sham acupuncture

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Mainstream Medical Journals say Acupuncture Works; Skeptics Irritated.

September 5, 2010 in Acupuncture, News, Research | No comments

I’m a bit tired so I’ll just quote this article and comment on it:

Outrage over Acupuncture Evidence Attacks NIH (http://www.healthcmi.com/index.php/acupuncturist-news-online/291-outrageacupunctureproofnih)

Doctors from the University of Maryland School of Medicine, Baltimore and the University of Vermont College of Medicine, Burlington published a case vignette in the New England Journal of Medicine recommending acupuncture for the treatment of lower back pain. The article cites that patients with lower back pain account for over $90 billion in annual health care expenses in the US. The doctors conclude that acupuncture is an effective means for treating lower back pain based partly on a recent study of 6,359 patients published in Spine1. For the lower back pain patient in the case study presented, 10-12 acupuncture treatments over an 8 week period are recommended.

Hmmm, why do these names sound familiar?  Oh I recall!  I had cited the University of Maryland Medical Center for it’s excellent website resource on astragalus root (Huang qi) research.  (http://qi-spot.com/2009/10/20/astragalus-root-for-swine-flu/).   Apparently, those guys are quite open minded.

So anyway, what this means is that some doctors published their opinions that acupuncture should be recommended.  Fair enough.  Everyone’s entitled to an opinion, right?  If it’s wrong, let it be proven wrong through tact and reasoning.

NOT.

The pro-acu docs cite extensive evidence:

The doctors cite physiological phenomena that measure the effects of acupuncture. Local anesthesia at needle insertion sites block the the analgesic effects of acupuncture showing that acupuncture is dependent upon neural innervation2. Acupuncture has been proven to cause the release of endogenous opioids in brain-stem, subcortical, and limbic structures3,4. Acupuncture has also been proven to induce the secretion of adrenocorticotropic hormone and cortisol from the pituitary gland thereby creating a systemic anti-inflammatory response5. Functional MRI studies in humans reveal that acupuncture stimulates limbic and basal forebrain areas involved in pain processing6. PET scan MRIs (positron-emission tomography) show that acupuncture increases opioid binding potential in the brain for several days7. Acupuncture has also been proven to mechanically stimulate connective tissues8, release adenosine at the site of needle stimulation9, and increase local blood blow10. The doctors then cite clinical trials showing the efficaciousness of acupuncture in the treatment of thousands of patients10-15.

So what do some skeptics do?  Do they try to base their argument on refuting the evidence?

Despite this overwhelming evidence proving the mechanisms of action and efficaciousness of acupuncture, skeptics were outraged at the publication of an article supportive of acupuncture in the venerable New England Journal of Medicine. An article recently posted in the Forbes “science business” section stated that the article is “embarrassing” and that acupuncture “infiltrates” the University of Maryland Medical School. In the article, the author calls acupuncture “pseudoscience” and states that it is based on “magical thinking of non-existent life-force.” The skeptic author’s only proof of his theory is that one of the many studies cited in the article found that acupuncture was only 47.6% effective for the treatment of lower back pain and that sham acupuncture was 44.2% effective. Therefore, the author concludes that using “toothpicks” randomly on the human body will have the same pain relieving effects as acupuncture. What the author fails to mention in the Forbes attack article is that conventional western medicine therapy (a combination of drugs, physical therapy, and exercise) was only 27.4% effective in that very same study. Should we therefore abolish western medicine by MDs and call it pseudoscience? Acupuncturists have noted that the success of sham acupuncture noted in that particular study of 1,162 patients in Germany reveals that poorly placed acupuncture needles also derive benefit for the patient.

I have already blogged at length on the physiologic differences between sham and real acupuncture (http://qi-spot.com/2010/04/30/definite-proof-acupuncture-more-than-placebo/) and why it SEEMS that acupuncture is hard to validate using holy grail of western medicine studies – the double blind study (http://qi-spot.com/2010/03/30/how-to-research-acupuncture/).

