NHS will now pay for acupuncture

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Re: NHS will now pay for acupuncture

Postby Dream » Mon Jun 01, 2009 11:48 am UTC

netcrusher88 wrote:if there's a more solid proof that something is a placebo I don't know what it is.
Shivahn wrote:Though, again, still a placebo.

Everyone has been talking about he placebo effect as if it is by definition useless. Things like "if the control group reports the same effect, the treatment is a sham". What if the effect was actually very strong for significant parts of bot hthe control and subject groups? No one has addressed how powerful the placebo effect in acupuncture is. If we accept that the placebo effect can in fact physiologically affect pain levels, surely it is important to assess just how much it does so in this case. I don't think it's far fetched to think that the effect for acupuncture could be a great deal stronger for people who believe in it than it would be for the same people given a sugar pill and told it's codeine. I think that is significant, if true.
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Re: NHS will now pay for acupuncture

Postby gmalivuk » Mon Jun 01, 2009 1:35 pm UTC

Dream wrote:Everyone has been talking about he placebo effect as if it is by definition useless. Things like "if the control group reports the same effect, the treatment is a sham".

No, we're saying the second thing, which is true, but which doesn't imply that we think it's "by definition useless".
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Re: NHS will now pay for acupuncture

Postby Dream » Mon Jun 01, 2009 2:27 pm UTC

gmalivuk wrote:
Dream wrote:Everyone has been talking about he placebo effect as if it is by definition useless. Things like "if the control group reports the same effect, the treatment is a sham".

No, we're saying the second thing, which is true, but which doesn't imply that we think it's "by definition useless".

Fair enough, but you did say several times that the invasiveness of the procedure is unacceptable because the effect is unquantifiable next to a placebo. Well, I don't believe there is a significant risk from a procedure that should be trivially easy for the NHS to do safely. So what, in that case, if the effect, which is still placebo effect, is actually significant to the patient? Is it then ok to prescribe it, because you know it is safe and effective, even though the effect is entirely created by the mind and body of the patient, not the procedure itself?
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Re: NHS will now pay for acupuncture

Postby Gelsamel » Mon Jun 01, 2009 2:34 pm UTC

It's only an unacceptable risk because you can do it with special equipment that only -feels- like you're having acupuncture but there is no piercing of the skin. That has been shown to be as effective as acupuncture that does pierce the skin.
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Re: NHS will now pay for acupuncture

Postby Heisenberg » Mon Jun 01, 2009 2:50 pm UTC

Dream wrote:Is it then ok to prescribe it, because you know it is safe and effective, even though the effect is entirely created by the mind and body of the patient, not the procedure itself?

I don't think so. Lying to the patient to trick them into feeling better does not seem ethical to me. Acupuncturists are at least honest when communicating the procedure, whether or not it has any medicinal effects.

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Re: NHS will now pay for acupuncture

Postby gmalivuk » Mon Jun 01, 2009 2:53 pm UTC

Gelsamel wrote:It's only an unacceptable risk because you can do it with special equipment that only -feels- like you're having acupuncture but there is no piercing of the skin. That has been shown to be as effective as acupuncture that does pierce the skin.

Right. The risk, however small,* is unacceptable because it's 100% unnecessary.

* The risk is always there, because there will always be mistakes in sterilization and so forth. It doesn't matter how much I trust them to do a good job, because nothing is perfect.
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Re: NHS will now pay for acupuncture

Postby Gelsamel » Mon Jun 01, 2009 2:58 pm UTC

These are the options

A) Treat with "official" acupuncturists who will almost certainly bait and switch, will almost certainly use the money they are subsidized with to fund their endeavors into getting more victims for their dubious 'treatments' for diseases and cancer etc. And which presents a risk of infection etc.
B) Treat with doctors doing "sham acupuncture" who won't bait and switch, will use the money only for the acupuncture/real-treatments. Presents no risk of infection.
C) Don't treat with acupuncture, since it's as efficient as placebo.

MOST ethics of doctors and medical authorities would automatically discount A, because B is available and would discount A AND B because they both require essentially lying to the subject (and thus, they would not be able to informed consent).
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Re: NHS will now pay for acupuncture

Postby BlackSails » Mon Jun 01, 2009 4:29 pm UTC

Its worth noting that if we decide that the placebo effect is good medicine, then the NHS should start paying voodoo witchdoctors and Faith healers. Those also "work" via the placebo effect.

