I always thought it must be difficult to be a SCAM provider, like a chiropractor, naturopath or acupuncturist. Having your whole job based on a fiction must nag at least some of them. I suppose it must be a little like clergy who don’t believe in God. So many people define themselves by their occupation and the realization nagging that their occupation is bogus must grate on some. I always followed the spirit of Bill Russell, who said, when asked if was a basketball player, would say
“No. That’s what I do, that’s not what I am. I’m not a basketball player. I am a man who plays basketball.”
Such an attitude did make the transition to retirement a piece of cake. Although saying, “I’m not a chiropractor, I’m a man who pretends to be a doctor” probably would be a tough sell
But what do you do when reality and the medical literature points to your whole raison de etre as divorced from reality, no better than placebo and does little to nothing for the patient? I mean, besides mass firings? Contortions that rival Cirque du Soleil performers.
Gorski and Mercola walk together into a pub but the bartender could not deal with the paradox.
Paradoxes in Acupuncture Research: Strategies for Moving Forward showed up in my feeds. The article is 15 years old, but interesting none the less for what it reveals about how people can react when faced with information that strikes at their core beliefs.
Did you know that acupuncture research has resulted in a pair of paradoxes? They aren’t at the level of the black hole information paradox, mind you. More of the Alanis Morissette’s ‘Ironic’ Isn’t Ironic. sort. You know, where you exhibit a lack of understanding of what constitutes a paradox.
But what, you ask, are
The emergent potential paradoxes?
(1) A large number of well-designed clinical trials have reported that true acupuncture is superior to usual care, but does not significantly outperform sham acupuncture, findings apparently at odds with traditional theories regarding acupuncture point specificity and needling technique.
(2) While many studies in animal and human experimental models have reported physiological e\ufb00ects that vary as a function of needling parameters (e.g.,needle insertion depth, mode of stimulation), the extent to which these parameters influence therapeutic outcomes in clinical trials is unclear
Regular readers of this blog know the answer. No spoilers until the end. But let us see how they deal with the irony, er, I mean, paradox.
Response to the first paradox?
The simplest explanation for Paradox 1 is that, when no differences are found between verum and sham acupuncture treatments, the effects of both are due to nonspecific factors (e.g., expectancy, contact time, device-related ritual) rather than needling or other components specific to acupuncture. If this is the case, the implication would be that the mechanisms underlying the therapeutic effects of acupuncture are essentially placebo-related.
Wait. What? By George, I think they’ve got it. Being an Occam kind of a guy and having read way too many acupuncture clinical studies, I think they can stop there. Acupuncture is a placebo.
But to admit that renders the practice of acupuncture a fraud. Can’t have that. How are the bills to be paid? No,
A central thrust of this White Paper is that there are other explanations that are just as plausible.
Well, not. Let’s see what those other explanations might be. To start
- both verum and sham needling may have therapeutic effects,
This gets to my contention that there is no such thing as acupuncture. It is acupunctures, plural, and there are as many forms as there are practitioners and as many styles as there are cultures that use it. They point this out as
A major factor potentially underlying Paradox 1 is the lack of consensus on which component(s) of acupuncture needling are therapeutically important. There has been little systematic investigation regarding the importance of needle placement and depth, type and intensity of stimulation, needle number, and so forth
They recognize that acupuncturists don’t really know what they are doing, as
Moreover, studies attempting to develop valid protocols based on consensus of multiple acupuncturists have revealed significant pluralism regarding what constitutes appropriate treatment.
Significant pluralism. I am glad I was not drinking milk when I read that. Now is not the time to be buying a new laptop due to unexpected dairy induced keyboard dysfunction.
There has been little systematic investigation regarding the importance of needle placement and depth, type and intensity of stimulation, needle number, and so forth [5], as well as the mechanisms by which these parameters influence immediate and longer-term physiological responses.
That is because there is no monolithic acupuncture that can be systematically evaluated. Acupuncture is a 1000 points of nonsense.
It is not that verum and sham have therapeutic effects. They do. It is called the placebo effect.
They note
The challenge in designing appropriate sham acupuncture is that ignorance of acupuncture mechanism prevents us from knowing what to avoid when inserting a sham acupuncture needle
That will be difficult when the whole basis of acupuncture is a fiction. Their next rationalization
acupuncture-specific nonneedle and/or needle components may be retained in sham treatments,
What they are saying, but seem not to recognize it, is that placebo has the same effect as acupuncture. These people need to run for office. And finally.
- the therapeutic effects of the provision of verum acupuncture treatments in the context of clinical trials may be suboptimal.
What they are saying is that, in the context of a clinical trial, they are applying suboptimal treatment? Yep.
verum acupuncture treatments are less than optimal.