What I also find interesting is the insistence of skeptics that acupuncture works by balancing Qi or something.  That is the lynchpin of their argument.  I can hear it now:

Skeptic: “They believe in some quasi mystical energy flow!  That means acupuncture MUST be quackery!”

Acupuncturist:  ”There are modern, scientifically proven phenomena that explains what we mean by qi flow.  The “needling sensation” is a result of stimulation of nerve fibers, and can be inhibited by certain drugs.  Qi can also be used to mean function, so when “qi” is deficient, one can say there may be decreased circulation to a certain area, or decreased organ function.  An excess of qi can mean a muscle is too tense… (cites more examples)”

Skeptic: (oblivious) “They believe in some quasi mystical energy flow!  That means acupuncture MUST be quackery!”

Acupuncturist:  ”Never mind.”

Seriously, I feel that way sometimes, talking to skeptics.  What’s the point?  You can treat pain in these people and they’ll assign all sorts of reasons EXCEPT the obvious – acupuncture works.

The use of the word “toothpick” also indicates a lack of even a basic awareness of how acupuncture is performed.  You don’t just “prick” people, you insert the needle and manipulate it.

Oh well…

And lastly, a list of references cited by the link I cited…

References

1. Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S. Effectiveness of acupuncture for low back pain: a systematic review. Spine 2008;33:E887-E900.

2. Wang SM, Kain ZN, White P. Acupuncture analgesia: I. The scientific basis. Anesth Analg 2008;106:602-10.

3. Han JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 2003;26:17-22.

4. Pomeranz B. Scientific research into acupuncture for the relief of pain. J Altern Complement Med 1996;2:53-60.

5. Li A, Lao L, Wang Y, et al. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalamus to alleviate edema in a rat model of inflammation. BMC Complement Altern Med 2008;8:20.

6. Dhond RP, Kettner N, Napadow V. Neuroimaging acupuncture effects in the human brain. J Altern Complement Med 2007;13:603-16.

7. Harris RE, Zubieta JK, Scott DJ, Napa- dow V, Gracely RH, Clauw DJ. Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs). Neuroimage 2009;47:1077-85.

8. Langevin HM, Churchill DL, Wu J, et al. Evidence of connective tissue involvement in acupuncture. FASEB J 2002;16:872-4.

9. Goldman N, Chen M, Fujita T, et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nat Neurosci 2010 May 30 (Epub ahead of print).

10. Sandberg M, Lundeberg T, Lindberg LG, Gerdle B. Effects of acupuncture on skin and muscle blood flow in healthy subjects. Eur J Appl Physiol 2003;90:114-9.

11. Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med 2006;166:450-7.

12. Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, paralel-group trial with 3 groups. Arch Intern Med 2007;167:1892-8. [Erratum, Arch In- tern Med 2007;167:2072.]

13. Cherkin DC, Sherman KJ, Avins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch In- tern Med 2009;169:858-66.

14. Thomas KJ, MacPherson H, Thorpe L, et al. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ 2006; 333:623. 15. Witt CM, Jena S, Selim D, et al. Prag- matic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol 2006;164:487-96.

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Definite Proof: Acupuncture More Than Placebo

April 30, 2010 in Acupuncture, Research | No comments

Enough with answering back at mudslingers.  I get more than enough of that in the local media, with the Philippine elections just around the corner.  Let’s move on to being proactive instead of being defensive.

A common “debunking” technique of anti-acupuncture bigots is to come up with “evidence” that acupuncture is clinical similar to placebo and then “conclude” that acupuncture is therefore useless or irrelevant.  This plays the assumption that placebo = no effect, when in actuality placebo  = the doc does nothing but the patient feels an effect. (http://qi-spot.com/2010/04/28/the-smear-campaign-continues-acupuncture-does-not-relieve-childbirth-pain/)

Of course, even if both acupuncture and sham acupuncture have clinical effects that seem similar (and studies have shown that the real thing beats the fake stuff, even if not by much), the argument the skeptics pose is that if acupuncture is no different than placebo, then what’s the point of doing real acupuncture at all?

