Mar 08 2013
Acupuncture and Allergic Rhinitis: Another Opportunity for Intellectual Sterility
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“An ideal acupuncture study would have 4 groups: one that receives real acupuncture and is told they are receiving either real or sham and a group that receives sham acupuncture and is told they are receiving real or sham”
For a moment, I thought you were going to say real/sham/usual_treatment/waiting_list. The last two groups add nothing, of course, and serve only to reduce the numbers in the two groups that can actually tell us something about acupuncture. The four groups in the quote are effectively two groups cut two ways, so nothing is lost and something is actually gained. It should become the standard for trials of acupuncture, though I think it is high time trials of acupuncture were abandoned as a waste of time, money, and manpower.
Mark, thank you for this excellent post . My concerns with publications in some medical journals date back to the claims for positive outcomes published by physicians treating patients with magnets. The experiments weren’t even double blind– impossible to restrict paperclips from any participant. Nevertheless respected science journalists , even from the NY TIMES seized on the claim and wrote heart warming articles about their success. It took years to pull the claims from press releases and a law suit by the National Council Against Health Fraud to pull them from the shelves of Drug Stores. Now thanks to the German Study’s publication and its possible press release the unwary will be urged to seek acupuncture for running noses.
thanks,
Eugenie Mielczarek
Will this be sent to every “integrative” clinic in The Land–especially the ones at formerly prestigious medical centers?
As I sit here with my ever-present runny nose (since I stopped the allergy shots), I can only hope so. I won’t be getting needled, but I might try the plastic bottle version of the netti-pot the allergist gave me, for some temporary relief.
I think the netti-pot concept (in whatever form you use it) is possibly an example of a “woo that works” and is therefore no longer woo. I suppose the ritual of the real netti pot is better for believers than my plastic bottle which simply helps me get saline water through my nose to rinse out some of the snot so I won’t have snot-streaked sleeves ay noon.
Or I could take an antihistamine.
“Outside of vaccines and some biologics such as Rituxan, I cannot think of any medical intervention whose affect upon disease physiology persists longer than a few days after cessation. ”
Immunotherapy, a legitimate treatment for allergies, can achieve this lasting effect. I received this for four years, and it’s been five years since I stopped. In the last five years my allergies have slowly begun to return, but they are still nowhere near the levels they were at before I began the shots. It wasn’t until a year ago that I had to return to daily antihistamines. Before I got the shots, I suffered greatly during ragweed season, even with the pills and nasal sprays.
Dr Crislip:
I beg to differ. I had a medical intervention performed upon my foot following an injury. It did involve the insertion of needles. Seventh months later, its beneficial effect persists! Of course, the needles were for the injection of sedatives and anasthetic so they could repair my joint.
My good friend had her severe GERD cured surgically, I know several who were cured surgically of cancer, and I know three people who no longer have such bad problems with their sinuses during allergy season because they had surgery to widen them. (Or something. I’m not entirely clear on what exactly was done, but I know they’re all breathing much better now. One of them has practically undergone a personality shift, since he’s able to get a decent night’s sleep now.)
I have learned one thing from reading articles and watching documentaries about how acupuncture is performed, the philosophies behind it, and the efficacy of it. It has utterly convinced me of one thing: that acupuncturists have no idea what they are doing, but believe they do. If they do help anyone, it is by accident, and they won’t actually know which patients they’ve really helped. Just which ones stopped complaining.
One further observation: they found that there was a statistically if not clinically significant improvement in quality of life after 8 weeks. Given that seasonal allergic rhinitis is, y’know, *seasonal*, I would expect it to vary over the course of 8 weeks no matter what the hell you did. Maybe the maple bloom ended. I don’t see any indication they considered that.
How about ‘the 8 guiding principles’ ?
Being a staunch pastafarian, I would suggest “the eight ‘I really rather you dids’”.
I slipped into doctor speak and did not know it. In the world of internal medicine, there are medical therapies and surgical therapies.