It is quite the excuse for why your intervention is no better than placebo: we don’t know what we are doing and besides we are doing a lousy job of it.
It is just so hard for them to accept. Acupuncture is a fancy-schancy placebo. And your whole career is nonsense.
What about the second paradox?
Another possible explanation is that at least some of the physiological effects of needling are therapeutic, but these effects are difficult to demonstrate in the context of a clinical trial.
Acupuncturists are sticking needles in people and animals. That can be stressful and painful. That will cause a physiologic effect. I would expect physiologic consequences from acupuncture. Just not effects what treats any disease.
It is evident that much remains to be learned about which physiological effects of acupuncture needling are clinically relevant.
I can help them with that. None. It is a nonstandard treatment based on fiction. Ain’t gonna do nothin’.
They summarize as follows
In summary, possible explanations for why specific effects of needling are clearly demonstrable in basic science studies, but not as evident in sham-controlled clinical trials are as follows:
(i) Some or all of the needle-related physiological effects observed in basic science experiments are unrelated to therapeutic effects
(ii) Acupuncture needling does have therapeutic effects, but these effects are proportionately small compared with nonneedle and nonspeciffic effects in clinical trials.
(iii) Sham-controlled clinical trials are compromised methodologically because (a) the influence of needling parameters for verum and sham needling are poorly understood, and (b) objective biomarkers relevant to the commonly treated clinical conditions are lacking.
Boy, that’s a lot of excuses and obfuscations to avoid the realization that acupuncture is placebo.
So what do they want to do to make acupuncture great again because of
a growing sense of puzzlement in the acupuncture research community regarding the apparent disparities between the results of basic science and sham-controlled trials on the one hand and the clinical practice of acupuncture on the other.
Besides recognizing acupuncture is a placebo? I guess finding a reality-based job isn’t on the to-do list.
A number of interrelated challenges must be met to resolve the paradoxes identified in this paper.
The biggest challenge appears to be the ability to recognize the significance of a placebo-controlled trial. But then, no SCAM ever changes, or is abandoned, in the face of evidence.
The best way is to give up on placebo trials, as they don’t provide the justification for continued acupuncture. Go with the lessor trials, such as
“whole systems research,” pragmatic trials and surveys of real-world clinical practice can help to provide a more comprehensive understanding of the multiple components that potentially underlie the therapeutic effects of acupuncture treatment.
They want to consider the whole song and dance:
In seeking to evaluate how the parameters of acupuncture needling contribute to acupuncture treatment, it is also of major interest to learn what is most important to practitioners and patients among the multiple components of acupuncture beyond simply needling.
In other words, they recognize that acupuncture is theater. As noted by others, more than theater, Acupuncture Is Theatrical Placebo. They are certainly desperate to avoid that conclusion.
And the whole issue that acupuncture is based on the fantasy that is traditional Chinese pseudo-medicine (TCPM). They suggest finding biomarkers that correlate with TCPM diagnoses based on tongue and pulse diagnosis. Mapping reality onto fiction? This is like applying horse physiology to the care and feeding of skeletal Pegasus.
They conclude
It is conceivable, as stated above, that the therapeutic effects of acupuncture treatments are all or largely based on nonspecific, placebo-related responses. If this is true, the implications for the investigation and practice of acupuncture are profound as this would certainly raise interesting questions as to the value of specific acupuncture point location and needling techniques.
Lol. It has been conceived, but his paper is from an intellectual red state and acupuncture cannot be terminated, even if it it is not compatible with survival outside the acupuncture uterus.
An opinion commonly voiced in the acupuncture community is that acupuncture cannot be studied using randomized controlled trial. We strongly disagree.
It can be, and has been, studied. The result is that acupuncture is placebo and its use is no longer justified. But study acupuncture in a way that obfuscates the basic reality that acupuncture is a placebo based on fiction.
As has been shown in the field of ecology, complex phenomena are best tackled using a pluralistic strategy including both a top-down approaches that evaluate the behavior of a whole intact system, as well as bottom-up approaches that evaluate smaller-scale cause-and-effect links. Acupuncture treatments thus should be studied both from the top down as multicomponent whole-system interventions employing a pragmatic systems perspective, as well from the bottom up as mechanistic studies that focus on understanding individual treatment components and how the effects of these components interact and translate into clinical outcomes.
So much sound and fury, signifying nothing. I remain amazed at the mental contortions and denial humans can manifest. More depressed today than amazed.
In the end the paper is the Invisible Boy argument for studying acupuncture. Ever see the movie Mystery Men? Been years, but I remember it as very funny. One of the characters was Invisible Boy, who can become invisible only when nobody is looking at him. Similarly, acupuncture only works when no one is investigating it. Good luck otherwise.
And this white paper? The results of Spleen.