Well, a while back, I posted about a study I was looking forward to. (http://qi-spot.com/2010/04/04/a-study-to-look-forward-to-acupuncture-more-than-just-placebo/).  Thanks to Chris, I now have the whole article.   I would like to start by quoting thus:

As long as acupuncture and sham acupuncture treatments produce similar clinical improvements, the results of respective trials can only be taken as evidence against the efficacy of acupuncture. (I don’t think so… – Philip) Only when it can be shown that acupuncture and sham acupuncture effects are mediated differently, this can be taken as evidence that acupuncture effects are different from placebo effects, although both may still be equally effective.

I still can’t help but detect a bit of bias.  When something can be interpreted negatively, it “can only be taken as evidence against…” meaning there is no other way to interpret it, supposedly.

Coke can Definite Proof: Acupuncture More Than Placebo

Similar clinical effect, different mechanism of action

Still the point is valid.  If we can show that the real deal triggers physiologic reactions distinct from sham, then that should construe evidence that acupuncture is not only valid, but should be encouraged.

According to the article “Acupuncture, Psyche and the Placebo Response” (the article mentioned above) they HAVE found such physiologic differences.  Why does this matter?  It matters because a) skeptics can’t say it’s like placebo anymore and b) we now have an increased knowledge of acupuncture mechanism of action, which is more than what we can say for such western drugs as lithium.

533d8cf85e38b801ac15cad9c45dd896 Definite Proof: Acupuncture More Than Placebo

Take two of these and call me in the morning, even if we don't know how they work

So how does the real thing differ from the fake stuff?  Let’s count the ways as enumerated by Enck et al:

a) “Acupuncture but not sham acupuncture was found to induce both cerebellar as well as limbic cortex activation indicating both motor as well as affective component modulation of the pain matrix.  Acupuncture resp. electroacupuncture at non-acupuncture points and tactile stimulation alone served as controls in early fMRI studies (Wu et al., 2002; Yoo et al.m 2004)

b) Verum (true) acupuncture in contrast to non-penetrating placebo nedles activated cortical centers involved in affective pain modulation (Chae et al., 2009)

c) Greater activation of sensorimotor areas by sham procedure (superficial manipulation at acupuncture points) than by true acupuncture (Napadow et al 2009) – (note that stimulation of true acupuncture points by non-needling methods was considered sham by the authors, whereas in chinese medicine it is a valid method of stimulation)

d) Variances of time of central activation between verum and sham acupuncture, attributed to stronger peripheral actions of true acupuncture

e) PET scans on fibromyalgia patients show that needling at true points elicited significant activation of mu opoid receptor binding capacity in the cingulate, caudate, thalamus and amygdala both after one session and after four weeks, while with sham (insertion into non acupuncture points), small DEactivations were noted, an effect that is seen with placebo analgesia. (Zubieta et al., 2005)

There are more, but these should suffice to prove the point.

All in all I believe this evidence validates my personal belief that real acupuncture has longer lasting effects than sham acupuncture.  This is shown by the fact that real acupuncture has more central (meaning up in the brain, as opposed to just local pain mediation) effects.

Another thing worth noting is that different people have different definitions of sham.  For some, it’s using real points but not inserting.  For others, it’s inserting into non-acupoints.  Logic dictates that both have different effects.  Controls used in acupuncture studies should be standardized!

The crazy thing is that all this has been known by Stux, Berman and others since I was in grammar school in the early 80s!  Jeez!

_________________________
Enck, P., et al., Acupuncture, psyche and the placebo response.  Auton. Neurosci. (2010), doi: 10.1016/j.autneu.2010.03.005
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The Smear Campaign Continues: Acupuncture “does not relieve” Childbirth Pain

April 28, 2010 in Acupuncture, News, Research | 3 comments

Firstly, I’d like to apologize for not posting for two weeks. I’ve been travelling a lot through Hong Kong and China. I will blog more on some observations I’ve made while in Hong Kong as soon as I get some of my photographs uploaded to my laptop.

