposition from developing it. But it itself will not be a sole instigator or precipitator (is that a word?) of heart disease.

  4. K says:

    “Dong Bang”

    *snigger*

    1. CHotel says:

      Good, I wasn’t the only one immature enough to laugh at that.

    2. brewandferment says:

      dang, somebody beat me to it…

  5. Andrey Pavlov says:

    the results of this randomized, sham-controlled trial show that arthroscopic partial medial meniscectomy provides no significant benefit over sham surgery in patients with a degenerative meniscal tear and no knee osteoarthritis. These results argue against the current practice of performing arthroscopic partial meniscectomy in patients with a degenerative meniscal tear

    Seems to me this is excellent reason to do sham surgeries, no?

    1. CHotel says:

      Do I still get the propofol?

      1. windriven says:

        Go for the fentanyl.

    2. MMoran says:

      Or, go back to open meniscectomy (i.e. not endoscopic)? Or, should they too be subjected to RCT?

      Or, probably, the ability to perform a less invasive procedure has meant that arhtroscopies are being performed on people with minimal symptoms when benefits will be confined to certain subgroups such as those with regular “locking” of the joint..

  6. TwistBarbie says:

    Regarding the meniscus tear study how on earth do they do this “sham surgery”? You’d think if ever there was a case for inadequate blinding that would be it, but clearly in this study it seemed to be adequate. If someone could elaborate I’d very much appreciate it.

    1. Andrey Pavlov says:

      @twistbarbie:

      It is sham surgery because they did not do the actual meniscotomy. The premise is that if the meniscal tear is causing the pain, and a meniscotomy would improve it, that going in and actually removing the offending piece of the meniscus should have a greater effect than just going in, looking around, and doing nothing else. Since it did not, we can conclude that merely going in for surgery and having a dramatic intervention is the placebo effect that makes you believe you knee is better without actually having done anything to directly address the supposed anatomical issue.

      1. TwistBarbie says:

        Sorry, what I meant specifically is:
        1) do they still put the patient under general anaesthetic/give them an epidural
        2)Do they cut at all all, and if not wouldn’t the patient notice that they don’t have a wound.

        If they do put the patient under and cut them open without doing the “actual” surgery, isn’t that too much of a risk for the placebo group? I’m not sure how these things are assessed.

        1. MTDoc says:

          1) These are done under “local”, actually by a qualified anesthesiologist, using a variety of techniques. I can tell you from personal experience, you are “awake” and pain free. And I had the real surgery.
          2) They do make a skin incision, take the usual amount of time, and even the surgeon doesn’t know ahead of time which procedure he will perform. And yes the patient is aware, and consents to be part of this study. In fact, I don’t believe they ever know, because long term followup is such an important part of the study. Remember, placebo effects tend to be short lived, and what we really want to know is what will help the patient long term.

          1. TwistBarbie says:

            Thank you, you’ve answered my questions :)

        2. Andrey Pavlov says:

          Well, Erik Jacobson answered it but yes, they do simulate everything about the real surgery including the anesthesia and all that jazz.

    2. MTDoc says:

      This is a subject of considerable interest to me, as I have said degenerative tear of the medial meniscus in my left knee. I considered having it scoped last year, but held off and it improved somewhat. Unfortunately the patella “bone on bone” isn’t likely to heal itself. However I need to point out that some meniscal injuries do deserve intervention, as the bucket handle tear in my right knee demonstrated several years ago. As to your question about the study, I believe I saw such a report on “you tube”. The study appeared sound, and the sham methodology was very convincing. Sorry I can’t tell you how to access it, but I’m sure someone will, if they haven’t already.

      1. windriven says:

        Is this it MTDoc?

        Sham Arthroscopy

          1. MTDoc says:

            No unfortunately. It was a somewhat official report showing the surgery and explaining the findings in some detail. I seem to recall it came from a major medical center, Texas, I think. I recall thinking it was a spoof at first, since it went so against what we all thought. Of course, in my early days we took out the entire meniscus, but only for a locked or “trick” knee, and that I’m reasonably sure is still an indication for a scoped partial procedure. As for total meniscectomy, early results are O.K., but the joint is shot in 15 or 20 years. But we did learn from that, hence the partial, and we will learn from this rather brave study. Science moves ahead.

      2. goodnightirene says:

        I think this is the same study–NY Times, Dec. 25, 2013
        It seems the Finns knock ’em out.