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Re: NHS will now pay for acupuncture

Postby Dream » Mon Jun 01, 2009 4:43 pm UTC

There's no need to lie to the patient. You just tell them: " We're going to try acupuncture. It doesn't have any effect in the usual sense of a treatment, but it stimulates the release of endorphins that will help you deal with your pain, in a way that is very well understood."

"So, it's like a placebo?"

"It works by the same mechanism as a placebo, but unlike a placebo, it isn't based on lying about a cure to control an experiment. It works in about [whatever] percentage of cases. It's worth a try, because we can't keep you on the painkillers. You're becoming tolerant, and they aren't working anymore. We only really prescribe this as a last resort, but it has helped a lot of people, and I think you might benefit from it."

Doctors have to tell the truth, but they don't have to argue against the treatment they're prescribing. Tell the patient how the treatment works, and tell them about any dangers or side effects, and they decide themselves whether to accept it.
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Re: NHS will now pay for acupuncture

Postby BlackSails » Mon Jun 01, 2009 4:51 pm UTC

Dream wrote:"It works by the same mechanism as a placebo, but unlike a placebo, it isn't based on lying about a cure to control an experiment.


It is placebo.

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Re: NHS will now pay for acupuncture

Postby Dream » Mon Jun 01, 2009 5:27 pm UTC

BlackSails wrote:
Dream wrote:"It works by the same mechanism as a placebo, but unlike a placebo, it isn't based on lying about a cure to control an experiment.


It is placebo.

What? A placebo is a control pill in an experiment. It's only a placebo if you pretend it's actually another, potent drug to make sure people aren't imagining their alleviation of symptoms. No one is pretending acupuncture actually does anything, nor are they claiming any benefits it can't provide. So it's not a placebo, it just works the same way as one, by fooling the brain into thinking it has relief so it releases endorphins and alleviates the pain. It only works for some people, and no one claims otherwise. It doesn't treat any symptoms, and no one claims otherwise. These things set it far apart from a placebo.
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Re: NHS will now pay for acupuncture

Postby Enuja » Mon Jun 01, 2009 5:45 pm UTC

When I had mono, I was taking Tylenol to get my fever down, but it got my fever down too far (and so it wasn't fighting the virus), and I was trying to be too active. My Western-Science nurse practitioner told me to cut back on the Tylenol, but to not let my fever get *too* high. I couldn't seem to find a happy balance: either my temperature was skyrocketing or it was "normal". So my roommate (studying acupuncture) stuck some needles in me, and my fever remained, but didn't get too high. I only got the needles stuck in me once, they were sterile, and I have no idea why it worked, if it was placebo, some physiological mechanism, or just relaxing and laying down to get the needles.

I think that the harm in alternative medicine is when it is used as an exclusive alternative to "Western" medicine. Individual medicine is still trial and error, so I don't have any problem with adding more things to try into the medical arsenal. I don't for a second buy that there are meridians of chi in my body, but I do think that it's possible that needle insertions and skin pressure does have a physiological effect, including directly stimulating certain nerves to do specific things. I think we need to do more controlled, randomized studies on acupuncture and on "standard" treatments, and I don't have any problem with the UK's NHS paying for acupuncture, especially if they will insist on continuing studies on efficacy and side effects.

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Re: NHS will now pay for acupuncture

Postby Terebrant » Mon Jun 01, 2009 6:12 pm UTC

Dream wrote:
BlackSails wrote:
Dream wrote:"It works by the same mechanism as a placebo, but unlike a placebo, it isn't based on lying about a cure to control an experiment.


It is placebo.
What? A placebo is a control pill in an experiment. It's only a placebo if you pretend it's actually another, potent drug to make sure people aren't imagining their alleviation of symptoms.

No, it can be that but it isn't only that.

Edit :
Enuja wrote:I think that the harm in alternative medicine is when it is used as an exclusive alternative to "Western" medicine.

As evidenced by the rest of your post, there are more problems to it than its exclusive use.

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Re: NHS will now pay for acupuncture

Postby gmalivuk » Mon Jun 01, 2009 7:45 pm UTC

Enuja wrote:I think we need to do more controlled, randomized studies on acupuncture

But there have already been dozens, and they've all shown that acupuncture doesn't do what proponents claim.

