I find it fascinating that the conclusion of many looking at this study
seems to be that acupuncture works.
No study could be any more clearcut that acupuncture (i.e., placement and
manipulation of needles in very specific locations) does not work. Perhaps
random needle placement (?randopuncture) does work for pain relief, just
like pinching the rat's tail; but a more likely explanation, given that
other forms of sham acupuncture involving no actual needle insertion
(?shamopuncture) also seem to work (to greater or lesser degrees depending
on which study you look at), is that acupuncture is an elaborate placebo.
Ed Greeno
From: "David Stone"
"Acupuncture - real or sham - is more effective at treating back pain than conventional therapies, research suggests."
[sigh] At what point does sham acupuncture stop *being* acupuncture? If tiny knives are jabbed into people in random locations, is that acupuncture? Is snakebite or a mosquito bite acupuncture? Is any intravenous injection acupuncture?
For a puncture of the skin to be considered acupuncture, shouldn't it include the intention of the practitioner to practice acupuncture, which means using standard acupuncture sites and all the other trappings--twirling/manipulating the needles, standard depth, etc?
Short of that, it's just jabbing people with needles, and if jabbing people in random locations with needles is as effective, that result cannot be considered evidence that acupuncture (the theory and associated specific rituals) is effective. Instead, it suggests that the theory and specific rituals are irrelevant.
From: "Lauren Eve Pomerantz"
What about this. Take a group of people who complain of something
like backpain. Ask them about other complaints. Let's say that some
of them want to lose weight, too.
Give them all acupuncture meant to help back pain. Tell half of the
group that the treatment is intended for back pain. Tell the other
half it is intended for weight loss.
If you have a bacterial infection and I give you an Antibiotic to
which that bacterium is susceptible, you will get better, even if I
tell you that the pill I am giving you is to boost memory.
Lauren Eve Pomerantz
From: "Peter Moran"
In the recent sham-controlled trial of acupuncture for allergic rhinitis,
published in the MJA and discussed a bit here, the sham needles were 13mm
long and the "real" ones 3cm ("or more"} long. Would not most patients
have seen the longer acupuncture needles employed whenever acupuncture has
been depicted in the media, and be able to guess that 13mm (about 1/2 inch)
needles were a sham? No exit poll was performed in that trial to determine
whether patients were able to guess what they were getting. This was a
rather unconvincing study for this and other reasons including rather patchy
"benefits".
The present trial can be interpreted as showing that placebo treatments
having mystical and theatrical qualities, and the potential for weak
counter irritation and distraction effects, can appear to be of benefit to
patients with chronic back pain when compared to ho-hum treatment that has
probably already been tried in most of the same patients. (But I admit I
haven't seen the full paper).
I say "appear" because the design of this trial allows reporting biases
(answers of politeness and experimental subordination) to be an important
influence in the way patients fill in their questionnaires. Patients
invariably try to give the "right" answers. It would be useful to have the
answer to some simple questions such as to whether acupuncture helped more
patients get back to work. Another somewhat objective measure is the
amount of medications used.
Peter Moran
From: "Harriet Hall, MD"
Was there an "exit poll" where subjects said whether they thought they'd
gotten the real thing?
Isn't the real message here that acupuncture doesn't work but thinking
you've been acupunctured does?
Harriet Hall, MD
The SkepDoc
From: "David Stone"
How does "superficial needling" compare in terms of puncture depth to actual acupuncture needling? The authors refer to it as 'sham acupuncture' rather than, say, 'non-acupuncture', but does 'sham' mean the location of the needling or the depth or both?
It seems we never quite get the control group that we want, in which the patients think they are being "acupunctured" but they aren't at all---no needling.
Is it considered necessary for the patient to feel the needling in order for them to report improvement (ie, for acupuncture to "work")?
If not, why not use a local anesthetic for these experiments so that needling can be entirely dispensed with in the control group? Does the needling of standard acupuncture result, after the session, in noticeable soreness that would be missing in a non-needled control group?