        The volunteer patients in the Finnish study all received anesthesia and incisions. But some received actual surgery, others simulated procedures. They did not know which.

        A year later, most patients in both groups said their knees felt better, and the vast majority said they would choose the same method again, even if it was fake! (! is mine).

        http://www.nytimes.com/2013/12/26/health/common-knee-surgery-does-very-little-for-some-study-suggests.html?_r=0

  7. wildman says:

    The sad thing about surgeries such as medial meniscus, patellar shaving, epidural steroid injections and cement injections of compression fractures of the spine that have all been shown to be ineffective in well designed studies is that insurance continues to pay for these procedures. Speciality lobbyists and the AMA can be thanked for this.

    1. David Gorski says:

      Yeah, search “vertebroplasty” on this blog. I wrote a long post about how image-guided vertebroplasty is no better than a placebo for compression fractures. That was probably four years ago.

    2. mousethatroared says:

      @Wildman – Epidural steroid injections shown ineffective? Could you elaborate?

      1. Pacopicopiedra says:

        There are various kinds of epidural steroid injections. Caudal and inter laminar appear ineffective. Transforaminal have bee shown to be effective for radicular pain, but axial pain. Large meta analyses which include old studies done without fluoroscopy and new studies of caudal, interlaminar, and treatment for axial back pain conclude that they are ineffective. They miss the point. That’s like saying surgery doesn’t work for abdominal problems. You need to be a little more specific. Transforaminal epidural steroid injections have been shown to be effective for radicular pain.

        1. mousethatroared says:

          @ Pacopicopiedra – Thanks! I was a bit taken aback by wildman’s claims. I just recently had my second cervical cortesteroid epidural for cervical radioapathy. The two shots have brought me great relief from the pain and tingling sensations in my hand, arm and shoulder, that I have been having for the last 9 months. All my reading and my doctors had lead me to believe that the cortesteroid shots were a reasonably standard next step (after PT) and had good record of success (although not a sure bet). Now I’m just hoping that the benefit “sticks”. I also had success with steroid injection for shoulder brusitis in the past, which also seemed to be standard treatment.

          Although, clearly, there are things that corticosteroid injections won’t work for, I wonder what, specifically, wildman’s concern was. I guess he has moved on, so I won’t ever know.

          1. mousethatroared says:

            opps, spell check fail – Radiculopathy – not radioapathy.

          2. Pacopicopiedra says:

            Wildman was probably referring to a recent review article (I think in NEJM, but not sure), which was covered in the NY Times, which concluded that ESIs are not effective. It was a terrible review. It included treatment for axial back pain with no diagnosis, spinal stenosis, and radiculopathy. It included caudals, interlaminars, and transforaminals, and it included blind (non-fluoroscopic guided) injections. It also included various different steroids at various doses (some very low), and many outcome measures were ridiculous. Terrible study, but it got a lot of press. Most of the good research has been done on lumbar procedures. There’s very little evidence for cervicals. If you ever have another one, make sure the doctor only injects dexamethasone for the steroid. It’s the only safe one to inject transforaminally.

            1. mousethatroared says:

              @Pacopicopiedra – Thanks!

  8. Sastra says:

    All pseudo-medical interventions are like kissing a skinned knee in a child – comforting but with no important physical effects.

    Ah, so you don’t think it important to comfort a scared child?

    Sorry, thought I’d bring up another Mole to Whack. My altie friends like to embrace the benefits of placebo as if placebos were both 1.) magically effective (mind-body connection!) and 2.) deeply compassionate. That way, even if they don’t technically work they’re still as good as kissing the skinned knee of a child — and how could that be wrong?

    1. Thor says:

      I think it can only be classified as placebo if the recipient doesn’t know that it’s a placebo. Ask them if they’d lie to one of their kids when they have, say, a bad headache, by giving them a sugar pill instead of aspirin and telling them that the ‘medicine’ will make the pain better.

      1. goodnightirene says:

        Why would a child have a bad headache? I would be alarmed and seek medical opinion in such a case. I have four children (small sample acknowledged) and no one ever had aspirin for “headache”. Headaches aren’t really normal is what I was told when I had horrible ones for a few years, and even less so in children I should think.

        At any rate, I take your point in spite of the example–nor am I saying my view is the last work on headache in children.

        1. nancy brownlee says:

          @goodnightirene
          Why wouldn’t a kid have a headache? Severe or persistent headache needs to be investigated, of course- in anyone. But the common-or-garden variety (for lots of us) that come from tension, or UR allergies often start pretty early. In my allergic, OC family, anyway.