Saying we need to keep studying it is like saying we need to keep spending money to look for Atlantis. But it's not there, and it never was, and we need to move onto reality now.
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Re: NHS will now pay for acupuncture

Postby Enuja » Mon Jun 01, 2009 7:45 pm UTC

There have been more than dozens of studies, and some have shown the efficacy of acupuncture.

Testing "alternative" medicine and putting it them into the category of "medicine" when it works causes absolutely no net harm. See this WHO 2003 report for evidence, including the chart of controlled trials, including some that compare acupuncture to conventional treatment and find an improvement with the acupuncture treatment. If this is just a placebo, it's sometimes a better placebo with fewer side effects than the current conventional treatment.

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Re: NHS will now pay for acupuncture

Postby JazzPenguin » Mon Jun 01, 2009 8:07 pm UTC

I don't think anyones claiming it has NO effect, the point is that the studies that show a more-than-placebo effect are almost always poorly controlled, and as the studies become better blinded and more controlled in general the effect>placebo see:

http://www.sciencebasedmedicine.org/?p=492

Go ahead and get acupuncture if you want, the point is this gives credibility to people who don't deserve it, acupuncturists and chiropractors (there suggesting both) WILL push this further, and people WILL get ill/die, because this won't just be back pain, and it will allow people to choose CAM INSTEAD of western proven medicene

again http://whatstheharm.net/

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Re: NHS will now pay for acupuncture

Postby gmalivuk » Mon Jun 01, 2009 8:15 pm UTC

Okay, my "dozens" was about large, well controlled studies. A study with only a couple dozen subjects doesn't yield statistically significant results, and studies in which numerous variables differed between the test group(s) and control group(s) aren't well controlled.

Small or poorly controlled studies are unhelpful because the acupuncture itself may only account for a tiny fraction of any observed difference in results, if at all. The rest could be due to random chance (small studies or studies which show a minuscule difference) or any number of other variables that also differed between the test and control groups.

Also, by the way, when the the "control" group receives something like herbal medicine instead, that's not a control. Differences might be due to the herbs actually causing harm rather than acupuncture doing anything to help. (For example, if flu sufferers receiving acupuncture recovered in 7 days on average and those receiving some other kind of alternative remedy recovered in 9 days, that doesn't tell you anything about acupuncture. You must also know how long it takes someone in the same experiment to recover if they receive no treatment of either kind.)
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Re: NHS will now pay for acupuncture

Postby Will » Mon Jun 01, 2009 8:34 pm UTC

Enuja wrote:There have been more than dozens of studies, and some have shown the efficacy of acupuncture.

No, no there have not. Unless you want to count poorly controlled studies, or studies done with a very small sample size, which I don't, because the results of such studies cannot be trusted and so are meaningless.
There have been no well-controlled scientific studies that have shown the efficacy of acupuncture. And more than dozens of studies to show that is ineffective.
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Re: NHS will now pay for acupuncture

Postby Enuja » Mon Jun 01, 2009 8:58 pm UTC

From the WHO report I linked ...
The pain section introduction includes this paragraph
WHO 2003 wrote:The effectiveness of acupuncture analgesia has already been established in controlled clinical studies. As mentioned previously, acupuncture analgesia works better than a placebo for most kinds of pain, and its effective rate in the treatment of chronic pain is comparable with that of morphine. In addition, numerous laboratory studies have provided further evidence of the efficacy of acupuncture’s analgesic action as well as an explanation of the mechanism involved. In fact, the excellent analgesic effects of acupuncture have stimulated research on pain.

That bit didn't cite any sources (being a summary), so I went to a section. The head-pain part includes this
WHO 2003 wrote:The use of acupuncture for treating chronic pain of the head and face has been studied extensively. For tension headache, migraine and other kinds of headache due to a variety of causes, acupuncture has performed favourably in trials comparing it with standard therapy, sham acupuncture, or mock transcutaneous electrical nerve stimulation (TENS) (17-27). The results suggest that acupuncture could play a significant role in treating such conditions.

Here are sources 12-27
WHO 2003 wrote:17. Ahonen E et al. Acupuncture and physiotherapy in the treatment of myogenic headache patients: pain relief and EMG activity. Advances in Pain Research and Therapy, 1983, 5:571-576.