Speaking of Hong Kong, I am beginning to wonder if there is some grand plot to discredit acupuncture in Hong Kong. First comes the “letter to the editor” concerning acupuncture spreading disease (http://qi-spot.com/2010/03/20/new-bashing-technique-acupuncture-causes-disease/) and now this.

“Acupuncture does not relieve childbirth pain” (http://www.guardian.co.uk/society/2010/apr/28/acupuncture-childbirth-pain-study)

I am the first person in the world to admit where acupuncture is one big FAIL (such as in colour blindness). But I would like to call the attention of the reader to the weasel wording evident in this smear campaign of a headline.

Look at the title. “Acupuncture does not relieve childbirth pain.” What does this imply to the reader? It implies that acupuncture has no effect at all on the pain felt by mummy.

Yet the sub-title below the headline betrays a hint of the truth:

“Research suggests results from complementary therapy during labour may be placebo effect”

Now, we have no idea, based on this sub-headline if this is a single study or a meta-analysis.  As we have said before, a meta-analysis is a fancy way of saying, “let’s put different studies together just to get the numbers up.  We can always find a way to put the studies together that the sum total numbers can be made to say whatever we want.”

Secondly, it “suggests” (whatever that means) that the results may be placebo effect.  Wait.  Results?  RESULTS?  I thought that acupuncture “does not relieve” childbirth pain?  So if it is useless, why are there “results”?  That means there WAS relief of pain.

So why come up with a headline saying otherwise?  Because the results “may” be placebo effect.

pregnacy The Smear Campaign Continues: Acupuncture does not relieve Childbirth Pain

Actually, I wouldn't use those points in pregnancy... but what the heck. Then again, he just might be some really fat guy...

The finding, which has already prompted a vigorous debate about the value of acupuncture, came from British and Korean researchers who examined previous studies of its use in labour.

“The results show that there is little convincing evidence that women who had acupuncture experienced less labour pain than those who received no pain relief, a conventional analgesia, a placebo or sham acupuncture,” researchers told BJOG: An International Journal of Obstetrics and Gynaecology. The journal is owned by the Royal College of Obstetricians and Gynaecologists, which represents most of the UK’s doctors specialising in childbirth and maternity care.

The finding, which has already prompted a vigorous debate about the value of acupuncture, came from British and Korean researchers who examined previous studies of its use in labour.
“The results show that there is little convincing evidence that women who had acupuncture experienced less labour pain than those who received no pain relief, a conventional analgesia, a placebo or sham acupuncture,” researchers told BJOG: An International Journal of Obstetrics and Gynaecology. The journal is owned by the Royal College of Obstetricians and Gynaecologists, which represents most of the UK’s doctors specialising in childbirth and maternity care.

So it IS a meta-analysis.  Strike one.  I wonder what points were used? Hmmm…

Prof Edzard Ernst, of the Peninsula medical school at Exeter and Plymouth Universities and co-author of the report, said: “The effects of acupuncture perceived by women are largely due to placebo. Acupuncture has many qualities that maximise placebo effects: it involves touch and is invasive and, psychologically, is attached to the mysticism of the east.”

Ernst is a known skeptic of acupuncture and makes a living (i.e. buy his book!) by bashing it.  Then again, I make my living healing patients with it, so I guess we cancel each other out.  Still, he admits that acupuncture DOES have an effect, it’s just that he either cannot or will not recognize the evidence that acupuncture DONE PROPERLY is more than placebo. (http://qi-spot.com/2010/04/04/a-study-to-look-forward-to-acupuncture-more-than-just-placebo/)

I would like to point out that even in western medicine, there exist drugs for which the mechanism of action is unknown.  Lithium is used for bipolar disorder and it is not known how it works.  Yet it is given, despite toxicity, because it has been observed to work.  I leave it to the reader to witness where the double standard lies.