      2. brewandferment says:

        I wouldn’t give my kid a sugar pill if they were in real pain. But if they were just fine playing on electronics and their pain oh so suspiciously manifested itself the moment they were requested to come do the dishes or some such unwelcome parental directive, then I might well give them a sugar pill and tell them it will make them better in a few minutes so they might as well get started on the dishes as a distraction until the “medicine” made them better.

        I did actually use a few left over homeopathic tabs (from before I really got a handle on how silly the concept is) on my kids when much smaller and I had a pretty good notion they were exaggerating the pain from the miniscule scabbed over scratch…and once or twice when I’d given a kid the full dose of pain meds but it hadn’t yet taken effect, I gave a sugar (homeopathic) pill. Because the yelping about “need more medicine” after already attempting to explain to a preschooler that I couldn’t give any more of the real meds…yeah try that nightmare sometime…was scaring the cat and leading an older sibling who was past all that stuff to snarl at the poor kid and making the upset little one even worse due to all the uproar…

        1. Harriet Hall says:

          Your example of washing the dishes made me laugh. One of my teenage chores was washing the dinner dishes (by hand, since we had no dishwasher). Numerous times I tried to get out of it by complaining of not feeling well or having a headache. Dad had a stock answer: “You know the best cure for a headache? Hot dishwater!”

          1. brewandferment says:

            I probably heard some similar variant from one of my parents too. Dad’s answer to our whining about why wouldn’t he buy a dishwasher: I have 5 kids, who needs a machine to do what you can all do by now.

            I have a dishwasher but it seems silly to fire it up for a few dishes (it’s too loud no matter what, and old enough to be inefficient and not very effective either) so my kids still get the handwashed dishes routine. Besides husband cannot go to bed with unwashed dishes even if they were in the dishwasher waiting for a full load…so why bother with it, we just use the sink. Of course we alternate: whoever cooks, the other cleans up!

            1. cloudskimmer says:

              When I mentioned that I wash dishes by hand, someone claimed that using a dishwasher was better in every way: did a better job, used less soap, less energy and less water. I asked what evidence supported this claim and was told there were “lots of studies” that all showed the same thing. I also asked who paid for the studies: was it a dishwasher company? Certainly not, I was told.

              A brief search of the Internet showed that there was only one study; they thanked Electrolux for their help, (they make dishwashers.). Volunteers washed stacks of dishes any way they wanted, but mostly with the water running continuously. It seemed pretty clear that the study, which had been picked up by the news media, really was pretty slanted to support use of dishwashers. The study didn’t say what tools were provided to those who washed by hand; without sink stoppers or basins, they would have to do it under running water.

              Thank you skeptical movement for the ability to question such claims and evaluate them. It made no difference to the person making the claim. When questioned she tried to bolster her argument with inaccurate claims (many studies instead of just one, no dishwasher company involvement, it doesn’t matter how you wash them, the dishwasher is always better in every way.) Finding things out is simple compared to trying to discuss things with people who take questions as a personal affront. I still don’t know how to do that without offense.

    2. Lost Marble says:

      Absolutely comfort a scared child, but maybe but some disinfectant and a band-aid on their knee too. SCAM would only ‘kiss it’ and if you die of gangrene you clearly didn’t believe.

  9. All of the subjects were in the process of being scoped to see if they met requirements for the trial. Then the surgeon would open an envelope to see which group the subject had been assigned to. If surgery, then they would go on with the procedure. If control…

    “For the sham surgery, a standard arthroscopic partial meniscectomy was simulated. To mimic the sensations and sounds of a true arthroscopic partial meniscectomy, the surgeon asked for all instruments, manipulated the knee as if an arthroscopic partial meniscectomy was being performed, pushed a mechanized shaver (without the blade) firmly against the patella (outside the knee), and used suction. The patient was also kept in the operating room for the amount of time required to perform an actual arthroscopic partial meniscectomy.”

  10. Chris says:

    Great article, however I initially thought this was going to be about a new acupuncture method as I immediately had the image in my mind of a version of the whac-a-mole game being used to apply acupuncture

    The patient being positioned under the board and when the practitioner hits the mole a needle attached to the mole is driven into the patient.

    While this was rather distracting as I read the article it seems to be as plausible and sane as anything I have read about “real” acupuncture.

    1. BillyJoe says:

      A few brief comments.