18. Chen XS et al. [Observation of penetrating acupuncture treatment of migraine in 45 cases.] Shanxi Journal of Traditional Chinese Medicine, 1997, 13(6):32-33 [in Chinese].

19. Doerr-Proske H et al. [A muscle and vascular oriented relaxation program for the treatment of chronic migraine patients. A randomized clinical control groups study on the effectiveness of a biobehavioural treatment program]. Zeitschrift für Psychosomatische Medizin und Psychoanalyse, 1985, 31(3):247-266 [in German].

20. Dowson DI et al. The effects of acupuncture versus placebo in the treatment of headache. Pain, 1985, 21:35-42.

21. Kubiena G et al. Akupunktur bei Migräne. [Acupuncture treatment of migraine.] Deutsche Zeitschrift für Akunpunktur, 1992, 35(6):140-148 [in German].

22. Liu AS et al. [“Three Scalp Needles” in the treatment of migraine.] New Tradiitional Chinese Medicine, 1997, 29(4) 25-26 [in Chinese].

23. Loh L et al. Acupuncture versus medical treatment for migraine and muscle tension headaches. Journal of Neurology, Neurosurgery and Psychiatry, 1984, 47:333-337.

24. Tavola T et al. Traditional Chinese acupuncture in the treatment of tension-type headache: a controlled study. Pain, 1992, 48:325-329.

25. Vincent CA. A controlled trial of the treatment of migraine by acupuncture. Clinical Journal of Pain, 1989, 5:305-312.

26. Weinschütz T et al. Zur neuroregulativen Wirkung der Akupunktur bei Kopfschmerzpatienten. [Neuroregulatory action of acupuncture in headache patients.] Deutsche Zeitschrift für Akunpunktur, 1994, 37(5):106-117 [in German].

27. Xu Z et al. [Treatment of migraine by qi-manipulating acupuncture.] Shanghai Journal of Acupuncture and Moxibustion, 1993, 12(3):97-100 [in Chinese].


I'm brand new to this field, but what I'm reading from blogs and opinion pieces you all are linking doesn't seem as convincing as what I've glanced at in this report. The specific set of papers I've quoted from the WHO report are pretty old, and many are in German and Chinese, but it doesn't appear to support what you're telling me. So, I figured, maybe more recent papers have cited some of those papers. Here's an abstract from a recent paper.

Sun, Y. and Gan, T.J. 2008. Acupuncture for the Management of Chronic Headache: A Systematic Review. ANESTHESIA AND ANALGESIA 107(6):2038-2047
the abstract wrote:OBJECTIVE: The objective of this review was to evaluate the efficacy of acupuncture for treatment of chronic headache.

METHODS: We searched the databases of Medline (1966-2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials investigating the use of acupuncture for chronic headache. Studies were included in which adults with chronic headache, including migraine, tension-type headache or both, were randomized to receive needling acupuncture treatment or control consisting of sham acupuncture, medication therapy, and other nonpharmacological treatments. We extracted the data on headache intensity, headache frequency, and response rate assessed at early and late follow-up periods.

RESULTS: Thirty-one Studies were included in this review. The majority of included trials comparing true acupuncture and sham acupuncture showed a trend in favor of acupuncture. The combined response rate in the acupuncture group was significantly higher compared with sham acupuncture either at the early follow-up period (risk ratio [RR]: 1.19, 95% confidence interval [CI]: 1.08, 1.30) or late follow-Lip period (RR: 1.22, 95% CI: 1.04, 1.43). Combined data also showed acupuncture was superior to medication therapy for headache intensity (weighted mean difference: -8.54 mm, 95% CI: -15.52, -1.57), headache frequency (standard mean difference: -0.70, 95% CI: -1.38, -0.02), physical function (weighted mean difference: 4.16, 95% CI: 1.33, 6.98), and response rate (RR: 1.49, 95% CI: 1.02, 2.1.7).

CONCLUSION: Needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate.


If you define "acupuncture" as manipulation of chi with needles to make people healthy, I agree, it's bunk. If you define "acupuncture" as a resource of related disciplines where practitioners use needles, pressure, vacuum and specific anatomical rules to manipulate the skin and get a specific physiological responses, I think that it is quite likely that there is useful medical knowledge and procedures in the discipline. So far, I haven't seen anything here to convince me otherwise.

