Nov 28 2012
Journal of Clinical Oncology editorial: “Compelling” evidence acupuncture “may be” effective for cancer related fatigue
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13 Responses to “Journal of Clinical Oncology editorial: “Compelling” evidence acupuncture “may be” effective for cancer related fatigue”
Outstanding.
I really liked the detailed deconstruction of some of the editorial. Perhaps it was the first time I really learned to look out for the little trick in the “preferably under supervision of a rehabilitation professional” part – though likely not the first time I was taught.
The folks selling woo are getting very handy at writing good-sounding stuff. Politics is similar. Perhaps the plethora of examples available to emulate is helping the rhetoric hit new heights. Perhaps we can collaborate on: “This is the first sentence of a lying medical article that knows no shame.”
She has a PhD, but it feels like she’s trying to slip something past her 8th grade teacher.
James Coyne:
Has JCO gone downhill in general (i.e., when writing about real medicine), or is CAM a special soft spot in their heads?
It’s a CAM soft spot. JCO is generally a good journal—except for a CAM blind spot.
I agree with David the JCO is generally a good journal, but that it has soft spots for both CAM and psychoneuroimmunology. Some of this has to do with the past involvement of UCLA and particularly the Norman Cousins Center on both the editorial board and in writing invited editorials. JCO takes a particularly uncritical stance with respect to articles about mind-body relations in cancer, no matter how speculative the articles are and how inconsistent the speculations are with the data that are presented.
Personally I have found it frustrating when JCO allowed an author who was formerly an associate editor to keep my critical letter to the editor by simply refusing to respond. That’s a very unfortunate editorial policy at odds with international standards. I now tend to prefer blogging about the excesses of JCO rather than writing letters to the editor that may be vetoed by authors.
I guess it’s better that they are only out of their heads on one or two topics rather than all topics, but it’s also extremely weird to have such contrast. There’s some editor going over the various submissions, making notes and rational criticisms here and there. Then the whacko paper comes up, the black alien smoke from the X-Files floats across the editor’s eyes, he recites the CAM propaganda in a flat voice, and stamps it APPROVED or whatever they do. And then he moves on to the next real paper, the alien smoke fades away, and he resumes normal editing.
http://archinte.jamanetwork.com/article.aspx?articleid=1357513
More grist for the acupuncture mill, that seemingly will not stop grinding away simply because some of us say it should. I have also tried to access in full what looks like a thoughtful commentary on that paper at –
http://archinte.jamanetwork.com/article.aspx?articleid=1357516
– but I got sick of trying to get the damn-it-to-hell registration to work so that I could pay the $19 it demanded for one extra page.
We have a neatly sown-up intellectual frame-work which allows us to justify to ourselves a total dismissal of, and extreme hostility to “acupuncture”, despite considerable likelihood that it can help folk as a complex, largely psychological intervention that probably in works mainly by recruiting a number of useful nonspecific influences including placebo responses.
Is this hostility entirely justified when there is fairly robust evidence that it is helping people with otherwise difficult conditions? I deeply apologise for keeping on coming back to this question but there are questions of scientific accuracy, fairness, self-understanding, and above all, patient welfare to be considered.
Just for everyone’s information, the latest Consumer Reports on Health (Jan 2013 edition) recommends acupuncture to relieve osteoarthritis: “Real acupuncture provided modest benefits over a sham procedure in relieving chronic pain, including pain due to osteoarthritis, according to a review of 29 clincial trials involving nearly 18,000 patients published in the Oct. 22 2012 Annals of Internal Medicine”.
Is there a contrary view here at SBM?
I really wish they’d start those recommendations with a breakdown of what “acupuncture” actually is. Is it:
- any solid-core needle put into the body
- needling specific points
- needling after a Traditional Chinese Medicine diagnosis
- needling based on chi
- deep or superficial needling
- needling for specific conditions (i.e. knee pain due to osteoarthritis) or general ones (i.e. “pain”)
- needling that penetrates the skin (versus retracting needles or toothpicks)
- needling with an enthusiastic versus indifferent practitioner
I doubt those 29 trials compared the same thing, in the same way. There are so many variable to acupuncture, one must take great care when comparing.
My view is that acupuncture is probably a placebo – but a very effective one, enhanced by the drama, exoticness, alleged historicity, and salience of the intervention. It has its uses when disconnected from the science-bashing common to most alternative medicine approaches, science-eroding TCM systems, specific claims of treatment beyond pain and nausea, practiced using sterile conditions by practitioners trained to avoid anatomical danger areas, using shallow-penetrating or filiform needles (if needles are used rather than toothpicks and a guide tube), without substituting for actual care (and never for serious conditions). I’m sure there are contributors who believe it to be complete placebo that should not be practiced though.
mdcatdad,
If you look to your far right you will see the heading “Categories”.
The first item in the list is “Acupuncture”.
There are 119 articles.
But it all comes down to this:
- there is no evidence for chi or qi
- there is no evidence for meridians
- there is no a anatomical correlate for acupuncture points
Clinical trials have found that
- it doesn’t matter where you stick the needles in
- it doesn’t matter if you stick them in deep or superficial
- it doesn’t matter if you don’t stick them in
The results of clinical trials show
- there is some effect for pain and nausea
- the effect reduces as the adequacy of the placebo arm increases
- the effect disappears when the placebo arm is ideal.
Most practitioners here would not recommend acupuncture because
- it does not work
- it is unethical to provide treatments that do not work
- it is often provided by practitioners who are pro CAM and anti science based medicine
Yes, BillyJoe, I’m well-read in the skepical literature on acupuncture, including the science-based rebuttals of almost all the positive findings.
That’s why I was surpised to find a respected publication citing an even more respected journal’s pro-acupunture findings.
WilliamLawrenceUtridge, I’d also add ayurveda (and I think there’s a Japanese acupuncture) as other variants.
So why did you ask?
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