Oh man. Of course. Treat a disease at the start of the season and it will be better at the end of the season when all the pollen is gone. Wish I had thought of that; it makes the study even more ridiculous if they did not include, at a minimum, pollen counts, and they note that pollen exposure varies from site to site but that “everything should have balanced out”
Although classic TCM would not even consider the pollen as a factor in the look of the tongue and the nature of the pulse, since dx and treatment is classically based on pure bogosity.
I guess I’ll be a nuisance and add another medical intervention that lasts longer than a few days post treatment.
Let’s not forget my favorite needle based medical intervention – cortisone injections – the last one I had for bursitis lasted years.
also I like WLU’s – I’d really rather you dids. Although I don’t know what a pastafarian is – someone who likes pasta, someone who paturizes?
mtr…google…just google.
Fascinating read. Made so much better by Neil Young’s “needle and damage done” coming on the classic rock station as I read…
JJ Borgman – No – I’d just like to contemplate all the things it could be…like in the old days, before the internet and google, when phones had cords, cars had distributors caps and you could get really terrified over a good urban legend without having snopes ruin it for you.
…used to be – when you wanted to start your own religion you had to do it through word of mouth and poorly xeroxed flyers using 50′s clip art.
So. You can’t be troubled to google “pastafarian”? You don’t seem to be the lazy sort. A google on that phrase would give you everything you need to know about it.
(down a peg)
mtr, I certainly empathize with your sentiment to the “good old days”. That sentiment has robbed me of numerous employment opportunities. Keep up or get out is the norm, it seems. Even a well-informed use of modern apps won’t get you far if you fail to meet other criteria.
Anyway, googling seems to help one keep abreast of modern terminology.
MTR
Yes, do google. You will be richly rewarded, His Noodly Appendage will grace you with blessings. Ramen.
Thank you for this article & for this excellent list of strong suggestions. I am particularly taken with the first one:
This reminds me of the Declaration of Independence and holding certain things to be self-evident. I find reality to be self-evident and think it a great place to start searching for the truth. As noted, this stands in contrast to the first principles or assumptions of many “alternative modalities” whose first premises reside somewhere in ancient history, implausible physics or chemistry, or simply go with the “we don’t really know but keep and open mind” sort of thing. I think starting with reality and methodical search for truth to be a much stronger foundation than anything in the alt-world.
jjborgman – it’s not that I can’t be bothered, it’s that I would rather wander in the desert until I reach a transcendental epiphany…
MTR — that seems remarkable apt for pastafarianism, actually.
Pastafarianism is a joke religion used to parody religious establishments. It’s the church of the Flying Spaghetti Monster. You can even get symbols to put on your car which resemble Jesus fish, only with meatballs and tentacles. Pastafarians say “Ramen” instead of “Amen”, and refer to their deity’s “noodly appendages”. Even as a Christian, I can appreciate the joke. It’s developed into a fairly extensive meme.
Oh, rats. Spring is coming. I noticed I sneezed several times as I was reading a book. I think I will reach for an antihistamine instead getting needled. Stupid alder trees (the allergen which traveled up my arm during the allergy prick test on my arm).
Try telling that to the cats. I did allergy desensitization for about seven years, gave up in my teens out of sheer cussedness, and then gave up on antihistamines in college because of the sedative effect. I now just fill my back pockets with paper towels and have violent sneezing attacks every few days.
JJ Borgman, WLU and Calli Arcale – but does this “spaghetti monster” offer Eternal Salvation — Or TRIPLE your money back!?
CA: ” Pastafarianism is a joke religion”
Pastafarianism, joke, religion?
I think the idea is that these words are interchangeable.
mtr…according to Wikipedia:
“The Pastafarian conception of Heaven includes a beer volcano and a stripper factory. The Pastafarian Hell is similar, except that the beer is stale and the strippers have sexually transmitted diseases.”
I’m fairly certain the financial policy is All Sales Final ~:^)
By the way, He is properly addressed as Flying Spaghetti Monster or FSM rather than ‘this”spaghetti monster”‘.
JJ Borgman “The Pastafarian conception of Heaven includes a beer volcano and a stripper factory.”
Oh I think “Bob” would approve then.
Most of this discussion reminds me of my favorite bit of found public restroom graffiti:
End the Salad Hegemony! Long Live the Pasta Republic!