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Re: NHS will now pay for acupuncture

Postby tetromino » Mon Jun 01, 2009 9:16 pm UTC

Enuja wrote:If you define "acupuncture" as manipulation of chi with needles to make people healthy, I agree, it's bunk. If you define "acupuncture" as a resource of related disciplines where practitioners use needles, pressure, vacuum and specific anatomical rules to manipulate the skin and get a specific physiological responses, I think that it is quite likely that there is useful medical knowledge and procedures in the discipline. So far, I haven't seen anything here to convince me otherwise.

This.

When a study shows that real acupuncture has the same effect as "sham" acupuncture, you can conclude that piercing the skin and precise needle placement are unnecessary, but you cannot conclude that acupuncture is a placebo - because then you would be making the completely unwarranted assumption that "sham" acupuncture is a placebo.

There is traditional acupuncture, which involved sticking needles through the skin. There is "sham" acupuncture, where the needles do not piece the skin. There is shiatsu, where instead of sticking needles, you just poke people really hard with your fingers. There is moxibustion, where instead of needles or fingers, you burn pellets of herbs on the skin. Then there are various schools of massage, vacuum jars, and so forth.

I would not be at all surprised if all of the above share the same underlying mechanism by which they have a (real, better than placebo) effect on chronic pain.

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Re: NHS will now pay for acupuncture

Postby JazzPenguin » Mon Jun 01, 2009 9:17 pm UTC

The "blog and opinon piece" i linked to is by an assistant professor of neurology, who spends an awful lot of time looking into these things, and wasn't written six years ago. As I said earlier studies HAVE shown there to be a more-than-placebo effect and those studies are generally not properly blinded, or the "control" wasn't a true control, in that it was obviously fake (either to the patient or practitioner, both matter), a list of titles of studies, names and et als doesnt say anything about the studies, infact your last section is clearly pulling the trick gmailvuk metioned, namely the control not even being the same thing!

Here have another source, (yes a blog but it's linked to a proper paper) http://www.badscience.net/2007/09/acupuncture-and-back-pain-some-interesting-background-references/ surprise surprise, acupuncture works better than a treatment thats failed the people, and EXACTLY AS WELL as fake accupuncture. These treatments work because the're a novel treatment the patient expects to work, especially people whoeve been let down, If there'd been enough talk and reaseach into seeing if my beanie baby collection could help chronic lower backpain, i bet it would.

The point here is while it helps, it only helps because of the placebo, and that we should be spending money on real medicine, not CAM, not when people are dieing because hospitals aren't clean enough, and not on unethical practitioners.

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Re: NHS will now pay for acupuncture

Postby Enuja » Mon Jun 01, 2009 9:26 pm UTC

I did read this Scientific American Skeptic article years ago, and here's Micheal Shermer's conclusion
Micheal Shermer wrote:Finding that sham acupuncture is as effective as "real" acupuncture demonstrates that the Qi theory is full of holes. The effects of being poked by needles, however, cannot be ignored. Understanding the psychology and neurophysiology of acupuncture and pain will lead to a better theory. And for all such alternative medicine claims, testimonials can steer us in the direction of where to conduct research; science is the only tool that can tell us whether they really work or not.


What I'm hearing here is that "acupuncture should not be used to inspire research into effective medical treatments", and that's what I very strongly disagree with. I also think that putting acupuncture into the medical establishment will strengthen the testing and recording of its efficacy and reduce the number of people who use acupuncture when there is a much better conventional treatment.

Also, it looks to me that sham acupuncture is sometimes not as effective as "real" acupuncture (see the abstract I quoted above).

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Re: NHS will now pay for acupuncture

Postby JazzPenguin » Mon Jun 01, 2009 9:49 pm UTC

My point was "define sham accupuncture" is it needles in the skin at random (not double blind), blunt needs uncovered (not double blind) or properly blinded and controled studies, where the patients can't be influenced by a practitoner that knows what result to aim for. I heard of one study when a nurse was plain fiddling the results, and the poor unlucky practitioner was made to look like a fool when it was uncovered (ill try to cite later).

Again, I'm not saying don't get it done, but the good research says it's nothing more than a placebo, now maybe a scientific inquiry into how it works (a hypothesis of a reaslistic non-chi mechanism would be nice to hear) is maybe worth doing, but that doesn't mean pay for it on the NHS now, does it? would you be saying the same thing if i proposed a drug and said "this treats back pain, i can't prove it works, but you may aswell let me give it to people and let me suggest it for other things while you look into it" would you?

