David Gorski has a devastating takedown of a recent study being hyped by the media as showing that acupuncture boosts the efficacy of painkillers. As Gorski points out, the study does nothing of the sort:
Harris acknowledges up front that several studies have now shown acupuncture to be no more efficacious than sham acupuncture. Indeed, we have written about such studies right here on SBM that show that acupuncture is no more effective than sham acupuncture. It doesn’t matter if the sham acupuncture is needles inserted in the “wrong” acupuncture points or fake needles that do not penetrate the skin or even toothpicks. The most reasonable scientific conclusion from all of these studies is that acupuncture, as practiced by adherents of traditional Chinese medicine, does not work. At the very best, it’s a nonspecific effect that doesn’t rely on anything resembling a system. More likely, acupuncture is nothing more than an elaborate placebo. None of this, however, stops Harris’ group from trying to show that there is a different between sham acupuncture and real acupuncture at some sort of level, and this study is their attempt to do just that.[...]
I can’t prove it, but certainly the methodological shortcomings of this trial make it hard to take as any definitive evidence that there is different neurobiology going on between real acupuncture and sham acupuncture. All it does is to show that maybe there is a neurobiological difference between having needles sticking out of the skin and not having needles sticking out of the skin, which would be of little surprise, although the exact difference could be of interest. What this study does not show is that acupuncture “works.” I suppose it’s possible that sticking needles in the skin may have nonspecific effects that might alleviate pain, but this very study shows that they are no different than placebo. After all, there was no difference in pain relief between subjects receiving sham acupuncture and real acupuncture. Both experienced the same amount of subjective pain relief!
Read the whole thing, and keep it in mind the next time someone tells you that acupuncture “works.”
Image Credit: Migraine Chick
Here’s what happens: people are in pain. They try acupuncture. They feel better, for whatever reason, psychosomatic or not. They persist, and continue to feel less pain. Ask them. Who cares if it’s “real”?
As long as skepticism has ridicule as the heart of its project , it is my enemy.
I care about people diverting their money to con artists. Because acupuncture, chiropracty, etc. are nothing more than placebos, the folks who run the shops have a guaranteed source of income for doing nothing at all.
Moreover, because folks are constantly going to those quacks and thinking that they feel better while science says “no”, it makes people less inclined to trust doctors. Which means that they go to the doctor less and serious conditions don’t get caught as early as they should be. So, on balance, people are sicker because of the existence of quacks than they would be otherwise.
That’s why I can’t stand them.
I care about people diverting their money to con artists. Because acupuncture, chiropracty, etc. are nothing more than placebos, the folks who run the shops have a guaranteed source of income for doing nothing at all.
But they aren’t doing nothing. They are, in fact, reducing the pain of the people who feel pain reduction when they go to them. I know many people who tell me, whatever the reason, that they feel a reduction in their pain from getting acupuncture. Pain is subjective; there is no referent beyond the experience of the person feeling the pain. If people trade money for a method that makes them feel less pain, and the pain is not a symptom of a larger problem that conventional medicine can fix– and bear in mind that things like acupuncture are pursued precisely because they have been told by doctors that their pain is persistent– what, exactly, is the harm? Again, there’s no meaningful difference in saying that pain was relieved by placebo and that pain was relieved by a treatment. Pain is relieved when the person experiencing it says it has been relieved. If people go to an acupuncturist, feel better, and return again, that is utterly rational.
But hey, your comment demonstrates the degree of your good faith and your commitment to the spirit of inquiry…
Freddie,
One reason why this matters is that the placebos simply do not work nearly as well as conventional painkillers when it comes to pain relief. That’s consistent throughout longitudinal studies. If we want pain relief, we can use medication. Indeed, acupuncture doesn’t work nearly as well as regular exercise which is actually one of the best fixes for pain relief. And both pain killers and exercise address the root of chronic pain–something that acupuncture doesn’t do.
And to extend my point about acupuncture and chiropracty vs. doctors, let me also point out that a LOT of acupuncturists and chiropractors claim that they can cure disease, not just dull pain. (See here, for example). Now, because anecdotes are a powerful focal point for belief, if people believe their acupuncturist is actually doing something to dull their pain, then hey, they might go ahead and try it for their acne. Or their flu. Or their STD. Or their cancer… And people do actually do this.
If there’s no scientific basis for a course of treatment, then that treatment is harmful even if people think they’re feeling better, because it can lead them to distrust science when their life depends on that trust.
I don’t think people should go to an acupuncturist or similar for their acne, or whatever else. I do think that, as much as placebo effects may be inferior to the pain relief of narcotics, many people do feel genuine relief from that placebo effect, and that’s valuable, in a context where for many people the choice is pain or drug addiction.
I think that in our culture, we don’t have a full enough appreciation of the very real problem of chronic pain management. Western medicine is a miracle when it comes to acute or emergency care but much less successful when it comes to chronic illness and pain management. Unfortunately, the huge blessing of opiate pain medications comes with the difficulty of addiction and its attendant problems. It’s a very real issue. What I want is for people to have the space to be respected for pursuing a treatment that they feel works when they have pursued other avenues and found failed intervention or intervention that comes with too many side effects and tradeoffs.
The problem, though, is that by going to an acupuncturist and trusting them, you trust doctors less, you go to doctors less, and you might go ahead and take that acne or asthma treatment. After all, the acupuncturist makes the pain go away, right?
Moreover, Freddie, two ibuprofens results in better pain treatment, even for chronic pain, than placebos do. Why should people pay $500 for a sham treatment when they could spend $0.50 on a more effective one?
Plus there’s a societal value, too. Acupuncturists, chiropractors and the like stand in the way of truthfully finding out the causes of things like chronic pain and the best pain management. They cloud the issue and make things harder for those of us who want to find genuine, scientifically based treatments. I’m sorry, but you’ll have a rough time convincing me that having desperate people in pain handing their money over to con artists is a good thing, even if it does make them temporarily “feel better.”
[...] few weeks ago when I was doing one of my routine lambasts of acupuncture, Freddie of the League of Ordinary Gentlemen and I got into a discussion over [...]
Plus there’s a societal value, too. Acupuncturists, chiropractors and the like stand in the way of truthfully finding out the causes of things like chronic pain and the best pain management. They cloud the issue and make things harder for those of us who want to find genuine, scientifically based treatments. I’m sorry, but you’ll have a rough time convincing me that having desperate people in pain handing their money over to con artists is a good thing, even if it does make them temporarily “feel better.”
You talk as though Doctors care. I have visited many doctors who are total incompetents. Here is one of many stories I could relate. Years ago I injured my knee and there was some swelling and the Doctor told me I had chronic arthritis and wanted to start immediate gold injections. I walked out and did not pay him. A week later the swelling was gone and it never came back. My point is this: I was in pain and this ‘con artist” asked for money without a proper diagnosis, so I really don’t see the difference. In Australia many doctors are now treating patients with Acupuncture and charging it to the National Health Scheme. Please don’t call natural therapists “Con Artists” without including Doctors in this category.