Easy, I'll choose the one our Dear Professional Skeptic Dr. Steven Novella referenced, but weasel worded into his SBM hit piece on the CAM industry (remember, this is the source most of the anti-CAM crowd in this thread have pointed at as "definitive proof" of failure to reject the Null Hypothesis!! Nuts!!!) So, whereas you anti-CAM folks with your politically charged opinions can continue to peddle the opinion of a single neurologist who has never undertaken a CAM study in his entire life, AFAIK... If I am gullible, Vickers et al. are gullible. So, which doctors are we to believe? The one (or minority) who want to DEFUND an entire arm of medical science, or the doctors and research scientists at Sloan Kettering etc who are working very hard at...the actual science, in labs, with real patients, at qualified medical centers... ...not mouthboxing about acupuncture behind keyboards, no matter WHAT your medical credentials. MDs can be peanut gallery fools too. http://www.ncbi.nlm.nih.gov/pubmed/22965186 I rest my case. If you prefer reading blog opinions and go no further than Google's #1 hit to CRITICALLY evaluate medical research, you deserve the conclusions you make.
Fixed for you. Ref: Vickers, et al. Is this well respected clinical researcher as gullible as I? Dr. Steven is part of a shrinking minority, and his entire career has been based on being a Skeptic, and has spent decades campaigning against CAM. So, his opinion is pretty extreme, heavily biased, and shouldn't even be considered in a scientific discussion on acupuncture, in my opinion. Funny, I didn't fail at all to come up with excellent data. In fact, I have more than enough to indicate the anti-CAM crowd is relatively small, getting smaller, and that most MDs are willing to refer acupuncture as treatment for several disorders, because of the growing amount of well-constructed research with positive results. But I knew that already, based on first hand experience with acupuncture patients. According to anti-CAM detractors, these experiences..never happened. They're not "real". Well, then you're not real, either. Take that! Another professional alternative medicine "scourge". Too biased for online opinions to be taken objectively. Yep, critical thinking is all about latching onto the most controversial, biased medical professionals instead of well-constructed meta-studies. You are "arguing from ignorance" when you will only accept studies that you claim fail to support the positive,without also including the (growing number of) studies that: 1 - DO support the positive 2 - ARE randomized 3 - DO take into account statistical anomalies 4 - DO account for bias 5 - ARE published in peer reviewed journals 6 - SO they can receive proper scientific scrutiny from other experts, and 7 - NONE of following periodicals are peer reviewed science: http://edzardernst.com (professional "myth buster" with big investment in anti-CAM)) http://sciencebasedmedicine.org (professional "myth buster" with big investment in anti-CAM) http://whatstheharm.com (pool drownings = acupuncture casualties!!)
I see some interesting portions of the paper: "Randomized trials were eligible for analysis if they included at least one group receiving acupuncture needling and one group receiving either sham (placebo) acupuncture or no acupuncture control." "The 29 trials comprised 18 comparisons with 14,597 patients of acupuncture with no acupuncture group and 20 comparisons with 5,230 patients of acupuncture and sham acupuncture." "Effect sizes are larger for the comparison between acupuncture and no acupuncture control than for the comparison between acupuncture and sham: 0.37, 0.26 and 0.15 in comparison with sham versus 0.55, 0.57 and 0.42 in comparison with no acupuncture control for musculoskeletal pain, osteoarthritis and chronic headache respectively." "To give an example of what these effect sizes mean in real terms, baseline pain score on a 0 – 100 scale for a typical trial might be 60. Given a standard deviation of 25, follow-up scores might be 43 in a no acupuncture group, 35 in sham acupuncture and 30 in patients receiving true acupuncture. If response were defined in terms of a pain reduction of 50% or more, response rates would be approximately 30%, 42.5% and 50%, respectively." "We found acupuncture to be superior to both no acupuncture control and sham acupuncture for the treatment of chronic pain. Although the data indicate that acupuncture is more than a placebo, the differences between true and sham acupuncture are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to therapeutic effects." Sounds like they haven't ruled out the possibility that needles are just something that we oughta shove into ourselves… As long as it's also got nice music :]
You are comparing apples to oranges. There is no multi-billion dollar, international medical industry devoted to either astrology or psychics. We already knew you were heavily biased. You just confirmed it, so thanks for playing.