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Re: NHS will now pay for acupuncture

Postby tetromino » Mon Jun 01, 2009 10:06 pm UTC

JazzPenguin wrote:Here have another source, (yes a blog but it's linked to a proper paper) http://www.badscience.net/2007/09/acupuncture-and-back-pain-some-interesting-background-references/ surprise surprise, acupuncture works better than a treatment thats failed the people, and EXACTLY AS WELL as fake accupuncture.

Suppose you prove that effectiveness(traditional acupuncture) = effectiveness(sham acupuncture).

The above equality alone does not allow you to conclude that effectiveness(traditional acupuncture) = placebo.

You would first need to prove that effectiveness(sham acupuncture) = placebo, and nobody has done that.

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Re: NHS will now pay for acupuncture

Postby gmalivuk » Mon Jun 01, 2009 10:24 pm UTC

Enuja wrote:What I'm hearing here is that "acupuncture should not be used to inspire research into effective medical treatments"

No, what you're hearing here is that acupuncture *has* inspired competent research into medical treatments, and has been found wanting.

But that aside, it's like JazzPenguin just said: fine, do research into how what effect there is happens. Don't start spending other people's money on the treatment itself before that research has been done, though.

tetromino wrote:You would first need to prove that effectiveness(sham acupuncture) = placebo, and nobody has done that.

No, but we have shown that there's no reason to pay extra and incur extra risk for chi-based penetrative acupuncture when that doesn't do any more than sham acupuncture does.
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Re: NHS will now pay for acupuncture

Postby JazzPenguin » Mon Jun 01, 2009 10:43 pm UTC

Suppose you prove that effectiveness(traditional acupuncture) = effectiveness(sham acupuncture).

The above equality alone does not allow you to conclude that effectiveness(traditional acupuncture) = placebo.

You would first need to prove that effectiveness(sham acupuncture) = placebo, and nobody has done that.


Do you know why medical studies have controls? it's because of the placebo effect, specifically, because it needs removing.

If I prove (errgg it's never proven, only likely, which it is,very) that accupuncture=sham accupuncture then yes, we need to show that the sham is just placebo, however WE SAID IT WAS WHEN WE DEFINED IT AS THE CONTROL, right?

Ok, so you say the sham accupuncture works? well what are you going to say doesnt have any possible way of working? because this is turning into an accupuncture of the gaps, a scientific investigation into anything involving medicine and people living things (animals can have placebos)needs a control to remove the placebo effect. It's not up to me to prove it isnt a placebo, I can't prove a negative, it's up to you to prove, or at least suggest a way of proving, that your method of poking people is more than just placebo, and that needs an agreed control.

Also again, this debate isnt whether accupuncture works (it doesn't), it's whether accupuncture is worth paying for instead of cleaning the hospital my grandmother is in properly, and whether we want our health survice giving it a big thumbs up.
Last edited by JazzPenguin on Mon Jun 01, 2009 10:57 pm UTC, edited 1 time in total.

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Re: NHS will now pay for acupuncture

Postby gmalivuk » Mon Jun 01, 2009 10:46 pm UTC

Yeah, placebo is generally defined by actual use as "everything that might have an effect other than the specific variable we're trying to check."
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Re: NHS will now pay for acupuncture

Postby tetromino » Mon Jun 01, 2009 11:09 pm UTC

JazzPenguin wrote:Do you know why medical studies have controls? it's because of the placebo effect, specifically, because it needs removing.

No. They have controls so that you can test one variable at a time. This is the fundamental approach to experiments in all scientific fields - physics, chemistry, biology, anything - and has nothing to do specifically with medicine and placebos.

If I prove (errgg it's never proven, only likely, which it is,very) that accupuncture=sham accupuncture then yes, we need to show that the sham is just placebo, however WE SAID IT WAS WHEN WE DEFINED IT AS THE CONTROL, right?

You defined it as the control. You cannot define something as having a placebo effect - you can only show it, with a separate experiment.

Ok, so you say the sham accupuncture works? well what are you going to say doesnt have any possible way of working?

All medicine works due to the placebo effect. To show that a treatment's effect is no better than a placebo, compare it to an actual placebo, for example to something like a sugar pill or "faith healing".

gmalivuk wrote:Yeah, placebo is generally defined by actual use as "everything that might have an effect other than the specific variable we're trying to check."