Also, I find it disturbing that people will look down (albeit unintentionally) on patients’ experience just to pooh-pooh acupuncture.

Prof Philip Steer, BJOG’s editor-in-chief, said labour pain can be so intense that a women would do anything to minimise it.

Please, by that logic we can get a shaman in pyjamas to conduct ritual chants and that would work.  Yet it doesn’t, and acupuncture does.

“Acupuncture is a drug-free approach and that may explain why some women prefer its use during labour. This review shows that in a very small number of cases acupuncture may be of help, usually for short periods of time after treatment, and this may be down to psychological rather than a physiological effect. Generally the consensus is that the evidence does not support its use.”

The only benefits were 11% less pain in the first 30 minutes after receiving acupuncture and a need for less pharmacological pain relief, the authors say.

Wait wait wait.   The “only” benefits? So “they” begrudgingly admit that there are benefits!  Back to my first question: why the irresponsible headline, then?  The last part of the sentence betrays the answer:

“…a need for less pharmacological pain relief” – in english: LESS DRUGS.

Less drugs, less profit for big pharma.

I will skip to the last part:

Mike O’Farrell, chief executive of the British Acupuncture Council, said: “We’re surprised by these findings as previous trials, along with the evidence that our members see in their practices every day, suggest that acupuncture can be effective in providing pain relief in many different circumstances.”

Again, as I have said before, people not biased by big pharma can see where acupuncture works and it doesn’t.  I am happy to report, both first hand and through correspondence with other OB-Gynecologists even in the US, that acupuncture can work in reducing childbirth pain IF DONE PROPERLY.

My final thoughts: this article should have been entitled “Acupuncture apparently no better than placebo” instead of “Acupuncture doesn’t work”.  News bias, bah humbug.

Campbell, Denis.  ”Acupuncture does not relieve childbirth pain” The Guardian.  28 April 2010.  <http://www.guardian.co.uk/society/2010/apr/28/acupuncture-childbirth-pain-study> Accessed 28 April 2010
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I Love Mayo! (the Clinic, not the Condiment) Mayo Loves Acupuncture!

April 5, 2010 in Acupuncture, Research, integrative medicine | 1 comment

Why can’t more western doctors and skeptics adapt the attitude of the Mayo Clinic?

Earlier I had blogged about how a physician from the Mayo Clinic endorses acupuncture for low back pain.  Now I had chanced upon their website primer on acupuncture under the heading “Tests and Procedures”

http://www.mayoclinic.com/health/acupuncture/MY00946

Here are some notable exerpts:

Under “Definition”

Acupuncture involves the insertion of extremely thin needles in your skin at strategic points on your body. Acupuncture originated in China thousands of years ago, but over the past three decades its popularity has grown significantly within the United States.

Traditional Chinese theory explains acupuncture as a technique for balancing the flow of energy or life force — known as qi or chi (chee) — believed to flow through pathways (meridians) in your body. By inserting needles into specific points along these meridians, acupuncture practitioners believe that your energy flow will re-balance.

In contrast, many Western practitioners view the acupuncture points as places to stimulate nerves, muscles and connective tissue. This stimulation appears to boost the activity of your body’s natural painkillers and increase blood flow.

Nice to see that the website presents both theories with neither preference nor prejudice.

Now, under “Why It’s Done”, and this is a beaut.

Scientists don’t fully understand how or why acupuncture affects the amount of pain you feel. Several studies have found that acupuncture has little or no effect beyond that of the sham treatment used in some study participants — the control group — for comparison. The lack of firm results can be explained, in part, by the difficulty of devising a realistic but inactive stand-in for acupuncture. (emphasis mine)


Rob and stunt double I Love Mayo! (the Clinic, not the Condiment) Mayo Loves Acupuncture!

A Good Stand-In is hard to find.