Haven't ruled out the possibility is right. But again, what happens when THIS kind of study comes out, the anti-CAM crowd like Edzard Ernst and Steven Novella come out with their hit pieces. I have been watching it happen for almost 20 years. Remember, I am not heavily biased either positive or negative. I am middle ground, LEANING positive based on TRENDING. Because I just capitalized those words, some of the most adamant posters with heavy negative bias will refuse to read them, much like they refuse to even acknowledge the existence of the recent work of Vickers, et al. All that matters when your bias is strongly established is for Ed or Steve to write an opinion piece about how they are STILL RIGHT AFTER ALL THESE YEARS!!.... Not scientific. Not critical thinking. Shame on you all!
Tends to happen when you don't propose a mechanism for your effect. No theoretical explanation of acupuncture, just a descriptive study. Was more interested in John R. Gambit's paper.
There are still no real explanations for so many physical phenomena, but plenty of empirical data. They exist in biology, astronomy, physics, anatomy... Give me a theoretical explanation for autism spectrum disorders? This is another area of medicine where you see doctors going online to "dismiss" studies, especially if they have a vested interest in doing so. Did you know there is not only a lobby devoted to dismissing Autism, ADHD, and Asberger's Syndrome as a real disorder (there are billions of research dollars at stake), but also a HUGE number of folks online who believe these are all fake because of what they read online? Sounds like acupuncture suffers the same. Yet, knowing one child with such a disorder would probably sway their opinion more than all the online hit pieces. All their cynicism disguised as skepticism becomes very "real" when they meet that child. Bias swings from negative to positive with a single experience. Remember, I approach medicine as a novice and somewhat of a skeptic myself. My field is information assurance...determining the quality and integrity of data, so I have a different perspective than the doctors, and I really do READ IT ALL. As always, thanks for the debate folks. No hard feelings. See you next week.
What does that have to do with the price of peas in China? If all you have to support your medical treatment is a small difference that could be explained by either researcher bias or improper experimental design… well, yeah, don't be surprised if people are skeptical. That's great, it doesn't validate bad science or hasty conclusions though. There's papers on the efficacy of prayer healing, some of which even managed to get significant results. That doesn't mean it works. Just because something managed to get published does not mean that it's perfect.
I don't validate bad science or hasty conclusions either. You'll note that to date in this thread, the only source I've posted was peer reviewed, legitimate medical research. Where's the bad science and hasty conclusion in that? There isn't any. On the other hand: Bad science = whatstheharm.com ("Acupuncture makes you drown in pools or die from AIDS! A hundred thousand dead!") Hasty conclusions = sciencebasedmedicine.org ("Defund all CAM research now. Every penny!")
Using this paper to claim that acupuncture has an honest effect is… well, yeah, it's bad science and a hasty conclusion. It's not a strong paper and it is far from conclusive. You've said that it's better structured than the other papers that found no effect, but haven't really said why. Why is it compelling to you besides the fact that it demonstrated a statistical blip? Why do you think that it stands up to Steven Novella's critique of it? I actually thought that his questions were astute. Edit: What would falsify acupuncture's efficacy?
It should be pointed out that acupuncture studies do consistently support acupuncture being more effective than sham acupuncture, even though the margin is fairly small, but the effect is usually much greater than the control group. And the placebo effect isn't a universal effect either. The placebo effect of faith healing will be different than the placebo effect of sham acupuncture. Some placebo effects are substantially more beneficial than other placebo effects. It's possible (and often reported in studies) that sham acupuncture is still quite therapeutic for patients. Mathematically and observationally there is absolutely something happening in genuine acupuncture that doesn't happen in sham acupuncture, small effect aside, and potentially the placebo effect in sham acupuncture could be much greater than most other placebo effects making it abnormally useful. I finally got around to reading the 18,000 patient meta-analysis again. And that MD blogger who wrote that very long-winded opinion fluff piece calling to defund all future acupuncture research is a twit. He wrote that long ass article and all he concluded were weaknesses about small differences between study and placebo group and a lack of double-blinding. Well that would be very insightful if it hadn't taken him several pages to do and if the original author hadn't summarized and admitted to those exact same points himself in a whopping two paragraphs under a section titled "study limitations" within the very journal article being so harshly critiqued. (The blogger's tone implied these details were somehow overlooked in the original study.) I should point out that I don't have a stake in this science whatsoever. I had never personally given acupuncture much thought until researching pain management solutions for a family member a few years ago and my opinion has been formed soley by reading several journal articles. I've never received acupuncture and hope I never need to, but it's inexpensive and widely available so it's certainly worth investigating if other therapies don't help. And trust me when I say you will do whatever happens to work to get rid of chronic pain, even if it's building an altar to the pain gods to sacrifice cats on. I don't think it's responsible to discourage people from trying a therapy for themselves that 18,000 patients have reported reduces their pain by 50%, 20% more than the control group in the studies, especially when it's starting to be successfully used as an alternative to narcotics in post operation pediatric surgery. (Children are far more susceptible to die from drug reactions following recommended child dosing of even common over-the-counter pain medicines.) [Harvard Medical School is the highest ranked research medical school in the United States, and one of best in the world.]