@BillyJoe – Oh I thought it was the words “joke” and “life” that were interchangeable…probably just my life though.
Oh, Michelle, no…
“There are many here among us who feel that life is but a joke.
But you and I, we’ve been through that, and this is not our fate.
So let us not talk falsely now, the hour is getting late…”
(Bob Dylan “All Along The Watchtower”)
“The only part of the human body that is routinely free of acupuncture points in the genitalia. I doubt they were needling there.” Really?! Did you check rule 34?
@Narad, I am not a doctor, but it occurs to me that there might be a way to mitigate the cat dander in your environment.
They generally require sedation for shaving. I’m also an allogrooming target, so there are certain proteins that I’m stuck with. They’re my rescues; I deal.
I am also allergic to cats. But obviously not enough to not have them in my home.
For a certain birthday in my 20s I knew dear spouse was getting me a pet. I actually asked for a dog, but the family gears were already in motion for a cat. So I ended up with a cat. Despite me wanting a Siamese, spouse chose an orange tabby. Despite wanting to give it a weird scientific/math name (Pythagoras), dear spouse made sure it was named after a character he liked in a TV program, “Louie.”
On the bright side: I got to take care of Louie, the partial orange tabby, for almost nineteen years. He was was a very good cat. He never shredded the furniture, and he never peed where he was not supposed to. Plus he was a good mouser.
I dealt with my allergy by washing my hands every time I touched him, by vacuuming, and by getting an electronic filter on the furnace. And by the fact he did go outside, and until the last year of his life he was not much of a lap cat.
Unfortunately, after he had lived a good long life as a cat, he was in a great deal of arthritic pain and had kitty dementia. It is no fun being awakened in the middle of the night by his mournful meows because he could not find a water dish a few inches from where he was sitting. Le sigh.
But the real problem is that then we had kids. They thought they could have their own cats after Louie was gone. So now we have two. AAARGH! I cannot believe how many messes we have to clean up for “normal” cats. I really miss Louie. What is worse is that one child has moved out of the house and left us with the most stupid psycho cat in the world.
I still wash my hands after touching them. Also I make sure that electronic furnace filter is kept clean!
Plus I have a freaking kitty pheromone emitter to make sure they are happy and don’t pee (or spray in the case of rescued Tomcat) all over the place (it actually works! I did not replace it, and then the idiot cat peed all over the bathroom… put it back and that stops… I am sticking with that anecdote). Both of the cats hate each other. While the ex-Tomcat as had the important parts removed, he still leaves a pungent reminder when he is upset. And it doesn’t help the other cat is just psycho.
So much angst would have been avoided if Dear Hubby had gotten me a little dog for that twenty-something birthday.
BillyJoe – Bob Dylan takes life very seriously…I suppose somebody’s gotta do it.
My good friend’s husband is allergic to cats. Until recently they had a sphynx cat* a hairless cat that is often quite hypoallergenic with no problems with his allergies. Although the cat looked like the arch villain in a Marvel comic book, he was an incredibly sweet, playful and affectionate cat.
Of course if you already have cats, that’s not helpful. But if you’re allergic and married to a cat lover….
* http://www.petside.com/slideshow/breed-profile-sphynx
Michelle, I think we are equivocating, no?
“My life is a joke” is not the same as “my life is filled with humour”.
I do hope you meant the latter though. (:
I can’t believe I am reading about “hypoallergenic” cats on a science blog! Hairless, shmareless–it doesn’t matter. The protein that allergic people react to is in the dander, saliva, and urine (some people react to one, some to all). It’s in skin flakes that are shed regardless of the presence of hair in the case of dander. It may seem to make a difference for the mildly allergic, but no help to me and my ilk at the allergy clinic who can’t even sit next to a person who has been in the same room with a cat.
The reason I stopped allergy shots is that the cat component was causing me reactions that required epi pens every other time I got a shot. This was after extra-slow progression over a three-year period. I had to have an ice pack for half a day after a shot and that was with use of antihistamines before the shot. I was wheezing five minutes after the shot toward the end. I was using inhalers all the time and even a nebulizer. Now I just sniffle and have returned to strict avoidance.