      - I consider it rude to post links without comment for no other reason than that we cannot read your mind as to the purpose of your posting them.
      - the two studies could only be regarded as being preliminary studies as there were only 13 and 18 subjects respectively, no control groups, and no blinding. As such, they can only suggest proper clinical studies be done to see if the effect is real.
      - fMRI interpretation is notoriously subjective and imprecise.
      - placebos can cause changes on fMRI, so these studies could simply be consistent with acupuncture being a placebo.
      - you would expect a change in the fMRI of the brain of any subject undergoing a change in sensory experience, because where else is this change coming from other than the brain.

      I haven’t watched your hour long video yet.

      1. Frederick says:

        Seem my Comment did not show, Anyway those lin only prove the point of Mark Crislip. I’m not experienced enough to analyze Science paper, and i don’t have competence for statistic, But 13 subject, and 2 experience so effect. THAT i know, it is not significant. false positive is more probable.
        So he reality you are reinforcing Crislip Point, so Yeah Thank you :-)

    2. WilliamLawrenceUtridge says:

      I love fMRI acupuncture studies. Who would have thought that jabbing people with a needle causes changes in neurological firing? Such an amazing conclusion since jabbing people with a needle doesn’t cause activation of the pressure, penetration, pain and temperature sensors in the skin. Bonus points if the needle is twisted to activate subcutaneous muscle contraction.

      Feeling things causes changes in the thing that feels? Amazing!

    1. Frederick says:

      Are those the kind of bad research he is talking about? Maybe, I unfortunately don’t have experience with Science paper, and barely the competence to read stats correctly. And that’s exactly why a like to find people ( like the writers on this site) with the competent to analyze it. Science journal and paper publish a lot of bad studies, and preliminaries studies with sample samples size (13 subject in the pubmed one) that turns out to be false positive after more research are done. At least THAT I know, so yeah what your links does not seem like ‘proof’ that “it work” but more example of : ” Yeah that what Crislip is talking about”. With you “nick name” with can guess you bias anyway and what you take of this article is :-) No offense :-)

      1. Frederick says:

        My first comment did Show. Sorry for double posting, the system had a lag with my comments it seem.

        1. Chris says:

          Yeah, it happens. Every single one of my comments go into moderation, and the admins here don’t know why. I have learned to be patient.

          1. BillyJoe says:

            Same here. All my comments are moderated and take time to appear. This also happens on Jerry Coyne’s blog “why evolution is true”, but I think this was a deliberate act on his part after I posted a joke that he took exception to. I wrote and explained but to no avail. One wrong move over there and you’re either ejected or damned to being moderated for ever. I don’t think that has happened here though.

            1. Andrey Pavlov says:

              All of my comments are moderated as well…. and I have co-authored a couple of posts for this site! So I certainly wouldn’t take it personally. I believe there is some way I can sign in under my author-login or whatever, but I’m not bothered by a bit of delay in getting the comment up. Plus I don’t think I’d be saving those who approve much time by doing so given the background amount that they do anyways.

              In any event, I can’t imagine a situation where I needed to get the comment up immediately. The whole point is that – just like text messaging – this is a conversation in pieces with delays. For example, I will be getting to Andres latest post, I just haven’t had the time yet.

    2. BillyJoe says:

      (Already posted this but the Acupuncturist’s post appears twice)

      A few brief comments.

      - I consider it rude to post links without comment for no other reason than that we cannot read your mind as to the purpose of your posting them.
      - the two studies could only be regarded as being preliminary studies as there were only 13 and 18 subjects respectively, no control groups, and no blinding. As such, they can only suggest proper clinical studies be done to see if the effect is real.
      - fMRI interpretation is notoriously subjective and imprecise.
      - placebos can cause changes on fMRI, so these studies could simply be consistent with acupuncture being a placebo.
      - you would expect a change in the fMRI of the brain of any subject undergoing a change in sensory experience, because where else is this change coming from other than the brain.

      I haven’t watched your hour long video yet.

    3. BillyJoe says:

      Regarding the video linked to above.

      There are two things that seemed to finally convince the reporter that acupuncture works for at least some conditions.

      ———————————–

      The first was a trial of the effect on arthritic knee pain of true vs sham acupuncture performed by Berman in 2004.
      I found the paper here:

      http://zone.medschool.pitt.edu/ENRICHMENT/rehab/Documents/Medical%20Student%20ICAM%20Research%20(NIH%20T35)/Periosteal%20Stim%20(Weiner)/Journal%20Club.pdf

      The results are underwhelming.
      In the video, the reporter had demonstrate to her the ideal sham acupuncture needle. And it seems Berman was aware of this needle but chose for some reason to use a modified needle. Why?