Are you sure? If you are comparing, say, three different strains of penicillin, are you going to call one of them a placebo, even though it really does kill bacteria?
Also, wikipedia disagrees, and defines a placebo as "a substance or procedure ... that is objectively without specific activity for the condition being treated".

JazzPenguin wrote:Do you know why medical studies have controls? it's because of the placebo effect, specifically, because it needs removing.

No. They have controls so that you can test one variable at a time. This is the fundamental approach to experiments in all scientific fields - physics, chemistry, biology, anything - and has nothing to do specifically with medicine and placebos.

If I prove (errgg it's never proven, only likely, which it is,very) that accupuncture=sham accupuncture then yes, we need to show that the sham is just placebo, however WE SAID IT WAS WHEN WE DEFINED IT AS THE CONTROL, right?

You defined it as the control. You cannot define something as having a placebo effect - you can only show it, with a separate experiment.

Ok, so you say the sham accupuncture works? well what are you going to say doesnt have any possible way of working?

All medicine will work to some degree due to the placebo effect. To show that a treatment's effect is no better than a placebo, compare it to an actual placebo, for example to something like a sugar pill or "faith healing".

gmalivuk wrote:Yeah, placebo is generally defined by actual use as "everything that might have an effect other than the specific variable we're trying to check."

Are you sure? If you are comparing, say, three different strains of penicillin, are you going to call one of them a placebo, even though it really does kill bacteria?
Also, wikipedia disagrees, and defines a placebo as "a substance or procedure ... that is objectively without specific activity for the condition being treated".

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Re: NHS will now pay for acupuncture

Postby BlackSails » Mon Jun 01, 2009 11:22 pm UTC

tetromino wrote:that is objectively without specific activity for the condition being treated".


And you are arguing that poking someone with toothpicks has some specific activity for something?

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Re: NHS will now pay for acupuncture

Postby setzer777 » Mon Jun 01, 2009 11:28 pm UTC

This is random question:

It seems like a real difficulty of coming up with an acceptable placebo is that people can tell whether or not you're poking them in the back. So to make sure it is purely psychological, why not have an experiment where everyone is put under, some are giving acupuncture, and some are left completely alone. Tell everyone that they are going to receive acupuncture. If the two groups have similar results we will know that the actual poking them isn't having an effect, only their conscious belief that they are being treated.
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Re: NHS will now pay for acupuncture

Postby gmalivuk » Mon Jun 01, 2009 11:32 pm UTC

That would be an interesting way to allow for a (singly) blinded study, though it still wouldn't stop proponents pointing out that some of the effects of acupuncture probably do require some kind of intervening brain activity.
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Re: NHS will now pay for acupuncture

Postby tetromino » Mon Jun 01, 2009 11:35 pm UTC

BlackSails wrote:
tetromino wrote:that is objectively without specific activity for the condition being treated".


And you are arguing that poking someone with toothpicks has some specific activity for something?

Yes, that is precisely what I am doing.

Pain - if I understand it right - is one way in which the brain interprets signals coming from sensory neurons. If we change the input that the brain receives from sensory neurons in other parts of the body - for example, by pricking the sensitive skin with very sharp objects - perhaps we can cause the brain to interpret some of its input differently, at least for a while.

The hypothesis does not seem unreasonable.

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Re: NHS will now pay for acupuncture

Postby tetromino » Mon Jun 01, 2009 11:41 pm UTC

gmalivuk wrote:That would be an interesting way to allow for a (singly) blinded study, though it still wouldn't stop proponents pointing out that some of the effects of acupuncture probably do require some kind of intervening brain activity.

I suspect that it probably does require intervening brain activity.

And to test for that, I would suggest running a study where volunteers receive acupuncture under anesthesia and can neither see nor feel what part of the body is getting the needles.

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Re: NHS will now pay for acupuncture

Postby gmalivuk » Mon Jun 01, 2009 11:42 pm UTC

tetromino wrote:I would suggest running a study where volunteers receive acupuncture under anesthesia and can neither see nor feel what part of the body is getting the needles.

