Tuesday, September 25, 2007

Fake acupuncture works!

The inimitable Fox News reports today:

Fake Acupuncture Works Nearly as Well as the Real Thing for Low Back Pain, Study Finds.
Which is to say, it doesn't work at all.
Almost half the patients treated with acupuncture needles felt relief that lasted months. In contrast, only about a quarter of the patients receiving medications and other Western medical treatments felt better.


Although the study was not designed to determine how acupuncture works, Endres said, its findings are in line with a theory that pain messages to the brain can be blocked by competing stimuli.
They briefly point out the flamingly obvious:
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, he said.
Yes. When your negative control group (sham acupuncture) and your test group (acupuncture) are indistinguishable - it means it doesn't work. Acupuncture is solely a placebo effect.

And then go flying off into woo-land again:
Dr. Brian Berman, the University of Maryland's director of complementary medicine, said the real and the sham acupuncture may have worked for reasons that can be explained in Western terms: by changing the way the brain processes pain signals or by releasing natural painkillers in the body.
I wish that Fox News were distorting this story and sensationalizing it. But they're not. The abstract from the paper that they are discussing states:
Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy.
This is not true. When compared to the proper control, acupuncture shows no increase in its ability to make people feel better. That means it doesn't work.


They also state:
The superiority of both forms [meaning sham and real] of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals, or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy. The underlying mechanism may be a kind of superplacebo effect produced by placebo and all nonspecific factors working together. Nevertheless, the effectiveness of acupuncture cannot be attributed merely to a placebo effect because there is no reason to believe that the action mechanism of conventional therapy is the result solely of the placebo effect.
No. What it suggests is that the authors of this study don't understand what a negative control group is. Your negative control group is the sham group.

If you want to test if there's actually an effect of magically inserting needles, you need to control for patients knowing that they're receiving acupuncture. I.e. You need to perform your sham acupuncture on an unconscious patient. Or you need to tell your patient in advance that it is a sham. Then see if you have an effect compared to the group who doesn't get stuck with a needle. As it is, you have merely shown that people like to have needles stuck in them by a magical healing man.

It's a beautiful study. It's a pity the authors don't know how to interpret it.



memory foam said...
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The Factician said...

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