Difficulty in devising a realistic but inactive stand-in… isn’t that what I’ve been trying to point out for a long time?  How come THEY get it and some can’t? (or won’t?) (see http://qi-spot.com/2010/03/30/how-to-research-acupuncture/)

Now do we remember this line? (http://qi-spot.com/2010/03/20/new-bashing-technique-acupuncture-causes-disease/) Here’s what Mayo has to say:

The risks of acupuncture are low if you have a competent, certified acupuncture practitioner. Possible side effects and complications include:

  • Soreness, bleeding or bruising at the needle sites
  • Internal organ injury, particularly to the lungs, if the needles are pushed in too deeply
  • Infectious disease, such as hepatitis, contracted from reused needles

Again, balanced and fair and most of all, TRUTHFUL.

The rest of the site talks about who is eligible and who is not, how to prepare, what to expect, etc.  And it ends with a balanced note:

The effects of acupuncture are sometimes difficult to measure, but many people swear by it as a means to control a variety of painful conditions.

Several studies, however, show that simulated acupuncture appears to work just as well as real acupuncture. There also is evidence that acupuncture works best in people who expect it to work.

Since acupuncture has few side effects, it may be worth a try if you’re having trouble controlling pain with more-conventional methods.

I post this knowing skeptics will come in and say “see? placebo!” Yet I still do so because I am interested in the truth.  And the truth is any treatment will work better in people who expect it to work.  But the fact that it works in patients who also don’t expect it to work says something.

And yes, darned well worth a try.

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A Study to Look Forward To: Acupuncture More than Just Placebo?

April 4, 2010 in Acupuncture, News, Research | No comments

Ah Germany, land of good beer, great sausages, and acupuncture research.  Stux et al have contributed much to acupuncture, and now a new study awaits publication that I am eager to read.

From http://www.ncbi.nlm.nih.gov/pubmed/20359961?dopt=Abstract:

Acupuncture, Psyche and the Placebo Response

Enck P, Klosterhalfen S, Zipfel S.

Auton Neurosci. 2010 Mar 30. [Epub ahead of print

University Hospital Tübingen, Dept. of Psychosomatic Medicine, Tübingen, Germany.

With growing use of acupuncture treatment in various clinical conditions, the question has been posed whether the reported effects reflect specific mechanisms of acupuncture or whether they represent placebo responses, as they often are similar in effect size and resemble similarities to placebo analgesia and its mechanisms. We reviewed the available literature for different placebos (sham procedures) used to control the acupuncture effects, for moderators and potential biases in respective clinical trials, and for central and peripheral mechanisms involved that would allow differentiation of placebo effects from acupuncture and sham acupuncture effects. While the evidence is still limited, it seems that biological differences exist between a placebo response, e.g. in placebo analgesia, and analgesic response during acupunture that does not occur with sham acupuncture. It seems advisable that clinical trials should include potential biomarkers of acupuncture, e.g. measures of the autonomic nervous system function to verify that acupuncture and sham acupuncture are different despite similar clinical effects. (emphasis mine)

Copyright © 2010 Elsevier B.V. All rights reserved.

Now like I've been blogging, I'm not out to prove acupuncture works or not.  I believe it does for many but not all conditions.  However, data such as this would only verify what I've been saying.  Yes, there ARE changes differentiating between sham and "real" acupuncture.  I am sure this refers to stimulation of a-delta fibers, stimulation of the periaqueductal gray and the VPL nuclei of the hypothalamus.  Nonetheless, I shall be on the lookout for the actual article.

Is Acupuncture All in the Mind?