Cat dander is much smaller than other animal danders, it is sticky, and it remains active for up to two years even if the cat isn’t there, so all the precautions (I tried them all–ripped out all the carpet, bathed (!) the cat weekly, air cleaners, hand washing, nasal spray, inhalers, etc) in the world make it difficult to avoid it and for the very sensitive, you will end up with horrible, chronic asthma and other lung problems if you try to keep a cat. The shots have made it possible for me to be in a house with cats for about 15 minutes (that would be 15 minutes longer than before the shots), but that’s about it.
Allergic reaction to dander has nothing to do with breed, color, hair, etc. There are likely individual animals that an allergic person can tolerate, which may lead to anecdotes about certain colors or breeds being “hypoallergenic”, but I have yet to find one. I am able to tolerate my weenie dog with elaborate precautions, but she is probably the source of my previously mentioned runny nose.
Everyone’s length of response to immunotherapy is different–some people are good for life, but most need maintenance or a redo after a few years. It’s helped my pollen allergies a lot, but not so much with the cat thing.
Sorry for the rant, but this subject has occupied a big chunk of my life and I have found it rife with misinformation and scams.
Ah, you caught me there Janet, sorry about the misinformation. Possibly my friend’s allergy was not a true cat allergy, not sure.
But wikipedia confirms “Although Sphynx cats are sometimes thought to be hypoallergenic due to their lack of coat, this is not the case for cat-specific allergies. Allergies to cats are triggered by a protein called Fel d1, not cat hair itself. Fel d1 is a tiny and sticky protein primarily found in cat saliva and sebaceous glands. “
eh…messed up my wikiquote…it goes on to say that Sphinx still have the protein, etc.
http://en.wikipedia.org/wiki/Sphynx_(cat)
BillyJoe – Life is a joke, clearly.
Who’s playing it then?
@Janet “bathed (!) the cat weekly”.
Crikey Mikey, Janet, you were truly desperate! I used to have a show cat that got a bran bath before going to the shows … no water involved! … stuck her (head out) into a pillowcase 1/4 full of warm bran and rubbed it in. The look in her eyes resembled the furious glare of a bowler (in cricket, for those of you that don’t know about civilised sport) staring at a basman that has just hit him for six, and thinking, “I’m gonna get you, I’m gonna get you …”
batsman
@Calli – The interventions you mentioned are all surgical, cutting bits up/out tends to work long-term because we can’t regenerate most parts of ourselves!
Having said that, I’ve scared myself because I’ve imagined a surgical form of acupuncture, where organs are exposed and then directly needled. FSM save me from my insomnia-fuelled imagination.
kathy,
You are English then?
My brother is a vet. He sometimes has to attend a cat that looks like something the…um…cat dragged in. His strategy is to give the cat a false sense of security, stroking it gently and talking sweet nothings into its ear. He then slowly curls one hand around the front paws and the other around the back paws and, before it knows what hit it, rapidly submerge it in a tub of water, shake as fast and furiously as he can for a few seconds, and then let it go, giving the cat a wide birth as he does so.
BillyJoe, your brother is a hero. You’d be astonished (but your brother can no doubt tell you!) how strong a 5-pound cat can be when she is angry enough, and how she can turn into a whirling dervish armed with about 500 claws and the fangs of 40 vipers, when dunked into a basin of water … besides being slippery.
[Not English, no, South African, or as we say here, Sarth Efrican. Also a Protea cricket team supporter, and (I know it's waaaay off forum, so abject advance 'pologies) rejoicing in my beloved cricket team FINALLY getting the success they deserve. Being a Protea supporter has, for the past twenty or so years, been a triumph of hope over common sense and logic, and all things held dear in this forum. GO PROTEAS!!]
@BillyJoe – Bill Gates or maybe Stephen Kowalski, I’m not 100% sure which.
Protea maybe is a good thing for the genteel of SA, but must remind that you are describing love of game to BillyJoe who lives in the nation that birthed the finest team sport ever devised by Homo sapiens — Footy. To my mind the only dandered cats severely in need of a bath are in Geelong. GO THE MAGPIES !
elburto — I know, I was intending to be cheeky by mentioning surgery.
