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HalfMooner
Dingaling
Philippines
15831 Posts |
 Posted - 05/13/2009 : 15:03:47 [Permalink]
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Originally posted by Kil
Acupuncture Does Not Work for Back Pain by Steven Novella
A new study which randomized 638 adults to either standard acupuncture, individualized acupuncture, placebo acupuncture using tooth picks that did not penetrate the skin, and standard therapy found exactly what previous evidence has also suggested - it does not seem to matter where you stick the needles or even if you stick the needles through the skin. The only reasonable scientific conclusion to draw from this is that acupuncture does not work.
But let me back up a minute. Imagine if we were evaluating the efficacy of a new pain drug. This drug, when tested in open trials (no blinding or control) has an effect on reducing pain - it is superior to no treatment. When compared to a placebo, however, the drug is no more effective than the placebo, although both are more effective than no treatment.
Now imagine that the pharmaceutical company who manufactures this drug sends out a press release declaring that their drug is effective for pain, but that their research shows that a placebo of their drug is also effective (FDA applications are pending). Therefore more research is needed to determine how their drug works. Would you buy it?
That is the exact situation we are facing with acupuncture research. |
Read on…
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I think that study is flawed. Poking with non-penetrating toothpicks in non-acupuncture locations is not the same as "placebo acupuncture." There would still be a sensation of pin-pricks, which may activate a release of endorphins.
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“Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive. |
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filthy
SFN Die Hard
USA
14408 Posts |
Posted - 05/13/2009 : 16:05:03 [Permalink]
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Originally posted by Kil
Originally posted by filthy
Originally posted by Kil
Originally posted by filthy
Originally posted by Kil
Originally posted by filthy
I read on. Good write-up, Kil, indeed excellent, but don't worry; they're just tryin' to needle us. 
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Ahhhh, leave it to you to get right to the point.
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Well, it was a pretty sharp article.
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And somewhat penetrating as well.
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Indeed, it stabbed to the very nerve of the matter.
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Yup. It accurately punctured that myth.
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Hm, that's a tough one to top, if it's even possible. I'll have to poke around a bit.
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"What luck for rulers that men do not think." -- Adolf Hitler (1889 - 1945)
"If only we could impeach on the basis of criminal stupidity, 90% of the Rethuglicans and half of the Democrats would be thrown out of office." ~~ P.Z. Myres
"The default position of human nature is to punch the other guy in the face and take his stuff." ~~ Dude
Brother Boot Knife of Warm Humanitarianism,
and Crypto-Communist! 
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Dave W.
Info Junkie
USA
26020 Posts |
Posted - 05/13/2009 : 18:12:41 [Permalink]
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Originally posted by HalfMooner
I think that study is flawed. Poking with non-penetrating toothpicks in non-acupuncture locations is not the same as "placebo acupuncture." There would still be a sensation of pin-pricks, which may activate a release of endorphins. |
If that's all it takes, then acupuncture doesn't work as advertised, and all anyone with pain needs to do is poke themselves with toothpicks, a much cheaper and safer alternative to acupuncturists.
That's true whether it "works" by releasing endorphins in response to pin-pricks or not. If all of our attempts at placebo work just as well as the "real thing," regardless of the mechanism, then why pay for the real thing? It could very well be that it's all placebo, and that's the mechanism.
David Gorski's comment at SBM lays out the real reason this is the death knell for taking acupuncture seriously:Actually, this study is an even better piece of evidence that any effect from acupuncture is due to nonspecific placebo effects than Steve argues. The reason? There was no restriction on "usual care" among the acupuncture groups. Thus, the three acupuncture groups were getting their version of acupuncture or sham acupuncture added to their usual care, the same usual care given to the "usual care" group. Given such an experimental design, I would have been shocked if the acupuncture groups didn't show superiority to the "usual treatment" arm. Such a result was exactly expected based on the expected placebo effect from being in one of the acupuncture arms of the study. And of course, Dr. Novella sums up quite nicely why journalists should leave science reporting to scientists. |
- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too. |
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HalfMooner
Dingaling
Philippines
15831 Posts |
Posted - 05/14/2009 : 02:16:16 [Permalink]
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Originally posted by Dave W.