      In the trial patients were asked to identify whether they have received true or sham acupuncture. Of those who received true acupuncture, 75% thought they had received true acupuncture. Of those who received sham acupuncture, 58% thought they had received true acupuncture. This, alone, could expel an the differences in results between true and sham acupuncture, especially when the differences were small.

      For example the true acupuncture group improved their pain score from 8.92 to 5.13, whilst the sham acupuncture group improved their pain score from 8.90 to 5.98; and the true acupuncture group improved their functional score from 31.31 to 17.89 whilst the sham acupuncture group improved their functional score from 31.29 to 20.31. All at 28 weeks.
      Also the sham acupuncture group had more college graduates (141 v 127), more with both knees affected (55 v 47), and more with severe pain (46 v 44)

      ——————————————–

      The second was the fMRI studies where they compared superficial needling (needle piercing the skin) followed by deep needling (needle pushed a further .5 cm into the subcutaneous tissues. The superficial needling was their control! The fMRI, showed activation whilst the needle was inserted into the skin and deactivation after it was pushed into the subcutaneous tissues.

      Not only did they not use the correct sham acupuncture needle, they didn’t use a sham acupuncture needle at all. They didn’t compare true with sham acupuncture!
      What this was meant to prove escapes me but all four experts and the reporter were certainly impressed.

      As I explained in the previous post, even if acupuncture was relieving pain purely via placebo effects, you would expect to see changes on fMRI simply because pain is perceived by the brain.

      1. Frederick says:

        Thank for taking the time to analyze all this :-) of course like i said it mostly demonstrate the point of M. Crislip :-)

  11. Chris says:

    Oh, good grief:
    http://doubtfulnews.com/2014/01/knees-strewn-with-gold-thread/

    The woman got some kind of acupuncture that involves putting pieces of gold permanently into the body:

    It is presumed they are made of gold and were left there intentionally for “continued stimulation”. Doctors note this is a REALLY BAD idea. Not only is there no scientific evidence that this form of acupuncture works or does anything resembling what they claim, it’s also dangerous. The needles may migrate and damage other parts, they can cause a reaction or infection as the body tries to get rid of the foreign object and they make Xrays hard to read. This picture is insane! Look at how tiny they are!

  12. Larry says:

    Acupuncture has helped me tremendously with back and neck pain.

    1. WilliamLawrenceUtridge says:

      Well it really depends on what you mean by “helped”. If you mean “temporarily reduced the pain”, yes, acupuncture “helps”. Bonus points because most neck and back pain goes away on its own without intervention – so while you briefly feel better after needling, and therefore relax about it, the muscles unknot themselves anyway. It’s like playing a video game or watching TV to distract yourself while the pain eases anyway. The whole point of scientific investigation is to determine what really “helps”. And in the case of acupuncture, what apparently “helps” is the drama, salience and nonspecific aspects of the intervention, not the actual needling. You don’t need to penetrate the skin. You don’t need to needle specific points. There is no such thing as chi that needs to be manipulated. But you do need a lengthy consultation with an acupuncturist in which you discuss, at length, all your symptoms. Then you get to lie quietly, surrounded by the reassurance that you will get better.

      If you have ongoing back pain issues, I highly recommend Paul Ingraham’s Save Yourself from Low Back Pain tutorial. It was instrumental, almost miraculous, in making my acute low back pain disappear, literally in an hour. It posits that much back pain is caused by worry and muscle knots, and certainly loosening knots in my buttocks made my back pain disappear almost like magic. I went from lying on the floor, whimpering, to literally doing jumping jacks to impress my wife at how much better I was.

      She wasnt’ impressed.

      There’s also a tutorial for neck pain.

      1. mousethatroared says:

        WLU “There’s also a tutorial for neck pain.”

        From the link “I have excluded detailed discussion of: face and jaw pain; neck pain with prominent nerve symptoms (tingling, numbness, zapping pain) in the arm; ”

        Ha! I’ve read alot of Paul Ingrahams excellent work. Sadly, I have come to believe that it is my fate to be the exception to his advice.

        1. mousethatroared says:

          Doh! Sorry WLU. I thought the back pain link was for Larry and the neck pain link was for me (due to my comment upthread)…but I see that Larry has both back and neck pain. (that sucks for him).

          Ignore my comment.

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