(Though it occurs to me my mom took a *drug* therapy that had long-term effects. Radioactive iodine to treat her Grave’s Disease. Also sort of cheeky to mention in this context since although it isn’t technically surgery, it does completely kill the thyroid which would obviously have a permanent effect.)
Janet — the difference with hairless cats is only that they’re easier to bathe. I am allergic to both cats and dogs (more violently to cats) and so I have a poodle. Her coat doesn’t shed, which helps control the allergens, but I am still careful to wash my hands every time I pet her, lest I get dog dander on my face. That said, there are researchers attempting to genetically engineer a truly hypoallergenic cat. This strikes me as a little silly, but hey, if they can get someone to pay the big bucks for such a cat, I guess it’s fair. Just seems like a waste of resources.
Narad — “”Treat a disease at the start of the season and it will be better at the end of the season when all the pollen is gone.” Try telling that to the cats.” Well, strictly speaking, cat allergy isn’t seasonal allergic rhinitis, since it is *not* seasonal.
So that experience wouldn’t apply to this study, although if you just get a bunch of people with allergic rhinitis and treat ‘em all with whatever hokum strikes your fancy, enough probably will have seasonal allergies to make a statistical difference. And if you’ve taken pains to find out what they’re all allergic to, you’ll notice that only the seasonal ones had an improvement, and then you’ll trumpet your study as proving that the hokum is good for seasonal allergic rhinitis. Voila! 
LOL! OK, OK … DevoutCat, I’ll tell the rough-edged lot of boytjies that blog on the horseracing forum I often go to, that they are the “genteel of SA” next time they say nasty things about the Proteas’ latest (non)performance in 20-20 cricket. Since they are thinking in betting terms they may not agree with me … eek! … just saying.
Good luck to the Magpies next time out. Me, I prefer the SA-NZ version to Oz Futbal, but that’s upbringing for you. It’s not as if I ever played either.
@elburto: “Having said that, I’ve scared myself because I’ve imagined a surgical form of acupuncture, where organs are exposed and then directly needled. FSM save me from my insomnia-fuelled imagination.”
Fueling your nightmares, I recently had my cervix needled multiple times!!!!11!!
But for an awesome, actual medical reason! (To inject some sort of numbing agent so that it could be pried open to facilitate placing fallopian tube inserts intended to prevent any more little anthropologists from occupying my uterus.)
@everyone else: The solution to cat allergies is to have a dog instead. *ducks…*
Or one of Belyaev’s adorable foxes. *quacks…*
Okay – Now Anthropologist Underground just gave me nightmares….Please tell me that you weren’t conscious for that, cause it sounds awful.
@mtr: Only the first two needle sticks really hurt. After that, I got to watch on a monitor! Biology is so cool! And the inside of my uterus is gorgeous…;)
@devoutcatalyst: yes! So cute!
Cats really do rule the interwebs!!
This thread is already totally derailed, so may I suggest anyone interested in either cats or cancer check out Tuxedo Stanley? Before him, I thought euthanasia was the only option for cats with cancer, but to my great surprise this poor lovely cat is getting chemotherapy for an aggressive lymphoma of the kidneys.
Another really big surprise to me (how out of touch can one get??), from the comments I gather that some people think marijuana can cure cancer?? Trying to imagine a cat smoking a joint……..
Do check him out – Tuxedo Stan is much nicer than “Count Stan”!
tuxedostan.com
https://www.facebook.com/pages/Tuxedo-Party/391884324181841?ref=ts&fref=ts
The facebook page has more info, and thousands more comments (!!) than the website.
Believe or not, there are a few places in the U.S. where one can obtain feline hemodialysis. My understanding is that this is generally part of a plan for transplant. (And you have to adopt the donor cat.)
Mark, did they perform pill counts so as to have an objective measure of rescue medication use? If so, how do you explain the apparently quite substantial medication-sparing effect of real acupuncture at 7-8 weeks in the second graph? How does biased reporting account for that?
We can, of course, choose to regard that as some other kind of study glitch, but there are other studies, along with those suggesting considerable placebo responsiveness of allergic rhinitis, that make this a plausible finding.