What would such a study show, if those who receive acupuncture fare no differently from those who don't?
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Re: NHS will now pay for acupuncture

Postby netcrusher88 » Mon Jun 01, 2009 11:49 pm UTC

Acupuncture has been shown to cause a raise in endorphins (wikipedia but well cited), which are the actual phsyiologically active part of the treatment. Or of, say, faith healing or hypnosis or anything that is obviously placebo against a physical condition because it is unabashedly purely psychological. Furthermore, this is the exact same physiological effect that is observed from a placebo. I don't know what more proof you need.
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Re: NHS will now pay for acupuncture

Postby tetromino » Mon Jun 01, 2009 11:55 pm UTC

gmalivuk wrote:What would such a study show, if those who receive acupuncture fare no differently from those who don't?

If the study compares volunteers who receive sham acupuncture while conscious but under local anesthesia and volunteers who receive sham acupuncture without anesthesia fare the same, then it would show whether or not intervening brain activity is not involved.

Suppose it showed that intervening brain activity is not involved. You could then with a clean conscience run the study that setzer777 proposed: compare the effects of acupuncture on conscious and unconscious volunteers. Supposing those also fare the same, you have shown that the autonomic nervous system is not involved either.

At that point - and only at that point - you would be able to conclude that sham acupuncture is without specific activity for the condition being treated, and therefore is a placebo, and hence that traditional acupuncture has an effect equivalent to a placebo.

And if not, you would have proven that acupuncture works.

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Re: NHS will now pay for acupuncture

Postby Dream » Mon Jun 01, 2009 11:59 pm UTC

gmalivuk wrote:That would be an interesting way to allow for a (singly) blinded study, though it still wouldn't stop proponents pointing out that some of the effects of acupuncture probably do require some kind of intervening brain activity.

That's because it does. There is no effect that is caused specifically by the needle poking. (The potential for needle poking to cause an effect is beside the point, for our purposes traditional methods do nothing.) There is an effect caused by the subject's brain interpreting the pinpricks as promoting various responses. This effect could possibly be quantified by comparing the effect on a conscious patient to the effect on an unconscious patient. The conscious patient might parse the stimulus in such a way as to make them therapeutically useful, while the unconscious patient provides a baseline (of zero, probably, plus the placebo effect) to measure against. They're told they're having acupuncture, and they believe it, but they do not experience the treatment itself. If a bigger, significant proportion of the conscious group reports alleviation of pain, then the alleviation can be said to be caused by the conscious brain's reaction to the acupuncture.

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Re: NHS will now pay for acupuncture

Postby gmalivuk » Tue Jun 02, 2009 12:08 am UTC

tetromino wrote:
gmalivuk wrote:What would such a study show, if those who receive acupuncture fare no differently from those who don't?

If the study compares volunteers who receive sham acupuncture while conscious but under local anesthesia and volunteers who receive sham acupuncture without anesthesia fare the same, then it would show whether or not intervening brain activity is not involved.

The study you describe isn't particularly well controlled, because people know whether they've received anesthetic or not. If people in those groups had the same outcome, it would merely suggest that consciously feeling the treatment is not necessary. It wouldn't say anything about intervening brain activity on an unconscious level.

And anyway, that's not what I asked. I want to know what it would show if half the anesthetized people received no treatment (but perhaps believed they had), and they fared as well as those who were poked.
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Re: NHS will now pay for acupuncture

Postby Dream » Tue Jun 02, 2009 12:17 am UTC

gmalivuk wrote:And anyway, that's not what I asked. I want to know what it would show if half the anesthetized people received no treatment (but perhaps believed they had), and they fared as well as those who were poked.

I would imagine that there would be no difference at all. Certainly no one has claimed that there would be. But this:
gmalivuk wrote:If people in those groups had the same outcome, it would merely suggest that consciously feeling the treatment is not necessary.

Would be very significant. If there were a difference it would suggest that acupuncture plus brain activity is more potent than acupuncture without, and thus the placebo effect proper (i.e. the patient merely believing they are receiving treatment where they are not) cannot explain the effect of acupuncture.
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Re: NHS will now pay for acupuncture

Postby gmalivuk » Tue Jun 02, 2009 12:49 am UTC

No, I don't think it would be "very significant", because as I said before such a study wouldn't be blinded, and therefore wouldn't be properly controlled.

It would merely suggest the possibility that consciously feeling the pain either is or isn't relevant to getting an effect, but it wouldn't offer significant evidence for the suggestion. Because conscious sensations of pain aren't the only thing that would be different between the two groups.
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