This website has nothing to do with bad science; it is only pointing out the harm that may arise when people decide to treat their illnesses with non-convential 'treatments'. The two cases you've mentioned there were a woman diagnosed with HIV who decided to treat it with homeopathy, acupuncture and drinking urine; unsurprisingly, she died of AIDS. The other case was someone who decided to treat his seizures with acupuncture; he later fell into a pool, suffered a seizure and drowned. The point being that treating serious conditions non-conventionally can have serious consequences. I am not against anyone having any 'treatment' whatsoever if it makes them feel any better and helps their pain relief but I do have a problem with CAM practitioners saying they can cure any one of hundreds of ailments and suggesting their clients should not seek out medical help for their condition. Anyway, back to the topic in hand. Do you think that anyone who doesn't advocate CAM must therefore be biased against it in some way or another? Is that not biased thinking in itself? A quick look on Google Scholar of Cochrane reviews of acupuncture brings up the following links: 1. Acupuncture & Assisted Conception - conclusion: evidence likely attributable to placebo effect. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086273/ 2. Acupuncture for Osteoarthritis - conclusion: benefits are small and non-clinically relevant. Partially due to placebo and incomplete blinding. http://summaries.cochrane.org/CD001977/acupuncture-for-osteoarthritis 3. Acupuncture for IBS - conclusion: sham-controlled RCTs show no benefit of acupuncture. http://www.nature.com/ajg/journal/v107/n6/abs/ajg201266a.html One of the authors of the top study works for the US National Centre for CAM and one of the authors of the bottom study is from the College of Acupuncture at Shanghai University. Now, I'm assuming you don't think they're biased or professional skeptics?
I guess I'd point out that sham acupuncture doesn't always mean random needles. I'm working my way through the individual papers that Vickers looked at right now, I'm not sure if this is the case for any of them, but various sham acupuncture also includes a variety of techniques that do not actually use needles at all. For example: http://acupmed.bmjjournals.com/content/20/4/168.full.pdf Even in sham controlled groups, I'd be curious about the individual techniques used as the sham. I wouldn't be confident claiming that the difference between sham and real acupuncture aren't due to the type of sham used. I guess (again) I can't help but look at the experimental design and wonder if this is just due to the study. First paper I read was the Haake GERAC paper, and for their placebo they told people that they were part of an acupuncture trial but were not to receive acupuncture. In other words, they were left to whatever ineffective treatments they were already pursuing. I can imagine myself being quite resentful and saying "OF COURSE IT'S NOT GETTING BETTER YOU'RE NOT DOING ANYTHING" to a few researchers, but then, I'm a cranky person. In terms of something happening in sham vs. genuine, looking at the GERAC paper, they didn't find it. Do you know if they've done acupuncture/sham acupuncture trials on animals? That would be pretty cool. Haha, I did get the sense that he liked hearing himself talk. Yeah, I guess maybe I'm being a little academic about this and not looking at the real cost to people. I guess I'd just point out that the placebo effect really is that strong. Telling people that a drug will work for chronic pain vs. telling them it won't work basically doubled the efficacy in the first case and negated it in the second. We're not just comparing whether acupuncture works against nothing at all, but whether acupuncture works compared to doing pretty much anything else. I'd hesitate to recommend acupuncture to me Mum if she could receive the same benefit from a doctor telling you to jump up and down three times on Tuesday.