I agree that the superiority of “real” acupuncture over sham is more likely to be a response to perceptions regarding treatment effectiveness, its invasiveness, and its distracting abilities, than any mysterious physiological activity of acupuncture.
@ pmoran:
Statistical variation. Picking out that one point as important is a classic case of failing to correct for multiple comparisons. The error bars would have to be MUCH smaller to say there’s any effect there at all.
Yet symptom scores followed the same pattern, also with P values of <.001 at this end-point, and similar confidence intervals, Scott. Makes a purely chance finding very unlikely.
If placebo responses are as capable as some think (without going to the overly-imaginative extremes of a few) then it is likely that CAM modalities will regularly produce results like this. Can we defend the position that patient biases at certain end points could retrospectively influence the number of tablets used for symptom relief?
Hardly that unlikely when you consider how many possibilities there were for such coincidences to arise. You HAVE to do the proper correction for multiple comparisons before you can make the slightest claim that there’s anything there.
Well, even Mark seems to agree that there is “something there”, since he has gone to some lengths with his preferred explanation, that of biased patient reporting.
That is one possible explanation, but is it the most likely reason for people taking less medication for symptoms?
Narad, that is quite remarkable! For serious cat lovers with plenty of moolah only, I expect…..
I was somewhat taken aback to find myself paying $400 for a feline ultrasound (heart murmur) a few years ago. I cannot imagine how much a transplant would set one back.
The feline fans, feline allergy sufferers, and feline “phobiasts” took over the comments to this fine post.
Perhaps this has something to do with toxiplasmosis?
That’s really scary. Have the SCAM folks got a fix for that too?
To continue the nitpicking…
“Outside of vaccines and some biologics such as Rituxan, I cannot think of any medical intervention whose affect upon disease physiology persists longer than a few days after cessation.”
I might be misunderstanding your meaning here.
Ketamine for depression or for treatment of complex regional pain syndrome seems to be capable of lasting long after serum level of drug are gone. (ECT has a lasting effect as well on depression as well.)
Radionuclides for metastatic bone pain?
Bisphosphonates have long lasting effects on bone density as well as on hypercalcemia or perhaps bony metastatic pain.
Chemical or electrical cardioversions?
———-
None of this should suggest in any way that I don’t generally agree with and appreciate your post. Or that I think that acupuncture has any medical indications.
@physicsmum
I don’t remember the price, but perhaps seven years ago I was referred to a specialty vet clinic way out in the suburbs for a liver ultrasound. Two things stand out: (1) That it was way nicer than the local university medical center. (2) The somewhat shaken look on the doctor’s face when she came out to ask whether they could administer a sedative, even though I had warned them in advance that he was, shall we say, rather a tough cat.
[...] And this article is meant to be applied to reality/science based treatment. As I mentioned in my last blog entry it is even more problematic when statistics are applied to fantasy interventions [...]
It is remarkable how these tips can be applied to SCAM-related articles and the articles are found wanting. For example, the acupuncture article I reviewed last week: barely significant p-values, large confidence intervals and misleading multiple tests; the sine qua non of positive SCAM studies.
This is a bit loose, Mark. P<.001 is now "barely significant"? Two measurements (which correlated very plausibly between the three groups) are now "multiple tests"? Were those confidence intervals unusually large for medical studies involving subjective complaints with "placebo responsive" conditions (I don't know, — I am no statistician either, but I seriously doubt it)?
If you really believed the findings were this easy to dismiss on statistical grounds, then there was no real need for your extensive explanation of how the differences observed were probably due to reporting biases. I asked you to support that view further at the time, but you either missed several comments or chose not to answer.
Note also that most of the findings in that study are replicated by numerous other studies on acupuncture using sham and "untreated" controls, including the differences (typically much smaller, of course) between sham and real acupuncture.
The only difference here was this unusually poor performance from sham acupuncture. That fits your case that there was a very inadequate placebo for any comparison of "real" and "sham", but it does not exclusively support any particular explanation for the apparent "effects" observed here, and also in many other studies.
Just very busy, a slow typist, and you are partly correct.