Originally posted by HalfMooner
I think that study is flawed. Poking with non-penetrating toothpicks in non-acupuncture locations is not the same as "placebo acupuncture." There would still be a sensation of pin-pricks, which may activate a release of endorphins. |
If that's all it takes, then acupuncture doesn't work as advertised, and all anyone with pain needs to do is poke themselves with toothpicks, a much cheaper and safer alternative to acupuncturists.
That's true whether it "works" by releasing endorphins in response to pin-pricks or not. If all of our attempts at placebo work just as well as the "real thing," regardless of the mechanism, then why pay for the real thing? It could very well be that it's all placebo, and that's the mechanism.
David Gorski's comment at SBM lays out the real reason this is the death knell for taking acupuncture seriously:Actually, this study is an even better piece of evidence that any effect from acupuncture is due to nonspecific placebo effects than Steve argues. The reason? There was no restriction on "usual care" among the acupuncture groups. Thus, the three acupuncture groups were getting their version of acupuncture or sham acupuncture added to their usual care, the same usual care given to the "usual care" group. Given such an experimental design, I would have been shocked if the acupuncture groups didn't show superiority to the "usual treatment" arm. Such a result was exactly expected based on the expected placebo effect from being in one of the acupuncture arms of the study. And of course, Dr. Novella sums up quite nicely why journalists should leave science reporting to scientists.
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I was just pointing out my doubt that the study got the placebo right, at least in terms of any possible endorphin effect.
Just as a sugar pill placebo needs to be mistaken as a medicine by the patient, "placebo acupuncture" must be mistaken as needles being inserted. (I think it would be hard for the subject to tell the difference between non-penetrating toothpicks and penetrating needles.) Which means pin-prick pain, which means, probably, endorphin release. I frankly can't think of any way to design "placebo acupuncture" which would retain its placebo effect, yet not have the possibility of endorphin release.
We already knew that fake-acupuncture (needles inserted in non-"meridian" places) was just as marginally useful/useless as "real" acupuncture. It may be the powerful one-two punch of placebo plus endorphins that produces any marginal results.
I agree that acupuncture has been shown here to be no better that a random-needle or toothpick prick "treatment."
Nobody needs a professional acupuncturist anymore than one needs an amateur toothpickist.
Still, it would be a shame to miss all the possibilities. It would be nice, I think, to scientifically study whether or not endorphins (with or without any placebo effect) might be releasable through simple techniques, and whether this might be refined into reliable treatments for pain.
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“Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive. |
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Kil
Evil Skeptic
USA
13476 Posts |
Posted - 05/14/2009 : 08:02:54 [Permalink]
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Mooner:
I was just pointing out my doubt that the study got the placebo right, at least in terms of any possible endorphin effect. |
There is at least one limited study that suggests that the very idea of taking something purported to relieve pain causes the patient to produce endorphins. If that were the case, than the study that you question was as good as any study in determining the placebo effect and pain reduction. It could be that the very idea that relief is on the way produces endorphins regardless of the treatment. There are a few articles on this that cite the same study. here is one:
Placebo Effect Has Scientific Basis, Study Finds
This study does find that endorphins played a roll in reducing pain. What it doesn't do, because there was no control group, or a group receiving actual pain medication, is to establish that a placebo has anywhere near the efficacy of an actual pain medication. A much larger study would be in order, it seems, that would include what is missing from of this study. But again, all that would do is link the release of endorphins to the placebo effect. It would tell us more about how the effect works.
Because most clinical trials do use placebo's in one group, and the effect is well known if not completely understood, and even if endorphins do play a roll in pain reduction in the placebo group, pain relief medication is not approved if it does not show a significantly better result in pain reduction than the placebo group, even if there is an endorphin link to the effect. Also, it seems likely that the release of endorphins would effect both the placebo group and the group taking a real pain medication. So the pain medication group might be getting a little extra boost in their pain relief.
But yeah, the release endorphins might play a roll in the placebo effect. |
Uncertainty may make you uncomfortable. Certainty makes you ridiculous.
Why not question something for a change?
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HalfMooner
Dingaling
Philippines
15831 Posts |
Posted - 05/14/2009 : 09:26:18 [Permalink]
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Damn, I wish I'd invested in the Big Pharma company that invented Placebo.
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“Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive. |
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Acupuncture..... with toothpicks?