Um, what? How did you get from A-Z? Well what is interesting is that those who respond to acupuncture, because not everyone does, also respond to sham acupuncture. You're either responsive to both or neither it seems. And yeah, I'd be curious about that too. Yeah, I try to focus on the established medical schools I trust when examining treatments like acupuncture. Hopefully their methods are more uniformly sound. Well I was referring to the fMRI studies indicating different brain regions being activated between true and sham acupuncture. I'm not a fan of anything requiring patient reporting of results as a measurement criteria. And if Wikipedia is anything to go by: Apparently the animal studies are plagued with poor methods, lack of replication, and unimpressive results. I imagine there probably isn't a lot of funding for it either. Haha. I'm all for people doing whatever works for their pain. If it's a mental thing, and the theater works, do it. If narcotics work for you, do that instead. I am absolutely not stating that the effect is strong with acupuncture, or that the evidence is overwhelming, but I am stating that it is not only placebo happening between true and sham acupuncture in major US medical school studies tracking blood flow in human brains. When you have the very limited and very crappy pain management options available that modern medicine uses, which is narcotics for everyone or nothing at all, a few extra tools until we have better solutions isn't a bad thing.
I know you didn't put this study up (?I thiink) but I wanted to point something out that might not be obvious. People talkabout pain scales as though they actually mean something other than greater or less than. This is ordinal data at best. I is silly to think that a stoics pain level of 4 and a ''hypochondriac's'' pain scale value of 4 amount to the same thing. People treat this stuff as though it was interval data and could be added/subtracted etc when it breaks most of the rules for statistical analysis and should be questioned as to the validity of using it. Unfortunately most studies seem to gravitate to this sort of measure which just obscures things further. LFD
This is the scientist commented on the study in the same journal - Dr. Andrew L. Avins, an epidemiologist at the University of California, San Francisco and a research scientist at Kaiser Permanente, a large nonprofit health plan based in Oakland, California. "Acupuncture does appear to have some very small benefit above and beyond placebo acupuncture or sham acupuncture," says Avins, who wrote an editorial accompanying the study. "But the effects really are pretty small, and the majority of the effect is a placebo effect."... What's more, he adds, the modest difference between genuine and sham acupuncture may not be meaningful for the average real-world patient. Pain relief of 50% or more on a 100-point scale -- pain that drops from a 60 to a 30, say -- is a commonly used standard of effectiveness in pain research. By this measure, the study found, the effectiveness rates for real acupunture, sham acupuncture, and treatment as usual are 50%, 43%, and 30%, respectively.'' This sort of suggests that it isn't important to train people in real acupuncture if sham acupunture produces much the same results. I have seen this mentioned in the past as one reason why people should just opt for dry needling (that is part of western medicine) and avoid all the oriental medical info confusion. LFD
It's good, peer reviewed science performed using state of the art research practices in one of the world's top medical research centers. It's not a Chinese study full of publishing bias, or a poorly put together Western study. You have not shown any evidence at all that it's "bad science" or a "hasty conclusion". Neither has any of the anti-CAM crowd. If they wanted to put their money where their mouths are, they'd fund a REAL study, and publish in a REAL journal, not their blog. They are afraid to....they might actually find an effect and bolster CAM even further. Wouldn't that be ironic? No, Dr. Novella is SAFEST on his own blog, with his circle of supporters like any good demagogue. That's why they call it research. Remember, I do not lean heavily positive towards acupuncture, I am middle positive. My position, middle positive, is well supported by this research. But this study is not unique, in fact it supports past studies and certainly does NOT support the extreme positions of Dr. Novella. Read the study to find out why. The improvements are obvious over past studies, in fact Vickers et al made this one of their key goals. They went to great pains to do so. The time of attacking CAM studies for structure and bias is ending, because the studies (correctly) are now taking all of that into account (as they should have years ago). The needle could have swung in either direction...Vickers study could have shown no effects at all. But that didn't happen...so why are people pretending it did? It might be their bias talking, not their objectivity. Of course they seemed astute: it is a political piece filled with rhetoric. Not an objective source. Why do all the folks in the thread who claim to be proponents of science support such nonobjective sources? Countering a well-received medical study out of a major center with the online musings of a neurologist who would LOOK LIKE A FOOL if CAM were ever proven effective...invalidating decades of his claims...terrible source. Statistical blip is your weasel wording for "statistically significant". You cannot set your "goal posts", as Dr. Novella does, at some arbitrary point to satisfy yourself. That is NOT how the Null Hypothesis functions. 1% beyond placebo rejects the null hypothesis. Not 10% or 50%. A humble 1% would do so. Guess what? Vickers study just appears to have done so. 1%? 5%? Null Hypothesis rejected, unless of course you can PROVE it's a statistical ERROR, versus "blip". No indications yet it is an error at all, which was your original argument. A lack of well supported evidence that would reject the Null Hypothesis, of course. But this is not the TREND. The trend as studies improve, is more evidence supporting a modest effect. Dr. Novella's answer to Vickers study is essentially "Not good enough". But he is betraying his bias; the fact remains that ANY notable effect at all, once bias and other pitfalls are adjusted for...rejects Null and indicates a positive relationship between healing and acupuncture, however small. And, logically, and small effect would seem to support additional research, as Vickers argues...not complete defunding, as Novella does. One of these...doesn't make sense!!
