Wednesday, September 26, 2007

Fake acupuncture works

Here's a headline: "Fake Acupuncture Is Still Better than Western Medicine." Uh, I may get in trouble for this post. This AP article reports on a German study where they took patients with back pain and divided them into three groups.
In the largest experiment on acupuncture for back pain to date, more than 1,100 patients were randomly assigned to receive either acupuncture, sham acupuncture or conventional therapy. For the sham acupuncture, needles were inserted, but not as deeply as for the real thing. The sham acupuncture also did not insert needles in traditional acupuncture points on the body and the needles were not manually moved and rotated.

After six months, patients answered questions about pain and functional ability and their scores determined how well each of the therapies worked. In the real acupuncture group, 47 percent of patients improved. In the sham acupuncture group, 44 percent did. In the usual care group, 27 percent got relief.

Now, why did this happen? Could it be that acupuncture is better than "usual care?" If that was the case then why did the fake acupuncture group still score better than the usual care group? Two words: Placebo Effect. Here is how WebMD defines it.
A placebo effect is an improvement in the symptoms of a disease or condition when a person is treated with a drug or other treatment that he or she expects to work, even though the treatment has not been proven effective. When a drug or treatment seems to work for some people but has not been scientifically proven to be any more effective than a "sugar pill" or placebo, it may be said to have a placebo effect.
Getting back to the AP article, it even outlines the bias limitation that this study has, while still trying to persuade you that their theory are still correct (nice try).
Positive expectations the patients held about acupuncture -- or negative expectations about conventional medicine -- also could have led to a placebo effect and explain the findings, [the study co-author] said.

Although the study was not designed to determine how acupuncture works, [the study co-author] said, its findings are in line with a theory that pain messages to the brain can be blocked by competing stimuli.

So, this is another research study in which the results (the facts) did not prove their theory, the most important take away point they want you to know is that acupuncture, whether real or fake, is still better than Western medicine and that insurance companies should pay for it - as exhibited by the last two paragraphs of the article.
Funding came from German health insurance companies, and the findings already have led to more coverage in Germany of acupuncture.

In the United States, some health plans cover acupuncture for some conditions, but may require pre-approval, according to the National Center for Complementary and Alternative Medicine. An acupuncture session can cost $45 (euro32) to $100 (euro71).
C'mon, gimme a break! Don't get me wrong, I'm not dissing acupuncture. I think this treatment has value. But to make policy changes based on this bad data? That's irresponsible. Either get better data or just acknowledge your bias toward acupuncture (or against Western medicine), make your policy decision (insurance companies should pay for acupuncture), and move on.

Update (10:32pm 10/26): Here's something interesting. This post got picked up overseas. To see what this post looks like in German, just click here. Enjoy!


Anonymous said...

I agree we need better research on acupuncture. But I'd encourage you not to be so quick to whip out the phrase "placebo effect" here, either. I tried conventional medicine for twelve years myself without ever getting any relief. I'm a medical librarian, deeply steeped in the same beliefs most Western doctors have, and I never thought stuff like acupuncture was worth bothering with.

Finally, out of ideas, I decided I couldn't just give up until I'd tried everything, so I gave acupuncture a try, without a single smidgen of hope that it would actually work. Not only did it work, but I went from a 7 on the pain scale to a zero in two weeks of treatments.

In TWELVE YEARS of conventional medicine, I never got to a zero. That's not placebo effect -- there was no reason for me to believe for a moment acupuncture would help, and, indeed, I had spent the last twelve years trying a gazillion different Western treatments I had far more faith in.

So, there's definitely something real going on here. It's a pity we can't get more doctors and scientists to take it seriously enough to construct a real study. It's an even worse pity, in my opinion, that in twelve years of suffering, not one conventional medicine practitioner suggested I try acupuncture, because I could've saved our health care system a ton of wasted money in useless tests, stop-gap pain drugs, pointless physical therapy, and etc. etc. etc., not to mention myself a heck of a lot of misery -- if only I'd tried acupuncture first instead of last.

Anonymous said...

p.s. I'd also like to posit that the "fake" acupuncture was effective because just inserting needles into the muscles makes a difference of some sort. Though acupuncture has worked well for me, I don't believe in the concepts of "Qi" and meridians and whatnot. I'm still trying to figure out how Western medicine -- what I still believe in most -- can explain why it works. It's not placebo effect -- it's something else. Endorphins? A disruption of the nervous system? Stimulation of the nervous system? I mean, traditional physical therapy involves stuff like "strain counter-strain" techniques to try to force a muscle into relaxing -- those techniques are not that different from acupressure, which maybe isn't so different from acupuncture, eh? In any case, I think if we could get some more research on it, eventually we'll discover it has explanations that make sense in Western medicine. But first, it would help if Western doctors weren't quite so quick to dismiss it as all in their patients' heads. Placebo effect is real, yes. But it shouldn't be the default explanation for every effect you have yet to fully understand.

Interesting post, thanks!

twilite said...

Hi Dr A!

I recalled a caucasian Australian medical doctor living in Hongkong who experimented acupuncture on herself. She lacked the knowledge and unknowingly, she must have punctured one of the nerve neurons (?), she went berserk for a while. Her husband had to call in the police to help subdue her! She eventually recovered. Thereafter she refrained from such!

I hope Americans will not go for these hocus-pocus! Perhaps it's like paying voodoos?! or...

Wow! People are willing to pay so much for acupuncturists...more than a medical practitioner perhaps?! It's certainly good business!!!

Current Rant said...

I had a stroke 12 mths ago, and have been living with the residual effects since then. Im on medication for epilepsy but this does not and has not given me relief from the frequent headaches, dizzyness, fatigue, slurried speech, irritability and stress of noise that is constant within my ear canal from damage to the right side of my brain. Living a balanced life has been fraught with stressful repercussions. Only someone who has had a stroke would understand. Very recently - I resorted to acupuncture for relief. And relief is what I got! Due diligence was paid to the condition of my organs, particularly spleen, kidneys and serious concern was expressed re high blood pressure (which can be the precursor to another more serious stroke). 20 or so needles and a wonderful nap for 40 minutes under a heat lamp with occasional rotation of the needles and I now have relief, energy and hope! As for the cost...? Show me a medical practitioner that will consult for $40 for an hour and I will eat my hat! If acupuncture doesnt work for you and the cost of it is exorbitant - put that down to experience! Im all for it and it sure as hell is better for my health than a body ravaging anti-epilepsy drug!