Note: This is slightly revised from an article I originally wrote as a “SkepDoc” column for Skeptic magazine. It was pre-released online in eSkeptic and it has already generated a lot of comments, including “a truly amazing piece of peurile pseudo-intellectualism,” “an ad hominem attack on one form of alternative medicine so beset by poor thinking that one must come to the conclusion this woman might just be paid to write such propaganda,” and “twaddle wrapped in swaddling rhetoric.” (I treasure comments like those as evidence that my critics are so bankrupt of real arguments that they have to dip into the insult pouch for ammunition.) I thought it would be interesting to post it here on the blog and see how much controversy it would stir up among my co-bloggers and readers. Please keep in mind that it was written for a popular audience and excuse the lack of scholarly citations. You may recognize some of the studies I refer to from previous blog entries.
“Alternative” medicine is by definition medicine that has not been scientifically proven and has not been accepted into mainstream scientific medicine. The question I keep hearing is, “But what about acupuncture? It’s been proven to work, it’s supported by lots of good research, more and more doctors are using it, and insurance companies even pay for it.”
It’s time the acupuncture myth was punctured – preferably with an acupuncture needle. Almost everything you’ve heard about acupuncture is wrong. (more…)
In yet another round of science by press release, a particularly unimpressive acupuncture study is making the rounds of the major news outlets proclaiming that acupuncture works. I guess that is a sort-of answer to my title question – why are so many scientifically worthless acupuncture studies being done?
Let’s take a look at this particular study to see why it is so weak. All I have to go on is the press release, since the study is not published. It was presented at a scientific meeting – which is legitimate, I just don’t have access to it. (The bar for publication in a peer-reviewed journal is much higher than presentation at a meeting, and there may, in fact, be changes to the text prior to publication.) But we can still say a great deal about this study from the information provided.
Last week I received the news release below that Steve Zeitzew, an orthopedic surgeon at VA Hospital Los Angeles and UCLA, sent to the Healthfraud list. It was sent to me by our colleague Liz Woeckner, President of the nonprofit research protection advocacy organization Citizens for Responsible Care in Research (CIRCARE) http://www.circare.org/
Ms. Woeckner sent it on with a cryptic comment, wondering if this action was a quid pro quo for the Chinese granting less than a dozen FDA “inspection stations” in Chinese cities. The latter is supposed to be an attempt to control the impurities and adulterants of Chinese herbal products.
But before proceeding, read for yourselves:
Monday, June 16, 2008 Contact: HHS Press Office
HHS Secretary and Chinese Minister of Health Sign Memorandum of Understanding on Traditional Chinese Medicine Research .
HHS Secretary Mike Leavitt today signed a memorandum of understanding with Chinese Vice Minister of Health Wang Guoqiang to foster collaboration between scientists in both countries in research on integrative and traditional Chinese medicine. The signing marks the opening of a two-day traditional Chinese medicine Research Roundtable at the National Institutes of Health (NIH). The roundtable features scientific presentations by researchers from China and the United States. Topics include the synthesis of Western medicine and traditional Chinese medicine, criteria for evaluating traditional Chinese medicine practices, and the application of modern scientific tools such as proteomics (the study of proteins) to the study of traditional Chinese medicine. “Many Americans incorporate alternative medical practices into their personal health care and are interested in the potential of a variety of traditional Chinese medicine approaches,” Secretary Leavitt said. “This project will advance our understanding of when and how to appropriately integrate traditional Chinese medicine with Western medical approaches to improve the health of the American and Chinese people.” The memorandum of understanding and the establishment of the international collaboration will aid in furthering scientific research on traditional Chinese medicine. Participants in the roundtable include a delegation from the Chinese State Administration on Traditional Chinese Medicine, academics from U.S. universities, and scientists and researchers from NIH, Indian Health Service and the Food and Drug Administration (FDA). Thirty-six percent of Americans use some form of complementary and alternative medicine (CAM), according to the 2002 National Health Interview Survey. In the United States, traditional Chinese medicine is an alternative medical system that is considered a part of complementary and alternative medicine. Integrative medicine combines mainstream medical practices with alternative medical practices. Traditional Chinese medicine involves numerous practices including acupuncture, tai chi, and herbal therapies. In 2007, NIH’s National Center for Complementary and Alternative Medicine (NCCAM) supported nearly $20 million in research on traditional Chinese medicine practices. Secretary Leavitt was joined at the signing by FDA Commissioner Andrew von Eschenbach, M.D., and NCCAM Director Josephine P. Briggs, M.D. The roundtable, which was coordinated by NCCAM, National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine and the Fogarty International Center, is being held in advance of the Fourth Session of the United States-China Strategic Economic Dialogue, which began today in Annapolis, Md.
Patients with heartburn are often diagnosed with GERD (gastroesophageal reflux disease) and treated with a drug called a proton pump inhibitor (PPI) to reduce stomach acid production. It is pretty effective, but it doesn’t always work. When it doesn’t, standard practice has been to double the dose of PPI. Doubling the dose only improves symptoms in 20-25%. Most patients who fail the single dose turn out to have normal esophageal acid exposure, or “functional” heartburn. In other words, the symptoms appear to be due to something other than excess acid – so it really may not make much sense to double the PPI dose. What else could doctors try?
How about acupuncture? A recent clinical trial compared acupuncture to doubling the proton pump inhibitor dose in refractory heartburn. (more…)
There it was on Friday greeting me on the ABC News website: “Study: Acupuncture May Boost Pregnancy” in bold blue letters, with the title of the webpage being “Needles Help You Become Pregnant.” The story began:
It sounds far-fetched sticking needles in women to help them become pregnant but a scientific review suggests that acupuncture might improve the odds of conceiving if done right before or after embryos are placed in the womb.
The surprising finding is far from proven, and there are only theories for how and why acupuncture might work. However, some fertility specialists say they are hopeful that this relatively inexpensive and simple treatment might ultimately prove to be a useful add-on to traditional methods.
By the end of the day, the story was all over the media, including radio, TV, news websites, the blogosphere, and various other outlets, all trumpeting the message that a scientific study says that acupuncture can help infertile couples conceive. Nary a skeptical word seemed to be found. Knowing very well just how far parents will go to conceive, I was curious: Did this study actually say what the media says it said? What was so new and radical about this study that it rated a press release and a lot of promotion? Do we here at SBM (particularly Steve) need to rethink our extreme skepticism about acupuncture, given the poor quality evidence and lack of even a glimmer of a convincing physiologic mechanism to explain its supposed activities?
News bulletin on BBC NEWS International version, 8 Feruary 2008:“Acupuncture ‘boosts IVF chances.’ Acupuncture may increase the success rates of fertility treatment, according to a study. “
(Manheimer E, Zhang G, Udoff L, Haramati A, Langenberg P, Berman BM, Bouter LM. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ. 2008 Feb 7)
First off, how plausible is the claim? The press release states that acupuncture had been used in China fior thousands of years for infertility. Has it? No medical historian writing I have seen made such an interpretation of ancient texts. Maybe I missed something…possible. But acupuncture was not used for specific disorders or purposes, but was used as a sort of panacea to cause balance of either the Yin and Yang or of the relationship of the individual with the 5 elements and the cosmos and the earth. There is nothing specific in claims of acupuncture in traditional Chinese Medicine history. Who gave the news people that misleading lead-in?
Second, what is the plausibility that acupuncture could possibly affect a laboratory procedure on tissue removed from the subject, regardless of timing? Negligible to none. There is no consistent and credible information that acupuncture is effective for anything, except as a conditiong agent for perception of symptoms.
So, does acupuncture increase the success of IVF?