It does because it claims to provide statistics on injuries and death, that if you re-read the thread, were used to argue against CAM. Claiming to provide the public with statistics in an attempt to sway their opinion of a treatment, and then digging into the "math" to find that they count so many ridiculous, non-correlating factors... Correlation is not causation. You know that. To be frank, I agree, but I know several licensed acupuncturists (who are also martial artists), and none of them believe they can cure hundreds of ailments or would dissuade anyone from mainstream medical treatment. That's one major irony of this subject: it's the anti-CAM doctors that appear to be the most extreme party here. I don't see many big-name acupuncturists online raging against the failures of modern medical science (and there have been sooooo many failures). No, I believe the reason for not advocating CAM can depend on many factors, the simplest being uneducated in CAM. But concluding it is sham because it's old, or is poorly understood, or has a lot of anecdote associated with it, is problematic. That is throwing the baby out with the bath water. Let's face it most peoples' opinions' are not those of CAM practitioners or patients with DIRECT experience. They are second hand, formed by either reading something about CAM or knowing someone who has told you about their experience. Or, doing a web search and forming your opinion on the #1 hit. So, the pieces such as Dr. Novella's do a disservice to medicine at large because its not objective. Once a doctor takes a STRONG position, they can sway anyone who generally "trusts doctors". Doctors are not Gods, though, and so no matter how strongly Dr. Novella words his opinion, it is not scripture. Especially noteworthy is that Dr. Novella is not an acupuncture researcher at all. He appears, if anything, to be a slave to his beliefs that formed decades ago, when acupuncture studies outside Asia weren't around. Had Vickers et al. come out with a nonobjective opinion piece of their own, it would have immediately made their research appear questionable. That did not happen. Dr. Vickers is a leading, world class research professional. Dr. Novella is a man who has built most of his career campaigning against CAM. Actual conclusion: (note the "could") Actual conclusion: (note the "may" and "probably") OK acupuncture may not work for everything, as you said. It's clinical effectiveness may be limited to certain conditions and not others. The conditions that both clinical data AND anecdote seem to support treatment for fall into the areas of pain management, inflammation, and tending muscular injuries. No, but the top study clearly indicates a beneficial effect that it can't definitively associate with placebo (note the "could"). This is a common finding in these studies...an inability to conclusively find it's "placebo". The reason for this, if you follow the positive research, is that acupuncture's effect may be a combination of BOTH real and placebo effects (common in many other effective treatments!). The bottom study pertains to a condition that is not known from any modern CAM studies to show a positive effect. However, the study itself objectively notes the publishing bias of Chinese studies but doesn't outright dismiss them, as Novella often does whenever the research findings conflict with a conclusive he reached 30 years ago.
I'm going to blow your minds, ladies and gentlemen. "small benefit" "beyond placebo" "effects are pretty small" "majority... is placebo" "modest difference" ALL of these statements suggest that acupuncture appears to reject the Null Hypothesis. You can't move the goal posts for Null Hypothesis and say "WELL....ok there's an effect but its SUPER TINY". If you do this you've moved outside of scientific method, and into rhetoric.