Interestingly, I see another, seemingly contradictory article, while browsing the first one.  This time, from Sweden.  Now we see they've got more than just massage and meatballs: (http://www.ncbi.nlm.nih.gov/pubmed/19525330)

Is Placebo Acupuncture What it Is Intended to Be?
Evid Based Complement Alternat Med. 2009 Jun 12. [Epub ahead of print]
Lundeberg T, Lund I, Sing A, Näslund J.
RPT, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. jan.e.naslund@ki.se.
Randomized, placebo-controlled clinical trials are recommended for evaluation of a treatment’s efficacy with the goal of separating the specific effects (verum) from the non-specific ones (placebo). In order to be able to carry out placebo-controlled acupuncture trials, minimal/sham acupuncture procedures and a sham acupuncture needle has been used with the intention of being inert. However, clinical and experimental results suggest that sham/minimal acupuncture is not inert since it is reported that both verum acupuncture and sham/minimal acupuncture induce a significant alleviation of pain. This alleviation is as pronounced as the alleviation obtained with standard treatment and more obvious than the one obtained with placebo medication or by the use of waiting list controls. These results also suggest that sham acupuncture needles evoke a physiological response. In healthy individuals sham acupuncture results in activation of limbic structures, whereas a deactivation is seen in patients with pain, i.e. results from healthy individuals do not reflect what is seen in clinical conditions. Also, depending on the etiology of pain (or any under clinical condition under investigation), the response to sham acupuncture is varying. The acupuncture ritual may also be seen as an emotional focused therapy allowing for psychological re-orientation. Sham needling in such context may be as powerful as verum acupuncture. We recommend that the evaluated effects of acupuncture could be compared with those of standard treatment, also taking the individual response into consideration, before its use or non-use is established. (emphasis and italics mine)

What do these two studies together mean?

1) Current methods of sham and real acupuncture seem to evoke similar physiological responses. Studies have shown that at times, sham and real acupuncture seem to be effective.  Skeptics are quick to jump and say there, that means acupuncture is no better than placebo!  The proper term is that acupuncture SEEMS to be just the same as sham.  The problem with the skeptic logic is that they forget that both sham and real acupuncture are better than nothing, or TRUE placebo.  I can see it now:

Skeptic: Fake needling just the same as real needling! Hence, acupuncture isn’t real!

Acupuncturist: But both fake and real needling is better than nothing, what say ye?

Skeptic: So why not just massage? Why use needles?

Acupuncturist: I only have two hands right? (refer to Doctor Octopus as per my previous post http://qi-spot.com/2010/03/30/how-to-research-acupuncture/) And clinical experience says it works faster.

Skeptic: “Clinical experience” bah humbug!

On to point two:

2) So the second research says there’s a difference between nothing and acupuncture, whether sham or not.  The first research says there’s a difference, physiologically, between sham and real acupuncture.  I can foresee the dialogue now:

Skeptic: okay you say that clinically there’s a difference between sham and real acupuncture.  I want empirical evidence that there is a difference.  Otherwise I can just ignore your clinical experience like I ignore all other evidence that acupuncture can work and work well.  I’ll take the words of statisticians and published journals funded by Big Pharma over clinicians anyday.

Acupuncturist: Well what if there is proof that there is a physiologic difference between real and sham?

Skeptic: Is there?

Acupuncturist: That’s what the first study quoted above says.

Skeptic: Hmmm it says that it’s clinically similar, just physiologically different!

Acupuncturist: Jeez, I don’t know how to talk to you guys sometimes.  You say the real thing is no different than sham, so who cares if it works or not.  Then we say but both sham and real thing are better than nothing, you say that guys like Ernst et al say the studies suck, utterly ignoring that western medicine is also guilty of the same sins at times (perhaps more on that on a later blog post.. oh wait, lots of those already!)

Skeptic: Not all acupuncture studies suck, just the ones that prove acupuncture doesn’t work.

Acupuncturist: Then you insist in your holy grail of treating acupuncture like a pill, even though I’ve explained kabodles of times that Acupuncture is a procedure, not a pill (ka ching, five cents).

Patient (sneaking in): Uh guys, I don’t give a crap about that stuff, I just want to feel better so I can get on with my life.

Skeptic: You’re an idiot.  You don’t know squat.  We’re the only ones with brains and we know what’s best for you and what medicines you should buy.  Any perceived benefits from acupuncture and Chinese medicines are all in your head.  You’re too dumb to know the difference.

Philip: Okay I should stop now.  I’m going overboard with this blog post ha ha.

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